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Sample records for non-union scaphoid four-corner

  1. Scaphoid non-unions, where do they come from? The epidemiology and initial presentation of 270 scaphoid non-unions.

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    Reigstad, Ole; Grimsgaard, Christian; Thorkildsen, Rasmus; Reigstad, Astor; Røkkum, Magne

    2012-01-01

    Scaphoid injury and subsequent non-union is a well documented and researched subject. This article gives an overview of the epidemiology and results of the patients we have treated for scaphoid non-union at a University Hospital. 283 scaphoid non-unions in 268 patients (83% men) were operated upon, 230 as a primary and 47 as a secondary. The median age at time of surgery was 27 years. One-third of the non-unions were located in the proximal part of the scaphoid and the remaining two-thirds in the middle part. Of the 146 patients (55%) who contacted a doctor at the time of injury, 53 fractures where diagnosed (20%). Fourteen (5%) were operated primarily while 39 (15%) (seven dislocated) were immobilized in plaster casts. Thirty-two (12%) were under the age of 16 at the time of injury. The average time from the injury to the initial non-union surgery was 1.5 years with 2.8 years to the second procedure. The risk of osteoarthritis increased time from injury to surgery (both primary and secondary procedures). The greatest potential for the reduction of scaphoid non-union is an increased awareness amongst younger men. There is also potential for improved accuracy in the diagnosis of scaphoid fractures (better clinical tests, the use of radiographs, CTs and MRIs) in order to identify the fracture and evaluate dislocation at the initial injury. Early diagnosis and treatment of fractures and non-unions will reduce the development of degenerative wrist changes.

  2. Human scaphoid non-unions exhibit increased osteoclast activity compared to adjacent cancellous bone.

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    Schira, Jessica; Schulte, Matthias; Döbele, Carmen; Wallner, Christoph; Abraham, Stephanie; Daigeler, Adrien; Kneser, Ulrich; Lehnhardt, Marcus; Behr, Björn

    2015-12-01

    Scaphoid bones have a high prevalence for non-union. Even with adequate treatment, bone regeneration may not occur in certain instances. Although this condition is well described, the molecular pathology of scaphoid non-unions is still poorly defined. In this study, gene expression of osteogenic and angiogenic growth and transcription factors as well as inflammatory mediators were analysed in human scaphoid non-unions and intraindividually compared to adjacent autologous cancellous bone from the distal radius. In addition, histology and immunohistochemical stainings were performed to verify qRT-PCR data. Gene expression analysis revealed a significant up-regulation of RANKL, ALP, CYCLIN D1, MMP-13, OPG, NFATc1, TGF-β and WNT5A in scaphoid non-unions. Interestingly, RANKL and NFATc1, both markers for osteoclastogenesis, were significantly induced in non-unions. Moreover, WNT5A was highly up-regulated in all non-union samples. TRAP staining confirmed the observation of induced osteoclastogenesis in non-unions. With respect to genes related to osteogenesis, alkaline phosphatase was significantly up-regulated in scaphoid non-unions. No differences were detectable for other osteogenic genes such as RUNX-2 or BMP-2. Importantly, we did not detect differences in angiogenesis between scaphoid non-unions and controls in both gene expression and immunohistochemistry. Summarized, our data indicate increased osteoclast activity in scaphoid non-unions possibly as a result of the alterations in RANKL, TGF-β and WNT5A expression levels. These data increase our understanding for the reduced bone regeneration capacity present in scaphoid non-unions and may translate into the identification of new therapeutic targets to avoid secondary damages and prevent occurrence of non-unions to scaphoid bones. © 2015 The Authors. Journal of Cellular and Molecular Medicine published by John Wiley & Sons Ltd and Foundation for Cellular and Molecular Medicine.

  3. Management of a 15-year-old scaphoid non-union.

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    Wong, Kai Yuen; Sharp, Olivia; Johnston, Phillip

    2018-01-04

    Scaphoid non-union affects wrist joint function and is often associated with a predictable pattern of degenerative change. A 30-year-old man presented with a symptomatic 15-year-old right scaphoid fracture with secondary scaphoid non-union advanced collapse of his right wrist. There was no evidence of avascular necrosis. The initial injury was from a fall onto his outstretched hand. We performed a right scaphoid open reduction, internal fixation and iliac crest bone graft. One year after the operation, the patient had good wrist function and grip strength. A CT scan showed union of the fracture. Studies have shown that if the time between initial fracture and treatment of non-union exceeds 5 years, the chances of healing of the non-union are markedly reduced. In our case, despite the long duration between timing of injury and surgery, there was union and good return of function. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  4. Analysis of deformity in scaphoid non-unions using two- and three-dimensional imaging.

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    Ten Berg, P W L; Dobbe, J G G; Horbach, S E R; Gerards, R M; Strackee, S D; Streekstra, G J

    2016-09-01

    Pre-operative assessment of the deformity in scaphoid non-unions influences surgical decision-making. To characterize deformity, we used three-dimensional computed tomographic modelling in 28 scaphoid non-unions, and quantified bone loss, dorsal osteophyte volume and flexion deformity. We further related these three-dimensional parameters to the intrascaphoid and capitate-lunate angles, and stage of scaphoid non-union advanced collapse assessed on conventional two-dimensional images and to the chosen surgical procedure. Three-dimensional flexion deformity (mean 26°) did not correlate with intrascaphoid and capitate-lunate angles. Osteophyte volume was positively correlated with bone loss and stage of scaphoid non-union advanced collapse. Osteophyte volume and bone loss increased over time. Three-dimensional modelling enables the quantification of bone loss and osteophyte volume, which may be valuable parameters in the characterization of deformity and subsequent decision-making about treatment, when taken in addition to the clinical aspects and level of osteoarthritis. Level IV. © The Author(s) 2015.

  5. Prognostic factors in the treatment of carpal scaphoid non-unions.

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    Schuind, F; Moungondo, F; El Kazzi, W

    2017-01-01

    In this literature review, the authors analyse the prognostic factors in the curative treatment of scaphoid non-unions. The main negative prognostic factors are smoking, the time elapsed since the fracture, and avascular necrosis of the proximal fragment. If the latter is present, the revascularization by a pedicle or microsurgical bone autograft is probably the treatment of choice. In non-unions without evidence of osteonecrosis, vascularized bone grafts are probably not superior to conventional bone grafts, which can presently be performed under arthroscopic control, with minimal morbidity.

  6. A modified Matti-Russe technique of grafting scaphoid non-unions.

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    Dustmann, Moritz; Bajinski, Ralf; Tripp, Alexander; Gülke, Joachim; Wachter, Nikolaus

    2017-06-01

    In treatment of scaphoid non-union bone healing requires beside vital tissue and stability, enduring compression and a good interface between the graft and scaphoid fragments. While fixation techniques show a good primary stability, they reduce sintering and thus compression of fragments in the long term. Therefore, a modified technique optimising the cancellous interface between graft and scaphoid but still providing enough stability without fixating implants should be evaluated. A corticocancellous bone graft from iliac crest was shaped ellipsoid and was implanted in a modified Matti-Russe press fit-technique. Thereby the cancellous side contacts the scaphoid fragments. In a retrospective design, we reviewed 52 patients with documented non-unions of the scaphoid. The average length of follow-up was 8.6 months. Range-of-motion, pain and grip-strength was measured and compared with contralateral wrist. Radiological assessment included beside X-rays CT scans. Results were further measured by DASH score and Mayo wrist score. The average postoperative pain was 0.9 based on NRS-Score. The mean range-of-motion was satisfactory with a dorsal-palmar arch of 115.3°, radial-ulnar: 48.2° and pro-supination: 171.3°. Mayo Wrist Score showed with 91.2 out of 100 an excellent result. The analysis of DASH score revealed a mild subjective constriction (9.2/100). Regarding roentgenographic findings complete union was confirmed in 44 of the 52 patients (84.6%). Patients with non-union were significantly older than patients with union (p < 0.05). Grip-strength on average was equal to that of the uninjured hand although in failure cases a slightly reduced grip-strength was seen. The modified technique of Matti-Russe provided a good contact of the cancellous part of the bone graft to the scaphoid in grafting a scaphoid pseudarthrosis with a high healing rate. However, since age, previous failed surgery and a proximal fracture line are the most important handicaps for bone

  7. What is the Optimal Treatment of Atrophic Scaphoid Non-Union?

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    Alper Cirakli

    2016-09-01

    Full Text Available Aim: To evaluate the efficacy of the treatment method of autogenous iliac wing or radius bone graft and fixation with screw applied to cases of scaphoid non-union. Material and Method: A retrospective evaluation was made of 89 cases between 2000 and 2014. Postoperative measurements were taken of both wrists%u2019 movement with a goniometer and muscle strength was assessed with a dynamometer. Fractures were evaluated radiologically according to the Herbert-Fisher System and the functional results according to the Herbert-Fisher Classification System and the Mayo Clinic Modified Wrist Scoring System. The data were input to the SPSS system and evaluated with the Shapiro-Wilk test. Results: Non-union were on the right side in 47 and the left side in 42 cases. The fracture was seen to be in the waist in 60 cases (67.5%, in the proximal third in 27 cases (30.3% and in the distal third in two cases (2.2%. The mean follow-up period was 16.4 months (range, 5-72 months. Definitive findings of union were observed in 71 cases. The mean time to union was 14.9 weeks (range, 8-40 weeks. Discussion: The grafting procedure applied is an invasive technique but if it is considered that there are negative effects of open surgery on the feeding of the scaphoid bone, then in the treatment of scaphoid non-union which is atrophic non-union, ultimately autogenous bone grafting and screw fixation is a safe and successful method and because of the pain created by an iliac wing graft, radius distal bone graft can be considered more appropriate.

  8. Time-dependent changes in bone healing capacity of scaphoid fractures and non-unions.

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    Schmidle, Gernot; Ebner, Hannes Leonhard; Klima, Günter; Pfaller, Kristian; Fritz, Josef; Hoermann, Romed; Gabl, Markus

    2018-02-27

    The scaphoid is the most frequently fractured carpal bone and prone to non-union due to mechanical and biological factors. Whereas the importance of stability is well documented, the evaluation of biological activity is mostly limited to the assessment of vascularity. The purpose of this study was to select histological and immunocytochemical parameters that could be used to assess healing potential after scaphoid fractures and to correlate these findings with time intervals after fracture for the three parts of the scaphoid (distal, gap and proximal). Samples were taken during operative intervention in 33 patients with delayed or non-union of the scaphoid. Haematoxylin and Eosin (HE), Azan, Toluidine, von Kossa and Tartrate-resistant acid phosphatase (TRAP) staining were used to characterise the samples histologically. We determined distribution of collagen 1 and 2 by immunocytochemistry, and scanning electron microscopy (SEM) was used to investigate the ultrastructure. To analyse the samples, parameters for biological healing status were defined and grouped according to healing capacity in parameters with high, partial and little biological activity. These findings allowed scoring of biological healing capacity, and the ensuing results were correlated with different time intervals after fracture. The results showed reduced healing capacity over time, but not all parts of the scaphoid were affected in the same way. For the distal fragment, regression analysis showed a statistically significant correlation between summarised healing activity scores and time from initial fracture (r = -0.427, P = 0.026) and decreasing healing activity for the gap region (r = -0.339, P = 0.090). In contrast, the analyses of the proximal parts for all patients did not show a correlation (r = 0.008, P = 0.969) or a decrease in healing capacity, with reduced healing capacity already at early stages. The histological and immunocytochemical characterisation of scaphoid non-unions

  9. Factors Influencing Outcome in the Management of Scaphoid Non-union and Comparison of Matti Russe and Interpositional Grafting Techniques.

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    Kiran, Manish; Persaud, Ian; Jariwala, Arpit; Wigderowitz, Carlos

    2017-09-01

    Scaphoid non-union is often caused due to missed fractures, inadequate or inappropriate management. Matti-Russe and interpositional grafting techniques are used in the treatment of non-union. There are very few studies in literature that compare the outcomes of these techniques. The aim of our study was to analyse the factors influencing outcome in the management of scaphoid non-union and to compare the results of the Matti Russe procedure with interpositional grafting techniques. Fifty scaphoid non-unions with a mean follow-up of 39.9 ± 5.5 months were included in this retrospective study. Demographic parameters, treatment, functional and radiological outcomes were recorded. The influence of demographic and treatment factors on union in this cohort was statistically analysed. Union was achieved in 76% of cases. Good to excellent results were achieved in 84% of patients. There was no significant difference in union rates, deformity correction achieved and period of immobilisation between the MR and IG techniques. The occurrence of arthritic changes correlated with the time interval between injury and surgery (p = 0.002). The most important factor that influences the outcome is the time period between the occurrence of the fracture and surgery for non-union. The Matti-Russe procedure can achieve comparable results to interpositional grafting techniques with a shorter period of immobilisation than previously thought to be required. We believe that the presence of a deformity is not a contraindication for the procedure.

  10. Symptomatic non-union of the carpal scaphoid: Matti-Russe bone grafting versus Herbert screw fixation.

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    Parkinson, R W; Hodgkinson, J P; Hargadon, E J

    1989-05-01

    We have reviewed 19 patients who have had Matti-Russe bone grafting and 16 patients who have had Herbert screw fixation for symptomatic non-union of the carpal scaphoid. The success rate in both groups was similar, 74 per cent in the Matti-Russe group and 71 per cent in the Herbert screw group. Only five patients in the Herbert screw group had bone grafts. The advantages and disadvantages of both methods of treatment are discussed.

  11. Carpal scaphoid non-union treatment: a retrospective trial comparing simple retrograde percutaneous screw fixation versus percutaneous screw fixation plus pulsed electromagnetic fields (Physiostim®).

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    Pereira, Alexis; Hidalgo Díaz, Juan José; Saur, Maurise; Salazar Botero, Santiago; Facca, Sybille; Liverneaux, Philippe

    2017-05-01

    The purpose of this retrospective comparative study was to assess whether a complementary treatment by pulsed electromagnetic field could increase the bone-healing rate of scaphoid non-union without SNAC (scaphoid non-union advanced collapse) treated by retrograde percutaneous screw fixation. Eighteen patients with scaphoid non-union were included in this retrospective study. The group 1 was made of nine cases (seven stage IIA and two stage IIB) of scaphoid non-union treated by retrograde percutaneous screw fixation and pulsed electromagnetic fields (Physiostim ® ). The group 2 was made of nine cases (six stage IIA and three stage IIB) treated by simple retrograde percutaneous screw fixation. With a 10-month follow-up in group 1 and a 9.5-month follow-up in group 2, there were three cases of non-union in group 1 and two cases in group 2. Regarding the type of non-union, there was one case among the stage IIB and four cases among the stage IIA. The results of the study did not show any interest in the use of pulsed electromagnetic field for the treatment of carpal scaphoid non-union. They should be dropped. III.

  12. A new variant of scaphoid reconstruction: Treatment of scaphoid non-union with avascular bone interponate and high compression screw (Synthes

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    Eder, Christian

    2015-08-01

    Full Text Available Scaphoid fractures as frequently overseen injuries often result in scaphoid non-unions, that need to be treated to prevent carpal collapse and secondary cartilage damage. Vital bone tissue and compression of fracture and bone graft ends seem to be crucial in for ossification and final bone healing. In the present study we compare our results using a high compression screw (HCS Synthes to results in the literature using different kinds of internal fixation including compression screws of various types. We present 22 patients with scaphoid non-unions treated with a bone graft and a HCS Synthes. We evaluated our post-operative results. The Manchester-Modified Disability of the Shoulder, Arm and Hand–Score (M-Dash imposed with an average of 29.8 points (MD=29 / SD=9.46 / MIN=18 / MAX=48. None of the re-evaluated patients sorrowed for pain in rest. Five patients stated pain (ranging from 4 to 8 on numeric analogue scale after heavy burden (e.g. boxing, weight lifting.In exploring the range of motion of the operated hand we deliver the following results: dorsal extension: average 72.73° (MD=80° / SD=17.23° / MIN=30° / MAX=85°, flexion: average 73.64° (MD=80° / SD=8.97° / MIN=60° / MAX=80°, ulnar deviation: average 39.09°, (MD=40° / SD=2.02° / MIN=35° / MAX=40°, radial deviation: average 29.09°, (MD=30° / SD=3.01° / MIN=20° / MAX=30°. Additionally a performance testing was conducted: fist clenching sign: complete without pain in 100%, pinch grip: complete in 100%, moderate pain in n=1 (8.33%, opposition digitus manus I–V complete in 100%, moderate pain n=2 (16.67%. Three patients with persisting fracture gap had a scaphoid bone fractured in the proximal third; one patient even with a very small proximal fragment. One persisting non-union was localized in the middle third (period between injury and operation = . In conclusion, our patients showed better healing rates compared to results presented in the literature. Non-unions

  13. Evaluation of bone remodeling in regard to the age of scaphoid non-unions

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    Rein, Susanne; Hanisch, Uwe; Schaller, Hans-Eberhard; Zwipp, Hans; Rammelt, Stefan; Weindel, Stefan

    2016-01-01

    AIM: To analyse bone remodeling in regard to the age of scaphoid non-unions (SNU) with immunohistochemistry. METHODS: Thirty-six patients with symptomatic SNU underwent surgery with resection of the pseudarthrosis. The resected material was evaluated histologically after staining with hematoxylin-eosin (HE), tartrate resistant acid phosphatase (TRAP), CD 68, osteocalcin (OC) and osteopontin (OP). Histological examination was performed in a blinded fashion. RESULTS: The number of multinuclear osteoclasts in the TRAP-staining correlated with the age of the SNU and was significantly higher in younger SNU (P = 0.034; r = 0.75). A higher number of OP-immunoreactive osteoblasts significantly correlated with a higher number of OC-immunoreactive osteoblasts (P = 0.001; r = 0.55). Furthermore, a greater number of OP-immunoreactive osteoblasts correlated significantly with a higher number of OP-immunoreactive multinuclear osteoclasts (P = 0.008; r = 0.43). SNU older than 6 mo showed a significant decrease of the number of fibroblasts (P = 0.04). Smoking and the age of the patients had no influence on bone remodeling in SNU. CONCLUSION: Multinuclear osteoclasts showed a significant decrease in relation to the age of SNU. However, most of the immunhistochemical findings of bone remodeling do not correlate with the age of the SNU. This indicates a permanent imbalance of bone formation and resorption as indicated by a concurrent increase in both osteoblast and osteoclast numbers. A clear histological differentiation into phases of bone remodeling in SNU is not possible. PMID:27458552

  14. Results of percutaneous fixation and distal radius core decompression in scaphoid waist non-unions treated without grafting.

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    Dedeoğlu, S S; İmren, Y; Çabuk, H; Tekin, A C; Türe, Y C; Gürbüz, H

    2018-02-01

    Scaphoid non-union management is still a challenge in clinical practice for orthopaedic surgeons. Though several treatment methods have been described, there is an ongoing debate about optimum management. Based on new concepts about avascular conditions, promising results were reported with metaphyseal decompression of the distal radius by increasing the vascularization of the radial column of the carpus. We aimed to evaluate the clinical, radiological, and functional outcomes of distal radius core decompression and fixation with palmar percutaneous cannulated compression screws without grafting in patients with scaphoid waist fracture non-union. Twenty-nine patients with scaphoid non-union were included in this prospective study. There were 27 male and 2 female patients with an average age of 29 years (range 18-45 years). Mean time from the injury to surgery was 18.3 months. The Slade and Geissler classification was used to classify the non-unions. Wrist range of motion (ROM), pain based on a visual analog scale (VAS), and the Mayo wrist score were used to assess the clinical outcomes. Postoperative radiographs and CT-scans were reviewed to assess fracture union, carpal alignment and screw position. The average clinical follow-up was 76 weeks (range: 74-87 weeks) postoperatively. Mean time to union was 11 weeks (range: 7-18 weeks). There was no humpback/no DISI in any of the cases. Twenty-six patients healed successfully with no additional procedures. Three patients with failed union underwent revision surgery with grafting. At the final follow-up, average wrist ROM was 61° (range: 30-80) in extension and 61° (range: 35-80) in flexion, the average Mayo wrist score was 66±20 (range: 20-90), and the mean VAS was 2±2 (range: 0-7). Percutaneous fixation without grafting associated with distal radius core decompression can provide satisfactory outcomes in surgical management of scaphoid non-unions. II. Copyright © 2017 SFCM. Published by Elsevier Masson SAS. All

  15. A comparison of the use of distal radius vascularised bone graft and non-vascularised iliac crest bone graft in the treatment of non-union of scaphoid fractures.

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    Braga-Silva, J; Peruchi, F M; Moschen, G M; Gehlen, D; Padoin, A V

    2008-10-01

    We compared two surgical techniques for the treatment of scaphoid non-union, namely, using distal radius vascularised bone graft and iliac crest non-vascularised bone graft. Eighty patients with symptomatic scaphoid non-union underwent surgical treatment, including 35 patients treated with distal radius vascularised bone graft and 45 treated by iliac crest non-vascularised bone graft. Patients were assessed objectively by examination of wrist range of motion, grip strength and radiographic findings in the postoperative period after a mean time of 2.8 (1.4) (range 1-5.2) years. Similar functional results were obtained with the two techniques. All cases of non-union in the non-vascularised group obtained consolidation in a mean time of 8.89 (2.26) months and in the vascularised group in a mean time of 7.97 (3.06) months. Three cases of consolidation failure occurred in the vascularised group and were related to technical difficulties.

  16. Effect of four-corner fusion with locking plate without bone graft on functional recovery of the wrist: New treatment guidelines

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    Tielemans, Alexandre; Van Innis, Fernand; Troussel, Serge; Detrembleur, Christine; Libouton, Xavier; Lequint, Thierry

    2017-01-01

    We assessed the effect of four-corner intercarpal fusion with locking plate without bone graft on daily activities and pain in patients with stage II and III scapholunate advanced collapse and scaphoid nonunion. Twenty-one patients who underwent four-corner fusion with scaphoidectomy without bone graft were evaluated with the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Visual Analog Scale (VAS) pain scores before and 16 months after surgery. We also compared postoperative grip ...

  17. Four Corners Television History: Gallipoli and the Fall of Singapore

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    Kevin Blackburn

    2007-08-01

    Full Text Available This article analyses how the Australian current affairs programme, Four Corners, which follows a style modelled on the BBC programme Panorama, has represented Australian military history in two of its programmes, Gallipoli: The Fatal Shore and No Prisoners on Australian deserters at the fall of Singapore. Chris Masters was the reporter on both programmes. These historical documentaries claim to investigate Australian Anzac mythology. Four Corners is noted for its rigorous pursuit of issues in current affairs. Programmes construct argument that the journalists steadfastly pursue in order to ‘expose the truth’. Rather than neutrally representing both sides of a debate, the programmes tend to take the side that the journalists perceive to be in the public interest. Examining how Four Corners has applied its own style of investigative journalism to the Anzac mythology is explored by outlining whether the programmes follow Ken Burn’s ideas of documentary-makers as ‘tribal story-teller’ crafting stories that uphold national identity or Bill Nichols’ view that documentary is an argument that is representative of reality rather than reflects reality. Examining the history of Gallipoli and the fall of Singapore in the Four Corners programmes tends suggest that the journalists working on the programmes preferred to reaffirm the assumptions of the Anzac legend, but attack or ignore historians and evidence that questions it. The programmes appear to be a mixture of Burns’s and Nichols’ ideas of documentary making.

  18. The Four Corners timber harvest and forest products industry, 2007

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    Steven W. Hayes; Todd A. Morgan; Erik C. Berg; Jean M. Daniels; Mike Thompson

    2012-01-01

    This report traces the flow of timber harvested in the "Four Corners" States (Arizona, Colorado, New Mexico, and Utah) during calendar year 2007, describes the composition and operations of the region's primary forest products industry, and quantifies volumes and uses of wood fiber. Historical wood products industry changes are discussed, as well as...

  19. The Four Corners timber harvest and forest products industry, 2002

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    Todd A. Morgan; Thale Dillon; Charles E. Keegan; Alfred L. Chase; Mike T. Thompson

    2006-01-01

    This report traces the flow of timber harvested in the "Four Corners" States (Arizona, Colorado, New Mexico, and Utah) during calendar year 2002, describes the composition and operations of the region's primary forest products industry, and quantifies volumes and uses of wood fiber. Historical wood products industry changes are discussed, as well as...

  20. 40 CFR 81.121 - Four Corners Interstate Air Quality Control Region.

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    2010-07-01

    ... Quality Control Regions § 81.121 Four Corners Interstate Air Quality Control Region. The Four Corners Interstate Air Quality Control Region (Colorado-New Mexico-Utah) has been revised to consist of the... 40 Protection of Environment 17 2010-07-01 2010-07-01 false Four Corners Interstate Air Quality...

  1. Effect of four-corner fusion with locking plate without bone graft on functional recovery of the wrist: New treatment guidelines.

    Science.gov (United States)

    Tielemans, A; Van Innis, F; Troussel, S; Detrembleur, C; Libouton, X; Lequint, T

    2017-06-01

    We assessed the effect of four-corner intercarpal fusion with locking plate without bone graft on daily activities and pain in patients with stage II and III scapholunate advanced collapse and scaphoid nonunion. Twenty-one patients who underwent four-corner fusion with scaphoidectomy without bone graft were evaluated with the Disabilities of the Arm, Shoulder and Hand (QuickDASH) and Visual Analog Scale (VAS) pain scores before and 16 months after surgery. We also compared postoperative grip strength between the operated and the healthy side. A principal component analysis was used to establish the relationship between functional benefit, immobilization period and number of physiotherapy sessions. We compared our results with published data. VAS and QuickDASH scores improved significantly. Loss of strength was observed postoperatively. QuickDASH score improved the most with a short immobilization period. No significant difference was found relative to the literature for follow-up time, range of motion, grip strength and QuickDASH score. All patients had bone fusion after 1 year. Four-corner fusion with locking plate is a procedure that reduces pain and improves functional scores. Our results are equal to those reported in the literature with bone graft. The union rate seemed high despite the absence of bone graft but was only assessed by x rays. This study allowed us to establish a treatment guideline: a shorter immobilization leads to better recovery. Copyright © 2017. Published by Elsevier Masson SAS.

  2. Physics from the four corners of the world

    CERN Multimedia

    2005-01-01

    The field of particle physics is well-known for being a world without frontiers, bringing together researchers of all nationalitie who in spite of their linguistic and cultural differences, work together in the shared pursuit of a fundamental understanding of the universe. On 2nd December, this reality was demonstrated on the internet with a webcast called 'Beyond Einstein', organised by CERN, which for 12 hours brought together physics communities from the four corners of the world. The event, the first of its kind organised on this scale, attracted 30,000 spectators on the Web and in numerous studios. Furthermore, Pakistani national television broadcast all 12 hours of programming, an Italian channel also provided coverage, and many more people tuned in on satellite television. The site of the webcast during the programme from Imperial Colllege London presented by Gareth Mitchell.At Fermilab near Chicago in the US, Nobel-Prize winner Leon Lederman hosted a show called The Late Show with Leon Lederman, feat...

  3. Pulsed Electromagnetic Fields in the treatment of fresh scaphoid fractures. A multicenter, prospective, double blind, placebo controlled, randomized trial.

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    Hannemann, P.; Gottgens, K.W.; Wely, B.J. van; Kolkman, K.A.; Werre, A.J.; Poeze, M.; Brink, P.R.

    2011-01-01

    Abstract Background The scaphoid bone is the most commonly fractured of the carpal bones. In the Netherlands 90% of all carpal fractures is a fracture of the scaphoid bone. The scaphoid has an essential role in functionality of the wrist, acting as a pivot. Complications in healing can result in poor functional outcome. The scaphoid fracture is a troublesome fracture and failure of treatment can result in avascular necrosis (up to 40%), non-union (5-21%) and early osteo-arthritis (up to 32%) ...

  4. Challenging the ‘Four Corner Press’ as framework for invitational leadership in South African schools

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    Rita Niemann

    2010-06-01

    Research purpose: This study challenges the internationally accepted ‘Four Corner Press’ of Purkey and Novak (1984 as a framework for IL in the South African school context. Motivation for the study: IL appears to be a comprehensive model for successful school leadership. This necessitated an investigation to determine whether the ‘Four Corner Press’ reflects the expectations of teachers and, if so, whether it could serve as a valuable leadership tool. Research design, approach and method: A questionnaire containing 31 Likert-scale items, underpinned by the principles of IL, was disseminated to 600 educators conveniently drawn from the population of 88 828 teachers in Free State and Eastern Cape schools. Main findings: The data obtained from the survey enabled the researchers to perform a factor analysis, which revealed that South African educators’ expectations of leadership aligned with the ‘Four Corner Press’. Managerial implications: The ‘Four Corner Press’ can be used as a plausible framework for IL in South African schools, which has implications for the development and training of principals. Contribution/value-add: The ‘Four Corner Press’ can be regarded as a reliable prototype of IL expectations within the South African context, which contributes to extending the body of knowledge of education leadership in South Africa.

  5. Baseline ambient gaseous ammonia concentrations in the Four Corners area and eastern Oklahoma, USA.

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    Sather, Mark E; Mathew, Johnson; Nguyen, Nghia; Lay, John; Golod, George; Vet, Robert; Cotie, Joseph; Hertel, Terry; Aaboe, Erik; Callison, Ryan; Adam, Jacque; Keese, Danielle; Freise, Jeremy; Hathcoat, April; Sakizzie, Brenda; King, Michael; Lee, Chris; Oliva, Sylvia; San Miguel, George; Crow, Leon; Geasland, Frank

    2008-11-01

    Ambient ammonia monitoring using Ogawa passive samplers was conducted in the Four Corners area and eastern Oklahoma, USA during 2007. The resulting data will be useful in the multipollutant management of ozone, nitrogen oxides, and visibility (atmospheric regional haze) in the Four Corners area, an area with growing oil/gas production and increasing coal-based power plant construction. The passive monitoring data also add new ambient ammonia concentration information for the U.S. and will be useful to scientists involved in present and future visibility modeling exercises. Three week integrated passive ammonia samples were taken at five sites in the Four Corners area and two sites in eastern Oklahoma from December, 2006 through December, 2007 (January, 2008 for two sites). Results show significantly higher regional background ammonia concentrations in eastern Oklahoma (1.8 parts per billion (ppb) arithmetic mean) compared to the Four Corners area (0.2 ppb arithmetic mean). Annual mean ammonia concentrations for all Four Corners area sites for the 2007 study ranged from 0.2 ppb to 1.5 ppb. Peak ambient ammonia concentrations occurred in the spring and summer in both areas. The passive samplers deployed at the Stilwell, Oklahoma site compared favorably with other passive samplers and a continuous ammonia monitoring instrument.

  6. [Non-unions. From diagnosis to healing].

    Science.gov (United States)

    Steinhausen, E; Glombitza, M; Böhm, H-J; Hax, P-M; Rixen, D

    2013-07-01

    Non-unions are a relevant medical and socio-economic problem. Hyper-, oligo- and atrophic non-unions as well as septic and aseptic non-unions are differentiated. Correct classification is essential for the selected therapy. The "diamond concept" describes five pillars, on which bone healing is based and that have to be considered in the treatment of non-unions: osteogenic cells (mesenchymal stem cells), osteoinduction (growth factors), osteoconduction (scaffolds), mechanical stability, and vascularization. Factors that predispose to non-union also influence fracture healing. The gold standard of therapy are still resection of the non-union, decortication and autologous bone grafting. No advantage could be proven for any of the numerous procedures in monotherapy. But the combination of various procedures - polytherapy - seems to be promising. The aim is to optimize these concepts.

  7. Magnetic resonance imaging versus bone scintigraphy in suspected scaphoid fracture

    Energy Technology Data Exchange (ETDEWEB)

    Tiel-van Buul, M.M.C. [Dept. of Nuclear Medicine, Academic Medical Center, Univ. of Amsterdam (Netherlands); Roolker, W. [Dept. of Nuclear Medicine, Academic Medical Center, Univ. of Amsterdam (Netherlands); Verbeeten, B.W.B. Jr. [Dept. of Radiology, Academic Medical Center, Univ. of Amsterdam (Netherlands); Broekhuizen, A.H. [Dept. of Traumatology, Academic Medical Center, Univ. of Amsredam (Netherlands)

    1996-08-01

    Magnetic resonance imaging (MRI) has become increasingly useful in the evaluation of musculoskeletal problems, including those of the wrist. In patients with a wrist injury, MRI is used mainly to assess vascularity of scaphoid non-union. However, the use of MRI in patients in the acute phase following carpal injury is not common. Three-phase bone scintigraphy is routinely performed from at least 72 h after injury in patients with suspected scaphoid fracture and negative initial radiographs. We evaluated MRI in this patient group. The bone scan was used as the reference method. Nineteen patients were included. Bone scintigraphy was performed in all 19 patients, but MRI could be obtained in only 16 (in three patients, MRI was stopped owing to claustrophobia). In five patients, MRI confirmed a scintigraphically suspected scaphoid fracture. In one patient, a perilunar luxation, without a fracture, was seen on MRI, while bone scintigraphy showed a hot spot in the region of the lunate bone, suspected for fracture. This was confirmed by surgery. In two patients, a hot spot in the scaphoid region was suspected for scaphoid fracture, and immobilization and employed for a period of 12 weeks. MRI was negative in both cases; in one of them a scaphoid fracture was retrospectively proven on the initial X-ray series. In another two patients, a hot spot in the region of MCP I was found with a negative MRI. In both, the therapy was adjusted. In the remaining six patients, both modalities were negative. We conclude that in the diagnostic management of patients with suspected scaphoid fracture and negative initial radiographs, the use of MRI may be promising, but is not superior to three-phase bone scintigraphy. (orig.)

  8. Challenging the ‘Four Corner Press’ as framework for invitational leadership in South African schools

    Directory of Open Access Journals (Sweden)

    Rita Niemann

    2010-03-01

    Full Text Available Orientation: Invitational leadership (IL is consistent with current leadership trends and, because South African schools are in need of sound leadership, it is necessary to have a framework that can guide principals to act in accordance with the expectations of their educators.Research purpose: This study challenges the internationally accepted ‘Four Corner Press’ of Purkey and Novak (1984 as a framework for IL in the South African school context.Motivation for the study: IL appears to be a comprehensive model for successful school leadership. This necessitated an investigation to determine whether the ‘Four Corner Press’ reflects the expectations of teachers and, if so, whether it could serve as a valuable leadership tool.Research design, approach and method: A questionnaire containing 31 Likert-scale items, underpinned by the principles of IL, was disseminated to 600 educators conveniently drawn from the population of 88 828 teachers in Free State and Eastern Cape schools.Main findings: The data obtained from the survey enabled the researchers to perform a factor analysis, which revealed that South African educators’ expectations of leadership aligned with the ‘Four Corner Press’.Managerial implications: The ‘Four Corner Press’ can be used as a plausible framework for IL in South African schools, which has implications for the development and training of principals.Contribution/value-add: The ‘Four Corner Press’ can be regarded as a reliable prototype of IL expectations within the South African context, which contributes to extending the body of knowledge of education leadership in South Africa.

  9. Scaphoid fractures in children

    Directory of Open Access Journals (Sweden)

    Gajdobranski Đorđe

    2014-01-01

    Full Text Available Introduction. Scaphoid fractures are rare in childhood. Diagnosis is very difficult to establish because carpal bones are not fully ossified. In suspected cases comparative or delayed radiography is used, as well as computerized tomography, magnetic resonance imaging, ultrasound and bone scintigraphy. Majority of scaphoid fractures are treated conservatively with good results. In case of delayed fracture healing various types of treatment are available. Objective. To determine the mechanism of injury, clinical healing process, types and outcome of treatment of scaphoid fractures in children. Methods. We retrospectively analyzed patients with traumatic closed fracture of the scaphoid bone over a ten-year period (2002-2011. The outcome of the treatment of “acute” scaphoid fracture was evaluated using the Mayo Wrist Score. Results. There were in total 34 patients, of mean age 13.8 years, with traumatic closed fracture of the scaphoid bone, whose bone growth was not finished yet. Most common injury mechanism was fall on outstretched arm - 76% of patients. During the examined period 31 children with “acute” fracture underwent conservative treatment, with average immobilization period of 51 days. Six patients were lost to follow-up. In the remaining 25 patients, after completed rehabilitation, functional results determined by the Mayo Wrist Score were excellent. Conclusion. Conservative therapy of “acute” scaphoid fractures is an acceptable treatment option for pediatric patients with excellent functional results.

  10. Computed tomography versus magnetic resonance imaging versus bone scintigraphy for clinically suspected scaphoid fractures in patients with negative plain radiographs

    NARCIS (Netherlands)

    Mallee, Wouter H.; Wang, Junfeng; Poolman, Rudolf W.; Kloen, Peter; Maas, Mario; de Vet, Henrica C. W.; Doornberg, Job N.

    2015-01-01

    In clinically suspected scaphoid fractures, early diagnosis reduces the risk of non-union and minimises loss in productivity resulting from unnecessary cast immobilisation. Since initial radiographs do not exclude the possibility of a fracture, additional imaging is needed. Computed tomography (CT),

  11. Assessing the risk of nitrogen deposition to natural resources in the Four Corners area

    Science.gov (United States)

    Reed, Sasha C.; Belnap, Jayne; Floyd-Hanna, Lisa; Crews, Tim; Herring, Jack; Hanna, Dave; Miller, Mark E.; Duniway, Michael C.; Roybal, Carla M.

    2013-01-01

    Nitrogen (N) deposition in the western U.S. is on the rise and is already dramatically affecting terrestrial ecosystems. For example, N deposition has repeatedly been shown to lower air and water quality, increase greenhouse gas emissions, alter plant community composition, and significantly modify fire regimes. Accordingly, the effects of N deposition represent one of our largest environmental challenges and make difficult the National Park Service’s (NPS) important mission to “preserve the scenery and the natural and historic objects and the wildlife… unimpaired for the enjoyment of future generations”. Due to increased population growth and energy development (e.g., natural gas wells), the Four Corners region has become a notable ‘hotspot’ for N deposition. However, our understanding of how increased N deposition will affect these unique ecosystems, as well as how much deposition is actually occurring, remains notably poor. Here we used a multi-disciplinary approach to gathering information in an effort to help NPS safeguard the Four Corners national parks, both now and into the future. We applied modeling, field, and laboratory techniques to clarify current N deposition gradients and to help elucidate the ecosystem consequences of N deposition to the national parks of the Four Corners area. Our results suggest that NOx deposition does indeed represent a significant source of N to Mesa Verde National Park and, as expected, N deposition significantly affects coupled biogeochemical cycling (N, carbon, and phosphorus) of these landscapes. We also found some surprising results. For example, perhaps due to the low nutrient availability in these (and other) dryland ecosystems, although most other research suggests that adding N reduces N fixation rates, N additions did not consistently reduce natural N inputs via biological N2 fixation at our dryland sites. While the timeline of this pilot project is too brief to elucidate all the potential insight from

  12. Regional air quality in the four corners studys region: modeling approach

    Energy Technology Data Exchange (ETDEWEB)

    Nochumson, D.

    1982-01-01

    A two-dimensional Eulerian air pollutant transport model was used in an air quality study of the Four Corners region conducted for the National Commission on Air Quality. The regional modeling methodology and some sample results from the regional air quality analysis are presented. One major advantage of the regional transport model that was employed is that its solution involves the calculation of transfer coefficients that relate emissions to ambient concentrations and deposition and which can be used repeatedly to evaluate alternative scenarios and regulatory policies which represent different emission source configurations. The regional transport model was used in the calculation of the concentration and deposition of SO/sub 2/, SO/sub 4/, and primary fine particulates; and these estimates were used as inputs to regional atmospheric visibility and mass budget calculations. Previous studies have shown that the methods used in the regional air quality analysis give good agreement when comparing observed and estimated values.

  13. Pulsed Electromagnetic Fields in the treatment of fresh scaphoid fractures. A multicenter, prospective, double blind, placebo controlled, randomized trial.

    Science.gov (United States)

    Hannemann, Pascal; Göttgens, Kevin W A; van Wely, Bob J; Kolkman, Karel A; Werre, Andries J; Poeze, Martijn; Brink, Peter R G

    2011-05-06

    The scaphoid bone is the most commonly fractured of the carpal bones. In the Netherlands 90% of all carpal fractures is a fracture of the scaphoid bone. The scaphoid has an essential role in functionality of the wrist, acting as a pivot. Complications in healing can result in poor functional outcome. The scaphoid fracture is a troublesome fracture and failure of treatment can result in avascular necrosis (up to 40%), non-union (5-21%) and early osteo-arthritis (up to 32%) which may seriously impair wrist function. Impaired consolidation of scaphoid fractures results in longer immobilization and more days lost at work with significant psychosocial and financial consequences.Initially Pulsed Electromagnetic Fields was used in the treatment of tibial pseudoarthrosis and non-union. More recently there is evidence that physical forces can also be used in the treatment of fresh fractures, showing accelerated healing by 30% and 71% reduction in nonunion within 12 weeks after initiation of therapy. Until now no double blind randomized, placebo controlled trial has been conducted to investigate the effect of this treatment on the healing of fresh fractures of the scaphoid. This is a multi center, prospective, double blind, placebo controlled, randomized trial. Study population consists of all patients with unilateral acute scaphoid fracture. Pregnant women, patients having a life supporting implanted electronic device, patients with additional fractures of wrist, carpal or metacarpal bones and pre-existing impairment in wrist function are excluded. The scaphoid fracture is diagnosed by a combination of physical and radiographic examination (CT-scanning).Proven scaphoid fractures are treated with cast immobilization and a small Pulsed Electromagnetic Fields bone growth stimulating device placed on the cast. Half of the devices will be disabled at random in the factory.Study parameters are clinical consolidation, radiological consolidation evaluated by CT-scanning, functional

  14. Pulsed Electromagnetic Fields in the treatment of fresh scaphoid fractures. A multicenter, prospective, double blind, placebo controlled, randomized trial

    Directory of Open Access Journals (Sweden)

    Poeze Martijn

    2011-05-01

    Full Text Available Abstract Background The scaphoid bone is the most commonly fractured of the carpal bones. In the Netherlands 90% of all carpal fractures is a fracture of the scaphoid bone. The scaphoid has an essential role in functionality of the wrist, acting as a pivot. Complications in healing can result in poor functional outcome. The scaphoid fracture is a troublesome fracture and failure of treatment can result in avascular necrosis (up to 40%, non-union (5-21% and early osteo-arthritis (up to 32% which may seriously impair wrist function. Impaired consolidation of scaphoid fractures results in longer immobilization and more days lost at work with significant psychosocial and financial consequences. Initially Pulsed Electromagnetic Fields was used in the treatment of tibial pseudoarthrosis and non-union. More recently there is evidence that physical forces can also be used in the treatment of fresh fractures, showing accelerated healing by 30% and 71% reduction in nonunion within 12 weeks after initiation of therapy. Until now no double blind randomized, placebo controlled trial has been conducted to investigate the effect of this treatment on the healing of fresh fractures of the scaphoid. Methods/Design This is a multi center, prospective, double blind, placebo controlled, randomized trial. Study population consists of all patients with unilateral acute scaphoid fracture. Pregnant women, patients having a life supporting implanted electronic device, patients with additional fractures of wrist, carpal or metacarpal bones and pre-existing impairment in wrist function are excluded. The scaphoid fracture is diagnosed by a combination of physical and radiographic examination (CT-scanning. Proven scaphoid fractures are treated with cast immobilization and a small Pulsed Electromagnetic Fields bone growth stimulating device placed on the cast. Half of the devices will be disabled at random in the factory. Study parameters are clinical consolidation

  15. Validation of the Non-Union Scoring System in 300 long bone non-unions.

    Science.gov (United States)

    Calori, G M; Colombo, M; Mazza, E L; Mazzola, S; Malagoli, E; Marelli, N; Corradi, A

    2014-12-01

    Non-union of long bones is a significant consequence of fracture treatment. The ideal classification for non-union of long bones would give sufficient significant information to the orthopaedic surgeon to enable good management of the treatment required and to facilitate the creation of comparable study groups for research purposes. The Non-Union Scoring System (NUSS) is a new scoring system to assist surgeons in the choice of the correct treatment in non-union surgery. The aim of this study was to determine the evidence supporting the use of the NUSS classification in the treatment of non-unions of long bones and to validate the treatment algorithm suggested by this scoring system. A total of 300 patients with non-union of the long bones were included in the clinical study. A radiographic and clinical healing was reached in 60 of 69 non-unions (86%) in group 1 (0-25 points), in 102 of 117 non-unions (87%) in group 2 (26-50 points), and in 69 of 84 (82%) in group 3 (51-75 points). The mean time to clinical healing was 7.17 ± 1.85 months in group 1, 7.30 ± 1.72 months in group 2 and 7.60 ± 1.49 months in group 3. The mean time to radiographic healing was 8.78 ± 2.04 months in group 1, 9.02 ± 1.84 months in group 2 and 9.53 ± 1.40 months in group 3. There are few articles in the scientific literature that examine the classification systems for non-union. A statistical analysis of the first results we have obtained with the use of NUSS showed significant rates of union in all the evaluated groups. This indicates that NUSS could be an appropriate scoring system to classify and stratify non-unions and to enable the surgeon to choose the correct treatment. Copyright © 2014 Elsevier Ltd. All rights reserved.

  16. Gaseous Oxidized Mercury Dry Deposition Measurements in the FourCorners Area and Eastern Oklahoma, U.S.A.

    Science.gov (United States)

    Gaseous oxidized mercury (GOM) dry deposition measurements using surrogate surface passive samplers were collected in the Four Corners area and eastern Oklahoma from August, 2009–August, 2011. Using data from a six site area network, a characterization of the magnitude and spatia...

  17. Vascularized osseous graft for scaphoid

    International Nuclear Information System (INIS)

    Mendez Daza, Carlos Hernan; Mathoulin, Cristophe

    2004-01-01

    The most commonly used technique for treatment of pseudo-arthrosis of the scaphoid is osteo-synthesis with Kirschnet wires and cortical sponge grafts. Results reported by different teams using this procedure show no more than 90% osseous consolidation, especially in cases where vascularisation of the proximal fragment of the scaphoid is compromised. Here we present a series of ten cases of pseudo-arthrosis of the scaphoid, treated using a new surgical technique involving a vascularized osseous graft of the distal radius. Using this procedure we obtained 100% consolidation, with no complications either during the procedure or immediately post-operatively. Patients returned to work in week 15 on average. In 4 cases we observed discomfort in the area of the scar, which was successfully treated using local cortisone injection. The results obtained are very similar to those seen in the literature on the different techniques for vascularized osseous grafts for pseudo-arthrosis of the scaphoid

  18. Top-down constraints on methane and non-methane hydrocarbon emissions in the US Four Corners

    Science.gov (United States)

    Petron, G.; Miller, B. R.; Vaughn, B. H.; Kofler, J.; Mielke-Maday, I.; Sherwood, O.; Schwietzke, S.; Conley, S.; Sweeney, C.; Dlugokencky, E. J.; White, A. B.; Tans, P. P.; Schnell, R. C.

    2017-12-01

    A NASA and NOAA supported field campaign took place in the US Four Corners in April 2015 to further investigate a regional "methane hotspot" detected from space. The Four Corners region is home to the fossil fuel rich San Juan Basin, which extends between SE Colorado and NE New Mexico. The area has been extracting coal, oil and natural gas for decades. Degassing from the Fruitland coal outcrop on the Colorado side has also been reported. Instrumented aircraft, vans and ground based wind profilers were deployed for the campaign with the goal to quantify and attribute methane and non-methane hydrocarbon emissions in the region. A new comprehensive analysis of the campaign data sets will be presented and top-down emission estimates for methane and ozone precursors will be compared with available bottom-up estimates.

  19. Analysis of ulnar variance as a risk factor for developing scaphoid nonunion.

    Science.gov (United States)

    Lirola-Palmero, S; Salvà-Coll, G; Terrades-Cladera, F J

    2015-01-01

    Ulnar variance may be a risk factor of developing scaphoid non-union. A review was made of the posteroanterior wrist radiographs of 95 patients who were diagnosed of scaphoid fracture. All fractures with displacement less than 1mm treated conservatively were included. The ulnar variance was measured in all patients. Ulnar variance was measured in standard posteroanterior wrist radiographs of 95 patients. Eighteen patients (19%) developed scaphoid nonunion, with a mean value of ulnar variance of -1.34 (-/+ 0.85) mm (CI -2.25 - 0.41). Seventy seven patients (81%) healed correctly, and the mean value of ulnar variance was -0.04 (-/+ 1.85) mm (CI -0.46 - 0.38). A significant difference was observed in the distribution of ulnar variance (pvariance less than -1mm, and ulnar variance greater than -1mm. It appears that patients with ulnar variance less than -1mm had an OR 4.58 (CI 1.51 to 13.89) with pvariance less than -1mm have a greater risk of developing scaphoid nonunion, OR 4.58 (CI 1.51 to 13.89) with p<.007. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  20. A very rare Presentation of Bifocal Non Union Radius with Ipsilateral Ulnar Shaft Non Union: Case Report.

    Science.gov (United States)

    Padha, Vikas; Awasthi, Bhanu; Singh, Dhananjay; Kalia, Sandeep

    2016-01-01

    A bifocal non-union of shaft of radius associated with ipsilateral non-union shaft of ulna in an adult has not been reported in the literature till date to the best of our knowledge, though few similar cases of fresh fractures have been reported. The case being reported by us is the first of its kind. We report a case of bifocal non-union of shaft radius with non-union ipsilateral shaft of ulna in a 48-year-old right handed male along with discussion of alternative treatment options. We describe an extremely rare and complicated non-union in which our patient got excellent results along with satisfactory functional recovery as a result of appropriate surgical treatment.

  1. Distribution of Scaphoid Nutrient Foramina

    African Journals Online (AJOL)

    The blood supply to the scaphoid comes mainly from the radial artery and the proximal pole has been shown to have limited interosseous supply. (7, 8). Alternative blood supply comes from the dorsal, laterovolar and distal groups of extraossoeus blood vessels that enter the bone via foramina on the surface of the bone (7).

  2. The treatment of low-grade septic non-unions.

    Science.gov (United States)

    Verdoni, F; D’Amato, R D; Mangiavini, L; Lombardo, M D; Peretti, G M

    Non-union (or pseudoarthrosis) is defined as a fracture that fails to consolidate after 6 months from the trauma. Current conservative treatments consist of biological (i.e. with calcium, Vitamin D) and mechanical stimulation. Moreover, surgical approaches include the use of endomidollar nail osteosynthesis, compression plates that are often associated with bone grafts. External fixation is a valid surgical alternative especially in case of septic non-unions. Indeed, compression-distraction osteosynthesis results in a significant improvement in bone vascularisation and exerts a powerful osteoinductive stimulus on the non-union site. In this review, we will describe a cohort of patients affected by low-grade septic non-unions and treated with external fixation.

  3. Multi-Scale Science Framework for Attributing and Tracking Greenhouse Gas Fluxes at LANL's Four Corners New Mexico Test Bed

    Science.gov (United States)

    Costigan, K. R.; Dubey, M. K.; Chylek, P.; Love, S. P.; Henderson, B. G.; Flowers, B. A.; Reisner, J. M.; Rahn, T.; Quick, C. R.

    2010-12-01

    Agreements to limit greenhouse gas emissions require scientifically valid methods for monitoring and validating anthropogenic emissions. However, the task of monitoring CO2 emissions is difficult because relatively small increases need to be detected against CO2’s variable and large background concentrations. To ensure fair compliance, remotely sensed measurements and an understanding of the atmospheric transport of CO2 from the sources are required. We hypothesize that CO2 from various natural and anthropogenic sources can be distinguished and tracked by monitoring co-emitted gases (e.g. NO2, SO2, and CO) and isotopomers (e.g.13CO2). The ratio of a co-emitted species to CO2 depends on fuel composition and combustion process and thus varies by energy sector. These ratios provide an independent method to quantify CO2 emissions. Their low backgrounds, their large perturbations from energy activities, and our ability to measure them precisely make them sensitive probes to attribute sources, especially when emission ratios of multiple species are used concurrently. This strategy of observing emission ratios of co-emitted species to derive regional and source-specific baselines and CO2 fluxes is being tested in the Four Corners region of northwestern New Mexico. The semi-arid ecology in the region has a weak natural carbon cycle, facilitating our goal of dissection of anthropogenic sector-specific sources. The net Four Corners and San Juan power plant emissions are the largest point source of CO2 and NOx in North America. The Four Corners plant produces much more NOx than the San Juan power plant, while their energy and CO2 outputs, and coal used, are similar. This difference offers us a unique opportunity to test discrimination methods. While their CO2 signals remain elusive for current satellites, their NO2 plumes have recently been resolved from space. The region also experiences dispersed CO2 urban emissions as well as emissions and leaks from thousands of oil

  4. Climate change in the four corners and adjacent regions: Implications for environmental restoration and land-use planning

    Energy Technology Data Exchange (ETDEWEB)

    Waugh, W.J. [ed.

    1995-09-01

    This document contains the workshop proceedings on Climate Change in the Four Corners and Adjacent Regions: Implications for Environmental Restoration and Land-Use Planning which took place September 12-14, 1994 in Grand Junction, Colorado. The workshop addressed three ways we can use paleoenvironmental data to gain a better understanding of climate change and its effects. (1) To serve as a retrospective baseline for interpreting past and projecting future climate-induced environmental change, (2) To differentiate the influences of climate and humans on past environmental change, and (3) To improve ecosystem management and restoration practices in the future. The papers presented at this workshop contained information on the following subjects: Paleoclimatic data from the Pleistocene and Holocene epochs, climate change and past cultures, and ecological resources and environmental restoration. Selected papers are indexed separately for inclusion in the Energy Science and Technology Database.

  5. Decoupling the Wrist: A Cadaveric Experiment Examining Wrist Kinematics Following Midcarpal Fusion and Scaphoid Excision

    Science.gov (United States)

    Nichols, Jennifer A.; Bednar, Michael S.; Havey, Robert M.; Murray, Wendy M.

    2016-01-01

    At the wrist, kinematic coupling (the relationship between flexion-extension and radial-ulnar deviation) facilitates function. Although the midcarpal joint is critical for kinematic coupling, many surgeries, such as four-corner fusion (4CF) and scaphoid-excision four-corner fusion (SE4CF), modify the midcarpal joint. This study examines how 4CF and SE4CF influence kinematic coupling by quantifying wrist axes of rotation. Wrist axes of rotation were quantified in eight cadaveric specimens using an optimization algorithm, which fit a two-revolute joint model to experimental data. In each specimen, data measuring the motion of the third metacarpal relative to the radius was collected for three conditions (nonimpaired, 4CF, SE4CF). The calculated axes of rotation were compared using spherical statistics. The angle between the axes of rotation was used to assess coupling, as the nonimpaired wrist has skew axes (i.e., angle between axes approximately 60°). Following 4CF and SE4CF, the axes are closer to orthogonal than those of the nonimpaired wrist. The mean angle (±95 percent confidence interval) between the axes was 92.6° ± 25.2° and 99.8° ± 22.0° for 4CF and SE4CF, respectively. The axes of rotation defined in this study can be used to define joint models, which will facilitate more accurate computational and experimental studies of these procedures. PMID:27705062

  6. Conservative management of fracture scaphoid

    Directory of Open Access Journals (Sweden)

    Mittal V

    2006-01-01

    Full Text Available Background : Conservative management of fracture scaphoid with cast is still the most common modality of management, but the results following this protocol are not always satisfactory. Methods : Twenty five patients with fracture scaphoid were treated with a below elbow scaphoid cast and were followed up for minimum duration of one year. On follow up patients were examined clinicoradiologically and functional results were evaluated using the modification of the Mayo wrist scoring chart. Results : Nineteen fractures showed union, two were malunited and five went for nonunion. Two fractures developed avascular necrosis and three patients had wrist arthritis on follow up. Nineteen patients had excellent functional results, one had good results and six patients had poor results. Patients with delayed diagnosis had nonunion and poor functional results. Patients with premature removal of cast had comparatively inferior results Conclusion : For displaced unstable fracture, open reduction and internal fixation should be the preferred modality of treatment as cast treatment gives unacceptably high rate of malunion and nonunion with poor functional results.

  7. [Chondroblastoma of the carpal scaphoids].

    Science.gov (United States)

    Repáraz, F J; Garbayo, J; Arrechea, M A; Corchuelo, C; Tejero, A; Ayala, H

    2008-01-01

    A chondroblastoma is a benign tumour of cartilaginous origin which represents less than 1% of all primary osseous tumours. It is typically localised in the epiphysis of the long bones. Some 10% of chondroblastomas affect the bones of the foot and the hand. It is extremely rare for the seat of this lesion to be in the carpal bones. We present a case of chondroblastoma of the carpal scaphoids that was treated through curretage of the lesion and filling with autologous osseous graft from the iliac crest.

  8. Intertrochanteric fracture non-unions with implant failure of the ...

    African Journals Online (AJOL)

    Failure of internal fixation of intertrochanteric fracture is associated with delayed union or malunion resulting in persistent pain and diminished function. We report a rare case of implant failure of the gamma nail with intertrochanteric fracture non union treated by DCS plate screw and bone graft. Pan African Medical Journal ...

  9. Neglected dorsal dislocation of the scaphoid

    Directory of Open Access Journals (Sweden)

    Amaravati Rajkumar

    2009-01-01

    Full Text Available Isolated dislocation of the scaphoid is very rare. A 45-year old male, industrial worker reported two and half months after injury with wrist pain and swelling on the dorsum of left wrist. He was diagnosed as neglected dorsal dislocation of scaphoid. Proximal row carpectomy with capsular interposition was done stabilizing the distal carpus on the radius using Kirschner wires. At-12 months follow-up the patient had good wrist function and was satisfied with the outcome of the treatment. We hereby report this neglected dorsal dislocation of scaphoid in view of rarity and discuss the various options for management.

  10. Vegetation productivity responses to drought on tribal lands in the four corners region of the Southwest USA

    Science.gov (United States)

    El-Vilaly, Mohamed Abd Salam; Didan, Kamel; Marsh, Stuart E.; van Leeuwen, Willem J. D.; Crimmins, Michael A.; Munoz, Armando Barreto

    2018-03-01

    For more than a decade, the Four Corners Region has faced extensive and persistent drought conditions that have impacted vegetation communities and local water resources while exacerbating soil erosion. These persistent droughts threaten ecosystem services, agriculture, and livestock activities, and expose the hypersensitivity of this region to inter-annual climate variability and change. Much of the intermountainWestern United States has sparse climate and vegetation monitoring stations, making fine-scale drought assessments difficult. Remote sensing data offers the opportunity to assess the impacts of the recent droughts on vegetation productivity across these areas. Here, we propose a drought assessment approach that integrates climate and topographical data with remote sensing vegetation index time series. Multisensor Normalized Difference Vegetation Index (NDVI) time series data from 1989 to 2010 at 5.6 km were analyzed to characterize the vegetation productivity changes and responses to the ongoing drought. A multi-linear regression was applied to metrics of vegetation productivity derived from the NDVI time series to detect vegetation productivity, an ecosystem service proxy, and changes. The results show that around 60.13% of the study area is observing a general decline of greenness ( p<0.05), while 3.87% show an unexpected green up, with the remaining areas showing no consistent change. Vegetation in the area show a significant positive correlation with elevation and precipitation gradients. These results, while, confirming the region's vegetation decline due to drought, shed further light on the future directions and challenges to the region's already stressed ecosystems. Whereas the results provide additional insights into this isolated and vulnerable region, the drought assessment approach used in this study may be adapted for application in other regions where surface-based climate and vegetation monitoring record is spatially and temporally limited.

  11. Vegetation productivity responses to drought on tribal lands in the four corners region of the Southwest USA

    Science.gov (United States)

    El-Vilaly, Mohamed Abd Salam; Didan, Kamel; Marsh, Stuart E.; van Leeuwen, Willem J. D.; Crimmins, Michael A.; Munoz, Armando Barreto

    2017-05-01

    For more than a decade, the Four Corners Region has faced extensive and persistent drought conditions that have impacted vegetation communities and local water resources while exacerbating soil erosion. These persistent droughts threaten ecosystem services, agriculture, and livestock activities, and expose the hypersensitivity of this region to inter-annual climate variability and change. Much of the intermountainWestern United States has sparse climate and vegetation monitoring stations, making fine-scale drought assessments difficult. Remote sensing data offers the opportunity to assess the impacts of the recent droughts on vegetation productivity across these areas. Here, we propose a drought assessment approach that integrates climate and topographical data with remote sensing vegetation index time series. Multisensor Normalized Difference Vegetation Index (NDVI) time series data from 1989 to 2010 at 5.6 km were analyzed to characterize the vegetation productivity changes and responses to the ongoing drought. A multi-linear regression was applied to metrics of vegetation productivity derived from the NDVI time series to detect vegetation productivity, an ecosystem service proxy, and changes. The results show that around 60.13% of the study area is observing a general decline of greenness (p<0.05), while 3.87% show an unexpected green up, with the remaining areas showing no consistent change. Vegetation in the area show a significant positive correlation with elevation and precipitation gradients. These results, while, confirming the region's vegetation decline due to drought, shed further light on the future directions and challenges to the region's already stressed ecosystems. Whereas the results provide additional insights into this isolated and vulnerable region, the drought assessment approach used in this study may be adapted for application in other regions where surfacebased climate and vegetation monitoring record is spatially and temporally limited.

  12. OSTEOID OSTEOMA IN SCAPHOID: CASE REPORT.

    Science.gov (United States)

    Severo, Antônio Lourenço; de Araújo Filho, Raimundo; Puentes, Rulby; Lemos, Marcelo Barreto; Piluski, Paulo Faiad; Lech, Osvandré

    2012-01-01

    Osteoid osteoma is a benign osteoblastic tumor that is unusual in the hand. A location in the carpal bones is infrequent, which leads to errors in diagnosing it because of polymorphism of the clinical symptoms. Reviewing the literature shows that nine cases of osteoid osteoma in the scaphoid have been reported. Here, one case of osteoid osteoma in the scaphoid that was initially treated as De Quervain's stenosing tenosynovitis is reported, with a definitive diagnosis that was delayed for five years.

  13. OSTEOID OSTEOMA IN SCAPHOID: CASE REPORT

    Science.gov (United States)

    Severo, Antônio Lourenço; de Araújo Filho, Raimundo; Puentes, Rulby; Lemos, Marcelo Barreto; Piluski, Paulo Faiad; Lech, Osvandré

    2015-01-01

    Osteoid osteoma is a benign osteoblastic tumor that is unusual in the hand. A location in the carpal bones is infrequent, which leads to errors in diagnosing it because of polymorphism of the clinical symptoms. Reviewing the literature shows that nine cases of osteoid osteoma in the scaphoid have been reported. Here, one case of osteoid osteoma in the scaphoid that was initially treated as De Quervain's stenosing tenosynovitis is reported, with a definitive diagnosis that was delayed for five years. PMID:27047881

  14. Four-corner fusion: comparison of patient satisfaction and functional outcome of conventional K-wire technique vs. a new locking plate.

    Science.gov (United States)

    Hernekamp, J F; Reinecke, A; Neubrech, F; Bickert, B; Kneser, U; Kremer, T

    2016-04-01

    Four-corner fusion is a standard procedure for advanced carpal collapse. Several operative techniques and numerous implants for osseous fixation have been described. Recently, a specially designed locking plate (Aptus©, Medartis, Basel, Switzerland) was introduced. The purpose of this study was to compare functional results after osseous fixation using K-wires (standard of care, SOC) with four-corner fusion and locking plate fixation. 21 patients who underwent four-corner fusion in our institution between 2008 and 2013 were included in a retrospective analysis. In 11 patients, osseous fixation was performed using locking plates whereas ten patients underwent bone fixation with conventional K-wires. Outcome parameters were functional outcome, osseous consolidation, patient satisfaction (DASH- and Krimmer Score), pain and perioperative morbidity and the time until patients returned to daily work. Patients were divided in two groups and paired t-tests were performed for statistical analysis. No implant related complications were observed. Osseous consolidation was achieved in all cases. Differences between groups were not significant regarding active range of motion (AROM), pain and function. Overall patient satisfaction was acceptable in all cases; differences in the DASH questionnaire and the Krimmer questionnaire were not significant. One patient of the plate group required conversion to total wrist arthrodesis without implant-related complications. Both techniques for four-corner fusion have similar healing rates. Using the more expensive locking implant avoids a second operation for K-wire removal, but no statistical differences were detected in functional outcome as well as in patient satisfaction when compared to SOC.

  15. Non-Anatomical Surgical Solutions for Difficult Non-Unions: Case Series

    OpenAIRE

    Zaki Said, Galal; Farouk, Osama Ahmed; Galal Said, Hatem; Mohamed El-Sharkawi, Mohamed Mostafa

    2013-01-01

    Abstract Non-union occurs when bone healing ceases and does not continue without some type of intervention. Classification of non-union is traditionally based on the amount of callus or bone healing at the fracture site. Successful treatment of non-union often depends on appropriate reduction and realignment of the fracture, bone grafting if necessary, and stabilization. This may not be possible in some neglected and complicated non-unions. Under these circumstances, modification of the stand...

  16. Modified Carpal Box Technique in the Diagnosis of Suspected Scaphoid Fractures

    Energy Technology Data Exchange (ETDEWEB)

    Toth, F.; Mester, S.; Cseh, G.; Bener, A.; Nyarady, J.; Lovasz, G. [Pecs Univ. (Hungary). Medical School

    2003-05-01

    Purpose: To establish and test the clinical efficacy of a new diagnostic algorithm with the extensive utilization of modified carpal box radiography (mX-CB) in the detection of scaphoid fractures. Material and Methods: Initial and early follow-up radiographic evaluation of 146 suspected scaphoid fractures were carried out by mX-CB. Patients with unconfirmed diagnosis were referred to CT. Patients were followed for 1 year after injury. Sensitivity, specificity and interobserver agreement of reading mX-CB images were determined statistically. Results: No non-union or avascular necrosis was seen at 1 year after the injury. 90% of the fractures were diagnosed by mX-CB, only 6.8% of the patients needed referral to CT. Sensitivity of mX-CB at initial presentation was 81.6%. Interobserver agreement was very high among evaluators of mX-CB images. Conclusion: Extensive utilization of mX-CB as primary and early follow-up investigation resulted in high initial diagnostic accuracy and low referral rate to a more expensive diagnostic modality.

  17. Scaphoid pseudo-arthrosis: Frequency, pathogenesis and course

    Energy Technology Data Exchange (ETDEWEB)

    Schunk, K.; Teifke, A.; Benning, R.; Dahm, M.; Thelen, R.; Schild, H.

    1989-06-01

    Eighty-three scaphoid pseudo-arthroses were found amongst 1.104 scaphoid examinations. Sixtyseven were present at the first examination and 16 pseudo-arthroses developed amongst 252 scaphoid fractures. Men were affected predominantly, particularly in the 20 to 40-year old group. Fractures in the proximal third of the scaphoid and vertical oblique fractures had a particular tendency to pseudo-arthrosis formation. The operative treatment of choice is a Matti-Russe bone graft. Only one patient in seven with definite scaphoid pseudo-arthrosis showed firm fusion. (orig.).

  18. Scaphoid pseudo-arthrosis: Frequency, pathogenesis and course

    International Nuclear Information System (INIS)

    Schunk, K.; Teifke, A.; Benning, R.; Dahm, M.; Thelen, R.; Schild, H.; Mainz Univ.

    1989-01-01

    Eighty-three scaphoid pseudo-arthroses were found amongst 1.104 scaphoid examinations. Sixtyseven were present at the first examination and 16 pseudo-arthroses developed amongst 252 scaphoid fractures. Men were affected predominantly, particularly in the 20 to 40-year old group. Fractures in the proximal third of the scaphoid and vertical oblique fractures had a particular tendency to pseudo-arthrosis formation. The operative treatment of choice is a Matti-Russe bone graft. Only one patient in seven with definite scaphoid pseudo-arthrosis showed firm fusion. (orig.) [de

  19. Establishing a central zone in scaphoid surgery: a computational approach.

    Science.gov (United States)

    Guo, Yang; Tian, Guang Lei; Chen, Shanlin; Tapia, Carla

    2014-01-01

    Scaphoid fractures are commonly fixed with headless cannulated screws positioned centrally in the scaphoid. Judgement of central placement of the screw may be difficult. We generated a central zone using computer analysis of 3D reconstructions of computed tomography (CT) images. As long as the screw axis is completely contained within this central zone, the screw would be considered as centrally placed. Thirty cases of 3D CT reconstructions of normal scaphoids in a computerised operation planning and simulation system (Vxwork software) were obtained. The central zone was established after some distance shrinkage of the original scaphoid surface reconstruction model using the function "erode" in the software. The shape of the central zone was evaluated, and the width of the central zone in the proximal pole, waist portion and distal pole was measured. We also established the long axis of the scaphoid to see whether it stays in the central zone. All central zones could be divided into distal, waist and proximal portions according to the corresponding irregular shape of the scaphoid. As the geometry of the central zone was so irregular and its width very narrow, it was possible to completely contain the screw axis either in the proximal portion alone, waist alone or distal central zone alone. Establishing the central zone of scaphoid 3D CT images provided a baseline for discussion of central placement of a scaphoid screw. The geometry of the scaphoid central zone determined that the screw could hardly be inserted through entire scaphoid central area during surgery.

  20. A new hypothesis on the mechanism of atrophic non-union.

    Science.gov (United States)

    Sun, Deyi; Yuan, Ding; Zhang, Xiangsheng

    2011-07-01

    Non-union after bone fracture is rather common with an increasing frequency of incidence rate due to poorly treated early operations, among which the mechanism of atrophic non-union remains unclear. Previous opinions showed that impaired blood supply of affected limbs might mostly contribute to the atrophic non-union, which discriminated it with hypertrophic non-union. Nevertheless, there had been increasingly adequate evidences supporting that normal blood supplies existed in atrophic non-unions, as well as in hypertrophic non-unions or healthy bone fractures. Our hypothesis, based on the newly acquired evidences of atrophic non-union, was that there existed mesenchymal stem cells in the area of atrophic non-union. These mesenchymal stem cells, which remained temporally quiescent, could perform re-ossification under certain growth conditions, such as pressure during callus distraction with external fixator. According to the hypothesis, treatment for atrophic non-union should focus on the stimulation and reactivation of endogenetic mesenchymal stem cells or transplantation of autologous normal mesenchymal stem cells. This hypothesis may shed some light on the mechanism of atrophic non-union. Copyright © 2011 Elsevier Ltd. All rights reserved.

  1. Management of tibial non-unions according to a novel treatment algorithm.

    Science.gov (United States)

    Ferreira, Nando; Marais, Leonard Charles

    2015-12-01

    Tibial non-unions represent a spectrum of conditions that are challenging to treat. The optimal management remains unclear despite the frequency with which these diagnoses are encountered. The aim of this study was to determine the outcome of tibial non-unions managed according to a novel tibial non-union treatment algorithm. One hundred and eighteen consecutive patients with 122 uninfected tibial non-unions were treated according to our proposed tibial non-union treatment algorithm. All patients were followed-up clinically and radiologically for a minimum of six months after external fixator removal. Four patients were excluded because they did not complete the intended treatment process. The final study population consisted of 94 men and 24 women with a mean age of 34 years. Sixty-seven non-unions were stiff hypertrophic, 32 mobile atrophic, 16 mobile oligotrophic and one true pseudoarthrosis. Six non-unions were classified as type B1 defect non-unions. Bony union was achieved after the initial surgery in 113/122 (92.6%) tibias. Nine patients had failure of treatment. Seven persistent non-unions were successfully retreated according to the tibial non-union treatment algorithm. This resulted in final bony union in 120/122 (98.3%) tibias. The proposed tibial non-union treatment algorithm appears to produce high union rates across a diverse group of tibial non-unions. Tibial non-unions however, remain difficult to treat and should be referred to specialist units where advanced reconstructive techniques are practiced on a regular basis. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Chondroblastoma of the scaphoid: A case report

    Directory of Open Access Journals (Sweden)

    Sandeep Vijayan

    2015-01-01

    Full Text Available Benign Chondroblastoma generally occur in the epiphysis of long bones and rarely arise in carpal bones. We report a young male with chondroblastoma of scaphoid treated with curettage, bone grafting and K-wire fixation. At the last follow-up, 4 years after surgery, the patient was asymptomatic without recurrence.

  3. [Scaphoid enchondroma revealed by a fracture].

    Science.gov (United States)

    El Mrini, A; Daoudi, A; Loudyi, D; Boutayeb, F; Agoumi, O; El Yaacoubi, M

    2006-06-01

    Enchondroma is a common bone tumor of hand. It is rarely localized in scaphoid. We report a new case of this tumor revealed by fracture. The diagnosis was suggested by standard radiography and confirmed then by anatomic pathology examination. Enucleation and bone graft with osteosynthesis yielded good result.

  4. Missed isolated volar dislocation of the scaphoid

    DEFF Research Database (Denmark)

    Kolby, Lise; Larsen, Søren; Jørring, Stig

    2007-01-01

    A patient presented with volar dislocation of the scaphoid, the diagnosis of which had been missed for two weeks. He was treated with open reduction through a combined volar and dorsal approach with decompression of the median nerve, internal fixation, and a cast for eight weeks. One year postope...... postoperatively the functional result was good. A radiograph showed no sign of avascular necrosis....

  5. Palmar dislocation of scaphoid and lunate

    Directory of Open Access Journals (Sweden)

    Khalid Koulali Idrissi

    2011-11-01

    Full Text Available A palmar dislocation of scaphoid and lunate is uncommon. We have found only 19 reported cases in the literature. We reported a simultaneous, divergent dislocation. The closed reduction followed by percutaneous pinning has given a good result without avascular necrosis of any carpal bone.

  6. Non-Union in Upper Limb Fractures - Clinical Evaluation and Treatment Options.

    Science.gov (United States)

    Neumann, M V; Zwingmann, J; Jaeger, M; Hammer, T O; Südkamp, N P

    2016-01-01

    Although non-unions in the upper limb are rare different treatment options of this challenging situation are still affected with up to 20% of failure rate due to current literature. Risk factors for delayed and non-union of fractures are mainly the size of the fracture gap and bone loss of open fractures or in primary surgery followed by other relevant internal and external factors. In the upper limb non-unions of long bones are described with up to 30% after operative intervention. Especially in the upper limb range of motion is limited in non-union cases and disables adjacent joints like the shoulder, elbow and wrist hence reducing the total activity level of affected patients. Beside careful investigation of the causes leading to the non-union a comprehensive treatment plan should be defined to achieve successful results. Treatment can be non-operative in several, selected cases, but in the majority of cases revision surgery is necessary to achieve osseous healing. Our own experience showed that non-union in the upper limb are rare and account for only 1.7% of all surgical managed upper limb fractures. Non-union of upper limb fractures occur most frequently in clavicle fractures followed by humeral fractures. Atrophic non-union is the most frequent reason for osseous non-union (57%) and osseous healing after revision surgery in non-unions is completed after a mean of 6.45 months. This article will give a brief overview of the genesis, clinical evaluation, treatment options and recommendations in upper limb non-unions according to the current literature. Key words: fracture, upper-limb, non-union, osteosynthesis, cancellous bone-graft.

  7. Osteoblastoma of the scaphoid bone – A rare case report

    Directory of Open Access Journals (Sweden)

    Khodamorad Jamshidi

    2009-04-01

    Full Text Available

    • Osteoblastoma is rarely found in the hand or wrist. Review of literature  evealed that only five cases of osteoblastoma have been reported in scaphoid bone. This paper presents a rare case of scaphoid steoblastoma with unusual course ina young patient and its treatment process.
    • KEYWORDS: Hand, osteoblastoma, scaphoid, wrist.

  8. Treatment of Tibial Non-Unions - State of the Art and Future Implications.

    Science.gov (United States)

    Märdian, S; Giesecke, M; Haschke, F; Tsitsilonis, S; Wildemann, B; Schwabe, P

    2016-01-01

    healing disturbances occur in 5-10% of the cases. The anatomical region of the lower limb predisposes the tibia for bone healing disturbances. Reports about the incidence of non-unions of the tibial shaft are inhomogeneous. Different treatment strategies have been published which depend on the type of non-union as well as the history of the patient. These range from conservative approaches to complex procedures including segmental resection and bone transport. This review aimed to summarize the state of the art treatment of tibial non-unions and report about recent basic research results that may improve bone healing. Key words: tibial non-unions, treatment strategies, bone healing.

  9. PSEUDARTHROSIS OF THE SCAPHOID IN IMMATURE SKELETONS.

    Science.gov (United States)

    de Lemos, Marcelo Barreto; Bentes, Ádria Simone Ferreira; Neto, Miguel Flores do Amaral; Spinelli, Leandro de Freitas; Severo, Antônio Lourenço; Lech, Osvandré

    2012-01-01

    This paper presents a review of the literature on pseudarthrosis of the scaphoid in skeletally immature individuals, taking into consideration its epidemiology, diagnosis and treatment, as well as its controversies. Knowledge of this subject makes it possible for patients to be given appropriate treatment immediately. Pseudarthrosis of the scaphoid in skeletally immature patients is a rare condition that results from error or lack of diagnosis of a fracture. Thus, careful clinical and radiographic examination should be performed in order to confirm or rule out this diagnosis. Several treatment methods have been reported and have shown good results. These include conservative plaster cast treatment, bone graft without osteosynthesis, bone graft with Kirschner wires, percutaneous screws and bone graft with compression screws. The treatment performed depends on the characteristics of the pseudarthrosis and the surgeon's experience.

  10. PSEUDARTHROSIS OF THE SCAPHOID IN IMMATURE SKELETONS

    Science.gov (United States)

    de Lemos, Marcelo Barreto; Bentes, Ádria Simone Ferreira; Neto, Miguel Flores do Amaral; Spinelli, Leandro de Freitas; Severo, Antônio Lourenço; Lech, Osvandré

    2015-01-01

    This paper presents a review of the literature on pseudarthrosis of the scaphoid in skeletally immature individuals, taking into consideration its epidemiology, diagnosis and treatment, as well as its controversies. Knowledge of this subject makes it possible for patients to be given appropriate treatment immediately. Pseudarthrosis of the scaphoid in skeletally immature patients is a rare condition that results from error or lack of diagnosis of a fracture. Thus, careful clinical and radiographic examination should be performed in order to confirm or rule out this diagnosis. Several treatment methods have been reported and have shown good results. These include conservative plaster cast treatment, bone graft without osteosynthesis, bone graft with Kirschner wires, percutaneous screws and bone graft with compression screws. The treatment performed depends on the characteristics of the pseudarthrosis and the surgeon's experience. PMID:27042636

  11. Congenital Scaphoid Megalourethra: A Case Report

    Directory of Open Access Journals (Sweden)

    Kenji Obara

    2017-09-01

    Full Text Available A congenital megalourethra is an enlargement of the pendulous urethra without evidence of distal obstruction. A 1-month-old boy presented to us with complaint of weak stream, ballooning of the penis before and during voiding and post voiding dribbling, since birth. Physical examination and cystourethroscope confirmed the diagnosis of congenital scaphoid megalourethra. He underwent reduction urethroplasty. During postoperative follow up, he had normal looking penis with good urinary stream.

  12. Non-anatomical surgical solutions for difficult non-unions: case series.

    Science.gov (United States)

    Zaki Said, Galal; Farouk, Osama Ahmed; Galal Said, Hatem; Mohamed El-Sharkawi, Mohamed Mostafa

    2013-01-01

    Non-union occurs when bone healing ceases and does not continue without some type of intervention. Classification of non-union is traditionally based on the amount of callus or bone healing at the fracture site. Successful treatment of non-union often depends on appropriate reduction and realignment of the fracture, bone grafting if necessary, and stabilization. This may not be possible in some neglected and complicated non-unions. Under these circumstances, modification of the standard techniques or a limited surgical interference, that might not be anatomical, may succeed in improving function. We present four cases of non-anatomical salvage solutions for difficult long bone non-unions with satisfactory functional outcome.

  13. Enchondroma of the scaphoid: a case report | Ali | Pan African ...

    African Journals Online (AJOL)

    Enchondroma represents a common bone tumor of the hand. The scaphoid is a rare location. We report the case of a scaphoid enchondroma presenting as chronic wrist pain following a relatively minor trauma. The diagnosis was suggested by radiological study and then confirmed by histological study after biopsy.

  14. scaphoid dimensions and appropriate screw sizes in a kenyan ...

    African Journals Online (AJOL)

    dimensions will aid in identifying appropriate screw systems. Objective: The purpose of this study was to determine the dimensions of the scaphoid and its distal pole and relating this to commonly used screw systems. Methods: One hundred and four human scaphoids were studied and their dimensions determined. These.

  15. Distribution of Scaphoid Nutrient Foramina | Owira | Annals of ...

    African Journals Online (AJOL)

    Introduction: Avascular necrosis (AVN) is a frequent complication of scaphoid fractures especially those involving the proximal segment of the bone. This has been attributed to its precarious blood supply which is further compromised by the fracture and surgery. Knowledge of the distribution of scaphoid nutrient foramina, ...

  16. Complications associated with plate fixation of acute midshaft clavicle fractures versus non-unions.

    Science.gov (United States)

    Sawalha, Seif; Guisasola, Inigo

    2018-03-13

    An important consideration when counselling patients with midshaft clavicle fractures is whether operative treatment of non-union, if it develops after non-operative treatment, is associated with higher complication rate than acute fracture fixation. The aim of this study is to compare complications and re-operations after open reduction and plate fixation for acute midshaft clavicle fractures versus non-unions. The study was retrospective. There were 90 patients in the acute fixation group and 20 patients in the non-union group. The mean follow-up was 8 and 15 months, respectively, Logistic regression analysis was used to assess whether 'non-union surgery' was a predictor of complications and re-operations. Of 90 patients, 23 had complications in acute fixation group. Of 20, 7 developed 8 complications in the non-union group (p = 0.4). Of 90, 12 required re-operations in the acute fixation group compared to 5/20 requiring 7 re-operations in the non-union group (p = 0.19). When any complication or re-operation was considered, 'non-union surgery' was not significant predictor for complications (p = 0.78) or re-operations (p = 0.99). The complication and re-operation rates were not higher after non-union surgery compared to acute fracture fixation and were mostly related to persistent delayed or non-union, rather than operative complications. When counselling patients about treatment of midshaft clavicle fractures, a 'higher complication rate after surgery for non-union, should it happen' should not be an argument against non-operative treatment.

  17. Extracorporeal shock wave therapy for non-unions and delayed fracture healing

    Science.gov (United States)

    Schaden, Wolfgang; Fischer, Andreas; Sailler, Andreas; Karadas, Ender

    2005-04-01

    Although the primary management of fractures is highly developed in Central Europe 1% of fractures develop a non-union. After successful pilot studies the Traumacenter Meidling started in December 1998 to treat non-unions regularly with shock wave therapy. From December 1998 to August 2004, 1153 patients with non-union and delayed healing fractures were treated. The results of 755 patients are available up to September 2004. The patients consisted of 250 (33%) female and 505 (67%) male. The mean age was 44.1 years (10; 90). The mean age of the non-union was 15.5 months. In 74 (10%) osteomyelitis was present before shockwave therapy. Out of 755 non-unions 593 (79%) achieved bony healing. As expected, the subgroup of 284 delayed unions (shockwave therapy 3-6 months after the trauma or the last surgery concerning the bone) showed the best results. 245 (86%) healed. Out of 471 non-unions being older than 6 months 348 (72%) achieved bony healing. Because of the efficacy and the lack of complications as well as the economic advantage in comparison to surgery, shockwave therapy is considered as therapy of first choice in the treatment of non-union and delayed healing fractures.

  18. Experimental investigations for prevention and improvement of surgical therapy of tibia shaft non-unions

    OpenAIRE

    Schwabe, Philipp

    2015-01-01

    Non-unions after fractures of the tibia shaft show an incidence of 3-54%. The treatment of tibial shaft non-unions is time consuming and demanding for the surgeon and the patient. We could demonstrate that even sucessfully treated patients in terms of an adequate bone and soft tissue consolidation are suffering from a significant loss of function and reduction in quality of life. Therefore experimental approaches for prevention and treatment of tibial non-union have been introduced and evalua...

  19. Use of bone marrow derived stem cells in a fracture non-union

    Directory of Open Access Journals (Sweden)

    Binod C. Raulo

    2012-01-01

    Full Text Available This is an attempt of using in vitro cultured mesenchymal stem cells (MSCs from bone marrow in joining of a fracture non-union. Bone marrow cells were obtained and differentially centrifuged for MSCs that were grown in vitro in mesenchymal stem cell basal medium aseptically, for 10 d. The cell mass was injected around the fracture non-union. Healthy conditions of development of tissue regeneration at the trauma site and due bone joining were recorded. It is concluded that in vitro cultured MSCs had a blithesome effect on the fracture non-union.

  20. Comparison of conventional radiography and MDCT in suspected scaphoid fractures.

    Science.gov (United States)

    Behzadi, Cyrus; Karul, Murat; Henes, Frank Oliver; Laqmani, Azien; Catala-Lehnen, Philipp; Lehmann, Wolfgang; Nagel, Hans-Dieter; Adam, Gerhard; Regier, Marc

    2015-01-28

    To determine the diagnostic accuracy and radiation dose of conventional radiography and multidetector computed tomography (MDCT) in suspected scaphoid fractures. One hundred twenty-four consecutive patients were enrolled in our study who had suffered from a wrist trauma and showed typical clinical symptoms suspicious of an acute scaphoid fracture. All patients had initially undergone conventional radiography. Subsequent MDCT was performed within 10 d because of persisting clinical symptoms. Using the MDCT data as the reference standard, a fourfold table was used to classify the test results. The effective dose and impaired energy were assessed in order to compare the radiation burden of the two techniques. The Wilcoxon test was performed to compare the two diagnostic modalities. Conventional radiography showed 34 acute fractures of the scaphoid in 124 patients (42.2%). Subsequent MDCT revealed a total of 42 scaphoid fractures. The sensitivity of conventional radiography for scaphoid fracture detection was 42.8% and its specificity was 80% resulting in an overall accuracy of 59.6%. Conventional radiography was significantly inferior to MDCT (P < 0.01) concerning scaphoid fracture detection. The mean effective dose of MDCT was 0.1 mSv compared to 0.002 mSv of conventional radiography. Conventional radiography is insufficient for accurate scaphoid fracture detection. Regarding the almost negligible effective dose, MDCT should serve as the first imaging modality in wrist trauma.

  1. Peri-prosthetic humeral non-union: Where biology meets bio-mechanic. A case report

    Directory of Open Access Journals (Sweden)

    Ciurlia Emanuele

    2017-01-01

    Conclusion: We assume that an aggressive revision surgery done with bone autograft implant and a bone healing therapy administering teriparatide off-label can reduce the convalescence in non-unions and can improve prognosis.

  2. Treatment of midshaft clavicular delayed and non-unions with anteroinferior locking compression plating

    NARCIS (Netherlands)

    Stufkens, S.A.; Kloen, P.

    2010-01-01

    INTRODUCTION: Pain and impaired shoulder function are the predominant symptoms of midshaft clavicle non-unions. Obtaining consolidation and improvement of shoulder function is often successfully achieved with osteosynthesis and bone grafting. Most data in the literature pertain to plate

  3. The morphological and morphometric features of the scaphoid.

    Science.gov (United States)

    Ceri, N; Korman, E; Gunal, I; Tetik, S

    2004-08-01

    This cadaveric study used 200 scaphoid bones (100 left and 100 right) to assess 24 morphological and 11 morphometric parameters. At least one morphometric feature was absent in all scaphoids, though the tubercle and the dorsal sulcus were present in all instances. There were significant differences in the circumferences of the waist and the base of the tubercle, the width of the main sulcus and the secondary height of the tubercle between left and right scaphoids. Detailed knowledge of anatomy and correlations between the anatomical features may help better understanding of clinical problems.

  4. Effectiveness of exchange K-nail and augmented plating in aseptic femoral diaphyseal non-union.

    Science.gov (United States)

    Sancheti, K H; Pradhan, Chetan; Patil, Atul; Puram, Chetan; Bharti, Parkalp; Sancheti, Parag; Shyam, Ashok

    2017-08-01

    Femoral diaphyseal non-unions present difficult scenario to manage. There are multiple options but most of them still report varying incidences of failure. We combined the principles of augmented plating and exchange nailing and aim to study the effectiveness of this technique. A retrospective study at a tertiary trauma centre was conducted. Seventy patients (60 men, 10 women), average age 40.7±15.27 years (range 18-81 years) with diaphyseal femoral fracture non-unions treated between July 2010 and January 2015 were reviewed. The average interval between first and the last surgery was 18.07±17.65 months (range 4-96 months). Forty six patients had hypertrophic non-union and 24 patients had atrophic non-union. Twenty one patients had undergone a prior surgery for non-union, 13 dynamisation, 4 bone grafting, 1 augmented plating and 3 exchange nailing. Non-unions were treated with implant removal, freshening of bone edges and exchange K-nailing and augmented plating. Autologous bone grafting and raising of osteoperiosteal flaps was done in all cases. Outcome measures were radiographic evidence of fracture union at minimum three out of four cortices, knee range of motion as compared to opposite knee, and study of complications. All patients demonstrated radiographic evidence of fracture union with an average time of 16.77±2.38 weeks (range 12-26 weeks). Mean knee range of motion of unaffected limb was 126±9.76° (range 90-140°) while in operated limb it was 121.1±11.36° (range 80-140°), p>0.01. Patients with hypertrophic non-unions, prior surgery for non-union and supra- or infra-isthmal non-unions had shorter union time. Two patients had superficial infection which was managed by superficial debridement and two patients had pain at proximal nail tip site which was managed by anti-inflammatory medication. None of the patients required additional surgery for implant removal. Exchange K nailing with Bone graft and additional plating technique for non-union

  5. Co-expression of BMPs and BMP-inhibitors in human fractures and non-unions.

    Science.gov (United States)

    Kloen, Peter; Lauzier, Dominique; Hamdy, Reggie C

    2012-07-01

    Bone morphogenetic proteins (BMPs) are increasingly being used clinically to enhance fracture repair and healing of non-unions. However, the potential efficacy of supraphysiological dosing for clinical results warrants further clarification of the BMP signaling pathway in human fracture healing. As BMP signaling can be fine-tuned at numerous levels, the role of BMP-inhibitors has become a major focus. The aim of the present study was to document co-expression of BMPs, pSmad 1/5/8, and BMP-inhibitors in human fracture callus and human non-unions. Using human tissue of fracture callus (n=14) and non-unions (n=4) we documented expression of BMPs (BMP2, BMP3 and BMP7), pSmad 1/5/8 and the BMP-inhibitors noggin, gremlin, chordin, Smad-6, Smad-7 and BAMBI. Co-expression of pSmad 1/5/8, BMPs and BMP-inhibitors was noted in the osteoblasts of fracture callus as well as of non-unions. Expression of BMP-inhibitors was generally stronger in non-unions than in fracture callus. The most pertinent differences were noted in the cartilaginous tissue components. Expression of BMP2 in chondrocytes was markedly decreased in non-unions compared to fracture callus and that of BMP7 was almost completely absent. Expression of BMP-inhibitors was almost the same in osteoblasts, chondrocytes and fibroblasts of fracture callus and well as in non-unions. Interestingly, although BMP ligands were present in the chondrocytes and fibroblasts of non-unions, they did not co-express pSmad 1/5/8 suggesting that BMP signaling may have been inhibited at some point before Smad 1/5/8 phosphorylation. These results suggest co-expression of BMP, pSmad 1/5/8 and BMP-inhibitors occurs in human fracture callus as well as non-unions but the relative expression of BMPs vs. BMP-inhibitors was different between these two tissue types. In contrast to our expectations, the expression of BMP inhibitors was comparable between fracture callus and non-unions, whereas the expression of BMPs was notably lower in the

  6. Osteomedullography: a simple tool for early detection of impending non union of diaphyseal fracture of tibia

    OpenAIRE

    Arun Vashisht; Arunim Swarup

    2016-01-01

    Background: Fractures of the tibial shaft are one of the most common bony injuries to occur and are frequently associated with slow union and non-union. These fractures are commonly treated by closed reduction and internal fixation with intramedullary interlocking nail under image intensifier control. We present the results of a simple diagnostic tool the and ldquo;Osteomedullography and rdquo; for early detection of impending non union in diaphyseal fractures of tibia. Methods: 35 patie...

  7. Minimally invasive plate augmentation in the treatment of long-bone non-unions.

    Science.gov (United States)

    Park, Ki-Chul; Oh, Chang-Wug; Kim, Joon-Woo; Park, Kyeong-Hyeon; Oh, Jong-Keon; Park, Il-Hyung; Kyung, Hee-Soo; Heo, Jeong

    2017-11-01

    Exchange nailing is most acceptable for treating hypertrophic non-union of the long bones, requiring the removal of previously fixed implant. However, its main effect of mechanical stabilization is controversial in non-isthmal area. We hypothesized that minimally invasive plate augmentation over the non-union site may have a better option, without the need of bone grafting or removing pre-existing implants. Seventeen patients with hypertrophic non-union of the long bones between 2010 and 2014 on radiography who previously underwent intramedullary (IM) nailing or plate osteosynthesis for long-bone fractures were included. A locking compression plate was inserted with at least three mono- or bicortical screws at each proximal and distal segment. Broken or loosened interlocking screws of IM nail were simultaneously re-fixed. Fracture site exposure, pre-fixed implant removal, and bone grafting were not performed. We investigated whether union occurred and analyzed functional outcomes and complications. Eleven femoral and six tibial non-unions were prospectively included. In the pre-existing implants, 13 nails and 4 plates were found. All cases achieved union at a mean 22.7 weeks. One case of superficial infection was managed with oral antibiotics. Deep infection or implant failure did not occur. Minimally invasive plate augmentation can achieve additional stability and promote healing of hypertrophic non-union of the long bones. When indicated, this technique is the least invasive alternative to exchange nailing and reduces surgical risks in the treatment of diaphyseal non-union.

  8. Prune belly syndrome with pouch colon with scaphoid megalourethra

    African Journals Online (AJOL)

    We here report a rare association of megalourethra with pouch colon with prune belly syndrome. We also provide a newer embryological and prognostic perspective to this association. Keywords: megalourethra, prune belly syndrome pouch colon, scaphoid ...

  9. The Four Corners Sign: A Specific Imaging Feature in Differentiating Systemic Sclerosis-related Interstitial Lung Disease From Idiopathic Pulmonary Fibrosis.

    Science.gov (United States)

    Walkoff, Lara; White, Darin B; Chung, Jonathan H; Asante, Dennis; Cox, Christian W

    2018-01-16

    Differentiating between systemic sclerosis-related interstitial lung disease (SSc-ILD) and idiopathic pulmonary fibrosis (IPF) is important because of the differences in workup, prognosis, and treatment. However, there is much overlap in the appearance of these 2 entities on high-resolution computed tomography. We propose that inflammation and/or fibrosis focally or disproportionately involving the bilateral anterolateral upper lobes and posterosuperior lower lobes ["Four Corners" Sign (FCS)] is specific for SSc-ILD. Randomized high-resolution computed tomography studies from 74 IPF and 73 SSc-ILD cases were evaluated by 2 thoracic radiologists blinded to all patient data. For each case the reviewers noted whether the FCS was present and assigned a confidence level on the basis of a 7-point Likert scale. The same process was then performed on a randomized external validation group of 42 SSc-ILD and 42 IPF cases. For Likert scores of 6 or 7 ("mostly agree" or "entirely agree" that the FCS is present, respectively) the sensitivity in SSc was 16.4% (95% confidence interval, 9.7%, 26.6%), specificity 100.0% (95% confidence interval, 95.1%, 100.0%). There was a significant association between a confidently present FCS and SSc compared with a confidently present FCS and IPF (P=0.0003). Analysis on an external validation group of 42 SSc and 42 IPF cases conferred similarly high specificity for SSc in cases characterized as FCS with high confidence. The FCS, a pattern of focal or disproportionate inflammation and/or fibrosis involving the bilateral anterolateral upper lobes and posterosuperior lower lobes, is specific for SSc-ILD when readers are confident of its presence.

  10. Point-of-care ultrasound detection of acute scaphoid fracture.

    Science.gov (United States)

    Tessaro, Mark O; McGovern, Terrance R; Dickman, Eitan; Haines, Lawrence E

    2015-03-01

    In cases of traumatic wrist pain, emergency physicians must maintain a high index of suspicion for scaphoid fractures due to their potential for serious complications. A growing body of literature supports the use of point-of-care ultrasonography by emergency physicians in the evaluation of potential fractures. We report a case of a pediatric scaphoid fracture that was initially not visualized on x-ray and was subsequently detected using point-of-care ultrasound in the ED.

  11. Reaming in treatment of non-unions in long bones: cytokine expression course as a tool for evaluation of non-union therapy.

    Science.gov (United States)

    Westhauser, Fabian; Zimmermann, Gerald; Moghaddam, Sanaz; Bruckner, Tom; Schmidmaier, Gerhard; Biglari, Bahram; Moghaddam, Arash

    2015-08-01

    The analysis of peripheral serum cytokine expression patterns has been shown to be a possible method for demonstrating changes in bone metabolism. The aim of this study is to evaluate the effectiveness of this method within the treatment of long bone non-union with intramedullary reaming, a well-established non-union treatment concept. Three groups were added to this study: group one (G1) suffered from long bone non-unions, treated successfully with intramedullary reaming; group two (G2) consisted of long bone fractures with proper fracture healing; and group three (G3) included long bone fractures resulting in non-unions. We took blood samples on day 2, and after week 1, 4, 6, month 3 and 6 after initial treatment. Clinical and radiological follow-up were provided for 6 months. We measured transforming growth factor ß-1 (TGFß-1), platelet-derived growth factor (PDGF-AB), and insulin like growth factor-1 (IGF-1) at all-time points. TGF-ß1 levels in G1 and G2 increased from day 2 to 6 weeks after surgery. In general, G1 and G2 showed parallel TGF-ß1 expression patterns, and G3 had a significant peak during first week compared to G1 (p = 0.023). PDGF peaked in G3 during first week after treatment, whereas G1 had its maximum after 4 weeks and G2 after 6 weeks. We were able to detect a significantly lower PDGF concentration at 3 months in G1 compared to G3 (p = 0.029). IGF-1 showed a peak concentration in G1 during the first 4 weeks. Afterwards, concentration levels in both G1 and G2 were higher. Our study was able to show that the cytokine expression pattern in physiological bone healing is similar to that in successful non-union treatment with intramedullary reaming. Our results show that the effect of non-union therapy could be observed objectively by measuring cytokine expression patterns in peripheral blood even in a small group of patients.

  12. Clinical diagnostic evaluation for scaphoid fractures: a systematic review and meta-analysis

    NARCIS (Netherlands)

    Mallee, Wouter H.; Henny, Erik P.; van Dijk, C. Niek; Kamminga, Sjoerd P.; van Enst, Wynanda A.; Kloen, Peter

    2014-01-01

    To provide an overview of available clinical evaluation tests for scaphoid fractures and to compare their diagnostic accuracies. PWe performed a systematic review of all studies assessing diagnostic characteristics of clinical evaluation in scaphoid fractures by searching MEDLINE, EMBASE, Cochrane,

  13. MANAGEMENT OF INFECTED NON UNION TIBIAL FRACTURES WITH ILIZAROV EXTERNAL FIXATION

    Directory of Open Access Journals (Sweden)

    Nageshwara Rao

    2015-10-01

    Full Text Available BACKGROUND & OBJECTIVES: Infected non - union of tibia per se is a challenge to treat. Subcutaneous bone causes susceptibility to compartment syndrome, non - responsive infection, non - union, fibrosis, sinuses, deformities, shortening and various other sets of problems which are assoc iated with it. Ilizarov External fixation provides correction of all the complications associated with non - union, bone gap, infection, shortening, and deformities. Objective of this study is to assess the efficacy and safety of Ilizarov fixator method of t reatment in infected non - union tibia and to study various complications associated with Ilizarov external fixation. MATERIALS AND METHODS: 23 patients admitted and treated in Government General Hospital under the Department of Orthopaedics during the perio d of May 2010 to December 2012 were included in the study. Results were evaluated according to ASAMI criteria . 1 RESULTS : 59% patients had excellent bony results, 27.3% had good bony results, 9.1% had fair bony results, 4.6% had poor bony results. 68.1% had excellent functional results, 9.1% had good functional results, 9.1% had fair functional results, 13.7% had poor functional results. CONCLUSION : Ilizarov external fixator system is the best device and best solution for infected non - union tibia management.

  14. Treatment of aseptic tibial shaft non-union without bone defect.

    Science.gov (United States)

    Tall, M

    2018-02-01

    Non-union is incomplete consolidation of a fracture, without effective formation of a uniting callus. Despite better understanding of the physiology of bone consolidation, management of tibial non-union remains a challenge for orthopedic surgeons. Several treatments have been developed in recent decades, and we now have a range of techniques, with indications based on type of non-union, prior treatments, available equipment, and the surgeon's experience. Firstly, there are surgical techniques such as osteo-periosteal decortication, cancellous iliac graft, or inter-tibiofibular graft. The decision to fix the non-union (or revise existing fixation) and choice of type of internal fixation depend on the stability of the fracture site. There are also non-operative biological and biochemical consolidation stimulation techniques: local injection of bone-marrow, platelet-rich plasma (PRP) or bone morphogenetic protein (BMP). Stimulation can also be physical, applying ultrasound or an electromagnetic field to the non-union site. Each technique may be used in isolation or association. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  15. 21 CFR 888.3760 - Wrist joint carpal scaphoid polymer prosthesis.

    Science.gov (United States)

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Wrist joint carpal scaphoid polymer prosthesis. 888.3760 Section 888.3760 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN... scaphoid polymer prosthesis. (a) Identification. A wrist joint carpal scaphoid polymer prosthesis is a one...

  16. VALGUSING INTERTROCHANTERIC OSTEOTOMY FOR THE TREATMENT OF FEMORAL NECK NON-UNIONS: REPORT OF 32 CASES.

    Science.gov (United States)

    Schwartsmann, Carlos Roberto; Telöken, Marco Aurélio; Boschin, Leonardo Carbonera; Schmiedt, Ivo; Falavinha, Ricardo; Crestani, Marcus Vinicius

    2009-01-01

    The purpose of the present study was to review the results of femoral neck non-unions treatment with valgusing intertrochanteric osteotomy. Between 1988 and 2003 we treaded thirty two femoral neck non-unions with valgusing osteotomy and fixation. The mean follow-up time was 9.8 years and the mean age was 41.7 years. Twenty eight (87.4%) of the thirty two valgusing osteotomies evolved to femoral neck union, while four cases (12.6%) evolved to total hip arthroplasty. Eight cases evolved to partial osteonecrosis. The valgusing intertrochanteric osteotomy for treating femoral neck non-unions achieved consolidation in 87.4% (28/32). However, only 56.2% (18/32) achieved full recovery of hip function.

  17. Extracorporeal shockwave therapy (ESWT)--First choice treatment of fracture non-unions?

    Science.gov (United States)

    Schaden, Wolfgang; Mittermayr, Rainer; Haffner, Nicolas; Smolen, Daniel; Gerdesmeyer, Ludger; Wang, Ching-Jen

    2015-12-01

    Fracture non-unions are still a challenging problem in orthopedics. The treatment of non-unions remains highly individualized, complex, and demanding. In most countries the surgical approach with debridement of the non-union gap, anatomical reduction and appropriate osteosynthesis along with autologous bone grafting is considered as the standard of care. One of the very first non-urologic applications of extracorporeal shockwave treatment (ESWT) concerned non-healing fractures. Since the early 1990ties the knowledge of the working mechanism has increased enormously. The purpose of this review article is to demonstrate by peer-reviewed literature in conjunction with our own experiences that ESWT can be an efficient, non-invasive, almost complication-free and cost effective alternative to surgical treatment of non-healing fractures. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  18. Treatment of symptomatic non-unions of the base of the ulnar styloid with plate osteosynthesis.

    Science.gov (United States)

    Nunez, F A; Luo, T D; Nunez, F A

    2017-05-01

    The purpose of this prospective case series was to assess the efficacy of plate osteosynthesis using a low profile distal ulna plate for the management of persistently symptomatic non-unions of the base of the ulnar styloid. Six consecutive patients underwent resection of the non-union and plate osteosynthesis with a 2.0 mm distal ulna hook plate. Post-operative measurements of mean pain scores, QuickDASH scores, grip strength, and range of motion parameters showed significant improvements compared with the pre-operative values. No complications were reported at a mean follow-up of 25 months. The present study presents an alternative method for treating symptomatic ulnar styloid non-unions that provides stable fixation with low risk of implant removal. Therapeutic IV.

  19. Late onset venous thoracic outlet syndrome following clavicle non-union fracture: A case report.

    Science.gov (United States)

    Wong, Daniel J; Holm, Tammy M; Dyer, George S M; Gates, Jonathan D

    2015-04-01

    A 59-year-old woman was admitted three times over a six-month period with recurrent upper extremity deep venous thrombosis (UEDVT). It was determined that this patient was suffering from an unusual presentation of Paget-Schröetter syndrome secondary to a 20-year-old non-union of a midshaft clavicle fracture. Following thrombolysis the patient underwent resection and plate fixation of the clavicle fracture non-union. Despite the anatomic proximity of the subclavian vessels to the clavicle, vascular complications from fracture are rare. Treatment of midshaft clavicle fractures is often non-operative. Non-union rates are generally less than 10%, and easily treated secondarily without complication. Clavicular pseudo-arthroses from trauma have been implicated in the development of the thoracic outlet syndromes, however, onset 20 years after fracture has never before been reported. © The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

  20. [NITINOL shape memory staple for osteosynthesis of the scaphoid].

    Science.gov (United States)

    Winkel, Reiner; Schlageter, Michael

    2009-11-01

    Reconstruction of the scaphoid with use of NITINOL shape "memory" staples. Unstable fractures and nonunion of the middle third of the scaphoid, which need open reduction and internal fixation from palmar. The staples can only be used, if the arms of the staples can be inserted parallel to and at a distance of 3 mm to the fracture line. Allergy to nickel. Cases in which the arms of the staple cannot be inserted parallel to and at best 3 mm apart from the fracture line. In fractures, open reduction of the scaphoid through a palmar approach. If necessary, interposition of a bone graft and Kirschner wire transfixation. Drilling of the drill holes parallel and at a distance of 3 mm to the fracture line. Insertion of the NITINOL staple. In nonunion, excision of the fibrous nonunion, refreshening of the fracture surfaces, interposition of a bone graft and, if needed, fixation with a Kirschner wire. Drilling of the drill holes for the NITINOL staple and insertion of the staple. Within a few minutes the warming-up staple contracts and thereby compresses the scaphoid. Immobilization in a short cast with thumb support for 6 weeks. Control for bone healing by radiographs or computed tomography. Staples, which do not cause hardware problems, are not removed. Kirschner wires are removed after bone healing. From October 1995 to December 2006, the authors used NITINOL staples for 65 osteosyntheses of the scaphoid. Indications were 15 unstable fractures, 47 nonunions, and three partial necroses. 61 out of 65 scaphoids healed without further surgery, three of the 61 patients showed a delayed healing. Two of the four nonunions were related to the use of the NITINOL staples. Seven staples were removed, one for loosening. NITINOL shape memory staples have proven to be very helpful for osteosynthesis in fractures and nonunion of the scaphoid, if the prerequisites are given for their use.

  1. Fixation and Grafting After Limited Debridement of Scaphoid Nonunions.

    Science.gov (United States)

    McInnes, Colin W; Giuffre, Jennifer L

    2015-09-01

    To evaluate a surgical technique of treating nondisplaced waist and proximal pole scaphoid nonunions without avascular necrosis (AVN). We performed a retrospective review of all patients with nondisplaced, scaphoid waist or proximal pole nonunions without AVN treated with the following technique. Two K-wires are positioned along the scaphoid axis to stabilize the proximal and distal poles. Debridement with a curette or burr is performed parallel to the nonunion site until the K-wires are visualized and punctate bleeding of the proximal and distal fragments is encountered. The volar, radial fibrous union is left intact. Distal radius cancellous bone graft is packed into the nonunion site. A headless screw is placed perpendicular to the fracture and the K-wires are removed. Between 2012 and 2014, 12 patients (ages 13-29 y) with clinical and radiographic evidence (10 had computed tomography or magnetic resonance imaging; 2 had radiographs only) of scaphoid nonunion were identified (10 transverse waist and 2 proximal pole fractures). Median interval from injury to surgery was 38 weeks (range, 3 mo to 9 y). Four patients were active smokers and 2 had failed previous iliac crest bone grafting. All patients healed as confirmed by computed tomography. Average time to union was 14 weeks (range, 6-31 wk). Four patients had delayed union requiring a bone stimulator. All patients had resolution of pain and there were no complications. The technique described is an effective and efficient method of treating nondisplaced scaphoid nonunions without AVN. We suggest that complete debridement of the nonunion is not essential to achieve union. In addition, pinning the proximal and distal scaphoid poles initially and maintaining the volar fibrous union of the scaphoid nonunion stabilizes the fracture fragments, increasing the technical ease of grafting and fixation. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights

  2. Treatment of diaphyseal non-unions of the ulna and radius.

    Science.gov (United States)

    Kloen, Peter; Wiggers, Jim K; Buijze, Geert A

    2010-12-01

    Non-unions of the forearm often cause severe dysfunction of the forearm as they affect the interosseus membrane, elbow and wrist. Treatment of these non-unions can be challenging due to poor bone stock, broken hardware, scarring and stiffness due to long-term immobilisation. We retrospectively reviewed a large cohort of forearm non-unions treated by using a uniform surgical approach during a period of 33 years (1975-2008) in a single trauma centre. All non-unions were managed following the AO-principles of compression plate fixation and autologous bone grafting if needed. The study cohort consisted of 47 patients with 51 non-unions of the radius and/or ulna. The initial injury was a fracture of the diaphyseal radius and ulna in 22 patients, an isolated fracture of the diaphyseal ulna in 13, an isolated fracture of the diaphyseal radius in 5, a Monteggia fracture in 5, and a Galeazzi fracture-dislocation of the forearm in 2 patients. Index surgery for non-union consisted of open reduction and plate fixation in combination with a graft in 30 cases (59%), open reduction and plate fixation alone in 14 cases (27%), and only a graft in 7 cases (14%). The functional result was assessed in accordance to the system used by Anderson and colleagues. Average follow-up time was 75 months (range 12-315 months). All non-unions healed within a median of 7 months. According to the system of Anderson and colleagues, 29 patients (62%) had an excellent result, 8 (17%) had a satisfactory result, and 10 (21%) had an unsatisfactory result. Complications were seen in six patients (13%). Our results show that treatment of diaphyseal forearm non-unions using classic techniques of compression plating osteosynthesis and autologous bone grafting if needed will lead to a high union rate (100% in our series). Despite clinical and radiographic bone healing, however, a substantial subset of patients will have a less than optimal functional outcome.

  3. Non union of the neck of radius: a case report and review of the ...

    African Journals Online (AJOL)

    Fractures of the neck of radius are frequent in trauma. They happen without being noticed at the moment of injury of the elbow or in the context of polytrauma. A case of non union of the radius neck occurring in a young person due to ignorance, during first consultation has been reported by the authors. They insist on the ...

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

    LENUS (Irish Health Repository)

    O'Neill, Barry James

    2014-04-03

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

  5. Assessment of the Use of Tourniquet in the Plating of Non-Union of ...

    African Journals Online (AJOL)

    Background: In non-union surgery, tourniquet may be needed to prevent the increased bleeding during surgical dissection caused by fibrosis and provide clearer surgical field in the presence of altered anatomy due to deformity. Tourniquets have been shown to be associated with adverse effects when used in plating acute ...

  6. Monotherapy vs. polytherapy in the treatment of forearm non-unions and bone defects.

    Science.gov (United States)

    Calori, G M; Colombo, M; Mazza, E; Ripamonti, C; Mazzola, S; Marelli, N; Mineo, G V

    2013-01-01

    To determinate the efficacy of "polytherapy", a surgical technique that utilize all the components of the diamond concept (mesenchymal stem cells, bone morphogenetic proteins and scaffold) versus a "monotherapy", a surgical technique that utilize only one component of the diamond conceptin the treatment of severe forearm non-unions. We studied a database of 52 patients with 52 forearm non-unions; we classified the patients with the NUSS SCORE and we divided the patients in two group according to the treatment received. So we distinguished a group of patients treated according to the principles of "monotherapy" (33 patients) and a group of patients treated according to the principles of "polytherapy" (19 patients). The minimum follow up was 12 months. In the monotherapy group 21/33 non-unions (63.64%) went on to develop a radiographic and clinical healing within a period of 12 months, the calculated DASH SCORE showed a mean value of 55.15 points. In the polytherapy group 17/19 (89.47%) nonunions went on to develop clinical and radiographic healing within 12 months, and the average DASH score showed a mean value of 45.47 points. The polytherapy technique with the use of recombinant morphogenetic proteins, autologous MSCs and scaffold in the same surgical time appears to be an effective treatment for patients with severe forearm non-unions. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. Bilateral clavicle non-unions treated with anteroinferior locking compression plating (LCP": a case report

    NARCIS (Netherlands)

    Kloen, Peter

    2004-01-01

    The author reports the case of a 30-year-old female patient with bilateral atrophic non-union of the clavicle; the latter both healed after internal fixation with a locking compression plate fixed on the anteroinferior aspect of the clavicle, combined with autologous cancellous bone grafting. The

  8. Percutaneous autologous bone marrow injections for delayed or non-union of bones.

    Science.gov (United States)

    Singh, Ashok K; Shetty, Sanat; Saraswathy, Jayadeep J; Sinha, Amit

    2013-04-01

    To evaluate 12 patients with delayed or nonunion of bones treated with bone marrow injections. 6 men and 6 women aged 15 to 70 (mean, 45) years underwent bone marrow injections for delayed union (n=2) or atrophic non-union (n=10) of the ulna (n=6), femur (n=3), humerus (n=2), or metacarpal (n=1). Bone marrow was aspirated from the anterior iliac crest and injected to the delayed and non-union sites. Two injections were given for children and adolescents, and 3 for adults. The interval between the injections was 6 to 8 weeks. The amount of bone marrow injected was 30 to 40 ml for long bones and 20 ml for metacarpals. Ten of the 12 delayed or non-union of bones healed after bone marrow injections. The mean time for callus formation was 5.8 (range, 3-10) weeks, for clinical union was 7 (range, 4-12) weeks, and for radiological union was 16 (range, 10-24) weeks. Multiple injections of low-volume bone marrow can be used for treatment of delayed or non-union of bones.

  9. The incidence of non-union following unreamed intramedullary nailing of femoral shaft fractures

    NARCIS (Netherlands)

    el Moumni, M.; Leenhouts, P. A.; ten Duis, H. J.; Wendt, K. W.

    Introduction: Stabilisation. of fractures with an intramedullary nail is a widespread technique in the treatment of femoral shaft fractures in adults. To ream or not to ream is still debated. The primary objective of this Study was to determine the incidence of non-union following unreamed

  10. Two-stage surgical treatment for septic non-union of the forearm.

    Science.gov (United States)

    Perna, Fabrizio; Pilla, Federico; Nanni, Matteo; Berti, Lisa; Lullini, Giada; Traina, Francesco; Faldini, Cesare

    2017-06-18

    To investigate the effectiveness of a two-stage surgical procedure for the treatment of septic forearm non-union. Septic non-unions are rare complications of forearm fractures. When they occur, they modify the relationship between forearm bones leading to a severe functional impairment. Treatment is challenging and surgery and antibiotic therapy are required to achieve infection resolution. It is even harder to obtain non-union healing with good functional results. The aim of this study is to present a two stages surgical treatment for septic forearm non-union with revision and temporary stabilization of the non-union until infection has cleared and subsequently perform a new synthesis with plate, opposite bone graft strut and intercalary graft. We retrospectively reviewed 18 patients with a mean age at the time of primary injury of 34.5 years (19-57 years) and a mean follow-up of 6 years (2-10 years). All patients presented an atrophic non-union with a mean length of the bone defect of 1.8 cm (1.2-4 cm). Complications and clinical results after surgical treatment were recorded. Mean time to resolution of the infectious process was 8.2 wk (range 4-20 wk) after the first surgery and specific antibiotic therapy. All the non-union healed with an average time of 5 mo (range 2-10 mo) after the second step surgery. Cultures on intraoperative samples were positive in all cases. No major intraoperative complications occurred. Two patients developed minor complications and one needed a second surgical debridement for infection resolution. At the last follow-up functional results were excellent in 5 (27.8%) patients, satisfactory in 10 (55.5%) and unsatisfactory in 3 (16.7%) patients. No activities of daily living (ADLs) limitations were reported by 12 (66.6%) patients, slight by 3 (16.6%) and severe limitation by 3 (16.6%) patients. Mean visual analog scale at the last follow-up was 1 (0-3). The two-step technique has proven to be effective to achieve resolution of the

  11. Accordion technique combined with minimally invasive percutaneous decortication for the treatment of bone non-union.

    Science.gov (United States)

    Zhang, Qun; Zhang, Wei; Zhang, Zhuo; Tang, Peifu; Zhang, Lihai; Chen, Hua

    2017-10-01

    A variety of approaches have been used to treat oligotrophic or atrophic non-union. Conventional methods are often associated with great operative trauma, increased blood loss, a risk of re-infection, higher medical costs, and complications at the donor site. This study aimed to assess the clinical efficacy of the accordion technique combined with Minimally Invasive Percutaneous Decortication (MIPD) for these types of bone non-union. From January 2010 to December 2015, 20 patients with long bone aseptic non-unions of the lower extremities without bone defects who were treated with the accordion technique combined with MIPD. The limb-length discrepancy (LLD) was less than 2cm in all patients. None of the patients received autogenous bone grafts during follow-up. All surgeries were performed by the same surgeon, and the modified Application of methods of Ilizarov (ASAMI) criteria were used to evaluate the operative effectiveness. A total of 20 patients were included in this study, and 1 patient was lost during follow-up. Fifteen of these patients presented with oligotrophic non-unions, and 5 patients presented with atrophic non-unions. The average follow-up period in these patients was 12.1 months (range: 8-42 months). The alternative compression and distraction procedure was repeated 1-3 times. Blood loss was 30 to 250ml during surgery. Ultimately, bone union was achieved in 19 patients and failed in 1 patient. The fractures healed within 4-8 months (average time: 5.9 months), and fracture healing was considered excellent in 19 patients and poor in 1 patient. Postoperative function was evaluated as excellent in 9 patients, good in 6 patients, fair in 4 patients, and poor in 1 patient. The accordion technique combined with MIPD, which is a simple, minimally invasive procedure that does not require autologous bone grafting, resulted in a high bone union rate and good postoperative function. Copyright © 2017 Elsevier Ltd. All rights reserved.

  12. Dynamic contrast-enhanced magnetic resonance imaging can assess vascularity within fracture non-unions and predicts good outcome.

    Science.gov (United States)

    Schoierer, Oliver; Bloess, Konstantin; Bender, Daniel; Burkholder, Iris; Kauczor, Hans-Ulrich; Schmidmaier, Gerhard; Weber, Marc-André

    2014-02-01

    To prospectively evaluate whether dynamic contrast-enhanced (DCE) MRI can assess vascularity within non-unions and predicts clinical outcome in combination with the clinical Non-Union Scoring System (NUSS). Fifty-eight patients with non-unions of extremities on CT underwent 3-T DCE MRI. Signal intensity curves obtained from a region-of-interest analysis were subdivided into those with more intense contrast agent uptake within the non-union than in adjacent muscle (vascularised non-union) and those with similar or less contrast uptake. The pharmacokinetic parameters of the Tofts model K trans, K ep, iAUC and V e were correlated with union at CT 1 year later (n = 49). Despite inserted osteosynthetic material, DCE parameters could be evaluated in 57 fractures. The sensitivity/specificity of vascularised non-unions as an indicator of good outcome was 83.9%/50.0 % compared to 96.8%/33.3% using NUSS (n = 49). Logistic regression revealed a significant impact of NUSS on outcome (P = 0.04, odds ratio = 0.93). At first examination, median iAUC (initial area under the enhancement curve) for the ratio non-union/muscle was 10.28 in patients with good outcome compared with 3.77 in non-responders (P = 0.023). K trans, K ep and Ve within the non-union were not significantly different initially (n = 57) or 1 year later (n = 19). DCE MRI can assess vascularity in fracture non-unions. A vascularised non-union correlates with good outcome. • Dynamic contrast-enhanced magnetic resonance imaging can assess vascularity within bony non-unions. • Vascularised ununited fractures appear better at 1-year CT than poorly vascularised fractures. • Non-union healing after osteosynthesis or osteoinductive drugs fundamentally requires vascularity. • DCE MRI predicts treatment outcome better than the clinical Non-Union Scoring System. • DCE MRI is clinically feasible to predict treatment outcome in bony non-unions.

  13. Autologous Bone Grafting and Revision Plating in a Case of Persistent High Tibial Osteotomy Non-Union.

    Science.gov (United States)

    Ming, Tan Shi; Koon, Wong Merng

    2016-01-01

    Uni-compartmental knee arthritis may be treated with several surgical options including uni-compartmental knee arthroplasty, total knee arthroplasty and high tibial osteotomy. Non-union is a well-established and common complication that may arise from the latter option and few reports have shown successful treatment of persistent non-union of high tibial osteotomy. We present a case of persistent non-union after high tibial osteotomy treated with autologous iliac crest bone grafting and revision plating. At 1 year post-operative interval, successful union was achieved after revision internal fixation. In addition, a good functional outcome was achieved. In this patient with persistent non-union following high tibial osteotomy, the aim of revision was to restore alignment and effect bone healing while preserving adequate tibial bone stock. Revision plating with autologous bone grafting is a good surgical strategy in the treatment ofpersistent non-union with hardware failure.

  14. Clinical effectiveness of Osigraft in long-bones non-unions.

    Science.gov (United States)

    Calori, Giorgio Maria; Colombo, Massimiliano; Bucci, Miguel; Mazza, Emilio Luigi; Fadigati, Piero; Mazzola, Simone

    2015-12-01

    Current evidence, based primarily on case series, suggest that the eptotermin alfa (recombinant bone morphogenetic protein-7 (rhBM-7)), which is commercialized as Osigraft with an indication for tibial non-union, used in monotherapy or polytherapy, is a safe and effective therapy for long bones non-unions of lower and upper limbs. No previous study has compared the safety and the efficacy of Osigraft and the "gold standard" treatment for recalcitrant long-bones non-union, autologous bone graft (ABG). This study aims to compare the effectiveness of Osigraft and ABG in the treatment of post-traumatic, persistent long bone non-unions. In particular, the present study will focus exclusively on complex persistent non-unions, excluding simpler cases, in which it is likely that a simple revision of the osteosynthesis will be sufficient to promote union, and extremely severe cases in which there is an indication for amputation and prosthesis. The study addresses the following research question: 1. Is the effectiveness of eptotermin alfa comparable to that of ABG in the treatment of complex long bone non-unions? 2. Are there significant differences in the prevalence of adverse events between patients treated with eptotermin alfa and those treated with ABG? The study is an observational, retrospective study, located in one Experimental Recruiting Center (Ospedale Universitario G. PINI - Milano). The study was conducted with ethics approval and according with the existing Italian law. Demographic and clinical data were collected from patients Clinical Medical Records and other existing documentation, through a web based eCRF. The treatment (surgery with Osigraft or ABG) effectiveness was evaluated comparing the number of success cases (primary endpoint) and the length for clinical and radiological healing (secondary end-points). The treatment safety was evaluating comparing the prevalence of Adverse Events. Osigraft was demonstrated to be statistically equivalent to ABG with

  15. Dynamic contrast-enhanced magnetic resonance imaging can assess vascularity within fracture non-unions and predicts good outcome

    International Nuclear Information System (INIS)

    Schoierer, Oliver; Bender, Daniel; Schmidmaier, Gerhard; Bloess, Konstantin; Kauczor, Hans-Ulrich; Weber, Marc-Andre; Burkholder, Iris

    2014-01-01

    To prospectively evaluate whether dynamic contrast-enhanced (DCE) MRI can assess vascularity within non-unions and predicts clinical outcome in combination with the clinical Non-Union Scoring System (NUSS). Fifty-eight patients with non-unions of extremities on CT underwent 3-T DCE MRI. Signal intensity curves obtained from a region-of-interest analysis were subdivided into those with more intense contrast agent uptake within the non-union than in adjacent muscle (vascularised non-union) and those with similar or less contrast uptake. The pharmacokinetic parameters of the Tofts model K trans , K ep , iAUC and V e were correlated with union at CT 1 year later (n = 49). Despite inserted osteosynthetic material, DCE parameters could be evaluated in 57 fractures. The sensitivity/specificity of vascularised non-unions as an indicator of good outcome was 83.9 %/50.0 % compared to 96.8 %/33.3 % using NUSS (n = 49). Logistic regression revealed a significant impact of NUSS on outcome (P = 0.04, odds ratio = 0.93). At first examination, median iAUC (initial area under the enhancement curve) for the ratio non-union/muscle was 10.28 in patients with good outcome compared with 3.77 in non-responders (P = 0.023). K trans , K ep and V e within the non-union were not significantly different initially (n = 57) or 1 year later (n = 19). DCE MRI can assess vascularity in fracture non-unions. A vascularised non-union correlates with good outcome. (orig.)

  16. NON-UNIONIZED WORKERS IN BRITISH GREEN SECTORS: EVIDENCE FROM THE LABOR FORCE SURVEY*

    Directory of Open Access Journals (Sweden)

    Ayhan Gormus

    2017-02-01

    Full Text Available International Labour Organization (ILO and United Nations Environment Programme (UNEP suggest that green sectors should offer decent jobs respecting to unions and international labor rights and fulfill requirements of labor laws and collective bargaining system. Also, non-unionized working in green sectors poses a significant challenge in terms of creation decent jobs. In this line, this article presents several evidences from British Labour Force Survey to find some socio-economic obstacles behind unionization in green sectors by using logistic regression modeling method. The results suggest that union membership decision in green sectors is affected by a range of demographic and work-related factors used in the study. For example, those who are 16-24 age band, women workers, those who are employed by small sized enterprises and takes charge in high-ranked occupations are higher likelihood of non-unionized working in green sectors, compared to rest of the sectors.

  17. Management of gap non-union of tibia by tibialisation of ipsilateral vascular fibula.

    Directory of Open Access Journals (Sweden)

    Date A

    1996-10-01

    Full Text Available Gap non-union of tibia following traumatic bone loss or infection dramatically emphasizes the limitation of conventional reconstructive techniques. With presence of significant skin loss or poorly vascularised recepient bed, complications and failure rate increase and solution often lies in amputation. Vascularised ipsilateral fibular grafting offers a viable alternative to this. This is a series of 16 cases of gap non-union of tibia treated by tibialisation of fibula at KEM Hospital, Bombay. All the cases were secondary to osteomyelitis following compound fracture of tibia-fibula or hematogenous osteomyelitis with a large sequestrum. 15 cases had good results with good hypertrophy of bone after union. One case had poor result with fracture going into delayed union with no hypertrophy. We discuss the technique, complications and results of this procedure.

  18. Classifications of Acute Scaphoid Fractures: A Systematic Literature Review

    NARCIS (Netherlands)

    ten Berg, Paul W.; Drijkoningen, Tessa; Strackee, Simon D.; Buijze, Geert A.

    2016-01-01

    Background In the lack of consensus, surgeon-based preference determines how acute scaphoid fractures are classified. There is a great variety of classification systems with considerable controversies. Purposes The purpose of this study was to provide an overview of the different classification

  19. Scaphoid dimensions and appropriate screw sizes in a Kenyan ...

    African Journals Online (AJOL)

    While most injuries are amenable to non operative management, internal fixation is gaining traction due to predictable results and early return to physical activities. As scaphoid dimensions vary across populations, determining our population specific dimensions will aid in identifying appropriate screw systems. Objective: ...

  20. Osteoblastoma of scaphoid of the carpus: a case report | Bahouq ...

    African Journals Online (AJOL)

    Osteoblastoma is a rather uncommon tumor, especially when located in the wrist (and hand). Its diagnosis therefore appears to be problematic. We describe a case of osteoblastoma of the scaphoid bone and its management. To our knowledge, this is the fourth case of osteoblatoma of the carpus reported in the literature.

  1. Intramedullary nailing with reaming to treat non-union of the tibia.

    Science.gov (United States)

    Sledge, S L; Johnson, K D; Henley, M B; Watson, J T

    1989-08-01

    The records of fifty-one patients who were treated by intramedullary nailing with reaming for non-union of the tibia were retrospectively reviewed. The fractures had been treated initially by closed reduction and immobilization in a cast, external fixation followed by immobilization in a cast, fixation by pins incorporated in a plaster cast, minimum internal fixation and immobilization in a cast, dynamic compression plating, or intramedullary nailing with or without reaming. After the initial treatment had failed, intramedullary nailing with reaming was done to gain union. Although closed nailing of the tibia was preferred, in thirty-three patients, the site of the non-union was opened to improve alignment by performing an osteotomy or to remove failed hardware. Bone grafts from the iliac crest were used in ten patients, and a fibular ostectomy or osteotomy was done in thirty-three. Of thirty-four open fractures (fourteen grade I, seven grade II, and thirteen grade III), eight were infected at the time of intramedullary nailing. The average time of the diagnosis of a non-union was 9.6 months; the average length of follow-up after nailing was twenty months. In forty-nine (96 per cent) of the fifty-one patients, tibial union occurred at an average of seven months postoperatively. Complications included persistent infection (three patients), acquired infection after intramedullary nailing with reaming (three patients), fracture of the nail that necessitated an additional operation (two patients), shortening of more than one centimeter (two patients), malrotation of more than 15 degrees (one patient), peroneal palsy (one patient), and amputation (one patient). When used to treat non-union of the tibia, intramedullary nailing with reaming can produce union as effectively as other alternatives, while enabling the patient to function more normally without external immobilization or walking aids.

  2. Peri-prosthetic humeral non-union: Where biology meets bio-mechanic. A case report

    OpenAIRE

    Ciurlia Emanuele; Puddu Leonardo; Caggiari Gianfilippo; Andreozzi Matteo; Carlo Doria

    2017-01-01

    Introduction: The worldwide incidence of traumatic fractures has been growing over the last years due to the progressive aging of the population. Today, the increase of arthroplasty procedures in orthopaedic surgery is related to a high rate of peri-prosthetic fractures. Healing of the fracture is a multifactorial metabolic process; if these factors are impaired, healing process could be interrupted resulting in non-union. Presentation of case: We report our experience about a case of a hu...

  3. Extracorporeal shockwave therapy (ESWT) in the treatment of atrophic non-unions of femoral shaft fractures.

    Science.gov (United States)

    Kuo, Shu-Jui; Su, I-Chang; Wang, Ching-Jen; Ko, Jih-Yang

    2015-12-01

    As of now, the role of extracorporeal shockwave therapy (ESWT) in the treatment of atrophic non-unions is inconclusive. The purpose of the study was to investigate the effectiveness of ESWT and the role of this technology in the treatment of atrophic non-union of femurs. We retrospectively analyzed 22 patients treated between July 1999 and September 2007 in our hospital with ESWT for atrophic non-unions of isthmic femoral shaft fractures that were initially treated surgically using closed reamed nailing procedure. Patients with open fractures, skeletal immaturity, on anti-osteoporotic medications, with infections, pathological fractures, smokers, with systemic disease compromising bone healing, and excessive deformity were excluded from this study. Due to incomplete follow-up one (1) patient who moved abroad after ESTW treatment was not included in this study and as part of the 22-patients cohort. Radiographs were obtained before treatment and once a month after treatment for 12 months. Using ESWT we showed that 14 fractures out of 22 (63.6%) achieved bony union with an average union time of 9.2 months (range 6-13 months). The union rate was 100% (8 of 8 cases) when ESWT was performed within 12 months from closed reamed nailing surgery versus 42.9% (6 of 14 cases) when ESWT was performed after 12 months from initial surgery. The eight (8) patients out of the total 22 patients cohort, who did not achieve bony union after ESWT, received subsequent treatment with bone grafting with augmentative plating surgery and all achieved bony union within 5 months after intervention. For patients with atrophic non-unions of femoral shaft fractures, ESWT can be used as an alternative and effective non-invasive method of treatment. ESWT treatment does not negatively influence/compromise previous surgeries and if needed it can be followed by additional surgeries without any complications. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  4. [Non-union of the clavicle after intramedullary nailing with a steel Kirschner wire].

    Science.gov (United States)

    Faymonville, C; Jubel, A; Schiffer, G

    2010-04-01

    Elastically stable intramedullary nailing is a safe surgical procedure used to treat mid-shaft clavicular fractures of types A and B according to the Orthopaedic Trauma Association (OTA) classification. In the case reported intramedullary fixation with a Kirschner wire and an incorrectly performed surgical technique led to pseudoarthrosis (non-union). After revision surgery with an elastically stable titanium nail and a correct surgical technique, fracture healing was achieved.

  5. Use of Fibula Bridge Graft Technique to Treat a Distal Tibia Non Union- A Case Report

    OpenAIRE

    Rajani, Amyn; Thakkar, C J; Shah, Ravi; Shyam, Ashok

    2013-01-01

    Introduction: Compound distal tibia fractures have high incidence of nonunions and have varied presentation as far as status of fibula is concerned. If fibula is sufficiently healthy we can use it for bridging the nonunion of tibia.Case Report: We present a case of 20 year old female with compound and segmental tibia fracture. Primary stablisation by external fixation and later cast brace application achieved union at the proximal end of the segmental fragment with non union at the distal en...

  6. Scaphoid nonunion treated with vascularised bone graft from dorsal radius.

    Science.gov (United States)

    Özalp, Taçkın; Öz, Çağlar; Kale, Gürler; Erkan, Serkan

    2015-07-01

    The main aim of this retrospective study was to present our experience on scaphoid nonunion treated with vascularised bone graft. Between 2006 and 2012, 58 patients presenting with symptomatic scaphoid nonunion were eligible to participate in this study. Topography of the nonunion included 29 proximal, 25 waist and 4 distal scaphoid nonunions. Vascularised bone graft from distal dorsal radius was used in all cases which were stabilised with the headless cannulated compression screws. Scapholunate angles, Natrass carpal height ratio were evaluated pre and postoperatively. Range of motion of the affected side was compared to that of the contralateral side after the surgery. Radiographic union was achieved in 50, out of 58 cases with an average time of 9.9 weeks (range, 6-18 weeks). Out of all the non-united cases, four of them were in proximal, three in the waist and one was in distal scaphoid. In nine proximal nonunions treated by 4+5 ECA graft all but one were united. The mean follow up was 21.7 months (12-62 months). The flexion was 91.6%, the extension was 91.5%, the radial deviation was 81.2%, and the ulnar deviation was 89.5% compared to the other side. The grip strength was 93%. Preoperative DASH score was 61.5 diminishing to 28.7 postoperatively. There was no significant change in Natrass carpal height ratio but a slight improvement occurred in scapholunate angles both pre and postoperatively. Vascularised bone graft is a good solution for scaphoid nonunion to enhance the healing rate especially in the presence of avascular necrosis. Proximal pole nonunions, humpback deformity and smoking are important negative factors for scaphoid nonunion despite the use of a vascularised bone graft. A trapezoidal wedge graft is necessary for the volar type nonunions with humpback deformity. 1,2 ICSRA offer an advantage with its proximity to scaphoid in all nonunion locations. Nonetheless, 4+5 ECA graft is also a good solution for proximal nonunions. Copyright © 2015

  7. Exchange nailing for femoral diaphyseal fracture non-unions: Risk factors for failure.

    Science.gov (United States)

    Tsang, S T J; Mills, L A; Baren, J; Frantzias, J; Keating, J F; Simpson, A H R W

    2015-12-01

    The aim of this study was to identify risk factors for failure of exchange nailing for femoral diaphyseal fracture non-unions. The study cohort comprised 40 patients with femoral diaphyseal non-unions treated by exchange nailing, of which six were open injuries. The median time to exchange nailing from primary fixation was 8.4 months. The main outcome measures were union, number of secondary fixation procedures required to achieve union and time to union. Multiple causes for non-union were found in 16 (40%) cases, with infection present in 12 (30.0%) patients. Further surgical procedures were required in nine (22.5%) cases, one of whom (2.5%) required the use of another fixation modality to achieve union. Union was ultimately achieved with exchange nailing in 34/37 (91.9%) patients. The median time to union after the exchange nailing was 9.4 months. Cigarette smoking and infection were risk factors for failure of exchange nailing. Multivariate analysis found infection to be the strongest predictor of exchange failure (punion. However, 50% of patients undergoing exchange nailing in the presence of infection required at least one further procedure. It is important to counsel patients of this so that they can plan for it and do not consider that the first exchange operation has failed. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Ilizarov ring fixator in the management of infected non-unions of tibia.

    Science.gov (United States)

    Wani, Naveed Bashir; Syed, Basit

    2015-07-29

    The purpose of the study was to evaluate the effectiveness of debridement and application of Ilizarov ring fixator (IRF) in the management of infected tibial non-unions. Twenty six patients with infected non-unions of tibia were managed by debridement and resection of infected portion ± partial fibulectomy and stabilization by Ilizarov ring fixator. Bone segment transport was done in 18 patients who had greater than 2.5 cm bone defect after debridement. Bone grafting was required in three patients to augment union. All fractures united and infection eradicated completely. There were 13 excellent, nine good, and four fair results. Functional results were excellent in nine, good in 11, fair in five and poor in one. Pin site inflammation was the most common problem and occurred in 23 (88%) patients. There were no major complications or neurovascular complications. We conclude that debridement combined with Ilizarov ring fixator with or without partial fibulectomy is a reliable method of treatment of infected non-unions of tibia.

  9. Are polymorphisms of molecules involved in bone healing correlated to aseptic femoral and tibial shaft non-unions?

    Science.gov (United States)

    Zeckey, Christian; Hildebrand, Frank; Glaubitz, Lena-Marie; Jürgens, Simon; Ludwig, Theresa; Andruszkow, Hagen; Hüfner, Tobias; Krettek, Christian; Stuhrmann, Manfred

    2011-11-01

    Fracture healing is a well-organized process between several molecules and mediators. As known from other diseases, genetic polymorphisms may exhibit different expression patterns in these mediators. Concerning fracture healing, this may lead to an extended healing process or non-union. We investigated the incidence of polymorphisms in patients with aseptic non-unions after femoral and tibial shaft fractures as compared to patients with uneventful healing. Exclusion criteria were smoking, diabetes, bilateral fractures, systemic corticoid therapy, and septic non-unions. Analysis of allele frequencies and genotype distribution of various mediators were carried out following PCR. Clinical parameters such as injury severity and in-hospital were analyzed. Fifty patients following non-union (group NU) were enrolled, the control group consisted of 44 patients (group H). A significant association of a PDGF haplotype and non-unions following fracture could be observed. There was a significantly increased in-hospital time and amount of surgical procedures in group NU. Polymorphisms within the PDGF gene seem to be a genetic risk factor for the development of non-unions of the lower extremity following fracture. The early identification of high risk patients could result in an adapted therapeutical strategy and might contribute to a significant decrease of posttraumatic non-unions. Copyright © 2011 Orthopaedic Research Society.

  10. [Platelet-rich plasma combined with autologous cancellous bone : An alternative therapy for persistent non-union?].

    Science.gov (United States)

    Hakimi, M; Jungbluth, P; Thelen, S; Betsch, M; Linhart, W; Flohé, S; Windolf, J; Wild, M

    2011-11-01

    In addition to a stabile osteosynthesis autologous cancellous bone graft remains an essential therapy option in persistent non-union. Despite this therapy regimen persistent non-union can occasionally occur. The aim of this study was to evaluate the treatment of persistent non-union with a combination of platelet-rich plasma (PRP) and autologous cancellous bone. In this prospective study 17 patients with persistent non-union of long bones were treated by a combination of PRP and autologous iliac crest bone. Inclusion criteria were a minimum of one previously failed cancellous bone transplantation and an atrophic non-union persisting for 6-14 months (mean 9 months). The patients were examined clinically and radiologically at intervals of 3, 6 and 9 months postoperatively. After an average time of 17 months (range 15-23 months) the patients were treated by a combination of PRP and autologous cancellous bone. In all cases the non-union was successfully treated and osseous bridging was found radiologically after an average of 5 months (range 4-7 months) without any complications. The combination of PRP and autologous cancellous bone appears to be a safe and effective method for treatment of persistent non-union. The use of PRP does not result in substantial additional costs. Allergies and graft versus host reactions are not expected because of the autologous origin.

  11. Union of Scaphoid Waist Fractures Assessed by CT Scan.

    Science.gov (United States)

    Clementson, Martin; Jørgsholm, Peter; Besjakov, Jack; Björkman, Anders; Thomsen, Niels

    2015-02-01

    Background Union of a scaphoid fracture is difficult to assess on a standard series of radiographs. An unnecessary and prolonged immobilization is inconvenient and may impair functional outcome. Although operative treatment permits early mobilization, its influence on time to union is still uncertain. Purpose To assess union of scaphoid waist fractures based on computed tomography (CT) scan at 6 weeks, and to compare time to union between conservative treatment and arthroscopically assisted screw fixation. Patients and methods CT scan in the longitudinal axis of the scaphoid was used to provide fracture characteristics, and to assess bone union at 6 weeks in 65 consecutive patients with scaphoid waist fractures. In a randomized subgroup from this cohort with nondisplaced fractures, we compared time to union between conservative treatment (n = 23) and arthroscopically assisted screw fixation (n = 15). Results Overall, at 6 weeks we found a 90% union rate for non- or minimally displaced fracture treated conservatively, and 82% for those who underwent surgery. In the randomized subgroup of nondisplaced fractures, no significant difference in time to union was demonstrated between those treated conservatively and those who underwent surgery. The conservatively treated fractures from this subgroup with prolonged time to union (10 to 14 weeks) were comminuted, demonstrating a radial cortical or corticospongious fragment. Conclusion The majority of non- or minimally displaced scaphoid waist fractures are sufficiently treated with 6 weeks in a cast. Screw fixation does not reduce time to fracture union compared with conservative treatment. Level of Evidence level II, Therapeutic study.

  12. Symptomatic medial humeral epicondylar fracture non-union- rare presentation of a relatively common injury.

    Science.gov (United States)

    Kulkarni, Vidisha S; Arora, Nitish; Gehlot, Harshit; Saxena, Sagar; Kulkarni, Sunil G; Bajwa, Supreet

    2017-08-01

    Symptomatic non-union of medial humeral epicondylar fractures is a limited entity. Some studies recommend surgical excision of the fragment, but the results are controversial. The purpose of this study is to evaluate the outcome of open reduction and internal fixation of a medial epicondyle non-union fragment. A retrospective study was conducted in all the patients, who were operated in our hospital between the year 2010 and 2015 for symptomatic medial humeral epicondyle non-union. Inclusion criteria were open reduction and internal fixation of symptomatic medial epicondyle non-union and minimum one year of follow-up from time of surgery. Exclusion criteria included other associated musculoskeletal disorders of the affected limb. Open reduction and internal fixation of the fragment was done in all patients and the ulnar nerve was decompressed and anteriorly transposed in cases where symptomatology was present. Outcome was assessed with radiograph, range/arc of motion, Visual analogue pain scoring and two functional outcome tools. Study sample consisted of 14 patients, with mean age at presentation of 14.9 years (range 6 to 50 years) with mean time since injury of 7.7 months (range 3 to 24 months). Patients presented with medial elbow pain and prominence, limited range of motion, valgus instability, and ulnar nerve compression. After open reduction and internal fixation, at a mean of three years after surgery (range 1.5 to 5 years), patients reported an improvement in visual analogue pain score from a mean of 7.29±1.3 to 0.21±0.4, and the difference was statistically significant (p=0.001). Mean postoperative Quick DASH (Disability of Arm, Shoulder, and Hand) score was 5.21±7.2. Mean Mayo Elbow Performance Score was 96.7±6.1. Improvement in arc of motion was statistically significant (p=0.001). Radiographic union was achieved in all patients except one who had fibrous union. Functional elbow range of motion was achieved in 13 out of 14 cases (92.8%) and ulnar

  13. Subtrochanteric fracture non-unions with implant failure managed with the "Diamond" concept.

    Science.gov (United States)

    Giannoudis, Peter V; Ahmad, Mudussar A; Mineo, Giuseppe V; Tosounidis, Theodoros I; Calori, Giorgio M; Kanakaris, Nikolaos K

    2013-01-01

    Subtrochanteric femoral non-unions in the setting of failed metalwork pose a challenging clinical problem. This study assessed the clinical outcome of patients treated according to the principles of the "Diamond" concept. Between 2007 and 2011 all patients presented with a subtrochanteric atrophic aseptic non-union in the setting of metalwork failure (broken cephalomedullary reconstruction nail), and treated in a single tertiary referral unit were included to this study. The hypertrophic and the non-unions of pathologic fractures were excluded. The revision strategy was based on the "Diamond concept"; optimisation of the mechanical and the biological environment (implantation of growth factor (rhBMP-7), scaffold (RIA bone graft from contralateral femur) and concentrated mesenchymal stem cells (MSCs) harvested from the iliac crest). The minimum follow up was 26 months (16-48). Fourteen patients met the inclusion criteria. A specific sequence of metalwork failure was noted with initial breakage of the distal locking screws followed by nail breakage at the lag screw level. The intraoperative examination of the removed nails revealed no gross structural damage indicative of inappropriate drilling at the time of the initial intramedullary nailing. Varus mal-alignment was present in the majority of the cases, with an average of 5.2 degrees (0-11). The average time to distal locking screw failure was 4.4 months (2-8.5) and nail failure was 6.5 months (4-10). The time to union after the revision surgery was 6.8 months (5-12). Complications included two deaths in elderly patients (due to unrelated causes), one pulmonary embolism, one myocardial infarction, one below the knee deep vein thrombosis and one blade plate failure that required further revision with double plating and grafting. Varus mal-alignment must be avoided in the initial stabilisation of subtrochanteric fractures. Distal locking screw failure is predictive of future fracture non-union and nail breakage. In

  14. Long bone non-unions treated with the diamond concept: a case series of 64 patients.

    Science.gov (United States)

    Giannoudis, Peter V; Gudipati, Suri; Harwood, Paul; Kanakaris, Nikolaos K

    2015-12-01

    The aim of this retrospective study with prospectively documented data was to report the clinical results of treatment of long bone non-unions using the "diamond concept". Over a 4-year period, patients that presented with a long bone non-union and were managed with the diamond conceptual framework of bone repair were evaluated. Exclusion criteria were hypertrophic, pathological, and infected non-unions. Fixation was revised as it was indicated whilst biological enhancement included the implantation of RIA graft, BMP-7 and concentrated bone marrow aspirate. Data recorded included patient demographics, initial fracture pattern and type of stabilisation, number of previous interventions, time to reoperation, time to union and functional outcome. Painless full weight bearing defined clinical union. Radiological union was defined as the presence of mature callous bridging to at least 3 bone cortices. The minimum follow up was 12 months (range 12-32). In total 64 patients (34 males) with a mean age of 45 years (17-83) were evaluated. Anatomical distribution of non-unions included the femur (54.68%), tibia (34.38%), humerus (4.68%), radius (3.13%) and clavicle (3.13%). The median number of previous interventions was 1 (range 1-5). The majority of patients (82.62%) underwent revision of fixation whereas only bone grafting was performed 9.38% of patients. Three patients developed superficial wound infection (one was MRSA), 1 had deep vein thrombosis and 1 developed heterotopic bone formation. Union was successful in 63/64 (98.4%) non-unions at a mean time of 6 months (range 3-12). All patients were mobilising pain free and returned to their daily living activities at the final follow up. The application of the "diamond concept" in this cohort of patients was associated with a high union rate by providing an optimal mechanical and biological environment. Such an approach should be considered in the surgeon's armamentarium particularly in such cases where difficulty of bone

  15. Modeling Staphylococcus epidermidis-Induced Non-Unions: Subclinical and Clinical Evidence in Rats.

    Directory of Open Access Journals (Sweden)

    Arianna Barbara Lovati

    Full Text Available S. epidermidis is one of the leading causes of orthopaedic infections associated with biofilm formation on implant devices. Open fractures are at risk of S. epidermidis transcutaneous contamination leading to higher non-union development compared to closed fractures. Although the role of infection in delaying fracture healing is well recognized, no in vivo models investigated the impact of subclinical low-grade infections on bone repair and non-union. We hypothesized that the non-union rate is directly related to the load of this commonly retrieved pathogen and that a low-grade contamination delays the fracture healing without clinically detectable infection. Rat femurs were osteotomized and stabilized with plates. Fractures were infected with a characterized clinical-derived methicillin-resistant S. epidermidis (10(3, 10(5, 10(8 colony forming units and compared to uninfected controls. After 56 days, bone healing and osteomyelitis were clinically assessed and further evaluated by micro-CT, microbiological and histological analyses. The biofilm formation was visualized by scanning electron microscopy. The control group showed no signs of infection and a complete bone healing. The 10(3 group displayed variable response to infection with a 67% of altered bone healing and positive bacterial cultures, despite no clinical signs of infection present. The 10(5 and 10(8 groups showed severe signs of osteomyelitis and a non-union rate of 83-100%, respectively. The cortical bone reaction related to the periosteal elevation in the control group and the metal scattering detected by micro-CT represented limitations of this study. Our model showed that an intra-operative low-grade S. epidermidis contamination might prevent the bone healing, even in the absence of infectious signs. Our findings also pointed out a dose-dependent effect between the S. epidermidis inoculum and non-union rate. This pilot study identifies a relevant preclinical model to assess the

  16. MR imaging of avascular scaphoid nonunion before and after vascularized bone grafting

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    Anderson, Suzanne E.; Tschering-Vogel, Dechen; Martin, Matthias [University Hospital of Bern, Inselspital, Department of Radiology, Bern (Switzerland); Steinbach, Lynne S. [University of California San Francisco, Department of Radiology, San Francisco, California (United States); Nagy, Ladislav [University Hospital of Bern, Inselspital, Department of Orthopedic Surgery, Bern (Switzerland)

    2005-06-01

    To investigate the magnetic resonance (MR) imaging appearances of chronic nonunion of the scaphoid with proximal pole avascular necrosis before and after insertion of a vascularized bone graft, using computed tomography (CT) as the imaging gold standard. A retrospective study was performed involving MR imaging (n=26), CT scans (n=37) and radiographs (n=52) of 13 men (mean age 29 years, age range 20-38 years) with avascular scaphoid nonunion. Avascular necrosis of the scaphoid proximal pole was confirmed intraoperatively (n=13). MR images were acquired preoperatively and following placement of a vascularized bone graft. Scaphoid MR signal characteristics were assessed for evidence of vascular bone graft incorporation and revascularization of the bone marrow of the proximal pole of the scaphoid and compared with the gold standard of CT. Surgical and clinical notes were reviewed with a minimum 3 year imaging and clinical follow-up in all patients. Graft incorporation with revascularization of the proximal pole of the scaphoid was documented in 9 patients (69%). Graft failure with persistent pseudoarthrosis and avascular necrosis of the scaphoid was seen in 4 patients (31%). MR imaging is useful to determine whether vascularized bone graft incorporation and revascularization of the proximal pole of the scaphoid has occurred in the setting of avascular scaphoid nonunion. (orig.)

  17. MR imaging of avascular scaphoid nonunion before and after vascularized bone grafting

    International Nuclear Information System (INIS)

    Anderson, Suzanne E.; Tschering-Vogel, Dechen; Martin, Matthias; Steinbach, Lynne S.; Nagy, Ladislav

    2005-01-01

    To investigate the magnetic resonance (MR) imaging appearances of chronic nonunion of the scaphoid with proximal pole avascular necrosis before and after insertion of a vascularized bone graft, using computed tomography (CT) as the imaging gold standard. A retrospective study was performed involving MR imaging (n=26), CT scans (n=37) and radiographs (n=52) of 13 men (mean age 29 years, age range 20-38 years) with avascular scaphoid nonunion. Avascular necrosis of the scaphoid proximal pole was confirmed intraoperatively (n=13). MR images were acquired preoperatively and following placement of a vascularized bone graft. Scaphoid MR signal characteristics were assessed for evidence of vascular bone graft incorporation and revascularization of the bone marrow of the proximal pole of the scaphoid and compared with the gold standard of CT. Surgical and clinical notes were reviewed with a minimum 3 year imaging and clinical follow-up in all patients. Graft incorporation with revascularization of the proximal pole of the scaphoid was documented in 9 patients (69%). Graft failure with persistent pseudoarthrosis and avascular necrosis of the scaphoid was seen in 4 patients (31%). MR imaging is useful to determine whether vascularized bone graft incorporation and revascularization of the proximal pole of the scaphoid has occurred in the setting of avascular scaphoid nonunion. (orig.)

  18. Fractures of the bilateral distal radius and scaphoid: a case report

    Directory of Open Access Journals (Sweden)

    Ozkan Korhan

    2008-03-01

    Full Text Available Abstract Introduction Bilateral fractures of the distal radius and scaphoid are extremely rare injuries. Case presentation A patient with bilateral comminuted, displaced distal fractures of the radius and bilateral fractures of the scaphoid was treated via internal fixation of the scaphoid fractures with Herbert screws and internal fixation of the distal radius fractures with locked volar plating. Conclusion Rigid internal fixation of distal radius and scaphoid fractures is mandatory to start early active rehabilitation of the wrist without the need for wrist immobilization with a plaster or external skeletal fixation.

  19. Non-unions treated with bone morphogenic protein 7: introducing the quantitative measurement of human serum cytokine levels as promising tool in evaluation of adjunct non-union therapy.

    Science.gov (United States)

    Moghaddam, Arash; Breier, Lisa; Haubruck, Patrick; Bender, Daniel; Biglari, Bahram; Wentzensen, Andreas; Zimmermann, Gerald

    2016-01-01

    In this study we sought to determine if application of bone morphogenic protein 7 (BMP-7) promotes physiological bone healing of non-unions and to investigate if serum cytokine analysis may serve as a promising tool in the analysis of adjunct non-union therapy. Therefore we analyzed the influence of BMP-7 application on the serum cytokine expression patterns on patients with impaired bone healing compared to patients that showed proper bone healing. Our study involved analyzing blood samples from 208 patients with long bone fractures together with patients that subsequently developed non-unions. From this large pool, 15 patients with atrophic non-union were matched to 15 patients with atrophic non-union treated with local application of BMP-7 as well as normal bone healing. Changes in the cytokine expression patterns were monitored during the 1st, 2nd, 4th, 8th, 12th and 52nd week. The patients were followed both clinically and radiologically for the entire duration of the study. Serum cytokine expression levels of transforming growth factor beta (TGF-β), platelet-derived growth factor (PDGF) and basic fibroblast growth factor (bFGF) were analyzed and compared. Serum expression of TGF-β were nearly parallel in all three groups, however serum concentrations were significantly higher in patients with proper bone healing and those treated with BMP-7 than in patients with non-unions (p unions (p unions led to similar cytokine expression patterns after treatment as those found in patients with proper bone healing. Our results suggest that treatment with BMP-7 promote healing of non-unions. Furthermore, quantitative measurement of serum cytokine expression is a promising tool for evaluating the effectiveness of additional non-union therapies such as adjunct application of growth factors.

  20. 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.

  1. The incidence of non-union following unreamed intramedullary nailing of femoral shaft fractures.

    Science.gov (United States)

    el Moumni, M; Leenhouts, P A; ten Duis, H J; Wendt, K W

    2009-02-01

    Stabilisation of fractures with an intramedullary nail is a widespread technique in the treatment of femoral shaft fractures in adults. To ream or not to ream is still debated. The primary objective of this study was to determine the incidence of non-union following unreamed intramedullary stabilisation of femoral fractures. Secondary objectives were intra- and postoperative complications and implant failure. Between March 1995 and June 2005, 125 patients with 129 traumatic femoral shaft fractures were treated with as unreamed femoral nail. From this retrospective single centre study, 18 patients were excluded due to insufficient follow up data, including 1 patient who died within 2 days after severe head injury. Sixty-six patients had suffered multiple injuries. 21 fractures were open. According to the AO classification, there were 54 type A, 42 type B, and 14 type C fractures. Dynamic proximal locking was performed in 44 cases (36 type A and 8 type B fractures). Non-union occurred in two patients (1.9%; one type B and one type C fractures). Intra-operative complications were seen in three patients (2.8%). Postoperative in-hospital complications occurred in 29 patients (27%). Local superficial infection occurred in two patients (1.9%), there were no cases of deep infection. Implant failure occurred in three patients (2.8%): nail breakage was seen in two patients. In this study, the incidence of non-union following unreamed intramedullary nailing is low (1.9%) and comparable with the best results of reamed nailing in the literature.

  2. Pulsed Electromagnetic Fields in the treatment of fresh scaphoid fractures. A multicenter, prospective, double blind, placebo controlled, randomized trial.

    NARCIS (Netherlands)

    Hannemann, P.; Gottgens, K.W.; Wely, B.J. van; Kolkman, K.A.; Werre, A.J.; Poeze, M.; Brink, P.R.

    2011-01-01

    BACKGROUND: The scaphoid bone is the most commonly fractured of the carpal bones. In the Netherlands 90% of all carpal fractures is a fracture of the scaphoid bone. The scaphoid has an essential role in functionality of the wrist, acting as a pivot. Complications in healing can result in poor

  3. [Tibial defects and infected non-unions : Treatment results after Masquelet technique].

    Science.gov (United States)

    Moghaddam, A; Ermisch, C; Fischer, C; Zietzschmann, S; Schmidmaier, G

    2017-03-01

    The treatment of non-unions with large bone defects or osteitis is a major challenge in orthopedic and trauma surgery. A new concept of therapy is a two-step procedure: Masquelet technique according to the diamond concept. Between February 2010 and June 2014, 55 patients with tibia non-unions or infections were treated in a two-step Masquelet technique in our center. The patients' average age was 48 (median 50; minimum 15-maximum 72) with an average BMI (body mass index) of 28 (27; 18-52). There were 10 (18 %) female and 45 (82 %) male patients in the group. All study patients went through a follow up. Bone healing and clinical functional data were collected, as well as data according to subjective patient statements about pain and everyday limitations. In 42 cases (76.4 %) the outcome was a sufficient bony consolidation. On average, the time to heal was 10.3 (8, 5; 3-40) months, defect gaps were 4 cm (3 cm; 0,6-26 cm), and on average the patients had had 6 (median 4; range 1-31) previous operations . In all cases patients received osteosynthesis as well as a defect filling with RIA (reamer-irrigator-aspirator), and growth factor BMP-7 (bone morphogenetic protein-7). In 13 cases (23.6 %) there was no therapeutic success. In the evaluation of the SF12 questionnaire the mental health score increased from 47.4 (49.1; 27.6-65.7) to 49.8 (53.0; 28.7-69.4) and the well-being score from 32.7 (32.7;16.9-55.7) to 36.6 (36.5; 24.6-55.9). The two-step bone grafting method in the Masquelet technique used for tibia non-unions according to the diamond concept is a promising treatment option. Its application for tibia shaft non-unions with large bone defects or infections means a high degree of safety for the patient.

  4. Management of infected non-union tibia by intercalary bone transport

    International Nuclear Information System (INIS)

    Pirwani, M.A.; Siddiqui, A.; Soomro, Y.H.

    2008-01-01

    To evaluate the efficacy of ilizarov ring fixator in treating infected non-union tibia by intercalary bone transport. Sixteen patients, all males, aged 20-60 years (mean 32 years), with infected non-union tibia (Lax/Cierney Type IV Osteomyelitis); the commonest cause being open fracture and the commonest site being lower 1/3rd. In infected non-union of tibia with draining sinus, wound swab was sent for culture and sensitivity, and sinogram done. Debridement and sequestrectomy was done, leaving behind a gap ranging from 2-8 cms (mean 4.5 cms) and ilizarov ring fixator, a transport assembly, applied. A navigation wire was passed through medial malleolus, irrigation system set up and the wound closed in a single layer. Proximal metaphyseal corticotomy was done. Irrigation with 2-3 litres of normal saline with appropriate antibiotic was continued for five days. On the 5th day irrigation system was removed and the transport started. Patients remained on partial weight bearing till soft tissue healing occured. Transport took place over the navigation wire at the rate of 1mm/day till docking achieved. Full weight bearing was allowed after soft tissue healing; knee and ankle physiotherapy was started from day one. Navigation wire was removed after 2-3 weeks of docking. Follow up ranged from 12-27 months (mean 16 months). Union was achieved at the docking site in all the cases at the time of frame removal i.e. 8-13 months. The duration of union at docking site ranged from 3.5 months to 6 months (mean 4.5 months). Two patients needed bone graft at the docking site. The regenerate was broken in one case due to fall which was treated in cast. All the patients were satisfied except a 60 years old who had severe osteoarthritis of knee. Pin tract infection occurred on and off in all the patients; appropriate antibiotic was given. The infection subsided in all the cases except two in whom debridement was followed by application of a local flap. Intercalary bone transport by

  5. Sport related stress fracture of the clavicle with non-union: Case report and review

    Science.gov (United States)

    Constantinou, Demitri; Kastanos, Konstantinos

    2008-01-01

    Stress fractures are relatively uncommon sports injuries and when they do occur, are mostly found in the lower limb. Stress fractures of the clavicle are particularly rare, having been described in a number of non-sport related pathologies, such as nervous tics and post radical neck dissection. In sport, there have only been seven cases reported in the literature. We report on a clavicle stress fracture in a 47-year-old male, partaking in recreational weight lifting activities. This is the first reported case of a non-union stress fracture of the clavicle. The patient underwent an open reduction and internal fixation and made a full recovery. PMID:21264151

  6. The role of MR imaging in scaphoid disorders

    Energy Technology Data Exchange (ETDEWEB)

    Karantanas, Apostolos [University of Crete, Department of Radiology, Medical School, Heraklion (Greece); University Hospital, Department of Radiology, Stavrakia, Heraklion (Greece); Dailiana, Zoe; Malizos, Konstantinos [University of Thessaly, Department of Orthopedic Surgery, School of Health Sciences, Larissa (Greece)

    2007-11-15

    The scaphoid bone of the wrist is one of the most commonly fractured bones in the body. Due to its importance in the biomechanics and functionality of the wrist, it is important to depict and characterize the type of injury. Plain radiographs and scintigraphy may fail to disclose the type and severity of the injury. In patients with normal initial plain radiographs, MR imaging can discriminate occult fractures from bone bruises and may also demonstrate ligamentous disruption. MR imaging can also discriminate the proximal pole viability versus avascular necrosis secondary to previous fracture, which is important for treatment planning. Treatment of non-united fractures with vascularized grafts can be evaluated with contrast-enhanced MR imaging. Idiopathic osteonecrosis or Preiser's disease was originally described after trauma. The non-traumatic disorders of the scaphoid include post-traumatic osteoarthritis, inflammatory bone marrow edema in patients with rheumatoid arthritis, and osteomyelitis. MR imaging is helpful in all the above disorders to demonstrate early bone marrow edema, cartilage degeneration and associated subchondral marrow changes. The most commonly found tumors in the scaphoid are usually benign and include enchondroma, osteoblastoma and osteoid osteoma. MR imaging is not mandatory for the initial diagnosis, which should be based on plain X-ray findings. (orig.)

  7. The role of MR imaging in scaphoid disorders

    International Nuclear Information System (INIS)

    Karantanas, Apostolos; Dailiana, Zoe; Malizos, Konstantinos

    2007-01-01

    The scaphoid bone of the wrist is one of the most commonly fractured bones in the body. Due to its importance in the biomechanics and functionality of the wrist, it is important to depict and characterize the type of injury. Plain radiographs and scintigraphy may fail to disclose the type and severity of the injury. In patients with normal initial plain radiographs, MR imaging can discriminate occult fractures from bone bruises and may also demonstrate ligamentous disruption. MR imaging can also discriminate the proximal pole viability versus avascular necrosis secondary to previous fracture, which is important for treatment planning. Treatment of non-united fractures with vascularized grafts can be evaluated with contrast-enhanced MR imaging. Idiopathic osteonecrosis or Preiser's disease was originally described after trauma. The non-traumatic disorders of the scaphoid include post-traumatic osteoarthritis, inflammatory bone marrow edema in patients with rheumatoid arthritis, and osteomyelitis. MR imaging is helpful in all the above disorders to demonstrate early bone marrow edema, cartilage degeneration and associated subchondral marrow changes. The most commonly found tumors in the scaphoid are usually benign and include enchondroma, osteoblastoma and osteoid osteoma. MR imaging is not mandatory for the initial diagnosis, which should be based on plain X-ray findings. (orig.)

  8. Treatment of scaphoid waist fractures with the HCS screw

    Directory of Open Access Journals (Sweden)

    Gehrmann, Sebastian V.

    2014-11-01

    Full Text Available The aim of the study was to evaluate the clinical results of the Headless Compression Screw (HCS, Synthes when used for treatment of acute scaphoid waist fractures. The new screw design generates interfragmentary compression with use of a compression sleeve. Twenty-one patients were treated for acute scaphoid waist fractures type B2 with HCS screws. The average time to the final follow-up examination was 12.8 months. All 21 fractures united after a mean time of 7.2 weeks. The mean DASH score was 7.1. The average motion of the wrist in extension was 61°, flexion was 46°, radial abduction reached 25° and the ulnar abduction was 31°. The maximally achieved grip strength was 86% compared to the uninjured side. Treatment of type B2 scaphoid fractures with the Headless Compression Screw showed good functional and radiographic results. The results are similar to those identified using other screw fixation systems.

  9. Role of injecting bone marrow aspiration injection in treating delayed union and non-union.

    Science.gov (United States)

    Akram, Muhammad; Irshad, Muhammad; Farooqi, Faheem Mubashir; Sah, Ranjeet Kumar; Shahzad, Muhammad Latif; Sarfraz, Ahmad Humayun; Awais, Syed Muhammad

    2014-12-01

    To access the role of bone marrow injection in the management of delayed union and non-union. The prospective study was conducted at the Department of Orthopaedic Surgery and Traumatology, Mayo Hospital, Lahore, from January 2012 to December 2013, and comprised patients who had long bone fractures that resulted in delayed or non-union and were treated with bone marrow injections. Aspiration of bone marrow was done from tibial tuberosity and was injected percutaneously at the fracture site. The whole procedure was carried out as a day case. Fracture site mobility, tenderness and radiological features were assessed using the Union Scale score. Of the 25 patients, 18(72%)were male and 7(28%) were female with an overall mean age of 38±12.96SD years (range: 17-61 years). There were 19(76%) tibial shaft fractures, 4(16%) had shaft of femur fracture, and 2(8%) had humeral shaft fracture. Mean time duration between the injury and the procedure was 34 ±3.46 SD weeks (range: 30-42 weeks). Overall, 23 (92%) patients showed union and the mean time of healing was 15 ±2.73SD weeks (range: 12-22 weeks) after the procedure. Percutaneous bone marrow injection provided an alternative to open bone grafting, having least complications, especially for early intervention in the fracture-healing process.

  10. Perspectives and expectations of union member and non- union member teachers on teacher unions

    Directory of Open Access Journals (Sweden)

    Tuncer FİDAN

    2015-12-01

    Full Text Available Unions, which can be regarded as one of the constitutive elements of democracy, are the pressure groups in political and social fields. Unions were born out of industrial confrontations and expanded into the field of public services over time, and thus teachers – who are also public employees-, also obtained the right to establish and affiliate to unions. In this research the views of union member and non-union member teachers on the most important functions and operational effectiveness of unions, teachers’ expectations from unions and teachers’ evaluation of the solidarity, competition and cooperation between unions were determined and the perspectives of teachers on unionization were revealed. qualitative research design was used. The data needed were collected through semi-structured interviews from volunteering union member and non-union member teachers who were working in the primary and secondary schools in Ankara province and who were selected through “maximum variation sampling approach”. The data were then analyzed by using the content analysis technique. In conclusion, it was found that political ideology was the most important reason for membership of teachers’ unions. Protection and development of personal rights was found to be the most important function of teacher unions and unions were thought to be insufficient in performing those functions.

  11. Supracondylar Femoral Nail in the management of non-union of humeral shaft fractures.

    Science.gov (United States)

    Bajaj, S K; Mohan, N Rama; Kumar, C Senthil

    2004-05-01

    We reviewed seven patients with established non-union of a shaft of humerus fracture, treated by locked intramedullary nailing using the Intramedullary Supracondylar Nail (IMSC Nail; Smith & Nephew Richards, Memphis TN). The mean age of the patients was 65 years (range 48-78 years). Three of the fractures involved the proximal third of the diaphysis while the remaining four involved the middle third. Six of the original fractures were closed and one was an open fracture. The time interval between the original injury and final surgery averaged 9.3 months. All the nailings were done by the ante-grade approach with static locking. Six of the patients had closed nailing and one had open nailing with bone grafting. The mean follow-up was 8 months and osseous union was achieved in all seven cases at a mean of 5.6 months. We conclude that the Supracondylar Femoral Nail is a useful alternative implant in the management of non-union of fractures of the humeral shaft with wide medullary canals.

  12. Recalcitrant aseptic atrophic non-union of the shaft of the humerus after failure of surgical treatment: management by excision of non-union, bone grafting and stabilization by LCP in different modes.

    Science.gov (United States)

    Babhulkar, Sudhir; Babhulkar, Sushrut; Vasudev, Aditya

    2017-08-01

    Non-union of the humeral shaft is infrequently noticed after surgical fixation. Sixty eight patients whose osteosynthesis of humeral shaft had failed leading to non-union were identified over a duration of 10 years from (January 2006 to December 2015). Clinical and radiographical follow-up was available for 64 patients (4 patients were lost for follow-up), with a mean age of 58 years (range 25-78 years). All patients had aseptic atrophic non-union of either: proximal shaft (n=12), mid shaft (n=38), and lower shaft (n=14). All these patients had failure of primary fixation, with a minimum duration from 36 to 110 weeks. Non-unions were operated by excision of non-union, autogenous bone grafting and osteosynthesis by locking compression plating. Adequate fixation of non-union with bone grafting was achieved in all patients. All non-unions healed well at an average of 16 weeks (range 6-36 weeks). The mean length of follow-up was 120 weeks (range 60-250 weeks). The mean range of movements following healing of non-union was forward flexion of 140°, external rotation and internal rotation of 30° at shoulder and average fixed flexion deformity of 10° and flexion of 130° at elbow. Two patients had postoperative radial nerve palsy because of neuropraxia, which recovered in eight weeks. Three patient developed superficial infections at the iliac crest, which settled with antibiotics, dressings in 3 weeks time and two patients had some discomfort over the fibular graft harvest site. In all patients complete clinical and radiological union was achieved with satisfactory outcome in terms of relief of symptoms and functional improvement in the range of movements. The main points in surgical treatment were complete excision of non-union, correction of deformity, use of plenty of corticocancellous graft, furthermore the use of intramedullary fibula and osteosynthesis by long locking compression plating in different modes of fixation provided good to excellent results and

  13. [The risk non-union following closed-focus nailing and reaming. Results of 1059 interventions using the Kunstcher method].

    Science.gov (United States)

    Babin, S R; Graf, P; Vidal, P; Sur, N; Schvingt, E

    1983-01-01

    The authors have studied a series of 1059 compound and closed fractures of the diaphysis of long bones treated by intramedullary nailing according to the technique of Kuntscher, to assess the incidence of non-union. Between January 1st 1967 and December 31st 1980, 503 fractures of the tibia, 440 of the femur and 116 of the humerus were so treated in both adolescents and adults. The fractures were mostly sustained in road traffic accidents. The risk of aseptic non-union was small, but occurred more readily when the skin was damaged and when the site of the fracture was at the junction of the lower two quarters of the tibia; the incidence was highest when the technique of nailing was incorrect or when the going was undertaken too late. The incidence of non-union and infection are compared with those of other series using the same closed technique and with reports describing insertion of the nail of the plate by opening the fracture. It is concluded that intramedullary nailing using the Kuntscher technique is the most reliable treatment for this type of injury for routine use in an acute fracture service. In this series the incidence of aseptic non-union was approximately 1%, of infection with non-union less than 0.5% and of early infection with eventual union less than 1.5%.

  14. A novel bimodal approach for treating atrophic bone non-unions with extracorporeal shockwaves and autologous mesenchymal stem cell transplant.

    Science.gov (United States)

    Sansone, Valerio; Brañes, Manuel; Romeo, Pietro

    2018-02-01

    We propose a novel approach for the treatment of atrophic bone non-unions via parallel applications of extracorporeal shock wave therapy (ESWT) and an autologous mesenchymal stem cell transplant. The hypothesis resides on the potentiality of shock waves (SWs) to act as a tool for manipulating the patient's mesenchymal stem cells (MSCs). In addition to the conventional physical stimulus achieved by delivering SWs at the site of non-union to stimulate the well-known trophic effects on bone tissue, a series of concomitant ESWT would be administered in tandem at a bone marrow donor site, such as the iliac crest, to precondition resident bone marrow stromal cells (BMSCs) in vivo, priming resident MSCs by enlarging and conditioning their population prior to bone marrow aspiration. The resulting sample could then be treated to further augment cell concentration and injected, under fluoroscopic control, into the non-union site through a percutaneous approach. Copyright © 2017 Elsevier Ltd. All rights reserved.

  15. Fusion of the subtalar joint for post-traumatic arthrosis: a study of functional outcomes and non-unions.

    Science.gov (United States)

    Ziegler, Patrick; Friederichs, Jan; Hungerer, Sven

    2017-07-01

    The aim of this prospective cohort study was to quantify the rate of non-unions after arthrodesis of the subtalar joint, to identify risk factors and to evaluate the functional outcome. Patients with subtalar fusion from 2000 to 2013 and pre-existing post-traumatic osteoarthritis of the subtalar joint were analysed for risk factors like revision surgery, infection history in the area of operation, obesity, diabetes, cigarette smoking and alcohol abuse. The osseous consolidation was proven by x-ray or CT-scan and clinical aspects, e.g. consistent pain or functional disorders. The outcome was measured using the AOFAS hindfoot score, the SF-36 score and additionally by the visual analog scale. This study included 214 patients with 267 operations (n = 214, age 49 ± 12 years, 83% men); 59% of the cases had a calcanear fracture (n = 126). Non-unions were substantially high with 23.8%, including all risk factors whereas the non-union rate without any risk factors was only 12%. Considering revision surgery, there were no remarkable differences in the rate of non-union. Infections showed an odds ratio for non-union of 4.33 compared to patients without any risk factors. The AOFAS hindfoot score showed 49 ± 20 after primary arthrodesis and 46 ± 17 after secondary arthrodesis. Failure of subtalar fusion after post-traumatic osteoarthritis is attributable to various examined risk factors. The presence of an infection was stated as a major negative predictive factor for osseous consolidation. Especially the summation of risk factors increases the chance for non-union. Level II Prospective Comparative Study.

  16. Morphological and morphometric features of scaphoid bone in north eastern population, India.

    Science.gov (United States)

    Purushothama, C; Sarda, R K; Konuri, A; Tamang, B K; Gupta, C; Murlimanju, B V

    2011-03-01

    A study was performed to analyse the morphometry and morphological variants of adult scaphoid bone in Sikkimese population of North Eastern India. The study included 100 dry human scaphoid bones. The bones which had previous signs of fracture were excluded. The morphometric parameters were measured with vernier caliper of 0.02 mm accuracy; the circumferences were measured by placing a thread around them and measuring its length. A magnifying lens was used to observe the number of foramina. From our observations, 22 (44%) of the left scaphoid were having conical shape and 28 (56%) were pyramidal in shape. On the right side, 36 (72%) had conical shape and 14 (28%) were pyramidal. All the bones had waist, except one right sided scaphoid (2%) in which the waist was absent. The scaphoid had main dorsal sulcus in 63% of cases, 29% had two dorsal sulci and 6% had Y shaped sulci. The dorsal sulcus was absent in 3 cases (1 on left side and 2 on the right side). All the scaphoids had a minimum of one foramen in the main dorsal sulcus and 92% had more than one foramen. The present study has provided the additional information on morphology and morphometry of adult human scaphoid bones in north eastern population, India. We believe that the data obtained from the present study are important for the hand surgeons and radiologists. The details obtained will also be helpful for the morphologists and clinical anatomists.

  17. Novel Treatment of a Scapholunate Ligament Injury with Proximal Pole Scaphoid Nonunion

    Science.gov (United States)

    Gaspar, Michael P.; Kane, Patrick M.; Jacoby, Sidney M.; Culp, Randall W.

    2016-01-01

    Background  Nonunion of scaphoid proximal pole fractures presents a challenging management dilemma to hand surgeons. This problem is further complicated in the uncommon concurrence of scapholunate (SL) ligament disruption. Case Description  A 39-year-old male patient presented with new-onset wrist pain following a remote history of a proximal pole scaphoid fracture sustained as a teenager, which was treated nonoperatively. Six months before presentation, the patient sustained a fall while snowboarding. The patient was found to have a chronic nonunion of his scaphoid proximal pole with an associated SL ligament disruption. As the proximal fragment was too small to be amenable to fixation, the patient was treated with an arthroscopic partial scaphoid excision and SL ligament reconstruction using a scapholunateintercarpal screw placed percutaneously. At 26 months, the patient exhibited no pain, near-normal strength, and wrist motion, and expressed a high-level of satisfaction from his surgery. Literature Review  Although cases of SL ligament disruption with concomitant proximal scaphoid fractures have been reported, to our knowledge, this is the first report of SL ligament rupture occurring in the setting of a preexisting proximal pole scaphoid nonunion. Clinical Relevance  We report the use of SL ligament reconstruction augmented with intercarpal screw fixation, and excision of the proximal pole scaphoid nonunion. This minimallyinvasive approach may be a particularly useful option in young, active patients such as our own, where a motion-sacrificing salvage procedure would be less than ideal. PMID:27616829

  18. Three-dimensional analysis of osteophyte formation on distal radius following scaphoid nonunion.

    Science.gov (United States)

    Oura, Keiichiro; Moritomo, Hisao; Kataoka, Toshiyuki; Oka, Kunihiro; Murase, Tsuyoshi; Sugamoto, Kazuomi; Yoshikawa, Hideki

    2017-01-01

    The purposes of this study were to quantitatively analyze osteophyte formation of the distal radius following scaphoid nonunion and to investigate how fracture locations relate to osteophyte formation patterns. Three-dimensional surface models of the scaphoid and distal radius were constructed from computed tomographic images of both the wrists of 17 patients' with scaphoid nonunion. The scaphoid nonunions were classified into 3 types according to the location of the fracture line: distal extra-articular (n = 6); distal intra-articular (n = 5); and proximal (n = 6). The osteophyte models of the radius were created by subtracting the mirror image of the contralateral radius model from the affected radius model using a Boolean operation. The osteophyte locations on the radius were divided into 5 areas: styloid process, dorsal scaphoid fossa, volar scaphoid fossa, dorsal lunate fossa, and volar lunate fossa. Osteophyte volumes were compared among the areas and types of nonunion. The presence or absence of dorsal intercalated segment instability (DISI) deformity was also determined. The distal intra-articular type exhibited significantly larger osteophytes in the styloid process than the distal extra-articular type. Furthermore, the proximal type exhibited significantly larger osteophytes in the dorsal scaphoid fossa than the distal extra-articular type. Finally, the distal intra- and extra-articular types were more associated with DISI deformity and tended to have larger osteophytes in the lunate fossa than the proximal type. The pattern of osteophyte formation in the distal radius determined using three-dimensional computed tomography imaging varied among the different types of scaphoid nonunion (distal extra-articular, distal intra-articular, and proximal). The results of this study are clinically useful in determining whether additional resection of osteophytes or radial styloid is necessary or not during the treatment of the scaphoid nonunion. Copyright

  19. Osteoblastoma of scaphoid of the carpus: a case report.

    Science.gov (United States)

    Bahouq, Hanane; Allali, Fedoua; Hajjaj-Hassouni, Najia

    2011-01-01

    Osteoblastoma is a rather uncommon tumor, especially when located in the wrist (and hand). Its diagnosis therefore appears to be problematic. We describe a case of osteoblastoma of the scaphoid bone and its management. To our knowledge, this is the fourth case of osteoblatoma of the carpus reported in the literature. Proximal row carpectomy was chosen because of the aggressive nature of the tumor. A tendon transfer was performed in the same session for wrist stabilization. Other authors have opted for a more conservative approach (tumor curettage with bone grafting).

  20. The risk of non-union per fracture: current myths and revised figures from a population of over 4 million adults.

    Science.gov (United States)

    Mills, Leanora A; Aitken, Stuart A; Simpson, A Hamish R W

    2017-08-01

    Background and purpose - Fracture non-union remains a major clinical problem, yet there are no data available regarding the overall risk of fractures progressing to non-union in a large population. We investigated the rate of non-union per fracture in a large adult population. Methods - National data collected prospectively over a 5-year period and involving just under 5,000 non-unions were analyzed and compared to the incidence of fracture in the same period. Results and interpretation - The overall risk of non-union per fracture was 1.9%, which is considerably less than previously believed. However, for certain fractures in specific age groups the risk of non-union rose to 9%. As expected, these higher rates of non-union were observed with tibial and clavicular fractures, but-less expectedly-it was in the young and middle-aged adults rather than in the older and elderly population. This study is the first to examine fracture non-union rates in a large population according to age and site, and provides more robust (and lower) estimates of non-union risk than those that are frequently quoted.

  1. Lower extremity fractures in patients with spinal cord injury Characteristics, outcome and risk factors for non-unions.

    Science.gov (United States)

    Grassner, Lukas; Klein, Barbara; Maier, Doris; Bühren, Volker; Vogel, Matthias

    2017-05-25

    Sublesional osteoporosis is an important sequel after spinal cord injury (SCI) resulting in a high incidence of fractures and impaired osseous healing due to altered bone metabolism. The following study aims to identify demographic characteristics and outcome of patients with SCI with lower extremity fractures. Retrospective observational study. Level-I cross-regional trauma center. All patients with SCI suffering from osteoporotic/pathologic fractures during an 11-year-period (01/2003-12/2013) at the Center for Spinal Cord Injuries (Trauma Center Murnau) were analyzed via a chart review. Demographics, surgical and radiologic outcome as well as complication rate were assessed with a special emphasis on union rates and independent risk factors for non-unions. We identified 132 patients (105 males) who fulfilled the inclusion criteria. Most of them were paraplegic (n=101) and showed motor complete syndromes (n=119). Supracondylar femur fractures were the most prevalent in this study (n=47). We observed a non-union rate of 15.9% (n=21). The development of pseudarthrosis was associated with the time interval since the initial SCI (P union, regardless of their management (conservative or surgical). The following independent predictors for non-unions were identified: fracture localization (P unions remain a common complication in patients with SCI. Risk factors for non-unions of lower extremity fractures are identified.

  2. Management of aseptic non-unions of the distal third of the tibial diaphysis using static interlocking intramedullary nailing.

    Science.gov (United States)

    Begkas, Dimitrios; Katsenis, Dimitrios; Pastroudis, Alexandros

    2014-02-01

    To evaluate the management of aseptic non-unions of the distal third of the tibial diaphysis, using static interlocking intramedullary nailing. Between January 2005 and November 2012, a total number of 42 patients who underwent surgery at our hospital for aseptic non-unions of the distal third of the tibial diaphysis, were included in our study. Preoperatively, all the patients were tested for the presence of infection of non-union. The post-operative follow up was based on clinical and radiological findings. Union was achieved in 41 (98%) patients, at a mean time of 5.8 months (four-eight months). One (2%) patient developed infection of the wound four weeks after the operation. A small decrease of the tibial length, of about one cm was seen in three (7%) patients. Pain of the patellar tendon, at the entry point of the nail, was observed in six (14%) patients, without impacting the range of motion of the knee. In two (5%) patients, a decrease in dorsiflexion of the ankle joint occurred, of about ten degrees angle. Static interlocking intramedullary nailing is the preferable technique in the management of aseptic non-unions of the distal third of the tibial diaphysis, because it provides high union rate and few postoperative complications. A good preoperative evaluation for infections, use of proper surgical technique with respect to soft tissues, use of autogenous bone grafts and early mobilization of patients, are the keys to success of this method.

  3. Negligence claims following non-union and malunion of long bone fractures: An analysis of 15 years of data.

    Science.gov (United States)

    Metcalfe, C W; Harrison, W D; Nayagam, S; Narayan, B

    2016-10-01

    Non-unions and malunions are recognised to be complications of the treatment of long bone fractures. No previous work has looked at the implications of these complications from a medicolegal perspective. A complete database of litigation claims in Trauma and Orthopaedic Surgery was obtained from the NHS Litigation Authority. Two separate modalities of the treatment of long bone fractures were examined i) non-union and ii) acquired deformity. The type of complaint, whether defended or not, and costs were analysed. There were claims of which 97 related to non-union and 32 related to postoperative limb deformity. The total cost was £8.2 million over a 15-year period in England and Wales. Femoral and tibial non-unions were more expensive particularly if they resulted in amputation. Rotational deformity cost nearly twice as much as angulation deformities. The cosmetic appearances of rotational malalignment and amputation results in higher compensation; this reinforces an outward perception of outcome as being more important than harmful effects. Notwithstanding the limitations of this database, there are clinical lessons to be gained from these litigation claims. Crown Copyright © 2016. Published by Elsevier Ltd. All rights reserved.

  4. [{sup 18}F]FDG PET accurately differentiates infected and non-infected non-unions after fracture fixation

    Energy Technology Data Exchange (ETDEWEB)

    Wenter, Vera; Albert, Nathalie L.; Brendel, Matthias; Fendler, Wolfgang P.; Bartenstein, Peter [University of Munich, Department of Nuclear Medicine, Munich (Germany); Cyran, Clemens C. [University of Munich, Institute for Clinical Radiology, Munich (Germany); Friederichs, Jan; Mueller, Jan-Philipp; Militz, Matthias; Hungerer, Sven [BG Trauma Center Murnau, Department of Reconstructive Arthroplasty, Murnau (Germany); PMU Salzburg, Paracelsus Medical University, Salzburg (Austria); Hacker, Marcus [University of Vienna, Division of Nuclear Medicine, Department of Biomedical Imaging and Image-guided Therapy, Vienna (Austria)

    2017-03-15

    Complete fracture healing is crucial for good patient outcomes. A major complication in the treatment of fractures is non-union. The pathogenesis of non-unions is not always clear, although implant-associated infections play a significant role, especially after surgical treatment of open fractures. We aimed to evaluate the value of [{sup 18}F]FDG PET in suspected infections of non-union fractures. We retrospectively evaluated 35 consecutive patients seen between 2000 and 2015 with suspected infection of non-union fractures, treated at a level I trauma center. The patients underwent either [{sup 18}F]FDG PET/CT (N = 24), [{sup 18}F]FDG PET (N = 11) plus additional CT (N = 8), or conventional X-ray (N = 3). Imaging findings were correlated with final diagnosis based on intraoperative culture or follow-up. In 13 of 35 patients (37 %), infection was proven by either positive intraoperative tissue culture (N = 12) or positive follow-up (N = 1). [{sup 18}F]FDG PET revealed 11 true-positive, 19 true-negative, three false-positive, and two false-negative results, indicating sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 85 %, 86 %, 79 %, 90 %, and 86 %, respectively. The SUV{sub max} was 6.4 ± 2.7 in the clinically infected group and 3.0 ± 1.7 in the clinically non-infected group (p <0.01). The SUV{sub ratio} was 5.3 ± 3.3 in the clinically infected group and 2.6 ± 1.5 in the clinically non-infected group (p <0.01). [{sup 18}F]FDG PET differentiates infected from non-infected non-unions with high accuracy in patients with suspected infections of non-union fractures, for whom other clinical findings were inconclusive for a local infection. [{sup 18}F]FDG PET should be considered for therapeutic management of non-unions. (orig.)

  5. Osteoinduction properties of different growth factors on cells from non-union patients: in vitro study for clinical application.

    Science.gov (United States)

    Gigante, A; Cappella, M; Manzotti, S; Cecconi, S; Greco, F; Di Primio, R; Mattioli-Belmonte, M

    2010-01-01

    This report compares the effect of rhBMPs and PRG on cells derived from human non-union sites. Treatment of non-union continues to be a challenging task for the trauma surgeon often resulting in unsatisfactory results and long-term morbidity. Over the past two decades, the possibility to use growth factors in bone regeneration has been investigated. In this study we compared the in vitro capability of two recombinant human bone morphogenetic proteins (rhBMP-2 and rhBMP-7) and activated platelet-rich plasma (PRG) to stimulate proliferation and/or differentiation of cells derived from non-union patients. Cells derived from the lesion sites, osteoblasts and mesenchymal stem cells (MSCs) derived from other bone sites of the same patients were used. Treatment with rhBMP-7 or rhBMP-2 showed an improvement in the expression of osteoblastic markers (osteonectin and osteocalcin) in cells derived from human non-union sites. This enhancement was more marked in MSCs, while no significant changes were observed in osteoblast cultures. The PRG treatment produced in all analysed samples a considerable increase in cell proliferation without affecting cell differentiation. On the basis of our results, for an effective biological treatment of non-unions, small amounts of autologous bone marrow (MSCs) are necessary in the lesion site in order to provide both growth factors and a sufficient number of responsive cells. Finally, our results prove that sequential timing administration of PRG and rhBMPs may be used in new therapeutic strategy.

  6. One-stage reconstruction with open bone grafting and vacuum-assisted closure for infected tibial non-union.

    Science.gov (United States)

    Deng, Zhouming; Cai, Lin; Jin, Wei; Ping, Ansong; Wei, Renxiong

    2014-08-29

    Non-union of the tibia complicated by osteomyelitis is one of the most challenging problems in orthopaedic surgery. There remains a significant amount of debate and controversy regarding the optimal medical management of infected tibial non-union. There are few articles which have reported the outcomes of treatment for infected non-union of tibia from single-stage reconstruction with open bone grafting plus vacuum-assisted closure (VAC). Our report covers experience between March 2007 and February 2010 of open bone grafting plus VAC in one stage for patients with infected tibial non-union. The time for bone union and wound healing to occur, the duration of hospitalisation, and the rate of resolution of infection were all analysed. The main outcome measures were based on a clinical scoring system that assessed functional ability, range of knee and ankle motion, shortening, infection and pain. Fifteen patients were involved in this study. All patients were followed up for an average of 22.6 months (range: 14-42 months). Bone union was achieved in 93.3% (14/15) of patients after a mean of 5.93 months (range: 3-10 months). All wounds healed within an average period of 5 weeks (range: 3-10 weeks), and the function and appearance of all limbs were satisfactory. Open bone grafting combined with VAC in a one-stage procedure can be a feasible alternative to the treatment of infected tibial non-union, especially for those wounds which are not good candidates for microsurgery; however, further studies are required to confirm the likely benefits.

  7. Vascularized bone graft in scaphoid fractures. Anatomical details and clinical indications. A cases series

    International Nuclear Information System (INIS)

    Vergara A, Enrique

    2007-01-01

    The fracture of scaphoid continues being a challenge for orthopedist and hand surgeons. Objective. To show the anatomical details of the bony strip from the second metacarpal in corpses injected with green latex and the results of the surgical technique in a series of patients with scaphoid pseudarthrosis. Materials and methods. We carry out an initial anatomical analysis before employing the surgical technique in clinical setting, and then we did a descriptive study of patients with pseudarthrosis of scaphoid,treated with vascularized bony graft by the first metacarpal artery. Results. All patients consolidated and improved in the pain scale, they did not have mobility deterioration or residual carpus instability, after ten years of observations. Conclusions. The vascularized graft is a useful option in the management of the pseudarthrosis of the scaphoid.

  8. Recurrent hydatosis at the site of non-union humerus fracture

    Directory of Open Access Journals (Sweden)

    Mohsen Nourbakhsh

    2012-01-01

    Full Text Available Hydatid disease is still endemic in several regions of the world and is caused by two species of tapeworms, Echinococcus granulosus and Echinococcus alveolaris. It primary involves liver and lung, and bone involvement is relatively rare (0.2-4%, where it is most commonly seen in the spine. The skeletal involvement is usually due to secondary extension such as hematogenous spread. The disease has usually a silent manifestation until a complication exists; so, many cases are diagnosed intraoperatively. Treatment of hydatid disease because of its bone involvement and spillage of fluid with subsequent contamination seeding is difficult, so it has a high mortality rate and many cases will recur. Therefore, we can prevent these occurrences if we treat hydatid disease completely and in the primary stage. Adjuvant medical treatment, if the diagnosis is known, prevents systemic spread and recurrence. Here, we present a primary recurrent hydatosis at the site of non-union humerus fracture. We have pointed out osseous hydatosis as one of the important differential diagnoses in destructive bone lesions and the necessity of its radical resection.

  9. Dorsal Scaphoid Subluxation on Sagittal Magnetic Resonance Imaging as a Marker for Scapholunate Ligament Tear.

    Science.gov (United States)

    Meister, David W; Hearns, Krystle A; Carlson, Michelle G

    2017-09-01

    To evaluate the diagnostic utility of scaphoid dorsal subluxation on magnetic resonance imaging (MRI) as a predictor of scapholunate interosseous ligament (SLIL) tears and compare this with radiographic findings. Thirty-six MRIs were retrospectively reviewed: 18 with known operative findings of complete Geissler IV SLIL tears that were surgically repaired, and 18 MRIs performed for ulnar-sided wrist pain but no SLIL tear. Dorsal subluxation of the scaphoid was measured on the sagittal MRI cut, which demonstrated the maximum subluxation. Independent samples t tests were used to compare radiographic measurements of scapholunate (SL) gap, SL angle, and capitolunate/third metacarpal-lunate angles between the SLIL tear and the control groups and to compare radiographic measurements between wrists that had dorsal subluxation of the scaphoid and wrists that did not have dorsal subluxation. Interrater reliability of subluxation measurements on lateral radiographs and on MRI were calculated using kappa coefficients. Thirteen of 18 wrists with complete SLIL tears had greater than 10% dorsal subluxation of the scaphoid relative to the scaphoid facet. Average subluxation in this group was 34%. Four of 18 wrists with known SLIL tears had no subluxation. No wrists without SLIL tears (control group) had dorsal subluxation. The SL angle, capitolunate/third metacarpal-lunate angle and SL gap were greater in wrists that had dorsal subluxation of the scaphoid on MRI. Interrater reliability of measurements of dorsal subluxation of the scaphoid was superior on MRI than on lateral x-ray. An MRI demonstration of dorsal subluxation of the scaphoid, of as little as 10%, as a predictor of SLIL tear had a sensitivity of 72% and a specificity of 100%. The high positive predictive value indicates that the presence of dorsal subluxation accurately predicts SLIL tear. Diagnostic II. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  10. Deceptive appearance of normal variant of scaphoid bone in a teenage patient: a diagnostic challenge

    Directory of Open Access Journals (Sweden)

    Amjad N. Bhatti

    2012-02-01

    Full Text Available Scaphoid fractures are a common injury in late teens and mid twenties with a peak period in skeletally immature children at about 15 years of age, although considered to be rare in first decade of life, its exact incidence in early teen age remains to be a subject of debate. We report an unusual case of anatomical variation of scaphoid bone at the level of waist which could potentially cause diagnostic confusion. A 14-years-old boy presented in the fracture clinic 2 weeks after injury to his Right wrist which was managed in a scaphoid cast. X-ray examinations, both at the time of injury and later on in the fracture clinic revealed features suspicious of a fracture at the level of waist of the scaphoid bone, however the clinical examination did not correlate with imaging, in view of that radiological imaging of the unaffected side was performed for comparison, which revealed it to be an anatomical variant of scaphoid at this age. To our knowledge there are very few cases of such variation reported in literature in this age group of patients. This case highlights the importance of anatomical variants in scaphoid bone in this age group, which might pose a diagnostic challenge and the need for appropriate management plan and reassurance to avoid unnecessary anxiety.

  11. Efficacy of longitudinal computed tomography for scaphoid fracture. A new posture

    Energy Technology Data Exchange (ETDEWEB)

    Adachi, Keisuke; Yasui, Natsuo [Tokushima Univ. (Japan). School of Medicine; Takai, Hiroaki [Kaminaka Town Hospital, Tokushima (Japan)

    2002-08-01

    We developed a new method for taking reproducible and accurate longitudinal computed tomography of the scaphoid ({delta} hand CT). The patient makes an equilateral triangle with bilateral thumbs in radial abduction with the index fingers. The patient lies prone in the CT scanner with both hands on the midline above the head, ensuring that the axis of the thumbs is perpendicular to the body axis. Twelve patients with scaphoid fracture were evaluated utilizing the {delta} hand CT. In eight patients, {delta} hand CT was performed before treatment. We compared findings with those of plain radiograms. Target sign indicating accurate longitudinal scan of the scaphoid were obtained in sixteen of seventeen contralateral (normal) scaphoid on {delta} hand CT without any position adjustment after scouting. Humpback deformity was observed in seven of eight fractured scaphoid on {delta} hand CT performed before treatment. However, in just one case of the eight on plain radiograms, was deformity noted. The bony continuity between proximal and distal fragments was observed in five out of twelve scaphoid on {delta} hand CTs, even though fracture lines were clearly seen on the plain radiograms. Thus, the {delta} hand CT method has been shown to be highly reproducible and at an early stage provides good information regarding minimal displacement, deformity and bone union before such are detectable on plain radiograms. (author)

  12. Scaphoid and lunate movement in different ranges of carpal radioulnar deviation.

    Science.gov (United States)

    Tang, Jin Bo; Xu, Jing; Xie, Ren Guo

    2011-01-01

    We aimed to investigate scaphoid and lunate movement in radial deviation and in slight and moderate ulnar deviation ranges in vivo. We obtained computed tomography scans of the right wrists from 20° radial deviation to 40° ulnar deviation in 20° increments in 6 volunteers. The 3-dimensional bony structures of the wrist, including the distal radius and ulna, were reconstructed with customized software. The changes in position of the scaphoid and lunate along flexion-extension motion (FEM), radioulnar deviation (RUD), and supination-pronation axes in 3 parts--radial deviation and slight and moderate ulnar deviation--of the carpal RUD were calculated and analyzed. During carpal RUD, scaphoid and lunate motion along 3 axes--FEM, RUD, and supination-pronation--were the greatest in the middle third of the measured RUD (from neutral position to 20° ulnar deviation) and the smallest in radial deviation. Scaphoid motion along the FEM, RUD, and supination-pronation axes in the middle third was about half that in the entire motion range. In the middle motion range, lunate movement along the FEM and RUD axes was also the greatest. During carpal RUD, the greatest scaphoid and lunate movement occurs in the middle of the arc--slight ulnar deviation--which the wrist frequently adopts to accomplish major hand actions. At radial deviation, scaphoid and lunate motion is the smallest. Copyright © 2011 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  13. Can antibiotic impregnated cement nail achieve both infection control and bony union in infected diaphyseal femoral non-unions?

    Science.gov (United States)

    Pradhan, Chetan; Patil, Atul; Puram, Chetan; Attarde, Dheeraj; Sancheti, Parag; Shyam, Ashok

    2017-08-01

    Infected non-union is complex and debilitating disorder affecting orthopaedic surgeon and patient in terms of cost and time. Many methods are described in the literature for treatment of infected non-union. Local high concentration of antibiotic and mechanical stability of antibiotic cement impregnated intramedullary nail (ACIIN) proves cost and time effective. Recently it was suggested that ACIIN can achieve both union and infection control in infected non-unions with bone gap less than 4cm. The aim of our study was to investigate this hypothesis and study the outcome of antibiotic cement impregnated intramedullary nail in term of both infection control and osseous union. We retrospectively studied 21 patients with infected diaphyseal femoral non-union. Inclusion criteria were bone gap less than 4cm after debridement and more than 1 year follow-up of the case. ACIIN prepared using K nail was used as primary procedure after adequate debridement. Infection control and osseous union was judged on the basis of clinical, radiological and haematological parameters. All patients were followed up with an average follow-up of 20.23±3.65 months (range 14-28 months). Infection control was achieved in all 21 patients at end of 12 months follow-up, out of which 16 patients had osseous union and infection control without any secondary procedure. Of the remaining 5 patients: two patients had good infection control but had broken ACCIN due to non-compliance to weight bearing protocol. One patient underwent exchange nailing and plate augmentation whilst the other underwent simple exchange nailing, One more patient who had infection control but had persistent non-union had to undergo exchange nailing and augmented plating to achieve union. One other patient required debridement and implant removal and attained union and fifth patient required two additional debridements to control infection after which the fracture united. Apart from above 5 cases there were two further

  14. Treatment of atrophic tibia non-unions according to 'diamond concept': Results of one- and two-step treatment.

    Science.gov (United States)

    Moghaddam, Arash; Zietzschmann, Severin; Bruckner, Thomas; Schmidmaier, Gerhard

    2015-10-01

    The successful treatment of atrophic tibia non-unions and tibia non-unions with large bone defects or infections is a major challenge in orthopedic and trauma surgery. This article evaluates the use of the 'diamond concept' using a one-step or two-step procedure according to 'Masquelet technique' in the treatment of atrophic tibia non-unions. Between February 2010 and March 2014, 102 patients with atrophic non-unions were treated according to the 'diamond concept' in our center. Ninety-nine were available for follow-up. Forty-nine received a one-step treatment (Group 1, G1) and 50 patients received a two-step treatment according to the 'Masquelet technique' (Group 2, G2). Clinical and radiological parameters were measured preoperatively as well as 4, 6, and 12 weeks and 6 and 12 months postoperatively. In order to evaluate the subjective health of patients, we used the SF-12 questionnaire. Data analysis was performed one year after treatment. The rate of consolidation in G1 was 84% and 80% in G2. The time to heal in G2 was 8.6 ± 2.9 months, which is significantly longer than in G1 being 6.9 ± 3.1 months. In comparison patients in G1/G2 had an average of 3.2/6.7 previous major surgeries. In G1, 4 of 8 patients who did not heal successfully showed positive intraoperative cultures. In G2, 26 patients (52%) initially presented with positive cultures. The results of the SF-12 questionnaire improved in both groups during the postoperative follow-up, but showed no significant differences between groups. In 29 patients a gentamycin-coated nail was used for reosteosynthesis. These patients showed by trend a lower rate of complications at a higher rate of consolidation. Our study showed that the 'diamond concept' is a suitable method for safely and effectively treating non-unions with large defects or infections. The use of an antibiotic-coated nail provides a therapeutic benefit. For large bone defects of infected non-unions the two-step procedure after Masquelet is an

  15. Shape change in the atlas with congenital midline non-union of its posterior arch: a morphometric geometric study.

    Science.gov (United States)

    Ríos, Luis; Palancar, Carlos; Pastor, Francisco; Llidó, Susana; Sanchís-Gimeno, Juan Alberto; Bastir, Markus

    2017-10-01

    The congenital midline non-union of the posterior arch of the atlas is a developmental variant present at a frequency ranging from 0.7% to 3.9%. Most of the reported cases correspond to incidental findings during routine medical examination. In cases of posterior non-union, hypertrophy of the anterior arch and cortical bone thickening of the posterior arches have been observed and interpreted as adaptive responses of the atlas to increased mechanical stress. We sought to determine if the congenital non-union of the posterior arch results in a change in the shape of the atlas. This study is an analysis of the first cervical vertebrae from osteological collections through morphometric geometric techniques. A total of 21 vertebrae were scanned with a high-resolution three-dimensional scanner (Artec Space Spider, Artec Group, Luxembourg). To capture vertebral shape, 19 landmarks and 100 semilandmarks were placed on the vertebrae. Procrustes superimposition was applied to obtain size and shape data (MorphoJ 1.02; Klingenberg, 2011), which were analyzed through principal component analysis (PCA) and mean shape comparisons. The PCA resulted in two components explaining 22.32% and 18.8% of the total shape variance. The graphic plotting of both components indicates a clear shape difference between the control atlas and the atlas with posterior non-union. This observation was supported by statistically significant differences in mean shape comparisons between both types of vertebra (patlas is associated with significant changes in the shape of the vertebra. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Single-stage treatment of infected tibial non-unions and osteomyelitis with bone marrow granulocytes precursors protecting bone graft.

    Science.gov (United States)

    Hernigou, Philippe; Dubory, Arnaud; Homma, Yasuhiro; Flouzat Lachaniette, Charles Henri; Chevallier, Nathalie; Rouard, Helene

    2017-11-13

    Infected non-unions present a clinical challenge, especially with risk of recurrent infection. Bone marrow contains granulocyte precursors identified in vitro as colony forming units-granulocyte macrophage (CFU-GM) have a prophylactic action against infection. We therefore tested the hypothesis that bone marrow concentrated granulocytes precursors added to a standard bone graft could decrease the risk of recurrence of infection when single-stage treatment of infected tibial non-unions is performed with bone graft. During a single-stage procedure 40 patients with infected tibial non-union received a spongious bone graft supercharged with granulocytes precursors after debridement (study group). A control group (40 patients) was treated in a single stage with local debridement and standard bone graft obtained from the iliac crest. The antibiotic therapy protocol was the same (60 days) in the two groups. CFU-GM progenitors were harvested from bone marrow aspirated on the opposite iliac crest of the site where the cancellous bone was obtained. Union (radiographs and CT scan), a recurrence of clinical infection, and need for subsequent surgery were evaluated. Thirty-eight (95%) patients who received graft supercharged with granulocytes precursors achieved successful union without recurrence of infection during the seven-year follow-up versus 28 (70%) control patients; for the control group the mean graft resorption volume was 40%, while no bone graft resorption was found for the study group. Supercharging the cancellous bone graft with bone marrow granulocytes precursors protect the site of infected non-union from recurrence of infection and bone resorption of the graft.

  17. Soft Tissue Swelling Associated with the Use of Recombinant Human Bone Morphogenetic Protein-2 in Long Bone Non-unions.

    Science.gov (United States)

    Young, Andrew; Mirarchi, Adam

    2015-01-01

    This report describes two cases of long bone non-union associated with the use of recombinant human bone morphogenetic protein-2 (rhBMP-2) and is the first of its kind. The first case describes a 25-year-old male who sustained a left diaphyseal femoral shaft fracture initially treated with operative fixation using an intramedullary nail, which subsequently loosened distally and was treated with exchange nailing and rhBMP-2 application. This patient developed acute local soft tissue inflammation post-operatively. The second case describes a 61-year-old female who sustained a right diaphyseal humeral shaft fracture that was initially treated with intramedullary nail fixation with subsequent distal interlock screw loosening. She underwent nail removal, and compression plating with rhBMP-2 placement, and postoperatively developed severe acute local tissue swelling centered over the rhBMP-2 sponge. Surgeons should be aware that rhBMP-2 may cause local acute tissue swelling and recombinant bone morphogenic proteins such as rhBMP-2 may have a role in the management for atrophic fracture non-unions. The authors recommend careful consideration prior to rhBMP-2 use in long bone non-unions.

  18. Occult fractures of the scaphoid: the role of ultrasonography in the emergency department.

    Science.gov (United States)

    Platon, Alexandra; Poletti, Pierre-Alexandre; Van Aaken, Jan; Fusetti, Cesare; Della Santa, Dominique; Beaulieu, Jean-Yves; Becker, Christoph D

    2011-07-01

    To evaluate ultrasonography (US) performed by an emergency radiologist in patients with clinical suspicion of scaphoid fracture and normal radiographs. Sixty-two consecutive adult patients admitted to our emergency department with clinical suspicion of scaphoid fracture and normal radiographs underwent US examination of the scaphoid prior to wrist computed tomography (CT), within 3 days following wrist trauma. US examination was performed by a board-certified emergency radiologist, non-specialized in musculoskeletal imaging, using the linear probe (5-13 MHz) of the standard sonographic equipment of the emergency department. The radiologist evaluate for the presence of a cortical interruption of the scaphoid along with a radio-carpal or scapho-trapezium-trapezoid effusion. A CT of the wrist (reference standard) was performed in every patient, immediately after ultrasonography. Fractures were classified into two groups according to their potential for complication: group 1 (high potential, proximal or waist), group 2 (low-potential, distal or tubercle). A scaphoid fracture was demonstrated by CT in 13 (21%) patients: eight (62%) of them belonged to group 1 (three in the proximal pole, five in the waist), five (38%) to group 2 (three in the distal part, two in the tubercle). US was 92% sensitive (12/13) in demonstrating a scaphoid fracture. It was 100% sensitive (8/8) in demonstrating a fracture with a high potential of complication (group 1). Our data show that, in emergency settings, US can be used for the triage to CT in patients with clinical suspicion of scaphoid fracture and normal radiographs.

  19. Percutaneous autologous bone marrow injection for treatment of delayed and non-union of long bone: a retrospective study of 45 cases.

    Science.gov (United States)

    Gross, Jean-Baptiste; Diligent, Jérôme; Bensoussan, Danièle; Galois, Laurent; Stoltz, Jean-François; Mainard, Didier

    2015-01-01

    Non-union of long bones is still a current problem in traumatology. Although corticocancellous bone autograft remains the usual procedure for the treatment of non-union, innovative therapies such as, percutaneous autologous concentrated bone marrow grafting (PABMG), are now appearing. Over a period of 8 years, 45 non-union of long bones were treated by PABMG in the Department of Orthopaedic and Traumatologic Surgery (University Hospital of Nancy, France): 26 tibiae, 16 femurs, 3 humeri. Efficiency was evaluated by clinical criteria: full weight-bearing without pain, absence of motion at non-union site, and radiological criteria: healing of 3 corticales out of 4. Eighteen out of 28 non-unions at the tibia were healed (69%), 10 at the femur (63%), but none was noticed at the humerus. Some pejorative prognosis factors were noted such as: tobacco, alcohol abuse, diabetes and history of infection at the fracture site. An earlier grafting improved the success rate. The number of CFU-F (Colony Forming Unit Fibroblastic) affected the healing time more than the healing rate. The procedure, even though a little invasive, enables the healing of non-union in two out of three cases with less morbidity than conventional procedures. This procedure fits perfectly into the therapeutic arsenal of non-union.

  20. Intraosseous rotation of the scaphoid: assessment by using a 3D CT model - an anatomic study

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    Schmidle, Gernot; Gabl, Markus [Medical University Innsbruck, Department of Trauma Surgery, Innsbruck (Austria); Rieger, Michael [Regional Hospital Hall, Department of Radiology, Hall in Tirol (Austria); Klauser, Andrea Sabine; Thauerer, Michael [Medical University Innsbruck, Department of Radiology, Innsbruck (Austria); Hoermann, Romed [Medical University Innsbruck, Department of Anatomy, Histology and Embryology-Division of Clinical and Functional Anatomy, Innsbruck (Austria)

    2014-06-15

    The purpose of this study was to assess intraosseous rotation as the third dimension of scaphoid anatomy on a 3D CT model using common volume rendering software to impact anatomical reconstruction of scaphoid fractures. CT images of 13 cadaver wrist pairs were acquired. Reference axes for the alignment of distal and proximal scaphoid poles were defined three-dimensionally. Two methods for rotation measurement - the reference axis method (RAM) and the scapho-trapezio-trapezoidal joint method (STTM) - were developed and compared by three independent observers. Rotation measured by the RAM averaged 66.9 ± 7 for the right and 67.2 ± 5.8 for the left wrists. Using the STTM there was a mean rotation of 68.6 ± 6.6 for the right and 68.6 ± 6.8 for the left wrists. The overall results showed a significant variability of the measured values between different specimens (P < 0.05). There was no significant difference between left and right wrists of the same specimen, neither for the RAM (P = 0.268) nor for the STTM (P = 0.774). Repeatability coefficients between the observers were low, indicating good repeatability. The presented methods are practical tools to quantify intraosseous rotation between distal and proximal scaphoid poles using common volume rendering software. For clinical application the opposite side provides the best reference values to assess malrotation in scaphoid fracture cases. (orig.)

  1. [Scaphoid pseudarthrosis : Indications for avascular iliac crest or radius bone grafts].

    Science.gov (United States)

    Asmus, A; Lautenbach, M; Schacher, B; Kim, S; Eisenschenk, A

    2016-11-01

    Operative treatment of the scaphoid nonunion includes avascular corticocancellous and cancellous bone grafts and increasingly the use of vascular pedicled and free vascular corticocancellous grafts. Especially the latter require a fair amount of operative expertise and experience in microsurgical techniques. Which criteria lead to the decision for or against an avascular graft used for reconstruction of scaphoid nonunion? Is our current classification system of a scaphoid pseudarthrosis able to illustrate our diagnostic potential in a way that makes us refer to operative procedures? Evaluation of current literature and expert opinions RESULTS: Avascular bone grafts show a high union rate as long as a sufficient vascularisation of the remaining fragments is present. In general, patients benefit from a very good functional outcome. Even revisions of failed scaphoid union may be successfully treated with an avascular bone graft. Failures of union are repeatedly experienced in treating proximal pole fractures with critical vascularisation or extensive bone loss, especially including avascular necrosis of the proximal pole (AVN). Current classification systems do not allow description and correlation of morphologic findings so as to compare results profoundly and to recommend specific procedures. As long as sufficient vascularisation of remaining fragments is seen, the avascular bone graft is eligible for reconstructing scaphoid nonunion. Classification systems do not seem to reflect the status quo of diagnostic possibilities and make it difficult to provide guidelines for state-of-the-art operative procedures.

  2. Three-Dimensional Assessment of Bilateral Symmetry of the Scaphoid: An Anatomic Study

    Directory of Open Access Journals (Sweden)

    Paul W. L. ten Berg

    2015-01-01

    Full Text Available Preoperative 3D CT imaging techniques provide displacement analysis of the distal scaphoid fragment in 3D space, using the matched opposite scaphoid as reference. Its accuracy depends on the presence of anatomical bilateral symmetry, which has not been investigated yet using similar techniques. Our purpose was to investigate symmetry by comparing the relative positions of distal and proximal poles between sides. We used bilateral CT scans of 19 adult healthy volunteers to obtain 3D scaphoid models. Left proximal and distal poles were matched to corresponding mirrored right sides. The left-to-right positional differences between poles were quantified in terms of three translational and three rotational parameters. The mean (SD of ulnar, dorsal, and distal translational differences of distal poles relative to proximal poles was 0.1 (0.6; 0.4 (1.2; 0.2 (0.6 mm and that of palmar rotation, ulnar deviation, and pronation differences was −1.1 (4.9; −1.5 (3.3; 1.0 (3.7°, respectively. These differences did not significantly differ from zero and thus were not biased to left or right side. We proved that, on average, the articular surfaces of scaphoid poles were symmetrically aligned in 3D space. This suggests that the contralateral scaphoid can serve as reference in corrective surgery. No level of evidence is available.

  3. Radiographic Parameters to Predict Union After Volar Percutaneous Fixation of Herbert Type B1 and B2 Scaphoid Fractures.

    Science.gov (United States)

    Mahmoud, Mostafa; Hegazy, Mohamed; Khaled, Sherif Ahmed; Abdelatif, Nasef Mohamed Nasef; Osman, Walid; Elfar, John C

    2016-02-01

    To study the angle of screw placement in relation to the scaphoid fracture plane and its effect on union after percutaneous fixation of scaphoid waist fractures. Twenty-four consecutive scaphoid waist fractures were retrospectively evaluated for the orientation of screws in relation to the fracture plane using a method in which the sum-of-smaller angles (SSA) in 3 different radiographs were used to correlate with time to fracture union. All but one patient achieved union after percutaneous fixation of the scaphoid. Another patient required revision surgery within the study period for inadequate fixation. A shortened time to union was significantly correlated to larger SSA. SSA may be a reasonable predictor of union after percutaneous fixation of scaphoid waist fracture. It can be reliably calculated using plain radiographs. An SSA of 190° or more correlated with union by 8 weeks postoperatively. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  4. Effects of third fragment size and displacement on non-union of femoral shaft fractures after locking for intramedullary nailing.

    Science.gov (United States)

    Lee, J R; Kim, H-J; Lee, K-B

    2016-04-01

    The femoral shaft fractures with large fragments makes anatomical reduction challenging and often results in non-union. In some studies, the degree of fragment displacement was reported to have affected non-union, but the association between the one fragment size and degree of displacement has not been fully clarified. Therefore we performed a retrospective study to assess: (1) the more influential factor of non-union: the degree of fragment displacement, or the fragment size? (2) the non-union rates according to different sizes and degrees of displacement. The degree of displacement is the more potent factor of non-union than the third fragment size in femoral shaft fractures. We assessed retrospectively 64 cases, which could be followed up for longer than one year. Fragments were divided according to the length of their long axis into three groups: group A (0-3.9cm), (n=21); group B (4-7.9cm), (n=22); group C (8cm or more), (n=21). Fragment displacement was also assessed in the proximal (P) or distal (D) end to the nearest cortex of the femoral shaft, and divided into the following groups: group P1 (n=44) or D1 (n=47), (0-9mm); group P2 (n=10) or D2 (n=11), (10-19mm); group P3 (n=7) or D3 (n=3), (20-29mm); and group P4 (n=3) or D4 (n=3), (30mm or more). The bone union rate was 86% in the small (less than 8cm) fragment groups and 71% in the large (8cm or more) fragment group (P=0.046). With respect to the degree of displacement, the union rate was lower (P=0.001) and the average union time was longer (P=0.012) in the 20mm or more group for both the proximal fragment part and the distal fragment part (P=0.002, P=0.014). A logistic regression analysis underlined the displacement in the proximal site (OR: 0.298, 95% CI: 0.118-0.750) as in the distal site (OR: 0.359, 95% CI: 0.162-0.793) as a larger effect on union rate than the fragment size that as no effect in logistic regression (OR 3.8, 95% CI: 0.669-21.6). Non-union develops significantly more frequently in

  5. Non-union of osteoporotic vertebral fractures - identification and treatment of an underestimated pathology in elderly patients with persistent back pain.

    Science.gov (United States)

    Adler, Daniel; Tschoeke, Sven K; von der Hoeh, Nicolas; Gulow, Jens; von Salis-Soglio, Georg; Heyde, Christoph-E

    2014-12-01

    Non-union of osteoporotic vertebra fractures are a seldom entity. However, when back pain persists in the course of conservatively treated osteoporotic vertebra fractures, a non-union should be considered. We thus sought to validate our diagnostic algorithm in patients with known osteoporotic vertebra fractures presenting persistent back pain and advert to the diagnosis and treatment of vertebral non-unions. Patients admitted with preexisting osteoporotic vertebra fractures and therapy-resistant back pain were retrospectively analysed. All admitted patients were subject to standard plain radiographs in erect position and conventional CT or MR imaging of the spine, respectively. In addition, patients with suspected non-union were subject to lateral fulcrum radiographs in supine position. From a total of 172 admitted patients, four patients presented with non-union of a fractured osteoporotic vertebra (2%). The subsequent surgical therapy included cement-augmented rod-and-screw stabilization, with or without additional correction of deformity, and kyphoplasty (N = 3) or kyphoplasty alone (N = 1). All surgical interventions were successful in pain reduction and allowed immediate and improved postoperative mobilisation. Non-union of osteoporotic vertebra fractures must be considered when symptoms outlast conservative treatment. In these cases, plain lateral fulcrum radiographs are a simple and effective adjunct to the conventional diagnostic methods. Surgical stabilization then proves to be the effective treatment of choice.

  6. Gadolinium-enhanced dynamic MRI of the fractured carpal scaphoid: Preliminary results

    International Nuclear Information System (INIS)

    Munk, P.L.; Lee, M.J.; Janzen, D.; Connell, D.G.; Poon, P.Y.; Struk, D.; Munk, P.L.; Lee, M.; Janzen, D.L.; Connell, D.G.; Poon, P.Y.; Struk, D.; Munk, P.L.; Janzen, D.L.; Favero, K.J.; Poon, P.Y.; Vellet, A.D.; Logan, P.M.

    1998-01-01

    The aim of the present report was to evaluate the vascularity of fracture fragments of the fractured carpal scaphoid in the acute ( 3 months) phases using a gadolinium-enhanced dynamic MRI sequence. Eight patients with acute scaphoid fractures, six patients with chronic scaphoid fractures, and three control patients without fractures were evaluated using a T1-weighted fast spoiled gradient recalled acquisition (fSPGR) sequence with gadolinium-DTPA enhancement (0.1 mmol/kg bodyweight). Signal intensity over time plots were obtained using region of interest measurements from both fracture fragments. Enhancement factors (EF) were then calculated from the plots. No enhancement of the scaphoid was seen in control subjects (EF: distal scaphoid pole 1.04 + 0.01, proximal pole 1.07 + 0.08). In acute fracture patients, enhancement of the distal pole was greater than that of the proximal in all cases but one in which the two poles enhanced in a similar fashion (EF: distal 1.99 + 0.77, proximal 1.43 + 0.99). In chronic fracture patients the enhancement pattern was reversed, as the proximal pole enhanced to a greater degree than the distal with the exception of one case where both poles enhanced equally (EF: distal 1.74 + 0.52, proximal 2.64 + 0.50). Using a two-tailed non-parametric Mann-Whitney U-test, the difference in enhancement of the proximal poles between the acute and chronic groups was found to be highly significant (P < 0.003). Dynamic contrast- enhanced (fSPGR) MRI demonstrates significant differences in the enhancement patterns of the scaphoid when chronic and acute fractures are compared. Copyright (1998) Blackwell Science Pty Ltd

  7. Congenital scaphoid megalourethra associated with posterior urethral valve: A case report

    Directory of Open Access Journals (Sweden)

    Apoorva Achyut Kulkarni

    2018-01-01

    Full Text Available Congenital scaphoid megalourethra is a very rare congenital anomaly of the anterior urethra in males. Here, a case of scaphoid megalourethra and posterior urethral valves is presented. A one and half year old male child came to us with complaints of ballooning at the tip of penis since birth. Micturating cystourethrogram showed a dilated glanular urethra. The patient underwent a Nesbitt’s longitudinal reduction urethroplasty with a single-staged, single layered repair. Post-operatively, the child passed a healthy stream of urine without straining

  8. Non-vascularized iliac bone grafting for scaphoid nonunion with avascular necrosis.

    Science.gov (United States)

    Kim, Jihyeung; Park, Jin Woo; Chung, Jeehyeok; Jeong Bae, Kee; Gong, Hyun Sik; Baek, Goo Hyun

    2018-01-01

    We present the surgical outcomes of non-vascularized bone grafting taken from the iliac crest in 24 patients with scaphoid nonunion and avascular necrosis. The Fisk-Fernandez technique was used in 11 patients, and cancellous bone grafting was used in 13 patients. Bony union was achieved in 22 of the 24 patients. Non-vascularized iliac bone grafting can be used for the surgical management of scaphoid nonunion with avascular necrosis. Although revascularization of the proximal fragment after surgery was not evaluated, bony union was confirmed in nearly all patients. IV.

  9. Scaphoid Stress Fracture in High-Level Gymnast: A Case Report

    Directory of Open Access Journals (Sweden)

    J. C. Nakamoto

    2011-01-01

    Full Text Available We present the case of an 18-year-old high-level gymnast who sustained a stress fracture of the scaphoid associated with a distal radial epiphysiolysis. Clinical evaluation demonstrated decreased range of motion of the affected wrist and insidious pain on the snuffbox and tenderness on the distal radial physis. He was submitted to surgical treatment with scaphoid percutaneous fixation and radial styloid process in situ fixation. Clinical features improved, and he got back to competition 6 months after surgery without symptoms and with complete range of motion.

  10. Isolated scaphotrapeziotrapezoid osteoarthritis treatment using resurfacing arthroplasty with scaphoid anchorage.

    Science.gov (United States)

    Humada Álvarez, G; Simón Pérez, C; García Medrano, B; Faour Martín, O; Marcos Rodríguez, J J; Vega Castrillo, A; Martín Ferrero, M A

    The aim of this study is to show the results of scaphotrapeziotrapezoid (STT) joint osteoarthritis treatment performing resurfacing arthroplasty with scaphoid anchorage. An observational, descriptive and retrospective study was performed. Ten patients with isolated STT joint osteoarthritis were studied between 2013 and 2015. The mean follow-up time was 26months. Clinical results, functional and subjective scores were reviewed. The patients were satisfied, achieving an average of 2.1 (0-3) on the VAS score and 16 (2 to 28) in the DASH questionnaire, and returning to work in the first three months post-surgery. Recovery of range of motion compared to the contralateral wrist was 96% in extension, 95% in flexion, 87% in ulnar deviation and 91% in radial deviation. The average handgrip strength of the wrist was 95% and pinch strength was 95% compared to the contralateral side. There were no intraoperative complications or alterations in postoperative carpal alignment. Resurfacing arthroplasty is proposed as a good and novel alternative in treating isolated SST joint arthritis. Achieving the correct balance between the strength and mobility of the wrist, without causing carpal destabilisation, is important to obtain satisfactory clinical and functional results. Copyright © 2017. Publicado por Elsevier España, S.L.U.

  11. Surgical interventions for treating acute fractures or non-union of the middle third of the clavicle.

    Science.gov (United States)

    Lenza, Mário; Faloppa, Flávio

    2015-05-07

    This review covers two conditions: acute clavicle fractures and non-union resulting from failed fracture healing. Clavicle (collarbone) fractures account for around 4% of all fractures. While treatment for these fractures is usually non-surgical, some types of clavicular fractures, as well as non-union of the middle third of the clavicle, are often treated surgically. This is an update of a Cochrane review first published in 2009. To evaluate the effects (benefits and harms) of different methods of surgical treatment for acute fracture or non-union of the middle third of the clavicle. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (27 June 2014), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2014, Issue 5), MEDLINE (1966 to June week 3 2014), EMBASE (1988 to 2014 week 25), LILACS (1982 to 27 June 2014), trial registries and reference lists of articles. We applied no language or publication restrictions. We considered randomised and quasi-randomised controlled trials evaluating any surgical intervention for treating people with fractures or non-union of the middle third of the clavicle. The primary outcomes were shoulder function or disability, pain and treatment failure (measured by the number of participants who had undergone or were being considered for a non-routine secondary surgical intervention for symptomatic non-union, malunion or other complications). Two review authors selected eligible trials, independently assessed risk of bias and cross-checked data. Where appropriate, we pooled results of comparable trials. We included seven trials in this review with 398 participants. Four trials were new in this update.The four new trials (160 participants) compared intramedullary fixation with open reduction and internal fixation with plate for treating acute middle third clavicle fractures in adults. Low quality evidence from the four trials indicated that intramedullary fixation did not

  12. [High bone consolidation rates after humeral head-preserving revision surgery in non-unions of the proximal humerus].

    Science.gov (United States)

    Aytac, S D; Schnetzke, M; Hudel, I; Studier-Fischer, S; Grützner, P A; Gühring, T

    2014-12-01

    Fractures of the subcapital and proximal humerus shaft region are common fractures of the human skeleton. Their treatment should provide an early functional after-care of the shoulder joint, that is prone to arthrofibrosis. Although the upper extremity is not weight-bearing the occurrence of proximal humerus non-unions leads to severe impairment with inability to work and restrictions of activity of daily life. The aim of this study was to investigate whether an operative revision of proximal humerus non-unions with reosteosynthesis and application of distant autologous bone grafts can lead to sufficient bone healing. The second aim was to find out whether patients achieved an acceptable functional outcome, as alternatively patients could be treated by reconstruction with a shoulder prosthesis. 27 patients (female = 15, male = 12) with reosteosynthesis of the proximal humerus and proximal humeral shaft due to non-union after initially operative fracture treatment were included between 2008 and 2014. Average age of patients was 56 years (23-87), 48% had no comorbidities, while 52% of the patients had at least 1 comorbidity such as diabetes, hypertension or nicotine abusus. The mean number of prior surgical intervention was 1.2 (1-3). The mean time between initial surgery and re-osteosynthesis was 12.3 months. Patients with signs of infection pseudarthrosis were excluded. The initial type of osteosynthesis was with plates (n = 16; thereof PHILOS Plate n = 14), and intramedullary nails (T2, Targon Nail, PHN, Seidel Nail; n = 11). Revision surgery was done with plate osteosynthesis (n = 26; thereof PHILOS Plate n = 4; LC Plate n = 10; angle plate n = 12). In 23 patients (89%) a distant bone transplantation was done from the iliac crest, and 1 patient received allogenous bone. Three patients (11%) received bone morphogenetic protein 7 (BMP 7) in combination with distant bone graft. Intraoperative swabs from the pseudarthrosis area

  13. A Scaphoid Stress Fracture in a Female Collegiate-Level Shot-Putter and Review of the Literature

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    Jessica M. Kohring

    2016-01-01

    Full Text Available Scaphoid stress fractures are rare injuries that have been described in young, high-level athletes who exhibit repetitive loading with the wrist in extension. We present a case of an occult scaphoid stress fracture in a 22-year-old female Division I collegiate shot-putter. She was successfully treated with immobilization in a thumb spica splint for 6 weeks. Loaded wrist extension activities can predispose certain high-level athletes to sustain scaphoid stress fractures, and a high index of suspicion in this patient population may aid prompt diagnosis and management of this rare injury.

  14. Is non-union of tibial shaft fractures due to nonculturable bacterial pathogens? A clinical investigation using PCR and culture techniques

    Directory of Open Access Journals (Sweden)

    Gille Justus

    2012-05-01

    Full Text Available Abstract Background Non-union continues to be one of the orthopedist’s greatest challenges. Despite effective culture methods, the detection of low-grade infection in patients with non-union following tibial fracture still presents a challenge. We investigated whether “aseptic” tibial non-union can be the result of an unrecognized infection. Methods A total of 23 patients with non-union following tibial shaft fractures without clinical signs of infection were investigated. Intraoperative biopsy samples obtained from the non-union site were examined by means of routine culture methods and by polymerase chain reaction (PCR for the detection of 16 S ribosomal RNA (rRNA. Control subjects included 12 patients with tibial shaft fractures. Results 23 patients (8 women and 15 men; mean age: 47.4 years were included into this study. Preoperative C-reactive protein levels (mean: 20.8 mg/l and WBC counts (mean: 8,359/μl in the study group were not significantly higher than in the control group. None of the samples of non-union routine cultures yielded microorganism growth. Bacterial isolates were found by conventional culturing methods in only 1 case of an open fracture from the control group. In this case, PCR yielded negative results. 16 S rRNA was detected in tissue specimens from 2 patients (8.7% with non-union. The analysis of these variable species-specific sequences enabled the identification of specific microorganisms (1x Methylobacterium species, 1x Staphylococcus species. Both PCR-positive patients were culture-negative. Conclusions The combination of microbiological culture and broad-range PCR seems to substantially add to the number of microbiological diagnoses obtained and may improve the clinican’s ability to tailor therapy to the individual patient’s needs.

  15. Using computed tomography to assist with diagnosis of avascular necrosis complicating chronic scaphoid nonunion.

    Science.gov (United States)

    Smith, Michael L; Bain, Gregory I; Chabrel, Nick; Turner, Perry; Carter, Chris; Field, John

    2009-01-01

    The primary aim of our study was to investigate use of long axis computed tomography (CT) in predicting avascular necrosis of the proximal pole of the scaphoid and subsequent fracture nonunion after internal fixation. In addition, we describe a new technique of measuring the position of a scaphoid fracture and provide data on its reproducibility. Thirty-one patients operated on by the senior author for delayed union or nonunion of scaphoid fracture were included. Preoperative CT scans were independently assessed for increased radiodensity of the proximal pole, converging trabeculae, degree of deformity, comminution, and fracture position. Intraoperative biopsies of the proximal pole were obtained and histologically assessed for evidence of avascular necrosis. The radiologic variables were statistically compared with the histologic findings. The presence of avascular necrosis was also compared with postoperative union status, identified on longitudinal CT scans. Preoperative CT features that statistically correlated with histologic evidence of avascular necrosis were increased radiodensity of the proximal pole and the absence of any converging trabeculae between the fracture fragments. The radiologic changes of avascular necrosis and the histologic confirmation of avascular necrosis were associated with persistent nonunion. Preoperative longitudinal CT of scaphoid nonunion is of great value in identifying avascular necrosis and predicting subsequent fracture union. If avascular necrosis is suspected based on preoperative CT, management options include vascularized bone grafts and bone morphogenic protein for younger patients and limited wrist arthrodesis for older patients. Diagnostic II.

  16. A capsular-based vascularized distal radius graft for proximal pole scaphoid pseudarthrosis.

    Science.gov (United States)

    Sotereanos, Dean G; Darlis, Nickolaos A; Dailiana, Zoe H; Sarris, Ioannis K; Malizos, Konstantinos N

    2006-04-01

    To evaluate the clinical results of the application of a capsular-based dorsal distal radius vascularized bone graft in scaphoid proximal pole nonunions. Thirteen patients with symptomatic nonunion at the proximal pole of the scaphoid (10 with avascular necrosis) were treated and reviewed retrospectively. The vascularized bone graft was harvested from the distal aspect of the dorsal radius and was attached to a wide distally based strip of the dorsal wrist capsule. It was inserted press-fit into a dorsal trough across the nonunion site after scaphoid fixation with a Herbert screw. After a mean follow-up period of 19 months 10 of the 13 nonunions (8 of the 10 with avascular necrosis) achieved solid bone union. No complications other than the 3 persistent nonunions occurred. Results of the use of a capsular-based vascularized bone graft from the distal radius for proximal pole scaphoid nonunions compare favorably with the results of pedicled or free vascularized grafts. It is a simple technique that eliminates the need for dissection of small-caliber pedicle or microsurgical anastomoses. No donor site morbidity was observed. Therapeutic, Level IV.

  17. Introducing a Clinical Practice Guideline Using Early CT in the Diagnosis of Scaphoid and Other Fractures

    Directory of Open Access Journals (Sweden)

    Pincus, Steven

    2009-11-01

    Full Text Available Objective: We developed and implemented clinical practice guideline (CPG using computerized tomography (CT as the initial imaging method in the emergency department management of scaphoid fractures. We hypothesized that this CPG would decrease unnecessary immobilization and lead to earlier return to work.Methods: This observational study evaluated implementation of our CPG, which incorporated early wrist CT in patients with “clinical scaphoid fracture”: a mechanism of injury consistent with scaphoid fracture, anatomical snuff box tenderness, and normal initial plain x-rays. Outcome measures were the final diagnosis as determined by orthopaedic review of the clinical and imaging data. Patient outcomes included time to return to work and patient satisfaction as determined by telephone interview at ten days.Results: Eighty patients completed the study protocol in a regional emergency department.In this patient population CT detected 28 fractures in 25 patients, including six scaphoid fractures, five triquetral fractures, four radius fractures, and 13 other related fractures. Fifty-three patients had normal CT. Eight of these patients had significant ongoing pain at follow up and had an MRI, with only two bone bruises identified. The patients with normal CTs avoided prolonged immobilization (mean time in plaster 2.7 days and had no or minimal time off work (mean 1.6 days. Patient satisfaction was an average 4.2/5.Conclusion: This CPG resulted in rapid and accurate management of patients with suspected occult scaphoid injury, minimized unnecessary immobilization and was acceptable to patients.[WestJEM. 2009;10(4:227-232.

  18. Treatment of avascular proximal pole scaphoid nonunions with vascularized distal radius bone grafting.

    Science.gov (United States)

    Lim, Tae Kang; Kim, Hyo Kon; Koh, Kyoung Hwan; Lee, Hyun Il; Woo, Sung Jong; Park, Min Jong

    2013-10-01

    To investigate the outcomes of vascularized distal radius pedicled bone grafting secured with K-wires for scaphoid nonunions with small avascular proximal fragments. We included patients with scaphoid nonunions and small, avascular proximal fragments that were too small for screw fixation. The mean size of the proximal pole fragments was 21% (range, 9% to 28%) of the entire scaphoid, based on quantitative radiographic measurement. All patients had distal radius bone grafting based on the 1,2-intercompartmental supraretinacular artery pedicle and fixation with K-wires. There were 21 wrists in 18 men and 2 women with the mean age of 34 years (range, 22 to 57 y). The mean duration of postoperative follow-up was 40 months (range, 12 to 103 mo). Radiographic union and clinical outcomes, including the ranges of wrist motion, grip strength, and the modified Mayo wrist score, were evaluated. Union was achieved in 18 of 21 wrists (86%) at a mean time of 14 weeks after surgery (range, 8 to 28 wk). Nonunions with proximal fragments less than 20% of the total scaphoid healed in 6 of 8 wrists. In a subset of these 8 wrists in which the proximal fragment was less than 15%, healing occurred in 2 of 4. The modified Mayo wrist score significantly improved from 46 to 78 points, and final wrist functions were rated as excellent in 5, good in 5, fair in 10, and poor in 1. Ranges of motion and grip strengths did not show significant changes after surgery. Vascularized distal radius bone grafting and K-wire fixation can heal scaphoid nonunions with small avascular proximal fragments, although motion and grip strength remain unchanged. Healing may be related to the size of the proximal pole fragment. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  19. Utilising magnetic resonance imaging as the gold-standard in management of suspected scaphoid fractures in the emergency department setting

    LENUS (Irish Health Repository)

    Ramasubbu, B

    2017-02-01

    Scaphoid fractures are the most common carpal bone fracture. Up to 40% of scaphoid fractures can be missed at initial presentation and investigation. Follow-up plain film radiograph has overall poor sensitivity and reliability. MRI has been shown to have an almost 100% sensitivity and specificity and so is the gold standard in scaphoid fracture diagnosis. Additionally, early specialist involvement is recommended. We proposed that following a designated pathway, there would be no significant increase in MRI requests. Following implementation of a pathway for the management of suspected scaphoid fractures in St James’s Hospital in 2012 re-auditing demonstrated that management changed to either MRI directly after initial x-ray (16\\/145, 11%), MRI after second x-ray (9\\/28, 32%) or orthopaedic follow-up (19\\/28, 68%). The number of MRIs requested was consistent with our predictors of demand. Thus, our new protocol maximises diagnostics, cost effectiveness and quality of patient care.

  20. Reconstruction of Scaphoid Nonunion Fractures of the Proximal One Third With a Vascularized Bone Graft From the Distal Radius

    OpenAIRE

    Werdin, Frank; Jaminet, Patrick; Naegele, Beate; Pfau, Matthias; Schaller, Hans-Eberhard

    2014-01-01

    Objective: The treatment of proximal located scaphoid nonunion is a well-known and common problem. For these patients, we used a vascular pedicled bone graft of the distal radius. Methods: In the last 7 years, 75 patients were treated with the vascular pedicled bone graft. Retrospectively, patients’ data, healing rates, and factors influencing scaphoid healing were analyzed. Results: The overall healing rate in cases with proximal located nonunions (n = 54) was approximately 70%. Out of these...

  1. Genetic polymorphisms of NOS2 and predisposition to fracture non-union: A case control study based on Han Chinese population.

    Science.gov (United States)

    Huang, Wei; Zhang, Kun; Zhu, Yangjun; Wang, Zhan; Li, Zijun; Zhang, Jun

    2018-01-01

    A non-union, especially atrophic non-unions, is a permanent failure of healing following a fracture and can be difficult to treat. Approximately 5-10% of fractures will result in a non-union during the healing process. non-unions can be classified into two types: atrophic non-union which is often due to impaired bone healing with a potential biological mechanism, and hypertrophic non-union which is due to inadequate fixation after fracture. Genetic variations also play an important role in the fracture healing response. Previous studies based on animal models have indicated that NOS2 might be greatly involved in the bone fracture healing process. In this case-control study, 346 nonunion patients were compared to 883 patients with normal fracture healing to investigate the potential genetic association between NOS2 and the fracture healing process using study subjects of Chinese Han ancestry. Twenty-seven single nucleotide polymorphisms (SNPs) covering NOS2 were genotyped in our study subjects and analyzed. In addition to the single marker-based analysis, we performed a gene-by-environment analysis to examine the potential interactions between genetic polymorphisms and some environmental factors. SNP rs2297514 showed significant association with the fracture healing process after adjusting for age and gender (OR = 1.38, P = 0.0005). Our results indicated that the T allele of rs2297514 significantly increased the risk of a non-union during the fracture healing process by 38% compared to the C allele. Further stratification analyses conducted for this SNP using data from subgroups classified by different sites of fracture indicated that significance could only be observed in the tibial diaphysis subgroup (N = 428, OR = 1.77, P = 0.0007) but not other groups including femur diaphysis, humeral shaft, ulnar shaft, and femur neck. Gene-by-environment interaction analyses of the three environmental factors showed no significant results. In this study, rs2297514 was

  2. The challenge of non-union in subtrochanteric fractures with breakage of intramedullary nail: evaluation of outcomes in surgery revision with angled blade plate and allograft bone strut.

    Science.gov (United States)

    Rollo, G; Tartaglia, N; Falzarano, G; Pichierri, P; Stasi, A; Medici, A; Meccariello, L

    2017-12-01

    Subtrochanteric fractures have a bimodal age distribution. They usually require open reduction and internal fixation. Closed reduction and intramedullary nail fixation rate are increased for this type of fracture. As a result, the hardware breakage and non-union rate is high among such patients. Our purpose is to evaluate the outcomes of the role of blade plate and bone strut allograft in the management of subtrochanteric non-union by femoral nailing. We reported a group of 22 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail with medial femoral allograft bone and lateral blade plate and wire (PS) s; and a group of 13 patients with subtrochanteric non-union, associated with breakage of the intramedullary nail treated with lateral blade plate and screws (CG). The chosen criteria to evaluate the two group during the clinical and radiological follow-up were the quality of life, measured by The Short Form (12) Health Survey (SF-12), the hip function and quality of life related to it, measured by the Harris Hip Score (HHS), bone healing, measured by Radiographic Union Score (RUS) by XR and CT at 1 year after the surgery, and postoperative complications. The evaluation endpoint was set at 12 months. The Bone healing measured by RUS occurred and also the full recovery before the first trauma measured by SF-12 and HHS are better in PS group. We only had three unimportant complications in PS while four breakage hardware in CG. We conclude that in complicated non-unions, the use of blade plate and bone strut allograft has a definite positive role in the management of such cases.

  3. The clinical and radiological outcome of pulsed electromagnetic field treatment for acute scaphoid fractures: a randomised double-blind placebo-controlled multicentre trial

    NARCIS (Netherlands)

    Hannemann, P.F.; Gottgens, K.W.; van Wely, B.J.; Kolkman, K.A.; Werre, A.J.; Poeze, M.; Brink, P.R.

    2012-01-01

    The use of pulsed electromagnetic fields (PEMF) to stimulate bone growth has been recommended as an alternative to the surgical treatment of ununited scaphoid fractures, but has never been examined in acute fractures. We hypothesised that the use of PEMF in acute scaphoid fractures would accelerate

  4. Longitudinal analysis of osteogenic and angiogenic signaling factors in healing models mimicking atrophic and hypertrophic non-unions in rats.

    Science.gov (United States)

    Minkwitz, Susann; Faßbender, Mirja; Kronbach, Zienab; Wildemann, Britt

    2015-01-01

    Impaired bone healing can have devastating consequences for the patient. Clinically relevant animal models are necessary to understand the pathology of impaired bone healing. In this study, two impaired healing models, a hypertrophic and an atrophic non-union, were compared to physiological bone healing in rats. The aim was to provide detailed information about differences in gene expression, vascularization and histology during the healing process. The change from a closed fracture (healing control group) to an open osteotomy (hypertrophy group) led to prolonged healing with reduced mineralized bridging after 42 days. RT-PCR data revealed higher gene expression of most tested osteogenic and angiogenic factors in the hypertrophy group at day 14. After 42 days a significant reduction of gene expression was seen for Bmp4 and Bambi in this group. The inhibition of angiogenesis by Fumagillin (atrophy group) decreased the formation of new blood vessels and led to a non-healing situation with diminished chondrogenesis. RT-PCR results showed an attempt towards overcoming the early perturbance by significant up regulation of the angiogenic regulators Vegfa, Angiopoietin 2 and Fgf1 at day 7 and a further continuous increase of Fgf1, -2 and Angiopoietin 2 over time. However µCT angiograms showed incomplete recovery after 42 days. Furthermore, lower expression values were detected for the Bmps at day 14 and 21. The Bmp antagonists Dan and Twsg1 tended to be higher expressed in the atrophy group at day 42. In conclusion, the investigated animal models are suitable models to mimic human fracture healing complications and can be used for longitudinal studies. Analyzing osteogenic and angiogenic signaling patterns, clear changes in expression were identified between these three healing models, revealing the importance of a coordinated interplay of different factors to allow successful bone healing.

  5. Longitudinal analysis of osteogenic and angiogenic signaling factors in healing models mimicking atrophic and hypertrophic non-unions in rats.

    Directory of Open Access Journals (Sweden)

    Susann Minkwitz

    Full Text Available Impaired bone healing can have devastating consequences for the patient. Clinically relevant animal models are necessary to understand the pathology of impaired bone healing. In this study, two impaired healing models, a hypertrophic and an atrophic non-union, were compared to physiological bone healing in rats. The aim was to provide detailed information about differences in gene expression, vascularization and histology during the healing process. The change from a closed fracture (healing control group to an open osteotomy (hypertrophy group led to prolonged healing with reduced mineralized bridging after 42 days. RT-PCR data revealed higher gene expression of most tested osteogenic and angiogenic factors in the hypertrophy group at day 14. After 42 days a significant reduction of gene expression was seen for Bmp4 and Bambi in this group. The inhibition of angiogenesis by Fumagillin (atrophy group decreased the formation of new blood vessels and led to a non-healing situation with diminished chondrogenesis. RT-PCR results showed an attempt towards overcoming the early perturbance by significant up regulation of the angiogenic regulators Vegfa, Angiopoietin 2 and Fgf1 at day 7 and a further continuous increase of Fgf1, -2 and Angiopoietin 2 over time. However µCT angiograms showed incomplete recovery after 42 days. Furthermore, lower expression values were detected for the Bmps at day 14 and 21. The Bmp antagonists Dan and Twsg1 tended to be higher expressed in the atrophy group at day 42. In conclusion, the investigated animal models are suitable models to mimic human fracture healing complications and can be used for longitudinal studies. Analyzing osteogenic and angiogenic signaling patterns, clear changes in expression were identified between these three healing models, revealing the importance of a coordinated interplay of different factors to allow successful bone healing.

  6. Scaphoid fracture: Bone marrow edema detected with dual-energy CT virtual non-calcium images and confirmed with MRI

    Energy Technology Data Exchange (ETDEWEB)

    Dareez, Nazeer M.; Engesland, Eirin; Lindland, Elisabeth S. [Department of Radiology, SSHF Arendal, Arendal (Norway); Dahlslett, Kristine H. [Haukelands Universitetssjukehus, Department of Radiology, Bergen (Norway)

    2017-12-15

    We aimed to determine whether bone marrow edema (BME) in acute traumatic scaphoid fracture could be demonstrated with dual-energy CT (DECT) using MRI as the gold standard. In recent years, virtual non-calcium (VNCa) images have been used to demonstrate BME in trauma cases, for example, in vertebral compression fractures, hip trauma to detect occult fractures and knee fractures. We present three cases of acute scaphoid trauma. Two patients had subtle or invisible fractures on x-ray and conventional CT images, while DECT VNCa images clearly visualized the BME, which was confirmed by MRI. One patient had negative findings on both VNCa and MRI images. The DECT VNCa algorithm is a promising technique to demonstrate BME in scaphoid fractures, with potential for increasing the diagnostic value of CT in this type of injury. (orig.)

  7. Reconstruction of scaphoid nonunion fractures of the proximal one third with a vascularized bone graft from the distal radius.

    Science.gov (United States)

    Werdin, Frank; Jaminet, Patrick; Naegele, Beate; Pfau, Matthias; Schaller, Hans-Eberhard

    2014-01-01

    The treatment of proximal located scaphoid nonunion is a well-known and common problem. For these patients, we used a vascular pedicled bone graft of the distal radius. In the last 7 years, 75 patients were treated with the vascular pedicled bone graft. Retrospectively, patients' data, healing rates, and factors influencing scaphoid healing were analyzed. The overall healing rate in cases with proximal located nonunions (n = 54) was approximately 70%. Out of these 54 patients, 47 patients showed avascular proximal fragments. Multivariate analysis showed no significant impact for the factors age, smoking, duration of disease, or previous operation. In our negative selected patient group, we were able to achieve good results with the usage of a pedicled vascularized bone graft of the distal radius. Our results indicate a favorable outcome for the use of a pedicled vascularized distal radius bone graft in both scaphoid nonunion fractures of the proximal third, with or without an avascular proximal pole.

  8. Treatment of Non Unions of Subtrochanteric Fractures Using an Anatomical Proximal Femur Locked Compression Plate - A Prospective Study of 13 Patients.

    Science.gov (United States)

    Balasubramanian, Navin; Babu, Ganesh; Prakasam, Sindhuja

    2016-01-01

    Subtrochanteric fractures have a bimodal age distribution. They are mostly due to high violence trauma in the younger age group. They almost always require open reduction and internal fixation. Due to the increase in the emergence of native bone setters, these fractures are increasingly been managed by these spurious bone setters using native splints. As a result, non-union rate is high among such patients. These patients definitely need open reduction with internal fixation +/- bone grafting. The choice of implants used can be either a dynamic condylar screw plate (DCS) orproximal femoral nail (PFN). Here we have used a surgical grade 316 L stainless steel proximal femoral anatomical locked compression plate (PF-LCP). We analyzed 13 patients with established non unions of subtrochanteric fractures treated in our centre by the use of the PF-LCP. There were 10 males and 3 females. The average age was 48.23 years. All our patients were followed up by serial radiographs at 6, 12, 18, 24 weeks and thereafter at 6 months interval. Union was achieved in 11 out of 13 patients at 12 weeks whereas two patients had delayed union which eventually healed at 18 weeks and 24 weeks. The average Harris hip score at 1 year follow-up was excellent in eight, good in four and fair in one patient respectively. We conclude that in complicated non-unions, the use of PF-LCP has a definite positive role in the management of such cases.

  9. Ipsilateral Femoral Fracture Non-Union and Delayed Union Treated By Hybrid Plate Nail Fixation and Vascularized Fibula Bone Grafting: A Case Report

    Directory of Open Access Journals (Sweden)

    CK Chan

    2013-07-01

    Full Text Available Non-union is a well recognized complication of femoral neck fractures. The decision whether to attempt fracture fixation or to resort to hip replacement is particularly difficult in patients in the borderline age group in whom complex attempts at gaining union may fail and later present a difficult revision. On the other hand the patient may be young enough that arthroplasty best be avoided . Besides, presence of ipsilateral femoral shaft fracture with delayed union in addition to the femoral neck non-union will pose major problems at operation. We share our experience in treating a femoral neck fracture non-union with ipsilateral femoral shaft delayed union in the shaft and in the distal femur in a fifty years old patient. The fracture was treated with an angle blade plate and supracondylar nail supplemented with a free vascularised fibular bone grafting and autologous cancellous graft. There was radiological union at fourth month. At sixth months, the patient was free of pain and able to walk without support. Thus, we would like to suggest that vascularised fibula bone grafting with supracondylar nailing is a viable option for this pattern of fracture.

  10. 1st metatarsophalangeal joint fusion: A comparison of non-union and gender differences between locking and non-locking plating systems.

    Science.gov (United States)

    Bass, Edward James; Sirikonda, Siva Prasad

    2015-12-01

    Fusion of the first metatarsophalangeal joint (1st MTPJ) is a common surgical procedure used to treat a variety of diseases and deformities of the forefoot. Fixation methods vary and typically fusion rates are good. The objectives of the study are to demonstrate whether there is any advantage to using locking as opposed to non-locking plates for 1st MTPJ fusion. Additionally the study aims to determine whether there is any difference in non-union rates according to gender. One hundred and seventy two consecutive 1st MTPJ fusions were performed for 153 patients. 40 patients (23%) were male and 132 (77%) female. Twenty patients received Hallu-fix™ plates, 76 Charlotte™ plates and 76 Anchorage™ plates. Postoperative radiographs were reviewed for non-union. Failure rates were compared using Fisher's exact tests (p=0.05). Twelve (6.9%) non-unions were identified. The difference in failure rates between all systems was not statistically significant. However, the difference in fusion rates between males (17.5%) and females (3.8%) was significant. This study finds that 1st MTPJ fusion is an effective method to treat diseases of the 1st MTPJ. Locking plates may offer better fusion rates than their non-locking counterparts. This is especially evident in male patients. Copyright © 2015 Elsevier Ltd. All rights reserved.

  11. A Rare Complete Metacarpal Pseudoepiphysis in a Teenager With a Scaphoid Fracture.

    Science.gov (United States)

    Geffen, Rachel B; Colberg, Ricardo E

    2017-11-01

    A 13-yr-old adolescent boy presented with wrist pain after falling off a scooter onto his outstretched hand. Radiographs revealed a nondisplaced hairline fracture of the scaphoid bone and an irregular radiolucent line in the proximal metaphysis of the second metacarpal bone, consistent with an anomalous growth plate, or complete pseudoepiphysis. Complete pseudoepiphysis is a rare finding, with only a few cases reported. Learning about the common locations of growth plates and the radiographic differences between normal, injured, and anomalous growth plates can help decrease physician error and improve patient outcomes.

  12. Processing Academic Language through Four Corners Vocabulary Chart Applications

    Science.gov (United States)

    Smith, Sarah; Sanchez, Claudia; Betty, Sharon; Davis, Shiloh

    2016-01-01

    4 Corners Vocabulary Charts (FCVCs) are explored as a multipurpose vehicle for processing academic language in a 5th-grade classroom. FCVCs typically display a vocabulary word, an illustration of the word, synonyms associated with the word, a sentence using a given vocabulary word, and a definition of the term in students' words. The use of…

  13. Multiplanar reconstruction computed tomography for diagnosis of scaphoid waist fracture union: a prospective cohort analysis of accuracy and precision

    International Nuclear Information System (INIS)

    Hannemann, P.F.W.; Brouwers, L.; Gottgens, K.W.A.; Poeze, M.; Brink, P.R.G.; Zee, D. van der; Stadler, A.; Weijers, R.

    2013-01-01

    To examine reliability and validity concerning union of scaphoid fractures determined by multiplanar reconstruction computed tomography randomized at 6, 12, and 24 weeks after injury. We used Fleiss' kappa to measure the opinions of three observers reviewing 44 sets of computed tomographic scans of 44 conservatively treated scaphoid waist fractures. We calculated kappa for the extent of consolidation (0-24 %, 25-49 %, 50-74 %, or 75-100 %) on the transverse, sagittal and coronal views. We also calculated kappa for no union, partial union, and union, and grouped the results for 6, 12, and 24 weeks after injury. As the reference standard for union, CT scans were performed at a minimum of 6 months after injury to determine validity. Overall inter-observer agreement was found to be moderate (κ = 0.576). No union (κ = 0.791), partial union (κ = 0.502), and union (κ = 0.683) showed substantial, moderate, and substantial agreement, respectively. The average sensitivity of multiplanar reconstruction CT for diagnosing union of scaphoid waist fractures was 73 %. The average specificity was 80 %. Our results suggest that multiplanar reconstruction computed tomography is a reliable and accurate method for diagnosing union or nonunion of scaphoid fractures. However, inter-observer agreement was lower with respect to partial union. (orig.)

  14. Comparative Study of the Diagnostic Value of Panoramic and Conventional Radiography of the Wrist in Scaphoid Fractures

    Science.gov (United States)

    Ezoddini Ardakani, Fatemeh; Zangoie Booshehri, Maryam; Banadaki, Seyed Hossein Saeed; Nafisi-Moghadam, Reza

    2012-01-01

    Background Scaphoid fractures are the most common type of carpal fractures. Objectives The aim of the study was to compare the diagnostic value of panoramic and conventional radiographs of the wrist in scaphoid fractures. Patients and Methods The panoramic and conventional radiographs of 122 patients with acute and chronic wrist trauma were studied. The radiographs were analyzed and examined by two independent radiologist observers; one physician radiologist and one maxillofacial radiologist. The final diagnosis was made by an orthopedic specialist. Kappa test was used for statistical calculations, inter- and intra-observer agreement and correlation between the two techniques. Results Wrist panoramic radiography was more accurate than conventional radiography for ruling out scaphoid fractures. There was an agreement in 85% or more of the cases. Agreement values were higher with better inter and intra observer agreement for panoramic examinations than conventional radiographic examinations. Conclusion The panoramic examination of the wrist is a useful technique for the diagnosis and follow-up of scaphoid fractures. Its use is recommended as a complement to conventional radiography in cases with inconclusive findings. PMID:23599708

  15. Usefulness of dynamic contrast-enhanced MRI in the evaluation of the viability of acute scaphoid fracture

    International Nuclear Information System (INIS)

    Larribe, Maud; Gay, Andre; Freire, Veronique; Bouvier, Corinne; Chagnaud, Christophe; Souteyrand, Philippe

    2014-01-01

    To evaluate the usefulness of dynamic gadolinium-enhanced magnetic resonance imaging (MRI) for assessing the viability of the proximal pole of the scaphoid in patients with acute scaphoid fractures. Eighteen consecutive patients with acute scaphoid fracture who underwent dynamic gadolinium-enhanced MRI 7 days or less before surgery were prospectively included between August 2011 and December 2012. All patients underwent MR imaging with unenhanced images, enhanced images, and dynamic enhanced images. A radiologist first classified the MRI results as necrotic or viable based on T1- and T2-weighted images only, followed by a second blinded interpretation, this time including analysis of pre- and post-gadolinium administration images and a third blinded interpretation based on the time-intensity curve of the dynamic enhanced study. The standard of reference was the histologic assessment of a cylindrical specimen of the proximal pole obtained during surgery in all patients. The sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were calculated for unenhanced, enhanced, and dynamic gadolinium-enhanced MRI studies. The sensitivity, specificity, PPV, and NPV were 67, 67, 50, and 80 % for unenhanced images, 83, 100, 100, and 92 for enhanced images, and 83, 92, 83, and 92 for dynamic contrast-enhanced images. Our data are consistent with previously reported data supporting contrast-enhanced MRI for assessment of viability, and showing that dynamic imaging with time-intensity curve analysis does not provide additional predictive value over standard delayed enhanced imaging for acute scaphoid fracture. (orig.)

  16. A Capsular-based Vascularized Distal Radius Graft in Treatment of Proximal Pole Scaphoid Pseudoarthrosis. Case Study.

    Science.gov (United States)

    Sroga, Wojciech; Perez Giner, Rosa Ana

    2016-11-30

    We present a possible option for surgical treatment of proximal pole scaphoid pseudarthrosis. We used a vascularized distal radius bone graft that was pedicled on the dorsal capsule of the wrist joint. The publication consists of a case study, conclusions, indications and contraindications for the surgery.

  17. MRT of scaphoid pseudo-arthrosis using Gd-DTPA. Staging and clinical correlation

    International Nuclear Information System (INIS)

    Vogl, T.J.; Beutel, F.; Wilhelm, K.; Tempka, A.; Schedel, H.; Haas, R.; Felix, R.

    1994-01-01

    During a period of two years, 134 patients with pseudo-arthrosis of the scaphoid were examined by conventional radiography and by MRI in the course of a prospective study. The aim of the study was to define radiological staging using contrast enhanced MRI in order to improve the prognostic criteria. All MRI examinations were carried out with a 1.5 Tesla scanner (SP63) using a surface coil and T 1 weighted spin echo sequences in sagittal and frontal projection and frontal FLASH T 2 -sequences and axial spin echo T 2 sequences. The T 1 weighted SE sequences in frontal projection were carried out before and after iv contrast (0.1 mmol Gd-DTPA/kg KG). All sequences were compared with conventional radiographs and the operative findings. Eight patients in stage 0 showed high signal intensity of both fragments in T 1 weighted SE sequences and at surgery there was good vascularisation. In 22 cases there was reduced signal intensity in at least one fragment (stage I). 45 patients with scaphoid pseudo-arthrosis showed complete signal loss but marked contrast uptake with still vital nuclei at surgery (stage II). In 22 patients, there was no increase in signal intensity after contrast and complete loss of vitality of the fragments at surgery. Staging was not possible in 37 patients because of previous operative intervention. The use of contrast enhanced MRI provides additional information compared with conventional radiography or plain MRI. (orig.) [de

  18. Scaphocapitate Syndrome With Associated Trans-Scaphoid, Trans-Hamate Perilunate Dislocation

    Science.gov (United States)

    Nunez, Fiesky A.; Luo, T. David; Jupiter, Jesse B.; Nunez, Fiesky A.

    2016-01-01

    Background: Perilunate fracture dislocations are often associated with fractures of the distal pole of the scaphoid or the proximal pole of the capitate. However, the combination of perilunate dislocation with multiple carpal fractures and associated scaphocapitate syndrome is very rare. Methods: We report a unique case of scaphocapitate fracture syndrome with perilunate dislocation and fracture of the hamate resulting from a high-energy injury to the wrist during a dirt-bike competition. Results: Open reduction and internal fixation of the scaphoid fracture with a 3.0-mm headless screw, the head of the capitate with a 1.5-mm lag screw, and the hamate fracture with a 1.3-mm lag screw was performed. The lunotriquetral dissociation was reduced, with the ligament repaired and the joint stabilized using a Kirschner wire. All screw heads are carefully buried under the articulate cartilage. Conclusions: Prompt anatomic reduction and stable osteosynthesis of all fractures in this patient resulted in successful healing and return to activity. PMID:28344539

  19. Percutaneous, Transtrapezial Fixation without Bone Graft Leads to Consolidation in Selected Cases of Delayed Union of the Scaphoid Waist.

    Science.gov (United States)

    Vanhees, Matthias; van Riet, Roger R P; van Haver, Annemieke; Kebrle, Radek; Meermans, Geert; Verstreken, Frederik

    2017-08-01

    Purpose  We evaluated clinical and radiographic outcome of percutaneous transtrapezial fixation of the scaphoid delayed union or nonunion using a headless bone screw without bone grafting. Methods  Sixteen patients with delayed union or nonunion of the scaphoid were included in this retrospective study between 2006 and 2011. All patients had a delayed presentation of scaphoid fracture, and none of them was treated conservatively elsewhere. Patients with bone graft, sclerotic bone debridement, or displacement of the fragment at the nonunion site were excluded. A percutaneous transtrapezial fixation technique was used in all cases. Patients were reviewed until clinical and radiographic union was observed. At the final follow-up, DASH (Disabilities of the Arm, Shoulder and Hand) and PRWHE (Patient-Rated Wrist and Hand Evaluation) outcome scores were completed. Results  Radiographic union was obtained in 15 out of 16 patients (94%) at an average follow-up of 36 months (range: 12-98 months). No complications from the percutaneous technique were noted. The average DASH score was 6 (range: 0-39) and the average PRWHE score was 10 (range: 0-56). No statistical significant difference in range of motion and grip strength was found between the operated side and the contralateral side. Conclusion  Percutaneous transtrapezial screw fixation for delayed or nonunion of selected scaphoid fractures without bone grafting is promising. At a mean of 4 months, 94% union was obtained with good functional results when there was no sclerosis, minimal osteolysis, and no displacement at the scaphoid nonunion site. Type of Study  Therapeutic study. Level of Evidence  IV.

  20. Avascular necrosis (AVN) of the proximal fragment in scaphoid nonunion: Is intravenous contrast agent necessary in MRI?

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, R., E-mail: schmitt.radiologie@herzchirurgie.de [Department of Diagnostic and Interventional Radiology, Cardiovascular Center, Bad Neustadt an der Saale (Germany); Christopoulos, G.; Wagner, M. [Department of Diagnostic and Interventional Radiology, Cardiovascular Center, Bad Neustadt an der Saale (Germany); Krimmer, H. [Department of Hand Surgery, Cardiovascular Center, Bad Neustadt an der Saale (Germany); Fodor, S. [Department of Diagnostic and Interventional Radiology, Cardiovascular Center, Bad Neustadt an der Saale (Germany); Schoonhoven, J. van; Prommersberger, K.J. [Department of Hand Surgery, Cardiovascular Center, Bad Neustadt an der Saale (Germany)

    2011-02-15

    Purpose: The purpose of this prospective study is to assess the diagnostic value of intravenously applied contrast agent for diagnosing osteonecrosis of the proximal fragment in scaphoid nonunion, and to compare the imaging results with intraoperative findings. Materials and methods: In 88 patients (7 women, 81 men) suffering from symptomatic scaphoid nonunion, preoperative MRI was performed (coronal PD-w FSE fs, sagittal-oblique T1-w SE nonenhanced and T1-w SE fs contrast-enhanced, sagittal T2*-w GRE). MRI interpretation was based on the intensity of contrast enhancement: 0 = none, 1 = focal, 2 = diffuse. Intraoperatively, the osseous viability was scored by means of bleeding points on the osteotomy site of the proximal scaphoid fragment: 0 = absent, 1 = moderate, 2 = good. Results: Intraoperatively, 17 necrotic, 29 compromised, and 42 normal proximal fragments were found. In nonenhanced MRI, bone viability was judged necrotic in 1 patient, compromised in 20 patients, and unaffected in 67 patients. Contrast-enhanced MRI revealed 14 necrotic, 21 compromised, and 53 normal proximal fragments. Judging surgical findings as the standard of reference, statistical analysis for nonenhanced MRI was: sensitivity 6.3%, specificity 100%, positive PV 100%, negative PV 82.6%, and accuracy 82.9%; statistics for contrast-enhanced MRI was: sensitivity 76.5%, specificity 98.6%, positive PV 92.9%, negative PV 94.6%, and accuracy 94.3%. Sensitivity for detecting avascular proximal fragments was significantly better (p < 0.001) in contrast-enhanced MRI in comparison to nonenhanced MRI. Conclusion: Viability of the proximal fragment in scaphoid nonunion can be significantly better assessed with the use of contrast-enhanced MRI as compared to nonenhanced MRI. Bone marrow edema is an inferior indicator of osteonecrosis. Application of intravenous gadolinium is recommended for imaging scaphoid nonunion.

  1. Avascular necrosis (AVN) of the proximal fragment in scaphoid nonunion: Is intravenous contrast agent necessary in MRI?

    International Nuclear Information System (INIS)

    Schmitt, R.; Christopoulos, G.; Wagner, M.; Krimmer, H.; Fodor, S.; Schoonhoven, J. van; Prommersberger, K.J.

    2011-01-01

    Purpose: The purpose of this prospective study is to assess the diagnostic value of intravenously applied contrast agent for diagnosing osteonecrosis of the proximal fragment in scaphoid nonunion, and to compare the imaging results with intraoperative findings. Materials and methods: In 88 patients (7 women, 81 men) suffering from symptomatic scaphoid nonunion, preoperative MRI was performed (coronal PD-w FSE fs, sagittal-oblique T1-w SE nonenhanced and T1-w SE fs contrast-enhanced, sagittal T2*-w GRE). MRI interpretation was based on the intensity of contrast enhancement: 0 = none, 1 = focal, 2 = diffuse. Intraoperatively, the osseous viability was scored by means of bleeding points on the osteotomy site of the proximal scaphoid fragment: 0 = absent, 1 = moderate, 2 = good. Results: Intraoperatively, 17 necrotic, 29 compromised, and 42 normal proximal fragments were found. In nonenhanced MRI, bone viability was judged necrotic in 1 patient, compromised in 20 patients, and unaffected in 67 patients. Contrast-enhanced MRI revealed 14 necrotic, 21 compromised, and 53 normal proximal fragments. Judging surgical findings as the standard of reference, statistical analysis for nonenhanced MRI was: sensitivity 6.3%, specificity 100%, positive PV 100%, negative PV 82.6%, and accuracy 82.9%; statistics for contrast-enhanced MRI was: sensitivity 76.5%, specificity 98.6%, positive PV 92.9%, negative PV 94.6%, and accuracy 94.3%. Sensitivity for detecting avascular proximal fragments was significantly better (p < 0.001) in contrast-enhanced MRI in comparison to nonenhanced MRI. Conclusion: Viability of the proximal fragment in scaphoid nonunion can be significantly better assessed with the use of contrast-enhanced MRI as compared to nonenhanced MRI. Bone marrow edema is an inferior indicator of osteonecrosis. Application of intravenous gadolinium is recommended for imaging scaphoid nonunion.

  2. Safety study: is there a pathologic IGF-1, PDGF and TGF-ß cytokine expression caused by adjunct BMP-7 in tibial and femoral non-union therapy?

    Directory of Open Access Journals (Sweden)

    Fischer C

    2018-04-01

    Full Text Available Christian Fischer,1 Christian Reiner,2 Gerhard Schmidmaier,1 Julian Doll,1 Christopher Child,3 Paul Alfred Grützner,4 Bahram Biglari,4 Sonja Boxriker,5 Arash Moghaddam5 1Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, HTRG – Heidelberg Trauma Research Group, Heidelberg University Hospital, Heidelberg, Germany; 2Department of Trauma and Orthopedic Surgery, Paracelsus Medical University, Nuremberg Hospital South, Nuremberg, Germany; 3Department of Trauma Surgery, University Hospital Zurich, Zurich, Switzerland; 4Trauma and Orthopedics, BG Trauma Center Ludwigshafen, Ludwigshafen, Germany; 5Center of Orthopedics, Trauma Surgery and Sport Medicine, ATORG Aschaffenburg-Alzenau, Aschaffenburg, Germany Background: In this prospective safety study, we investigated if the characteristic cytokine expression during bone regeneration is manipulated by the local application of bone morphogenetic protein-7 (BMP-7 in non-union surgery. Therefore, the levels of insulin like growth factor 1 (IGF-1, platelet-derived growth factor AB (PDGF-AB and transforming growth factor beta (TGF-β were compared between patients with the gold standard use of autologous bone graft (ABG and those with additional application of BMP-7 as part of the diamond concept.Patients and methods: Between 2009 and 2014, of the 153 patients with tibial and femoral non-unions, a matched pair analysis was performed to compare the serological cytokine expressions. Blood samples were collected preoperatively, 1, 2 and 6 weeks as well as 3 and 6 months after non-union surgery. Matching criteria were smoking status, fracture location, gender, age and body mass index (BMI. Patients in G1 (n=10 were treated with ABG and local BMP-7 while their matching partners in G2 (n=10 received ABG only. The routine clinical and radiologic follow-up was 1 year.Results: Although the IGF-1 quantification in G2 showed higher pre- and postoperative values compared to G1 (p<0.05, the courses of both

  3. Chronic infection and infected non-union of the long bones in paediatric patients: preliminary results of bone versus beta-tricalcium phosphate grafting after induced membrane formation.

    Science.gov (United States)

    Rousset, Marie; Walle, Marjolaine; Cambou, Ludivine; Mansour, Mounira; Samba, Antoine; Pereira, Bruno; Ghanem, Ismat; Canavese, Federico

    2018-02-01

    Chronic infection (CO) and infected non-union of the long bones are relatively rare conditions in paediatric patients. Large bone defects secondary to these conditions can be managed with the induced membrane technique. The technique requires grafting of the bone void, although it is not yet established what bone substitute is the best option. The aim of this work was to evaluate the outcome and efficacy of treatment in children with CO and infected non-union of the long bones using the induced membrane technique and bone (BG) versus beta-tricalcium phosphate (BTP) grafting. Eight skeletally immature patients with CO and infected non-union of the long bones were treated surgically between 2010 and 2017 by a combination of resection of necrotic infected bone, debridement of surrounding soft tissue, osteosynthesis using a stable internal fixation when needed, and application of antibiotic-laden cement (ALC) spacer inducing new membrane before final bone reconstruction with bone substitutes: BTP in five cases, BG (allograft and/or autologous graft) in three cases. A second surgical step, once inflammatory markers had normalized, consisted of ALC spacer removal, application of BG or BTP graft and concomitant stable osteosynthesis, if needed, if this had not been done during the first surgical stage. All the patients underwent clinical, laboratory and imaging evaluation before and after surgery. Antibiotics were adjusted according to culture and sensitivity. Mean patient age at time of diagnosis was 13 ± four years (range, 4-16) and all had at least a 12-month follow-up (range 12-60). Estimated time for induced membrane formation was significantly shorter in patients treated with BTP compared with BG: 3±1 vs. 10±2 (p = 0.02). This result was confirmed by multivariate analysis (p = 0.044) taking into account adjustment for age of patients and time after initial surgery. Time of final union was about 5.5 ± 4.1 months (range 2-66). At the last follow-up visit

  4. Additional bone graft accelerates healing of clavicle non-unions and improves long-term results after 8.9 years: a retrospective study.

    Science.gov (United States)

    Schnetzke, Marc; Morbitzer, Christian; Aytac, Sara; Erhardt, Matthias; Frank, Christian; Muenzberg, Matthias; Studier-Fischer, Stefan; Helbig, Lars; Suda, Arnold J; Gruetzner, Paul-Alfred; Guehring, Thorsten

    2015-01-09

    Clavicle non-unions can occur after both conservative and operative treatment failure. Here, we investigated the outcome of patients with delayed fracture healing or non-unions of the clavicle. Patients underwent revision surgery by plate osteosynthesis of the clavicle with or without bone grafting. Our aim was to determine rates of bone healing and the functional long-term outcome. The study population of 58 consecutive patients was divided into group 1 (n = 25; no bone graft) and group 2 (n = 33; iliac crest bone graft). Bone consolidation was determined by the Lane-Sandhu score preoperatively and after 2.2 ± 1.8 years, respectively. The functional long-term outcome was determined after 8.9 ± 2.7 years in all available patients (n = 30) by the Constant score, DASH (Disabilities of the Arm, Shoulder and Hand) score and SF-36, and clavicle length was measured by ultrasound as compared to the healthy side. Clavicle consolidation was achieved in 54 out of 58 patients (93.1%) after revision surgeries. The radiographic score and bone consolidation rates were significantly higher in group 2 (93.3%) as compared with 72% in group 1 (p = 0.02), resulting in a significantly shorter time to bone consolidation in group 2. Similarly, the relative risk for additional surgery after the first revision surgery was 4.7-fold higher in group 1 (p = 0.02). The long-term results showed overall very good results in DASH score (14.9 ± 16.5) and good results in Constant scores (77.9 ± 19.9). The group analyses found significantly better Constant scores and better visual analogue pain scale (VAS) numbers in group 2. Clavicle shortening appeared to affect the clinical results, and a mild correlation between shortening and Constant scores (R = -0.31) was found. This study shows high rates of bone healing and good functional outcomes after surgical revision of clavicle non-unions and further demonstrates that additional bone graft could

  5. 2. The Effect of Combined Therapy, Percutaneous Autologous Concentrated Bone Marrow Grafting and Low-Intensity Pulsed Ultrasound (LIPUS), on the Treatment of Non-Unions.

    Science.gov (United States)

    Mishima, Hajime; Sugaya, Hisashi; Yoshioka, Tomokazu; Wada, Hiroshi; Aoto, Katsuya; Hyodo, Kojirou; Tomaru, Youhei; Kumagai, Hiroshi; Akaogi, Hiroshi; Ochiai, Naoyuki; Yamazaki, Masashi

    2016-08-01

    We discuss the effect of combined therapy of percutaneous autologous concentrated bone graft and LIPUS on complex non-union treatment. Seventeen of 27 treated patients who had received the therapy at least 1 year before were discussed (10 femurs, 5 tibiae, 1 humerus, and 1 ulna). The average age of the patients was 40.7, and atrophic degeneration was observed in all cases. After 12 months of treatment, bone union was recognized in 76% in all cases, and in 87% of lower long bones. It was reported that LIPUS was effective at improving blood flow, accelerating cytokines which induce angiogenesis, promoting the transport of nutrition and enzymes to living cells, developing the differentiation of osteoblast from mesenchymal stem cells (MSC), inhibiting the differentiation and development of osteoclast, and promoting endochondral ossification. In this study, all patients had been treated with LIPUS for more than 3 months before the grafting was conducted, but the bone union seemed to stop. It was thought that this combined therapy provided a bone marrow cell growth factor sufficient to enable new bone formation to re-start bone union, and then LIPUS worked effectively to promote the initial differentiation, contributing to new bone formation. This combination therapy-less invasive, safe, and low cost-was considered one useful treatment option for non-union.

  6. Bone graft in the treatment of nonunion of the scaphoid with necrosis of the proximal pole: a literature review

    Directory of Open Access Journals (Sweden)

    Antônio Lourenço Severo

    Full Text Available ABSTRACT Scaphoid fractures are the most common fractures of the carpal bones, corresponding to 60%. Of these, 10% progress to nonunion; moreover, 3% can present necrosis of the proximal pole. There are various methods of treatment using vascularized and non-vascularized bone grafts. To evaluate and compare the rate of scaphoid consolidation with necrosis of the proximal pole using different surgical techniques. The authors conducted a review of the literature using the following databases: PubMed and BIREME/LILACS, where 13 case series were selected (ten with use of vascularized bone grafts and three of non-vascularized bone grafts, according to inclusion and exclusion criteria. In most cases VBGs were used, especially those based on the 1,2 intercompartmental supraretinacular artery, due to greater reproducibility in performing the surgical technique.

  7. Two-Dimensional Image Fusion of Planar Bone Scintigraphy and Radiographs in Patients with Clinical Scaphoid Fracture: An Imaging Study

    DEFF Research Database (Denmark)

    Henriksen, O.M.; Lonsdale, M.N.; Jensen, T.D.

    2008-01-01

    experienced nuclear medicine physicians. In addition to the diagnosis, the degree of diagnostic confidence was scored in each case. Results: The addition of fusion images changed the interpretation of each of the three observers in seven, four, and two cases, respectively, reducing the number of positive....... Bone scintigraphy is highly sensitive for the detection of fractures, but exact localization of scintigraphic lesions may be difficult and can negatively affect diagnostic accuracy. Purpose: To investigate the influence of image fusion of planar bone scintigraphy and radiographs on image interpretation...... in patients with suspected scaphoid fracture. Material and Methods: In 24 consecutive patients with suspected scaphoid fracture, a standard planar bone scintigraphy of both hands was supplemented with fusion imaging of the injured wrist. Standard and fusion images were evaluated independently by three...

  8. Two-dimensional fusion imaging of planar bone scintigraphy and radiographs in patients with clinical scaphoid fracture: an imaging study

    DEFF Research Database (Denmark)

    Henriksen, Otto Mølby; Lonsdale, Markus Georg; Jensen, T D

    2009-01-01

    experienced nuclear medicine physicians. In addition to the diagnosis, the degree of diagnostic confidence was scored in each case. RESULTS: The addition of fusion images changed the interpretation of each of the three observers in seven, four, and two cases, respectively, reducing the number of positive....... Bone scintigraphy is highly sensitive for the detection of fractures, but exact localization of scintigraphic lesions may be difficult and can negatively affect diagnostic accuracy. PURPOSE: To investigate the influence of image fusion of planar bone scintigraphy and radiographs on image interpretation...... in patients with suspected scaphoid fracture. MATERIAL AND METHODS: In 24 consecutive patients with suspected scaphoid fracture, a standard planar bone scintigraphy of both hands was supplemented with fusion imaging of the injured wrist. Standard and fusion images were evaluated independently by three...

  9. Bone graft in the treatment of nonunion of the scaphoid with necrosis of the proximal pole: a literature review.

    Science.gov (United States)

    Severo, Antônio Lourenço; Lemos, Marcelo Barreto; Lech, Osvandré Luiz Canfield; Barreto Filho, Danilo; Strack, Daniel Paulo; Candido, Larissa Knapp

    2017-01-01

    Scaphoid fractures are the most common fractures of the carpal bones, corresponding to 60%. Of these, 10% progress to nonunion; moreover, 3% can present necrosis of the proximal pole. There are various methods of treatment using vascularized and non-vascularized bone grafts. To evaluate and compare the rate of scaphoid consolidation with necrosis of the proximal pole using different surgical techniques. The authors conducted a review of the literature using the following databases: PubMed and BIREME/LILACS, where 13 case series were selected (ten with use of vascularized bone grafts and three of non-vascularized bone grafts), according to inclusion and exclusion criteria. In most cases VBGs were used, especially those based on the 1,2 intercompartmental supraretinacular artery, due to greater reproducibility in performing the surgical technique.

  10. Evaluation of a prototype correction algorithm to reduce metal artefacts in flat detector computed tomography of scaphoid fixation screws

    Energy Technology Data Exchange (ETDEWEB)

    Filli, Lukas; Finkenstaedt, Tim; Andreisek, Gustav; Guggenberger, Roman [University Hospital of Zurich, Department of Diagnostic and Interventional Radiology, Zurich (Switzerland); Marcon, Magda [University Hospital of Zurich, Department of Diagnostic and Interventional Radiology, Zurich (Switzerland); University of Udine, Institute of Diagnostic Radiology, Department of Medical and Biological Sciences, Udine (Italy); Scholz, Bernhard [Imaging and Therapy Division, Siemens AG, Healthcare Sector, Forchheim (Germany); Calcagni, Maurizio [University Hospital of Zurich, Division of Plastic Surgery and Hand Surgery, Zurich (Switzerland)

    2014-12-15

    The aim of this study was to evaluate a prototype correction algorithm to reduce metal artefacts in flat detector computed tomography (FDCT) of scaphoid fixation screws. FDCT has gained interest in imaging small anatomic structures of the appendicular skeleton. Angiographic C-arm systems with flat detectors allow fluoroscopy and FDCT imaging in a one-stop procedure emphasizing their role as an ideal intraoperative imaging tool. However, FDCT imaging can be significantly impaired by artefacts induced by fixation screws. Following ethical board approval, commercially available scaphoid fixation screws were inserted into six cadaveric specimens in order to fix artificially induced scaphoid fractures. FDCT images corrected with the algorithm were compared to uncorrected images both quantitatively and qualitatively by two independent radiologists in terms of artefacts, screw contour, fracture line visibility, bone visibility, and soft tissue definition. Normal distribution of variables was evaluated using the Kolmogorov-Smirnov test. In case of normal distribution, quantitative variables were compared using paired Student's t tests. The Wilcoxon signed-rank test was used for quantitative variables without normal distribution and all qualitative variables. A p value of < 0.05 was considered to indicate statistically significant differences. Metal artefacts were significantly reduced by the correction algorithm (p < 0.001), and the fracture line was more clearly defined (p < 0.01). The inter-observer reliability was ''almost perfect'' (intra-class correlation coefficient 0.85, p < 0.001). The prototype correction algorithm in FDCT for metal artefacts induced by scaphoid fixation screws may facilitate intra- and postoperative follow-up imaging. (orig.)

  11. Evaluation of a prototype correction algorithm to reduce metal artefacts in flat detector computed tomography of scaphoid fixation screws

    International Nuclear Information System (INIS)

    Filli, Lukas; Finkenstaedt, Tim; Andreisek, Gustav; Guggenberger, Roman; Marcon, Magda; Scholz, Bernhard; Calcagni, Maurizio

    2014-01-01

    The aim of this study was to evaluate a prototype correction algorithm to reduce metal artefacts in flat detector computed tomography (FDCT) of scaphoid fixation screws. FDCT has gained interest in imaging small anatomic structures of the appendicular skeleton. Angiographic C-arm systems with flat detectors allow fluoroscopy and FDCT imaging in a one-stop procedure emphasizing their role as an ideal intraoperative imaging tool. However, FDCT imaging can be significantly impaired by artefacts induced by fixation screws. Following ethical board approval, commercially available scaphoid fixation screws were inserted into six cadaveric specimens in order to fix artificially induced scaphoid fractures. FDCT images corrected with the algorithm were compared to uncorrected images both quantitatively and qualitatively by two independent radiologists in terms of artefacts, screw contour, fracture line visibility, bone visibility, and soft tissue definition. Normal distribution of variables was evaluated using the Kolmogorov-Smirnov test. In case of normal distribution, quantitative variables were compared using paired Student's t tests. The Wilcoxon signed-rank test was used for quantitative variables without normal distribution and all qualitative variables. A p value of < 0.05 was considered to indicate statistically significant differences. Metal artefacts were significantly reduced by the correction algorithm (p < 0.001), and the fracture line was more clearly defined (p < 0.01). The inter-observer reliability was ''almost perfect'' (intra-class correlation coefficient 0.85, p < 0.001). The prototype correction algorithm in FDCT for metal artefacts induced by scaphoid fixation screws may facilitate intra- and postoperative follow-up imaging. (orig.)

  12. Management of scaphoid nonunions with vascularized bone grafts from the distal radius: mid- to long-term follow-up.

    Science.gov (United States)

    Malizos, Konstantinos N; Dailiana, Zoe; Varitimidis, Sokratis; Koutalos, Antonios

    2017-01-01

    Scaphoid nonunion represents a challenging problem that leads to disability if neglected. Vascularized bone grafts are proposed to augment the local biology and increase the likelihood of union but long-term outcomes are sparse. In this work, we present the mid- to long-term outcome of 140 scaphoid nonunions managed with vascularized bone grafts from the distal radius. Sixteen patients underwent concomitant closed wedge osteotomy of the distal radius because of arthritic changes. There were 130 males and ten females, with mean time from injury to surgery 3.3 years. Delayed presentation was associated with arthritic changes. Forty-two patients had avascular necrosis of the proximal pole and sixteen had more severe arthritic changes. The mean follow-up was 10 years. Pain decreased postoperatively but range of motion did not improve but only in early reconstructions. Grip strength reached 79% of the non-injured hand. Mayo modified wrist score improved from 56 to 84 (p radius reliably led to highest rate of bone healing with good mid- to long-term outcomes. Enhancement of the local biology and reconstitution of scaphoid and carpal height resulted in improved function mostly in early interventions.

  13. 17β-estradiol improves the efficacy of exploited autologous bone marrow-derived mesenchymal stem cells in non-union radial defect healing: A rabbit model.

    Science.gov (United States)

    Zamani Mazdeh, Delaram; Mirshokraei, Pezhman; Emami, Mohammadreza; Mirshahi, Ali; Karimi, Iraj

    2017-12-28

    Exploiting mesenchymal stem cells (MSCs) appears to be an appealing alternative to the traditional clinical approach in the treatment of non-union bone defects. It has been shown that 17β-estradiol improves the osteogenesis and proliferation potential of the MSCs via estrogen receptors. We investigated the effect of 17β-estradiol on exploiting autologous BMSCs (bone marrow-derived MSCs) for the purpose of healing of radial non-union segmental defect in rabbit. Twenty rabbits were divided into 4 experimental groups: 1. Control group; 2. MSC treatment group; 3. 17β-estradiol (E2) treatment group; and 4. E2+MSC treatment group. Isolated BMSCs were seeded in a critical-sized defect on radial mid-diaphysis that was filled with autologous fibrin clot differently in 4 groups: 1. intact fibrin clot (control); 2. Fibrin clot containing MSCs; 3. Estradiol; and 4. E 2 and MSCs. Defect healing was assessed by radiological (week 0, 2, 4, 6, 8 and 10) and histopathological evaluation (week 10). Radiological evaluation data demonstrated that quantities for the E2+MSC group were significantly the greatest in comparison with the other groups at week 4 to 10 inclusive. Moreover, Histopathological evaluation indicated that the E2+MSC group had the highest score which was significantly greater than the E2 group and the control group (Punion bone fractures. Exploiting mesenchymal stem cells (MSCs) appears to be an appealing alternative to the traditional clinical approach in the treatment of non-union bone defects. It has been shown that 17β-estradiol improves the osteogenesis and proliferation potential of the MSCs via estrogen receptors. We investigated the effect of 17β-estradiol on exploiting autologous BMSCs (bone marrow-derived MSCs) for the purpose of healing of radial non-union segmental defect in rabbit. Twenty rabbits were divided into 4 experimental groups: 1. Control group; 2. MSC treatment group; 3. 17β-estradiol (E2) treatment group; and 4. E2+MSC treatment group

  14. Use of autologous human mesenchymal stromal cell/fibrin clot constructs in upper limb non-unions: long-term assessment.

    Directory of Open Access Journals (Sweden)

    Stefano Giannotti

    Full Text Available BACKGROUND: Tissue engineering appears to be an attractive alternative to the traditional approach in the treatment of fracture non-unions. Mesenchymal stromal cells (MSCs are considered an appealing cell source for clinical intervention. However, ex vivo cell expansion and differentiation towards the osteogenic lineage, together with the design of a suitable scaffold have yet to be optimized. Major concerns exist about the safety of MSC-based therapies, including possible abnormal overgrowth and potential cancer evolution. AIMS: We examined the long-term efficacy and safety of ex vivo expanded bone marrow MSCs, embedded in autologous fibrin clots, for the healing of atrophic pseudarthrosis of the upper limb. Our research work relied on three main issues: use of an entirely autologous context (cells, serum for ex vivo cell culture, scaffold components, reduced ex vivo cell expansion, and short-term MSC osteoinduction before implantation. METHODS AND FINDINGS: Bone marrow MSCs isolated from 8 patients were expanded ex vivo until passage 1 and short-term osteo-differentiated in autologous-based culture conditions. Tissue-engineered constructs designed to embed MSCs in autologous fibrin clots were locally implanted with bone grafts, calibrating their number on the extension of bone damage. Radiographic healing was evaluated with short- and long-term follow-ups (range averages: 6.7 and 76.0 months, respectively. All patients recovered limb function, with no evidence of tissue overgrowth or tumor formation. CONCLUSIONS: Our study indicates that highly autologous treatment can be effective and safe in the long-term healing of bone non-unions. This tissue engineering approach resulted in successful clinical and functional outcomes for all patients.

  15. Management of resistant distal femur non-unions with allograft strut and autografts combined with osteosynthesis in a series of 22 patients.

    Science.gov (United States)

    Kanakeshwar, Raja Bhaskara; Jayaramaraju, Dheenadhayalan; Agraharam, Devendra; Rajasekaran, Shanmuganathan

    2017-08-01

    Challenges to the surgeon in managing cases of resistant non-union of the distal femur include poor bone stock, disuse osteopenia and joint contractures. Procedures varying from simple bone grafting to megaprosthesis revision have been described. We successfully managed such cases using our technique of combining cortical allograft struts to augment the defect in the femoral condyle coupled with autogenous iliac crest bone grafting and locking plate osteosynthesis. Between April 2012 and May 2014, 22 patients who presented with resistant nonunions of the distal femur following initial surgery were managed using this technique. Cortical allograft struts were taken from the tissue bank of our institution. All patients were followed up post operatively and their time to union was noted. Functional outcome was calculated using LEFS (Lower extremity functional score). The average follow up of all our patients was 24 months. All patients went on to achieve complete bony union. The average union time was 6.2 months (5 to 8 months). One patient who was a diabetic had superficial infection post operatively which was treated successfully with IV antibiotics. Average knee flexion was 110 degrees (80 to 130 degrees). The mean LEFS score was 72 (59 to 79). Combing a locking plate fixation with the bone grafting technique of using an allograft strut to support the metaphyseal medial bone defect and autografts gives a good union and a good functional outcome in the management of resistant non-unions of the distal femur by enhancing the biology and providing a good structural support to the distal femur. © 2017 Elsevier Ltd. All rights reserved.

  16. In Vivo Kinematics of the Scaphoid, Lunate, Capitate, and Third Metacarpal in Extreme Wrist Flexion and Extension

    Science.gov (United States)

    Rainbow, Michael J; Kamal, Robin N; Leventhal, Evan; Akelman, Edward; Moore, Douglas C; Wolfe, Scott W; Crisco, Joseph J

    2013-01-01

    Purpose Insights into the complexity of active in vivo carpal motion have recently been gained using 3D imaging; however kinematics during extremes of motion have not been elucidated. The purpose of this study was to determine motion of the carpus during extremes of wrist flexion and extension. Methods Computed tomography scans of 12 healthy wrists were obtained in neutral-grip, extreme loaded flexion, and extreme loaded extension. Three-dimensional bone surfaces and 6-degree-of-freedom kinematics were obtained for the radius and carpal bones. The flexion and extension rotation from neutral-grip to extreme flexion and extreme extension of the scaphoid and lunate was expressed as a percentage of capitate flexion and extension and then compared to previous studies of active wrist flexion and extension. We also tested the hypothesis that the capitate and third metacarpal function as a single rigid body. Finally, joint space metrics at the radiocarpal and midcarpal joints were used to describe arthrokinematics. Results In extreme flexion, the scaphoid and lunate flexed 70% and 46% of the amount the capitate flexed, respectively. In extreme extension, the scaphoid extended 74% and the lunate extended 42% of the amount the capitates extended, respectively. The third metacarpal extended 4° farther than the capitate in extreme extension. The joint contact area decreased at the radiocarpal joint during extreme flexion. The radioscaphoid joint contact center moved onto the radial styloid and volar ridge of the radius in extreme flexion from a more proximal and ulnar location in neutral. Conclusions The contributions of the scaphoid and lunate to capitate rotation were approximately 25% less in extreme extension compared to wrist motion through an active range of motion. More than half the motion of the carpus when the wrist was loaded in extension occured at the midcarpal joint. Clinical Relevance These findings highlight the difference in kinematics of the carpus during at

  17. Time-lagged effects of weather on plant demography: drought and Astragalus scaphoides.

    Science.gov (United States)

    Tenhumberg, Brigitte; Crone, Elizabeth E; Ramula, Satu; Tyre, Andrew J

    2018-04-01

    Temperature and precipitation determine the conditions where plant species can occur. Despite their significance, to date, surprisingly few demographic field studies have considered the effects of abiotic drivers. This is problematic because anticipating the effect of global climate change on plant population viability requires understanding how weather variables affect population dynamics. One possible reason for omitting the effect of weather variables in demographic studies is the difficulty in detecting tight associations between vital rates and environmental drivers. In this paper, we applied Functional Linear Models (FLMs) to long-term demographic data of the perennial wildflower, Astragalus scaphoides, and explored sensitivity of the results to reduced amounts of data. We compared models of the effect of average temperature, total precipitation, or an integrated measure of drought intensity (standardized precipitation evapotranspiration index, SPEI), on plant vital rates. We found that transitions to flowering and recruitment in year t were highest if winter/spring of year t was wet (positive effect of SPEI). Counterintuitively, if the preceding spring of year t - 1 was wet, flowering probabilities were decreased (negative effect of SPEI). Survival of vegetative plants from t - 1 to t was also negatively affected by wet weather in the spring of year t - 1 and, for large plants, even wet weather in the spring of t - 2 had a negative effect. We assessed the integrated effect of all vital rates on life history performance by fitting FLMs to the asymptotic growth rate, log(λt). Log(λt) was highest if dry conditions in year t - 1 were followed by wet conditions in the year t. Overall, the positive effects of wet years exceeded their negative effects, suggesting that increasing frequency of drought conditions would reduce population viability of A. scaphoides. The drought signal weakened when reducing the number of monitoring years. Substituting space for time

  18. CT scan-evaluated outcome of pulsed electromagnetic fields in the treatment of acute scaphoid fractures: a randomised, multicentre, double-blind, placebo-controlled trial.

    Science.gov (United States)

    Hannemann, P F W; van Wezenbeek, M R; Kolkman, K A; Twiss, E L L; Berghmans, C H J; Dirven, P A M G M; Brink, P R G; Poeze, M

    2014-08-01

    We hypothesised that the use of pulsed electromagnetic field (PEMF) bone growth stimulation in acute scaphoid fractures would significantly shorten the time to union and reduce the number of nonunions in a randomised, double-blind, placebo-controlled multicentre trial. A total of 102 patients (78 male, 24 female; mean age 35 years (18 to 77)) from five different medical centres with a unilateral undisplaced acute scaphoid fracture were randomly allocated to PEMF (n = 51) or placebo (n = 51) and assessed with regard to functional and radiological outcomes (multiplanar reconstructed CT scans) at 6, 9, 12, 24 and 52 weeks. The overall time to clinical and radiological healing did not differ significantly between the active PEMF group and the placebo group. We concluded that the addition of PEMF bone growth stimulation to the conservative treatment of acute scaphoid fractures does not accelerate bone healing. ©2014 The British Editorial Society of Bone & Joint Surgery.

  19. The Role of Dynamic Contrast-Enhanced MRI in a Child with Sport-Induced Avascular Necrosis of the Scaphoid: A Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Baris Beytullah Koc

    2016-01-01

    Full Text Available Avascular necrosis (AVN of the scaphoid in children is very rare and there is currently no consensus when conservative or operative treatment is indicated. A 10-year-old boy, practicing karate, presented with acute pain in his left wrist after falling on the outstretched hand. Imaging showed a scaphoid waist fracture with signs of an ongoing AVN. The diagnosis of AVN was confirmed with signal loss of the scaphoid on MRI T1. A dynamic contrast-enhanced MRI was performed for further assessment of the proximal pole vascularity and treatment planning. As dynamic contrast-enhanced MRI showed fair perfusion of the proximal pole, an adequate healing potential with conservative treatment was estimated. We achieved union and good function with cast immobilization for fourteen weeks. This case study showed dynamic contrast-enhanced MRI to be a valuable tool in assessing whether conservative or operative treatment is indicated to achieve union and good functional outcome.

  20. Opening-wedge high tibial osteotomy without bone grafting in severe varus osteoarthritic knee. Rate and risk factors of non-union in 41 cases.

    Science.gov (United States)

    Siboni, R; Beaufils, P; Boisrenoult, P; Steltzlen, C; Pujol, N

    2018-03-16

    Using locking plates in opening-wedge high tibial osteotomy (OWHTO) via a medial opening theoretically allows early weight-bearing without need for bone or bone-substitute grafting. It incurs a risk of non-consolidation in case of large correction (> 10°), although rates and risk factors of non-union are not known. The present retrospective study compared OWHTO with correction 10°, with a view to determining: 1) complications rates (non-union) according to degree of correction, and 2) risk factors for such complications. OWHTO with correction greater than 10° without graft shows normal consolidation and allows early weight-bearing. Forty-one patients treated by OWHTO for medial osteoarthritis of the knee between January 2101 and November 2015 were included in a retrospective study. HKA angle was assessed by long-leg axis radiographs, preoperatively and at 3 months. Clinical and radiological follow-up at 6 weeks, 3 months and 6 months assessed consolidation in terms of >40% filling of the osteotomy site. Partial (contact) weight-bearing was allowed from the first postoperative day, with full weight-bearing at 6 weeks. Mean patient age was 59 ± 5 years. Mean body-mass index (BMI) was 30.3 ± 5.2; 17 patients (41.5%) had BMI >30. Mean initial HKA angle was 173.5° ± 3° (range, 167° - 178°) and mean correction was 10.7°± 2.7° (range, 5° - 15°). There were 27 corrections of 10° or more, and 14 less than 10°. At 3 months, mean HKA was 182.9° ± 2.5° (range, 178° - 187°). Twelve cases showed lateral tibial cortex fracture after opening. Thirty-six patients (87.8%) showed consolidation, at a mean 5 ± 3 months. Five patients showed osteotomy site non-union; in all these cases, the lateral cortex was broken initially (p=0.003); all had BMI >30 (mean, 37.2± 3.8; p 30 (OR=1.18; 95% CI, (1.03-1.41)) and correction ≥10° (OR=10.50; 95% CI, (2.49-53.86)) were associated with delayed consolidation. On multivariate analysis, only degree of osteotomy was

  1. Modified Masquelet technique using allogeneic umbilical cord-derived mesenchymal stem cells for infected non-union femoral shaft fracture with a 12 cm bone defect: A case report

    Directory of Open Access Journals (Sweden)

    Ismail Hadisoebroto Dilogo

    2017-01-01

    Conclusion: The application of allogeneic UC-MSC, BMP-2, HA and Masquelet technique as proposed in the diamond concept is a viable method in treating critical-sized bone defect and provides an effective way to overcome non-union caused by large defect.

  2. Revision of 120 tibial infected non-unions with bone and soft tissue loss treated with epidermato-fascial osteoplasty according to Umiarov.

    Science.gov (United States)

    Mora, Redento; Maccabruni, Anna; Bertani, Barbara; Tuvo, Gabriella; Lucanto, Stefano; Pedrotti, Luisella

    2014-02-01

    Treatment of tibial infected non-unions with bone and soft tissue loss has to solve three problems: infection, lack of bone continuity and lack of skin coverage. The aims of treatment are infection healing, bone consolidation with preservation of limb length and soft tissue reconstruction. The most important stage in the planning is an accurate débridement. Soft tissue reconstruction can be achieved using plastic surgery, and bone reconstruction is accomplished with bone grafts or induced membrane technique, but these methods may present disadvantages and risks. Epidermato-fascial osteoplasty is a modified procedure of compression-distraction osteosynthesis that was first described by Umiarov in 1982. This procedure offers the advantages of exactly classifying the phases of simultaneous bone and soft tissue regeneration, and of eliminating large tissue losses without previous closure of soft tissues or use of grafts, because the transported fragment takes fascia and skin along during the transport and closes the edges of the soft tissue gap until the epidermic and fascial reconstruction is complete. A total of 120 patients underwent this kind of surgery between 1986 and 2010 and were followed up for 2-26 years. Average age was 34 years (range 21-57 years). Cultures were positive for Staphylococcus in all cases, and for Pseudomonas in 27 cases. Adequate antibiotic therapy was administered in collaboration with the Infectious Diseases Specialist. Tibial bone resection was from 6 to 18cm (average 9.5cm). The Ilizarov apparatus was used with the oblique wire technique for bone transport in all patients. No intraoperative complications were observed. One patient died 40 days after the operation because of pulmonary embolism. The duration of treatment for the remaining 119 patients was 7-18 months. In all cases, infection eradication, healing of regenerate bone, consolidation at the docking site (with the aid of an autoplastic bone graft in only 11 patients), and

  3. Interfragmentary Compression Forces Vary Based on Scaphoid Bone Screw Type and Fracture Location.

    Science.gov (United States)

    Patel, Samik; Tiedeken, Nathan; Qvick, Lars; Debski, Richard E; Kaufmann, Robert; Fowler, John R

    2017-12-01

    The objective of this study was to determine the interfragmentary compression forces generated in a foam model as a function of headless compression screw type (fully threaded and central threadless) and fracture location. Eighty-eight polyurethane foam models were fixed across a simulated transverse fracture with either a fully threaded screw or a central threadless screw. The location of the transverse fracture varied along the length of the foam model in 2 mm increments for 11 fracture locations. The force generated at the fracture site upon fixation was utilized to determine the interfragmentary compression. Interfragmentary compression was compared using a paired t test and 2-way analysis of variance, with significance set at P compression was found to vary based on fracture location and screw type. The fully threaded screw generated significantly greater compression for fracture locations at 12 mm and 18 mm from the top edge of the foam model, while the central threadless screw generated significantly greater compression for fractures located 2 mm from the top edge of the foam model. The central threadless screw and the fully threaded screw had different fracture locations where maximum compression force occurred. The fully threaded screw generated greater compression force toward the screw center due to greater thread purchase. However, the central threadless screw generated greater compression at the most proximal fracture location due to its greater thread pitch toward the screw head. Maximizing interfragmentary compression may aid in reducing nonunion rates associated with the internal fixation of proximal scaphoid fractures.

  4. Is Casting for Non-Displaced Simple Scaphoid Waist Fracture Effective? A CT Based Assessment of Union.

    Science.gov (United States)

    Grewal, Ruby; Suh, Nina; MacDermid, Joy C

    2016-01-01

    The purpose of this study is to report the union rate and time to union for acute non-displaced scaphoid waist fractures treated with a short arm thumb spica cast. A database was searched (2006-2013) to identify acute undisplaced scaphoid waist fractures. Cases that were not given a trial of casting were excluded (n=33). X-rays, CT scans and health records for each patient were reviewed to extract data. 172 patients met inclusion criteria. There were 138 males, 34 females, the mean age was 30 ± 16 years. The union rate was 99.4% (1 nonunion/172 subjects). The mean time to union was approximately 7.5 weeks (53 ± 37 days). Energy of injury, age or gender did not affect union rates or time to union. Cysts did not affect the union rate (p=0.73) but patients with cystic resorption along the fracture line required approximately 10 weeks for union (69 ± 60 days) compared to 7 weeks (51 ± 34 days) for those without cysts (p=0.05). Diabetes did not affect the union rate (p=0.81) but was found to increase the risk of delayed union (p=0.05). There was a weak, but statistically significant correlation between the number of days before the fracture was casted and the length of time needed to achieve union (r=0.27, p=0.001). Non-displaced scaphoid waist fractures have a high healing rate with appropriate identification and immobilization. Follow-up CT scans to assess healing can identify union within a shorter time frame (~7 weeks) than previously reported in the literature.

  5. Two-Dimensional Image Fusion of Planar Bone Scintigraphy and Radiographs in Patients with Clinical Scaphoid Fracture: An Imaging Study

    International Nuclear Information System (INIS)

    Henriksen, O.M.; Lonsdale, M.N.; Jensen, T.D.; Weikop, K.L.; Holm, O.; Duus, B.; Friberg, L.

    2009-01-01

    Background: Although magnetic resonance imaging (MRI) is now considered the gold standard in second-line imaging of patients with suspected scaphoid fracture and negative radiographs, bone scintigraphy can be used in patients with pacemakers, metallic implants, or other contraindications to MRI. Bone scintigraphy is highly sensitive for the detection of fractures, but exact localization of scintigraphic lesions may be difficult and can negatively affect diagnostic accuracy. Purpose: To investigate the influence of image fusion of planar bone scintigraphy and radiographs on image interpretation in patients with suspected scaphoid fracture. Material and Methods: In 24 consecutive patients with suspected scaphoid fracture, a standard planar bone scintigraphy of both hands was supplemented with fusion imaging of the injured wrist. Standard and fusion images were evaluated independently by three experienced nuclear medicine physicians. In addition to the diagnosis, the degree of diagnostic confidence was scored in each case. Results: The addition of fusion images changed the interpretation of each of the three observers in seven, four, and two cases, respectively, reducing the number of positive interpretations of two of the observers from 11 and nine cases to six and seven cases, respectively. The degree of diagnostic confidence increased significantly in two observers, and interobserver agreement increased in all three pairs of observers from 0.83, 0.57, and 0.73 to 0.89, 0.8, and 0.9, respectively. Conclusion: Image fusion of planar bone scintigrams and radiographs has a significant influence on image interpretation and increases both diagnostic confidence and interobserver agreement

  6. The Comparison Of Results For The Bone Grafting In Treatment Of Scaphoid Nonunion With And Without Avascular Necrosis

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    Iman Qomashi

    2011-02-01

    Full Text Available Background: The varieties of treatment methods for the scaphoid nonunion have always been a discussable issue for orthopaedic surgeons. The current study, considered to be review for treatment results of the patients who sustained the scaphoid nonunion with or without avascular necrosis and compared these two groups clinically and radiologically. Methods: The clinical and radiologic files of the patients who sustained the scaphoid nonunion and underwent surgical treatment between 2004 and 2009 in our hospital, were collected and in the final follow-up, 37 patients and 38 nonunions underwent physical exam, grip power test, DASH questionnaire and radiography. Results: Avascular necrosis was detected in 22 cases and 16 cases had no avascular necrosis changes. Following open reduction and bone grafing, union was seen in 36 cases, and nonunion in 2 cases which one was in the avascular necrosis group and another in without avascular necrosis group. The comparison of the residual pain, range of motion, DASH score and grip power in two groups, did not show a meaningful difference (p>0.05. Conclusion: Although multiple studies indicated that in the presence of the avascular necrosis in the proximal fragment of the scaphiod, possibility of union in the conventional graft methods was lower than vascular pedicle grafts, but this study demonstrated that the conventional treatment method yet was associated with a considerable successs and a reliable treatment method.

  7. The head to foot screw fixation. A new technique of percutaneous screw fixation of the scaphoid bone.

    Science.gov (United States)

    Zaraa, Mourad; Ben Slama, Safouane; Mahjoub, Sabri; Sehli, Heithem; Hadj Salah, Méhdi; Mbarek, Mondher

    2017-01-01

    Many techniques have been described for screw fixation of the scaphoid bone. The approach is either proximal or dorsal. A new percutaneous technique is presented by the authors called the head to foot screw fixation. Indications and results are evaluated. It is a percutaneous technique with fixation of the scaphoid bone by two screws introduced in an opposite direction: a proximal screw and a distal screw. No postoperative immobilization was necessary. A prospective study was conducted in 40 patients over a period of three years. The average age was 25 years with extremes of 14 and 44 years. This technique was practiced in fractures (30 cases) and nonunion (10 cases) in which the localization was proximal, corresponding to Schernberg types I, II and III. Forms associated with perilunate dislocation of the carpus were excluded from the study. The results were analysed with a mean of 8 months (6-30). Union was obtained in all the cases. No tendon injury related to percutaneous approach was noted. The technique required a learning curve with progressive decrease in operative time from 45 to 15 minutes. It was necessary in two cases to change protruding screws which were not diagnosed during the first intervention. Percutaneous screw fixation was achieved again in both cases.   Conclusions: The combination in our experience of two screws allowed us to prevent rotation around the unthreated area of a single screw. Our technique, bringing together the head to the foot of the screw, reduces the crowding at the proximal part of the scaphoid bone. This non-invasive method permitted early mobilization with no pain until biological union.

  8. Cast immobilization with and without immobilization of the thumb for nondisplaced and minimally displaced scaphoid waist fractures: a multicenter, randomized, controlled trial

    NARCIS (Netherlands)

    Buijze, G. A.; Goslings, J. C.; Rhemrev, S. J.; Weening, A. A.; van Dijkman, B.; Doornberg, J. N.; Ring, D.; Terra, Maaike P.; Macmahon, Peter J.; Coerkamp, Emile G.; van der Woude, H. J.; de Jong, Vincent M.; Beeres, Frank J. P.; de Haseth, Kristin B.; Souer, J. Sebastiaan; Jupiter, Jesse B.; Mudgal, Chaitanya S.; van der Vlies, Cees H.; Blazar, Philip; Day, Charles S.; Fostvedt, Sigi; Kloen, Peter; van Dijk, C. Niek; Maas, Mario; Poolman, Rudolf W.; Haverlag, Robert; Scholtes, Vanessa A. B.; Jellema-de Bont, Jolanda J. M.; Thomassen, Bregje J.; Hollander, Peter den; de Muinck Keizer, Robert-Jan

    2014-01-01

    The aim of this prospective randomized trial was to test the null hypothesis that there was no difference in the percentage of the fracture line of scaphoid waist fractures that demonstrated bridging bone on computed tomography (CT) 10 weeks after injury between patients treated in a below-elbow

  9. CT scan-evaluated outcome of pulsed electromagnetic fields in the treatment of acute scaphoid fractures: a randomised, multicentre, double-blind, placebo-controlled trial

    NARCIS (Netherlands)

    Hannemann, P.F.; van Wezenbeek, M.R.; Kolkman, K.A.; Twiss, E.L.; Berghmans, C.H.; Dirven, P.A.; Brink, P.R.; Poeze, M.

    2014-01-01

    We hypothesised that the use of pulsed electromagnetic field (PEMF) bone growth stimulation in acute scaphoid fractures would significantly shorten the time to union and reduce the number of nonunions in a randomised, double-blind, placebo-controlled multicentre trial. A total of 102 patients (78

  10. Inter-observer agreement between 2-dimensional CT versus 3-dimensional I-space model in the diagnosis of occult scaphoid fractures

    NARCIS (Netherlands)

    Drijkoningen, T. (Tessa); Knotter, R. (Robert); Coerkamp, E.G. (Emile G.); A.H.J. Koning (Anton); S. Rhemrev (Steven); Beeres, F.J. (Frank J.)

    2016-01-01

    textabstractBackground: The I-Space is a radiological imaging system in which Computed Tomography (CT)-scans can be evaluated as a three dimensional hologram. The aim of this study is to analyze the value of virtual reality (I-Space) in diagnosing acute occult scaphoid fractures. Methods: A

  11. Proximal row carpectomy versus scaphoid excision and intercarpal arthrodesis: intraoperative assessment and procedure selection.

    Science.gov (United States)

    Zinberg, Ephraim M; Chi, Ying

    2014-06-01

    To demonstrate the relative frequency of degenerative changes of the radiolunate and capitolunate joints in osteoarthritis of the wrist as seen by direct visualization, and to demonstrate the disparity between findings on preoperative radiographs and direct visualization. We reviewed 18 consecutive patients who underwent either a proximal row carpectomy (PRC) or a scaphoid excision and 4-corner arthrodesis (SEFCA) for symptomatic degenerative arthritis of the wrist. In each case, the articular surfaces of the radiolunate and capitolunate joints were inspected intraoperatively; based on the relative degree of degenerative changes, either a PRC or an SEFCA was performed. We compared preoperative radiographs and the predicted procedure based on them with intraoperative findings and the procedure actually performed. Of 18 wrists, 15 had more severe degenerative changes on the proximal articular surface of the lunate than on the capitate head and underwent a PRC; the remaining 3 had more severe changes on the capitate head than on the proximal surface of the lunate and underwent an SEFCA. In contrast, preoperative radiographs in 13 of the 18 cases revealed degenerative changes at the capitolunate joint and minimal or no changes at the radiolunate joint. An SEFCA was the predicted procedure in all 13, but was performed in 3. The remaining 10 underwent a PRC. Preoperative radiographs did not correlate well with intraoperative findings in the assessment of degenerative changes at the radiolunate and capitolunate joints, with changes at the radiolunate joint often underestimated. Our findings contradict the widely held contention that the radiolunate joint is consistently spared in osteoarthritis. The lunate fossa of the radius appears to be consistently spared, but not the proximal surface of the lunate. We recommend intraoperative assessment of the articular surfaces, rather than preoperative radiographs, for selection of the surgical procedure. Therapeutic IV. Copyright

  12. Scaphocapitate Syndrome With Associated Trans-Scaphoid, Trans-Hamate Perilunate Dislocation: A Case Report and Description of Surgical Fixation.

    Science.gov (United States)

    Nunez, Fiesky A; Luo, T David; Jupiter, Jesse B; Nunez, Fiesky A

    2017-03-01

    Background: Perilunate fracture dislocations are often associated with fractures of the distal pole of the scaphoid or the proximal pole of the capitate. However, the combination of perilunate dislocation with multiple carpal fractures and associated scaphocapitate syndrome is very rare. Methods: We report a unique case of scaphocapitate fracture syndrome with perilunate dislocation and fracture of the hamate resulting from a high-energy injury to the wrist during a dirt-bike competition. Results: Open reduction and internal fixation of the scaphoid fracture with a 3.0-mm headless screw, the head of the capitate with a 1.5-mm lag screw, and the hamate fracture with a 1.3-mm lag screw was performed. The lunotriquetral dissociation was reduced, with the ligament repaired and the joint stabilized using a Kirschner wire. All screw heads are carefully buried under the articulate cartilage. Conclusions: Prompt anatomic reduction and stable osteosynthesis of all fractures in this patient resulted in successful healing and return to activity.

  13. Modified Masquelet technique using allogeneic umbilical cord-derived mesenchymal stem cells for infected non-union femoral shaft fracture with a 12 cm bone defect: A case report.

    Science.gov (United States)

    Dilogo, Ismail Hadisoebroto; Primaputra, Muhammad Rizqi Adhi; Pawitan, Jeanne Adiwinata; Liem, Isabella Kurnia

    2017-01-01

    Non-union due to large bone loss often causes significant long-term morbidity. We incorporate the use of allogeneic umbilical cord-derived mesenchymal stem cells (UC-MSCs) as part of the diamond concept of regenerative medicine in a case of infected non-union fracture. We reported a 54-year-old female patient presenting with pain on the right thigh. She was previously diagnosed with a closed fracture of the right femoral shaft and underwent four surgeries before finally being referred to Dr. Cipto Mangunkusumo General Hospital with infected non-union of the right femoral shaft. The patient was treated with a combination of UC-MSCs, bone morphogenetic protein-2 (BMP-2), Hydroxyapatite (HA), and mechanical stabilization using Masquelet Technique. The combination of allogeneic MSCs, BMP2, HA, and Masquelet Technique was successful in creating new bone with no apparent side effects. Bone loss might be caused by external factors (true defects), or structural loss of the existing bone. The combination of allogeneic UC-MSCs, BMP-2, HA and an induced membrane technique pioneered by Masquelet allowed for faster regeneration process and more optimal bone healing. This paper aims to assess and compare the result of such procedures with the previous four surgeries done to the patient, which did not yield satisfactory results. The application of allogeneic UC-MSC, BMP-2, HA and Masquelet technique as proposed in the diamond concept is a viable method in treating critical-sized bone defect and provides an effective way to overcome non-union caused by large defect. Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

  14. Accuracy of enhanced and unenhanced MRI in diagnosing scaphoid proximal pole avascular necrosis and predicting surgical outcome

    Energy Technology Data Exchange (ETDEWEB)

    Fox, M.G. [University of Virginia, Department of Radiology and Medical Imaging, Charlottesville, VA (United States); Wang, D.T. [University of Virginia, Department of Radiology and Medical Imaging, Charlottesville, VA (United States); Medical College of Wisconsin, Milwaukee, WI (United States); Chhabra, A.B. [University of Virginia Health System, Department of Orthopedics, Charlottesville, VA (United States)

    2015-11-15

    Determine the sensitivity, specificity and accuracy of unenhanced and enhanced MRI in diagnosing scaphoid proximal pole (PP) avascular necrosis (AVN) and correlate whether MRI can help guide the selection of a vascularized or nonvascularized bone graft. The study was approved by the IRB. Two MSK radiologists independently performed a retrospective review of unenhanced and enhanced MRIs from 18 patients (16 males, 2 females; median age, 17.5 years) with scaphoid nonunions and surgery performed within 65 days of the MRI. AVN was diagnosed on the unenhanced MRI when a diffusely decreased T1-W signal was present in the PP and on the enhanced MRI when PP enhancement was less than distal pole enhancement. Surgical absence of PP bleeding was diagnostic of PP AVN. Postoperative osseous union (OU) was assessed with computed tomography and/or radiographs. Sensitivity, specificity and accuracy for PP AVN were 71, 82 and 78 % for unenhanced and 43, 82 and 67 % for enhanced MRI. Patients with PP AVN on unenhanced MRI had 86 % (6/7) OU; 100 % (5/5) OU with vascularized bone grafts and 50 % (1/2) OU with nonvascularized grafts. Patients with PP AVN on enhanced MRI had 80 % (4/5) OU; 100 % (3/3) OU with vascularized bone grafts and 50 % (1/2) OU with nonvascularized grafts. Patients with viable PP on unenhanced and enhanced MRI had 91 % (10/11) and 92 % (12/13) OU, respectively, all but one with nonvascularized graft. When PP AVN is evident on MRI, OU is best achieved with vascularized grafts. If PP AVN is absent, OU is successful with nonvascularized grafts. (orig.)

  15. Accuracy of enhanced and unenhanced MRI in diagnosing scaphoid proximal pole avascular necrosis and predicting surgical outcome.

    Science.gov (United States)

    Fox, M G; Wang, D T; Chhabra, A B

    2015-11-01

    Determine the sensitivity, specificity and accuracy of unenhanced and enhanced MRI in diagnosing scaphoid proximal pole (PP) avascular necrosis (AVN) and correlate whether MRI can help guide the selection of a vascularized or nonvascularized bone graft. The study was approved by the IRB. Two MSK radiologists independently performed a retrospective review of unenhanced and enhanced MRIs from 18 patients (16 males, 2 females; median age, 17.5 years) with scaphoid nonunions and surgery performed within 65 days of the MRI. AVN was diagnosed on the unenhanced MRI when a diffusely decreased T1-W signal was present in the PP and on the enhanced MRI when PP enhancement was less than distal pole enhancement. Surgical absence of PP bleeding was diagnostic of PP AVN. Postoperative osseous union (OU) was assessed with computed tomography and/or radiographs. Sensitivity, specificity and accuracy for PP AVN were 71, 82 and 78% for unenhanced and 43, 82 and 67% for enhanced MRI. Patients with PP AVN on unenhanced MRI had 86% (6/7) OU; 100% (5/5) OU with vascularized bone grafts and 50% (1/2) OU with nonvascularized grafts. Patients with PP AVN on enhanced MRI had 80% (4/5) OU; 100% (3/3) OU with vascularized bone grafts and 50% (1/2) OU with nonvascularized grafts. Patients with viable PP on unenhanced and enhanced MRI had 91% (10/11) and 92% (12/13) OU, respectively, all but one with nonvascularized graft. When PP AVN is evident on MRI, OU is best achieved with vascularized grafts. If PP AVN is absent, OU is successful with nonvascularized grafts.

  16. A Scapholunate Ligament-Sparing Technique Utilizing the Medial Femoral Condyle Corticocancellous Free Flap to Reconstruct Scaphoid Nonunions With Proximal Pole Avascular Necrosis.

    Science.gov (United States)

    Kazmers, Nikolas H; Thibaudeau, Stephanie; Levin, L Scott

    2016-09-01

    This article demonstrates a technique for the treatment of scaphoid fracture waist and proximal pole nonunions with avascular necrosis using a free vascularized medial femoral condyle flap. We present our surgical technique and representative case examples in which the scapholunate ligament, a key structure required to preserve carpal kinematics, is spared. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  17. [Application of bone flap pedicled on retrograde branch of radial artery for treatment of old scaphoid bone fractures of type AO-B].

    Science.gov (United States)

    Sun, Qing-peng

    2015-05-01

    To investigate application of the bone flap pedicled on the retrograde branch of radial artery for treatment of old scaphoid bone fractures of type AO-B. From October 2007 to October 2011,41 patients with old scaphoid bone fractures of type AO-B were treated by transplantation of the bone flap pedicled on the retrograde branch of radial artery including 26 males and 15 females with an average of (27.3±4.5) years old ranging from 16 to 43 years old. The courses before operation ranged from 6 to 22 months with an average of 11 months. All fractures belonged to the type B of AO classification, that is old wrist fracture of scaphoid bone. All patients' wrist function (pain, function, motion, grip strength) were evaluated by Cooney's modifiedwrist scoring system before and 6 months after operation,and the conditions of bone healing were observed during the follow-up time. Among them, 36 patients were followed up from 4 to 15 months with an average of 8.3 months. The wounds were healed well without other complications as infection appearing. X-rays or CT confirmed that all fractures were healed completely. The Cooney wrist score was improved from preoperative 53.61±13.97 to postoperative 81.81±8.71 (Pfractures,which is scientific and has curative effects, and valuable for clinical application.

  18. Inter-observer agreement between 2-dimensional CT versus 3-dimensional I-Space model in the Diagnosis of Occult Scaphoid Fractures

    Directory of Open Access Journals (Sweden)

    Tessa Drijkoningen

    2016-10-01

    Full Text Available Background: The I-Space is a radiological imaging system in which Computed Tomography (CT-scans can be evaluated as a three dimensional hologram. The aim of this study is to analyze the value of virtual reality (I-Space in diagnosing acute occult scaphoid fractures.   Methods: A convenient cohort of 24 patients with a CT-scan from prior studies, without a scaphoid fracture on radiograph, yet high clinical suspicion of a fracture, were included in this study. CT-scans were evaluated in the I-Space by 7 observers of which 3 observers assessed the scans in the I-Space twice. The observers in this study assessed in the I-Space whether the patient had a scaphoid fracture. The kappa value was calculated for inter- and intra-observer agreement. Results: The Kappa value varied from 0.11 to 0.33 for the first assessment. For the three observers who assessed the CT-scans twice; observer 1 improved from a kappa of 0.33 to 0.50 (95% CI 0.26-0.74, P=0.01, observer 2 from 0.17 to 0.78 (95% CI 0.36-1.0, P

  19. Osteotomia valgizante para pseudartrose do colo do fêmur: relato de 32 casos Valgusing intertrochanteric osteotomy for the treatment of femoral neck non-unions: report of 32 cases

    Directory of Open Access Journals (Sweden)

    Carlos Roberto Schwartsmann

    2009-04-01

    Full Text Available OBJETIVO: Avaliar a consolidação pós-osteotomia osteotomia valgizante do fêmur no tratamento do pseudartrose do colo femoral. MÉTODO: Durante 15 anos (1988-2003, 32 casos de pseudartrose do colo do fêmur foram tratados com osteotomia valgizante e fixação. O seguimento médio dos casos foi de 9,8 anos e a média de idade dos pacientes foi de 41,7 anos. RESULTADOS: Dos 32 casos quatro evoluíram para prótese total do quadril e 28 evoluíram para consolidação (87,4%. Oito casos evoluíram necrose parcial. CONCLUSÃO: A osteotomia valgizante é altamente eficaz para obtenção da consolidação na pseudartrose do colo do fêmur 87,4% (28/32 A recuperação integral da função do quadril só foi obtida em 56,2% (18/32PURPOSE: The purpose of the present study was to review the results of femoral neck non-unions treatment with valgusing intertrochanteric osteotomy. METHODS: Between 1988 and 2003 we treaded thirty two femoral neck non-unions with valgusing osteotomy and fixation. The mean follow-up time was 9.8 years and the mean age was 41.7 years. RESULTS: Twenty eight (87.4% of the thirty two valgusing osteotomies evolved to femoral neck union, while four cases (12.6% evolved to total hip arthroplasty. Eight cases evolved to partial osteonecrosis. CONCLUSIONS: The valgusing intertrochanteric osteotomy for treating femoral neck non-unions achieved consolidation in 87.4% (28/32. However, only 56.2% (18/32 achieved full recovery of hip function.

  20. Treatment of infected non-unions of the femur and tibia in a French referral center for complex bone and joint infections: Outcomes of 55 patients after 2 to 11 years.

    Science.gov (United States)

    Bauer, T; Klouche, S; Grimaud, O; Lortat-Jacob, A; Hardy, P

    2018-02-01

    An infected non-union is a major complication following bone fracture. While bone union can be obtained in 70% to 100% of cases, treatment of osteomyelitis is less predictable, with reported healing rates ranging from 40% to 100%. The primary aim of this study was to assess the success rate of treating infected non-unions of the tibia and femur by a team specializing in complex bone and joint infections. This single-center retrospective study included all patients operated between 2002 and 2012 due to an infected non-union of the femur or tibia using standardized surgical methods. The procedure was typically done in two phases: excision of the infected site and stabilization, followed by bone reconstruction after a waiting period. Additional procedures (lavage and/or bone grafting) were performed in some cases. A minimum 6-week course of antibiotic therapy was given. The primary endpoint was successful medical and surgical treatment after a minimum 2 years' follow-up defined as healing of the infection (no local clinical signs of infection, ESR≤20mm and CRP≤10mg/L, no mortality attributed to the infection) and radiological and clinical bone union, with the lower limb spared. Fifty-five patients (39 men, 16 women) were included with an average age of 37±11 years. There were 40 tibial fractures and 15 femur fractures. A polymicrobial infection was present in 47% of cases. Repeat surgery was required in 56.4% of patients. At an average of 4±2 years from the first surgical procedure, the treatment was successful in 49 patients (89%): 36 tibia (90%) and 13 femur (87%). The mean time to union was 9±4 months. There were six failures: 3 amputations at 5, 6 and 16 months; 1 mechanical and infection-related failure; 2 failed union. This study found that 89% of patients with an infected tibial or femoral non-union treated by a team specialized in complex bone and joint infections using a standardized surgical protocol had bone union and healing of the infection in an

  1. Computer-Assisted 3-Dimensional Reconstructions of Scaphoid Fractures and Nonunions With and Without the Use of Patient-Specific Guides: Early Clinical Outcomes and Postoperative Assessments of Reconstruction Accuracy.

    Science.gov (United States)

    Schweizer, Andreas; Mauler, Flavien; Vlachopoulos, Lazaros; Nagy, Ladislav; Fürnstahl, Philipp

    2016-01-01

    To present results regarding the accuracy of the reduction of surgically reconstructed scaphoid nonunions or fractures using 3-dimensional computer-based planning with and without patient-specific guides. Computer-based surgical planning was performed with computed tomography (CT) data on 22 patients comparing models of the pathological and the opposite uninjured scaphoid in 3 dimensions. For group 1 (9 patients), patient-specific guides were designed and manufactured using additive manufacturing technology. During surgery, the guides were used to define the orientation of the reduced fragments. The scaphoids in group 2 (13 patients) were reduced with the conventional freehand technique. All scaphoids in both groups were fixed with a headless compression screw or K-wires, and all bone defects (except one) were filled with autologous bone grafts or vascularized grafts. Postoperative CT scans were acquired 2 or more months after the operations to monitor consolidation and compare the final result with the preoperative plan. The clinical results and accuracy of the reconstructions were compared. In group 1, 8 of 9 scaphoids healed after 2 to 6 months, and partial nonunion after 9 months was observed in one patient. In group 2, 11 of 13 scaphoids healed between 2 and 34 months whereas 2 scaphoids did not consolidate. Comparison of the preoperative and postoperative 3-dimensional data revealed an average residual displacement of 7° (4° in flexion-extension, 4° in ulnar-radial deviation, and 3° in pronation-supination) in group 1. In group 2, residual displacement after surgery was 26° (22° in flexion-extension, 12° in ulnar-radial deviation, and 7° in pronation-supination). The difference in the accuracy of reconstruction was significant. Although the scaphoid is small, patient-specific guides can be used to perform scaphoid reconstructions. When the guides were used, the reconstructions were significantly more anatomic compared with those resulting from the

  2. Rationale and design of the SMaRT trial: A randomised, prospective, parallel, non-blinded, one-centre trial to evaluate the use of magnetic resonance imaging in acute setting in patients presenting with suspected scaphoid fracture.

    Science.gov (United States)

    Rua, Tiago; Vijayanathan, Sanjay; Parkin, David; Goh, Vicky; McCrone, Paul; Gidwani, Sam

    2017-12-01

    Background Wrist injury is a common presentation to the Emergency Department in the United Kingdom. Among these injuries, the scaphoid is the most common fractured carpal bone. However, given the limited ability of conventional radiography to accurately diagnose a suspected scaphoid fracture on presentation, its diagnosis and management remain challenging. Despite the vast clinical evidence supporting the superior accuracy of magnetic resonance imaging, there is little to no evidence around the real-world clinical and economic impact of immediate magnetic resonance imaging in the management of suspected scaphoid fractures. Methods Review of design and implementation challenges associated with the identification and subsequent recruitment of eligible patients, implementation of a novel clinical pathway in an acute setting, rationale behind the primary and secondary outcomes selected and measurement of the primary outcome. Results The Scaphoid Magnetic Resonance Imaging in Trauma trial is a single-site prospective, randomised, non-blinded, parallel design trial that aims to evaluate the use of immediate magnetic resonance imaging in the management of patients presenting to the acute setting with suspected scaphoid fractures. The primary outcome is the total 3-month cost per patient associated with the diagnosis and treatment of suspected scaphoid fractures. It is hypothesised that the immediate use of magnetic resonance imaging, a more accurate but expensive imaging modality, in patients with negative findings in the initial four-view radiography, will reduce the overall National Health Service costs by promoting definitive care and avoiding unnecessary diagnostic and treatment procedures. Other rationale design considerations in the recruitment, randomisation, data acquisition and intervention implementation are also discussed. Several of these challenges derive from real-world operational issues associated with the provision of magnetic resonance imaging in an

  3. Feasibility and safety of treating non-unions in tibia, femur and humerus with autologous, expanded, bone marrow-derived mesenchymal stromal cells associated with biphasic calcium phosphate biomaterials in a multicentric, non-comparative trial.

    Science.gov (United States)

    Gómez-Barrena, Enrique; Rosset, Philippe; Gebhard, Florian; Hernigou, Philippe; Baldini, Nicola; Rouard, Helène; Sensebé, Luc; Gonzalo-Daganzo, Rosa M; Giordano, Rosaria; Padilla-Eguiluz, Norma; García-Rey, Eduardo; Cordero-Ampuero, José; Rubio-Suárez, Juan Carlos; Stanovici, Julien; Ehrnthaller, Christian; Huber-Lang, Markus; Flouzat-Lachaniette, Charles Henri; Chevallier, Nathalie; Donati, Davide Maria; Ciapetti, Gabriela; Fleury, Sandrine; Fernandez, Manuel-Nicolás; Cabrera, José-Rafael; Avendaño-Solá, Cristina; Montemurro, Tiziana; Panaitescu, Carmen; Veronesi, Elena; Rojewski, Markus Thomas; Lotfi, Ramin; Dominici, Massimo; Schrezenmeier, Hubert; Layrolle, Pierre

    2018-03-19

    ORTHO-1 is a European, multicentric, first in human clinical trial to prove safety and feasibility after surgical implantation of commercially available biphasic calcium phosphate bioceramic granules associated during surgery with autologous mesenchymal stromal cells expanded from bone marrow (BM-hMSC) under good manufacturing practices, in patients with long bone pseudarthrosis. Twenty-eight patients with femur, tibia or humerus diaphyseal or metaphyso-diaphyseal non-unions were recruited and surgically treated in France, Germany, Italy and Spain with 100 or 200 million BM-hMSC/mL associated with 5-10 cc of bioceramic granules. Patients were followed up during one year. The investigational advanced therapy medicinal product (ATMP) was expanded under the same protocol in all four countries, and approved by each National Competent Authority. With safety as primary end-point, no severe adverse event was reported as related to the BM-hMSC. With feasibility as secondary end-point, the participating production centres manufactured the BM-hMSC as planned. The ATMP combined to the bioceramic was surgically delivered to the non-unions, and 26/28 treated patients were found radiologically healed at one year (3 out of 4 cortices with bone bridging). Safety and feasibility were clinically proven for surgical implantation of expanded autologous BM-hMSC with bioceramic. EU-FP7-HEALTH-2009, REBORNE Project (GA: 241876). Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  4. Proximal Row Carpectomy for Coexisting Kienböck’s Disease and Giant Intraosseous Ganglion of the Scaphoid: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Miguel Morón

    2014-01-01

    Full Text Available The etiologies of Keinböck’s disease and intraosseous ganglion remain unknown. Both entities are rare and the coexistence of these two pathologies in the same patient and hand is even less frequent. We report the case of a 40-year-old man with a longstanding history of martial arts practice (karate who developed an avascular necrosis of the lunate concomitant with a giant intraosseous ganglion of the scaphoid bone successfully managed by proximal row carpectomy. We review the literature of these two diseases.

  5. The treatment of scaphoid nonunion using the Ilizarov fixator without bone graft, a study of 18 cases

    Directory of Open Access Journals (Sweden)

    Bumbaširević Marko

    2011-11-01

    Full Text Available Abstract Objectives Evaluating the safety and efficacy of the Ilizarov fine-wire compression/distraction technique in the treatment of scaphoid nonunion (SNU, without the use of bone graft. Design A retrospective review of 18 consecutive patients in one centre. Patients and Methods 18 patients; 17 males; 1 female, with a mean SNU duration of 13.9 months. Patients with carpal instability, humpback deformity, carpal collapse, avascular necrosis or marked degenerative change, were excluded. Following frame application the treatment consisted of three stages: the frame was distracted 1 mm per day until radiographs showed a 2-3 mm opening at the SNU site (mean 10 days; the SNU site was then compressed for 5 days, at a rate of 1 mm per day, with the wrist in 15 degrees of flexion and 15 degrees of radial deviation; the third stage involved immobilization with the Ilizarov fixator for 6 weeks. The technique is detailed herein. Results Radiographic (CT and clinical bony union was achieved in all 18 patients after a mean of 89 days (70-130 days. Mean modified Mayo wrist scores improved from 21 to 86 at a mean follow-up of 37 months (24-72 months, with good/excellent results in 14 patients. All patients returned to their pre-injury occupations and levels of activity at a mean of 117 days. Three patients suffered superficial K-wire infections, which resolved with oral antibiotics. Conclusions In these selected patients this technique safely achieved bony union without the need to open the SNU site and without the use of bone graft.

  6. Pseudoartrose do tubérculo do escafoide em esqueleto imaturo: relato de caso Pseudarthrosis of the tubercle of the scaphoid bone in immature skeleton: case report

    Directory of Open Access Journals (Sweden)

    Eduardo Amaral Gomes

    2012-01-01

    Full Text Available O presente estudo tem o objetivo de apresentar um relato de caso sobre pseudoartrose do tubérculo do escafoide, patologia que acomete uma população jovem e ativa, que se desenvolve muitas vezes em decorrência à falha no diagnóstico precoce e início tardio de tratamento. O relato descreve o caso de um paciente de 15 anos com histórico de fratura negligenciada do tubérculo do escafoide há um ano evoluindo para pseudoartrose do tubérculo, uma localização pouco usual para este tipo de complicação. O diagnóstico foi dado pela história clínica e exame radiográfico. O tratamento foi realizado segundo a técnica de Matti-Russe, por via volar, evitando a lesão da vascularização do escafoide, com boa evolução clínica e radiográfica. A pseudoartrose do tubérculo do escafoide é a uma condição rara decorrente de fratura em local incomum no osso escafoide tendo a sua importância pelo fato de afetar uma população jovem e ativa. O diagnóstico correto raramente é feito no momento da fratura por radiologistas ou cirurgiões, devido principalmente à falha em reconhecer essa entidade. Esse equívoco atrasa e dificulta o tratamento das complicações decorrentes deste tipo de fratura, sendo essencial considerar essa lesão em diagnósticos diferenciais para evitar condutas equivocadas. O tratamento escolhido se mostrou uma opção eficaz neste caso específico.The aim of this study was to present a case report on pseudarthrosis of the scaphoid tubercle, a pathological condition that affects the young and active population. This entity often develops as a result of failure to make an early diagnosis and a late start to treatment. This report describes the case of a 15-year-old patient with a history of a neglected fracture of the scaphoid tubercle that occurred one year earlier and evolved to pseudarthrosis of the tubercle, which is an unusual location for this type of complication. The diagnosis was made from the clinical history

  7. MX Missile MOA Between Four Corners Regional Commission and the United States Air Force.

    Science.gov (United States)

    1981-08-20

    rodents, the genus ofthe porcupine is mis spelled. Under carnivores, the specific name of the grey fox is misspelled. li I SPAGE PARAGRAPH SENTENCE...to Native Ameri- can people. Request: plan of operation that would Include equity in dispersal of funds to Native American peoples and tribal govern

  8. 40 CFR 49.23 - Federal Implementation Plan Provisions for Four Corners Power Plant, Navajo Nation.

    Science.gov (United States)

    2010-07-01

    ... be used as audit standards. (7) Nothing herein shall limit EPA's ability to ask for a test at any... systems (CEMS) software as required in this section, compliance with the emissions limits set for SO2 and... software which complies with the requirements of this section. The owner or operator of the Plant may...

  9. Uso da placa onda no tratamento das fraturas diafisárias do fêmur não consolidadas The wave plate method in non union femoral shaft fractures treatment

    Directory of Open Access Journals (Sweden)

    Silvia Regina Nogueira Jorge

    2006-01-01

    Full Text Available Estudou-se retrospectivamente 25 pacientes com fratura diafisária do fêmur não consolidadas e que foram tratados com placa onda. A consolidação ocorreu em 96% dos pacientes num tempo médio de 5,32 meses, variando entre três e sete meses. Vinte e um pacientes (84% foram considerados como resultados excelentes e bons nos critérios de avaliação final. O método de tratamento não ocasionou diferença no comprimento dos membros. Não ocorreram desvios rotacionais. O arco de movimento dos quadris e joelhos não foi acometido, embora em quatro pacientes (16% tenha-se encontrado limitação na flexão do joelho, esta era prévia ao tratamento com placa onda. Dois pacientes (8% tiveram infecção profunda durante o tratamento com a placa onda, recidiva de processo infeccioso prévio. Houve soltura da placa no nono mês de pós-operatório em um paciente (4%, embora tenha havido a consolidação óssea. Em outro paciente (4% a placa onda quebrou um ano e dois meses após a cirurgia, tendo-se trocado a primeira por outra placa onda e posterior consolidação. Mesmo assim, considerou-se falha do método. A placa onda é uma opção de tratamento das fraturas do fêmur não consolidadas pelas suas propriedades biomecânicas favoráveis à consolidação óssea, conferindo estabilidade sem prejudicar o suprimento sangüíneo, com características de síntese biológica.Twenty-five patients with non union femoral diaphyseal fractures treated with the wave plate method were retrospectively studied. Union was achieved in 24 patients (96% in an average time of 5.32 months, ranging from three to seven months. We observed excellent and good results in 21 patients (84% in the endpoint evaluation. This treatment approach didn't cause leg-length discrepancy. No rotational deviations were seen. The range of motion of hips and knees was not affected, although in four patients (16% knee flexion restraint was found, but previously to the wave plate treatment

  10. MRT of scaphoid pseudo-arthrosis using Gd-DTPA. Staging and clinical correlation; MRT der Skaphoidpseudarthrose mit Gd-DTPA. Stadieneinteilung und klinische Korrelation

    Energy Technology Data Exchange (ETDEWEB)

    Vogl, T.J. [Freie Univ. Berlin (Germany). Strahlenklinik und Poliklinik; Beutel, F. [Freie Univ. Berlin (Germany). Strahlenklinik und Poliklinik; Wilhelm, K. [LMU Muenchen (Germany). Abt. fuer Handchirurgie; Tempka, A. [Freie Univ. Berlin (Germany). Klinik fuer Unfall- und Wiederherstellungschirurgie; Schedel, H. [Freie Univ. Berlin (Germany). Strahlenklinik und Poliklinik; Haas, R. [Freie Univ. Berlin (Germany). Strahlenklinik und Poliklinik; Felix, R. [Freie Univ. Berlin (Germany). Strahlenklinik und Poliklinik

    1994-11-01

    During a period of two years, 134 patients with pseudo-arthrosis of the scaphoid were examined by conventional radiography and by MRI in the course of a prospective study. The aim of the study was to define radiological staging using contrast enhanced MRI in order to improve the prognostic criteria. All MRI examinations were carried out with a 1.5 Tesla scanner (SP63) using a surface coil and T{sub 1} weighted spin echo sequences in sagittal and frontal projection and frontal FLASH T{sub 2}-sequences and axial spin echo T{sub 2} sequences. The T{sub 1} weighted SE sequences in frontal projection were carried out before and after iv contrast (0.1 mmol Gd-DTPA/kg KG). All sequences were compared with conventional radiographs and the operative findings. Eight patients in stage 0 showed high signal intensity of both fragments in T{sub 1} weighted SE sequences and at surgery there was good vascularisation. In 22 cases there was reduced signal intensity in at least one fragment (stage I). 45 patients with scaphoid pseudo-arthrosis showed complete signal loss but marked contrast uptake with still vital nuclei at surgery (stage II). In 22 patients, there was no increase in signal intensity after contrast and complete loss of vitality of the fragments at surgery. Staging was not possible in 37 patients because of previous operative intervention. The use of contrast enhanced MRI provides additional information compared with conventional radiography or plain MRI. (orig.) [Deutsch] Im Rahmen einer prospektiven Studie wurden in einem Zeitraum von 2 Jahren 134 Patienten mit einer Skaphoidpseudarthrose (SPA) vergleichend konventionell roentgenologisch und magnetresonanztomographisch untersucht. Ziel der Studie war die Erstellung einer klinisch radiologischen Stadieneinteilung mit Hilfe der kontrastverstaerkten MRT zur Verbesserung von Prognosekriterien. Alle MRT-Untersuchungen wurden an einem 1,5 Tesla-Geraet (SP63) mittels einer Oberflaechenspule unter Verwendung von T{sub 1

  11. Four-Corner Arthrodesis Versus Proximal Row Carpectomy: A Retrospective Study With a Mean Follow-Up of 17 Years

    NARCIS (Netherlands)

    Berkhout, Merel J. L.; Bachour, Yara; Zheng, Kang He; Mullender, Margriet G.; Strackee, Simon D.; Ritt, Marco J. P. F.

    2015-01-01

    To compare the long-term outcomes of proximal row carpectomy (PRC) and 4-corner arthrodesis (FCA) in a consecutive series of patients surgically treated between 1989 and 1998 in a single teaching hospital. We included 12 patients (14 wrists) in the PRC group and 8 patients (8 wrists) in the FCA

  12. Four-Corner Arthrodesis Versus Proximal Row Carpectomy. A Retrospective Study With a Mean Follow-Up of 17 Years

    NARCIS (Netherlands)

    Berkhout, M.J.L.; Bachour, Y.; Zheng, K.H.; Mullender, M.G.; Strackee, S.D.; Ritt, M.J.P.F.

    2015-01-01

    Purpose To compare the long-term outcomes of proximal row carpectomy (PRC) and 4-corner arthrodesis (FCA) in a consecutive series of patients surgically treated between 1989 and 1998 in a single teaching hospital. Methods We included 12 patients (14 wrists) in the PRC group and 8 patients (8 wrists)

  13. Gaseous Oxidized Mercury Dry Deposition Measurements in Southwestern USA: Comparison between texas, Eastern Oklahoma, and the Four Corners Area

    Science.gov (United States)

    Gaseous oxidized mercury (GOM) dry deposition measurements using aerodynamic surrogate surface passive samplers were collected in central and eastern Texas and eastern Oklahoma, from September 2011 to September 2012.The purpose of this study was to provide an initial characteriza...

  14. MR imaging of scaphoid fractures

    DEFF Research Database (Denmark)

    Meincke, Louise; Radev, Dimitar; Eriksen, Rie Østbjerg

    2017-01-01

    the importance of early MRI and hereby predict bone bruise with the help of fat suppression sequence; however, only a limited selection articles compares various fat suppression techniques. The purpose of this prospective study was to compare the short tau inversion recovery (STIR) and T2 fat saturation (FAT SAT...

  15. Outcome of Management of Humerus Diaphysis Non-union This ...

    African Journals Online (AJOL)

    jen

    which resolved within 8 weeks post surgery following physiotherapy, while 2 patients had persistent extension deficit of more than 40° and one had elbow stuck at 90° flexion. Complications experienced include iatrogenic injury to the radial nerve occurred in 3 patients. These patients had neuropraxia: one recovered fully in ...

  16. The Productivity Effect of Non-Union Representation

    OpenAIRE

    Mueller, Steffen

    2009-01-01

    Declining union density in many industrialized countries directs attention to alter- native ways of labor relations and worker representation as, e.g., works councils. German works councils belong to the most powerful worker representations in de- veloped countries but little is known of their causal effect on productivity. A large linked employer-employee panel is used to examine this issue. Comparing firms with and without a works council I find that firms with a works council are on averag...

  17. Outcome of management of humerus diaphysis non-union | Sitati ...

    African Journals Online (AJOL)

    Background: The majority of diaphyseal humerus fractures heal uneventfully when treated nonoperatively, however, nonunion is not a rare event. Nonunion after conservative treatment can be successfully treated by open reduction and internal fixation. A nonunion of a diaphyseal fracture of the humerus can present a ...

  18. Valores de vitamina D en fracturas no consolidadas. [Vitamin D levels in non-union fractures].

    Directory of Open Access Journals (Sweden)

    Leandro Ariel Salcedo Zunino

    2016-08-01

    Full Text Available Introducción: La falta de consolidación de una fractura es generalmente un fenómeno multifactorial. Objetivo: Estimar valores de referencia de Vitamina D (25 OH D3 en fracturas que no consolidaron, estudiar su asociación con la edad y la localización de la cirugía. Materiales y Métodos: Se realizó un estudio prospectivo, observacional y descriptivo, en el cual se evaluaron 29 pacientes (26 hombres y 3 mujeres  con no-consolidaciones. El dosaje de los niveles séricos de Vitamina D (25 OH D3 fue llevado a cabo junto con estudios prequirúrgicos. Fueron estimados modelos generalizados para la estimación de los efectos de edad y localización y detección de grupos de pacientes con niveles inferiores al valor recomendado. Resultados: El 68,9% de los pacientes presentó un dosaje promedio de los niveles séricos de Vitamina D menor al valor normal de 30,0 ng/mL, el cual estuvo asociado inversamente con la edad, siendo 40 años el punto de corte a partir del cual otras características, como la localización de la cirugía (en huesos que afectan a los miembros inferiores, condiciona conjuntamente la no consolidación. Conclusión: La mayoría de los pacientes que evolucionaron hacia la no-consolidación de sus fracturas tuvieron deficiencia de vitamina D y este fenómeno es marcado a partir de los 40 años de edad. Es importante identificar a los pacientes con mayor riesgo de presentar este déficit en las primeras etapas del tratamiento de sus fracturas, ya el aporte de este micronutriente es aspecto reconocido para la disminución del riesgo de la evolución de estas fracturas hacia la no-consolidación.

  19. A Comparative Study of Principal Turnover in Union and Non-Unionized School Districts in Ohio

    Science.gov (United States)

    Hawthorne-Clay, Suszanne A.

    2010-01-01

    This study compares the succession of urban principals working under negotiated collective bargaining agreements and conferred "memorandums of understanding" with particular school boards in three of Ohio's major cities: Cincinnati, Cleveland, and Toledo. Relying on the following information: tenure, licensure status, professional…

  20. Projected Cropping Patterns, Livestock Enterprises, Processing Activities, Capital Requirements, Employment, Income, and Training Needs for Alternative Farm Organizational Structures for the Navajo Indian Irrigation Project. A Special Report to the Four Corners Regional Commission.

    Science.gov (United States)

    Gorman, William D.; And Others

    Information on the expected cropping patterns, livestock enterprises, processing and related activities, income and employment opportunities, capital needs, and training requirements for alternative farm organizational structures that could be selected for development of the Navajo Indian Irrigation Project is presented in this report. The major…

  1. The Seminole Serpent Warrior At Miramar, FL, Shows Settlement Locations Enabled Environmental Monitoring Reminiscent Of the Four-corners Kokopelli-like EMF Phenomena, and Related to Earthquakes, Tornados and Hurricanes.

    Science.gov (United States)

    Balam Matagamon, Chan; Pawa Matagamon, Sagamo

    2004-03-01

    Certain Native Americans of the past seem to have correctly deduced that significant survival information for their tradition-respecting cultures resided in EMF-based phenomena that they were monitoring. This is based upon their myths and the place or cult-hero names they bequeathed us. The sites we have located in FL have been detectable by us visually, usually by faint blue light, or by the elicitation of pin-like prickings, by somewhat intense nervous-system response, by EMF interactions with aural electrochemical systems that can elicit tinitus, and other ways. In the northeast, Cautantowit served as a harbinger of Indian summer, and appears to be another alter ego of the EMF. The Miami, FL Tequesta site along the river clearly correlates with tornado, earthquake and hurricane locations. Sites like the Mohave Deserts giant man may have had similar significance.

  2. Order Granting the Petition to Object to Williams Four Corners, LLC - Sims Mesa Central Delivery Point natural gas processing plant and compressor station, Rio Arriba County, New Mexico, Title V Operating Permit

    Science.gov (United States)

    This document may be of assistance in applying the Title V air operating permit regulations. This document is part of the Title V Petition Database available at www2.epa.gov/title-v-operating-permits/title-v-petition-database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

  3. Petition to Object to the Williams Four Corners, LLC - Sims Mesa Central Delivery Point natural gas processing plant and compressor station, Rio Arriba County, New Mexico, Title V Operating Permit

    Science.gov (United States)

    This document may be of assistance in applying the Title V air operating permit regulations. This document is part of the Title V Petition Database available at www2.epa.gov/title-v-operating-permits/title-v-petition-database. Some documents in the database are a scanned or retyped version of a paper photocopy of the original. Although we have taken considerable effort to quality assure the documents, some may contain typographical errors. Contact the office that issued the document if you need a copy of the original.

  4. [Treatment results of aseptic non-unions of long bones with medullary canal reaming followed by intramedullary nailing].

    Science.gov (United States)

    Panasiuk, Michał; Kmieciak, Marek

    2004-01-01

    This paper presents results of treatment of 46 consecutive patients with pseudoarthroses of the long bones treated with closed intramedullary reaming followed by intramedullary nailing. There were 22 nonunions of the tibia, 15 of the femur, 3 of the humerus and 6 of the forearm. The union occurred in 40 cases, among them in 3 of 4 treated atrophic, that gives 87% success. None of treated pseudoarthrosis of the humerus united.

  5. Treatment of infected non union tibia: A novel technique - lengthening using limb reconstruction system over intramedullary nail

    Directory of Open Access Journals (Sweden)

    Mahantesh Y Patil

    2013-01-01

    Full Text Available Background: To assess combination of an intramedullary interlocking (IMIL nail with limb reconstruction system (LRS in cases of infected nonunion tibia and to show influence of nail in predicting good outcome. Materials and Methods: From 2009 to 2011, records of 20 patients (17 men and three women aged 18 to 65 years (mean, 38.4 years with infected nonunion of the tibia treated with the LRS over IMIL Nail technique were prospectively reviewed. According to Jain et al., patients were classified into five cases of A1, five cases of type A2, seven cases of type B1, and three cases of type B2. All cases underwent LRS and IMIL. Mean amount of target lengthening was 54.65 mm. The mean follow-up was 14 months. Results: Mean amount of tibia lengthening was 51.70 mm. Leg length equalization was achieved in 19 cases (±5. According to modified scoring by Paley et al., 12 patients had excellent results, three patients had good, four patients had fair outcome, and one patient had poor outcome. Mean distraction index was 0.97. Mean maturation index was 2.43. Mean consolidation index was 3.47. Mean healing index was 1.40. One case had proximal locking screw failure. One case developed pre mature consolidation as distraction was started at delayed period due to non-compliance. Two cases developed decreased dorsi flexion of ankle. Two cases required flap surgeries for cover of bone. One case had pin breakage, which had to be exchanged. One case developed re-infection. Conclusion: The advantages of this technique include complete eradication of infective foci, reduced risk of deformity during lengthening, decrease risk of fractures post external fixator removal and reduction of time required for external fixator use thus decreasing healing index: Number of days of external fixation required per centimetre of lengthening.

  6. Ilizarov methodology for infected non union of the Tibia: Classic circular transfixion wire assembly vs. hybrid assembly

    Directory of Open Access Journals (Sweden)

    Baruah Ranjit

    2007-01-01

    Full Text Available Introduction: Conventional wire fixation of Ilizarov rings often fails to provide 90-90 configuration because of vital structures, which is essential for optimum stability. Hybrid assembly with half pins is an alternative. The aim of this study is to compare the results of Hybrid assembly with that of conventional classic circular transfixion wire Ilizarov assembly in 50 cases of infected nonunion of tibia between 1994 and 2003. Materials and Methods: This study includes two groups with 25 patients in each group: Group (A conventional Ilizarov assembly and Group (B hybrid Ilizarov assembly. Thirty-five cases developed infected nonunion following road traffic accidents while others after fall (6 bullet injury (4, infected osteosynthesis (3 and assault (2. There were 45 males and five females with mean age (18 to 56 years. All active cases (n=28 were treated by debridement including removal of implants in infected osteosynthesis. Twenty out of 22 cases in the quiescent group (non draining for last three consecutive months were treated without open debridement; only two cases required open debridement for various reasons. All the cases were finally treated as atrophic aseptic nonunion with bone defect and were classified according to ASAMI. Type B1: length of the limb maintained with bone gap (14 cases in both Group A and B and Type B3: combined shortening with defect (five and seven cases in Group A and B respectively, were treated by bifocal osteosynthesis. Only one case in the B3 group was treated by trifocal osteosynthesis to shorten the time. Type B2: segments in contact with limb shortening (total nine cases; five and four cases in Group A and B respectively with shortening up to 2 cm (total five cases were treated with monofocal osteosynthesis while shortening up to 5 cm and beyond (total four cases were treated with bifocal osteosynthesis. Results: The cases were followed up for two to six years and the results were evaluated by Paley criteria of bony results ( union, infection, deformity and leg-length discrepancy and Functional Results (significant limp , equinus rigidity of the ankle, soft-tissue dystrophy, pain and inactivity . In both the groups, 24 cases out of 25, had excellent to good bony result with Group B having twice more excellent result than Group A. Functional results were found to be similar in both the groups. Although persistence of infection and Grade III pin tract infection (PTI were slightly higher in Group B, complications like delayed consolidation of regenerate, refracture, deformity and aneurysm of vessel were less in this group. Discussion and Conclusion: Ilizarov methodology produced a satisfactory result in infected nonunion of the tibia. Hybrid assembly was a fruitful advancement in the Ilizarov armamentarium. The results were comparable to Conventional assembly in terms of docking site problems, corticotomy site problems, PTIs and other problems.

  7. Tension Band Wiring Is As Effective As A Compression Screw In A Neglected, Medial Maleolus Non-Union: A Case-Based Discussion & Literature Review.

    Science.gov (United States)

    John, Rakesh; Dhillon, Mandeep Singh; Khurana, Ankit; Aggarwal, Sameer; Kumar, Prasoon

    2017-01-01

    Isolated, neglected medial malleolus nonunion cases are a rare entity in orthopedic literature. All studies (except one) have described the use of compression screws (with or without plates) for medial malleolar nonunion management. In acute fractures, tension band wiring (TBW) has shown excellent results both in biomechanical and in clinical studies. On the contrary, it has seldom been used in nonunion or in neglected cases. We describe a 6-month-old neglected medial malleolus gap nonunion case who presented with progressive pain and limp. TBW with a monoblock, inlay, tricortical, and iliac crest bone graft for the defect was performed. The fracture united within 12 weeks and patient went back to his normal work routine; on the latest follow-up at 3 years, the patient was asymptomatic with no clinicoradiologic signs of secondary osteoarthritis of the ankle joint. TBW may be better than screw fixation in the management of medial malleolus nonunion as it is technically straightforward and cost-effective, can provide equal or more compression than a screw; it does not damage the sandwiched inlay bone graft, and the amount of compression is surgeon-controlled. It is also more suitable for fractures with small distal fragments and/or osteoporosis.

  8. TO EVALUATE THE SURGICAL OUTCOME OF NON-UNION CLAVICLE USING PLATE AND SLIVERS OF AUTOLOGOUS ILIAC CREST CORTICOCANCELLOUS BONE GRAFT

    Directory of Open Access Journals (Sweden)

    Mohammed

    2016-03-01

    Full Text Available INTRODUCTION Clavicle fracture is one of the most common fracture presenting to the fracture clinic, accounting for about 5-10% of all the adult trauma reported but still the controversy exists with regards to the definitive management. AIM To evaluate the surgical outcome of nonunion clavicle in patients treated previously with surgical management or conservative management, using plate and slivers of autologous iliac crest corticocancellous bone. DESIGN Retrospective analysis of patients operated between May 2005 and February 2013 for nonunion of the clavicle. METHODS AND MATERIALS Twenty patients who were operated between May 2005 and February 2013 for nonunion of the clavicle at our hospital were recruited for our study and followup data was collected from our hospital records till their last outpatient visit. Inclusion criteria included patients with no evidence of radiological union, persistence of pain, cosmetic deformity, dysfunction or gross movement at the fracture site even after 16 weeks of conservative treatment or in cases of primary fixation failure. STATISTICAL ANALYSIS All Statistical analyses were made using Statistical Package Software for Social Sciences (SPSS version 17.0 software (Chicago, IL, USA for descriptive data. Chi2 test was used to compare the categorical data. RESULTS At the end of an average followup of 19 months, the average Visual Analogue Score for pain was 1.9±2.2 (range 0-6, the mean ASES score was 81±18.5 (51-100, and the mean Constant–Murley score was 80±17 (51-100. All the patients had a stable radiological union at the end of the followup period. There were no complications pertaining to the hardware or infection. CONCLUSION Treatment of nonunion of clavicle by using corticocancellous bone is well documented; however, use of iliac corticocancellous bone graft shaped in long slivers will give mechanical stability to the plate reconstruct in addition to providing a scaffold for new bone formation than just pieces of corticocancellous bone graft.

  9. Core curriculum illustration: trans-scaphoid volar perilunate fracture-subluxation.

    Science.gov (United States)

    Mann, F A; Gillespy, Thurman

    2015-02-01

    This is the 11th installment of a series that will highlight one case per publication issue from the bank of cases available online as part of the American Society of Emergency Radiology (ASER) educational resources. Our goal is to generate more interest in the use of our online materials. To view more cases online, please visit the ASER Core Curriculum and Recommendations for Study online at http://www.aseronline.org/curriculum/toc.htm .

  10. Reproducibility of X-rays and CT arthrography in SLAC, SNAC, SCAC wrists.

    Science.gov (United States)

    Belhaouane, R; Lebeau, N; Maes-Clavier, C; Hustin, C; Krief, E; Bonnaire, B; Warin, M; Rotari, V; David, E

    2016-12-01

    The purpose of this study was to assess the inter-observer and intra-observer reproducibility of the interpretation of CT arthrography and plain X-rays for scapholunate advanced collapse (SLAC), scaphoid non-union advanced collapse (SNAC) and scaphoid chondrocalcinosis advanced collapse (SCAC) wrist conditions, as well as the clinical relevance of these imaging modalities. The CT and X-rays images were reviewed twice in a blinded and randomized manner by two experienced orthopedic surgeons specialized in hand surgery, two orthopedic surgery residents and two experienced radiologists specialized in bone and joint imaging. Cohen's kappa and Fleiss' kappa coefficients were used to analyze the reproducibility of interpretation of the radiological examinations. With CT arthrography, the overall diagnosis was often a problem, in terms of both inter- or intra-observer reproducibility. The assessment of the joint line appeared to be fairly reproducible for each observer but was poorly reproducible between different observers. Plain X-rays are not sufficient to assess cartilage quality in degenerative wrist disease. CT arthrography is a reliable examination, but its interpretation is not always standardized. Diagnostic arthroscopy may be justified in doubtful cases. Copyright © 2016 SFCM. Published by Elsevier Masson SAS. All rights reserved.

  11. Residual non-union in a case of two and half year old child congenital pseudoarthrosis of ipsilateral tibia and fibula treated by intramedullary fixation with K-wire and allogeniccancellous strut graft: A case report

    Directory of Open Access Journals (Sweden)

    Siddaram N Patil, Sankar Rao P, Ranjith K Yalamanchili

    2013-04-01

    Full Text Available The pseudarthrosis usually develops during the first two years of life; however, there are reports of cases in which fractures developed before birth and reports of late-onset pseudarthrosis. There is a strong association between Congenital pseudoarthrosis and Type I neurofibromatosis. CPT develops in about 5.7% of patients with NF-I and 40% of patients with pseudoarthrosis were found to have NF-I. Main pathology is hyperplasia of fibroblasts with the formation of dense fibrous tissue at fracture site causing osteolysis, and persistence of pseudarthrosis. The difficulty in treating this condition occurs because of two factors. 1 Biologic: poor healing ability of the dysplastic segment of bone and 2 Mechanical: technical difficulty to fix small and osteopenic bone fragments in children without damaging the distal physis. A multitude of treatment protocols focusing on stimulating the healing process by using different bone grafting techniques were documented6. The graft materials most commonly used included osteoperiosteal graft, massive onlay graft, autogenous iliac crest bone graft, and vascularised bone graft.

  12. An Information-Centric Approach to Autonomous Trajectory Planning Utilizing Optimal Control Techniques

    Science.gov (United States)

    2009-09-01

    Dissertation Supervisor: I. Michael Ross i REPORT DOCUMENTATION PAGE Form Approved OMB No. 0704-0188 Public reporting burden for this collection of...Michael A. Hurni Approved by: ______________________ I. Michael Ross Professor of Mechanical and Astronautical Engineering...Figure 128a. Four Corners Scenario Trajectory (Snapshots)................................................197 Figure 128b . Four Corners Scenario

  13. Machining technique prevents undercutting in tensile specimens

    Science.gov (United States)

    Moscater, R. E.; Royster, D. M.

    1968-01-01

    Machining technique prevents undercutting at the test section in tensile specimens when machining the four corners of the reduced section. Made with a gradual taper in the test section, the width of the center of the tensile specimen is less than the width at the four corners of the reduced section.

  14. 76 FR 52946 - Clean Air Act Operating Permit Program; Petition for Objection to State Operating Permit for...

    Science.gov (United States)

    2011-08-24

    ... Sims Mesa Central Delivery Point (CDP) compressor station in northwestern Rio Arriba County, New Mexico... Williams Four Corners, LLC, Sims Mesa CDP Compressor Station AGENCY: Environmental Protection Agency (EPA... the Williams Four Corners, LLC, Sims Mesa CDP Compressor Station is available electronically at: http...

  15. Case report

    African Journals Online (AJOL)

    ebutamanya

    2015-06-17

    Jun 17, 2015 ... Abstract. Enchondroma represents a common bone tumor of the hand. The scaphoid is a rare location. We report the case of a scaphoid enchondroma presenting as chronic wrist pain following a relatively minor trauma. The diagnosis was suggested by radiological study and then confirmed by histological ...

  16. Luxation trans-scapho-lunaire associée à une fracture-luxation ...

    African Journals Online (AJOL)

    We report the case of a 21-year-old man who injured his right hand in a fall from his motorbike, causing a trans-scaphoid perilunate fracture-dislocation associated with vertical fracture of the pyramid (A and B). On day 2, patient underwent a bloody reduction (C) of disorganized carpal bones with osteosynthesis of scaphoid ...

  17. 76 FR 12731 - Proposed Consent Decree, Clean Air Act Citizen Suit

    Science.gov (United States)

    2011-03-08

    ...'') Mesa Central Delivery Point facility. Under the terms of the proposed consent decree, EPA has agreed to... Environment Department, Air Quality Bureau to Williams Four Corners LLC for the Sims Mesa Central Delivery...

  18. The Leadership Puzzle, Putting the Pieces Together

    OpenAIRE

    Nelson, Cindy

    2017-01-01

    This curriculum relates leadership to putting together a puzzle, including the five steps of leadership, understanding the value of each person in the leadership process/puzzle, learning the four corners of leadership: communication, commitment, cooperation, and character.

  19. Trends in lumber processing in the western United States. Part I: board foot Scribner volume per cubic foot of timber

    Science.gov (United States)

    Charles E. Keegan; Todd A. Morgan; Keith A. Blatner; Jean M. Daniels

    2010-01-01

    This article describes trends in board foot Scribner volume per cubic foot of timber for logs processed by sawmills in the western United States. Board foot to cubic foot (BF/CF) ratios for the period from 2000 through 2006 ranged from 3.70 in Montana to 5.71 in the Four Corners Region (Arizona, Colorado, New Mexico, and Utah). Sawmills in the Four Corners Region,...

  20. Two-stage bargaining with coverage extension in a dual labour market

    DEFF Research Database (Denmark)

    Roberts, Mark A.; Stæhr, Karsten; Tranæs, Torben

    2000-01-01

    in extending coverage of a minimum wage to the non-union sector. Furthermore, the union sector does not seek to increase the non-union wage to a level above the market-clearing wage. In fact, it is optimal for the union sector to impose a market-clearing wage on the non-union sector. Finally, coverage......This paper studies coverage extension in a simple general equilibrium model with a dual labour market. The union sector is characterized by two-stage bargaining whereas the firms set wages in the non-union sector. In this model firms and unions of the union sector have a commonality of interest...

  1. G7 BiSpherical Acetabular Shell PMCF Study

    Science.gov (United States)

    2017-11-22

    Rheumatoid Arthritis; Osteoarthritis; Noninflammatory Degenerative Joint Disease; Avascular Necrosis; Correction of Functional Deformity; Non-Union Fracture; Femoral Neck Fractures; Trochanteric Fractures

  2. Two-stage bargaining with coverage extension in a dual labour market

    DEFF Research Database (Denmark)

    Roberts, Mark A.; Stæhr, Karsten; Tranæs, Torben

    2000-01-01

    This paper studies coverage extension in a simple general equilibrium model with a dual labour market. The union sector is characterized by two-stage bargaining whereas the firms set wages in the non-union sector. In this model firms and unions of the union sector have a commonality of interest...... in extending coverage of a minimum wage to the non-union sector. Furthermore, the union sector does not seek to increase the non-union wage to a level above the market-clearing wage. In fact, it is optimal for the union sector to impose a market-clearing wage on the non-union sector. Finally, coverage...

  3. In vivo 3-dimensional analysis of stage III Kienböck disease: pattern of carpal deformity and radioscaphoid joint congruity.

    Science.gov (United States)

    Kawanishi, Yohei; Moritomo, Hisao; Omokawa, Shohei; Murase, Tsuyoshi; Sugamoto, Kazuomi; Yoshikawa, Hideki

    2015-01-01

    To examine 3-dimensional carpal alignment and radioscaphoid joint (RSJ) congruity among normal wrists and those with Lichtman stage III Kienböck disease or scapholunate dislocation (SLD). We conducted 3-dimensional analysis based on computed tomographic data to compare 10 wrists of stage III Kienböck disease (5 IIIa and 5 IIIb) with 5 normal wrists and 3 wrists with SLD. A markerless bone registration technique was used to investigate the 3-dimensional position of the scaphoid relative to the radius. To evaluate RSJ congruency, the inferred contact area between the scaphoid proximal pole and the distal radius was calculated from 3-dimensional bone models. The scaphoid position was not significantly different from normal wrists in stage IIIa Kienböck disease. Stage IIIb Kienböck disease was meaningfully associated with a flexed scaphoid and proximal translation of the centroid, but not dorsal translation of the scaphoid proximal pole, where RSJ congruity was preserved. With SLD, the scaphoid flexed to the same extent as that in stage IIIb Kienböck disease, and the proximal pole translated dorsally together with the capitate, producing RSJ incongruity. The patterns of carpal collapse differed between stage IIIb Kienböck disease and SLD in terms of RSJ congruity. Our study showed that stage IIIb Kienböck disease did not involve dorsal subluxation of the scaphoid proximal pole and that RSJ congruity was retained, unlike SLD. Our results suggest that carpal collapse in Kienböck disease is not associated with RSJ incongruity, which may explain why there are asymptomatic patients with Kienböck disease and carpal collapse. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  4. Teaching with Stories as the Content and Context for Learning

    Science.gov (United States)

    Vitali, Frances

    2016-01-01

    Undergraduate teacher education program students have the opportunity to work with diverse student populations in a local school district in the Four Corners Area in the Northwest part of New Mexico. The family oral history practicum is a way to connect theory and practice while recognizing the issue that language is not a neutral landscape. What…

  5. Playing with Wolves: An Interview with C. J. Rogers

    Science.gov (United States)

    American Journal of Play, 2010

    2010-01-01

    Since 1992 C. J. Rogers has lived with wolves and studied their societies at Raised by Wolves, a licensed, nonprofit research sanctuary situated in a high valley of New Mexico's Zuni Mountains, not far from the Four Corners. Rogers, who has taught at Northeastern Illinois University and Western New Mexico University, holds doctorates in both…

  6. RODENTIA: MURIDAE

    African Journals Online (AJOL)

    of the nest box and was often accompanied by a yawn or by licking the wall of the nest box. Stretching usually occurred on entering the nest box, with the adult moving from one corner to the next, stretching in all four corners. This is contrary to the situation found in. Gerbillurus (Stutterheim & Skinner 1973) where stretching ...

  7. 77 FR 62258 - Notice To Reopen and Extend the Scoping Comment Period for the Environmental Impact Statement for...

    Science.gov (United States)

    2012-10-12

    ... Enforcement Notice To Reopen and Extend the Scoping Comment Period for the Environmental Impact Statement for the Four Corners Power Plant and Navajo Mine Energy Project AGENCY: Office of Surface Mining... alternatives that we should consider in the planning and preparation of an environmental impact statement (EIS...

  8. 77 FR 51619 - Source Specific Federal Implementation Plan for Implementing Best Available Retrofit Technology...

    Science.gov (United States)

    2012-08-24

    ... Source Specific Federal Implementation Plan for Implementing Best Available Retrofit Technology for Four... Available Retrofit Technology for Four Corners Power Plant: Navajo Nation AGENCY: Environmental Protection...-fired power plant located on the Navajo Nation near Farmington, New Mexico, to achieve emissions...

  9. 75 FR 69373 - Source Specific Federal Implementation Plan for Implementing Best Available Retrofit Technology...

    Science.gov (United States)

    2010-11-12

    ... Federal Implementation Plan for Implementing Best Available Retrofit Technology for Four Corners Power... Available Retrofit Technology (BART) provision. The proposal was published in the Federal Register on... open houses and public hearings will occur in Shiprock, New Mexico on December 7, 2010, Farmington, New...

  10. 78 FR 21408 - Notice of Inventory Completion: U.S. Department of the Interior, Bureau of Indian Affairs...

    Science.gov (United States)

    2013-04-10

    ..., a kiva, and a pithouse located on one side of a crevice overlooked by a cliff. The architecture is... and the modern-day Pueblo tribes. Migration stories and oral histories specify the Four Corners area... preponderance of evidence, including archeology, architecture, material culture, oral traditions, and expert...

  11. A Debilitating Orthopaedic Complication following Corticosteroid Therapy for Polymyalgia Rheumatica

    Directory of Open Access Journals (Sweden)

    Paul Rai

    2014-01-01

    Full Text Available Avascular necrosis (AVN of the scaphoid secondary to corticosteroid use is a rare entity. Previous reports in the literature refer to chronic steroid intake. We report a case secondary to low dose, short term use. AVN has a multifactorial cellular and genetic aetiology and most frequently affects the femoral head. Diagnosis relies on a high index of suspicion and early magnetic resonance (MR scanning. Treatment options are similar to those of traumatic scaphoid nonunions and include vascularised bone grafting and scaphoid excision. Polymyalgia Rheumatica is a common condition and its treatment is led by corticosteroid use. Mild to moderate strengths are advocated. However in our report we show that even with small doses serious adverse effects can be encountered.

  12. Use of Pulsing Electromagnetic Fields for the Treatment of Pelvic Stress Fractures Among Female Soldiers

    National Research Council Canada - National Science Library

    Jones, D

    1995-01-01

    .... Pulsing electromagnetic fields (PEMFs)have been shown to speed the healing of non-union fractures and we have used them successfully to treat stress fractures in the lower limbs. All women at Ft...

  13. Annals of Pediatric Surgery - Vol 11, No 1 (2015)

    African Journals Online (AJOL)

    Prune belly syndrome with pouch colon with scaphoid megalourethra: A newer embryological and prognostic perspective · EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT. Saurabh Garge, Monika Bawa, Katragadda Lakshmi Narasimha Rao, 42-45 ...

  14. The MR trainer. Upper extremities. 2. rev. and enl. ed.; Der MR-Trainer. Obere Extremitaet

    Energy Technology Data Exchange (ETDEWEB)

    Breitenseher, Martin [Landesklinikum Waldviertel Horn (Austria). Inst. fuer Radiologie und Interventionelle Radiologie

    2016-05-01

    The MR (magnetic resonance) trainer covers the indications in NMR images of hands, elbows and shoulder, including fractures and instabilities at the wrist, tendon and ligament lesions, carpal tunnel syndrome, ulnar tunnel syndrome, scaphoid bone fracture, (posttraumatic) osteonecrosis, synovial lesions, luxations, osteocondrosis, soft tissue rumors and bone tumors. The book includes training tasks for each issue.

  15. Case report

    African Journals Online (AJOL)

    ebutamanya

    28 août 2015 ... (intra-osseous synovial cyst) Clinical and therapeutic aspect: case report. Chir Main. 2009 Feb; 28(1):37-41. PubMed |. Google Scholar. 10. Chantelot C, Laffargue P, Masmejean E, Peltier B, Barouk P,. Fontaine C. Fracture of the scaphoid carpal bone secondary to an intraosseous cyst: apropos of a case.

  16. On the history and definition of Preiser's disease

    NARCIS (Netherlands)

    Kallen, A. M.; Strackee, S. D.

    2014-01-01

    In 1910, Georg Preiser (1876-1913) described five cases of rarifying osteitis. Based on his imaging studies, he diagnosed post-traumatic avascular necrosis (AVN) of the scaphoid without any sign of primary fracture. This was followed by an article in 1911 in which Preiser related his findings to

  17. Images in medicine

    African Journals Online (AJOL)

    ebutamanya

    26 mars 2016 ... We report the case of a 21-year-old man who injured his right hand in a fall from his motorbike, causing a trans-scaphoid perilunate fracture-dislocation associated with vertical fracture of the pyramid. (A and B). On day 2, patient underwent a bloody reduction (C) of disorganized carpal bones with ...

  18. Is there a place for radionuclide bone scintigraphy in the ...

    African Journals Online (AJOL)

    ... shown the importance of bone scintigraphy in the detection of fractures in radiographnegative skeletal trauma.T-3 The early detection and immobilisation of fractures of the scaphoid are thought to be essential in preventing the disabling sequelae of avascular necrosis and pseudo-arthrosis,4 Several studies allude to the

  19. Evaluation and diagnosis of wrist pain: a case-based approach.

    Science.gov (United States)

    Shehab, Ramsey; Mirabelli, Mark H

    2013-04-15

    Patients with wrist pain commonly present with an acute injury or spontaneous onset of pain without a definite traumatic event. A fall onto an outstretched hand can lead to a scaphoid fracture, which is the most commonly fractured carpal bone. Conventional radiography alone can miss up to 30 percent of scaphoid fractures. Specialized views (e.g., posteroanterior in ulnar deviation, pronated oblique) and repeat radiography in 10 to 14 days can improve sensitivity for scaphoid fractures. If a suspected scaphoid fracture cannot be confirmed with plain radiography, a bone scan or magnetic resonance imaging can be used. Subacute or chronic wrist pain usually develops gradually with or without a prior traumatic event. In these cases, the differential diagnosis is wide and includes tendinopathy and nerve entrapment. Overuse of the muscles of the forearm and wrist may lead to tendinopathy. Radial pain involving mostly the first extensor compartment is commonly de Quervain tenosynovitis. The diagnosis is based on history and examination findings of a positive Finkelstein test and a negative grind test. Nerve entrapment at the wrist presents with pain and also with sensory and sometimes motor symptoms. In ulnar neuropathies of the wrist, the typical presentation is wrist discomfort with sensory changes in the fourth and fifth digits. Activities that involve repetitive or prolonged wrist extension, such as cycling, karate, and baseball (specifically catchers), may increase the risk of ulnar neuropathy. Electrodiagnostic tests identify the area of nerve entrapment and the extent of the pathology. Copyright © 2013 American Academy of Family Physicians.

  20. Images in medicine

    African Journals Online (AJOL)

    abp

    11 mars 2016 ... Vissage percutané rétrograde du scaphoïde. Retrograde percutaneous screwing of the scaphoid. Younes Mhammdi1,&, Berrada Mohamed Saleh1. 1Service de Traumatologie Orthopédie, Hopital Ibn Sina, CHU Rabat, Maroc. &Corresponding author: Younes Mhammdi, Service de Traumatologie ...

  1. Author Details

    African Journals Online (AJOL)

    Kigera, James. Vol 13, No 2 (2016) - Articles Distribution of Scaphoid Nutrient Foramina Abstract PDF · Vol 13, No 2 (2016) - Articles Semitendinosus Tendon for Solitary Use in Anterior Cruciate Ligament Reconstruction Abstract PDF · Vol 13, No 2 (2016) - Articles Dupuytren's Diathesis in an African Male Abstract PDF.

  2. ATLAS TileCal Sub-Module Production at UIUC - Production Submodule Photos (current)

    CERN Multimedia

    Errede, Steve

    2000-01-01

    Step 5 - Welding tacl_weld - Our Welder from Nucor (Tuscola, IL) tack-welds each of the four corners of the submodule. The submodule can then be safely lifted out of the stacking fixture by crane. Step 5 - WELDING tack_weld - Stan Lamb, our welder from Nucor (Tuscola, IL) tack-welds each of the four corners of the submodule. The submodule can then be safely lifted out of the stacking fixture by crane. Photo 9 - This is our handy Submodule Final Welding Jig designed and built by our very own Fred Cogswell. Photo 10 - A submodule being lowered into the welding jig for final welding. Photo 11 - Stan Lamb final-welds the submodule. The welding jig saves us an enormous amount of time, since the submodule can be easily be rotated by hand for each weld.

  3. CFD Investigation Of The Effect Of Tilt Angles To Flow And Combustion In A 120 Mw Gas-Fired Full Scale Industrial Boiler

    OpenAIRE

    Wisam Saad Azeez; Hasril Hasini; Zamri Yusoff

    2015-01-01

    Abstract Extensive Computational Fluid Dynamic simulations on combustion process in a 120 MW natural gas-fired industrial boiler have been performed. The boiler is of tangential system by which natural gas and air are fired into the furnace from its four corners at three different elevation levels. Fuel burners and air nozzles can be tilted in the range of 30.The simulation results show good prediction of temperature profile and distribution as compared to practical observation. The flow in...

  4. Brazilian World cup 2014: Terrorism, tourism, and social conflict

    OpenAIRE

    Tzanelli, R; Korstanje, M; Clayton, A

    2014-01-01

    The World cup transcends the interests of culture and nations worldwide. Every 4 years, delegations from the four corners of the world compete for a month. The mass tourist demand an event of this caliber generates prompts policy makers and tourism scholars to devote considerable time in planning in detail the infrastructure and service industry for the benefit of incomers. Unfortunately, in areas of the world plagued by political instability, some groups may use the media events to communica...

  5. Approach to valuing visual pollution from Western Electricity Production. [For Western Systems Coordinating Council area

    Energy Technology Data Exchange (ETDEWEB)

    Erickson, L.E.

    1977-02-01

    This paper outlines an approach to valuing visual pollution from electric power plants. The differences between public-good pollution externalities, such as these aesthetic damages, and other market failures are discussed. Approaches generally used to value externalities are briefly described. The approach used relies heavily on an earlier application of bidding games to estimate people's willingness to pay for abatement of emissions from the Four Corners fossil-fuel power plant in northwestern New Mexico. The results of these surveys were used here to estimate the value of visual pollution from electric power plants for residents of and visitors to the Four Corners Air Quality Control Region, as a function of power plant emissions in that region. The approach presented here for the Four Corners region is structured so that replication for other air quality control regions is relatively easy. Preliminary results of this procedure for all of the air quality control regions in the Western Systems Coordinating Council area are presented. Visual pollution damages from electric power plants to residents of and recreational visitors to these western regions are estimated to total more than $100 million annually by 1985. These damages are expected to occur unless additional pollution controls are implemented, even if these subject populations do not increase.

  6. Osteomedullography: for early diagnosis of the fracture healing, nonunion and avascular necrosis

    International Nuclear Information System (INIS)

    Kim, Y. C.; Lee, S. H.; Lee, Y. C.; Whang, I. S.; Kim, H. S.

    1981-01-01

    Complications of non-union and avascular necrosis during fracture healing process are the most important problem. Early detection of the evidence of non-union and avascular necrosis and follow-up study of fracture healing process will reduce complications and sequellae in fracture patients. Femoral neck and tibial shaft are the most important fracture sites where non-union and/or avascular necrosis are frequently developed. Osteomedullography was performed in 30 cases of fracture, 21 femoral neck, 8 tibial shafts and 1 talar neck, in the Department of Radiology of National Medical Center during the period from August 1977 to March 1981. The following results were obtained: 1. 16 patients of femoral neck fracture were performed osteomedullography once. Non-union showing no crossing vein through the fracture site was noted in 12 cases from 16 patients. 4 cases from the 12 patients of non-union showed decreased viability but 2 case revealed good viability of the femoral head. 1 case from 4 cases of good union of fracture showed no evidence of viability of the femoral head. 2. More than twice of osteomedullography were performed in 5 cases of femoral neck fracture, and crossing vein was not appeared in 4 cases at 3 weeks after fracture. 3 cases showed crossing veins at 6 weeks, and 1 case revealed evidence of avascular necrosis of the femoral head at 9 weeks. 3. In 8 cases of tibial shaft fracture, 4 cases were non-union. Another 4 cases revealed intraosseous veins crossing in fracture site or additional Kaski's osteomedullographic signs, indicating bony union. 4. One talar neck fracture showed bony union with decreased viability of the body on 12 month after fracture. 5. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing, non-union and avascular necrosis

  7. For early diagnosis of the fracture healing, nonunion and avascular necorsis

    International Nuclear Information System (INIS)

    Kim, Y. C.; Lee, S. H.; Lee, Y. C.; Whang, I. S.; Kim, H. S.

    1981-01-01

    Complications of non-union and avascular necrosis during fracture healing process are the most important problems. Early detection of the evidence of non-union and avascular necrosis and follow-up study of fracture healing process will reduce complications and sequellae in fracture patients. Femoral neck and tibial shaft are the most important fracture sites where non-union and/or avascular necorsis are frequently developed. Osteomedullography was performed in 30 cases of fracture, 21 femoral neck, 8 tibial shafts and 1 talar neck, in the Department of Radiology of national Medical Center during the period form August 1977 to March 1981. The following results were obtained: 1. 16 patients of femoral neck fracture were performed osteomedullography one. Non-union showing no crossing vein through the fracture site was noted in 12 cases from 16 patients. 4 cases from the 12 patients of non-union showed decreased viability but 2 case revealed good viability of the femoral head. 1 case from 4 case of good union of fracture showed no evidence of viability of the femoral head. 2. More than twice of osteomedullography were performed in 5 cases of femoral neck fracture, and crossing vein was not appeared in 4 cases at 3 weeks after fracture. 3 cases showed crossing veins at 6 weeks, and 1 case revealed evidence of avascular necrosis of the femoral head at 9 weeks. 3. In 8 cases of tibial shaft fracture, 4 cases were non-union. Another 4 cases revealed intraosseous veins crossing in fracture site or additional Kaski's osteomedullographic signs, indicating bony union. 4. One talar neck fracture showed bony union with decreased viability of the bony on 12 months after fracture. 5. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing, non-union and avascular necrosis

  8. Carpal instabilities and secondary degenerative changes due to lesions of the radiocarpal ligament complex

    International Nuclear Information System (INIS)

    Stabler, A.; Berger, H.; Lissner, J.

    1990-01-01

    This paper reports on trauma, rheumatoid arthritis, calcium pyrophosphate dihydrate crystal deposition (CPDD), neurologic disease, and beta 2 -microglobulin-related amyloid deposits in patients undergoing chronic hemodialysis that can lead to distinct lesions of the radiocarpal ligament complex, causing rotational subluxation of the scaphoid and ulnar translocation of the carpus. The clinical and radiologic findings were analyzed in 35 patients, examined from 1985 to 1989. Degenerative changes in rotational subluxation of the scaphoid develop in three steps. First there is osteoarthritis at the styloid process, then the degeneration progresses into the central midcarpal joint, and finally it progresses to the ulnar midcarpal joint. Despite different etiologies of ligament failure, the radiologic features are very similar, because the mechanism of degeneration is identical in posttraumatic, inflammatory, neurogenic, CPDD, or beta 2 -microglobulin-related instability. However, there are some distinct radiologic differences in relation to the primary cause of the ligament defect

  9. Case of bilateral Galeazzi fractures associated with dislocation of the right elbow.

    Science.gov (United States)

    Nanno, Mitsuhiko; Sawaizumi, Takuya; Takai, Shinro

    2011-01-01

    We report an unusual case of bilateral Galeazzi fractures associated with dislocation of the right elbow and fracture of the right scaphoid caused by a motorbike accident in a 32-year-old man. Bilateral radiuses were fixed with plates, and the right scaphoid was fixed with a screw after closed reduction of the right elbow. A satisfactory result was obtained with a return to work and no radiographic problems 7 years after surgery. The mechanism of the injury was thought to be a high-velocity fall on the outstretched hands combined with extreme pronation of the forearms and extension of the wrists and the elbows. This case had a favorable outcome following operative stabilization of the fracture-dislocations and early mobilization.

  10. Diagnostic imaging of the hand. 3. rev. and enl. ed.

    International Nuclear Information System (INIS)

    Schmitt, Rainer; Lanz, Ulrich

    2015-01-01

    The book on diagnostic imaging of the hand covers the following issues: projection radiography, cinematography, MRT and CR arthrography, arthroscopy, arteriography, skeleton scintiscanning, sonography, computerized tomography, magnetic resonance tomography, anatomy of forearm and carpus, anatomy of metacarpus and fingers, carpal function and morphometry, postoperative X-ray diagnostic, growing hand skeleton, normative variants, malformations and deformities, trauma of the distal forearm, lesions of the ulnocarpal complex (TFCC), scaphoid fractures, scaphoid arthrosis, fractures of other carpus bones, carpal luxations and luxation fractures, carpal instabilities, fractures of the metacarpalla, finger fractures, arthrosis deformans, enthesiopathies, sport induced soft tissue lesions, osteonecrosis, impingement syndromes, osteopenic skeletal diseases, metabolis diseases, crystal-induced osteoarthropaties, rheumatoid arthritis, spondyloarthritis, rheumatic fever, collagenoses, infective arthritis, osteomyelitis, soft tissue infections, cystoids bone lesions, skeletal tumors, soft tissue tumors, carpal tunnel syndrome, nerve compression syndrome, arterial perfusion disturbances, differential diagnostic tables on hand lesions.

  11. Diagnostic imaging of the hand. 3. rev. and enl. ed.; Bildgebende Diagnostik der Hand

    Energy Technology Data Exchange (ETDEWEB)

    Schmitt, Rainer [Herz und Gefaessklinik GmbH, Bad Neustadt (Germany). Klinik fuer Diagnostische und Interventionelle Radiologie; Lanz, Ulrich

    2015-07-01

    The book on diagnostic imaging of the hand covers the following issues: projection radiography, cinematography, MRT and CR arthrography, arthroscopy, arteriography, skeleton scintiscanning, sonography, computerized tomography, magnetic resonance tomography, anatomy of forearm and carpus, anatomy of metacarpus and fingers, carpal function and morphometry, postoperative X-ray diagnostic, growing hand skeleton, normative variants, malformations and deformities, trauma of the distal forearm, lesions of the ulnocarpal complex (TFCC), scaphoid fractures, scaphoid arthrosis, fractures of other carpus bones, carpal luxations and luxation fractures, carpal instabilities, fractures of the metacarpalla, finger fractures, arthrosis deformans, enthesiopathies, sport induced soft tissue lesions, osteonecrosis, impingement syndromes, osteopenic skeletal diseases, metabolis diseases, crystal-induced osteoarthropaties, rheumatoid arthritis, spondyloarthritis, rheumatic fever, collagenoses, infective arthritis, osteomyelitis, soft tissue infections, cystoids bone lesions, skeletal tumors, soft tissue tumors, carpal tunnel syndrome, nerve compression syndrome, arterial perfusion disturbances, differential diagnostic tables on hand lesions.

  12. Post Traumatic Avascular Necrosis of the Proximal Carpal Row--A Case Report.

    Science.gov (United States)

    Manohara, Ruben; Sebastin, Sandeep Jacob; Puhaindran, Mark Edward

    2015-10-01

    We report a case of avascular necrosis of the scaphoid, lunate and triquetrum in a young 21-year-old patient, after a purely ligamentous peri-lunate dislocation of the wrist. He presented with a Mayfield III peri-lunate dislocation after a road traffic accident and underwent an open reduction and internal fixation. Post-operatively, the scapho-lunate gap widened after removal of the temporary K-wires, and he gradually developed avascular necrosis of the scaphoid, lunate and triquetrum, and osteoarthritis of his wrist. We present this unusual case of simultaneous avascular necrosis of multiple carpal bones and discuss the possible risk factors and subsequent management plans for this complex injury. Our patient has no identifiable contributing factors to developing avascular necrosis. We suspect that the violence of the injury and surgery may have compromised the circulation, and advise caution when treating and counseling these patients pre-operatively.

  13. Role of muscles in the stabilization of ligament-deficient wrists.

    Science.gov (United States)

    Esplugas, Mireia; Garcia-Elias, Marc; Lluch, Alex; Llusá Pérez, Manuel

    2016-01-01

    This article reviews the results of a series of cadaver investigations aimed at clarifying the role of muscles in the stabilization of ligament-deficient wrists. According to these studies, isometric contraction of some forearm muscles induces midcarpal (MC) supination (ie, the abductor pollicis longus, extensor carpi radialis longus, and flexor carpi ulnaris), whereas other muscles induce MC pronation (ie, the extensor carpi ulnaris). Because MC supination implies tightening of the volar scaphoid-distal row ligaments, the MC supination muscles are likely to prevent scaphoid collapse of wrists with scapholunate ligament insufficiency. MC pronator muscles, by contrast, would be beneficial in stabilizing wrists with ulnar-sided ligament deficiencies owing to their ability to tighten the triquetrum-distal row ligaments. Should these laboratory findings be validated by additional clinical research, proprioceptive reeducation of selected muscles could become an important tool for the treatment of dynamic carpal instabilities. Copyright © 2016 Hanley & Belfus. Published by Elsevier Inc. All rights reserved.

  14. Measuring and comparing normal ear protrusion using computerized tomography

    International Nuclear Information System (INIS)

    Otsuka, Yasushi; Hosaka, Yoshiaki; Kiuchi, Tatsuya

    1998-01-01

    The normal external ears of 128 Japanese individuals (64 men and 64 women) were measured using the angle-measuring function of analytic software for computerized tomography (CT). The initial baseline for measurement was the orbitomeatal line (OM line); second measurements were taken 1 cm above the baseline (OM+1 cm), and third measurements 2 cm above the baseline (OM+2 cm). The sample was divided into two groups by sex (64 men and 64 women) and into three groups by age (20-39, 40-59, and 60+), and protrusion measurements for the three sections were compared by both sex and age. The results showed that males have larger auricular values (auricular concha cranial angle, auricular concha scaphoid angle, auricular cranial angle) than do females. In terms of age, the results showed that the auricular concha cranial angle becomes larger with increasing age, while the auricular concha scaphoid angle and auricular cranial angle become smaller with age. (author)

  15. Extranodal Rosai-Dorfman disease in a carpal bone

    Directory of Open Access Journals (Sweden)

    Kalpalata Tripathy

    2012-01-01

    Full Text Available We report a case of extranodal Rosai-Dorfman Disease (RDD of the scophoid in a 52-year old female. The patient presented with pain, swelling, and tenderness on deep palpation of the left wrist. Clinicoradiological diagnosis was osteomyelitis or tenosynovitis and curettage was performed on the lytic lesion over scaphoid to procure tissue. Diagnosis was made by histomorphology supported by immunostaining. The patient was managed conservatively with resolution of the lesion.

  16. Megalourethra associated with prune-belly syndrome.

    Science.gov (United States)

    Gökalp, A; Gültekin, E Y

    1993-01-01

    A 14-day-old male infant with megalourethra is presented because of the rarity of the anomaly and its association with prune-belly syndrome. The lax, wrinkled appearance of the abdomen, bilateral cryptorchidism and severe dilatation of the urinary system are features included in the classic triad of the prune-belly syndrome. Our patient had the scaphoid variety of megalourethra since the penis appeared elongated and floppy in the fusiform form.

  17. Is there a place for radionuclide bone scintigraphy in the ...

    African Journals Online (AJOL)

    1996-05-05

    May 5, 1996 ... Basil C. Vretlos, Bruce K. Adams,. John D. Knotlenbelt, Andrew Lee. Objective. To evaluate the role of ... Basil C. Yrettos, 1.1.8. CH.8., FACS. (HlIN.) Bruce K. Adams. M.B. CH..8.. M.MED. .... Table III lists details of 35 cases of non-scaphoid focal uptake visualised in 30 patients on scintigraphy. InjUries to.

  18. Transstyloid, transscaphoid, transcapitate fracture: a variant of scaphocapitate fractures.

    LENUS (Irish Health Repository)

    Burke, Neil G

    2014-01-01

    Transstyloid, transscaphoid, transcapitate fractures are uncommon. We report the case of a 28-year-old man who sustained this fracture following direct trauma. The patient was successfully treated by open reduction internal fixation of the scaphoid and proximal capitate fragment, with a good clinical outcome at 1-year follow-up. This pattern is a new variant of scaphocapitate fracture as involves a fracture of the radial styloid as well.

  19. Thumb Metacarpal Subsidence After Partial Trapeziectomy With Capsular Interposition Arthroplasty: A Biomechanical Study.

    Science.gov (United States)

    Salas, Christina; Mercer, Deana M; O'Mahony, Gavin; Love, James; LaBaze, Dukens; Moneim, Moheb S

    2016-12-01

    Background: In a cadaveric model, we evaluated thumb metacarpal subsidence, indicated by a decreased metacarpal-to-scaphoid distance, after 2 surgical procedures used to treat thumb carpometacarpal (CMC) osteoarthritis (OA): partial trapeziectomy with capsular interposition (PTCI), which involves removal of 2 mm of both the distal trapezium and base of the metacarpal; and total trapeziectomy with capsular interposition (TTCI). Methods: Nine matched pairs of cadaveric hands were randomly assigned to undergo either PTCI or TTCI. Preoperatively, physiologic forces were applied across the thumb CMC joint by loading 6 tendons, simulating lateral pinch. Anteroposterior radiographs were obtained, and the metacarpal-to-scaphoid distance on each image was estimated independently by 3 separate readers using customized software. A hand surgeon then performed the PTCI and TTCI procedures, and the measurements under loading were repeated. The results were assessed for interrater reliability. Mean values for metacarpal-to-scaphoid distance before and after the surgical procedures were compared. Results: Preoperatively, the metacarpal-to-scaphoid distance in the PTCI and TTCI groups was not significantly different. Postoperatively, metacarpal subsidence was significantly less in the PTCI group (17% compared with 34% for TTCI; P = .05). Conclusions: Metacarpal subsidence occurred after both PTCI and TTCI, but significantly less subsidence was observed after PTCI; thus, thumb length was better preserved. Previous research has shown an inverse correlation between maintenance of thumb length and overall Disabilities of the Arm, Shoulder, and Hand (DASH) score. A procedure for treating thumb CMC OA that preserves thumb length and minimizes disruption of stabilizing joint tissue may provide enhanced maintenance of thumb stability and improved patient outcomes.

  20. High-resolution MRI of the ulnar and radial collateral ligaments of the wrist.

    Science.gov (United States)

    Nozaki, Taiki; Wu, Wei Der; Kaneko, Yasuhito; Rafijah, Gregory; Yang, Lily; Hitt, Dave; Yoshioka, Hiroshi

    2017-12-01

    Background Accurate diagnosis of injuries to the collateral ligaments of the wrist is technically challenging on MRI. Purpose To investigate usefulness of high-resolution two-dimensional (2D) and isotropic three-dimensional (3D) magnetic resonance imaging (MRI) for identifying and classifying the morphology of the ulnar and radial collateral ligaments (UCL and RCL) of the wrist. Material and Methods Thirty-seven participants were evaluated using 3T coronal 2D and isotropic 3D images by two radiologists independently. The UCL was classified into four types: 1a, narrow attachment to the tip of the ulnar styloid (Tip); 1b, broad attachment to the Tip; 2a, narrow attachment to the medial base of the ulnar styloid (Base); and 2b, broad attachment to the Base. The RCL was also classified into four types: 1a, separate radioscaphoid and scaphotrapezial ligaments (RS + ST) with narrow scaphoid attachment; 1b, RS + ST with broad scaphoid attachment; 2a, continuous radio-scapho-trapezial ligaments (RST) with narrow scaphoid attachment; and 2b, RST with broad scaphoid attachment. The inter-observer reliability of these classifications was calculated. Results Type 1a was the most common of both collateral ligaments. Of UCL classifications, 31.4% were revised after additional review of multiplanar reconstruction (MPR) images from isotropic data. The inter-observer reliability of UCL classification was substantial (k = 0.62) without MPR, and almost perfect (k = 0.84) with MPR. The inter-observer reliability of RCL classification was almost perfect (k = 0.89). Anatomic delineation between the two sequences was not statistically different. Conclusion The UCL and RCL were each identified on high-resolution 2D and isotropic 3D MRI equally well. MPR allows accurate identification of the UCL attachment to the ulnar styloid.

  1. MRI findings of the wrist in patients with multiple osteonecrosis in large joints of the extremities

    Energy Technology Data Exchange (ETDEWEB)

    Saitoh, Shinobu; Ebata, Tatsuki; Abe, Kazuhiro [Chiba Univ. (Japan). School of Medicine; Imai, Katsumi; Rokkaku, Tomoyuki

    1998-02-01

    We evaluated MRI findings of the wrist in patients who had multiple osteonecrosis in the large joints of their extremities (hips, knees, shoulders, and ankles) and compared these with the clinical symptoms and radiographical findings. Sixty wrists of 30 patients (3 males and 27 females) with multiple osteonecrosis were studied. Subjects ranged in age from 16 to 59 years. Their primary diseases were SLE in 24 patients, alcoholic osteonecrosis in two, Sjoegren`s syndrome in one, dermatomyositis in one, leukemia in one, and MCTD in one patient. Using MRI, we found osteonecrosis in seven wrists of four patients. Lesions were seen in six scaphoids of three patients, in two lunates of two patients, and in one capitate. We noted a reduced range of motion in three of the seven wrists with osteonecrosis. Two of the seven complained at wrist pain at motion, although three wrists were symptom free. Radiographically, an abnormality was recognized in two of the seven wrists. Generally, osteonecrosis of the lunate (Kienboeck`s disease) is more frequent than that of the scaphoid (Preiser`s disease). However in the present series, we found a higher osteonecrosis rate of the scaphoid than the lunate, using MRI. The discrepancy can be explained by the vascularity. In 1986, Gelberman reported that the scaphoid, the capitate, and 8% of the lunate had either vessels entering only one surface or large areas of bone that were dependent on a single vessel. The present study is consistent with these anatomical features. In other words, the present results demonstrated that Kienboeck`s disease can be induced not only by a deficient blood supply but also by some additional factors. (author)

  2. Predicting Clinical Outcomes and Lost Work in Patients with Work-Related Upper Extremity Disorders

    Science.gov (United States)

    1998-02-13

    the controversy, a receut weIl-coaducted large-scale (&=7,651) meta -ana1ysis ofthe existing researeh on the relationsbip of chronic pain and financial...Berger, R. (1996), ’Clinica1l118D8p11lent ofcarpal tunnel syndrome: ~ ten year review.ofoutcomes. In Fisher, CD.., & Gitelson, R. (1983). A meta ...24-32. Monsivais, JJ., &: Scully, S. (1992). Rotary subluxation ofthe scaphoid resulting in persistent carpal tunnel syndrome. Journal ofHand

  3. [Middle field and low field magnetic resonance tomography in wrist injuries].

    Science.gov (United States)

    Happel, Brigitte; Breitenseher, M; Trattnig, S; Gäbler, Ch; Kukla, Ch; Rand, Th; Imhof, H; Lechner, G

    2002-01-01

    To evaluate the diagnostic value of magnet resonance imaging in comparison of a dedicated 0.2-T unit and a 1.0-T unit in patients with clinically suspected scaphoid fractures and other wrist fractures. In 20 patients (14 m/6 f) with clinically suspected scaphoid fractures and a normal six view radiographic exam, magnet resonance imaging was performed first with the dedicated 1.0-T unit and afterwards with the 0.2-T unit within 7 days after trauma. T1 weighted spin-echo, STIR and T2-weighted 3D GRE sequences were performed. The 0.2 Tesla dedicated system is inferior to the 1.0 Tesla unit concerning the outcome of the 3 examiners. Especially the areas of bone bruise showed different results: each examiner detected at least two more cases of bone bruise with the 1.0 Telsa unit, which could not be defined with the 0.2 Tesla unit. This study shows, how utmost sensitive magnet resonance imaging is referring to unremoved fractures of the scaphoid and to other wrist abnormalities. Results with the 0.2 Tesla dedicated system was inferior compared to the 1.0 Tesla unit.

  4. Use of Particulated Juvenile Articular Cartilage Allograft for Osteochondral Lesions of the Wrist.

    Science.gov (United States)

    Hess, Daniel E; Werner, Brian C; Deal, D Nicole

    2017-09-01

    Articular cartilage injuries are a common injury among young, active patients, and the most appropriate treatment for these injuries remains controversial. A promising new technology in the treatment of high-grade cartilage injuries is particulated juvenile articular cartilage (PJAC) allograft (DeNovo NT, Zimmer, Warsaw, Indiana). This has been shown to be successful in multiple joints including the knee, talus, and elbow. No studies or case reports exist in supporting or discouraging its use in injuries of the wrist, in specific, the scaphoid. The use of PJAC allograft is described for the treatment of an active 21-year-old male with an Outerbridge Grade IV chondral lesion on the proximal pole of his right scaphoid and right distal radius scaphoid facet who had failed conservative management. The patient was followed clinically and radiographically for 21 months. The patient had return to full sport (jujutsu) and full range-of-motion, both of which represented an improvement from his preoperative exam. Radiographically, the chondral lucency seen had decreased in size and was almost completely absent on radiographs after 21 months. The results of this case suggest that PJAC can be used safely and effectively in the wrist thereby potentially broadening the indications for its use.

  5. Casablanca Hotel: Witness a great accommodation and service

    OpenAIRE

    Gretchen Cepeda

    2018-01-01

    Let us first talk about how accommodating and helpful the staff of Casablanca Hotel was to every guest. Each was trained to provide a great service to each individual visiting the hotel, making sure that their stay would end up very satisfying to them. The staff can definitely help you with your needs while giving an amicable service. Every room at Casablanca Hotel also has enough space for guests to become comfortable around the four corners of a room. A huge group won’t be a probl...

  6. Stabilization of flow past a cylinder with rounded corners

    Science.gov (United States)

    Zhang, Wei; Samtaney, Ravi

    2015-11-01

    We present results of global linear stability analysis for flow past a cylinder in the low Reynolds number regime Re = 50 - 110 . The four corners of the square cylinder are rounded with a radius of curvature R+ = R / D in which R is the rounding radius and D is the cylinder diameter. Analysis is carried out for R+ = 0 . 00 (square cylinder with sharp corners) to R+ = 0 . 50 (circular cylinder) to investigate its effect on the stability characteristics of the flow. The results reveal that the flow may be stabilized by the rounding of the corners for Re Gene/P Shaheen at KAUST was utilized for the simulations.

  7. Portrait of a Contender: Corey Morris

    Directory of Open Access Journals (Sweden)

    Corey Morris

    2010-03-01

    Full Text Available “Language at Work – Bridging Theory and Practice” caught up with busy Corey Morris on a cold and rainy November day in Denmark. We had two main reasons for looking up Corey at his work. First, we knew that his work takes him to the four corners of the world of branding on a daily basis. Second, we were well aware that Corey would be the right person to ask questions as to where branding is going these days.

  8. Radium-226 in plants and substrates at inactive uranium mill sites in the southwestern United States

    International Nuclear Information System (INIS)

    Marple, M.L.; Potter, L.D.

    1982-01-01

    The uptake and translocation of contaminants from uranium mill tailings piles and other similar wastes could be an important transport mechanism of these contaminants into the environment. The content of Ra-226, the radionuclide of most concern in this context, was investigated in plants growing on inactive uranium mill tailings sites in Four Corners Region of the southwestern United States and in plants grown under greenhouse conditions with minimal surficial contamination. This study provides a basis for estimating intake levels for herbivores and for evaluating transfer coefficients

  9. Design and implementation of a fault tolerant vehicle controller - an active steering approach

    OpenAIRE

    Kokogias, Stefanos

    2015-01-01

    KTH has developed a novel Research Concept Vehicle (RCV) based on the concept of "autonomous corner modules". An autonomous corner module is basically a wheel with a built-in electric hub motor, and additional actuators to tilt and yaw the wheel. One module is attached at each of the four corners of a 'skateboard' chassis. The addition of a computer to command each corner module, and a battery, results in a vehicle with a completely electric drive train. This topology can provide major advant...

  10. A 20-DOF hybrid stress general shell element

    Science.gov (United States)

    Kang, David S.; Pian, Theodore H. H.

    1988-01-01

    A hybrid-stress general shell element is developed based on the Hellinger-Reissner principle modified for relaxed element compatibility conditions. The element is based on a thin-shell theory with Love-Kirchhoff hypothesis. It is of quadrilateral shape with only four corner nodes and five degrees of freedom per node. The geometry of the element is approximated through a cubic polynomial surface patch. Numerical examples consisting of torsion-loaded slit cylinder and pinched cylinders with open ends and rigid diaphragmed ends demonstrate excellent performance of the present element.

  11. Effectiveness of various non-steroidal anti-inflammatory drugs in ...

    African Journals Online (AJOL)

    healing, non-union and delay in reunion were more evident in those taking naproxen, indomethacin or flurbiprofen than in those taking piroxicam, ... roles played by NSAIDs in bone healing, pain, and management of inflammation. ..... alveolar bone healing: a histometric study in rats. J Appl. Oral Sci. 2010; 18(6): 630-634.

  12. Femoral nailing in adults : doctor and patient reported outcomes

    NARCIS (Netherlands)

    El Moumni, Mostafa

    2016-01-01

    The treatment of traumatic femoral shaft fractures using an unreamed nail is associated with good results. Both antegrade and retrograde unreamed nailing techniques result in high union rates and low rates of complications, such as non-union, deep infection and septic arthritis. These results are

  13. Management of long bone fractures using SIGN nail: experience ...

    African Journals Online (AJOL)

    ... bone fractures. The major challenges were seen in multiply injured patients with multiple fractures. Also patients that present after several years of injury with malunion and\\or non-union may pose some challenges in treatment using SIGN nail. Keywords: Sign, Intramedullary Nail, Image Intensifier, External Jig, Fractures ...

  14. Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial

    NARCIS (Netherlands)

    Stegeman, S.A.; Jong, M. de; Sier, C.F.M.; Krijnen, P.; Duijff, J.W.; Thiel, T.P. van; Rijcke, P.A. de; Soesman, N.M.; Hagenaars, T.; Boekhoudt, F.D.; Vries, M.R. de; Roukema, G.R.; Tanka, A.F.; Bremer, J. van den; Meulen, H.G. van der; Bronkhorst, M.W.; Dijkman, B.A. van; Zutphen, S.W. van; Vos, Dieuwke; Schep, N.W.; Eversdijk, M.G.; Olden, G.D.J. van; Brand, J.G. van den; Hillen, R.J.; Frolke, J.P.M.; Schipper, I.B.

    2011-01-01

    BACKGROUND: The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. Recent studies have presented a relatively high incidence of non-union and

  15. Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial

    NARCIS (Netherlands)

    Stegeman, S.A.; de Jong, M.; Sier, C.F.M.; Krijnen, P.; Duijff, J.W.; van Thiel, T.P.H.; de Rijcke, P.A.R.; Soesman, N.M.R.; Hagenaars, T.; Boekhoudt, F.D.; de Vries, M.R.; Roukema, G.R.; Tanka, A.F.K.; van den Bremer, J.; van der Meulen, H.G.W.M.; Bronkhorst, M.W.G.A.; van Dijkman, B.A.; van Zutphen, S.W.A.M.; Vos, D.I.; Schep, N.W.L.; Eversdijk, M.G.; van Olden, G.D.J.; van den Brand, J.G.H.; Hillen, R.J.; Frolke, J.P.M.; Schipper, I.B.

    2011-01-01

    Background: The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. Recent studies have presented a relatively high incidence of non-union and

  16. Displaced midshaft fractures of the clavicle: non-operative treatment versus plate fixation (Sleutel-TRIAL). A multicentre randomised controlled trial

    NARCIS (Netherlands)

    Stegeman, Sylvia A.; de Jong, Mireille; Sier, Cornelis F. M.; Krijnen, Pieta; Duijff, Jan W.; van Thiel, Tom P. H.; de Rijcke, Piet A. R.; Soesman, Nicolaj M. R.; Hagenaars, Tjebbe; Boekhoudt, Freek D.; de Vries, Mark R.; Roukema, Gert R.; Tanka, Andras F. K.; van den Bremer, Jephta; van der Meulen, Hub G. W. M.; Bronkhorst, Maarten W. G. A.; van Dijkman, Bart A.; van Zutphen, Stephan W. A. M.; Vos, Dagmar I.; Schep, Niels W. L.; Eversdijk, Martin G.; van Olden, Ger D. J.; van den Brand, Johan G. H.; Hillen, Robert Jan; Frölke, Jan Paul M.; Schipper, Inger B.

    2011-01-01

    The traditional view that the vast majority of midshaft clavicular fractures heal with good functional outcomes following non-operative treatment may be no longer valid for all midshaft clavicular fractures. Recent studies have presented a relatively high incidence of non-union and identified

  17. An evaluation of the effect of bone morphogenetic protein-2 in a ...

    African Journals Online (AJOL)

    There was progressive filling of osseous defects in group 1, which was total at the 16th week post-surgical (PS); group 2 dogs had radiographic non-union at the 16th PS week. It was concluded that BMP implanted with a hydroxyapatite carrier significantly enhanced the rate of cortical restoration of massive bone defects in ...

  18. Ultrasound stimulation of maxillofacial bone healing

    NARCIS (Netherlands)

    Schortinghuis, J; Stegenga, B; Raghoebar, GM; de Bont, LGM

    A substantial part of the maxillofacial surgery practice deals with maxillofacial bone healing. In the past decades, low-intensity ultrasound treatment has been shown to reduce the healing time of fresh fractures of the extremities up to 38%, and to heal delayed and non-unions up to 90% and 83%,

  19. USE OF ANTIBIOTIC CEMENT SPACERS/BEADS IN TREATMENT ...

    African Journals Online (AJOL)

    Background: Chronic musculoskeletal infection involving bone present a big challenge to orthopaedic surgeons. These include chronic osteomyelitis, septic non union and open fractures of long bones. Objective: The study was done to determine ... 'External fixators were applied after which antibiotic impregnated cement ...

  20. Bedside Split Thickness Skin Graft using a Safety Razor Blade: A ...

    African Journals Online (AJOL)

    Background: Orthopedic and Plastic surgeons deal with wounds on daily basis. Open fractures are prone to development of deep infections which may result in infected non-unions or chronic Osteomyelitis, the management of which are complicated. Split thickness skin graft done in the theatre is the standard means of ...

  1. Effects of radiation and surgery on healing of femoral fractures in a rat model.

    Science.gov (United States)

    Nicholls, Fred; Janic, Katarina; Filomeno, Paola; Willett, Thomas; Grynpas, Marc; Ferguson, Peter

    2013-08-01

    Management of soft tissue sarcoma involves multimodality treatment, including surgery and radiotherapy. Pathologic fracture of the femur after such treatment in the thigh is one serious, late complication and nonunion rates of 80-90% are reported. We hypothesize that the combination of radiotherapy and periosteal stripping (during tumor resection) leads to greater impairment of the fracture repair process than either intervention alone. Female Wistar retired breeder rats were randomized into four treatment groups (control, radiotherapy, surgery, and combination of radiotherapy and surgery) and three end-points (21, 28, and 35 days post-fracture). Designated animals first underwent radiotherapy, followed by surgical stripping of the periosteum 3 weeks later and femoral fracture with fixation after another 3 weeks. Animals were sacrificed and fractures examined using microCT and histomorphometry. Simple transverse or short oblique femoral fractures were produced. By 35 days, control animals formed unions, periosteum-stripped animals formed hypertrophic non-unions and irradiated animals formed atrophic non-unions. Histomorphometry revealed an absence of chondroid and osteoid production in animals undergoing radiotherapy. The relative contribution of periosteal stripping to occurrence of non-union was statistically insignificant. Radiation prior to fracture reliably resulted in atrophic non-union in our model. The contribution of periosteal stripping was negligible. Copyright © 2013 Orthopaedic Research Society.

  2. CASE REPORT

    African Journals Online (AJOL)

    effective means of handling femoral non-union in third world societies where instrumentation and implants for interlocked nailing may not be readily available. Key Words: Interlocked-Intramedullary nail, Femur, Cortical window. INTRODUCTION. CASE HISTRORY. Interlocked intramedullary nailing is a standard. A female ...

  3. Tendon transfers in radial nerve palsy with fractures of the humerus ...

    African Journals Online (AJOL)

    Case 1: A 25 year old right handed male soldier who was referred to Kenyatta National Hospital (KNH) in February 2008, from Burundi, with non-union of the left humerus and wrist drop. He sustained a compound fracture of the humerus and wrist drop following a gunshot injury a year earlier. Open reduction, plating of the ...

  4. The effect of concentrated bone marrow aspirate in operative treatment of fifth metatarsal stress fractures; a double-blind randomized controlled trial

    NARCIS (Netherlands)

    Weel, Hanneke; Mallee, Wouter H.; van Dijk, C. Niek; Blankevoort, Leendert; Goedegebuure, Simon; Goslings, J. Carel; Kennedy, John G.; Kerkhoffs, Gino M. M. J.

    2015-01-01

    Fifth metatarsal (MT-V) stress fractures often exhibit delayed union and are high-risk fractures for non-union. Surgical treatment, currently considered as the gold standard, does not give optimal results, with a mean time to fracture union of 12-18 weeks. In recent studies, the use of bone marrow

  5. Systemic treatment with pulsed electromagnetic fields do not affect bone microarchitecture in osteoporotic rats

    NARCIS (Netherlands)

    O.P. van der Jagt (Olav); J.C. van der Linden (Jacqueline); J.H. Waarsing (Jan); J.A.N. Verhaar (Jan); H.H. Weinans (Harrie)

    2012-01-01

    textabstractPurpose: Pulsed electromagnetic fields (PEMF) are currently used in the treatment of spinal fusions and non-unions. There are indications that PEMF might also be effective in the treatment of osteoporosis. In this study we examined whether whole-body PEMF treatment affects the bone

  6. Preliminary in vitro and in vivo characterizations of a sol–gel derived ...

    Indian Academy of Sciences (India)

    Unknown

    SEM of the implanted site after 24 weeks revealed good osteointegration of the material with the newly formed bone and host ... allografts have the high risk of transmission of infections, fracture and non-union, high cost and .... 2.4c Post operative care: The wound was dressed with neosporin and ampicillin and cloxicillin 50 ...

  7. Results of Operative Fixation of Fractures of the Ankle at a Tertiary ...

    African Journals Online (AJOL)

    Results of Operative Fixation of Fractures of the Ankle at a Tertiary Hospital in a Developing Country. ... Complications included wound infection 14.3%, wound dehiscence with exposed implants 2.9%, malunion 8.6% and non union 5.7%. Good to excellent functional outcomes were achieved in 77.1% of the patients.

  8. A NEW CLASSIFICATION OF OSTEOMYELITIS FOR DEVELOPING ...

    African Journals Online (AJOL)

    Kateee

    2003-07-01

    Jul 1, 2003 ... Healing of the gap fracture after 12 weeks. Controllable refers to diffuse type of Cierny-Mader where bone debridement and grafts impregnated with antibiotics are used to achieve control of bone infection for a variable number of years. Complicated OSM refers to pathological fracture, infected non-union.

  9. Cancellous bone autografts: Donor sites, indications, techniques ...

    African Journals Online (AJOL)

    A prospective study of patients who had cancellous bone-graft was conducted to identify the indications and complications related to the techniques used in harvesting such grafts from the ilium, distal femur and proximal tibia. The commonest indication for cancellous bone graft was non-union. Donor site pain was the most ...

  10. A model for the prediction of time to union in fractures of the tibia.

    Science.gov (United States)

    Fourie, J A; Thompson, M L

    1998-01-01

    This report covers the second arm of a trial, the main focus of which was to assess the effect of interferential currents (IFCs) on time to union in tibial fractures. No significant improvement was found with the use of IFCs for the parameters employed (Fourie & Bowerbank, 1997). The focus of this study is the development of logistic regression models which used subject characteristics to predict non-union of fracture within 24, 32 and 40 weeks. Such models could be used to identify clients for consideration of alternative interventions, for example, electric current stimulation, bone grafting or the injection of bone morphogenic proteins (BMPs). The usefulness of such models would depend on their ability to correctly identify subjects whose fractures do or do not unite. These models were validated with respect to their sensitivity and specificity to predict non-union for a separate data set. The results indicated, for instance, that use of a model to predict non-union of fracture within 24 weeks would lead to 27% of subjects being correctly classified (as union or non-union), 51% of subjects whose fractures did not unite within 24 weeks were identified and 65% of subjects (diagnosed as non-union) whose fractures did not unite within 24 weeks (the closer these values are to 100% the more accurate the model). The conclusion reached was that the models may have value for low-cost, non-invasive interventions, but that they could not be used to predict those cases where surgical involvement would be necessary, due to the high false-positive rate.

  11. Infrared optical properties of a coal-fired power plant plume

    International Nuclear Information System (INIS)

    Stearns, L.P.; Pueschel, R.F.

    1983-01-01

    Infrared measurements in the 8--14-μm spectral region were made of two coal-fired power plant plumes and area haze in the Four Corners region of New Mexico from 1 to 7 Nov. 1980. The layer tranmittance, optical depth, and volume extinction coefficient derived from measurements on four nonconsecutive days show the effects of the plumes on the IR optical properties of the atmosphere. The average contribution of the plume alone to the IR extinction coefficient was 74% at the Four Corners plant; the background haze contributed 7--11%. More efficient particulate emission control at the San Juan power plant reduced the average contribution of its plume to 57% of the extinction coefficient. The haze contributed an average of 16%. The results show an increase with time of the haze bulk extinction coefficient during a persistent anticyclonic synoptic situation. Extinction coefficients of the haze showed a linearity with particulate loading, which led to estimates of IR volume extinctions of the free troposphre from aerosol measurements

  12. Suspension Arthroplasty Combined with Ligament Reconstruction of the Thumb Carpometacarpal Joint to Salvage Two Failed Arthroplasties: A Case Report.

    Science.gov (United States)

    Kakinoki, Ryosuke; Hashimoto, Kazuhiko; Tanaka, Hiroki; Akagi, Masao

    2017-01-01

    Thumb basal joint arthroplasty with removal of the entire trapezium is often followed by proximal subsidence and impingement of the thumb metacarpal to the scaphoid, which is a common cause of post-operative thumb pain. Treatment of this impingement is a challenge among surgeons. We performed suspension arthroplasty combined with intercarpal ligament reconstruction using a strip of the extensor carpi radialis longus (ECRL) tendon on a patient suffering from pain caused by this type of the impingement and obtained a successful outcome. We treated a 52-year-old female pianist who complained of pain in her left thumb carpometacarpal (CMC) joint. She had undergone two previous ligament reconstruction and tendon interposition arthroplasty procedures on the joint, for which strips of the flexor carpi radialis tendon and the abductor pollicis longus tendon were used in the first and second operations, respectively. The pre-operative X-ray demonstrated proximal subsidence and impingement of the first metacarpal on the scaphoid. We performed suspension arthroplasty combined with intercarpal ligament reconstruction using a strip of the ECRL tendon to create the trapezial space. 3 years after surgery, despite the 3 mm subsidence of the thumb compared with immediately after surgery, her thumb pinch and grip strength had improved, and the thumb basal pain was relieved. This case shows that suspension arthroplasty with intermetacarpal ligament reconstruction using an ECRL strip can be applied in revision surgery for impingement of the first metacarpal with the scaphoid following thumb CMC joint arthroplasty after removal of the entire trapezium. This is the first report to describe the treatment of first metacarpal impingement after CMC joint arthroplasty using suspension arthroplasty combined with intercarpal ligament reconstruction.

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

    Science.gov (United States)

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

    2009-12-15

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

  14. Acute hand and wrist injuries in athletes: evaluation and management.

    Science.gov (United States)

    Morgan, W J; Slowman, L S

    2001-01-01

    Acute hand and wrist injuries in the athlete constitute a unique orthopaedic challenge. Because of the particular demands on the athlete (e.g., financial implications, coaching and administration pressures, self-esteem issues), a specialized management approach is often necessary. Common sites of injury include the ulnar collateral ligament of the thumb metacarpophalangeal joint, proximal interphalangeal joint, metacarpals and phalanges, scaphoid, hamate, and distal radius. Treatment of these injuries varies depending on the patient's age, sport, position played, and level of competition, but departures from standard practice as regards surgery, rehabilitation, and return to competition should never compromise care.

  15. [Cinematography, a new diagnostic procedure in evaluation of the injured painful wrist joint].

    Science.gov (United States)

    Werber, K D; Wuttge-Hannig, A; Hannig, C

    1990-01-01

    By the X-ray Cineradiografie we are able to examine and to judge the dynamic of the wrist bones by 50 pictures/sec. in comparison to one another and also depending on their ligaments. We did an investigation of 170 patients with painful wrist. With the method we were able to make up a clear diagnosis and to propose the therapy. I.e.: If consecutive shortening of the radius after distal radius fracture resulting ingruency of the wrist joint is relevant, or a scaphoid pseudarthrosis is fixed elastically, or a scaphoic dissociation is effective. The variations were shown in comparison to normal circumstances.

  16. Prosthesis of the wrist-joint

    Energy Technology Data Exchange (ETDEWEB)

    Feldmeier, C.

    1983-02-25

    Function of the hand-joint and the well-being of patients can be severely affected by arthrosis of the wrist-joint. Therapeutically, arthrodesis usually results in a painfree status of stiffness. A painless and well functioning joint can be achieved by alloplastic joint replacement or resurfacing. The possibilities and clinical results in cases of arthrosis of the carpo-metacarpal joint of the thumb, pseudarthrosis of the scaphoid, aseptic necrosis of the Lunate and severe arthrosis of the radio-carpal joint are demonstrated.

  17. Prosthesis of the wrist-joint

    International Nuclear Information System (INIS)

    Feldmeier, C.

    1983-01-01

    Function of the hand-joint and the well-being of patients can be severely affected by arthrosis of the wrist-joint. Therapeutically, arthrodesis usually results in a painfree status of stiffness. A painless and well functioning joint can be achieved by alloplastic joint replacement or resurfacing. The possibilities and clinical results in cases of arthrosis of the carpo-metacarpal joint of the thumb, pseudarthrosis of the scaphoid, aseptic necrosis of the Lunate and severe arthrosis of the radio-carpal joint are demonstrated. (orig.) [de

  18. MR imaging of avascular necrosis of carpal bones

    International Nuclear Information System (INIS)

    Taniguchi, Yasunori; Funaoka, Nobuhiko; Yoshida, Munehito; Iwahashi, Toshiyuki; Egawa, Hiromitsu; Shima, Kimihiro; Tamaoki, Tetsuya.

    1991-01-01

    The usefulness of MRI in carpal avascular necrosis was investigated in 20 cases, 16 in lunates, 3 in scaphoids and 1 in triquetrum, with T1 and T2 weighted images of the spin echo and T2 weighted images of the field echo. Early diagnosis of carpal bone necrosis was possible when the T1 weighted image showed a moderate low intensity signal. A high intensity signal in the T2 weighted image indicated the onset of revascularization, and a favorable prognosis. A normal signal indicated healing of carpal avascular necrosis. MRI was found to be very useful in establishing the diagnosis and in determining the prognosis of carpal osteonecrosis. (author)

  19. TREATMENT OF FRACTURES TO THE HAND

    Directory of Open Access Journals (Sweden)

    Valentina Colombo

    2012-03-01

    Full Text Available The aim of this article is to discuss the treatment of fractures to the hand given the importance of this organ in terms of functional anatomy. After classifying the various types of fractures, surgery and rehabilitation options for all types are discussed. Particular emphasis is placed on therapy for the most frequently seen lesions such as fractures to the scaphoid, the fifth metacarpal and the base of the first metacarpal. The importance of the use of prophylaxis against stiffness and treatment for oedema, which are commonly seen in fractures to the hand, is also highlighted.

  20. Is the early percutaneous spine total care to treat the polytrauma patient a good way?

    Directory of Open Access Journals (Sweden)

    Gabriele Falzarano

    2015-03-01

    Full Text Available The “ideal“ timing and modality of fracture fixation for unstable thoracolumbar spine fractures in multiply injured patients remains controversial. The concept of “damage control orthopedics” is expressed. We presented a case report of a 27 years' old male who sustained a multilevel spine fractures associated a floating knee (Fraser's Type A, ulna fracture and carpal scaphoid fracture in July 2014 after car accident (very high energy trauma. All these fractures were treated in early total care. We reported a case control to discuss about the early spinal total care associated at orthopedic total care in patients with multiple trauma.

  1. Capitate-Lunate instability: recognition by manipulation under fluoroscopy

    International Nuclear Information System (INIS)

    White, S.J.; Louis, D.S.; Braunstein, E.M.; Hankin, F.M.; Greene, T.L.

    1984-01-01

    Videotape fluoroscopy was used to diagnose a previously undescribed carpal dissociation, the capitate lunate instability pattern. In eight patients with midcarpal pain and clicking, the examiner simultaneously applied pressure to the scaphoid tuberosity while applying longitudinal traction and flexion to the wrist under fluoroscopic control. This maneuver revealed dorsal subluxation of the proximal carpal row and capitate lunate subluxation in each of the eight patients. Plain radiography and arthrography were not helpful in the diagnosis. All eight cases were managed conservatively. Videotape fluoroscopy is the best radiologic method of diagnosing capitate-lunate instability

  2. [Fractures of the tibial shaft treated by blind intramedullary nailing. A review of 521 cases].

    Science.gov (United States)

    Masse, Y; Aubriot, J H; Lamotte, N

    1977-09-01

    The authors have studied a series of 521 fractures of the tibia treated by blind intramedullary nailing without reaming. Union by the 120th day was obtained in 93.3% of cases. Malunion was uncommon and was related to an inadequate initial reduction. A secondary procedure was only necessary in two cases of malunion. In closed fractures, no case suffered infection. In compound fractures, 4.3% became infected (5 osteitis, 4 septic non-union) but all cases were cured by secondary procedures. Aseptic non-union occurred in 2.3% of cases. The authors recommend the use of nails of at least 8 mm diameter driven down to the region of the lower articular surface. In patients with a narrow medullary canal, or in fractures of the lower third of the tibia, the authors consider that reaming would have given better results. In other types of fracture reaming is more hazardous than useful.

  3. [Parathyroid hormone injection to counteract delayed bone fractures].

    Science.gov (United States)

    Brunnemann, C E; Reisinger, E C; Ganzer, D; Schober, H C

    2010-08-01

    Two women, aged 71 and 53 years with periprosthetic fractures of the left femur and an 18 year old man with a non-union of fracture of the left radius presented for assessment and treatment. Serial radiographs showed that osteosynthesis and/or autogenous bone-grafting and multiple revisions had not resulted in healing of the fractures. In all three patients parathyroid hormone (teriparatide), 20 to 60 microg, was injected subcutaneously once daily for 6 - 10 weeks. Subsequently a stable consolidation of the bone occurred in all of them. Administration of parathyroid hormone can induce stable consolidation of the bone in non-unions and delayed healing of bone fractures. Georg Thieme Verlag KG Stuttgart, New York.

  4. Stimulation of bone healing with interferential therapy.

    Science.gov (United States)

    Ganne, J M

    1988-01-01

    Methods of electrical stimulation of bone are reviewed for a comparison with the use of interference currents and for a consideration of the possible merits of various methods. A summary is given of results of treatment of 38 patients with delayed or non-union and predisposition to non-union, and the technique used with Interferential Therapy is described in detail. Results are also given of a study of the effects of stimulation on 11 patients with acute fractures of the tibial shaft, compared with 11 closely matched patients with similar acute fractures who did not receive Interferential Therapy. The advantages of surgically non-invasive techniques are emphasised and recommendations are made for the use of interference currents prophylactically in specific cases. Copyright © 1988 Australian Physiotherapy Association. Published by . All rights reserved.

  5. Immediate mobilisation with complete weight bearing after uncemented total hip replacement in elderly

    Directory of Open Access Journals (Sweden)

    Sankarlingam P, Shivraj V, V R Subramaniyam

    2014-11-01

    Full Text Available This prospective study was analyzed in 23 patients who were allowed to do immediate weight bearing after uncemented total hip arthroplasty. Immediate mobilization shortened the hospital stay and facilitated early rehabilitation of hip. Immediate mobilization was started on postoperative Day 3 rather than Day 7 without any adverse consequences to the patients. A series of 23 elderly patients of age more than 60 years, who were diagnosed with conditions such as avascular necrosis of hip, non union of fracture neck of femur, trochanteric non union and rheumatoid arthritis, underwent uncemented total hip replacement and immediate mobilization was started in our hospital. Patients were evaluated by Harris Hip Scoring Scale. All ambulated patients had painless hip and the mean Harris Hip Score was 85. There were no incidence of stem subsidence, acetabular component loosening, and heterotrophic ossification. This data concluded that early intensive rehabilitation yielded faster attainment of short-term functional milestones in fewer days.

  6. Biomechanical assessment and clinical analysis of different intramedullary nailing systems for oblique fractures.

    Science.gov (United States)

    Alierta, J A; Pérez, M A; Seral, B; García-Aznar, J M

    2016-09-01

    The aim of this study is to evaluate the fracture union or non-union for a specific patient that presented oblique fractures in tibia and fibula, using a mechanistic-based bone healing model. Normally, this kind of fractures can be treated through an intramedullary nail using two possible configurations that depends on the mechanical stabilisation: static and dynamic. Both cases are simulated under different fracture geometries in order to understand the effect of the mechanical stabilisation on the fracture healing outcome. The results of both simulations are in good agreement with previous clinical experience. From the results, it is demonstrated that the dynamization of the fracture improves healing in comparison with a static or rigid fixation of the fracture. This work shows the versatility and potential of a mechanistic-based bone healing model to predict the final outcome (union, non-union, delayed union) of realistic 3D fractures where even more than one bone is involved.

  7. Geochemistry and hydrodynamics of the Paradox Basin region, Utah, Colorado and New Mexico

    Science.gov (United States)

    Hanshaw, B.B.; Hill, G.A.

    1969-01-01

    The Paradox Basin region is approximately bounded by the south flank of the Uinta Basin to the north, the Uncompahgre uplift and San Juan Mountains to the east, the Four Corners structural platform to the southeast, the north rim of the Black Mesa Basin and the Grand Canyon to the south and southwest, and the Wasatch Plateau and Hurricane fault system to the west. Some of these geologic features are areas of ground-water recharge or discharge whereas others such as the Four Corners platform do not directly influence fluid movement. The aquifer systems studied were: (1) Mississippian rocks; (2) Pinkerton Trail Limestone of Wengerd and Strickland, 1954; (3) Paradox Member of the Hermosa Formation; (4) Honaker Trail Formation of Wengerd and Matheny, 1958; (5) Permian rocks. Recharge in the Paradox Basin occurs on the west flank of the San Juan Mountains and along the west side of the Uncompahgre uplift. The direction of ground-water movement in each analyzed unit is principally southwest-ward toward the topographically low outcrop areas along the Colorado River in Arizona. However, at any point in the basin, flow may be in some other direction owing to the influence of intrabasin recharge areas or local obstructions to flow, such as faults or dikes. A series of potentiometric surface maps was prepared for the five systems studied. Material used in construction of the maps included outcrop altitudes of springs and streams, drill-stem tests, water-well records, and an electric analog model of the entire basin. Many structurally and topographically high areas within the basin are above the regional potentiometric surface; recharge in these areas will drain rapidly off the high areas and adjust to the regional water level. With a few exceptions, most wells in formations above the Pennsylvanian contain fresh ( 35,000 mg/l T.D.S.) reported. Most water samples from strata below the Permian are brines of the sodium chloride type but with large amounts of calcium sulfate or

  8. A CLINICAL STUDY OF SURGICAL MANAGEMENT OF DIAPHYSEAL FRACTURES OF TIBIA WITH INTRAMEDULLARY INTERLOCKING NAIL

    OpenAIRE

    Radhakrishna; Shivananda; Santhosh Kumar

    2014-01-01

    BACKGROUND: Intramedullary interlocking is currently considered the treatment of choice for tibial shaft fractures, with high rates of fracture union, advantage of early stabilization which decreases the morbidity and mortality rate in patients, allows early mobilization, reduces the incidence of infection, malunion, non-union or implant failure. OBJECTIVES: To assess and study diaphyseal fractures of tibia and to evaluate the functional outcome of patients with tibial shaft fracture treated ...

  9. Muscle-bone Interactions During Fracture Healing

    Science.gov (United States)

    2015-03-01

    fracture heal - ing. The rate of delayed union or non-union in tibial fractures with associated compartment syndrome was 55...complications of open tibial shaft fractures stratified as per the Gustilo–Ander- son classification. Injury 2011;42:1408-15. 121. Giannoudis PV, Harwood PJ...Kontakis G, et al. Long- term quality of life in trauma patients following the full spectrum of tibial injury (fasciotomy, closed fracture , grade

  10. Extracorporeal Shock Wave Therapy for Nonunion of the Tibia

    Science.gov (United States)

    2010-03-01

    the tibia treated with a reamed intramedullary interlocking nail . Clin Orrhop Relul Res. 1995; 315:56-63. 12. Wiss DA, Stetson WB. Tibial nonunion...atrophic and infected non unions . 18 24 A promising technology, extracorporeal shock wave therapy (ESWT), has been used to treat various musculoskel...nonunions has engendered innovative and alternative treat - ment approaches, including mechanical and molecular inter- ventions in the fonn of nail

  11. MANAGEMENT OF PSEUDOARTHROSIS OF SHAFT HUMERUS BY PLATING (FIVE YEARS FOLLOW UP – A CASE STUDY

    Directory of Open Access Journals (Sweden)

    Shirish Virupanna

    2016-02-01

    Full Text Available Pseudoarthrosis is a condition where union at fracture site is very difficult to obtain. But sticking to the very basic principles of management of non-union – that is freshening at fracture site, removal of sclerotic bone, reaming of medullary canal, rigid fixation and abundant bone grafting-helps in achieving the goal. In the below case, all the steps were carried out and the fracture has healed two months postoperatively.

  12. Physiology of fracture healing: New aspects

    OpenAIRE

    Gajdobranski Đorđe R.; Živković Dragana 1

    2003-01-01

    Introduction Skeletal system has a great regenerative potential, but it isn't the case with other tissues. Bone fracture healing includes a complex cascade of processes at cellular and biochemical levels, ending with a complete structural and functional restoration of the damaged bone. Impaired healing occurs in 5-10% of all fractures, manifesting as delayed union or non-union Such a high incidence of impaired healing certainly presents a problem, and therefore, permanent research regarding p...

  13. Voice, silence, and diversity in 21st century organizations: strategies for inclusion of gay, lesbian, bisexual, and transgender employees

    OpenAIRE

    Myrtle P. Bell; Mustafa F. Özbilgin; T. Alexandra Beauregard; Olca Sürgevil

    2011-01-01

    Employee voice has been largely examined as a universal concept in unionized and non-unionized settings, with insuffi cient attention to diversity of workers (Rank, 2009). As invisible minorities, gay, lesbian, bisexual, and transgender (GLBT) employees provide a valuable focal point from which to examine employee voice mechanisms. Positing that GLBT employees are often silenced by what is perceived as “normal” in work organizations, this paper identifi es some of the negative consequences of...

  14. A different trauma, a different fracture

    Directory of Open Access Journals (Sweden)

    Ü. Kaldırım

    2013-12-01

    Discussion and conclusion: The epiphyses and the apophyses are the weakest part of all the skeletal system. In these regions, avulsion fractures may occur with sudden and severe spasm of the muscles. Avulsion fractures of SIAS are mostly treated conservatively unless there is more than 2 cm fragment separated and non-union case in which case surgery is recommended. This type of injuries can be easily overlooked or misdiagnosed due to history of trauma free. It may also effects

  15. Effects of Local Delivery of d-amino Acids from Biofilm-dispersive Scaffolds on Infection in Contaminated Rat Segmental Defects

    Science.gov (United States)

    2013-07-05

    chronic, resulting in increased rates of surgical revisions, non-union, and extremity amputation [1e3]. Among the pathogenic microorganisms associated with...life cycle that contributes to survival of the organism and disease transmission. For both Gram-positive and Gram-negative microorganisms , biofilm...release. J Biomed Mater Res 2001;57:313e20. [48] Noel SP, Courtney HS, Bumgardner JD, Haggard WO. Chitosan sponges to locally deliver amikacin and

  16. Sliding-screw plate fixation of proximal femoral fractures: Radiographic assessment

    Energy Technology Data Exchange (ETDEWEB)

    Sartoris, D.J.; Resnick, D.; Kerr, R.; Goergen, T.

    1985-07-01

    The sliding compression screw-sideplate combination is currently the most widely employed device for internal fixation of stable and unstable intertrochanteric fractures of the femur. The normal and abnormal radiographic appearances of this device in the immediate post-operative period are discussed. Potential long-term complications including mal- or non-union, intra-articular penetration, metal failure, rotation of the proximal fracture fragment, disengagement, trochanteric bursitis, leg length discrepancy, delayed cervical stress fracture, and ischemic necrosis are reviewed.

  17. Sliding-screw plate fixation of proximal femoral fractures: Radiographic assessment

    International Nuclear Information System (INIS)

    Sartoris, D.J.; Resnick, D.; California Univ., San Diego, La Jolla; Kerr, R.; Goergen, T.

    1985-01-01

    The sliding compression screw-sideplate combination is currently the most widely employed device for internal fixation of stable and unstable intertrochanteric fractures of the femur. The normal and abnormal radiogrpahic appearances of this device in the immediate post-operative period are discussed. Potential long-term complications including mal- or non-union, intra-articular penetration, metal failure, rotation of the proximal fracture fragment, disengagement, trochanteric bursitis, leg length discrepancy, delayed cervical stress fracture, and ischemic necrosis are reviewed. (orig.)

  18. Comparative study between reamed versus unreamed interlocking intramedullary nailing in compound fractures of shaft tibia

    OpenAIRE

    Subhash Puri; Samar Kumar Biswas; Anil Salgia; Sahil Sanghi; Tushar Agarwal; Rohit Malhotra

    2013-01-01

    Background: Tibia is the commonest bones to sustain open injury because of subcutaneous position. Treatment of open fractures requires simultaneous management of both skeletal and soft tissue injury. Intramedullary nailing with reaming is generally considered to be contraindicated for open fractures tibia, because it damages the endosteal blood supply which will lead to non-union, deep infection. However, recent studies with or without reaming in open fracture tibia shows no influence in heal...

  19. A STUDY OF EXCHANGE OF FAILED IMPLANT WITH INTRAMEDULLARY INTERLOCKING NAIL IN FRACTURES OF FEMUR AND TIBIA

    OpenAIRE

    Rapaka; Maheshwar; Gouru

    2015-01-01

    The aim of the fracture treatment is to achieve union with timely functional recovery. Internal fixation with adherence to strict biomechanical principles is often required to achieve this. However, a fixation device may fail to hold a redu ced fracture until union, giving rise to non - union or delayed union with implant failure. The aim of this study was to see the efficacy of exchange of failed implant with an intra - medullary interlocking nail. PATIENTS AND ...

  20. Lower Limb Disabilities Following Motorcyle Crashes | Kortor ...

    African Journals Online (AJOL)

    The commonest complication after treatment was joint stiffness (21.4%) followed by malunion (7.1%), wound infection (5.0%), joint deformity (3.6%), limb length discrepancy (2.9%) and non union (1.4%). 45.6% of patients at 12th month of follow up had physical impairment while only 23.8 percent of them had psychosocial ...

  1. Considering the impact of the 'Right to Bargain' Legislation in Ireland: A Review

    OpenAIRE

    Cullinane, Niall; Dobbins, Anthony

    2014-01-01

    Ireland is rare among advanced economies in not having statutory trade union recognition legislation for collective bargaining purposes. The matter has been a source of policy contention over the years with attempts to resolve it encapsulated in the so-called ‘Right to Bargain’ legislation, introduced in 2001. This legislation has sought to circumvent statutory recognition in Ireland by putting in place an alternative mechanism for unions to represent members in non-union firms where collecti...

  2. Use of Pulsing Electromagnetic Fields for the Treatment of Pelvic Stress Fractures Among Female Soldiers.

    Science.gov (United States)

    1995-08-11

    activities. Pulsing electromagnetic fields ( PEMFs )have been shown to speed the healing of non-union fractures and we have used them successfully to...and then randomized into actual PEMF and placebo PEMF groups and treated for one hour per day until they return to duty. Changes in the bone scan are...musculoskeletal groups. Results to date indicate that pelvic stress fractures are being misdiagnosed. If these results are confirmed, treatments for

  3. Comparative analysis of uniplanar external fixator and retrograde intramedullary nailing for ankle arthrodesis in diabetic Charcot′s neuroarthropathy

    Directory of Open Access Journals (Sweden)

    Nakul S Shah

    2011-01-01

    Results: All five (100% patients treated by intramedullary nailing achieved radiological union on an average follow-up of 16 weeks. The external fixation group had significantly higher rate of complications with one amputation, four non unions (66.7% and a delayed union which went on to full osseous union. Conclusion: The retrograde intramedullary nailing for tibio-talar arthrodesis in Charcot′s neuroarthropathy yielded significantly better outcomes as compared to the use of uniplanar external fixator.

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

    OpenAIRE

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

    2009-01-01

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

  5. Union Membership and Perceived Job Insecurity: Thirty Years of Evidence from the American General Social Survey

    OpenAIRE

    Pierre Brochu; Louis-Philippe Morin

    2012-01-01

    Using the American General Social Survey covering the period 1978-2008, the authors investigate the link between union membership and perceived job insecurity. They find that overall, union members are 3.5 percentage points more likely than non-union members to feel insecure about their current jobs as well as future job prospects, especially during recessionary periods. This result is twice that in the manufacturing sector. By contrast, there is virtually no union effect on job insecurity in...

  6. Sequential evaluation for bone union of transferred fibula flaps in reconstructed mandibles: panoramic X-ray versus computed tomography.

    Science.gov (United States)

    Akashi, M; Hashikawa, K; Kakei, Y; Sakakibara, A; Hasegawa, T; Minamikawa, T; Komori, T

    2015-08-01

    The purpose of this study was to sequentially evaluate bone union of fibular grafts in mandibular reconstruction. Patients who underwent routine follow-up computed tomography (CT) and panoramic X-ray imaging during a period of ≥2 years were enrolled. On panoramic X-ray images, bone union was scored as 0 (absent callus formation) or 1 (complete callus formation). On CT images, a scale of 0 to 2 was used (0, absent callus formation; 1, complete callus formation only on the labial side; 2, complete callus formation on both the labial and lingual side). A total of 56 bone junctions were evaluated in 20 patients. Five of 56 junctions (9%) in four of 20 patients (20%) showed radiological non-union (panoramic X-ray score=0, CT score=0 or 1) at 2 years after surgery. All bone junctions with radiological non-union were located at the mandibular angle. No categorical values, including diabetes mellitus and radiation therapy, were significantly associated with radiological non-union. In conclusion, assessing at least two sides (i.e. labial and lingual sides) on CT images is adequate to evaluate bone union in transferred fibula flaps. Careful fixation at the mandibular angle may improve the rate of bone union. Copyright © 2015 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. Developmental feature of the lumbosacral vertebral arch in childhood

    International Nuclear Information System (INIS)

    Yoshifuji, Kazuhisa; Morota, Nobuhito; Ihara, Satoshi

    2007-01-01

    We investigated a developmental feature of the lumbosacral vertebral arch in childhood that has rarely been reported previously. Sixty-seven patients underwent functional posterior rhizotomy from September 2000 to June 2006 at National Center for Child Health and Development. Sixty of these patients, who had no deformity in their lumbosacral spine, were included in this study and their Computed Tomography (CT) images were analyzed retrospectively. There were 36 boys and 24 girls, aged from 2-12 years. The rate and mean number of non-union vertebral arches between L1 and S3 were 78.3% (95% CI, 65.8-87.9%) and 1.7 (standard deviation (SD), 1.3). The non-union arch was most frequently found at the S1 level, and was more significantly observed in the younger age group (2-5 years of age). The S4 and S5 arches, which often remained open as the sacral hiatus, were constantly open in childhood. This study demonstrates that the vertebral arches of the lumbosacral spine in normal development are often not fused during childhood. It is important to differentiate normal non-union arches from pathological spina bifida. (author)

  8. Local drug delivery for enhancing fracture healing in osteoporotic bone.

    Science.gov (United States)

    Kyllönen, Laura; D'Este, Matteo; Alini, Mauro; Eglin, David

    2015-01-01

    Fragility fractures can cause significant morbidity and mortality in patients with osteoporosis and inflict a considerable medical and socioeconomic burden. Moreover, treatment of an osteoporotic fracture is challenging due to the decreased strength of the surrounding bone and suboptimal healing capacity, predisposing both to fixation failure and non-union. Whereas a systemic osteoporosis treatment acts slowly, local release of osteogenic agents in osteoporotic fracture would act rapidly to increase bone strength and quality, as well as to reduce the bone healing period and prevent development of a problematic non-union. The identification of agents with potential to stimulate bone formation and improve implant fixation strength in osteoporotic bone has raised hope for the fast augmentation of osteoporotic fractures. Stimulation of bone formation by local delivery of growth factors is an approach already in clinical use for the treatment of non-unions, and could be utilized for osteoporotic fractures as well. Small molecules have also gained ground as stable and inexpensive compounds to enhance bone formation and tackle osteoporosis. The aim of this paper is to present the state of the art on local drug delivery in osteoporotic fractures. Advantages, disadvantages and underlying molecular mechanisms of different active species for local bone healing in osteoporotic bone are discussed. This review also identifies promising new candidate molecules and innovative approaches for the local drug delivery in osteoporotic bone. Copyright © 2014 Acta Materialia Inc. Published by Elsevier Ltd. All rights reserved.

  9. First Metatarsophalangeal Joint Arthrodesis in Hallux Valgus Versus Hallux Rigidus Using Cup and Cone Preparation Compression Screw and Dorsal Plate Fixation.

    Science.gov (United States)

    Chien, Calvin; Alfred, Terrence; Freihaut, Richard; Pit, Sabrina

    2017-10-19

    Various techniques have been described for first metatarsophalangeal (MTP) joint arthrodesis. The purpose of this study was to determine if cup and cone preparation by a single surgeon with an interfragmentary screw and dorsal plate fixation provides a comparable union rate in hallux valgus versus hallux rigidus. Our study included all patients who underwent first MTP joint fusions using cup and cone preparation with an interfragmentary compression screw and dorsal plate fixation from 2010 to 2015. We compared union rates in 65 patients with hallux rigidus with 47 who had hallux valgus. One of 65 hallux rigidus cases developed non-union and underwent revision surgery. One of 47 patients in the hallux valgus group developed a painless non-union. All other patients achieved union based on post operative radiographs. Our rate of painful non-union was 1.5% for hallux rigidus and 0% for hallux valgus, which is lower than recent published literature of 7% for hallux valgus and 3.7% for hallux rigidus. We found no difference between the two groups suggesting this method may provide stronger fixation and may be preferable when dealing with hallux valgus. First metatarsophalangeal joint fusion in patients with severe hallux valgus and hallux rigidus, using spherical reamers, compression screw and dorsal plate fixation is equally successful at achieving clinical and radiographic fusion in both hallux valgus and hallux rigidus.

  10. Use of the medial femoral condyle vascularized bone flap in traumatic avascular necrosis of the navicular: a case report.

    Science.gov (United States)

    Holm, Janson; Vangelisti, Garrett; Remmers, Jared

    2012-01-01

    The medial femoral condyle vascularized bone flap has a high success rate in published literature regarding its use in nonunions and avascular necrosis of the upper and lower extremities. It is reported to have minimal donor site morbidity and the ability to provide structural support and torsional strength to load-bearing areas. The flap has found particular success in the treatment of scaphoid nonunions. The tarsal navicular, similar to the scaphoid, is largely articular cancellous bone with little surface area for vascular inflow. These anatomic features make the navicular prone to nonunion and avascular necrosis in traumatic scenarios. We describe a case of nonunion and avascular necrosis of the tarsal navicular occurring as sequelae of a high-impact midfoot injury sustained in an automobile accident. After an initial attempt at open reduction and internal fixation with midfoot bridge plating, subsidence and nonunion resulted. An attempt at arthrodesis of the talonavicular and naviculocuneiform joints was then undertaken. This too failed, leading to the development of additional collapse and avascular necrosis. The site was treated with a medial femoral condyle vascularized bone flap. In this single case, the patient returned to pain-free ambulation and reported excellent outcomes and functional capacity. Although we present a successful case, a larger case series is necessary to establish the use of this flap as a reliable option for the treatment of nonunion and avascular necrosis of the tarsal navicular. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Quantifying complex shapes: elliptical fourier analysis of octocoral sclerites.

    Science.gov (United States)

    Carlo, Joseph M; Barbeitos, Marcos S; Lasker, Howard R

    2011-06-01

    Species descriptions of most alcyonacean octocorals rely heavily on the morphology of sclerites, the calcium carbonate spicules embedded in the soft tissue. Sclerites provide taxonomic characters for species delineation but require qualitative descriptions, which introduce ambiguities in recognizing morphological features. Elliptical Fourier analysis of the outline of sclerites was used to quantify the morphology of eight species of gorgoniid octocoral in the genus Pseudopterogorgia. Sclerites from one to seven colonies of each species were compared. Scaphoids and spindles were examined separately; rods and octoradiates were excluded from the analyses because of their morphologic similarity across all species. Discriminant analysis of elliptical Fourier descriptors (EFDs) was used to determine whether the elliptical Fourier analysis could be used to identify the specimens. Sclerites were highly variable even within a single colony. Correct species assignments of individual sclerites were greater than 50% for both scaphoids and spindles. Species assignments based on averages of the EFDs for each colony approached 90%. Elliptical Fourier analysis quantifies morphological differences between species and measures colony variance in sclerite size and shape among colonies and species. Phylogenetic analysis based on EFDs did not capture monophyletic groups. The quantification of complex shapes such as sclerites provides an important tool in alpha taxonomy but may be less useful in phylogenetic analyses.

  12. Failure characteristics of the isolated distal radius in response to dynamic impact loading.

    Science.gov (United States)

    Burkhart, Timothy A; Andrews, David M; Dunning, Cynthia E

    2012-06-01

    We examined the mechanical response of the distal radius pre-fracture and at fracture under dynamic impact loads. The distal third of eight human cadaveric radii were potted and placed in a custom designed pneumatic impact system. The distal intra-articular surface of the radius rested against a model scaphoid and lunate, simulating 45° of wrist extension. The scaphoid and lunate were attached to a load cell that in turn was attached to an impact plate. Impulsive impacts were applied at increasing energy levels, in 10 J increments, until fracture occurred. Three 45° stacked strain gauge rosettes were affixed along the length of the radius quantifying the bone strains. The mean (SD) fracture energy was 45.5 (16) J. The mean (SD) resultant impact reaction force (IRFr) at failure was 2,142 (1,229) N, resulting in high compressive strains at the distal (2,718 (1,698) µε) and proximal radius (3,664 (1,890) µε). We successfully reproduced consistent fracture patterns in response to dynamic loads. The fracture energy and forces reported here are lower and the strains are higher than those previously reported and can likely be attributed to the controlled, incremental, dynamic nature of the applied loads. Copyright © 2011 Orthopaedic Research Society.

  13. Ultrathin plasmonic quarter waveplate using broken rectangular annular metasurface

    Science.gov (United States)

    Zhu, Aijiao; Qian, Qinyu; Yan, Ying; Hu, Jingpei; Zhao, Xiaonan; Wang, Chinhua

    2017-07-01

    We propose an ultrathin plasmonic metasurface-enabled quarter waveplate using a subwavelength broken rectangular annulus (BRA) arrays. The BRA structure is formed by two pairs of slits with perpendicular orientation embedded in a silver thin film. The elimination of the overlapping parts at four corners of a regular rectangular annulus increases significantly the phase anisotropy induced by localized surface plasmons, and thus decreases significantly the thickness of the metal film in order to achieve the required phase difference for a designed waveplate. Simulations show that an ultrathin quarter waveplate can be obtained with a as thin as 10 nm thickness of a silver BRA arrays at wavelength band of 1.55 μm which provides great potential in advancing manufacture of nanophotonic devices.

  14. A multi-material topology optimization approach for wrinkle-free design of cable-suspended membrane structures

    Science.gov (United States)

    Luo, Yangjun; Niu, Yanzhuang; Li, Ming; Kang, Zhan

    2017-06-01

    In order to eliminate stress-related wrinkles in cable-suspended membrane structures and to provide simple and reliable deployment, this study presents a multi-material topology optimization model and an effective solution procedure for generating optimal connected layouts for membranes and cables. On the basis of the principal stress criterion of membrane wrinkling behavior and the density-based interpolation of multi-phase materials, the optimization objective is to maximize the total structural stiffness while satisfying principal stress constraints and specified material volume requirements. By adopting the cosine-type relaxation scheme to avoid the stress singularity phenomenon, the optimization model is successfully solved through a standard gradient-based algorithm. Four-corner tensioned membrane structures with different loading cases were investigated to demonstrate the effectiveness of the proposed method in automatically finding the optimal design composed of curved boundary cables and wrinkle-free membranes.

  15. The power of stars

    CERN Document Server

    Penprase, Bryan E

    2017-01-01

    Completely revised and updated, this new edition provides a readable, beautifully illustrated journey through world cultures and the vibrant array of sky mythology, creation stories, models of the universe, temples and skyscrapers that each culture has created to celebrate and respond to the power of the night sky. Sections on the archaeoastronomy of South Asia and South East Asia have been expanded, with original photography and new research on temple alignments in Southern India, and new material describing the astronomical practices of Indonesia, Malaysia and other Southeast Asian countries. Beautiful photographs of temples in India and Asia have been added, as well as new diagrams explaining the alignment of these structures and the astronomical underpinnings of temples within the Pallava and Chola cultures. From new fieldwork in the Four Corners region of North America, Dr. Penprase has included accounts of Pueblo skywatching and photographs of ceremonial kivas that help elucidate the rich astronomical k...

  16. Magnetodielectric detection of magnetic quadrupole order in Ba(TiO)Cu4(PO4)4 with Cu4O12 square cupolas

    Science.gov (United States)

    Kimura, K.; Babkevich, P.; Sera, M.; Toyoda, M.; Yamauchi, K.; Tucker, G. S.; Martius, J.; Fennell, T.; Manuel, P.; Khalyavin, D. D.; Johnson, R. D.; Nakano, T.; Nozue, Y.; Rønnow, H. M.; Kimura, T.

    2016-10-01

    In vortex-like spin arrangements, multiple spins can combine into emergent multipole moments. Such multipole moments have broken space-inversion and time-reversal symmetries, and can therefore exhibit linear magnetoelectric (ME) activity. Three types of such multipole moments are known: toroidal; monopole; and quadrupole moments. So far, however, the ME activity of these multipole moments has only been established experimentally for the toroidal moment. Here we propose a magnetic square cupola cluster, in which four corner-sharing square-coordinated metal-ligand fragments form a noncoplanar buckled structure, as a promising structural unit that carries an ME-active multipole moment. We substantiate this idea by observing clear magnetodielectric signals associated with an antiferroic ME-active magnetic quadrupole order in the real material Ba(TiO)Cu4(PO4)4. The present result serves as a useful guide for exploring and designing new ME-active materials based on vortex-like spin arrangements.

  17. Characterization of seven United States coal regions. The development of optimal terrace pit coal mining systems

    Energy Technology Data Exchange (ETDEWEB)

    Wimer, R.L.; Adams, M.A.; Jurich, D.M.

    1981-02-01

    This report characterizes seven United State coal regions in the Northern Great Plains, Rocky Mountain, Interior, and Gulf Coast coal provinces. Descriptions include those of the Fort Union, Powder River, Green River, Four Corners, Lower Missouri, Illinois Basin, and Texas Gulf coal resource regions. The resource characterizations describe geologic, geographic, hydrologic, environmental and climatological conditions of each region, coal ranks and qualities, extent of reserves, reclamation requirements, and current mining activities. The report was compiled as a basis for the development of hypothetical coal mining situations for comparison of conventional and terrace pit surface mining methods, under contract to the Department of Energy, Contract No. DE-AC01-79ET10023, entitled The Development of Optimal Terrace Pit Coal Mining Systems.

  18. Fossil Energy Planning for Navajo Nation

    Energy Technology Data Exchange (ETDEWEB)

    Acedo, Margarita [Lawrence Livermore National Lab. (LLNL), Livermore, CA (United States)

    2017-08-11

    This project includes fossil energy transition planning to find optimal solutions that benefit the Navajo Nation and stakeholders. The majority of the tribe’s budget currently comes from fossil energy-revenue. The purpose of this work is to assess potential alternative energy resources including solar photovoltaics and biomass (microalgae for either biofuel or food consumption). This includes evaluating carbon-based reserves related to the tribe’s resources including CO2 emissions for the Four Corners generating station. The methodology for this analysis will consist of data collection from publicly available data, utilizing expertise from national laboratories and academics, and evaluating economic, health, and environmental impacts. Finally, this report will highlight areas of opportunities to implement renewable energy in the Navajo Nation by presenting the technology requirements, cost, and considerations to energy, water, and environment in an educational structure.

  19. Testing of badminton specific endurance

    DEFF Research Database (Denmark)

    Madsen, Christian Møller; Højlyng, Mads; Nybo, Lars

    2016-01-01

    In the present study, a novel intermittent badminton endurance test (B-ENDURANCE) was developed and tested in elite (n=17) and skilled (n=9) badminton players as well as in age-matched physically active men (non-badminton players; n=8). In addition, B-ENDURANCE test-retest reproducibility...... was evaluated in nine badminton players.B-ENDURANCE is an incremental test where each level consists of repeated sequences of badminton specific actions towards the four corners on the court. The subject starts in the center of the court in front of a computer screen and within each sequence he must...... decreases until the subjects cannot follow the dictated tempo.B-ENDURANCE performance for elite players was better (PENDURANCE performance correlated (r=0.8; P

  20. Photoactivated toxicity of PAH to endangered fishes and standard laboratory test species

    International Nuclear Information System (INIS)

    Buckler, D.R.; Mount, D.R.; Tillitt, D.E.

    1994-01-01

    Polynuclear aromatic hydrocarbons (PAH) have been detected in water and sediment from the San Juan River Basin, located in the Four Corners area of the southwestern US. In addition to possessing extensive oil and gas deposits, the San Juan contains several threatened or endangered fish species such as Colorado squawfish and razorback suckers. Proposed expansion of oil and gas development in the basin has sparked concerns that potential increases in PAH loading may jeopardize these and other native fishes. In response, the authors conducted laboratory exposures of threatened and endangered species to various PAH both with and without accompanying exposure to UV light. As predicted from the literature, exposure to UV light caused a marked photo-activated toxicity response in all species; however, the sensitivity to PAH both with and without UV exposure varied among species and lifestages. Supplemental studies were conducted to evaluate the physiological mechanisms for variation in sensitivity between species and lifestage

  1. When Google Plays with Private Information…The Right to Digital Oblivion in Europe, a Fight of Titans

    Directory of Open Access Journals (Sweden)

    Ana María Pérez Gómez

    2016-12-01

    Full Text Available The development of the Internet has brought with it the ability to store personal information that can be viewed on the four corners of the globe, creating a vast digital memory that perpetuates information. Search engines are key players indexing the information in the virtual memory thus contributing to their access. In Europe, the legislator has tried to regulate the balance of interests between the Internet user protecting their right to privacy and search engines who defend their economic interest. Within this context, the European judge ordered to Google the de-indexing of URLS that violated the right to privacy and it just deindexed information exclusively from European geographical extensions brandishing the general interest. The French personal data authority then waged a battle against Google to extend the right to digital oblivion to all geographical extensions of the search engines. This power struggle stress the difficulty of becoming forgotten in Internet.

  2. Beam conditioning multilayer optics for laboratory x-ray sources

    Science.gov (United States)

    Platonov, Yuriy; Verman, Boris; Jiang, Licai; Kim, Bonglea

    2015-08-01

    Practically, all modern x-ray diffractometers, SAXS, TXRF systems and many other laboratory X-ray instruments are equipped with multilayer X-ray optics. It is due to a much higher flux these instruments have comparing with those having no optics or having a grazing incidence optics without multilayer coatings. There are variety of the multilayer optics designs - from one bounce collimating parabolic mirror to four corners double bounce focusing mirrors. Design of multilayer optics depends on application, X-ray source parameters, requirements on divergence, focal spot, available room for the optics, manufacturing capability and cost. Key characteristics of the optics, requirements on multilayers d-spacing accuracy, optics slope errors, and substrates surface roughness are discussed in the paper. Different optics designs are considered including recently developed optics for a laboratory topography system and a Hybrid optics combining multilayer and crystal optics for XRR and XRD.

  3. Chondrocalcinosis of the wrist.

    Science.gov (United States)

    Saffar, P

    2004-10-01

    Calcium Pyrophosphate Dihydrate Deposition (CPDD) disease has characteristic radiographic features including soft tissue calcification, joint space narrowing, bone sclerosis, subchondral cyst formation without osteophyte formation, and large intraosseous geodes. Triangular fibrocartilage calcification is frequently found and isolated scapho-trapezio-trapezoid (STT) arthritis is specific for CPDD. Distal radio-ulnar (DRUJ), isolated midcarpal joint and piso-triquetral joint involvement also occur. 127 patients were reviewed. Seventy-eight had symptomatic STT joint arthritis, for which 36 underwent surgery. Twenty-two patients had a SLAC wrist deformity for which ten underwent surgery. Eight patients had isolated midcarpal arthritis for which three midcarpal arthrodeses, two four-bone arthrodeses and two carpal tunnel releases were performed. Nineteen patients had a generalized arthritis and seven of the patients underwent surgery: four-corner arthrodesis+scaphoidectomy (one case), carpal tunnel release (two cases) extensor synovectomy (two cases) and trigger finger release (two cases).

  4. The Colorado Plateau III: integrating research and resources management for effective conservation

    Science.gov (United States)

    Sogge, Mark K.; van Riper, Charles

    2008-01-01

    Roughly centered on the Four Corners region of the southwestern United States, the Colorado Plateau covers an area of 130,000 square miles. The relatively high semi-arid province boasts nine national parks, sixteen national monuments, many state parks, and dozens of wilderness areas. With the highest concentration of parklands in North America and unique geological and ecological features, the area is of particular interest to researchers. Derived from the Eighth Biennial Conference of Research on the Colorado Plateau, this third volume in a series of research on the Colorado Plateau expands upon the previous two books. This volume focuses on the integration of science into resource management issues, summarizes what criteria make a successful collaborative effort, outlines land management concerns about drought, provides summaries of current biological, sociological, and archaeological research, and highlights current environmental issues in the Four Corner States of Arizona, New Mexico, Colorado, and Utah. With broad coverage that touches on topics as diverse as historical aspects of pronghorn antelope movement patterns through calculating watershed prescriptions to the role of wind-blown sand in preserving archaeological sites on the Colorado River, this volume stands as a compendium of cuttingedge management-oriented research on the Colorado Plateau. The book also introduces, for the first time, tools that can be used to assist with collaboration efforts among landowners and managers who wish to work together toward preserving resources on the Colorado Plateau and offers a wealth of insights into land management questions for many readers, especially people interested in the natural history, biology, anthropology, wildlife, and cultural management issues of the region.

  5. Treatment of Oil & Gas Produced Water.

    Energy Technology Data Exchange (ETDEWEB)

    Dwyer, Brian P. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2016-02-01

    Production of oil and gas reserves in the New Mexico Four Corners Region results in large volumes of "produced water". The common method for handling the produced water from well production is re-injection in regulatory permitted salt water disposal wells. This is expensive (%7E $5/bbl.) and does not recycle water, an ever increasingly valuable commodity. Previously, Sandia National Laboratories and several NM small business tested pressure driven membrane-filtration techniques to remove the high TDS (total dissolved solids) from a Four Corners Coal Bed Methane produced water. Treatment effectiveness was less than optimal due to problems with pre-treatment. Inadequate pre-treatment allowed hydrocarbons, wax and biological growth to foul the membranes. Recently, an innovative pre-treatment scheme using ozone and hydrogen peroxide was pilot tested. Results showed complete removal of hydrocarbons and the majority of organic constituents from a gas well production water. ACKNOWLEDGEMENTS This report was made possible through funding from the New Mexico Small Business Administration (NMSBA) Program at Sandia National Laboratories. Special thanks to Juan Martinez and Genaro Montoya for guidance and support from project inception to completion. Also, special thanks to Frank McDonald, the small businesses team POC, for laying the ground work for the entire project; Teresa McCown, the gas well owner and very knowledgeable- fantastic site host; Lea and Tim Phillips for their tremendous knowledge and passion in the oil & gas industry.; and Frank Miller and Steve Addleman for providing a pilot scale version of their proprietary process to facilitate the pilot testing.

  6. Navajo transmission project. Final Environmental Impact Statement (FEIS)

    International Nuclear Information System (INIS)

    1997-08-01

    Dine Power Authority, a Navajo Nation enterprise, proposes to construct a 500 kilovolt transmission line planned to deliver electrical power from the Shiprock Substation in northwestern New Mexico to the Marketplace Substation in southern Nevada. The line would relieve constraints on transmission of electricity west from the Four Corners area; improve operational flexibility and reliability of the overall system; and allow increased economical transfers, sales, and purchases in the Rocky Mountains/Four Corners/Desert Southwest region. Also, the project allows an opportunity for the Navajo Nation to participate in the electrical utility industry and promote economic development to benefit the people of the Navajo Nation. Six alternatives were considered and include (1) energy conservation and electric load management, (2) new generation facilities, (3) use of existing transmission systems, (4) alternative transmission technologies, (5) no action, and (6) the proposed action. For the proposed action, the following alternative routes and ancillary facility locations are addressed in the EIS: four alternative routes and five substations in the eastern portion of the project area; and six alternative routes, three substation sites, and a microwave communication facility in the western portion of the project area. The existing condition of the environmental resources in the project area is described, and potential impacts on those resources as a result of the proposed action are addressed. The impacts of the proposed action would be caused mainly by access roads, tower sites, and other associated facilities on soils, vegetation, wildlife, and cultural and paleontological resources; and the impact of the transmission line's presence on visual resources and land uses. Public comments on the draft EIS are addressed in this FEIS

  7. Applying complexity theory: A primer for identifying and modeling firm anomalies

    Directory of Open Access Journals (Sweden)

    Arch G. Woodside

    2018-01-01

    Full Text Available This essay elaborates on the usefulness of embracing complexity theory, modeling outcomes rather than directionality, and modeling complex rather than simple outcomes in strategic management. Complexity theory includes the tenet that most antecedent conditions are neither sufficient nor necessary for the occurrence of a specific outcome. Identifying a firm by individual antecedents (i.e., non-innovative versus highly innovative, small versus large size in sales or number of employees, or serving local versus international markets provides shallow information in modeling specific outcomes (e.g., high sales growth or high profitability—even if directional analyses (e.g., regression analysis, including structural equation modeling indicates that the independent (main effects of the individual antecedents relate to outcomes directionally—because firm (case anomalies almost always occur to main effects. Examples: a number of highly innovative firms have low sales while others have high sales and a number of non-innovative firms have low sales while others have high sales. Breaking-away from the current dominant logic of directionality testing—null hypotheses statistic testing (NHST—to embrace somewhat precise outcome testing (SPOT is necessary for extracting highly useful information about the causes of anomalies—associations opposite to expected and “statistically significant” main effects. The study of anomalies extends to identifying the occurrences of four-corner strategy outcomes: firms doing well in favorable circumstances, firms doing badly in favorable circumstances, firms doing well in unfavorable circumstances, and firms doing badly in unfavorable circumstances. Models of four-corner strategy outcomes advances strategic management beyond the current dominant logic of directional modeling of single outcomes.

  8. [Results of lumbar and lumbosacral fusion: clinical and radiological correlations in 113 cases reviewed at 3.8 years].

    Science.gov (United States)

    Steib, J P; Bogorin, I; Brax, M; Lang, G

    2000-04-01

    Spinal fusion requires the use of hardware for reduction and stabilization. We present the clinical and radiological behavior of a population of patients with lumbar and lumbosacral spinal fusion. Between 1990 and 1992, 113 patients were operated for lumbar and lumbosacral fusion. Mean age of the population was 43 years and mean follow-up was 3.8 years. Most of the fusions were L4-S1 fusions. 56% of the patients had a previous surgery. Thirteen patients in the series were reoperated and analyzed separately. In the majority of the cases, the indication for surgery was back pain with or without leg pain. Diagnoses were: spondylolisthesis, discopathy, scoliosis, and pseudoarthrosis. The spine was fused and reduced using two lordotic rods. Peroperative and postoperative lordosis were calculated on X-rays. Clinical results were analyzed with the Beaujon-Lassale score. Mean improvement was significantly better for spondylolisthesis than for other pathologies (85.6% versus 77.1%). Returning to work was possible for 85.5% of those with improvement and was not possible for 69.8%. The gain achieved in lordosis at surgery was lost at last follow-up. The lordosis of the construct appeared to protect against the development of discopathies above and below the construct. Discopathis led to a poor score. The rate of non-union was 7.9%, the rate of repeated surgery 6.1% and the rate of hardware removal 23.8%. At last follow-up, improvement was achieved in 45.6% of the 13 patients of the series who had repeat surgery. The results in our series are similar to those reported by others. Lumbar lordosis is an important factor: if lost, more interbody fusions may be subsequently required. Diagnosis of non-union is difficult and reoperation is the only sure manner to prove it by applying distraction-compression manoeuvres on the screws. All non-unions presented were symptomatic; incidence in the series was thus probably higher. Non-union and reoperation with a longer fusion are perhaps

  9. Magnetic resonance imaging of the wrist in early rheumatoid arthritis: a pictorial essay

    International Nuclear Information System (INIS)

    Stewart, N.R.; Crabbe, J.P.; McQueen, F.M.

    2001-01-01

    This pictorial essay describes the changes seen in the wrist in early rheumatoid arthritis (RA) on MRI. Magnetic resonance imaging can demonstrate bone erosions, bone marrow signal changes, synovitis and tenosynovitis in early rheumatoid arthritis. Magnetic resonance imaging of the wrist can identify erosions in RA earlier than plain radiographs and can detect more erosions. Common sites include the capitate, lunate and scaphoid. Bone marrow signal changes occur frequently and are most common in the capitate, lunate and triquetrum. Synovial thickening and enhancement are clearly demonstrated with MRI and are most commonly seen in the radiocarpal joint (RCJ). Tenosynovitis can be seen in the wrist in more than half of patients presenting with RA. This most commonly involves the extensor carpi ulnaris tendon and is seen as sheath fluid, thickening and enhancement. Copyright (2001) Blackwell Science Pty Ltd

  10. Osteoblastoma of the carpal navicular: a case report and review of the literature.

    Science.gov (United States)

    Rhanim, Abdelkarim; El Bardouni, Ahmed; Dlimi, Fayçal; Abouzahir, Mohammed; Berrada, Mohammed Saleh; El Yaacoubi, Moradh

    2013-11-01

    Osteoblastoma of the scaphoid is an infrequent cause of hand and wrist pain. The few reported cases emphasize the rarity of osteoblastoma in hand and wrist localizations. Pathological examination is mandatory before treatment due to lack of distinctive clinical and radiological features. We report the case of a 17-year-old right-handed girl who presented with a more than 7-month history of progressive right-wrist pain. No history of trauma was reported. Conservative treatment with anti-inflammatory medications before referral was unsuccessful. The authors present the diagnostic difficulties and the treatment that was applied: proximal row carpectomy. Treatment options, according to the literature, also include scaphoidectomy and tumor curettage with bone grafting.

  11. Extended uses for the Herbert/Whipple screw: six case reports out of 35 illustrating technique.

    Science.gov (United States)

    Reimer, H; Kreibich, M; Oettinger, W

    1996-01-01

    We have used 6.5-mm and 4.5-mm Herbert/Whipple screws in our Trauma Center since 1991. This double-threaded headless device is used primarily in the scaphoid to manage fractures and delayed unions, but can be used successfully to fixate other fractures at diverse sites. In reviewing our experience, we will discuss several characteristics of this screw. These include advantages of the screw, such as generation of only minor soft-tissue trauma in areas of poor soft-tissue coverage or for transcartilaginous fixation, as well as its disadvantages, such as weak interfragmentary compression and low pullout resistance. Case reports are presented to illustrate applications of this device in the upper extremity (fractures of the humeral neck, the articular surface of the shoulder blade, and pseudarthrosis of the olecranon) and in the lower extremity (fractures of the talar neck, the medial malleolus, and Volkmann's triangle).

  12. TC study of the carpal tunnel

    International Nuclear Information System (INIS)

    Martelli, A.; Gozzoli, L.; Uggetti, C.; Zanlungo, M.; Ferrari, P.; Leddi, G.

    1987-01-01

    The standard technique for CT investigation of the carpal tunnel and its normal anatomy were studied. Ten healty asymptomatic volunteers, age 25-45, underwent wrist CT. The hand is placed in prone position with the third metacarpus in line with radius. Digital radiograph and four axial CT scans are performed respectively: at the distal end of the radius, at the scaphoid tubercle level, at the hamate hook level and at the carpal and metacarpal joint. Standard carpal tunnel diameters are thus available with good reliability and repeatibility when correct technique is adopted. The results permit a morphological description of the osseous walls, transverse ligament, flexor tendons with synovial sheets and median nerve. Gujon's canal and its content can also be investigated

  13. Preiser’s disease: two cases report

    Directory of Open Access Journals (Sweden)

    G.P. Ferrari

    2011-09-01

    Full Text Available Preiser’s syndrome is a rare osteochondrosis affecting the carpal scaphoid, frequently related with an avascular necrosis. Osteoarthritic changes of the articular cartilage, local synovitis, and loose fragments are the most common findings associated with this syndrome. We report here two patients with Preiser’s syndrome, one with and one without a traumatic history, both presenting with pain, swelling and functional impairement of the wrist. In one patient radiography was sufficient for the diagnosis, in the other NMR was necessary to clearly establish type and extension of the lesion. Differential diagnosis may be sometimes difficult and the therapeutic approach on depends on several aspects, including etiology and type of occupational activity.

  14. A Case of Trapezium Avascular Necrosis Treated Conservatively.

    Science.gov (United States)

    Petsatodis, Evangelos; Ditsios, Konstantinos; Konstantinou, Panagiotis; Pinto, Iosafat; Kostretzis, Lazaros; Theodoroudis, Ioannis; Pilavaki, Mayia

    2017-01-01

    Avascular necrosis (AVN) of the bones of the wrist most commonly involves the lunate followed by the proximal pole of the scaphoid and the capitate. Trapezium avascular necrosis is extremely rare with only two cases reported in the literature, both of which were treated surgically. In this article, we report a unique case of trapezium avascular necrosis treated conservatively. A 38-year-old man complaining of a 4-month history of mild pain on the base of his right thumb. MRI scan was performed. The clinical presentation and the imaging findings indicated avascular osteonecrosis of the trapezium. The patient was treated with immobilization of the wrist joint for a period of six weeks. Three months later, the patient was free of symptoms and the MRI scan revealed a normal trapezium. AVN of trapezium is extremely rare. Our case shows that immobilization of an early stage avascular necrosis of the trapezium might be a treatment option.

  15. Absence of uptake of the rib cage; diagnosis of a Poland's syndrome with the bone SPECT-CT; Absence de fixation du gril costal: diagnostic d'un syndrome de Poland par la TEMP-TDM osseuse

    Energy Technology Data Exchange (ETDEWEB)

    Granier, P.; Mourad, M. [Centre Hospitalier Antoine-Gayraud, Service de Medecine Nucleaire, 11 - Carcassonne (France)

    2008-09-15

    We report the case of a 37-year-old man, investigated for pains of the right upper limb impairing the hand, the wrist and the shoulder after a surgery for fracture of the radius and the scaphoid. The {sup 99m}Tc-H.D.P. three-phase bone scintigraphy confirmed the diagnosis of acute phase of a reflex sympathetic dystrophy. The delayed images highlighted a focal absence of tracer uptake of the left anterior rib cage. The single photon emission computerized tomography guided by computerized tomography showed that it was related to the absence of the anterior part of the third and the fourth left ribs highlighting an aplasia of the left pectoralis major muscle. These anomalies led to the diagnosis of congenital malformation in connection with a Poland's syndrome. The differential diagnosis of this syndrome resulted in discussing the multiple etiologies of the photopenic lesions of the rib cage. (authors)

  16. Squamous cell carcinoma in Hand – Case reportCarcinoma de células escamosas na mão - Estudo de caso

    Directory of Open Access Journals (Sweden)

    Joaquim José de Lima Silva

    2016-03-01

    Full Text Available Introduction: Squamous cell carcinoma (SCC is a type of skin malignancy that originates in the squamous layer of the epidermis.  A lower incidence than basal cell carcinomas is reported. There is a predominance of areas heavily exposed to sunlight Objectives: To report a case of squamous cell carcinoma in left hand compromising the hypothenar region. To carry out a literature review and emphasize the main methods of diagnosis and treatment. Methods: Information obtained from medical records, photographic record of pre and post-operative. Result: Histopathological diagnosis was made, confirming squamous cell carcinoma due to the evolution of metastatic basal cell carcinoma, with the removal of bones: 5th metacarpal and scaphoid. After relapse, requiring amputation of the left hand. Conclusion: To report a rare case of bone metastasis derived from a skin cancer.

  17. Stress fractures of ankle and wrist in childhood: nature and frequency

    Energy Technology Data Exchange (ETDEWEB)

    Oestreich, Alan E. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Cincinnati, OH (United States); Bhojwani, Nicholas [University of Cincinnati College of Medicine, Cincinnati, OH (United States)

    2010-08-15

    Stress fractures of many etiologies are found not infrequently in various tarsal bones but are less commonly recognized in carpal bones. To assess the distribution of tarsal and carpal stress fractures. During the last three decades, the senior author collected locations of tarsal and carpal bone stress fracture callus seen on plain radiographs. 527 children with tarsal and carpal stress fractures were identified (88 children had multiple bones involved). The totals were: calcaneus 244, cuboid 188, talus 121, navicular 24, cuneiforms 23, capitate 18, lunate 1, and scaphoid 1. Stress fractures were more frequently seen once we became aware each particular bone could be involved. Tarsal and carpal stress fractures in children are not rare. Careful perusal of these bones is urged in all susceptible children with limping or wrist pain. (orig.)

  18. Stress fractures of ankle and wrist in childhood: nature and frequency

    International Nuclear Information System (INIS)

    Oestreich, Alan E.; Bhojwani, Nicholas

    2010-01-01

    Stress fractures of many etiologies are found not infrequently in various tarsal bones but are less commonly recognized in carpal bones. To assess the distribution of tarsal and carpal stress fractures. During the last three decades, the senior author collected locations of tarsal and carpal bone stress fracture callus seen on plain radiographs. 527 children with tarsal and carpal stress fractures were identified (88 children had multiple bones involved). The totals were: calcaneus 244, cuboid 188, talus 121, navicular 24, cuneiforms 23, capitate 18, lunate 1, and scaphoid 1. Stress fractures were more frequently seen once we became aware each particular bone could be involved. Tarsal and carpal stress fractures in children are not rare. Careful perusal of these bones is urged in all susceptible children with limping or wrist pain. (orig.)

  19. Two stage procedure for neglected transscaphoid perilunate dislocation

    Directory of Open Access Journals (Sweden)

    Hitesh Lal

    2012-01-01

    Full Text Available We report a two-staged surgical procedure for neglected 3 month old volar transscaphoid, transcapitate perilunate fracture dislocation wrist in an 18 year old right handed male student. The lunate with proximal scaphoid and proximal capitate maintained its articulation with distal end radius while the rest of carpal bones had dislocated volarly. In the first stage, bilateral uniplanar wrist distractor was applied with the aim of stretching soft tissue. In the next stage open reduction and internal fixation was done by a combined volar and dorsal approach augmented by pronator quadratus flap. At 3 years followup the patient was pain free and had a full range of supination pronation of the forearms and radial and ulnar deviation of wrist with 10΀ dorsiflexion deficit.

  20. Anthropometric measurements in patients with growth hormone deficiency before treatment with human growth hormone.

    Science.gov (United States)

    Zachmann, M; Fernandez, F; Tassinari, D; Thakker, R; Prader, A

    1980-05-01

    In 74 children (52 males, 22 females) with growth hormone (GH) deficiency (30 cases with isolated GH-deficiency, two of them familial; 4 familial and one isolated case with tendency for formation of antibodies against hGH; 29 with other pituitary hormone defects; 10 craniopharyngiomas), various anthropometric measurements were analyzed before treatment with hGH. In all groups, standing height, sitting height, and subischial leg height were equally retarded, and bihumeral width was more retarded than biiliac width; the head was relatively large; fat tissue was increased with subscapular skinfolds being greater than triceps skinfolds, indicating relative obestiy of the trunk; muscle and/or bone mass was reduced. In isolated GH-deficiency, head shape was slightly scaphoid; in combined defects, it was round, and in craniopharyngioma cases, it was brachycephalic. It is concluded that antrhopometric measurements may help in differentiating the type of GH-deficiency.

  1. The EULAR-OMERACT rheumatoid arthritis MRI reference image atlas: the wrist joint

    DEFF Research Database (Denmark)

    Ejbjerg, B; McQueen, F; Lassere, M

    2005-01-01

    , capitate, and a metacarpal base. In these bones, grades 0-3 of bone oedema are illustrated, and for bone erosion, grades 0-3 and examples of higher grades are presented. The presented reference images can be used to guide scoring of wrist joints according to the OMERACT RA MRI scoring system......This paper presents the wrist joint MR images of the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. Reference images for scoring synovitis, bone oedema, and bone erosions according to the OMERACT RA MRI scoring (RAMRIS) system are provided. All grades (0-3) of synovitis...... are illustrated in each of the three wrist joint areas defined in the scoring system-that is, the distal radioulnar joint, the radiocarpal joint, and the intercarpal-carpometacarpal joints. For reasons of feasibility, examples of bone abnormalities are limited to five selected bones: the radius, scaphoid, lunate...

  2. Limited open reduction is better for simple- distal tibial shaft fractures than minimally invasive plate osteosynthesis.

    Science.gov (United States)

    Li, Q; Zeng, B F; Luo, C F; Song, S; Zhang, C Q; Kong, W Q

    2014-07-24

    The aim of this study was to compare the effects and indications of minimally invasive plate osteosynthesis (MIPO) and limited open reduction (LOR) for managing distal tibial shaft fractures. A total of 79 cases of distal tibial shaft fractures were treated surgically in our trauma center. The 79 fracture cases were classified into type A, B, and C (C1) according to the Arbeitsgemeinschaft für Osteosynthesefragen (AO) classification, with 28, 32, and 19 cases, respectively. Among the 79 fracture cases, 52 were closed fractures and 27 were open fractures (GUSTILO, I-II). After adequate preparation, 48 cases were treated with LOR and 31 cases were treated with MIPO. All cases were followed up for 12 to 18 months, with an average of 16.4 months. During the follow-up period, 76 fracture cases were healed in the first stage, whereas the 3 cases that developed non-union were treated by changing the fixation device and autografting. For types A, B, and some of C simple fractures (C1), LOR accelerated the fracture healing and lowered the non-union rate. One case suffered from regional soft tissue infection, which was controlled by wound dressing and intravenous antibiotics. Another case that developed local skin necrosis underwent local flap transplant. LOR promoted bone healing and lowered the non-union rate of several simple-distal tibial shaft fractures. Thereafter, the incidence of soft tissue complication was not significantly increased. However, for complex and comminuted fractures, MIPO was the preferred method for correcting bone alignment and protecting soft tissue, leading to functional recovery.

  3. The effect of unions on the distribution of wages of hospital-employed registered nurses in the United States.

    Science.gov (United States)

    Spetz, Joanne; Ash, Michael; Konstantinidis, Charalampos; Herrera, Carolina

    2011-01-01

    We estimate the impact of unionisation on the wage structure of hospital-employed registered nurses in the USA. We examine whether unions have an effect on wage differences associated with race, gender, immigration status, education and experience, as well as whether there is less unexplained wage variation among unionised nurses. In the past decade, there has been resurgence in union activity in the health care industry in the USA, particularly in hospitals. Numerous studies have found that unions are associated with higher wages. Unions may also affect the structure of wages paid to workers, by compressing the wage structure and reducing unexplained variation in wages. Cross-sectional analysis of pooled secondary data from the United States Current Population Survey, 2003-2006. Multivariate regression analysis of factors that predict wages, with models derived from labour economics. There are no wage differences associated with gender, race or immigration status among unionised nurses, but there are wage penalties for black and immigrant nurses in the non-union sector. For the most part, the pay structures of the union and non-union sectors do not significantly differ. The wage penalty associated with diploma education for non-union nurses disappears among unionised nurses. Unionised nurses receive a lower return to experience, although the difference is not statistically significant. There is no evidence that unexplained variation in wages is lower among unionised nurses. While in theory unions may rationalise wage-setting and reduce wage dispersion, we found no evidence to support this hypothesis. The primary effect of hospital unions is to raise wages. Unionisation does not appear to have other important wage effects among hospital-employed nurses. © 2010 Blackwell Publishing Ltd.

  4. SOUND LABOR RELATIONS AT ENTERPRISE LEVEL IN THAILAND

    Directory of Open Access Journals (Sweden)

    Vichai Thosuwonchinda

    2016-07-01

    Full Text Available The objective of this research was to study the pattern of sound labor relations in Thailand in order to reduce conflicts between employers and workers and create cooperation. The research was based on a qualitative approach, using in-depth interview with 10 stakeholder groups of Thai industrial relations system. They were employees of non unionized companies at the shop floor level, employees of non unionized companies at the supervisor level, trade union leaders at the company level, trade union leaders at the national level, employers of non-unionized companies, employers’ organization leaders, and human resource managers, members of tripartite bodies, government officials and labor academics. The findings were presented in a model identifying 5 characteristics that enhance sound relations in Thailand, i.e. recognition between employer and workers, good communication, trust, data revealing and workers’ participation. It was suggested that all parties, employers, workers and the government should take part in the promotion of sound labor relations. The employer have to acknowledge labor union with a positive attitude, have good communication with workers , create trust with workers, disclose information, create culture of mutual benefits as well as accept sincerely the system that include workers’ participation. Workers need a strong labor union, good and sincere representatives for clear communication, trust, mutual benefits and seek conflict solutions with employer by win-win strategy. The government has a supporting role in adjusting the existing laws in the appropriate way, by creating policy for sound labor relations, and putting the idea of sound labor relations into practice.

  5. Can MRI predict subsequent pseudarthrosis resulting from osteoporotic thoracolumbar vertebral fractures?

    Science.gov (United States)

    Omi, Hirotsugu; Yokoyama, Toru; Ono, Atsushi; Numasawa, Takuya; Wada, Kanichiro; Fujisawa, Yoichi

    2014-12-01

    The purpose of this study was to assess the ability of short inversion time inversion-recovery (STIR) in magnetic resonance imaging for predicting the prognosis of osteoporotic vertebral fractures. We analyzed 63 vertebrae of 56 patients who had osteoporotic vertebral fracture (Th10-L2) prospectively. Image finding of a homogeneous high signal change on a fractured vertebra was evaluated and all vertebrae were divided into "homogenous high signal change group" or "non-homogenous high signal change group". On the other hand, image finding of linear black signal area was evaluated and all vertebrae were divided into "linear black signal area group" or "non-linear black signal area group". Sixteen and 24 vertebrae were included in the homogenous high signal change group or the linear black signal area group, respectively. The 16 homogenous high signal change cases did not result in non-union, and 47 non-homogenous high signal change cases resulted in 14 non-unions, a significant difference. Twenty-four linear black signal area and 39 non-linear black signal area cases resulted in 10, and 4 non-unions, respectively, also a significant difference. The kyphosis progression rate of the linear black signal area group (mean 35%) was significantly higher than that of non-linear black signal area group (mean 23%). The visual analog scale of back pain of the linear black signal area group (mean 35 mm) was significantly higher than that of the non-linear black signal area group (mean 23 mm). STIR was useful for predicting bone union, kyphosis, and back pain in patients with osteoporotic vertebral fracture.

  6. The early functional outcome of Mau osteotomy for the correction of moderate-severe hallux valgus

    Directory of Open Access Journals (Sweden)

    Tanujan Thangarajah

    2013-11-01

    Full Text Available Hallux valgus is one of the commonest conditions of the foot and has been reported to affect nearly half of the adult population. It is most effectively treated by a corrective osteotomy of which there a numerous subtypes. The Mau osteotomy confers the greatest structural stability but is not thought to provide adequate correction of moderate-severe deformities. Accordingly, complications such as under correction and non-union are common. The aim of this study was to determine the functional outcome in patients with moderate-severe hallux valgus following a Mau osteotomy. A retrospective review of 23 patients with moderate-severe hallux valgus treated by Mau osteotomy was conducted. Patients were assessed clinically by the American Orthopedic Foot and Ankle Society (AOFAS scoring system and radiologically by measuring the first intermetatarsal (IM and hallux abductovalgus angles (HAV. The mean AOFAS score had improved from 47 preoperatively to 92 postoperatively (P<0.01. Additionally, preoperative HAV and IM angles improved from 39° and 15° respectively to 15° and 9° respectively (P<0.01. There were no cases of undercorrection or non-union. In this series, the Mau osteotomy was able to achieve good correction of the IM and HAV angles in patients with moderate-severe hallux valgus. This was reflected in a significantly higher postoperative AOFAS score. Contrary to other studies there were no cases of undercorrection and despite allowing patients to fully weight-bear postoperatively there were no cases of non-union.

  7. ANTEROINFERIOR PLATING OF DISPLACED MIDDLE THIRD FRACTURE OF CLAVICLE

    Directory of Open Access Journals (Sweden)

    Shashi Kumar

    2016-05-01

    Full Text Available PURPOSE Even though clavicle fractures have a good union rate conservatively, there are several indications for surgical management. Among the surgical techniques open reduction and plate fixation have been used extensively. Although most surgeons prefer a superior plating technique, an anteroinferior plate location seems to be more advantageous considering the position and reduction of fragments. MATERIAL AND METHODS Fifteen consecutive patients with displaced middle-third fracture, delayed unions and non-unions of the clavicle underwent open reduction and internal fixation using an anteroinferior 3.5 mm reconstruction locking compression plate and screws. Patients were evaluated using patient symptoms, clinical signs and radiographic union, the Short Form-36 (SF-36, the American Shoulder and Elbow Surgeons Shoulder Assessment (ASES, and Constant Shoulder Score (CSS outcomes questionnaire. RESULTS The mean age of the patients was 34.6 years (range 19 to 53 years and all of them (n=15 were males. All patients were satisfied with their shoulder and upper extremity function as well as cosmesis from first week of surgery and were able to carry out their activities of daily living. Mean union time (absence of clinical tenderness and time for radiological union of fracture was 14.6 weeks, range being 12 to 21 weeks. ASES score was 89. Constant shoulder score was 84 at the latest follow-up. CONCLUSIONS Anteroinferior plating of acute displaced middle-third fractures of the clavicle and non-union using 3.5 mm reconstruction locking compression plate typically results in early healing, few complications and an excellent return of function. Advantages of this technique include stable bony fixation with screws directed away from potentially dangerous infraclavicular structures, minimal or no incidence of implant prominence problems and good patient compliance. Further, we would like to emphasise the fact that reduction of small inferior fragments in

  8. The relationship between labor unions and safety in US airlines: Is there a "union effect?"

    Science.gov (United States)

    Zapf, Renee Catherine

    Every airline union claims to work for safety and presents anecdotes where greater airline safety has been achieved through union efforts. The effect unionization has on safety outcomes in U.S. commercial airlines, however, wasn't found to be previously tested. Studies have shown that in industries such as coal mining, retail, and construction, unionization does lead to an increase in safety. This study evaluated the safety rates of 15 major US commercial airlines to compare the difference between unionized and non-unionized airlines. These safety rates were compared based on if and how long each airline's pilots and flight attendants have been unionized, to determine if unionization had an effect on safety outcomes. The 15 airlines included in the study identified as operating most of the years between 1990 and 2013, with annual departures averaging over 130,000, available through the Bureau of Transportation Statistics. Accident and Incident information was acquired through the National Transportation Safety Board database. The number of accident and incidents divided by the total departures at each airline was used as the safety rate. Union websites provided information on unionization at the airlines. Due to the complex nature of the aviation industry, a number of confounding factors could have affected the tests, including mergers, route structures, and legislation. To help control for these confounding factors, this study was limited to airlines with a stable presence in the industry over time, which limited the number of airlines included. No significant difference was found between unionized and non-unionized airlines in this study, though the mean safety rate of unionized airlines was found be better than non-unionized airlines. This study did not take into account safety improvements that were union-backed and eventually required at all airlines, regardless of unionization. Due to the large sample size of the small population the difference in safety rate

  9. To fix or not to fix? The role of fibular fixation in distal shaft fractures of the leg.

    Science.gov (United States)

    Berlusconi, M; Busnelli, L; Chiodini, F; Portinaro, N

    2014-02-01

    The role of stabilisation of the fibula in distal two-bone fractures of the leg is controversial. Some studies indicate the need for fibular stabilisation in 43 AO fractures, but few studies consider the role of the fibula in 42 AO fractures. The aim of the current paper is to explain the role of stabilisation of the fibula in 42 AO fractures, correlating the rates of healing and non-union between patients with and without fibula fixation. A total of 60 patients with 42 AO (distal) shaft fracture of the tibia with associated fracture of the fibula were selected. Patients were divided into two groups according to whether or not the fibula was fixed: Group I (n=26) comprised patients who had their fibula fixed while Group II (n=34) comprised patients who did not. The fibular fracture was classified according to the AO and related to the level of the tibial fracture. Other parameters examined were the union rate of the two groups correlated to the fracture pattern and position of the fibular fracture; the demographic data, such as age and gender; the presence of an open fracture, and the type of tibial fixation device used (nail or plate). None of the parameters considered (open injury, AO classification, device used and level of the fibular fracture relative to the tibial) were shown to have an influence on the development of a non-union. This study showed a higher non-union rate when the fracture of the tibia and fibula were at the same level, the tibia was fixed with a bridging plate and the fibula left untouched. For this reason, we recommend fibular fixation in all 42 distal fractures when both fractures lie on the same plane and the tibial fracture is relatively stabilised. Copyright © 2013 Elsevier Ltd. All rights reserved.

  10. Different evolutionary pathways underlie the morphology of wrist bones in hominoids.

    Science.gov (United States)

    Kivell, Tracy L; Barros, Anna P; Smaers, Jeroen B

    2013-10-23

    The hominoid wrist has been a focus of numerous morphological analyses that aim to better understand long-standing questions about the evolution of human and hominoid hand use. However, these same analyses also suggest various scenarios of complex and mosaic patterns of morphological evolution within the wrist and potentially multiple instances of homoplasy that would benefit from require formal analysis within a phylogenetic context.We identify morphological features that principally characterize primate - and, in particular, hominoid (apes, including humans) - wrist evolution and reveal the rate, process and evolutionary timing of patterns of morphological change on individual branches of the primate tree of life. Linear morphological variables of five wrist bones - the scaphoid, lunate, triquetrum, capitate and hamate - are analyzed in a diverse sample of extant hominoids (12 species, 332 specimens), Old World (8 species, 43 specimens) and New World (4 species, 26 specimens) monkeys, fossil Miocene apes (8 species, 20 specimens) and Plio-Pleistocene hominins (8 species, 18 specimens). Results reveal a combination of parallel and synapomorphic morphology within haplorrhines, and especially within hominoids, across individual wrist bones. Similar morphology of some wrist bones reflects locomotor behaviour shared between clades (scaphoid, triquetrum and capitate) while others (lunate and hamate) indicate clade-specific synapomorphic morphology. Overall, hominoids show increased variation in wrist bone morphology compared with other primate clades, supporting previous analyses, and demonstrate several occurrences of parallel evolution, particularly between orangutans and hylobatids, and among hominines (extant African apes, humans and fossil hominins). Our analyses indicate that different evolutionary processes can underlie the evolution of a single anatomical unit (the wrist) to produce diversity in functional and morphological adaptations across individual wrist

  11. Radiocarpal Injuries: Cone Beam Computed Tomography Arthrography, Magnetic Resonance Arthrography, and Arthroscopic Correlation among 21 Patients.

    Science.gov (United States)

    Suojärvi, N; Haapamäki, V; Lindfors, N; Koskinen, S K

    2017-06-01

    Patients with acute or chronic wrist pain often undergo wrist arthroscopy for evaluation of chondral and ligamentous abnormalities. The purpose of this study was to compare findings of wrist arthroscopy with cone beam computed tomography arthrography and magnetic resonance arthrography. Altogether, 21 patients with wrist pain underwent cone beam computed tomography arthrography, magnetic resonance arthrography, and wrist arthroscopy. Chondral surfaces of the scaphoid, lunate, and radius facing the scaphoid and lunate were evaluated. The scapholunate ligament, the lunotriquetral ligament, and the triangular fibrocartilage complex were classified as either intact or torn. Sensitivity, specificity, positive and negative predictive values, and accuracy with 95% confidence intervals were assessed. For chondral lesions (n = 10), cone beam computed tomography arthrograms showed slightly higher specificity than magnetic resonance arthrography. The sensitivity of cone beam computed tomography arthrography was also better for these lesions, except for those on the chondral surface of the lunate. For triangular fibrocartilage complex injuries (n = 9), cone beam computed tomography arthrography showed a better specificity and sensitivity than magnetic resonance arthrography. For ligamentous injuries (n = 6), cone beam computed tomography arthrograms were more sensitive, but less specific than magnetic resonance arthrography images. However, the number of lesions was very small and the 95% confidence intervals are overlapping. Cone beam computed tomography is an emerging imaging modality that offers several advantages over computed tomography and magnetic resonance imaging. Its usefulness particularly in ligamentous injuries should be further explored in a larger study. Cone beam computed tomography arthrography seems to offer similar sensitivity, specificity, and accuracy compared to magnetic resonance arthrography and therefore serves as a valuable option in

  12. Intramedullary nailing in segmental tibial fractures.

    Science.gov (United States)

    Melis, G C; Sotgiu, F; Lepori, M; Guido, P

    1981-10-01

    Thirty-eight consecutive segmental fractures of the tibia were treated by intramedullary nailing with the Küntscher-Herzog nail. Twenty-two fractures were closed and sixteen were open. Reaming of the medullary cavity was performed and adequate fixation was ensured by use of a plaster cast. Weight-bearing was allowed after thirty-days for closed fractures and sixty days for open fractures. All of the closed fractures healed without malunion or infection. Of the patients with open fractures, one had an infection; one, non-union; and one, malunion. In all cases but one, union was slower at the distal fracture.

  13. Hamate hook stress fracture in a professional bowler: Case report of an unusual causal sport.

    Science.gov (United States)

    How Kit, N; Malherbe, M; Hulet, C

    2017-02-01

    Stress fracture of the hook of the hamate is uncommon and is usually seen in sports involving a club, racquet or bat (i.e., golf, tennis or baseball). It is caused by direct blunt trauma. We report an unusual case of stress fracture with non-union in a 23-year-old professional bowler, probably caused by endogenous constraints, 1 year after the start of symptoms. Treatment consisted of surgical resection of the hook of the hamate. Multimodal imaging of this fracture is reviewed. Copyright © 2016. Published by Elsevier Masson SAS.

  14. Anaesthetic Implications in Primary Hyperparathyroidism with Severe Hypercalcaemia; a Case Report

    Directory of Open Access Journals (Sweden)

    Pranav Bansal

    2013-07-01

    Full Text Available Primary hyperparathyroidism is a rare endocrinal disorder of excess production of parathormone. A wide array of presenting symptoms may occur from parathormone induced hypercalcaemia leading to nephrolithiasis, osteoporosis, muscle weakness and cardiac arrhythmias. We present a case of young female who presented with non union of an operated fracture femur and generalized bony pains and frequent complaints of vomiting, polyuria and polydipsia. She was diagnosed to have primary hyperparathyroidism with hypercalcaemia and underwent parathyroidectomy. The potential perioperative problems and anaesthetic concerns require a focused management and are discussed.

  15. Anaesthetic Implications in Primary Hyperparathyroidism with Severe Hypercalcaemia: a Case Report

    Directory of Open Access Journals (Sweden)

    Pranav Bansal

    2013-07-01

    Full Text Available Primary hyperparathyroidism is a rare endocrinal disorder of excess production of parathormone. A wide array of presenting symptoms may occur from parathormone induced hypercalcaemia leading to nephrolithiasis, osteoporosis, muscle weakness and cardiac arrhythmias. We present a case of young female who presented with non union of an operated fracture femur and generalized bony pains and frequent complaints of vomiting, polyuria and polydipsia. She was diagnosed to have primary hyperparathyroidism with hypercalcaemia and underwent parathyroidectomy. The potential perioperative problems and anaesthetic concerns are discussed.

  16. An unusual cause of pain post ankle arthrodesis in patients with rheumatoid arthritis.

    LENUS (Irish Health Repository)

    Burke, Neil G

    2012-02-01

    Rheumatoid arthritis is an autoimmune disease which frequently affects the ankle and foot. End stage ankle arthritis from rheumatic disease is commonly managed by the established practice of ankle arthrodesis. Among the adverse sequelae causing pain following this surgery is infection, pseudo-arthrosis and non-union. Stress fracture of the distal third is a recognised but unusual cause of pain of tibia following ankle arthrodesis. The authors\\' present three patients with rheumatoid arthritis who sustained a stress fracture of the distal tibia following arthrodesis, and discuss the contributing factors and highlight the need for orthopaedic surgeons to be suspicious of this complication post surgery.

  17. Explaining Leaving Union Membership by the Degree of Labour Market Attachment

    DEFF Research Database (Denmark)

    Leschke, Janine; Vandaele, Kurt

    2018-01-01

    By particularly stressing the weaker labour market attachment of workers with non-standard contracts, this article contributes to the rather unexplored issue of mainly non-union-related reasons for leaving trade unions. Germany has been selected as a case study because German unions experienced...... a steady decline in membership, while at the same time non-standard employment arrangements increased considerably and more so than the European average. Using the German Socio-Economic Panel data, the authors construct a labour market attachment variable capturing different degrees of attachment...

  18. Ambulatory treatment of femoral shaft fractures with cast-brace.

    Science.gov (United States)

    Brown, P E; Preston, E T

    1975-10-01

    Our early results support use of the cast-brace, early ambulation treatment of both open and closed fractures of the femoral shaft in all adult age groups. We believe initial traction should be used to reduce the fracture and maintain reduction until the fracture is clinically "sticky" to avoid subsequent malalignment in the cast-brace. The method facilitates early rehabilitation of the fractured extremity and the patient with minimal residual disability such as non-union, malunion, chronic infection and joint stiffness, so often associated with other forms of long bone fracture treatment.

  19. [Pediculated deltoid muscle flap: an alternative for coverage of chronic radionecrotic lesions in the shoulder region].

    Science.gov (United States)

    Löw, S; Herold, D; Eingartner, C

    2014-07-01

    Soft tissue lesions in the clavicular region may be the result of trauma, infections or oncological resection and necessitate plastic surgery coverage. A case of an 85-year-old woman is presented with non-union of the mid-portion of the left clavicle with an overlying skin defect and a brachial plexus lesion after radiation therapy for breast cancer. The left arm was functionless so after partial resection of the medial part of the clavicle coverage of the defect was conducted by a proximally pediculated anterior part of the deltoid muscle with a split thickness skin graft.

  20. Radium-226 in vegetation and substrates at inactive uranium mill sites

    International Nuclear Information System (INIS)

    Marple, M.L.

    1980-01-01

    Results of a study of the content of radium-226 in plants growing on inactive uranium mill tailings sites in the Four Corners Region of the southwestern United States and in plants grown under greenhouse conditions with minimal surficial contamination are reported. Field plant samples and associated substrates were analyzed from two carbonate tailings sites in the Grants Mineral Belt of New Mexico. Radium activities in air-cleaned samples ranged from 5 to 368 pCi/g (dry weight) depending on species and location: activities in plants growing on local soils averaged 1.0 pCi/g. The talings and local soils contain 140 to 1400 pCi/g and 2.1 pCi/g, respectively. An evaluation of cleaning methods on selected samples showed that from 17 to 79% of the radium activity measured in air-cleaned samples was due to surficial contamination, which varied with species and location. A survey of 18 inactive uranium mill sites in the Four Corners Region was performed. Radium activity in plant tissues from nine species ranged from 2 to 210 pCi/g on bare tailings and from 0.3 to 30 pCi/g on covered tailings The radium content in most of the soil overburdens on the covered tailings piles was 10 to 17 pCi/g. An experiment was performed to measure radium-226 uptake by two species grown on tailings covered with a shallow (5 cm) soil layer. A grass, Sporobolus airoides (alkali sacaton) and a shrub, Atriplex canescens (four-wing saltbush), were studied. The tailings were a mixture of sands and slimes from a carbonate pile. The tailings treatments were plants grown in a soil cover over tailings; the controls were plants grown only in soil. Three soil types, dune sand, clay loam, and loam, were used. The radium activity of the plant tissue from the tailings treatment compared to that of the appropriate control was 1 to 19 times greater for the grass and 4 to 27 times greater for the shrub

  1. Radium-226 in vegetation and substrates at inactive uranium mill sites

    Energy Technology Data Exchange (ETDEWEB)

    Marple, M.L.

    1980-01-01

    Results of a study of the content of radium-226 in plants growing on inactive uranium mill tailings sites in the Four Corners Region of the southwestern United States and in plants grown under greenhouse conditions with minimal surficial contamination are reported. Field plant samples and associated substrates were analyzed from two carbonate tailings sites in the Grants Mineral Belt of New Mexico. Radium activities in air-cleaned samples ranged from 5 to 368 pCi/g (dry weight) depending on species and location: activities in plants growing on local soils averaged 1.0 pCi/g. The talings and local soils contain 140 to 1400 pCi/g and 2.1 pCi/g, respectively. An evaluation of cleaning methods on selected samples showed that from 17 to 79% of the radium activity measured in air-cleaned samples was due to surficial contamination, which varied with species and location. A survey of 18 inactive uranium mill sites in the Four Corners Region was performed. Radium activity in plant tissues from nine species ranged from 2 to 210 pCi/g on bare tailings and from 0.3 to 30 pCi/g on covered tailings The radium content in most of the soil overburdens on the covered tailings piles was 10 to 17 pCi/g. An experiment was performed to measure radium-226 uptake by two species grown on tailings covered with a shallow (5 cm) soil layer. A grass, Sporobolus airoides (alkali sacaton) and a shrub, Atriplex canescens (four-wing saltbush), were studied. The tailings were a mixture of sands and slimes from a carbonate pile. The tailings treatments were plants grown in a soil cover over tailings; the controls were plants grown only in soil. Three soil types, dune sand, clay loam, and loam, were used. The radium activity of the plant tissue from the tailings treatment compared to that of the appropriate control was 1 to 19 times greater for the grass and 4 to 27 times greater for the shrub.

  2. Comparative analysis of treatment outcomes in patients with femoral neck fracture using monolateral wire and half-pin fixator of the authors' design and transosseous fixation wires

    Directory of Open Access Journals (Sweden)

    Allakhverdiev A.S.

    2014-12-01

    fractures of the proximal femur. Two groups of patients were studied: duration of surgery, duration of osteosynthesis, complications, and outcomes (in terms of one year after the dismantling clips using the modified scale Luboshyce — Mattis — Schwartzberg. Results. Fracture repair was achieved in 40 patients (62,5% of the 1st group. The following complications were observed in this group: non-union and pseudarthrosis — in 21 (32,8% case; aseptic necrosis of the femoral head in 3 (4,7% cases; hip ankyloses — in one (1,6% case, breakage and migration of wires into the joint cavity and smaller pelvis — 3 (4,7% patients and cutting out of wires from the femoral head was observed in 3 (4,7% cases. Totally 61 complication were revealed. In the second group of the patients non-union was found in one patient (64 years old. Complications were observed in 6 patients of this group — pint-tract infection, moderate secondary displacement of the fragments (the patient fell down on the operated limb and wire breakage. Conclusion. The efficiency of the femoral neck osteosynthesis with application of elaborated monolateral wire- and half-pin fixator made up 95,7% of the positive outcomes (in osteosynthesis using bunch of wires with llizarov frame fixation the same 60,9% of the positive outcomes.

  3. Controlling Arteriogenesis and Mast Cells Are Central to Bioengineering Solutions for Critical Bone Defect Repair Using Allografts

    Directory of Open Access Journals (Sweden)

    Ben Antebi

    2016-01-01

    Full Text Available Although most fractures heal, critical defects in bone fail due to aberrant differentiation of mesenchymal stem cells towards fibrosis rather than osteogenesis. While conventional bioengineering solutions to this problem have focused on enhancing angiogenesis, which is required for bone formation, recent studies have shown that fibrotic non-unions are associated with arteriogenesis in the center of the defect and accumulation of mast cells around large blood vessels. Recently, recombinant parathyroid hormone (rPTH; teriparatide; Forteo therapy have shown to have anti-fibrotic effects on non-unions and critical bone defects due to inhibition of arteriogenesis and mast cell numbers within the healing bone. As this new direction holds great promise towards a solution for significant clinical hurdles in craniofacial reconstruction and limb salvage procedures, this work reviews the current state of the field, and provides insights as to how teriparatide therapy could be used as an adjuvant for healing critical defects in bone. Finally, as teriparatide therapy is contraindicated in the setting of cancer, which constitutes a large subset of these patients, we describe early findings of adjuvant therapies that may present future promise by directly inhibiting arteriogenesis and mast cell accumulation at the defect site.

  4. A forward-striking technique for reducing fracture gaps during intramedullary nailing: A technical note with clinical results.

    Science.gov (United States)

    Lim, Seung-Jae; So, Sang-Yeon; Yoon, Yong-Cheol; Cho, Won-Tae; Oh, Jong-Keon

    2015-12-01

    A residual postoperative fracture gap between major bone fragments following intramedullary nailing of long-bone fractures is recognised as one of the major risk factors for delayed union and non-union. The most common method for reducing a fracture gap after nail insertion is through application of the backstroke technique. We introduce forward-striking as a new and simple technique that can be used to reduce fracture gaps during cephalomedullary or intramedullary nailing. The forward-striking technique was used in 20 patients with subtrochanteric or femoral shaft fractures and three patients with tibial shaft fractures who underwent cephalomedullary or intramedullary nailing at two university teaching hospitals between February 2013 and March 2014. Bone union was achieved in all cases, with a mean time of 5.7 months (range, 3-9 months). No major complications, including, non-union, implant failure, or infection, were encountered during the follow-up period. A forward-striking technique is simple, convenient, and highly efficient in terms of reducing fracture gaps during cephalomedullary or intramedullary nailing. The advantage of this technique is that it carries no risk of deforming the proximal interlocking screw, prevents excessive protrusion of the nail, and enables the lag screw to be placed into the optimal lag screw position relative to the femoral head at the time of cephalomedullary nailing. The forward-striking technique is particularly useful if no compression screw system is available. Copyright © 2015 Elsevier Ltd. All rights reserved.

  5. Alterations in the biosynthesis of extracellular matrix molecules in connective tissues by electric and magnetic fields

    Energy Technology Data Exchange (ETDEWEB)

    Ciombor, D.M.

    1992-01-01

    Pulsed electromagnetic fields (PEMFs) of certain configurations have been shown to be effective clinically in promoting the healing of fracture non-unions and are believed to enhance calcification of extracellular matrix. In vitro studies have suggested that PEMFs may also have the effect of modifying the extracellular matrix by promoting the synthesis of matrix molecules. This study examines the effect of one particular type of PEMF and a sinusoidal continuous wave upon the extracellular matrix and calcification of endochondral ossification in vivo. The pulsed magnetic field (SS-22) utilized in these studies is being used clinically for the treatment of fracture non-unions, a condition in which the bone is not restored to form or function. The sinusoidal continuous wave was designed to provide a 5 Gauss amplitude at a 15 Hz. rate. The synthesis of cartilage molecules is enhanced by this type of PEMF and since wave and subsequent endochondral calcification is stimulated. Histomorphometric studies indicate that the maturation of bone trabeculae is also promoted by this type of PEMF stimulation. These results indicate that a specific PEMF or continuous waveform can change the composition of cartilage extracellular matrix in vivo and raises the possibility that the effects on other processes of endochondral ossification (e.g., fracture healing and growth plates) may occur through a similar mechanism.

  6. Extracorporeal shock wave therapy in orthopedics, basic research, and clinical implications

    Science.gov (United States)

    Hausdorf, Joerg; Jansson, Volkmar; Maier, Markus; Delius, Michael

    2005-04-01

    The molecular events following shock wave treatment of bone are widely unknown. Nevertheless patients with osteonecrosis and non unions are already treated partly successful with shock waves. Concerning the first indication, the question of the permeation of the shock wave into the bone was addressed. Therefore shockwaves were applied to porcine femoral heads and the intraosseous pressure was measured. A linear correlation of the pressure to the intraosseous distance was found. Approximately 50% of the pressure are still measurable 10 mm inside the femoral head. These findings should encourage continued shock wave research on this indication. Concerning the second indication (non union), osteoblasts were subjected to 250 or 500 shock waves at 25 kV. After 24, 48, and 72 h the levels of the bone and vascular growth factors bFGF, TGFbeta1, and VEGF were examined. After 24 h there was a significant increase in bFGF levels (p<0.05) with significant correlation (p<0.05) to the number of impulses. TGFbeta1, and VEGF showed no significant changes. This may be one piece in the cascade of new bone formation following shock wave treatment and may lead to a more specific application of shock waves in orthopedic surgery.

  7. Treatment of acute fractures of the femoral shaft with reamed intramedullary interlocking AO nails.

    Science.gov (United States)

    Umer, M; Niazi, A K; Hussain, D; Ahmad, M

    2004-08-01

    To review and audit our experience with closed intramedullary interlocking nailing for acute femoral shaft fractures. All patients admitted to The Aga Khan University Hospital, over the last six years and with a minimum follow-up of twelve months, with acute fractures of the femoral shaft were included in the study. All patients treated for established non-unions and infections or with pathological fractures were excluded from the study. There were 89 fractures, 74% of whom were closed and 50% were associated with other orthopedic injuries. Most of these were younger patients involved in high velocity road traffic accidents. The union rate was 88% with 4.4% of fractures going into non-union. The remaining 8% of the fractures went into a phase of delayed union, but ultimately united, making the overall success rate to be 95.6%. The mean time for union was 11.5 weeks. At the final clinical follow-up, 4% of the patients had minor pain, 7% had limp, 4% had leg length discrepancy of more than 2 cm and 4% had decreased range of motion at the hip or knee joints. We had a 4% rate of superficial infection. There were 3 cases of pudendal nerve neuropraxia and 2 cases of deep vein thrombosis. Intramedullary Interlocking nailing is a safe and effective treatment modality for acute fractures of the femoral shaft. Proper surgical decision making regarding static versus dynamic mode of locking can avoid problems of delayed union.

  8. The role of 3D plating system in mandibular fractures: A prospective study

    Directory of Open Access Journals (Sweden)

    Rajendra Prasad

    2013-01-01

    Full Text Available Aim: The aim of our study was to evaluate the advantages and disadvantages of 3D plating system in the treatment of mandibular fractures. Patients and Methods: 20 mandibular fractures in 18 patients at various anatomic locations and were treated by open reduction and internal fixation using 3D plates. All patients were followed at regular intervals of 4 th , 8 th and 12 th weeks respectively. Patients were assessed post-operatively for lingual splay and occlusal stability. The incidence of neurosensory deficit, infection, masticatory difficulty, non-union, malunion was also assessed. Results: A significant reduction in lingual splay (72.2% and occlusal stability (72.2% was seen. The overall complication rate was (16.6% which included two patients who developed post-operative paresthesia of lip, three patients had infection and two cases of masticatory difficulty which later subsided by higher antibiotics and 4 weeks of MMF. No evidence of non-union, malunion was noted. Conclusion: A single 3D 2 mm miniplate with 2 mm × 8 mm screws is a reliable and an effective treatment modality for mandibular fracture.

  9. Emergence of hantaviral disease in the southwestern United States.

    Science.gov (United States)

    Hjelle, B; Jenison, S; Mertz, G; Koster, F; Foucar, K

    1994-11-01

    Hantaviruses are parasites of small mammals, predominantly peridomestic and commensal rodents. They have a worldwide distribution. Hantavirus-related illness occurs in rural areas where humans come into contact with rodents. In most cases human infection is manifested by one of a variety of acute illnesses involving hemorrhagic fever and renal disease. In May 1993, a cluster of patients with an acute pulmonary disease with high mortality was noted in the Four Corners region of the southwestern United States. Serologic and genetic studies indicated that the etiologic agent was a novel hantavirus. The uncertainty engendered by the emergence of a new disease with high mortality forced a rapid response by state and federal agencies and by the University of New Mexico Medical Center, Albuquerque, where most patients from this region were referred. Considerable progress has been made in identifying infected cases on clinical and laboratory grounds and in ensuring that appropriate supportive care is made available to patients as soon as they are suspected of having hantaviral infection. Cases of hantavirus pulmonary syndrome--both new and retrospectively diagnosed--are still being recognized throughout the western United States. Many important questions remain unanswered.

  10. A warm and wet Little Climatic Optimum and a cold and dry Little Ice Age in the southern Rocky Mountains, USA

    Energy Technology Data Exchange (ETDEWEB)

    Petersen, K.L.

    1992-05-01

    In the next century, increases in atmospheric trace gas concentration could warm the global average temperature beyond what it has ranged during the past century. Examination of larger-than-historic climatic changes that have occurred in the past in specific regions provides realistic context for evaluating such potential future changes. This paper has contrasted the climatic manifestation of the Little Climatic Optimum or Medieval Warm Period (AD 900--1300) with that of the Little Ice Age (AD 1300--1850) in the northern Colorado Plateau region of the southwestern USA. The zenith of the Anasazi occupation coincides with the former and their demise coincides with the latter, when conditions became too cold and especially dry (in the summer) to support upland dry farming. During the height of the Little Climatic Optimum the region was characterized by a relatively long growing season and greater winter and summer precipitation than that of today. This resulted in a relatively rapid development of a potential dry-farming belt that was twice as wide as the present and areas that cannot be dry farmed today were routinely farmed by the Anasazi. Such conditions would be beneficial to dry farmers in the Four Corners region if those conditions were repeated in the near future.

  11. Control rod

    International Nuclear Information System (INIS)

    Fukumoto, Takashi; Hirakawa, Hiromasa; Kawashima, Norio; Goto, Yasuyuki.

    1994-01-01

    Neutron absorbers are contained in a tubular member comprising, integrally a tubular portion and four corners disposed at the outer circumference of the tubular portion at every 90deg, to provide a neutron absorbing tube. A plurality of neutron absorbing tubes are arranged in parallel in the lateral direction, and adjacent corners are joined, into a blade to constitute a control rod. Such a control rod has a great structural strength, simple in the structure and relatively light in weight and can contain a great amount of neutron absorbers. Upon formation of the control rod by arranging the blades in a cross-like shape, at least a portion thereof is constituted with short neutron absorbing tubes shorter than the entire length of the blade, and gaps are formed at positions in adjacent in the axial direction. With such a constitution, there is no worry that a wing end of the blade collides against or be abraded with a fuel channel box or a fuel support. Even if fuel channels are vibrated upon scram of the reactor, such as occurrence of earthquakes, it can be inserted to the reactor easily. (N.H.)

  12. An implantable telemetry device to measure intra-articular tibial forces.

    Science.gov (United States)

    D'Lima, Darryl D; Townsend, Christopher P; Arms, Steven W; Morris, Beverly A; Colwell, Clifford W

    2005-02-01

    Tibial forces are important because they determine polyethylene wear, stress distribution in the implant, and stress transfer to underlying bone. Theoretic estimates of tibiofemoral forces have varied between three and six times the body weight depending on the mathematical models used and the type of activity analyzed. An implantable telemetry system was therefore developed to directly measure tibiofemoral compressive forces. This system was tested in a cadaver knee in a dynamic knee rig. A total knee tibial arthroplasty prosthesis was instrumented with four force transducers located at the four corners of the tibial tray. These transducers measured the total compressive forces on the tibial tray and the location of the center of pressure. A microprocessor performed analog-to-digital signal conversion and performed pulse code modulation of a surface acoustic wave radio frequency oscillator. This signal was then transmitted through a single pin hermetic feed-through tantalum wire antenna located at the tip of the stem. The radio frequency signal was received by an external antenna connected to a receiver and to a computer for data acquisition. The prosthesis was powered by external coil induction. The tibial transducer accurately measured both the magnitude and the location of precisely applied external loads. Successful transmission of the radio frequency signal up to a range of 3m was achieved through cadaveric bone, bone cement, and soft tissue. Reasonable accuracy was obtained in measuring loads applied through a polyethylene insert. The implant was also able to detect unicondylar loading with liftoff.

  13. Automated mapping of mineral groups and green vegetation from Landsat Thematic Mapper imagery with an example from the San Juan Mountains, Colorado

    Science.gov (United States)

    Rockwell, Barnaby W.

    2013-01-01

    Multispectral satellite data acquired by the ASTER (Advanced Spaceborne Thermal Emission and Reflection Radiometer) and Landsat 7 Enhanced Thematic Mapper Plus (TM) sensors are being used to populate an online Geographic Information System (GIS) of the spatial occurrence of mineral groups and green vegetation across the western conterminous United States and Alaska. These geospatial data are supporting U.S. Geological Survey national-scale mineral deposit database development and other mineral resource and geoenvironmental research as a means of characterizing mineral exposures related to mined and unmined hydrothermally altered rocks and mine waste. This report introduces a new methodology for the automated analysis of Landsat TM data that has been applied to more than 180 scenes covering the western United States. A map of mineral groups and green vegetation produced using this new methodology that covers the western San Juan Mountains, Colorado, and the Four Corners Region is presented. The map is provided as a layered GeoPDF and in GIS-ready digital format. TM data analysis results from other well-studied and mineralogically characterized areas with strong hydrothermal alteration and (or) supergene weathering of near-surface sulfide minerals are also shown and compared with results derived from ASTER data analysis.

  14. Ground truth measurements plan for the Multispectral Thermal Imager (MTI) satellite

    Energy Technology Data Exchange (ETDEWEB)

    Garrett, A.J.

    2000-01-03

    Sandia National Laboratories (SNL), Los Alamos National Laboratory (LANL), and the Savannah River Technology Center (SRTC) have developed a diverse group of algorithms for processing and analyzing the data that will be collected by the Multispectral Thermal Imager (MTI) after launch late in 1999. Each of these algorithms must be verified by comparison to independent surface and atmospheric measurements. SRTC has selected 13 sites in the continental U.S. for ground truth data collections. These sites include a high altitude cold water target (Crater Lake), cooling lakes and towers in the warm, humid southeastern US, Department of Energy (DOE) climate research sites, the NASA Stennis satellite Validation and Verification (V and V) target array, waste sites at the Savannah River Site, mining sites in the Four Corners area and dry lake beds in the southwestern US. SRTC has established mutually beneficial relationships with the organizations that manage these sites to make use of their operating and research data and to install additional instrumentation needed for MTI algorithm V and V.

  15. Twin lead ballistic conductor based on nanoribbon edge transport

    Science.gov (United States)

    Konôpka, Martin; Dieška, Peter

    2018-03-01

    If a device like a graphene nanoribbon (GNR) has all its four corners attached to electric current leads, the device becomes a quantum junction through which two electrical circuits can interact. We study such system theoretically for stationary currents. The 4-point energy-dependent conductance matrix of the nanostructure and the classical resistors in the circuits are parameters of the model. The two bias voltages in the circuits are the control variables of the studied system while the electrochemical potentials at the device's terminals are non-trivially dependent on the voltages. For the special case of the linear-response regime analytical formulae for the operation of the coupled quantum-classical device are derived and applied. For higher bias voltages numerical solutions are obtained. The effects of non-equilibrium Fermi levels are captured using a recursive algorithm in which self-consistency between the electrochemical potentials and the currents is reached within few iterations. The developed approach allows to study scenarios ranging from independent circuits to strongly coupled ones. For the chosen model of the GNR with highly conductive zigzag edges we determine the regime in which the single device carries two almost independent currents.

  16. Design and Validation of a Low-Cost Portable Device to Quantify Postural Stability

    Directory of Open Access Journals (Sweden)

    Yong Zhu

    2017-03-01

    Full Text Available Measurement of the displacement of the center-of-pressure (COP is an important tool used in biomechanics to assess postural stability and human balance. The goal of this research was to design and validate a low-cost portable device that can offer a quick indication of the state of postural stability and human balance related conditions. Approximate entropy (ApEn values reflecting the amount of irregularity hiding in COP oscillations were used to calculate the index. The prototype adopted a portable design using the measurements of the load cells located at the four corners of a low-cost force platform. The test subject was asked to stand on the device in a quiet, normal, upright stance for 30 s with eyes open and subsequently for 30 s with eyes closed. Based on the COP displacement signals, the ApEn values were calculated. The results indicated that the prototype device was capable of capturing the increase in regularity of postural control in the visual-deprivation conditions. It was also able to decipher the subtle postural control differences along anterior–posterior and medial–lateral directions. The data analysis demonstrated that the prototype would enable the quantification of postural stability and thus provide a low-cost portable device to assess many conditions related to postural stability and human balance such as aging and pathologies.

  17. An explanation for the pseudogap states and the quantum phase transitions beneath the Dome

    Science.gov (United States)

    Cabo, Alejandro Genaro; Vielza, Yoandri; Domingues, Mauricio

    The work present the results of a model proposed to improve the understanding of the normal state of cuprate superconductors. The analysis reproduces the antiferromagnetic correlations and insulator character of these materials. Further, the discussion led to an outstanding prediction: the existence of well defined pseudogap states, which physical origin constitutes still today a debated question. The pseudogap emerges as a paramagnetic excited state, breaking the square crystal symmetry of the CuO planes in the same way as the AF order does it in the real material. The results defined the pseudogap effect as being of pure Coulomb origin. The Fermi surface exhibits the property defining its name: a momentum dependent gap which, that closes at the four corners of the Brillouin cell. The effect of the hole doping on both the AF-Insulator and the pseudogap states was investigated. The evolutions of the energy and band structure with hole doping, became able to predict the quantum phase transition (QPT) which La2CuO4 and other cuprate materials show at doping value, laying ``beneath'' the superconductor ``Dome''. The energies of the insulator and pseudogap states, both tend to coincide at a critical doping value of 0.2, at which the QPT is observed in the material. The doping evolution of the Fermi surface evaluated in for the insulator state, reproduce the experimental results for La2CuO4. We acknoweledge the support received from the Network of the ICTP Net-35.

  18. Combined Survey Format (CSF) Archaeogeophysical (Metal Detecting, Radiometrics and Resistivity) and Archaeochemical (XRF) Investigations of the 19th Century La Hacienda Y Presidio of Babocomari Military Site in Arizona

    Science.gov (United States)

    Lundin, R. J.; Aydin, N.; Brackett, C.

    2007-05-01

    Recent archaeological investigations of Historic Era Mexican and Anglo-American and Prehistoric and Protohistoric Hohokam and Sobaipuri culture sites on the Babacomari Land Grant near Sierra Vista Arizona by Carothers Environmental, LLC (CE), Wondjina Research Institute (WRI) and DMG Four Corners Research (FCR) led to the discovery of two major 19th Century military sites that were known from the literature but had not been scientifically investigated. It was decided by WRI and BABACOMARI RANCH that this project was ideal for an experimental cooperative training program for archaeologists and geologists from the anthropology and geology departments of UA, ASU, NAU, PC, and members of AAS, AAHS, AAC, THS and USFS personnel in the use of the new CSF archaeogeophysical, archaeochemical and airbourne remote sensing technologies and field techniques that have just been recently introduced in the US. WRI, CE and Statistical Research Inc. (SRI) conducted CSF VLF Metal Detecting, Radiometrics and Resistivity studies and portable X-Ray Fluorescence (XRF) archaeochemical studies. The results will be presented along with suggestions as to use of these technologies in CSF studies.

  19. Episodic Late Holocene dune movements on the sand-sheet area, Great Sand Dunes National Park and Preserve, San Luis Valley, Colorado, USA

    Science.gov (United States)

    Forman, S. L.; Spaeth, M.; Marín, L.; Pierson, J.; Gómez, J.; Bunch, F.; Valdez, A.

    2006-07-01

    The Great Sand Dunes National Park and Preserve (GSDNPP) in the San Luis Valley, Colorado, contains a variety of eolian landforms that reflect Holocene drought variability. The most spectacular is a dune mass banked against the Sangre de Cristo Mountains, which is fronted by an extensive sand sheet with stabilized parabolic dunes. Stratigraphic exposures of parabolic dunes and associated luminescence dating of quartz grains by single-aliquot regeneration (SAR) protocols indicate eolian deposition of unknown magnitude occurred ca. 1290-940, 715 ± 80, 320 ± 30, and 200-120 yr ago and in the 20th century. There are 11 drought intervals inferred from the tree-ring record in the past 1300 yr at GSDNPP potentially associated with dune movement, though only five eolian depositional events are currently recognized in the stratigraphic record. There is evidence for eolian transport associated with dune movement in the 13th century, which may coincide with the "Great Drought", a 26-yr-long dry interval identified in the tree ring record, and associated with migration of Anasazi people from the Four Corners areas to wetter areas in southern New Mexico. This nascent chronology indicates that the transport of eolian sand across San Luis Valley was episodic in the late Holocene with appreciable dune migration in the 8th, 10-13th, and 19th centuries, which ultimately nourished the dune mass against the Sangre de Cristo Mountains.

  20. Ablation front hydrodynamic instability experiments on Nova

    International Nuclear Information System (INIS)

    Remington, B.A.; Marinak, M.M.; Weber, S.V.; Budil, K.S.; Landen, O.L.; Haan, S.W.; Wallace, R.J.

    1995-01-01

    The x-ray driven ablation front hydrodynamic instability experiments at Nova span 1988-present, and can be divided into three generations. The 1st generation experiments consisted of planar foils with perturbations of the form k = k x imposed on the drive side of the foil. A variety of drive pulse shapes, foil materials, and perturbation wavelengths and amplitudes were investigated, with growth factors of up to 80 being observed. The 2nd generation experiments investigated mode-mode interactions with imposed perturbations corresponding to the superposition of modes. They have done experiments with two-mode and eight-mode foils. In the linear regime, the modes grow independently with their own respective growth rates. In the nonlinear regime, in addition to the higher harmonics of the pre-existing modes, coupled terms k i ± k j occur. The 3rd generation experiments focus on 3D Rayleigh-Taylor growth. They have recently done experiments with an imposed 3D single-mode perturbation of the form k = (k x ,k y ), with k x = k y . In the linear regime, this perturbation grows exponentially with wave vector k = (k x 2 + k y 2 ) 1/2 . In the nonlinear regime, the perturbations evolve into broad bubbles surrounded on four corners by very dense, localized spikes with archways or saddle points in between. Simulations suggest that this 3D square mode grows larger than the corresponding 2D perturbation with the same magnitude wavevector and initial amplitude

  1. Baseline Glass Development for Combined Fission Products Waste Streams

    International Nuclear Information System (INIS)

    Crum, Jarrod V.; Billings, Amanda Y.; Lang, Jesse B.; Marra, James C.; Rodriguez, Carmen P.; Ryan, Joseph V.; Vienna, John D.

    2009-01-01

    Borosilicate glass was selected as the baseline technology for immobilization of the Cs/Sr/Ba/Rb (Cs), lanthanide (Ln) and transition metal fission product (TM) waste steams as part of a cost benefit analysis study.(1) Vitrification of the combined waste streams have several advantages, minimization of the number of waste forms, a proven technology, and similarity to waste forms currently accepted for repository disposal. A joint study was undertaken by Pacific Northwest National Laboratory (PNNL) and Savannah River National Laboratory (SRNL) to develop acceptable glasses for the combined Cs + Ln + TM waste streams (Option 1) and Cs + Ln combined waste streams (Option 2) generated by the AFCI UREX+ set of processes. This study is aimed to develop baseline glasses for both combined waste stream options and identify key waste components and their impact on waste loading. The elemental compositions of the four-corners study were used along with the available separations data to determine the effect of burnup, decay, and separations variability on estimated waste stream compositions.(2-5) Two different components/scenarios were identified that could limit waste loading of the combined Cs + LN + TM waste streams, where as the combined Cs + LN waste stream has no single component that is perceived to limit waste loading. Combined Cs + LN waste stream in a glass waste form will most likely be limited by heat due to the high activity of Cs and Sr isotopes.

  2. Neonatal response to control of noise inside the incubator.

    Science.gov (United States)

    Johnson, A N

    2001-01-01

    The purpose of this study was to test the effect of acoustical foam on the level of noise inside the incubator and examine neonatal response behaviors to changes in environmental noise. The study used a repeated measure, within subject, comparative design. Data on 65 premature neonates were collected over a 14-month period at a large teaching hospital in Delaware. Sound levels, oxygen saturation, and infant states were measured and recorded during three study conditions: pre-study neonate in incubator, neonate in incubator with 5 x 5 x 1 inch acoustical foam pieces placed in each of four corners, and post-study recovery of neonate in incubator with foam removed. All state assessments were measured with oxygen saturation and sound level measurements every 2 minutes of the study for a total 40 minutes. The findings demonstrate a significant treatment effect of acoustical foam on decreasing environmental noise measurements inside the incubator (p = 0.006). Findings also demonstrate significantly changed neonatal state response behaviors with decreasing environmental noise measurements inside the incubator (p = 0.00). The results of this study support the use of acoustical foam as one method of environmental noise management in the intensive care nursery. Because there was a significant correlation between higher noise levels and oxygen support therapy, the findings suggest that special nursing considerations should be taken when caring for ventilator-dependent infants. Noise control protocols should focus on essential environmental interventions for care of these infants.

  3. Weathering damage evaluation of rock properties in the Bunhwangsa temple stone pagoda, Gyeongju, Republic of Korea

    Science.gov (United States)

    Lee, Chan Hee; Yi, Jeong Eun

    2007-06-01

    The stone pagoda of the Bunhwangsa temple in Republic of Korea was made of piling small brick-shaped stones. The majority of stone bricks are andesitic rocks with variable geneses. Rock properties of the pagoda roof suffer partial significant deterioration, such as multiple peel-offs, exfoliation, onion-peel-like decomposition, cracks forming round lines and falling-off stone pieces. The stylobates and tabernacles at the four corners are composed of granitic rocks, which are heavily contaminated by lichens and mosses. Some of these contamination marks show dark black or yellowish brown colors by inorganic secondary hydrates. The four tabernacles and northern face of the pagoda body have been exposed to relatively high humidity, which causes light gray efflorescence as stalactites between the northern and western sides of the body. The efflorescences are composed of calcite, gypsum and clay minerals. The stone lion statues at the southeast and northeast corners are made of alkali granite, while the others are lithic tuff. Total rock properties of the pagoda consist of 9,708 stone bricks. Among them, 11.0% are fractured, 6.7% are fallen off, and 7.0% show considerable surface efflorescence, which shows that the pagoda has been highly deteriorated by physical, chemical and biological weathering. The authors strongly suggest long-term monitoring and comprehensive conservation researches.

  4. Proyecto MercadoFRESCO: a multi-level, community-engaged corner store intervention in East Los Angeles and Boyle Heights.

    Science.gov (United States)

    Ortega, Alexander N; Albert, Stephanie L; Sharif, Mienah Z; Langellier, Brent A; Garcia, Rosa Elena; Glik, Deborah C; Brookmeyer, Ron; Chan-Golston, Alec M; Friedlander, Scott; Prelip, Michael L

    2015-04-01

    Urban food swamps are typically situated in low-income, minority communities and contribute to overweight and obesity. Changing the food landscape in low income and underserved communities is one strategy to combat the negative health consequences associated with the lack of access to healthy food resources and an abundance of unhealthy food venues. In this paper, we describe Proyecto MercadoFRESCO (Fresh Market Project), a corner store intervention project in East Los Angeles and Boyle Heights in California that used a multi-level approach with a broad range of community, business, and academic partners. These are two neighboring, predominantly Latino communities that have high rates of overweight and obesity. Located in these two communities are approximately 150 corner stores. The project used a community-engaged approach to select, recruit, and convert four corner stores, so that they could become healthy community assets in order to improve residents' access to and awareness of fresh and affordable fruits and vegetables in their immediate neighborhoods. We describe the study framework for the multi-level intervention, which includes having multiple stakeholders, expertise in corner store operations, community and youth engagement strategies, and social marketing campaigns. We also describe the evaluation and survey methodology to determine community and patron impact of the intervention. This paper provides a framework useful to a variety of public health stakeholders for implementing a community-engaged corner store conversion, particularly in an urban food swamp.

  5. CFD Investigation Of The Effect Of Tilt Angles To Flow And Combustion In A 120 Mw Gas-Fired Full Scale Industrial Boiler

    Directory of Open Access Journals (Sweden)

    Wisam Saad Azeez

    2015-08-01

    Full Text Available Abstract Extensive Computational Fluid Dynamic simulations on combustion process in a 120 MW natural gas-fired industrial boiler have been performed. The boiler is of tangential system by which natural gas and air are fired into the furnace from its four corners at three different elevation levels. Fuel burners and air nozzles can be tilted in the range of 30.The simulation results show good prediction of temperature profile and distribution as compared to practical observation. The flow in the furnace is highly swirling with intense mixing of natural gas and air. The turbulence level is extremely high and combustion gas flows in helical shape in anti-clockwise direction towards the furnace exit. The results revealed the importance of the effect of heat transfer to the water wall as the temperature distribution and flow pattern is significantly difference with heat transfer and without heat transfer cases. Temperature distribution prior to the entry to the re-heater elevation is non-uniform with lower velocity at vortex core where the fireball is located. The average temperature at re-heater level reduces when the burner is negatively tilted up to -10. A slight change in firing angle will interrupt the temperature and flow contour at furnace-re-heater. However this is only true for air nozzles where the overall flow pattern inside the furnace is dominated by these sources..

  6. 24-GHz LTCC Fractal Antenna Array SoP With Integrated Fresnel Lens

    KAUST Repository

    Ghaffar, Farhan A.

    2012-09-30

    A novel 24-GHz mixed low-temperature co-fired ceramic (LTCC) tape based system-on-package (SoP) is presented, which incorporates a fractal antenna array with an integrated grooved Fresnel lens. The four-element fractal array employs a relatively low dielectric constant substrate (CT707, εr = 6.4), whereas the lens has been realized on a high-dielectric-constant superstrate (CT765, εr = 68.7 ). The two (substrate and superstrate) are integrated through four corner posts to realize the required air gap (focal distance). The fractal array alone provides a measured gain of 8.9 dBi. Simulations predict that integration of this array with the lens increases the gain by 6 dB. Measurements reveal that the design is susceptible to LTCC fabrication tolerances. In addition to high gain, the SoP provides a bandwidth of 8%. The high performance and compact size (24 × 24 × 4.8 mm3 ) of the design makes it highly suitable for emerging wireless applications such as automotive radar front end.

  7. Health response to Hajj mass gathering from emergency perspective, narrative review

    Directory of Open Access Journals (Sweden)

    Asaad Shujaa

    2015-12-01

    Full Text Available Hajj is a unique gathering with Mecca and Kaaba being spiritually important to many faiths across the globe, especially Muslims. This is because of the proclamation of the prophet's father, Ibrahaam, when he called all mankind to perform Hajj. That is why all Muslims on Earth feel that they have to visit Mecca and Kaaba on a specific date and time, and that is the reason this small location hosts one of the largest human gatherings in the world. Hajj is one of the five pillars of Islam that every financially and physically able Muslim must perform once in his/her lifetime. For 14 centuries countless millions of Muslim men and women from the four corners of the earth have undertaken pilgrimage to Mecca.In conclusion this review article confirm that Hajj is oldest and largest mass gathering in all mankind and there is some issues influence the health response such as size of gathering. diversity of population, climate and health facilities around hajj site, also we discuss the infectious and non infectious related illness in hajj and their prevention methods. Keywords: Hajj, Disaster medicine, Terrorism and mass casualty events

  8. High-precision approach to localization scheme of visible light communication based on artificial neural networks and modified genetic algorithms

    Science.gov (United States)

    Guan, Weipeng; Wu, Yuxiang; Xie, Canyu; Chen, Hao; Cai, Ye; Chen, Yingcong

    2017-10-01

    An indoor positioning algorithm based on visible light communication (VLC) is presented. This algorithm is used to calculate a three-dimensional (3-D) coordinate of an indoor optical wireless environment, which includes sufficient orders of multipath reflections from reflecting surfaces of the room. Leveraging the global optimization ability of the genetic algorithm (GA), an innovative framework for 3-D position estimation based on a modified genetic algorithm is proposed. Unlike other techniques using VLC for positioning, the proposed system can achieve indoor 3-D localization without making assumptions about the height or acquiring the orientation angle of the mobile terminal. Simulation results show that an average localization error of less than 1.02 cm can be achieved. In addition, in most VLC-positioning systems, the effect of reflection is always neglected and its performance is limited by reflection, which makes the results not so accurate for a real scenario and the positioning errors at the corners are relatively larger than other places. So, we take the first-order reflection into consideration and use artificial neural network to match the model of a nonlinear channel. The studies show that under the nonlinear matching of direct and reflected channels the average positioning errors of four corners decrease from 11.94 to 0.95 cm. The employed algorithm is emerged as an effective and practical method for indoor localization and outperform other existing indoor wireless localization approaches.

  9. Navajo Coal Combustion and Respiratory Health Near Shiprock, New Mexico

    Directory of Open Access Journals (Sweden)

    Joseph E. Bunnell

    2010-01-01

    Full Text Available Indoor air pollution has been identified as a major risk factor for acute and chronic respiratory diseases throughout the world. In the sovereign Navajo Nation, an American Indian reservation located in the Four Corners area of the USA, people burn coal in their homes for heat. To explore whether/how indoor coal combustion might contribute to poor respiratory health of residents, this study examined respiratory health data, identified household risk factors such as fuel and stove type and use, analyzed samples of locally used coal, and measured and characterized fine particulate airborne matter inside selected homes. In twenty-five percent of homes surveyed coal was burned in stoves not designed for that fuel, and indoor air quality was frequently found to be of a level to raise concerns. The average winter 24-hour PM2.5 concentration in 20 homes was 36.0 μg/m3. This is the first time that PM2.5 has been quantified and characterized inside Navajo reservation residents' homes.

  10. Spatio-temporal examination of precipitation isotopes from the North American monsoon in Arizona, New Mexico, and Utah from 2014 to 2017

    Science.gov (United States)

    Tulley-Cordova, C. L.; Bowen, G. J.

    2017-12-01

    A significant summertime feature of climate in the southwestern United States (US) is the North American monsoon (NAM), also known as the Mexican monsoon, Arizona monsoon, and the southwestern United States monsoon. NAM is a crucial contributor to total annual precipitation in the Four Corners region of the US. Modern investigation of NAM in this region using stable isotopes has been poorly studied. This study characterizes the spatio-temporal changes of NAM based on stable isotopic results from 40 sites, located within the boundaries of the Navajo Nation, in Arizona, New Mexico, and Utah from 2014 to 2017. Sample collections were collected monthly at each site from May to October. Examination of temporal trends of precipitation revealed strong monthly and interannual changes; spatial analysis showed weak large-scale relationships across the study area. Analysis of stable isotopes in precipitation, surface, ground, and spring waters can be used to interpret the isotopic differences in the modern hydro-climate of the Navajo Nation and Colorado Plateau to help predict future hydro-climate changes and its implications on future water resources.

  11. Deer Mice As Laboratory Animals.

    Science.gov (United States)

    Joyner, Charlotte P.; Myrick, Lisa C.; Crossland, Janet P.; Dawson, Wallace D.

    1998-09-01

    Although laboratory mice (Mus) and rats (Rattus) are the most widely used research rodents, deer mice (Peromyscus maniculatus) and their congeneric species are favored as nontraditional alternatives for some purposes. Mice of the native genus Peromyscus are the most abundant and widely distributed rodents in North America. They occur in a great diversity of habitats and play a significant role in natural ecosystems. Because of their abundance, peromyscines are commonly hosts for larva of ticks that transmit Lyme disease bacteria, and they are implicated in several other vector-borne diseases. Deer mice also are the principal carriers of the virus that causes hantaviral pulmonary syndrome, or "Four Corners disease." Deer mice are useful as laboratory models for a variety of other types of pure and applied research. They are easily maintained and bred in captivity using the husbandry protocols developed for other small laboratory rodent species. The Peromyscus Genetic Stock Center at the University of South Carolina maintains more than 50 laboratory-bred, well-characterized stocks of deer mice and other peromyscine species for research and educational use.

  12. Phyllotaxis: a framework for foam topological evolution.

    Science.gov (United States)

    Rivier, Nicolas; Sadoc, Jean-François; Charvolin, Jean

    2016-01-01

    Phyllotaxis describes the arrangement of florets, scales or leaves in composite flowers or plants (daisy, aster, sunflower, pinecone, pineapple). As a structure, it is a geometrical foam, the most homogeneous and densest covering of a large disk by Voronoi cells (the florets), constructed by a simple algorithm: Points placed regularly on a generative spiral constitute a spiral lattice, and phyllotaxis is the tiling by the Voronoi cells of the spiral lattice. Locally, neighboring cells are organized as three whorls or parastichies, labelled with successive Fibonacci numbers. The structure is encoded as the sequence of the shapes (number of sides) of the successive Voronoi cells on the generative spiral. We show that sequence and organization are independent of the position of the initial point on the generative spiral, that is invariant under disappearance (T2 of the first Voronoi cell or, conversely, under creation of a first cell, that is under growth. This independence shows how a foam is able to respond to a shear stress, notably through grain boundaries that are layers of square cells slightly truncated into heptagons, pentagons and hexagons, meeting at four-corner vertices, critical points of T1 elementary topological transformations.

  13. The Colorado Plateau V: research, environmental planning, and management for collaborative conservation

    Science.gov (United States)

    Villarreal, Miguel L.; van Riper, Carena J.; Johnson, Matthew J.; van Riper, Charles

    2012-01-01

    Roughly centered on the Four Corners region of the southwestern United States, the Colorado Plateau covers some 130,000 square miles of sparsely vegetated plateaus, mesas, canyons, arches, and cliffs in Arizona, Utah, Colorado, and New Mexico. With elevations ranging from 3,000 to 14,000 feet, the natural systems found within the plateau are dramatically varied, from desert to alpine conditions. This volume, the fifth from the University of Arizona Press and the tenth overall, focuses on adaptation of resource management and conservation to climate change and water scarcity, protecting biodiversity through restructured energy policies, ensuring wildlife habitat connectivity across barriers, building effective conservation networks, and exploring new opportunities for education and leadership in conservation science. An informative read for people interested in the conservation and natural history of the region, the book will also serve as a valuable reference for those people engaged in the management of cultural and biological resources of the Colorado Plateau, as well as scientists interested in methods and tools for land and resource management throughout the West.

  14. The modernization of the port area of Bejaia and its impact on the architectural heritage

    Directory of Open Access Journals (Sweden)

    Walid Hamma

    2018-09-01

    Full Text Available Bejaia, a city of light, art, history and knowledge, is no longer the university that attracted scholars from all four corners of the world during the Middle Ages. It suffers from many problems such as the degradation and demolition of its heritage, pollution, accessibility, under-equipment and unorganized mass tourism. In order to resolve part of this problem, the local authorities decided to modernize the port area of the city. The plan of this intervention unfortunately did not foresee a study of impact on the heritage since the zone is historical. To detect actions that had negative impacts, we investigated by comparing the current state with the old. Then we checked the compatibility of these with the national legislation and the international regulations on intervention on the heritage. It appears that certain actions in the plan to modernize the port area of Bejaia have had negative impacts, such as the demolition of old buildings, non-compliance with heritage easements, encroachment of archaeological areas, attacks on authenticity , increased traffic and poor integration of new buildings. These actions also violate national and international regulations.

  15. Gold-silver mining districts, alteration zones, and paleolandforms in the Miocene Bodie Hills Volcanic Field, California and Nevada

    Science.gov (United States)

    Vikre, Peter G.; John, David A.; du Bray, Edward A.; Fleck, Robert J.

    2015-09-25

    The Bodie Hills is a ~40 by ~30 kilometer volcanic field that straddles the California-Nevada state boundary between Mono Lake and the East Walker River. Three precious metal mining districts and nine alteration zones are delineated in Tertiary-Quaternary volcanic and Mesozoic granitic and metamorphic rocks that comprise the volcanic field. Cumulative production from the mining districts, Bodie, Aurora, and Masonic, is 3.4 million ounces of gold and 28 million ounces of silver. Small amounts of mercury were produced from the Potato Peak, Paramount-Bald Peak, and Cinnabar Canyon-US 395 alteration zones; a native sulfur resource in the Cinnabar Canyon-US 395 alteration zone has been identified by drilling. There are no known mineral resources in the other six alteration zones, Red Wash-East Walker River, East Brawley Peak, Sawtooth Ridge, Aurora Canyon, Four Corners, and Spring Peak. The mining districts and alteration zones formed between 13.4 and 8.1 Ma in predominantly ~15–9 Ma volcanic rocks of the Bodie Hills volcanic field. Ages of hydrothermal minerals in the districts and zones are the same as, or somewhat younger than, the ages of volcanic host rocks.

  16. USING REMOTE SENSING AND RPAS FOR ARCHAEOLOGY AND MONITORING IN WESTERN GREENLAND

    Directory of Open Access Journals (Sweden)

    K. Pavelka

    2016-06-01

    Full Text Available Since 2002, German low-cost scientific expeditions to Greenland have been performed. The objective was a geodetic survey and glaciology with GNSS technology – mainly the measurement of glacier profiles (height. The same glacier profiles along the route were measured during German expeditions in 2006, 2010, 2012 and 2015. The last international expedition was supplemented with RPAS (UAV measurement, the testing of small corner reflectors for Terra SAR X satellite measurement and the use of image based modelling technology for historical monuments documentation, all in specific arctic conditions. The RPAS measurement was focused on the documentation of existing valuable archaeological sites near Ilulissat city and the testing of RPAS technology for the monitoring of the face of the moving glacier. Two typical church wooden constructions were documented by simple photogrammetric technology based on image correlation. Both experiments were evaluated as successfully case projects. The last part of the experiments deals with the monitoring of a moving inland glacier using SAR technology; four corner reflectors were installed on the glacier and on a massive nearby rock. Two ascending and two descending overflights of the Terra SAR X satellite in fine resolution mode were performed. The InSAR technology give inconclusive results, but some movements were detected; small and inexpensive corner reflectors of our own production have proven suitable. Experience and expertise from the measurement such as the first outputs from the expedition are the content of the present article.

  17. Model for the analysis of transitories and stability of a BWR reactor with fuel of thorium

    International Nuclear Information System (INIS)

    Nunez C, A.; Espinosa P, G.; Francois L, J.L.

    2004-01-01

    In this work it is described the thermo hydraulic and neutronic pattern used to simulate the behavior of a nucleus of thorium-uranium under different conditions of operation. The analysed nucleus was designed with base to assemblies that operate under the cover-seed concept. The pattern was proven to conditions of stationary state and transitory state. Here it is only presented the simulation of the one SCRAM manual and it is compared in the behavior of a nucleus with UO 2 . Additionally one carries out an analysis of stability taking into account the four corners that define the area of stability of the map flow-power and to conditions of 100% of flow and 100% of power. The module of stability is based on the pattern of Lahey and Podowsky to estimate the drops of pressure during a perturbation. It is concludes that the behavior of this nucleus is not very different to the one shown by the nuclei loaded with the fuel of UO 2 . (Author)

  18. Disaster risk assessment case study: Recent drought on the Navajo Nation, USA

    Science.gov (United States)

    Hiza, Margaret; Kelley, Klara B.; Francis, Harris; Block, Debra

    2011-01-01

    The Navajo Nation is an ecologically sensitive semi-arid to arid section of the southern Colorado Plateau. In this remote part of the United States, located at the Four Corners (Arizona, New Mexico, Colorado, and Utah), traditional people live a subsistence lifestyle that is inextricably tied to, and dependent upon, landscape conditions and water supplies. Soft bedrock lithologies and sand dunes dominate the region, making it highly sensitive to fluctuations in precipitation intensity, percent vegetation cover, and local land use practices. However, this region has sparse and discontinuous meteorological monitoring records. As a complement to the scant long-term meteorological records and historical documentation, we conducted interviews with 50 Native American elders from the Navajo Nation and compiled their lifetime observations on the changes in water availability, weather, and sand or dust storms. We then used these observations to further refine our understanding of the historical trends and impacts of climate change and drought for the region. In addition to altered landscape conditions due to climatic change, drought, and varying land use practices over the last 130 years, the Navajo people have been affected by federal policies and harsh economic conditions which weaken their cultural fabric. We conclude that a long-term drying trend and decreasing snowpack, superimposed on regional drought cycles, will magnify drought impacts on the Navajo Nation and leave its people increasingly vulnerable.

  19. 24th ICM

    CERN Document Server

    Yeung, David

    2003-01-01

    Since the first Congress in Zürich in 1897, the ICM has been an eagerly­ awaited event every four years. Many of these occasions are celebrated for historie developments and seminal contributions to mathematics. 2002 marks the year of the 24th ICM, the first of the new millennium. Also historie is the first ICM Satellite Conference devoted to game theory and applications. It is one of those rare occasions, in which masters of the field are able to meet under congenial surroundings to talk and share their gathered wisdom. As is usually the case in ICM meetings, participants of the ICM Satellite Conference on Game Theory and Applications (Qingdao, August 2(02) hailed from the four corners of the world. In addition to presentations of high qual­ ity research, the program also included twelve invited plenary sessions with distinguished speakers. This volume, which gathers together selected papers read at the conference, is divided into four sections: (I) Foundations, Concepts, and Structure. (II) Equilibrium P...

  20. Expelling Slavery from the Nation: Representations of labour exploitation in Australia’s supply chain

    Directory of Open Access Journals (Sweden)

    Anna Szörényi

    2016-09-01

    Full Text Available On 4 May 2015, the Australian national broadcaster’s current affairs programme Four Corners aired an episode titled ‘Slaving Away: The dirty secrets behind Australia’s fresh food’, that provided revelations of labour exploitation of migrant workers on working holiday visas. The government reacted swiftly to these allegations with an ‘operation’ ostensibly designed to stop the exploitation. In reports of Operation Cloudburst, however, there was a shift in the media’s definition of the problem: worker exploitation became visa violations and newspapers shortly reported the resulting action taken: the ‘illegal workers’ in Australia’s food industry had been arrested. This paper tracks the competing discursive and visual representations of this case that ultimately made questions of labour rights become questions of immigration, making it plausible and acceptable that concern over exploitation of workers should be addressed by deportation of ‘illegal immigrants’. Such discursive slippage is enabled by cultural amnesia over Australia’s history of exploitation of racialised and migrant labourers, which allows ‘slavery’ to be represented as a ‘foreign’ problem that can be expelled in defence of the purity of the national domestic space.