Cartilage Degeneration and Alignment in Severe Varus Knee Osteoarthritis.

Science.gov (United States)

Nakagawa, Yasuaki; Mukai, Shogo; Yabumoto, Hiromitsu; Tarumi, Eri; Nakamura, Takashi

2015-10-01

The aim of this study was to examine the relationship between cartilage, ligament, and meniscus degeneration and radiographic alignment in severe varus knee osteoarthritis in order to understand the development of varus knee osteoarthritis. Fifty-three patients (71 knees) with primary varus knee osteoarthritis and who underwent total knee arthroplasty were selected for this study. There were 6 men and 47 women, with 40 right knees and 31 left knees studied; their mean age at operation was 73.5 years. The ligament, meniscus, degeneration of joint cartilage, and radiographic alignments were examined visually. The tibial plateau-tibial shaft angle was larger if the condition of the cartilage in the lateral femoral condyle was worse. The femorotibial angle and tibial plateau-tibial shaft angle were larger if the conditions of the lateral meniscus or the cartilage in the lateral tibial plateau were worse. Based on the results of this study, progression of varus knee osteoarthritis may occur in the following manner: medial knee osteoarthritis starts in the central portion of the medial tibial plateau, and accompanied by medial meniscal extrusion and anterior cruciate ligament rupture, cartilage degeneration expands from the anterior to the posterior in the medial tibial plateau. Bone attrition occurs in the medial tibial plateau, and the femoro-tibial angle and tibial plateau-tibial shaft angle increase. Therefore, the lateral intercondylar eminence injures the cartilage of the lateral femoral condyle in the longitudinal fissure type. Thereafter, the cartilage degeneration expands in the whole of the knee joints.

Impaired Varus-Valgus Proprioception and Neuromuscular Stabilization in Medial Knee Osteoarthritis

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Chang, Alison H.; Lee, Song Joo; Zhao, Heng; Ren, Yupeng; Zhang, Li-Qun

2014-01-01

Impaired proprioception and poor muscular stabilization in the frontal plane may lead to knee instability during functional activities, a common complaint in persons with knee osteoarthritis (KOA). Understanding these frontal plane neuromechanical properties in KOA will help elucidate the factors contributing to knee instability and aid in the development of targeted intervention strategies. The study objectives were to compare knee varus-valgus proprioception, isometric muscle strength, and active muscular contribution to stability between persons with medial KOA and healthy controls. We evaluated knee frontal plane neuromechanical parameters in 14 participants with medial KOA and 14 age- and gender-matched controls, using a joint driving device (JDD) with a customized motor and a 6-axis force sensor. Analysis of covariance with BMI as a covariate was used to test the differences in varus-valgus neuromechanical parameters between these two groups. The KOA group had impaired varus proprioception acuity (1.08 ± 0.59° vs. 0.69 ± 0.49°, p < 0.05), decreased normalized varus muscle strength (1.31 ± 0.75% vs. 1.79 ± 0.84% body weight, p < 0.05), a trend toward decreased valgus strength (1.29 ± 0.67% vs. 1.88 ± 0.99%, p = 0.054), and impaired ability to actively stabilize the knee in the frontal plane during external perturbation (4.67 ± 2.86 vs. 8.26 ± 5.95 Nm/degree, p < 0.05). The knee frontal plane sensorimotor control system is compromised in persons with medial KOA. Our findings suggest varus-valgus control deficits in both the afferent input (proprioceptive acuity) and muscular effectors (muscle strength and capacity to stabilize the joint). PMID:24321442

Modified french osteotomy for cubitus varus deformity

International Nuclear Information System (INIS)

Ahmad, I.; Idrees, M.

2007-01-01

To evaluate the outcome of Modified French Osteotomy for correction of cubitus varus deformity. All children, aged 3-12 years, with cubitus varus deformity were included in the study. Pre-operative clinical as well as radiological assessment of upper extremities were done in all cases. Modified French osteotomy was done to correct the deformity. All patients were followed for seven months. Physical examination for the range of motion, scar and post-operative complications were assessed. Antero-posterior and lateral radiographs of the elbow were obtained, and the carrying angles and lateral condylar prominence index were measured and recorded. Out of the total 30 patients, 26 were male and four female. Left side was involved in 24 cases and the right side in six. The average age at the time of osteotomy was seven years (range 3.5-12 years). The average pre-operative carrying angle was 25.2 degree (range 18-30 degree) and the post-operative angle 8.7 degree (range 5-13 degree valgus). The average pre- operative range of motion was 122.6 degree (range 105-135 degree) and the post-operative range 123.86 degree (range 90-135 degree). The average pre-operative lateral condylar prominence index (LCPI) was 175.56 (range 128-232) and the post-operative lateral condylar prominence 156 (range 100-240). Based on Bellmore criteria, 25 patients showed excellent, three good and two a poor result. Modified French technique of supracondylar osteotomy has excellent results in the management of cubitus varus in terms of cosmesis, radiological findings and fewer complications. (author)

IATROGENIC HALLUX VARUS: CAUSES OF DEFORMITY AND POSSIBILITIES OF PERCUTANEOUS SURGICAL CORRECTION (RETROSPECTIVE ANALYSIS OF CASE REPORTS

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S. Yu. Berezhnoy

2017-01-01

Full Text Available Introduction. Hallux varus is a relatively rare foot deformity. Commonly, hallux varus is a complication after the hallux valgus surgery and typically is the result of the first metatarsal medial eminence over resection, first and second metatarsal excessive convergence, over release of the lateral soft tissues, overtightening of the medial soft tissues and soft tissue imbalance of the first metatarsophalangeal joint.The purpose of this study was to clarify the causes and timing of the iatrogenic hallux varus formation and to evaluate the possibility and efficiency of percutaneous techniques in its surgical treatment.Material and methods. Thirty-one feet (31 females suffering from iatrogenic hallux varus were examined clinically and radiologically, including 14 patients who underwent surgery. The average age of the whole group was 57 years (range, 39 to 74, the subgroup of operated patients — 60 years (range from 53 to 68. The time after primary interventions before the examination varied from 2 to 44 years. The mean follow-up after surgery was 6 months (range from 1.5 to 54.Results. No infection or wound-healing issues were observed. Overall, the patients were completely satisfied with the outcomes of 12 surgeries and satisfied with reservation in 2 cases.Conclusions. The visual manifestations of hallux varus are determined not only by the hallux varus angle, but also by the value of the first intermetatarsal angle. In addition to well-known factors, hallux varus formation is determined by first metatarsal bone elongation and first metatarsophalangeal joint instability. In rare cases, only one of the factors leads to the hallux varus; as a rule, we see a combination of factors with their mutual reinforcement. Despite the demonstration of usage possibility and the efficiency of percutaneous techniques in hallux varus correcting, a small number of observations in the study does not yet allow giving recommendations on the use of specific

Influence of biomechanical characteristics on pain and function outcomes from exercise in medial knee osteoarthritis and varus malalignment

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Bennell, Kim L.; Dobson, Fiona; Roos, Ewa M.

2015-01-01

and McMaster Universities Osteoarthritis Index). Candidate biomechanical characteristics measured at baseline included: i) visually-observed varus thrust during walking; ii) obesity determined by body mass index; iii) static varus alignment; and iv) isometric quadriceps strength. Data were analysed...... between type of exercise and both varus thrust (p=0.001) and obesity (p=0.023). Neuromuscular exercise was more effective for non-obese participants (mean(95%CI) change=29.5(20.5-38.5)mm) and for those with a varus thrust (mean change=28.7(19.4-38.1)mm), whereas quadriceps strengthening was more effective...... for obese people (mean change=24.7(14.9-34.4)mm) and for those without a varus thrust (mean change=29.4(21.2-37.7)mm). Biomechanical characteristics did not influence the effect of exercise on physical function (p>0.05). Conclusions: These preliminary findings suggest varus thrust and obesity influence...

Prenatal diagnosis of congenital hallux varus deformity associated with pericentric inversion of chromosome 9.

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Gürel, Sebahat Atar

2015-04-01

Congenital hallux varus is a rare deformity of the great toe characterized by adduction of the hallux and medial displacement of the first metatarsophalangeal joint. Prenatal diagnosis of congenital hallux varus is presented herein. A 32-year-old woman was referred to our unit due to significant deviation of the fetal right great toe at 22(+2) weeks of pregnancy. Ultrasound examination revealed a thick and short great toe, which was significantly angulated medially on the right side. Amniocentesis was performed and the result was reported as inv(9) (p11;q12). After delivery, the clinical examination confirmed the prenatal diagnosis. To our knowledge, this is the first reported prenatal diagnosis of an isolated congenital hallux varus. Congenital hallux varus can be diagnosed easily in the prenatal period by 2-D and 4-D ultrasonography. Prenatal karyotyping should be taken into consideration, especially in the presence of associated anomalies, such as polydactyly and clubfoot. © 2014 The Author. Journal of Obstetrics and Gynaecology Research © 2014 Japan Society of Obstetrics and Gynecology.

Influence of increasing knee flexion angle on knee-ankle varus stress during single-leg jump landing

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Mariam A. Ameer, PhD

2017-12-01

Full Text Available Objectives: The primary aim of this study was to identify the relationship between the peak knee flexion angle and knee-ankle varus stress in the landing phase of the single-leg jump during running. Methods: Fifteen male handball players from the first Saudi Arabian handball team were incorporated in this study. Each player performed a single-leg jump-land after running a fixed distance of 450 cm. The data were measured using a 3D motion analysis system. The maximum knee flexion angle, knee varus angle, centre of pressure pathway in the medio-lateral direction, and ankle varus moment were measured. Results: The Pearson Product Moment Correlation showed that a greater knee flexion angle was related to a greater lateral displacement of the centre of pressure (r = 0.794, P = 0.000, a greater ankle varus moment (r = 0.707, P = 0.003, and a greater knee varus angle (r = 0.753, P = 0.001. In addition, the greater ankle varus moment was related to the greater lateral displacement of the centre of pressure (r = 0.734, P = 0.002. Conclusions: These findings may help physical therapists and conditioning professionals to understand the impact of increasing knee flexion angle on the lower limb joints. Such findings may help to develop training protocols for enhancing the lateral body reaction during the landing phase of the single-leg jump, which may protect the knee and ankle joints from excessive varus stresses. Keywords: 3D motion analysis, Ankle kinetic, Centre of pressure pathway, Handball playing, Knee kinematic, Single-leg jump

Factors contributing to inherent varus alignment of lower limb in normal Asian adults: role of tibial plateau inclination.

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Shetty, Gautam M; Mullaji, Arun; Bhayde, Sagar; Nha, Kyung Wook; Oh, Hyoung Keun

2014-03-01

This prospective study aimed to evaluate radiographically, mechanical or hip-knee-ankle (HKA) axis in healthy, asymptomatic, Asian (Indian and Korean) adults between 20 and 40 years of age to determine the incidence of inherent varus (mechanical limb alignment of >3° varus) and the factors influencing it. Three hundred and eighty-eight lower limbs were evaluated using full length, standing hip-to-ankle radiographs in 198 healthy, asymptomatic, Asian (Indian and Korean) adults between 20 and 40 years of age to assess the hip-knee-ankle (HKA) angle, medial proximal tibial angle (MPTA), femoral bowing and femoral neck-shaft angle to determine the incidence of inherent varus (mechanical limb alignment of >3° varus) and the factors influencing it. Overall, the mean HKA angle was 177.6°±2.6° with 34.5% of limbs in inherent varus (mean HKA angle 174.9°±1.8°). The incidence of inherent varus was significantly higher (p=0.01) in males (40%) compared to females (28%) but similar among Indian (34%) and Korean subjects (35%). The hip-knee-ankle (HKA) angle showed significant positive correlation (r=0.82, palignment of the lower limb is fairly common among asymptomatic, Asian adults. These results raise several pertinent questions regarding the role of inherent varus in the aetiopathogenesis of knee osteoarthritis and in lower limb realignment procedures. © 2013 Elsevier B.V. All rights reserved.

Weight-bearing computed tomography findings in varus ankle osteoarthritis: abnormal internal rotation of the talus in the axial plane.

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Kim, Ji-Beom; Yi, Young; Kim, Jae-Young; Cho, Jae-Ho; Kwon, Min-Soo; Choi, Seung-Hyuk; Lee, Woo-Chun

2017-08-01

To assess the incidence of abnormal internal rotation of the talus in the axial plane in patients with varus ankle osteoarthritis, and to determine whether this incidence differs from the severity of varus ankle osteoarthritis (moderate versus severe). We retrospectively evaluated weight-bearing computed tomography (CT) and plain radiographs of 52 ankles with no abnormalities (control group) and 96 ankles with varus osteoarthritis (varus-OA group), which were further stratified into a moderate-OA subgroup (50 ankles) and a severe-OA subgroup (46 ankles). A new radiographic parameter on weight-bearing CT, the talus rotation ratio, was used to assess the rotation of the talus in the axial plane. The normal range of the talus rotation ratio was defined as the 95% prediction interval for talus rotation ratio values in the control group. Abnormal internal rotation of the talus was defined for talus rotation ratio values above the normal range. We determined the incidence of abnormal internal rotation of the talus in the varus-OA group, moderate-OA subgroup, and severe-OA subgroup. In the varus-OA group, the incidence of abnormal internal rotation of the talus was 45% (43 ankles), which corresponded to an incidence of 32% (16 ankles) in the moderate-OA subgroup and 59% (27 ankles) in the severe-OA subgroup (p = 0.013). Our study demonstrates that abnormal internal rotation of the talus occurs in patients with varus ankle osteoarthritis, and is more frequently noted in severe than in moderate varus ankle osteoarthritis.

Weight-bearing computed tomography findings in varus ankle osteoarthritis: abnormal internal rotation of the talus in the axial plane

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Kim, Ji-Beom; Yi, Young; Lee, Woo-Chun [Seoul Foot and Ankle Center, Dubalo Orthopaedic Clinic, Seochogu, Seoul (Korea, Republic of); Kim, Jae-Young; Kwon, Min-Soo; Choi, Seung-Hyuk [Inje University Seoul Paik Hospital, Department of Orthopaedic Surgery, Jung-gu, Seoul (Korea, Republic of); Cho, Jae-Ho [Hallym University, ChunCheon Sacred Heart Hospital, Department of Orthopaedic Surgery, Chuncheon, GangWon-do (Korea, Republic of)

2017-08-15

To assess the incidence of abnormal internal rotation of the talus in the axial plane in patients with varus ankle osteoarthritis, and to determine whether this incidence differs from the severity of varus ankle osteoarthritis (moderate versus severe). We retrospectively evaluated weight-bearing computed tomography (CT) and plain radiographs of 52 ankles with no abnormalities (control group) and 96 ankles with varus osteoarthritis (varus-OA group), which were further stratified into a moderate-OA subgroup (50 ankles) and a severe-OA subgroup (46 ankles). A new radiographic parameter on weight-bearing CT, the talus rotation ratio, was used to assess the rotation of the talus in the axial plane. The normal range of the talus rotation ratio was defined as the 95% prediction interval for talus rotation ratio values in the control group. Abnormal internal rotation of the talus was defined for talus rotation ratio values above the normal range. We determined the incidence of abnormal internal rotation of the talus in the varus-OA group, moderate-OA subgroup, and severe-OA subgroup. In the varus-OA group, the incidence of abnormal internal rotation of the talus was 45% (43 ankles), which corresponded to an incidence of 32% (16 ankles) in the moderate-OA subgroup and 59% (27 ankles) in the severe-OA subgroup (p = 0.013). Our study demonstrates that abnormal internal rotation of the talus occurs in patients with varus ankle osteoarthritis, and is more frequently noted in severe than in moderate varus ankle osteoarthritis. (orig.)

Weight-bearing computed tomography findings in varus ankle osteoarthritis: abnormal internal rotation of the talus in the axial plane

International Nuclear Information System (INIS)

Kim, Ji-Beom; Yi, Young; Lee, Woo-Chun; Kim, Jae-Young; Kwon, Min-Soo; Choi, Seung-Hyuk; Cho, Jae-Ho

2017-01-01

To assess the incidence of abnormal internal rotation of the talus in the axial plane in patients with varus ankle osteoarthritis, and to determine whether this incidence differs from the severity of varus ankle osteoarthritis (moderate versus severe). We retrospectively evaluated weight-bearing computed tomography (CT) and plain radiographs of 52 ankles with no abnormalities (control group) and 96 ankles with varus osteoarthritis (varus-OA group), which were further stratified into a moderate-OA subgroup (50 ankles) and a severe-OA subgroup (46 ankles). A new radiographic parameter on weight-bearing CT, the talus rotation ratio, was used to assess the rotation of the talus in the axial plane. The normal range of the talus rotation ratio was defined as the 95% prediction interval for talus rotation ratio values in the control group. Abnormal internal rotation of the talus was defined for talus rotation ratio values above the normal range. We determined the incidence of abnormal internal rotation of the talus in the varus-OA group, moderate-OA subgroup, and severe-OA subgroup. In the varus-OA group, the incidence of abnormal internal rotation of the talus was 45% (43 ankles), which corresponded to an incidence of 32% (16 ankles) in the moderate-OA subgroup and 59% (27 ankles) in the severe-OA subgroup (p = 0.013). Our study demonstrates that abnormal internal rotation of the talus occurs in patients with varus ankle osteoarthritis, and is more frequently noted in severe than in moderate varus ankle osteoarthritis. (orig.)

Metatarsalgia located by synovitis and uncertainty of the articulation metatarsus-phalanges of the II toe

International Nuclear Information System (INIS)

Gerstner G, Juan Bernardo

2002-01-01

The synovitis and the uncertainty of the articulation metatarsus-phalanges (MP) of the II toe they are the causes more frequent of metatersalgia located in this articulation of the foot, frequently bad diagnosed and not well managed by the general orthopedist. The natural history understands stadiums so precocious as the synovitis without alteration of peri-articular structures, going by the frank uncertainty, and finishing with the angular deformities and the complete luxation of the articulation MP. The meticulous and directed interrogation, the physical exam specifies and the classification of the diagnostic they are the keys for the successful handling of the pathology. The surgical correction of this condition should always be associated to the correction of associate deformities as the hallux valgus and the fingers in claw

Boomerang proximal tibial osteotomy for the treatment of severe varus gonarthrosis.

Science.gov (United States)

Sangkaew, Chanchit; Piyapittayanun, Peerapong

2013-06-01

The purpose of the study was to review the results of modified infratubercle displacement osteotomy in patients with severe varus gonarthrosis and to determine the factors influencing outcomes. A total of 177 knees in 133 patients with severe varus gonarthrosis were treated with infratubercle boomerang-shaped osteotomy, stabilised with dual plates. The mean age of the patients was 63.8 years (range 43-80 years), and the mean follow-up period was 61.4 months (range 24 -139 months). The factors associated with clinical and survival outcomes were analysed including age, gender, body mass index (BMI), preoperative and post-operative femorotibial angle and femorotibial angle at one year after surgery. Using the Knee Society clinical rating system 149 knees or 84.2 % were rated as having good to excellent results and 21 knees or 15.8 % as having fair to poor results. Overall, the mean preoperative knee score of 33.6 points had improved significantly to 80.7 points at the final follow-up (p boomerang osteotomy can create adequate valgus alignment in severe varus gonarthrosis. The one-year post-operative knee alignment of 11° valgus provided the most satisfactory results and that between six and 15° valgus the longest survival time.

The Relationship of Throwing Arm Mechanics and Elbow Varus Torque: Within-Subject Variation for Professional Baseball Pitchers Across 82,000 Throws.

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Camp, Christopher L; Tubbs, Travis G; Fleisig, Glenn S; Dines, Joshua S; Dines, David M; Altchek, David W; Dowling, Brittany

2017-11-01

Likely due to the high level of strain exerted across the elbow during the throwing motion, elbow injuries are on the rise in baseball. To identify at-risk athletes and guide postinjury return-to-throw programs, a better understanding of the variables that influence elbow varus torque is desired. To describe the within-subject relationship between elbow varus torque and arm slot and arm rotation in professional baseball pitchers. Descriptive laboratory study. A total of 81 professional pitchers performed 82,000 throws while wearing a motusBASEBALL sensor and sleeve. These throws represented a combination of throw types, such as warm-up/catch, structured long-toss, bullpen throwing from a mound, and live game activity. Variables recorded for each throw included arm slot (angle of the forearm relative to the ground at ball release), arm speed (maximal rotational velocity of the forearm), arm rotation (maximal external rotation of the throwing arm relative to the ground), and elbow varus torque. Linear mixed-effects models and likelihood ratio tests were used to estimate the relationship between elbow varus torque and arm slot, arm speed, and arm rotation within individual pitchers. All 3 metrics-arm slot (χ 2 = 428, P relationship with elbow varus torque. Within individual athletes, a 1-N.m increase in elbow varus torque was associated with a 13° decrease in arm slot, a 116 deg/s increase in arm speed, and an 8° increase in arm rotation. Elbow varus torque increased significantly as pitchers increased their arm rotation during the arm cocking phase, increased the rotational velocity of their arm during the arm acceleration phase of throwing, and decreased arm slot at ball release. Thus, shoulder flexibility, arm speed, and elbow varus torque (and likely injury risk) are interrelated and should be considered collectively when treating pitchers. It is well established that elbow varus torque is related to ulnar collateral ligament injuries in overhead throwers. This

Favourable outcomes of a preventive screening and counselling programme for older people in underprivileged areas in the Netherlands: The PRIMUS project

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D.J. Annemarie van Dijk

2017-06-01

Full Text Available An aging population is associated with an increased prevalence of diabetes, cardiovascular diseases and depression. Important aspects of programmes targeted at older people are: to reach those at risk, effective screening, optimising advice, and referral to local interventions. We examined the effect of a preventive health consultation (PRIMUS, a multi-behavioural screening programme for persons aged 55–74 years in primary care. In a multi-centre randomised controlled trial, the effects of participating in the PRIMUS intervention were compared to a comparison group receiving personalised summaries and advice by postal mail, both preceded by a health risk assessment via a questionnaire. The intervention consisted of a baseline health risk assessment, followed by a preventive health consultation (after 4 weeks, and a follow-up visit (2 weeks later in the primary care centre. A newly developed web-based computer-tailored programme supported the nurse practitioner during the consultation. Main outcomes measures were awareness of, and compliance with referral advice for changing unhealthy lifestyles. The PRIMUS preventive health consultation was successful in older people at risk for cardio metabolic diseases compared to the comparison group (compliance: RR 1.43; 95% CI 1.12–1.79; p < 0.05. The intervention was less successful in older people at risk for mental health problems. This preventive health consultation for older people resulted in positive changes in unhealthy behaviours by optimising reach, raising awareness, motivating and assisting individuals to change, and referring to local interventions.

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

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Mahmood Jabalameli

2013-07-01

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

Supracondylar corrective osteotomy for cubitus varus--the internal rotation component and its importance. An unique bone experiment.

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Jimulia T

1994-10-01

Full Text Available In 20 patients with cubitus varus, a clinical test suggested by Yamamoto et al (1985 was carried out to measure the internal rotation. Average internal rotation was found to be 37.5 +/- 9.390. A correction for internal rotation was carried out for all the patients having angle more than 20 degrees. Following osteotomy, post-operative Yamamoto′s angle was measured and was found to be 8.85 +/- 6.5. An experiment was carried out on postmortem human humerus with cubitus varus. The internal rotation was measured with Kirschner wires and was found to be 30 degrees. Osteotomy was carried out to eliminate varus and correct internal rotation. Radiographs taken before and after the osteotomy confirmed the correction. We conclude that this derotation has to be corrected and Yamamoto′s test should be used to assess the correction.

Comparison of radiographic and anatomic femoral varus angle measurements in normal dogs.

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Swiderski, Jennifer K; Radecki, Steven V; Park, Richard D; Palmer, Ross H

2008-01-01

To determine if the clinically practiced method of radiographic femoral varus angle (R-FVA) measurement is repeatable, reproducible, and accurate. Radiographic and anatomic study. ANIMALS/SAMPLE POPULATION: Normal Walker hound cadavers (n=5) and femora (n=10). Cadavers were held in dorsally-recumbent and torso-elevated positions as 3 craniocaudal radiographs were made of each femur, by each of 2 different technicians. Femora were then harvested for direct measurement of anatomic femoral varus angle (A-FVA). R-FVA was measured on each radiograph by each of 3 examiners on 3 separate occasions. Intra-observer (repeatability) and inter-observer (reproducibility) variance in R-FVA measurement and the strength of relationship between R-FVA and A-FVA (accuracy) were determined. Mean (+/-SD) A-FVA was 5.2+/-2.1 degrees (range, 2.4-8.2 degrees). Mean (+/-SD) R-FVA was 5.8+/-1.0 degrees (range, 2.7-9.6 degrees). Intra-observer variance (range: 11-16%) and inter-observer variance (16%) were acceptable. The strength of relationship between measured R-FVA and A-FVA (maximum adjusted R(2)hounds. The detected inaccuracy may be real or the result of a selection bias for normal dogs obscuring the true relationship. R-FVA may not be an accurate method of femoral varus measurement in dogs with A-FVA10 degrees), the procedure would not have been erroneously performed in any of the normal dogs of this study.

Individualised distal femoral cut improves femoral component placement and limb alignment during total knee replacement in knees with moderate and severe varus deformity.

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Palanisami, Dhanasekararaja; Iyyampillai, Geethan; Shanmugam, Sivaraj; Natesan, Rajkumar; S, Rajasekaran

2016-10-01

Our aim was to determine the variation in valgus correction angle and the influence of individualised distal femoral cut on femoral component placement and limb alignment during total knee replacement (TKR) in knees with varus deformity. The study was done prospectively in two stages. In the first stage, the valgus correction angle (VCA) was calculated in long-limb radiographs of 227 patients and correlated with pre-operative parameters of femoral bowing, neck-shaft angle and hip-knee-ankle angle. In the second part comprising of 240 knees with varus deformity, 140 (group 1) had the distal femoral cut individualised according to the calculated VCA, while the remaining 100 knees (group 1) were operated with a fixed distal femoral cut of 5°. The outcome of surgery was studied by grouping the knees as varus 15°. Of the 227 limbs analysed in stage I, 70 knees (31 %) had a VCA angle outside 5-7°. Coronal bowing (p shaft angle (p alignment when VCA was individualised in the groups of knees with varus 10-15° (p 0.002) and varus >15° (p 0.002). Valgus correction angle is highly variable and is influenced by femoral bowing, neck-shaft angle and pre-operative deformity. Individualisation of VCA is preferable in patients with moderate and severe varus deformity. Level 2.

Proximal Opening Wedge Osteotomy Provides Satisfactory Midterm Results With a Low Complication Rate.

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Oravakangas, Rami; Leppilahti, Juhana; Laine, Vesa; Niinimäki, Tuukka

2016-01-01

Hallux valgus is one of the most common foot deformities. Proximal opening wedge osteotomy is used for the treatment of moderate and severe hallux valgus with metatarsus primus varus. However, hypermobility of the first tarsometatarsal joint can compromise the results of the operation, and a paucity of midterm results are available regarding proximal open wedge osteotomy surgery. The aim of the present study was to assess the midterm results of proximal open wedge osteotomy in a consecutive series of patients with severe hallux valgus. Thirty-one consecutive adult patients (35 feet) with severe hallux valgus underwent proximal open wedge osteotomy. Twenty patients (35.5%) and 23 feet (34.3%) were available for the final follow-up examination. The mean follow-up duration was 5.8 (range 4.6 to 7.0) years. The radiologic measurements and American Orthopaedic Foot and Ankle Society hallux-metatarsophalangeal-interphalangeal scores were recorded pre- and postoperatively, and subjective questionnaires were completed and foot scan analyses performed at the end of the follow-up period. The mean hallux valgus angle decreased from 38° to 23°, and the mean intermetatarsal angle correction decreased from 17° to 10°. The mean improvement in the American Orthopaedic Foot and Ankle Society hallux metatarsophalangeal-interphalangeal score increased from 52 to 84. Two feet (5.7%) required repeat surgery because of recurrent hallux valgus. No nonunions were identified. Proximal open wedge osteotomy provided satisfactory midterm results in the treatment of severe hallux valgus, with a low complication rate. The potential instability of the first tarsometatarsal joint does not seem to jeopardize the midterm results of the operation. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Radiographic assessment of knee-ankle alignment after total knee arthroplasty for varus and valgus knee osteoarthritis.

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Gao, Fuqiang; Ma, Jinhui; Sun, Wei; Guo, Wanshou; Li, Zirong; Wang, Weiguo

2017-01-01

There are unanswered questions about knee-ankle alignment after total knee arthroplasty (TKA) for varus and valgus osteoarthritis (OA) of the knee. The aim of this retrospective study was to assess knee-ankle alignment after TKA. The study consisted of 149 patients who had undergone TKA due to varus and valgus knee OA. The alignment and angles in the selected knees and ankles were measured on full-length standing anteroposterior radiographs, both pre-operatively and post-operatively. The paired t-test and Pearson's correlation tests were used for statistical analysis. The results showed that ankle alignment correlated with knee alignment both pre-operatively and postoperatively (Pknee was corrected (Pknee-ankle alignment on the non-operative side (P>0.05). These findings indicated that routine TKA could correct the varus or valgus deformity of a knee, and improve the tilt of the ankle. Ankle alignment correlated with knee alignment both pre-operatively and postoperatively. Both pre-operative knee and ankle malalignment can be simultaneously corrected following TKA. Level III. Copyright © 2016 Elsevier B.V. All rights reserved.

Association of knee confidence with pain, knee instability, muscle strength, and dynamic varus-valgus joint motion in knee osteoarthritis.

Science.gov (United States)

Skou, Søren T; Wrigley, Tim V; Metcalf, Ben R; Hinman, Rana S; Bennell, Kim L

2014-05-01

To investigate associations between self-reported knee confidence and pain, self-reported knee instability, muscle strength, and dynamic varus-valgus joint motion during walking. We performed a cross-sectional analysis of baseline data from 100 participants with symptomatic and radiographic medial tibiofemoral compartment osteoarthritis (OA) and varus malalignment recruited for a randomized controlled trial. The extent of knee confidence, assessed using a 5-point Likert scale item from the Knee Injury and Osteoarthritis Outcome Score, was set as the dependent variable in univariable and multivariable ordinal regression, with pain during walking, self-reported knee instability, quadriceps strength, and dynamic varus-valgus joint motion during walking as independent variables. One percent of the participants were not troubled with lack of knee confidence, 17% were mildly troubled, 50% were moderately troubled, 26% were severely troubled, and 6% were extremely troubled. Significant associations were found between worse knee confidence and higher pain intensity, worse self-reported knee instability, lower quadriceps strength, and greater dynamic varus-valgus joint motion. The multivariable model consisting of the same variables significantly accounted for 24% of the variance in knee confidence (P knee confidence is associated with higher pain, worse self-reported knee instability, lower quadriceps muscle strength, and greater dynamic varus-valgus joint motion during walking. Since previous research has shown that worse knee confidence is predictive of functional decline in knee OA, addressing lack of knee confidence by treating these modifiable impairments could represent a new therapeutic target. Copyright © 2014 by the American College of Rheumatology.

The reliability and validity of radiographic measurements for determining the three-dimensional position of the talus in varus and valgus osteoarthritic ankles

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Nosewicz, Tomasz L. [Kantonsspital Liestal, Department of Orthopaedic Surgery and Traumatology, Liestal (Switzerland); Academic Medical Center, Department of Orthopaedic Surgery, Meibergdreef 9, AZ, Amsterdam (Netherlands); Knupp, Markus; Bolliger, Lilianna; Hintermann, Beat [Kantonsspital Liestal, Department of Orthopaedic Surgery and Traumatology, Liestal (Switzerland)

2012-12-15

To assess the most accurate radiographic method to determine talar three-dimensional position in varus and valgus osteoarthritic ankles, we evaluated the reliability and validity of different radiographic measurements. Nine radiographic measurements were performed blindly on weight-bearing mortise, sagittal, and horizontal radiographs of 33 varus and 33 valgus feet (63 patients). Intra- and interobserver reliability was determined with the intraclass coefficient (ICC). Discriminant validity of measurements between varus and valgus feet was assessed with effect size (ES). Convergent validity (Pearson's r) was evaluated by correlating measurements to the dichotomized varus and valgus groups. Obtained measurements in both groups were finally compared with each other and with 30 control feet. Reliability was excellent (ICC > 0.80) in all but two measurements. Whereas frontal plane validity was excellent (ES and r > 0.80), horizontal and sagittal measurements showed poor to moderate validity (ES and r between 0.00 and 0.60). Four measurements were significantly different among all groups (p < 0.05). Talar positional tendency was found towards dorsiflexion or endorotation in the varus group and towards plantarflexion or exorotation in the valgus group. The frontal tibiotalar surface angle, sagittal talocalcaneal inclination angle, and horizontal talometatarsal I angle showed the best reliability, validity, and difference among the groups. The frontal tibiotalar surface angle, sagittal talocalcaneal inclination angle, and horizontal talometatarsal I angle accurately determine talar three-dimensional radiographic position in weight-bearing varus and valgus osteoarthritic ankles. Careful radiographic evaluation is important, as these deformities affect talar position in all three planes. (orig.)

The reliability and validity of radiographic measurements for determining the three-dimensional position of the talus in varus and valgus osteoarthritic ankles

International Nuclear Information System (INIS)

Nosewicz, Tomasz L.; Knupp, Markus; Bolliger, Lilianna; Hintermann, Beat

2012-01-01

To assess the most accurate radiographic method to determine talar three-dimensional position in varus and valgus osteoarthritic ankles, we evaluated the reliability and validity of different radiographic measurements. Nine radiographic measurements were performed blindly on weight-bearing mortise, sagittal, and horizontal radiographs of 33 varus and 33 valgus feet (63 patients). Intra- and interobserver reliability was determined with the intraclass coefficient (ICC). Discriminant validity of measurements between varus and valgus feet was assessed with effect size (ES). Convergent validity (Pearson's r) was evaluated by correlating measurements to the dichotomized varus and valgus groups. Obtained measurements in both groups were finally compared with each other and with 30 control feet. Reliability was excellent (ICC > 0.80) in all but two measurements. Whereas frontal plane validity was excellent (ES and r > 0.80), horizontal and sagittal measurements showed poor to moderate validity (ES and r between 0.00 and 0.60). Four measurements were significantly different among all groups (p < 0.05). Talar positional tendency was found towards dorsiflexion or endorotation in the varus group and towards plantarflexion or exorotation in the valgus group. The frontal tibiotalar surface angle, sagittal talocalcaneal inclination angle, and horizontal talometatarsal I angle showed the best reliability, validity, and difference among the groups. The frontal tibiotalar surface angle, sagittal talocalcaneal inclination angle, and horizontal talometatarsal I angle accurately determine talar three-dimensional radiographic position in weight-bearing varus and valgus osteoarthritic ankles. Careful radiographic evaluation is important, as these deformities affect talar position in all three planes. (orig.)

The reliability and validity of radiographic measurements for determining the three-dimensional position of the talus in varus and valgus osteoarthritic ankles.

Science.gov (United States)

Nosewicz, Tomasz L; Knupp, Markus; Bolliger, Lilianna; Hintermann, Beat

2012-12-01

To assess the most accurate radiographic method to determine talar three-dimensional position in varus and valgus osteoarthritic ankles, we evaluated the reliability and validity of different radiographic measurements. Nine radiographic measurements were performed blindly on weight-bearing mortise, sagittal, and horizontal radiographs of 33 varus and 33 valgus feet (63 patients). Intra- and interobserver reliability was determined with the intraclass coefficient (ICC). Discriminant validity of measurements between varus and valgus feet was assessed with effect size (ES). Convergent validity (Pearson's r) was evaluated by correlating measurements to the dichotomized varus and valgus groups. Obtained measurements in both groups were finally compared with each other and with 30 control feet. Reliability was excellent (ICC > 0.80) in all but two measurements. Whereas frontal plane validity was excellent (ES and r > 0.80), horizontal and sagittal measurements showed poor to moderate validity (ES and r between 0.00 and 0.60). Four measurements were significantly different among all groups (p reliability, validity, and difference among the groups. The frontal tibiotalar surface angle, sagittal talocalcaneal inclination angle, and horizontal talometatarsal I angle accurately determine talar three-dimensional radiographic position in weight-bearing varus and valgus osteoarthritic ankles. Careful radiographic evaluation is important, as these deformities affect talar position in all three planes.

INFLUENCE OF RESIDUAL VARUS DEFORMITY ON CLINICAL, FUNCTIONAL, RADIOLOGICAL AND DYNAMOMETRIC OUTCOMES OF TOTAL KNEE ARTHROPLASTY

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M. P. Zinoviev

2017-01-01

Full Text Available Purpose of the study – to evaluate the influence of residual varus deformity of the lower leg on clinical, functional and dynamometric outcomes of TKR.Material and methods. In the period from September 2014 till May 2015 951 total knee replacement surgeries were performed in Ural clinical and rehabilitation center in 933 patients with initial varus deformity of lower limb. However, in 52 cases (5.5% residual varus deformity of >3° persisted. The main group included 36 patients with mean residual varus deformity of lower leg of 3.9°±0.74° (from 3.1° to 5.6°, the control group included 34 patients with neutral mechanic axis of the lower leg. Evaluation of treatment outcomes was performed on average 14.2±1.8 months after the procedure using functional assessment of the patients according to KSS (Knee Society Score, subjective assessment of life quality (SF36, as well as evaluation of the static-dynamic function of the lower leg on diagnostic and treatment complex Biodex Systems 4 Quick Set and assessment of stability of components fixation by F.C. Ewald scale in modification of O.A. Kudinov et al.Results. Functional assessment of the patients according to KSS (Knee Society Score for the main group was 84.0±4.6, in control group – 82.2±4.1 points (p>0.05. Subjective assessment of life quality (SF36 in the main group was 162.6±6.4 points, in control group – 164.3±8.1 points (p>0.05. In terms of flexion and extension of lower leg there were no significant differences between two groups when assessing static and dynamic function by treatment and diagnostic complex «Biodex Systems 4 Quick Set» on average in 14.2±1.8 months after procedure: neither isometric nor isokinetic parameters in both groups demonstrated statistically significant differences (p>0.05. Based on X-rays evaluation there were no abnormalities in components fixation in both groups. There were no statistically significant differences identified in KSS and SF36 scales

Application of computer-aided design osteotomy template for treatment of cubitus varus deformity in teenagers: a pilot study.

Science.gov (United States)

Zhang, Yuan Z; Lu, Sheng; Chen, Bin; Zhao, Jian M; Liu, Rui; Pei, Guo X

2011-01-01

Treatment of cubitus varus deformity from a malunited fracture is a challenge. Anatomically accurate correction is the key to obtaining good functional outcomes after corrective osteotomy. The aim of this study was to attempt to increase the accuracy of treatment by use of 3-dimensional (3D) computer-aided design. We describe a novel method for ensuring an accurate osteotomy method in the treatment of cubitus varus deformity in teenagers by means of 3D reconstruction and reverse engineering. Between January 2006 and May 2008, 12 male and 6 female patients with cubitus varus deformities underwent scanning with spiral computed tomography (CT) preoperatively. The mean age was 15.7 years, ranging from 13 to 19 years. Three-dimensional CT image data of the affected and contralateral normal bones of cubitus were transferred to a computer workstation. Three-dimensional models of cubitus were reconstructed by use of MIMICS software. The 3D models were then processed by Imageware software. An osteotomy template that best fitted the angle and range of osteotomy was "reversely" built from the 3D model. These templates were manufactured by a rapid prototyping machine. The osteotomy templates guide the osteotomy of cubitus. An accurate angle of osteotomy was confirmed by postoperative radiography. After 12 to 24 months' follow-up, the mean postoperative carrying angle in 18 patients with cubitus varus deformity was 7.3° (range, 5° to 11°), with a mean correction of 21.9° (range, 12° to 41°). The patient-specific template technique is easy to use, can simplify the surgical act, and generates highly accurate osteotomy in cubitus varus deformity in teenagers. Copyright © 2011 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Mosby, Inc. All rights reserved.

Agreement and reliability of femoral varus measurements: a comparison of four techniques

DEFF Research Database (Denmark)

Miles, James Edward; Svalastoga, Eiliv Lars; Eriksen, Thomas

with the diaphysis positioned horizontally and inclined at both 12.5° and 25° to the horizontal. Radiographs were blinded, randomised and read twice by one observer using ImageJ. Using coordinate data, varus angles were calculated using Microsoft Excel for the three previously reported techniques and a novel method...

[Minimally invasive therapy for hallux valgus with deformity of little toe varus].

Science.gov (United States)

Gu, Shi-Wei; Yang, Ke; Zhao, Si-Qiao; Gao, Zhan-Ao; Ma, Shun-Qian; Zhang, Wen-Qing

2018-03-25

To explore clinical effect of minimally corrective osteotomy for the treatment of hallux valgus with deformity of little toe varus through small incision. From January 2013 to June 2016, 168 hallux valgus patients with deformity of little toe varus were treated by minimally corrective osteotomy through small incision. Among them, 7 males and 161 females were aged from 22 to 75 years old with an average of(59.3±3.5) years old. Preoperative clinical manifestation mainly focus on red and swollen of bunion, pain around with metatarsal bones, and diagnosed as hallux valgus with deformity of little toe varus through small incision. Operative time, postoperative complications, pre and post-operative IMA(angle between the first and the second metatarsal bones), HVA (hallux valgus angle), LDA(valgus angle of the fifth metatarsal bones), MPA(valgus angle of little toe), IM4-5 (angle between the forth and the fifth metatarsal bones) and PASA(fixed angle of proximal joint), postoperative AOFAS score were used to evaluate foot function. One hundred and sixty-eight patients were followed up for 6 to 48 months with an average of (28.6±3.2) months. All wounds were healed well without infection, sinus tract and other complications. Operative time ranged from 16 to 28 min with an average of (18.3±2.1) min. IMA, HVA, LDA, MPA and IM A 4-5 were (10.1±2.1)°, (32.6±4.2)°, (6.9±2.3)°, (18.5±5.2)°, (15.1±2.9)°preoperatively, improved to (8.3±2.2)°, (10.9±2.9)°, (2.7±0.4)°, (6.5±1.6)°, (8.9±1.8)° postoperatively, and had significant differences before and after operation. While there was no difference in PASA before (9.1±2.1)°and after operation(8.7±1.9)°. AOFAS score were improved from (31.6±3.9) before operation to(83.7±5.2) after operation, but no significant difference( P >0.05). According to AOFAS score, 147 patients obtained excellent results, 13 good, 6 moderate and 2 poor. Minimally corrective osteotomy for the treatment of hallux valgus with deformity

Neuromuscular versus quadriceps strengthening exercise in patients with medial knee osteoarthritis and varus malalignment

DEFF Research Database (Denmark)

Bennell, Kim L; Kyriakides, Mary; Metcalf, Ben

2014-01-01

OBJECTIVE: To compare the effects of neuromuscular exercise (NEXA) and quadriceps strengthening (QS) on the knee adduction moment (an indicator of mediolateral distribution of knee load), pain, and physical function in patients with medial knee joint osteoarthritis (OA) and varus malalignment. ME...

Longitudinal bracketed epiphysis of proximal phalanx of the great toe with congenital hallux varus managed simultaneously with monorail external fixator: a case report.

Science.gov (United States)

Verma, Vineet; Batra, Amit; Singla, Rohit; Gogna, Paritosh; Magu, Narender; Gupta, Rakesh

2014-02-01

Longitudinal bracketed epiphysis (delta phalanx) is a rare congenital anomaly that affects phalanges in the hand more commonly than toes. We present a rare case of congenital hallux varus with longitudinal bracketed epiphysis of proximal phalanx with bifid distal phalanx of the great toe, which was managed with monorail type of external fixator. To the best of our knowledge, this is the first report of its successful implementation in simultaneous treatment of longitudinal bracketed epiphysis of the proximal phalanx of the great toe and hallux varus. Apart from adding to the literature a case of rare subtype of delta phalanx with hallux varus, the present study highlights the role of a reliable alternative in its management.

The reliability and validity of radiographic measurements for determining the three-dimensional position of the talus in varus and valgus osteoarthritic ankles

OpenAIRE

Nosewicz, Tomasz L.; Knupp, Markus; Bolliger, Lilianna; Hintermann, Beat

2012-01-01

Objective To assess the most accurate radiographic method to determine talar three-dimensional position in varus and valgus osteoarthritic ankles, we evaluated the reliability and validity of different radiographic measurements. Materials and methods Nine radiographic measurements were performed blindly on weight-bearing mortise, sagittal, and horizontal radiographs of 33 varus and 33 valgus feet (63 patients). Intra- and interobserver reliability was determined with the intraclass coefficien...

The remarkable medical lineage of the Monro family: contributions of Alexander primus, secundus, and tertius.

Science.gov (United States)

Wu, Osmond C; Manjila, Sunil; Malakooti, Nima; Cohen, Alan R

2012-06-01

Among the families that have influenced the development of modern medicine into what it is today, the Monro lineage stands as one of the most notable. Alexander Monro primus (1697-1767) was the first of 3 generations with the same name, a dynasty that spanned 126 years occupying the Chair of Anatomy one after the other at the University of Edinburgh. After becoming Professor of Anatomy at the University of Edinburgh in 1719, Monro primus played a principal role in the establishment of the University of Edinburgh School of Medicine and the Edinburgh Royal Infirmary. In 1726, he published The Anatomy of the Humane Bones, of which 8 editions were printed during his lifetime. His son, Alexander Monro secundus (1733-1817), arguably the most notable of the 3 men, succeeded him as Professor of Anatomy. A highly regarded lecturer and anatomist, Monro secundus studied under many great physicians, including William Hunter and Johann Friedrich Meckel the Elder, and was also teacher to other well-known figures at the time, such as Joseph Black and Thomas Trotter. His most notable contributions include his work with the lymphatic system, the interventricular foramen (of Monro), and the Monro-Kellie doctrine. Alexander Monro tertius (1773-1859), the last of the dynasty, also succeeded his father as Professor of Anatomy. His work included insights into abdominal aortic aneurysms and the anatomy of the genitourinary system. The prominent association of the Monro family with the University of Edinburgh and the effects of a tenured professorship under the concept of "Ad vitam aut culpam" over successive generations are also described. To the best of the authors' knowledge, this historical review of the Monro family is among the few published in neurosurgical literature. A vivid historical overview of the medical contributions of the most famous and influential dynasty of physicians in Edinburgh at that time is provided, with relevant excerpts from original publications.

PRIMUS: CONSTRAINTS ON STAR FORMATION QUENCHING AND GALAXY MERGING, AND THE EVOLUTION OF THE STELLAR MASS FUNCTION FROM z = 0-1

Energy Technology Data Exchange (ETDEWEB)

Moustakas, John [Department of Physics and Astronomy, Siena College, 515 Loudon Road, Loudonville, NY 12211 (United States); Coil, Alison L.; Mendez, Alexander J. [Center for Astrophysics and Space Sciences, Department of Physics, University of California, 9500 Gilman Dr., La Jolla, CA 92093 (United States); Aird, James [Department of Physics, Durham University, Durham DH1 3LE (United Kingdom); Blanton, Michael R. [Center for Cosmology and Particle Physics, Department of Physics, New York University, 4 Washington Place, New York, NY 10003 (United States); Cool, Richard J. [MMT Observatory, University of Arizona, 1540 E Second Street, Tucson, AZ 85721 (United States); Eisenstein, Daniel J. [Harvard-Smithsonian Center for Astrophysics, 60 Garden Street, Cambridge, MA 02138 (United States); Wong, Kenneth C. [Steward Observatory, University of Arizona, 933 North Cherry Avenue, Tucson, AZ 85721 (United States); Zhu, Guangtun [Department of Physics and Astronomy, The Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218 (United States); Arnouts, Stephane, E-mail: jmoustakas@siena.edu [Canada-France-Hawaii Telescope Corporation, 65-1238 Mamalahoa Hwy, Kamuela, HI 96743 (United States)

2013-04-10

We measure the evolution of the stellar mass function (SMF) from z = 0-1 using multi-wavelength imaging and spectroscopic redshifts from the PRism MUlti-object Survey (PRIMUS) and the Sloan Digital Sky Survey (SDSS). From PRIMUS we construct an i < 23 flux-limited sample of {approx}40, 000 galaxies at z = 0.2-1.0 over five fields totaling Almost-Equal-To 5.5 deg{sup 2}, and from the SDSS we select {approx}170, 000 galaxies at z = 0.01-0.2 that we analyze consistently with respect to PRIMUS to minimize systematic errors in our evolutionary measurements. We find that the SMF of all galaxies evolves relatively little since z = 1, although we do find evidence for mass assembly downsizing; we measure a Almost-Equal-To 30% increase in the number density of {approx}10{sup 10} M{sub sun} galaxies since z Almost-Equal-To 0.6, and a {approx}< 10% change in the number density of all {approx}> 10{sup 11} M{sub sun} galaxies since z Almost-Equal-To 1. Dividing the sample into star-forming and quiescent using an evolving cut in specific star formation rate, we find that the number density of {approx}10{sup 10} M{sub sun} star-forming galaxies stays relatively constant since z Almost-Equal-To 0.6, whereas the space density of {approx}> 10{sup 11} M{sub sun} star-forming galaxies decreases by Almost-Equal-To 50% between z Almost-Equal-To 1 and z Almost-Equal-To 0. Meanwhile, the number density of {approx}10{sup 10} M{sub sun} quiescent galaxies increases steeply toward low redshift, by a factor of {approx}2-3 since z Almost-Equal-To 0.6, while the number of massive quiescent galaxies remains approximately constant since z Almost-Equal-To 1. These results suggest that the rate at which star-forming galaxies are quenched increases with decreasing stellar mass, but that the bulk of the stellar mass buildup within the quiescent population occurs around {approx}10{sup 10.8} M{sub sun}. In addition, we conclude that mergers do not appear to be a dominant channel for the stellar mass

Autograft reconstructions for bone defects in primary total knee replacement in severe varus knees

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Yatinder Kharbanda

2014-01-01

Full Text Available Background: Large posteromedial defects encountered in severe varus knees during primary total knee arthroplasty can be treated by cementoplasty, structural bone grafts or metallic wedges. The option is selected depending upon the size of the defect. We studied the outcome of autograft (structural and impaction bone grafting reconstruction of medial tibial bone defects encountered during primary total knee replacement in severe varus knees. Materials and Methods: Out of 675 primary varus knees operated, bone defects in proximal tibia were encountered in 54 knees. Posteromedial defects involving 25-40% of the tibial condyle cut surface and measuring more than 5 mm in depth were grafted using a structural graft obtained from cut distal femur or proximal tibia in 48 knees. For larger, peripheral uncontained vertical defects in six cases, measuring >25 mm in depth and involving >40% cut surface of proximal tibial condyle, impaction bone grafting with a mesh support was used. Results: Bone grafts incorporated in 54 knees in 6 months. There was no graft collapse or stress fractures, loosening or nonunion. The average followup period was 7.8 years (range 5-10 years. We observed an average postoperative increase in the Knee Society Score from 40 to 90 points. There was improvement in the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC scores in terms of pain, stiffness and physical function during activities of daily living. Conclusion: Bone grafting for defects in primary total knee is justified as it is biological, available then and is cost effective besides preserving bone stock for future revisions. Structural grafts should be used in defects >5 mm deep and involving 25-40% of the cut proximal tibial condyle surface. For larger peripheral vertical defects, impaction bone grafting contained in a mesh should be done.

Geschichtswissenschaft für den Ostseeraum? Der Conventus primus historicorum Balticorum 1937 in Riga

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Ulrike Hanssen-Decker

2009-07-01

Full Text Available In August 1937, a historical conference named Conventus primus historicorum Balticorum was held in Riga, the capitol of Lettland, a country which was strongly influenced by its dictatorial leader, President Kārlis Ulmanis, who had come into power in 1935. In this context, this article first examines the attempts to institutionalise research on the history of the Baltic Sea region on a transnational level. Second, it analyses the different concepts the conference’s hosts had concerning the history of the Baltic Sea region in general. In this context, it also investigates the question of whether Ulmanis’ politics of exploiting history for his political aims played an important role in this conference. The main question is whether it is really appropriate to speak of a history of the Baltic Sea region as such, as suggested by the conference’s title, or whether the conference’s focus was dominated by national approaches.

Effects of total knee arthroplasty on ankle alignment in patients with varus gonarthrosis: Do we sacrifice ankle to the knee?

Science.gov (United States)

Gursu, Sarper; Sofu, Hakan; Verdonk, Peter; Sahin, Vedat

2016-08-01

Total knee arthroplasty is one of the most commonly preferred surgical methods in the treatment of patients with varus gonarthrosis. In this study, we aimed to evaluate the radiological changes observed in the ankles after total knee arthroplasty. Between May 2012 and June 2013, 80 knees of 78 patients with varus deformity over 10° underwent total knee arthroplasty. For each patient, full-leg standing radiographs were obtained pre- and post-operatively. Mechanical and anatomical axes (HKA and AA), lateral distal femoral angle, medial proximal tibial angle, lateral distal tibial angle (LDTA), ankle joint line orientation angle (AJOA), tibial plafond talus angle (PTA) and talar shift were measured for each patient both pre- and post-operatively. Pre-operatively, the mean HKA was 16.6° and the mean AA was 10.41°, both in favour of varus alignment. Post-operatively, the mean HKA decreased to 3.6° and the mean AA to -2.1. The mean LDTA was 87.3°. Before the operation, the mean AJOA was -7.6°, opening to the medial aspect of the ankle, and it was 0.04° after the operation and opening to the lateral aspect (p < 0.05). Our study reveals the changes occurring in the ankle after acute correction of long-standing varus deformity of the knee using total knee arthroplasty. In cases undergoing knee arthroplasty, effect of the acute change in the alignment of the knee on the ankle should be taken into consideration and the amount of correction should be calculated carefully in order not to damage the alignment of the ankle. IV.

Accuracy evaluation of distance inverse square law in determining virtual electron source location in Siemens Primus linac.

Science.gov (United States)

Douk, Hamid Shafaei; Aghamiri, Mahmoud Reza; Ghorbani, Mahdi; Farhood, Bagher; Bakhshandeh, Mohsen; Hemmati, Hamid Reza

2018-01-01

The aim of this study is to evaluate the accuracy of the inverse square law (ISL) method for determining location of virtual electron source ( S Vir ) in Siemens Primus linac. So far, different experimental methods have presented for determining virtual and effective electron source location such as Full Width at Half Maximum (FWHM), Multiple Coulomb Scattering (MCS), and Multi Pinhole Camera (MPC) and Inverse Square Law (ISL) methods. Among these methods, Inverse Square Law is the most common used method. Firstly, Siemens Primus linac was simulated using MCNPX Monte Carlo code. Then, by using dose profiles obtained from the Monte Carlo simulations, the location of S Vir was calculated for 5, 7, 8, 10, 12 and 14 MeV electron energies and 10 cm × 10 cm, 15 cm × 15 cm, 20 cm × 20 cm and 25 cm × 25 cm field sizes. Additionally, the location of S Vir was obtained by the ISL method for the mentioned electron energies and field sizes. Finally, the values obtained by the ISL method were compared to the values resulted from Monte Carlo simulation. The findings indicate that the calculated S Vir values depend on beam energy and field size. For a specific energy, with increase of field size, the distance of S Vir increases for most cases. Furthermore, for a special applicator, with increase of electron energy, the distance of S Vir increases for most cases. The variation of S Vir values versus change of field size in a certain energy is more than the variation of S Vir values versus change of electron energy in a certain field size. According to the results, it is concluded that the ISL method can be considered as a good method for calculation of S Vir location in higher electron energies (14 MeV).

Aspectos radiográficos de periostite ossificante em metatarso de vaca Holandesa Radiografic aspects of ossifying periostitis in metatarsus of Holstein cow

Directory of Open Access Journals (Sweden)

Rodrigo Melo Meneses

2010-05-01

Full Text Available Periostite ossificante é uma neoformação óssea inflamatória extensa, frequentemente oriunda de infecção de tecidos moles adjacentes ao osso afetado, sendo mais proeminente nos bovinos, especialmente em animais jovens. Neste trabalho, é descrito um caso de periostite ossificante no osso metatársico III direito de uma vaca Holandesa após trauma. O diagnóstico foi realizado com base nos achados clínicos e radiográficos e confirmado cirurgicamente.Ossifying periostitis is an extensive inflamatory new bone formation frequently extensive from soft tissue infection next to these bones. It is more observed in young bovines. A case of pos traumatic ossifying periostitis in the right metatarsus of a Holstein cow is described. The diagnosis was made based on clinical and radiographic findings and confirmed cirurgically.

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 a...

A comparison of men's and women's strength to body mass ratio and varus/valgus knee angle during jump landings.

Science.gov (United States)

Haines, Tracie L; McBride, Jeffrey M; Triplett, N Travis; Skinner, Jared W; Fairbrother, Kimberly R; Kirby, Tyler J

2011-10-01

The purpose of this investigation was to compare valgus/varus knee angles during various jumps and lower body strength between males and females relative to body mass. Seventeen recreationally active females (age: 21.94 ± 2.59 years; height: 1.67 ± 0.05 m; mass: 64.42 ± 8.39 kg; percent body fat: 26.89 ± 6.26%; squat one-repetition maximum: 66.18 ± 19.47 kg; squat to body mass ratio: 1.03 ± 0.28) and 13 recreationally active males (age: 21.69 ± 1.65 years; height: 1.77 ± 0.07 m; mass: 72.39 ± 9.23 kg; percent body fat: 13.15 ± 5.18%; squat one-repetition maximum: 115.77 ± 30.40 kg; squat to body mass ratio: 1.59 ± 0.31) performed a one-repetition maximum in the squat and three of each of the following jumps: countermovement jump, 30 cm drop jump, 45 cm drop jump, and 60 cm drop jump. Knee angles were analysed using videography and body composition was analysed by dual-energy X-ray absorptiometry to allow for squat to body mass ratio and squat to fat free mass ratio to be calculated. Significant differences (P ≤ 0.05) were found between male and female one-repetition maximum, male and female squat to body mass ratio, and male and female squat to fat free mass ratio. Significant differences were found between male and female varus/valgus knee positions during maximum flexion of the right and left leg in the countermovement jump, drop jump from 30 cm, drop jump from 45 cm, and drop jump from 60 cm. Correlations between varus/valgus knee angles and squat to body mass ratio for all jumps displayed moderate, non-significant relationships (countermovement jump: r = 0.445; drop jump from 30 cm: r = 0.448; drop jump from 45 cm: r = 0.449; drop jump from 60 cm: r = 0.439). In conclusion, males and females have significantly different lower body strength and varus/valgus knee position when landing from jumps.

THE CORRECTION OF HALLUX VARUS DEFORMITY IN CONSEQUENCE OF SURGICAL TREATMENT FOR HALLUX VALGUS

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V. M. Mashkov

2010-01-01

Full Text Available The analysis of treatment of 21 patients (24 feet with postoperative hallux varus deformity which have arisen after operations apropos hallux valgus is carried out. For correction of vicious position of the first finger we successfully carried out the Brandes procedure, sometimes in a combination to operations on sinews of muscles of the first finger - an adductor hallucis tendotomy and/or lengthening of the extensor hallucis longus tendon.

Effects of toe-in and toe-in with wider step width on level walking knee biomechanics in varus, valgus, and neutral knee alignments.

Science.gov (United States)

Bennett, Hunter J; Shen, Guangping; Cates, Harold E; Zhang, Songning

2017-12-01

Increased peak external knee adduction moments exist for individuals with knee osteoarthritis and varus knee alignments, compared to healthy and neutrally aligned counterparts. Walking with increased toe-in or increased step width have been individually utilized to successfully reduce 1st and 2nd peak knee adduction moments, respectfully, but have not previously been combined or tested among all alignment groups. The purpose of this study was to compare toe-in only and toe-in with wider step width gait modifications in individuals with neutral, valgus, and varus alignments. Thirty-eight healthy participants with confirmed varus, neutral, or valgus frontal-plane knee alignment through anteroposterior radiographs, performed level walking in normal, toe-in, and toe-in with wider step width gaits. A 3×3 (group×intervention) mixed model repeated measures ANOVA compared alignment groups and gait interventions (pstep width compared to normal gait. The 2nd peak adduction moment was increased in toe-in compared to normal and toe-in with wider step width. The adduction impulse was also reduced in toe-in and toe-in with wider step width compared to normal gait. Peak knee flexion and external rotation moments were increased in toe-in and toe-in with wider step width compared to normal gait. Although the toe-in with wider step width gait seems to be a viable option to reduce peak adduction moments for varus alignments, sagittal, and transverse knee loadings should be monitored when implementing this gait modification strategy. Copyright © 2017 Elsevier B.V. All rights reserved.

A radiographic analysis of alignment of the lower extremities--initiation and progression of varus-type knee osteoarthritis.

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Matsumoto, T; Hashimura, M; Takayama, K; Ishida, K; Kawakami, Y; Matsuzaki, T; Nakano, N; Matsushita, T; Kuroda, R; Kurosaka, M

2015-02-01

This study aimed to investigate alignment based on age in normal knees and alignment based on deformity in osteoarthritis (OA) knees using detailed radiographic parameters. Various parameters were measured from weight-bearing long leg radiographs of 1251 legs (797 normal and 454 OA knees) as a cross-sectional study. Normal knees were classified by age (young, middle aged, aged, and elderly) and symptomatic OA knees on the basis of the alignment (femorotibial angle (FTA): mild, moderate, severe and profound). The mean measurements in each group were calculated and compared within each group. The femoral shaft showed medially bowed curvature (femoral bowing) of approximately 2° in the young normal group, which shifted to lateral bowing with age. However, OA knees showed larger lateral bowing with OA grade, which might reduce the condylar-shaft angle and subsequently shifted the mechanical axis medially. Progression of mild to moderate OA might be associated with a decreasing condylar-shaft angle (femoral condylar orientation) and widening condylar-plateau angle (joint space narrowing) rather than decreasing tibial plateau flattering. Steeping of the tibial plateau inclination due to increasing tibial plateau shift (tibial plateau compression) rather than medial tibial bowing might be the main contributor to worsening of varus deformity in knees with severe and profound OA. This cross-sectional study might provide the possibility of OA initiation and progression. The lateral curvature of the femoral shaft associated with aging may contribute to the initiation of varus-type OA of the knee. These changes in the femur may be followed by secondary signs of OA progression including varus femoral condylar orientation, medial joint space narrowing, and tibial plateau compression. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

Long-term stress distribution patterns of the ankle joint in varus knee alignment assessed by computed tomography osteoabsorptiometry.

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Onodera, Tomohiro; Majima, Tokifumi; Iwasaki, Norimasa; Kamishima, Tamotsu; Kasahara, Yasuhiko; Minami, Akio

2012-09-01

The stress distribution of an ankle under various physiological conditions is important for long-term survival of total ankle arthroplasty. The aim of this study was to measure subchondral bone density across the distal tibial joint surface in patients with malalignment/instability of the lower limb. We evaluated subchondral bone density across the distal tibial joint in patients with malalignment/instability of the knee by computed tomography (CT) osteoabsorptiometry from ten ankles as controls and from 27 ankles with varus deformity/instability of the knee. The quantitative analysis focused on the location of the high-density area at the articular surface, to determine the resultant long-term stress on the ankle joint. The area of maximum density of subchondral bone was located in the medial part in all subjects. The pattern of maximum density in the anterolateral area showed stepwise increases with the development of varus deformity/instability of the knee. Our results should prove helpful for designing new prostheses and determining clinical indications for total ankle arthroplasty.

[Humerus varus: correction by proximal valgus osteotomy with precontourned plate fixation in children].

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Tallón-López, J; Domínguez-Amador, J J; Andrés-García, J A

2014-01-01

Varus deformity of the proximal humerus in children is a little known pathology due to its low incidence of presentation. Progress has been made in recent years in understanding the possible etiology and pathophysiological causes. Radiological criteria for diagnosis and functional impairment that occurs have also been defined. However, there are few reports in the literature about the surgical treatment of this deformity in children. In this paper we present a case of surgical treatment of this deformity by corrective osteotomy fixed with precontoured external maleolar plate osteosynthesis. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

The reliability and validity of radiographic measurements for determining the three-dimensional position of the talus in varus and valgus osteoarthritic ankles

NARCIS (Netherlands)

Nosewicz, Tomasz L.; Knupp, Markus; Bolliger, Lilianna; Hintermann, Beat

2012-01-01

To assess the most accurate radiographic method to determine talar three-dimensional position in varus and valgus osteoarthritic ankles, we evaluated the reliability and validity of different radiographic measurements. Nine radiographic measurements were performed blindly on weight-bearing mortise,

Influence of varus/valgus positioning of the Nanos® and Metha® short-stemmed prostheses on stress shielding of metaphyseal bone.

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Brinkmann, V; Radetzki, F; Gutteck, N; Delank, S; Zeh, A

2017-03-01

The aim of this study was to analyze bone remodeling around the Nanos® (Smith & Nephew) and Metha® (Aesculap AG) implants as a function of varus/valgus stem positioning. In 75 patients with diagnosed coxarthrosis, either Nanos® (n= 51) or Metha® (n= 24) prostheses were implanted. Digital assessment of plain radiographs immediately, 97 days, and 381 days after THA showed no clinically-relevant migration, angulation, or change in offset and center of rotation. The DEXA scans showed significant BMD changes in Gruen zones 1 (-12.8%), 2 (-3.3%), 6 (+6.4%), and 7(-7.8%)(t-test). The pre/postoperative CCD for the Nanos® was 129°/ 135° and for the Metha® 131°/ 127°. Linear regression analysis showed no prediction for BMD by postoperative CCD or stem type. In conclusion, there was no clinically-relevant influence on proximal femur BMD according to varus/valgus implantation of the Nanos® or Metha® prostheses.

Pie varus equino congénito (Factores etiológicos

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Valentín Malagón-Castro

1955-04-01

Full Text Available La causa eficiente del pié varus equino congénito, es en la actualidad desconocida. Existen, sin embargo, múltiples teorías orientadas a la explicación de este problema : Teorías atávica y arquiterígea, de Bardeleben, 1878 y Gegenbauer, 1864. Teoría de la Falla circulatoria de Keith, 1940, y de la Displasia fetal de Streeter, 1930; Teoría de la "Flictena" de Bagg, 1920 y Bonnevie, 1934. La Miodistrofia de Middleton, 1934; La presión mecánica intrauterina de Hipócrates, Dermis Browne, etc. La acción de las bridas amniótica y de la Enfermedad ulcerosa del amnios. Ombredanne. La detención en el desarrollo embrionario. Bohm. Los factores genéticos y las causas adyuvantes que pueden obrar sobre éstos: Deficiencia de la dieta materna durante el embarazo; irradiaciones, traumas, enfermedades y drogas recibidas durante la gestación, etc.

Late results after intertrochanteric varus angulation in aseptic femoral head necrosis in adults

International Nuclear Information System (INIS)

Schneider, E.; Ahrendt, J.; Niethard, F.U.; Blaesius, K.

1989-01-01

25 patients suffering from femoral head necrosis in 30 hip joints were radiologically studied for an average of 11.6 years following intertrochanteric varus angulation osteotomy. Preoperatively only stages 2 and 3 according to Meyers were seen. The follow-up results could be distributed into 4 groups. At best the osteonecrosis was reconstructed within 6 to 9 years while the trabeculae started to become rearranged within 2 to 4 years. At worst, rapid destruction in absence of bony reaction was observed. The ability of the bone outside the osteonecrosis to react to changed circumstances following angulation osteotomy correlates with long-term results. This may indicate a general osteopathy even outside the necrotic area. (orig.) [de

Knee joint contact mechanics during downhill gait and its relationship with varus/valgus motion and muscle strength in patients with knee osteoarthritis.

Science.gov (United States)

Farrokhi, Shawn; Voycheck, Carrie A; Gustafson, Jonathan A; Fitzgerald, G Kelley; Tashman, Scott

2016-01-01

The objective of this exploratory study was to evaluate tibiofemoral joint contact point excursions and velocities during downhill gait and assess the relationship between tibiofemoral joint contact mechanics with frontal-plane knee joint motion and lower extremity muscle weakness in patients with knee osteoarthritis (OA). Dynamic stereo X-ray was used to quantify tibiofemoral joint contact mechanics and frontal-plane motion during the loading response phase of downhill gait in 11 patients with knee OA and 11 control volunteers. Quantitative testing of the quadriceps and the hip abductor muscles was also performed. Patients with knee OA demonstrated larger medial/lateral joint contact point excursions (p knee OA compared to their control counterparts (p = 0.02). Additionally, patients with knee OA demonstrated significantly increased frontal-plane varus motion excursions (p knee OA were linearly associated with greater frontal-plane varus motion excursions (p knee OA may be related to compromised frontal-plane joint stability but not with deficits in muscle strength.

Photo neutron dose equivalent rate in 15 MV X-ray beam from a Siemens Primus Linac

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A Ghasemi

2015-01-01

Full Text Available Fast and thermal neutron fluence rates from a 15 MV X-ray beams of a Siemens Primus Linac were measured using bare and moderated BF 3 proportional counter inside the treatment room at different locations. Fluence rate values were converted to dose equivalent rate (DER utilizing conversion factors of American Association of Physicist in Medicine′s (AAPM report number 19. For thermal neutrons, maximum and minimum DERs were 3.46 × 10 -6 (3 m from isocenter in +Y direction, 0 × 0 field size and 8.36 × 10 -8 Sv/min (in maze, 40 × 40 field size, respectively. For fast neutrons, maximum DERs using 9" and 3" moderators were 1.6 × 10 -5 and 1.74 × 10 -5 Sv/min (2 m from isocenter in +Y direction, 0 × 0 field size, respectively. By changing the field size, the variation in thermal neutron DER was more than the fast neutron DER and the changes in fast neutron DER were not significant in the bunker except inside the radiation field. This study showed that at all points and distances, by decreasing field size of the beam, thermal and fast neutron DER increases and the number of thermal neutrons is more than fast neutrons.

Conventional radiotherapy treatments (direct planning) of head and neck with photon XLO planning system (cms) and Siemens Primus accelerator: proposed protocol planning, difficulties encountered, tricks practical and possible amendments to the class solution; Tratamiento de radioterapia convencional (planificacion directa) de cabeza y cuello con fotones para sistema de planificacion XI0 (cms) y acelerador Siemens Primus: propuesta de protocolo de planificacion, dificultades encontradas, trucos practicos y posibles modificaciones de la calss solution

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Saez, F.; Benito, M. A.; Saez, M.

2011-07-01

In this paper we propose a protocol for the systematic planning process for a planner and an Accelerator XiO Primus. This protocol includes the creation of ancillary volumes for better dosimetric evaluation and design fields. Are some practical tips and cases arise in which you can change the Class Solution home. We compare this treatment with 10 turns without turning table with other tables. Finally, we show the advantages of this method from the radiobiological point of view to the bone, the main body of this type of risk treatments.

Conventional radiotherapy treatments (direct planning) of head and neck with photon X10 planning system (cms) and Siemens Primus accelerator: proposed protocol planning, difficulties encountered, tricks practical and possible amendments to the class solution

International Nuclear Information System (INIS)

Saez, F.; Benito, M. A.; Saez, M.

2011-01-01

In this paper we propose a protocol for the systematic planning process for a planner and an Accelerator XiO Primus. This protocol includes the creation of ancillary volumes for better dosimetric evaluation and design fields. Are some practical tips and cases arise in which you can change the Class Solution home. We compare this treatment with 10 turns without turning table with other tables. Finally, we show the advantages of this method from the radiobiological point of view to the bone, the main body of this type of risk treatments.

EVALUATION OF FUNCTIONAL RESULTS OF MEDIAL OPENING WEDGE HIGH TIBIAL OSTEOTOMY FOR UNICOMPARTMENTAL OSTEOARTHRITIS VARUS KNEE

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Shyam Sundar Bakki

2017-01-01

Full Text Available BACKGROUND Osteoarthritis commonly affects the medial compartment of knee giving rise to varus deformity in majority of cases. Significant varus deformity further aggravates the pathology due to medialisation of the weight bearing line osteotomy of the proximal tibia realigns this weight bearing axis, thereby relieving pressure on the damaged medial compartment. OWHTO is a promising option in this scenario because it is associated with high accuracy in correcting the deformity and less number of complications when compared to lateral closing wedge HTO or UKA. In this study, we evaluate the functional outcome of HTO in patients with unicompartmental osteoarthritis. MATERIALS AND METHODS This is a prospective study of patients who attended the orthopaedic outpatient clinic in Government Hospital, Kakinada, between August 2013 to August 2015. The patients were evaluated by clinical examination and weight bearing radiographs. The patients who were found to have unicompartmental osteoarthritis with knee pain not relieved by conservative management and who satisfy the inclusion criteria were selected. RESULTS Excellent results can be achieved by appropriate selection criteria and planning with long limb weight bearing radiographs. There is an excellent relief of pain, which can be achieved within first few months postoperatively, which is assessed by VAS score. The KSS- knee score is excellent in 35%, good in 40%, fair in 20% and poor in 5%. The KSS- function score is excellent in 30%, good in 45%, fair in 20% and poor in 5%. There is significant improvement in the range of movement of the knee joint postoperatively. CONCLUSION In this study, we conclude that medial OWHTO is the preferred modality for unicompartmental OA in those aged <60 years and in developing nations like India where squatting is an important function, it has major role as it can restore near normal knee function without disturbing anatomy.

Acquired cavo-varus deformity caused by an accessory calcaneus: a case report and literature review

International Nuclear Information System (INIS)

Singh Baghla, Davinder Paul; Shariff, Sajid; Bashir, Waseem A.

2010-01-01

We describe an unusual cause of an acquired cavo-varus foot deformity produced by progressive enlargement of an accessory calcaneal ossicle. A 13-year-old boy with constitutional plano-valgus flat feet noted a gradual change in foot shape associated with lateral ankle pain on ambulation following an inversion injury 2 years earlier. CT and MRI scans confirmed a large accessory calcaneal ossicle lying within the sinus tarsi, with associated marrow oedema. Following surgical excision of the ossicle, the foot returned to its original shape and the symptoms were alleviated. This is the fifth reported case of an accessory calcaneal ossicle, but the only case that has occurred in a flatfooted individual. We also present the first reported MRI images of the lesion confirming pathological marrow oedema as a response to mechanical stress. (orig.)

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

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Hirotaka Sano

2015-01-01

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

Comparison of neuromuscular and quadriceps strengthening exercise in the treatment of varus malaligned knees with medial knee osteoarthritis: a randomised controlled trial protocol

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Bennell Kim L

2011-12-01

Full Text Available Abstract Background Osteoarthritis of the knee involving predominantly the medial tibiofemoral compartment is common in older people, giving rise to pain and loss of function. Many people experience progressive worsening of the disease over time, particularly those with varus malalignment and increased medial knee joint load. Therefore, interventions that can reduce excessive medial knee loading may be beneficial in reducing the risk of structural progression. Traditional quadriceps strengthening can improve pain and function in people with knee osteoarthritis but does not appear to reduce medial knee load. A neuromuscular exercise program, emphasising optimal alignment of the trunk and lower limb joints relative to one another, as well as quality of movement performance, while dynamically and functionally strengthening the lower limb muscles, may be able to reduce medial knee load. Such a program may also be superior to traditional quadriceps strengthening with respect to improved pain and physical function because of the functional and dynamic nature. This randomised controlled trial will investigate the effect of a neuromuscular exercise program on medial knee joint loading, pain and function in individuals with medial knee joint osteoarthritis. We hypothesise that the neuromuscular program will reduce medial knee load as well as pain and functional limitations to a greater extent than a traditional quadriceps strengthening program. Methods/Design 100 people with medial knee pain, radiographic medial compartment osteoarthritis and varus malalignment will be recruited and randomly allocated to one of two 12-week exercise programs: quadriceps strengthening or neuromuscular exercise. Each program will involve 14 supervised exercise sessions with a physiotherapist plus four unsupervised sessions per week at home. The primary outcomes are medial knee load during walking (the peak external knee adduction moment from 3D gait analysis, pain, and self

Varus deformity of the left lower extremity causing degenerative lesion of the posterior horn of the left medial meniscus in a patient with Paget’s disease of bone

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Al Kaissi, Ali

2014-09-01

Full Text Available [english] We report on a 42-year-old woman who presented with persistent pain in her left knee with no history of trauma. Sagittal T1-weighted MRI of the left knee showed discontinuity between the anterior and posterior horns of the left medial meniscus, causing effectively the development of degenerative lesion of the posterior horn. The latter was correlated to varus deformity of the left lower extremity associated with subsequent narrowing of the medial knee joint. The unusual craniofacial contour of the patient, the skeletal survey and the elevated serum alkaline phosphatase were compatible with the diagnosis of Paget’s disease of the bone. To alleviate the adverse effect of the mal-alignment of the left femur onto the left knee, corrective osteotomy of the left femoral diaphysis by means of fixators was performed. To the best of our knowledge this is the first clinical report describing the management and the pathological correlation of a unilateral varus deformity of the femoral shaft and degenerative lesions of the left knee in a patient with Paget’s disease of the bone.

Varus femoral osteotomy improves sphericity of the femoral head in older children with severe form of Legg-Calvé-Perthes disease.

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Terjesen, Terje; Wiig, Ola; Svenningsen, Svein

2012-09-01

In the Norwegian prospective study on Legg-Calvé-Perthes disease (LCPD), we found varus femoral osteotomy gave better femoral head sphericity at a mean of 5 years postoperative than physiotherapy in children older than 6.0 years at diagnosis with femoral head necrosis of more than 50%. That study did not include separate analyses for hips with 100% necrosis and those with a percentage of necrosis between 50% and 100%. We asked whether (1) femoral osteotomy improves femoral head sphericity at followup in all patients with more than 50% femoral head necrosis or in selected groups only and (2) there is a critical age between 6.0 and 10.0 years over which femoral osteotomy does not improve the prognosis. We treated 70 patients with unilateral LCPD, age at diagnosis of more than 6.0 years, and femoral head necrosis of more than 50% with varus femoral osteotomy between 1996 and 2000. We classified necrosis using the Catterall classification. We established a control group of 51 similar children who received physiotherapy. At the 5-year followup visit, the hips were graded according to femoral head shape: spherical, ovoid, or flat. At 5-year followup, there was no difference between the treatment groups in radiographic outcome in Catterall Group 3 hips. In Catterall Group 4 hips, femoral head sphericity was better in the osteotomy group, with flat femoral heads in 14% compared to 75% after physiotherapy. The same trend toward better head sphericity occurred when the lateral pillar classification was used. In children aged 6.0 to 10.0 years, in whom the whole femoral head is affected, femoral head sphericity 5 years after femoral osteotomy was better than that after physiotherapy.

Study on forefoot by computerized tomography

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Machida, Eiichi (Nihon Univ., Tokyo. School of Medicine)

1983-10-01

Computerized tomography (CT) was used to study coronary sections of the forefoot in both normal and abnormal human feet. CT images of the transverse arches at the metatarsal head, middle and base of the shaft were classified into five patterns. In the pattern most commonly found in normal feet, the second metatarsus appeared elevated above the other metatarsal bones at all points, and there was a gradual and even reduction in elevation from the second to the fifth metatarsal. In cases of hallux valgus, however, a variety of deformities were noted in the arc of the second to fifth metatarsals, particularly at the head. The rotation of the first metatarsus and shift of the sesamoids were measured from CT images at the head of the first metatarsus. In hallux valgus, both the rotation and the sesamoid shift appeared to have a wider angle than in the case of normal feet. In normal feet, the differences between the rotation of the first metatarsus and shift of the sesamoids were relatively small, whereas in hallux valgus there was a much greater degree of variation. Furthermore, while normal feet the variation in rotation of the first metatarsus and sesamoid shift both tended to be either great or small, in hallux valgus a large degree of sesamoid shift was sometimes found in combination with a small degree of rotation of the first metatarsus.

Study on forefoot by computerized tomography

International Nuclear Information System (INIS)

Machida, Eiichi

1983-01-01

Computerized tomography (CT) was used to study coronary sections of the forefoot in both normal and abnormal human feet. CT images of the transverse arches at the metatarsal head, middle and base of the shaft were classified into five patterns. In the pattern most commonly found in normal feet, the second metatarsus appeared elevated above the other metatarsal bones at all points, and there was a gradual and even reduction in elevation from the second to the fifth metatarsal. In cases of hallux valgus, however, a variety of deformities were noted in the arc of the second to fifth metatarsals, particularly at the head. The rotation of the first metatarsus and shift of the sesamoids were measured from CT images at the head of the first metatarsus. In hallux valgus, both the rotation and the sesamoid shift appeared to have a wider angle than in the case of normal feet. In normal feet, the differences between the rotation of the first metatarsus and shift of the sesamoids were relatively small, whereas in hallux valgus there was a much greater degree of variation. Furthermore, while normal feet the variation in rotation of the first metatarsus and sesamoid shift both tended to be either great or small, in hallux valgus a large degree of sesamoid shift was sometimes found in combination with a small degree of rotatin of the first metatarsus. (author)

Late results after intertrochanteric varus angulation in aseptic femoral head necrosis in adults. Spaetergebnisse nach intertrochanterer Varisierungsosteotomie bei der aseptischen Hueftkopfnekrose Erwachsener

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Schneider, E.; Ahrendt, J.; Niethard, F.U.; Blaesius, K. (Heidelberg Univ. (Germany, F.R.). Orthopaedische Klinik und Poliklinik)

1989-04-01

25 patients suffering from femoral head necrosis in 30 hip joints were radiologically studied for an average of 11.6 years following intertrochanteric varus angulation osteotomy. Preoperatively only stages 2 and 3 according to Meyers were seen. The follow-up results could be distributed into 4 groups. At best the osteonecrosis was reconstructed within 6 to 9 years while the trabeculae started to become rearranged within 2 to 4 years. At worst, rapid destruction in absence of bony reaction was observed. The ability of the bone outside the osteonecrosis to react to changed circumstances following angulation osteotomy correlates with long-term results. This may indicate a general osteopathy even outside the necrotic area. (orig.).

Performance characterization of siemens primus linear accelerator under small monitor unit and small segments for the implementation of step-and-shoot intensitymodulated radiotherapy

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Reena P

2006-01-01

Full Text Available Implementation of step-and-shoot intensity-modulated radiotherapy (IMRT needs careful understanding of the accelerator start-up characteristic to ensure accurate and precise delivery of radiation dose to patient. The dosimetric characteristic of a Siemens Primus linear accelerator (LA which delivers 6 and 18 MV x-rays at the dose rate of 300 and 500 monitor unit (MU per minutes (min respectively was studied under the condition of small MU ranging from 1 to 100. Dose monitor linearity was studied at different dose calibration parameter (D1_C0 by measuring ionization at 10 cm depth in a solid water phantom using a 0.6 cc ionization chamber. Monitor unit stability was studied from different intensity modulated (IM groups comprising various combinations of MU per field and number of fields. Stability of beam flatness and symmetry was investigated under normal and IMRT mode for 20x20 cm2 field under small MU using a 2D Profiler kept isocentrically at 5 cm depth. Inter segment response was investigated form 1 to 10 MU by measuring the dose per MU from various IM groups, each consisting of four segments with inter-segment separation of 2 cm. In the range 1-4 MU, the dose linearity error was more than 5% (max -32% at 1 MU for 6 MV x-rays at factory calibrated D1_C0 value of 6000. The dose linearity error was reduced to -10.95% at 1 MU, within -3% for 2 and 3 MU and ±1% for MU ≥4 when the D1_C0 was subsequently tuned at 4500. For 18 MV x-rays, the dose linearity error at factory calibrated D1_C0 value of 4400 was within ±1% for MU ≥ 3 with maximum of -13.5 observed at 1 MU. For both the beam energies and MU/field ≥ 4, the stability of monitor unit tested for different IM groups was within ±1% of the dose from the normal treatment field. This variation increases to -2.6% for 6 MV and -2.7% for 18 MV x-rays for 2 MU/field. No significant variation was observed in the stability of beam profile measured from normal and IMRT mode. The beam flatness

The humidity in a Dräger Primus anesthesia workstation using low or high fresh gas flow and with or without a heat and moisture exchanger in pediatric patients.

Science.gov (United States)

Bicalho, Gustavo P; Braz, Leandro G; de Jesus, Larissa S B; Pedigone, Cesar M C; de Carvalho, Lídia R; Módolo, Norma S P; Braz, José R C

2014-10-01

An inhaled gas absolute humidity of 20 mg H2O·L is the value most considered as the threshold necessary for preventing the deleterious effects of dry gas on the epithelium of the airways during anesthesia. Because children have small minute ventilation, we hypothesized that the humidification of a circle breathing system is lower in children compared with adults. The Primus anesthesia workstation (Dräger Medical, Lübeck, Germany) has a built-in hotplate to heat the patient's exhaled gases. A heat and moisture exchanger (HME) is a device that can be used to further humidify and heat the inhaled gases during anesthesia. To evaluate the humidifying properties of this circle breathing system during pediatric anesthesia, we compared the temperature and humidity of inhaled gases under low or high fresh gas flow (FGF) conditions and with or without an HME. Forty children were randomly allocated into 4 groups according to the ventilation of their lungs by a circle breathing system in a Dräger Primus anesthesia workstation with low (1 L·min) or high (3 L·min) FGF without an HME (1L and 3L groups) or with an HME (Pall BB25FS, Pall Biomedical, East Hills, NY; HME1L and HME3L groups). The temperature and absolute humidity of inhaled gases were measured at 10, 20, 40, 60, and 80 minutes after connecting the patient to the breathing circuit. The mean inhaled gas temperature was higher in HME groups (HME1L: 30.3°C ± 1.1°C; HME3L: 29.3°C ± 1.2°C) compared with no-HME groups (1L: 27.0°C ± 1.2°C; 3L: 27.1°C ± 1.5°C; P [HME3L: 23 ± 2 mg H2O·L] > [1L: 17 ± 1 mg H2O·L] > [3L: 14 ± 1 mg H2O·L]; P pediatric circle breathing system, the use of neither high nor low FGF provides the minimum humidity level of the inhaled gases thought to reduce the risk of dehydration of airways. Insertion of an HME increases the humidity and temperature of the inhaled gases, bringing them closer to physiological values. The use of a low FGF enhances the HME efficiency and

Performance characterization of Siemens primus linear accelerator under small monitor unit and small segments for the implementation of step-and-shoot intensity-modulated radiotherapy

International Nuclear Information System (INIS)

Reena, P.; Pai, Rajeshri; Gupta, Tejpal; Rajeev, S.; Dayananda, S.; Jamema, S.V.; Deepak, D.

2006-01-01

Implementation of step-and-shoot intensity-modulated radiotherapy (IMRT) needs careful understanding of the accelerator start-up characteristic to ensure accurate and precise delivery of radiation dose to patient. The dosimetric characteristic of a Siemens Primus linear accelerator (LA) which delivers 6 and 18 MV x-rays at the dose rate of 300 and 500 monitor unit (MU) per minutes (min) respectively was studied under the condition of small MU ranging from 1 to 100. Dose monitor linearity was studied at different dose calibration parameter (D1 C O) by measuring ionization at 10 cm depth in a solid water phantom using a 0.6 cc ionization chamber. Monitor unit stability was studied from different intensity modulated (IM) groups comprising various combinations of MU per field and number of fields. Stability of beam flatness and symmetry was investigated under normal and IMRT mode for 20x20 cm 2 field under small MU using a 2D Profiler kept isocentrically at 5 cm depth. Inter segment response was investigated form 1 to 10 MU by measuring the dose per MU from various IM groups, each consisting of four segments with inter-segment separation of 2 cm. In the range 1-4 MU, the dose linearity error was more than 5% (max -32% at 1 MU) for 6 MV x-rays at factory calibrated D1 C O value of 6000. The dose linearity error was reduced to -10.95% at 1 MU, within -3% for 2 and 3 MU and ± 1% for MU ≥4 when the D1 C O was subsequently tuned at 4500. For 18 MV x-rays, the dose linearity error at factory calibrated D1 C O value of 4400 was within ± 1% for MU ≥3 with maximum of -13.5 observed at 1 MU. For both the beam energies and MU/field ≥4, the stability of monitor unit tested for different IM groups was within ± 1% of the dose from the normal treatment field. This variation increases to -2.6% for 6 MV and -2.7% for 18 MV x-rays for 2 MU/field. No significant variation was observed in the stability of beam profile measured from normal and IMRT mode. The beam flatness was

Quantification and reduction of peripheral dose from leakage radiation on Siemens Primus accelerators in electron therapy mode.

Science.gov (United States)

Yeboah, Collins; Karotki, Alex; Hunt, Dylan; Holly, Rick

2010-06-15

In this work, leakage radiation from EA200 series electron applicators on Siemens Primus accelerators is quantified, and its penetration ability in water and/or the shielding material Xenolite-NL established. Initially, measurement of leakage from 10 x 10 - 25 x 25 cm2 applicators was performed as a function of height along applicator and of lateral distance from applicator body. Relative to central-axis ionization maximum in solid water, the maximum leakage in air observed with a cylindrical ion chamber with 1 cm solid water buildup cap at a lateral distance of 2 cm from the front and right sidewalls of applicators were 17% and 14%, respectively; these maxima were recorded for 18 MeV electron beams and applicator sizes of >or=20 x 20 cm2. In the patient plane, the applicator leakage gave rise to a broad peripheral dose off-axis distance peak that shifted closer to the field edge as the electron energy increases. The maximum peripheral dose from normally incident primary electron beams at a depth of 1 cm in a water phantom was observed to be equal to 5% of the central-axis dose maximum and as high as 9% for obliquely incident beams with angles of obliquity dose curves showed that the "practical range" of the leakage electrons in water varies from approximately 1.4 to 5.7 cm as the primary electron beam energy is raised from 6 to 18 MeV. Next, transmission measurements of leakage radiation through the shielding material Xenolite-NL showed a 4 mm thick sheet of this material is required to attenuate the leakage from 9 MeV beams by two-thirds, and that for every additional 3 MeV increase in the primary electron beam energy, an additional Xenolite-NL thickness of roughly 2 mm is needed to achieve the aforementioned attenuation level. Finally, attachment of a 1 mm thick sheet of lead to the outer surface of applicator sidewalls resulted in a reduction of the peripheral dose by up to 80% and 74% for 9 and 18MeV beams, respectively. This sidewall modification had an

Mindre inventar og personlige ejendele

DEFF Research Database (Denmark)

Madsen, Hans Jørgen; Pedersen, Unn; Roesdahl, Else

2014-01-01

Groups of finds from Aggersborg: keys and locks, casket-hasps, ornamental mount and nail, combs, tweezers, bone pins and bodkins, gamin-pieces, pierced metatarsus, small axe-head, weight......Groups of finds from Aggersborg: keys and locks, casket-hasps, ornamental mount and nail, combs, tweezers, bone pins and bodkins, gamin-pieces, pierced metatarsus, small axe-head, weight...

Pre-clinical test of the virtual wedge option of a PRIMUS linear accelerator and verification of the calculation algorithm in the treatment planning system HEAX-TMS

International Nuclear Information System (INIS)

Gesheva-Atanassova, N.; Balabanova, A.

2006-01-01

Full text: The purpose of the study is to check the long-time stability of the wedge angle and the wedge factor (WF) of Virtual Wedges for 6 and 18 MV photon beams, and the accuracy of the TPS HELAX-TMS, in order to accept the virtual wedge technique for patient treatment. All measurements - dose profiles, central axis dose distributions and applied dose for pre-calculated monitor units, have been performed in water, applying a calibrated 0.3 cm 3 ion chamber, 47 ion chamber array LA48 and the beam analyzing system MP3. The measured data has been compared with the corresponding planned data. During a four years time period the long time stability checking revealed no changes in the central axis distributions and variations of the wedge angles are within ± 2 deg. The values of WFs and the differences between calculated and measured dose values are in the acceptable limits, except for the 6 MV beam with wedge angle 60 deg and field size 20x20 cm 2 , where the deviation reaches 6.5%. The dose profile for depth up to 10 cm showed a good coincidence. Non acceptable deviations have been found for beam profiles at depth 20 cm and field size 20x20 cm 2 for both 6 and 18 MV. The Virtual Wedge Option of PRIMUS in combination with HELAX-TMS can be applied with confidence for radiotherapy with wedged beams except for the combination of field 20x20 cm 2 and angle 60 deg

In-toeing in children with type I osteogenesis imperfecta: an observational descriptive study.

Science.gov (United States)

Losa Iglesias, Marta Elena; Becerro de Bengoa Vallejo, Ricardo; Salvadores Fuentes, Paloma

2009-01-01

Osteogenesis imperfecta is an autosomal-dominant disorder of the connective tissue. Also known as brittle bone disease, it renders those affected susceptible to fractures after minimal trauma. Therefore, it is important to minimize the risk of falls and subsequent fractures in patients with this disease. In-toeing is a common condition in children that can result from various pathologic entities, including anteversion, internal tibial torsion, and metatarsus adductus. These conditions can result in frequent tripping and other functional problems. A descriptive study was undertaken to determine the prevalence of in-toeing gait attributable to tibial or femoral torsion or metatarsus adductus in children with type I osteogenesis imperfecta. The study involved orthopedic and biomechanical examination of 15 children (9 girls and 6 boys) aged 4 to 9 years with confirmed type I osteogenesis imperfecta. Patients who used assistive ambulatory devices, such as canes, crutches, and wheelchairs, were excluded from the study. Of the 15 children studied, 12 (80%) demonstrated previously undiagnosed in-toeing gait attributable to torsional deformity or metatarsus adductus in all but one child. Many children with confirmed type I osteogenesis imperfecta have in-toeing gait caused by torsional deformity or metatarsus adductus. Detection and control of in-toeing gait in children with osteogenesis imperfecta is important to prevent fractures resulting from trauma directly related to these conditions.

Monoplanar versus biplanar medial open-wedge proximal tibial osteotomy for varus gonarthrosis: a comparison of clinical and radiological outcomes.

Science.gov (United States)

Elmalı, Nurzat; Esenkaya, Irfan; Can, Murat; Karakaplan, Mustafa

2013-12-01

We compared clinical and radiological results of two proximal tibial osteotomy (PTO) techniques: monoplanar medial open-wedge osteotomy and biplanar retrotubercle medial open-wedge osteotomy, stabilised by a wedged plate. We evaluated 88 knees in 78 patients. Monoplanar medial open-wedge PTO was performed on 56 knees in 50 patients with a mean age of 55 ± 9 years. Biplanar retrotubercle medial open-wedge PTO was performed on 32 knees in 28 patients with a mean age of 57 ± 7 years. Mean follow-up periods were 40.6 ± 7 months for the monoplanar PTO group and 38 ± 5 months for the biplanar retrotubercle PTO group. Clinical outcome was evaluated using the hospital for special surgery scoring system, and radiological outcome was evaluated by the measurements of femorotibial angle (FTA), patellar height and tibial slope changes. In both groups, post-operative HSS scores increased significantly. No significant difference was found between groups in FTA alteration, but the FTA decreased significantly in both groups. Patellar index ratios decreased significantly in the monoplanar PTO group (Insall-Salvati Index by 0.07, Blackburne-Peel Index by 0.07), but not in the biplanar retrotubercle PTO group. Tibial slopes were increased significantly in the monoplanar PTO group, but not in the retrotubercle PTO group. Biplanar retrotubercle medial open-wedge osteotomy and monoplanar medial open-wedge osteotomy are both clinically effective for the treatment for varus gonarthrosis. Retrotubercle osteotomy also prevents patella infera and tibial slope changes radiologically.

Radiographic Shape of Foot With Second Metatarsophalangeal Joint Dislocation Associated With Hallux Valgus.

Science.gov (United States)

Kokubo, Tetsuro; Hashimoto, Takeshi; Suda, Yasunori; Waseda, Akeo; Ikezawa, Hiroko

2017-12-01

Second metatarsophalangeal (MTP) joint dislocation is associated with hallux valgus, and the treatment of complete dislocation can be difficult. The purpose of this study was to radiographically clarify the characteristic foot shape in the presence of second MTP joint dislocation. Weight-bearing foot radiographs of the 268 patients (358 feet) with hallux valgus were examined. They were divided into 2 groups: those with second MTP joint dislocation (study group = 179 feet) and those without dislocation (control group = 179 feet). Parameters measured included the hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), second MTP joint angle, hallux interphalangeal angle (IPA), second metatarsal protrusion distance (MPD), metatarsus adductus angle (MAA), and the second metatarsal declination angle (2MDA). Furthermore, the dislocation group was divided into 3 subgroups according to second toe deviation direction: group M (medial type), group N (neutral type), and group L (lateral type). The IPA and the 2MDA were significantly greater in the study group than in the control group. By multiple comparison analysis, the IMA was greatest in group M and smallest in group L. The IPA was smaller and 2MDA greater in group N than in group L. The HVA and MAA in group L were greatest, and MPD in group L was smallest. The patients with second MTP joint dislocation associated with hallux valgus had greater hallux interphalangeal joint varus and a second metatarsal more inclined than with hallux valgus alone. The second toe deviated in a different direction according to the foot shape. Level III, retrospective comparative study.

Measuring cutaneous thermal nociception in group-housed pigs using laser technique - effects of laser power output

DEFF Research Database (Denmark)

Herskin, Mette S.; Ladevig, Jan; Arendt-Nielsen, Lars

2009-01-01

Nociceptive testing is a valuable tool in the development of pharmaceutical products, for basic nociceptive research, and for studying changes in pain sensitivity is investigated after inflammatory states or nerve injury. However, in pigs only very limited knowledge about nociceptive processes...... nociceptive stimulation from a computer-controlled CO2-laser beam applied to either the caudal part of the metatarsus on the hind legs or the shoulder region of gilts. In Exp. 1, effects of laser power output (0, 0.5, 1, 1.5 and 2 W) on nociceptive responses toward stimulation on the caudal aspects...... of the metatarsus were examined using 15 gilts kept in one group and tested in individual feeding stalls after feeding. Increasing the power output led to gradually decreasing latency to respond (P 

Udvikling af medicinsk behandling mod bipolar lidelse

DEFF Research Database (Denmark)

Ellegaard, Pernille Kempel

2015-01-01

Selvom Esbjerg ligger i vandkants Danmark, er det den Psykiatriske Forskningsenhed i denne by, der er primus motor for et stort forsøg blandt mennesker, der lider af bipolar lidelse. Forsøget hedder ”NACOS”, og er et medicinsk forsøg til mennesker, der befinder sig i den depressive fase.......Selvom Esbjerg ligger i vandkants Danmark, er det den Psykiatriske Forskningsenhed i denne by, der er primus motor for et stort forsøg blandt mennesker, der lider af bipolar lidelse. Forsøget hedder ”NACOS”, og er et medicinsk forsøg til mennesker, der befinder sig i den depressive fase....

Foot Problems

Science.gov (United States)

... early. Start OverDiagnosisThe cause may be FEMORAL ANTEVERSION, TIBIAL TORSION or METATARSUS ADDUCTUS, commonly called intoeing. Self CareSee your doctor. Start OverDiagnosisYou may have a STRESS FRACTURE of the bones in your foot. The pain ...

Spectrum and H(10) of secondary neutrons around Linacs

International Nuclear Information System (INIS)

Ortiz H, A.; Hernandez A, B.; Vega C, H. R.; Hernandez D, V. M.; Rivera M, T.

2009-10-01

Neutron spectrum and ambient dose equivalent has been measured around two 10 MV linear accelerators. Accelerators are Siemens, one is a Mevatron model while another is the Primus. Main differences between those models are the beam collimator and the vault room. Here, Bonner sphere spectrometer with a passive thermal neutron detector has been utilized to measure the neutron spectrum inside the vault. Using an active detector the neutron spectrum was measured by the vaults door of both accelerators. With a neutron area monitor the dose equivalent was measured by the doors. Neutron strength, total fluence rate and ambient dose equivalent were compared, from this was found that shielding conditions are better in the Primus model. (Author)

Inside anesthesia breathing circuits: time to reach a set sevoflurane concentration in toddlers and newborns: simulation using a test lung.

Science.gov (United States)

Kern, Delphine; Larcher, Claire; Basset, Bertrand; Alacoque, Xavier; Fesseau, Rose; Samii, Kamran; Minville, Vincent; Fourcade, Olivier

2012-08-01

We measured the time it takes to reach the desired inspired anesthetic concentration using the Primus (Drägerwerk, AG, Lübeck, Germany) and the Avance (GE Datex-Ohmeda, Munich, Germany) anesthesia machines with toddler and newborn ventilation settings. The time to reach 95% of inspired target sevoflurane concentration was measured during wash-in from 0 to 6 vol% sevoflurane and during wash-out from 6 to 0 vol% with fresh gas flows equal to 1 and 2 times the minute ventilation. The Avance was faster than the Primus (65 seconds [95% confidence interval (CI): 55 to 78] vs 310 seconds [95% CI: 261 to 359]) at 1.5 L/min fresh gas flow, tidal volume of 50 mL, and 30 breaths/min. Times were shorter by the same magnitude at higher fresh gas flows and higher minute ventilation rates. The effect of doubling fresh gas flow was variable and less than expected. The Primus is slower during newborn than toddler ventilation, whereas the Avance's response time was the same for newborn and toddler ventilation. Our data confirm that the time to reach the target-inspired anesthetic concentration depends on breathing circuit volume, fresh gas flow, and minute ventilation.

Sound : Albumid, singlid / Ülo Külm

Index Scriptorium Estoniae

Külm, Ülo

1998-01-01

Uutest albumitest Helloween "Better than raw", Primus "Rhinoplasty", Unbelievable Truth "Almost here", Dallas "Sleepers entertainer" (eesti), Massive Attack "Mezzanine" ja singlist Busta Rhymes "Turn it up /Fire it up"

Reliability and relationship of radiographic measurements in hallux valgus.

Science.gov (United States)

Lee, Kyoung Min; Ahn, Soyeon; Chung, Chin Youb; Sung, Ki Hyuk; Park, Moon Seok

2012-09-01

Although various radiographic measurements have been developed and used for evaluating hallux valgus, not all are universally believed to be necessary and their relationships have not been clearly established. Determining which are related could provide some insight into which might be useful and which would not. We investigated the reliability of eight radiographic measurements used to evaluate hallux valgus, and determined which were correlated and which predicted the hallux valgus angle. We determined eight radiographic indices for 732 patients (mean age, 51 years; SD, 17 years; 107 males and 625 females) with hallux valgus: hallux valgus angle, intermetatarsal angle, hallux interphalangeal angle, distal metatarsal articular angle, proximal phalangeal articular angle, simplified metatarsus adductus angle, first metatarsal protrusion distance, and sesamoid rotation angle. Intraobserver and interobserver reliabilities of each radiographic measurement were analyzed on 36 feet from 36 randomly selected patients. Correlations among the radiographic measurements were analyzed. Radiographic measurements predicting hallux valgus angle were evaluated using multiple regression analysis. Hallux valgus angle had the highest reliability, whereas the distal metatarsal articular angle and simplified metatarsus adductus angle had the lowest. Distal metatarsal articular angle, intermetatarsal angle, and sesamoid rotation angle had the highest correlations with hallux valgus angle. Distal metatarsal articular angle correlated with sesamoid rotation angle. The intermetatarsal angle, interphalangeal angle, distal metatarsal articular angle, first metatarsal protrusion distance, sesamoid rotation angle, and metatarsus adductus angle predicted the hallux valgus angle. We suggest using hallux valgus angle, intermetatarsal angle, interphalangeal angle, sesamoid rotation angle, and first metatarsal protrusion distance considering their reliability and prediction of the deformity.

Lateral collateral ligament (image)

Science.gov (United States)

The lateral collateral ligament connects the end of the femur (thigh) to the top of the fibula (the thin bone that runs next to the shin bone). The lateral collateral ligament provides stability against varus stress. Varus stress ...

Case report - Achondroplastic syndrome in a West African dwarf lamb

African Journals Online (AJOL)

A three week old, male, West African Dwarf (WAD) lamb presented with disproportionate hind limb was diagnosed of having achondroplastic syndrome by physical and radiological examination. Physical examination showed the right hind limb was deformed at the level of the tarsus, metatarsus and phalanges. Radiological ...

Methodology Research on Evaluating the Developmental and Retentive Capacity Level of Human Single -joint Muscular Power in Mode of Isotonic Test%应用等张模式测定人体单关节肌群功率发展与保持能力的方法学研究

Institute of Scientific and Technical Information of China (English)

徐红旗; 张欣; 冉令华; 杨帆; 史冀鹏; 王安利; 郑秀瑗

2011-01-01

人体肌肉功率的发展与保持能力在完成生产劳动、日常体力活动和体育运动中具有重要的作用.本文以12名健康普通大学生为研究对象,运用模拟仿真测试评价训练系统( BTE PrimusRS)的等张测量模式来探讨人体单关节肌群功率发展与保持能力的测评方法.结果表明BTE PrimusRS系统能客观、准确地评价人体单关节肌群功率发展与保持能力的水平；此等张测试模式下,50％等长峰值肌力(或力矩)的阻力负荷设置较为合理；等长峰值肌力应采用非爆发式静力性测量模式获得.%The developmental and retentive capacity of muscular power is of great importance to human endeavor in productive labor, physical activities of daily living and sports events. Twelve healthy college students volunteered to participate in this study; the purpose was to explore the measurement method about the developmental and retentive capacity of human single -joint muscular power, combined with the mode of isotonic test on BTE PrimusRS system. The results show that BTE PrimusRS system could objectively and accurately evaluate the developmental and retentive capacity level of human single -joint muscular power. The reasonable load resistance was 50% of the isometric peak strength or torque (IPS or IPT) in the isotonic test; the mode of isometric peak strength (IPS) should be non -explosively static.

Takistusteta kõrgkooliõpe?! / Getter Tiirik

Index Scriptorium Estoniae

Tiirik, Getter

2010-01-01

SA Archimedes PRIMUS programmi töörühma poolt välja töötatud juhendmaterjalist kõrgkoolidele ”Takistusteta kõrgkooliõpe”, et tagada erivajadustega tudengitele tugiteenused kõrghariduse omandamisel

Inglise firma ründab kõnekaartide ja mobiiltelefonidega Eesti turgu / Toivo Tänavsuu

Index Scriptorium Estoniae

Tänavsuu, Toivo

2005-01-01

Inglise firma Primus Telecommunications hakkab Eestis pakkuma soodsaid kaugekõnehindu. Kõnekaardiäriga hakkab tegelema American Tours'i omanik Ülle Turgan. Lisa: Ülle Turgan müüb poole American Toursist. Lisa: Inglise suurfirma

Neglected distal humeral epiphyseal injury - Two Case Reports ...

African Journals Online (AJOL)

We present two cases of neglected distal humeral epiphyseal injury in children that resulted in cubitus varus deformity in one case. Full range of movements was achieved in both cases after proper management. Keywords: Neglected epiphyseal injury; Cubitus varus; Diagnosis; Treatment Internet Journal of Medical Update ...

Case-related factors affecting cutting errors of the proximal tibia in total knee arthroplasty assessed by computer navigation.

Science.gov (United States)

Tsukeoka, Tadashi; Tsuneizumi, Yoshikazu; Yoshino, Kensuke; Suzuki, Mashiko

2018-05-01

The aim of this study was to determine factors that contribute to bone cutting errors of conventional instrumentation for tibial resection in total knee arthroplasty (TKA) as assessed by an image-free navigation system. The hypothesis is that preoperative varus alignment is a significant contributory factor to tibial bone cutting errors. This was a prospective study of a consecutive series of 72 TKAs. The amount of the tibial first-cut errors with reference to the planned cutting plane in both coronal and sagittal planes was measured by an image-free computer navigation system. Multiple regression models were developed with the amount of tibial cutting error in the coronal and sagittal planes as dependent variables and sex, age, disease, height, body mass index, preoperative alignment, patellar height (Insall-Salvati ratio) and preoperative flexion angle as independent variables. Multiple regression analysis showed that sex (male gender) (R = 0.25 p = 0.047) and preoperative varus alignment (R = 0.42, p = 0.001) were positively associated with varus tibial cutting errors in the coronal plane. In the sagittal plane, none of the independent variables was significant. When performing TKA in varus deformity, careful confirmation of the bone cutting surface should be performed to avoid varus alignment. The results of this study suggest technical considerations that can help a surgeon achieve more accurate component placement. IV.

Preoperative Planning and Intraoperative Technique for Accurate Translation of a Distal First Metatarsal Osteotomy.

Science.gov (United States)

Wynes, Jacob; Lamm, Bradley M; Andrade, Bijan J; Malay, D Scot

2016-01-01

We used preoperative radiographic and intraoperative anatomic measurements to predict and achieve, respectively, the precise amount of capital fragment lateral translation required to restore anatomic balance to the first metatarsophalangeal joint. Correlation was used to relate the amount of capital fragment translation and operative reduction of the first intermetatarsal angle (IMA), hallux abductus angle (HAA), tibial sesamoid position (TSP), metatarsus adductus angle, and first metatarsal length. The mean capital fragment lateral translation was 5.54 ± 1.64 mm, and the mean radiographic reductions included a first IMA of 5.04° ± 2.85°, an HAA of 9.39° ± 8.38°, and a TSP of 1.38 ± 0.9. These changes were statistically (p < .001) and clinically (≥32.55%) significant. The mean reduction of the metatarsus adductus angle was 0.66° ± 4.44° and that for the first metatarsal length was 0.33 ± 7.27 mm, and neither of these were statistically (p = .5876 and 0.1247, respectively) or clinically (≤3.5%) significant. Pairwise correlations between the amount of lateral translation of the capital fragment and the first IMA, HAA, and TSP values were moderately positive and statistically significant (r = 0.4412, p = .0166; r = 0.5391, p = .0025; and r = 0.3729, p = .0463; respectively). In contrast, the correlation with metatarsus adductus and the first metatarsal shortening were weak and not statistically significant (r = 0.2296, p = .2308 and r = -0.2394, p = .2109, respectively). The results of our study indicate that predicted preoperative and executed intraoperative lateral translation of the capital fragment correlates with statistically and clinically significant reductions in the first IMA, HAA, and TSP. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Movement coordination patterns between the foot joints during walking

Directory of Open Access Journals (Sweden)

John B. Arnold

2017-10-01

Full Text Available Abstract Background In 3D gait analysis, kinematics of the foot joints are usually reported via isolated time histories of joint rotations and no information is provided on the relationship between rotations at different joints. The aim of this study was to identify movement coordination patterns in the foot during walking by expanding an existing vector coding technique according to an established multi-segment foot and ankle model. A graphical representation is also described to summarise the coordination patterns of joint rotations across multiple patients. Methods Three-dimensional multi-segment foot kinematics were recorded in 13 adults during walking. A modified vector coding technique was used to identify coordination patterns between foot joints involving calcaneus, midfoot, metatarsus and hallux segments. According to the type and direction of joints rotations, these were classified as in-phase (same direction, anti-phase (opposite directions, proximal or distal joint dominant. Results In early stance, 51 to 75% of walking trials showed proximal-phase coordination between foot joints comprising the calcaneus, midfoot and metatarsus. In-phase coordination was more prominent in late stance, reflecting synergy in the simultaneous inversion occurring at multiple foot joints. Conversely, a distal-phase coordination pattern was identified for sagittal plane motion of the ankle relative to the midtarsal joint, highlighting the critical role of arch shortening to locomotor function in push-off. Conclusions This study has identified coordination patterns between movement of the calcaneus, midfoot, metatarsus and hallux by expanding an existing vector cording technique for assessing and classifying coordination patterns of foot joints rotations during walking. This approach provides a different perspective in the analysis of multi-segment foot kinematics, and may be used for the objective quantification of the alterations in foot joint

Imaging diagnostics of the foot; Bildgebende Diagnostik des Fusses

Energy Technology Data Exchange (ETDEWEB)

Szeimies, Ulrike; Staebler, Axel [Radiologie in Muenchen-Harlaching, Muenchen (Germany); Walther, Markus (eds.) [Schoen-Klinik Muenchen-Harlaching, Muenchen (Germany). Zentrum fuer Fuss- und Sprunggelenkchirurgie

2012-11-01

The book on imaging diagnostics of the foot contains the following chapters: (1) Imaging techniques. (2) Clinical diagnostics. (3) Ankle joint and hind foot. (4) Metatarsus. (5) Forefoot. (6) Pathology of plantar soft tissue. (7) Nervous system diseases. (8) Diseases without specific anatomic localization. (9) System diseases including the foot. (10) Tumor like lesions. (11) Normative variants.

Minimally invasive unicompartmental knee replacement: retrospective clinical and radiographic evaluation of 83 patients.

Science.gov (United States)

Bruni, Danilo; Iacono, Francesco; Russo, Alessandro; Zaffagnini, Stefano; Marcheggiani Muccioli, Giulio Maria; Bignozzi, Simone; Bragonzoni, Laura; Marcacci, Maurilio

2010-06-01

We performed a retrospective clinical and radiographic evaluation of 83 nonconsecutive patients operated in our institute between February 1996 and March 2003 with a mean follow-up of 60 months to assess the efficiency of unicompartmental knee replacement (UKR) performed with a minimally invasive technique. The aim of this study was to correlate the clinical outcome with the pre- and post-operative alignment and with implant positioning on coronal and sagittal plane. Eighty-three nonconsecutive patients (60 males, 23 females) underwent cemented UKR (De Puy Preservation Uni with all-poly tibial component), for both medial OA (80 patients) and AVN of the medial femoral condyle (3 patients). All patients were available at final follow-up evaluation, and they all presented an evident varus alignment at pre-operative clinical and radiographic evaluation. At radiographic measurement, we considered a knee with femoro-tibial angle (FTA) > 175 degrees as varus knee, 170 degrees FTA FTA 90 degrees for valgus knee and a TPA clinical result presented a mean varus deformity of 7.2 degrees (3.6 degrees-10.8 degrees) pre-operatively. According to literature, we demonstrated that a small amount of undercorrection with a small amount of residual varus deformity of 3 degrees-5 degrees is the goal to be reached in order to avoid both rapid degeneration of the nonreplaced compartment and the premature loosening of the replaced compartment. We performed a mean axial correction of 5 degrees (SD 3.9 degrees), leaving a mean axial varus deformity of 2.2 degrees in the excellent group. In our series, the group with excellent results also showed a post-operative PTS of 7 degrees (2.4 degrees-11.6 degrees), while mean pre-operative PTS was 6.5 degrees (2.7 degrees-10.3 degrees). In this study, results have shown that minimally invasive UKR producing a small amount of varus undercorrection in selected patients with medial tibio-femoral osteoarthritis or moderate avascular necrosis of the

Comparison of the temperature and humidity in the anesthetic breathing circuit among different anesthetic workstations: Updated guidelines for reporting parallel group randomized trials.

Science.gov (United States)

Choi, Yoon Ji; Min, Sam Hong; Park, Jeong Jun; Cho, Jang Eun; Yoon, Seung Zhoo; Yoon, Suk Min

2017-06-01

For patients undergoing general anesthesia, adequate warming and humidification of the inspired gases is very important. The aim of this study was to evaluate the differences in the heat and moisture content of the inspired gases with low-flow anesthesia using 4 different anesthesia machines. The patients were divided into 11 groups according to the anesthesia machine used (Ohmeda, Excel; Avance; Dräger, Cato; and Primus) and the fresh gas flow (FGF) rate (0.5, 1, and 4 L/min). The temperature and absolute humidity of the inspired gas in the inspiratory limbs were measured at 5, 10, 15, 30, 45, 60, 75, 90, 105, and 120 minutes in 9 patients scheduled for total thyroidectomy or cervical spine operation in each group. The anesthesia machines of Excel, Avance, Cato, and Primus did not show statistically significant changes in the inspired gas temperatures over time within each group with various FGFs. They, however, showed statistically significant changes in the absolute humidity of the inspired gas over time within each group with low FGF anesthesia (P humidity of the inspired gas over time within each group with an FGF of 4 L/min (P humidities of the inspired gas for all anesthesia machines were lower than the recommended values. There were statistical differences in the provision of humidity among different anesthesia workstations. The Cato and Primus workstations were superior to Excel and Avance. However, even these were unsatisfactory in humans. Therefore, additional devices that provide inspired gases with adequate heat and humidity are needed for those undergoing general anesthetic procedures.

Differences between opening versus closing high tibial osteotomy on clinical outcomes and gait analysis.

Science.gov (United States)

Deie, Masataka; Hoso, Takayuki; Shimada, Noboru; Iwaki, Daisuke; Nakamae, Atsuo; Adachi, Nobuo; Ochi, Mitsuo

2014-12-01

High tibial osteotomy (HTO) for medial knee osteoarthritis (OA) is mainly performed via two procedures: closing wedge HTO (CW) and opening wedge HTO (OW). In this study, differences between these procedures were assessed by serial clinical evaluation and gait analysis before and after surgery. Twenty-one patients underwent HTO for medial knee OA in 2011 and 2012, with 12 patients undergoing CW and nine undergoing OW. The severity of OA was classified according to the Kellgren-Lawrence classification. The Japanese Orthopedic Association score for assessment of knee OA (JOA score), the Numeric Rating Scale (NRS), and the femoral tibial angle (FTA) on X-ray were evaluated. For gait analysis, gait speed, varus moment, varus angle and lateral thrust were calculated. The JOA score and NRS were improved significantly one year postoperatively in both groups. The FTA was maintained in both groups at one year. Varus angle and varus moment were significantly improved in both groups at each postoperative follow-up, when compared preoperatively. Lateral thrust was significantly improved at three months postoperatively in both groups. However, the significant improvement in lateral thrust had disappeared in the CW group six months postoperatively, whereas it was maintained for at least one year in the OW group. This study found that clinical outcomes were well maintained after HTO. OW reduced knee varus moment and lateral thrust, whereas CW had little effect on reducing lateral thrust. Level IV. Copyright © 2014 Elsevier B.V. All rights reserved.

Measurement of consumption of sevoflurane for short pediatric anesthetic procedures: Comparison between dion′s method and dragger algorithm

Directory of Open Access Journals (Sweden)

Preet Mohinder Singh

2013-01-01

Methodology: One hundred pediatric patients scheduled for ophthalmological examination under anesthesia were included in the study. Anesthesia was induced and maintained using sevoflurane with oxygen and nitrous oxide (1:1 on Primus workstation (Drager Inc., Germany. Total sevoflurane consumed for each procedure was calculated using Dion′s equation and the values obtained from Drager Primus were noted and compared. Results: Both methods showed a very strong correlation (0.895 [P < 0.001]. Dion′s method underestimated consumption by 2.59 ml with limits of agreement between 5.188 ml and −0.008 ml. Both test results showed a strong correlation, but poor concordance. Conclusions: Dion′s method strongly correlates with Drager protocol although concordance between the two methods for measuring anesthetic gas consumption is poor. Dion′s method underestimates the consumption and with slight modification addressing this underestimation, it can be electronically incorporated in other workstations to overcome limitations of real-time measurement of inhalation agent consumption.

Immediate Effects of Sports Taping Applied on the Lead Knee of Low- and High-Handicapped Golfers During Golf Swing.

Science.gov (United States)

Kim, Tae-Gyu; Kim, Eun-Kuk; Park, Jong-Chul

2017-04-01

Kim, T-G, Kim, E-K, and Park, J-C. Immediate effects of sports taping applied on the lead knee of low- and high-handicapped golfers during golf swing. J Strength Cond Res 31(4): 981-989, 2017-Elite golf athletes suffer from various musculoskeletal injuries due to repeated golf swings. Repetitive varus moment during golf swing has been suggested as a possible cause of injuries to the lead knee. The aim of this study was to objectively and quantitatively evaluate the immediate effects of sports taping on the lead knee of elite golfers to restrict varus moment. Thirty-one elite golfers were assigned to the low- (LHG, n = 15) or high-handicapped group (HHG, n = 16). Using 3-dimensional motion analysis, the lead knee position on the frontal plane with and without rigid taping (RT), elastic taping (ET), and placebo taping was identified in 4 separate phases by the 5 events of golf swing as follows: the peak of the backswing (E1), parallel to the ground during downswing (E2), ball impact (E3), parallel to the ground during follow-through (E4), and finish (E5). The LHG when using a driver club had decreased movement toward knee varus with RT and ET than that without it from E1 to E2 (p = 0.001). The LHG when using a 5-iron club decreased movement toward knee varus with RT than that without it from E1 to E2 (p = 0.006) and from E2 to E3 (p = 0.019). The HHG when using a driver club had decreased movement toward knee varus with RT from E1 to E2 (p = 0.014). Sports taping may be helpful for elite golfers in terms of reducing varus moment of the lead knee during the downswing and be useful for the development of preventive strategies for golf-related knee injuries.

Selected Biometric Characteristics of Wild Boar (Sus Scrofa Ferus in North-East Romania

Directory of Open Access Journals (Sweden)

Alina Narcisa Postolache

2015-05-01

Full Text Available Our study analyzed selected biometric characteristics from 117 wild boars (Sus scrofa ferus harvested during 2008 – 2014 in the Frasin and Marginea Forest hunting ground districts of Suceava County. Hunted boars were measured individually for head-body length (cm, height at withers (cm, length of metatarsus (cm, ear length (cm, tail length (cm and body weight (kg in accordance with their age-class and gender. These characteristics give information on the growth and development of wild boars and on the quality of their habitat. It was found that the average carcass weight was: piglets – 28.4 kg, yearling – 78.1 kg, subadults – 102.9 kg. The results show a faster body growth in females during their first year, while males make up for the weight difference in their 2nd and 3rd year. Statistical differences shown that males differentiate significantly to females by weight, body length, height at withers and length of metatarsus (P < 0.05 starting with their second year of life. The results regarding growth dynamic go along with the changes in boar’s social life, when the males are forced to leave and form smaller groups.

Femoral varus: what's the angle

DEFF Research Database (Denmark)

Miles, James Edward; Svalastoga, Eiliv Lars; Eriksen, Thomas

angles were calculated using Microsoft Excel for the three previously reported techniques and a novel method, which we believed would be more reliable. Reliability between readings was assessed using the within-subject standard deviation and repeatability coefficient, and the effect of angulation...

Operative Treatment of Fifth Metatarsal Jones Fractures (Zones II and III) in the NBA.

Science.gov (United States)

O'Malley, Martin; DeSandis, Bridget; Allen, Answorth; Levitsky, Matthew; O'Malley, Quinn; Williams, Riley

2016-05-01

Proximal fractures of the fifth metatarsal (zone II and III) are common in the elite athlete and can be difficult to treat because of a tendency toward delayed union, nonunion, or refracture. The purpose of this case series was to report our experience in treating 10 NBA players, determine the healing rate, return to play, refracture rate, and role of foot type in these athletes. The records of 10 professional basketball players were retrospectively reviewed. Seven athletes underwent standard percutaneous internal fixation with bone marrow aspirate concentrate (BMAC) whereas the other 3 had open bone grafting primarily in addition to fixation and BMAC. Radiographic features evaluated included fourth-fifth intermetatarsal, fifth metatarsal lateral deviation, calcaneal pitch, and metatarsus adductus angles. Radiographic healing was observed at an overall average of 7.5 weeks and return to play was 9.8 weeks. Three athletes experienced refractures. There were no significant differences in clinical features or radiographic measurements except that the refracture group had the highest metatatarsus adductus angles. Most athletes were pes planus and 9 of 10 had a bony prominence under the fifth metatarsal styloid. This is the largest published series of operatively treated professional basketball players who exemplify a specific patient population at high risk for fifth metatarsal fracture. These players were large and possessed a unique foot type that seemed to be associated with increased risk of fifth metatarsal fracture and refracture. This foot type had forefoot metatarsus adductus and a fifth metatarsal that was curved with a prominent base. We continue to use standard internal fixation with bone marrow aspirate but advocate additional prophylactic open bone grafting in patients with high fourth-to-fifth intermetatarsal, fifth metatarsal lateral deviation, and metatarsus adductus angles as well as prominent fifth metatarsal styloids in order to improve fracture

Pop / Mart Kuldkepp

Index Scriptorium Estoniae

Kuldkepp, Mart

2006-01-01

Heliplaatidest: Depeche Mode "The Best of, Volume 1", Lambchop "The Decline of Country and Western Civilisation Part II: The Woodwind Years"/"Damaged", Moby "Go - The Very Best of Moby", [Re: Jazz] "Expansion", Primus "They Can't All Be Zingers", Koop "Koop islands", Wolf Eyes "Human Animal", Erinevad esitajad "The Plague Songs"

Effect of greater trochanteric epiphysiodesis after femoral varus osteotomy for lateral pillar classification B and B/C border Legg-Calvé-Perthes disease: A retrospective observational study.

Science.gov (United States)

Kwon, Keun-Sang; Wang, Sung Il; Lee, Ju-Hyung; Moon, Young Jae; Kim, Jung Ryul

2017-08-01

This is a retrospective observational study. Greater trochanteric epiphysiodesis (GTE) has been recommended to prevent Trendelenburg gait and limitation of the hip joint motion due to trochanteric overgrowth after femoral varus osteotomy (FVO) in Legg-Calvé-Perthes disease (LCPD). However, capital femoral physeal arrest frequently occurs in patients with severe disease (lateral pillar C), so GTE might not be as effective in these patients. The aim of this study was to compare trochanteric growth inhibition due to GTE after FVO between 2 age groups (8 years) in patients with lateral pillar B and B/C border LCPD and evaluate the effectiveness of GTE compared with the normal, unaffected hip.This study included 19 children with lateral pillar B and B/C border LCPD in 1 leg who underwent FVO followed by GTE. Of the 19 children, 9 underwent GTE before the age of 8 years and 10 underwent GTE after 8 years of age. On radiographs taken at the immediate postoperative period and at skeletal maturity, the articulo-trochanteric distance (ATD), center-trochanteric distance (CTD), and neck-shaft angle (NSA) were compared between the 2 age groups. The amount of correction was compared between groups. The contralateral, unaffected hip was used as a control for trochanteric growth. The patients were clinically evaluated with Iowa hip score at the final follow-up.There was no significant difference between the 2 age groups in terms of time to GTE, length of follow-up, or lateral pillar classification. In the affected hip, the amount of correction of the ATD, CTD, and NSA was significantly greater in patients  8 years. However, in the unaffected hip, the change in the ATD, CTD, and NSA did not differ significantly between the 2 groups.We suggest that FVO followed by GTE for lateral pillar B and B/C border LCPD in patients under the age of 8 years can affect growth of the greater trochanter. However, effective growth inhibition due to GTE was not achieved after 8 years of age.

Does low-constraint mobile bearing knee prosthesis give satisfactory results for severe coronal deformities? A five to twelve year follow up study.

Science.gov (United States)

Czekaj, Jaroslaw; Fary, Camdon; Gaillard, Thierry; Lustig, Sebastien

2017-07-01

Severe varus and valgus knee deformities traditionally are replaced with constrained implants, with a number of disadvantages. We present our results in this challenging group using a low constraint deep-dish mobile bearing implant design. One hundred fifty-four patients (170 arthroplasties) who underwent primary TKA using a deep-dish, mobile bearing posterior-stabilized implant for severe varus (HKA  190°) deformity between 2004 and 2009 were evaluated at a mean of 6.6 years post-operatively (minimum of 5 years). Alignment improved from a pre-operative mean (±SD) varus deformity of 167.4° (±2.6°) and a mean (±SD) valgus deformity of 194.1° (±4.0°) to an overall mean (±SD) post-operative mechanical alignment of 178.6° (±3.2°). Twenty-three patients had post-operative varus alignment, five patients had post-operative valgus alignment and 134 knees were in neutral alignment (within 3° spread). Clinical scores at final follow-up were excellent (IKS score 93.8 (±7.4) and function score 82.4 (±20.2)). Three patients were re-operated upon: one deep infection, one periprosthetic fracture and one revision at 144 months for aseptic loosening of the femoral component. No patient was revised for instability or implant failure. The survival rate at five years was 99.4% and at ten years 98.6%. Satisfactory outcomes can be achieved in patients with substantial varus or valgus deformities using low constraint deep-dish mobile bearing implant, standard approach and appropriate soft tissue releases.

Malalignment and subchondral bone turnover in contralateral knees of overweight/obese women with unilateral osteoarthritis: implications for bilateral disease.

Science.gov (United States)

Mazzuca, Steven A; Brandt, Kenneth D; Lane, Kathleen A; Chakr, Rafael

2011-11-01

To explore whether the risk of incident tibiofemoral (TF) osteoarthritis (OA) in the radiographically normal contralateral knee of overweight/obese women with unilateral knee OA is mediated by malalignment and/or preceded by increased turnover of subchondral bone. We used data of post hoc analyses from a randomized controlled trial. Cross-sectional analyses evaluated the baseline association between frontal plane alignment and bone turnover in the medial TF compartment in 78 radiographically normal contralateral knees. Longitudinal analyses ascertained whether incident radiographic OA (TF osteophyte formation within 30 months) was associated with malalignment and/or increased bone turnover at baseline. Alignment subcategories (varus/neutral/valgus) were based on the anatomic axis angle. (99m)Tc-methylene diphosphonate uptake in a late-phase bone scan was quantified in regions of interest in the medial tibia (MT) and medial femur (MF) and adjusted for uptake in a reference segment of the ipsilateral tibial shaft (TS). MF and MT uptake in varus contralateral knees was 50-55% greater than in the TS. Adjusted MT uptake in varus contralateral knees was significantly greater than that in neutral and valgus contralateral knees (mean 1.55 versus 1.38 and 1.43, respectively; P < 0.05). Among 69 contralateral knees followed longitudinally, 22 (32%) developed TF OA. Varus angulation was associated with a marginally significant increase in the odds of incident OA (adjusted odds ratio 3.98, P = 0.067). While the small sample size limited our ability to detect statistically significant risk factors, these data suggest that the risk of developing bilateral TF OA in overweight/obese women may be mediated by varus malalignment. Copyright © 2011 by the American College of Rheumatology.

Assessment and validation of CT scanogram to compare per-operative and post-operative mechanical axis after navigated total knee replacement

Science.gov (United States)

Jain, Sunil

2008-01-01

Our objective was to assess and validate low-dose computed tomography (CT) scanogram as a post-operative imaging modality to measure the mechanical axis after navigated total knee replacement. A prospective study was performed to compare intra-operative and post-operative mechanical axis after navigated total knee replacements. All consecutive patients who underwent navigated total knee replacement between May and December 2006 were included. The intra-operative final axis was recorded, and post-operatively a CT scanogram of lower limbs was performed. The mechanical axis was measured and compared against the intra-operative measurement. There were 15 patients ranging in age from 57 to 80 (average 70) years. The average final intra-operative axis was 0.56° varus (4° varus to 1.5° valgus) and post-operative CT scanogram axis was 0.52° varus (3.1° varus to 1.8° valgus). The average deviation from final axes to CT scanogram axes was 0.12° valgus with a correlation coefficient of 0.9. Our study suggests that CT scanogram is an imaging modality with reasonable accuracy for measuring mechanical axis despite significantly low radiation. It also confirms a high level of correlation between intra-operative and post-operative mechanical axis after navigated total knee replacement. PMID:18696064

Does joint alignment affect the T2 values of cartilage in patients with knee osteoarthritis?

Energy Technology Data Exchange (ETDEWEB)

Friedrich, Klaus M. [Medical University of Vienna, Department of Radiology, Vienna (Austria); Shepard, Timothy; Chang, Gregory; Wang, Ligong; Babb, James S.; Regatte, Ravinder [New York University Langone Medical Center, Department of Radiology, New York, NY (United States); Schweitzer, Mark [Ottawa Hospital, Diagnostic Imaging, Ottawa, ON (Canada)

2010-06-15

To assess the relationship between T2 values of femorotibial cartilage and knee alignment in patients with clinical symptoms of medial osteoarthritis (OA). Twenty-four patients (mean age {+-} standard deviation, 62.5 {+-} 9.9 years) with clinical symptoms of medial knee OA, 12 with varus and 12 with valgus alignment of the femorotibial joint, were investigated on 3T MR using a 2D multi-echo spin echo (MESE) sequence for T2 mapping. Analysis of covariance, Spearman correlation coefficients, exact Mann-Whitney tests, and Fisher's exact tests were used for statistical analysis. Overall the T2 values of cartilage in the medial compartment (median {+-} interquartile-range, 49.44 {+-} 6.58) were significantly higher (P = 0.0043) than those in the lateral compartment (47.15 {+-} 6.87). Patients with varus alignment (50.83 {+-} 6.30 ms) had significantly higher T2 values of cartilage (P < 0.0001) than patients with valgus alignment (46.20 {+-} 6.00 ms). No statistically significant association between the T2 values of cartilage (in either location) and the Kellgren Lawrence score was found in the varus or in the valgus group. T2 measurements were increased in medial knee OA patients with varus alignment, adding support to the theory of an association of OA and joint alignment. (orig.)

Elbow joint laxity after experimental radial head excision and lateral collateral ligament rupture

DEFF Research Database (Denmark)

Jensen, Steen Lund; Olsen, Bo Sanderhoff; Tyrdal, Stein

2005-01-01

The objectives of this experimental study were to investigate the effect of radial head excision and lateral collateral ligament (LCL) division on elbow joint laxity and to determine the efficacy of radial head prosthetic replacement and LCL repair. Valgus, varus, internal rotation, and external...... rotation of the ulna were measured during passive flexion-extension and application of a 0.75-Nm torque in 6 intact cadaveric elbows and after (1) either excision of the radial head or division of the LCL, (2) removal of both constraints, (3) isolated radial head prosthetic replacement, (4) isolated LCL...... normalized varus laxity but resulted in a 2.9 degrees increase in external rotatory laxity. The combined procedures restored laxity completely. The radial head is a constraint to varus and external rotation in the elbow joint, functioning by maintaining tension in the LCL. Still, removal of both constraints...

Anthropology with an Agenda: Four Forgotten Dance Anthropologists

Science.gov (United States)

Richter, Katrina

2010-01-01

In response to postcolonial, feminist and subaltern critiques of anthropology, this article seeks to answer the question, "For whom should research be conducted, and by whom should it be used?" by examining the lives and works of four female dance anthropologists. Franziska Boas, Zora Neale Hurston, Katherine Dunham and Pearl Primus used…

Measurement of dosimetric parameters for Hi-ART helical tomotherapy unit

International Nuclear Information System (INIS)

Wang Yunlai; Sha Xiangyou; Dai Xiangkun; Ma Lin; Feng Linchun; Qu Baolin

2008-01-01

Objective: To develop a measurement method of dosimetric parameters for Hi-ART tomotherapy unit. Methods: Percentage depth doses and beam profiles were measured using the dedicated mini water phantom, and compared to the results of 6 MV X-ray from Primus accelerator. Following the AAPM TG51 protocol, absolute dose calibration was carried out under SSD of 8.5 cm at depth of 1.5 cm for field of 5 cm x 40 cm. The output linearity and reproducibility were evaluated. The output variation with the gantry rotation was also investigated using 0.6 cm 3 ion chamber in cylindrical perplex phantom and on-board MVCT detectors. Leaf fluence output factors were quantified for the leaf of interest and its adjacent leaves. Results: The buildup depth was around 1.0 cm. The PDD values at 10 cm for Hi-ART and Primus were 59.7% and 64.7%, respectively. Varying with the field width, the lateral and longitudinal beam profiles were not so homogeneous as the Primus fields. The measured dose rate was 848.38 cGy/min. The fitted linear function between the readings of dosimeter and the irradiated time was R(nC) =-0.017 + 0.256· t(sec), with a relative coefficient of 0.999. The maximum deviation and standard deviation of output were 1.6% and less than 0.5%; The maximum deviation and standard deviation of output changed by gantry angle were 1.1% and 0.5%, respectively. Leaf fluence output factors did not increase significantly when leaves were opened beyond the two adjacent leaves. Conclusions: Hi-ART Tomotherapy unit has a very high dose output and inhomogeneous beam profiles owing to its special design of the treatment head. This may be useful in dose calculation and treatment delivery. (authors)

Modeling of a collimator micro-multilayers in the Pinnacle planning system

International Nuclear Information System (INIS)

Garcia Hernandez, T.; Brualla Gonzalez, L.; Vicedo Gonzalez, A.; Rosello Ferrando, J.; Granero Cabanero, D.

2013-01-01

To model and validate, in the system of planning and calculation Pinnacle, a micro-multilayers collimator mounted on an accelerator Siemens Primus. The objective is to take advantage of the improvements offered by the algorithm of convolution of cone collapsed and the capacity of the system of modeling the rounded end of the blades. (Author)

Modeling of a collimator micro-multilayers in the Pinnacle planning system; Modelado de un colimador micromultilaminas en el sistema de planificacion Pinnacle

Energy Technology Data Exchange (ETDEWEB)

Garcia Hernandez, T.; Brualla Gonzalez, L.; Vicedo Gonzalez, A.; Rosello Ferrando, J.; Granero Cabanero, D.

2013-07-01

To model and validate, in the system of planning and calculation Pinnacle, a micro-multilayers collimator mounted on an accelerator Siemens Primus. The objective is to take advantage of the improvements offered by the algorithm of convolution of cone collapsed and the capacity of the system of modeling the rounded end of the blades. (Author)

Evaluation of the integral and Peripheral dose of healthy tissue in external radiotherapy treatments of prostate cancer with technical 3DCRT, reverse IMRT and VMAT; Evaluacion de la dosis integral y dosis periferica del tejido sano en tratamientos de radioterapia externa de cancer de prostata con tecnicas de 3DCRT, IMRT inversa y VMAT

Energy Technology Data Exchange (ETDEWEB)

Vicente Granado, D.; Carrasco Herrera, M. A.; Mateo Perez, C.; Velazquez Miranda, S.; Herrador Cordoba, M.

2013-07-01

To model and validate, in the system of planning and calculation Pinnacle, a micro-multilayers collimator mounted on an accelerator Siemens Primus. The objective is to take advantage of the improvements offered by the algorithm of convolution of cone collapsed and the capacity of the system of modeling the rounded end of the blades. (Author)

Lossi tn 16, Kuressaare / Tõnu Sepp

Index Scriptorium Estoniae

Sepp, Tõnu

2006-01-01

1893. a. valminud kahe torniga puithoone ajaloost ja restaureerimisest (juuni 2004 - märts 2005) eravillaks. Projekteerija: Kuressaare Kommunaalprojekt OÜ. Ehituse peatöövõtja: Deena Ehitus OÜ, tööde tegelik tegija: Primus PR OÜ. Muinsuskaitseline järelevalve: Tõnu Sepp. 3 värv. välis- ja 2 sisevaadet

Lateral collateral ligament of the elbow joint

DEFF Research Database (Denmark)

Olsen, Bo Sanderhoff; Vaesel, M T; Søjbjerg, Jens Ole

1996-01-01

The structure and kinematics of the lateral collateral ligament of the elbow joint were investigated in 10 cadaveric specimens. The lateral collateral ligament was observed to be a distinct part of the lateral collateral ligament complex. It contains posterior fibers that pass through the annular....... Division of the posterolateral capsule caused no further laxity. Cutting the lateral collateral ligament induced a maximum laxity of 11.8 degrees at 110 degrees of flexion in forced varus and a maximum laxity of 20.6 degrees at 110 degrees of flexion in forced external rotation. The corresponding maximal...... posterior radial head translation was observed at 80 degrees to 100 degrees of flexion and was 5.7 mm in forced varus and 8.1 mm in forced external rotation. This study suggests the lateral collateral ligament to be an important stabilizer of the humeroulnar joint and the radial head in forced varus...

CRRIS: a methodology for assessing the impact of airborne radionuclide releases

International Nuclear Information System (INIS)

Baes, C.F. III; Miller, C.W.

1983-01-01

The Computerized Radiological Risk Investigation System (CRRIS) consists of six fully integrated computer codes which calculate environmental transport and resulting doses and risks to individuals or populations exposed to atmospheric radionuclide releases. The individual codes may be used alone for various assessment applications or may be run as a system. This presentation provides an overview and introduction to this system of computer codes and their use in conducting nuclear assessments. Radionuclides are handled by CRRIS either in terms of the released radionuclides or in terms of exposure radionuclides which consist of both the released nuclides and all (or a subset of) the decay daughters that grow in during environmental transport. The capability of CRRIS to handle radionuclide chains is accomplished through PRIMUS which serves as a preprocessor by accessing a library of radionuclide decay data and sets up matricies of decay constants which are used by the other CRRIS codes in all calculations involving transport and decay. PRIMUS may also be run independently by the user to define the decay chains, radionuclide decay constants, and branching ratios

Proximal Femoral Varus Derotation Osteotomy in Children with Cerebral Palsy: The Effect of Age, Gross Motor Function Classification System Level, and Surgeon Volume on Surgical Success.

Science.gov (United States)

Shore, Benjamin J; Zurakowski, David; Dufreny, Chantal; Powell, Dustin; Matheney, Travis H; Snyder, Brian D

2015-12-16

The purpose of this study was to evaluate mid-term results of proximal femoral varus derotation osteotomy (VDRO) in children with cerebral palsy and determine what effect age, Gross Motor Function Classification System (GMFCS) level, and surgeon volume had on surgical success. We analyzed a cohort of children with cerebral palsy who underwent VDRO for hip displacement at a tertiary-level pediatric hospital between 1994 and 2007. Age, sex, GMFCS level, preoperative radiographic parameters, previous botulinum toxin administration or soft-tissue release, adjunctive pelvic osteotomy, the performance of bilateral surgery at the index VDRO, and surgeon volume (the number of procedures performed) were recorded. Results were analyzed via univariate and multivariate analyses for association with the need for revision hip surgery. Kaplan-Meier survivorship curves were generated, determining the time from index surgery to failure (defined as the need for subsequent surgical procedures on the hip and/or pelvis, or a hip migration percentage of >50% at the time of final follow-up), and were further stratified according to osseous versus soft-tissue revision. A total of 567 VDROs were performed in 320 children (mean age [and standard deviation], 8.2 ± 3.8 years). The mean follow-up was 8.3 years (range, three to eighteen years). Of the initial 320 patients, 117 (37%) were considered to have had failure. Multivariate Cox regression analysis confirmed that younger age at surgery (p < 0.001), increased GMFCS level (p = 0.01), and lower annual surgical hip volume (p = 0.02) were significant independent predictors of any type of surgical revision. Furthermore, soft-tissue release at VDRO was protective against revision (p = 0.02). Five-year survivorship analysis revealed a 92% success rate for children classified as GMFCS levels I and II compared with a 76% success rate for those of GMFCS level V (p < 0.01). This study demonstrated a 37% failure rate after VDRO in children with

Does joint alignment affect the T2 values of cartilage in patients with knee osteoarthritis?

International Nuclear Information System (INIS)

Friedrich, Klaus M.; Shepard, Timothy; Chang, Gregory; Wang, Ligong; Babb, James S.; Regatte, Ravinder; Schweitzer, Mark

2010-01-01

To assess the relationship between T2 values of femorotibial cartilage and knee alignment in patients with clinical symptoms of medial osteoarthritis (OA). Twenty-four patients (mean age ± standard deviation, 62.5 ± 9.9 years) with clinical symptoms of medial knee OA, 12 with varus and 12 with valgus alignment of the femorotibial joint, were investigated on 3T MR using a 2D multi-echo spin echo (MESE) sequence for T2 mapping. Analysis of covariance, Spearman correlation coefficients, exact Mann-Whitney tests, and Fisher's exact tests were used for statistical analysis. Overall the T2 values of cartilage in the medial compartment (median ± interquartile-range, 49.44 ± 6.58) were significantly higher (P = 0.0043) than those in the lateral compartment (47.15 ± 6.87). Patients with varus alignment (50.83 ± 6.30 ms) had significantly higher T2 values of cartilage (P < 0.0001) than patients with valgus alignment (46.20 ± 6.00 ms). No statistically significant association between the T2 values of cartilage (in either location) and the Kellgren Lawrence score was found in the varus or in the valgus group. T2 measurements were increased in medial knee OA patients with varus alignment, adding support to the theory of an association of OA and joint alignment. (orig.)

Increases in tibial force imbalance but not changes in tibiofemoral laxities are caused by varus-valgus malalignment of the femoral component in kinematically aligned TKA.

Science.gov (United States)

Riley, Jeremy; Roth, Joshua D; Howell, Stephen M; Hull, Maury L

2018-01-29

The purposes of this study were to quantify the increase in tibial force imbalance (i.e. magnitude of difference between medial and lateral tibial forces) and changes in laxities caused by 2° and 4° of varus-valgus (V-V) malalignment of the femoral component in kinematically aligned total knee arthroplasty (TKA) and use the results to detemine sensitivities to errors in making the distal femoral resections. Because V-V malalignment would introduce the greatest changes in the alignment of the articular surfaces at 0° flexion, the hypotheses were that the greatest increases in tibial force imbalance would occur at 0° flexion, that primarily V-V laxity would significantly change at this flexion angle, and that the tibial force imbalance would increase and laxities would change in proportion to the degree of V-V malalignment. Kinematically aligned TKA was performed on ten human cadaveric knee specimens using disposable manual instruments without soft tissue release. One 3D-printed reference femoral component, with unmodified geometry, was aligned to restore the native distal and posterior femoral joint lines. Four 3D-printed femoral components, with modified geometry, introduced V-V malalignments of 2° and 4° from the reference component. Medial and lateral tibial forces were measured during passive knee flexion-extension between 0° to 120° using a custom tibial force sensor. Eight laxities were measured from 0° to 120° flexion using a six degree-of-freedom load application system. With the tibial component kinematically aligned, the increase in the tibial force imbalance from that of the reference component at 0° of flexion was sensitive to the degree of V-V malalignment of the femoral component. Sensitivities were 54 N/deg (medial tibial force increasing > lateral tibial force) (p  medial tibial force) (p imbalance to increase significantly, whereas the laxities were relatively unaffected. Because tibial force imbalance has the potential to

Results of computer assisted mini-incision subvastus approach for total knee arthroplasty.

Science.gov (United States)

Turajane, Thana; Larbpaiboonpong, Viroj; Kongtharvonskul, Jatupon; Maungsiri, Samart

2009-12-01

Mini-incision subvastus approach is soft tissue preservation of the knee. Advantages of the mini-incision subvastus approach included reduced blood loss, reduced pain, self rehabilitation and faster recovery. However, the improved visualization, component alignment, and more blood preservation have been debatable to achieve the better outcome and preventing early failure of the Total Knee Arthroplasty (TKA). The computer navigation has been introduced to improve alignment and blood loss. The purpose of this study was to evaluate the short term outcomes of the combination of computer assisted mini-incision subvastus approach for Total Knee Arthroplasty (CMS-TKA). A prospective case series of the initial 80 patients who underwent computer assisted mini-incision subvastus approach for CMS-TKA from January 2007 to October 2008 was carried out. The patients' conditions were classified into 2 groups, the simple OA knee (varus deformity was less than 15 degree, BMI was less than 20%, no associated deformities) and the complex deformity (varus deformity was more than 15 degrees, BMI more was than 20%, associated with flexion contractor). There were 59 patients in group 1 and 21 patients in group 2. Of the 80 knees, 38 were on the left and 42 on the right. The results of CMS-TKA [the mean (range)] in group 1: group 2 were respectively shown as the incision length [10.88 (8-13): 11.92 (10-14], the operation time [118 (111.88-125.12): 131 (119.29-143.71) minutes, lateral releases (0 in both groups), postoperative range of motion in flexion [94.5 (90-100): 95.25 (90-105) degree] and extension [1.75 (0-5): 1.5 (0-5) degree] Blood loss in 24 hours [489.09 (414.7-563.48): 520 (503.46-636.54) ml] and blood transfusion [1 (0-1) unit? in both groups], Tibiofemoral angle preoperative [Varus = 4 (varus 0-10): Varus = 17.14 (varus 15.7-18.5) degree, Tibiofemoral angle postoperative [Valgus = 1.38 (Valgus 0-4): Valgus = 2.85 (valgus 2.1-3.5) degree], Tibiofemoral angle outlier (85% both

Total knee replacement influences both knee and hip joint kinematics during stair climbing

OpenAIRE

Saari, Tuuli; Tranberg, Roy; Zügner, Roland; Uvehammer, Johan; Kärrholm, Johan

2004-01-01

A gait analysis system was used to evaluate the kinematics of the hip and knee during stair ascending and descending after operation with total knee replacement. Patients with 5° varus/valgus alignment or less were selected randomly to receive either a flat or a concave tibial component with retention of the posterior cruciate ligament. Patients who had more than 5° varus/valgus alignment and/or an extension defect of 10° or more were selected randomly to receive the concave or posterior-stab...

Renewable Firming EnergyFarm Final Report

Energy Technology Data Exchange (ETDEWEB)

Stepien, Tom [Primus Power, Hayward, CA (United States); Collins, Mark [Primus Power, Hayward, CA (United States)

2017-01-26

The American Recovery and Reinvestment Act (ARRA) of 2009 (Recovery Act) provided the U.S. Department of Energy (DOE) with funds to modernize the electric power grid. One program under this initiative is the Smart Grid Demonstration program (SGDP). The SGDP mandate is to demonstrate how a suite of existing and emerging smart grid technologies can be innovatively applied and integrated to prove technical, operational, and business-model feasibility. Primus Power is a provider of low cost, long life and long duration energy storage systems. The Company’s flow batteries are shipping to US and international microgrid, utility, military, commercial and industrial customers. Primus Power’s EnergyPod® is a modular battery system for grid scale applications available in configurations ranging from 25 kW to more than 25 MW. The EnergyPod provides nameplate power for 5 hours. This long duration unlocks economic benefits on both sides of the electric meter. It allows commercial and industrial customers to shift low cost electricity purchased at night to offset afternoon electrical peaks to reduce utility demand charges. It also allows utilities to economically reduce power peaks and defer costly upgrades to distribution infrastructure. An EnergyPod contains one or more EnergyCells-a highly engineered flow battery core made from low cost, readily available materials. An EnergyCell includes a membrane-free stack of titanium electrodes located above a novel liquid electrolyte management system. This patented design enables reliable, low maintenance operation for decades. It is safe and robust, featuring non-flammable aqueous electrolyte, sophisticated fault detection and built-in secondary containment. Unlike Li Ion batteries, the EnergyCell is not susceptible to thermal runaway. This cooperative agreement project was started in Feb 2010. The objectives of the project are: 1. Trigger rapid adoption of grid storage systems in the US by demonstrating a low cost, robust and

Method for determining the wedge angle from the daily measurements made with the measurement enabled devices DC6; Metodo para la determinacion del angulo de cuna a partir de las medidas diarias realizadas con el dispositio de medida QC6

Energy Technology Data Exchange (ETDEWEB)

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

2011-07-01

The aim of this paper is to present a method for determining the angle of the wedges virtual electron linear accelerator (ALE) Siemens Primus, from the daily measurements made with the measurement system PTW-QC6Plus and found to be sufficiently sensitive to determine variations of {+-} 1 of this parameter. In addition, we study the behavior statistically CUFLE angle over a year.

The Validity of a New Low-Dose Stereoradiography System to Perform 2D and 3D Knee Prosthetic Alignment Measurements

OpenAIRE

Meijer, Marrigje F.; Velleman, Ton; Boerboom, Alexander L.; Bulstra, Sjoerd K.; Otten, Egbert; Stevens, Martin; Reininga, Inge H. F.

2016-01-01

Introduction The EOS stereoradiography system has shown to provide reliable varus/valgus (VV) measurements of the lower limb in 2D (VV2D) and 3D (VV3D) after total knee arthroplasty (TKA). Validity of these measurements has not been investigated yet, therefore the purpose of this study was to determine validity of EOS VV2D and VV3D. Methods EOS images were made of a lower limb phantom containing a knee prosthesis, while varying VV angle from 15 degrees varus to 15 degrees valgus and flexion a...

Case report - curved femoral osteotomy for management of medial patellar luxation

DEFF Research Database (Denmark)

Allpass, Maja; Miles, James Edward

2015-01-01

Medial patellaluxation kan forårsages af femoral varus hos hund. Førhen har patienter med excessiv femoralvarus været korrigeret ved en lateralt placeret femoral kile-ostektomi. Her præsenteres en case, hvor en buet osteotomi blev anvendt til behandling af medial patellaluxation.......Medial patellaluxation kan forårsages af femoral varus hos hund. Førhen har patienter med excessiv femoralvarus været korrigeret ved en lateralt placeret femoral kile-ostektomi. Her præsenteres en case, hvor en buet osteotomi blev anvendt til behandling af medial patellaluxation....

Neglected Distal Humeral Epiphyseal Injury - Two Case Reports

Directory of Open Access Journals (Sweden)

Dr. Pankaj Kumar

2008-07-01

Full Text Available Distal humeral epiphyseal separation is an uncommon injury in children, which can be missed or misdiagnosed at initial presentation. Awareness of this injury and appropriate radiological assessment helps in proper management. Neglected cases because of inappropriate diagnosis can result in cubitus varus deformity. Full range of movements of elbow can be achieved if properly diagnosed and managed. We present two cases of neglected distal humeral epiphyseal injury in children that resulted in cubitus varus deformity in one case. Full range of movements was achieved in both cases after proper management.

Biomechanics of the classic metaphyseal lesion: finite element analysis

Energy Technology Data Exchange (ETDEWEB)

Tsai, Andy; Kleinman, Paul K. [Boston Children' s Hospital, Department of Radiology, Harvard Medical School, Boston, MA (United States); Coats, Brittany [University of Utah, Department of Mechanical Engineering, Salt Lake City, UT (United States)

2017-11-15

The classic metaphyseal lesion (CML) is strongly associated with infant abuse, but the biomechanics responsible for this injury have not been rigorously studied. Radiologic and CT-pathological correlates show that the distal tibial CML always involves the cortex near the subperiosteal bone collar, with variable extension of the fracture into the medullary cavity. Therefore, it is reasonable to assume that the primary site of bone failure is cortical, rather than intramedullary. This study focuses on the strain patterns generated from finite element modeling to identify loading scenarios and regions of the cortex that are susceptible to bone failure. A geometric model was constructed from a normal 3-month-old infant's distal tibia and fibula. The model's boundary conditions were set to mimic forceful manipulation of the ankle with eight load modalities (tension, compression, internal rotation, external rotation, dorsiflexion, plantar flexion, valgus bending and varus bending). For all modalities except internal and external rotation, simulations showed increased cortical strains near the subperiosteal bone collar. Tension generated the largest magnitude of cortical strain (24%) that was uniformly distributed near the subperiosteal bone collar. Compression generated the same distribution of strain but to a lesser magnitude overall (15%). Dorsiflexion and plantar flexion generated high (22%) and moderate (14%) localized cortical strains, respectively, near the subperiosteal bone collar. Lower cortical strains resulted from valgus bending, varus bending, internal rotation and external rotation (8-10%). The highest valgus and varus bending cortical strains occurred medially. These simulations suggest that the likelihood of the initial cortical bone failure of the CML is higher along the margin of the subperiosteal bone collar when the ankle is under tension, compression, valgus bending, varus bending, dorsiflexion and plantar flexion, but not under internal

Biomechanics of the classic metaphyseal lesion: finite element analysis

International Nuclear Information System (INIS)

Tsai, Andy; Kleinman, Paul K.; Coats, Brittany

2017-01-01

The classic metaphyseal lesion (CML) is strongly associated with infant abuse, but the biomechanics responsible for this injury have not been rigorously studied. Radiologic and CT-pathological correlates show that the distal tibial CML always involves the cortex near the subperiosteal bone collar, with variable extension of the fracture into the medullary cavity. Therefore, it is reasonable to assume that the primary site of bone failure is cortical, rather than intramedullary. This study focuses on the strain patterns generated from finite element modeling to identify loading scenarios and regions of the cortex that are susceptible to bone failure. A geometric model was constructed from a normal 3-month-old infant's distal tibia and fibula. The model's boundary conditions were set to mimic forceful manipulation of the ankle with eight load modalities (tension, compression, internal rotation, external rotation, dorsiflexion, plantar flexion, valgus bending and varus bending). For all modalities except internal and external rotation, simulations showed increased cortical strains near the subperiosteal bone collar. Tension generated the largest magnitude of cortical strain (24%) that was uniformly distributed near the subperiosteal bone collar. Compression generated the same distribution of strain but to a lesser magnitude overall (15%). Dorsiflexion and plantar flexion generated high (22%) and moderate (14%) localized cortical strains, respectively, near the subperiosteal bone collar. Lower cortical strains resulted from valgus bending, varus bending, internal rotation and external rotation (8-10%). The highest valgus and varus bending cortical strains occurred medially. These simulations suggest that the likelihood of the initial cortical bone failure of the CML is higher along the margin of the subperiosteal bone collar when the ankle is under tension, compression, valgus bending, varus bending, dorsiflexion and plantar flexion, but not under internal

Hip Ultrasonography in the Diagnosis of Developmental Dysplasia of the Hip: Bakırköy Experience

Directory of Open Access Journals (Sweden)

Altuğ Duramaz

2014-12-01

Full Text Available Aim: The purpose of the study was to determine the prevalence, incidence, and etiology as well as the risk factors for developmental dysplasia of the hip in newborns in whom we performed ultrasonography for screening using Graff’s method in our clinic. Methods: We retrospectively evaluated 2632 hip ultrasonography records of 1316 babies performed between 2008 and 2013. We analyzed the questionnaires of the Turkish Pediatric Orthopaedic Society which were filled by the physician during examination. The babies were divided into two groups according to ultrasonographic hip angles as pathological and normal. Results: The study is made on 1316 babies [680 girls (51.6%, 636 boys (48.4%]. The risk for developmental dysplasia of the hip was higher in girls, babies with a family history, babies with metatarsus adductus and those have been swaddled before. The mean gestational age and gestational weight was statistically significantly lower in the pathological group (p=0.0011. Conclusion: In our cross-sectional study, the incidence of developmental dysplasia of the hip was 0.5%. Female gender, positive family history of developmental dysplasia of the hip,metatarsus adductus and swaddling are still risk factors. Researching risk factors carefully, patient education and adding hip ultrasonograpy to newborn routine screening program are important measures in preventing developmental dysplasia of the hip.

Ultrasound assessment of the meniscus complex formation in health children and with the 1st stage of longitudinal platypodia ones

Directory of Open Access Journals (Sweden)

Alexei Ivantsov

2013-04-01

Full Text Available Objectives: Foot arch reduces the exposure of weight and buf load due to its bufer function. in longitudinal platypodia foot looses this function and articular menisci have to take the role of the bufers (shock absorbers. Materials and Methods: Ultrasound assessment of meniscus thickness was performed on the joint space level. Results: varus type (43.4% of the meniscus complex adaptation was dominant in 5-7 years old patients with the 1st stage longitudinal platypodia; symmetric type (51.9% – in 8-12 years old patients; valgus type (56% – in 13-17 years old ones. Healthy children showed the valgus type in all age periods. Conclusions: in our opinion the dominance of the varus type of the meniscus complex in 5-7 aged children and its further conversion into the valgus type in case of the 1st stage longitudinal platypodia refects the reduction of the lower extremities transformation processes from the varus into the most functional convenient valgus position at the age of 13-17. Keywords: meniscus, children, ultrasound investigation.

Collateral ligament strains during knee joint laxity evaluation before and after TKA.

Science.gov (United States)

Delport, Hendrik; Labey, Luc; De Corte, Ronny; Innocenti, Bernardo; Vander Sloten, Jos; Bellemans, Johan

2013-08-01

Passive knee stability is provided by the soft tissue envelope. There is consensus among orthopedic surgeons that good outcome in Total Knee Arthroplasty requires equal tension in the medial/lateral compartment of the knee joint, as well as equal tension in the flexion/extension gap. The purpose of this study was to quantify the ligament laxity in the normal non-arthritic knee before and after Posterior-Stabilized Total Knee Arthroplasty. We hypothesized that the Medial/Lateral Collateral Ligament shows minimal changes in length when measured directly by extensometers in the native human knee during varus/valgus laxity testing. We also hypothesized that due to differences in material properties and surface geometry, native laxity is difficult to reconstruct using a Posterior-Stabilized Total Knee. Six specimens were used to perform this in vitro cadaver test using extensometers to provide numerical values for laxity and varus-valgus tilting in the frontal plane. This study enabled a precise measurement of varus-valgus laxity as compared with the clinical assessment. The strains in both ligaments in the replaced knee were different from those in the native knee. Both ligaments were stretched in extension, in flexion the Medial Collateral Ligament tends to relax and the Lateral Collateral Ligament remains tight. As material properties and surface geometry of the replaced knee add stiffness to the joint, we recommend to avoid overstuffing the joint, when using this type of Posterior-Stabilized Total Knee Arthroplasty, in order to obtain varus/valgus laxity close to the native joint. Copyright © 2013 Elsevier Ltd. All rights reserved.

The Valgus Inclination of the Tibial Component Increases the Risk of Medial Tibial Condylar Fractures in Unicompartmental Knee Arthroplasty.

Science.gov (United States)

Inoue, Shinji; Akagi, Masao; Asada, Shigeki; Mori, Shigeshi; Zaima, Hironori; Hashida, Masahiko

2016-09-01

Medial tibial condylar fractures (MTCFs) are a rare but serious complication after unicompartmental knee arthroplasty. Although some surgical pitfalls have been reported for MTCFs, it is not clear whether the varus/valgus tibial inclination contributes to the risk of MTCFs. We constructed a 3-dimensional finite elemental method model of the tibia with a medial component and assessed stress concentrations by changing the inclination from 6° varus to 6° valgus. Subsequently, we repeated the same procedure adding extended sagittal bone cuts of 2° and 10° in the posterior tibial cortex. Furthermore, we calculated the bone volume that supported the tibial component, which is considered to affect stress distribution in the medial tibial condyle. Stress concentrations were observed on the medial tibial metaphyseal cortices and on the anterior and posterior tibial cortices in the corner of cut surfaces in all models; moreover, the maximum principal stresses on the posterior cortex were larger than those on the anterior cortex. The extended sagittal bone cuts in the posterior tibial cortex increased the stresses further at these 3 sites. In the models with a 10° extended sagittal bone cut, the maximum principal stress on the posterior cortex increased as the tibial inclination changed from 6° varus to 6° valgus. The bone volume decreased as the inclination changed from varus to valgus. In this finite element method, the risk of MTCFs increases with increasing valgus inclination of the tibial component and with increased extension of the sagittal cut in the posterior tibial cortex. Copyright © 2016 Elsevier Inc. All rights reserved.

A comparison of radiographic anatomic axis knee alignment measurements and cross-sectional associations with knee osteoarthritis

Science.gov (United States)

Goulston, L.M.; Sanchez-Santos, M.T.; D'Angelo, S.; Leyland, K.M.; Hart, D.J.; Spector, T.D.; Cooper, C.; Dennison, E.M.; Hunter, D.; Arden, N.K.

2016-01-01

Summary Objective Malalignment is associated with knee osteoarthritis (KOA), however, the optimal anatomic axis (AA) knee alignment measurement on a standard limb radiograph (SLR) is unknown. This study compares one-point (1P) and two-point (2P) AA methods using three knee joint centre locations and examines cross-sectional associations with symptomatic radiographic knee osteoarthritis (SRKOA), radiographic knee osteoarthritis (RKOA) and knee pain. Methods AA alignment was measured six different ways using the KneeMorf software on 1058 SLRs from 584 women in the Chingford Study. Cross-sectional associations with principal outcome SRKOA combined with greatest reproducibility determined the optimal 1P and 2P AA method. Appropriate varus/neutral/valgus alignment categories were established using logistic regression with generalised estimating equation models fitted with restricted cubic spline function. Results The tibial plateau centre displayed greatest reproducibility and associations with SRKOA. As mean 1P and 2P values differed by >2°, new alignment categories were generated for 1P: varus 182° and for 2P methods: varus 185°. Varus vs neutral alignment was associated with a near 2-fold increase in SRKOA and RKOA, and valgus vs neutral for RKOA using 2P method. Nonsignificant associations were seen for 1P method for SRKOA, RKOA and knee pain. Conclusions AA alignment was associated with SRKOA and the tibial plateau centre had the strongest association. Differences in AA alignment when 1P vs 2P methods were compared indicated bespoke alignment categories were necessary. Further replication and validation with mechanical axis alignment comparison is required. PMID:26700504

Prevalencia del juanete de sastre y quinto dedo adducto varo en el baile flamenco profesional. Prevalence of tailor's bunion and fifth toe adductus varus in professional flamenco dancing.

Directory of Open Access Journals (Sweden)

Nadia Salti

2013-05-01

and 14 men flamenco dancers´ feet. The results revealed tailor’s bunions prevalence was 14.8% and 35% of varus fifth toe. Both of them have a higher prevalence in women population. Significant differences in the presence of deformities were found according to the years of professional activity.

Repeatability of stance phase kinematics from a multi-segment foot model in people aged 50 years and older.

Science.gov (United States)

Arnold, John B; Mackintosh, Shylie; Jones, Sara; Thewlis, Dominic

2013-06-01

Confidence in 3D multi-segment foot models has been limited by a lack of repeatability data, particularly in older populations that may display unique functional foot characteristics. This study aimed to determine the intra and inter-observer repeatability of stance phase kinematic data from a multi-segment foot model described by Leardini et al. [2] in people aged 50 years or older. Twenty healthy adults participated (mean age 65.4 years SD 8.4). A repeated measures study design was used with data collected from four testing sessions on two days from two observers. Intra (within-day and between-day) and inter-observer coefficient of multiple correlations revealed moderate to excellent similarity of stance phase joint range of motion (0.621-0.975). Relative to the joint range of motion (ROM), mean differences (MD) between sessions were highest for the within-day comparison for all planar ROM at the metatarsus-midfoot articulation (sagittal plane ROM 5.2° vs. 3.9°, MD 3.1°; coronal plane ROM 3.9 vs. 3.1°, MD 2.3°; transverse plane ROM 6.8° vs. 5.16°, MD 3.5°). Consequently, data from the metatarsus-midfoot articulation in the Istituto Ortopedico Rizzoli (IOR) foot model in adults aged over 50 years needs to be considered with respect to the findings of this study. Crown Copyright © 2012. Published by Elsevier B.V. All rights reserved.

Comparison of 2 surgical techniques for reconstructing posterolateral corner of the knee: a cadaveric study evaluated by navigation system.

Science.gov (United States)

Ho, Eric Po-Yan; Lam, Mak-Ham; Chung, Mandy Man-Ling; Fong, Daniel Tik-Pui; Law, Billy Kan-Yip; Yung, Patrick Shu-Hang; Chan, Wood-Yee; Chan, Kai-Ming

2011-01-01

This study aimed to evaluate the immediate effect on knee kinematics by 2 different techniques of posterolateral corner (PLC) reconstruction. Five intact formalin-preserved cadaveric knees were used in this study. A navigation system was used to measure knee kinematics (posterior translation, varus angulation, and external rotation) after application of a constant force and torque to the tibia. Four different conditions of the knee were evaluated during the biomechanical test: intact knee and PLC-sectioned knee and PLC-reconstructed knee by the double-femoral tunnel technique and single-femoral tunnel technique. Sectioning of the PLC structures resulted in significant increases in external rotation at 30° of flexion from 11.2° (SD, 2.6) to 24.6° (SD, 6.2), posterior translation at 30° of flexion from 3.4 mm (SD, 1.5) to 7.4 mm (SD, 3.8), and varus angulation at 0° of flexion from 2.3° (SD, 2.1) to 7.9° (SD, 5.1). Both reconstruction techniques significantly restored the varus stability. The external rotation and posterior translation at 30° of flexion after reconstruction with the double-femoral tunnel technique were 10.2° (SD, 1.3) and 3.4° (SD, 2.7), respectively, which were significantly better than those of the single-femoral tunnel technique. Both techniques of reconstruction showed improved stability compared with PLC-sectioned knees. The double-femoral tunnel technique in PLC reconstruction showed better rotational stability and resistance to posterior translation than the single-femoral tunnel technique without compromising varus stability. PLC reconstruction by a double-femoral tunnel technique achieves better rotational control and resistance to posterior translation. Copyright © 2011 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

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

Science.gov (United States)

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

2015-12-01

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

Racism, crisis, Brexit

OpenAIRE

Virdee, S.; McGeever, Brendan Francis

2017-01-01

This article offers a conjunctural analysis of the financial and political crisis within which Brexit occurred with a specific attentiveness to race and racism. Brexit and its aftermath have been overdetermined by racism, including racist violence. We suggest that the Leave campaign secured its victory by bringing together two contradictory but inter-locking visions. The first comprises an imperial longing to restore Britain’s place in the world as primus inter pares that occludes any coming ...

Trochantoplasty for Total Hip Arthroplasty in Patients With Coxa Vara Deformity.

Science.gov (United States)

Yoo, Jun-Il; Parvizi, Javad; Song, Ji-Ung; Ha, Yong-Chan; Lee, Young-Kyun; Koo, Kyung-Hoi

2017-07-01

In total hip arthroplasty (THA) of hips with coxa vara, the femoral stems might be inserted in a varus alignment. To avoid varus insertion, we designed a technique, which we termed "trochantoplasty." In this procedure, the medial half of the greater trochanter was removed during THA. We evaluated 30 patients (31 hips) who had coxa vara deformity and underwent THA using trochantoplasty at the mean follow-up of 5 years (range, 3-9 years). All stems were inserted in the neutral position. One Vancouver type 1 periprosthetic femoral fracture occurred after a fall at postoperative 2 months. At the latest follow-up, the mean power of abductor was 4.3 (range, 3-5). Four patients had moderate limp whereas 26 patients had slight limp. The abduction at 90° flexion ranged from 15° to 45° (mean, 35°). There was no revision. All prostheses had bone-ingrown stability without any detectable wear or osteolysis. The mean Harris hip score was improved from 66.9 to 89.4 points. Trochantoplasty can be used to avoid varus insertion of the femoral stem while performing THA in patients with coxa vara deformity without compromising the abductor mechanism. Copyright © 2017 Elsevier Inc. All rights reserved.

Relationship between knee alignment and T1ρ values of articular cartilage and menisci in patients with knee osteoarthritis

International Nuclear Information System (INIS)

Wang, Ligong; Vieira, Renata La Rocca; Rybak, Leon D.; Babb, James S.; Chang, Gregory; Krasnokutsky, Svetlana; Abramson, Steven

2013-01-01

Objective: To assess the relationship between knee alignment and subregional T1ρ values of the femorotibial cartilage and menisci in patients with mild (Kellgren–Lawrence grade 1) to moderate (KL3) osteoarthritis (OA) at 3 T. Materials and methods: 26 subjects with a clinical diagnosis of KL1-3 OA were included and subdivided into three subgroups: varus, valgus, and neutral. All subjects were evaluated on a 3 T MR scanner. Mann–Whitney and Wilcoxon signed rank tests were performed to determine any statistically significant differences in subregional T1ρ values of femorotibial cartilage and menisci among the three subgroups of KL1-3 OA patients. Results: Medial femoral anterior cartilage subregion in varus group had significantly higher (p < 0.05) T1ρ values than all cartilage subregions in valgus group. Medial tibial central cartilage subregion had significantly higher T1ρ values (p < 0.05) than lateral tibial central cartilage subregion in varus group. The posterior horn of the medial meniscus in neutral group had significantly higher T1ρ values (p < 0.0029) than all meniscus subregions in valgus group. Conclusion: There exists some degree of association between knee alignment and subregional T1ρ values of femorotibial cartilage and menisci in patients with clinical OA

Relationship between knee alignment and T1ρ values of articular cartilage and menisci in patients with knee osteoarthritis

Energy Technology Data Exchange (ETDEWEB)

Wang, Ligong, E-mail: ligong.wang@hotmail.com [Quantitative Multinuclear Musculoskeletal Imaging Group (QMMIG), Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, New York, NY 10016 (United States); School of Radiation Medicine and Protection, Medical College of Soochow University, School for Radiological and interdisciplinary Sciences (RAD-X), Soochow University, Suzhou, Jiangsu 215123 (China); Vieira, Renata La Rocca, E-mail: relarocca@gmail.com [Quantitative Multinuclear Musculoskeletal Imaging Group (QMMIG), Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, New York, NY 10016 (United States); Rybak, Leon D., E-mail: Leon.Rybak@nyumc.org [Quantitative Multinuclear Musculoskeletal Imaging Group (QMMIG), Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, New York, NY 10016 (United States); Babb, James S., E-mail: James.Babb@nyumc.org [Quantitative Multinuclear Musculoskeletal Imaging Group (QMMIG), Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, New York, NY 10016 (United States); Chang, Gregory, E-mail: gregory.chang@nyumc.org [Quantitative Multinuclear Musculoskeletal Imaging Group (QMMIG), Center for Biomedical Imaging, Department of Radiology, New York University Langone Medical Center, New York, NY 10016 (United States); Krasnokutsky, Svetlana, E-mail: Svetlana.Krasnokutsky@nyumc.org [Department of Rheumatology, New York University Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003 (United States); Abramson, Steven, E-mail: StevenB.Abramson@nyumc.org [Department of Rheumatology, New York University Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003 (United States); and others

2013-11-01

Objective: To assess the relationship between knee alignment and subregional T1ρ values of the femorotibial cartilage and menisci in patients with mild (Kellgren–Lawrence grade 1) to moderate (KL3) osteoarthritis (OA) at 3 T. Materials and methods: 26 subjects with a clinical diagnosis of KL1-3 OA were included and subdivided into three subgroups: varus, valgus, and neutral. All subjects were evaluated on a 3 T MR scanner. Mann–Whitney and Wilcoxon signed rank tests were performed to determine any statistically significant differences in subregional T1ρ values of femorotibial cartilage and menisci among the three subgroups of KL1-3 OA patients. Results: Medial femoral anterior cartilage subregion in varus group had significantly higher (p < 0.05) T1ρ values than all cartilage subregions in valgus group. Medial tibial central cartilage subregion had significantly higher T1ρ values (p < 0.05) than lateral tibial central cartilage subregion in varus group. The posterior horn of the medial meniscus in neutral group had significantly higher T1ρ values (p < 0.0029) than all meniscus subregions in valgus group. Conclusion: There exists some degree of association between knee alignment and subregional T1ρ values of femorotibial cartilage and menisci in patients with clinical OA.

Isolation of Pseudomonas cepacia in cystic fibrosis patient

Directory of Open Access Journals (Sweden)

Elizabeth de Andrade Marques

1993-03-01

Full Text Available Pulmonary infection on cystic fibrosis (CF patients are associated with a limited qualitative number of microorganisms. During the colonization process, Staphylococcus aureus usually preceedes Pseudomonas aeruginosa. This latter is at first non-mucoid, being replaced or associated to a mucoid morphotype which is rare in other diseases. In 1980, Pseudomonas cepacia appeared as an important agent in CF pulmonary infections with a mean frequency of about 6.1% isolations in different parts of the world. The primus colonization mainly occurs in the presence of pre-existent tissue lesions and the clinical progress of the disease is variable. In some patients it can be fulminant; in others it can cause a gradual and slow decrease in their pulmonary functions. The concern with this germ isolation is justified by its antibiotic multiple resistence and the possibility of direct transmission from a colonized patient to a non-colonized one. We reported the first case of P. cepacia infection in a CF patient in our area. The microbiological attendance to this patient had been made from 1986 to 1991 and the first positive culture appeared in 1988. The sensitivity profile showed that the primus colonization strain was sensitive to 9 of 17 tested antibiotics, however in the last culture the strain was resistent to all antibiotics. These data corroborate the need for monitoring the bacterial flora on CF patients respiratory system.

Physical properties of a linear accelerator-based stereotactic installed at national cancer institute

International Nuclear Information System (INIS)

Attala, E.M.; Deiab, N.A.; Elawady, R.A.

2005-01-01

The purpose of this paper is to present the dosimetry and mechanical accuracy of the first dedicated Siemens PRIMUS M6/6ST linear accelerator-based Stereotactic installed in National Cancer Institute for stereotactic radiosurgery and radiotherapy (SRS/SRT). The data were obtained during the installation, acceptance test procedure, and commissioning of the unit. The Primus M6/6ST has a single 6-MV beam with the same beam characteristics as that of the mother unit, the Siemens. The dosimetric data were taken using pin point ion chamber. The cone sizes vary from 12.5 to 40.0 mm diameter. The mechanical stability of the entire system was verified. The variations in isocenter position with table, gantry, and collimator rotation were found to be < 0.5 mm with a compounded accuracy of < or = 1.0 mm. The beam profiles of all cones in the x and y directions were within +/- 0.5 mm and match with the physical size of the cone. The basic dosimetry parameters such as tissue maximum ratio (TMR), off-axis ratio (OAR) and cone factor needed for patient treatment were evaluated. The mechanical and dosimetric characteristics including dose linearity of this unit are presented and found to be suitable for SRS/SRT. The difficulty in absolute dose measurement for small cone is discussed

Kriminologie und Kriminalistik im Zugriff der Geschichtswissenschaft

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Peter-Alexis Albrecht

2007-01-01

Full Text Available Rezensierte Werke:Silviana Galassi, Kriminologie im Deutschen Kaiserreich. Geschichte einer gebrochenen Verwissen­schaftlichung, Stuttgart: Franz Steiner Verlag 2004, 452 S., ISBN 3-515-08352-9; Peter Becker, Dem Täter auf der Spur. Eine Geschichte der Kriminalistik, Darmstadt: Primus Verlag 2005, 287 S., ISBN 3-89678-275-4; Peter Becker, Richard F. Wetzell (Hg., Criminals and their Scientists. The History of Criminology in International Perspective, Cambridge: Cambridge University Press 2006, 492 S., ISBN 0-521-81012-4

3D Biometrics for Hindfoot Alignment Using Weightbearing CT.

Science.gov (United States)

Lintz, François; Welck, Matthew; Bernasconi, Alessio; Thornton, James; Cullen, Nicholas P; Singh, Dishan; Goldberg, Andy

2017-06-01

Hindfoot alignment on 2D radiographs can present anatomical and operator-related bias. In this study, software designed for weightbearing computed tomography (WBCT) was used to calculate a new 3D biometric tool: the Foot and Ankle Offset (FAO). We described the distribution of FAO in a series of data sets from clinically normal, varus, and valgus cases, hypothesizing that FAO values would be significantly different in the 3 groups. In this retrospective cohort study, 135 data sets (57 normal, 38 varus, 40 valgus) from WBCT (PedCAT; CurveBeam LLC, Warrington, PA) were obtained from a specialized foot and ankle unit. 3D coordinates of specific anatomical landmarks (weightbearing points of the calcaneus, of the first and fifth metatarsal heads and the highest and centermost point on the talar dome) were collected. These data were processed with the TALAS system (CurveBeam), which resulted in an FAO value for each case. Intraobserver and interobserver reliability were also assessed. In normal cases, the mean value for FAO was 2.3% ± 2.9%, whereas in varus and valgus cases, the mean was -11.6% ± 6.9% and 11.4% ± 5.7%, respectively, with a statistically significant difference among groups ( P biometrics. The present study introduces the concept of 3D biometrics and describes an efficient, semiautomatic tool for measuring hindfoot alignment. Level III, retrospective comparative study.

Posterolateral Corner Reconstruction using the Anatomical Two-Tailed Graft Technique: Clinical Outcomes in the Multiligament Injured Knee.

Science.gov (United States)

Woodmass, Jarret M; Sanders, Thomas L; Johnson, Nick R; Wu, Isabella T; Krych, Aaron J; Stuart, Michael J; Levy, Bruce A

2018-02-14

Injury to the posterolateral corner (PLC) of the knee can lead to both varus and rotational instability. Multiple PLC reconstruction techniques have been described, including one-tailed graft (fibula-based constructs) or two-tailed graft (combined fibula- and tibia-based constructs). The purpose of our study was to evaluate the clinical outcomes of anatomical two-tailed graft reconstruction of the PLC in the setting of multiligament knee injuries (MKLIs) with grade III varus instability. Patients were identified through a prospective MLKI database between 2004 and 2013. Patients who received fibular collateral ligament and PLC reconstructions using a two-tailed graft and had a minimum follow-up of 2 years were included. Patients were assessed for clinical laxity grade, range of motion, and functional outcomes using Lysholm and International Knee Documentation Committee (IKDC) scores. Twenty patients (16 male, 4 female) with a mean age of 30.7 (range: 16-52) and a mean follow-up of 52.2 months (range: 24-93 months) were included. Knee dislocation (KD) grades included: 4 KD-1, 10 KD 3-L, 5 KD-4, and 1 KD-5. No patients had isolated PLC injuries. Mean IKDC and Lysholm score were 73.1 ± 25.8 and 78 ± 26, respectively. Mean range of motion was -1.1 to 122.8. In full extension, two patients (10%) had grade 1 laxity to varus stress. In 30 degrees of knee flexion, five (25%) patients had grade 1 laxity, and two (10%) had grade 2 laxity. Anatomical two-tailed PLC reconstruction can reliably restore varus stability when performed on patients with MLKIs and type C posterolateral instability with hyperextension external rotation recurvatum deformity. Satisfactory functional outcome scores were achieved in the majority of patients. This study supports the use of an anatomical two-tailed PLC reconstruction in the multiligament injured knee. The level of evidence is IV, case series. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Satisfactory knee function after single-stage posterolateral corner reconstruction in the multi-ligament injured/dislocated knee using the anatomic single-graft technique.

Science.gov (United States)

Sanders, Thomas L; Johnson, Nick R; Pareek, Ayoosh; Krych, Aaron J; Marx, Robert G; Stuart, Michael J; Levy, Bruce A

2018-04-01

Increasing importance has been placed on the posterolateral corner (PLC) in maintaining varus and rotational stability of the knee. The goal of this study was to evaluate knee function and clinical stability following a single-graft PLC reconstruction technique and identify factors associated with poor knee function. This study identified patients with a multi-ligament knee injury between 2006 and 2013. Patients who received a single-graft fibular collateral ligament and PLC reconstruction with a single-stage surgery during the study period and had a minimum follow-up of 2 years after surgery were included. Functional outcomes were assessed using Lysholm and IKDC scores. Varus and rotational knee laxity and range of motion were assessed using physical examination. The final study cohort included 61 patients who underwent PLC reconstruction using a single-graft technique. The mean IKDC score was 74.1 (± 22.3) and the mean Lysholm score was 80.3 (± 21.8) at mean follow-up of 3.8 years (range 2-9 years). Mean range of motion at final follow-up measured from 0° to 126° [range flexion: 95-145, range extension: 0-5]. Fifty-eight patients (95%) had grade 0 varus laxity in full knee extension, and 54 patients (88.5%) had grade 0 varus laxity at 30° of knee flexion. Female gender was associated with a lower postoperative IKDC score (p = 0.04). Surgical treatment of the PLC using a single-graft technique can result in satisfactory knee function and stable physical examination findings at minimum 2 years after surgery. Female gender was predictive of poor knee function after PLC reconstruction. Surgical treatment of PLC injuries should be individualized based on the timing of surgery, specific injured knee structures, and physical examination findings. This study helps validate the use of a single-graft technique for PLC reconstruction and can be used to help counsel patients about expected knee function after surgical treatment of PLC injuries. Level of evidence

Correction of coronal plane deformities around the knee using a tension band plate in children younger than 10 years

Directory of Open Access Journals (Sweden)

Ruta M Kulkarni

2015-01-01

Full Text Available Background: Guided growth through temporary hemiepiphysiodesis has gained acceptance as the preferred primary treatment in treating pediatric lower limb deformities as it is minimally invasive with a lesser morbidity than the traditional osteotomy. The tension band plate is the most recent development in implants used for temporary hemiepiphysiodesis. Our aim was to determine its safety and efficacy in correcting coronal plane deformities around the knee in children younger than 10 years. Materials and Methods: A total of 24 children under the age of 10 were operated for coronal plane deformities around the knee with a single extra periosteal tension band plate and two nonlocking screws. All the children had a pathological deformity for which a detailed preoperative work-up was carried out to ascertain the cause of the deformity and rule out physiological ones. The average age at hemiepiphysiodesis was 5 years 3 months (range: 2 years to 9 years 1 month. Results: The plates were inserted for an average of 15.625 months (range: 7 months to 29 months. All the patients showed improvement in the mechanical axis. Two patients showed partial correction. Two cases of screw loosening were observed. In the genu valgum group, the tibiofemoral angle improved from a preoperative mean of 19.89° valgus (range: 10° valgus to 40° valgus to 5.72° valgus (range: 2° varus to 10° valgus. In patients with genu varum the tibiofemoral angle improved from a mean of 28.27° varus (range: 13° varus to 41° varus to 1.59° valgus (range: 0-8° valgus. Conclusion: Temporary hemiepiphysiodesis through the application of the tension band plate is an effective method to correct coronal plane deformities around the knee with minimal complications. Its ease and accuracy of insertion has extended the indication of temporary hemiepiphysiodesis to patients younger than 10 years and across a wide variety of diagnosis including pathological physis, which were traditionally

Incidence of non-traumatic anterior knee pain among 11 - 17-year-olds

African Journals Online (AJOL)

valgus or varus knee, external tibial torsion, increased Q-. ORIGINAL RESEARCH ... incidence of anterior knee pain, the effect of sport participation, age at onset of the condition, gender differences and other factors that could influence the ...

Management of professionals in school practices

DEFF Research Database (Denmark)

Jacobsen, Alice Juel; Buch, Anders

2016-01-01

related to an under-standing of professionals are used to investigate the practices involved in the change processes. The article argues that the ambiguity of a primus inter pares management position among professionals leads to several paradoxes, deadlocks, and detours, all of which affect the work......This article investigates organizational reform changes as they are con-structed in the interaction between managers and teachers in a school context. The empirical basis is comprised of case studies carried out in Danish upper secondary schools. An ethnographic approach and a concept of paradox...

Jan de Witt's Elementa Curvarum Linearum Liber Secundus

CERN Document Server

Grootendorst, Albert W; Bakker, Miente; Erne, Reinie

2010-01-01

Following on from the 2000 edition of Jan De Witt's "Elementa Curvarum Linearum, Liber Primus", this book provides the accompanying translation of the second volume of "Elementa Curvarum Linearum (Foundations of Curved Lines)". One of the first books to be published on Analytic Geometry, it was originally written in Latin by the Dutch statesman and mathematician Jan de Witt, soon after Descartes' invention of the subject. Born in 1625, Jan de Witt served with distinction as Grand Pensionary of Holland for much of his adult life. In mathematics, he is best known for his work

Imaging features of iBalance, a new high tibial osteotomy: what the radiologist needs to know.

Science.gov (United States)

Alaia, Erin FitzGerald; Burke, Christopher J; Alaia, Michael J; Strauss, Eric J; Ciavarra, Gina A; Rossi, Ignacio; Rosenberg, Zehava Sadka

2017-01-01

To describe the post-surgical imaging appearance and complications of high tibial osteotomy in patients with the iBalance implant system (iHTO; Arthrex, Naples, FL, USA). Retrospective, institutional review board-approved, Health Insurance Portability and Accountability Act-compliant review of imaging after 24 iBalance procedures was performed with attention to: correction of varus malalignment, healing at the osteotomy site, resorption of the osteoinductive compound, and complications. Immediate correction of the varus deformity was present in all cases. Lobular radiolucency was present in all cases, more pronounced on the lateral knee radiograph, simulating infection or erosive disease. Four radiographic signs of healing were observed: blurring at the opposing osteotomy bony margins and at the osteoinductive compound and the adjacent bone interface, callus formation, and resorption of the osteoinductive compound. Complications were present in 33 % of cases, including fracture through the lateral tibial cortex (21 %), genu varum recurrence (8 %), painful exuberant bone formation (4 %), persistent pain, requiring total knee arthroplasty (4 %), and non-union (after >6 months' follow-up), with suspected infection (4 %). Radiologists should be aware of the normal radiographic appearance following iBalance high tibial osteotomy, which may be confused with infection. Radiologists should also be aware of potential post-operative complications and compare all post-operative radiographs with the immediate post-operative examination to detect collapse of the osteotomy site and recurrence of varus angulation.

Does the Angle of the Nail Matter for Pertrochanteric Fracture Reduction? Matching Nail Angle and Native Neck-Shaft Angle.

Science.gov (United States)

Parry, Joshua A; Barrett, Ian; Schoch, Bradley; Yuan, Brandon; Cass, Joseph; Cross, William

2018-04-01

To determine whether fixation of pertrochanteric hip fractures with cephalomedullary nails (CMNs) with a neck-shaft angle (NSA) less than the native NSA affects reduction and lag screw cutout. Retrospective comparative study. Level I trauma center. Patients treated with a CMN for unstable pertrochanteric femur fractures (OTA/AO 31-A2.2 and 31-A2.3) between 2005 and 2014. CMN fixation. NSA reduction and lag screw cutout. Patients fixed with a nail angle less than their native NSA were less likely to have good reductions [17% vs. 60%, 95% confidence interval (CI), -63% to -18%; P = 0.0005], secondary to more varus reductions (41% vs. 10%, 95% CI, 9%-46%; P = 0.01) and more fractures with ≥4 mm of displacement (63% vs. 35%, 95% CI, 3%-49%; P = 0.03). The cutout was not associated with the use of a nail angle less than the native NSA (60% vs. 76%, 95% CI, -56% to 18%; P = 0.5), varus reductions (60% vs. 32%, 95% CI, -13% to 62%; P = 0.3), or poor reductions (20% vs. 17%, 95% CI, -24% to 44%; P = 1.0). The fixation of unstable pertrochanteric hip fractures with a nail angle less than the native NSA was associated with more varus reductions and fracture displacement but did not affect the lag screw cutout. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Conventional radiographic examination in the evaluation of sequelae after tibial plateau fractures

International Nuclear Information System (INIS)

Jensen, D.B.; Bjerg-Nielsen, A.; Laursen, N.; Glostrup Univ. Hospital

1988-01-01

Seventy patients with 72 conservatively treated tibial plateau fractures were re-examined after an average of 5 3/4 years. Among 55 fractured knees with a primary articular depression of 1-20 mm, the depression was still present radiographically in 47 knees. No correlation existed between the persistent radiographic depression and function of the knee. Moderate to severe osteoarthrosis was found in 10 knees; in five of these the osteoarthrosis was of clinical importance. More than 10 degrees of valgus/varus deformity was present in two knees. In two patients osteotomy had been performed to correct deformity. It is concluded that a persistent radiographic articular depression is of no clinical importance in tibial plateau fractures treated by conservative methods, which include early movement of the knee. The radiographic examination, however is, useful in the evaluation of valgus/varus deformity and osteoarthrosis. (orig.)

The subtalar distraction bone block arthrodesis following the late complications of calcaneal fractures: A systematic review

NARCIS (Netherlands)

T. Schepers (Tim)

2013-01-01

textabstractIntroduction: The late complications following a displaced intra-articular calcaneal fractures includes painful arthrosis for which a subtalar fusion might be considered. In case of malalignment due to loss of height and varus deformity a reconstructive arthrodesis is necessary. The

PRIMUS: THE DEPENDENCE OF AGN ACCRETION ON HOST STELLAR MASS AND COLOR

Energy Technology Data Exchange (ETDEWEB)

Aird, James; Coil, Alison L.; Moustakas, John; Smith, M. Stephen M. [Center for Astrophysics and Space Sciences, Department of Physics, University of California, 9500 Gilman Dr., La Jolla, San Diego, CA 92093 (United States); Blanton, Michael R.; Zhu Guangtun [Center for Cosmology and Particle Physics, Department of Physics, New York University, 4 Washington Place, New York, NY 10003 (United States); Burles, Scott M. [D.E. Shaw and Co., L.P., 20400 Stevens Creek Blvd., Suite 850, Cupertino, CA 95014 (United States); Cool, Richard J. [Department of Astrophysical Sciences, Princeton University, Peyton Hall, Princeton, NJ 08544 (United States); Eisenstein, Daniel J. [Harvard College Observatory, 60 Garden St., Cambridge, MA 02138 (United States); Wong, Kenneth C. [Steward Observatory, University of Arizona, 933 N. Cherry Ave., Tucson, AZ 85721 (United States)

2012-02-10

We present evidence that the incidence of active galactic nuclei (AGNs) and the distribution of their accretion rates do not depend on the stellar masses of their host galaxies, contrary to previous studies. We use hard (2-10 keV) X-ray data from three extragalactic fields (XMM-LSS, COSMOS, and ELAIS-S1) with redshifts from the Prism Multi-object Survey to identify 242 AGNs with L{sub 2-10keV} = 10{sup 42-44} erg s{sup -1} within a parent sample of {approx}25,000 galaxies at 0.2 < z < 1.0 over {approx}3.4 deg{sup 2} and to i {approx} 23. We find that although the fraction of galaxies hosting an AGN at fixed X-ray luminosity rises strongly with stellar mass, the distribution of X-ray luminosities is independent of mass. Furthermore, we show that the probability that a galaxy will host an AGN can be defined by a universal Eddington ratio distribution that is independent of the host galaxy stellar mass and has a power-law shape with slope -0.65. These results demonstrate that AGNs are prevalent at all stellar masses in the range 9.5< log M{sub *}/M{sub sun}<12 and that the same physical processes regulate AGN activity in all galaxies in this stellar mass range. While a higher AGN fraction may be observed in massive galaxies, this is a selection effect related to the underlying Eddington ratio distribution. We also find that the AGN fraction drops rapidly between z {approx} 1 and the present day and is moderately enhanced (factor {approx}2) in galaxies with blue or green optical colors. Consequently, while AGN activity and star formation appear to be globally correlated, we do not find evidence that the presence of an AGN is related to the quenching of star formation or the color transformation of galaxies.

Kinematics of Different Components of the Posterolateral Corner of the Knee in the Lateral Collateral Ligament-intact State: A Human Cadaveric Study.

Science.gov (United States)

Domnick, Christoph; Frosch, Karl-Heinz; Raschke, Michael J; Vogel, Nils; Schulze, Martin; von Glahn, Mathias; Drenck, Tobias C; Herbort, Mirco

2017-10-01

To determine the static stabilizing effects of different anatomical structures of the posterolateral corner (PLC) of the knee in the lateral collateral ligament (LCL)-intact state. Thirteen fresh-frozen human cadaveric knees were dissected and tested using an industrial robot with an optical tracking system. Kinematics were determined for 134 N anterior/posterior loads, 10 N m valgus/varus loads, and 5 N m internal/external rotatory loads in 0°, 20°, 30°, 60°, and 90° of knee flexion. The PLC structures were dissected and consecutively released: (I) intact knee joint, (II) with released posterior cruciate ligament (PCL), (III) popliteomeniscal fibers, (IV) popliteofibular ligament, (V) arcuat and popliteotibial fibers, (VI) popliteus tendon (PLT), and (VII) LCL. Repeated-measures analysis of variance was performed with significance set at P < .05. After releasing the PCL, posterior tibial translation increased by 5.2 mm at 20° to 9.4 mm at 90° of joint flexion (P < .0001). A mild 1.8° varus instability was measured in 0° of flexion (P = .0017). After releasing the PLC structures, posterior tibial translation further increased by 2.9 mm at 20° to 5.9 mm at 90° of flexion (P < .05) and external rotation angle increased by 2.6° at 0° to 7.9° at 90° of flexion (P < .05, vs II). Varus stability did not decrease. Mild differences between states V and VI were found in 60° and 90° external rotation tests (2.1° and 3.1°; P < .05). The connecting ligaments/fibers to the PLT act as a primary static stabilizer against external rotatory loads and a secondary stabilizer against posterior tibial loads (when PCL is injured). After releasing these structures, most static stabilizing function of the intact PLT is lost. The PLC has no varus-stabilizing function in the LCL-intact knee. Anatomy and function of these structures for primary and secondary joint stability should be considered for clinical diagnostics and when performing surgery in

The effects of thermal manipulations during embryogenesis of broiler chicks on growth of embryo and skeletal traits

Energy Technology Data Exchange (ETDEWEB)

Aygün, Ali, E-mail: aaygun@selcuk.edu.tr [Selcuk University, Faculty of Agriculture, Department of Animal Science, Konya, 42075 (Turkey); Narinç, Doğan, E-mail: narincd@gmail.com [Namik Kemal University, Faculty of Veterinary Medicine, Department of Genetics, Tekirdag, 59100 (Turkey)

2016-04-18

Incubation temperature is one of the important environmental factors that can induce epigenetic thermal adaptation of different physiological control systems. Thus, post hatch thermo tolerance ability of birds may be gained using these manipulations during different incubation periods. The current study was carried out to reveal the effects of temperature manipulations during early and late embryogenesis on weight of embryo and size of skeletal bilateral traits (face, wings, metatarsus, tibia, and femur) in broiler chicken embryos. One thousand commercial broiler eggs from 46 week old breeder flock were used in study. Treatments consisted of eggs incubated at 37.8°C and 55% relative humidity throughout (control; DG1), heated to 36.9°C and supplied 60% relative humidity for 6 hours daily from day 0 to 8 (DG2), heated to 36.9°C and supplied 60% relative humidity for 6 hours daily from day 10 to 18 (DG3), heated to 41°C and supplied 65% relative humidity for 3 hours daily from day 8 to 10 (DG4), and heated to 41°C and supplied 65% relative humidity for 3 hours daily from day 16 to 18 (DG5). Measurements of embryo weight and bilateral traits were obtained at 20 day of incubation and at hatch (at day 21). It was determined that the live weights of embryo and chick were affected significantly by treatment; DG3 group has shown higher mean values than the other treatment groups (P<0.05). There were differences in lengths of femur, tibia and metatarsus among treatment groups at hatch. Particularly, the high incubator temperatures at the second half of incubation accelerated growth of body and bone in embryos. These consequences of the treatments performed at different temperatures and times indicate that the different metabolic shifts realized by the embryos.

Lymphedema during pregnancy - case study

Directory of Open Access Journals (Sweden)

Katarzyna Korabiusz

2017-06-01

Full Text Available Pregnancy is a period when woman’s body undergoes a lot of changes in her hormonal balance, lymphatic system, musculoskeletal system and cardiovascular system. As a result of disorders in defense mechanisms, a significant amount of liquid accumulates in spaces between tissues. A clinical manifestation of this condition is swelling located around ankles and lower legs. Sedentary lifestyle, unhealthy eating habits, excessive weight and pregnancy are also well known causes of lymphatic swelling. Comprehensive anti-swelling therapy that is used in treating lymphatic swelling in pregnant patients includes: patients’ education, manual lymphatic drainage, kinesitherapy, multilayer bandaging, skin care, drainage positions and kinesiotaping. Dissertation’s objective: Dissertation’s objective is to evaluate implementation of manual lymphatic drainage and anti-swelling kinesiotaping in pregnant woman with lymphatic swelling of lower legs. Research methods: Research methods were collected basing on: interview with a patient, medical documentation analysis and physical examination conduced before and after therapy. Research was conducted between 34th and 36th week of pregnancy. Case study: 38 year old patient in her fourth singleton pregnancy. Two prior pregnancies in 2009 and 2010 were delivered with C-section and one missed abortion in 2015 occurred. During this pregnancy patient gained over 30kg. She was diagnosed with lymphatic swelling of metatarsus, lower legs and ankles in 34th week of pregnancy. Lymphatic drainage of lower limbs and anti-swelling kinesiotaping was implemented. Results: After two weeks of therapy decrease in swelling was observed in left lower limb: in metatarsus by 8cm, in ankles by 9cm and in lower legs by 6cm. In right lower limb swelling decreased accordingly by 7cm, 10cm and 5cm. Conclusion: Anti-swelling lymphatic drainage, kinesiotherapy and kinesiotaping are effective physiotherapy methods used in treating lymphedema

Forefoot Adduction Is a Risk Factor for Jones Fracture.

Science.gov (United States)

Fleischer, Adam E; Stack, Rebecca; Klein, Erin E; Baker, Jeffrey R; Weil, Lowell; Weil, Lowell Scott

Jones fractures are among the most common fractures of the foot; however, much remains unknown about their etiology. The purpose of the present study was to further examine the risk factors of forefoot and hindfoot alignment on Jones fractures using an epidemiologic study design. We used a retrospective, matched, case-control study design. Cases consisted of patients with acute, isolated Jones fractures confirmed on plain film radiographs seen at our institute from January 2009 to December 2013. Patients presenting with pain unrelated to metatarsal fractures served as controls. Controls were matched to cases by age (±2 years), gender, and year of presentation. Weightbearing foot radiographs were assessed for 13 angular relationships by a single rater. Conditional multivariable logistic regression was used to identify important risk factors. Fifty patients with acute Jones fractures and 200 controls were included. The only significant variables in the final multivariable model were the metatarsus adductus angle (odds ratio [OR] 1.16, 95% confidence interval [CI] 1.08 to 1.25) and fourth/fifth intermetatarsal angle (OR 0.69, 95% CI 0.57 to 0.83)-both measures of static forefoot adduction. The presence of metatarsus adductus (defined as >15°) on foot radiographs was associated with a 2.4 times greater risk of a Jones fracture (adjusted OR 2.4, 95% CI 1.2 to 4.8). We have concluded that the risk of Jones fracture increases with an adducted forefoot posture. In our population, which consisted primarily of patients presenting after a fall (10 of 50; 20%) or misstep/inversion injury (19 of 50; 38%), the hindfoot alignment appeared to be a less important factor. Copyright © 2017 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Stress changes of lateral collateral ligament at different

Directory of Open Access Journals (Sweden)

ZHONG Yan-lin

2011-04-01

Full Text Available 【Abstract】 Objective: To create a 3-dimensional finite element model of knee ligaments and to analyse the stress changes of lateral collateral ligament (LCL with or without displaced movements at different knee flexion conditions. Methods: A four-major-ligament contained knee specimen from an adult died of skull injury was prepared for CT scanning with the detectable ligament insertion footprints, locations and orientations precisely marked in advance. The CT scanning images were converted to a 3-dimensional model of the knee with the 3-dimensional reconstruction technique and transformed into finite element model by the software of ANSYS. The model was validated using experimental and numerical results obtained by other scientists. The natural stress changes of LCL at five different knee flexion angles (0°, 30°, 60°, 90°, 120° and under various motions of anterior-posterior tibial translation, tibial varus rotation and internal-external tibial rotation were measured. Results: The maximum stress reached to 87%-113% versus natural stress in varus motion at early 30° of knee flexions. The stress values were smaller than the peak value of natural stress at 0° (knee full extension when knee bending was over 60° of flexion in anterior-posterior tibial translation and internal-external rotation. Conclusion: LCL is vulnerable to varus motion in almost all knee bending positions and susceptible to anterior- posterior tibial translation or internal-external rotation at early 30° of knee flexions. Key words: Knee joint; Collateral ligaments; Finite element analysis

Proximal femoral anatomy and collared stems in hip arthroplasty: is a single collar size sufficient?

Science.gov (United States)

Bonin, Nicolas; Gedouin, Jean-Emmanuel; Pibarot, Vincent; Bejui-Hughues, Jacques; Bothorel, Hugo; Saffarini, Mo; Batailler, Cécile

2017-10-03

Even if the benefits of collars are unclear, they remain widely used, in several femoral stem designs. This study aimed to determine whether collar size should be proportional to hip dimensions and morphology. The hypothesis was that the collar should be larger for greater stem sizes and for varus femoral necks. Computed Tomography scans of 204 healthy hips were digitally analysed and manually templated to determine principle dimensions, appropriate stem size and model, as well as cortical distance at the femoral calcar (ideal collar size). Univariable analysis revealed that cortical distance was moderately correlated with mediolateral offset (r = 0.572; p < 0.0001) and stem model (r = 0.520; p < 0.0001). Cortical distance was weakly correlated with head diameter (r = 0.399; p < 0.0001), stem size (r = 0.200; p = 0.017), and patient gender (r = 0.361; p < 0.0001). Multivariable analysis confirmed that stem model (p < 0.0001) and head diameter (p = 0.0162) are directly correlated to cortical distance. We found that cortical distance along the femoral calcar is directly correlated with the model of the stem implanted ('standard' or 'varus') and with the head diameter. This cortical distance indicates optimal collar size, which would grant maximum calcar coverage without prosthetic overhang. Collar size should be proportional to the size of the operated hip, and should be larger for 'varus' stem models than for 'standard' stem models.

The effect of inferomedial screw on postoperative shoulder function and mechanical alignment in proximal humerus fractures.

Science.gov (United States)

Erdoğan, Murat; Desteli, Engin Eren; İmren, Yunus; Üztürk, Ali; Kılıç, Mesut; Sezgin, Hicabi

2014-10-01

The aim of the study was to evaluate the clinical and radiologic results of locking plate fixation with or without inferomedial screw (IMS) in surgically treated proximal humerus fractures. Thirty-six patients with displaced proximal humerus fractures from two centers were operated using locking plate. All of the fractures were classified according to the Neer classification. In 18 of the cases, an additional IMS running through the medial curvature of the surgical neck was used. There was no significant difference among both groups in terms of height, gender, weight, and mechanism of injury. The fractures were evaluated according to the radiographic and functional findings during follow-up period of 14 months in average (range 8-32 months). At the end of first year, shoulder radiographs were received and shoulder examinations were performed using ASES scores. Humeral head-shaft angles were measured by true AP projections. Head-shaft angle measurements were categorized as varus if 145. Mean time for fracture healing was 18 weeks. Complete union was achieved in 35 patients by the end of 6 months. In one of the 18 displaced proximal humerus fractures of IMS (+) group, the head-shaft angle was measured to be <125, whereas six patients had varus deviation in IMS (-) group at follow-up (p < 0.05). Mean ASES scores of IMS (+) group and IMS (-) group were 58.21 ± 5.82 and 38.61 ± 3.44, respectively (p < 0.001). Use of inferomedial screw running through the medial curvature of surgical neck prevents varus deformity and improves functional outcome after surgical treatment for proximal humerus fractures.

Bracing of the Reconstructed and Osteoarthritic Knee during High Dynamic Load Tasks.

Science.gov (United States)

Hart, Harvi F; Crossley, Kay M; Collins, Natalie J; Ackland, David C

2017-06-01

Lateral compartment osteoarthritis accompanied by abnormal knee biomechanics is frequently reported in individuals with knee osteoarthritis after anterior cruciate ligament reconstruction (ACLR). The aim of this study was to evaluate changes in knee biomechanics produced by an adjusted and unadjusted varus knee brace during high dynamic loading activities in individuals with lateral knee osteoarthritis after ACLR and valgus malalignment. Nineteen participants who had undergone ACLR 5 to 20 yr previously and had symptomatic and radiographic lateral knee osteoarthritis with valgus malalignment were assessed. Quantitative motion analysis experiments were conducted during hopping, stair ascent, and descent under three test conditions: (i) no brace, (ii) unadjusted brace with sagittal plane support and neutral frontal plane alignment, and (iii) adjusted brace with sagittal plane support and varus realignment (valgus to neutral). Sagittal, frontal, and transverse plane knee kinematics, external joint moment, and angular impulse data were calculated. Relative to an unbraced knee, braced conditions significantly increased knee flexion and adduction angles during hopping (P = 0.003 and P = 0.005; respectively), stair ascent (P = 0.003 and P stair ascent (P = 0.008) and flexion moments during stair descent (P = 0.006). There were no significant differences between the adjusted and the unadjusted brace conditions (P > 0.05). A knee brace, with or without varus alignment, can modulate knee kinematics and external joint moments during hopping, stairs ascent, and descent in individuals with predominant lateral knee osteoarthritis after ACLR. Longer-term use of a brace may have implications in slowing osteoarthritis progression.

Alterations in walking knee joint stiffness in individuals with knee osteoarthritis and self-reported knee instability.

Science.gov (United States)

Gustafson, Jonathan A; Gorman, Shannon; Fitzgerald, G Kelley; Farrokhi, Shawn

2016-01-01

Increased walking knee joint stiffness has been reported in patients with knee osteoarthritis (OA) as a compensatory strategy to improve knee joint stability. However, presence of episodic self-reported knee instability in a large subgroup of patients with knee OA may be a sign of inadequate walking knee joint stiffness. The objective of this work was to evaluate the differences in walking knee joint stiffness in patients with knee OA with and without self-reported instability and examine the relationship between walking knee joint stiffness with quadriceps strength, knee joint laxity, and varus knee malalignment. Overground biomechanical data at a self-selected gait velocity was collected for 35 individuals with knee OA without self-reported instability (stable group) and 17 individuals with knee OA and episodic self-reported instability (unstable group). Knee joint stiffness was calculated during the weight-acceptance phase of gait as the change in the external knee joint moment divided by the change in the knee flexion angle. The unstable group walked with lower knee joint stiffness (p=0.01), mainly due to smaller heel-contact knee flexion angles (pknee flexion excursions (pknee stable counterparts. No significant relationships were observed between walking knee joint stiffness and quadriceps strength, knee joint laxity or varus knee malalignment. Reduced walking knee joint stiffness appears to be associated with episodic knee instability and independent of quadriceps muscle weakness, knee joint laxity or varus malalignment. Further investigations of the temporal relationship between self-reported knee joint instability and walking knee joint stiffness are warranted. Copyright © 2015 Elsevier B.V. All rights reserved.

The subtalar distraction bone block arthrodesis following the late complications of calcaneal fractures: a systematic review

NARCIS (Netherlands)

Schepers, T.

2013-01-01

The late complications following a displaced intra-articular calcaneal fractures includes painful arthrosis for which a subtalar fusion might be considered. In case of malalignment due to loss of height and varus deformity a reconstructive arthrodesis is necessary. The primary aim of the current

Treatment modalities for patients with varus medial knee osteoarthritis

NARCIS (Netherlands)

T. Duivenvoorden (Tijs)

2015-01-01

markdownabstractAbstract Osteoarthritis (OA) is one of the most common joint disorders in the Western population, which causes pain, stiffness, loss of function and disability. In patients with OA the cartilage, located at the ends of long bones, is damaged. OA is most prevalent in the knee

Elbow joint instability

DEFF Research Database (Denmark)

Olsen, Bo Sanderhoff; Henriksen, M G; Søjbjerg, Jens Ole

1994-01-01

The effect of simultaneous ulnar and radial collateral ligament division on the kinematics of the elbow joint is studied in a cadaveric model. Severance of the anterior part of the ulnar collateral ligament and the annular ligament led to significant elbow joint instability in valgus and varus...

Angles measuring on radiographic images as a tool for the diagnosis of Blount disease

International Nuclear Information System (INIS)

Mora Rojas, Raul

2010-01-01

The etiology of Blount disease has followed unknown at the present; although are described factors that could be related to the appearance of the same. Even, to make the diagnosis of this disease remains a challenge, due to it difficult to predict the behavior of the tibia varus in young children. Some measures were described in the radiographs of patients with tibia vara (the most currently used has been the Tibial Proximal Diaphyseal Goal Angle) to try to provide another tool in the diagnosis, but without be able to establish a free relationship between disruption of these measures with the pathological development of tibial varus. A new measurement (Tibial Proximal Fibular Mechanic Angle) established in the radiographs has been the purpose, taking into account the structures and concepts that are altered in patients with Blount diseases. The proximal tibial physis and the mechanical axis of the tibia are performed without to take into account in some of the measurements described above. (author) [es

Experience of collaboration between a Dutch surgical team in a ...

African Journals Online (AJOL)

We describe our experience over a 3-year period of intensive collaboration between specialized teams from .... primary and secondary fracture and orthopedic care. As ... Due to a limited recovery capacity and facilities, regional .... Congenital bone abnormality: this patient had a varus deformity of the left knee, and a valgus.

A systematic review and meta-analysis of lower limb neuromuscular alterations associated with knee osteoarthritis during level walking.

Science.gov (United States)

Mills, Kathryn; Hunt, Michael A; Leigh, Ryan; Ferber, Reed

2013-08-01

Neuromuscular alterations are increasingly reported in individuals with knee osteoarthritis (KOA) during level walking. We aimed to determine which neuromuscular alterations are consistent in KOA individuals and how these may be influenced by osteoarthritis severity, varus alignment and/or joint laxity. Electronic databases were searched up to July 2012. Cross-sectional observational studies comparing lower-limb neuromuscular activity in individuals with KOA, healthy controls or with different KOA cohorts were included. Two reviewers assessed methodological quality. Effect sizes were used to quantify the magnitude of observed differences. Where studies were homogenous, effect sizes were pooled using a fixed-effects model. Fourteen studies examining neuromuscular alterations in indices of co-contraction, muscle amplitude and muscle activity duration were included. Data pooling revealed that moderate KOA individuals exhibit increased co-contraction of lateral knee muscles (ES 0.64 [0.3 to 0.97]) and moderately increased rectus femoris (ES 0.73 [0.23 to 1.22]), vastus lateralis (ES 0.77 [0.27 to 1.27]) and biceps femoris (ES 1.18 [0.67 to 1.7]) mean amplitude. Non-pooled data indicated prolonged activity of these muscles. Increased medial knee neuromuscular activity was prevalent for those exhibiting varus alignment and medial knee joint laxity. Interpretation Individuals with KOA exhibited increased co-contraction, amplitude and duration of lateral knee muscles regardless of disease severity, limb alignment or medial joint laxity. Individuals with severe disease, varus alignment and medial joint laxity demonstrate up-regulation of medial knee muscles. Future research investigating the efficacy of neuromuscular rehabilitation programs should consider the effect of simultaneous up-regulation of medial and lateral knee muscles on disease progression. © 2013.

Frontal plane stability following UKA in a biomechanical study.

Science.gov (United States)

Heyse, Thomas J; Tucker, Scott M; Rajak, Yogesh; Kia, Mohammad; Lipman, Joseph D; Imhauser, Carl W; Westrich, Geoffrey H

2015-06-01

Function and kinematics following unicondylar knee arthroplasty (UKA) have been reported to be close to the native knee. Gait, stair climbing and activities of daily living expose the knee joint to a combination of varus and valgus moments. Replacement of the medial compartment via UKA is likely to change the physiologic knee stability and its ability to respond to varus and valgus moments. It was hypothesized that UKA implantation would stiffen the knee and decrease range of motion in the frontal plane. Six fresh frozen cadaver knees were prepared and mounted in a six-degrees-of-freedom robot. An axial load of 200 N was applied with the knee in 15°, 45° and 90° of flexion. Varus and valgus moments were added, respectively, before and after implantation of medial UKA. Tests were than redone with a thicker polyethylene inlay to simulate overstuffing of the medial compartment. Range of motion in the frontal plane and the tibial response to moments were recorded via the industrial robot. The range of motion in the frontal plane was decreased with both, balanced and overstuffed UKA and shifted towards valgus. When exposed to valgus moments, knees following UKA were stiffer in comparison with the native knee. The effect was even more pronounced with medial overstuffing. In UKA, the compressive anatomy is replaced by much stiffer components. This lack of medial compression and relative overstuffing leads to a tighter medial collateral ligament. This drives the trend towards a stiffer joint as documented by a decrease in frontal plane range of motion. Overstuffing should strictly be avoided when performing UKA.

Dynamic knee valgus alignment influences impact attenuation in the lower extremity during the deceleration phase of a single-leg landing.

Directory of Open Access Journals (Sweden)

Akihiro Tamura

Full Text Available Dynamic knee valgus during landings is associated with an increased risk of non-contact anterior cruciate ligament (ACL injury. In addition, the impact on the body during landings must be attenuated in the lower extremity joints. The purpose of this study was to investigate landing biomechanics during landing with dynamic knee valgus by measuring the vertical ground reaction force (vGRF and angular impulses in the lower extremity during a single-leg landing. The study included 34 female college students, who performed the single-leg drop vertical jump. Lower extremity kinetic and kinematic data were obtained from a 3D motion analysis system. Participants were divided into valgus (N = 19 and varus (N = 15 groups according to the knee angular displacement during landings. The vGRF and angular impulses of the hip, knee, and ankle were calculated by integrating the vGRF-time curve and each joint's moment-time curve. vGRF impulses did not differ between two groups. Hip angular impulse in the valgus group was significantly smaller than that in the varus group (0.019 ± 0.033 vs. 0.067 ± 0.029 Nms/kgm, p<0.01, whereas knee angular impulse was significantly greater (0.093 ± 0.032 vs. 0.045 ± 0.040 Nms/kgm, p<0.01. There was no difference in ankle angular impulse between the groups. Our results indicate that dynamic knee valgus increases the impact the knee joint needs to attenuate during landing; conversely, the knee varus participants were able to absorb more of the landing impact with the hip joint.

The influence of sex and obesity on gait biomechanics in people with severe knee osteoarthritis scheduled for arthroplasty.

Science.gov (United States)

Paterson, K L; Sosdian, L; Hinman, R S; Wrigley, T V; Kasza, J; Dowsey, M; Choong, P; Bennell, K L

2017-11-01

Sex and body mass may influence knee biomechanics associated with poor total knee arthroplasty (TKA) outcomes for knee osteoarthritis (OA). This study aimed to determine if gait differed between men and women, and overweight and class I obese patients with severe knee OA awaiting TKA. 34 patients with severe knee OA (average age 70.0 (SD 7.2) years, body mass index 30.3 (4.1kg/m 2 )) were recruited from a TKA waiting list. Three-dimensional gait analysis was performed at self-selected walking speed. Comparisons were made between men and women, and overweight (body mass index (BMI) 25.0-29.9kg/m 2 ) and class I obese (BMI 30.0-34.9kg/m 2 ) participants. Biomechanical outcomes included absolute and body size-adjusted peak knee adduction moment (KAM), KAM impulse, peak knee flexion moment, as well as peak knee flexion and varus-valgus angles, peak varus-valgus thrust, and peak vertical ground reaction force (GRF). Men had a higher absolute peak KAM, KAM impulse and peak GRF compared to women, and this sex-difference in frontal plane moments remained after adjusting for body size. However, when additionally adjusting for static knee alignment, differences disappeared. Knee biomechanics were similar between obesity groups after adjusting for the greater body weight of those with class I obesity. Men had greater KAM and KAM impulse even after adjustment for body size; however adjustment for their more varus knees removed this difference. Obesity group did not influence knee joint kinematics or moments. This suggests sex- and obesity-differences in these variables may not be associated with TKA outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

Peripheral dose in photon beams from a linear accelerator with a multileaf collimator

International Nuclear Information System (INIS)

Lope Lope, R.; Lozano Flores, F.; Gracia Sorrosal, J.; Font Gomez, J.A.; Hernandez Vitoria, A.

2001-01-01

Radiation doses outside the radiotherapy treatment field are of radiation protection interest when anatomical structures with very low dose tolerances might be involved. One of the major sources of peripheral dose, scatter from secondary collimators, depends on the configuration of the collimator. In this study, peripheral dose was measured at two depths for 6 and 18 MV photons from a linac Primus (Siemens) with a multileaf collimator (MLC). Comparative measurements were made both with leaves and with the upper jaw positioned at the field edge near to the detector. Configuring the MLC leaves at the field edge yielded a reduction in peripheral dose. (author)

The Validity of a New Low-Dose Stereoradiography System to Perform 2D and 3D Knee Prosthetic Alignment Measurements

NARCIS (Netherlands)

Meijer, Marrigje F.; Velleman, Ton; Boerboom, Alexander L.; Bulstra, Sjoerd K.; Otten, Egbert; Stevens, Martin; Reininga, Inge H. F.

2016-01-01

Introduction The EOS stereoradiography system has shown to provide reliable varus/valgus (VV) measurements of the lower limb in 2D (VV2D) and 3D (VV3D) after total knee arthroplasty (TKA). Validity of these measurements has not been investigated yet, therefore the purpose of this study was to

Epiphyseal involvement in unicameral bone cysts

International Nuclear Information System (INIS)

Capanna, R.; Ruggieri, P.; Biagini, R.; Horn, J. van

1986-01-01

Twelve patients are reported in whom a unicameral bone cyst was found to involve the epiphysis or apophysis across an open growth plate. Nine patients showed pathologic fracture. In four patients a growth disturbance was found. A varying amount of varus angulation was present in most cases. No patient had functional impairment. (orig.)

Epiphyseal involvement in unicameral bone cysts

Energy Technology Data Exchange (ETDEWEB)

Capanna, R.; Ruggieri, P.; Biagini, R.; Horn, J. van

1986-08-01

Twelve patients are reported in whom a unicameral bone cyst was found to involve the epiphysis or apophysis across an open growth plate. Nine patients showed pathologic fracture. In four patients a growth disturbance was found. A varying amount of varus angulation was present in most cases. No patient had functional impairment.

Addis Ababa, Ethiopia

African Journals Online (AJOL)

user

about 1-3/1000 live births on average. The main components of the deformity are: forefoot adduction, hind foot varus, inverted calcaneus under equinus talus, and medial displacement of navicular and cuboid bones. New molecular- biology studies confirmed that the deforming genes are active at the 2nd trimester; hence it ...

Biomechanical evaluation of straight antegrade nailing in proximal humeral fractures: the rationale of the "proximal anchoring point".

Science.gov (United States)

Euler, Simon A; Petri, Maximilian; Venderley, Melanie B; Dornan, Grant J; Schmoelz, Werner; Turnbull, Travis Lee; Plecko, Michael; Kralinger, Franz S; Millett, Peter J

2017-09-01

Varus failure is one of the most common failure modes following surgical treatment of proximal humeral fractures. Straight antegrade nails (SAN) theoretically provide increased stability by anchoring to the densest zone of the proximal humerus (subchondral zone) with the end of the nail. The aim of this study was to biomechanically investigate the characteristics of this "proximal anchoring point" (PAP). We hypothesized that the PAP would improve stability compared to the same construct without the PAP. Straight antegrade humeral nailing was performed in 20 matched pairs of human cadaveric humeri for a simulated unstable two-part fracture. Biomechanical testing, with stepwise increasing cyclic axial loading (50-N increments each 100 cycles) at an angle of 20° abduction revealed significantly higher median loads to failure for SAN constructs with the PAP (median, 450 N; range, 200-1.000 N) compared to those without the PAP (median, 325 N; range, 100-500 N; p = 0.009). SAN constructs with press-fit proximal extensions (endcaps) showed similar median loads to failure (median, 400 N; range, 200-650 N), when compared to the undersized, commercially available SAN endcaps (median, 450 N; range, 200-600 N; p = 0.240). The PAP provided significantly increased stability in SAN constructs compared to the same setup without this additional proximal anchoring point. Varus-displacing forces to the humeral head were superiorly reduced in this setting. This study provides biomechanical evidence for the "proximal anchoring point's" rationale. Straight antegrade humeral nailing may be beneficial for patients undergoing surgical treatment for unstable proximal humeral fractures to decrease secondary varus displacement and thus potentially reduce revision rates.

Do PFNA devices and Intertan nails both have the same effects in the treatment of trochanteric fractures? A prospective clinical study.

Science.gov (United States)

Seyhan, Mustafa; Turkmen, Ismail; Unay, Koray; Ozkut, Afsar Timucin

2015-11-01

To clinically and radiologically compare third-generation intramedullary nails used in the treatment of trochanteric hip fractures and to determine their efficacy. Seventy-five of 88 patients admitted to our hospital with trochanteric fractures were enrolled in the study; 43 were treated with PFNA devices and 32 with Intertan nails. The amount of compression applied during the procedure, duration of the procedure, amount of subsequent shortening in the proximal femoral area, subsequent backup of proximal screws, and changes in the tip-apex and tip-cortex distances were compared between groups. The postoperative change in the varus angle of the proximal femur and times to mobilization, full weight bearing, and fracture union were also evaluated. On early postoperative radiographs, the tip-apex distance was ≤25 mm in 86 % of patients in the PFNA group and 96.9 % of those in the Intertan group. Twelve months postoperatively, the tip-apex distance did not differ between groups. No cut-out of the screws into the coxofemoral joint was observed. Fracture healing was achieved in all patients. At 12 months postoperatively, the rates of proximal screw backup, proximal femoral shortening, and decrease in the varus angle of the proximal femur were significantly higher in the PFNA group than in the Intertan group. Trochanteric fractures may be treated effectively with PFNA devices or Intertan nails. During the healing period, the rates of reverse displacement of the proximal screw, shortening of the proximal femur, and decrease in the varus angle of the proximal femur were significantly higher in the PFNA group than in the Intertan group. Surgical technique, implant positioning, and the choice of implant play roles in the successful treatment of trochanteric fractures. Level 1, prospective, prognostic study.

Assessment of knee laxity using a robotic testing device: a comparison to the manual clinical knee examination.

Science.gov (United States)

Branch, T P; Stinton, S K; Siebold, R; Freedberg, H I; Jacobs, C A; Hutton, W C

2017-08-01

The purpose of this study was to collect knee laxity data using a robotic testing device. The data collected were then compared to the results obtained from manual clinical examination. Two human cadavers were studied. A medial collateral ligament (MCL) tear was simulated in the left knee of cadaver 1, and a posterolateral corner (PLC) injury was simulated in the right knee of cadaver 2. Contralateral knees were left intact. Five blinded examiners carried out manual clinical examination on the knees. Laxity grades and a diagnosis were recorded. Using a robotic knee device which can measure knee laxity in three planes of motion: anterior-posterior, internal-external tibia rotation, and varus-valgus, quantitative data were obtained to document tibial motion relative to the femur. One of the five examiners correctly diagnosed the MCL injury. Robotic testing showed a 1.7° larger valgus angle, 3° greater tibial internal rotation, and lower endpoint stiffness (11.1 vs. 24.6 Nm/°) in the MCL-injured knee during varus-valgus testing when compared to the intact knee and 4.9 mm greater medial tibial translation during rotational testing. Two of the five examiners correctly diagnosed the PLC injury, while the other examiners diagnosed an MCL tear. The PLC-injured knee demonstrated 4.1 mm more lateral tibial translation and 2.2 mm more posterior tibial translation during varus-valgus testing when compared to the intact knee. The robotic testing device was able to provide objective numerical data that reflected differences between the injured knees and the uninjured knees in both cadavers. The examiners that performed the manual clinical examination on the cadaver knees proved to be poor at diagnosing the injuries. Robotic testing could act as an adjunct to the manual clinical examination by supplying numbers that could improve diagnosis of knee injury. Level II.

Clinical Comparison of Extensile Lateral Approach and Sinus Tarsi Approach Combined with Medial Distraction Technique for Intra-Articular Calcaneal Fractures.

Science.gov (United States)

Zhou, Hai-Chao; Yu, Tao; Ren, Hao-Yang; Li, Bing; Chen, Kai; Zhao, You-Guang; Yang, Yun-Feng

2017-02-01

To study and compare the clinical outcomes of open reduction and internal fixation via extensile L-shape incision and limited open reduction via the sinus tarsi approach using the medial distraction technique for intra-articular calcaneal fractures. We performed a retrospective review of 65 intra-articular calcaneal fractures treated operatively between March 2012 and February 2015. Patients were divided into two groups: 28 were in the sinus tarsi approach group and 37 were in the extensile lateral approach group. All patients were asked to return for a research visit that included radiography and clinical evaluation. The postoperative function was evaluated using the ankle and hindfoot score of the American Orthopaedic Foot and Ankle Society (AOFAS) and the visual analogue scale (VAS). No significant difference was found in demographics between the two groups. The corrected value of the calcaneal varus angle between the two groups is statistically significant (P articular calcaneal fractures could reduce the incidence of wound complications effectively, and the medial distraction technique is helpful for correcting the calcaneus varus deformity. © 2017 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

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

Energy Technology Data Exchange (ETDEWEB)

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

2015-03-15

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

Self-reported knee joint instability is related to passive mechanical stiffness in medial knee osteoarthritis.

Science.gov (United States)

Creaby, Mark W; Wrigley, Tim V; Lim, Boon-Whatt; Hinman, Rana S; Bryant, Adam L; Bennell, Kim L

2013-11-20

Self-reported knee joint instability compromises function in individuals with medial knee osteoarthritis and may be related to impaired joint mechanics. The purpose of this study was to evaluate the relationship between self-reported instability and the passive varus-valgus mechanical behaviour of the medial osteoarthritis knee. Passive varus-valgus angular laxity and stiffness were assessed using a modified isokinetic dynamometer in 73 participants with medial tibiofemoral osteoarthritis. All participants self-reported the absence or presence of knee instability symptoms and the degree to which instability affected daily activity on a 6-point likert scale. Forward linear regression modelling identified a significant inverse relationship between passive mid-range knee stiffness and symptoms of knee instability (r = 0.27; P 0.05). Conceivably, a stiffer passive system may contribute toward greater joint stability during functional activities. Importantly however, net joint stiffness is influenced by both active and passive stiffness, and thus the active neuromuscular system may compensate for reduced passive stiffness in order to maintain joint stability. Future work is merited to examine the role of active stiffness in symptomatic joint stability.

Relative biological value of 1α-hydroxycholecalciferol to 25-hydroxycholecalciferol in broiler chicken diets.

Science.gov (United States)

Han, J C; Chen, G H; Zhang, J L; Wang, J G; Qu, H X; Yan, Y F; Yang, X J; Cheng, Y H

2017-07-01

This study was conducted to evaluate the relative biological value (RBV) of 1α-hydroxycholecalciferol (1α-OH-D3) to 25-hydroxycholecalciferol (25-OH-D3) in one- to 21-day-old broiler chickens fed calcium (Ca)- and phosphorus (P)-deficient diets. On the d of hatch, 450 male Ross 308 broiler chickens were weighed and randomly allotted to 9 treatments with 5 replicates of 10 birds per replicate. The basal diet contained 0.50% Ca and 0.25% non-phytate phosphorus (NPP) but was not supplemented with cholecalciferol (vitamin D3). The levels of Ca and NPP in basal diets were lower than those recommended by NRC (1994). 25-OH-D3 was fed at zero, 1.25, 2.5, 5.0, and 10.0 μg/kg, and 1α-OH-D3 was fed at 0.625, 1.25, 2.5, and 5.0 μg/kg. The RBV of 1α-OH-D3 to 25-OH-D3 based on vitamin D intake was determined by the slope ratio method. Results showed that 25-OH-D3 or 1α-OH-D3 improved the growth performance and decreased the mortality in one- to 21-day-old broilers. A linear relationship was observed between the level of 25-OH-D3 or 1α-OH-D3 and mineralization of the femur, tibia, or metatarsus. The RBV of 1α-OH-D3 to 25-OH-D3 were 234, 253, and 202% when the weight, ash weight, and Ca percentage of femur were used as criteria. The corresponding RBV of 1α-OH-D3 to 25-OH-D3 were 232 to 263% and 245 to 267%, respectively, when tibia and metatarsus mineralization were used as criteria. These data indicate that when directly feeding a hormonally active form of vitamin D as 1α-OH-D3 proportionally less is needed than when using the precursor (25-OH-D3) in diets deficient in Ca and P. © 2017 Poultry Science Association Inc.

Radiography of syndactylous limbs of cattle

International Nuclear Information System (INIS)

Taura, Y.; Takeuchi, A.; Uchino, T.

1985-01-01

Fore and hind limbs of 4-month-old Holstein-Friesian cattle ♀ (No.I) and those of 1-month-old Holstein-Friesian×Japanese Black cattle ♀ (No.II) suffering from syndactyly were dissected by means of radiographic examinations. The details were reported as follows. 1. The phalanges of both fore and left hind limbs of No.II cattle were completely fused. But, all the phalanges of left fore limb and proximal phalanges of right fore limb in No.I and the distal phalanges of right hind limb in No.II were normal, the others being of partial synostosis. 2. The distal parforating canal was absent in the metacarpus and the right metatarsus in No.II cattle. Also, in No.II on the distal part of the metacarpal or metatarsal, bone vestiges were noted, not only of the fifth and second metacarpus or metatarsus, but also the mutually jointed phalanges. 3. In No.I cattle, the left fore limb and 4 proximal sesamoid bones and 2 distal sesamoid bones, but the right limb had 4 sesamoid bones and 0 distal one. In No.II cattle, the fore limbs had 2 proximal and 0 distal sesamoid bones, left hind limb had 3 proximal and 0 distal ones, right hind limb had 3 proximal and 1 distal ones. 4. The arteries accommodated the syndactylous deformities. The median and radial arteries were fixed to be descended on to the palmar side of the metacarpus and mutually anastomosed to form a deep palmar arch. arising from the deep palmar arch, two branches (palmar proper digital aa. III and IV) were terminated by the lateral and medial palmar surfaces of the digit, where some anastomosing arches were formed by them. The arteries of the hind limbs were also similar to those of the fore limbs. 5. In radiographic examinations of syndactyly (in No.II) after 7-month feeding, hoof and digital bones were noted to have been developed, but distal phalanges were destructed and left in suspicion of bad prognosis

Dynamic compression plate (DCP) fixation of propagating medial condylar fractures of the third metacarpal/metatarsal bone in 30 racehorses: retrospective analysis (1990-2005).

Science.gov (United States)

Goodrich, L R; Nixon, A J; Conway, J D; Morley, P S; Bladon, B M; Hogan, P M

2014-11-01

An in-depth review of dynamic compression plate (DCP) fixation of propagating medial condyle fractures of the third metacarpus or metatarsus has not been previously reported. To describe the technique, evaluate short-term outcome and long-term race performance of racehorses that underwent DCP fixation for repair of propagating or spiralling medial condylar fractures of the third metacarpal (McIII) or metatarsal (MtIII) bone. Retrospective case series. The surgical case records of 30 horses with propagating fractures of the medial condyle of McIII or MtIII were reviewed. Medical information included: age, breed, sex, presentation, how injury occurred (racing or training), surgical treatment and post operative complications. Racing information included: starts, top 3 placing and career earnings. Long propagating fractures of the medial condyle of Mc/tIII were identified in 23 Thoroughbred (TB) and 7 Standardbred (STB) racehorses. The fracture spiralled proximally in 22 of 30 cases (73%). Standardbreds had a higher propensity for hindlimb involvement (71%), whereas TBs tended to have more front limb involvement (61%). Twelve of 30 (40%) horses raced post surgery. Career earnings were significantly lower for TB horses with medial condylar fractures; $34,916 when compared with the national average of $60,841 (P≤0.03). Overall, horses having DCP fixation for medial condylar fractures had less starts post surgery (3.1 TBs and 5.8 STBs) compared with the national average (7 TBs and 17.3 STBs) and decreased lifetime starts 13.4 (TBs) compared with 17.3 nationally. Propagating medial condyle fractures can be repaired with plate fixation to potentially lessen the risk of catastrophic fracture destabilisation and return to racing can be expected in 40% of horses. Further prospective studies are warranted comparing lag screw fixation with DCP fixation for repair of severe medial condylar fractures of the metacarpus/metatarsus. © 2013 The Authors. Equine Veterinary Journal

Refinement of the Collagen Induced Arthritis Model in Rats by Infrared Thermography

DEFF Research Database (Denmark)

Jasemian, Yousef; Deleuran, Bent Winding; Svendsen, Pia

2011-01-01

correlation between temperature and clinical scores. Conclusion: The thermographic response appeared prior to the clinical signs, suggesting that thermography may be used as a predictive sign for the development of disease. This technique could be a non-invasive, objective, rapid, and reproducible method...... with other clinical parameters such as clinical score and edema and may serve as a method for quantification of the degree of inflammation. Study design: Experimental animal study. Place and Duration of Study: Institute of Biomedicine, University of Aarhus, Denmark between February and March 2010....... Methodology: Arthritis was induced with collagen immunization in sixteen Lewis rats. Four of the animals were treated with dexamethasone to function as negative controls. Clinical scores were based on the magnitude of paw edema. The mean temperature of the hind feet (region covering the metatarsus and tarsus...

Improved accuracy of component alignment with the implementation of image-free navigation in total knee arthroplasty.

Science.gov (United States)

Rosenberger, Ralf E; Hoser, Christian; Quirbach, Sebastian; Attal, Rene; Hennerbichler, Alfred; Fink, Christian

2008-03-01

Accuracy of implant positioning and reconstruction of the mechanical leg axis are major requirements for achieving good long-term results in total knee arthroplasty (TKA). The purpose of the present study was to determine whether image-free computer navigation technology has the potential to improve the accuracy of component alignment in TKA cohorts of experienced surgeons immediately and constantly. One hundred patients with primary arthritis of the knee underwent the unilateral total knee arthroplasty. The cohort of 50 TKAs implanted with conventional instrumentation was directly followed by the cohort of the very first 50 computer-assisted TKAs. All surgeries were performed by two senior surgeons. All patients received the Zimmer NexGen total knee prosthesis (Zimmer Inc., Warsaw, IN, USA). There was no variability regarding surgeons or surgical technique, except for the use of the navigation system (StealthStation) Treon plus Medtronic Inc., Minnesota, MI, USA). Accuracy of implant positioning was measured on postoperative long-leg standing radiographs and standard lateral X-rays with regard to the valgus angle and the coronal and sagittal component angles. In addition, preoperative deformities of the mechanical leg axis, tourniquet time, age, and gender were correlated. Statistical analyses were performed using the SPSS 15.0 (SPSS Inc., Chicago, IL, USA) software package. Independent t-tests were used, with significance set at P alignment between the two cohorts. To compute the rate of optimally implanted prostheses between the two groups we used the chi(2) test. The average postoperative radiological frontal mechanical alignment was 1.88 degrees of varus (range 6.1 degrees of valgus-10.1 degrees of varus; SD 3.68 degrees ) in the conventional cohort and 0.28 degrees of varus (range 3.7 degrees -6.0 degrees of varus; SD 1.97 degrees ) in the navigated cohort. Including all criteria for optimal implant alignment, 16 cases (32%) in the conventional cohort and 31

PRIMUS: INFRARED AND X-RAY AGN SELECTION TECHNIQUES AT 0.2 < z < 1.2

Energy Technology Data Exchange (ETDEWEB)

Mendez, Alexander J.; Coil, Alison L.; Aird, James; Diamond-Stanic, Aleksandar M. [Center for Astrophysics and Space Sciences, Department of Physics, University of California, 9500 Gilman Dr., La Jolla, San Diego, CA 92093 (United States); Moustakas, John [Department of Physics and Astronomy, Siena College, 515 Loudon Road, Loudonville, NY 12211 (United States); Blanton, Michael R. [Center for Cosmology and Particle Physics, Department of Physics, New York University, 4 Washington Place, New York, NY 10003 (United States); Cool, Richard J. [Observatories of the Carnegie Institution for Science, 813 Santa Barbara Street, Pasadena, CA 91101 (United States); Eisenstein, Daniel J. [Harvard College Observatory, 60 Garden St., Cambridge, MA 02138 (United States); Wong, Kenneth C. [Steward Observatory, University of Arizona, 933 N. Cherry Ave., Tucson, AZ 85721 (United States); Zhu Guangtun [Department of Physics and Astronomy, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218 (United States)

2013-06-10

We present a study of Spitzer/IRAC and X-ray active galactic nucleus (AGN) selection techniques in order to quantify the overlap, uniqueness, contamination, and completeness of each. We investigate how the overlap and possible contamination of the samples depend on the depth of both the IR and X-ray data. We use Spitzer/IRAC imaging, Chandra and XMM-Newton X-ray imaging, and spectroscopic redshifts from the PRism MUlti-object Survey to construct galaxy and AGN samples at 0.2 < z < 1.2 over 8 deg{sup 2}. We construct samples over a wide range of IRAC flux limits (SWIRE to GOODS depth) and X-ray flux limits (10 ks to 2 Ms). We compare IR-AGN samples defined using both the IRAC color selection of Stern et al. and Donley et al. with X-ray-detected AGN samples. For roughly similar depth IR and X-ray surveys, we find that {approx}75% of IR-selected AGNs are also identified as X-ray AGNs. This fraction increases to {approx}90% when comparing against the deepest X-ray data, indicating that at most {approx}10% of IR-selected AGNs may be heavily obscured. The IR-AGN selection proposed by Stern et al. suffers from contamination by star-forming galaxies at various redshifts when using deeper IR data, though the selection technique works well for shallow IR data. While similar overall, the IR-AGN samples preferentially contain more luminous AGNs, while the X-ray AGN samples identify a wider range of AGN accretion rates including low specific accretion rate AGNs, where the host galaxy light dominates at IR wavelengths. The host galaxy populations of the IR and X-ray AGN samples have similar rest-frame colors and stellar masses; both selections identify AGNs in blue, star-forming and red, quiescent galaxies.

Subtrochanteric Femoral Fracture during Trochanteric Nailing for the Treatment of Femoral Shaft Fracture

OpenAIRE

Yun, Ho Hyun; Oh, Chi Hun; Yi, Ju Won

2013-01-01

We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nai...

The migration of femoral components after total hip replacement surgery: accuracy and precision of software-aided measurements

International Nuclear Information System (INIS)

Decking, J.; Schuetz, U.; Decking, R.; Puhl, W.

2003-01-01

Objective: To assess the accuracy and precision of a software-aided system to measure migration of femoral components after total hip replacement (THR) on digitised radiographs. Design and patients: Subsidence and varus-valgus tilt of THR stems within the femur were measured on digitised anteroposterior pelvic radiographs. The measuring software (UMA, GEMED, Germany) relies on bony landmarks and comparability parameters of two consecutive radiographs. Its accuracy and precision were calculated by comparing it with the gold standard in migration measurements, radiostereometric analysis (RSA). Radiographs and corresponding RSA measurements were performed in 60 patients (38-69 years) following cementless THR surgery. Results and conclusions: The UMA software measured the subsidence of the stems with an accuracy of ±2.5 mm and varus-valgus tilt with an accuracy of ±1.8 (95% confidence interval). A good interobserver and intraobserver reliability was calculated with Cronbach's alpha ranging from 0.86 to 0.97. Measuring the subsidence of THR stems within the femur is an important parameter in the diagnosis of implant loosening. Software systems such as UMA improve the accuracy of migration measurements and are easy to use on routinely performed radiographs of operated hip joints. (orig.)

Minimally invasive plate osteosynthesis for humeral shaft fractures: are results reproducible?

Science.gov (United States)

Concha, Juan M; Sandoval, Alejandro; Streubel, Philipp N

2010-12-01

Minimally invasive plate osteosynthesis (MIPO) has been advocated as a safe approach to humeral shaft fracture management. We evaluated the reproducibility of this technique in a regional hospital. Thirty-five patients underwent MIPO of humerus shaft fractures. Fifteen patients had an open fracture, six a preoperative radial nerve palsy, and nine a concomitant thoracic, musculoskeletal or vascular injury. At an average 12-month follow-up, 91% of fractures healed after a mean of 12 weeks (range, 8-16). Two infections occurred. Final alignment averaged 4° of varus (range, 5° of valgus to 20° of varus). Active elbow ROM averaged 114° (range, 60-135°) and was less than 100° in nine elbows. Five of six preoperative radial nerve injuries recovered spontaneously. Healing and infection rates in this study are consistent with those reported in the literature. Lower elbow ROM and higher fracture angulation at healing were nevertheless found. MIPO is technically demanding and requires adequate intraoperative imaging and surgical experience in order to obtain adequate fracture alignment. Brachialis muscle scarring and inadequate postoperative rehabilitation may be involved in limited elbow range of motion.

Diagnostic performance of MRI measurements to assess hindfoot malalignment. An assessment of four measurement techniques

Energy Technology Data Exchange (ETDEWEB)

Buck, Florian M.; Hoffmann, Adrienne; Mamisch-Saupe, Nadja; Hodler, Juerg [University Hospital Balgrist and University of Zurich, Radiology, Zuerich (Switzerland); Farshad, Mazda; Espinosa, Norman [University Hospital Balgrist and University of Zurich, Department of Orthopaedic Surgery, Zuerich (Switzerland); Resnick, Donald [University of California San Diego, Department of Radiology, San Diego, CA (United States)

2013-09-15

To investigate the ability of coronal non-weight-bearing MR images to discriminate between normal and abnormal hindfoot alignment. Three different measurement techniques (calcaneal axis, medial/lateral calcaneal contour) based on weight-bearing hindfoot alignment radiographs were applied in 49 patients (mean, 48 years; range 21-76 years). Three groups of subjects were enrolled: (1) normal hindfoot alignment (0 -10 valgus); (2) abnormal valgus (>10 ); (3) any degree of varus hindfoot alignment. Hindfoot alignment was then measured on coronal MR images using four different measurement techniques (calcaneal axis, medial/lateral calcaneal contour, sustentaculum tangent). ROC analysis was performed to find the MR measurement with the greatest sensitivity and specificity for discrimination between normal and abnormal hindfoot alignment. The most accurate measurement on MR images to detect abnormal hindfoot valgus was the one using the medial calcaneal contour, reaching a sensitivity/specificity of 86 %/75 % using a cutoff value of >11 valgus. The most accurate measurement on MR images to detect abnormal hindfoot varus was the sustentaculum tangent, reaching a sensitivity/specificity of 91 %/71 % using a cutoff value of <12 valgus. It is possible to suspect abnormal hindfoot alignment on coronal non-weight-bearing MR images. (orig.)

Diagnostic performance of MRI measurements to assess hindfoot malalignment. An assessment of four measurement techniques

International Nuclear Information System (INIS)

Buck, Florian M.; Hoffmann, Adrienne; Mamisch-Saupe, Nadja; Hodler, Juerg; Farshad, Mazda; Espinosa, Norman; Resnick, Donald

2013-01-01

To investigate the ability of coronal non-weight-bearing MR images to discriminate between normal and abnormal hindfoot alignment. Three different measurement techniques (calcaneal axis, medial/lateral calcaneal contour) based on weight-bearing hindfoot alignment radiographs were applied in 49 patients (mean, 48 years; range 21-76 years). Three groups of subjects were enrolled: (1) normal hindfoot alignment (0 -10 valgus); (2) abnormal valgus (>10 ); (3) any degree of varus hindfoot alignment. Hindfoot alignment was then measured on coronal MR images using four different measurement techniques (calcaneal axis, medial/lateral calcaneal contour, sustentaculum tangent). ROC analysis was performed to find the MR measurement with the greatest sensitivity and specificity for discrimination between normal and abnormal hindfoot alignment. The most accurate measurement on MR images to detect abnormal hindfoot valgus was the one using the medial calcaneal contour, reaching a sensitivity/specificity of 86 %/75 % using a cutoff value of >11 valgus. The most accurate measurement on MR images to detect abnormal hindfoot varus was the sustentaculum tangent, reaching a sensitivity/specificity of 91 %/71 % using a cutoff value of <12 valgus. It is possible to suspect abnormal hindfoot alignment on coronal non-weight-bearing MR images. (orig.)

Case report

African Journals Online (AJOL)

abp

29 avr. 2016 ... universitaire de Avicenne de Rabat entre 2004 et 2013. Les cubitus varus opérés sont tous séquellaires de fractures supra condyliennes de l'extrémité inférieure de l'humérus de stade 3 dans l'enfance. Les patients ont été suivis cliniquement et radiologiquement avec un recul de 38 mois en moyenne.

Predicting positional error of MLC using volumetric analysis

International Nuclear Information System (INIS)

Hareram, E.S.

2008-01-01

IMRT normally using multiple beamlets (small width of the beam) for a particular field to deliver so that it is imperative to maintain the positional accuracy of the MLC in order to deliver integrated computed dose accurately. Different manufacturers have reported high precession on MLC devices with leaf positional accuracy nearing 0.1 mm but measuring and rectifying the error in this accuracy is very difficult. Various methods are used to check MLC position and among this volumetric analysis is one of the technique. Volumetric approach was adapted in our method using primus machine and 0.6cc chamber at 5 cm depth In perspex. MLC of 1 mm error introduces an error of 20%, more sensitive to other methods

Effects of strength and neuromuscular training on functional performance in athletes after partial medial meniscectomy.

Science.gov (United States)

Zhang, Xiaohui; Hu, Min; Lou, Zhen; Liao, Bagen

2017-02-01

The aims of this study were to determine an effective knee function rehabilitation program for athletes undergoing partial medial meniscectomy. Participants were randomly assigned to neuromuscular training (NT) or strength training (ST) group and subjected to functional assessments before surgery and again at 4, and 8 weeks post hoc . Functional knee assessment, such as Lysholm knee scoring, star excursion balance, and BTE PrimusRS isokinetic performance tests were evaluated in each group. All postoperational symptoms were significantly improved after 4 and 8 weeks of NT and ST. Both NT and ST programs showed effective knee function recovery seen as an increase in muscular strength and endurance. However, the NT program showed the most significant functional improvement of dynamic balance and coordination.

The Validity of a New Low-Dose Stereoradiography System to Perform 2D and 3D Knee Prosthetic Alignment Measurements.

Science.gov (United States)

Meijer, Marrigje F; Velleman, Ton; Boerboom, Alexander L; Bulstra, Sjoerd K; Otten, Egbert; Stevens, Martin; Reininga, Inge H F

2016-01-01

The EOS stereoradiography system has shown to provide reliable varus/valgus (VV) measurements of the lower limb in 2D (VV2D) and 3D (VV3D) after total knee arthroplasty (TKA). Validity of these measurements has not been investigated yet, therefore the purpose of this study was to determine validity of EOS VV2D and VV3D. EOS images were made of a lower limb phantom containing a knee prosthesis, while varying VV angle from 15° varus to 15° valgus and flexion angle from 0° to 20°, and changing rotation from 20° internal to 20° external rotation. Differences between the actual VV position of the lower limb phantom and its position as measured on EOS 2D and 3D images were investigated. Rotation, flexion or VV angle alone had no major impact on VV2D or VV3D. Combination of VV angle and rotation with full extension did not show major differences in VV2D measurements either. Combination of flexion and rotation with a neutral VV angle showed variation of up to 7.4° for VV2D; maximum variation for VV3D was only 1.5°. A combination of the three variables showed an even greater distortion of VV2D, while VV3D stayed relatively constant. Maximum measurement difference between preset VV angle and VV2D was 9.8°, while the difference with VV3D was only 1.9°. The largest differences between the preset VV angle and VV2D were found when installing the leg in extreme angles, for example 15° valgus, 20° flexion and 20° internal rotation. After TKA, EOS VV3D were more valid than VV2D, indicating that 3D measurements compensate for malpositioning during acquisition. Caution is warranted when measuring VV angle on a conventional radiograph of a knee with a flexion contracture, varus or valgus angle and/or rotation of the knee joint during acquisition.

How accurate is image-free computer navigation for hip resurfacing arthroplasty? An anatomical investigation

International Nuclear Information System (INIS)

Schnurr, C.; Nessler, J.; Koenig, D.P.; Meyer, C.; Schild, H.H.; Koebke, J.

2009-01-01

The existing studies concerning image-free navigated implantation of hip resurfacing arthroplasty are based on analysis of the accuracy of conventional biplane radiography. Studies have shown that these measurements in biplane radiography are imprecise and that precision is improved by use of three-dimensional (3D) computer tomography (CT) scans. To date, the accuracy of image-free navigation devices for hip resurfacing has not been investigated using CT scans, and anteversion accuracy has not been assessed at all. Furthermore, no study has tested the reliability of the navigation software concerning the automatically calculated implant position. The purpose of our study was to analyze the accuracy of varus-valgus and anteversion using an image-free hip resurfacing navigation device. The reliability of the software-calculated implant position was also determined. A total of 32 femoral hip resurfacing components were implanted on embalmed human femurs using an image-free navigation device. In all, 16 prostheses were implanted with the proposed position generated by the navigation software; the 16 prostheses were inserted in an optimized valgus position. A 3D CT scan was undertaken before and after operation. The difference between the measured and planned varus-valgus angle averaged 1 deg (mean±standard deviation (SD): group I, 1 deg±2 deg; group II, 1 deg±1 deg). The mean±SD difference between femoral neck anteversion and anteversion of the implant was 4 deg (group I, 4 deg±4 deg; group II, 4 deg±3 deg). The software-calculated implant position differed 7 deg±8 deg from the measured neck-shaft angle. These measured accuracies did not differ significantly between the two groups. Our study proved the high accuracy of the navigation device concerning the most important biomechanical factor: the varus-valgus angle. The software calculation of the proposed implant position has been shown to be inaccurate and needs improvement. Hence, manual adjustment of the

Predicted osteotomy planes are accurate when using patient-specific instrumentation for total knee arthroplasty in cadavers: a descriptive analysis.

Science.gov (United States)

Kievit, A J; Dobbe, J G G; Streekstra, G J; Blankevoort, L; Schafroth, M U

2018-06-01

Malalignment of implants is a major source of failure during total knee arthroplasty. To achieve more accurate 3D planning and execution of the osteotomy cuts during surgery, the Signature (Biomet, Warsaw) patient-specific instrumentation (PSI) was used to produce pin guides for the positioning of the osteotomy blocks by means of computer-aided manufacture based on CT scan images. The research question of this study is: what is the transfer accuracy of osteotomy planes predicted by the Signature PSI system for preoperative 3D planning and intraoperative block-guided pin placement to perform total knee arthroplasty procedures? The transfer accuracy achieved by using the Signature PSI system was evaluated by comparing the osteotomy planes predicted preoperatively with the osteotomy planes seen intraoperatively in human cadaveric legs. Outcomes were measured in terms of translational and rotational errors (varus, valgus, flexion, extension and axial rotation) for both tibia and femur osteotomies. Average translational errors between the osteotomy planes predicted using the Signature system and the actual osteotomy planes achieved was 0.8 mm (± 0.5 mm) for the tibia and 0.7 mm (± 4.0 mm) for the femur. Average rotational errors in relation to predicted and achieved osteotomy planes were 0.1° (± 1.2°) of varus and 0.4° (± 1.7°) of anterior slope (extension) for the tibia, and 2.8° (± 2.0°) of varus and 0.9° (± 2.7°) of flexion and 1.4° (± 2.2°) of external rotation for the femur. The similarity between osteotomy planes predicted using the Signature system and osteotomy planes actually achieved was excellent for the tibia although some discrepancies were seen for the femur. The use of 3D system techniques in TKA surgery can provide accurate intraoperative guidance, especially for patients with deformed bone, tailored to individual patients and ensure better placement of the implant.

Prognostic factors and outcome of treatment in Perthes' disease: a prospective study of 368 patients with five-year follow-up.

Science.gov (United States)

Wiig, O; Terjesen, T; Svenningsen, S

2008-10-01

This nationwide prospective study was designed to determine prognostic factors and evaluate the outcome of different treatments of Perthes' disease. A total of 28 hospitals in Norway were instructed to report all new cases of Perthes' disease over a period of five years and 425 patients were reported and followed for five years. Of these, 368 with unilateral disease were included in the present study. The hips were classified radiologically according to a modified two-group Catterall classification and the lateral pillar classification. A total of 358 patients (97%) attended the five-year follow-up, when a modified three-group Stulberg classification was used as a radiological outcome measure. For patients over six years of age at diagnosis and with more than 50% necrosis of the femoral head (152 patients), the surgeons at the different hospitals had chosen one of three methods of treatment: physiotherapy (55 patients), the Scottish Rite abduction orthosis (26), and proximal femoral varus osteotomy (71). Of these hips, 146 (96%) were available for the five-year follow-up. The strongest predictor of outcome was femoral head involvement of more or less than 50% (odds ratio (OR) = 7.76, 95% confidence interval (CI) 2.82 to 21.37), followed by age at diagnosis (OR = 0.98, 95% CI 0.92 to 0.99) and the lateral pillar classification (OR = 0.62, 95% CI 0.40 to 0.98). In children over six years at diagnosis with more than 50% of femoral head necrosis, proximal femoral varus osteotomy gave a significantly better outcome than orthosis (p = 0.001) or physiotherapy (p = 0.001). There was no significant difference between the physiotherapy and orthosis groups (p = 0.36), and we found no difference in outcome after any of the treatments in children under six years (p = 0.73). We recommend proximal femoral varus osteotomy in children aged six years and over at the time of diagnosis with hips having more than 50% femoral head necrosis. The abduction orthosis should be abandoned in

Treatment of medial condylar fractures of the third metatarsus in three horses with fibreglass casts under standing neuroleptanalgesia.

Science.gov (United States)

Lloyd, D; Johanson, C; Phillips, T J

2008-05-03

Minimally displaced condylar fractures propagating into the third metatarsal diaphysis were treated conservatively in one thoroughbred and two Arabian racehorses. In each case a neuroleptanalgesic protocol provided adequate pain relief for a rigid fibreglass cast to be applied in a weight-bearing position. The fractures healed completely and the three horses recovered uneventfully. Two of them returned successfully to racing and the third was used for breeding.

[Sinus tarsi approach combined with medial distraction technique for treatment of intra-articular calcaneus fractures].

Science.gov (United States)

Zhou, Haichao; Ren, Haoyang; Li, Bing; Yu, Tao; Yang, Yunfeng

2016-07-08

?To discuss the effectiveness of limited open reduction via sinus tarsi approach using medial distraction technique in the treatment of intra-articular calcaneus fractures by comparing with open reduction and internal fixation via extensile L-shaped incision. ?A retrospective analysis was made on the clinical data of 21 patients with intra-articular calcaneus fractures treated by sinus tarsi approach combined with medial distraction technique between April 2013 and November 2014 (minimally invasive group), and 32 patients treated by extensile L-shaped incision approach between June 2012 and September 2014 (extensile incision group). No significant difference was found in gender, age, injury pattern, fracture classification, time from injury to operation, preoperative Böhler angle, Gissane angle, calcaneal varus angle, the ankle and hind-foot score of American Orthopaedic Foot and Ankle Society (AOFAS), and visual analogue scale (VAS) score between 2 groups (P>0.05), which was comparable. The operation time, wound complications, and bone healing time were recorded. The postoperative function was also evaluated by AOFAS score and VAS score. The pre-and post-operative Böhler angle, Gissane angle, and calcaneal varus angle were measured on the X-ray films, and the corrective angle was calculated. ?Sixteen patients were followed up 6-18 months (mean, 11.5 months) in the minimally invasive group, and 23 patients for 6-24 months (mean, 13.5 months) in the extensile incision group. Difference was not significant in operation time between 2 groups (t=0.929, P=0.796). No complication occurred in the minimally invasive group; partial skin flap necrosis occurred in 3 cases of the extensile incision group, was cured after dressing change. There was no loosening of implants or reduction loss in 2 groups at last follow-up. Subtalar joint stiffness occurred in 1 case of the minimally invasive group and 4 cases of the extensile incision group, and 1 patient had discomfort for the

Isolated coronoid fracture: Assessment by magnetic resonance imaging for concomitant injuries

Directory of Open Access Journals (Sweden)

Aashay L Kekatpure

2016-01-01

Conclusion: LCL injury was consistent in all isolated coronoid fracture. The forces resulting in the injury appear similar to varus distraction forces acting in the knee leading to distraction injuries of the lateral structures of the knee joint. As concurrent osteochondral injuries and ligamentous injuries are not rare, magnetic resonance analysis serves as an excellent tool for analysis of the ligamentous injuries preoperatively and aids in surgical planning.

PRIMUS: Galaxy clustering as a function of luminosity and color at 0.2 < z < 1

Energy Technology Data Exchange (ETDEWEB)

Skibba, Ramin A.; Smith, M. Stephen M.; Coil, Alison L.; Mendez, Alexander J. [Department of Physics, Center for Astrophysics and Space Sciences, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA 92093 (United States); Moustakas, John [Department of Physics and Astronomy, Siena College, 515 Loudon Road, Loudonville, NY 12211 (United States); Aird, James [Department of Physics, Durham University, Durham DH1 3LE (United Kingdom); Blanton, Michael R. [Center for Cosmology and Particle Physics, Department of Physics, New York University, 4 Washington Place, New York, NY 10003 (United States); Bray, Aaron D.; Eisenstein, Daniel J. [Harvard-Smithsonian Center for Astrophysics, 60 Garden Street, Cambridge, MA 02138 (United States); Cool, Richard J. [MMT Observatory, 1540 E Second Street, University of Arizona, Tucson, AZ 85721 (United States); Wong, Kenneth C. [Steward Observatory, The University of Arizona, 933 North Cherry Avenue, Tucson, AZ 85721 (United States); Zhu, Guangtun, E-mail: rskibba@ucsd.edu [Department of Physics and Astronomy, Johns Hopkins University, 3400 North Charles Street, Baltimore, MD 21218 (United States)

2014-04-01

We present measurements of the luminosity and color-dependence of galaxy clustering at 0.2 < z < 1.0 in the Prism Multi-object Survey. We quantify the clustering with the redshift-space and projected two-point correlation functions, ξ(r{sub p} , π) and w{sub p} (r{sub p} ), using volume-limited samples constructed from a parent sample of over ∼130, 000 galaxies with robust redshifts in seven independent fields covering 9 deg{sup 2} of sky. We quantify how the scale-dependent clustering amplitude increases with increasing luminosity and redder color, with relatively small errors over large volumes. We find that red galaxies have stronger small-scale (0.1 Mpc h {sup –1} < r{sub p} < 1 Mpc h {sup –1}) clustering and steeper correlation functions compared to blue galaxies, as well as a strong color dependent clustering within the red sequence alone. We interpret our measured clustering trends in terms of galaxy bias and obtain values of b {sub gal} ≈ 0.9-2.5, quantifying how galaxies are biased tracers of dark matter depending on their luminosity and color. We also interpret the color dependence with mock catalogs, and find that the clustering of blue galaxies is nearly constant with color, while redder galaxies have stronger clustering in the one-halo term due to a higher satellite galaxy fraction. In addition, we measure the evolution of the clustering strength and bias, and we do not detect statistically significant departures from passive evolution. We argue that the luminosity- and color-environment (or halo mass) relations of galaxies have not significantly evolved since z ∼ 1. Finally, using jackknife subsampling methods, we find that sampling fluctuations are important and that the COSMOS field is generally an outlier, due to having more overdense structures than other fields; we find that 'cosmic variance' can be a significant source of uncertainty for high-redshift clustering measurements.

Bone scintigraphy in renal osteopathy

International Nuclear Information System (INIS)

Hermann, H.J.; Gahl, G.; Freie Univ. Berlin

1976-01-01

25 patients with chronic renal disease are investigated. In 16 cases with conservative treatment the bone scintigram showed pathological uptake according to the creatinine level, mainly in the joints of iliosacrum, hip, knee and ankles. In three patients increased uptake in the skull was found. The bone uptake found by scintigraphy was highly pronounced in the patients treated by dialysis. The most frequently involved regions were the joints of iliocacrum and hip, facial cranium, skull, pelvis and metatarsus. The count-rate ratio of cranium to chest was significantly increased in 6 patients. The investigations 6 months later showed in 4 cases a further increase compared with the first values. Count-rates of the skull were found to be comparable to the highly increased uptake in Paget's disease. Bone scintigraphy is a suitable method to estimate semiquantitatively the bone turnover in renal disease. (orig.) [de

Study of variability in a virtual wedges A.L.E. Primus, measured weekly, for two years; Estudio de la variabilidad de las cunas virtuales en un A. L. E. Primus, medidas semanalmente, dure dos anos

Energy Technology Data Exchange (ETDEWEB)

Sanchez Segovia, J.; Ruiz Vazquez, M.; Carrera Magarino, F.

2011-07-01

We try to analyze the stability of virtual wedges in the daily control of an electron linear accelerator (ALE), measuring weekly each wedge angle and for the two photon energies available on the machine.

Dosimetric properties characterization of silicon diodes used in photon beam radiotherapy

International Nuclear Information System (INIS)

Bizetto, Cesar Augusto

2013-01-01

In the current work it was studied the performance of epitaxial (EPI) and float zone (FZ) silicon diodes as on-line dosimeters for megavoltage (EPI diode) and orthovoltage (EPI and FZ diode) photon beam radiotherapy. In order to be used as dosimeters the diodes were enclosed in black polymethylmethacrylate (PMMA) probes. The devices were then connected, on photovoltaic mode, to an electrometer Keithley® 6517B to allow measurements of the photocurrent. The irradiations were performed with 6 and 18 MV photon beams (Siemens Primus® linear accelerator), 6 and 15 MV (Novalis TX®) and 10, 25, 30 and 50 kV of a Pantak / Seifert X ray radiation device. During the measurements with the Siemens Primus the diodes were held between PMMA plates placed at 10.0 cm depth. When using Novalis TX® the devices were held between solid water plates placed at 50 cm depth. In both cases the diodes were centered in a radiation field of 10 x 10 cm 2 , with the source-to-surface distance (SSD) kept at 100 cm. In measurements with orthovoltage photon beams the diodes were placed 50.0 cm from the tube in a radiation field of 8 cm diameter. The dose-rate dependency was studied for 6 and 15 MV (varying the dose-rate from 100 to 600 monitor units per minute) and for the 50 kV beam by varying the current tube from 2 to 20 mA. All devices showed linear response with dose rate and, within uncertainties the charge collected is independent of dose rate. The current signals induced showed good instantaneous repeatability of the diodes, characterized by coefficients of variation of current (CV) smaller than 1.14% (megavoltage beams) and 0.15% for orthovoltage beams and coefficients of variation of charge (CV) smaller than 1.84% (megavoltage beams) and 1.67% (orthovoltage beams). The dose response curves were quite linear with linear correlation coefficients better than 0.9999 for all diodes. (author)

Dosimetric properties characterization of silicon diodes used in photon beam radiotherapy; Caracterizacao das propriedades dosimetricas de diodos de silicio empregados em radioterapia com feixe de fotons

Energy Technology Data Exchange (ETDEWEB)

Bizetto, Cesar Augusto

2013-07-01

In the current work it was studied the performance of epitaxial (EPI) and float zone (FZ) silicon diodes as on-line dosimeters for megavoltage (EPI diode) and orthovoltage (EPI and FZ diode) photon beam radiotherapy. In order to be used as dosimeters the diodes were enclosed in black polymethylmethacrylate (PMMA) probes. The devices were then connected, on photovoltaic mode, to an electrometer Keithley Registered-Sign 6517B to allow measurements of the photocurrent. The irradiations were performed with 6 and 18 MV photon beams (Siemens Primus Registered-Sign linear accelerator), 6 and 15 MV (Novalis TX Registered-Sign ) and 10, 25, 30 and 50 kV of a Pantak / Seifert X ray radiation device. During the measurements with the Siemens Primus the diodes were held between PMMA plates placed at 10.0 cm depth. When using Novalis TX Registered-Sign the devices were held between solid water plates placed at 50 cm depth. In both cases the diodes were centered in a radiation field of 10 x 10 cm{sup 2}, with the source-to-surface distance (SSD) kept at 100 cm. In measurements with orthovoltage photon beams the diodes were placed 50.0 cm from the tube in a radiation field of 8 cm diameter. The dose-rate dependency was studied for 6 and 15 MV (varying the dose-rate from 100 to 600 monitor units per minute) and for the 50 kV beam by varying the current tube from 2 to 20 mA. All devices showed linear response with dose rate and, within uncertainties the charge collected is independent of dose rate. The current signals induced showed good instantaneous repeatability of the diodes, characterized by coefficients of variation of current (CV) smaller than 1.14% (megavoltage beams) and 0.15% for orthovoltage beams and coefficients of variation of charge (CV) smaller than 1.84% (megavoltage beams) and 1.67% (orthovoltage beams). The dose response curves were quite linear with linear correlation coefficients better than 0.9999 for all diodes. (author)

Dosimetric properties characterization of silicon diodes used in photon beam radiotherapy; Caracterizacao das propriedades dosimetricas de diodos de silicio empregados em radioterapia com fotons

Energy Technology Data Exchange (ETDEWEB)

Bizetto, Cesar Augusto

2013-07-01

In the current work it was studied the performance of epitaxial (EPI) and float zone (FZ) silicon diodes as on-line dosimeters for megavoltage (EPI diode) and orthovoltage (EPI and FZ diode) photon beam radiotherapy. In order to be used as dosimeters the diodes were enclosed in black polymethylmethacrylate (PMMA) probes. The devices were then connected, on photovoltaic mode, to an electrometer KeithleyÒ 6517B to allow measurements of the photocurrent. The irradiations were performed with 6 and 18 MV photon beams (Siemens PrimusÒ linear accelerator), 6 and 15 MV (Novalis TXÒ) and 10, 25, 30 and 50 kV of a Pantak / Seifert X ray radiation device. During the measurements with the Siemens PrimusÒ the diodes were held between PMMA plates placed at 10.0 cm depth. When using Novalis TXÒ the devices were held between solid water plates placed at 50 cm depth. In both cases the diodes were centered in a radiation field of 10 x 10 cm{sup 2}, with the source-to-surface distance (SSD) kept at 100 cm. In measurements with orthovoltage photon beams the diodes were placed 50.0 cm from the tube in a radiation field of 8 cm diameter. The dose-rate dependency was studied for 6 and 15 MV (varying the dose-rate from 100 to 600 monitor units per minute) and for the 50 kV beam by varying the current tube from 2 to 20 mA. All devices showed linear response with dose rate and, within uncertainties the charge collected is independent of dose rate. The current signals induced showed good instantaneous repeatability of the diodes, characterized by coefficients of variation of current (CV) smaller than 1.14% (megavoltage beams) and 0.15% for orthovoltage beams and coefficients of variation of charge (CV) smaller than 1.84% (megavoltage beams) and 1.67% (orthovoltage beams). The dose response curves were quite linear with linear correlation coefficients better than 0.9999 for all diodes. (author)

Unstable elbow dislocations: the description and cadaveric feasibility study of a new surgical technique

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Harris Mark

2015-01-01

Full Text Available Introduction: A small proportion of simple elbow dislocations are grossly unstable and joint congruence is not maintained after reduction. In this rare situation operative treatment is indicated. We describe a new intra articular reconstruction that utilises a slip of triceps tendon to provide immediate stability to the elbow. Methods: We assessed 20 cadaveric elbows, measuring the length of triceps tendon available and required to complete the reconstruction. We then sequentially sectioned the ligamentous stabilisers of an elbow before performing the new technique. We measured the displacement and angulation possible at the elbow before and after the reconstruction. Results: All 20 elbows had sufficient triceps tendon length to complete the new technique. Prior to the reconstruction greater than 30 mm of joint distraction and 90 degrees varus or valgus angulation was possible. Following the reconstruction it was not possible to re-dislocate the elbow. Only 2 mm of joint distraction and 10 degrees of varus or valgus angulation were possible with the triceps graft fixed in position. Discussion: This novel technique elegantly avoids many of the problems associated with current methods. We have demonstrated that it is technically feasible and easy to perform with minimal equipment requirements or costs.

Dynamic osseous scintigraphy in the knee hyper-pressure syndromes

International Nuclear Information System (INIS)

Laurin, J.; Jau, P.; Ferro, L.; Fouque, M.

1997-01-01

This retrospective study of 49 patients, carrying an internal mono-compartmental algic syndrome of the knee, determines the place of the dynamical osseous scintigraphy in three times: in comparison with the pan-goniometry (for 42 of them), in the diagnosis of the hyper-pressure syndrome and in the evaluation of its severity. The vascularization is augmented in 10 patients and the sanguinary pool in 14. Forty eight internal compartments exhibit a tracer hyper-fixation at late times. These anomalies have been classified according to their tibial or condylar localization and intensity, than compared with the pan-goniometric values of the deviation, which in case of a varus, entail an over-pressure risk. These comparisons show a good correlation between the hyper-fixation in the sub-chondral band of the internal tibial plateau and a syndrome of hyper-pressure by deviation in varus, whether this hyper-fixation was moderated and isolated or severe or associated to a condylar image; the intensity of the fixation indicates the severity. The tibial fixation intensity is always superior to that of the rest of compartment, what is essential for the differential diagnosis in case of a simple, without hyper-pressure, arthritis, or other pathology. From this exploration stem 8 osteotomies and 1 prosthesis

Medium-term evaluation of total knee arthroplasty without patellar replacement

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José Wanderley Vasconcelos

2013-06-01

Full Text Available OBJECTIVE: To mid-term evaluate patients who were submitted to total knee arthroplasty without patellar resurfacing. METHODS: It was realized a retrospective cross-sectional study of patients who were submitted to total knee arthroplasty without patellar resurfacing. In all patients clinical examination was done based on the protocol of the Knee Society Scoring System, which assessed pain, range of motion, stability, contraction, knee alignment and function, and radiological evaluation. RESULTS: A total of 36 patients were evaluated. Of these, 07 were operated only on left knee, 12 only on right knee and 17 were operated bilaterally, totaling 53 knees. Ages ranged from 26 to 84 years. Of the 53 knees evaluated, 33 (62.26% had no pain. The maximum flexion range of motion averaged 104.7°. No knee had difficulty in active extension. As to the alignment for anatomical axis twelve knees (22.64% showed deviation between 0° and 4° varus. Thirty-nine (75.49% knees showed pace without restriction and the femorotibial angle ranged between 3° varus and 13° valgus with an average of 5° valgus. The patellar index ranged from 0.2 to 1.1. CONCLUSION: Total knee arthroplasty whitout patellar resurfacing provides good results in mid-term evaluation.

A new captorhinid reptile from the Lower Permian of Oklahoma showing remarkable dental and mandibular convergence with microsaurian tetrapods

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Reisz, R. R.; LeBlanc, Aaron R. H.; Sidor, Christian A.; Scott, Diane; May, William

2015-10-01

The Lower Permian fossiliferous infills of the Dolese Brothers Limestone Quarry, near Richards Spur, Oklahoma, have preserved the most diverse assemblage of Paleozoic terrestrial vertebrates, including small-bodied reptiles and lepospondyl anamniotes. Many of these taxa were previously known only from fragmentary remains, predominantly dentigerous jaw elements and numerous isolated skeletal elements. The recent discovery of articulated skulls and skeletons of small reptiles permits the recognition that dentigerous elements, previously assigned at this locality to the anamniote lepospondyl Euryodus primus, belong to a new captorhinid eureptile, Opisthodontosaurus carrolli gen. et sp. nov. This mistaken identity points to a dramatic level of convergence in mandibular and dental anatomy in two distantly related and disparate clades of terrestrial tetrapods and sheds light on the earliest instance of durophagy in eureptiles.

Subtrochanteric femoral fracture during trochanteric nailing for the treatment of femoral shaft fracture.

Science.gov (United States)

Yun, Ho Hyun; Oh, Chi Hun; Yi, Ju Won

2013-09-01

We report on three cases of subtrochanteric femoral fractures during trochanteric intramedullary nailing for the treatment of femoral shaft fractures. Trochanteric intramedullary nails, which have a proximal lateral bend, are specifically designed for trochanteric insertion. When combined with the modified insertion technique, trochanteric intramedullary nails reduce iatrogenic fracture comminution and varus malalignment. We herein describe technical aspects of trochanteric intramedullary nailing for femoral shaft fractures to improve its application and prevent implant-derived complications.

The Effects of Fatigue, Load Carriage, and Physical Activity History on Musculoskeletal Injury Mechanisms

Science.gov (United States)

2013-09-01

20kg, as described in the ACSM’s Guidelines for Exercise Testing and Prescription [3]. Two minutes of rest was given between trials. The assessment was...injuries during military training. Mil Med, 1999. 164(2): p. 153-6. 3. Thompson, W., ACSM’s Guidelines for Exercise Testing and Prescription. 2009...leads to cartilage degeneration and medial knee osteoarthritis (OA) [5,6,7]. Thus, the long- term effect of repetitive high varus knee loading could

The Validity of a New Low-Dose Stereoradiography System to Perform 2D and 3D Knee Prosthetic Alignment Measurements.

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Marrigje F Meijer

Full Text Available The EOS stereoradiography system has shown to provide reliable varus/valgus (VV measurements of the lower limb in 2D (VV2D and 3D (VV3D after total knee arthroplasty (TKA. Validity of these measurements has not been investigated yet, therefore the purpose of this study was to determine validity of EOS VV2D and VV3D.EOS images were made of a lower limb phantom containing a knee prosthesis, while varying VV angle from 15° varus to 15° valgus and flexion angle from 0° to 20°, and changing rotation from 20° internal to 20° external rotation. Differences between the actual VV position of the lower limb phantom and its position as measured on EOS 2D and 3D images were investigated.Rotation, flexion or VV angle alone had no major impact on VV2D or VV3D. Combination of VV angle and rotation with full extension did not show major differences in VV2D measurements either. Combination of flexion and rotation with a neutral VV angle showed variation of up to 7.4° for VV2D; maximum variation for VV3D was only 1.5°. A combination of the three variables showed an even greater distortion of VV2D, while VV3D stayed relatively constant. Maximum measurement difference between preset VV angle and VV2D was 9.8°, while the difference with VV3D was only 1.9°. The largest differences between the preset VV angle and VV2D were found when installing the leg in extreme angles, for example 15° valgus, 20° flexion and 20° internal rotation.After TKA, EOS VV3D were more valid than VV2D, indicating that 3D measurements compensate for malpositioning during acquisition. Caution is warranted when measuring VV angle on a conventional radiograph of a knee with a flexion contracture, varus or valgus angle and/or rotation of the knee joint during acquisition.

Burnei's technique of femoral neck variation and valgisation by using the intramedullary rod in Osteogenesis imperfecta.

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Georgescu, I; Gavriliu, Șt; Nepaliuc, I; Munteanu, L; Țiripa, I; Ghiță, R; Japie, E; Hamei, S; Dughilă, C; Macadon, M

2014-01-01

Varus or valgus deviations of the femoral neck in osteogenesis imperfecta have been an ignored chapter because the classic correction procedures were applied in medical practice with unsatisfying results. Until the use of telescopic rods, coronal deviations remained unsolved and the distal configuration of the proximal femoral extremity remained uncorrected or partially corrected, which required an extensive use of the wheel chair or bed immobilization of the patient. The concomitant correction of the complex deformities, coxa vara/valga and femoral integrated configuration, have been a progress which allowed the patients to walk with or without support. The purpose of this study is to present the Burnei's technique, a therapeutic alternative in deformity corrections of the varus or valgus hip in children with osteogenesis imperfecta. The paper is about a retrospective study done in a single center, which analyses Burnei technique and other procedures described in literature. The content of the article is based on a 12 years experience on a batch of 51 patients with osteogenesis imperfecta from which 10 patients (13 hips) presented frontal plane deviations of the femoral neck. All the patients with osteogenesis imperfecta who presented coxa vara or valga were submitted to investigations with the purpose of measuring blood loss, the possibility of extending the surgical intervention to the leg, the association of severe deformities of the proximal extremity of the femur and the necessity of postoperative intensive care. Burnei's technique: The operation was first performed in 2002. A subtrochanteric osteotomy was made in an oblique cut, from the internal side to the external side and from proximal to distal for coxa vara, or by using a cuneiform resection associated with muscular disinsertions. Only telescopic rods were used for osteosynthesis. There are a few articles in literature, which approach corrections of vara or valgus deviations in osteogenesis imperfecta

The impact of antegrade intramedullary nailing start site using the SIGN nail in proximal femoral fractures: A prospective cohort study.

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Mustafa Diab, Mohamed; Wu, Hao-Hua; Eliezer, Edmund; Haonga, Billy; Morshed, Saam; Shearer, David W

2018-02-01

In many low and middle-income countries (LMICs) SIGN nail is commonly used for antegrade femoral intramedullary (IM) nailing, using a start site either at the tip of the greater trochanter or piriformis fossa. While a correct start site is considered an essential technical step; few studies have evaluated the impact of using an erroneous start site. This is particularly relevant in settings with limited access to fluoroscopy to aid in creating a nail entry point. The purpose of this study was to evaluate the impact of antegrade SIGN IM nailing start site on radiographic alignment and health-related quality of life. In this prospective cohort study, adult patients with proximal femur fractures (OTA 32, subtrochanteric zone) treated with antegrade IM SIGN nail at Muhimbili Orthopaedic Institute (MOI), Dar es Salaam, Tanzania were enrolled. Start site was determined on the immediate postoperative X-ray and was graded on a continuous scale based on distance of the IM nail center from the greater trochanteric tip. The primary outcome measurement was coronal alignment on the post-operative x-ray. The secondary outcomes were reoperation rates, RUST scores and EQ5D scores at one year follow-up. Seventy-nine patients were enrolled. 50 of them (63.3%) had complete data at 1year and were included in the final data analysis. Of the fifty patients, nine (18%) had IM nails placed laterally, 26 (52%) medially and 15 (30%) directly over the tip of the greater trochanter. Compared to a start site at the tip or medial to the greater trochanter, a lateral start site was 9 times more likely to result in a varus malalignment (95% CI: 1.42-57.70, p=0.021). Lateral start site was associated with varus malalignment. Although lateral start site was not significantly associated with reoperation, varus deformity was associated with higher reoperation rates. Surgeons should consider avoiding a start site lateral to the tip of the greater trochanter or allow the nail to rotate to avoid

Comparison of migration behavior between single and dual lag screw implants for intertrochanteric fracture fixation

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Katonis Pavlos G

2009-05-01

Full Text Available Abstract Background Lag screw cut-out failure following fixation of unstable intertrochanteric fractures in osteoporotic bone remains an unsolved challenge. This study tested if resistance to cut-out failure can be improved by using a dual lag screw implant in place of a single lag screw implant. Migration behavior and cut-out resistance of a single and a dual lag screw implant were comparatively evaluated in surrogate specimens using an established laboratory model of hip screw cut-out failure. Methods Five dual lag screw implants (Endovis, Citieffe and five single lag screw implants (DHS, Synthes were tested in the Hip Implant Performance Simulator (HIPS of the Legacy Biomechanics Laboratory. This model simulated osteoporotic bone, an unstable fracture, and biaxial rocking motion representative of hip loading during normal gait. All constructs were loaded up to 20,000 cycles of 1.45 kN peak magnitude under biaxial rocking motion. The migration kinematics was continuously monitored with 6-degrees of freedom motion tracking system and the number of cycles to implant cut-out was recorded. Results The dual lag screw implant exhibited significantly less migration and sustained more loading cycles in comparison to the DHS single lag screw. All DHS constructs failed before 20,000 cycles, on average at 6,638 ± 2,837 cycles either by cut-out or permanent screw bending. At failure, DHS constructs exhibited 10.8 ± 2.3° varus collapse and 15.5 ± 9.5° rotation around the lag screw axis. Four out of five dual screws constructs sustained 20,000 loading cycles. One dual screw specimens sustained cut-out by medial migration of the distal screw after 10,054 cycles. At test end, varus collapse and neck rotation in dual screws implants advanced to 3.7 ± 1.7° and 1.6 ± 1.0°, respectively. Conclusion The single and double lag screw implants demonstrated a significantly different migration resistance in surrogate specimens under gait loading simulation with

Effects of Knee Alignments and Toe Clip on Frontal Plane Knee Biomechanics in Cycling

Science.gov (United States)

Shen, Guangping; Zhang, Songning; Bennett, Hunter J.; Martin, James C.; Crouter, Scott E.; Fitzhugh, Eugene C.

2018-01-01

Effects of knee alignment on the internal knee abduction moment (KAM) in walking have been widely studied. The KAM is closely associated with the development of medial knee osteoarthritis. Despite the importance of knee alignment, no studies have explored its effects on knee frontal plane biomechanics during stationary cycling. The purpose of this study was to examine the effects of knee alignment and use of a toe clip on the knee frontal plane biomechanics during stationary cycling. A total of 32 participants (11 varus, 11 neutral, and 10 valgus alignment) performed five trials in each of six cycling conditions: pedaling at 80 rpm and 0.5 kg (40 Watts), 1.0 kg (78 Watts), and 1.5 kg (117 Watts) with and without a toe clip. A motion analysis system and a customized instrumented pedal were used to collect 3D kinematic and kinetic data. A 3 × 2 × 3 (group × toe clip × workload) mixed design ANOVA was used for statistical analysis (p < 0.05). There were two different knee frontal plane loading patterns, internal abduction and adduction moment, which were affected by knee alignment type. The knee adduction angle was 12.2° greater in the varus group compared to the valgus group (p = 0.001), yet no difference was found for KAM among groups. Wearing a toe clip increased the knee adduction angle by 0.95º (p = 0.005). The findings of this study indicate that stationary cycling may be a safe exercise prescription for people with knee malalignments. In addition, using a toe clip may not have any negative effects on knee joints during stationary cycling. Key points Varus or valgus alignment did not cause increased frontal-plane knee joint loading, suggesting stationary cycling is a safe exercise. This study supports that using a toe clip did not lead to abnormal frontal-plane knee loading during stationary cycling. Two different knee frontal plane loading patterns, knee abduction and adduction moment, were observed during stationary cycling, which are likely affected by

Altered Knee and Ankle Kinematics During Squatting in Those With Limited Weight-Bearing–Lunge Ankle-Dorsiflexion Range of Motion

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Dill, Karli E.; Begalle, Rebecca L.; Frank, Barnett S.; Zinder, Steven M.; Padua, Darin A.

2014-01-01

Context: Ankle-dorsiflexion (DF) range of motion (ROM) may influence movement variables that are known to affect anterior cruciate ligament loading, such as knee valgus and knee flexion. To our knowledge, researchers have not studied individuals with limited or normal ankle DF-ROM to investigate the relationship between those factors and the lower extremity movement patterns associated with anterior cruciate ligament injury. Objective: To determine, using 2 different measurement techniques, whether knee- and ankle-joint kinematics differ between participants with limited and normal ankle DF-ROM. Design: Cross-sectional study. Setting: Sports medicine research laboratory. Patients or Other Participants: Forty physically active adults (20 with limited ankle DF-ROM, 20 with normal ankle DF-ROM). Main Outcome Measure(s): Ankle DF-ROM was assessed using 2 techniques: (1) nonweight-bearing ankle DF-ROM with the knee straight, and (2) weight-bearing lunge (WBL). Knee flexion, knee valgus-varus, knee internal-external rotation, and ankle DF displacements were assessed during the overhead-squat, single-legged squat, and jump-landing tasks. Separate 1-way analyses of variance were performed to determine whether differences in knee- and ankle-joint kinematics existed between the normal and limited groups for each assessment. Results: We observed no differences between the normal and limited groups when classifying groups based on nonweight-bearing passive-ankle DF-ROM. However, individuals with greater ankle DF-ROM during the WBL displayed greater knee-flexion and ankle-DF displacement and peak knee flexion during the overhead-squat and single-legged squat tasks. In addition, those individuals also demonstrated greater knee-varus displacement during the single-legged squat. Conclusions: Greater ankle DF-ROM assessed during the WBL was associated with greater knee-flexion and ankle-DF displacement during both squatting tasks as well as greater knee-varus displacement during

Taxonomic notes on the crab spider genera Stephanopoides and Isaloides (Araneae: Thomisidae: Stephanopinae).

Science.gov (United States)

Teixeira, Renato Augusto; Barros, Bruno Augusto Reis

2015-05-08

According to current catalogues, two species are allocated to the genus Parastephanops F. O. Pickard-Cambridge, 1900. The examination of the type of Parastephanops cognatus (O. Pickard-Cambridge, 1892) (type-species of Parastephanops) has revealed the presence of a high cephalic region, legs with dark metatarsus and apex of tibia, and triangular epigynum with median ridge, all diagnostic features of Stephanopoides Keyserling, 1880. However, the female of P. echinatus (Banks, 1914) has a low cephalic region, a median ocular quadrangle longer than wide and a large atrium of the epigynum, which are diagnostic features of Isaloides F. O. Pickard-Cambridge, 1900. Thus, Parastephanops is synonymized with Stephanopoides and its two species, P. cognatus and P. echinatus, are redescribed, illustrated and assigned to Stephanopoides and Isaloides, respectively. We also propose that Pyresthesis berlandi Caporiacco, 1947 is a junior synonym of Stephanopoides simoni Keyserling, 1880 based on shape and arrangement of the epigynal plate, copulatory ducts and spermathecae.

[Which foot deformities should be radiologist be familiar with?

Science.gov (United States)

von Stillfried, E

2018-05-01

Most deformities of the foot are visible at birth and can be diagnosed without imaging. They can be divided into congenital flexible, congenital structural and acquired foot deformities. The most common congenital flexible foot deformity in children is the metatarsus adductus, which usually requires no long-term therapy. Regarding congenital structural deformities, such as the clubfoot and talus verticalis, plaster therapy should be started during the first week of life, so that by the end of the first year of life and the beginning of the verticalization, a pain-free resilient foot with normal function is present. Imaging is usually only necessary if a relapse arises. Coalitio of the tarsal bones is often visible only in the course of growth through the development of a rigid flatfoot and always requires imaging to confirm the diagnosis. This article is intended to give the radiologist an overview of the most important deformities and to inform about their course and therapy.

A gigantic new dinosaur from Argentina and the evolution of the sauropod hind foot.

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González Riga, Bernardo J; Lamanna, Matthew C; Ortiz David, Leonardo D; Calvo, Jorge O; Coria, Juan P

2016-01-18

Titanosauria is an exceptionally diverse, globally-distributed clade of sauropod dinosaurs that includes the largest known land animals. Knowledge of titanosaurian pedal structure is critical to understanding the stance and locomotion of these enormous herbivores and, by extension, gigantic terrestrial vertebrates as a whole. However, completely preserved pedes are extremely rare among Titanosauria, especially as regards the truly giant members of the group. Here we describe Notocolossus gonzalezparejasi gen. et sp. nov. from the Upper Cretaceous of Mendoza Province, Argentina. With a powerfully-constructed humerus 1.76 m in length, Notocolossus is one of the largest known dinosaurs. Furthermore, the complete pes of the new taxon exhibits a strikingly compact, homogeneous metatarsus--seemingly adapted for bearing extraordinary weight--and truncated unguals, morphologies that are otherwise unknown in Sauropoda. The pes underwent a near-progressive reduction in the number of phalanges along the line to derived titanosaurs, eventually resulting in the reduced hind foot of these sauropods.

Short term outcome of varus derotation osteotomy in late presenting perthes disease

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Narendra Joshi

2018-01-01

Full Text Available Background: Untreated Perthes disease can lead to osteoarthritis by the fourth decade. The treatment is conservative for children 10 years of age at presentation. All patients had limitation of abduction and internal rotation. Eight patients (53.33% had pain at the hip and 12 patients (80% had limp. Mean time between diagnosis and corrective surgery was 3 weeks. Results: The evaluation was done using caput index (CI and epiphyseal quotient (EQ and articulotrochanteric distance radiologically, range of motion and Harris Hip Score for clinical outcome. All the measurements were carried out on pre- and postoperative X-rays after 3 years followup and compared with the contralateral normal hip. After a mean followup period of 3.4 years, we noted the statistically significant difference between pre- and postoperative values. We noted that all (100% children in Stage IB, IIA and 50% children in Stage IIB achieved satisfactory results. There was a significant change (P = 0.000 in CI among all the patients after surgery. The final EQ after 3 years of VDRO was 0.606 and was significant (P = 0.0000. Conclusion: In our opinion, based on the encouraging short term radiological and clinical outcomes, VDRO may be regarded as a treatment procedure for late presenting Perthes disease in stage IB, IIA, IIB.

Revision with suture-tape augmentation after failed collateral ligament reconstruction for chronic interphalangeal instability of the hallux.

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Cho, Byung-Ki; Park, Ji-Kang; Choi, Seung-Myung; SooHoo, Nelson F

2017-12-01

Chronic varus instability or recurrent subluxation following isolated interphalangeal dislocation of the hallux is a rare injury. No consensus has been reached regarding the best joint-salvage procedure for patients with the failed collateral ligament reconstruction using tendon graft. We report a case who achieved satisfactory clinical outcome through a modified surgical procedure (revision collateral ligament reconstruction augmented with suture-tape). Copyright © 2017 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

Assessment of Energy Storage Alternatives in the Puget Sound Energy System

Energy Technology Data Exchange (ETDEWEB)

Balducci, Patrick J. [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Jin, Chunlian [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Wu, Di [Pacific Northwest National Lab. (PNNL), Richland, WA (United States); Leslie, Patrick [Puget Sound Energy, Bellevue, WA (United States); Daitch, Charles [Puget Sound Energy, Bellevue, WA (United States); Marshall, A. [Primus Power, Hayward, CA (United States)

2013-12-01

As part of an ongoing study co-funded by the Bonneville Power Administration, under its Technology Innovation Grant Program, and the U.S. Department of Energy, the Pacific Northwest National Laboratory (PNNL) has developed an approach and modeling tool for assessing the net benefits of using energy storage located close to the customer in the distribution grid to manage demand. PNNL in collaboration with PSE and Primus Power has evaluated the net benefits of placing a zinc bromide battery system at two locations in the PSE system (Baker River / Rockport and Bainbridge Island). Energy storage can provide a number of benefits to the utility through the increased flexibility it provides to the grid system. Applications evaluated in the assessment include capacity value, balancing services, arbitrage, distribution deferral and outage mitigation. This report outlines the methodology developed for this study and Phase I results.

Fixator-assisted medial tibial plateau elevation to treat severe Blount's disease: outcomes at maturity.

Science.gov (United States)

Fitoussi, F; Ilharreborde, B; Lefevre, Y; Souchet, P; Presedo, A; Mazda, K; Penneçot, G F

2011-04-01

Severe forms of Blount's disease may be associated with medial tibial plateau (MTP) depression. Management should then take account of joint congruence, laxity, limb axis, torsional abnomality, leg length discrepancy (LLD) and eventual recurrence history. Eight knees (six patients) were managed in a single step comprising MTP elevation osteotomy, lateral epiphysiodesis and proximal tibia osteotomy to correct varus and rotational deformity. Fixation was achieved using an Ilizarov external fixator. Mean age was 10.5 years. Mean hip-knee-ankle (HKA) angle was 151°; distal femoral varus, 94°; metaphyseal-diaphyseal angle (MDA), 27°; and angle of depression of the medial tibial plateau (ADMTP), 42°. Predicted residual proximal tibial growth was 2.6 cm. At a mean 48 months' follow-up, results were good in six cases, medium in one and poor (due to incomplete lateral epiphysiodesis) in one. Mean lateral tibial torsion was 9° and final LLD 11 mm. Weight-bearing was resumed at 2 months, and the fixator was removed at 5.5 months postoperatively. At end of follow-up, mean HKA angle was 179.6°, MDA 7.3° and ADMTP 5.4°. This technically demanding procedure gave satisfactory results in terms of axes and congruence; longer term assessment remains needed. Level IV. Retrospective study. Copyright © 2011 Elsevier Masson SAS. All rights reserved.

Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure.

Science.gov (United States)

Pagenstert, Geert; Hintermann, Beat

2011-10-13

Simultaneous osteoarthritis (OA) of the ankle joint complicates primary total knee arthroplasty (TKA). In such cases, rehabilitation of TKA is limited by debilitating ankle pain, but varus or valgus ankle arthritis may even compromise placement of knee prosthetic components. We present a patient with simultaneous bilateral valgus and patellofemoral OA of the knees and bilateral varus OA of the ankle joints that equally contributed to overall disability. This 63 years old, motivated and otherwise healthy patient was treated by simultaneous bilateral total knee and ankle arthroplasty (quadruple total joint arthroplasty, TJA) during the same anesthesia. Two years outcome showed excellent alignment and function of all four replaced joints. Postoperative time for rehabilitation, back to work (6th week) and hospital stay (12 days) of this special patient was markedly reduced compared to the usual course of separate TJA. Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient.

Effect of cranial cruciate ligament deficiency, tibial plateau leveling osteotomy, and tibial tuberosity advancement on contact mechanics and alignment of the stifle in flexion.

Science.gov (United States)

Kim, Stanley E; Pozzi, Antonio; Banks, Scott A; Conrad, Bryan P; Lewis, Daniel D

2010-04-01

To assess contact mechanics and 3-dimensional (3-D) joint alignment in cranial cruciate ligament (CCL)-deficient stifles before and after tibial plateau leveling osteotomy (TPLO) and tibial tuberosity advancement (TTA) with the stifle in 90 degrees of flexion. In vitro biomechanical study. Cadaveric pelvic limb pairs (n=8) from dogs weighing 28-35 kg. Contralateral limbs were assigned to receive TPLO or TTA. Digital pressure sensors were used to measure femorotibial contact area, peak and mean contact pressure, and peak pressure location with the limb under a load of 30% body weight and stifle flexion angle of 90 degrees . 3-D poses were obtained using a Microscribe digitizer. Specimens were tested under normal, CCL deficient, and treatment conditions. Significant disturbances in alignment were not observed after CCL transection, although medial contact area was 10% smaller than normal (P=.003). There were no significant differences in contact mechanics or alignment between normal and TTA conditions; TPLO induced 6 degrees varus angulation (PCranial tibial subluxation is nominal in CCL-deficient stifles loaded in flexion. Stifle alignment and contact mechanics are not altered by TTA, whereas TPLO causes mild varus and a subsequent increase in medial compartment loading. Cranial tibial subluxation of CCL-deficient stifles may not occur during postures that load the stifle in flexion. The significance of minor changes in loading patterns after TPLO is unknown.

Autogenous cultured growth plate chondrocyte transplantation in the treatment of physeal injury in rabbits.

Science.gov (United States)

Tomaszewski, R; Bohosiewicz, J; Gap, A; Bursig, H; Wysocka, A

2014-11-01

The aim of this experimental study on New Zealand's white rabbits was to investigate the transplantation of autogenous growth plate cells in order to treat the injured growth plate. They were assessed in terms of measurements of radiological tibial varus and histological characteristics. An experimental model of plate growth medial partial resection of the tibia in 14 New Zealand white rabbits was created. During this surgical procedure the plate growth cells were collected and cultured. While the second surgery was being performed, the autologous cultured growth plate cells were grafted at the right tibia, whereas the left tibia was used as a control group. Histological examinations showed that the grafted right tibia presented the regular shape of the plate growth with hypertrophic maturation, chondrocyte columniation and endochondral calcification. Radiological study shows that the mean tibial deformity at the left angle was 20.29° (6.25 to 33) and 7.21° (5 to 10) in the right angle. This study has demonstrated that grafting of autogenous cultured growth plate cells into a defect of the medial aspect of the proximal tibial physis can prevent bone bridge formation, growth arrest and the development of varus deformity. Cite this article: Bone Joint Res 2014;3:310-16. ©2014 The British Editorial Society of Bone & Joint Surgery.

Trunnion Corrosion and Early Failure in Monolithic Metal-on-Polyethylene TMZF Femoral Components: A Case Series

Directory of Open Access Journals (Sweden)

Peter Walker

2016-09-01

Full Text Available We describe four patients who were treated with primary total hip arthroplasty (THA at two tertiary academic Australian teaching hospitals that experienced premature failure of head-neck trunnions through dissociation of the head-neck taper junction. This retrospective case series have similar clinical presentations and macroscopic pathology with severe head-neck taper junction loss of material, corrosion and early catastrophic failure. It is proposed that the accelerated wear is related to use of varus offset neck in a proprietary beta titanium alloy (Ti-12Mo-6Zr-2Fe  or TMZFÒ Stryker Osteonics, Mahwah NJ, USA TMZF femoral stem, longer head-neck combination in a relatively active, older, male patient population. In this limited case series presentation was on average 80 months (range 53-92 following index procedure. In three of the four patients, a prodromal period of groin or buttock pain was reported for between 1 week and 2 months prior to acute presentation. Significant metallosis and local tissue damage including gluteal muscle insufficiency was evident. Each stem revised was well fixed. An extended trochanteric osteotomy was required in two of the four cases for stem extraction. We recommend caution and further evaluation on the relationship between TMZF metal alloy and its longevity in higher demand patients with high neck offset, varus stem geometry and large CoCr bearing heads.

Does Tibial Slope Affect Perception of Coronal Alignment on a Standing Anteroposterior Radiograph?

Science.gov (United States)

Schwartz, Adam J; Ravi, Bheeshma; Kransdorf, Mark J; Clarke, Henry D

2017-07-01

A standing anteroposterior (AP) radiograph is commonly used to evaluate coronal alignment following total knee arthroplasty (TKA). The impact of coronal alignment on TKA outcomes is controversial, perhaps due to variability in imaging and/or measurement technique. We sought to quantify the effect of image rotation and tibial slope on coronal alignment. Using a standard extramedullary tibial alignment guide, 3 cadaver legs were cut to accept a tibial tray at 0°, 3°, and 7° of slope. A computed tomography scan of the entire tibia was obtained for each specimen to confirm neutral coronal alignment. Images were then obtained at progressive 10° intervals of internal and external rotation up to 40° maximum in each direction. Images were then randomized and 5 blinded TKA surgeons were asked to determine coronal alignment. Continuous data values were transformed to categorical data (neutral [0], valgus [L], and varus [R]). Each 10° interval of external rotation of a 7° sloped tibial cut (or relative internal rotation of a tibial component viewed in the AP plane) resulted in perception of an additional 0.75° of varus. The slope of the proximal tibia bone cut should be taken into account when measuring coronal alignment on a standing AP radiograph. Copyright © 2017 Elsevier Inc. All rights reserved.

Correlation between Ahlbäck radiographic classification and anterior cruciate ligament status in primary knee arthrosis

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Glaucus Cajaty Martins

Full Text Available ABSTRACT OBJECTIVE: To correlate the Ahlbäck radiographic classification with the anterior cruciate ligament (ACL status in knee arthritis patients. METHODS: The study evaluated 89 knees of patients who underwent total knee arthroplasty due to primary osteoarthritis: 16 male and 69 females, with mean age 69.79 years (53-87 years. Osteoarthritis was classified radiographically by the Ahlbäck radiographic classification into five grades. The ACL was classified in the surgery as present or absent. The correlation of ACL status and Ahlbäck classification was assessed, as well as those of ACL status and the parameters age, gender, and tibiofemoral angulation (varus-valgus. RESULTS: In cases of varus knees, there was a correlation between grades I to III and ACL presence in 41/47 (86.7% cases and between grades IV and V and ACL absence in 15/17 (88.2% cases (p < 0.0001. In valgus knees, no statistically significant correlation was observed between the ACL status and the Ahlbäck classification. In the present study, absence of the ACL was more common in men (9/17; 52% than in women (19/72; 26%. CONCLUSION: In cases of medial osteoarthritis, the Ahlbäck radiographic classification is a useful parameter to predict ACL status (presence or absence. In gonarthritis in genu valgum, ACL status was not predicted by Ahlbäck's classification.

Simultaneous bilateral total knee and ankle arthroplasty as a single surgical procedure

Directory of Open Access Journals (Sweden)

Hintermann Beat

2011-10-01

Full Text Available Abstract Background Simultaneous osteoarthritis (OA of the ankle joint complicates primary total knee arthroplasty (TKA. In such cases, rehabilitation of TKA is limited by debilitating ankle pain, but varus or valgus ankle arthritis may even compromise placement of knee prosthetic components. Case presentation We present a patient with simultaneous bilateral valgus and patellofemoral OA of the knees and bilateral varus OA of the ankle joints that equally contributed to overall disability. This 63 years old, motivated and otherwise healthy patient was treated by simultaneous bilateral total knee and ankle arthroplasty (quadruple total joint arthroplasty, TJA during the same anesthesia. Two years outcome showed excellent alignment and function of all four replaced joints. Postoperative time for rehabilitation, back to work (6th week and hospital stay (12 days of this special patient was markedly reduced compared to the usual course of separate TJA. Conclusions Simultaneous quadruple TJA in equally disabling OA of bilateral deformed knees and ankles resulted in a better functional outcome and faster recovery compared to the average reported results after TKA and TAA in literature. However, careful preoperative planning, extensive patient education, and two complete surgical teams were considered essential for successful performance. To the best of our knowledge this is the first case report in literature about quadruple major total joint arthroplasty implanted during the same anesthesia in the same patient.

Twice cutting method reduces tibial cutting error in unicompartmental knee arthroplasty.

Science.gov (United States)

Inui, Hiroshi; Taketomi, Shuji; Yamagami, Ryota; Sanada, Takaki; Tanaka, Sakae

2016-01-01

Bone cutting error can be one of the causes of malalignment in unicompartmental knee arthroplasty (UKA). The amount of cutting error in total knee arthroplasty has been reported. However, none have investigated cutting error in UKA. The purpose of this study was to reveal the amount of cutting error in UKA when open cutting guide was used and clarify whether cutting the tibia horizontally twice using the same cutting guide reduced the cutting errors in UKA. We measured the alignment of the tibial cutting guides, the first-cut cutting surfaces and the second cut cutting surfaces using the navigation system in 50 UKAs. Cutting error was defined as the angular difference between the cutting guide and cutting surface. The mean absolute first-cut cutting error was 1.9° (1.1° varus) in the coronal plane and 1.1° (0.6° anterior slope) in the sagittal plane, whereas the mean absolute second-cut cutting error was 1.1° (0.6° varus) in the coronal plane and 1.1° (0.4° anterior slope) in the sagittal plane. Cutting the tibia horizontally twice reduced the cutting errors in the coronal plane significantly (Pcutting the tibia horizontally twice using the same cutting guide reduced cutting error in the coronal plane. Copyright © 2014 Elsevier B.V. All rights reserved.

Evaluation of clinical methods for peroneal muscle testing.

Science.gov (United States)

Sarig-Bahat, Hilla; Krasovsky, Andrei; Sprecher, Elliot

2013-03-01

Manual muscle testing of the peroneal muscles is well accepted as a testing method in musculoskeletal physiotherapy for the assessment of the foot and ankle. The peroneus longus and brevis are primary evertors and secondary plantar flexors of the ankle joint. However, some international textbooks describe them as dorsi flexors, when instructing peroneal muscle testing. The identified variability raised a question whether these educational texts are reflected in the clinical field. The purposes of this study were to investigate what are the methods commonly used in the clinical field for peroneal muscle testing and to evaluate their compatibility with functional anatomy. A cross-sectional study was conducted, using an electronic questionnaire sent to 143 Israeli physiotherapists in the musculoskeletal field. The survey questioned on the anatomical location of manual resistance and the combination of motions resisted. Ninety-seven responses were received. The majority (69%) of respondents related correctly to the peronei as evertors, but asserted that resistance should be located over the dorsal aspect of the fifth metatarsus, thereby disregarding the peroneus longus. Moreover, 38% of the respondents described the peronei as dorsi flexors, rather than plantar flexors. Only 2% selected the correct method of resisting plantarflexion and eversion at the base of the first metatarsus. We consider this technique to be the most compatible with the anatomy of the peroneus longus and brevis. The Fisher-Freeman-Halton test indicated that there was a significant relationship between responses on the questions (P = 0.0253, 95% CI 0.0249-0.0257), thus justifying further correspondence analysis. The correspondence analysis found no clustering of the answers that were compatible with anatomical evidence and were applied in the correct technique, but did demonstrate a common error, resisting dorsiflexion rather than plantarflexion, which was in agreement with the described

MISCELLANEOUS BOTANICAL NOTES 2

Directory of Open Access Journals (Sweden)

A.J.G.H KOSTERMANS

2014-01-01

Full Text Available 1.   Durio  cupreus Ridley is considered to  represent a  distinct  species.2.   Durio wyatt-smithii Kosterm. is reported from Borneo.3.   Machilus nervosa Merr. represents Meliosma bontoeensis Merr.4.   Beilschmiedia brassii Allen represents Vavaea brassii (Allen Kosterm.5.   The author of the generic name Heritiera is Aiton.6.   Heritiera macrophylla (non Wall. Merr. is conspecific with H. ungus-tata Pierre.7.   Some specimens from N. Celebes, attributed formerly to H. sylvatica Merr., belong to H. arafurensis Kosterm.8.   Additional note on Heritiera littoralis Ait. and H. macrophylla Wall, ex Kurz.9.   Heritiera   montana   Kosterm.,   nov.   spec,   from   New   Guinea   and H. khidii Kosterm., nov. spec, from Northern Siam.10.   Additional note on Heritiera, novoguineensis Kosterm. and H. pereo-riacea Kosterm. and an undescribed species.11.   Heritiera acuminata Wall, ex Kurz represents a distinct species.12.   Heritiera  solomonensis  Kosterm.,  nov.  spec,  from the  Solomon  Isl.13.   A note on Firmiana bracteata A. DC.14.   Firmiana fulgens (Wall, ex King  Corner is based on a mixtum com-positum and has been the source of constant confusion. For the element, which occurs in Malaysia a new name is coined: F. malayana Kosterm. It does not occur in Tenasserim.15.   A revised bibliography of Firmiana colorata R. Br., F. pallens Stearn and F. malayana Kosterm. is presented.16.   Additional note on Firmiana hainanensis Kosterm.17.   Firmiana kerrii (Craib Kosterm., comb, nov., based on Sterculia kerrii Craib.18.   Additional specimens of Firmiana papuana Mildbr.19.   Cryptocarya hintonii Allen is referred to Primus as Primus hintonii (Allen  Kosterm.20.   Beilschmiedia wallichiana (G. Don   Kosterm., based on Sideroxylon wallichianum, G. Don, is described. Formerly it was relegated to Litsea by Kurz.21.   New species in Lauraceae: Beilschmiedia aborensis Kosterm., B

Neurologic disturbances in case of breast cancer disseminated into cranial bones

International Nuclear Information System (INIS)

Tarasyuk, S.V.; Letyagin, V.P.

1986-01-01

The paper presents data on 52 cases of breast cancer disseminated into cranial vault bones (2 into the orbit). Metastases into the brain (2) and meninges (6) were detected in 17 cases with the aid of computerized tomography of the brain and examination of cerebrospinal fluid. The latter cases were not included into the study group. Metastases into cranial bones were identified by craniography and scanning of the skeleton. Half the patients (18 out of 35) revealed the following neurologic syndromes which were determined by the site of metastases into cranial vault bones and tumour growth pattern (into cranial cavity or soft tissues of the head): lesions in ramus primus nervi trigemini, greater occipital nerve, migraine, pseudotumorous and pseudoencephalitic syndromes. Cases of such neurologic disorders require an all-round examination including ophthalmooscopy, EEG, computerized tomography of the brain, craniography and scanning of the skeleton

Monte Carlo simulation of a medical linear accelerator for radiotherapy use

International Nuclear Information System (INIS)

Serrano, B.; Hachem, A.; Franchisseur, E.; Herault, J.; Marcie, S.; Costa, A.; Bensadoun, R. J.; Barthe, J.; Gerard, J. P.

2006-01-01

A Monte Carlo code MCNPX (Monte Carlo N-particle) was used to model a 25 MV photon beam from a PRIMUS (KD2-Siemens) medical linear electron accelerator at the Centre Antoine Lacassagne in Nice. The entire geometry including the accelerator head and the water phantom was simulated to calculate the dose profile and the relative depth-dose distribution. The measurements were done using an ionisation chamber in water for different square field ranges. The first results show that the mean electron beam energy is not 19 MeV as mentioned by Siemens. The adjustment between the Monte Carlo calculated and measured data is obtained when the mean electron beam energy is ∼15 MeV. These encouraging results will permit to check calculation data given by the treatment planning system, especially for small fields in high gradient heterogeneous zones, typical for intensity modulated radiation therapy technique. (authors)

The Impact of Osseous Malalignment and Realignment Procedures in Knee Ligament Surgery: A Systematic Review of the Clinical Evidence.

Science.gov (United States)

Tischer, Thomas; Paul, Jochen; Pape, Dietrich; Hirschmann, Michael T; Imhoff, Andreas B; Hinterwimmer, Stefan; Feucht, Matthias J

2017-03-01

Failure rates of knee ligament surgery may be high, and the impact of osseous alignment on surgical outcome remains controversial. Basic science studies have demonstrated that osseous malalignment can negatively affect ligament strain and that realignment procedures may improve knee joint stability. The purpose of this review was to summarize the clinical evidence concerning the impact of osseous malalignment and realignment procedures in knee ligament surgery. The hypotheses were that lower extremity malalignment would be an important contributor to knee ligament surgery failure and that realignment surgery would contribute to increased knee stability and improved outcome in select cases. Systematic review; Level of evidence, 4. According to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, a systematic electronic search of the PubMed database was performed in November 2015 to identify clinical studies investigating (A) the influence of osseous alignment on postoperative stability and/or failure rates after knee ligament surgery and (B) the impact of osseous realignment procedures in unstable knees with or without additional knee ligament surgery on postoperative knee function and stability. Methodological quality of the studies was assessed using the Oxford Centre for Evidence-Based Medicine Levels of Evidence and the Coleman Methodological Score (CMS). Of the 1466 potentially relevant articles, 28 studies fulfilled the inclusion and exclusion criteria. Average study quality was poor (CMS, 40). For part A, studies showed increased rerupture rate after anterior cruciate ligament (ACL) replacement in patients with increased tibial slope. Concerning the posterior cruciate ligament (PCL)/posterolateral corner (PLC)/lateral collateral ligament (LCL), varus malalignment was considered a significant risk factor for failure. For part B, studies showed decreased anterior tibial translation after slope-decreasing high tibial

Stability and migration across femoral varus derotation osteotomies in children with neuromuscular disorders

DEFF Research Database (Denmark)

Buxbom, Peter; Sonne-Holm, Stig; Ellitsgaard, Niels

2017-01-01

), and acetabuloplasty. Relapse is observed in one-fifth of cases during adolescence. In this prospective cohort study, we performed a descriptive evaluation of translation and rotation across VDROs in children with neuromuscular disorders and syndromes by radiostereometric analysis (RSA). We assessed "RSA stability......" and migration across the VDROs. Patients and methods - Children with a neuromuscular disorder were set up for skeletal corrective surgery of the hip. RSA follow-ups were performed postoperatively, at 5 weeks, and 3, 6, and 12 months after surgery. Results - 27 femoral VDROs were included; 2 patients were...... excluded during the study period. RSA data showed stability across the VDRO in the majority of cases within the first 5 weeks. At the 1-year follow-up, the mean translations (SD) of the femoral shaft distal to the VDRO were 0.51 (1.12) mm medial, 0.69 (1.61) mm superior, and 0.21 (1.28) mm posterior...

Experimentally induced cam impingement in the sheep hip.

Science.gov (United States)

Siebenrock, Klaus A; Fiechter, Ruth; Tannast, Moritz; Mamisch, Tallal C; von Rechenberg, Brigitte

2013-04-01

Sheep hips have a natural non-spherical femoral head similar to a cam-type deformity in human beings. By performing an intertrochanteric varus osteotomy, cam-type femoro-acetabular impingement (FAI) during flexion can be created. We tested the hypotheses that macroscopic lesions of the articular cartilage and an increased Mankin score (MS) can be reproduced by an experimentally induced cam-type FAI in this ovine in vivo model. Furthermore, we hypothesized that the MS increases with longer ambulatory periods. Sixteen sheep underwent unilateral intertrochanteric varus osteotomy of the hip with the non-operated hip as a control. Four sheep were sacrificed after 14, 22, 30, and 38-weeks postoperatively. We evaluated macroscopic chondrolabral alterations, and recorded the MS, based on histochemical staining, for each ambulatory period. A significantly higher prevalence of macroscopic chondrolabral lesions was found in the impingement zone of the operated hips. The MS was significantly higher in the acetabular/femoral cartilage of the operated hips. Furthermore, these scores increased as the length of the ambulatory period increased. Cam-type FAI can be induced in an ovine in vivo model. Localized chondrolabral degeneration of the hip, similar to that seen in humans (Tannast et al., Clin Orthop Relat Res 2008; 466: 273-280; Beck et al., J Bone Joint Surg Br 2005; 87: 1012-1018), can be reproduced. This experimental sheep model can be used to study cam-type FAI. Copyright © 2012 Orthopaedic Research Society.

Evaluation of shoulder and elbow functions after treatment of humeral shaft fractures: a 20-132-month follow-up study.

Science.gov (United States)

Fırat, Ahmet; Deveci, Alper; Güler, Ferhat; Oçgüder, Ali; Oğuz, Temel; Bozkurt, Murat

2012-01-01

The aim of this study was to evaluate the long-term results of shoulder and elbow functions in humeral shaft fractures treated with functional brace, plate and screw osteosynthesis or intramedullary nailing. The study included 128 patients treated for humeral shaft fracture. The patients were divided into three groups according to treatment method: Group 1 (n=62) received functional brace, Group 2 (n=36) plate and screw osteosynthesis and Group 3 (n=30) intramedullary nailing. Coronal and sagittal humeral angulations were measured radiologically during the final follow-up. Shoulder and elbow functions were evaluated using the Constant shoulder score, the Mayo Elbow Performance Scoring and range of movement measurements. The mean follow-up time was 74 (range: 20 to 132) months. Mean Constant shoulder scores were 92.4 in Group 1, 85.6 in Group 2 and 74 in Group 3. A statistically significant difference was detected between the Constant shoulder scores of Groups 2 and 3 (p0.05). In the statistical evaluation of the Constant shoulder scores, a statistically significant difference was detected between the Constant scores of patients with a varus angulation greater than 20° and those with neutral alignment. Functional results of humeral shaft fractures treated with functional brace appear to be satisfactory. Varus and antecurvatum may affect shoulder and elbow function. In the presence of surgical indications, plate and screw fixation technique is the most effective method in terms of shoulder and elbow functions.

Humeral lengthening and proximal deformity correction with monorail external fixator in young adults.

Science.gov (United States)

Ruan, Hongjiang; Zhu, Yi; Liu, Shen; Kang, Qinglin

2018-05-01

Several humeral lengthening or simultaneous deformity corrections through one osteotomy using various external fixators were reported, while literature regarding correction of shortening and proximal varus deformity is scarce. This retrospective clinical study evaluated the results of preforming an acute correction and delayed lengthening in young adults through two osteotomies using monorail external fixator. We report seven patients with various pathologies who underwent humeral proximal deformity correction and lengthening between 2009 and 2015. Pre-operative and post-operative clinical and radiographic data were collected. The mean follow-up time was 33.4 months (25-46 months). The humeral neck-shaft angle improved from 97.9° (85-110°) to 138.6° (135-145°). The magnitude of lengthening achieved was average 7.6 cm (range, 6-10 cm) at an average healing index of lengthening of 30.2 days/cm (range, 27.7-35.4 days/cm). There was a significant increase in range of shoulder abduction, and active abduction improved from pre-operative 136.4° (range, 95-160°) to post-operative 166.4° (range, 150-180°). The DASH score improved significance from 23.29 ± 8.36 to 6.57 ± 3.65 (t = 4.848; p monorail external fixator can be used for humeral shortening and proximal varus angular deformity. Functional improvement is expected after surgery and post-operative therapy.

Value of radiographic examination of the knee joint for the orthopedic surgeon; Wertigkeit der radiologischen Bildgebung beim Kniegelenk fuer den Orthopaeden

Energy Technology Data Exchange (ETDEWEB)

Pietsch, M.; Hofmann, S. [Allgemeines und Orthopaedisches LKH Stolzalpe (Austria). Abteilung fuer Orthopaedie und orthopaedische Chirurgie

2006-01-01

Extended radiographic examinations offer excellent options for diagnosis and strategy for treatment of the knee joint. The whole-leg radiograph is indispensable in measuring alignment for osteotomy or total knee arthroplasty (TKA). Fluoroscopically assisted varus-valgus stress radiographs provide the possibility for verifying mechanical function of the implanted knee prosthesis. Ultrasound examinations have been widely replaced by magnetic resonance imaging (MRI). MRI is the golden standard to examine intra-articular structures of the knee (meniscus, ligaments, cartilage) and surrounding soft tissue. For evaluating femoral and tibial torsion and determining axial rotation of TKA, computed tomography (CT) is best qualified. Imaging of the patellofemoral joint (patella instability) is difficult; CT scans in combination with true lateral radiographs seem to be helpful. (orig.) [German] Die erweiterte Roentgendiagnostik bietet gute Moeglichkeiten der Diagnose und Therapieplanung beim Kniegelenk. Das Ganzbeinroentgen ist unabdingbar zur Achsvermessung bei der Planung einer Umstellungsosteotomie oder der Implantation einer Knietotalendoprothese (KTEP). Varus-/Valgusaufnahmen unter Bildwandler gestatten die Ueberpruefung der Mechanik einer liegenden KTEP. Sonographische Untersuchungen des Kniegelenks sind weitgehend durch die Magnetresonanztomographie (MRT) ersetzt. Die MRT ist die Methode der Wahl zur Beurteilung der Kniebinnenstrukturen (Meniskus, Baender, Knorpel) und der umgebenden Weichteile. Zur Bestimmung der Torsion von Femur und Tibia sowie der Rotation der Komponenten einer KTEP ist die Computertomographie (CT) am besten geeignet. Die Beurteilung des Femorpatellargelenks (Patellainstabilitaet) ist schwierig, am vielversprechendsten erscheint die CT in Kombination mit streng seitlichen Roentgenbildern. (orig.)

Intraoperative positioning of the hindfoot with the hindfoot alignment guide: a pilot study.

Science.gov (United States)

Frigg, Arno; Jud, Lukas; Valderrabano, Victor

2014-01-01

In a previous study, intraoperative positioning of the hindfoot by visual means resulted in the wrong varus/valgus position by 8 degrees and a relatively large standard deviation of 8 degrees. Thus, new intraoperative means are needed to improve the precision of hindfoot surgery. We therefore sought a hindfoot alignment guide that would be as simple as the alignment guides used in total knee arthroplasty. A novel hindfoot alignment guide (HA guide) has been developed that projects the mechanical axis from the tibia down to the heel. The HA guide enables the positioning of the hindfoot in the desired varus/valgus position and in plantigrade position in the lateral plane. The HA guide was used intraoperatively from May through November 2011 in 11 complex patients with simultaneous correction of the supramalleolar, tibiotalar, and inframalleolar alignment. Pre- and postoperative Saltzman views were taken and the position was measured. The HA guide significantly improved the intraoperative positioning compared with visual means: The accuracy with the HA guide was 4.5 ± 5.1 degrees (mean ± standard deviation) and without the HA guide 9.4 ± 5.5 degrees (P guide (2 avoided osteotomies, 5 additional osteotomies). The HA guide helped to position the hindfoot intraoperatively with greater precision than visual means. The HA guide was especially useful for multilevel corrections in which the need for and the amount of a simultaneous osteotomy had to be evaluated intraoperatively. Level IV, case series.

Effect of an ankle-foot orthosis on knee joint mechanics: a novel conservative treatment for knee osteoarthritis.

Science.gov (United States)

Fantini Pagani, Cynthia H; Willwacher, Steffen; Benker, Rita; Brüggemann, Gert-Peter

2014-12-01

Several conservative treatments for medial knee osteoarthritis such as knee orthosis and laterally wedged insoles have been shown to reduce the load in the medial knee compartment. However, those treatments also present limitations such as patient compliance and inconsistent results regarding the treatment success. To analyze the effect of an ankle-foot orthosis on the knee adduction moment and knee joint alignment in the frontal plane in subjects with knee varus alignment. Controlled laboratory study, repeated measurements. In total, 14 healthy subjects with knee varus alignment were analyzed in five different conditions: without orthotic, with laterally wedged insoles, and with an ankle-foot orthosis in three different adjustments. Three-dimensional kinetic and kinematic data were collected during gait analysis. Significant decreases in knee adduction moment, knee lever arm, and joint alignment in the frontal plane were observed with the ankle-foot orthosis in all three different adjustments. No significant differences could be found in any parameter while using the laterally wedged insoles. The ankle-foot orthosis was effective in reducing the knee adduction moment. The decreases in this parameter seem to be achieved by changing the knee joint alignment and thereby reducing the knee lever arm in the frontal plane. This study presents a novel approach for reducing the load in the medial knee compartment, which could be developed as a new treatment option for patients with medial knee osteoarthritis. © The International Society for Prosthetics and Orthotics 2013.

Stressfraktur efter epifysiodese i femur

DEFF Research Database (Denmark)

Al-Aubaidi, Zaid; Engell, Vilhelm; Lundgaard, Bjarne

2010-01-01

Growth guiding is currently widely practiced for deformity correction in the growing child. Different methods have been developed. In 2007 Stevens described a tension band device (8-plates) as a simple growth control method. Since then it has been widely used, e.g. in hemiepiphysiodesis to correct...... varus or valgus deformities or extension defect in the knee. Temporary epiphysiodesis can also be used to correct leg length discrepancy more accurately. Complications after treatment with 8-plates are well-described. Stress fracture after the usage of this device has to our knowledge not yet been...

A new Agraecina spider species from the Balkan Peninsula (FYR Macedonia) (Araneae: Liocranidae).

Science.gov (United States)

Deltshev, Christo; Wang, Chunxia

2016-05-30

        Specimens were collected using pitfall traps. Coloration is described from alcohol-preserved specimens. Specimens were examined and measured using a Wild M5A stereomicroscope. Further details were studied and measured under an Olympus BX41 compound microscope. All drawings were made using a drawing apparatus attached to a Leica stereomicroscope. Male palps and female genitalia were examined and illustrated after they were dissected from the spiders' bodies. Photos were taken with an Olympus C7070 wide zoom digital camera mounted on an Olympus SZX12 stereomicroscope. The images were montaged using Helicon Focus image stacking software. Measurements of the legs are taken from the dorsal side. Total length of the body includes the chelicerae. All measurements were taken in mm. Abbreviations used in text include: AME, anterior median eyes; ALE, anterior lateral eyes; EM, embolus; MA, median apophysis; CD, copulatory duct; ST, spermatheca; fe, femur; pa, patella; ti, tibia; mt, metatarsus; p, prolateral; d, dorsal; r, retrolateral; v, ventral. Type specimens are deposited in the National Museum of Natural History (NMNHS), Sofia, Bulgaria.

DDH Epidemiology Revisited: Do We Need New Strategies?

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Amir R. Vafaee

2017-11-01

Full Text Available Background: Although the developmental dysplasia of the hip (DDH is well known to pediatric orthopedists, its etiology has still remained unknown and despite dedication of a vast majority of research, the results are still inadequate and confusing. The exact incidence of DDH and its relationship with known risk factors in Iran is still unknown. Here we represent the results of one year study on the incidence and related conditions of DDH. Methods: Sonography was performed on the hip joints of 1073 full term healthy newborns at Imam Khomeini Hospital from March 2013 to March 2014. The results were classified according to Graf’s classification. Pathologic hips were cross checked by the known risk factors for DDH. Results: A significant correlation was found between DDH and breech presentation (P=0.000, torticollis (P=0.004, metatarsus adductus (P=0.024. Conclusion: The incidence of DDH is significantly high in the studied group of neonates, suggesting reevaluation of current approach to DDH. The screening protocols need to be improved with the help of trained pediatricians and other health professions.

BioXTAS RAW: improvements to a free open-source program for small-angle X-ray scattering data reduction and analysis.

Science.gov (United States)

Hopkins, Jesse Bennett; Gillilan, Richard E; Skou, Soren

2017-10-01

BioXTAS RAW is a graphical-user-interface-based free open-source Python program for reduction and analysis of small-angle X-ray solution scattering (SAXS) data. The software is designed for biological SAXS data and enables creation and plotting of one-dimensional scattering profiles from two-dimensional detector images, standard data operations such as averaging and subtraction and analysis of radius of gyration and molecular weight, and advanced analysis such as calculation of inverse Fourier transforms and envelopes. It also allows easy processing of inline size-exclusion chromatography coupled SAXS data and data deconvolution using the evolving factor analysis method. It provides an alternative to closed-source programs such as Primus and ScÅtter for primary data analysis. Because it can calibrate, mask and integrate images it also provides an alternative to synchrotron beamline pipelines that scientists can install on their own computers and use both at home and at the beamline.

Presidents' words - Michel Goossens

CERN Multimedia

Staff Association

2015-01-01

Michel Goossens Already at the beginning of 1955, just a few months after the creation of CERN, the members of the Organization's staff who then numbered less than 200, realized that they had to organize themselves into a corporate body to ensure a formal representation with Management and Member States. The Staff Association was born. As the 27th President of the Staff Association since its inception 60 years ago my task is highly interesting and rewarding, with plenty of responsibility, yet not always simple. Indeed, chosen by one’s peers as primus inter pares, the president is like the conductor of an orchestra, who must first convince his musicians to study the score together, before playing it in harmony. Of course, in my position I can rely on the solid foundations laid by my 26 predecessors, as well as the enthusiasm, loyalty, continuous efforts and perseverance of a core of dedicated collaborators, the elected delegates to the Staff Council. The strength of the Staff Associati...

Inhalational anaesthesia with low fresh gas flow

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Christian Hönemann

2013-01-01

Full Text Available During the inhalation of anaesthesia use of low fresh gas flow (0.35-1 L/min has some important advantages. There are three areas of benefit: pulmonary - anaesthesia with low fresh gas flow improves the dynamics of inhaled anaesthesia gas, increases mucociliary clearance, maintains body temperature and reduces water loss. Economic - reduction of anaesthesia gas consumption resulting in significant savings of > 75% and Ecological - reduction in nitrous oxide consumption, which is an important ozone-depleting and heat-trapping greenhouse gas that is emitted. Nevertheless, anaesthesia with high fresh gas flows of 2-6 L/min is still performed, a technique in which rebreathing is practically negligible. This special article describes the clinical use of conventional plenum vaporizers, connected to the fresh gas supply to easily perform low (1 L/min, minimal (0.5 L/min or metabolic flow anaesthesia (0.35 L/min with conventional Primus Draeger® anaesthesia machines in routine clinical practice.

Radiation dose delivery verification in the treatment of carcinoma-cervix

International Nuclear Information System (INIS)

Shrotriya, D.; Srivastava, R. N. L.; Kumar, S.

2015-01-01

The accurate dose delivery to the clinical target volume in radiotherapy can be affected by various pelvic tissues heterogeneities. An in-house heterogeneous woman pelvic phantom was designed and used to verify the consistency and computational capability of treatment planning system of radiation dose delivery in the treatment of cancer cervix. Oncentra 3D-TPS with collapsed cone convolution (CCC) dose calculation algorithm was used to generate AP/PA and box field technique plan. the radiation dose was delivered by Primus Linac (Siemens make) employing high energy 15 MV photon beam by isocenter technique. A PTW make, 0.125cc ionization chamber was used for direct measurements at various reference points in cervix, bladder and rectum. The study revealed that maximum variation between computed and measured dose at cervix reference point was 1% in both the techniques and 3% and 4% variation in AP/PA field and 5% and 4.5% in box technique at bladder and rectum points respectively

Radiation dose delivery verification in the treatment of carcinoma-cervix

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Shrotriya, D.; Kumar, S.; Srivastava, R. N. L.

2015-06-01

The accurate dose delivery to the clinical target volume in radiotherapy can be affected by various pelvic tissues heterogeneities. An in-house heterogeneous woman pelvic phantom was designed and used to verify the consistency and computational capability of treatment planning system of radiation dose delivery in the treatment of cancer cervix. Oncentra 3D-TPS with collapsed cone convolution (CCC) dose calculation algorithm was used to generate AP/PA and box field technique plan. the radiation dose was delivered by Primus Linac (Siemens make) employing high energy 15 MV photon beam by isocenter technique. A PTW make, 0.125cc ionization chamber was used for direct measurements at various reference points in cervix, bladder and rectum. The study revealed that maximum variation between computed and measured dose at cervix reference point was 1% in both the techniques and 3% and 4% variation in AP/PA field and 5% and 4.5% in box technique at bladder and rectum points respectively.

Radiation dose delivery verification in the treatment of carcinoma-cervix

Energy Technology Data Exchange (ETDEWEB)

Shrotriya, D., E-mail: shrotriya2007@gmail.com; Srivastava, R. N. L. [Department of Radiotherapy, J.K. Cancer Institute Kanpur-208019 (India); Kumar, S. [Department of Physics, Christ Church College, Kanpur-208001 (India)

2015-06-24

The accurate dose delivery to the clinical target volume in radiotherapy can be affected by various pelvic tissues heterogeneities. An in-house heterogeneous woman pelvic phantom was designed and used to verify the consistency and computational capability of treatment planning system of radiation dose delivery in the treatment of cancer cervix. Oncentra 3D-TPS with collapsed cone convolution (CCC) dose calculation algorithm was used to generate AP/PA and box field technique plan. the radiation dose was delivered by Primus Linac (Siemens make) employing high energy 15 MV photon beam by isocenter technique. A PTW make, 0.125cc ionization chamber was used for direct measurements at various reference points in cervix, bladder and rectum. The study revealed that maximum variation between computed and measured dose at cervix reference point was 1% in both the techniques and 3% and 4% variation in AP/PA field and 5% and 4.5% in box technique at bladder and rectum points respectively.

PROXIMAL FEMURAL VALGUS SUBTROCHANTERIC OSTEOTOMY FOR NON UNION OF TROCHANTERIC FRACTURES.

Science.gov (United States)

Silva, Paulo; Coelho, Danilo Lopes; Curi, Calim; de Oliveira, Leandro Alves; de Moraes, Frederico Barra; do Amaral, Rogério Andrade; Rebello, Percival Rosa

2012-01-01

To evaluate valgus subtrochanteric osteotomy for the treatment of trochanteric non-union. A retrospective study of cases series. From 1998 September to 2009 January, seventeen (17) cases with a diagnosis of non-union of trochanteric fracture were re-operated by the hip group of the Ortophaedic And Traumatology service of the Hospital Geral de Goiania (HGG). The patients presented pain at the fracture site, a femoral varus angle of less than 120°, and non-union of the fracture in the 3(rd) months after the initial surgery. Patients with ages ranging from 30 to 73 years, with a maximum follow-up of 09 years and minimum of 09 years. The mean time from first surgery to osteotomy was six months. Bone union was observed in 16 patients, with a mean union time of 12 weeks after surgery. The mean hip varus angle was 105(0) (120(0) to 90(0)). After surgery, the mean hip valgus angle was 144(0) (155(0) to 135(0)). We had one unsuccessful case; a 78-year old patient who had osteogtomy, fixed with DHS of 150(0), with valgization to 154(0). After six months of follow-up without union of the fracture, it was decided to perform total cemented hip artroplasthy, without complications. Valgus subtrochanteric osteotomies can be indicated for the treatment of trochanteric treatment of pseudoarthroses, with good final results for bone union, avoiding the need for total hip artroplasthy and maintaining biological fixation, as well as reestablishing the mechanical and anatomical axis of the affected limb.

Total knee reconstruction without posterior stabilization in rheumatoid arthritis patients

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Radu Prejbeanu

2010-12-01

Full Text Available Objectives: to present the results with posterior cruciate ligament-retaining total knee arthroplasty in rheumatoid arthritis (RA patients. Background: Total knee replacement in RA patients has many particularities. One of them is the difficulty of obtaining a proper ligamentous balance.Methods: 24 RA patients were followed for a 5-year period after posterior cruciate ligament-retaining total knee arthroplasty. Clinical assessments analyzed general health status by using Hospital for Special Surgery Knee Evaluation Form (HSSKEF and mediolateral and anteroposterior ligament stability by using varus-valgus and posterior drawer tests. Radiological assessments evaluated axial alignment, size and position of components, radiolucent lines in anteroposterior and lateral standard views, integrity of the posterior cruciate ligament on lateral view X-ray at 45 degrees of flexion.Results: the mean HSSKEF score increased from 32 to 84 points at the end of follow-up. Preoperative mean range of motion was 60 degrees; postoperative mean range of motion was of 105 degrees, with significant statistical difference (p<0.05. The mean femoral component axial deviation was 6 degrees. The tibial component had a mean axial deviation of 1 degree of varus. There were no radioluscency lines of more than 1mm. 21 patients had excellent results. None of the knees was unstable. Conclusion: posterior cruciate ligament-retaining total knee arthroplasty can be used in RA patients without excessive valgus deformity (over 15 degrees, providing thus sufficient stabilization. The outcomes re similar to those patients who followed a posterior stabilized endoprosthesis.

The Value of History, Physical Examination, and Radiographic Findings in the Diagnosis of Symptomatic Meniscal Tear among Middle-Age Subjects with Knee Pain

Science.gov (United States)

Katz, Jeffrey N.; Smith, Savannah R.; Yang, Heidi Y.; Martin, Scott D.; Wright, John; Donnell-Fink, Laurel A.; Losina, Elena

2016-01-01

Objective To evaluate the utility of clinical history, radiographic and physical exam findings in the diagnosis of symptomatic meniscal tear (SMT) in patients over age 45, in whom concomitant osteoarthritis is prevalent. Methods In a cross-sectional study of patients from two orthopedic surgeons’ clinics we assessed clinical history, physical examination and radiographic findings in patients over 45 with knee pain. The orthopedic surgeons rated their confidence that subjects’ symptoms were due to MT; we defined the diagnosis of SMT as at least 70% confidence. We used logistic regression to identify factors independently associated with diagnosis of SMT and we used the regression results to construct an index of the likelihood of SMT. Results In 174 participants, six findings were associated independently with the expert clinician having ≥70% confidence that symptoms were due to MT: localized pain, ability to fully bend the knee, pain duration <1 year, lack of varus alignment, lack of pes planus, and absence of joint space narrowing on radiographs. The index identified a low risk group with 3% likelihood of SMT. Conclusion While clinicians traditionally rely upon mechanical symptoms in this diagnostic setting, our findings did not support the conclusion that mechanical symptoms were associated with the expert’s confidence that symptoms were due to MT. An index that includes history of localized pain, full flexion, duration <1 year, pes planus, varus alignment, and joint space narrowing can be used to stratify patients according to their risk of SMT and it identifies a subgroup with very low risk. PMID:27390312

[Augmentation technique on the proximal humerus].

Science.gov (United States)

Scola, A; Gebhard, F; Röderer, G

2015-09-01

The treatment of osteoporotic fractures is still a challenge. The advantages of augmentation with respect to primary in vitro stability and the clinical use for the proximal humerus are presented in this article. In this study six paired human humeri were randomized into an augmented and a non-augmented group. Osteosynthesis was performed with a PHILOS plate (Synthes®). In the augmented group the two screws finding purchase in the weakest cancellous bone were augmented. The specimens were tested in a 3-part fracture model in a varus bending test. The augmented PHILOS plates withstood significantly more load cycles until failure. The correlation to bone mineral density (BMD) showed that augmentation could partially compensate for low BMD. The augmentation of the screws in locked plating in a proximal humerus fracture model is effective in improving the primary stability in a cyclic varus bending test. The targeted augmentation of two particular screws in a region of low bone quality within the humeral head was almost as effective as four screws with twice the amount of bone cement. Screw augmentation combined with a knowledge of the local bone quality could be more effective in enhancing the primary stability of a proximal humerus locking plate because the effect of augmentation can be exploited more effectively limiting it to the degree required. The technique of augmentation is simple and can be applied in open and minimally invasive procedures. When the correct procedure is used, complications (cement leakage into the joint) can be avoided.

The accuracy of intramedullary tibial guide of sagittal alignment of PCL-substituting total knee arthroplasty.

Science.gov (United States)

Han, Hyuk-Soo; Kang, Seung-Baik; Jo, Chris H; Kim, Sun-Hong; Lee, Jung-Ha

2010-10-01

Experimental and clinical studies on the accuracy of the intramedullary alignment method have produced different results, and few have addressed accuracy in the sagittal plane. Reported deviations are not only attributable to the alignment method but also to radiological errors. The purpose of this study was to evaluate the accuracy of the intramedullary alignment method in the sagittal plane using computed tomography (CT) and 3-dimensional imaging software. Thirty-one TKAs were performed using an intramedullary alignment method involving the insertion of a long 8-mm diameter rod into the medullary canal to the distal metaphysis of the tibia. All alignment instruments were set to achieve an ideal varus/valgus angle of 0° in the coronal plane and a tibial slope of 0° in the sagittal plane. The accuracy of the intramedullary alignment system was assessed by measuring the coronal tibial component angle and sagittal tibial slope angles, i.e., angles between the tibial anatomical axis and the tangent to the medial and lateral tibial plateau or the cut-surface. The mean coronal tibial component angle was 88.5° ± 1.2° and the mean tibial component slope in the sagittal plane was 1.6° ± 1.2° without anterior slope. Our intramedullary tibial alignment method, which involves passing an 8-mm diameter long rod through the tibial shaft isthmus, showed good accuracy (less than 3 degrees of variation and no anterior slope) in the sagittal plane in neutral or varus knees.

Strain measurements of the tibial insert of a knee prosthesis using a knee motion simulator.

Science.gov (United States)

Sera, Toshihiro; Iwai, Yuya; Yamazaki, Takaharu; Tomita, Tetsuya; Yoshikawa, Hideki; Naito, Hisahi; Matsumoto, Takeshi; Tanaka, Masao

2017-12-01

The longevity of a knee prosthesis is influenced by the wear of the tibial insert due to its posture and movement. In this study, we assumed that the strain on the tibial insert is one of the main reasons for its wear and investigated the influence of the knee varus-valgus angles on the mechanical stress of the tibial insert. Knee prosthesis motion was simulated using a knee motion simulator based on a parallel-link six degrees-of-freedom actuator and the principal strain and pressure distribution of the tibial insert were measured. In particular, the early stance phase obtained from in vivo X-ray images was examined because the knee is applied to the largest load during extension/flexion movement. The knee varus-valgus angles were 0° (neutral alignment), 3°, and 5° malalignment. Under a neutral orientation, the pressure was higher at the middle and posterior condyles. The first and second principal strains were larger at the high and low pressure areas, respectively. Even for a 3° malalignment, the load was concentrated at one condyle and the positive first principal strain increased dramatically at the high pressure area. The negative second principal strain was large at the low pressure area on the other condyle. The maximum equivalent strain was 1.3-2.1 times larger at the high pressure area. For a 5° malalignment, the maximum equivalent strain increased slightly. These strain and pressure measurements can provide the mechanical stress of the tibial insert in detail for determining the longevity of an artificial knee joint.

The role of knee joint moments and knee impairments on self-reported knee pain during gait in patients with knee osteoarthritis.

Science.gov (United States)

O'Connell, Megan; Farrokhi, Shawn; Fitzgerald, G Kelley

2016-01-01

The association between high mechanical knee joint loading during gait with onset and progression of knee osteoarthritis has been extensively studied. However, less attention has been given to risk factors related to increased pain during gait. The purpose of this study was to evaluate knee joint moments and clinical characteristics that may be associated with gait-related knee pain in patients with knee osteoarthritis. Sixty-seven participants with knee osteoarthritis were stratified into three groups of no pain (n=18), mild pain (n=27), or moderate/severe pain (n=22) based on their self-reported symptoms during gait. All participants underwent three-dimensional gait analysis. Quadriceps strength, knee extension range of motion, radiographic knee alignment and self-reported measures of global pain and function were also quantified. The moderate/severe pain group demonstrated worse global pain (Pknee flexion moments during the midstance phase of gait compared to the no pain group (P=0.02). Additionally, the moderate/severe pain group demonstrated greater varus knee malalignment (P=0.009), which was associated with higher weight acceptance peak knee adduction moments (P=0.003) and worse global pain (P=0.003) and physical function scores (P=0.006). Greater knee flexion moment is present during the midstance phase of gait in patients with knee osteoarthritis and moderate/severe pain during gait. Additionally, greater varus malalignment may be a sign of increased global knee joint dysfunction that can influence many activities of daily living beyond gait. Copyright © 2015 Elsevier Ltd. All rights reserved.

Tibial rotational osteotomy for idiopathic torsion. A comparison of the proximal and distal osteotomy levels.

Science.gov (United States)

Krengel, W F; Staheli, L T

1992-10-01

A retrospective analysis was done of 52 rotational tibial osteotomies (RTOs) performed on 35 patients with severe idiopathic tibial torsion. Thirty-nine osteotomies were performed at the proximal or midtibial level. Thirteen were performed at the distal tibial level with a technique previously described by one of the authors. Serious complications occurred in five (13%) of the proximal and in none of the distal RTOs. For severe and persisting idiopathic tibial torsion, the authors recommend correction by RTO at the distal level. Proximal level osteotomy is indicated only when a varus or valgus deformity required concurrent correction.

Fixator-Assisted Lengthening and Deformity Correction Over an Intramedullary Nail in a Patient with Achondroplasia

Directory of Open Access Journals (Sweden)

Erdal Uzun

2016-05-01

Full Text Available Achondroplasia is the most frequently encountered form of nonlethal skeletal dysplasia and a type of rhizomelic dwarfism. It results in considerable physical and psychologic handicaps owing to the disproportionate stature of the body and difficulty in performing routine activities of daily living. They also have major musculoskeletal problems including symptomatic malalignment of the lower limbs. Limb lengthening has been used in patients with achondroplasia by different techniques (Intramedullar nailing, monolateral or circular external fixator. We report our treatment of a patient 17 years of age with achondroplasia for bilateral lower limb length discrepancy and bilateral tibial varus deformity.

Trunk and hip biomechanics influence anterior cruciate loading mechanisms in physically active participants.

Science.gov (United States)

Frank, Barnett; Bell, David R; Norcross, Marc F; Blackburn, J Troy; Goerger, Benjamin M; Padua, Darin A

2013-11-01

Excessive trunk motion and deficits in neuromuscular control (NMC) of the lumbopelvic hip complex are risk factors for anterior cruciate ligament (ACL) injury. However, the relationship between trunk motion, NMC of the lumbopelvic hip complex, and triplanar knee loads during a sidestep cutting task has not been examined. To determine if there is an association between multiplanar trunk motion, NMC of the lumbopelvic hip complex, and triplanar knee loads with ACL injury during a sidestep cutting task. Descriptive laboratory study. The hip and knee biomechanics and trunk motion of 30 participants (15 male, 15 female) were analyzed during a sidestep cutting task using an optoelectric camera system interfaced to a force plate. Trunk and lower extremity biomechanics were calculated from the kinematic and ground-reaction force data during the first 50% of the stance time during the cutting task. Pearson product moment correlation coefficients were calculated between trunk and lower extremity biomechanics. Multiple linear regression analyses were carried out to determine the amount of variance in triplanar knee loading explained by trunk motion and hip moments. A greater internal knee varus moment (mean, 0.11 ± 0.12 N·m/kg*m) was associated with less transverse-plane trunk rotation away from the stance limb (mean, 20.25° ± 4.42°; r = -0.46, P = .011) and a greater internal hip adduction moment (mean, 0.33 ± 0.25 N·m/kg*m; r = 0.83, P < .05). A greater internal knee external rotation moment (mean, 0.11 ± 0.08 N·m/kg*m) was associated with a greater forward trunk flexion (mean, 7.62° ± 5.28°; r = 0.42, P = .020) and a greater hip internal rotation moment (mean, 0.15 ± 0.16 N·m/kg*m; r = 0.59, P = .001). Trunk rotation and hip adduction moment explained 81% (P < .05) of the variance in knee varus moment. Trunk flexion and hip internal rotation moment explained 48% (P < .05) of the variance in knee external rotation moment. Limited trunk rotation displacement

Computerized gait analysis in Legg Calvé Perthes disease--analysis of the frontal plane.

Science.gov (United States)

Westhoff, Bettina; Petermann, Andrea; Hirsch, Mark A; Willers, Reinhart; Krauspe, Rüdiger

2006-10-01

Current follow-up and outcome studies of Legg Calvé Perthes disease (LCPD) are based on subjective measures of function, clinical parameters and radiological changes [Herring JA, Kim HT, Browne RH. Legg-Calvé-Perthes disease. Part II: prospective multicenter study of the effect of treatment on outcome. J Bone Joint Surg 2004;86A:2121-34; Aksoy MC, Cankus MC, Alanay A, Yazici M, Caglar O, Alpaslan AM. Radiological outcome of proximal femoral varus osteotomy for the treatment of lateral pillar group-C. J Pediatr Orthop 2005;14 B:88-91; Kitakoji T, Hattori T, Kitoh H, Katho M, Ishiguro N. Which is a better method for Perthes' disease: femoral varus or Salter osteotomy? Clin Orthop 2005;430:163-170; Joseph B, Rao N, Mulpuri K, Varghese G, Nair S. How does femoral varus osteotomy alter the natural evolution of Perthes' disease. J Pediatr Orthop 2005;14B:10-5; Ishida A, Kuwajima SS, Laredo FJ, Milani C. Salter innominate osteotomy in the treatment of severe Legg-Calvé-Perthes disease: clinical and radiographic results in 32 patients (37 hips) at skeletal maturity. J Pediatr Orthop 2004;24:257-64.]. The objective of this study was to evaluate the frontal plane kinematics and the effect on hip joint loading on the affected side in children with a radiographic diagnosis of LCPD. Computerized, three-dimensional gait analysis was performed in 33 individuals aged > or =5 years (mean 8.0+/-2 years) with unilateral LCPD and no history of previous surgery to the hip or any disorder leading to gait abnormality. Frontal plane kinematics and kinetics were compared to a group of healthy children (n=30, mean age 8.1+/-1.2 years). Hip joint loading was estimated as a function of the hip abductor moment. Subjects with LCPD demonstrated two distinct frontal plane gait patterns, both deviating from normal. Type 1 (n=3) was characterized by a pelvic drop of the swinging limb, a trunk lean in relation to the pelvis towards the stance limb and hip adduction during stance phase and

Intracellular recording from a spider vibration receptor.

Science.gov (United States)

Gingl, Ewald; Burger, Anna-M; Barth, Friedrich G

2006-05-01

The present study introduces a new preparation of a spider vibration receptor that allows intracellular recording of responses to natural mechanical or electrical stimulation of the associated mechanoreceptor cells. The spider vibration receptor is a lyriform slit sense organ made up of 21 cuticular slits located on the distal end of the metatarsus of each walking leg. The organ is stimulated when the tarsus receives substrate vibrations, which it transmits to the organ's cuticular structures, reducing the displacement to about one tenth due to geometrical reasons. Current clamp recording was used to record action potentials generated by electrical or mechanical stimuli. Square pulse stimulation identified two groups of sensory cells, the first being single-spike cells which generated only one or two action potentials and the second being multi-spike cells which produced bursts of action potentials. When the more natural mechanical sinusoidal stimulation was applied, differences in adaptation rate between the two cell types remained. In agreement with prior extracellular recordings, both cell types showed a decrease in the threshold tarsus deflection with increasing stimulus frequency. Off-responses to mechanical stimuli have also been seen in the metatarsal organ for the first time.

Effects of Processing of Starter Diets on Performance, Nutrient Digestibility, Rumen Biochemical Parameters and Body Measurements of Brown Swiss Dairy Calves

Directory of Open Access Journals (Sweden)

J. Ghassemi Nejad

2012-07-01

Full Text Available In order to investigate the effect of physical forms of starter diets on performance, weaning age, nutrient digestibility and rumen biochemical factors, 24 female of neonatal Brown Swiss calves (average body weight of 39.5±1.2 kg were randomly assigned to three treatments. Dietary treatments were mashed (MS, pelleted (PS, and texturized (TS starter using 8 calves from birth till 90 days of age in each treatment. Diets were formulated to be iso-nitrogenous with 21% crude protein. Based on the experimental results, calves that received PS and TS diets, had significant higher average daily gain (ADG than those receiving MS (p0.05. Ruminal pH was higher (p<0.01 in MS than the other groups, but ruminal ammonia (g/dl concentration was not different among the treatments. Body measurements such as body length, pin width, hip width, pin to hip length, size of metacarpus and metatarsus bones, hip height, wither height, stomach size and heart girth were not significantly different among the treatments. Overall, it is concluded that starter diets in the form of pellet and texture can improve performance in neonatal Brown Swiss calves compared to the mashed form.

A novel approach to mechanical foot stimulation during human locomotion under body weight support.

Science.gov (United States)

Gravano, S; Ivanenko, Y P; Maccioni, G; Macellari, V; Poppele, R E; Lacquaniti, F

2011-04-01

Input from the foot plays an essential part in perceiving support surfaces and determining kinematic events in human walking. To simulate adequate tactile pressure inputs under body weight support (BWS) conditions that represent an effective form of locomotion training, we here developed a new method of phasic mechanical foot stimulation using light-weight pneumatic insoles placed inside the shoes (under the heel and metatarsus). To test the system, we asked healthy participants to walk on a treadmill with different levels of BWS. The pressure under the stimulated areas of the feet and subjective sensations were higher at high levels of BWS and when applied to the ball and toes rather than heels. Foot stimulation did not disturb significantly the normal motor pattern, and in all participants we evoked a reliable step-synchronized triggering of stimuli for each leg separately. This approach has been performed in a general framework looking for "afferent templates" of human locomotion that could be used for functional sensory stimulation. The proposed technique can be used to imitate or partially restore surrogate contact forces under body weight support conditions. Copyright © 2010 Elsevier B.V. All rights reserved.

Modified Thomas splint-cast combination for the management of limb fractures in small equids.

Science.gov (United States)

Ladefoged, Søren; Grulke, Sigrid; Busoni, Valeria; Serteyn, Didier; Salciccia, Alexandra; Verwilghen, Denis

2017-04-01

To describe the management and outcome of limb fractures in small domestic equids treated with a modified Thomas splint-cast combination (MTSCC). Retrospective case series. Client owned horses and donkeys. Medical records, including radiographs, were reviewed for details of animals diagnosed with a limb fracture and treated by external coaptation using a MTSCC (2001-2012). Follow-up >6 months after discharge was obtained via telephone consultation with owners or veterinarians. Nine horses and 4 donkeys were identified with fractures of the tibial diaphysis (n = 4), ulna (n = 3), distal metatarsus (n = 2), proximal metacarpus (n = 1), radial diaphysis (n = 1), calcaneus (n = 1), and distal femoral physis (n = 1). Follow-up was available for 12 equids, of which 8 (67%) recovered from the fracture and became pasture sound. Six equids developed obvious external deformation of the affected limb. Selected small equids with long bone fractures, and without athletic expectations, can be managed with external coaptation using an MTSCC. The owner should be informed that the treatment is considered a salvage procedure. © 2017 The American College of Veterinary Surgeons.

Phenotypic diagnosis of dwarfism in six Friesian horses.

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Back, W; van der Lugt, J J; Nikkels, P G J; van den Belt, A J M; van der Kolk, J H; Stout, T A E

2008-05-01

An extreme form of abnormal development, dwarfism, is common in man and some animals, but has not been officially reported in horses. Within the Friesian horse breed, congenital dwarfism has been recognised for many years, but no detailed report exists on its phenotype. The most salient feature of the dwarf syndrome is the physeal growth retardation in both limbs and ribs. Affected animals have approximately 25% shorter fore- and hindlimbs and approximately 50% reduced bodyweight. Postnatal growth is still possible in these animals, albeit at a slower rate: the head and back grow faster than the limbs and ribs leading to the characteristic disproportional growth disturbance. Thus, adult dwarfs exhibit a normal, but a relatively larger head conformation, a broader chest with narrowing at the costochondral junction, a disproportionally long back, abnormally short limbs, hyperextension of the fetlocks and narrow long-toed hooves. Furthermore, a dysplastic metaphysis of the distal metacarpus and metatarsus is radiographically evident. Microscopic analysis of the growth plates at the costochondral junction shows an irregular transition from cartilage to bone, and thickening and disturbed formation of chondrocyte columns, which is similar to findings in osteochondrodysplasia.

Nanofibre production in spiders without electric charge.

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Joel, Anna-Christin; Baumgartner, Werner

2017-06-15

Technical nanofibre production is linked to high voltage, because nanofibres are typically produced by electrospinning. In contrast, spiders have evolved a way to produce nanofibres without high voltage. These spiders are called cribellate spiders and produce nanofibres within their capture thread production. It is suggested that their nanofibres become frictionally charged when brushed over a continuous area on the calamistrum, a comb-like structure at the metatarsus of the fourth leg. Although there are indications that electrostatic charges are involved in the formation of the thread structure, final proof is missing. We proposed three requirements to validate this hypothesis: (1) the removal of any charge during or after thread production has an influence on the structure of the thread; (2) the characteristic structure of the thread can be regenerated by charging; and (3) the thread is attracted to or repelled from differently charged objects. None of these three requirements were proven true. Furthermore, mathematical calculations reveal that even at low charges, the calculated structural assembly of the thread does not match the observed reality. Electrostatic forces are therefore not involved in the production of cribellate capture threads. © 2017. Published by The Company of Biologists Ltd.

Effects of Knee Alignments and Toe Clip on Frontal Plane Knee Biomechanics in Cycling.

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Shen, Guangping; Zhang, Songning; Bennett, Hunter J; Martin, James C; Crouter, Scott E; Fitzhugh, Eugene C

2018-06-01

Effects of knee alignment on the internal knee abduction moment (KAM) in walking have been widely studied. The KAM is closely associated with the development of medial knee osteoarthritis. Despite the importance of knee alignment, no studies have explored its effects on knee frontal plane biomechanics during stationary cycling. The purpose of this study was to examine the effects of knee alignment and use of a toe clip on the knee frontal plane biomechanics during stationary cycling. A total of 32 participants (11 varus, 11 neutral, and 10 valgus alignment) performed five trials in each of six cycling conditions: pedaling at 80 rpm and 0.5 kg (40 Watts), 1.0 kg (78 Watts), and 1.5 kg (117 Watts) with and without a toe clip. A motion analysis system and a customized instrumented pedal were used to collect 3D kinematic and kinetic data. A 3 × 2 × 3 (group × toe clip × workload) mixed design ANOVA was used for statistical analysis (p < 0.05). There were two different knee frontal plane loading patterns, internal abduction and adduction moment, which were affected by knee alignment type. The knee adduction angle was 12.2° greater in the varus group compared to the valgus group (p = 0.001), yet no difference was found for KAM among groups. Wearing a toe clip increased the knee adduction angle by 0.95º (p = 0.005). The findings of this study indicate that stationary cycling may be a safe exercise prescription for people with knee malalignments. In addition, using a toe clip may not have any negative effects on knee joints during stationary cycling.

Comparison of two different Radiostereometric analysis (RSA) systems with markerless elementary geometrical shape modeling for the measurement of stem migration.

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Li, Ye; Röhrl, Stephan M; Bøe, B; Nordsletten, Lars

2014-09-01

Radiostereometric analysis (RSA) is the gold standard of measurement for in vivo 3D implants migration. The aim of this study was to evaluate the in vivo precision of 2 RSA marker-based systems compared with that of marker-free, elementary geometrical shape modeling RSA. Stem migration was measured in 50 patients recruited from an on-going Randomized Controlled Trial. We performed marker-based analysis with the Um RSA and RSAcore systems and compared these results with those of the elementary geometrical shape RSA. The precision for subsidence was 0.118 mm for Um RSA, 0.141 mm for RSAcore, and 0.136 mm for elementary geometrical shape RSA. The precision for retroversion was 1.3° for elementary geometrical shape RSA, approximately 2-fold greater than that for the other methods. The intraclass correlation coefficient between the marker-based systems and elementary geometrical shape RSA was approximately 0.5 for retroversion. All 3 methods yielded ICCs for subsidence and varus-valgus rotation above 0.9. We found an excellent correlation between marker-based RSA and elementary geometrical shape RSA for subsidence and varus-valgus rotation, independent of the system used. The precisions for out-of-plane migration were inferior for elementary geometrical shape RSA. Therefore, as a mechanism of failure, retroversion may be more difficult to detect early. This is to our knowledge the first study to compare different RSA systems with or without markers on the implant. Marker-based RSA has high precision in all planes, independent of the system used. Elementary geometrical shape RSA is inferior in out-of-plane migration. Copyright © 2014 Elsevier Ltd. All rights reserved.

[Application of tibial mechanical axis locator in tibial extra-articular deformity in total knee arthroplasty].

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Li, Guoliang; Han, Guangpu; Zhang, Jinxiu; Ma, Shiqiang; Guo, Donghui; Yuan, Fulu; Qi, Bingbing; Shen, Runbin

2013-07-01

To explore the application value of self-made tibial mechanical axis locator in tibial extra-articular deformity in total knee arthroplasty (TKA) for improving the lower extremity force line. Between January and August 2012, 13 cases (21 knees) of osteoarthritis with tibial extra-articular deformity were treated, including 5 males (8 knees) and 8 females (13 knees) with an average age of 66.5 years (range, 58-78 years). The disease duration was 2-5 years (mean, 3.5 years). The knee society score (KSS) was 45.5 +/- 15.5. Extra-articular deformities included 1 case of knee valgus (2 knees) and 12 cases of knee varus (19 knees). Preoperative full-length X-ray films of lower extremities showed 10-21 degrees valgus or varus deformity of tibial extra joint. Self-made tibial mechanical axis locator was used to determine and mark coronal tibial mechanical axis under X-ray before TKA, and then osteotomy was performed with extramedullary positioning device according to the mechanical axis marker.' All incisions healed by first intention, without related complications of infection and joint instability. All patients were followed up 5-12 months (mean, 8.3 months). The X-ray examination showed case of 2.9 degrees knee deviation angle at 3 days after operation, and the accurate rate was 95.2%. No loosening or instability of prosthesis occurred during follow-up. KSS score was 85.5 +/- 15.0 at last follow-up, showing significant difference when compared with preoperative score (t=12.82, P=0.00). The seft-made tibial mechanical axis locator can improve the accurate rate of the lower extremity force line in TKA for tibia extra-articular deformity.

Effects of counteracting external valgus moment on lateral tibial cartilage contact conditions and tibial rotation.

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Shriram, Duraisamy; Parween, Rizuwana; Lee, Yee Han Dave; Subburaj, Karupppasamy

2017-07-01

Knee osteoarthritis that prevalently occurs at the medial compartment is a progressive chronic disorder affecting the articular cartilage of the knee joint, and lead to loss of joint functionality. Valgus braces have been used as a treatment procedure to unload the medial compartment for patients with medial osteoarthritis. Valgus braces through the application of counteracting external valgus moment shift the load from medial compartment towards the lateral compartment. Previous biomechanical studies focused only on the changes in varus moments before and after wearing the brace. The objective of this study was to investigate the influence of opposing external valgus moment applied by knee braces on the lateral tibial cartilage contact conditions using a 3D finite element model of the knee joint. Finite element simulations were performed on the knee joint model without and with the application of opposing valgus moment to mimic the unbraced and braced conditions. Lateral tibial cartilage contact pressures and contact area, and tibial rotation (varus-valgus and internal-external) were estimated for the complete walking gait cycle. The opposing valgus moment increased the maximum contact pressure and contact area on the lateral tibial cartilage compared to the normal gait moment. A peak contact pressure of 8.2 MPa and maximum cartilage loaded area of 28% (loaded cartilage nodes) on the lateral cartilage with the application of external valgus moment were induced at 50% of the gait cycle. The results show that the use of opposing valgus moment may significantly increase the maximum contact pressures and contact area on the lateral tibial cartilage and increases the risk of articular cartilage damage on the lateral compartment.

Hypermobility of the first metatarsal bone in patients with Rheumatoid arthritis treated by lapidus procedure

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Popelka Stanislav

2012-08-01

Full Text Available Abstract Background Foot deformities and related problems of the forefoot are very common in patients with rheumatoid arthritis. The laxity of the medial cuneometatarsal joint and its synovitis are important factors in the development of forefoot deformity. The impaired joint causes the first metatarsal bone to become unstable in the frontal and sagittal planes. In this retrospective study we evaluated data of patients with rheumatoid arthritis who underwent Lapidus procedure. We evaluated the role of the instability in a group of patients, focusing mainly on the clinical symptoms and X-ray signs of the instability. Methods The study group included 125 patients with rheumatoid arthritis. The indications of the Lapidus procedure were a hallux valgus deformity greater than 15 degrees and varus deformity of the first metatarsal bone with the intermetatarsal angle greater than 15 degrees on anterio-posterior weight-bearing X-ray. Results Data of 143 Lapidus procedures of 125 patients with rheumatoid arthritis, who underwent surgery between 2004 and 2010 was evaluated. Signs and symptoms of the first metatarsal bone instability was found in 92 feet (64.3% in our group. The AOFAS score was 48.6 before and 87.6 six months after the foot reconstruction. Nonunion of the medial cuneometatarsal joint arthrodesis on X-rays occurred in seven feet (4.9%. Conclusion The Lapidus procedure provides the possibility to correct the first metatarsal bone varus position and its instability, as well as providing the possibility to achieve a painless foot for walking. We recommend using the procedure as a preventive surgery in poorly symptomatic patients with rheumatoid arthritis in case of the first metatarsal bone hypermobility.

A prospective dual-energy X-ray absorptiometry study of bone remodeling after implantation of the Nanos short-stemmed prosthesis.

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Zeh, Alexander; Pankow, Franziska; Röllinhoff, Marc; Delank, Stefan; Wohlrab, David

2013-04-01

The aim of this study was to analyze the bone remodeling around the Nanos stem (Smith & Nephew, Marl, Germany) after primary total hip arthroplasty for coxarthrosis. In 25 patients (15 male, 10 female, mean age 59.9 years) with the diagnosis of coxarthrosis, a DEXA scan was performed immediately after surgery, 97 days (SD 6.1 days) and 368 days (SD 6.2 days) after implantation of a Nanos prosthesis. Plain radiographs were analyzed digitally for radiolucent lines, varus-valgus femoral stem alignment, measurement of stem migration and changes in varus-valgus femoral stem alignment. The position of the center of rotation (COR) and the offset were assessed pre- and postoperatively. Harris Hip Score was used to evaluate the clinical outcome. The DEXA scan showed a significant and relevant increase in BMD (Bone Mineral Density) in Gruen-Zone 6 (12%) and a decrease in Zone 1 (15%), 2 (5%) and 7 (12%), which was interpreted as reflecting a distal load transfer in the metaphysis of the femur. There was no clinically relevant migration or tilting of the Nanos stem. Radiolucent lines were noted in 12 cases, mainly at the polished tip area of the prosthesis; this was not regarded as a sign of impaired osseointegration. There was no significant difference between the position of the COR and the pre- and postoperative offset. The absence of stem migration, angulation, or relevant radiolucent lines is seen as evidence for an unimpaired osseointegration of the Nanos stem approximately 12 months after implantation. It is concluded that the Nanos prosthesis can reduce loss of BMD of the proximal femur composed with conventional stems or other short-stemmed implants.

The alignment of the knee joint in relationship to age and osteoarthritis: the Copenhagen Osteoarthritis Study.

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Laxafoss, Erling; Jacobsen, Steffen; Gosvig, Kasper K; Sonne-Holm, Stig

2013-04-01

The aim of the present study was to describe the changes in the axis of the knee joint in both radiologically osteoarthritic and non-osteoarthritic knees, on the basis of angles measurable in standardized clinical short knee radiographs, in a cross sectional study of an epidemiological cohort. From the third inclusion of the Copenhagen City Heart Study, 4,151 subjects were selected for standardized radiography of the knees. After censuring the inclusion, the resulting cohort was comprised of 3,488 individuals. Images were analyzed for radiological knee joint osteoarthritis (OA) and the anatomical femorotibial axis of the knee joint was measured. The prevalence of knee joint OA in males was 27.9% and 27.5%, for the left and right knees respectively. In females this was 32.8% and 36.4%. The mean knee joint angles were 4.11° in males; and 5.45° in females. A difference of 1.3° was found between the genders. In non-osteoarthritic knees the increase in valgus orientation in relationship to increasing age was found to be 0.03° and 0.04° per year, respectively, for males and females. Likewise, Kellgren and Lawrence found that OA was seen to influence a shift towards varus of 0.55°-0.76° per level of OA. Stratification in accordance with morphological severity of OA documented a clear tendency for the axis of the diseased knees to depart from the mean, primarily in the direction of varus. In knees exhibiting no signs of radiographic osteoarthritis we found a significant relationship between increasing age and a shift in the anatomical axis in the direction of valgus.

Rotation of intramedullary alignment rods affects distal femoral cutting plane in total knee arthroplasty.

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Maderbacher, Günther; Matussek, Jan; Keshmiri, Armin; Greimel, Felix; Baier, Clemens; Grifka, Joachim; Maderbacher, Hermann

2018-02-17

Intramedullary rods are widely used to align the distal femoral cut in total knee arthroplasty. We hypothesised that both coronal (varus/valgus) and sagittal (extension/flexion) cutting plane are affected by rotational changes of intramedullary femoral alignment guides. Distal femoral cuts using intramedullary alignment rods were simulated by means of a computer-aided engineering software in 4°, 6°, 8°, 10°, and 12° of valgus in relation to the femoral anatomical axis and 4° extension, neutral, as well as 4°, 8°, and 12° of flexion in relation to the femoral mechanical axis. This reflects the different angles between anatomical and mechanical axis in coronal and sagittal planes. To assess the influence of rotation of the alignment guide on the effective distal femoral cutting plane, all combinations were simulated with the rod gradually aligned from 40° of external to 40° of internal rotation. Rotational changes of the distal femoral alignment guides affect both the coronal and sagittal cutting planes. When alignment rods are intruded neutrally with regards to sagittal alignment, external rotation causes flexion, while internal rotation causes extension of the sagittal cutting plane. Simultaneously the coronal effect (valgus) decreases resulting in an increased varus of the cutting plane. However, when alignment rods are intruded in extension or flexion partly contradictory effects are observed. Generally the effect increases with the degree of valgus preset, rotation and flexion. As incorrect rotation of intramedullary alignment guides for distal femoral cuts causes significant cutting errors, exact rotational alignment is crucial. Coronal cutting errors in the distal femoral plane might result in overall leg malalignment, asymmetric extension gaps and subsequent sagittal cutting errors.

Radiology in Gerard uncemented double cup arthroplasty

International Nuclear Information System (INIS)

Willems, W.J.; Rozing, P.M.; Obermann, W.R.

1988-01-01

A radiological follow-up was performed on 109 Gerard (uncemented) double cup arthroplasties, with special emphasis on shift of the femoral cup and protrusion of the acetabular cup, for which a new formula was introduced. Varus shift or axial collapse of the femoral cup played a major role in the failure of these cups. Fluoroscopic examination with video-tape recording seemed to be most helpful in determining abnormalities in this kind of arthroplasty. This examination revealed one normal and two abnormal types of movement, either between both cups or between acetabular cup and acetabular cavity. Those hips with normal movement showed a significantly better clinical score. 16 refs.; 6 figs

Quantitative bone scintigraphy in the evaluation of angular deformity of the lower extremity

International Nuclear Information System (INIS)

Harcke, H.T.; Zapf, S.E.; Mandell, G.A.; Sharkey, C.A.; Cooley, L.A.

1986-01-01

A technique for quantitative analysis of growth plates in varus or valgus deformity about the knee has been developed. Computer-generated regions of interest are placed on magnification scintigraphs to divide distal femoral and proximal tibial physes into four equal segments. The ratio of counts in the medial half to counts in the lateral half was studied in 31 children (22 normal, 9 with angular deformity). Normal ratios were 0.74 to 0.98 for femora and 0.98 to 1.20 for tibias. In eight of nine patients with deformity, the ratio was abnormal; in two patients the ratio returned to normal when the deformity ceased to progress

Parametric curve evaluation of a phototransistor used as detector in stereotactic radiosurgery X-ray beam

International Nuclear Information System (INIS)

Lima, Daniela Pontes A.; Santos, Luiz Antonio P.; Santos, Walter M.; Silva Junior, Eronides F. da

2005-01-01

Phototransistors have been widely used as detectors for low energy X-rays. However, when they are used in high energy X-rays fields like those generated from linear accelerators (linac), there is a certain loss of sensibility to the ionizing radiation. This damage is cumulative and irreversible. Thus, a correction factor must be applied to its response, which is proportional to the integrated dose. However, it is possible to estimate the correction factor by using the V x I parametric curve of the device. The aim of this work was to develop studies to evaluate and correlate the parametric response curve of a phototransistor with its loss of sensibility after irradiation. An Agilent 4155C semiconductor parameter analyzer was used to trace the parametric curve. X-rays were generated by a 14 MV Primus-Siemens linear accelerator. The results demonstrated that there is a correlation between the integrated dose applied to the phototransistor and the parametric response of the device. Studies are under way to determine how such behavior can provide information for the dosimetric planning in stereotactic radiosurgery. (author)

Photon Irradiation Response on Ge and Al-Doped SiO2 Optical Fibres

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Yaakob, Nor Haliza; Wagiran, Husin; Ramli, Ahmad Termizi; Ali, Hassan; Asni, Hazila

2010-07-01

Recently, research groups have reported a number of radiation effects on the applications of SiO2 optical fibres with possible use as dosimeter material because these optical fibre provide a good basis for medical radiation dosimetry. The objective of this study is to investigate the thermoluminescence response and fading characteristic for germanium and aluminium doped SiO2 optical fibres with photon irradiation. These optical fibres are placed in solid phantom and irradiated to 6 and 10 MV photon beam at dose ranging from 0.06 Gy to 0.24 Gy using Primus MLC 3339 linear accelerator at Hospital Sultan Ismail, Johor Bahru. In fading studies, the TL measurements were continued up to 14 days period. The optical fibres will produce glow curves whereby the information is then analyzed. Al and Ge-doped optical fibres have a linear dose-TL signal relationship that is proportionality between the TL signal and the doses. Comparison for TL response between different linear accelerator showed a good agreement because these optical fibres also have a linear dose-TL signal relationship even using different equipments.

Estimating doses and risks associated with decontamination and decommissioning activities using the CRRIS

International Nuclear Information System (INIS)

Miller, C.W.; Sjoreen, A.L.; Cotter, S.J.

1986-01-01

The Computerized Radiological Risk Investigation System (CRRIS) is applicable to determining doses and risks from a variety of decontamination and decommissioning activities. For example, concentrations in air from resuspended radionuclides initially deposited on the ground surface and the concentrations of deposited radionuclides in various soil layers can be obtained. The CRRIS will estimate exposure to radon and its progeny in terms of working-level months, and will compute the resulting health risks. The CRRIS consists of seven integrated computer codes that stand alone or are run as a system to calculate environmental transport, doses, and risks. PRIMUS output provides other CRRIS codes the capability to handle radionuclide decay chains. ANEMOS and RETADD-II calculate atmospheric dispersion and deposition for local and regional distances, respectively. Multiple ANEMOS runs for sources within a small area are combined on a master grid by SUMIT. MLSOIL is used to estimate effective ground surface concentrations for dose computations. TERRA calculates food chain transport, and ANDROS calculates individual or population exposures, doses, and risks. Applications of the CRRIS to decontamination problems are discussed. 16 refs., 1 fig

Study and evaluation of the Siemens virtual wedge factor: dosimetric monitor system and variable field effects

Energy Technology Data Exchange (ETDEWEB)

Sendon Rio, J R Sendon; Martinez, C Otero; GarcIa, M Sanchez; Busto, R Lobato; Vega, V Luna; Sueiro, J Mosquera; Camean, M Pombar [Servizo de Radiofisica e Proteccion Radioloxica, Complexo Hospitalario Universitario de Santiago de Compostela (CHUS), Santiago de Compostela (Spain)], E-mail: jose.ramon.sendon.del.rio@sergas.es

2008-03-07

In the year 1997 Siemens introduced the virtual wedge in its accelerators. The idea was that a dose profile similar to that of a physical wedge can be obtained by moving one of the accelerator jaws at a constant speed while the dose rate is changing. This work explores the observed behaviour of virtual wedge factors. A model is suggested which takes into account that at any point in time, when the jaw moves, the dose at a point of interest in the phantom is not only due to the direct beam. It also depends on the scattered radiation in the phantom, the head scatter and the behaviour of the monitoring system of the accelerator. Measurements are performed in a Siemens Primus accelerator and compared to the model predictions. It is shown that the model agrees reasonably well with measurements spanning a wide range of conditions. A strong dependence of virtual wedge factors on the dosimetric board has been confirmed and an explanation has been given on how the balance between different contributions is responsible for virtual wedge factors values.

Analysis of medial deviation of center of pressure after initial heel contact in forefoot varus

Directory of Open Access Journals (Sweden)

Wei-Li Hsi

2016-03-01

Conclusion: The most medial CoP of the row and CoP% detected increased medial CoP deviation in FV ≥ 8°, and may be applied to other clinical conditions where rearfoot angle and CoP of the array after initial heel contact cannot detect significant differences.

The development and validation of a custom built device for assessing frontal knee joint laxity.

Science.gov (United States)

Ismail, Shiek Abdullah; Simic, Milena; Clarke, Jillian L; Lopes, Thiago Jambo Alves; Pappas, Evangelos

2017-12-01

This study reports the development and validation of a quantitative technique of assessing frontal knee joint laxity through a custom built device named KLICP. The objectives of this study were to determine: (i) the intra- and inter-rater reliability and (ii) the validity of the device when compared to real time ultrasound. Twenty-five participants had their frontal knee joint laxity assessed by the KLICP, by manual varus/valgus tests and by ultrasound. Two raters independently assessed laxity manually by three repeated measurements, repeated at least 48h later. Results were validated by comparing them to the medial and lateral joint space opening measured by the ultrasound. Intraclass correlation coefficients and standard error of measurement reliability were calculated. Pearson's correlation coefficients were calculated to determine the correlation between the KLICP and the joint space. Intra-rater reliability (intra-session) for each rater was good on both sessions (0.91-0.98), intra-rater reliability (inter-sessions) was moderate to good (0.62-0.87), and inter-rater reliability (intra-session) was good (0.75-0.80). There is low agreement for intra-rater (inter-session) and for inter-rater (intra-session) reliability. The KLICP measurement has a significant positive fair to moderate correlation to the ultrasound measurement at the left (r: 0.61, p: 0.01) and right (r: 0.48, p: 0.02) knee in the valgus direction and at the left (r: 0.51, p: 0.01) and right (r: 0.39, p: 0.05) knee in the varus direction. There is low agreement between the KLICP and the RTU. Reliability and agreement was good only when measured for intra-rater, within session. Copyright © 2017 Elsevier B.V. All rights reserved.

Courses of change in knee adduction moment and lateral thrust differ up to 1 year after TKA.

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Shimada, Noboru; Deie, Masataka; Hirata, Kazuhiko; Hiate, Yasuhiko; Orita, Naoya; Iwaki, Daisuke; Ito, Yoshihiro; Kimura, Hiroaki; Pappas, Evangelos; Ochi, Mitsuo

2016-08-01

In total knee arthroplasty (TKA), dynamic knee loading may loosen the artificial joint and bone or cause polyethylene wear after prolonged use. TKA decreases knee adduction moment at 6 months, but this effect is lost by 1 year post-operatively. However, lateral thrust after TKA has not been clarified. We hypothesized that like knee adduction moment, lateral thrust would return to baseline levels by 1 year post-operatively. Participants were 15 patients who underwent TKA for medial knee OA. Japanese Orthopaedic Association (JOA) score, numeric rating scale, and gait analysis (measurement of peak knee adduction moment, knee varus angle at peak knee adduction moment, lateral thrust, and gait speed) were performed preoperatively (baseline) and 3 weeks, 3 and 6 months, and 1 year post-operatively. JOA score improved from 55 ± 9.8 to 78 ± 12.1 at 1 year post-operatively, and pain decreased significantly from baseline at each follow-up (p < 0.001). Significant increases in gait speed were observed at 6 months and 1 year (p < 0.001). Peak knee adduction moment during stance phase was significantly lower at 3 weeks, 3 months, and 6 months compared to baseline (p < 0.05), but no significant changes were seen at 1 year. Knee varus at peak knee adduction moment did not differ significantly between any measurement points, while lateral thrust was decreased at 6 months and 1 year compared to baseline (p < 0.05). Temporal courses of changes up to 1 year after TKA differed between knee adduction moment and lateral thrust, so our hypothesis was rejected. IV.

Which factor is most important for occurrence of cutout complications in patients treated with proximal femoral nail antirotation? Retrospective analysis of 298 patients.

Science.gov (United States)

Turgut, Ali; Kalenderer, Önder; Karapınar, Levent; Kumbaracı, Mert; Akkan, Hasan Ali; Ağuş, Haluk

2016-05-01

Mechanical complications, such as cut-out of the head-neck fixation device, are the most common causes of morbidity after trochanteric femur fracture treatment. The causes of cut-out complications are well defined in patients who are treated with sliding hip screws and biaxial cephalomedullary nails but there are few reports about the patients who are treated with proximal femoral nail antirotation. The purpose of this study was to evaluate the most important factor about occurance of cutout complication and also to evaluate the risks of the combination of each possible factors. Overally 298 patients were enrolled in the study. Medical records were reviewed for patients' age, fracture type, gender, anesthesia type and occurance of cut-out complication. Postoperatively taken radiographs were reviewed for tip-apex distance, obtained collo-diaphyseal angle, the quadrant of the helical blade and Ikuta reduction subgroup. The most important factor (s) and also predicted probability of cut-out complication was calculated for each combination of factors. Cut-out complication was observed in 14 patients (4.7 %). The most important factor about occurrence of the cut-out complication was found as varus reduction (p: 0.01), the second important factor was found as implantation of the helical blade in the improper quadrant (p: 0.02). Tip-apex distance was found as third important factor (p: 0.10). The predicted probability of cut-out complication was calculated as 45.6 % when whole of the four surgeon dependent factors were improperly obtained. Althought obtaining proper tip-apex distance is important to prevent cutout complication in these fractures, if the fracture is not reduced in varus position and helical blade is inserted in the proper quadrant, possibility of cut-out complication is very low even in the patients with high tip-apex distance.

Evaluation of Fibular Fracture Type vs Location of Tibial Fixation of Pilon Fractures.

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Busel, Gennadiy A; Watson, J Tracy; Israel, Heidi

2017-06-01

Comminuted fibular fractures can occur with pilon fractures as a result of valgus stress. Transverse fibular fractures can occur with varus deformation. No definitive guide for determining the proper location of tibial fixation exists. The purpose of this study was to identify optimal plate location for fixation of pilon fractures based on the orientation of the fibular fracture. One hundred two patients with 103 pilon fractures were identified who were definitively treated at our institution from 2004 to 2013. Pilon fractures were classified using the AO/OTA classification and included 43-A through 43-C fractures. Inclusion criteria were age of at least 18 years, associated fibular fracture, and definitive tibial plating. Patients were grouped based on the fibular component fracture type (comminuted vs transverse), and the location of plate fixation (medial vs lateral) was noted. Radiographic outcomes were assessed for mechanical failures. Forty fractures were a result of varus force as evidenced by transverse fracture of the fibula and 63 were due to valgus force with a comminuted fibula. For the transverse fibula group, 14.3% mechanical complications were noted for medially placed plate vs 80% for lateral plating ( P = .006). For the comminuted fibular group, 36.4% of medially placed plates demonstrated mechanical complications vs 16.7% for laterally based plates ( P = .156). Time to weight bearing as tolerated was also noted to be significant between groups plated medially and laterally for the comminuted group ( P = .013). Correctly assessing the fibular component for pilon fractures provides valuable information regarding deforming forces. To limit mechanical complications, tibial plates should be applied in such a way as to resist the original deforming forces. Level of Evidence Level III, comparative study.

3D atlas-based registration can calculate malalignment of femoral shaft fractures in six degrees of freedom.

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Crookshank, Meghan C; Beek, Maarten; Hardisty, Michael R; Schemitsch, Emil H; Whyne, Cari M

2014-01-01

This study presents and evaluates a semi-automated algorithm for quantifying malalignment in complex femoral shaft fractures from a single intraoperative cone-beam CT (CBCT) image of the fractured limb. CBCT images were acquired of complex comminuted diaphyseal fractures created in 9 cadaveric femora (27 cases). Scans were segmented using intensity-based thresholding, yielding image stacks of the proximal, distal and comminuted bone. Semi-deformable and rigid affine registrations to an intact femur atlas (synthetic or cadaveric-based) were performed to transform the distal fragment to its neutral alignment. Leg length was calculated from the volume of bone within the comminution fragment. The transformations were compared to the physical input malalignments. Using the synthetic atlas, translations were within 1.71 ± 1.08 mm (medial/lateral) and 2.24 ± 2.11 mm (anterior/posterior). The varus/valgus, flexion/extension and periaxial rotation errors were 3.45 ± 2.6°, 1.86 ± 1.5° and 3.4 ± 2.0°, respectively. The cadaveric-based atlas yielded similar results in medial/lateral and anterior/posterior translation (1.73 ± 1.28 mm and 2.15 ± 2.13 mm, respectively). Varus/valgus, flexion/extension and periaxial rotation errors were 2.3 ± 1.3°, 2.0 ± 1.6° and 3.4 ± 2.0°, respectively. Leg length errors were 1.41 ± 1.01 mm (synthetic) and 1.26 ± 0.94 mm (cadaveric). The cadaveric model demonstrated a small improvement in flexion/extension and the synthetic atlas performed slightly faster (6 min 24 s ± 50 s versus 8 min 42 s ± 2 min 25 s). This atlas-based algorithm quantified malalignment in complex femoral shaft fractures within clinical tolerances from a single CBCT image of the fractured limb.

Does measurement of the anatomic axis consistently predict hip-knee-ankle angle (HKA) for knee alignment studies in osteoarthritis? Analysis of long limb radiographs from the multicenter osteoarthritis (MOST) study.

Science.gov (United States)

Sheehy, L; Felson, D; Zhang, Y; Niu, J; Lam, Y-M; Segal, N; Lynch, J; Cooke, T D V

2011-01-01

Researchers commonly use the femoral shaft-tibial shaft angle (FS-TS) from knee radiographs to estimate the hip-knee-ankle angle (HKA) in studies examining risk factors for knee osteoarthritis (OA) incidence and progression. The objective of this study was to determine the relationship between HKA and FS-TS, depending on the method of calculating FS-TS and the direction and degree of knee deformity. 120 full-length digital radiographs were assigned, with 30 in each of four alignment groups (0.0°-4.9°, and ≥5.0° of varus and valgus), from a large cohort of persons with and at risk of knee OA. HKA and five measures of FS-TS (using progressively shorter shaft lengths) were obtained using Horizons Analysis Software, Orthopaedic Alignment & Imaging Systems Inc. (OAISYS). The offsets between HKA and the different versions of FS-TS were calculated, with 95% confidence intervals (CIs). Pearson correlations were calculated. In varus limbs use of a shorter shaft length increased the offset between HKA and FS-TS from 5.1° to 7.0°. The opposite occurred with valgus limbs (from 5.0° to 3.7°). Correlations between HKA and FS-TS for the whole sample of 120 individuals were excellent (r range 1.00-0.88). However, correlations for individual alignment groups were low to moderate, especially for the shortest-shaft FS-TS (r range 0.41-0.66). The offsets obtained using the shorter FS-TS measurements vary depending on direction and degree of knee deformity, and therefore may not provide reliable predictions for HKA We recommend that full-length radiographs be used whenever an accurate estimation of HKA is required, although broad categories of alignment can be estimated with FS-TS. Copyright © 2010 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

The effects of femoral external derotational osteotomy on frontal plane alignment.

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Nelitz, M; Wehner, T; Steiner, M; Dürselen, L; Lippacher, S

2014-11-01

Femoral osteotomies are the preferred treatment in significant torsional deformity of the femur. The influence of torsional osteotomies on frontal plane alignment is poorly understood. Therefore, the aim of the present study was to evaluate the effects of external derotational osteotomies on proximal, mid-shaft and distal levels onto frontal plane alignment. The effect of rotation around the anatomical axis of the femur on frontal plane alignment was determined with a 3D computer model, created from CT data of a right human cadaver femur. Virtual torsional osteotomies of 10°, 20° and 30° were performed at proximal, mid-shaft and distal levels under five antecurvatum angles of the femur. The change of the frontal plane alignment was expressed by the mechanical lateral femoral angle. Proximal derotational osteotomies resulted in an increased mechanical lateral distal femoral angle (mLDFA) of 0.8°-2.6° for 10°, of 1.6°-5.1° for 20° and of 2.3-7.9° for 30° derotational osteotomy, indicating an increased varus angulation. Supracondylar derotational osteotomy resulted in a decreased mLDFA of -0.1° to -1.7° for 10°, of -0.2 to -3.7° for 20° and of -0.7 to -6.9° for 30° derotational osteotomy, indicating an increased valgus angulation. The effect increased with the amount of torsional correction and virtually increased antecurvatum angles. Mid-shaft torsional osteotomies had the smallest effect on frontal plane alignment. This three-dimensional computer model study demonstrates the relationship between femoral torsional osteotomies and frontal plane alignment. Proximal external derotational osteotomies tend to result in an increased varus angulation, whilst distal external derotational osteotomies tend to result in an increased valgus angulation. As a clinical consequence, torsional osteotomies have an increased risk of unintentional implications on frontal plane alignment.

Three-dimensional hindfoot alignment measurements based on biplanar radiographs: comparison with standard radiographic measurements

International Nuclear Information System (INIS)

Sutter, Reto; Pfirrmann, Christian W.A.; Buck, Florian M.; Espinosa, Norman

2013-01-01

To establish a hindfoot alignment measurement technique based on low-dose biplanar radiographs and compare with hindfoot alignment measurements on long axial view radiographs, which is the current reference standard. Long axial view radiographs and low-dose biplanar radiographs of a phantom consisting of a human foot skeleton embedded in acrylic glass (phantom A) and a plastic model of a human foot in three different hindfoot positions (phantoms B1-B3) were imaged in different foot positions (20 internal to 20 external rotation). Two independent readers measured hindfoot alignment on long axial view radiographs and performed 3D hindfoot alignment measurements based on biplanar radiographs on two different occasions. Time for three-dimensional (3D) measurements was determined. Intraclass correlation coefficients (ICC) were calculated. Hindfoot alignment measurements on long axial view radiographs were characterized by a large positional variation, with a range of 14 /13 valgus to 22 /27 varus (reader 1/2 for phantom A), whereas the range of 3D hindfoot alignment measurements was 7.3 /6.0 to 9.0 /10.5 varus (reader 1/2 for phantom A), with a mean and standard deviation of 8.1 ± 0.6/8.7 ± 1.4 respectively. Interobserver agreement was high (ICC = 0.926 for phantom A, and ICC = 0.886 for phantoms B1-B3), and agreement between different readouts was high (ICC = 0.895-0.995 for reader 1, and ICC = 0.987-0.994 for reader 2) for 3D measurements. Mean duration of 3D measurements was 84 ± 15/113 ± 15 s for reader 1/2. Three-dimensional hindfoot alignment measurements based on biplanar radiographs were independent of foot positioning during image acquisition and reader independent. In this phantom study, the 3D measurements were substantially more precise than the standard radiographic measurements. (orig.)

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.

Clinical application of 3D computer simulation for upper limb surgery

International Nuclear Information System (INIS)

Murase, Tsuyoshi; Moritomo, Hisao; Oka, Kunihiro; Arimitsu, Sayuri; Shimada, Kozo

2008-01-01

To perform precise orthopaedic surgery, we have been developing a surgical method using a custom-made surgical device designed based on preoperative three-dimensional computer simulation. The purpose of this study was to investigate the preliminary results of its clinical application for corrective osteotomy of the upper extremity. Twenty patients with long bone deformities of the upper extremities (four cubitus varus deformities, nine malunited forearm fractures, six malunited distal radial fractures and one congenital deformity of the forearm) participated in this study. Three-dimensional computer models of the affected bone and the contralateral normal bone were constructed from computed tomography data. By comparing these models, the three-dimensional deformity axis and the accurate amount of deformity around it were quantified. Three-dimensional deformity correction was then simulated. A custom-made osteotomy template was designed and manufactured as a real plastic model aiming to reproduce the preoperative simulation in the actual operation. In the operation, we put the template on the bone surface, cut the bone through a slit on the template, and corrected the deformity as preoperatively simulated, followed by internal fixation. Radiographic and clinical evaluations were made in all cases before surgery and at the most recent follow-up. Corrective osteotomy was achieved as simulated in all cases. All patients had bone fusion within six months. Regarding the cubitus varus deformity, the average carrying angle and tilting angle were 5deg and 28deg after surgery. For malunited forearm fractures, angular deformities on radiographs were nearly nonexistent after surgery. All radiographic parameters in malunited distal radius fractures were normalized. The range of forearm rotation in cases of forearm malunion and that of wrist flexion-extension in cases of malunited distal radius improved after surgery. (author)

The Posterior Bundle's Effect on Posteromedial Elbow Instability After a Transverse Coronoid Fracture: A Biomechanical Study.

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Shukla, Dave R; Golan, Elan; Weiser, Mitch C; Nasser, Philip; Choueka, Jack; Hausman, Michael

2018-04-01

There has been increased interest in the role of the posterior bundle of the medial collateral ligament (pMUCL) in the elbow, particularly its effects on posteromedial rotatory stability. The ligament's effect in the context of an unfixable coronoid fracture has not been the focus of any study. The purposes of this biomechanical study were to evaluate the stabilizing effect of the pMUCL with a transverse coronoid fracture and to assess the effect of graft reconstruction of the ligament. We simulated a varus and internal rotatory subluxation in 7 cadaveric elbows at 30°, 60°, and 90° elbow flexion. The amount of ulnar rotation and medial ulnohumeral joint gapping were assessed in the intact elbow after we created a transverse coronoid injury, after we divided the pMUCL, and finally, after we performed a graft reconstruction of the pMUCL. At all angles tested, some stability was lost after cutting the pMUCL once the coronoid had been injured, because mean proximal ulnohumeral joint gapping increased afterward by 2.1, 2.2, and 1.3 mm at 90°, 60°, and 30°, respectively. Ulnar internal rotation significantly increased after pMUCL transection at 90°. At 60° and 30° elbow flexion, ulnar rotation increased after resection of the coronoid but not after pMUCL resection. An uninjured pMUCL stabilizes against varus internal rotatory instability in the setting of a transverse coronoid fracture at higher flexion angles. Further research is needed to optimize graft reconstruction of the pMUCL. The pMUCL is an important secondary stabilizer against posteromedial instability in the coronoid-deficient elbow. In the setting of an unfixable coronoid fracture, the surgeon should examine for posteromedial instability and consider addressing the pMUCL surgically. Copyright © 2018 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

FAILED PRIMARY TREATMENT OF CALCANEAL FRACTURE. WHAT TO DO?

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Matej Andoljšek

2008-02-01

When conservative treatment fails, operative treatment is indicated in most patients withbone and joint problems. The goals of surgical treatment are pain relief and restoration oftalocalcaneal alignment. In lateral impingement, when subtalar joint and general alignmentof the tuber are preserved, removal of the bulged lateral wall could suffice. In suchcases a corrective osteotomy of the tuber is rarely indicated. In painfull subtalar arthrosisfusion is the only option. Limited fusion is preferable. »In situ« subtalar fusion is advisablein cases without malalignment or deformity. When we have arthrosis and varus/valgusdeformity with preserved height, arthrodesis with corrective osteotomy is indicated. In mostcases, where complex deformity is present, corrective subtalar distraction bone-blockarthrodesis should be done

Radiographic evaluation of hallux valgus

International Nuclear Information System (INIS)

Richardson, M.L.; Hansen, S.T.; Kilcoyne, R.F.

1987-01-01

This paper presents the common preoperative and postoperative findings in hallux valgus, a common foot disorder of multiple etiologies, which can lead to significant foot pain and deformity. Little has been published in radiologic literature about the proper initial radiographic workup and the postoperative follow-up of this very common and very treatable cause of foot pain. Besides the primary findings of varus angulation of the first metatarsal and valgus angulation of the great toe, one may also see dorsal slaying of the first metatarsal head. As increased weight is borne by the central metatarsals, they may develop hyperostosis and stress fractures. Angular deformities of the hallux sesamoid joint and lesser toes may also be seen

Primary Ankle Arthrodesis for Severely Comminuted Tibial Pilon Fractures.

Science.gov (United States)

Al-Ashhab, Mohamed E

2017-03-01

Management of severely comminuted, complete articular tibial pilon fractures (Rüedi and Allgöwer type III) remains a challenge, with few treatment options providing good clinical outcomes. Twenty patients with severely comminuted tibial pilon fractures underwent primary ankle arthrodesis with a retrograde calcaneal nail and autogenous fibular bone graft. The fusion rate was 100% and the varus malunion rate was 10%. Fracture union occurred at a mean of 16 weeks (range, 13-18 weeks) postoperatively. Primary ankle arthrodesis is a successful method for treating highly comminuted tibial pilon fractures, having a low complication rate and a high satisfaction score. [Orthopedics. 2017; 40(2):e378-e381.]. Copyright 2016, SLACK Incorporated.

Disorders of the origin of the suspensory ligament: A diagnostic challenge

International Nuclear Information System (INIS)

Lischer, Ch.J.; Bischofberger, A.S.; Fürst, A.; Lang, J.; Ueltschi, G.

2006-01-01

Lameness in horses due to pain originating from the proximal metacarpal/metatarsal region remains a diagnostic challenge. In cases of obvious lameness the pain can be localised to this region by diagnostic anaesthesia. Because a variety of disorders can cause lameness in this region different imaging modalities including radiography, ultrasonography and scintigraphy should be used to arrive at an accurate diagnosis. Even though a precise anatomic-pathologic diagnosis can still be an enigma, because not only bone and joints, but also soft tissue structures including the proximal suspensory ligament, its origin at the proximal metacarpus/metatarsus, its fascia, the superficial fascia, as well as the intermetacarpal/metatarsal ligaments, the accessory ligament of the deep digital flexor tendon and both digital flexor tendons may be involved. Magnet resonance tomography (MRT) shows a high diagnostic sensitivity in imaging soft tissue structures and bone. In horses MRT is still at the beginning. The MRT appearance of the proximal metacarpal/metatarsal region has not yet been evaluated in detail and there are only few anatomic studies of the origin of the suspensory ligament in horses. The first experiences showed, that more gross and histologic examinations are necessary to fully interpret MRT-images and to differentiate pathologic alterations from clinically not relevant variations [de

SURGICAL TREATMENT OF SEVERE (2-3 DEGREE DEFORMING ARTHROSIS OF FIRST METATARSOPHALANGEAL JOINT OF FOOT: TASKS, APPROACHES, TECHNIQUE

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A. V. Mazalov

2011-01-01

Full Text Available Based on the experience of treating 67 patients (98 feet with deforming arthrosis of first metatarsophalangeal joint is shown that the treatment of this disease the distal decompressing osteotomy in combination with maximally radical the separation of the unions and cheilectomy possesses the significant health-improvement potential, which makes it possible to be turned to arthrodesis or arthroplasty only in the limiting cases of that the heavy cases of hallux rigidus. L-osteotomy 1-st metatarsus gives more than possibilities for the correction with the heavy deformations and the degenerate changes, the basic criterion of sufficiency of which is the volume of the intra-operating straightening of 1-st fingers reached. Optimum is reaching the straightening 1-st toes to 65° even above. An indispensable stage of complex operation is maximally radical of cheilectomy. During the formation of arthrodesis 1-st metatarsophalangeal joint in the horizontal plane the axis of 1 finger should be oriented in parallel to axis second metatarsal bones. The sagittal angle of the formation of arthrodesis depends on the manifestation of valgus of rear division. Active postoperative conducting essentially improves the distant results of the surgical treatment of deforming arthrosis of first metatarsophalangeal joint.

Cribellate thread production in spiders: Complex processing of nano-fibres into a functional capture thread.

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Joel, Anna-Christin; Kappel, Peter; Adamova, Hana; Baumgartner, Werner; Scholz, Ingo

2015-11-01

Spider silk production has been studied intensively in the last years. However, capture threads of cribellate spiders employ an until now often unnoticed alternative of thread production. This thread in general is highly interesting, as it not only involves a controlled arrangement of three types of threads with one being nano-scale fibres (cribellate fibres), but also a special comb-like structure on the metatarsus of the fourth leg (calamistrum) for its production. We found the cribellate fibres organized as a mat, enclosing two parallel larger fibres (axial fibres) and forming the typical puffy structure of cribellate threads. Mat and axial fibres are punctiform connected to each other between two puffs, presumably by the action of the median spinnerets. However, this connection alone does not lead to the typical puffy shape of a cribellate thread. Removing the calamistrum, we found a functional capture thread still being produced, but the puffy shape of the thread was lost. Therefore, the calamistrum is not necessary for the extraction or combination of fibres, but for further processing of the nano-scale cribellate fibres. Using data from Uloborus plumipes we were able to develop a model of the cribellate thread production, probably universally valid for cribellate spiders. Copyright © 2015 Elsevier Ltd. All rights reserved.

Combined Anterior Cruciate Ligament Reconstruction and High Tibial Osteotomy in Anterior Cruciate Ligament-Deficient Varus Knees

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Ayman M. Ebied

2017-12-01

Conclusion: The combined procedure of ACL reconstruction and high tibial osteotomy restored knee stability and reduced pain over the medial compartment. Although the combined procedure has a longer period of rehabilitation than an isolated ACL reconstruction, the elimination of lateral thrust and preservation of articular cartilage of the medial compartment are of paramount importance to the future of these knees.

Estabilidade articular do joelho no quadro do "joelho-flutuante" Knee joint stability in a "floating knee" condition

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Felipe Antônio de Marco

2008-01-01

examination of the knee. The joint instability was present in eight cases (47% followed by restricted movement in seven patients (41.2%. Anterior instability was diagnosed in five cases (29.4%, three of them associated with varus instability. Posterior instability was observed in two patients (11.8% and in both cases it was associated with varus instability. One patient presented with peripheral varus-valgus instability and an important knee movement restriction. Intra-articular and exposed fractures of the femur and tibia present a higher incidence of restricted arc movement. The results obtained in this study reinforce the need for the systemic assessment of knee joint stability in view of the fact that the "floating knee" condition is often associated with lesions of the knee joint capsule and ligament.

A NEW PERLEIDID FROM THE SPATHIAN (OLENEKIAN, EARLY TRIASSIC OF CHAOHU, ANHUI PROVINCE, CHINA

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ZUOYU SUN

2013-11-01

Full Text Available A new actinopterygian genus and species, Chaohuperleidus  primus gen. n. n. sp., is described from the Upper Member of the Nanlinghu Formation (Spathian, Olenekian, Early Triassic at Majiashan (Majia Hill, Chaohu City, Anhui Province, Southeast China. The new taxon is assigned to the order Perleidiformes on the base of a combination of features: large wedge-like preoperculum with expanded infraorbital process and sensory canal running almost vertical along the posterior margin of the preoperculum itself, flank scalessomewhat higher than longer in the trunk region and presence of epaxial rays in the caudal fin.AmongPerleidiformes, the new taxonbelongsto thePerleididae, being very similar to Perleidus in the general body shape, pattern of the skull bones, the dentitionmade of peg-like marginal teeth,and number of epaxial rays. The new genus is characterized by the presence of a very large antero-dorsal process on the suboperculum, a high number (about 55 of transversal scale rows and dorsal and anal fin quite posterior. Chaohuperleidus gen. n., beingSpathianin age,represents the oldest record of the order Perleidiformes. 

Modelling of electron contamination in clinical photon beams for Monte Carlo dose calculation

International Nuclear Information System (INIS)

Yang, J; Li, J S; Qin, L; Xiong, W; Ma, C-M

2004-01-01

The purpose of this work is to model electron contamination in clinical photon beams and to commission the source model using measured data for Monte Carlo treatment planning. In this work, a planar source is used to represent the contaminant electrons at a plane above the upper jaws. The source size depends on the dimensions of the field size at the isocentre. The energy spectra of the contaminant electrons are predetermined using Monte Carlo simulations for photon beams from different clinical accelerators. A 'random creep' method is employed to derive the weight of the electron contamination source by matching Monte Carlo calculated monoenergetic photon and electron percent depth-dose (PDD) curves with measured PDD curves. We have integrated this electron contamination source into a previously developed multiple source model and validated the model for photon beams from Siemens PRIMUS accelerators. The EGS4 based Monte Carlo user code BEAM and MCSIM were used for linac head simulation and dose calculation. The Monte Carlo calculated dose distributions were compared with measured data. Our results showed good agreement (less than 2% or 2 mm) for 6, 10 and 18 MV photon beams

Thermoluminescence Response of Copper-Doped Potassium Borate Glass Subjected to 6 Megavolt X-Ray Irradiation

Science.gov (United States)

Hossain, I.; Shekaili, N. K.; Wagiran, H.

2015-03-01

This study addresses the characteristics of Cu-doped and undoped potassium borate glass for use as ionizing radiation dosimeters by investigating and comparing the thermoluminescence responses, linearity, sensitivity and dose response s of the two types of glasses. A number of samples based on xK 2 CO 3 + (100 - x)H 3 BO 3 , where 10 ≤ x ≤ 30 mol.%, have been prepared using a melt quenching technique. The amorphous phases were identified using X-ray diffraction (XRD). The undoped potassium borate samples 20K 2 CO 3 + 80H 3 BO 3 (mol.%) and Cu-doped (0.5 mol.%) samples were placed in a solid phantom apparatus and irradiated with in X-ray tube under 6 MV accelerating voltage with doses ranging from 0.5 to 4.0 Gy. This beam was produced by the Primus MLC 3339 linear accelerator (LINAC) available at Hospital Sultan Ismail, Johor Bahru, Malaysia. The results clearly show the superiority of Cu-doped glass in terms of response and sensitivity to producing luminescence over undoped potassium borate glass. The sensitivity of Cu-doped glass is 6.75 times greater than that of undoped glass.

The Bible and ethics: Pathways for dialogue

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Volker Rabens

2017-05-01

Full Text Available The potential relevance of biblical ethics for today is a contested issue. What is the significance of individual ethical texts of the Bible, and how – if at all – can they be dialogue partners for the ethical discourses of the 21st century? This article suggests and discusses a number of interpretative steps on the way towards a fruitful dialogue between the biblical text and contemporary concerns of religious-ethical life. After some introductory remarks on the use of the Bible in a Christian context, the article submits six different parameters of practical hermeneutics in two sections: 1. Text and culture; and 2. Text and canon. From the perspective of the parameter of canonical centrality, for example, it is argued that the biblical narrative of love, as it culminates in the gospel of Jesus Christ, stands out as a primus inter pares reference point for the dialogue between biblical ethics and ethics today. In the course of a nuanced discussion of these hermeneutical parameters, the article also provides a critical review of a number of alternative proposals on the relationship of the Bible and ethics.

Measurement of back-scattered radiation from micro multileaf collimator into the beam monitor chamber from a dual energy linear accelerator

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Muralidhar K

2007-01-01

Full Text Available Measurements designed to find the collimator backscatter into the beam monitor chamber from Micro Multileaf collimator of 6 MV photon beams of the Siemens Primus linear accelerator were made with the help of dose rate feedback control. The photons and electrons backscattered from the upper and lower secondary collimator jaws give rise to a significant increase in the ion charge measured by monitor chamber. This increase varies between the different accelerators. The output measurements were carried out in air at the isocenter. The effect of collimator backscatter was investigated by measuring the pulse width, number of beam pulses per monitor unit, monitor unit rate and dose for different mMLC openings. These measurements were made with and without dose rate feedback control, i.e., with constant electron beam current in the accelerator. Monitor unit rate (MU/min was almost constant for all field sizes. The maximum variation between the open and the closed feedback control circuits was 2.5%. There was no difference in pulse width and negligible difference in pulse frequency. Maximum value of backscattered radiation from the micro Multileaf collimator into the beam monitor chamber was found to be 0.5%.

Presence of accessory penis, colonic duplication and several other congenital anomalies in a child: a very rare association.

Science.gov (United States)

Chatterjee, Sayan; Mondal, Prabodh Chandra; Pandey, Shashi Bhushan; Achar, Arun

2014-10-01

An accessory penis is a very rare anomaly. Only five cases have been reported thus far to our knowledge. We present the case of a child aged 2 years and 10 months who had a penis-like structure (containing phallus and glans) attached to the right buttock. Associated anomalies were a non-communicating type of colonic duplication, a paramedian stenosed anal opening, a horse-shoe kidney, posterior urethral valves, scoliosis of the lumbo-sacral spine, polydactyly and equino-varus deformity of the right foot. As far as we can tell, this is the first report of an accessory penis associated with colonic duplication and other congenital anomalies. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

Value of radiographic examination of the knee joint for the orthopedic surgeon

International Nuclear Information System (INIS)

Pietsch, M.; Hofmann, S.

2006-01-01

Extended radiographic examinations offer excellent options for diagnosis and strategy for treatment of the knee joint. The whole-leg radiograph is indispensable in measuring alignment for osteotomy or total knee arthroplasty (TKA). Fluoroscopically assisted varus-valgus stress radiographs provide the possibility for verifying mechanical function of the implanted knee prosthesis. Ultrasound examinations have been widely replaced by magnetic resonance imaging (MRI). MRI is the golden standard to examine intra-articular structures of the knee (meniscus, ligaments, cartilage) and surrounding soft tissue. For evaluating femoral and tibial torsion and determining axial rotation of TKA, computed tomography (CT) is best qualified. Imaging of the patellofemoral joint (patella instability) is difficult; CT scans in combination with true lateral radiographs seem to be helpful. (orig.) [de

[The elbow joint - a diagnostic challenge : anatomy, biomechanics, and pathology].

Science.gov (United States)

Schueller-Weidekamm, C; Kainberger, F

2008-12-01

The elbow is one of the most commonly injured joints in sports activities. In particular, weight lifters, golfers, tennis players, and pitchers are affected. Injuries in sports involving overhead throwing are commonly based on the pathophysiologic model of valgus extension overload syndrome. The injuries are commonly complex and demand a good knowledge of the symptoms, the exact anatomy, and the biomechanics to arrive at a precise radiologic diagnosis. The characteristic patterns of injury that occur in specific sports activities are related to a combination of increased varus or valgus and extension or flexion overload that results in tensile forces and/or compression and shear stress. Acute symptoms are frequently based on chronic degeneration of the tendons and ligamentous structures due to repetitive microtrauma from overuse syndrome.

Bunionette deformity.

Science.gov (United States)

Cohen, Bruce E; Nicholson, Christopher W

2007-05-01

The bunionette, or tailor's bunion, is a lateral prominence of the fifth metatarsal head. Most commonly, bunionettes are the result of a widened 4-5 intermetatarsal angle with associated varus of the metatarsophalangeal joint. When symptomatic, these deformities often respond to nonsurgical treatment methods, such as wider shoes and padding techniques. When these methods are unsuccessful, surgical treatment is based on preoperative radiographs and associated lesions, such as hyperkeratoses. In rare situations, a simple lateral eminence resection is appropriate; however, the risk of recurrence or overresection is high with this technique. Patients with a lateral bow to the fifth metatarsal are treated with a distal chevron-type osteotomy. A widened 4-5 intermetatarsal angle often requires a diaphyseal osteotomy for correction.

Favourable outcomes of a preventive screening and counselling programme for older people in underprivileged areas in the Netherlands: The PRIMUS project

NARCIS (Netherlands)

Dijk, D.J. van; Crone, M.R.; Empelen, P. van; Assendelft, W.J.; Middelkoop, B.J.

2017-01-01

An aging population is associated with an increased prevalence of diabetes, cardiovascular diseases and depression. Important aspects of programmes targeted at older people are: to reach those at risk, effective screening, optimising advice, and referral to local interventions. We examined the

Low-dose megavoltage cone-beam CT for radiation therapy

International Nuclear Information System (INIS)

Pouliot, Jean; Bani-Hashemi, Ali; Chen, Josephine; Svatos, Michelle; Ghelmansarai, Farhad; Mitschke, Matthias; Aubin, Michele; Xia Ping; Morin, Olivier; Bucci, Kara; Roach, Mack; Hernandez, Paco; Zheng Zirao; Hristov, Dimitre; Verhey, Lynn

2005-01-01

Purpose: The objective of this work was to demonstrate the feasibility of acquiring low-exposure megavoltage cone-beam CT (MV CBCT) three-dimensional (3D) image data of sufficient quality to register the CBCT images to kilovoltage planning CT images for patient alignment and dose verification purposes. Methods and materials: A standard clinical 6-MV Primus linear accelerator, operating in arc therapy mode, and an amorphous-silicon (a-Si) flat-panel electronic portal-imaging device (EPID) were employed. The dose-pulse rate of a 6-MV Primus accelerator beam was windowed to expose an a-Si flat panel by using only 0.02 to 0.08 monitor units (MUs) per image. A triggered image-acquisition mode was designed to produce a high signal-to-noise ratio without pulsing artifacts. Several data sets were acquired for an anthropomorphic head phantom and frozen sheep and pig cadaver heads, as well as for a head-and-neck cancer patient on intensity-modulated radiotherapy (IMRT). For each CBCT image, a set of 90 to 180 projection images incremented by 1 deg to 2 deg was acquired. The two-dimensional (2D) projection images were then synthesized into a 3D image by use of cone-beam CT reconstruction. The resulting MV CBCT image set was used to visualize the 3D bony anatomy and some soft-tissue details. The 3D image registration with the kV planning CT was performed either automatically by application of a maximization of mutual information (MMI) algorithm or manually by aligning multiple 2D slices. Results: Low-noise 3D MV CBCT images without pulsing artifacts were acquired with a total delivered dose that ranged from 5 to 15 cGy. Acquisition times, including image readout, were on the order of 90 seconds for 180 projection images taken through a continuous gantry rotation of 180 deg . The processing time of the data required an additional 90 seconds for the reconstruction of a 256 3 cube with 1.0-mm voxel size. Implanted gold markers (1 mm x 3 mm) were easily visible for all exposure

Differences in kinematics of single leg squatting between anterior cruciate ligament-injured patients and healthy controls.

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Yamazaki, J; Muneta, T; Ju, Y J; Sekiya, I

2010-01-01

Seventy to eighty percent of all anterior cruciate ligament (ACL) injuries are due to non-contact injury mechanisms. It has been reported that the majority of injuries due to single leg landing come from valgus positioning of the lower leg. Preventing valgus positioning during single leg landing is expected to help reduce the number of ACL injuries. We found that many ACL-deficient patients cannot perform stable single leg squatting. Therefore, we performed 3D motion analysis of the single-legged half squat for ACL-injured patients to evaluate its significance as a risk factor for ACL injuries. We evaluated the relative angles between the body, thigh, and lower leg using an electromagnetic device during single leg half squatting performed by 63 ACL-injured patients (32 males, 31 females) the day before ACL reconstruction and by 26 healthy control subjects with no knee problems. The uninjured leg of ACL-injured male subjects demonstrated significantly less external knee rotation than that of the dominant leg of the male control. The uninjured leg of ACL-injured female subjects demonstrated significantly more external hip rotation and knee flexion and less hip flexion than that of the dominant leg of the female control. Comparing injured and uninjured legs, the injured leg of male subjects demonstrated significantly less external knee and hip rotation, less knee flexion, and more knee varus than that of the uninjured leg of male subjects. The injured leg of female subjects demonstrated more knee varus than that of the uninjured leg of female subjects. Regarding gender differences, female subjects demonstrated significantly more external hip rotation and knee valgus than male subjects did in both the injured and uninjured legs (P < 0.05). The current kinematic study exhibited biomechanical characteristics of female ACL-injured subjects compared with that of control groups. Kinematic correction during single leg half squat would reduce ACL reinjury in female ACL

Effect of open wedge high tibial osteotomy on the lateral tibiofemoral compartment in sheep. Part III: analysis of the microstructure of the subchondral bone and correlations with the articular cartilage and meniscus.

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Ziegler, Raphaela; Goebel, Lars; Seidel, Roland; Cucchiarini, Magali; Pape, Dietrich; Madry, Henning

2015-09-01

First, to evaluate whether medial open wedge high tibial osteotomy (HTO) induces alterations of the microstructure of the lateral tibial subchondral bone plate of sheep. Second, to test the hypothesis that specific correlations exist between topographical structural alterations of the subchondral bone, the cartilage and the lateral meniscus. Three experimental groups received biplanar osteotomies of the right proximal tibiae: (a) closing wedge HTO (4.5° of tibial varus), (b) opening wedge HTO (4.5° tibial valgus; standard correction) and (c) opening wedge HTO (9.5° of valgus; overcorrection), each of which was compared to the non-osteotomised contralateral proximal tibiae. After 6 months, subchondral bone structure indices were measured by computed tomography. Correlations between the subchondral bone, the articular cartilage and the lateral meniscus were determined. Increased loading by valgus overcorrection led to an enlarged specific bone surface (BS/BV) in the subarticular spongiosa compared with unloading by varisation. The subchondral bone plate was 3.9-fold thicker in the central region of the lateral tibial plateau than in the submeniscal periphery. Its thickness in the central region significantly correlated with the thickness of the articular cartilage. In the submeniscal region, such correlation did not exist. In general, a higher degree of osteoarthritis (OA) correlated with alterations of the subchondral bone plate microstructure. OA of the submeniscal articular cartilage also correlated with worse matrix staining of the lateral meniscus. Osteoarthritis changes are associated with alterations of the subchondral bone plate microstructure. Specific topographical relationships exist in the central region between the articular cartilage and subchondral bone plate thickness, and in the submeniscal periphery between and the articular cartilage and lateral meniscus. From a clinical perspective, the combined follow-up data from this and the previous two

Intrinsic constraint of unlinked total elbow replacements--the ulnotrochlear joint.

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Kamineni, S; O'Driscoll, S W; Urban, M; Garg, A; Berglund, L J; Morrey, B F; An, K N

2005-09-01

Many unlinked total elbow replacement designs with radically differing articular geometries exist, suggesting that there is no consensus regarding an optimal design. A feature inherent to the articular design is the intrinsic constraint afforded to the joint by the implant. Our aim was to compare the intrinsic constraints of unlinked implants with that of the normal ulnotrochlear joint. We tested twelve cadaveric ulnotrochlear joints with a custom-made multiple-axis materials testing machine. With compressive loads ranging from 10 to 100 N, the joints were moved in either valgus or varus directions at 90 degrees of flexion. The ulnotrochlear components from a single example of five medium-sized unlinked elbow replacements (Ewald, Kudo, Pritchard ERS, Sorbie-Questor, and Souter-Strathclyde) were also tested. The recorded measurements included the torques and forces, angular displacement, and axial displacement of the humerus relative to the ulna. In general, the peak torque and the constraint ratio significantly increased with increasing compressive load for the implants as well as for the normal elbow. In valgus displacement, the Souter-Strathclyde implant had the highest and the Sorbie-Questor had the smallest peak torque and the Souter-Strathclyde had the highest and the Ewald had the smallest constraint ratio. In varus displacement, the Kudo had the highest and the Ewald had the smallest peak torque and constraint ratio. The constraint ratio is a characteristic that is useful for describing elbow joint behavior and for comparing the behavior of implants with that of the human elbow. Of the unlinked implants tested, the Souter-Strathclyde and Kudo prostheses most closely approximated the behavior of the human elbow joint. Implants that resemble the human elbow in appearance do not replicate normal behavior consistently, whereas other implants that do not resemble the human elbow closely do not deviate markedly from human behavior. Thus, much basic information

Observation of double loop insertion of silicone rubber tube anastomosis method combined with "Z" flap repair in the treatment of lacrimal ductule laceration

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Rui Hou

2017-03-01

Full Text Available AIM: To investigate the clinical curative effect of double loop insertion of silicone rubber tube combined with "Z" flap repair in the treatment of laceration of eyelid with canaliculus laceration. METHODS: The paper reviewed 45 cases of laceration of eyelid with laceration canaliculus, caused by trauma, which were treated in my hospital from January 2014 to January 2016. In the process of anastomosis of lacrimal duct and suture of eyelid laceration, either the method of single spinal anesthesia tube placement on skin contraposition suture or the method of dual annular silicone tube placement combined with the word "Z" flap repair was used. We compared the two methods and studied the possible complications like eyelid varus and valgus, lacrimal point valgus, eyelid scar, anastomotic dehiscence again. RESULTS: Out of the 22 cases in which the patients chose the single spinal anesthesia tube implantation on skin suture, 21 cases succeeded and patients received lacrimal duct patency results after extubation; and 1 case anastomosis failed. Complications: 20 cases had different degree of complications and the impact on their appearances were significant. Out of the 23 cases in which the patients chose double passage annular silicone tube joint prosthesis implantation Z flap, 23 received extubation results lacrimal patency or almost patency, the anastomosis of patients was successful. Complications: in two cases, patients had mild eyelid entropion and pomatum varus. Both eyelid deformity and severe wound tear did not occur in all cases again. Scar was not obvious. The success rate of anastomosis between the two groups was not significantly different(P=0.4889. To compare the rate of complications, there were significant differences(χ2=30.42, PCONCLUSION: The application of dual ring implantation silicon tube combined with the word "Z" flap repair in the treatment of lacrimal canaliculi laceration of eyelid laceration ensured the success rate of

Alignment After Intramedullary Nailing of Distal Tibia Fractures Without Fibula Fixation.

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De Giacomo, Anthony F; Tornetta, Paul

2016-10-01

To evaluate the efficacy of intramedullary nailing of distal tibia fractures using modern techniques, without fibula fixation, in obtaining and maintaining alignment. Retrospective case review. Level-I academic trauma center. One hundred thirty-two consecutive patients with distal tibia fractures. Intramedullary nail of distal tibia fracture, without fibula fixation, was performed in consecutive patients using modern reduction techniques. Malalignment and malunion were defined as >5 degrees of varus/valgus angulation or anterior/posterior angulation on the initial postoperative or final anteroposterior and lateral x-rays. There were 122 consecutive patients (86 men and 36 women) 16-93 years of age (average, 43 years) with 36 (30%) open and 85 (70%) closed fractures with complete follow-up. Mechanism of injury did not predict the presence or level of fibula fracture. Upon presentation, varus/valgus and procurvatum/recurvatum angulation was greatest when the fibula was fractured at the level of the tibia fracture (P = 0.001 and 0.028). The most common intraoperative reduction aids were nailing in relative extension, transfixion external fixation, and clamps at the fracture site. The OTA fracture type or level/presence of fibula fracture did not influence malalignment (P = 0.86 and 0.66), malunion (P = 0.81 and 0.79), or the change in alignment during union, which averaged 0.9 degrees. We found an overall low rate of both malalignment (2%) and malunion (3%) after intramedullary nailing of distal tibial shaft fracture without fibula fixation. We conclude that when modern nailing techniques are used, which allow for confirmation of reduction by visualization in fluoroscopy, from nail placement to distal interlocking, fibula fixation is not necessary to obtain or maintain alignment. Furthermore, standard 2 medial to lateral screws distally afford adequate stability to hold the reduction during union with a 0.9-degree difference in the initial postoperative and final

Three-dimensional quantitative analysis of healthy foot shape: a proof of concept study.

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Stanković, Kristina; Booth, Brian G; Danckaers, Femke; Burg, Fien; Vermaelen, Philippe; Duerinck, Saartje; Sijbers, Jan; Huysmans, Toon

2018-01-01

Foot morphology has received increasing attention from both biomechanics researches and footwear manufacturers. Usually, the morphology of the foot is quantified by 2D footprints. However, footprint quantification ignores the foot's vertical dimension and hence, does not allow accurate quantification of complex 3D foot shape. The shape variation of healthy 3D feet in a population of 31 adult women and 31 adult men who live in Belgium was studied using geometric morphometric methods. The effect of different factors such as sex, age, shoe size, frequency of sport activity, Body Mass Index (BMI), foot asymmetry, and foot loading on foot shape was investigated. Correlation between these factors and foot shape was examined using multivariate linear regression. The complex nature of a foot's 3D shape leads to high variability in healthy populations. After normalizing for scale, the major axes of variation in foot morphology are (in order of decreasing variance): arch height, combined ball width and inter-toe distance, global foot width, hallux bone orientation (valgus-varus), foot type (e.g. Egyptian, Greek), and midfoot width. These first six modes of variation capture 92.59% of the total shape variation. Higher BMI results in increased ankle width, Achilles tendon width, heel width and a thicker forefoot along the dorsoplantar axis. Age was found to be associated with heel width, Achilles tendon width, toe height and hallux orientation. A bigger shoe size was found to be associated with a narrow Achilles tendon, a hallux varus, a narrow heel, heel expansion along the posterior direction, and a lower arch compared to smaller shoe size. Sex was found to be associated with differences in ankle width, Achilles tendon width, and heel width. Frequency of sport activity was associated with Achilles tendon width and toe height. A detailed analysis of the 3D foot shape, allowed by geometric morphometrics, provides insights in foot variations in three dimensions that can not be

Lower extremity kinematics and kinetics of Division III collegiate baseball and softball players while performing a modified pro-agility task.

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Wallace, B J; Kernozek, T W; Bothwell, E C

2007-12-01

Females experience at least twice as many non-contact anterior cruciate ligament (ACL) injuries as males. The aim of this study was to investigate if males and females exhibited different characteristics while performing a modified pro-agility test. Collegiate Division III male baseball (n=14) and female softball (n=13) players performed 4 trials of a modified pro-agility task, which consisted of running toward a force platform target for 5 steps, planting their right foot, and propelling themselves off of the target with their left foot. Kinematic and kinetic parameters were compared using a multivariate analysis of variance between gender with the level of significance set at P<0.05. Males and females exhibited similar knee valgus angles. Females had a greater maximum knee extension angle (10.14 degrees vs 17.43 degrees ), and greater knee range of motion (46.12 degrees vs 40.12 degrees ). Both groups reached maximum knee flexion at 52% of stance. Females had significantly more maximum hip flexion than males (28.86 degrees vs 22.75 degrees ). Females had significantly smaller minimum internal knee varus moments than their male counterparts (1.12 Nm/kg vs 1.55 Nm/kg). Vertical ground reaction forces as a percentage of bodyweight, and stance time, were not statistically different. The female group displayed an external knee rotation angle (2.49 degrees ) during the beginning of their stance, which was significantly different than the internal rotation angle (4.11 degrees ) in the male group. Early in stance knee rotation angle was highly correlated with the lack of internal knee varus moment (males R(2)=0.75, females R(2)=0.88). Females displayed knee moments and kinematics that may place them at greater risk for ACL injury during a stop-cut task. Females should be coached to perform stop cuts with more knee flexion and a more neutral knee rotation angle upon foot contact in an effort to reduce moments that may place the ACL at risk.

AN EVALUATION OF THE REARFOOT POSTURE IN INDIVIDUALS WITH PATELLOFEMORAL PAIN SYNDROME

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Wendy Gilleard

2004-11-01

Full Text Available Structural abnormalities of the foot may cause abnormal subtalar joint compensatory motion in order to attain normal function of the lower extremity during gait although studies have not been conclusive. Current conflict in the literature may be related to the differing measures focused on the varying protocols and also the absence of a control group in some studies. This study investigated the rearfoot posture including Subtalar Joint Neutral Position (STJN and Relaxed Calcaneal Standing (RCS measurements in patellofemoral pain syndrome (PFPS and healthy subjects. The angle of STJN during non-weight bearing position and the two dimensional (2D rearfoot RCS posture was measured using a goniometer in 14 healthy females and 13 females with PFPS. The RCS posture was also measured three dimensionally (3D by attaching external markers to a tibia shell and the calcaneus and videoing with a four-camera three-dimensional motion analysis system. A one way ANOVA was used to assess the differences between the groups. The 2D and 3D RCS were significantly different between the groups (p ¡Ü 0.001 with mean -0.23¡ã ¡À 1.35¡ã , 2.52¡ã ¡À 3.11¡ã for the control group and 2.35¡ã ¡À 1.4¡ã, 7.02¡ã ¡À 3.33¡ã for the clinical group respectively. STJN showed a slight rearfoot varus (although significant p = 0.04 in PFPS (-2.20¡ã ¡À 1.51¡ã compared to the control group (-1.00¡ã ¡À 1.36¡ã. Negative values indicated inversion and positive values indicated eversion. The 2D and 3D RCS showed a significantly more everted posture of the rearfoot for the PFPS group. Subtalar joint varus may contribute to the increased eversion during relaxed standing in the PFPS group. Rearfoot measurements may be an important addition to other clinical measurements taken to explore the underlying aetiology of subjects with PFPS.

Minimally invasive unicompartmental knee replacement: Midterm clinical outcome.

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Tian, Shaoqi; Liu, Jiangjun; Yuan, Wanqing; Wang, Yuanhe; Ha, Chengzhi; Liu, Lun; Li, Qicai; Yang, Xu; Sun, Kang

2017-01-01

The purpose of this study was to explore the midterm clinical outcomes of unicompartmental knee replacement (UKR) for medial knee arthropathy through a minimally invasive approach (MIA). From January 2006 to June 2010, 442 consecutive patients (485 knees) were included in the study. All patients underwent MIA-UKR with the mobile bearing Oxford phrase III prosthesis. The incision was made starting 1 cm medial to the medial pole of the patella and extending distally to the tibial tubercle. Radiographic evaluations include femorotibial angle (FTA) from coronal x-rays and rectified varus deformity angle, while clinical evaluations included Knee Society Score (KSS, clinical score and function score), the Western Ontario and McMaster Universities Arthritis Index (WOMAC) osteoarthritis index and visual analog scale (VAS) for pain. Patients followed-up at 1, 3, 6, 12 months after surgery and each year thereafter. Four hundreds and two patients completed the entire follow-up, 40 patients (45 knees) were lost to follow-up. The average follow-up time was 73.0 ± 1.9 months. The mean length of the incisions was 5.0 ± 0.2 cm. The average FTA decreased from 183.6° ± 5.1° preoperatively to 174.3° ± 4.2° postoperatively, and the mean rectified varus deformity angle was 9.3° ± 1.2°. The KSS clinical score improved from 42.4 ± 2.9 to 92.9 ± 3.8, and the function score improved from 53.5 ± 3.8 to 93.5 ± 4.0. The WOMAC score improved from 47.5 ± 3.1 preoperatively to 12.3 ± 1.5 at the last evaluation. The VAS dropped from 7.8 ± 1.9 preoperatively to 1.6 ± 0.2 postoperatively. All clinical evaluations (KSS, WOMAC, VAS) were significantly different (p clinical outcomes of MIA-UKR are satisfactory in a Chinese patient population, which is a good surgical option for patients with medial arthropathy of the knee. However, longer-term follow-up studies should be performed in these patients.

[Perthes disease--results of a containment-oriented therapy concept].

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Rühmann, O; Lazović, D; Wirth, C J; Gossé, F; Franke, J

1997-01-01

In a retrospective study a treatment concept for Perthes' disease dependent on the containment was applied. 49 hips of 41 children (9 female, 32 male) were treated between 01. 01. 1990 and 31. 12. 1995. In our concept of treatment a varus femoral osteotomy was performed in 28 cases with not contained hips or less than 4/5 coverage of the femoral head (X-ray/MRI). The other 21 well contained hips with 4/5 coverage or more were treated conservatively with physiotherapy and in case of joint effusion and pain additionally with the use of crutches (partial weight bearing) and anti-inflammatory medication. The average age in the non-operative group at the time of first investigation was 4 years and 9 months (3 y./1 m. to 7 y./1 m.) and 6 years and 3 months (4 y/2 m. to 10 y/0 m.) at our last examination (mean follow up 17.7 months, range of 6 to 72 months). At the time of indication for a varus femoral osteotomy the patients had an average age 6 years and 1 month (3 y./6 m. to 10 y./2 m.), the mean age at the last postoperative examination was 7 years and 11 months (4 y./8 m. to 12 y./5 m.) with an average follow up of 21.5 months (6 to 77 months). For the conservatively treated children we achieved good results (still well contained hips with 4/5 coverage, no decrease of function, no increase of pain) in 85.7% (18 of 21 cases). In 85.7% (24 of 28 cases) we found good results (well contained hips, increase of coverage, no decrease of function, no increase of pain) in the operation group. The presented concept of therapy in Perthes' disease was practicable for all patients and included the possibility of decision for operative or non-operative treatment. In both groups we achieved good results in 85.7% of the cases.

Combined rotation scarf and Akin osteotomies for hallux valgus: a patient focussed 9 year follow up of 50 patients

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Kilmartin Timothy E

2010-02-01

Full Text Available Abstract Background The Cochrane review of hallux valgus surgery has disputed the scientific validity of hallux valgus research. Scoring systems and surrogate measures such as x-ray angles are commonly reported at just one year post operatively but these are of dubious relevance to the patient. In this study we extended the follow up to a minimum of 8 years and sought to address patient specific concerns with hallux valgus surgery. The long term follow up also allowed a comprehensive review of the complications associated with the combined rotation scarf and Akin osteotomies. Methods Between 1996 and 1999, 101 patients underwent rotation scarf and Akin osteotomies for the treatment of hallux valgus. All patients were contacted and asked to participate in this study. 50 female participants were available allowing review of 73 procedures. The average follow up was over 9 years and the average age at the time of surgery was 57. The participants were physically examined and interviewed. Results Post-operatively, in 86% of the participants there were no footwear restrictions. Stiffness of the first metatarsophalangeal joint was reported in 8% (6 feet; 10% were unhappy with the cosmetic appearance of their feet, 3 feet had hallux varus, and 2 feet had recurrent hallux valgus. There were no foot-related activity restrictions in 92% of the group. Metatarsalgia occurred in 4% (3 feet. 96% were better than before surgery and 88% were completely satisfied with their post-operative result. Hallux varus was the greatest single cause of dissatisfaction. The most common adverse event in the study was internal fixation irritation. Hallux valgus surgery is not without risk and these findings could be useful in the informed consent process. Conclusions When combined the rotation scarf and Akin osteotomies are an effective treatment for hallux valgus that achieves good long-term correction with a low incidence of recurrence, footwear restriction or metatarsalgia

The Frequency of AVN Following Reconstructive Hip Surgery in Children With Cerebral Palsy: A Systematic Review.

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Hesketh, Kim; Leveille, Lise; Mulpuri, Kishore

2016-03-01

Children with cerebral palsy (CP) undergoing reconstructive hip surgery are at risk for developing avascular necrosis (AVN). The purpose of this systematic review was to investigate the reported frequency of AVN, the amount and quality of literature available, and possibly identity risk factors for developing AVN following reconstructive surgery for hip displacement in children with CP. We performed a review of the literature using EMBASE and MEDLINE databases. Studies investigating the outcome of reconstructive hip surgery in patients with CP that identified the presence or absence of AVN were included. Study quality was assessed using the Methodological Index for Non-Randomized Studies and the Oxford Centre for Evidence-Based Medicine scale. Three hundred and ninety-nine articles were identified using our search strategy. Twenty-nine studies were included for data extraction after full-text review. The frequency of AVN ranged from 0% to 46% with an overall rate across studies of 7.5%. Presence of AVN was the primary outcome in 2 studies. The frequency of AVN in these studies was significantly higher than other studies at 37% and 46%. No statistically significant associations were found between age at surgery, severity of hip subluxation, length of follow-up, or type of surgery (combined varus derotation osteotomy and pelvic osteotomy vs. varus derotation osteotomy alone), and the rate of AVN. The majority of studies did not comment on methods used for determining diagnosis or severity of AVN and clinical significance was not well documented. Children with CP undergoing reconstructive hip surgery are at risk of developing AVN. Frequency and severity of this complication is poorly documented in the literature. On the basis of current evidence no significant risk factors were identified; however, it is not possible to draw firm conclusions about them. Incidence of AVN was higher in studies in which AVN was a primary outcome suggesting that the true frequency of AVN

Radiostrontium, radiocesium and stable mineral composition of bones of domestic reindeer from Vågå, Norway

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Hans Staaland

1991-10-01

Full Text Available Radiostrontium, radiocesium and macromineral concentrations were measured in metatarsal or metacarpal bones from 78 reindeer (59 calves and 19 adults in the Vågå reindeer herding district in Southern Norway. Samples were collected in the period August 1988 to May 1989. Radiocesium concentrations increased from August through the winter. Radiostrontium varied slightly around an average value 1810 Bq/kg DM. Mg concentrations decreased through the winter, the concentrations of other minerals and bone density showed only small variations. No signs of mineral deficiencies were observed. It is concluded that radiostrontium mainly originated from the Chernobyl nuclear accident.Radiostrontium, radiocesium og stabile mineraler in reinknokler fra Vågå, NorgeAbstract in Norwegian / Sammendrag: Innhold av radiostrontium, radiocesium og makromineraler ble målt i reinsdyrknokler (metatarsus og metacarpus innsamlet fra 78 dyr (59 kalver og 19 voksne tilhørende Vågå tamreinlag. Prøvene ble samlet i perioden august 1988 til mai 1989. Innholdet av radiocesium økte fra august og gjennom vinteren, mens innholdet av radiostrontium var temmelig konstant (1810 Bq/ kg tørrstoff. Magnesium innholdet avtok gjennom vinteren, mens innholdet av andre mineraler samt knoklenes tetthet varierte lite. Det ble ikke observert noen tegn på mineralmangel. Mesteparten av det radioaktive strontium kom fra atomkraftulykken i Tsjernobyl.

A lateral approach for screw repair in lag fashion of spiral third metacarpal and metatarsal medial condylar fractures in horses.

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Smith, Lewis C R; Greet, Timothy R C; Bathe, Andrew P

2009-08-01

To describe a lateral approach for screw fixation in lag fashion of simple spiral medial condylar fractures of the third metacarpus/metatarsus (MC3/MT3). Case series. Thoroughbred racehorses (n=9). Nondisplaced medial MC3/MT3 condylar fractures (3 thoracic, 6 pelvic limbs), with mean length 126 mm (range, 91-151 mm) were repaired by internal fixation, under general anesthesia, using multiple 4.5 mm cortical screws inserted in lag fashion from the lateral aspect of the limb, using radiographic or fluoroscopic guidance. Horses were recovered from anesthesia in half-limb casts; 7 unassisted and 2 using a rope-recovery system. Horses had 2 months box rest, 1 month in-hand walking, and follow-up radiographic examination at 3 months. Horses recovered uneventfully from anesthesia. Five horses raced; 1 returned to training, was persistently lame, and was retired to stud; 2 were retired directly to stud; and 1 horse was lost to follow-up. MC3/MT3 medial condylar fractures were successfully repaired by screws inserted n lag fashion form the lateral aspect. Use of a lateral approach to medial condylar MC3/MT3 fractures allows screw insertion perpendicular to the fracture plane without interference with palmar/plantar soft tissue structures or from the splint bones. Although repair was performed under general anesthesia, the technique should be adaptable to application in standing horses.

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

International Nuclear Information System (INIS)

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

1976-01-01

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

Anserina Bursitis—A Treatable Cause of Knee Pain in Patients with Degenerative Arthritis

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Brookler, Morton I.; Mongan, Edward S.

1973-01-01

The anserina bursa is located on the medial surface of the tibia deep to the tendons of the sartorius, gracilis, and semimembranosus muscles and superficial to the insertion of the tibial collateral ligament. Knee pain, a palpable swelling of the bursa, and tenderness over the medial anterior aspect of the tibia just below the knee are the hallmarks of anserina bursitis. In a three-year period, 24 patients with anserina bursitis were seen in a rheumatology clinic. All but one were women, 18 were obese, and only four were under 50 years old. Knee x-ray studies showed degenerative arthritis in 20 of the 24 patients. In ten, varus knee deformities were present, while three had valgus deformities. Ultrasound or local steroid injections gave dramatic relief in all but one patient. PMID:4731586

脑性瘫痪患儿踝足矫形器配戴前后对运动功能的量化评价%Quantitative assessment of motor function on children with cerebral palsy before and after wearing ankle foot orthopedic instruments

Institute of Scientific and Technical Information of China (English)

李润洁

2002-01-01

Objective To assess motor function quantitatively on children with cerebral palsy before and after wearing ankle foot orthopedic instruments.Method Ankle foot orthopedic instruments were made by Dalian Prosthesis Factory.Children' motor function was assessed with self made quantitative assessment scale according to the forth,fifth function area of motor assessment scale of children with cerebral palsy after one week of wearing orthopedic instruments. Result In all 23 patients, orthopedic instruments proved effective in controlling leg muscular tension,correcting equines,genu recurvatum,talips valgus and talipes varus,keeping erect posture and modifying gait.Motor function assessed show significant difference before and one week after wearing orthopedic instruments (P< 0.001).Conclusion Ankle foot orthopedic instruments play a positive role in improving motor function of lower extremity in cerebral palsy patients.

From containment to ... syzygy

Energy Technology Data Exchange (ETDEWEB)

Carr, H.M.

1995-04-18

The U S. is at an historic crossroads following the end of the Cold War. The old twin themes of containment and deterrence must now give way to a newer vision of the U.S. role as we approach the 21st century. This paper follows a visioning process requiring development of alternatives based on signposts, values and frameworks. Signposts are current domestic and global environments revealing a U.S. in economic trouble with budget and trade defidts, a falling dollar and multiplying peace operations at a time when Europe and Japan are becoming economic superpowers. Although U.S. values must be protected, economic competition requires increased emphasis on realpolitik. A balanced framework of internationalism and reduced multilateralism will suit the current environment and U.S. purposes. Recognizing that the U.S. must retain leadership to protect national interests, the vision unfolds as an alignment of major powers-a syzygy of purpose-with Europe, Japan, and the U.S. in a concert of power, sharing economic, political and military burdens to ensure world stability. Thus, the new U.S. role could be primus inter pares of a Pax Consortis with common interests and goals, allowing the U.S. time to restore its economic vitality.

Leakage pattern of linear accelerator treatment heads from multiple vendors

International Nuclear Information System (INIS)

Lonski, P.R.; Taylor, M.L.; Franich, R.D.; Harty, P.; Clements, N.; Kron, T.

2011-01-01

Full text: Patient life expectancy post-radiotherapy is becoming longer. Therefore, secondary cancers caused by radiotherapy treatment have more time to develop. Increasing attention is being given to out-of-field dose resulting from scatter and accelerator head leakage. Dose leakage from equivalent positions on Varian600C, Varian21-X, Siemens Primus and Elekta Synergy-II linacs were measured with TLD 1 00 H dosimeter chips and compared. Treatment parameters such as field size and beam energy were altered. Leakage doses are presented as a percentage of the dose to isocentre (5 Gy). Results illustrate significant variations in leakage dose between linac models where no model emits consistently lower amounts of radiation leakage for all treatment parameters. Results are shown below. Leakage through the collimator assembly in different units is varying as a function of location and unit design by more than a factor of 10. Differences are more pronounced in comparing Varian or Elekta models, which are fitted with an additional collimator separate from the MLC leaves, to the Siemens model, which uses MLC leaves as its only secondary collimator. Further measurements are currently being taken at the patient plane with a directional detector system to determine the spatial distribution of high leakage sources.

Characterization of radiochromic films EBT3 by means of the scanner Vidar dosimetry Pro Red and Epson 10000-XL use; Caracterizacion de films radiocromicos EBT3 mediante el uso de scanner Vidar dosimetry Pro Red y Epson 10000-XL

Energy Technology Data Exchange (ETDEWEB)

Medina, L.; Garrigo, E.; Venencia, D.; Adrada, A.; Filipuzzi, M., E-mail: fisicamedina11@gmail.com [Instituto Privado de Radioterapia, Obispo Oro 423, X5000BFI Cordoba (Argentina)

2014-08-15

The Radiochromic film have become an attractive tool for verification of dose distributions in IMRT because these have high spatial resolution film, are near water equivalent and not require revealed, A critical aspect of the use of these film is used for digitizing scanner The purpose of this paper is to characterize EBT3 using two types of scanner. Were employed The Radiochromic film EBT3, was used photon beam 6 MV generated by a linear accelerator Siemens Primus, he films were irradiated at a dose range between 0 Gy a 9 Gy. The stabilization time after irradiation was 24 hours. The films were digitized with a scanner Epson 10000-XL y el VIDAR Dosimetry Pro Red. We used the software for construction of the calibration curve. The resolution of each dosimetry system was analyzed through the results of the spatial response function by analyzing a step pattern. The Epson scanner is most sensitive to the red channel. This is less than that obtained with the Vidar. The Vidar scanner spatial response profiles disturbs not opposed to Epson analyzed. The calibration curves for both dosimetry systems can be employed. However, the sensitivity and repeatability of the system is better than Red Vidar Epson 10000-XL. (author)

Characterization of radiochromic films EBT3 by means of the scanner Vidar dosimetry Pro Red and Epson 10000-XL use

International Nuclear Information System (INIS)

Medina, L.; Garrigo, E.; Venencia, D.; Adrada, A.; Filipuzzi, M.

2014-08-01

The Radiochromic film have become an attractive tool for verification of dose distributions in IMRT because these have high spatial resolution film, are near water equivalent and not require revealed, A critical aspect of the use of these film is used for digitizing scanner The purpose of this paper is to characterize EBT3 using two types of scanner. Were employed The Radiochromic film EBT3, was used photon beam 6 MV generated by a linear accelerator Siemens Primus, he films were irradiated at a dose range between 0 Gy a 9 Gy. The stabilization time after irradiation was 24 hours. The films were digitized with a scanner Epson 10000-XL y el VIDAR Dosimetry Pro Red. We used the software for construction of the calibration curve. The resolution of each dosimetry system was analyzed through the results of the spatial response function by analyzing a step pattern. The Epson scanner is most sensitive to the red channel. This is less than that obtained with the Vidar. The Vidar scanner spatial response profiles disturbs not opposed to Epson analyzed. The calibration curves for both dosimetry systems can be employed. However, the sensitivity and repeatability of the system is better than Red Vidar Epson 10000-XL. (author)

Reliability and Validity of a New Method for Isometric Back Extensor Strength Evaluation Using A Hand-Held Dynamometer.

Science.gov (United States)

Park, Hee-Won; Baek, Sora; Kim, Hong Young; Park, Jung-Gyoo; Kang, Eun Kyoung

2017-10-01

To investigate the reliability and validity of a new method for isometric back extensor strength measurement using a portable dynamometer. A chair equipped with a small portable dynamometer was designed (Power Track II Commander Muscle Tester). A total of 15 men (mean age, 34.8±7.5 years) and 15 women (mean age, 33.1±5.5 years) with no current back problems or previous history of back surgery were recruited. Subjects were asked to push the back of the chair while seated, and their isometric back extensor strength was measured by the portable dynamometer. Test-retest reliability was assessed with intraclass correlation coefficient (ICC). For the validity assessment, isometric back extensor strength of all subjects was measured by a widely used physical performance evaluation instrument, BTE PrimusRS system. The limit of agreement (LoA) from the Bland-Altman plot was evaluated between two methods. The test-retest reliability was excellent (ICC=0.82; 95% confidence interval, 0.65-0.91). The Bland-Altman plots demonstrated acceptable agreement between the two methods: the lower 95% LoA was -63.1 N and the upper 95% LoA was 61.1 N. This study shows that isometric back extensor strength measurement using a portable dynamometer has good reliability and validity.

Optimisation of 12 MeV electron beam simulation using variance reduction technique

International Nuclear Information System (INIS)

Jayamani, J; Aziz, M Z Abdul; Termizi, N A S Mohd; Kamarulzaman, F N Mohd

2017-01-01

Monte Carlo (MC) simulation for electron beam radiotherapy consumes a long computation time. An algorithm called variance reduction technique (VRT) in MC was implemented to speed up this duration. This work focused on optimisation of VRT parameter which refers to electron range rejection and particle history. EGSnrc MC source code was used to simulate (BEAMnrc code) and validate (DOSXYZnrc code) the Siemens Primus linear accelerator model with the non-VRT parameter. The validated MC model simulation was repeated by applying VRT parameter (electron range rejection) that controlled by global electron cut-off energy 1,2 and 5 MeV using 20 × 10 7 particle history. 5 MeV range rejection generated the fastest MC simulation with 50% reduction in computation time compared to non-VRT simulation. Thus, 5 MeV electron range rejection utilized in particle history analysis ranged from 7.5 × 10 7 to 20 × 10 7 . In this study, 5 MeV electron cut-off with 10 × 10 7 particle history, the simulation was four times faster than non-VRT calculation with 1% deviation. Proper understanding and use of VRT can significantly reduce MC electron beam calculation duration at the same time preserving its accuracy. (paper)

Development and validation of a BEAMnrc component module for a miniature multileaf collimator

Science.gov (United States)

Doerner, E.; Hartmann, G. H.

2012-05-01

A new component module (CM) named mini multileaf collimator (mMLC) was developed for the Monte Carlo code BEAMnrc. It models the geometry of the add-on miniature multileaf collimator ModuLeaf (MRC Systems GmbH, Heidelberg, Germany, now part of Siemens, Erlangen, Germany). The new CM is partly based on the existing CM called DYNVMLC. The development was performed using a modified EGSnrc platform which enables us to work in the Microsoft Visual Studio environment. In order to validate the new CM, the PRIMUS linac with 6 MV x-rays (Siemens OCS, Concord, CA, USA) equipped with the ModuLeaf mMLC was modelled. Validation was performed by two methods: (a) a ray-tracing method to check the correct geometry of the multileaf collimator (MLC) and (b) a comparison of calculated and measured results of the following dosimetrical parameters: output factors, dose profiles, field edge position penumbra, MLC interleaf leakage and transmission values. Excellent agreement was found for all parameters. It was, in particular, found that the relationship between leaf position and field edge depending on the shape of the leaf ends can be investigated with a higher accuracy by this new CM than by measurements demonstrating the usefulness of the new CM.

Dosimetric evaluation of the response of the TLD-100 dosemeters in the IMRT technique by 'Step and Shoot'; Evaluacion dosimetrica de la respuesta de los dosimetros TLD-100 en la tecnica de IMRT por 'Step and Shoot'

Energy Technology Data Exchange (ETDEWEB)

Vasquez, J. [Fundacion Clinica Valle del Lili, A.A. 020338, Cali (Colombia); Benavides, S.O. [Depto. de Fisica, Universidad del Valle, A.A. 25360, Cali (Colombia)

2005-07-01

We show the results of the dosimetry response of LiF thermoluminescent crystals: TLD-100, where they were radiated in a linear accelerator Siemens Primus Hl using the Intensity Modulated Radiation Therapy (IMRT) by step and shoot technique. Previous to the crystals calibration and response evaluation, the acceptation procedures recommended by the TG-53 protocol for validation of the technique were carried out. The planning system utilized was the Theraplan Plus 3.8, using the algorithm of Pencil Kernel. The register and verification system was Lantis 5.2. The response curve of dose versus charge was obtained from the readings of the TLD in a Harshaw 3500. The crystals were radiated in a Bench- Marck phantom with doses previously determined by using ionization chambers for square radiation fields, in a beam with a 0.68 TPR20,10 corresponding to 6 MV of energy. We compare the response of these through of radiation of segmented fields in a Anthropomorphic phantom and the calculated doses by the planning system. The results obtained in the crystals response show deviations less than 5 % between the measured dose and the calculated dose in the zones of low gradient. It allows its implementation like routine control of quality by IMRT. (Author)

Development and validation of a BEAMnrc component module for a miniature multileaf collimator

International Nuclear Information System (INIS)

Doerner, E; Hartmann, G H

2012-01-01

A new component module (CM) named mini multileaf collimator (mMLC) was developed for the Monte Carlo code BEAMnrc. It models the geometry of the add-on miniature multileaf collimator ModuLeaf (MRC Systems GmbH, Heidelberg, Germany, now part of Siemens, Erlangen, Germany). The new CM is partly based on the existing CM called DYNVMLC. The development was performed using a modified EGSnrc platform which enables us to work in the Microsoft Visual Studio environment. In order to validate the new CM, the PRIMUS linac with 6 MV x-rays (Siemens OCS, Concord, CA, USA) equipped with the ModuLeaf mMLC was modelled. Validation was performed by two methods: (a) a ray-tracing method to check the correct geometry of the multileaf collimator (MLC) and (b) a comparison of calculated and measured results of the following dosimetrical parameters: output factors, dose profiles, field edge position penumbra, MLC interleaf leakage and transmission values. Excellent agreement was found for all parameters. It was, in particular, found that the relationship between leaf position and field edge depending on the shape of the leaf ends can be investigated with a higher accuracy by this new CM than by measurements demonstrating the usefulness of the new CM. (paper)

Dosimetric evaluation of the response of the TLD-100 dosemeters in the IMRT technique by 'Step and Shoot'

International Nuclear Information System (INIS)

Vasquez, J.; Benavides, S.O.

2005-01-01

We show the results of the dosimetry response of LiF thermoluminescent crystals: TLD-100, where they were radiated in a linear accelerator Siemens Primus Hl using the Intensity Modulated Radiation Therapy (IMRT) by step and shoot technique. Previous to the crystals calibration and response evaluation, the acceptation procedures recommended by the TG-53 protocol for validation of the technique were carried out. The planning system utilized was the Theraplan Plus 3.8, using the algorithm of Pencil Kernel. The register and verification system was Lantis 5.2. The response curve of dose versus charge was obtained from the readings of the TLD in a Harshaw 3500. The crystals were radiated in a Bench- Marck phantom with doses previously determined by using ionization chambers for square radiation fields, in a beam with a 0.68 TPR20,10 corresponding to 6 MV of energy. We compare the response of these through of radiation of segmented fields in a Anthropomorphic phantom and the calculated doses by the planning system. The results obtained in the crystals response show deviations less than 5 % between the measured dose and the calculated dose in the zones of low gradient. It allows its implementation like routine control of quality by IMRT. (Author)

PRIMUS: AN OBSERVATIONALLY MOTIVATED MODEL TO CONNECT THE EVOLUTION OF THE ACTIVE GALACTIC NUCLEUS AND GALAXY POPULATIONS OUT TO z ∼ 1

Energy Technology Data Exchange (ETDEWEB)

Aird, James [Department of Physics, Durham University, Durham DH1 3LE (United Kingdom); Coil, Alison L.; Diamond-Stanic, Aleksandar M. [Center for Astrophysics and Space Sciences, Department of Physics, University of California, 9500 Gilman Drive, La Jolla, San Diego, CA 92093 (United States); Moustakas, John [Department of Physics and Astronomy, Siena College, 515 Loudon Road, Loudonville, NY 12211 (United States); Blanton, Michael R. [Center for Cosmology and Particle Physics, Department of Physics, New York University, 4 Washington Place, New York, NY 10003 (United States); Cool, Richard J. [MMT Observatory, 1540 E Second Street, University of Arizona, Tucson, AZ 85721 (United States); Eisenstein, Daniel J. [Harvard College Observatory, 60 Garden Street, Cambridge, MA 02138 (United States); Wong, Kenneth C. [Steward Observatory, The University of Arizona, 933 N. Cherry Avenue, Tucson, AZ 85721 (United States); Zhu, Guangtun, E-mail: j.a.aird@durham.ac.uk [Department of Physics and Astronomy, Johns Hopkins University, 3400 N. Charles Street, Baltimore, MD 21218 (United States)

2013-09-20

We present an observationally motivated model to connect the active galactic nucleus (AGN) and galaxy populations at 0.2 < z < 1.0 and predict the AGN X-ray luminosity function (XLF). We start with measurements of the stellar mass function of galaxies (from the Prism Multi-object Survey) and populate galaxies with AGNs using models for the probability of a galaxy hosting an AGN as a function of specific accretion rate. Our model is based on measurements indicating that the specific accretion rate distribution is a universal function across a wide range of host stellar masses with slope γ{sub 1} ≈ –0.65 and an overall normalization that evolves with redshift. We test several simple assumptions to extend this model to high specific accretion rates (beyond the measurements) and compare the predictions for the XLF with the observed data. We find good agreement with a model that allows for a break in the specific accretion rate distribution at a point corresponding to the Eddington limit, a steep power-law tail to super-Eddington ratios with slope γ{sub 2}=-2.1{sup +0.3}{sub -0.5}, and a scatter of 0.38 dex in the scaling between black hole and host stellar mass. Our results show that samples of low luminosity AGNs are dominated by moderately massive galaxies (M{sub *} ∼ 10{sup 10}-10{sup 11} M{sub ☉}) growing with a wide range of accretion rates due to the shape of the galaxy stellar mass function rather than a preference for AGN activity at a particular stellar mass. Luminous AGNs may be a severely skewed population with elevated black hole masses relative to their host galaxies and in rare phases of rapid accretion.

Comparison of the BioRad Variant and Primus Ultra2 high-pressure liquid chromatography (HPLC) instruments for the detection of variant hemoglobins.

Science.gov (United States)

Gosselin, R C; Carlin, A C; Dwyre, D M

2011-04-01

Hemoglobin variants are a result of genetic changes resulting in abnormal or dys-synchronous hemoglobin chain production (thalassemia) or the generation of hemoglobin chain variants such as hemoglobin S. Automated high-pressure liquid chromatography (HPLC) systems have become the method of choice for the evaluation of patients suspected with hemoglobinopathies. In this study, we evaluated the performance of two HPLC methods used in the detection of common hemoglobin variants: Variant and Ultra2. There were 377 samples tested, 26% (99/377) with HbS, 8.5% (32/377) with HbC, 20.7% (78/377) with other hemoglobin variant or thalassemia, and 2.9% with increased hemoglobin A(1) c. The interpretations of each chromatograph were compared. There were no differences noted for hemoglobins A(0), S, or C. There were significant differences between HPLC methods for hemoglobins F, A(2), and A(1) c. However, there was good concordance between normal and abnormal interpretations (97.9% and 96.2%, respectively). Both Variant and Ultra2 HPLC methods were able to detect most common hemoglobin variants. There was better discrimination for fast hemoglobins, between hemoglobins E and A(2), and between hemoglobins S and F using the Ultra2 HPLC method. © 2010 Blackwell Publishing Ltd.

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

Directory of Open Access Journals (Sweden)

Tamara Alexandrov

2014-01-01

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

Analysis of cause-effect relationship of hip dysplasia in pre-school children

Directory of Open Access Journals (Sweden)

Anna Rudenko

2015-12-01

Full Text Available Purpose: to analyze and scientifically substantiate peculiarities of cause-effect relationship of hip dysplasia in pre-school children. Material and Methods: analysis and systematization of scientific and methodological literature, medical histories, anamneses, interviews and questionings. Results: it is specified that failure to timely identify and eliminate the symptoms of hip dysplasia in pre-school children leads to negative consequences, namely limited amplitude of hip joint movements; lower limp muscle weakness; valgus and varus deformations of lower limp; increasing of L-lordosis; skewness of hip bones; scoliosis; claudication. Conclusions: the modern state of the problem of hip dysplasia in pre-school children is analyzed. The cause-effect relationship is defined, their mutual transition is projected. All cause-effect relationships are in direct proportion and in constant interaction: the cause the forms effect and the effect influences the cause

Two-staged Bilateral, Femoral Alignment Osteotomy with Concomitant Total Knee Arthroplasty in an Achondroplasia Patient - A Case Report

Science.gov (United States)

Walter, Sebastian G; Schwering, Tobias; Preiss, Stefan

2017-01-01

Introduction: Achondroplasia is the most common form of dwarfism in humans and is orthopedically characterized by shortened extremities and an exaggerated lumbar lordosis. The surgical challenges are maintenance of axial alignment during limb lengthening as well as joint preservation and alignment restoration. Case Report: We present a 46-year-old female suffering from achondroplasia with severe pain in both knees. Severe varus deformities of both femurs and degeneration of both knee joints became apparent on clinical and radiological examination. On each femur, we performed one-staged, lateral closed-wedge osteotomy, and total knee arthroplasty (TKA). Subsequently, the patient was relieved of knee joint pain and gained a greater range of motion. Conclusion: One-staged valgization osteotomy and concomitant TKA represents a challenging, yet reasonable, surgical solution in axially severe malaligned and joint degenerated patients. PMID:28819598

Elbow joint stability in relation to forced external rotation

DEFF Research Database (Denmark)

Deutch, S.R.; Jensen, S.L.; Olsen, B.S.

2003-01-01

The objective of this study was to evaluate the osseous constraint related to forced forearm external rotation as the initial stage in a posterior elbow dislocation. Six joint specimens without soft tissues were examined in a joint analysis system developed for simulation of dislocation. The osse......The objective of this study was to evaluate the osseous constraint related to forced forearm external rotation as the initial stage in a posterior elbow dislocation. Six joint specimens without soft tissues were examined in a joint analysis system developed for simulation of dislocation...... external forearm rotation until the point of maximal torque decreased from a maximum in full extension to a minimum at 30 degrees of elbow flexion (P =.03). The elbow in a slightly flexed position, varus stress, and forearm external rotation trauma might be the important biomechanical factors...

Ankle and subtalar synovitis in a ball-and-socket ankle joint causing posterolateral painful coarse crepitus: a case report.

Science.gov (United States)

Fan, Ka Yuk; Lui, Tun Hing

2014-01-01

A 17-year-old girl with bilateral ball-and-socket ankles reported left medial heel pain. Her left heel had gone into a varus position on tiptoeing, and a painful clunk had occurred when returning to normal standing. The clunk persisted after physiotherapy and treatment with an orthosis. Subtalar arthroscopy and peroneal tendoscopy showed mild diffuse synovitis of the ankle joint, especially over the posterior capsule, and a patch of inflamed and fibrotic synovium at the posterolateral corner of the subtalar joint. The clunk subsided immediately after arthroscopic synovectomy and had not recurred during 5 years of follow-up. We found no other reported cases of ankle and subtalar synovitis occurring in patients with a ball-and-socket ankle joint. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

Verification of a table of phantom scatter factors for radiotherapy treatment planning

International Nuclear Information System (INIS)

Arts, J.K.; Bailey, M.J.; Hill, R.

2004-01-01

Full text: Many commercially available treatment planning systems require the medical physicist to measure and enter significant quantities of data for the verification of physics based algorithms. The CMS XiO (St. Louis, USA) treatment planning system requires a table of phantom scatter factors amongst other data. In a previous paper by Storchi et al, a table of phantom scatter factors is described. This table gives the phantom scatter factor as a function of field size and quality index determined from a collection of measured data for the total scatter factor and the collimator scatter factor from 25 different beam qualities ranging from 4MV up to 25MV. These factors have been determined at a fixed reference depth of 10cm for square fields of various sizes. This work investigates the claim that this table can be used as an alternative to calculated phantom scatter curve from measured data of a particular treatment unit. According to definition, it is difficult to directly measure the phantom scatter correction factor (Sp). This problem can be solved using the relation; S cp (A) = S c (A)S p (A) where S cp (A)) is the measured total scatter factor for a field size of square side dimension, A and S c (A) is the measured collimator scatter factor for a field size of square side dimension, A (Khan et al 1980, van Gasteren et al 1991). The total scatter correction factor (Sc,p) was measured in a full phantom, and the collimator scatter factor (Sc) measured using an ESTRO mini-phantom. These factors were measured on three Siemens linear accelerators (Concord, USA) with energies 6MV and 18MV and square field sizes ranging from 4x4cm to 40x40cm. The Primus and KD Mevatron produced 6 and 18MV X-rays and the MXE Mevatron produced 6Mv X-rays only. The values for Sp were calculated by rearranging equation (1). Phantom scatter factors were calculated from the data provided by Storchi et al using the quality index of each beam. For comparison, a set of Sp values was

Altitude, pasture type, and sheep breed affect bone metabolism and serum 25-hydroxyvitamin D in grazing lambs.

Science.gov (United States)

Willems, Helen; Leiber, Florian; Kohler, Martina; Kreuzer, Michael; Liesegang, Annette

2013-05-15

This study aimed to investigate the bone development of two mountain sheep breeds during natural summer grazing either in the lowlands or on different characteristic alpine pastures. Pasture types differed in topographic slope, plant species composition, general nutritional feeding value, Ca and P content, and Ca:P ratio of herbage. Twenty-seven Engadine sheep (ES) lambs and 27 Valaisian Black Nose sheep (VS) lambs were divided into four groups of 6 to 7 animals per breed and allocated to three contrasting alpine pasture types and one lowland pasture type. The lambs were slaughtered after 9 wk of experimental grazing. The steep alpine pastures in combination with a high (4.8) to very high (13.6) Ca:P ratio in the forage decreased total bone mineral content as measured in the middle of the left metatarsus of the lambs from both breeds, and cortical bone mineral content and cortical bone mineral density of ES lambs. Breed × pasture type interactions occurred in the development of total and cortical bone mineral content, and in cortical thickness, indicating that bone metabolism of different genotypes obviously profited differently from the varying conditions. An altitude effect occurred for 25-hydroxyvitamin D with notably higher serum concentrations on the three alpine sites, and a breed effect led to higher concentrations for ES than VS. Despite a high variance, there were pasture-type effects on serum markers of bone formation and resorption.

Unilateral hallux valgus: is it true unilaterality, or does it progress to bilateral deformity?

Science.gov (United States)

Young, Ki Won; Park, Young Uk; Kim, Jin Su; Jegal, Hyuk; Lee, Kyung Tai

2013-04-01

This study was undertaken to determine whether unilateral hallux valgus progresses unilaterally and to evaluate the demographics, etiologies, and radiographic findings associated with symptomatic unilateral hallux valgus deformities. Patients treated for hallux valgus between January 2004 and December 2008 were identified, and of these, 33 patients with unilateral deformities were enrolled. Progression of deformities in normal feet were evaluated at last follow-up visit, and the clinical information and radiographic measurements of those with a deformed normal foot or an unchanged normal foot were compared. Thirty-three patients (3.4%) had a unilateral hallux valgus deformity on preoperative radiographs. The mean length of follow up was 4.7 years (range, 2.4-11). Twenty-four cases had no deformity of the normal foot at last follow-up (the unchanged group), but 15 cases had developed hallux valgus deformity (the deformed group). No significant intergroup differences were found in terms of metatarsus adductus angle (P = .412), Meary angle (P = .771), talocalcaneal angle (P = 1.000), or calcaneal pitch angle (P = .267). However, members of the deformed group were significantly younger at disease onset (P = .045), exhibited a curved first metatarsal head (P = .046), and had a larger initial hallux valgus angle (P hallux valgus was found to be over 97.3%, and significant differences were found between the deformed and unchanged groups in terms of age of onset, metatarsal head shape, and hallux valgus angle.

Recurrence of Hallux Valgus Can Be Predicted from Immediate Postoperative Non-Weight-Bearing Radiographs.

Science.gov (United States)

Park, Chul Hyun; Lee, Woo-Chun

2017-07-19

The aims of this study were to identify risk factors for the recurrence of hallux valgus deformity and to clarify whether recurrence after surgery to treat hallux valgus can be predicted using radiographic parameters assessed on immediate postoperative non-weight-bearing radiographs. A proximal chevron osteotomy combined with a distal soft-tissue procedure was performed by a single surgeon to treat moderate to severe hallux valgus deformity in 93 patients (117 feet). The feet were grouped according to nonrecurrence or recurrence. Changes in the hallux valgus angle, the intermetatarsal angle, and sesamoid position over time were analyzed by comparing values measured during each postoperative period. The relative risks of recurrence as indicated by preoperative and postoperative radiographic parameters were determined. Twenty (17.1%) of the 117 feet showed hallux valgus recurrence at the time of the last follow-up. The hallux valgus angle and the intermetatarsal angle stabilized at 6 months after surgery in the nonrecurrence group. An immediate postoperative hallux valgus angle of ≥8°, an immediate postoperative sesamoid position of grade 4 or greater, a preoperative metatarsus adductus angle of ≥23°, and a preoperative hallux valgus angle of ≥40° were significantly associated with recurrence. Recurrence of hallux valgus after a proximal chevron osteotomy can be reliably predicted from immediate postoperative non-weight-bearing radiographs. Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.

Radiographic Measurements Associated With the Natural Progression of the Hallux Valgus During at Least 2 Years of Follow-up.

Science.gov (United States)

Lee, Seung Yeol; Chung, Chin Youb; Park, Moon Seok; Sung, Ki Hyuk; Ahmed, Sonya; Koo, Seungbum; Kang, Dong-Wan; Lee, Kyoung Min

2018-04-01

This study aimed to investigate the radiographic measurements associated with the progression of hallux valgus during at least 2 years of follow-up. Seventy adult patients with hallux valgus who were followed for at least 2 years and underwent weightbearing foot radiography were included. Radiographic measurements included the hallux valgus angle (HVA), hallux interphalangeal angle, intermetatarsal angle (IMA), metatarsus adductus angle, distal metatarsal articular angle (DMAA), tibial sesamoid position, anteroposterior (AP) talo-first metatarsal angle, and lateral talo-first metatarsal angle. Patients were divided into progressive and nonprogressive groups. Binary logistic regression analysis was performed to identify factors that significantly affected the progression of hallux valgus deformity. The correlation between change in HVA and changes in other radiographic indices during follow-up was analyzed. The DMAA ( P = .027) and AP talo-first metatarsal angle ( P = .034) at initial presentation were found to be significant factors affecting the progression of hallux valgus deformity. Change in the HVA during follow-up was significantly correlated with changes in the IMA ( r = 0.423; P = .001) and DMAA ( r = 0.541; P < .001). The change in the HVA was found to be significantly correlated with changes in the IMA and DMAA. A future study is required to elucidate whether this correlation can be explained by the progressive instability of the first tarsometatarsal joint. We believe special attention needs to be paid to patients with pes planus and increased DMAA. Level III, comparative study.

Relationship of Radiographic and Clinical Parameters With Hallux Valgus and Second Ray Pathology.

Science.gov (United States)

Gribbin, Caitlin K; Ellis, Scott J; Nguyen, Joseph; Williamson, Emilie; Cody, Elizabeth A

2017-01-01

Hallux valgus is frequently associated with additional forefoot pathologies, including hammertoes and midfoot osteoarthritis (OA). However, the pathogenesis of these concurrent pathologies remains to be elucidated. We sought to determine whether there is a relationship between demographic and radiographic parameters and the incidence of secondary pathologies in the setting of a bunion, with an emphasis on second tarsometatarsal (TMT) OA and hammertoes. A total of 153 patients (172 feet) who underwent reconstruction for hallux valgus were divided into 3 groups: (1) bunion only (61 patients), (2) bunion with hammertoe without second TMT joint OA (78 patients), and (3) bunion with second TMT joint OA (14 patients). Preoperative age, sex, and body mass index (BMI) as well as hallux valgus angle (HVA), intermetatarsal angle (IMA), metatarsus adductus angle (MAA), ratio of second to first metatarsal length, and Meary's angle were recorded. One-way analysis of variance (normality demonstrated) and Kruskal-Wallis (normality not demonstrated) tests were used to assess differences in continuous variables. Post hoc tests were conducted with the Bonferroni technique. Associations between discrete variables and the study groups were analyzed using χ 2 tests. Following the univariate analysis, multinomial logistic regression models were built to determine potential risk factors for hammertoe or TMT OA group placement. Patients in the hammertoe and TMT OA groups were significantly older than patients in the bunion only group ( P hallux valgus who are at greater risk for developing secondary pathologies. Level III, retrospective comparative series.

Why do lesser toes deviate laterally in hallux valgus? A radiographic study.

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Roan, Li-Yi; Tanaka, Yasuhito; Taniguchi, Akira; Tomiwa, Kiyonori; Kumai, Tsukasa; Cheng, Yuh-Min

2015-06-01

Hallux valgus foot with laterally deviated lesser toes is a complex condition to treat. Ignoring the laterally deviated lesser toes in hallux valgus might result in unsatisfactory foot shape. Without lateral support of the lesser toes, it might increase the risk of recurrence of hallux valgus. We sought to identify associated radiographic findings in patients where lesser toes follow the great toe in hallux valgus and deviate laterally. The weight-bearing, anteroposterior foot radiographs of 24 female hallux valgus feet with laterally deviated lesser toes (group L), 34 female hallux valgus feet with normal lesser toes (group H), and 43 normal female feet (group N) were selected for the study. A 2-dimensional coordinated system was used to analyze the shapes and angles of these feet by converting each dot made on the radiographs onto X and Y coordinates. Diagrams of the feet in each group were drawn for comparison. The hallux valgus angle, lateral deviation angle of the second toe, intermetatarsal angles, toe length, metatarsal length, and metatarsus adductus were calculated according to the coordinates of the corresponding points. The mapping showed the bases of the second, third, and fourth toe in group L shifted laterally away from their corresponding metatarsal head (P hallux valgus angles (P hallux valgus angle, more adducted first metatarsal, and divergent lateral splaying of the lesser metatarsals were associated with lateral deviation of the lesser toes in hallux valgus. Level III, comparative study. © The Author(s) 2015.

Validity and inter-rater reliability of medio-lateral knee motion observed during a single-limb mini squat

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Simic Milena

2010-11-01

Full Text Available Abstract Background Muscle function may influence the risk of knee injury and outcomes following injury. Clinical tests, such as a single-limb mini squat, resemble conditions of daily life and are easy to administer. Fewer squats per 30 seconds indicate poorer function. However, the quality of movement, such as the medio-lateral knee motion may also be important. The aim was to validate an observational clinical test of assessing the medio-lateral knee motion, using a three-dimensional (3-D motion analysis system. In addition, the inter-rater reliability was evaluated. Methods Twenty-five (17 women non-injured participants (mean age 25.6 years, range 18-37 were included. Visual analysis of the medio-lateral knee motion, scored as knee-over-foot or knee-medial-to-foot by two raters, and 3-D kinematic data were collected simultaneously during a single-limb mini squat. Frontal plane 2-D peak tibial, thigh, and knee varus-valgus angles, and 3-D peak hip internal-external rotation, and knee varus-valgus angles were calculated. Results Ten subjects were scored as having a knee-medial-to-foot position and 15 subjects a knee-over-foot position assessed by visual inspection. In 2-D, the peak tibial angle (mean 89.0 (SE 0.7 vs mean 86.3 (SE 0.4 degrees, p = 0.001 and peak thigh angle (mean 77.4 (SE 1.0 vs mean 81.2 (SE 0.5 degrees, p = 0.001 with respect to the horizontal, indicated that the knee was more medially placed than the ankle and thigh, respectively. Thus, the knee was in more valgus (mean 11.6 (SE 1.5 vs 5.0 (SE 0.8 degrees, p 0.90 and 96 between raters. Conclusions Medio-lateral motion of the knee can reliably be assessed during a single-leg mini-squat. The test is valid in 2-D, while the actual movement, in 3-D, is mainly exhibited as increased internal hip rotation. The single-limb mini squat is feasible and easy to administer in the clinical setting and in research to address lower extremity movement quality.

[Mini-subvastus approach for total knee replacement].

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Halder, Andreas; Beier, Alexander; Neumann, Wolfram

2009-03-01

Total knee replacement in minimally invasive technique without any trauma to the extensor apparatus and with soft-tissue-referenced bone resections. Only the subvastus approach preserves the integrity of the extensor apparatus and has therefore been modified to become a minimally invasive technique with a shorter skin incision and lateralization instead of eversion of the patella. Soft-tissue balancing is done through this direct anterior approach. Mild to moderate varus osteoarthritis of the knee up to 15 degrees of malalignment, mild and passively correctable valgus osteoarthritis of the knee up to 10 degrees of malalignment. Severe, contract varus osteoarthritis of the knee, severe and moderate, contract valgus osteoarthritis of the knee, severe obesity, exceptionally muscular patients, decreased skin perfusion. Central skin incision from the superior pole of the patella to the tibial tubercle. Exposure of the medial retinaculum and mobilization of the vastus medialis muscle subcutaneously. Incision of the medial retinaculum and blunt separation of the vastus medialis muscle from the intermuscular septum. Lateralization of the patella and flexion of the knee joint. Resection of the tibia perpendicular to the diaphysis. Adjustment of the anteroposterior (AP) resection block at the level of the anterior femoral cortex and of rotation by applying equal tension to the collateral ligaments. Balancing of soft-tissue tension in flexion gap by release, if necessary. After AP resection fixation of distal resection block in planned valgus angle. Balancing of soft-tissue tension in extension gap by release, if necessary. After distal femur resection facet resection, adaptation of posterior femoral condyles, and implantation of prosthesis. Check on stability and range of motion. Wound closure. Full weight bearing from the 1st postoperative day, CPM (continuous passive motion) with up to 90 degrees flexion with peridural anesthesia as tolerated, stair climbing starting on

Biomechanical in vitro assessment of screw augmentation in locked plating of proximal humerus fractures.

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Röderer, Götz; Scola, Alexander; Schmölz, Werner; Gebhard, Florian; Windolf, Markus; Hofmann-Fliri, Ladina

2013-10-01

Proximal humerus fracture fixation can be difficult because of osteoporosis making it difficult to achieve stable implant anchorage in the weak bone stock even when using locking plates. This may cause implant failure requiring revision surgery. Cement augmentation has, in principle, been shown to improve stability. The aim of this study was to investigate whether augmentation of particular screws of a locking plate aimed at a region of low bone quality is effective in improving stability in a proximal humerus fracture model. Twelve paired human humerus specimens were included. Quantitative computed tomography was performed to determine bone mineral density (BMD). Local bone quality in the direction of the six proximal screws of a standard locking plate (PHILOS, Synthes) was assessed using mechanical means (DensiProbe™). A three-part fracture model with a metaphyseal defect was simulated and fixed with the plate. Within each pair of humeri the two screws aimed at the region of the lowest bone quality according to the DensiProbe™ were augmented in a randomised manner. For augmentation, 0.5 ml of bone cement was injected in a screw with multiple outlets at its tip under fluoroscopic control. A cyclic varus-bending test with increasing upper load magnitude was performed until failure of the screw-bone fixation. The augmented group withstood significantly more load cycles. The correlation of BMD with load cycles until failure and BMD with paired difference in load cycles to failure showed that augmentation could compensate for a low BMD. The results demonstrate that augmentation of screws in locked plating in a proximal humerus fracture model is effective in improving primary stability in a cyclic varus-bending test. The augmentation of two particular screws aimed at a region of low bone quality within the humeral head was almost as effective as four screws with twice the amount of bone cement. Screw augmentation combined with a knowledge of the local bone quality

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

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

2018-05-01

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

Computer-assisted three-dimensional correlation between the femoral neck-shaft angle and the optimal entry point for antegrade nailing.

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Anastopoulos, George; Chissas, Dionisios; Dourountakis, Joseph; Ntagiopoulos, Panagiotis G; Magnisalis, Evaggelos; Asimakopoulos, Antonios; Xenakis, Theodore A

2010-03-01

Optimal entry point for antegrade femoral intramedullary nailing (IMN) remains controversial in the current medical literature. The definition of an ideal entry point for femoral IMN would implicate a tenseless introduction of the implant into the canal with anatomical alignment of the bone fragments. This study was undertaken in order to investigate possible existing relationships between the true 3D geometric parameters of the femur and the location of the optimum entry point. A sample population of 22 cadaveric femurs was used (mean age=51.09+/-14.82 years). Computed-tomography sections every 0.5mm for the entire length of femurs were produced. These sections were subsequently reconstructed to generate solid computer models of the external anatomy and medullary canal of each femur. Solid models of all femurs were subjected to a series of geometrical manipulations and computations using standard computer-aided-design tools. In the sagittal plane, the optimum entry point always lied a few millimeters behind the femoral neck axis (mean=3.5+/-1.5mm). In the coronal plane the optimum entry point lied at a location dependent on the femoral neck-shaft angle. Linear regression on the data showed that the optimal entry point is clearly correlated to the true 3D femoral neck-shaft angle (R(2)=0.7310) and the projected femoral neck-shaft angle (R(2)=0.6289). Anatomical parameters of the proximal femur, such as the varus-valgus angulation, are key factors in the determination of optimal entry point for nailing. The clinical relevance of the results is that in varus hips (neck-shaft angle shaft angle between 120 degrees and 130 degrees , the optimal entry point lies just medially to the trochanter tip (at the piriformis fossa) and the use of stiff implants is safe. In hips with neck-shaft angle over 130 degrees the anatomical axis of the canal is medially to the base of the neck, in a "restricted area". In these cases the entry point should be located at the insertion of the

Minimally invasive unicompartmental knee replacement: Midterm clinical outcome.

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Shaoqi Tian

Full Text Available The purpose of this study was to explore the midterm clinical outcomes of unicompartmental knee replacement (UKR for medial knee arthropathy through a minimally invasive approach (MIA.From January 2006 to June 2010, 442 consecutive patients (485 knees were included in the study. All patients underwent MIA-UKR with the mobile bearing Oxford phrase III prosthesis. The incision was made starting 1 cm medial to the medial pole of the patella and extending distally to the tibial tubercle. Radiographic evaluations include femorotibial angle (FTA from coronal x-rays and rectified varus deformity angle, while clinical evaluations included Knee Society Score (KSS, clinical score and function score, the Western Ontario and McMaster Universities Arthritis Index (WOMAC osteoarthritis index and visual analog scale (VAS for pain. Patients followed-up at 1, 3, 6, 12 months after surgery and each year thereafter.Four hundreds and two patients completed the entire follow-up, 40 patients (45 knees were lost to follow-up. The average follow-up time was 73.0 ± 1.9 months. The mean length of the incisions was 5.0 ± 0.2 cm. The average FTA decreased from 183.6° ± 5.1° preoperatively to 174.3° ± 4.2° postoperatively, and the mean rectified varus deformity angle was 9.3° ± 1.2°. The KSS clinical score improved from 42.4 ± 2.9 to 92.9 ± 3.8, and the function score improved from 53.5 ± 3.8 to 93.5 ± 4.0. The WOMAC score improved from 47.5 ± 3.1 preoperatively to 12.3 ± 1.5 at the last evaluation. The VAS dropped from 7.8 ± 1.9 preoperatively to 1.6 ± 0.2 postoperatively. All clinical evaluations (KSS, WOMAC, VAS were significantly different (p < 0.05 from pre and post-operative evaluations. The survival rate was 99.1% at 73 months, and the revision rate was 0.9%.The midterm clinical outcomes of MIA-UKR are satisfactory in a Chinese patient population, which is a good surgical option for patients with medial arthropathy of the knee. However, longer

Associations between lower extremity muscle mass and multiplanar knee laxity and stiffness: a potential explanation for sex differences in frontal and transverse plane knee laxity.

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Shultz, Sandra J; Pye, Michele L; Montgomery, Melissa M; Schmitz, Randy J

2012-12-01

Compared with men, women have disproportionally greater frontal (varus-valgus) and transverse (internal-external) plane laxity and lower stiffness, despite having similar sagittal (anterior-posterior) plane laxity and stiffness. While the underlying cause is unclear, the amount of lower extremity lean mass (LELM) may be a contributing factor. Lower extremity lean mass would be a stronger predictor of frontal and transverse plane laxity and incremental stiffness than the sagittal plane. Associations between LELM and stiffness would be stronger at lower force increments. Descriptive laboratory study. Sixty-three women and 30 men with no history of ligament injury were measured for knee laxity and incremental stiffness in the sagittal (-90- to 130-N posterior-to-anterior directed loads), frontal (±10-N·m varus-valgus torques), and transverse (±5-N·m internal-external rotation torques) planes and underwent dual-energy X-ray absorptiometry scans to measure LELM. Linear regressions examined the extent to which LELM predicted each laxity and stiffness value, while also accounting for a person's sex. Females (vs males) had greater laxity and less stiffness in the frontal and transverse planes but not the sagittal plane. Lower extremity lean mass was a poor predictor of sagittal laxity and stiffness (R (2) range = .021-.081; P > .06) but was a stronger predictor of frontal (R (2) range = .215-.567; P plane laxity and stiffness. Associations were stronger for low (R (2) = .495-.504) versus high (R (2) = .215-.435) frontal plane stiffness but were similar for low (R (2) = .233-.293) versus high (R (2) = .224-.356) transverse plane stiffness. Once we accounted for a person's LELM, sex had little effect on laxity and stiffness (change in R (2) after removal = .01-.08; P = .027-.797). Less LELM was associated with greater laxity and less stiffness in frontal and transverse planes, which may contribute to the disproportionally higher laxities and reduced stiffnesses observed

Clinical and radiographic evaluation of modular knee replacement

International Nuclear Information System (INIS)

Cartier, P.; Mammeri, M.; Villers, P.

1982-01-01

Ninety-five modular total knee replacements, 54 of them unicompartmental, have been reviewed. The average follow-up was three years. The major indication for operation was pain. A precise preoperative radiographic evaluation and a technique for a positioning the components are described. This had led to a significant improvement in the clinical and radiographic results in 67 out of 95 knees which were operated on. The modifications concern the orientation of the tibial cut, the placing of the femoral components and the correction of axial deviation. The main causes of the 13% of failures in our series were either errors in positioning the components or a preoperative diagnosis of rheumatoid arthritis. Unicompartmental replacement gave similar results in both valgus and varus knees, and the morbidity was lower than in the bicompartmental replacements. The best results were obtained in osteoarthristic knees in elderly patients and in posttraumatic osteoarthritis. (orig.)

The iliotibial band and anterolateral capsule have a combined attachment to the Segond fracture.

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Albers, Marcio; Shaikh, Humza; Herbst, Elmar; Onishi, Kentaro; Nagai, Kanto; Musahl, Volker; Fu, Freddie H

2018-05-01

The purpose of this report was to describe the injury mechanism, surgical findings, and outcomes in a 21-year-old professional female football player who presented with a complete anterior cruciate ligament (ACL) rupture and Segond fracture. Interview and video analysis were performed to elicit the injury mechanism. Clinical examination and imaging revealed a complete ACL tear, Segond fracture, lateral meniscus tear, MCL sprain, and posterolateral corner sprain. Examination under anaesthesia revealed Grade 2 pivot shift and varus/valgus instability. Surgical examination revealed attachment of the posterior fibres of the iliotibial band and the lateral capsule to the Segond fragment. The fracture was reduced with suture fixation, and an anatomic ACL reconstruction was performed. Follow-up demonstrated rotatory and anterior tibial translation stability, and imaging at 7 months post-operatively revealed no movement and continued osseous integration of the Segond fragment. Level of evidence V.

Management of “floating elbow” in children

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Suresh, SS

2007-01-01

Background: Supracondylar fractures associated with ipsilateral forearm fractures, aptly termed as “floating elbow” is a rare injury in children after a fall from height. The various authors have reported their results with conservative treatment of one or both injuries to aggressive emergency operative fixation of both components. Materials and Methods: During a period of three years, the author managed four cases of floating elbow in children. All cases were managed by closed reduction and pinning of both components of the injury. Results: All patients recovered full elbow range of motion at three months followup and were rated as excellent as per modified Flynn's criteria. None of the patients developed cubitus varus deformity, complications related to the pins or delayed union. Conclusions: Early closed reduction and K wire fixation of both components of this injury gives better stability and prevents development of complications like compartment syndrome and elbow deformities. PMID:21139796

Sex-specific automatic responses to infant cries: TMS reveals greater excitability in females than males in motor evoked potentials

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Irene eMessina

2016-01-01

Full Text Available Neuroimaging reveals that infant cries activate parts of the premotor cortical system. To validate this effect in a more direct way, we used event-related transcranial magnetic stimulation (TMS. Here, we investigated the presence and the time course of modulation of motor cortex excitability in young adults who listened to infant cries. Specifically, we recorded motor evoked potentials (MEPs from the biceps brachii (BB and interosseus dorsalis primus (ID1 muscles as produced by TMS delivered from 0 to 250 ms from sound onset in six steps of 50 ms in 10 females and 10 males. We observed an excitatory modulation of MEPs at 100 ms from the onset of the infant cry specific to females and to the ID1 muscle. We regard this modulation as a response to natural cry sounds because it was delayed, attenuated to stimuli increasingly different from natural cry, and was absent in a separate group of females who listened to non-cry stimuli physically matched to natural infant cries. Furthermore, the 100-ms latency of this modulation is not compatible with a voluntary reaction to the stimulus but suggests an automatic, bottom-up audiomotor association. The brains of adult females appear to be tuned to respond to infant cries with automatic motor excitation. This effect may reflect the greater and longstanding burden on females in caregiving infants.

A practical approach for electron monitor unit calculation

International Nuclear Information System (INIS)

Choi, David; Patyal, Baldev; Cho, Jongmin; Cheng, Ing Y; Nookala, Prashanth

2009-01-01

Electron monitor unit (MU) calculation requires measured beam data such as the relative output factor (ROF) of a cone, insert correction factor (ICF) and effective source-to-surface distance (ESD). Measuring the beam data to cover all possible clinical cases is not practical for a busy clinic because it takes tremendous time and labor. In this study, we propose a practical approach to reduce the number of data measurements without affecting accuracy. It is based on two findings of dosimetric properties of electron beams. One is that the output ratio of two inserts is independent of the cone used, and the other is that ESD is a function of field size but independent of cone and jaw opening. For the measurements to prove the findings, a parallel plate ion chamber (Markus, PTW 23343) with an electrometer (Cardinal Health 35040) was used. We measured the outputs to determine ROF, ICF and ESD of different energies (5-21 MeV). Measurements were made in a Plastic Water(TM) phantom or in water. Three linear accelerators were used: Siemens MD2 (S/N 2689), Siemens Primus (S/N 3305) and Varian Clinic 21-EX (S/N 1495). With these findings, the number of data set to be measured can be reduced to less than 20% of the data points. (note)

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

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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.

The role of hinges in primary total knee replacement.

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Gehrke, T; Kendoff, D; Haasper, C

2014-11-01

The use of hinged implants in primary total knee replacement (TKR) should be restricted to selected indications and mainly for elderly patients. Potential indications for a rotating hinge or pure hinge implant in primary TKR include: collateral ligament insufficiency, severe varus or valgus deformity (>20°) with necessary relevant soft-tissue release, relevant bone loss including insertions of collateral ligaments, gross flexion-extension gap imbalance, ankylosis, or hyperlaxity. Although data reported in the literature are inconsistent, clinical results depend on implant design, proper technical use, and adequate indications. We present our experience with a specific implant type that we have used for over 30 years and which has given our elderly patients good mid-term results. Because revision of implants with long cemented stems can be very challenging, an effort should be made in the future to use shorter stems in modular versions of hinged implants. ©2014 The British Editorial Society of Bone & Joint Surgery.

Single Stage Tibial Osteotomy and Long Stem Total Knee Arthroplasty to Correct Adverse Consequences of Unequal Tibial Lengthening with an Ilizarov Circular Fixator.

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Fletcher, M D

2015-01-01

Correction of limb alignment or length discrepancy by circular external fixation is an accepted technique which relies on the correct biomechanical application of the frame and precise corrections which are frequently delegated to the patient to perform. Errors can occur in the execution of the correction by the patient and may result in significant deformity that requires remedial intervention. A 67 Caucasian female underwent multifocal limb reconstruction of the lower limb utilising a complex Ilizarov frame. Attendance at follow-up visits did not occur and the patient presented at 6 months with severe deformity due to incorrect execution of the correction protocol which resulted in a 45 degree varus deformity of the tibia. Subsequent correction via acute tibial osteotomy and stabilisation with a stemmed total knee replacement resulted in a good outcome. Patient compliance with post-operative management is paramount with distraction osteogenesis and should be ensured prior to embarking on lengthening or deformity correction.

Management of chronic lateral instability due to lateral collateral ligament deficiency after total knee arthroplasty: a case report

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Petersilge William J

2010-05-01

Full Text Available Abstract Introduction Lateral instability following total knee arthroplasty (TKA is a rare condition with limited report of treatment options. The objective of this case presentation is to demonstrate the outcomes of different surgical procedures performed in a single patient with lateral collateral ligament (LCL deficiency. Case presentation We present a case of chronic lateral instability due to LCL deficiency after primary TKA in a 47-year-old Caucasian woman with an obesity problem. Multiple treatment options have been performed in order to manage this problem, including the following: ligament reconstruction; combined ligament reconstruction and constrained implant; and rotating-hinge knee prosthesis that was the most recent surgery. All ligament reconstruction procedures failed within one year. The varus-valgus constrained prosthesis provided stability for six years. Conclusions Ligament reconstruction alone cannot provide enough stability for the treatment of chronic lateral instability in patients with obesity problems and LCL deficiency. When the reconstruction fails, a salvage procedure with rotating-hinge knee is still available.

Association between knee alignment and knee pain in patients surgically treated for medial knee osteoarthritis by high tibial osteotomy. A one year follow-up study

DEFF Research Database (Denmark)

W-Dahl, Annette; Toksvig-Larsen, Sören; Roos, Ewa

2009-01-01

on for knee OA by high tibial osteotomy. METHODS: 182 patients (68% men) mean age 53 years (34 - 69) with varus alignment having tibial osteotomy by the hemicallotasis technique for medial knee OA were consecutively included. Knee alignment was assessed by the Hip-Knee-Ankle (HKA) angle from radiographs...... including the hip and ankle joints. Knee pain was measured by the subscale pain (0 - 100, worst to best scale) of the Knee injury and Osteoarthritis Outcome Score (KOOS) preoperatively and at one year follow-up. To estimate the association between knee alignment and knee pain multivariate regression...... with every degree of HKA angle, adjusted analysis 0.3 points (95% CI -1.3 - 0.6).The mean postoperative knee alignment was 184 degrees (171 - 185). The mean change in knee alignment was 13 degrees (0 - 30). The mean change in KOOS pain was 32 (-16 - 83). There was neither any association between change...

Variability of morphometric parameters of feet in various forms of lower extremities

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Konnova O.V.

2014-12-01

Full Text Available Purpose: to identify the various forms of lower extremities variability of linear and angular parameters of feet in girls aged 17-19 years. Material and Methods. The object of the study included 242 students from Saratov State Medical University, 17—19 years. Foot digital plantography photometric device-software complex «Plantvizor» and measuring distances between sibling points of lower extremities to highlight their forms have been used as a method of research. Results. 8 forms of lower extremities, among which half per cent occurs in isolated form, valgus-direct from the mil-lennim clearance opening and a trapezoidal shape of lower extremities varus. In all forms of lower extremities morphometric parameters of feet and ratio of statistically significant differences in various forms of lower extremities have been studied. Conclusion. Anatomical basis for operational adjustment of axial disorders of tibiae and its influence on morphofunctional state of foot can be resulted from the study.

The effects of thermal manipulations during embryogenesis of broiler chicks on growth of embryo and skeletal traits

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Aygün, Ali; Narinç, Doǧan

2016-04-01

Incubation temperature is one of the important environmental factors that can induce epigenetic thermal adaptation of different physiological control systems. Thus, post hatch thermo tolerance ability of birds may be gained using these manipulations during different incubation periods. The current study was carried out to reveal the effects of temperature manipulations during early and late embryogenesis on weight of embryo and size of skeletal bilateral traits (face, wings, metatarsus, tibia, and femur) in broiler chicken embryos. One thousand commercial broiler eggs from 46 week old breeder flock were used in study. Treatments consisted of eggs incubated at 37.8°C and 55% relative humidity throughout (control; DG1), heated to 36.9°C and supplied 60% relative humidity for 6 hours daily from day 0 to 8 (DG2), heated to 36.9°C and supplied 60% relative humidity for 6 hours daily from day 10 to 18 (DG3), heated to 41°C and supplied 65% relative humidity for 3 hours daily from day 8 to 10 (DG4), and heated to 41°C and supplied 65% relative humidity for 3 hours daily from day 16 to 18 (DG5). Measurements of embryo weight and bilateral traits were obtained at 20 day of incubation and at hatch (at day 21). It was determined that the live weights of embryo and chick were affected significantly by treatment; DG3 group has shown higher mean values than the other treatment groups (Pmetabolic shifts realized by the embryos.

MORPHOLOGICAL VARIATION AND TAXONOMY OF LEPIDOCOLAPTES ANGUSTIROSTRIS (VIEILLOT, 1818 (PASSERIFORMES: DENDROCOLAPTIDAE

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SERGIO BOLÍVAR-LEGUIZAMÓN

2015-01-01

Full Text Available Lepidocolaptes angustirostris is a South American woodcreeper that inhabits predominantly open lowlands such as the Cerrado, Chaco and Caatinga. Eight subspecies are currently recognized based on plumage patterns and geographical distribution. However, a more detailed morphological analysis and taxonomic revision have not been done in this species. The objective of this study was to conduct a taxonomic revision of L. angustirostris using morphometrical and plumage character, and a Generalized Linear Models analyzes (GLM were elaborated to identify environmental variables that could account for this variation. We found a high level of intergradation among all named populations. The principal component analyzes show certain levels of morphological differentiation among the taxa, with a first component formed by bill characters (bill length, exposed and total culmen, and a second one that includes the bill width and the tarsus-metatarsus length. In the GLM analyzes, two climatic variables explain the geographical variation in the taxon, temperature seasonality and precipitation of warmest quarter. The ecogeographic rules of Bergmann and Gloger can be applied to this variation, and, more narrowly, the Allen's rule. Thus, the populations of the Narrow-billed Woodcreeper tend to be larger to the south of the distribution. We propose here that L. angustirostris is a single species, with no subordinate taxa. Any evidence analyzed here did not support the taxonomic validity of the proposed subspecies in the taxon. Despite colour-polymorphism identified in the plumage patterns, the high level of intergradation and the poor resolution of geographical boundaries did not support the splitting of this species.

Feasibility and repeatability of cold and mechanical quantitative sensory testing in normal dogs

Science.gov (United States)

Briley, Jessica D.; Williams, Morika D.; Freire, Mila; Griffith, Emily H.; Lascelles, B. Duncan X.

2015-01-01

Feasibility and inter-session repeatability of cold and mechanical quantitative sensory testing (QST) were assessed in 24 normal dogs. Cold thermal latencies were evaluated using a thermal probe (0 °C) applied to three pelvic limb sites. Mechanical thresholds were measured using an electronic von Frey anesthesiometer (EVF) and a blunt-probed pressure algometer (PA) applied to the dorsal aspect of the metatarsus. All QST trials were performed with dogs in lateral recumbency. Collection of cold QST data was easy (feasible) in 19/24 (79%) dogs. However, only 18.4%, 18.9% and 13.2% of cold QST trials elicited a response at the medial tibia, third digital pad and plantar metatarsal regions, respectively. Collection of mechanical QST data was easy (feasible) in 20/24 (83%) dogs for both EVF and PA. At consecutive sampling times, approximately 2 weeks apart, the average EVF sensory thresholds were 414 ± 186 g and 379 ± 166 g, respectively, and the average PA sensory thresholds were 1089 ± 414 g and 1028 ± 331 g, respectively. There was no significant difference in inter-session or inter-limb threshold values for either mechanical QST device. The cold QST protocol in this study was achievable, but did not provide consistently quantifiable results. Both mechanical QST devices tested provided repeatable, reliable sensory threshold measurements in normal, client-owned dogs. These findings contribute to the validation of the EVF and PA as tools to obtain repeated QST data over time in dogs to assess somatosensory processing changes. PMID:24268475

Quantitative evaluation of subchondral bone injury of the plantaro-lateral condyles of the third metatarsal bone in Thoroughbred horses identified using nuclear scintigraphy: 48 cases.

Science.gov (United States)

Parker, R A; Bladon, B M; Parkin, T D H; Fraser, B S L

2010-09-01

Increased radio-isotope uptake (IRU) in the subchondral bone of the plantaro-lateral condyle of the third metatarsus (MTIII) is a commonly reported scintigraphic finding and potential cause of lameness in UK Thoroughbred racehorses in training and has not been fully documented. To characterise lameness attributable to IRU of the subchondral bone of MTIII, compare the scintigraphic findings of these horses with a normal population and evaluate the use of scintigraphy as an indicator of prognosis. IRU will be in significantly higher in horses with subchondral bone injury and will be related to prognosis and future racing performance. Data were analysed from 48 horses in which subchondral bone injury of the plantaro-lateral condyle of MTIII had been diagnosed using nuclear scintigraphy and that met the inclusion criteria. Data recorded included age, sex, trainer, racing discipline, lameness assessment, treatment regimes, radiographic and scintigraphic findings, response to diagnostic analgesia where performed and racing performance pre- and post diagnosis. Region of interest (ROI) counts were obtained for the plantar condyle and the mid diaphysis from the latero-medial view, the ratio calculated and then compared with a control group of clinically unaffected horses. The mean condyle mid-diaphysis ROI ratio was significantly (PThoroughbred racehorses. Nuclear scintigraphy is a useful diagnostic imaging modality in the detection of affected horses but is a poor indicator of prognosis for the condition. Better understanding of the clinical manifestations, diagnosis of and prognosis for subchondral bone injury will benefit the Thoroughbred industry in the UK.

Computer-navigated minimally invasive total knee arthroplasty for patients with retained implants in the femur

Directory of Open Access Journals (Sweden)

Sung-Yen Lin

2014-08-01

Full Text Available Total knee arthroplasty (TKA in patients with knee arthritis and retained implants in the ipsilateral femur is a challenge for knee surgeons. Use of a conventional intramedullary femoral cutting guide is not practical because of the obstruction of the medullary canal by implants. Previous studies have shown that computer-assisted surgery (CAS can help restore alignment in conventional TKA for patients with knee arthritis with retained femoral implants or extra-articular deformity, without the need for implant removal or osteotomy. However, little has been published regarding outcomes with the use of navigation in minimally invasive surgery (MIS-TKA for patients with this complex knee arthritis. MIS has been proven to provide less postoperative pain and faster recovery than conventional TKA, but MIS-TKA in patients with retained femoral implants poses a greater risk in limb malalignment. The purpose of this study is to report the outcome of CAS-MIS-TKA in patients with knee arthritis and retained femoral implants. Between April 2006 and March 2008, eight patients with knee arthritis and retained femoral implants who underwent the CAS-MIS-TKA were retrospectively reviewed. Three of the eight patients had extra-articular deformity, including two femur bones and one tibia bone, in the preoperative examination. The anteroposterior, lateral, and long-leg weight-bearing radiographs carried out at 3-month follow-up was used to determine the mechanical axis of lower limb and the position of components. The mean preoperative femorotibial angle in patients without extra-articular deformity was 3.8° of varus and was corrected to 4.6° of valgus. With the use of navigation in MIS-TKA, the two patients in this study with extra-articular femoral deformity also obtained an ideal postoperative mechanical axis within 2° of normal alignment. Overall, there was a good restoration of postoperative mechanical alignment in all cases, with a mean angle of 0.4° of

Improving tibial component coronal alignment during total knee arthroplasty with use of a tibial planing device.

Science.gov (United States)

Patil, Shantanu; D'Lima, Darryl D; Fait, James M; Colwell, Clifford W

2007-02-01

The outcomes of knee arthroplasty have been shown to be affected by component alignment. Intramedullary and extramedullary alignment instrumentation are fairly effective for achieving the desired mean tibial component coronal alignment. However, there are outliers representing >3 degrees of varus or valgus alignment with respect to the anatomic tibial shaft axis. We measured the efficacy of a custom tibial planing device for reducing the outliers in tibial alignment. We designed a tibial planing tool in an effort to improve tibial alignment. In one cohort (100 knees), we used traditional intramedullary alignment instrumentation to make the tibial bone cut. In a second cohort (120 knees), we used intramedullary alignment instrumentation to make the cut and also used a custom tool to check the cut and to correct an inexact cut. Tibial tray alignment relative to the long axis of the tibial shaft was measured in the coronal and sagittal planes on postoperative radiographs. The target coronal alignment was 90 degrees with respect to the tibial shaft axis (with alignment). A total of 100 anteroposterior radiographs and sixty-five lateral radiographs were analyzed for the group that was treated with traditional instrumentation alone, and a total of 120 anteroposterior radiographs and fifty-five lateral radiographs were analyzed for the group that was treated with use of the custom tibial planing device. The mean coronal alignment of the tibial component was 89.5 degrees +/- 2.1 degrees in the group that was treated with traditional instrumentation alone and 89.6 degrees +/- 1.4 degrees in the group that was treated with use of the custom planing device. Although the mean coronal alignment was not significantly different, the number of outliers was substantially reduced when the custom planing device was used. All 120 components that had been aligned with use of the custom planing device were within 3 degrees of the target coronal alignment, compared with only eighty

Percutaneous lateral ligament reconstruction with allograft for chronic lateral ankle instability.

Science.gov (United States)

Youn, Hyunkook; Kim, Yong Sang; Lee, Jongseok; Choi, Woo Jin; Lee, Jin Woo

2012-02-01

The majority of lateral ankle instability can be treated successfully with conservative method. However, if such treatments fail, surgical treatment should be considered. A wide variety of procedures have been introduced to treat chronic lateral ankle instability. The percutaneous method avoids dissection which is associated with open surgery and can lead to excessive morbidity. The purpose of this study was to evaluate the clinical and radiological outcomes of percutaneous lateral ligament reconstruction with an allograft in the treatment of chronic lateral ankle instability. Between October 2006 and April 2009, percutaneous lateral ligament reconstruction using an allograft was performed on 15 ankles in 13 patients for chronic lateral ankle instability. The patients included in this study satisfied at least one of the following criteria: a previously failed reconstruction of the ligament, severe ankle instability (more than 15 degrees of talar tilt, more than 10 mm of anterior drawer), general laxity of ligaments, body mass index (BMI) higher than 25. The mean followup period was 18.1 (range, 12 to 40) months. The grafted tendon was secured by double tenodeses at both the talus and calcaneus or triple tenodeses which included a fibular tenodesis. The clinical outcomes were evaluated with Visual Analogue Scale (VAS) for pain, Karlsson-Peterson ankle score, and patients' subjective satisfaction. The radiological results were evaluated using the varus tilting angle and the anterior displacement distance. The VAS improved from preoperative 3.7 ±2.2 to 1.6 ±1.3 at the last followup (p = 0.002). The Karlsson-Peterson ankle score increased from 54.2 ±8.8 to 80.9 ±7.2 (p = 0.001). Patients were satisfied in 13 cases (86.7%) with excellent or good results. Radiologically, the mean varus tilting angle was 15.5 ±4.4 degrees preoperatively and 7.3 ±3.6 at the last followup (p = 0.001). The anterior drawer distance was 10.1 ±3.3 mm preoperatively and 7.2 ±2.7 mm at

[Bone surgery for unstable hips in patients with cerebral palsy].

Science.gov (United States)

Poul, J; Pesl, M; Pokorná, M

2004-01-01

effective in providing hip joint stability; in addition, in order to achieve this, tilting of the proximal fragment to a varus position was generally higher than in combined operations. In three patients this treatment resulted in fixed adduction of the hip joint with negative consequences for movement. In the treatment of unstable hip joints a combination of varus derotation femoral osteotomy and pelvic osteotomy provides better containment of the joint than femoral osteotomy alone.

Onlinespieler abseits des Mainstreams

Directory of Open Access Journals (Sweden)

Harald Baumgartlinger

2012-12-01

Full Text Available MMO(RPGs „Massively Multiplayer Online (Role-Playing Games“ nehmen einen Sonderstatus unter den Onlinespielen ein, welcher durch den wachsenden wirtschaftlichen Erfolg, insbesondere durch den „breakthrough hit“ (Duchenaut et al. 2006: 407 World of Warcraft (WoW, auch an Bedeutung für die Medien- und Kommunikationswissenschaft gewinnt (vgl. Inderst 2009: 15; vgl. Seifert/Jöckel 2008: 297. Der Primus des Genres, WoW, repräsentiert gemeinsam mit einigen nahezu identen Titeln insgesamt 85 Prozent der gespielten MMOGs (vgl. Williams et al. 2008: 999. Daher befasst sich auch die Mehrheit der vorliegenden Studien mit eben diesen Spielen. Neue Formen von MMO(Gs können jedoch zu ebenso neuartigen Spielerfahrungen führen und damit unterschiedliche Nutzungsmotive befriedigen (vgl. Seifert/Jöckel 2008: 309 und folglich zu einem gänzlich anderen Spielerleben führen. Während im Mainstream die kooperativen Spielerbeziehungen überwiegen, dominiert in Darkfall Online der soziale Wettbewerb. Der von Williams et al. 2008 verwendete Fragebogen diente als Rohling für die Kreation eines für die speziellen Anforderungen adaptierten Erhebungstools zur Erforschung der Spielertypologie und der Motive der Darkfall-Online-SpielerInnen. Die in der Onlinebefragung (N = 506 gesammelten Daten belegen, dass sich sowohl die Spielerdemographie, als auch die Motive der Spieler von den Mainstream MMOs unterscheiden. Zudem konnten realweltliche Eigenschaften der Spieler als signifikante Einflussfaktoren für die Spielzuwendung identifiziert werden.

Study of the radioprotective effect of flavonoid quercetin on human lymphocytes

International Nuclear Information System (INIS)

Siqueira, Williams Nascimento de

2013-01-01

Ionizing radiation has been used in various fields of study, as medicine, industry, energy production, surgical materials sterilization, preservation and sterilization of foods, among others. These radiations may be responsible for adverse effects at molecular level in living organisms, where most important damage occurs in deoxyribonucleic acid molecule, DNA. These harmful effects caused by radiation highlights the importance of acquiring knowledge about radioprotector substances because they can act as protector of living tissue of those effects. In this research was investigated the possible radioprotective effect 'in vitro' of the flavonoid quercetin in human lymphocytes exposed to gamma radiation. At first, test was performed to evaluate the antioxidant activity of quercetin by capturing DPPH free radical molecules. Then, it was collected peripheral blood of volunteers donors. Then the samples were irradiated from linear accelerator (Siemens Primus - energy of 6 MeV and dose rate of 200 cGy/min from IMIP-PE). After samples irradiation, lymphocytes were isolated from whole blood and then the culture was carried out to obtain lymphocyte in metaphases and subsequent, analysis of chromosomal abnormalities were done at optical microscope. Statistical analysis was used Student 't' test. The results showed that quercetin at a concentration of 37.5 μM presented radioprotective against damage from gamma radiation on human lymphocytes in vitro. Have been also observed that the irradiated lymphocytes showed morphologically unchanged after undergoing the presence of the flavonoid quercetin. (author)

Freedom and friendship in Axel Honneth’s freedom’s right

Directory of Open Access Journals (Sweden)

Muders Sebastian

2017-01-01

Full Text Available In Axel Honneth’s Freedom’s Right (FR personal relations, among which Honneth includes not only family and partner relationships but friendship as well, enable the realization of one ‘specific form of freedom, which is difficult to specify’ (FR 233. This assertion constitutes one of the main thesis of Freedom’s Right. Accordingly, ‘freedom in the sense of individual autonomy’ should, among countless different ‘conceptions of freedom’ be understood as the only one that has the power to shape modern society, while all other values effective within modernity should be understood as ‘aspects of the constitutive idea of individual autonomy’ (FR 35. In this paper we argue that Honneth’s discussion of the value of friendship does not accomplish its aim for three reasons: first, Honneth is compelled by his argument to postulate one radical cleavage internal to the concept of friendship, by way of an exaggerated contrast between ancient and modern forms of friendship. Second, in his discussion Honneth marginalizes other existing axiologies of friendship, which attribute some other important instrumental, constitutive and final values to this term. Third, even a weaker thesis, one that treats the value of friendship as the precondition of individual freedom as a primus inter pares, seems to lose sight of the central importance that friendship has for us.” Honneth’s key thesis about the unique value of friendship in our society is thereby challenged.

Comparison between dose calculation in XiO Registered-Sign and dosimetric measurements in virtual wedge photon beams; Comparacao entre o calculo da dose no XiO Registered-Sign e medidas dosimetricas em feixes de fotons com filtro virtual

Energy Technology Data Exchange (ETDEWEB)

Almeida, Laila G.; Amaral, Leonardo L.; Oliveira, Harley F., E-mail: lailagalmeida@gmail.com [Universidade de Sao Paulo (HCFMRP/USP), Ribeirao Preto, SP (Brazil). Hospital das Clinicas. Servico de Radioterapia; Maia, Ana F. [Universidade Federal de Sergipe (UFS), Sao Cristovao (Sweden), (Brasil) Departamento de Fisica

2012-08-15

The virtual wedge is useful tool in the radiation treatment planning since it has series of advantages over the hard wedge. Quality control tests ensure correct performance of the planning done in treatment planning systems (TPS). This study aimed to compare doses calculated by TPS and doses measured by ionization chamber (CI) and an ionization chambers array in virtual wedge photon beams of 6 MV. Measures carried out in Primus linear accelerator with a solid water phantom and dosimeter positioned at 10 cm depth with gantry at 0 Degree-Sign in many fields sizes and angles in the virtual wedge. Measurements on the central axis used as dosimeter an IC and on off-axis used an IC array. The simulation in CMS-XiO used the CT images of the phantom in the same configuration of the irradiation. Maximum and minimum values of the percentage differences between the doses provided by TPS and measurements with ionization chamber on the central axis were 1.43 and -0.10%, respectively, with average percentage difference of 0.08% and confidence limit of {Delta}=1.72%. In the region off-axis, the average percentage difference was 0.04%, with a maximum of 1.9%, minimum of 0% and confidence limit of {Delta}=1.91%. All values for dose percentage differences were below 2% and lower confidence limit of 3% are thus, according to the recommendations of the Technical Report Series - TRS-430. (author)

Dosimetric comparison on tissue interfaces with TLD dosimeters, L-alanine, EDR2 films and Penelope simulation for a Co-60 source and linear accelerator in radiotherapy

International Nuclear Information System (INIS)

Vega R, J. L.; Cayllahua, F.; Apaza, D. G.; Javier, H.

2015-10-01

Percentage depth dose curves were obtained with TLD-100 dosimeters, EDR2 films and Penelope simulation at the interfaces in an inhomogeneous mannequin, composed by equivalent materials to the human body built for this study, consisting of cylindrical plates of solid water-bone-lung-bone-solid water of 15 cm in diameter and 1 cm in height; plates were placed in descending way (4-2-8-2-4). Irradiated with Co-60 source (Theratron Equinox-100) for small radiation fields 3 x 3 cm 2 and 1 x 1 cm 2 at a surface source distance of 100 cm from mannequin. The TLD-100 dosimeters were placed in the center of each plate of mannequin irradiated at 10 Gy. The results were compared between these measurement techniques, giving good agreement in interfaces better than 97%. This study was compared with the same characteristics of another study realized with other equivalent materials to human body not homogeneous acrylic-bone-cork-bone-acrylic. The percentage depth dose curves were obtained with mini-dosimeters L-alanine of 1 mm in diameter and 3 mm in height and 3.5 to 4.0 mg of mass with spectrometer band K (EPR). The mini-dosimeters were irradiated with a lineal accelerator PRIMUS Siemens 6 MV. The results of percentage depth dose of L-alanine mini-dosimeters show a good agreement with the percentage depth dose curves of Penelope code, better than 97.7% in interfaces of tissues. (Author)

How to Verify Plagiarism of the Paper Written in Macedonian and Translated in Foreign Language?

Science.gov (United States)

Spiroski, Mirko

2016-03-15

The aim of this study was to show how to verify plagiarism of the paper written in Macedonian and translated in foreign language. Original article "Ethics in Medical Research Involving Human Subjects", written in Macedonian, was submitted as an assay-2 for the subject Ethics and published by Ilina Stefanovska, PhD candidate from the Iustinianus Primus Faculty of Law, Ss Cyril and Methodius University of Skopje (UKIM), Skopje, Republic of Macedonia in Fabruary, 2013. Suspected article for plagiarism was published by Prof. Dr. Gordana Panova from the Faculty of Medical Sciences, University Goce Delchev, Shtip, Republic of Macedonia in English with the identical title and identical content in International scientific on-line journal "SCIENCE & TECHNOLOGIES", Publisher "Union of Scientists - Stara Zagora". Original document (written in Macedonian) was translated with Google Translator; suspected article (published in English pdf file) was converted into Word document, and compared both documents with several programs for plagiarism detection. It was found that both documents are identical in 71%, 78% and 82%, respectively, depending on the computer program used for plagiarism detection. It was obvious that original paper was entirely plagiarised by Prof. Dr. Gordana Panova, including six references from the original paper. Plagiarism of the original papers written in Macedonian and translated in other languages can be verified after computerised translation in other languages. Later on, original and translated documents can be compared with available software for plagiarism detection.

Dosimetric comparison on tissue interfaces with TLD dosimeters, L-alanine, EDR2 films and Penelope simulation for a Co-60 source and linear accelerator in radiotherapy; Comparacion dosimetrica en interfaces de tejidos con dosimetros TLD, L-alanina, peliculas EDR2 y simulacion Penelope para una fuente de Co-60 y acelerador lineal en radioterapia

Energy Technology Data Exchange (ETDEWEB)

Vega R, J. L.; Cayllahua, F.; Apaza, D. G.; Javier, H., E-mail: josevegaramirez@yahoo.es [Universidad Nacional de San Agustin, Departamento de Fisica, Av. Independencia s/n, Arequipa (Peru)

2015-10-15

Percentage depth dose curves were obtained with TLD-100 dosimeters, EDR2 films and Penelope simulation at the interfaces in an inhomogeneous mannequin, composed by equivalent materials to the human body built for this study, consisting of cylindrical plates of solid water-bone-lung-bone-solid water of 15 cm in diameter and 1 cm in height; plates were placed in descending way (4-2-8-2-4). Irradiated with Co-60 source (Theratron Equinox-100) for small radiation fields 3 x 3 cm{sup 2} and 1 x 1 cm{sup 2} at a surface source distance of 100 cm from mannequin. The TLD-100 dosimeters were placed in the center of each plate of mannequin irradiated at 10 Gy. The results were compared between these measurement techniques, giving good agreement in interfaces better than 97%. This study was compared with the same characteristics of another study realized with other equivalent materials to human body not homogeneous acrylic-bone-cork-bone-acrylic. The percentage depth dose curves were obtained with mini-dosimeters L-alanine of 1 mm in diameter and 3 mm in height and 3.5 to 4.0 mg of mass with spectrometer band K (EPR). The mini-dosimeters were irradiated with a lineal accelerator PRIMUS Siemens 6 MV. The results of percentage depth dose of L-alanine mini-dosimeters show a good agreement with the percentage depth dose curves of Penelope code, better than 97.7% in interfaces of tissues. (Author)

Thermoluminescence response of Ge-, Al- and Nd- doped optical fibers by 6 MeV - electron and 6 MeV - photon irradiations

International Nuclear Information System (INIS)

Hossain, I.; Moburak, A. A.; Saeed, M.A.; Wagiran, H.; Hida, N.; Yaakob, H.N.

2015-01-01

In this paper, we report the prediction of thermoluminescence responses of Neodymium-doped SiO 2 optical fibre with various dose ranges from 0.5 Gy to 4.0 Gy by 6 MeV - electron irradiations without requirement for experimental measurements. A technique has been developed to calculate prediction of 6 MeV - electron response of Neodymium-doped SiO 2 optical fibre by observing the measured TL response of 6 MV - photon and the ratio of known measured photon/electron yield ratio distribution for Ge-doped, Al-doped optical fibre and standard TLD 100 dosimeter. The samples were kept in gelatin capsule an irradiated with 6 MV - photon at the dose range from 0.5 Gy to 4.0 Gy. Siemens model Primus 3368 linear accelerator located at Hospital Sultan Ismail, Johor Bahru has been used to deliver the photon beam to the samples. We found the average response ratio of 6 MV - photon and 6 MeV - electron in Ge-doped, Al-doped optical fibre and standard TLD-100 dosimeter are 0.83(3). Observing the measured value of 6 MV - photon irradiation this average ratio is useful to find the prediction of thermoluminescence responses by 6 MeV - electron irradiation of Neodymium-doped SiO 2 optical fibre by the requirement for experimental measurements with various dose ranges from 0.5 Gy to 4.0 Gy by 6 MV - photon irradiations.

Comparison between dose calculation in XiO® and dosimetric measurements in virtual wedge photon beams

International Nuclear Information System (INIS)

Almeida, Laila G.; Amaral, Leonardo L.; Oliveira, Harley F.; Maia, Ana F.

2012-01-01

The virtual wedge is useful tool in the radiation treatment planning since it has series of advantages over the hard wedge. Quality control tests ensure correct performance of the planning done in treatment planning systems (TPS). This study aimed to compare doses calculated by TPS and doses measured by ionization chamber (CI) and an ionization chambers array in virtual wedge photon beams of 6 MV. Measures carried out in Primus linear accelerator with a solid water phantom and dosimeter positioned at 10 cm depth with gantry at 0° in many fields sizes and angles in the virtual wedge. Measurements on the central axis used as dosimeter an IC and on off-axis used an IC array. The simulation in CMS-XiO used the CT images of the phantom in the same configuration of the irradiation. Maximum and minimum values of the percentage differences between the doses provided by TPS and measurements with ionization chamber on the central axis were 1.43 and -0.10%, respectively, with average percentage difference of 0.08% and confidence limit of Δ=1.72%. In the region off-axis, the average percentage difference was 0.04%, with a maximum of 1.9%, minimum of 0% and confidence limit of Δ=1.91%. All values for dose percentage differences were below 2% and lower confidence limit of 3% are thus, according to the recommendations of the Technical Report Series - TRS-430. (author)

Effects of stacked wedge pads and chains applied to the forefeet of Tennessee Walking Horses for a five-day period on behavioral and biochemical indicators of pain, stress, and inflammation.

Science.gov (United States)

Everett, James B; Schumacher, Jim; Doherty, Thomas J; Black, Randi A; Amelse, Lisa L; Krawczel, Peter; Coetzee, Johann F; Whitlock, Brian K

2018-01-01

OBJECTIVE To determine the effects of stacked wedge pads and chains applied to the forefeet of Tennessee Walking Horses on behavioral and biochemical indicators of pain, stress, and inflamation. ANIMALS 20 Tennessee Walking Horses. PROCEDURES Horses were randomly assigned to 2 treatment groups: keg shoes (control; n = 10) or stacked wedge pads and exercise with chains (10). Ten days before treatment application, an accelerometer was attached at the left metatarsus of each horse to record daily activity. Horses were exercised for 20 minutes daily, beginning on day -7. On day 0, exercise ceased, the forefeet were trimmed, and the assigned treatment was applied. From days 1 through 5, horses were exercised as before. Blood samples for measurement of plasma cortisol, substance P, and fibrinogen concentrations were collected on days -5, 1, and 5 before and after exercise and every 30 minutes thereafter for 6 hours. RESULTS No significant differences in plasma concentrations of cortisol, substance P, and fibrinogen were detected between groups. Although lying behaviors changed after shoes were applied, these behaviors did not differ significantly between groups. Shoeing appeared to have altered behavior to a greater extent than did the type of treatment applied. CONCLUSIONS AND CLINICAL RELEVANCE Application of stacked wedge pads and chains to the forefeet of horses for a 5-day period as performed in this study evoked no acute or subacute stress or nociceptive response as measured. Although these findings should not be extrapolated to the long-term use of such devices in Tennessee Walking Horses performing the running walk, the data should be considered when making evidence-based decisions relating to animal welfare and the use of stacked wedge pads and chains.

Biomechanical stability of novel mechanically adapted open-porous titanium scaffolds in metatarsal bone defects of sheep.

Science.gov (United States)

Wieding, Jan; Lindner, Tobias; Bergschmidt, Philipp; Bader, Rainer

2015-04-01

Open-porous titanium scaffolds for large segmental bone defects offer advantages like early weight-bearing and limited risk of implant failure. The objective of this experimental study was to determine the biomechanical behavior of novel open-porous titanium scaffolds with mechanical-adapted properties in vivo. Two types of the custom-made, open-porous scaffolds made of Ti6Al4V (Young's modulus: 6-8 GPa and different pore sizes) were implanted into a 20 mm segmental defect in the mid-diaphysis of the metatarsus of sheep, and were stabilized with an osteosynthesis plate. After 12 and 24 weeks postoperatively, torsional testing was performed on the implanted bone and compared to the contralateral non-treated side. Maximum torque, maximum angle, torsional stiffness, fracture energy, shear modulus and shear stress were investigated. Furthermore, bone mineral density (BMD) of the newly formed bone was determined. Mechanical loading capabilities for both scaffolds were similar and about 50% after 12 weeks (e.g., max. torque of approximately 20 Nm). A further increase after 24 weeks was found for most of the investigated parameters. Results for torsional stiffness and shear modulus as well as bone formation depended on the type of scaffold. Increased BMD after 24 weeks was found for one scaffold type but remained constant for the other one. The present data showed the capability of mechanically adapted open-porous titanium scaffolds to function as bone scaffolds for large segmental defects and the influence of the scaffold's stiffness. A further increase in the biomechanical stability can be assumed for longer observation periods of greater than six months. Copyright © 2014 Elsevier Ltd. All rights reserved.

Comparison of the effects of topical application of UMF20 and UMF5 manuka honey with a generic multifloral honey on wound healing variables in an uncontaminated surgical equine distal limb wound model.

Science.gov (United States)

Tsang, A S; Dart, A J; Sole-Guitart, A; Dart, C M; Perkins, N R; Jeffcott, L B

2017-09-01

To compare the effect of application of manuka honey with unique manuka factor (UMF) 5 or 20 with a generic multifloral honey on equine wound healing variables. Two full-thickness skin wounds (2.5 × 2.5 cm) were created on the metatarsus of both hindlimbs of eight Standardbred horses. The wounds on each horse were assigned to 1 of 4 treatments: UMF20 (UMF20) and UMF5 (UMF5) manuka honey; generic multifloral honey (GH); and a saline control. Bandages were changed daily for 12 days, after which treatment was stopped and the bandages were removed. Wound area was measured on day 1, then weekly until day 42. Overall wound healing rate (cm 2 /day) and time to complete healing were recorded. There was no difference in wound area for any of the treatments on any measurement day except for day 21, where the mean wound area for wounds treated with UMF20 was smaller than the mean wound area for the UMF5-treated wounds (P = 0.031). There was no difference in mean (± SE) overall healing rate (cm 2 /day) among the treatment groups. There were differences in mean (± SE) days to complete healing. Wounds treated with UMF20 healed faster than wounds treated with GH (P = 0.02) and control wounds (P = 0.01). Treatment of wounds with UMF20 reduced overall wound healing time compared with wounds treated with GH and control wounds. However, using this model the difference in the overall time to complete healing was small. © 2017 Australian Veterinary Association.

The necessity of clinical application of tibial reduction for detection of underestimated posterolateral rotatory instability in combined posterior cruciate ligament and posterolateral corner deficient knee.

Science.gov (United States)

Lee, Han-Jun; Park, Yong-Beom; Ko, Young-Bong; Kim, Seong-Hwan; Kwon, Hyeok-Bin; Yu, Dong-Seok; Jung, Young-Bok

2015-10-01

The purpose of this study was to evaluate the usefulness of tibial reduction during dial test for clinical detection of underestimated posterolateral rotatory instability (PLRI) in combined posterior cruciate ligament (PCL)-posterolateral corner (PLC) deficient knee in terms of external rotation laxity and clinical outcomes. Twenty-one patients who classified as grade I PLRI using dial test with subluxated tibia, but classified as grade II with tibial reduction evaluated retrospectively. The mean follow-up was 39.3 months (range 24-61 months). Each patient was evaluated by the following variables: posterior translation and varus laxity on radiograph, KT-1000 arthrometer, dial test (reduced and subluxated position), International Knee Documentation Committee, Orthopädische Arbeitsgruppe Knie scoring system and Tegner activity scale. There were significant improvements in posterior tibial translation (8.6 ± 2.0 to 2.1 ± 1.0 mm; P application of reduction of posteriorly subluxated tibia during the dial test was essential for an appropriate treatment of underestimated PLRI in combined PCL-PLC deficient knee. Retrospective case series, Level IV.

Indirect reduction technique using a distraction support in minimally invasive percutaneous plate osteosynthesis of tibial shaft fractures.

Science.gov (United States)

Dong, Wen-Wei; Shi, Zeng-Yuan; Liu, Zheng-Xin; Mao, Hai-Jiao

2016-12-01

To describe an indirect reduction technique during minimally invasive percutaneous plate osteosynthesis (MIPPO) of tibial shaft fractures with the use of a distraction support. Between March 2011 and October 2014, 52 patients with a mean age of 48 years (16-72 years) sustaining tibial shaft fractures were included. All the patients underwent MIPPO for the fractures using a distraction support prior to insertion of the plate. Fracture angular deformity was assessed by goni- ometer measurement on preoperative and postoperative images. Preoperative radiographs revealed a mean of 7.6°(1.2°-28°) angulation in coronal plane and a mean of 6.8°(0.5°-19°) angulation in sagittal plane. Postoperative anteroposterior and lateral radio- graphs showed a mean of 0.8°(0°-4.0°) and 0.6°(0°-3.6°) of varus/valgus and apex anterior/posterior angulation, respectively. No intraoperative or postoperative complications were noted. This study suggests that the distraction support during MIPPO of tibial shaft fractures is an effective and safe method with no associated complications.

[Posttraumatic complications after pediatric ankle injuries].

Science.gov (United States)

Schneider, F J; Linhart, W E

2013-08-01

Ankle sprains are common injuries in childhood and are generally harmless. However, fractures of the ankle joint are rare, but complications (persistent rotational or axial deformity, alteration of growth of the distal tibia or fibula, or joint deformity) can lead to serious problems during growth. The clinical relevance of growth disturbances at the distal tibia or fibula depends on the age at the time of fracture more than on the fracture type, severity of dislocation, or interponated material in the fracture gap. Both stimulation and inhibition of growth are possible. Inhibition of growth at the distal tibial growth plate regularly leads to varus deformity and shortening. This is of clinical importance as this type of growth disturbance is the most common. Valgus deformity is rare, mostly due to persistent axial deviation of an insufficiently reduced fracture. Transitional fractures always occur at the time of growth plate closure; thus, growth disturbances do not play a role. Transitional fractures could be overlooked or treated insufficiently, leading to a step or gap of the joint surface.

Failure of fixation of trochanteric femur fractures: Clinical recommendations for avoiding Z-effect and reverse Z-effect type complications

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Balbachevsky Daniel

2011-06-01

Full Text Available Abstract Background Z-effect and reverse Z-effect are complications that arise from the surgical treatment of pertrochanteric fractures of the femur with proximal femoral nails (PFN comprising two interlocking head screws. Such complications are induced by the migration of screws in opposite directions, which may lead to failure of the osteosynthesis. Findings The paper describes three cases of pertrochanteric fractures that were treated with PFN with two interlocking screws that evolved to either Z-effect or reverse Z-effect. Literature-based explanations for this phenomenon are provided together with recommendations of how to avoid such complications. Conclusions Although intramedullary fixation is an established method of treatment of femoral intertrochanteric and subtrochanteric fractures, the evolution of the procedure may include complications associated with the migration of the interlocking head screws. The occurrence of Z-effect and reverse Z-effect has not been completely elucidated, but the main causes of such complications are probably fracture fixation in varus position, severe medial comminution, inappropriate entry point of the nail and poor bone quality.

Valgus osteotomy of the tibia with a Puddu plate combined with anterior cruciate ligament reconstruction

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Albuquerque Roberto Freire da Mota e

2003-01-01

Full Text Available Anterior knee instability associated with a varus deformity is a complex condition with several treatment possibilities. Among these, anterior cruciate ligament (ACL associated to a simultaneous valgus tibial osteotomy is a increasing indication. This simultaneous procedure adds technical issues to those related to the isolated surgeries. Thus, the osteotomy plane and location of fixation hardware shouldn?t conflict with tibial tunnel and ACL graft fixation. Authors analyze the relations between a opening tibial valgus osteotomy stabilized with a Puddu plate and ACL reconstruction with a patellar tendon graft fixated with interference screws in 10 human cadaver knees. A straight oblique tibial osteotomy starting on the medial tibial cortex and oriented laterally and proximally was performed on all knees with a 10mm opening medially and stabilized with a Puddu plate on the most posterior aspect of the medial tibia, and a tibial tunnel drilled 50° to tibial plateau. With this technique there was no intersection between tibial tunnel or interference screw and the osteotomy or the plate fixation screws.

ULTRASOUND GUIDED ILIOINGUINAL AND ILIOHYPOGASTRIC NERVE BLOCK FOR INGUINAL HERNIA REPAIR IN ARTHROGRYPOSIS MULTIPLEX CONGENITA

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Paul O.

2015-06-01

Full Text Available Arthrogryposis multiplex congenita (AMC refers to a syndrome of unknown etiology with multiple congenital contractures in one or more joints with a concomitant inability of passive extension and flexion . The overall prevalence of arthrogryposis is one in 3000 live births . The extensive contractures , tense skin , minimal muscle mass and subcutaneous tissue pose challenges in anaesthetic management. We report a seven year old boy (15 kg , known case of AMC with congenital talipes equino varus (CTEV and bilateral hip dislocation posted for right sided herniot omy and orchidopexy. We planned to combine general anaesthesia without muscle relaxants and regional nerve block. The child was induced with propofol and Classic LMA Size 2 was inserted. An ilioinguinal and i liohypogastric nerve block was given under ultrasound guidance using 0.2% ropivacaine. Pateint remained hemodynamically stable during surgery with minimal anaesthetic requirement and no anlgesics. Analgesia lasted for 8 hours postoperatively. Combining narcosis with regional anaesthesia leads to a reduced demand for anaesthetics , stable circulatory conditions , maintenance of spontaneous breathing , prevention of stress and sufficient postoperative analgesia

Extensive limb lengthening in Ollier's disease: 25-year follow-up.

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Märtson, Aare; Haviko, Tiit; Kirjanen, Kaur

2005-01-01

A case of extensive lower limb lengthening (32 cm) in a 14-year-old male patient with Ollier's disease is reported. A varus deformity of the femur and a valgus deformity of the tibia were evident. The femur was successfully lengthened 22 cm by metaphyseal distraction, and the tibia was lengthened 10 cm by two-stage distraction-compression method with a cylindrical bone allograft. Ilizarov's distraction device was used. Radiologically, a good bone regenerate was formed. Host bone has incorporated (like sarcophagi) the allograft of tibia. No evidence of vascular or neural disturbances was found. The lengthening indices were counted for femur 22.5 days per centimeter and for tibia 21 days per centimeter, altogether 15.5 days per centimeter. Bone lengthening was performed through the Ollier's disease foci. Fine needle biopsy investigation showed that most embryonic cartilage cells had been replaced with bone tissue. After five years and a 25-year follow-up the patient was satisfied with the result. The function of the knee joint was limited, but the limb was fully weight-bearing. Signs of knee osteoarthritis were found.

Tibial valgus aperture osteotomy

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De los Rios G, Adolfo Leon; Saavedra Abadia, Adolfo Leon; Palacios, Julio

2005-01-01

This study is based on work carried out a The knee clinic at the arthroscopic surgery unit of the Institute of osteo-articular diseases, Imbanaco Medical Centre, The University Hospital of the Valle (Cali-Colombia) and The Fractures Clinic Ltd. (Palmira-Valle). This is a descriptive study, which demonstrates very positive outcomes for aperture osteotomy, without detracting from the importance of, and the progress made in uni-compartmental and total joint articular replacements of the knee. 10 patients were treated with a highs tibial open osteotomy between November 1988 and December 2002: 3 had post-traumatic deformities, without arthrosic alterations; 1 had pseudo-arthrosis caused by a failed corrective procedure; 1 had complex instability of the knee with osseous varus; 6 had a degenerative lesion of the medial meniscus with medial condral alterations. Follow-up was form 12 to 54 months. Treatment involved a tibial valgus aperture osteotomy and osteo-synthesis. Evaluation was carried out using the International Knee Documentation Committee (IKDC) scale, the For Special Surgery and The Knee Society Score

KIN-Nav navigation system for kinematic assessment in anterior cruciate ligament reconstruction: features, use, and perspectives.

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Martelli, S; Zaffagnini, S; Bignozzi, S; Lopomo, N F; Iacono, F; Marcacci, M

2007-10-01

In this paper a new navigation system, KIN-Nav, developed for research and used during 80 anterior cruciate ligament (ACL) reconstructions is described. KIN-Nav is a user-friendly navigation system for flexible intraoperative acquisitions of anatomical and kinematic data, suitable for validation of biomechanical hypotheses. It performs real-time quantitative evaluation of antero-posterior, internal-external, and varus-valgus knee laxity at any degree of flexion and provides a new interface for this task, suitable also for comparison of pre-operative and post-operative knee laxity and surgical documentation. In this paper the concept and features of KIN-Nav, which represents a new approach to navigation and allows the investigation of new quantitative measurements in ACL reconstruction, are described. Two clinical studies are reported, as examples of clinical potentiality and correct use of this methodology. In this paper a preliminary analysis of KIN-Nav's reliability and clinical efficacy, performed during blinded repeated measures by three independent examiners, is also given. This analysis is the first assessment of the potential of navigation systems for evaluating knee kinematics.

[Clinical practice guideline on closed tibial plateau fractures in adulthood].

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Ocegueda-Sosa, Miguel Ángel; Valenzuela-Flores, Adriana Abigail; Aldaco-García, Víctor Daniel; Flores-Aguilar, Sergio; Manilla-Lezama, Nicolás; Pérez-Hernández, Jorge

2013-01-01

Closed tibiae plateau fractures are common injuries in the emergency room. The optimal treatment is not well defined or established. For this reason, there are several surgical management options: open reduction and internal fixation, closed reduction and percutaneous synthesis, external fixation, and even conservative treatment for this kind of fracture. The mechanism of production of this fracture is through large varus or valgus deformation to which is added a factor of axial load. The trauma may be direct or indirect. The degree of displacement, fragmentation and involvement of soft tissues like ligaments, menisci, vascular and nerve structures are determined by the magnitude of the force exerted. Any intra-articular fracture treatment can lead to an erroneous instability, deformity and limitation of motion with subsequent arthritic changes, leading to joint incongruity, limiting activity and significantly altering the quality of life. Open reduction and internal fixation with anatomic restitution is the method used in this type of fracture. However, the results of numerous publications can be questioned due to the inclusion in the same study of fractures treated with very different methods.

Total knee arthroplasty with computer-assisted navigation: an analysis of 200 cases,

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Marcus Vinicius Malheiros Luzo

2014-04-01

Full Text Available OBJECTIVE: to evaluate the results from surgery with computer-assisted navigation in cases of total knee arthroplasty.METHOD: a total of 196 patients who underwent total knee arthroplasty with computer-assisted navigation were evaluated. The extension and flexion spaces (gaps were evaluated during the operation and the alignment after the operation was assessed. The Knee Society Score (KSS questionnaire for assessing patient's function was applied preoperatively and postoperatively after a mean follow-up of 22 months.RESULTS: in all, 86.7% of the patients presented good alignment of the mechanical axis (less than 3◦ of varus or valgus in relation to the mechanical axis and 96.4% of the patients presented balanced flexion and extension gaps. Before the operation, 97% of the patients presented poor or insufficient KSS, but after the operation, 77.6% presented good or excellent KSS.CONCLUSION: the navigation system made it possible to achieve aligned and balanced implants, with notable functional improvement among the patients. It was found to be useful in assessing, understanding and improving knowledge in relation to performing arthroplasty procedures.

Rotational Osteotomy for Hallux Valgus. A New Technique for Primary and Revision Cases

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Ortiz, Cristian; Wagner, Emilio

2017-01-01

More than 200 different surgical techniques exist for hallux valgus (HV). Some of them are designed for mild, moderate, or severe deformities depending on their correction power. Nevertheless, they all correct only the coronal and/or sagittal plane deformity. Just a handful of them correct the known axial malrotation that exists in most HV cases. This malrotation is one possible factor that could be the source of recurrence of an operated HV as it has been described. We describe a new technique which simultaneously corrects the metatarsal internal rotation and varus deformity by rotating the metatarsal through an oblique plane osteotomy. This is performed with no bone wedge resection. Also, there is a broader bone surface contact than on a transverse proximal osteotomy. This technique is easy to remember and relatively simple to perform in primary and revision cases. The authors results show that it is as safe and effective as other procedures, with some advantages to be discussed. Levels of Evidence: Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence. PMID:28286430

Morphology of an Early Oligocene beaver Propalaeocastor irtyshensis and the status of the genus Propalaeocastor

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Lüzhou Li

2017-05-01

Full Text Available The Early to Late Oligocene Propalaeocastor is the earliest known beaver genus from Eurasia. Although many species of this genus have been described, these species are defined based on very fragmentary specimens. Propalaeocastor irtyshensis from the Early Oligocene Irtysh River Formation in northwestern Xinjiang, China is one of the earliest-known members of Propalaeocastor. This species is defined on a single maxillary fragment. We revise the diagnosis of P. irtyshensis and the genus Propalaeocastor, based on newly discovered specimens from the Irtysh River Formation. The dental morphology of P. irtyshensis is very similar to other early castorids. The caudal palatine foramen of P. irtyshensis is situated in the maxillary-palatine suture. This is a feature generally accept as diagnostic character for the castorids. On the other hand, P. irtyshensis has two upper premolars, a rudimentarily developed sciuromorph-like zygomatic plate, and a relatively large protrogomorph-like infraorbital foramen. Some previous researchers suggested that Propalaeocastor is a junior synonym of Steneofiber, while other took it as a valid genus. Our morphological comparison and phylogenetic analysis suggest that Propalaeocastor differs from Steneofiber and is a valid genus. We also suggest that Agnotocastor aubekerovi, A. coloradensis, A. galushai, A. readingi, Oligotheriomys primus, and “Steneofiber aff. dehmi” should be referred to Propalaeocastor. Propalaeocastor is the earliest and most basal beaver. The origin place of Propalaeocastor and castorids is uncertain. The Early Oligocene radiation of castorids probably is propelled by the global climate change during the Eocene-Oligocene transition.

Evaluation of the effect of tooth and dental restoration material on electron dose distribution and production of photon contamination in electron beam radiotherapy.

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Bahreyni Toossi, Mohammad Taghi; Ghorbani, Mahdi; Akbari, Fatemeh; Mehrpouyan, Mohammad; Sobhkhiz Sabet, Leila

2016-03-01

The aim of this study is to evaluate the effect of tooth and dental restoration materials on electron dose distribution and photon contamination production in electron beams of a medical linac. This evaluation was performed on 8, 12 and 14 MeV electron beams of a Siemens Primus linac. MCNPX Monte Carlo code was utilized and a 10 × 10 cm(2) applicator was simulated in the cases of tooth and combinations of tooth and Ceramco C3 ceramic veneer, tooth and Eclipse alloy and tooth and amalgam restoration materials in a soft tissue phantom. The relative electron and photon contamination doses were calculated for these materials. The presence of tooth and dental restoration material changed the electron dose distribution and photon contamination in phantom, depending on the type of the restoration material and electron beam's energy. The maximum relative electron dose was 1.07 in the presence of tooth including amalgam for 14 MeV electron beam. When 100.00 cGy was prescribed for the reference point, the maximum absolute electron dose was 105.10 cGy in the presence of amalgam for 12 MeV electron beam and the maximum absolute photon contamination dose was 376.67 μGy for tooth in 14 MeV electron beam. The change in electron dose distribution should be considered in treatment planning, when teeth are irradiated in electron beam radiotherapy. If treatment planning can be performed in such a way that the teeth are excluded from primary irradiation, the potential errors in dose delivery to the tumour and normal tissues can be avoided.

Analytical approach for determining beam profiles in water phantom of symmetric and asymmetric fields of wedged, blocked, and open photon beams.

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Tahmasebi Birgani, Mohamad Javad; Chegeni, Nahid; Arvandi, Shole; Razmjoo Ghalaee, Sasan; Zabihzadeh, Mansoor; Khezerloo, Davood

2013-11-04

Nowadays, in most radiotherapy departments, the commercial treatment planning systems (TPS) used to calculate dose distributions needs to be verified; therefore, quick, easy-to-use, and low-cost dose distribution algorithms are desirable to test and verify the performance of the TPS. In this paper, we put forth an analytical method to calculate the phantom scatter contribution and depth dose on the central axis based on the equivalent square concept. Then, this method was generalized to calculate the profiles at any depth and for several field shapes - regular or irregular fields - under symmetry and asymmetry photon beam conditions. Varian 2100 C/D and Siemens Primus Plus linacs with 6 and 18 MV photon beam were used for irradiations. Percentage depth doses (PDDs) were measured for a large number of square fields for both energies and for 45° wedge, which were employed to obtain the profiles in any depth. To assess the accuracy of the calculated profiles, several profile measurements were carried out for some treatment fields. The calculated and measured profiles were compared by gamma-index calculation. All γ-index calculations were based on a 3% dose criterion and a 3 mm dose-to-agreement (DTA) acceptance criterion. The γ values were less than 1 at most points. However, the maximum γ observed was about 1.10 in the penumbra region in most fields and in the central area for the asymmetric fields. This analytical approach provides a generally quick and fairly accurate algorithm to calculate dose distribution for some treatment fields in conventional radiotherapy.

Assessment of Neutron Contamination Originating from the Presence of Wedge and Block in Photon Beam Radiotherapy.

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Bahreyni Toossi, M T; Khajetash, B; Ghorbani, M

2018-03-01

One of the main causes of induction of secondary cancer in radiation therapy is neutron contamination received by patients during treatment. Objective: In the present study the impact of wedge and block on neutron contamination production is investigated. The evaluations are conducted for a 15 MV Siemens Primus linear accelerator. Simulations were performed using MCNPX Monte Carlo code. 30˚, 45˚ and 60˚ wedges and a cerrobend block with dimensions of 1.5 × 1.5 × 7 cm 3 were simulated. The investigation were performed in the 10 × 10 cm 2 field size at source to surface distance of 100 cm for depth of 0.5, 2, 3 and 4 cm in a water phantom. Neutron dose was calculated using F4 tally with flux to dose conversion factors and F6 tally. Results showed that the presence of wedge increases the neutron contamination when the wedge factor was considered. In addition, 45˚ wedge produced the most amount of neutron contamination. If the block is in the center of the field, the cerrobend block caused less neutron contamination than the open field due to absorption of neutrons and photon attenuation. The results showed that neutron contamination is less in steeper depths. The results for two tallies showed practically equivalent results. Wedge causes neutron contamination hence should be considered in therapeutic protocols in which wedge is used. In terms of clinical aspects, the results of this study show that superficial tissues such as skin will tolerate more neutron contamination than the deep tissues.

Silicon strip detector for a novel 2D dosimetric method for radiotherapy treatment verification

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Bocci, A.; Cortés-Giraldo, M. A.; Gallardo, M. I.; Espino, J. M.; Arráns, R.; Alvarez, M. A. G.; Abou-Haïdar, Z.; Quesada, J. M.; Pérez Vega-Leal, A.; Pérez Nieto, F. J.

2012-05-01

The aim of this work is to characterize a silicon strip detector and its associated data acquisition system, based on discrete electronics, to obtain in a near future absorbed dose maps in axial planes for complex radiotherapy treatments, using a novel technique. The experimental setup is based on two phantom prototypes: the first one is a polyethylene slab phantom used to characterize the detector in terms of linearity, percent depth dose, reproducibility, uniformity and penumbra. The second one is a cylindrical phantom, specifically designed and built to recreate conditions close to those normally found in clinical environments, for treatment planning assessment. This system has been used to study the dosimetric response of the detector, in the axial plane of the phantom, as a function of its angle with respect to the irradiation beam. A software has been developed to operate the rotation of this phantom and to acquire signals from the silicon strip detector. As an innovation, the detector was positioned inside the cylindrical phantom parallel to the beam axis. Irradiation experiments were carried out with a Siemens PRIMUS linac operating in the 6 MV photon mode at the Virgen Macarena Hospital. Monte Carlo simulations were performed using Geant4 toolkit and results were compared to Treatment Planning System (TPS) calculations for the absorbed dose-to-water case. Geant4 simulations were used to estimate the sensitivity of the detector in different experimental configurations, in relation to the absorbed dose in each strip. A final calibration of the detector in this clinical setup was obtained by comparing experimental data with TPS calculations.

Analisis Elektron Beam Profile Constancy pada Pesawat Linac

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Edi Guritna

2018-02-01

Full Text Available Radioterapi adalah pengobatan penyakit terutama tumor atau kanker ganas dengan menggunakan radiasi elektromagnetik (Sinar-X dan Gamma dan radiasi partikel (elektron, proton, dan neutron. Salah satu alat radioterapi modern yang digunakan dalam pengobatan penyakit kanker adalah linear accelerator (linac. Alat radioterapi ini menghasilkan elektron dan sinar-X (foton yang dibangkitkan oleh generator dan mempunyai energi yang bervariasi. Dalam penelitian profil dosis, digunakan pesawat liner accelerator (linac Siemens Primus berkas elektron 5 MeV dengan luas lapangan radiasi berkisar dari 5×5 cm2 sampai 25×25 cm2. Pengukuran profil dosis dilakukan dengan menggunakan water phantom,  detektor farmer chamber dan condenser chamber yang dilengkapi dengan  computer control units (CCU serta dilakukan untuk arah crossline dan inline pada kedalaman Dmax dan kedalaman tertentu. Penelitian ini bertujuan untuk menganalisis profil berkas sinar elektron energi 5 MeV pada kedalaman tertentu dan Dmax dengan variasi luas lapangan 5×5 cm2, 10×10 cm2, 15×15 cm2, 20×20 cm2, 25×25 cm2. Hasil analisis profil dosis pada berkas elektron 5 MeV menunjukkan bahwa lapangan 5×5 cm2 memiliki nilai flatness yang cukup besar sehingga dalam kalibrasi maupun terapi radiasi perlu diperhatikan penggunaan  luas lapangan tersebut. Dalam penelitian ini juga didapatkan bahwa nilai flatness paling ideal (nilai flatness rendah terjadi pada lapangan 15×15 cm2. Sehingga ada luas lapangan lain yang bisa digunakan untuk treatment maupun kalibrasi selain 10×10 cm2 yaitu 15×15 cm2 yang memiliki nilai flatness rendah.

SU-E-T-409: Evaluation of Tissue Composition Effect On Dose Distribution in Radiotherapy with 6 MV Photon Beam of a Medical Linac

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Ghorbani, M; Tabatabaei, Z; Noghreiyan, A Vejdani [Mashhad University of Medical Sciences, Mashhad (Iran, Islamic Republic of); Meigooni, A Soleimani [Comprehensive Cancer Center of Nevada, Las Vegas, NV (United States)

2015-06-15

Purpose: The aim of this study is to evaluate soft tissue composition effect on dose distribution for various soft tissues and various depths in radiotherapy with 6 MV photon beam of a medical linac. Methods: A phantom and Siemens Primus linear accelerator were simulated using MCNPX Monte Carlo code. In a homogeneous cubic phantom, six types of soft tissue and three types of tissue-equivalent materials were defined separately. The soft tissues were muscle (skeletal), adipose tissue, blood (whole), breast tissue, soft tissue (9-component) and soft tissue (4-component). The tissue-equivalent materials included: water, A-150 tissue-equivalent plastic and perspex. Photon dose relative to dose in 9-component soft tissue at various depths on the beam’s central axis was determined for the 6 MV photon beam. The relative dose was also calculated and compared for various MCNPX tallies including,F8, F6 and,F4. Results: The results of the relative photon dose in various materials relative to dose in 9-component soft tissue and using different tallies are reported in the form of tabulated data. Minor differences between dose distributions in various soft tissues and tissue-equivalent materials were observed. The results from F6 and F4 were practically the same but different with,F8 tally. Conclusion: Based on the calculations performed, the differences in dose distributions in various soft tissues and tissue-equivalent materials are minor but they could be corrected in radiotherapy calculations to upgrade the accuracy of the dosimetric calculations.

Reconstruction of 137Cs signal in cuba using 7be as a Tracer of vertical transport processes in the Atmosphere

International Nuclear Information System (INIS)

Alonso Hernandez, C.M.; Cartas Aguila, H.; Diaz Asencio, M.; Munnoz Caravaca, A.

2001-01-01

The goal of this study is to estimate the 137Cs signal in Cuba using the relation 137Cs/7Be for Miami and Cienfuegos City's obtained for four year and data base of 137Cs concentration in aerosols for Miami since 1957. The temporal behaviour of 137Cs and 7Be in aerosols in the Central and Southern region of Cuba are shown too. Sampling of aerosols was carried out in the Environmental Study Centre (22 grade 03'N, 80 grade 29'W) facilities during June/1994 - December/1998 in Cienfuegos Province. Aerosols were collected by an integral method using the facility Primus I, with 0.65 m2 collection area, 1200 m3h-1 air flux during 7 days collection time. Petrianov filter FPP-15-1.5 was used (efficiency collection of 99% to aerosols 0.3-1.5 mm diameter). After collection, the filters were ashed at 350 grade for 72 hours, put in appropriate geometry and analysed by gamma spectrometry. 137Cs mean concentration in aerosols was 1.09 mBqm-3 and the range of variations was 0.18-3.24 mBqm-3 ; while the 7Be was 4.10 mBqm-3 with 0.96-10.46 mBqm-3 variation range. These results allow to establish a relationship between 137Cs concentrations in aerosols from Cienfuegos and Miami in the same period, normalising in both cases with 7Be values; this normalisation allows to discriminate the variations due to local meteorological conditions and latitudinal position

Monte Carlo simulation of a clinical linear accelerator

International Nuclear Information System (INIS)

Lin, S.-Y.; Chu, T.-C.; Lin, J.-P.

2001-01-01

The effects of the physical parameters of an electron beam from a Siemens PRIMUS clinical linear accelerator (linac) on the dose distribution in water were investigated by Monte Carlo simulation. The EGS4 user code, OMEGA/BEAM, was used in this study. Various incident electron beams, for example, with different energies, spot sizes and distances from the point source, were simulated using the detailed linac head structure in the 6 MV photon mode. Approximately 10 million particles were collected in the scored plane, which was set under the reticle to form the so-called phase space file. The phase space file served as a source for simulating the dose distribution in water using DOSXYZ. Dose profiles at D max (1.5 cm) and PDD curves were calculated following simulating about 1 billion histories for dose profiles and 500 million histories for percent depth dose (PDD) curves in a 30x30x30 cm 3 water phantom. The simulation results were compared with the data measured by a CEA film and an ion chamber. The results show that the dose profiles are influenced by the energy and the spot size, while PDD curves are primarily influenced by the energy of the incident beam. The effect of the distance from the point source on the dose profile is not significant and is recommended to be set at infinity. We also recommend adjusting the beam energy by using PDD curves and, then, adjusting the spot size by using the dose profile to maintain the consistency of the Monte Carlo results and measured data

Towards the development of a comprehensive model of an electronic portal imaging device using Geant4

International Nuclear Information System (INIS)

Blake, S.; Kuncic, Z.; Vial, P.; Holloway, L.

2010-01-01

Full text: This work represents the first stage of an ongoing study to investigate the physical processes occurring within electronic portal imaging devices (EPlDs), including the effects of optical scattering on image quality and dosimetry. The objective of this work was to develop an initial Monte Carlo model of a linear accelerator (Iinac) beam and an EPID. The ability to simulate the radiation transport of both high energy and optical photons in a single Monte Carlo model was tested. Data from the Phase-space database for external beam radiotherapy (International Atomic Energy Agency, IAEA) was used with the Geant4 toolkit to construct a model of a Siemens Primus linac 6 MY photon source. Dose profiles and percent depth dose (PDD) curves were extracted from simulations of dose in water and compared to experimental measurements. A preliminary EPID model was developed to incorporate both high energy radiation and optical photon transport. Agreement in dose profiles inside the open beam was within 1.6%. Mean agreement in PDD curves beyond depth of dose maximum was within 6.1 % (local percent difference). The radiation transport of both high energy and optical photons were simulated and visualized in the EPID model. Further work is required to experimentally validate the EPID model. The comparison of simulated dose in water with measurements indicates that the IAEA phase-space may represent an accurate model of a linac source. We have demonstrated the feasibility of developing a comprehensive EPID model incorporating both high energy and optical physics in Geant4. (author)

[Characteristics in treatment of the hip in patients with Down syndrome].

Science.gov (United States)

Peterlein, C-D; Schiel, M; Timmesfeld, N; Schofer, M D; Eberhardt, O; Wirth, T; Fernandez, F F

2013-12-01

The treatment of hip instability in patients with Down syndrome is challenging. We have performed different pelvic osteotomies and corrections at the proximal femur for this indication. This retrospective study was conducted to evaluate the clinical and radiological outcome of each intervention. All in all, 166 patients with Down syndrome were treated at our orthopaedic department in the observation period. Problems related to the hip joint were diagnosed in 63 of those patients. Only patients who underwent surgery were included in this study. The charts and X-rays of these 31 patients were evaluated with respect to the following parameters: incidence of the hip problem, concomitant diseases, temporal progress, kind of operation method and date, duration of stay in the hospital, after-care, follow-on surgery related to complications, AC angle, CE angle, ACM angle, CCD angle, index of migration according to Reimers, classification of Bauer and Kerschbauer and general morphology of the femoral head. The group was compared with an age-matched group of 21 patients with hip dysplasia. Those patients underwent the same sort of operation in the same year. In the Morbus Down group, we performed surgery for preservation of the hip in 49 cases. This included 13 osteotomies according to Chiari, 11 triple osteotomies according to Tönnis, 10 corrections by femoral varus derotation osteotomy, 8 pelvic osteotomies according to Pemberton, 5 pelvic osteotomies according to Salter and 2 open reductions of the hip. With respect to the moment of surgery, we detected three peaks of age. There was no difference in course of disease and quantity of complications between the groups. Satisfactory results concerning clinical and radiological outcome were achieved predominantly by complete redirectional acetabular osteotomies. Half of the patients who were solely treated by femoral varus derotation osteotomy needed follow-on surgery in the form of pelvic osteotomy. Comparison of

Radiological evaluation of cartilage after microfracture treatment: A long-term follow-up study

International Nuclear Information System (INIS)

Von Keudell, A.; Atzwanger, J.; Forstner, R.; Resch, H.; Hoffelner, T.; Mayer, M.

2012-01-01

Introduction: Recent literature revealed good short-term results after microfracturing (MFX) of isolated focal cartilage defects in the knee joint. Study purpose was a long-term evaluation of patients who received MFX through a multimodal approach, correlating clinical scores and morphological pre- and postoperative MRI-scans. Materials and methods: Between 2000 and 2007 158 patients were treated with MFX for focal femoral or tibial defects at our department. Patients with instabilities, secondary surgical intervention, patellofemoral lesions, a plica mediopatellaris or more than one cartilage defect site and age >55 were excluded. 15 patients were included. Minimum postoperative follow-up (FU) was 18 months (18–78 m). Mean age at surgery was 45 years (27–54), mean FU-interval 48 months (18–78 m). Male to female ratio was 9:6. For clinical assessment the Knee Osteoarthritis Outcome Score (KOOS) and Lysholm Score were used, radiological evaluation was performed with radiographs and 3Tesla-MRI. Results: Clinical knee function was rated good to excellent in 1 patient, fair in 2 and poor in 10 patients. 2/15 patients received full knee replacement due to insufficient cartilage repair through MFX during FU period. Evaluation of pre- and postoperative MRI showed good cartilage repair tissue in 1 (7.7%), moderate repair in 2 (15.4%) and poor fill in 10 patients (76.9%). In these 10 patients the defect size increased. Average defect size preoperatively was 187 mm 2 (range 12–800 mm 2 ) and postoperatively 294 mm 2 (40–800 mm 2 ). The KOOS-Pain averaged 60 (39–94), KOOS-Symptoms 60.6 (21–100), KOOS-ADL 69 (21–91), KOOS-Sports 35.7 (5–60) and KOOS-QUL 37.2 (6–81). The average Lysholm Score was 73.9 (58–94). 10 patients showed a varus leg axis deviation (Ø 5.9°), 3 had a neutral alignment. The alignment correlated positively with KOOS and especially with the Lysholm Score. Conclusion: Our study demonstrated that MFX as a treatment option for cartilage

Influence of high-altitude grazing on bone metabolism of growing sheep.

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Liesegang, A; Hüttenmoser, D; Risteli, J; Leiber, F; Kreuzer, M; Wanner, M

2013-02-01

The objective of this study was to identify the effect of high alpine grazing, associated with varying pasture grass qualities and more pronounced exercise on typically steep slopes, on bone metabolism by improving bone density and enhancing bone turnover in growing sheep. Twenty-four 5-month-old sheep were randomly assigned to two groups. One group was kept at high altitude (HA; 2000-2200 m a.s.l.) for 3 months, and the other group (C; control) remained in the lowlands (400 m a.s.l.). Both groups were kept in grazing pastures with access to good-quality swards. Before the start of the experiment, blood samples were taken, the sheep were weighed, and the left metatarsus of each animal was analysed by quantitative computer tomography. After 1 month, blood samples were taken and body weight was measured, followed by biweekly sampling. Finally, the animals were slaughtered, and the bones were collected for analysis of various bone parameters. Body weight development did not differ between the groups. Concentrations of 25-OH-Vitamin D, carboxy-terminal telopeptide of type I collagen and activities of bone-specific alkaline phosphatase were always higher in the HA group than in the C group, except on the last two sampling dates. Bone mineral content and density increased in both groups during the experiment, but more intensively in the HA group. In addition, the cortical thickness of the HA group increased. The present study demonstrates an increase in bone turnover and mineral content of the bones of the growing sheep grazing in high alpine pastures. The factors associated with HA grazing, therefore, clearly seem to improve bone composition. © 2011 Blackwell Verlag GmbH.

MR imaging findings of fatigue fractures of lower extremity in young soldiers

International Nuclear Information System (INIS)

Mo, Jong Hyun; Moon, Sung Hee; Kim, Young Bok; Park, Yang Hee; Park, Jin Kyoon

1999-01-01

To evaluate the MR imaging findings of fatigue fractures of the lower extremity in young soldiers. In 22 cases of fatigue fractures of the lower extremity in young soldiers proven by clinical findings and radiological follow up, the MRI findings were retrospectively evalvated. All patients were male and aged between 19 and 21 years. As seen on MRI, the bone marrow edema, intramedullary low signal intensity band, cortical fracture line, periosteal reaction, surrounding soft tissue edema, and enhancement pattern were analyzed and the site of involvement was determined in the axial plane. The locations of fatigue fractures of the lower extremity were the tibia (n=12), fibula (n=8), femur (n=1) and second metatarsus (n=1). All occurred in diaphyses: the junction of the proximal and middle (n=10), middle (n=9), proximal (n=2), and distal shaft (n=1). The sites of involvement were the posteromedial (n=6) and medial side (n=6) of the tibia, and the entire portion of the fibula(n=5) in the axial plane. MRI findings were bone marrow edema in 20 cases, intramedullary low signal intensity band in 14 (which were continuous with the cortex or cortical fracture line), cortical fracture line in 13, and periosteal reaction and surrounding soft tissue edema in all. On gadolinium-enhanced images, enhancement was seen in the bone marrow in 19 cases, in the subperiosteal region in 18, and in the surrounding soft tissue in 22. In fatigue fractures of the lower extremity in young soldiers, the main locations were the tibia and fibula, and characteristic MR imaging findings were intramedullary low signal intensity bands, which were continuous with the cortex or cortical fracture line and often accompanied by bone marrow edema, periosteal reaction, and surrounding soft tissue edema

Prevalence of postural alterations in students of Basic Education in the city of Vila Velha, Espírito Santo state, Brazil

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Paula Lopes Rodrigues

Full Text Available Introduction Human posture goes through a series of changes in the course of body growth and development, i.e., in childhood and adolescence. Moreover, during these phases, individuals are subject to risk behaviors for spinal problems, especially those related to the use of backpacks and to poor sitting posture. Objective This study aimed to detect the prevalence of postural alterations in school children enrolled in the UMEF Vila Olímpica, Vila Velha, Espírito Santo. Methods We evaluated 513 schoolchildren in the orthostatic position and in the anterior, posterior and side view. The following structures were analyzed: head, shoulder, the cervical, thoracic and lumbar spine, pelvis and lower limbs. Results There was a high prevalence of postural deviations: rotated or tilted head, elevated shoulder and pelvis, valgus or varus knee, head protraction, alterations of the thoracic spine, anteriorized shoulders, pelvis in anteversion, knees semiflexion or hyperextension and cavus or planus feet. Conclusion Our results suggest that there is a high prevalence of postural alterations in students in the school network of Vila Velha (ES. This could be detected through public health policies, such as the federal government´s Health at School Program (PSE.

Role of gamma nail in management of pertrochanteric fractures of femur

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Sharma Vipin

2008-01-01

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

Unilateral Congenital Knee and Hip Dislocation with Bilateral Clubfoot – A rare Packaging disorder

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Mukesh Tiwari

2013-04-01

Full Text Available ntroduction: Reduced intrauterine space gives rise to ‘packaging disorder’ which may involve joint dislocations or contractures. We present an unique case where mutiple joints were dislocated involving left congenital knee dislocation (CDK, bilateral congenital hip dislocation (CDH and congenital talipes equino varus (CTEVdeformities. Case Report: A preterm baby boy born to mother with diagnosed oligohydramios presented with left CDK bilateral DDH and CTEV. The knee dislocation was treated first with gradual streaching and weekly above knee cast. At 7th week good flexion was achieved at both knees and abduction splint for DDH (using double diaper with ponseti cast for CTEV was done. At one year follow up all joints were reduced and maintained well with baby able to stand with support. Conclusion: Packaging disorders may present with multiple dislocations and deformities. Early intervention with serial casting and manipulation minimises disability and prevents ambulatory problems. In our case there was a good response to manipulation and serial casting. This differs from cases with inherent pathology like arthrogryposis where response to treatment is not so good. Keywords: Congenital genu recurvatum, Develpmental dysplasia hip, CTEV, Clubfoot, serial manipulation, packaging disorders

Congenital vertical talus in four generations of the same family

International Nuclear Information System (INIS)

Levinsohn, E. Mark; Shrimpton, Antony E.; Cady, Robert B.; Packard, David S.; Hootnick, David R.

2004-01-01

This paper presents four generations of a family with radiographically demonstrated congenital vertical talus (CVT) in whom a HOXD10 gene mutation was identified. Some members of the family with this mutation exhibited cavo-varus foot deformity consistent with a Charcot-Marie-Tooth (CMT)-like disorder. Physical examination was performed on nearly all of the affected and unaffected family members. DNA was extracted from blood obtained from 14 subjects who showed radiographic and clinical features of CVT (two of whom also had CMT), from two subjects with features of CMT but not CVT, and from 20 related family members who were clinically normal. Radiographs show the appearance of uncorrected CVT in infancy, in childhood, and in adulthood. DNA analysis revealed a mutation in a HOXD10gene located on chromosome 2 in all of the affected but none of the unaffected family members. There is an autosomal-dominant-inherited mutation with complete penetrance which is found in all members of a pedigree with CVT, some of whom exhibit a CMT-like foot disorder. Radiologic findings vary depending on the severity of involvement, treatment provided and age of the patient. (orig.)

Congenital vertical talus in four generations of the same family

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Levinsohn, E. Mark [Crouse Hospital, Department of Medical Imaging, Syracuse (United States); Shrimpton, Antony E. [SUNY Upstate Medical University, Department of Clinical Pathology, Syracuse (United States); Cady, Robert B. [SUNY Upstate Medical University, Department of Pediatrics, Syracuse (United States); Packard, David S. [SUNY Upstate Medical University, Department of Cell and Developmental Biology, Syracuse (United States); Hootnick, David R. [SUNY Upstate Medical University, Department of Pediatrics, Syracuse (United States); SUNY Upstate Medical University, Department of Cell and Developmental Biology, Syracuse (United States); SUNY Upstate Medical University, Department of Orthopedic Surgery, Syracuse (United States)

2004-11-01

This paper presents four generations of a family with radiographically demonstrated congenital vertical talus (CVT) in whom a HOXD10 gene mutation was identified. Some members of the family with this mutation exhibited cavo-varus foot deformity consistent with a Charcot-Marie-Tooth (CMT)-like disorder. Physical examination was performed on nearly all of the affected and unaffected family members. DNA was extracted from blood obtained from 14 subjects who showed radiographic and clinical features of CVT (two of whom also had CMT), from two subjects with features of CMT but not CVT, and from 20 related family members who were clinically normal. Radiographs show the appearance of uncorrected CVT in infancy, in childhood, and in adulthood. DNA analysis revealed a mutation in a HOXD10gene located on chromosome 2 in all of the affected but none of the unaffected family members. There is an autosomal-dominant-inherited mutation with complete penetrance which is found in all members of a pedigree with CVT, some of whom exhibit a CMT-like foot disorder. Radiologic findings vary depending on the severity of involvement, treatment provided and age of the patient. (orig.)

Two stage fracture of a polyethylene post in a 9-year-old posterior-stabilized knee prosthesis: a case report

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Congiu Terenzio

2010-02-01

Full Text Available Abstract Introduction Several cases of tibial post breakage are reported in the literature. To the best of our knowledge, only three cases of NexGen knee prosthesis (Zimmer, Warsaw, Indiana, USA tibial post failure have been reported. Case presentation In November 1999, a 63-year-old Caucasian woman from Italy with a history of symptomatic left knee osteoarthritis underwent a total knee arthroplasty. In March 2008, while rising from a chair, she felt a sudden pain and instability in her left knee. She reported a fracture of the polyethylene post of the tibial insert. No malposition or malalignment of either the femoral or tibial components were identified. The polyethylene tibial insert was studied under light microscopy and scanning electron microscopy. The fracture was also noted to have occurred without any notable polyethylene wear. Conclusion Scanning electron microscopy revealed two different damage patterns that could be explained with a two-stage rupture of our patient's polyethylene post. This could have been caused by a non-optimal ligamentous balancing during first implant surgery. Her knee probably developed a varus instability that weakened the post, and then a posterior anterior stress finally broke the polyethylene.

Clinic research on the treatment for humeral shaft fracture with minimal invasive plate osteosynthesis: a retrospective study of 128 cases.

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Chen, H; Hu, X; Yang, G; Xiang, M

2017-04-01

Minimal invasive plate osteosynthesis (MIPO) is one of the most important techniques in the treatment for humeral shaft fractures. This study was performed to evaluate the efficacy of MIPO technique for the treatment for humeral shaft fractures. We retrospectively evaluated 128 cases with humeral shaft fractures that were treated with MIPO technique from March 2005 to August 2008. All the patients were followed up by routine radiological imaging and clinical examinations. Constant-Murley score and HSS elbow joint score were used to evaluate the treatment outcome. The average duration of the surgery was 60 min (range 40-95 min) without blood transfusion. All fractures healed without infection. All cases recovered carrying angle except four cases with 10°-15° cubitus varus. After the average follow-up of 23 (13-38) months, satisfactory function was achieved according to Constant-Murley score and HSS elbow joint score. Constant-Murley score was 80 on average (range 68-91). According to HSS elbow joint score, there were 123 cases of excellent clinical outcome and five cases of effective outcome. It seems to be a safe and effective method for managing humeral shaft fractures with MIPO technique.

Double-Row Suture Anchor Repair of Posterolateral Corner Avulsion Fractures.

Science.gov (United States)

Gilmer, Brian B

2017-08-01

Posterolateral corner avulsion fractures are a rare variant of ligamentous knee injury primarily described in the skeletally immature population. Injury is often related to a direct varus moment placed on the knee during sporting activities. Various treatment strategies have been discussed ranging from nonoperative management, to excision of the bony fragment, to primary repair with screws or suture. The described technique is a means for achieving fixation of the bony avulsion using principles familiar to double-row transosseous equivalent rotator cuff repair. Proximal anchors are placed in the epiphysis, and sutures are passed in horizontal mattress fashion. Once tied, the limbs of these same sutures are then passed to more distal anchors. Remaining eyelet sutures can be used to manage peripheral tissue. The final repair provides anatomic reduction and compression of the fragment to its bony bed with minimal extracortical hardware prominence and no violation of the physis. Risks include potential for physeal injury or chondral damage to the lateral femoral condyle through aberrant anchor placement. Postoperative care includes toe-touch weight-bearing restrictions and range of motion restrictions of 0°-90° in a hinged brace for 6 weeks followed by gradual return to activity.

Isolated femoral hypoplasia: an intrauterine differential diagnosis to campomelia

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Koerber, Friederike; Benz-Bohm, Gabriele [University of Cologne, Department of Paediatric Radiology, Cologne (Germany); Schoenau, Eckard [University of Cologne, Department of Paediatrics, Cologne (Germany); Horwitz, A.Eldad [Klinikum Krefeld, Department of Paediatric Radiology, Krefeld (Germany)

2005-06-01

The isolated form of femoral bowing is an important differential diagnosis of campomelia. Therefore, knowledge of isolated anomalies is fundamental for prenatal diagnosis, especially for the differential diagnosis from severe syndromes. Four cases are presented to discuss the differential diagnosis of femoral bowing including a review of the literature. We report four newborn babies with unilateral bowing and shortening of the femur. Three had no further anomaly; one child had additional abnormalities due to coumarin embryopathy. The radiological findings were shortened femora with bowing and varus deformity and cortical thickening on the concave side. All other parts showed normal bone structure. The aetiology of femoral bowing is unknown. Early damage of the cartilaginous model followed by remodelling with thickening on the concave side of the bone similar to the healing of malaligned fractures is suspected. The isolated form of femoral bowing without any other anomalies has to be differentiated from complex and more often severe congenital syndromes such as campomelia. Postpartum radiological examination should be reduced to a single exposure of the affected limb and follow-up should be done by clinical examination. (orig.)

Results of Austin Moore replacement.

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Jadhav A

1996-04-01

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

The influence of foot position on stretching of the plantar fascia.

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Flanigan, Ryan M; Nawoczenski, Deborah A; Chen, Linlin; Wu, Hulin; DiGiovanni, Benedict F

2007-07-01

A recent study found nonweightbearing stretching exercises specific to the plantar fascia to be superior to the standard program of weightbearing Achilles tendon-stretching exercises in patients with chronic plantar fasciitis. The present study used a cadaver model to demonstrate the influence of foot and ankle position on stretching of the plantar fascia. Twelve fresh-frozen lower-leg specimens were tested in 15 different configurations representing various combinations of ankle and metatarsophalangeal (MTP) joint dorsiflexion, midtarsal transverse plane abduction and adduction, and forefoot varus and valgus. Measurements were recorded by a differential variable reluctance transducer (DVRT) implanted into the medial band of the plantar fascia, and primary measurement was a percent deformation of the plantar fascia (stretch) with respect to a reference position (90 degrees ankle dorsiflexion, 0 degrees midtarsal and forefoot orientation, and 0 degrees MTP dorsiflexion). Ankle and MTP joint dorsiflexion produced a significant increase (14.91%) in stretch compared to the position of either ankle dorsiflexion alone (9.31% increase, p plantar fascia tissue-specific stretching exercises and lends support to the use of ankle and MTP joint dorsiflexion when employing stretching protocols for nonoperative treatment in patients with chronic proximal plantar fasciitis.

Is There an Inherent Risk to Damage the Popliteus Tendon by Femoral Component With Inbuilt External Rotation? A Pilot Study in Indian Knees.

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Chouhan, Dervendra Kumar; Dhillon, Mandeep S

2016-02-01

Femoral components with inbuilt rotation require thicker flexion resection of the lateral femoral condyle and could have a potential risk of damaging the popliteus tendon, especially in the smaller Asian knees. We prospectively evaluated 10 patients with bilateral varus osteoarthritis knee to size the cuts and their location in relation to the popliteus tendon. Two different types of implant were used on either side; one side requires resection in 3° external rotation (group A) and the other side requires a femoral component with inbuilt external rotation (group B). We observed the incidence of injury to the popliteus tendon and distance between flexion cut to its attachment over the lateral femoral condyle between both groups. We had popliteus tendon injury in 3 knees all from group B. Risk of damaging the popliteus tendon was found higher in group B, as the distance between flexion cut to popliteus tendon attachment was significantly low. Femoral component with inbuilt external rotation has more risk of injuring the popliteus tendon because flexion cut takes out more bone from the lateral femoral condyle. Copyright © 2015 Elsevier Inc. All rights reserved.

Treatment of Osteoarthritis of the Knee (Nonarthroplasty)

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Richmond, John; Hunter, David; Irrgang, Jay; Jones, Morgan H.; Levy, Bruce; Marx, Robert; Snyder-Mackler, Lynn; Watters, William C.; Haralson, Robert H.; Turkelson, Charles M.; Wies, Janet L.; Boyer, Kevin M.; Anderson, Sara; Andre, St. Justin St.; Sluka, Patrick; McGowan, Richard

2011-01-01

The clinical practice guideline was explicitly developed to include only treatments less invasive than knee replacement (ie, arthroplasty). Patients with symptomatic osteoarthritis of the knee are to be encouraged to participate in self-management educational programs and to engage in self-care, as well as to lose weight and engage in exercise and quadriceps strengthening. The guideline recommends taping for short-term relief of pain as well as analgesics and intra-articular corticosteroids, but not glucosamine and/or chondroitin. Patients need not undergo needle lavage or arthroscopy with débridement or lavage. Patients may consider partial meniscectomy or loose body removal or realignment osteotomy, as conditions warrant. Use of a free-floating interpositional device should not be considered for symptomatic unicompartmental osteoarthritis of the knee. Lateral heel wedges should not be prescribed for patients with symptomatic medial compartmental osteoarthritis of the knee. The work group was unable either to recommend or not recommend the use of braces with either valgus- or varus-directing forces for patients with medial unicompartmental osteoarthritis; the use of acupuncture or of hyaluronic acid; or osteotomy of the tibial tubercle for isolated symptomatic patellofemoral osteoarthritis. PMID:19726743

Malformations of the first ray of the foot in children: diagnosis, clinical picture, treatment

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Mikhail Pavlovich Konyukhov

2015-06-01

Full Text Available Malformations of the first ray of the foot vary widely and are divided into simple and complex. Complex malformations include abnormality of development of the first metatarsal or the main phalanx and refer to atypical adducted foot deformity. They are also characterized by varus location of the first ray of varying severity. The cause of deformation is a damage of longitudinal epiphyseal growth plate area of the first metatarsal - “longitudinal epiphyseal bracket” or the so-called delta phalanx. Over the past five years, we treated 37 patients (53 feet aged from 6 months to 17 years old with developmental disabilities of the first ray of the foot. The spectrum of pathology is very diverse. In the majority of cases surgical treatment was multi-staged. It was revealed that the removal of deformity at the first stage of treatment should be complete, with maximum use of the bone to restore the length and shape of the affected bone. In treating combined deformities the good effect is guaranteed only with the removal of all the elements, including excision of the fibrous bridle along the inner surface of the first ray.

Does Knee Osteoarthritis Differentially Modulate Proprioceptive Acuity in the Frontal and Sagittal Planes of the Knee?

Science.gov (United States)

Cammarata, Martha L; Schnitzer, Thomas J; Dhaher, Yasin Y

2012-01-01

Objective Impaired proprioception may alter joint loading and contribute to the progression of knee osteoarthritis (OA). Though frontal plane loading at the knee contributes to OA, proprioception and its modulation with OA in this direction have not been examined. The aim of this study was to assess knee proprioceptive acuity in the frontal and sagittal planes in knee OA and healthy participants. We hypothesized that proprioceptive acuity will be decreased in the OA population in both planes of movement. Methods Thirteen persons with knee OA and fourteen healthy age-matched subjects participated. Proprioceptive acuity was assessed in varus, valgus, flexion, and extension using the threshold to detection of passive movement (TDPM). Repeated measures analysis of variance was used to assess differences in TDPM between subject groups and across movement directions. Linear regression analyses were performed to assess the correlation of TDPM between and within planes of movement. Results TDPM was found to be significantly higher (Pplanes of movement were only weakly correlated, especially in the OA group. Conclusions Consistent differences in TDPM between the OA and control groups across all movement directions suggest a global, not direction-specific, reduction in sensation in knee OA patients. PMID:21547895

Surgical correction of hallux valgus complicated with adult-type pes plano-valgus.

Science.gov (United States)

Choi, Jun Young; Yoon, Hyeong Hwa; Suh, Yu Min; Suh, Jin Soo

2017-01-01

To investigate the efficiency of simultaneous correction of moderate to severe hallux valgus deformity and adult-type pes planus. Twenty cases of moderate to severe hallux valgus complicated with adult-type pes planus in 19 consecutive patients (15 (79%) women, 4 (11%) men; mean age: 44.50 ± 17.13 years, mean follow-up duration: 31.30 ± 17.02 months) were included. Medial calcaneal sliding osteotomy was performed to correct hindfoot valgus, whereas treatments of hallux valgus were case dependent. The mean postoperative hallux valgus angle, intermetatarsal angle, hindfoot alignment angle, and hindfoot alignment ratio were 8.40 ± 5.29°, 4.20 ± 2.54°, 3.09 ± 2.92º and 0.41 ± 0.17, respectively. Although a hallux varus deformity occurred as a postoperative complication in one case (5%), there were no cases of postoperative recurrence. Simultaneous correction of hallux valgus and pes plano-valgus using medial calcaneal sliding osteotomy is an effective technique that reduces recurrence of hallux valgus and increases satisfaction in patients with moderate to severe hallux valgus deformity complicated with adult-type pes planus accompanying hindfoot valgus.

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.

Evaluation of the effect of tooth and dental restoration material on electron dose distribution and production of photon contamination in electron beam radiotherapy

International Nuclear Information System (INIS)

Bahreyni Toossi, M.T.; Ghorbani, Mahdi; Akbari, Fatemah; Sabet, Leila S.; Mehrpouyan, Mohammad

2016-01-01

The aim of this study is to evaluate the effect of tooth and dental restoration materials on electron dose distribution and photon contamination production in electron beams of a medical linac. This evaluation was performed on 8, 12 and 14 MeV electron beams of a Siemens Primus linac. MCNPX Monte Carlo code was utilized and a 10 × 10 cm 2 applicator was simulated in the cases of tooth and combinations of tooth and Ceramco C3 ceramic veneer, tooth and Eclipse alloy and tooth and amalgam restoration materials in a soft tissue phantom. The relative electron and photon contamination doses were calculated for these materials. The presence of tooth and dental restoration material changed the electron dose distribution and photon contamination in phantom, depending on the type of the restoration material and electron beam’s energy. The maximum relative electron dose was 1.07 in the presence of tooth including amalgam for 14 MeV electron beam. When 100.00 cGy was prescribed for the reference point, the maximum absolute electron dose was 105.10 cGy in the presence of amalgam for 12 MeV electron beam and the maximum absolute photon contamination dose was 376.67 μGy for tooth in 14 MeV electron beam. The change in electron dose distribution should be considered in treatment planning, when teeth are irradiated in electron beam radiotherapy. If treatment planning can be performed in such a way that the teeth are excluded from primary irradiation, the potential errors in dose delivery to the tumour and normal tissues can be avoided.

Q A IMRT comparison specific patient by means of radiochromic films, radiographic films and ionization chambers arrangement; Comparacion de QA IMRT paciente especifico mediante films radiocromicos, films radiograficos y arreglo de camaras de ionizacion

Energy Technology Data Exchange (ETDEWEB)

Medina, L.; Venencia, D.; Garrigo, E., E-mail: fisicamedina11@gmail.com [Instituto Privado de Radioterapia, Obispo Oro 423, X5000BFI Cordoba (Argentina)

2014-08-15

IMRT uses radiation beams of nonuniform intensity. Quality assurance (Q A) specific patient is mandatory in this treatment modality. The purpose of this study is to compare results of patient specific Q A IMRT dose distributions of the total plan and individual fields using different dosimetric systems. We used a photon beam 6 MV generated for linear accelerator PRIMUS, were used planning systems iPLAN and Konrad for IMRT inverse planning with modality Step and Shoot. For plans total dose distributions were measured with radiographic films EDR2 and Radiochromic Film EBT3. For individual fields the dose distributions were measured with radiographic films X-Omat-V, Radiochromic Film EBT3 and PTW 2D-Array. We used a scanner VIDAR Dosimetry Pro Red and software Rit v6.1 for analysis, was used Gamma index [Γ] for comparison of measured and calculated dose recording the number of pixels with Γ> 1. We analyzed 50 plan dose distributions total 50 individual fields. For the total plan the number of pixels with Γ>1 (3%-3m m) was 0.7%±1.2 [0.1%; 2.82%] for EBT3 y 1%±1.8 [0.2%; 3%] for EDR2. For individual fields (5%-3m m) was obtained 0.97%±1,7 [0%, 3%] for X-Omat-V, 0.84%±1.1[0.3%,3.1%] for EBT3 and 2.6%±1.9 [0.01%,6.8%] PTW 2D-Array. All three methods can be used. Radiochromic Films revealed the advantage and disadvantage of the cost. Both systems are slightly better film to PTW 2D-Array. (author)

Dosimetry verifications of the physical parameters of virtual wedge on a Siemens accelerator

International Nuclear Information System (INIS)

Zhong Heli; Li Xiaodong; Li Longxing

2002-01-01

Objective: To verify the wedge angle of virtual wedge and the relation between wedge factor and beam energy, field size, wedge angle and to study the difference in percent depth dose (PDD) of virtual wedge field, hard wedge field and open field. Methods: Using wedge angle and wedge factor of 15 degree, 30 degree, 45 degree and 60 degree virtual wedge of Siemens Mevatron 6 MV and Primus 8 MV, 18 MV X rays were measured by RFA-plus 3D water phantom and RK finger chamber the PDD of the virtual wedge field, hard wedge field and open field were measured by Kodak XV-2 verifying film and FDM-300 film dosimeter. These PDDs were normalized to Dmax then compared. Results: There was good conformation between virtual wedge measured by four point method and set value. The virtual wedge was almost equal to 1, with a maximal variation of 0.031 no matter what the value of beam energy, field size or wedge angle was. Generally, for certain energy and field size, the wedge factor of larger wedge angle was slightly larger than smaller wedge angle. For certain energy and wedge angle, the wedge factor of larger field was also a little larger than smaller field. The PDD of virtual wedge field was similar to that of open field. Conclusions: The four point method measurement for virtual wedge angle is good for daily QA. Radiotherapy of virtual wedge field is not only simpler than hard wedge field, but also spares the beam output. The PDD conferment between virtual field and open field simplifies radiation treatment planning and increases the accuracy of wedge field therapy

Halo histories versus galaxy properties at z = 0 II: large-scale galactic conformity

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Tinker, Jeremy L.; Hahn, ChangHoon; Mao, Yao-Yuan; Wetzel, Andrew R.; Conroy, Charlie

2018-06-01

Using group catalogues from the Sloan Digital Sky Survey (SDSS) Data Release 7, we measure galactic conformity in the local universe. We measure the quenched fraction of neighbour galaxies around isolated primary galaxies, dividing the isolated sample into star-forming and quiescent objects. We restrict our measurements to scales >1 Mpc to probe the correlations between halo formation histories. Over the stellar mass range 109.7 ≤ M*/M⊙ ≤ 1010.9, we find minimal evidence for conformity. We further compare these data to predictions of the halo age-matching model, in which the oldest galaxies are associated with the oldest haloes. For models with strong correlations between halo and stellar age, the conformity is too large to be consistent with the data. Weaker implementations of the age-matching model would not produce a detectable signal in SDSS data. We reproduce the results of Kauffmann et al., in which the star formation rates of neighbour galaxies are reduced around primary galaxies when the primaries are low star formers. However, we find this result is mainly driven by contamination in the isolation criterion; when removing the small fraction of satellite galaxies in the sample, the conformity signal largely goes away. Lastly, we show that small conformity signals, i.e. 2-5 per cent differences in the quenched fractions of neighbour galaxies, can be produced by mechanisms other than halo assembly bias. For example, if passive galaxies occupy more massive haloes than star-forming galaxies of the same stellar mass, a conformity signal that is consistent with recent measurements from PRIMUS (Berti et al.) can be produced.

TERRA: a computer code for simulating the transport of environmentally released radionuclides through agriculture

International Nuclear Information System (INIS)

Baes, C.F. III; Sharp, R.D.; Sjoreen, A.L.; Hermann, O.W.

1984-11-01

TERRA is a computer code which calculates concentrations of radionuclides and ingrowing daughters in surface and root-zone soil, produce and feed, beef, and milk from a given deposition rate at any location in the conterminous United States. The code is fully integrated with seven other computer codes which together comprise a Computerized Radiological Risk Investigation System, CRRIS. Output from either the long range (> 100 km) atmospheric dispersion code RETADD-II or the short range (<80 km) atmospheric dispersion code ANEMOS, in the form of radionuclide air concentrations and ground deposition rates by downwind location, serves as input to TERRA. User-defined deposition rates and air concentrations may also be provided as input to TERRA through use of the PRIMUS computer code. The environmental concentrations of radionuclides predicted by TERRA serve as input to the ANDROS computer code which calculates population and individual intakes, exposures, doses, and risks. TERRA incorporates models to calculate uptake from soil and atmospheric deposition on four groups of produce for human consumption and four groups of livestock feeds. During the environmental transport simulation, intermediate calculations of interception fraction for leafy vegetables, produce directly exposed to atmospherically depositing material, pasture, hay, and silage are made based on location-specific estimates of standing crop biomass. Pasture productivity is estimated by a model which considers the number and types of cattle and sheep, pasture area, and annual production of other forages (hay and silage) at a given location. Calculations are made of the fraction of grain imported from outside the assessment area. TERRA output includes the above calculations and estimated radionuclide concentrations in plant produce, milk, and a beef composite by location

TERRA: a computer code for simulating the transport of environmentally released radionuclides through agriculture

Energy Technology Data Exchange (ETDEWEB)

Baes, C.F. III; Sharp, R.D.; Sjoreen, A.L.; Hermann, O.W.

1984-11-01

TERRA is a computer code which calculates concentrations of radionuclides and ingrowing daughters in surface and root-zone soil, produce and feed, beef, and milk from a given deposition rate at any location in the conterminous United States. The code is fully integrated with seven other computer codes which together comprise a Computerized Radiological Risk Investigation System, CRRIS. Output from either the long range (> 100 km) atmospheric dispersion code RETADD-II or the short range (<80 km) atmospheric dispersion code ANEMOS, in the form of radionuclide air concentrations and ground deposition rates by downwind location, serves as input to TERRA. User-defined deposition rates and air concentrations may also be provided as input to TERRA through use of the PRIMUS computer code. The environmental concentrations of radionuclides predicted by TERRA serve as input to the ANDROS computer code which calculates population and individual intakes, exposures, doses, and risks. TERRA incorporates models to calculate uptake from soil and atmospheric deposition on four groups of produce for human consumption and four groups of livestock feeds. During the environmental transport simulation, intermediate calculations of interception fraction for leafy vegetables, produce directly exposed to atmospherically depositing material, pasture, hay, and silage are made based on location-specific estimates of standing crop biomass. Pasture productivity is estimated by a model which considers the number and types of cattle and sheep, pasture area, and annual production of other forages (hay and silage) at a given location. Calculations are made of the fraction of grain imported from outside the assessment area. TERRA output includes the above calculations and estimated radionuclide concentrations in plant produce, milk, and a beef composite by location.

Q A IMRT comparison specific patient by means of radiochromic films, radiographic films and ionization chambers arrangement

International Nuclear Information System (INIS)

Medina, L.; Venencia, D.; Garrigo, E.

2014-08-01

IMRT uses radiation beams of nonuniform intensity. Quality assurance (Q A) specific patient is mandatory in this treatment modality. The purpose of this study is to compare results of patient specific Q A IMRT dose distributions of the total plan and individual fields using different dosimetric systems. We used a photon beam 6 MV generated for linear accelerator PRIMUS, were used planning systems iPLAN and Konrad for IMRT inverse planning with modality Step and Shoot. For plans total dose distributions were measured with radiographic films EDR2 and Radiochromic Film EBT3. For individual fields the dose distributions were measured with radiographic films X-Omat-V, Radiochromic Film EBT3 and PTW 2D-Array. We used a scanner VIDAR Dosimetry Pro Red and software Rit v6.1 for analysis, was used Gamma index [Γ] for comparison of measured and calculated dose recording the number of pixels with Γ> 1. We analyzed 50 plan dose distributions total 50 individual fields. For the total plan the number of pixels with Γ>1 (3%-3m m) was 0.7%±1.2 [0.1%; 2.82%] for EBT3 y 1%±1.8 [0.2%; 3%] for EDR2. For individual fields (5%-3m m) was obtained 0.97%±1,7 [0%, 3%] for X-Omat-V, 0.84%±1.1[0.3%,3.1%] for EBT3 and 2.6%±1.9 [0.01%,6.8%] PTW 2D-Array. All three methods can be used. Radiochromic Films revealed the advantage and disadvantage of the cost. Both systems are slightly better film to PTW 2D-Array. (author)

The Influence of Radiographic Severity on the Relationship between Muscle Strength and Joint Loading in Obese Knee Osteoarthritis Patients

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Jens Aaboe

2011-01-01

Full Text Available Objective. To investigate the relationship between knee muscle strength and the external knee adduction moment during walking in obese knee osteoarthritis patients and whether disease severity influences this relationship. Methods. This cross-sectional study included 136 elderly obese (BMI>30 adults with predominant medial knee osteoarthritis. Muscle strength, standing radiographic severity as measured by the Kellgren and Lawrence scale, and the peak external knee adduction moment were measured at self-selected walking speed. Results. According to radiographic severity, patients were classified as “less severe” (KL 1-2, N=73 or “severe” (KL 3-4, N=63. A significant positive association was demonstrated between the peak knee adduction moment and hamstring muscle strength in the whole cohort (P=.047. However, disease severity did not influence the relationship between muscle strength and dynamic medial knee joint loading. Severe patients had higher peak knee adduction moment and more varus malalignment (P<.001. Conclusion. Higher hamstring muscle strength relates to higher estimates of dynamic knee joint loading in the medial compartment. No such relationship existed for quadriceps muscle strength. Although cross sectional, the results suggest that hamstrings function should receive increased attention in future studies and treatments that aim at halting disease progression.

Reduced Operating Time but Not Blood Loss With Cruciate Retaining Total Knee Arthroplasty

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Vermesan, Dinu; Trocan, Ilie; Prejbeanu, Radu; Poenaru, Dan V; Haragus, Horia; Gratian, Damian; Marrelli, Massimo; Inchingolo, Francesco; Caprio, Monica; Cagiano, Raffaele; Tatullo, Marco

2015-01-01

Background There is no consensus regarding the use of retaining or replacing cruciate implants for patients with limited deformity who undergo a total knee replacement. Scope of this paper is to evaluate whether a cruciate sparing total knee replacement could have a reduced operating time compared to a posterior stabilized implant. Methods For this purpose, we performed a randomized study on 50 subjects. All procedures were performed by a single surgeon in the same conditions to minimize bias and only knees with a less than 20 varus deviation and/or maximum 15° fixed flexion contracture were included. Results Surgery time was significantly shorter with the cruciate retaining implant (P = 0.0037). The mean duration for the Vanguard implant was 68.9 (14.7) and for the NexGen II Legacy was 80.2 (11.3). A higher range of motion, but no significant Knee Society Scores at 6 months follow-up, was used as controls. Conclusions In conclusion, both implants had the potential to assure great outcomes. However, if a decision has to be made, choosing a cruciate retaining procedure could significantly reduce the surgical time. When performed under tourniquet, this gain does not lead to reduced blood loss. PMID:25584102

Dynamic behavior of tripolar hip endoprostheses under physiological conditions and their effect on stability.

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Fabry, Christian; Kaehler, Michael; Herrmann, Sven; Woernle, Christoph; Bader, Rainer

2014-01-01

Tripolar systems have been implanted to reduce the risk of recurrent dislocation. However, there is little known about the dynamic behavior of tripolar hip endoprostheses under daily life conditions and achieved joint stability. Hence, the objective of this biomechanical study was to examine the in vivo dynamics and dislocation behavior of two types of tripolar systems compared to a standard total hip replacement (THR) with the same outer head diameter. Several load cases of daily life activities were applied to an eccentric and a concentric tripolar system by an industrial robot. During testing, the motion of the intermediate component was measured using a stereo camera system. Additionally, their behavior under different dislocation scenarios was investigated in comparison to a standard THR. For the eccentric tripolar system, the intermediate component demonstrated the shifting into moderate valgus-positions, regardless of the type of movement. This implant showed the highest resisting torque against dislocation in combination with a large range of motion. In contrast, the concentric tripolar system tended to remain in varus-positions and was primarily moved after stem contact. According to the results, eccentric tripolar systems can work well under in vivo conditions and increase hip joint stability in comparison to standard THRs. Copyright © 2013 IPEM. Published by Elsevier Ltd. All rights reserved.

A Computational Modeling Approach for Investigating Soft Tissue Balancing in Bicruciate Retaining Knee Arthroplasty

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Shahram Amiri

2012-01-01

Full Text Available Bicruciate retaining knee arthroplasty, although has shown improved functions and patient satisfaction compared to other designs of total knee replacement, remains a technically demanding option for treating severe cases of arthritic knees. One of the main challenges in bicruciate retaining arthroplasty is proper balancing of the soft tissue during the surgery. In this study biomechanics of soft tissue balancing was investigated using a validated computational model of the knee joint with high fidelity definitions of the soft tissue structures along with a Taguchi method for design of experiments. The model was used to simulate intraoperative balancing of soft tissue structures following the combinations suggested by an orthogonal array design. The results were used to quantify the corresponding effects on the laxity of the joint under anterior-posterior, internal-external, and varus-valgus loads. These effects were ranked for each ligament bundle to identify the components of laxity which were most sensitive to the corresponding surgical modifications. The resulting map of sensitivity for all the ligament bundles determined the components of laxity most suitable for examination during intraoperative balancing of the soft tissue. Ultimately, a sequence for intraoperative soft tissue balancing was suggested for a bicruciate retaining knee arthroplasty.

A Computational Modeling Approach for Investigating Soft Tissue Balancing in Bicruciate Retaining Knee Arthroplasty

Science.gov (United States)

Amiri, Shahram; Wilson, David R.

2012-01-01

Bicruciate retaining knee arthroplasty, although has shown improved functions and patient satisfaction compared to other designs of total knee replacement, remains a technically demanding option for treating severe cases of arthritic knees. One of the main challenges in bicruciate retaining arthroplasty is proper balancing of the soft tissue during the surgery. In this study biomechanics of soft tissue balancing was investigated using a validated computational model of the knee joint with high fidelity definitions of the soft tissue structures along with a Taguchi method for design of experiments. The model was used to simulate intraoperative balancing of soft tissue structures following the combinations suggested by an orthogonal array design. The results were used to quantify the corresponding effects on the laxity of the joint under anterior-posterior, internal-external, and varus-valgus loads. These effects were ranked for each ligament bundle to identify the components of laxity which were most sensitive to the corresponding surgical modifications. The resulting map of sensitivity for all the ligament bundles determined the components of laxity most suitable for examination during intraoperative balancing of the soft tissue. Ultimately, a sequence for intraoperative soft tissue balancing was suggested for a bicruciate retaining knee arthroplasty. PMID:23082090

Dynamic knee alignment and collateral knee laxity and its variations in normal humans

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Kamal eDeep

2015-11-01

Full Text Available Alignment of normal, arthritic and replaced human knees is a much debated subject as is the collateral ligamentous laxity. Traditional quantitative values have been challenged. Methods used to measure these are also not without flaws. Authors review the recent literature and a novel method of measurement of these values has been included. This method includes use of computer navigation technique in clinic setting for assessment of the normal or affected knee before the surgery. Computer navigation has been known for achievement of alignment accuracy during knee surgery. Now its use in clinic setting has added to the inventory of measurement methods. Authors dispel the common myth of straight mechanical axis in normal knees and also look at quantification of amount of collateral knee laxity. Based on the scientific studies it has been shown that the mean alignment is in varus in normal knees. It changes from lying non weight bearing position to standing weight bearing position in both coronal and the sagittal planes. It also varies with gender and race. The collateral laxity is also different for males and females. Further studies are needed to define the ideal alignment and collateral laxity which the surgeon should aim for individual knees.

THE EFFECTS OF RACKET INERTIA TENSOR ON ELBOW LOADINGS AND RACKET BEHAVIOR FOR CENTRAL AND ECCENTRIC IMPACTS

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Steven M. Nesbit

2006-06-01

Full Text Available This paper discusses the inertia tensors of tennis rackets and their influence on the elbow swing torques in a forehand motion, the loadings transmitted to the elbow from central and eccentric impacts, and the racket acceleration responses from central and eccentric impacts. Inertia tensors of various rackets with similar mass and mass center location were determined by an inertia pendulum and were found to vary considerably in all three orthogonal directions. Tennis swing mechanics and impact analyses were performed using a computer model comprised of a full-body model of a human, a parametric model of the racket, and an impact function. The swing mechanics analysis of a forehand motion determined that inertia values had a moderate linear effect on the pronation-supination elbow torques required to twist the racket, and a minor effect on the flexion-extension and valgus-varus torques. The impact analysis found that mass center inertia values had a considerable effect on the transmitted torques for both longitudinal and latitudinal eccentric impacts and significantly affected all elbow torque components. Racket acceleration responses to central and eccentric impacts were measured experimentally and found to be notably sensitive to impact location and mass center inertia values

Computer navigation experience in hip resurfacing improves femoral component alignment using a conventional jig.

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Morison, Zachary; Mehra, Akshay; Olsen, Michael; Donnelly, Michael; Schemitsch, Emil

2013-11-01

The use of computer navigation has been shown to improve the accuracy of femoral component placement compared to conventional instrumentation in hip resurfacing. Whether exposure to computer navigation improves accuracy when the procedure is subsequently performed with conventional instrumentation without navigation has not been explored. We examined whether femoral component alignment utilizing a conventional jig improves following experience with the use of imageless computer navigation for hip resurfacing. Between December 2004 and December 2008, 213 consecutive hip resurfacings were performed by a single surgeon. The first 17 (Cohort 1) and the last 9 (Cohort 2) hip resurfacings were performed using a conventional guidewire alignment jig. In 187 cases, the femoral component was implanted using the imageless computer navigation. Cohorts 1 and 2 were compared for femoral component alignment accuracy. All components in Cohort 2 achieved the position determined by the preoperative plan. The mean deviation of the stem-shaft angle (SSA) from the preoperatively planned target position was 2.2° in Cohort 2 and 5.6° in Cohort 1 (P = 0.01). Four implants in Cohort 1 were positioned at least 10° varus compared to the target SSA position and another four were retroverted. Femoral component placement utilizing conventional instrumentation may be more accurate following experience using imageless computer navigation.

Kaufman oculo-cerebro-facial syndrome in a child with small and absent terminal phalanges and absent nails.

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Kariminejad, Ariana; Ajeawung, Norbert Fonya; Bozorgmehr, Bita; Dionne-Laporte, Alexandre; Molidperee, Sirinart; Najafi, Kimia; Gibbs, Richard A; Lee, Brendan H; Hennekam, Raoul C; Campeau, Philippe M

2017-04-01

Kaufman oculo-cerebro-facial syndrome (KOS) is caused by recessive UBE3B mutations and presents with microcephaly, ocular abnormalities, distinctive facial morphology, low cholesterol levels and intellectual disability. We describe a child with microcephaly, brachycephaly, hearing loss, ptosis, blepharophimosis, hypertelorism, cleft palate, multiple renal cysts, absent nails, small or absent terminal phalanges, absent speech and intellectual disability. Syndromes that were initially considered include DOORS syndrome, Coffin-Siris syndrome and Dubowitz syndrome. Clinical investigations coupled with karyotype analysis, array-comparative genomic hybridization, exome and Sanger sequencing were performed to characterize the condition in this child. Sanger sequencing was negative for the DOORS syndrome gene TBC1D24 but exome sequencing identified a homozygous deletion in UBE3B (NM_183415:c.3139_3141del, p.1047_1047del) located within the terminal portion of the HECT domain. This finding coupled with the presence of characteristic features such as brachycephaly, ptosis, blepharophimosis, hypertelorism, short palpebral fissures, cleft palate and developmental delay allowed us to make a diagnosis of KOS. In conclusion, our findings highlight the importance of considering KOS as a differential diagnosis for patients under evaluation for DOORS syndrome and expand the phenotype of KOS to include small or absent terminal phalanges, nails, and the presence of hallux varus and multicystic dysplastic kidneys.

An evaluation of flexible intramedullary nail fixation in femoral shaft fractures in paediatric age group.

Science.gov (United States)

Kumar, Sanjay; Roy, Sandip Kumar; Jha, Amrish Kumar; Chatterjee, Debdutta; Banerjee, Debabrata; Garg, Anant Kumar

2011-06-01

Sixty-two femoral shaft fractures in 60 patients treated by elastic intramedullary nailing with mean age of the patients being 9.2 years (range 5 years to 12 years) and average follow-up of 15 months (range 7 months to 60 months) are evaluated. Twenty-eight fractures were fixed with titanium elastic nail while 34 fractures were fixed with Enders nail. There were 40 midshaft fractures, 18 proximal femoral and 4 were fractures of distal third. Fracture patterns were transverse in 35, short oblique in 14 cases and 13 were spiral fractures. Mean age of union in this series was 17 weeks (range 12 weeks to 28 weeks). Ten cases had complications, 5 had nail tip irritation, 3 varus or valgus malalignment and 2 had delayed union. In this series, we did not have any non-union, refracture, limb length discrepancy or any major infection. The result demonstrates 100% union rate irrespective of the age, weight and height of the patient. Regardless of the site of fracture and their pattern, it united every time with elastic nail fixation. We did not find and mismatch in the results of fractures stabilised with titanium elastic nail with that of elastic stainless steel nail.

Therapeutic actions for the compensation on postural changes in athletes of Race walking

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Annia Gómez Valdés

2017-07-01

Full Text Available The research that is presented refers to the importance of having a control on the posture alterations that can be appreciated in athletes of sport march (12-15 years old in the sport formation school “Ormani Arenado", Pinar del Río; especially according to the age of these walkers. Its objective is aimed at proposing therapeutic actions for the compensation of the posture alterations, treated from planning physical preparation, based on indications as the positions and convenient movements, treatment goals and exercises for each deformity; addressing individual characteristics. For the realization of the investigation it was used theoretical, empiric and statistical methods which were facilitated to conclude that the adoption of incorrect postures during the training and the intensive use of the skeletal-muscle and locomotive systems impacts in the occurrence of the posture alterations that they rebound negatively in working of the athletes study object, standing out in them cavus feet, varus knees, lordosis and scoliosis; with the result that it is necessary their compensation and / or correction from the training of the physical preparation; so the application of therapeutic actions proposed to confirm their effectiveness in order to extend the study to other categories is recommended.

Medial collateral ligament healing one year after a concurrent medial collateral ligament and anterior cruciate ligament injury: an interdisciplinary study in rabbits.

Science.gov (United States)

Yamaji, T; Levine, R E; Woo, S L; Niyibizi, C; Kavalkovich, K W; Weaver-Green, C M

1996-03-01

The optimal treatment for concurrent injuries to the medial collateral and anterior cruciate ligaments has not been determined, despite numerous clinical and laboratory studies. The objective of this study was to examine the effect of surgical repair of the medial collateral ligament on its biomechanical and biochemical properties 52 weeks after such injuries. In the left knee of 12 skeletally mature New Zealand White rabbits, the medial collateral ligament was torn and the anterior cruciate ligament was transected and then reconstructed. This is an experimental model previously developed in our laboratory. In six rabbits, the torn ends of the medial collateral ligament were repaired, and in the remaining six rabbits, the ligament was not repaired. Fifty-two weeks after injury, we examined varus-valgus and anterior-posterior knee stability; structural properties of the femur-medial collateral ligament-tibia complex; and mechanical properties, collagen content, and mature collagen crosslinking of the medial collateral ligament. We could not detect significant differences between repair and nonrepair groups for any biomechanical or biochemical property. Our data support clinical findings that when the medial collateral and anterior cruciate ligaments are injured concurrently and the anterior cruciate ligament is reconstructed, conservative treatment of the ruptured medial collateral ligament can result in successful healing.

Bilateral congenital deficiency of tibia: a case report.

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Sharma, Vijai; Yadav, Ganesh; Gupta, Anil Kumar; Kumar, Dileep

2014-01-01

Tibial hemimelia/amelia is a rare congenital anomaly characterized by deficiency of the tibia with relatively intact fibula. They can be identified as an isolated disorder or as part of malformation syndromes. This presentation expands the spectrum of tibial hemimelia characterizing its great clinical and radiological variability. A five year old female child, born to unaffected and non-consanguineous parents, presented with deformity and shortening of both legs. There was no other structural anomaly except in both lower limbs. Radiological imaging showed absence of the tibia, angulation of fibula and tarsal coalition of right side. Femur was seen to be normal in both lower limbs while patella, tibia and talus were absent on left side along with 1st ray deficiency. Severe varus deformity was seen in both feet. The parents were not willing for corrective surgery, therefore extension prosthesis was devised. We report a case of tibial hemimelia as well as to suggest methods to manage and rehabilitate such patients. A congenital malformations surveillance and record system needs to be developed to identify the demographic parameters, etiology, risk factors and associations of all types of limb deficiencies. Need is felt of a classification system which includes broader spectrum of limb malformations.

Hyaluronic acid and chondroitin sulfate content of osteoarthritic human knee cartilage: site-specific correlation with weight-bearing force based on femorotibial angle measurement.

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Otsuki, Shuhei; Nakajima, Mikio; Lotz, Martin; Kinoshita, Mitsuo

2008-09-01

This study analyzed glycosaminoglycan (GAG) content in specific compartments of the knee joint to determine the impact of malalignment and helped refine indications for osteotomy. To assess malalignment, the radiological femorotibial angle (FTA) was measured and knee joints were also graded for OA severity with the Kellgren/Lawrence (K/L) classification. Cartilage samples were obtained from 36 knees of 32 OA patients undergoing total knee replacement surgery. Explants were harvested from the medial femoral condyle (MFC), lateral femoral condyle (LFC), patellar groove (PG), and lateral posterior femoral condyle (LPC). Concentrations of hyaluronic acid (HA) and chondroitin sulfate (CS) were measured by high-performance liquid chromatography (HPLC). With OA severity, the average FTA significantly increased. HA and CS content in MFC was negatively correlated with radiographic FTA. In LFC, HA ratio, which is HA content in lateral condyle divided by medial condyle and chondroitin 6 sulfate, increased until about 190 degrees FTA. Importantly, at >190 degrees these contents were significantly decreased. HA and CS content of the femoral condyle shows topographic differences that are related to OA grade and weight-bearing force based on FTA. The clinical relevance is that osteotomy may not be indicated for patients with severe varus (>190 degrees) abnormalities. (c) 2008 Orthopaedic Research Society

Comparison between suture anchor and transosseous suture for the modified-Broström procedure.

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Cho, Byung-Ki; Kim, Yong-Min; Kim, Dong-Soo; Choi, Eui-Sung; Shon, Hyun-Chul; Park, Kyoung-Jin

2012-06-01

This prospective, randomized study was conducted to compare clinical outcomes of the modified Broström procedure using suture anchor or transosseous suture technique for chronic ankle instability. Forty patients were followed for more than 2 years after modified Broström procedure. Twenty procedures using a suture anchor and 20 procedures using a transosseous suture were performed by one surgeon. The clinical evaluation consisted of the Karlsson scale and the Sefton grading system. Talar tilt and anterior talar translation were measured on anterior and varus stress radiographs. The Karlsson scale had improved significantly to 90.8 points in the suture anchor group, and to 89.2 points in the transosseous suture group. According to Sefton grading system, 18 patients (90%) in suture anchor group and 17 patients (85%) in transosseous suture group achieved satisfactory results. The talar tilt angle and anterior talar translation improved significantly to 5.9 degrees and 4.2 mm in suture anchor group, and to 5.4 degrees and 4.1 mm in transosseous suture group, respectively. No significant differences existed in clinical and functional outcomes between the two techniques for ligament reattachment. Both modified Broström procedures using the suture anchor and transosseous suture seem to be effective treatment methods for chronic lateral ankle instability.

Possibilities and limitations of novel in-vitro knee simulator.

Science.gov (United States)

Verstraete, Matthias A; Victor, Jan

2015-09-18

The ex-vivo evaluation of knee kinematics remains vital to understand the impact of surgical treatments such as total knee arthroplasty (TKA). To that extent, knee simulators have been developed. However, these simulators have mainly focused on the simulation of a squatting motion. The relevance of this motion pattern for patients' activities of daily living is however questionable as squatting is difficult for elderly patients. Walking, stairs and cycling are more relevant motion patterns. This paper presents the design and control of a simulator that allows to independently control the applied kinematic and kinetic boundary conditions to simulate these daily life activities. Thereby, the knee is left with five degrees of freedom; only the knee flexion is actively controlled. From a kinetic point of view, the quadriceps and hamstring muscles are loaded. Optionally, a varus/valgus moment can be applied, facilitating a dynamic evaluation of the knee's stability. The simulator is based on three control loops, whose synchronization appears satisfactory. The input for these control loops can be determined from either musculoskeletal simulations or in accordance to literature data for traditional knee simulators. This opens the door towards an improved understanding of the knee biomechanics and comparison between different applied motion and force patterns. Copyright © 2015 Elsevier Ltd. All rights reserved.

[Mobility of a polyethylene tibial insert in a mobile total knee prosthesis].

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Castel, E; Roger, B; Camproux, A; Saillant, G

1999-03-01

We have studied the mobility of a mobile tibial implant in total knee arthroplasty (TKA) by a radiographical evaluation. We analyzed mobility of the polyethylene tibial insert of 15 "G2S" TKA implanted for one year or more. We established a dynamic radiographical evaluation. We used 3 weight-bearing radiographs: AP in extension and two lateral (one in extension and one at 90 degrees of flexion), two AP with femoral internal and external rotation, 2 strict lateral X-rays in neutral rotation in antero-posterior replacement with a 25 kilograms strength Telos, and 2 AP in varus and valgus with Telos. Wilcoxon's test and Fisher's exact test were used for statistical evaluation. Our study demonstrated preservation of the polyethylene mobility in tibial TKA implant in all movements: in rotation, in antero-posterior translation with Telos, and even in antero-posterior translation during physiological condition with flexion-extension weight-bearing radiographs. Statistical tests were very significant. We noticed that flexion induced anterior translation of tibial polyethylene when PCL was preserved. This study answered to our question whether mobility of TKA tibial implant persists after implantation. This mobility should reduce loosening forces to the tibia and stress in the polyethylene component. Now we have to determine the amplitude of mobility required to reach this objective.

Knee joint laxity and passive stiffness in meniscectomized patients compared with healthy controls.

Science.gov (United States)

Thorlund, Jonas B; Creaby, Mark W; Wrigley, Tim V; Metcalf, Ben R; Bennell, Kim L

2014-10-01

Passive mechanical behavior of the knee in the frontal plane, measured as angular laxity and mechanical stiffness, may play an important role in the pathogenesis of knee osteoarthritis (OA). Little is known about knee laxity and stiffness prior to knee OA onset. We investigated knee joint angular laxity and passive stiffness in meniscectomized patients at high risk of knee OA compared with healthy controls. Sixty patients meniscectomized for a medial meniscal tear (52 men, 41.4 ± 5.5 years, 175.3 ± 7.9 cm, 83.6 ± 12.8 kg, mean ± SD) and 21 healthy controls (18 men, 42.0 ± 6.7 years, 176.8 ± 5.7 cm, 77.8 ± 13.4 kg) had their knee joint angular laxity and passive stiffness assessed twice ~2.3 years apart. Linear regression models including age, sex, height and body mass as covariates in the adjusted model were used to assess differences between groups. Greater knee joint varus (-10.1 vs. -7.3°, pknee joint angular laxity and reduced passive stiffness ~3 months post surgery compared with controls. In addition, the results indicated that knee joint laxity may increase over time in meniscectomized patients. Copyright © 2014 Elsevier B.V. All rights reserved.

Valgus Slipped Capital Femoral Epiphysis in Patient with Hypopituitarism

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Yoshihiro Kotoura

2017-01-01

Full Text Available Slipped capital femoral epiphysis (SCFE is a common disease of adolescent and the epiphysis is positioned more posteromedially in relation to the femoral neck shaft with varus SCFE; however, posterolateral displacement of the capital epiphysis, valgus SCFE, occurs less frequently. We report a case of valgus SCFE in a 17-year-old boy with hypopituitarism. After falling down, he experienced difficulty in walking. The radiographs were inconclusive; however three-dimensional computed tomography images showed lateral displacement of the epiphysis on the right femoral head. Valgus SCFE was diagnosed. The patient underwent in situ pinning of both sides. In situ pinning on the left side was performed as a prophylactic pinning because of endocrine abnormalities. At the 1-year follow-up, he could walk without any difficulty and there were no signs of pain. The epiphysis is commonly positioned more posteromedially in relation to the femoral neck shaft with most SCFE, but, in this case, the epiphysis slipped laterally. Differential diagnosis included femoral neck fracture (Delbet-Colonna type 1; however, this was less likely due to the absence of other clinical signs. Therefore, we diagnosed the patient as SCFE. When children complain of leg pain and limp, valgus SCFE that may not be visualized on anteroposterior radiographs needs to be considered.

Geometrical analysis of stemless shoulder arthroplasty: a radiological study of seventy TESS total shoulder prostheses.

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Kadum, Bakir; Hassany, Hamid; Wadsten, Mats; Sayed-Noor, Arkan; Sjödén, Göran

2016-04-01

The aim of this study was to investigate the ability of a stemless shoulder prosthesis to restore shoulder anatomy in relation to premorbid anatomy. This prospective study was performed between May 2007 and December 2013. The inclusion criteria were patients with primary osteoarthritis (OA) who had undergone stemless total anatomic shoulder arthroplasty. Radiographic measurements were done on anteroposterior X-ray views of the glenohumeral joint. Sixty-nine patients (70 shoulders) were included in the study. The mean difference between premorbid centre of rotation (COR) and post-operative COR was 1 ± 2 mm (range -3 to 5.8 mm). The mean difference between premorbid humeral head height (HH) and post-operative HH was -1 ± 3 mm (range -9.7 to 8.5 mm). The mean difference between premorbid neck-shaft angle (NSA) and post-operative NSA was -3 ± 12° (range -26 to 20°). Stemless implants could be of help to reconstruct the shoulder anatomy. This study shows that there are some challenges to be addressed when attempting to ensure optimal implant positioning. The critical step is to determine the correct level of bone cut to avoid varus or valgus humeral head inclination and ensure correct head size.

Therapeutic compliance of first line disease-modifying therapies in patients with multiple sclerosis. COMPLIANCE Study.

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Saiz, A; Mora, S; Blanco, J

2015-05-01

Non-adherence to disease-modifying therapies (DMTs) in multiple sclerosis may be associated with reduced efficacy. We assessed compliance, the reasons for non-compliance, treatment satisfaction, and quality of life (QoL) of patients treated with first-line therapies. A cross-sectional, multicenter study was conducted that included relapsing multiple sclerosis patients. Compliance in the past month was assessed using Morisky-Green test. Seasonal compliance and reasons for non-compliance were assessed by an ad-hoc questionnaire. Treatment satisfaction and QoL were evaluated by means of TSQM and PRIMUS questionnaires. A total of 220 patients were evaluated (91% relapsing-remitting); the mean age was 39.1 years, 70% were female, and the average time under treatment was 5.4 years. Subcutaneous interferon (IFN) β-1b was used in 23% of the patients, intramuscular IFN β-1a in 21%, subcutaneous IFN β-1a in 37%, and with glatiramer acetate in 19%. The overall compliance was 75%, with no significant differences related to the therapy, and 81% did not report any seasonal variation. Compliant patients had significantly lower disability scores and time of diagnosis, and greater satisfaction with treatment and its effectiveness. Discomfort and flu-like symptoms were the most frequent reasons for non-compliance. The satisfaction and QoL were associated with less disability and number of therapeutic switches. The rate of compliance, satisfaction and QoL in multiple sclerosis patients under DMTs is high, especially for those newly diagnosed, less disabled, and with fewer therapeutic switches. Discomfort and flu-like symptoms associated with injected therapies significantly affect adherence. Copyright © 2013 Sociedad Española de Neurología. Published by Elsevier España, S.L.U. All rights reserved.

Sexuality as a promotion of Power: How the Chief Wife becomes a Means of Persuasion in the Vedic Rhetoric on Kingship

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Marianna Ferrara

2017-07-01

Full Text Available In the ancient South Asian texts about ritual known as Saṃhitās and Brāhmaṇas, the wives of the king play an interesting role in terms of bodily actions and ritual rhetoric. Especially the so-called “chief wife” (mahiṣī is described as a central and liminal player who serves as a sexual counterpart of the king at the main solemn rituals, i.e. Aśvamedha and Rājasūya, involving the travel of a horse in unconquered lands and the royal consecration, respectively. In this essay I suggest that the construction of female sexuality is a crucial point to fix the boundaries around the notion of authority, not only that of the king, but also that of his practitioner, i.e. the brāhmaṇa or purohita. From this starting point I suggest also that the chief wife of the king may be reconsidered as one of the most strategic actor on a ritual and political stage. I will try to show that the mahiṣī’s sexual function in the ritual exegesis had gained value, in connection with the attempt to deify the human primus inter pares of the political organisation, i.e. the king. More specifically, I will deal with the ritual language and codification concerning the mahiṣī’s sexuality in order to illustrate the formulation of her body in the rituals prescribed in the Brāhmaṇas about solemn rites. I will discuss how the persuasive force of description and prescription about her bodily actions served as a means of persuasion in displaying the king’s power. Finally, I suggest rethinking the role of gender in royal rituals from the perspective of literary criticism.

SU-E-T-611: Photon and Neutron Peripheral Dose Ratio for Low (6 MV) and High (15 MV) Energy for Treatment Selection

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Irazola, L; Sanchez-Doblado, F [Departamento de Fisiologia Medica y Biofisica, Universidad de Seville (Spain); Servicio de Radiofisica, Hospital Universitario Virgen Macarena, Seville (Spain); Terron, J; Ortiz-Seidel, M [Servicio de Radiofisica, Hospital Universitario Virgen Macarena, Seville (Spain); Departamento de Fisiologia Medica y Biofisica, Universidad de Seville (Spain); Sanchez-Nieto, B [Instituto de Fisica, Pontificia Universidad Catolica de Chile, Santiago (Chile)

2015-06-15

Purpose: Differences between radiotherapy techniques and energies, can offer improvements in tumor coverage and organs at risk preservation. However, a more complete decision should include peripheral doses delivered to the patient. The purpose of this work is the balance of photon and neutron peripheral doses for a prostate case solved with 6 different treatment modalities. Methods: Inverse and Forward IMRT and 3D-CRT in 6 and 15 MV for a Siemens Primus linac, using the same CT data set and contours. The methodology described in [1], was used with the TNRD thermal neutron detector [2] for neutron peripheral dose estimation at 7 relevant organs (colon, esophagus, stomach, liver, lung, thyroid and skin). Photon doses were estimated for these organs by terms of the algorithm proposed in [3]. Plans were optimized with the same restrictions and limited to 30 segments in the Inverse case. Results: A similar photon peripheral dose was found comparing 6 and 15 MV cases with slightly higher values of (1.9 ± 1.6) % in mean, for the 6 MV cases. Neutron presence when using 15 MV, represents an increase in peripheral dose of (18 ± 17) % in average. Due to the higher number of MU used in Inverse IMRT, an increasing of (22 ± 3) % in neutron dose is found related to Forward and 3D-CRT plans. This corresponds to photon doses within 44 and 255 mSv along the organs, for a dose prescription of 68 Gy at the isocenter. Conclusion: Neutron and photon peripheral doses for a prostate treatment planified in 6 different techniques have been analyzed. 6 MV plans are slightly more demanding in terms of photon peripheral doses. Inverse technique in 15 MV has Result to be the most demanding one in terms of total peripheral doses, including neutrons and photons.

Intestinal morphological effect of brachytherapy of low rate of dose, administrated in therapeutic form and its clinical manifestations in uterine cervix tumors

International Nuclear Information System (INIS)

Mendoza, Carmen; Contreras, Manuel

2005-01-01

Brachytherapy is effective to eradicate cancer in the cervix, in order to obtain the control of disease we use high dose with vesical and rectum toxicity. The objective is to investigate if brachytherapy by itself is the cause of intestinal damage, to know in addition if the intensity of the clinic manifestations is in direct relation to the given radiation dose and this gets worse when it is received in several applications. Hypothesis: The intensity of the radiation with brachytherapy of low rate of dose is proportional to the degree of clinical manifestations and morphologic damage of the intestine. A prospective analysis was made inpatients with cancer of cervix from september 2000 to june 2004. Each patient who enters to the department of brachytherapy of the hospital must be done laboratory examination that includes plaque and coagulation test before being accepted. We use the clinical card and a table in order to register data concerning teletherapy, implants of brachytherapy of low rate of dose, symptoms of intestinal toxicity and details of colonoscopia. Subsequent to the hospitable discharge the patient is sent to gastroenterology for clinical evaluation and to realize colonoscopia. From september 2000 to june 2004, 540 patients entered, 80 patients (15%) displayed intestinal manifestations, all received teletherapy and brachytherapy, nobody else received brachytherapy in exclusive form and only one patient (0.1%) received the total of the dose in 2 applications. The equipment of teletherapy Primus with energy of 6 and 18 Mv and implants of brachytherapy Manchester were used (70/55 patients). 79 (98%) patients received dose between 85-75 Gy in one single application, 58 (72%) received the total of the dose to the tumor, 21 (26%) in vaginal mucosa. Discussion: Brachytherapy is the cause of the damages in the intestinal mucosa. (The author)

Comparative usability of modern anaesthesia ventilators: a human factors study.

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Spaeth, J; Schweizer, T; Schmutz, A; Buerkle, H; Schumann, S

2017-11-01

The anaesthesia ventilator represents the key equipment for intraoperative respiratory care. Improper operation of this device may threaten a patient's health. A self-explanatory interface facilitates handling and decreases the risk of operating errors. This study systematically evaluates the usability of user interfaces in four modern anaesthesia ventilators. Twenty naïve operators were asked to execute 20 tasks on each of four different anaesthesia ventilators (Avance CS2™, GE Healthcare; Flow-i™, Maquet; and Perseus™ and Primus™, Dräger) in a randomized order. The success of task execution, frequency of requests for assistance, and processing times were recorded. During the tasks, the operators' visual focus was measured via eye-tracking. Additionally, subjective assessments of usability were evaluated by a standardized questionnaire. For comparison, six experienced operators undertook the same protocol. The overall rate of falsely executed tasks was low. Naïve operators requested assistance least when using the Perseus (26). Pooled processing times were shortest for the Perseus (222 s), followed by the Primus (223 s), the Avance (238 s), and the Flow-i (353 s). Task-specific processing times differed considerably between the devices. Eye-tracking analyses revealed associated interface issues that impeded the operators' performance. Operators rated usability best for the Perseus [mean (sd): 67 (17) arbitrary units] and worst for the Flow-i [50 (16) arbitrary units]. Results from experienced operators support these findings by trend. The usability of modern anaesthesia ventilators differs considerably. Interface issues of specific tasks impair the operator's efficiency. Eliminating the specific usability issues might improve the operator's performance and, as a consequence, the patient's safety. © The Author 2017. Published by Oxford University Press on behalf of the British Journal of Anaesthesia. All rights reserved. For Permissions, please

Investigation of optimal scanning protocol for X-ray computed tomography polymer gel dosimetry

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Sellakumar, P. [Bangalore Institute of Oncology, 44-45/2, II Cross, RRMR Extension, Bangalore 560 027 (India)], E-mail: psellakumar@rediffmail.com; James Jebaseelan Samuel, E. [School of Science and Humanities, VIT University, Vellore 632 014 (India); Supe, Sanjay S. [Department of Radiation Physics, Kidwai Memorial Institute of Oncology, Hosur Road, Bangalore 560 027 (India)

2007-11-15

X-ray computed tomography is one of the potential tool used to evaluate the polymer gel dosimeters in three dimensions. The purpose of this study is to investigate the factors which affect the image noise for X-ray CT polymer gel dosimetry. A cylindrical water filled phantom was imaged with single slice Siemens Somatom Emotion CT scanner. The imaging parameters like tube voltage, tube current, slice scan time, slice thickness and reconstruction algorithm were varied independently to study the dependence of noise on each other. Reductions of noise with number of images to be averaged and spatial uniformity of the image were also investigated. Normoxic polymer gel PAGAT was manufactured and irradiated using Siemens Primus linear accelerator. The radiation induced change in CT number was evaluated using X-ray CT scanner. From this study it is clear that image noise is reduced with increase in tube voltage, tube current, slice scan time, slice thickness and also reduced with increasing the number of images averaged. However to reduce the tube load and total scan time, it was concluded that tube voltage of 130 kV, tube current of 200 mA, scan time of 1.5 s, slice thickness of 3 mm for high dose gradient and 5 mm for low dose gradient were optimal scanning protocols for this scanner. Optimum number of images to be averaged was concluded to be 25 for X-ray CT polymer gel dosimetry. Choice of reconstruction algorithm was also critical. From the study it is also clear that CT number increase with imaging tube voltage and shows the energy dependency of polymer gel dosimeter. Hence for evaluation of polymer gel dosimeters with X-ray CT scanner needs the optimization of scanning protocols to reduce the image noise.

PHOTOMETRIC REDSHIFT PROBABILITY DISTRIBUTIONS FOR GALAXIES IN THE SDSS DR8

International Nuclear Information System (INIS)

Sheldon, Erin S.; Cunha, Carlos E.; Mandelbaum, Rachel; Brinkmann, J.; Weaver, Benjamin A.

2012-01-01

We present redshift probability distributions for galaxies in the Sloan Digital Sky Survey (SDSS) Data Release 8 imaging data. We used the nearest-neighbor weighting algorithm to derive the ensemble redshift distribution N(z), and individual redshift probability distributions P(z) for galaxies with r < 21.8 and u < 29.0. As part of this technique, we calculated weights for a set of training galaxies with known redshifts such that their density distribution in five-dimensional color-magnitude space was proportional to that of the photometry-only sample, producing a nearly fair sample in that space. We estimated the ensemble N(z) of the photometric sample by constructing a weighted histogram of the training-set redshifts. We derived P(z)'s for individual objects by using training-set objects from the local color-magnitude space around each photometric object. Using the P(z) for each galaxy can reduce the statistical error in measurements that depend on the redshifts of individual galaxies. The spectroscopic training sample is substantially larger than that used for the DR7 release. The newly added PRIMUS catalog is now the most important training set used in this analysis by a wide margin. We expect the primary sources of error in the N(z) reconstruction to be sample variance and spectroscopic failures: The training sets are drawn from relatively small volumes of space, and some samples have large incompleteness. Using simulations we estimated the uncertainty in N(z) due to sample variance at a given redshift to be ∼10%-15%. The uncertainty on calculations incorporating N(z) or P(z) depends on how they are used; we discuss the case of weak lensing measurements. The P(z) catalog is publicly available from the SDSS Web site.

SU-F-T-490: Separating Effects Influencing Detector Response in Small MV Photon Fields

Energy Technology Data Exchange (ETDEWEB)

Wegener, S; Sauer, O [University of Wuerzburg, Wuerzburg (Germany)

2016-06-15

Purpose: Different detector properties influence their responses especially in field sizes below the lateral electron range. Due to the finite active volume, the detector density and electron perturbation at other structural parts, the response factor is in general field size dependent. We aimed to visualize and separate the main effects contributing to detector behavior for a variety of detector types. This was achieved in an experimental setup, shielding the field center. Thus, effects caused by scattered radiation could be examined separately. Methods: Signal ratios for field sizes down to 8 mm (SSD 90 cm, water depth 10 cm) of a 6MV beam from a Siemens Primus LINAC were recorded with several detectors: PTW microDiamond and PinPoint ionization chamber, shielded diodes (PTW P-60008, IBA PFD and SNC Edge) and unshielded diodes (PTW E-60012 and IBA SFD). Measurements were carried out in open fields and with an aluminum pole of 4 mm diameter as a central block. The geometric volume effect was calculated from profiles obtained with Gafchromic EBT3 film, evaluated using FilmQA Pro software (Ashland, USA). Results: Volume corrections were 1.7% at maximum. After correction, in small open fields, unshielded diodes showed a lower response than the diamond, i.e. diamond detector over-response seems to be higher than that for unshielded diodes. Beneath the block, this behavior was amplified by a factor of 2. For the shielded diodes, the overresponse for small open fields could be confirmed. However their lateral response behavior was strongly type dependent, e.g. the signal ratio dropped from 1.02 to 0.98 for the P-60008 diode. Conclusion: The lateral detector response was experimentally examined. Detector volume and density alone do not fully account for the field size dependence of detector response. Detector construction details play a major role, especially for shielded diodes.

O tamanho do ovo não prediz o desenvolvimento físico de avestruzes (Struthio camelus aos quinze dias de idade The size of the egg does not predict the physical development of ostriches (Struthio camelus at fifteen days old

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Adriano Braga Brasileiro de Alvarenga

2008-06-01

Full Text Available O tamanho dos ovos está relacionado com a sobrevivência e o crescimento de filhotes de aves precociais. A inter-relação entre ovo e filhote pode ser importante para a produção animal, fornecendo subsídios para decisões estratégicas de economia, manejo e bem-estar animal. Este estudo analisou a relação entre o peso dos ovos antes da incubação e o desenvolvimento de filhotes de avestruzes (N=48 aos quinze dias de idade. Os filhotes foram criados em grupos, em berçários, com alimentação comercial e sem cuidado parental. Nos filhotes, mensurou-se o peso, a altura da cernelha e o comprimento do tarso-metatarso. Houve uma significativa diferença nos pesos dos ovos, mas as medidas corporais equivalentes dos filhotes não foram estatisticamente diferentes. Em concordância com estudos em outras espécies de aves, o peso do ovo não parece influenciar o crescimento dos filhotes de avestruzes até os 15 dias de vida, em avestruzes.The size of the eggs is related to survival and chick growth in precocial birds. The interrelationship between egg and chick development can be important for the animal production, supplying data for strategic decisions of economy, handling and animal welfare. This study analyzed the relation between the weight of the eggs and the development of ostrich chicks (N=48 at age of fifteen days old. The chicks were kept in indoor nurseries, in groups, without parental care, and fed commercial feed. It was recorded the weight, the back height and the length of the tarsus-metatarsus. There was a significant difference in the weight of the eggs, but the correspondent body chicken measures were not statistically different. In agreement to the studies in other species of birds, the weight of the egg does not seem to influence the growth of the ostriches at fifteen days old.

Handheld mechanical nociceptive threshold testing in dairy cows – intra-individual variation, inter-observer agreement and variation over time

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Raundal, Peter M; Andersen, Pia H; Toft, Nils; Forkman, Björn; Munksgaard, Lene; Herskin, Mette S

2014-01-01

Objective To examine the use of handheld methodology to assess mechanical nociceptive threshold (MNT) on cows kept loose-housed. Study design Prospective randomized partial cross-over experimental study. A one-factor (test day) design was used to evaluate MNT over time. Animals One hundred and fifteen healthy, loose-housed Danish Holstein cattle. Methods We evaluated intra-individual variation, inter-observer agreement and variation over time of MNT using two handheld devices and two stimulation sites. Mechanical, ramped stimulations were performed with an algometer (6.5 mm diameter steel probe, 0–10.0 kgf) or an electronic von Frey device (plastic tip with diameter 0.8 mm, 0–1000 gf). Each cow received 5–6 consecutive stimulations within a 2 × 5 cm skin area on the dorsal or lateral aspect of the left third metatarsus until an avoidance reaction occurred. We investigated the difference in precision [expressed as coefficient of variation (CV)] between the combinations of devices and stimulation sites. The inter-observer agreement and the difference in MNT between test day 1, 3, 7, 10 and 24 were investigated for selected combinations. Data were analysed in mixed models and Bland-Altman as relevant. Results The CVs did not differ [range 0.34–0.52 (p = 0.1)]. Difference between observers (95% limits) was 0.2 kgf (2.8) and 4 gf (369) for the algometer and von Frey device, respectively. Mechanical nociceptive threshold increased from 361 on test day one to 495 gf on test day 24 (p < 0.01). Conclusion and clinical relevance All methods showed a high degree of intra-individual variation, and no combination of device and stimulation site showed superior precision. Mean difference between observers was low, and MNT was not consistent over time. Further development of the methods is required before they can be used in research to investigate possible relations between claw lesions and hyperalgesia. PMID:24734991

Handheld mechanical nociceptive threshold testing in dairy cows - intra-individual variation, inter-observer agreement and variation over time.

Science.gov (United States)

Raundal, Peter M; Andersen, Pia H; Toft, Nils; Forkman, Björn; Munksgaard, Lene; Herskin, Mette S

2014-11-01

To examine the use of handheld methodology to assess mechanical nociceptive threshold (MNT) on cows kept loose-housed. Prospective randomized partial cross-over experimental study. A one-factor (test day) design was used to evaluate MNT over time. One hundred and fifteen healthy, loose-housed Danish Holstein cattle. We evaluated intra-individual variation, inter-observer agreement and variation over time of MNT using two handheld devices and two stimulation sites. Mechanical, ramped stimulations were performed with an algometer (6.5 mm diameter steel probe, 0-10.0 kgf) or an electronic von Frey device (plastic tip with diameter 0.8 mm, 0-1000 gf). Each cow received 5-6 consecutive stimulations within a 2 × 5 cm skin area on the dorsal or lateral aspect of the left third metatarsus until an avoidance reaction occurred. We investigated the difference in precision [expressed as coefficient of variation (CV)] between the combinations of devices and stimulation sites. The inter-observer agreement and the difference in MNT between test day 1, 3, 7, 10 and 24 were investigated for selected combinations. Data were analysed in mixed models and Bland-Altman as relevant. The CVs did not differ [range 0.34-0.52 (p = 0.1)]. Difference between observers (95% limits) was 0.2 kgf (2.8) and 4 gf (369) for the algometer and von Frey device, respectively. Mechanical nociceptive threshold increased from 361 on test day one to 495 gf on test day 24 (p < 0.01). All methods showed a high degree of intra-individual variation, and no combination of device and stimulation site showed superior precision. Mean difference between observers was low, and MNT was not consistent over time. Further development of the methods is required before they can be used in research to investigate possible relations between claw lesions and hyperalgesia. © 2014 The Authors Veterinary Anaesthesia and Analgesia published by John Wiley & Sons Ltd on behalf of Association of Veterinary Anaesthetists and the

Changes in thermal nociceptive responses in dairy cows following experimentally induced Escherichia coli mastitis

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Klaas Ilka C

2011-05-01

Full Text Available Abstract Background Mastitis is a high incidence disease in dairy cows. The acute stage is considered painful and inflammation can lead to hyperalgesia and thereby contribute to decreased welfare. The aim of this study was to examine changes in nociceptive responses toward cutaneous nociceptive laser stimulation (NLS in dairy cows with experimentally induced Escherichia coli mastitis, and correlate behavioral changes in nociceptive responses to clinical and paraclinical variables. Methods Seven Danish Holstein-Friesian cows were kept in tie-stalls, where the E. coli associated mastitis was induced and laser stimulations were conducted. Measurements of rectal temperature, somatic cell counts, white blood cell counts and E. coli counts were conducted. Furthermore, scores were given for anorexia, local udder inflammation and milk appearance to quantify the local and systemic disease response. In order to quantify the nociceptive threshold, behavioral responses toward cutaneous NLS applied to six skin areas at the tarsus/metatarsus and udder hind quarters were registered at evening milking on day 0 (control and days 1, 2, 3, 6 and 10 after experimental induction of mastitis. Results All clinical and paraclinical variables were affected by the induced mastitis. All cows were clinically ill on days 1 and 2. The cows responded behaviorally toward the NLS. For hind leg stimulation, the proportion of cows responding by stepping was higher on day 0 than days 3 and 6, and the frequency of leg movements after laser stimulation tended to decrease on day 1 compared to the other days. After udder stimulation, the proportion of cows responding by stepping was higher on day 1 than on all other days of testing. Significant correlations between the clinical and paraclinical variables of disease and the behavioral responses toward nociceptive stimulation were found. Conclusions Changes in behavioral responses coincide with peaks in local and systemic signs of E

[Combined closing-wedge high tibial osteotomy with arthroscopy for varus knee and medial compartment osteoarthritis: clinical results at a minimum follow-up for five years].

Science.gov (United States)

Liu, Jin-Song; Li, Zhi-Yao

2013-09-01

To study the results of closing-wedge high tibial osteotomy and arthroscopy for the treatment of medial compartment osteoarthritis of the knee. From October 2005 to June 2007, 25 patients met with our inclusion criteria. All the patients with medial compartment knee osteoarthritis were treated with arthroscopy and closing-wedge high tibial osteotomy. There were 11 males and 14 females,with a mean age of 53 years old. The pre-operative HSS knee score was 67.6 +/- 2.8, FTA was (185.54 +/- 1.11) degrees, and aLPTA was (96.54 +/- 0.52) degrees in average. The patients were followed up and evaluated according to HSS knee score. The efficacy of the osteotomy was evaluated by FTA and aLPTA. All surgeries were successful without serious complication. All the patients were followed up, and the duration ranged from 5 to 7 years. The HSS was 85.5 +/- 3.7 at the 1st year and 80.3 +/- 5.4 at the latest follow-up. There was significant difference between every two scores of before operation and the two after operation (t = -33.135, P = 0.000; t = -13.215, P = 0.000). The FTA was (173.65 +/- 0.92) degrees at the 1st year and (174.34 +/- 0.53) degrees at the latest follow-up. There was significant difference between every two angles of before operation and after operation (t = 28.739, P = 0.000; t = 2.331, P = 0.048). The aLPTA was (87.32 +/- 0.33) degrees at the 1st year and (87.67 +/- 2.82) degrees at the latest follow-up. There was significant difference between every two angles of before operation and after operation (t = 37.264, P = 0.000; t = 2.469, P = 0.039). Indication is important and good surgical technique is critical for good clinical outcome. A detailed plan before operation is essential for the operation. Arthroscopy is helpful for treating the intra-articular pathology. The osteoarthritis is still in progress but in a slow mode. The combined method of arthroscopy and closing-wedge high tibial osteotomy is a reliable way for medial compartment osteoarthritis of the knee.