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Sample records for plateau levelling osteotomy

  1. In vitro comparison of tibial plateau leveling osteotomy with and without use of a tibial plateau leveling jig.

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    Schmerbach, Kay Ingo; Boeltzig, Christian Konrad Matthias; Reif, Ullrich; Wieser, Jan Carsten; Keller, Thomas; Grevel, Vera

    2007-02-01

    To evaluate the influence of a tibial plateau leveling jig on osteotomy orientation, fragment reduction, and postoperative tibial plateau angle (TPA) during tibial plateau leveling osteotomy (TPLO). In vitro experimental study. Large-breed canine cadavers (n=20). TPLO was performed on 40 hindlimbs using 4 methods. Group 1: Jig; dogs in dorsal recumbency with the osteotomy parallel to the distal jig pin. Groups 2-4: No jig; dogs in lateral recumbency with the osteotomy in a vertical orientation (group 2: tibia parallel to the table top; group 3: controlled superimposition of the femoral condyles; group 4: internal rotation of the tibia). Postoperative TPA, fragment reduction, and osteotomy orientation relative to the tibial plateau were compared. Positive or negative values denoted deviation from parallel relative to the tibial plateau. Postoperative TPA, fragment reduction, and proximodistal osteotomy orientation were not significantly different between groups. Craniocaudal osteotomy orientation was significantly different (Ptable surface. TPLO without use of a jig reduces surgical trauma, is less time consuming, and reduces cost.

  2. Heat generation by two different saw blades used for tibial plateau leveling osteotomies.

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    Bachelez, Andreas; Martinez, Steven A

    2012-01-01

    During tibial plateau leveling osteotomy (TPLO) the saw blade produces frictional heat. The purpose of this study was to evaluate and compare heat generated by two TPLO blade designs (Slocum Enterprises [SE] and New Generation Devices [NDG]), with or without irrigation, on cadaveric canine tibias. Thirty-six paired tibias were used to continuously measure bone temperatures during osteotomy through both cortices (i.e., the cis and trans cortices). Each pair was assigned to either an irrigation or nonirrigation group during osteotomy, and each tibia within a pair was osteotomized using a different saw blade design. Saw blade temperatures were recorded and temperatures were compared for all combinations of blade type, cortex, and irrigation. In the cis cortex group, the SE blade generated more bone heat than the NGD blade (P=0.0258). Significant differences in temperature generation between saw blade types were seen only when the osteotomy site was not irrigated (P=0.0156). For all variables measured, bone and saw blade temperature generation was lower with irrigation (Psaw blade produced a critical duration of damaging temperature ranges in this study. Although saw blade design and irrigation influence heat generation during the TPLO, the potential for bone thermal damage during TPLO is low. The use of the NGD blade with irrigation is recommended.

  3. Tibial plateau levelling osteotomy in eleven cats with cranial cruciate ligament rupture.

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    Mindner, Julia K; Bielecki, Malgorzata J; Scharvogel, Stefan; Meiler, Diane

    2016-11-23

    To report the surgical procedure, intra- and postoperative complications, and short-term follow-up of tibial plateau levelling osteotomy (TPLO) in feline patients with cranial cruciate ligament (CrCL) rupture using a 2.0 or 2.4 mm Synthes(®) TPLO plate. Prospective study. Eleven cats with a CrCL rupture were included in the study. Inspection of intra-articular structures was carried out via arthroscopy or arthrotomy. Each patient was re-examined one and 10 days after surgery. Orthopaedic examination and follow-up radiographs were obtained four to 12 weeks postoperatively. Two meniscopathies and one partial CrCL rupture were detected. Minor intra-operative complications occurred in five cats (suboptimal positioning of the plate [n = 3], proximal fibular fracture [n = 1], a visible osteotomy gap [n = 1]). Postoperatively, minor complications were detected in three cats (mild patellar desmitis [n = 2], superficial wound infection [n = 1]). No additional surgical reintervention, graded as major complication, was necessary. Four to eight weeks postoperatively, all cats showed no to mild intermittent lameness. Complete bone union was apparent within four to 12 weeks. Owners reported a high level of comfort and mobility during the last follow-up. The preliminary results of this study support the use of TPLO in cats, but larger case numbers are needed to evaluate its practicability, as well as long-term outcome (>1 year), especially evaluating the development and the clinical relevance of osteoarthritis.

  4. Sagittal accuracy of tibial osteotomy position during in vivo tibial plateau levelling osteotomy performed without an alignment jig and cutting guide.

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    Craig, Andrew; Witte, Philip Georg; Scott, Harry William

    2017-01-16

    To assess the accuracy of tibial osteotomy location for tibial plateau levelling osteotomy (TPLO) in the sagittal plane and its effect on the postoperative tibial plateau angle (TPA), when performed without an alignment jig and saw guide. Also, to document the improvement gained with experience. Medical records and stifle radiographs of dogs undergoing TPLO, without the use of an alignment jig and saw guide, by one surgeon were reviewed (2010-2014). Postoperative radiographs were reviewed to record the distance and direction of eccentricity. Postoperative TPA was also recorded. In a series of 401 TPLO procedures, 231 met the inclusion criteria. The absolute distance of eccentricity (DOE) for all dogs was 3.0 ± 1.6 mm. When evaluating surgical experience, the DOE for the final 77 cases (2.72 ± 1.43 mm), the middle 77 cases (3.18 ± 1.49 mm), and the first 77 cases (3.24 ± 1.7 mm) were not significantly different (p = 0.07157). There was a very weak correlation between DOE and postoperative TPA (R = 0.029). The location of the tibial osteotomy when performing TPLO without an alignment jig and saw guide compared favourably with previously documented use of an alignment jig and saw guide. Whilst the location of the tibial osteotomy has a theoretical impact on the postoperative TPA, other factors appear to be of greater importance. Surgeon experience did not result in significant improvement in accuracy up to 231 procedures.

  5. The Clinical and Radiological Evaluation of Canine Cranial Cruciate Ligament Rupture Treatment with Tibial Plateau Leveling Osteotomy

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    Didar AYDIN KAYA

    2016-01-01

    Full Text Available Tibial plateau leveling osteotomy (TPLO is one of the tibial osteotomy techniques for canine cranial cruciate ligament rupture. The purpose of this study is to evaluate the clinically and radiologically findings of the patients with cranial cruciate ligament rupture treated by tibial plateau leveling osteotomy. In our clinical study, treatment of cranial cruciate ligament rupture in 18 dogs with a total of 20 stifles was performed. Cases were diagnosed with cranial cruciate ligament rupture, technical measurements for the operations are determined and the cases were prepared for the operation during the preoperative period of the clinical and radiological examinations. Following the operation, postoperative clinical and radiological evaluations were performed on the 10th, 30th, 60th, 90th and 120th days. At the end of the study, it was observed that the dogs retained stifle joint motion ability, early healing of the osteotomy side in the postoperative period, all stifle joint functions were retained after a period. It was determined that this method of operation can securely (in regards to joint stabilization be performed on especially in large breed dogs.

  6. In vitro performance testing of two arcuate oscillating saw blades designed for use during tibial plateau leveling osteotomy.

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    Farrell, Michael; Mathieson, Andrew; Chung, Peter; Heller, Jane; Clarke, Stephen P; McDonald, Mary Kate; Cardoni, Andrea

    2011-08-01

    To test the cutting performance of 2 commercially available oscillating saws designed for use during tibial plateau leveling osteotomy (TPLO) and to evaluate the influence of saline irrigation on cutting performance. In vitro experimental study. Composite polyurethane test blocks (n=40); 24 m TPLO saw blades. Controlled force cutting tests were performed using custom-made laminated bone substitute blocks to model the canine proximal tibia. Half of the trials were irrigated with 0.9% saline solution. Outcome measures were test block temperature (measured 1.5 m from the cutting zone), cutting rate, and cutting surface wear. Durability was measured by recording change in performance over multiple consecutive trials. The Synthes blade cut the test blocks with ∼64% less heat generation and at a 63% faster cutting rate compared with the Slocum blade. Although wear of the Synthes blade was ∼50% greater after 19 uses, this did not negatively impact cutting performance. Saline irrigation produced no significant effect on peak cutting temperature but significantly reduced cutting rate for both saws. Our results favor the Synthes blade in terms of cutting performance and the Slocum blade in terms of wear resistance. © Copyright 2011 by The American College of Veterinary Surgeons.

  7. Clinical efficacy of hydrocodone-acetaminophen and tramadol for control of postoperative pain in dogs following tibial plateau leveling osteotomy.

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    Benitez, Marian E; Roush, James K; McMurphy, Rose; KuKanich, Butch; Legallet, Claire

    2015-09-01

    To evaluate clinical efficacy of hydrocodone-acetaminophen and tramadol for treatment of postoperative pain in dogs undergoing tibial plateau leveling osteotomy (TPLO). ANIMALS 50 client-owned dogs. Standardized anesthetic and surgical protocols were followed. Each patient was randomly assigned to receive either tramadol hydrochloride (5 to 7 mg/kg, PO, q 8 h; tramadol group) or hydrocodone bitartrate-acetaminophen (0.5 to 0.6 mg of hydrocodone/kg, PO, q 8 h; hydrocodone group) for analgesia after surgery. The modified Glasgow composite measure pain scale was used to assess signs of postoperative pain at predetermined intervals by an investigator who was blinded to treatment group. Scoring commenced with the second dose of the assigned study analgesic. Pain scores and rates of treatment failure (ie, dogs requiring rescue analgesia according to a predetermined protocol) were compared statistically between groups. 12 of 42 (29%; 5/19 in the hydrocodone-acetaminophen group and 7/23 in the tramadol group) dogs required rescue analgesic treatment on the basis of pain scores. Median pain score for the hydrocodone group was significantly lower than that of the tramadol group 2 hours after the second dose of study analgesic. The 2 groups had similar pain scores at all other time points. Overall, differences in pain scores between dogs that received hydrocodone-acetaminophen or tramadol were minor. The percentage of dogs with treatment failure in both groups was considered unacceptable.

  8. Pharmacokinetics of hydrocodone and tramadol administered for control of postoperative pain in dogs following tibial plateau leveling osteotomy.

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    Benitez, Marian E; Roush, James K; KuKanich, Butch; McMurphy, Rose

    2015-09-01

    To evaluate the pharmacokinetics of hydrocodone (delivered in combination with acetaminophen) and tramadol in dogs undergoing tibial plateau leveling osteotomy (TPLO). 50 client-owned dogs. Dogs were randomly assigned to receive tramadol hydrochloride (5 to 7 mg/kg, PO, q 8 h; tramadol group) or hydrocodone bitartrate-acetaminophen (0.5 to 0.6 mg of hydrocodone/kg, PO, q 8 h; hydrocodone group) following TPLO with standard anesthetic and surgical protocols. Blood samples were collected for pharmacokinetic analysis of study drugs and their metabolites over an 8-hour period beginning after the second dose of the study medication. The terminal half-life, maximum serum concentration, and time to maximum serum concentration for tramadol following naïve pooled modeling were 1.56 hours, 155.6 ng/mL, and 3.90 hours, respectively. Serum concentrations of the tramadol metabolite O-desmethyltramadol (M1) were low. For hydrocodone, maximum serum concentration determined by naïve pooled modeling was 7.90 ng/mL, and time to maximum serum concentration was 3.47 hours. The terminal half-life for hydrocodone was 15.85 hours, but was likely influenced by delayed drug absorption in some dogs and may not have been a robust estimate. Serum concentrations of hydromorphone were low. The pharmacokinetics of tramadol and metabolites were similar to those in previous studies. Serum tramadol concentrations varied widely, and concentrations of the active M1 metabolite were low. Metabolism of hydrocodone to hydromorphone in dogs was poor. Further study is warranted to assess variables that affect metabolism and efficacy of these drugs in dogs.

  9. PLATEAU-PATELLA ANGLE: AN OPTION FOR ASSESSING PATELLAR HEIGHT ON PROXIMAL TIBIA OSTEOTOMY

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    BONADIO, MARCELO BATISTA; TORRES, JÚLIO AUGUSTO DO PRADO; MAZZARO, VICENTE; HELITO, CAMILO PARTEZANI; GOBBI, RICCARDO GOMES; DEMANGE, MARCO KAWAMURA

    2016-01-01

    ABSTRACT Objective: To compare the plateau-patella angle method to the methods already established for patellar height measurement in patients undergoing high tibial osteotomy. Methods: This is a retrospective study of 13 patients undergoing medial opening tibial osteotomy. The patellar height was measured in pre and post-operative radiographs by the methods from Insall-Salvati, Caton-Deschamps, Blackburne-Peel and patella-plateau angle, as well as the tibial slope and length of the patellar tendon. Measurements were performed by two knee surgeons at two different times. Results: The mean age was 41.33 ± 01.09 years old. The average rates of Caton-Deschamps, Blackburne-Peel, Insall-Salvati and plateau-patella angle were, respectively, 1.00; 0.89; 1.10; and 23.15° preoperatively, and 0.89; 0.78; 1.11; and 20.46°, postoperatively. The correlation of Caton-Deschamps, Blackburne-Pell, and Insall-Salvati indexes and plateau-patellar angle interobserver was 0.72 (p <0.001), 0:54 (p <0.001), 0.65 (p <0.001), and 0.67 (w <0.001), respectively. Conclusion: The plateau-patella angle method undergoes changes that are correlated with changes in tibial slope after osteotomy, unlike the classical methods. This fact may lead to overestimate the reduction of patellar height after osteotomy. Level of evidence IV. Case Series. PMID:27217812

  10. An Innovative Intra-articular Osteotomy in the Treatment of Posterolateral Tibial Plateau Fracture Malunion.

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    Wang, Yukai; Luo, Congfeng; Hu, Chengfang; Sun, Hui; Zhan, Yu

    2016-07-13

    Posterolateral tibial plateau fractures are not uncommon and the diagnosis can be easily missed. The treatment is technically demanding, which can easily lead to malunion of the posterolateral tibial plateau fracture. Here, we describe an innovative intra-articular osteotomy for the treatment of posterolateral tibial plateau fracture malunion. From 2010 through 2012, 13 patients with a posterolateral tibial plateau fracture malunion were treated in our trauma center. The patients were referred because of instability or knee pain. The instability was confirmed by physical examinations preoperatively. The depression malunion and lower limb alignment were evaluated on X-rays and computed tomography scans. All posterolateral tibial plateau fracture malunions were treated with an innovative intra-articular osteotomy via an extended anterolateral approach. The mean follow-up was 19.6 months (range, 14-28 months). The posterolateral osteotomy healed at an average of 15.1 weeks. The depression malunion was corrected in all patients, which was from 15.4 mm preoperatively to 3.3 mm at 12 months postoperatively. The average Lysholm, Knee Society Score, and visual analog scale scores were 91.7, 92.5, and 0.5, respectively. No loss of reduction, nonunion, or wound infection was observed. An innovative intra-articular osteotomy via an extended anterolateral approach is an effective treatment for posterolateral tibial plateau fracture malunion. The treatment achieved satisfactory functional results and knee stability restoration.

  11. Evaluation of the Effect of a Single Intra-articular Injection of Allogeneic Neonatal Mesenchymal Stromal Cells Compared to Oral Non-Steroidal Anti-inflammatory Treatment on the Postoperative Musculoskeletal Status and Gait of Dogs over a 6-Month Period after Tibial Plateau Leveling Osteotomy: A Pilot Study

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    Mathieu Taroni

    2017-06-01

    Full Text Available ObjectiveCompare the clinical and pressure walkway gait evolution of dogs after a tibial plateau leveling osteotomy (TPLO for a cranial cruciate ligament rupture (CrCLR and treatment with either a 1-month course of non-steroidal anti-inflammatory drugs (NSAIDs or a single postoperative intra-articular (IA injection of allogeneic neonatal mesenchymal stromal cells (MSCs.Study designProspective, double-blinded, randomized, controlled, monocentric clinical study.AnimalsSixteen client-owned dogs.Materials and methodsDogs with unilateral CrCLR confirmed by arthroscopy were included. Allogeneic neonatal canine MSCs were obtained from fetal adnexa retrieved after C-section performed on healthy pregnant bitches. The dogs were randomly allocated to either the “MSCs group,” receiving an IA injection of MSCs after TPLO, followed by placebo for 1 month, or the “NSAIDs group,” receiving IA equivalent volume of MSCs vehicle after TPLO, followed by oral NSAID for 1 month. One of the three blinded evaluators assessed the dogs in each group before and after surgery (1, 3, and 6 months. Clinical score and gait and bone healing process were assessed. The data were statistically compared between the two groups for pre- and postoperative evaluations.ResultsFourteen dogs (nine in the MSCs group, five in the NSAIDs group completed the present study. No significant difference was observed between the groups preoperatively. No local or systemic adverse effect was observed after MSCs injection at any time point considered. At 1 month after surgery, bone healing scores were significantly higher in the MSCs group. At 1, 3, and 6 months after surgery, no significant difference was observed between the two groups for clinical scores and gait evaluation.ConclusionA single IA injection of allogeneic neonatal MSCs could be a safe and valuable postoperative alternative to NSAIDs for dogs requiring TPLO surgery, particularly for dogs intolerant to this class of

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

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

    2016-09-20

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

  13. Owner Evaluation of a CORA-Based Leveling Osteotomy for Treatment of Cranial Cruciate Ligament Injury in Dogs.

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    Kishi, Erin N; Hulse, Don

    2016-05-01

    To evaluate a center of rotation of angulation (CORA)-based leveling osteotomy for cranial cruciate ligament injury in dogs. Retrospective case series. Dogs (n=70). Medical records (March 2011 to March 2012) of dogs diagnosed with a cranial cruciate ligament (CCL) injury treated with a CORA-based leveling osteotomy and stabilized using a bone plate and headless compression screw were reviewed. Radiographs were reviewed for tibial plateau angle and radiographic healing at final evaluation graded on a 5-point scale. Follow-up for a minimum of 6 months postoperatively was conducted by owner completion of a questionnaire regarding their dog's function after surgery. Based on owner responses, clinical outcomes were established. CORA-based leveling osteotomy was used for 70 stifles with CCL injury. The mean time to final radiographic recheck was 107 days (range, 32-424 days). Radiographic healing scores were 42 dogs (69%) with grade 4, 17 dogs (28%) with grade 3, and 2 dogs (3%) with grade 2. The mean time to follow-up was 11.9 months (range 6-18 months). Fifty-four of the 70 (77%) dogs had full function, 13 (19%) had acceptable function, and 3 (4%) had unacceptable function. Complications occurred in 11 stifles (16%), including 3 incisional, 6 late-onset meniscal tears, and 2 implant related. The described method of a CORA-based leveling osteotomy can be successfully performed for treatment of CCL injury in dogs. At the time of mid-term and long-term owner follow-up, most dogs in this case series had returned to full function. © Copyright 2016 by The American College of Veterinary Surgeons.

  14. Tibial plato leveling osteotomy / Osteotomia de nivelamento do plato da tíbia

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    Julia Maria Matera

    2008-08-01

    Full Text Available The tibial plateau leveling osteotomy (TPLO is a relatively new and innovative surgical treatment for the cranial cruciate ligament rupture in the canine species. The real intent of the procedure is to provide functional stability to the stifle joint by eliminating or neutralizing the cranial tibial thrust during weight bearing instead to restore the cranial cruciate ligament function. The proposal of this study is to report a review of the TPLO procedure, emphasizing procedure, surgical technique, post operative care and complications. The TPLO procedure consists in a radial osteotomy in the tibial plato and rotation of the caudal plateau in order to obtain a desired angle. After the leveling of the tibial plateau, a bone plate and screws are used to stabilize the osteotomy until bone is healed up. The complications that have been associated with the procedure include tibial tuberosity fracture and patellar tendon tendinosis. This procedure has become increasingly more popular for surgical treatment of cranial cruciate ligament injuries in large breed dog. The long term clinical results have not been completely elucidated yet. It has been showed that this technique doesn’t halt the degenerative joint disease.A osteotomia do platô da tíbia (TPLO é um tratamento relativamente novo e inovador para a ruptura do ligamento cruzado cranial (RLCC na espécie canina. Ao invés de restaurar a função do ligamento, o procedimento promove estabilidade funcional para a articulação do joelho, por eliminar ou neutralizar a força tibial cranial durante a sustentação de peso. A proposta do presente estudo é revisar a técnica de TPLO, enfatizando o procedimento, técnica cirúrgica, cuidados pós-operatórios e complicações. A técnica da TPLO consiste na realização de uma osteotomia circular do platô da tíbia com rotação de sua porção caudal até a obtenção do ângulo desejado. Após o nivelamento do platô da tíbia, placa e parafusos

  15. How to Calculate the Exact Angle for Two-level Osteotomy in Ankylosing Spondylitis?

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    Zheng, Guoquan; Song, Kai; Yao, Ziming; Zhang, Yonggang; Tang, Xiangyu; Wang, Zheng; Zhang, Xuesong; Mao, Keya; Cui, Geng; Wang, Yan

    2016-09-01

    A prospective case series study. To describe and assess a two-level osteotomy method for the management of severe thoracolumbar kyphosis (TLK) in patients with ankylosing spondylitis (AS). To achieve better postoperative outcomes in these patients, a sophisticated preoperative surgical plan is required. Most deformities are managed using a one-level osteotomy and a two-level osteotomy is seldomly reported. Till date, no study has described a two-level osteotomy for these cases. From January 2011 to December 2012, 10 consecutive patients with ankylosing spondylitis who underwent two-level spinal osteotomy were studied. Pre- and postoperative full-length free-standing radiographs, including the whole spine and pelvis, were available for all patients. Pre- and postoperative radiological parameters, including T5-S1 Cobb angles, TLK, lumbar lordosis, pelvic incidence, pelvic tilt, sacral slope, and sagittal vertical axis were measured. Health related quality of life , including Oswestry Disability Index and Scoliosis Research Society-22 surveys were administered before surgery and at 1-year follow up. The preoperative and postoperative T5-S1 Cobb angles was 51.3° and -7.1°, respectively (P osteotomy provides an accurate and reproducible method for ankylosing spondylitis correction. By which, we can obtain satisfactory radiological parameters and clinical outcomes. 4.

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

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

    2015-03-15

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

  17. Percutaneous pelvic osteotomy and intertrochanteric varus shortening osteotomy in nonambulatory GMFCS level IV and V cerebral palsy patients: preliminary report on 30 operated hips.

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    Canavese, Federico; Gomez, Horacio; Kaelin, André; Ceroni, Dimitri; de Coulon, Geraldo

    2013-01-01

    This study evaluated the outcome of severe cerebral palsy patients (Gross Motor Function Classification System level IV and V) treated by simultaneous percutaneous pelvic osteotomy and intertrochanteric varus shortening osteotomy for hip subluxation or dislocation between 2002 and 2011. Twenty-four patients (30 hips) with an average age of 9.4 years (5-16.5) were reviewed at a mean follow-up of 35.9 months (6-96). Percutaneous pelvic osteotomy lasted on average 30 min/patient per side (25-40) and was always performed through a skin incision of 2-3 cm. The migration percentage and acetabular angle were assessed on plain radiographs. The mean Reimers' migration percentage improved from 67.1% (42-100) preoperatively to 7.7% (0-70) at the last follow-up and the mean acetabular angle improved from 31.8° (22-48) to 15.7° (5-27). Five patients presented complications: one redislocation, one bone graft dislodgement, and three with avascular necrosis of the femoral head. This study should be considered as a pilot study. These results indicate that this combined approach is an effective, reliable, and minimally invasive alternative method for the treatment of spastic dislocated hips in severe cerebral palsy patients with an outcome similar to standard techniques reported in the literature.

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

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

    2016-01-01

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

  19. Stabilization of the CORA based leveling osteotomy for treatment of cranial cruciate ligament injury using a bone plate augmented with a headless compression screw.

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    Raske, Matthew; Hulse, Don; Beale, Brian; Saunders, W Brian; Kishi, Erin; Kunze, Christopher

    2013-08-01

    To report the effectiveness of a bone plate/headless compression screw (HCS) construct in preventing tibial plateau angle (TPA) shift postoperatively and to describe radiographic healing of the osteotomy. Case series. Dogs (n = 31). Records of dogs diagnosed with cranial cruciate ligament (CCL) injury treated with the center of rotation of angulation (CORA) based leveling osteotomy (CBLO) stabilized with a bone plate augmented with a HCS were reviewed. Breed, age, weight, and gender were recorded. Radiographs were reviewed for determination of preoperative tibial plateau angle (PreTPA), postoperative TPA (PostTPA), patellar tendon angle (PTA) postoperatively, and TPA at final evaluation (FinalTPA). Difference between PostTPA and FinalTPA was used to define any TPA shift. Radiographic healing at final evaluation was graded based on a 5-point scale. Mean time to final recheck was 88 days (range 49-237 days) with mean ± SD PreTPA = 28.6 ± 4.8°; PostTPA = 9.2 ± 2.2°; FinalTPA = 9.7 ± 2.6°; and TPA Shift = 0.52 ± 1.61°. There was no significant difference between PostTPA and FinalTPA (P = .084, power > 0.80). Mean postoperative PTA was 89.9 ± 1.7°. There were 2 implant related complications; 1 HCS migration and 1 HCS failure. Stabilization of the CBLO using a bone plate augmented with a HCS was effective in maintaining PostTPA and achieving satisfactory radiographic healing. © Copyright 2013 by The American College of Veterinary Surgeons.

  20. Osteotomy of the knee

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

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

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

    2001-11-01

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

  2. Activity Level and Severity of Dysplasia Predict Age at Bernese Periacetabular Osteotomy for Symptomatic Hip Dysplasia.

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    Matheney, Travis; Zaltz, Ira; Kim, Young-Jo; Schoenecker, Perry; Millis, Michael; Podeszwa, David; Zurakowski, David; Beaulé, Paul; Clohisy, John

    2016-04-20

    The age when patients present for treatment of symptomatic developmental dysplasia of the hip with periacetabular osteotomy (PAO) varies widely. Modifiable factors influencing age at surgery include preexisting activity level and body mass index (BMI). The severity of the hip dysplasia has also been implicated as a factor influencing the age at arthritis onset. The purpose of this study was to determine whether activity level, BMI, and severity of dysplasia are independent predictors of age of presentation for PAO. A retrospective, institutional review board-approved review of prospectively collected data from a multicenter study group identified 708 PAOs performed for developmental dysplasia of the hip. Demographic factors that were considered in the analysis included age at surgery, BMI, history of hip disorder or treatment, and duration of symptoms. The severity of the developmental dysplasia of the hip was assessed by radiographic measurement of the lateral and anterior center-edge angles and acetabular inclination. Activity level was assessed with the University of California, Los Angeles (UCLA) activity score. Spearman correlations and t tests were used for univariable analysis. Multivariable regression analysis using generalized estimating equations was applied to determine independent predictors of age at PAO. Univariable analysis indicated that age at presentation for treatment of PAO correlated with the lateral and anterior center-edge angles (p < 0.001), UCLA score (p < 0.001), and BMI (p = 0.04). Since the lateral and anterior center-edge angles were similarly correlated (Spearman rho = 0.61, p < 0.001), the lateral center-edge angle alone was used to classify the severity of the developmental dysplasia of the hip. Multivariable linear regression confirmed that a high UCLA score and severe hip dysplasia were independent predictors of age at PAO (p < 0.001). A high activity level and severe dysplasia lead to the development of symptoms and presentation

  3. Second-look arthroscopic findings after CORA-based leveling osteotomy.

    Science.gov (United States)

    Vasquez, Barbara; Hulse, Don; Beale, Brian; Kerwin, Sharon; Andrews, Chad; Saunders, Brian W

    2017-09-08

    To describe the arthroscopic appearance of intra-articular structures mid-term (9 months) and long-term (>12 months) after CORA-based leveling osteotomy (CBLO). Case series. Dogs (n = 41) with second-look arthroscopy of the stifle after CBLO for treatment of a cranial cruciate ligament (CCL) deficiency. Both stifles were re-evaluated (stifles n = 42) in 1 dog. Medical records of dogs that had second-look arthroscopy after CBLO were reviewed. Arthroscopic images of the femoral condyles were independently reviewed. The surgical report documented the integrity of menisci and articular cartilage of the tibial plateaus. The population included 7 stifles with stable partial CCL tears, 35 stifles with complete CCL tears (n = 28), or incompetent partial CCL tears (n = 7). Median time to second look arthroscopy was 16 months (9-24 months) for stable partial tears. The CCL remained intact in 6 stifles. The Outerbridge score of the articular cartilage of the femoral condyles was as 0 (6) or 1 (1). The articular cartilage of the tibial plateaus appeared normal in all stifles. Median time to second look arthroscopy of stifles with complete tears was 12 months (range, 9-34 months). The caudal cruciate ligament was normal or mildly fibrillated. The appearance of the articular cartilage of the femoral condyles was scored as 0 or near normal (grade 1-2) in all dogs. The articular cartilage of the tibial plateaus appeared normal, except in 1 dog with grade 4 lesion. CBLO results in minimal to no change in articular cartilage in at a median time of 14 months after surgery. Postoperative clinical lameness is often attributed to late onset meniscal pathology. © 2017 The American College of Veterinary Surgeons.

  4. Radiologic and clinical outcomes comparison between single- and two-level pedicle subtraction osteotomies in correcting ankylosing spondylitis kyphosis.

    Science.gov (United States)

    Xu, Hui; Zhang, Yonggang; Zhao, Yongfei; Zhang, Xuesong; Xiao, Songhua; Wang, Yan

    2015-02-01

    Single pedicle subtraction osteotomy (PSO) has been used to correct ankylosing spondylitis (AS) kyphosis successfully, but this approach seems insufficient to correct severe kyphosis. Two-level PSO has been attempted to correct advanced kyphosis in recent years. However, studies have not yet compared outcomes between single and double PSOs, and the indications to perform two-level PSO are unclear. This study aimed to compare the radiologic and clinical outcomes between single- and two-level PSOs in correcting AS kyphosis. This work is a retrospective cohort study. Sixty patients were included. Thirty-seven underwent single-level PSO, and 23 underwent one stage two-level PSO. The radiologic analysis included thoracic kyphosis, thoracolumbar junction, lumbar lordosis, pelvic index, chin-brow vertical angle (CBVA), sagittal vertical axis (SVA), and pelvic tilt (PT). Clinical assessment was performed with a Scoliosis Research Society-22 (SRS-22) outcomes instrument. The operative time, blood loss, and complications were also documented. All of the aforementioned measurements were recorded before surgery, after surgery, and at the last follow-up. The outcomes were compared between the two groups. The operating time was 232±52 minutes for single- and 282±43 minutes for two-level PSOs. The blood loss was 1,240±542 mL (Level 1) and 2,202±737 mL (Level 2). The total spine correction was 43.2°±15.1° (Level 1) and 60.6°±19.1° (Level 2) (p.05). All patients could walk with horizontal vision and lie on their backs postoperatively. The SRS-22 improved from 1.7±0.4 to 4.2±0.8 in the two-level group and 1.8±0.8 to 4.3±0.7 in the single-level group. The fusion of the osteotomy was achieved in each patient. The complications were similar in both groups. Pedicle subtraction osteotomy is an effective method to correct kyphosis with AS. Most patients can be successfully treated by single PSO. In severe patients, two-level PSO may be preferable because its correction

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

    Science.gov (United States)

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

    2016-08-01

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

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

    Science.gov (United States)

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

    2015-12-01

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

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

    Science.gov (United States)

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

    2016-09-01

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

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

    Science.gov (United States)

    Ogawa, H; Matsumoto, K; Akiyama, H

    2017-07-01

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

  9. Periacetabular osteotomy

    DEFF Research Database (Denmark)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2015-06-01

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

  11. San Luis Valley - Taos Plateau Landscape-Level Cultural Heritage Values and Risk Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Wescott, Konstance L. [Argonne National Lab. (ANL), Argonne, IL (United States); Abplanalp, Jennifer M. [Argonne National Lab. (ANL), Argonne, IL (United States); Brown, Jeff [Bureau of Land Management, Monte Vista, CO (United States); Cantwell, Brian [Argonne National Lab. (ANL), Argonne, IL (United States); Dicks, Merrill [Bureau of Land Management, Taos, NM (United States); Fredericks, Brian [Bureau of Land Management, Monte Vista, CO (United States); Krall, Angie [US Forest Service, Creede, CO (United States); Rollins, Katherine E. [Argonne National Lab. (ANL), Argonne, IL (United States); Sullivan, Robert [Argonne National Lab. (ANL), Argonne, IL (United States); Valdez, Arnie [Univ. of New Mexico, Albuquerque, NM (United States); Verhaaren, Bruce [Argonne National Lab. (ANL), Argonne, IL (United States); Vieira, Joseph [Bureau of Land Management, Monte Vista, CO (United States); Walston, Lee [Argonne National Lab. (ANL), Argonne, IL (United States); Zvolanek, Emily A. [Argonne National Lab. (ANL), Argonne, IL (United States)

    2016-10-01

    The San Luis Valley – Taos Plateau Landscape-Level Cultural Heritage Values and Risk Assessment (hereafter referred to as cultural assessment) is a BLM pilot project designed to see whether the Rapid Ecoregional Assessment (REA) framework (already established and implemented throughout many ecoregions in the West) can be applied to the cultural environment.

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

    Science.gov (United States)

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

    2013-11-16

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

  13. The pelvic support osteotomy: indications and preoperative planning

    OpenAIRE

    Pafilas, Dimitrios; Nayagam, Selvadurai

    2008-01-01

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

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

    Science.gov (United States)

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

    2016-09-01

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

  15. Modeling the cliff retreat response to base-level change in layered rocks, Colorado Plateau, USA

    Science.gov (United States)

    Ward, D.; Sheehan, C.

    2015-12-01

    The retreat of cliffs is an important mode of erosion in layered rocks of variable strength. For example, the iconic Colorado Plateau landscapes of Grand Canyon, Canyonlands, and Monument Valley owe their unique forms to this process. These landscapes are the end result of incision by trunk streams followed by cliff retreat. Local interactions between stochastic rockfall and first-order channels draining a cliff regulate the cliff retreat response to a base-level fall. However, nonlinear transport dynamics, steep slopes, and variable rock strength challenge the modeling of landscape evolution in these settings. Here, we employ structure-from-motion photogrammetry to generate high-resolution DTMs of a natural experiment site on the Colorado Plateau. The site features a simple, sandstone-over-shale stratigraphy with a continuous gradient in cliffband height and evidence for an ongoing transient response to base level fall. The terrain data inform a high-resolution (dx=5 m), 2D numerical model of cliffband erosion. The model simulates the interaction of three primary processes: fluvial erosion and sediment transport; hillslope transport of regolith, including shallow landsliding; and rockfall from resistant units. Crucially, the model allows us to modify stratigraphy arbitrarily to examine the landscape response to parameters such as thickness, spacing, and dip of resistant units. Results indicate that the contrast in fluvial erodibility sets the pattern of emergence of cliffs as a resistant layer is exhumed, while the difference in weathering rates across rock types sets the rate at which cliffs emerge. Once rockfall begins, erosion rates are modified by the thickness of the resistant layer, which sets the volume of rockfall debris reaching the channels below the cliff. The modeling highlights the need for process-based understanding of the conditions for cliff failure by rockfall and redistribution of the debris in very steep, rapidly-eroding landscapes.

  16. Arthroscopic-Assisted Fixation of Tibial Plateau Fractures: Patient-Reported Postoperative Activity Levels.

    Science.gov (United States)

    Kampa, John; Dunlay, Ryan; Sikka, Robby; Swiontkowski, Marc

    2016-05-01

    Tibial plateau fractures may result in significant limitations postoperatively. Studies have described outcomes of arthroscopic-assisted percutaneous fixation (AAPF) of these injuries but have rarely reported postoperative activity levels. Between 2009 and 2013, patients who sustained a lateral split, split depression, or pure depression type tibial plateau fracture (Schatzker types I-III fractures) and underwent outpatient AAPF were eligible for the study. Outcomes were assessed using Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Lysholm score, and Marx activity score. Twenty-five consecutive patients were eligible for the study, and 22 (88%) were included in the final analysis, with average follow-up of 2.5 years (range, 1-5.2 years). Thirteen women and 9 men with an average age of 48.3 years (range, 23-65 years) comprised the study population. Average number of screws used for fixation was 2 (range, 1-4). The average depression was 8 mm preoperatively and 0.9 mm (range, 0-3 mm) postoperatively. Four patients (18%) had complications: 2 with hardware removal and 2 with postoperative deep venous thrombosis. Average postoperative Marx activity score was 5.7. Average postoperative KOOS Symptoms, Sports, and Quality of Life scores were 88 (range, 68-100), 85 (range, 45-100), and 77 (range, 50-100), respectively. Average IKDC and Lysholm scores were 81 (range, 55-97) and 87 (range, 54-100), respectively. The AAPF surgical technique, which was performed in an outpatient setting, facilitated excellent postoperative range of motion, outcomes, and activity scores with minimal complications. [Orthopedics. 2016; 39(3):e486-e491.].

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

    Science.gov (United States)

    Pafilas, Dimitrios; Nayagam, Selvadurai

    2008-09-01

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

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

    Science.gov (United States)

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

    2011-01-01

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

  19. Addendum to Composite Analysis for Low-Level Waste Disposal in the 200 Area Plateau of the Hanford Site

    Energy Technology Data Exchange (ETDEWEB)

    Bergeron, Marcel P.; Freeman, Eugene J.; Wurstner, Signe K.; Kincaid, Charles T.; Coony, Mike M.; Strenge, Dennis L.; Aaberg, Rosanne L.; Eslinger, Paul W.

    2001-09-28

    This report summarizes efforts to complete an addendum analysis to the first iteration of the Composite Analysis for Low-Level Waste Disposal in the 200 Area Plateau of the Hanford Site (Composite Analysis). This document describes the background and performance objectives of the Composite Analysis and this addendum analysis. The methods used, results, and conclusions for this Addendum analysis are summarized, and recommendations are made for work to be undertaken in anticipation of a second analysis.

  20. Maquet Osteotomy, Results

    Science.gov (United States)

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

    2017-01-01

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

  1. Intraoral Zygoma Reduction Using L-shaped Osteotomy

    Science.gov (United States)

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

    2014-01-01

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

  2. Southwick Osteotomy Stabilised with External Fixator

    Science.gov (United States)

    Grubor, Predrag; Mitkovic, Milorad; Grubor, Milan

    2014-01-01

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

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

    Science.gov (United States)

    Hall, Matthew J; Mandalia, Vipul I

    2016-03-01

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

  4. Composite analysis for low-level waste disposal in the 200 area plateau of the Hanford Site

    Energy Technology Data Exchange (ETDEWEB)

    Kincaid, C.T.; Bergeron, M.P.; Cole, C.R. [and others

    1998-03-01

    This report presents the first iteration of the Composite Analysis for Low-Level Waste Disposal in the 200 Area Plateau of the Hanford Site (Composite Analysis) prepared in response to the U.S. Department of Energy Implementation Plan for the Defense Nuclear Facility Safety Board Recommendation 94-2. The Composite Analysis is a companion document to published analyses of four active or planned low-level waste disposal actions: the solid waste burial grounds in the 200 West Area, the solid waste burial grounds in the 200 East Area, the Environmental Restoration Disposal Facility, and the disposal facilities for immobilized low-activity waste. A single Composite Analysis was prepared for the Hanford Site considering only sources on the 200 Area Plateau. The performance objectives prescribed in U.S. Department of Energy guidance for the Composite Analysis were 100 mrem in a year and examination of a lower dose (30 mrem in a year) to ensure the {open_quotes}as low as reasonably achievable{close_quotes} concept is followed. The 100 mrem in a year limit was the maximum allowable all-pathways dose for 1000 years following Hanford Site closure, which is assumed to occur in 2050. These performance objectives apply to an accessible environment defined as the area between a buffer zone surrounding an exclusive waste management area on the 200 Area Plateau, and the Columbia River. Estimating doses to hypothetical future members of the public for the Composite Analysis was a multistep process involving the estimation or simulation of inventories; waste release to the environment; migration through the vadose zone, groundwater, and atmospheric pathways; and exposure and dose. Doses were estimated for scenarios based on agriculture, residential, industrial, and recreational land use. The radionuclides included in the vadose zone and groundwater pathway analyses of future releases were carbon-14, chlorine-36, selenium-79, technetium-99, iodine-129, and uranium isotopes.

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2016-07-01

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

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

    Science.gov (United States)

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

    2016-11-01

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

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

    Science.gov (United States)

    Ito, H; Matsuno, T; Minami, A

    2003-03-01

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

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

    Science.gov (United States)

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

    2015-12-01

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

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

    Science.gov (United States)

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

    2015-10-01

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

  11. Use of Supplemental Short Pre-Contoured Accessory Rods and Cobalt Chrome Alloy Posterior Rods Reduces Primary Rod Strain and Range of Motion Across the Pedicle Subtraction Osteotomy Level

    DEFF Research Database (Denmark)

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

    2016-01-01

    STUDY DESIGN: In vitro cadaveric biomechanical study. OBJECTIVE: To assess effects of 4-rod reconstruction, rod material, and anterior column support on motion and surface rod strain in a pedicle subtraction osteotomy model. SUMMARY OF BACKGROUND DATA: Pedicle subtraction osteotomy (PSO) can corr...

  12. Tibial Plateau Fractures

    DEFF Research Database (Denmark)

    Elsøe, Rasmus

    This PhD thesis reported an incidence of tibial plateau fractures of 10.3/100,000/year in a complete Danish regional population. The results reported that patients treated for a lateral tibial plateau fracture with bone tamp reduction and percutaneous screw fixation achieved a satisfactory level...... with only the subgroup Sport significantly below the age matched reference population. The thesis reports a level of health related quality of life (Eq5d) and disability (KOOS) significantly below established reference populations for patients with bicondylar tibial plateau fracture treated with a ring...... fixator, both during treatment and at 19 months following injury. In general, the thesis demonstrates that the treatment of tibial plateau fractures are challenging and that some disabilities following these fractures must be expected. Moreover, the need for further research in the area, both with regard...

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

    Science.gov (United States)

    Thambiraj, Sathya; Boszczyk, Bronek M

    2012-05-01

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

  14. Biplanar chevron osteotomy.

    Science.gov (United States)

    Nery, Caio; Barroco, Rui; Réssio, Cibele

    2002-09-01

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

  15. Hallux varus following scarf osteotomy.

    Science.gov (United States)

    Akhtar, Shahid; Malek, Sabur; Hariharan, Kartik

    2016-12-01

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

  16. Monitoring recent lake level variations on the Tibetan Plateau using CryoSat-2 SARIn mode data

    Science.gov (United States)

    Jiang, Liguang; Nielsen, Karina; Andersen, Ole B.; Bauer-Gottwein, Peter

    2017-01-01

    Lakes on the Tibetan Plateau (TP) are of great interest due to their value as water resources but also as an important indicator of climate change. However, in situ data in this region are extremely scarce and only a few lakes have gauge measurements. Satellite altimetry has been used successfully to monitor lake levels. In this study, Cryosat-2 SARIn mode data over the period 2010-2015 are used to investigate recent lake level variations. The estimated water levels of the 70 largest lakes (> 100 km2) on the TP show that 48 lakes reveal a rising trend (avg. 0.28 ± 0.06 m/yr) while the other 22 show a slightly decreasing trend (avg. -0.10 ± 0.04 m/yr). To compare with the change rates during 2003-2009, ICESat data which cover 42 of the 70 lakes are also used. When combining the data, the results show that during the period of 2003-2015, 28 lakes maintained a rising trend and the change rates are comparable. Lakes in the northern part of the TP experienced pronounced rising (avg. 0.37 ± 0.10 m/yr), while lakes in southern part were steady or decreasing even in glaciated basins with high precipitation. Factor analysis indicates that driving factors for lake change are variable due to high spatial heterogeneity. However, autumn/winter temperature plays an important role in lake level change. These results demonstrate that lakes on the TP are still rapidly changing under climate change, especially in northern part of the TP, but the driving factors are variable and more research is needed to understand the mechanisms behind observed changes.

  17. Complex osteotomies vertebral column resection and decancellation.

    Science.gov (United States)

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

    2014-07-01

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

  18. Valgus osteotomy of the tibia with a Puddu plate combined with anterior cruciate ligament reconstruction

    Directory of Open Access Journals (Sweden)

    Albuquerque Roberto Freire da Mota e

    2003-01-01

    Full Text Available Anterior knee instability associated with a varus deformity is a complex condition with several treatment possibilities. Among these, anterior cruciate ligament (ACL associated to a simultaneous valgus tibial osteotomy is a increasing indication. This simultaneous procedure adds technical issues to those related to the isolated surgeries. Thus, the osteotomy plane and location of fixation hardware shouldn?t conflict with tibial tunnel and ACL graft fixation. Authors analyze the relations between a opening tibial valgus osteotomy stabilized with a Puddu plate and ACL reconstruction with a patellar tendon graft fixated with interference screws in 10 human cadaver knees. A straight oblique tibial osteotomy starting on the medial tibial cortex and oriented laterally and proximally was performed on all knees with a 10mm opening medially and stabilized with a Puddu plate on the most posterior aspect of the medial tibia, and a tibial tunnel drilled 50° to tibial plateau. With this technique there was no intersection between tibial tunnel or interference screw and the osteotomy or the plate fixation screws.

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Science.gov (United States)

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

    2015-10-01

    -22 degrees), stage 2 (range, 1-5) and 6 degrees of plantar flexion (range, 8 degrees of dorsiflexion to 18 degrees of plantar flexion), respectively. The osteotomies consolidated at a mean of 7 weeks (range, 5-9 weeks). There were no cases of delayed union or nonunion. Of the cohort, 45 (96%) stated that they were satisfied overall with the results of their surgery and would have it again. The mean postoperative summary index Manchester-Oxford Foot Questionnaire (MOXFQ) score was 12.9 (range, 0-60.9) out of 100 at a mean follow-up of 45 months (range, 14-60 months). For the minority of cases, 8 (17%), that had preoperative scoring, the summary index MOXFQ score was 73.7 (range, 29.7-100). The double first metatarsal osteotomy (basal opening wedge and distal chevron osteotomy) with Akin osteotomy provides powerful correction and facilitates correction of the individual components of the hallux valgus deformity. The individual osteotomies that make up this procedure are familiar to the majority of foot and ankle surgeons, thus limiting the associated learning curve. Level IV, retrospective case series. © The Author(s) 2015.

  1. COMPARISON OF VENTED AND ABSOLUTE PRESSURE TRANSDUCERS FOR WATER-LEVEL MONITORING IN HANFORD SITE CENTRAL PLATEAU WELLS

    Energy Technology Data Exchange (ETDEWEB)

    MCDONALD JP

    2011-09-08

    Automated water-level data collected using vented pressure transducers deployed in Hanford Site Central Plateau wells commonly display more variability than manual tape measurements in response to barometric pressure fluctuations. To explain this difference, it was hypothesized that vented pressure transducers installed in some wells are subject to barometric pressure effects that reduce water-level measurement accuracy. Vented pressure transducers use a vent tube, which is open to the atmosphere at land surface, to supply air pressure to the transducer housing for barometric compensation so the transducer measurements will represent only the water pressure. When using vented transducers, the assumption is made that the air pressure between land surface and the well bore is in equilibrium. By comparison, absolute pressure transducers directly measure the air pressure within the wellbore. Barometric compensation is achieved by subtracting the well bore air pressure measurement from the total pressure measured by a second transducer submerged in the water. Thus, no assumption of air pressure equilibrium is needed. In this study, water-level measurements were collected from the same Central Plateau wells using both vented and absolute pressure transducers to evaluate the different methods of barometric compensation. Manual tape measurements were also collected to evaluate the transducers. Measurements collected during this study demonstrated that the vented pressure transducers over-responded to barometric pressure fluctuations due to a pressure disequilibrium between the air within the wellbores and the atmosphere at land surface. The disequilibrium is thought to be caused by the relatively long time required for barometric pressure changes to equilibrate between land surface and the deep vadose zone and may be exacerbated by the restriction of air flow between the well bore and the atmosphere due to the presence of sample pump landing plates and well caps. The

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

    Science.gov (United States)

    Vander Griend, Robert

    2017-02-01

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

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

    Science.gov (United States)

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

    2017-03-01

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

  4. Patella height changes post high tibial osteotomy

    Directory of Open Access Journals (Sweden)

    Siew Ghim Gooi

    2017-01-01

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

  5. Annual Status Report (FY2008) Composite Analysis of Low-Level Waste Disposal in the Central Plateau at the Hanford Site

    Energy Technology Data Exchange (ETDEWEB)

    Nichols, W. E. [Hanford Site (HNF), Richland, WA (United States)

    2009-12-18

    In accordance with the U.S. Department of Energy (DOE) requirements in DOE 0 435.1, Radioactive to be considered or purposes of Waste Management, and implemented by DOE/RL-2000-292, Maintenance Plan for the Composite Analysis of the Hanford Site, Southeast Washington, the DOE Richland Operations Office has prepared this annual report for fiscal year 2008 of PNNL-1 1800, Composite Analysis for the Low-Level Waste Disposal in the 200-Area Plateau of the Hanford Site, hereafter referred to as the Composite Analysis. The main emphasis of DOE/RL-2000-29 Is to identify additional data and information to enhance the Composite Analysis and the subsequent PNNL- 11800 Addendum, Addendum to Composite Analysis for Low-Level Waste Disposal in the 200 Area Plateau of the Hanford Site, hereafter referred to as the Addendum, and to address secondary issues identified during the review of the Composite Analysis.

  6. Osteotomy does not improve early outcome after slipped capital femoral epiphysis.

    Science.gov (United States)

    Diab, Mohammad; Daluvoy, Sanjay; Snyder, Brian D; Kasser, James R

    2006-03-01

    We performed a retrospective, nonrandomized cohort study of unilateral, chronic, severe, stable slipped capital femoral epiphysis comparing five girls and five boys who underwent in-situ screw fixation alone with five girls and five boys who underwent in-situ screw fixation combined with staged flexion intertrochanteric femoral osteotomy to restore proximal femoral alignment. Functional outcome was measured by the Harris hip score, with 20% selected as a goal for improvement in functional outcome after corrective osteotomy. While flexion intertrochanteric femoral osteotomy improved hip range of motion, we found no significant difference in functional outcome between the two groups at early follow-up. This is a level 3 evidence study.

  7. Comparison of three approaches of Bernese periacetabular osteotomy

    Directory of Open Access Journals (Sweden)

    Luo DZ

    2016-01-01

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

  8. Osteotomy for severe thoracolumbar kyphosis in advanced ankylosing spondylitis:skipping two-level pedide subtraction osteotomy%跳跃式双节段经椎弓根椎体截骨治疗重度强直性脊柱炎胸腰椎后凸畸形

    Institute of Scientific and Technical Information of China (English)

    钱邦平; 邱勇; 季明亮; 王斌; 俞杨; 朱泽章; 蒋军

    2013-01-01

    Objective To explore the feasibility of single-stage skipping two-level pedicle subtraction osteotomy (PSO) for severe thoracolumbar kyphosis (Cobb > 100°) in advanced ankylosing spondylitis (AS).Methods Ten AS patients with thoracolumbar kyphosis undergoing skipping two-level PSO were retrospectively reviewed.The most frequent levels of osteotomy was L1 and L4 (n =7),followed by T12 and L3 (n =2) and 12 and L5 (n =1).All patients were males with a mean age of 28.5 ±9.1 years (range:17-47).The pre-and post-operative values of thoracic kyphosis (TK),lumbar lordosis (LL),globe kyphosis (GK),local kyphosis of osteotomized vertebra (LK1,LK2) and sagittal imbalance (SVA)were measured.Results Significant differences were observed with respects to the improvements of LL,GK,LK1,LK2 and SVA (P<0.01).LL,GK,LK1,LK2 and SVA improved fron 41.9°,113.4°,40.5°,-0.3° and 25.2 cm preoperatively to-44.1°,71.6°,13.5°,-26.8° and 5.8 cm postoperatively respectively.The mean operative duration was 370 minutes (range:290-420) and the estimated volume of blood loss 2600 ml (range:1700-3800).Dural tear occurred intra-operatively in 1 patient.One had a transient brachial plexus paralysis and resolved after 1 week postoperatively.One had transient raiculopathy in right lower extremity and recovered completely 3 weeks postoperatively.Conclusion As a safe and effective technique for correction of severe thoracolumbar kyphosis (Cobb > 100°) secondary to AS,single-stage skipping two-level PSO osteotomy can achieve larger correction and better sagittal alignment with a mean correction of 86°in terms of LL.%目的 探讨一期跳跃式双节段经椎弓根椎体截骨术(PSO)治疗重度(Cobb> 100°)强直性脊柱炎(AS)胸腰椎后凸畸形的可行性.方法 回顾性分析2007年7月至2009年7月行跳跃式双节段PSO矫形内固定术的10例AS胸腰椎后凸畸形患者,截骨节段分布为L1、M(7例),T12、L3(2例),L2、L5(1例),患者均为男性,年龄17 ~47

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

    Science.gov (United States)

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

    2016-06-01

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

  10. Radiographic Correction Following Reconstruction of Adult Acquired Flat Foot Deformity Using the Cotton Medial Cuneiform Osteotomy.

    Science.gov (United States)

    Aiyer, Amiethab; Dall, Graham F; Shub, Jeffrey; Myerson, Mark S

    2016-05-01

    The Cotton osteotomy has been used to correct residual forefoot supination in flexible flatfoot deformity reconstruction. The purpose of this study was to delineate the radiographic effects of the Cotton osteotomy by controlling for concomitant procedures used for deformity correction. We retrospectively analyzed 67 patients who underwent a Cotton osteotomy as part of a flatfoot reconstructive procedure. We evaluated 12 radiographic parameters including the articular surface angles of the foot, Meary angle, and a newly defined medial arch sag angle (MASA). Twenty-eight of these patients were matched to a cohort that did not undergo a Cotton osteotomy. In all patients who underwent a Cotton osteotomy, there were statistically significant changes in the articular surface angles and medial arch height (P osteotomy did not improve Meary angle but provided an additional 6.5 degrees correction of the MASA (P = .002). After reliability testing, the intraclass correlation coefficient was found to be substantial for the MASA compared to Meary angle. The data suggest that the MASA was a useful radiographic tool for assessing midfoot collapse in the setting of pes planovalgus. The current study demonstrated the corrective capacity of the Cotton osteotomy on the MASA; at final follow-up, there was no evidence of radiographic instability. This is suggestive that a naviculocuneiform arthrodesis may not be warranted for medial column stabilization in the setting of flatfoot reconstruction. Level III, case control study. © The Author(s) 2015.

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

    NARCIS (Netherlands)

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

    1996-01-01

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

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

    Science.gov (United States)

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

    2017-02-01

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

  13. Is McMurray′s osteotomy obsolete?

    Directory of Open Access Journals (Sweden)

    Phaltankar P

    1995-10-01

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

  14. The effect of femoral neck osteotomy on femoral component position of a primary cementless total hip arthroplasty.

    Science.gov (United States)

    Dimitriou, Dimitris; Tsai, Tsung-Yuan; Kwon, Young-Min

    2015-12-01

    The aim of this study was to quantify the femoral canal diameter and version at different femoral neck osteotomy locations, and to investigate the effect of the osteotomy plane on femoral component position in total hip arthroplasty (THA). Preoperative and postoperative three-dimensional models were reconstructed in 15 patients (19 hips) who underwent primary cementless THA with tapered non-anatomical femoral stem. On the pre-operative models, the osteotomy plane was simulated at different levels (-5, 0, 5, and 10 mm from the femoral saddle [piriformis fossa]) and angles (30, 40, 50, and 60° from the femoral anatomical axis). Medullary canal version and mediolateral diameter were measured on the osteotomy surfaces. On the postoperative models, the femoral neck osteotomy plane, stem anteversion and alignment were measured. The average canal diameter ranged from 22.8 to 26.3 mm at different osteotomy levels and from 20.8 to 29.0 mm at different osteotomy angles. The average canal version ranged from 11.4 to 23.2° at different resection levels and from 12.8 to 21° at different resection angles. The femoral stem anteversion was correlated with neck osteotomy angle (R = 0.72), whereas stem alignment in frontal plane (varus/valgus) was correlated with neck osteotomy level (R = 0.87). The femoral neck osteotomy plane in THA affects the postoperative stem position due to the complex morphology of the proximal femoral medullary canal, suggesting that both femoral neck resection level and angle should be considered in optimizing femoral component alignment in THA patients.

  15. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage to predict early failure of Bernese periacetabular osteotomy for hip dysplasia.

    Science.gov (United States)

    Cunningham, Torin; Jessel, Rebecca; Zurakowski, David; Millis, Michael B; Kim, Young-Jo

    2006-07-01

    Hip dysplasia leads to abnormal loading of articular cartilage, which results in osteoarthritis. Pelvic osteotomies such as the Bernese periacetabular osteotomy can improve the mechanics of the joint, but the results are variable and appear to depend on the amount of preexisting arthritis. Delayed gadolinium-enhanced magnetic resonance imaging of cartilage (dGEMRIC) is a technique designed to measure early arthritis, and it potentially could be used to select hips with too severe arthritis to benefit from a joint-preserving reconstructive procedure. The purpose of our study was to identify radiographic, clinical, and magnetic resonance imaging measurements that predict failure after pelvic osteotomy. We performed a cohort study of forty-seven patients undergoing a Bernese periacetabular osteotomy for the treatment of hip dysplasia. Our goal was to identify preoperative radiographic factors, such as the grade of arthritis, joint congruency, and the dGEMRIC index, that are associated with a poor outcome after osteotomy. Hips in which the osteotomy did not fail had a significant decrease in pain compared with their status preoperatively (p Bernese periacetabular osteotomy for the treatment of hip dysplasia can decrease pain and improve function in symptomatic dysplastic hips. The dGEMRIC index, as an early measure of osteoarthritis, appears to be useful for identifying poor candidates for a pelvic osteotomy. Prognostic Level II. See Instructions to Authors for a complete description of levels of evidence.

  16. Computer assisted SCFE osteotomy planning

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-11-15

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

  17. Complications of intertrochanteric rotational osteotomy

    Energy Technology Data Exchange (ETDEWEB)

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

    1983-11-01

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

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

    Science.gov (United States)

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

    2017-07-01

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

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

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  20. Comparison of Postoperative Height Changes of the Second Metatarsal Among 3 Osteotomy Methods for Hallux Valgus Deformity Correction.

    Science.gov (United States)

    Choi, Jun Young; Suh, Yu Min; Yeom, Ji Woong; Suh, Jin Soo

    2017-01-01

    We aimed to compare the postoperative height of the second metatarsal head relative to the first metatarsal head using axial radiographs among 3 different commonly used osteotomy techniques: proximal chevron metatarsal osteotomy (PCMO), scarf osteotomy, and distal chevron metatarsal osteotomy (DCMO). We retrospectively reviewed the radiographs and clinical findings of the patients with painful callosities under the second metatarsal head, complicated by hallux valgus, who underwent isolated PCMO, scarf osteotomy, or DCMO from February 2005 to January 2015. Each osteotomy was performed with 20 degrees of plantar ward obliquity. Along with lateral translation and rotation of the distal fragment to correct the deformity, lowering of the first metatarsal head was made by virtue of the oblique metatarsal osteotomy. Significant postoperative change in the second metatarsal height was observed on axial radiographs in all groups; this value was greatest in the PCMO group (vs scarf: P = .013; vs DCMO: P = .008) but did not significantly differ between the scarf and DCMO groups ( P = .785). The power for second metatarsal height correction was significantly greater in the PCMO group (vs scarf: P = .0005; vs DCMO: P = .0005) but did not significantly differ between the scarf and DCMO groups ( P = .832). Among the 3 osteotomy techniques commonly used to correct hallux valgus deformity, we observed that PCMO yielded the most effective height change of the second metatarsal head. Level III, retrospective comparative series.

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  2. [Imaging and preoperative planning for osteotomies around the knee].

    Science.gov (United States)

    Pape, D; Hoffmann, A; Seil, R

    2017-08-01

    Physiologic alignment of the human lower leg is well defined. The etiology for malalignment comprises constitutional, degenerative and posttraumatic conditions. Osteotomies around the knee can correct the malalignment, provided that the origin of deviation is in proximity of the knee center. Crucial factors for the evaluation of axis deviation are the weight-bearing line, the mechanical axes of femur and tibia, the joint line angles and the center of the hip, knee and upper ankle joint. Careful preoperative planning is mandatory for reproducible clinical results. For the treatment of varus osteoarthritis of the knee, a slight overcorrection to the 62% width of the lateral tibial plateau is frequently advocated. In valgus knees, a correction of the postoperative weight-bearing line to physiologic conditions (44% of the lateral tibial width) is regarded to be sufficient. Recently, individualized planning of the correction angle is advocated to better address the underlying pathology of each patient.

  3. Effect of prior Salter or Chiari osteotomy on THA with developmental hip dysplasia.

    Science.gov (United States)

    Tokunaga, Kenji; Aslam, Nadim; Zdero, Rad; Schemitsch, Emil H; Waddell, James P

    2011-01-01

    Controversy exists regarding the outcome of THA after prior pelvic osteotomy. We conducted a retrospective chart and radiographic review to obtain outcome measures for perioperative complications, acetabular and femoral component revisions, Harris hip score, and survivorship and compared these outcomes for patients presenting with developmental dysplasia of the hip treated surgically using THA with and without prior pelvic osteotomy. We performed 103 primary THAs in 87 patients with osteoarthritis secondary to developmental dysplasia of the hip with a minimum 3-year followup. Previous pelvic osteotomy was performed in 52 hips (Salter, 40; Chiari, nine; Salter and Chiari, three), and 51 hips had no previous surgery (control group). The pelvic osteotomy group did not have higher rates of femoral or acetabular intraoperative fracture or dislocation compared with the control group. The overall revision rate was 28.8% in the pelvic osteotomy group compared with 19.6% in the control group. The revision rate for aseptic loosening was 23.1% in the pelvic osteotomy group compared with 17.6% in the control group. Harris hip scores (range, 20-87) were not compromised, and overall survivorship rates 8 years postoperatively were not different at any time between the pelvic osteotomy (83.3%) and control (88.4%) groups. Prior pelvic osteotomy did not lead to a higher perioperative complication rate, higher revision rate, compromised Harris hip score, or shortened survivorship in eventual THA in developmental dysplasia of the hip. Level III, therapeutic study. See the Guidelines for Authors for a complete description of levels of evidence.

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

    Science.gov (United States)

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

    2009-12-01

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

  5. Annual Status Report (FY2010) Composite Analysis of Low-Level Waste Disposal in the Central Plateau at the Hanford Site

    Energy Technology Data Exchange (ETDEWEB)

    Nichols, W. E. [CH2M HILL Plateau Remediation Company, Richland, WA (United States)

    2011-01-11

    In accordance with the U.S. Department of Energy (DOE) requirements in DOE O 435.1 Chg 1, Radioactive Waste Management, and implemented by DOE/RL-2000-29, Maintenance Plan for the Composite Analysis of the Hanford Site, Southeast Washington, the DOE Richland Operations Office (DOE-RL), also known as RL, has prepared this annual status report for fiscal year (FY) 2010 of PNNL-11800, Composite Analysis for Low-Level Waste Disposal in the 200 Area Plateau of the Hanford Site, hereafter referred to as the Composite Analysis.

  6. Annual Status Report (FY2009) Composite Analysis of Low-Level Waste Disposal in the Central Plateau at the Hanford Site

    Energy Technology Data Exchange (ETDEWEB)

    Nichols, W. E. [CH2M HILL Plateau Remediation Company, Richland, WA (United States)

    2010-02-10

    In accordance with the U.S. Department of Energy (DOE) requirements in DOE O 435.1, Radioactive Waste Management, and implemented by DOE/RL-2000-29, Maintenance Plan for the Composite Analysis of the Hanford Site, Southeast Washington, the DOE Richland Operations Office has prepared this annual status report for fiscal year (FY) 2009 of PNNL-11800, Composite Analysis for the Low-Level Waste Disposal in the 200-Area Plateau of the Hanford Site, hereafter referred to as the Composite Analysis.

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

    Science.gov (United States)

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

    2016-02-01

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

  8. The Effect of Risk Factors on the Levels of Chemical Elements in the Tibial Plateau of Patients with Osteoarthritis following Knee Surgery.

    Science.gov (United States)

    Lanocha-Arendarczyk, Natalia; Kosik-Bogacka, Danuta Izabela; Prokopowicz, Adam; Kalisinska, Elzbieta; Sokolowski, Sebastian; Karaczun, Maciej; Zietek, Pawel; Podlasińska, Joanna; Pilarczyk, Bogumila; Tomza-Marciniak, Agnieszka; Baranowska-Bosiacka, Irena; Gutowska, Izabela; Safranow, Krzysztof; Chlubek, Dariusz

    2015-01-01

    The aim of this study was to evaluate the aforementioned chemical elements in tibial plateau samples obtained during knee arthroplasty. The gender-specific analysis of chemical element levels in the bone samples revealed that there were statistically significant differences in the concentration of Pb and Se/Pb ratio. The contents of elements in the tibial plateau in the patients with osteoarthritis (OA) can be arranged in the following descending order: F(-) > K > Zn > Fe > Sr > Pb > Mn > Se > Cd > THg. We observed statistical significant effects of environmental factors including smoking, seafood diet, and geographical distribution on the levels of the elements in tibial bone. Significant positive correlation coefficients were found for the relationships K-Cd, Zn-Sr, Zn-F(-), THg-Pb, Pb-Cd, Se-Se/Pb, Se-Se/Cd, Se/Pb-Se/Cd, Pb-Cd/Ca, Cd-Cd/Ca, and F(-)-F(-)/Ca·1000. Significant negative correlations were found for the relationships THg-Se/Pb, Pb-Se/Pb, Cd-Se/Pb, K-Se/Cd, Pb-Se/Cd, Cd-Se/Cd, THg-Se/THg, Pb-Se/THg, Se-Pb/Cd, Zn-Cd/Ca, and Se/Cd-Cd/Ca. The results reported here may provide a basis for establishing reference values for the tibial plateau in patients with OA who had undergone knee replacement surgery. The concentrations of elements in the bone with OA were determined by age, presence of implants, smoking, fish and seafood diet, and sport activity.

  9. Subtrochanteric osteotomy for femoral mal-torsion through a surgical dislocation approach

    Science.gov (United States)

    Kamath, Atul F.; Ganz, Reinhold; Zhang, Hong; Grappiolo, Guido; Leunig, Michael

    2015-01-01

    Missed torsional femur deformities may contribute to reasons for failure after open and more likely arthroscopic hip preservation surgery. A number of surgical approaches have been described for addressing torsion abnormalities. This report describes a subtrochanteric osteotomy technique in a consecutive series of patients with complex hip pathologies, for which intertrochanteric osteotomy is not suitable and precise derotation is required. Subtrochanteric derotation was performed, always in combination with a surgical hip dislocation, in accordance with the authors’ preferred technique. Before osteotomy, a localized decortication was executed. Application of a 4.5-mm broad or narrow plate was undertaken with dynamic compression of the osteotomy. Twenty-eight consecutive subtrochanteric derotational osteotomies were performed in 26 patients. Twenty-one females and five males were treated at an average age of 21.4 years (range, 12–43). Underlying diagnoses included dysplasia, arthrogryposis, cerebral palsy, Down’s syndrome, instability and impingement. The decision to perform derotation was for antetorsion over 20° or less than 0° (retrotorsion). Patients were followed clinically and radiographically till final follow-up. All patients went on to successful osteotomy union. There were two initial failures: one delayed union prompting revision fixation in a chronic smoker and one plate failure due to self-accelerated weight-bearing in a patient status post successful contralateral derotational osteotomy. Rotational deformity of the femur must be considered in the patient undergoing hip preservation surgery. This technique of subtrochanteric derotational osteotomy, with adjunctive surgical hip dislocation, is applicable and reproducible in the setting of complex hip pathologies. Level of evidence: IV, case series. PMID:27011816

  10. 双椎体截骨术矫正强直性脊柱炎重度胸腰椎后凸畸形%Two-level pedicle subtraction osteotomy for correction of severe thoracolumbar kyphosis due to ankylosing spondylitis

    Institute of Scientific and Technical Information of China (English)

    陈志明; 杨滨; 马华松; 王晓平; 谭荣; 陈阳; 袁伟

    2014-01-01

    Objectives: To analyze the clinical results of two-level pedicle subtraction osteotomy for correc-tion of severe thoracolumbar kyphosis due to ankylosing spondylitis. Methods: From May 2009 to December 2010, 18 males with ankylosing spondylitis complicated with severe thoracolumbar kyphosis underwent two-level pedicle subtraction osteotomy, the average age at admission was 34.8 years(range, 19-47 years). Preoper-ative global kyphosis(GK) Cobb angle was 70°-108°(82.6°±17.5°) and the apex vertebra was at thoracolumbar region. Preoperative thoracic kyphosis(TK), thoracolumbar kyphosis(TLK) and lumbar lordosis(LL) angle was 46 °-67°(55.2°±15.3°), 25°-43°(32.4°±12.6°) and (-37°)-(-11°)[(-19.5°)±10.3°], respectively. Preoperative chin-brow vertical angle at standing position was 43°-130°(67.2°±21.9°). Global sagittal imbalance was determined by C7 plumb line and its relationship with the posterior superior corner of the sacrum, and the preoperative one was 11-35cm(18.3±14.8cm). Bridwell-Dewald scale was used to evaluate the clinical outcomes. Results: The aver-age operation time was 5.3±1.0h (3.7-6.9h), and the average blood loss was 1887.5±850.9ml (600-3000ml). Dura matter tearing was noted in 4 cases and skin infection in 1 case, 1 case developed transient neurologic deficits, but all healed after proper intervention. The average follow-up time was 33.5 months(24-48 months). The postoperative mean GK angle, chin-brow vertical angle, global sagittal imbalance was corrected to 21.3 °±4.2°, 9.3°±12.8° and 3.0±4.7cm, respectively. The postoperative GK, TK, TLK, LL, chin-brow vertical angle and global sagittal imbalance improved significantly compared with the preoperative data(P0.05). Instrument displacement was not noted at final follow-up. All patients could walk with normal vision. Satisfactory clinical outcomes including changes of pain, social and working status were noted at final follow-up(P0.05);X线片显示所有患者内

  11. LeFort I Osteotomy.

    Science.gov (United States)

    Buchanan, Edward P; Hyman, Charles H

    2013-08-01

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

  12. Vascular lesions secondary to osteotomy by corticotomy.

    Science.gov (United States)

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

    2007-01-01

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

  13. CENTRAL PLATEAU REMEDIATION OPTIMIZATION STUDY

    Energy Technology Data Exchange (ETDEWEB)

    BERGMAN, T. B.; STEFANSKI, L. D.; SEELEY, P. N.; ZINSLI, L. C.; CUSACK, L. J.

    2012-09-19

    THE CENTRAL PLATEAU REMEDIATION OPTIMIZATION STUDY WAS CONDUCTED TO DEVELOP AN OPTIMAL SEQUENCE OF REMEDIATION ACTIVITIES IMPLEMENTING THE CERCLA DECISION ON THE CENTRAL PLATEAU. THE STUDY DEFINES A SEQUENCE OF ACTIVITIES THAT RESULT IN AN EFFECTIVE USE OF RESOURCES FROM A STRATEGIC PERSPECTIVE WHEN CONSIDERING EQUIPMENT PROCUREMENT AND STAGING, WORKFORCE MOBILIZATION/DEMOBILIZATION, WORKFORCE LEVELING, WORKFORCE SKILL-MIX, AND OTHER REMEDIATION/DISPOSITION PROJECT EXECUTION PARAMETERS.

  14. Thoracolumbar imbalance analysis for osteotomy planification using a new method: FBI technique.

    Science.gov (United States)

    Le Huec, J C; Leijssen, P; Duarte, M; Aunoble, S

    2011-09-01

    Treatment of spine imbalance by posterior osteotomy is a valuable technique. Several surgical techniques have been developed and proposed to redress the vertebral column in harmonious kyphosis in order to recreate correct sagittal alignment. Although surgical techniques proved to be adequate, preoperative planning still is mediocre. Multiple suggestions have been proposed, from cutting tracing paper to ingenious mathematical formulas and computerised models. The analysis of the pelvic parameters to try to recover the initial shape of the spine before the spine imbalance occurred is very important to avoid mistakes during the osteotomy planification. The authors proposed their method for the osteotomy planning paying attention to the pelvic, and spine parameters and in accordance with Roussouly's classification. The pre operative planning is based on a full-body X-ray including the spine from C1 to the femoral head and the first 10 cm of the femur shaft. Using all the balance parameters provided, a formula name FBI is proposed. Calculation of the osteotomy is basic goniometry, the midpoint of the C7 inferior plateau (point a) is transposed horizontally on the projected future C7 plumb line (point b) crossing posterior S1 plateau on a sagittal X-ray. These are the first two reference points. A third reference point is made on the anterior wall of the selected vertebra for osteotomy at mid height of the pedicle (point c) mainly L4 vertebra. These three points form a triangle with the tip being the third reference point. The angle represented by this triangle is the theoretical angle of the osteotomy. Two more angles should be measured and eventually added. The femur angulation measured as the inclination of the femoral axis to the vertical. And a third angle named the compensatory pelvic tilt to integrate the type of pelvis. If the pelvic tilt is between 15 and 25° or is higher than 25° you must add 5 or 10°, respectively. This compensatory tilt is based on a

  15. Long-Term Outcome of Step-Cut Ulnar Shortening Osteotomy for Ulnar Impaction Syndrome.

    Science.gov (United States)

    Papatheodorou, Loukia K; Baratz, Mark E; Bougioukli, Sofia; Ruby, Tyler; Weiser, Robert W; Sotereanos, Dean G

    2016-11-02

    Extra-articular ulnar shortening osteotomy is a common procedure for the surgical treatment of ulnar impaction syndrome. Several techniques for this osteotomy have been developed to avoid the morbidity associated with a standard transverse osteotomy. However, these techniques require special instrumentation and are expensive. The purpose of this study was to evaluate the outcome of step-cut ulnar shortening osteotomy without special jigs for ulnar impaction syndrome. A retrospective study of 164 consecutive patients who underwent step-cut ulnar shortening osteotomy between 2000 and 2010 was performed. The long arm of the step-cut osteotomy was oriented in the coronal plane parallel to the long axis of the ulna. The short arms of the osteotomy were perpendicular to the long axis in the axial plane. Fixation was performed with a palmar 3.5-mm standard neutralization plate and a lag screw. The goal of the osteotomy was to reduce ulnar variance, which was assessed in all patients with pronated grip-view radiographs preoperatively and postoperatively. Preoperative ulnar variance ranged from +1 to +6 mm. All patients were followed for at least 24 months. Union of the osteotomy site was achieved at a mean of 8.2 weeks. The union rate was 98.8%. There were 2 cases of nonunion, which required additional surgery. The mean postoperative ulnar variance was +0.2 mm (range, -1 to +1.5 mm) after a mean overall ulnar shortening of 2.5 mm. All patients returned to their previous work, in a mean of 4 months. The plate was removed from 12 patients because of plate-related symptoms. No other complications were encountered. The step-cut ulnar shortening osteotomy provides ample bone-to-bone contact and simplifies control of rotation. Stable internal fixation with standard techniques allowed an early return to functional activities. Palmar placement of the plate diminishes the need for plate removal. This is a simple and less expensive technique for ulnar shortening that does not

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

    Science.gov (United States)

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

    2016-06-01

    is required even after osteotomy. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

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

    National Research Council Canada - National Science Library

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2016-08-01

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

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

    Science.gov (United States)

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

    2008-07-01

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

  20. Comparison of three approaches of Bernese periacetabular osteotomy.

    Science.gov (United States)

    Luo, Dianzhong; Zhang, Hong; Zhang, Weijia

    2016-01-01

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

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

    Science.gov (United States)

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

    2010-02-01

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

  2. Minimally Invasive Osteotomies of the Calcaneus.

    Science.gov (United States)

    Guyton, Gregory P

    2016-09-01

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

  3. Neurologic Deficit Associated With Lateralizing Calcaneal Osteotomy for Cavovarus Foot Correction.

    Science.gov (United States)

    VanValkenburg, Scott; Hsu, Raymond Y; Palmer, Daniel S; Blankenhorn, Brad; Den Hartog, Bryan D; DiGiovanni, Christopher W

    2016-10-01

    Lateralizing calcaneal osteotomy (LCO) is a frequently used technique to correct hindfoot varus deformity. Tibial nerve palsy following this osteotomy has been described in case reports but the incidence has not been quantified. Eighty feet in 72 patients with cavovarus foot deformity were treated over a 6-year span by 2 surgeons at their respective institutions. Variations of the LCO were employed for correction per surgeon choice. A retrospective chart review analyzed osteotomy type, osteotomy location, amount of translation, and addition of a tarsal tunnel release in relation to the presence of any postoperative tibial nerve palsy. Tibial nerve branches affected and the time to resolution of any deficits was also noted. The incidence of neurologic deficit following LCO was 34%. With an average follow-up of 19 months, a majority (59%) resolved fully at an average of 3 months. There was a correlation between the development of neurologic deficit and the location of the osteotomy in the middle third as compared to the posterior third of the calcaneal tuber. We found no relationship between the osteotomy type, amount of correction, or addition of a tarsal tunnel release and the incidence of neurologic injury. Tibial nerve palsy was not uncommon following LCO. Despite the fact that deficits were found to be transient, physicians should be more aware of this potential problem and counsel patients accordingly. To decrease the risk of this complication, we advocate extra caution when performing the osteotomy in the middle one-third of the calcaneal tuberosity. Although intuitively the addition of a tarsal tunnel release may protect against injury, no protective effect was demonstrated in this retrospective study. Level III, retrospective cohort study. © The Author(s) 2016.

  4. Rate of Malunion Following Bi-plane Chevron Medial Malleolar Osteotomy.

    Science.gov (United States)

    Bull, Patrick E; Berlet, Gregory C; Canini, Cameron; Hyer, Christopher F

    2016-06-01

    Access to the medial half of the talus can be challenging even with an osteotomy. Although several techniques are presented in the literature, critical evaluation of fixation, union, and alignment is lacking. The chevron medial malleolar osteotomy provides advantages of perpendicular instrumentation access and wide exposure to the medial talus. Postoperative displacement resulting in malunion, and possibly provoking ankle osteoarthritis, is a known complication. The present study describes our experience with the osteotomy. A consecutive series cohort of 50 bi-plane chevron osteotomies performed from 2004 to 2013 were evaluated. Forty-six were secured using 2 lag screws, and 4 were secured using 2 lag screws and a medial buttress plate. Radiographic studies performed at 2, 6, and 12 weeks and at final follow-up were analyzed for postoperative displacement, malunion, non-union, and hardware-related complications. At initial postoperative follow-up, 47 of 50 had adequate radiographs for review, and 18 of 47 (38.3%) showed some displacement when compared to the initial osteotomy fixation position. By final follow-up, 15 of 50 (30.0%) had measurable incongruence. Hardware removal was performed in 13 (26.0%) cases at an average of 2.4 years postoperation. Bi-plane medial malleolar chevron osteotomy fixed with 2 lag screws showed a 30.0% malunion rate with an average of 2 mm of incongruence on final follow-up radiographs, which is higher than what has been reported in the literature. In our practice, we now use a buttress plate and more recently have eliminated postoperative osteotomy displacement. Level IV, retrospective case series. © The Author(s) 2016.

  5. The dawn of computer-assisted robotic osteotomy with ytterbium-doped fiber laser.

    Science.gov (United States)

    Sotsuka, Yohei; Nishimoto, Soh; Tsumano, Tomoko; Kawai, Kenichiro; Ishise, Hisako; Kakibuchi, Masao; Shimokita, Ryo; Yamauchi, Taisuke; Okihara, Shin-ichiro

    2014-05-01

    Currently, laser radiation is used routinely in medical applications. For infrared lasers, bone ablation and the healing process have been reported, but no laser systems are established and applied in clinical bone surgery. Furthermore, industrial laser applications utilize computer and robot assistance; medical laser radiations are still mostly conducted manually nowadays. The purpose of this study was to compare the histological appearance of bone ablation and healing response in rabbit radial bone osteotomy created by surgical saw and ytterbium-doped fiber laser controlled by a computer with use of nitrogen surface cooling spray. An Ytterbium (Yb)-doped fiber laser at a wavelength of 1,070 nm was guided by a computer-aided robotic system, with a spot size of 100 μm at a distance of approximately 80 mm from the surface. The output power of the laser was 60 W at the scanning speed of 20 mm/s scan using continuous wave system with nitrogen spray level 0.5 MPa (energy density, 3.8 × 10(4) W/cm(2)). Rabbits radial bone osteotomy was performed by an Yb-doped fiber laser and a surgical saw. Additionally, histological analyses of the osteotomy site were performed on day 0 and day 21. Yb-doped fiber laser osteotomy revealed a remarkable cutting efficiency. There were little signs of tissue damage to the muscle. Lased specimens have shown no delayed healing compared with the saw osteotomies. Computer-assisted robotic osteotomy with Yb-doped fiber laser was able to perform. In rabbit model, laser-induced osteotomy defects, compared to those by surgical saw, exhibited no delayed healing response.

  6. Posterior bicondylar tibial plateau fractures.

    Science.gov (United States)

    Carlson, DuWayne A

    2005-02-01

    To present a case series of patients with posterior bicondylar tibial plateau fractures treated by direct fracture exposure and fixation through dual incisions. Retrospective clinical study. Level 1 trauma centers. Eight patients were identified that had posterior bicondylar tibial plateau fractures. Two patients had depressed posterolateral tibial plateau fractures with contained defects and did not have direct fracture exposure. One patient died of medical problems leaving 5 patients who underwent direct fracture exposure, reduction, and fixation. Posteromedial followed by posterolateral open reduction and internal fixation of posterior bicondylar tibial plateau fractures. At 6 to 24 months follow-up (mean 13 months), all patients returned to near full activities, each with aching after prolonged standing (8-hour shift). Range of motion averaged 2 degrees to 121 degrees of flexion. Three of 5 returned to manual labor jobs; the others were not employed at the time of injury. Posterior bicondylar tibial plateau fractures have a high association with lateral meniscal pathology and can be associated with anterior cruciate ligament injury. Reduction of the posterior plateau condyles is easiest with the knee in full extension. Flexion contractures can be a problem, and patients should be encouraged to regain/maintain knee extension. The dual-incision approach to these challenging fractures can result in good to excellent knee function for these patients.

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

    Science.gov (United States)

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

    2016-01-01

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

  8. TINGKAT KERUSAKAN LINGKUNGAN DI DATARAN TINGGI DIENG SEBAGAI DATABASE GUNA UPAYA KONSERVASI (The Level of Environmental Damage in Dieng Plateau for Database to Conservation Action

    Directory of Open Access Journals (Sweden)

    Sri Ngabekti

    2007-07-01

    area in Dieng Plateau has been reducing biodiversity. An assessment by Balai Konservasi Sumber Daya Alam Jawa Tengah in 2001 found less than fifty species vegetation per hectare in the area, which means poor diversity. This research aims to know the level of environmental damage in Dieng Plateau as a database for conservation attempts. The variables to assess will be the level of environmental damages, both physically and biologically, in connection with demographic, economic, societal, and cultural aspects. Physical observation showed that plantation area was seriously damaged, which reduced the potato crops. Whereas from biological observation, it was found that the vegetational diversity index was relatively low (0.81-0.98. From behavioral view, it seemed that the inhabitants have not fully supported the conservation attempts; it can be seen that the potato cultivation area has expanded as deforestation has also spread out. As a result, waters resources have depleted significantly. From the current research, it was concluded that the level of environmental damage in Dieng Plateau was seriously damaged. It was suggested to manage the Dieng Plateau area. Due to unique geographical conditions, plantation design implemented in the area should be followed by conservation review. To prevent erosion, it is important to find substitutes to potatoes

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

    Science.gov (United States)

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

    2005-03-15

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

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

    Science.gov (United States)

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

    2008-01-01

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

  11. L5 pedicle subtraction osteotomy for high-grade isthmic spondylolisthesis.

    Science.gov (United States)

    Radcliff, Kristen E; Jakoi, Andre M

    2015-04-01

    To the authors' knowledge, this is the first article to present a pedicle subtraction osteotomy in the lumbar spine to correct and stabilize a high-grade isthmic spondylolisthesis, which poses many challenges with regard to treatment options and outcomes. The optimal surgical treatment for high-grade spondylolisthesis is controversial, but the goals of treatment are to stabilize the affected spinal levels and to decompress the neural elements. A pedicle subtraction osteotomy is a reconstructive procedure that addresses fixed sagittal imbalance by increasing lumbar lordosis through posterior spinal column shortening. The authors report a 46-year-old patient with chronic, progressively worsening back and leg radiculopathy accompanied by sagittal plane malalignment and for which a pedicle subtraction osteotomy was performed. The procedure yielded stabilization of the patient's lumbar spondylolisthesis and sagittal plane alignment was restoration. At 3 months postoperatively, the patient's pain had fully resolved and her motor and neurologic examination exhibited no deficits. At 24 months postoperatively, she was still symptom-free and ambulating without assistance. This report is the first documented successful pedicle subtraction osteotomy in the treatment of high-grade spondylolisthesis. This report indicates that certain patient populations may be amenable to pedicle subtraction osteotomy as a treatment option for pathology involving high-grade isthmic spondylolisthesis.

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

    NARCIS (Netherlands)

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

    2009-01-01

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

  13. Tibial Tubercle Osteotomy: Indication and Techniques.

    Science.gov (United States)

    Grawe, Brian; Stein, Beth Shubin

    2015-08-01

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

  14. Method and effect of total knee arthroplasty osteotomy and soft tissue release for serious knee joint space narrowing

    Directory of Open Access Journals (Sweden)

    Yulou Si

    2015-01-01

    Full Text Available To discuss the method and effect of total knee arthroplasty osteotomy and soft tissue release for serious knee joint space narrowing. Clinical data of 80 patients from October 2013 to December 2014 was selected with a retrospective method. All patients have undergone total knee arthroplasty. Then the X-rays plain film in weight loading was measured before and after operation and osteotomy was performed accurately according to the knee joint scores and the conditions of lower limb alignments. The average angle of tibial plateau osteotomy of postoperative patients was 4.3°, and the corrective angle of soft tissue balancing was 10.7°; the postoperative patients’ indicies including range of joint motion, knee joint HSS score, angle between articular surfaces, tibial angle, femoral-tibial angle and flexion contracture were distinctly better than the preoperative indicies (p<0.05 and the differences were statistically significant; the postoperative patients’ flexion contracture and range of joint motion were distinctly better than the preoperative indicies (p<0.05 and the differences were statistically significant. The effective release of the soft tissue of the posterior joint capsule under direct vision can avoid excess osteotomy and get satisfactory knee replacement space without influencing the patients’ joint recovery.

  15. Evaluation of a new method to determine the tibial tuberosity advancement distance required to reduce the patellar tendon-tibial plateau angle to 90° with the modified Maquet technique in dogs.

    Science.gov (United States)

    Pillard, Paul; Livet, Veronique; Cabon, Quentin; Bismuth, Camille; Sonet, Juliette; Remy, Denise; Fau, Didier; Carozzo, Claude; Viguier, Eric; Cachon, Thibaut

    2017-04-01

    OBJECTIVE To assess use of a new radiographic method to determine the distance by which the tibial tuberosity should be advanced to reduce the patellar tendon-tibial plateau angle (PTA) to 90° by means of the modified Maquet technique (MMT) in dogs. SAMPLE 24 pelvic limbs from 12 adult medium-sized to large-breed canine cadavers. PROCEDURES Radiographs of stifle joints at 135° extension in true lateral position were used to determine tibial tuberosity advancement distances for use in the MMT. A method was devised to incorporate the planned osteotomy axis; distal patellar translations of 0, 3, 5, or 10 mm; and advancement cage implant application level along the osteotomy site in advancement planning measurements. Concordance correlation coefficients (CCCs) were calculated to compare these adjusted advancement measurements with true advancement measurements obtained for the same joints in another study after treatment by MMT. Intraobserver, interobserver, and total agreement for selected measurements were determined by assessment of CCCs for results obtained by 3 blinded observers. RESULTS Agreement between true advancement measurements and measurements obtained with osteotomy axis and cage position method calculations that incorporated a 5-mm distal patellar translation distance was excellent (CCC, 0.96). Intraobserver and interobserver agreements for the planning measurements evaluated were good to excellent (CCC, 0.83 to 0.96). CONCLUSIONS AND CLINICAL RELEVANCE Results suggested that the osteotomy axis and cage position method incorporating a 5-mm distal patellar translation distance has the potential to improve success rates for achieving a PTA of 90° in medium-sized to large-breed dogs undergoing MMT for treatment of cranial cruciate ligament rupture. Further research is warranted.

  16. Monitoring recent lake level variations on the Tibetan Plateau using CryoSat-2 SARIn mode data

    DEFF Research Database (Denmark)

    Jiang, Liguang; Nielsen, Karina; Andersen, Ole Baltazar;

    2017-01-01

    to monitor lake levels. In this study, Cryosat-2 SARIn mode data over the period 2010–2015 are used to investigate recent lake level variations. The estimated water levels of the 70 largest lakes (> 100 km2) on the TP show that 48 lakes reveal a rising trend (avg. 0.28 ± 0.06 m/yr) while the other 22 show...

  17. Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy.

    Science.gov (United States)

    Atilla, Bülent

    2016-03-01

    Patients with neglected developmental dysplasia (DDH) face with early osteoarthritis of the hip, limb length inequality and marked disability while total hip reconstruction is the only available choice.DDH has severe morphologic consequences, with distorted bony anatomy and soft tissue contractures around the hip. It is critical to evaluate patients thoroughly before surgery.Anatomic reconstruction at the level of true acetabulum with uncemented implant is the mainstay of treatment. This requires a subtrochanteric shortening osteotomy, which can be realised using different osteotomy and fixation options.Although a demanding technique with a high rate of related complications, once anatomic reconstruction of the hip is achieved, patients have a remarkably good functional capacity and implant survival during long follow-up periods. Cite this article: Atilla B. Reconstruction of neglected developmental dysplasia by total hip arthroplasty with subtrochanteric shortening osteotomy. EFORT Open Rev 2016;1:65-71. DOI: 10.1302/2058-5241.1.000026.

  18. Pseudoarthrosis of medial tibial plateau fracture-role of alignment procedure

    Directory of Open Access Journals (Sweden)

    Devgan Ashish

    2013-04-01

    Full Text Available 【Abstract】 Nonunion in tibial plateau fractures is very rare. Limited literature is available on Pubmed search on intraarticular tibial nonunion. Most of the cases reported have been following failed surgical treatment and none was neglected fractures. Three patients of isolated and neglected medial tibial plateau nonunion with almost similar demo-graphic profile are reported in this paper. All the three pa-tients were managed by minimally invasive compression fixation using lag screws supplemented with limb realign-ment procedure of high tibial osteotomy. We discussed the injury mechanism, management and rehabilitation in such cases and reviewed the available literature regarding such a presentation. Key words: Fracture healing; Tibial fractures; Frac-ture fixation; Osteotomy

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

    Science.gov (United States)

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

    2016-01-01

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

  20. Surgical Reconstruction of Metatarsal Type Preaxial Polydactyly Using an Amalgamating Osteotomy.

    Science.gov (United States)

    Boyle, Matthew J; Hogue, Grant D; Kasser, James R

    2016-09-01

    Polydactyly of the foot is a relatively common condition. Approximately 15% of cases are preaxial, with one third of these cases involving duplication of the metatarsal [metatarsal type preaxial polydactyly (MTPP)].Surgical reconstruction of polydactyly is indicated to improve shoe tolerance. Reconstruction of MTPP has traditionally involved resection of the hypoplastic lateral ray in addition to soft tissue reconstruction to correct hallux varus. Poor postoperative results have frequently been reported, primarily due to residual hallux varus. We present a novel surgical technique for the treatment of children with MTPP presenting with a cosmetic lateral hallux, involving an amalgamating osteotomy that permits retention of the stable medial metatarsotarsal joint while avoiding the complication of residual hallux varus. This was a retrospective case series describing the surgical technique of an amalgamating osteotomy in the treatment of patients with MTPP and a cosmetic lateral hallux. The surgical technique involves corresponding metatarsal osteotomies of the medial and lateral halluces, with amalgamation of the metatarsals and ablation of the residual medial hallux, without the need for extensive soft tissue reconstruction. Clinical and radiologic outcomes were evaluated at a minimum of 2 years postoperatively in 2 patients who underwent this technique. Two children, 1 female and 1 male, underwent an amalgamating osteotomy at the age of 31 and 18 months, respectively. At latest follow-up, 7.3 and 2.8 years after osteotomy, respectively, both patients displayed an excellent functional result according to the Phelps and Grogan clinical outcome scale. Plain radiographs in both cases demonstrated a well-aligned first ray with no growth abnormality and no hallux varus. We have presented a novel surgical technique for the reconstruction of MTPP presenting with a cosmetic lateral hallux, involving an amalgamating osteotomy without extensive soft tissue reconstruction

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

    Science.gov (United States)

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

    2009-01-01

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

  2. Segmental Maxillary Osteotomies in Conjunction With Bimaxillary Orthognathic Surgery: Indications - Safety - Outcome.

    Science.gov (United States)

    Posnick, Jeffrey C; Adachie, Anayo; Choi, Elbert

    2016-07-01

    in either the segmental or nonsegmental cases. Analysis of the periodontal status of the anterior 6 teeth after maxillary segmental osteotomies confirmed 15 of 1,008 sites (1.5%) with progressive gingival recession. A similar analysis after nonsegmental Le Fort I confirmed 11 of 564 sites (2%) with recession. No statistically significant difference was found between the segmental and nonsegmental Le Fort I osteotomies, with regard to recession. However, when recession did occur, it was more likely to occur at the canine teeth and least likely to occur at the lateral incisors (P = .001 and P = .003, respectively). Of the 1,572 anterior teeth at risk, 3 sustained a pulpal injury. All 3 subjects had undergone 3-segment Le Fort I. Two of the subjects who had undergone segmental osteotomy developed a persistent oronasal fistula and underwent successful closure with palatal flaps. Also, 3 of the 168 segmental subjects required maxillary hardware removal. The treating orthodontists' assessment of the occlusion and facial aesthetics achieved after segmental Le Fort I was favorable for most patients (91 and 97%, respectively). Most bimaxillary DFDs will have maxillary skeletal arch form anomalies. Those subjects undergoing maxillary premolar extractions were less likely to require maxillary segmentation. Segmentation of the Le Fort I osteotomy is a safe method of addressing these skeletal deformities. Orthodontists reported a high level of satisfaction with the outcomes after orthognathic surgery that has incorporated maxillary segmental osteotomies. Copyright © 2016 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  3. Pseudoarthrosis of medial tibial plateau fracture——role of alignment procedure

    Institute of Scientific and Technical Information of China (English)

    Ashish Devgan; Pradeep Kamboj; Vinay Gupta; Narender K Magu; Rajesh Rohilla

    2013-01-01

    Nonunion in tibial plateau fractures is very rare.Limited literature is available on Pubmed search on intraarticular tibial nonunion.Most of the cases reported have been following failed surgical treatment and none was neglected fractures.Three patients of isolated and neglected medial tibial plateau nonunion with almost similar demographic profile are reported in this paper.All the three patients were managed by minimally invasive compression fixation using lag screws supplemented with limb realignme nt procedure of high tibial osteotomy.We discussed theinjury mechanism,management and rehabilitation in such cases and reviewed the available literature regarding such a presentation.

  4. Clinical and radiological outcome after periacetabular osteotomy

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  5. Periacetabulaer osteotomi og hoftedysplasi hos yngre voksne

    DEFF Research Database (Denmark)

    Troelsen, Anders; Søballe, Kjeld

    2009-01-01

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

  6. Rod strain after pedicle subtraction osteotomy

    DEFF Research Database (Denmark)

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

    2016-01-01

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

  7. Response of Functional Structure of Soil Microbial Community to Multi-level Nitrogen Additions on the Central Tibetan Plateau

    Science.gov (United States)

    Zhang, G.; Yuan, Y.

    2015-12-01

    The use of fossil fuels and fertilizers has increased the amount of biologically reactive nitrogen in the atmosphere over the past century. Tibet is the one of the most threatened regions by nitrogen deposition, thus understanding how its microbial communities function maybe of high importance to predicting microbial responses to nitrogen deposition. Here we describe a short-time nitrogen addition conducted in an alpine steppe ecosystem to investigate the response of functional structure of soil microbial community to multi-level nitrogen addition. Using a GeoChip 4.0, we showed that functional diversities and richness of functional genes were unchanged at low level of nitrogen fertilizer inputs (nitrogen fertilizer inputs (>=40 kg N ha-1 yr-1). Detrended correspondence analysis indicated that the functional structure of microbial communities was markedly different across the nitrogen gradients. Most C degradation genes whose abundances significantly increased under elevated N fertilizer were those involved in the degradation of relatively labile C (starch, hemicellulose, cellulose), whereas the abundance of certain genes involved in the degradation of recalcitrant C (i.e. lignin) was largely decreased (such as manganese peroxidase, mnp). The results suggest that the elevated N fertilization rates might significantly accelerate the labile C degradation, but might not spur recalcitrant C degradation. The combined effect of gdh and ureC genes involved in N cycling appeared to shift the balance between ammonia and organic N toward organic N ammonification and hence increased the N mineralization potential. Moreover, Urease directly involved in urea mineralization significantly increased. Lastly, Canonical correspondence analysis showed that soil (TOC+NH4++NO3-+NO2-+pH) and plant (Aboveground plant productivity + Shannon Diversity) variables could explain 38.9% of the variation of soil microbial community composition. On the basis of above observations, we predict that

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

    Science.gov (United States)

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

    2015-12-01

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

  9. Genu valgum in Legg-Calvé-Perthes disease treated with femoral varus osteotomy.

    Science.gov (United States)

    Glard, Yann; Katchburian, Marcos V; Jacquemier, Michel; Guillaume, Jean-Marc; Bollini, Gérard

    2009-06-01

    Femoral varus osteotomy is one of the most common treatments for patients with symptomatic Legg-Calvé-Perthes disease with more severe deformities. We hypothesized knee valgus alignment at maturity in patients with Legg-Calvé-Perthes disease is an effect of the disease and not an effect of femoral varus osteotomy. We retrospectively compared matched groups of 28 patients with and without femoral varus osteotomy. The two groups were similar with respect to age at onset and classification of Herring et al. The distribution of valgus alignment among patients who had surgery and patients who did not have surgery was assessed at maturity and was similar between the operative and nonoperative groups. The data suggest valgus malalignment (genu valgum) is not a side effect of femoral varus osteotomy in patients with Legg-Calvé-Perthes disease, but rather an effect of the disease. Level III, prognostic study. See the Guidelines for Authors for a complete description of levels of evidence.

  10. Bernese periacetabular osteotomy in males: is there an increased risk of femoroacetabular impingement (FAI) after Bernese periacetabular osteotomy?

    Science.gov (United States)

    Ziebarth, K; Balakumar, J; Domayer, S; Kim, Y J; Millis, M B

    2011-02-01

    The Bernese periacetabular osteotomy (PAO) is a popular option for treating symptomatic acetabular dysplasia. We noted symptomatic impingement after PAO in several male patients. We therefore determined (1) the incidence of clinical signs of FAI after PAO in the male population; and (2) whether any factors were associated with the positive impingement signs after PAO in males. We retrospectively reviewed 38 males who underwent 46 periacetabular osteotomies (PAO) between 2000 and 2007. Clinical and radiographic data were analyzed with the focus on pre- and postoperative incidence of femoroacetabular impingement. Minimum followup was 12 months (average, 43 months; range, 12-90 months). We found a positive impingement sign in 19 of the 46 hips during the preoperative examination compared to 22 (47.8%) hips postoperatively. The ROM (flexion and internal rotation) decreased postoperatively compared to preoperatively. Radiographic parameters of coverage LCE-, ACE- and Tönnis angle improved into the normal range. Twenty hips had postoperative heterotopic ossification to varying degrees, mostly minor. WOMAC scores improved in the function and pain domains postoperatively. Despite normalization of coverage we found a high postoperative rate of clinical signs of FAI after PAO in males. Level IV, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence.

  11. Valgus osteotomy for nonunion and neglected neck of femur fractures.

    Science.gov (United States)

    Varghese, Viju Daniel; Livingston, Abel; Boopalan, P R; Jepegnanam, Thilak S

    2016-05-18

    Nonunion neck of femur can be a difficult problem to treat, particularly in the young, and is associated with high complication rates of avascular necrosis due to the precarious blood supply and poor biomechanics. The various treatment options that have been described can be broadly divided according to the aim of improving either biology or biomechanics. Surgeries aimed at improving the biology, such as vascularized fibula grafting, have good success rates but require high levels of expertise and substantial resources. A popular surgical treatment aimed at improving the biomechanics-valgus intertrochanteric osteotomy-optimizes conditions for fracture healing by converting shear forces across the fracture site into compressive forces. Numerous variations of this surgical procedure have been developed and successfully applied in clinical practice. As a result, the proximal femoral orientation for obtaining a good functional outcome has evolved over the years, and the present concept of altering the proximal femoral anatomy as little as possible has arisen. This technical objective supports attaining union as well as a good functional outcome, since excessive valgus can lead to increased joint reaction forces. This review summarizes the historical and current literature on valgus intertrochanteric osteotomy treatment of nonunion neck of femur, with a focus on factors predictive of good functional outcome and potential pitfalls to be avoided as well as controversies surrounding this procedure.

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

    Science.gov (United States)

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

    2013-01-01

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

  13. Early results of the Bernese periacetabular osteotomy: the learning curve at an academic medical center.

    Science.gov (United States)

    Peters, Christopher L; Erickson, Jill A; Hines, Jerod L

    2006-09-01

    Most reports on the results of the Bernese periacetabular osteotomy for the treatment of developmental dysplasia of the hip have been by the originators of the procedure. In 1997, we began to use this osteotomy without direct training from the originators of the procedure. Seventy-three patients (eighty-three hips) underwent a Bernese periacetabular osteotomy between 1997 and 2003 and were followed prospectively with use of the Harris hip score to assess clinical results and with use of anteroposterior pelvic and false-profile lateral plain radiographs to assess radiographic results. The three-dimensional position of the acetabulum was recorded preoperatively and postoperatively. The mean duration of follow-up was forty-six months. The average Harris hip score improved from 54 to 87 points (p Bernese periacetabular osteotomy have been encouraging, with a 92% survival rate at thirty-six months. The occurrence of complications demonstrates a substantial learning curve. Recognition of the true preoperative acetabular version and reorientation of the acetabulum into an appropriately anteverted position have become important factors in surgical decision-making. Therapeutic Level IV.

  14. Biomechanical characteristics of one-level versus multilevel osteotomy for kyphosis correction%应用单平面和多平面截骨术矫治脊椎后凸实验中发生的生物力学损伤特征比较

    Institute of Scientific and Technical Information of China (English)

    郭卫春; 明江华; 彭昊; 陶海鹰; 马友缘

    2005-01-01

    BACKGROUND: The clinical application of one-level osteotomy and multilevel osteotomy has been well documented, but currently few studies were reported to compare their biomechanical characteristics.OBJECTIVE: To investigate the biomechanical characteristics of one-level osteotomy with Dick screw fixation and multilevel osteotomy with Luque instrumentation in the treatment of kyphosis.DESIGN: Randomized comparative experiment.SETTING: Laboratory of the Department of Orthopedics, Renmin Hospital of Wuhan University.MATERIALS: Fresh specimens of thoracic and lumbar spinal segments obtained from 12 3 or 4-year-old calves.METHODS: The experiment was conducted in the laboratory of the Department of Orthopedics, Renmin Hospital of Wuhan University between September 2002 and September 2003. Fresh spinal segments T8-L5 from 12 calves were randomized into an intact group, Dick screw group with one-level osteotomy with Dick screw fixation and Luque group with multilevel osteotomy with Luque instrumentation, with 4 spesimens in each group. Lateral bending test of the specimens was performed to examine the physiological overload using an Instron 5 500 universal material testing machine at the constant speed of 10 mm/minute until fracture or dislocation was induced. Changes in the loading were recorded and the induced injuries observed to obtain the load-displacement curve of the injury test.MAIN OUTCOME MEASURES: The load-displacement curve of the destructive right bending test in each group.RESULTS:All the data of 12 canines were involved in the result analysis.The spinal segments of the intact group yielded to the force of 3 600 N with a flat and smooth load-displacement curve, and those of Dick screw group yielded to a load of 2 800 N with also a relatively flat curve, while in Luque group, the segments did not yield until a load of 7 160 N, followed by drastic decrease of the resistance to less than 4 000 N, generating a flat and smooth curve afterwards.CONCLUSION: Luque

  15. From sea level to high elevation in 15 million years: Uplift history of the northern Tibetan Plateau margin in the Altun Shan

    NARCIS (Netherlands)

    Ritts, B.D.; Yue, Y.; Graham, S.A.; Sobel, E.R.; Abbink, O.A.; Stockli, D.

    2008-01-01

    Approximately 1300 in of Oligocene-Miocene clastic strata are exposed along the Miran River in the southeastern Tarim basin, where the adjacent Altun Shan form the topographic escarpment of the northern Tibetan Plateau. The sedimentary section is faulted against Proterozoic rocks of the Altun Shan i

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

    Science.gov (United States)

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

    2015-05-01

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

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

    OpenAIRE

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

    2006-01-01

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

  18. Radial head dislocation during proximal radial shaft osteotomy.

    Science.gov (United States)

    Hazel, Antony; Bindra, Randy R

    2014-03-01

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

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

    Science.gov (United States)

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

    2013-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Furkan Erol Karabekmez

    2015-01-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2015-04-01

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

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

    Science.gov (United States)

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

    2016-02-01

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

  4. Modified basal osteotomy combined with osteogenic distraction (Hemi-Wing distraction) for correction of facial asymmetry: A new technique

    Science.gov (United States)

    Muñoz, Ruben; Diaz, Alvaro; Golaszewski, Jose

    2014-01-01

    Complete restoration of facial asymmetry is always difficult to achieve. Facial asymmetry due to growth disturbances of the jaws almost requires orthognathic surgical correction, followed, in many cases, by soft tissue corrections. Mandibular hypoplasia is the earliest skeletal manifestation of Hemifacial microsomy and the clinical defect becomes worse with the time, due to asymmetric growth and secondary midface deformity accompanying. Despite correction of the occlusal plane, facial asymmetry can persist if the mandibular body differs in height. We designed a new technique for skeletal correction of the mandibular basal plane combined with orthognatic surgery that avoided the disadvantages and limitations of other techniques. A 20-year-old male patient with facial asymmetry due to Hemifacial microsomy Type I also requires preoperative orthodontic treatment to align and level their teeth. He showed a 2mm midline shift to the left in combination with a cross bite of the left side. We decide to do a vertical enlargement of the mandibular left border by mandibular Hemiwing osteotomy and unilateral split ramus osteotomy for dental lines alignment with 8 mm of advancement of the hemi - wing genioplasty. Modificated basal osteotomy combined with osteogenic distraction works better than the classic total basal osteotomy with autologous bone graft, if used for the correct indications. We advocate this technique for its efficacy, simplicity, and safety. This technique can be apply for correction of vertical and transverse discrepancies of the mandibular border and combined with sagittal ramus osteotomies for correction of asymmetrical dental lines and oclusal plane. PMID:25593870

  5. How Often Does Femoroacetabular Impingement Occur After an Innominate Osteotomy for Acetabular Dysplasia?

    Science.gov (United States)

    Castañeda, Pablo; Vidal-Ruiz, Carlos; Méndez, Alfonso; Salazar, Diego Pérez; Torres, Armando

    2016-05-01

    patients with FAI, 10 had undergone a Pemberton osteotomy (10 of 46 [22%]) and eight a Salter osteotomy (eight of 108 [7%]). A change in the postoperative acetabular index greater than 20° was associated with a greater likelihood of developing FAI. The mean postoperative acetabular index was lower for the group with FAI, for whom it was 20°, compared with the group without FAI, for whom it was 27° (p = 0.04). The mean Iowa Hip Score for the group with FAI was 85, whereas for those without FAI, it was 93 (p = 0.03). FAI is not common after an innominate osteotomy for the treatment of acetabular dysplasia; however, overcorrection is related to a higher incidence. When FAI is present, it can affect the outcome. Overcorrection should be avoided when performing an innominate osteotomy for the treatment of acetabular dysplasia because it can create iatrogenic FAI and have an adverse effect on outcome. Level III, therapeutic study.

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

    Science.gov (United States)

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

    2016-11-01

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

  7. 3D imaging in corrective osteotomy of the distal radius

    NARCIS (Netherlands)

    Vroemen, Joy

    2013-01-01

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

  8. Triple pelvic osteotomy in the treatment of hip dysplasia

    Directory of Open Access Journals (Sweden)

    Vukašinović Zoran

    2009-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    宋若先; 张永刚; 张雪松; 毛克亚; 郑国权; 王岩

    2012-01-01

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

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

    Science.gov (United States)

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

    2007-06-01

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

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    Science.gov (United States)

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

    2015-09-01

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

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

    Science.gov (United States)

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

    2009-08-01

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

  16. Distal femoral extension osteotomy and patellar tendon advancement to treat persistent crouch gait in cerebral palsy.

    Science.gov (United States)

    Stout, Jean L; Gage, James R; Schwartz, Michael H; Novacheck, Tom F

    2008-11-01

    Hallmarks of a persistent crouched walking pattern exhibited by individuals with cerebral palsy usually include loss of an adequate plantar flexion/knee extension couple, hamstring and/or psoas tightness, or contracture in conjunction with quadriceps insufficiency. Traditional treatment addresses the muscle-tightness component, but not the contracture or the muscle insufficiency. This study was performed to evaluate the effectiveness of distal femoral extension osteotomy and/or patellar tendon advancement in the treatment of crouch gait in patients with cerebral palsy. A retrospective, nonrandomized, repeated-measures design was used. Individuals with a diagnosis of cerebral palsy were included if they had had (1) a distal femoral extension osteotomy in combination with a distal patellar tendon advancement (thirty-three patients), (2) a distal femoral extension osteotomy without patellar tendon advancement (sixteen), or (3) a distal patellar tendon advancement only (twenty-four). All subjects were evaluated with preoperative and postoperative gait analysis. Gait, radiographic, strength, and functional measures were included in the analysis to assess changes in knee function. Seventy-three individuals met the criteria for inclusion. A single side was chosen for the analysis of each subject. Ninety percent of the subjects had additional, concurrent surgery. Improvements were noted in the index assessing the level of gait pathology and in functional variables across all groups, and pain was consistently decreased. All preoperative stress fractures healed. Strength levels were maintained across all groups. The Koshino index of patellar height improved from 1.4 to -2.3 in the group treated with patellar tendon advancement only and from 1.5 to -2.9 in the group treated with both osteotomy and tendon advancement. The range of knee flexion improved an average of 15 degrees to 20 degrees, and stance-phase knee flexion was restored to the typical range (9 degrees to 10

  17. Opening- and Closing-Wedge Distal Femoral Osteotomy

    Science.gov (United States)

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

    2016-01-01

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

  18. Medial displacement calcaneal osteotomy using minimally invasive technique.

    Science.gov (United States)

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

    2015-03-01

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

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

    Science.gov (United States)

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

    2009-07-01

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

  20. Levels of Germinable Seed in Topsoil and Yak Dung on an Alpine Meadow on the North-East Qinghai-Tibetan Plateau

    Institute of Scientific and Technical Information of China (English)

    YU Xiao-jun; XU Chang-lin; WANG Fang; SHANG Zhan-huan; LONG Rui-jun

    2013-01-01

    In order to clarify the interactive mechanism between grazing yak and alpine meadow on the Qinghai-Tibetan Plateau, our study assessed seed density (by species) in the topsoil of alpine meadow with different grazing intensities in the Tianzhu area, north-eastern margins of the Qinghai-Tibetan Plateau and their rates of occurrence in yak dung. Seed density in the topsoil of the lightly grazed, moderately grazed, heavily grazed and extremely grazed alpine meadows in November, 2010 were 1551, 1692, 2660 and 1830 grains m-2,while in the same meadows in April, 2011 densities were 1530, 2404, 2530 and 2692 grains m-2, respectively. In the cold season pasture, mean seed density in yak dung from November to April in the lightly grazed, moderately grazed, heavily grazed and extremely grazed sites were 121, 127, 187, and 120 grains kg-1 of dry yak dung. The proportion of total seed numbers in yak dung to soil seed bank in lightly grazed, moderately grazed, heavily grazed and extremely grazed alpine meadow was 1.40, 2.62, 0.69, and 0.90%. 12 species out of the 47 were not found in topsoil but were found in yak dung, 10 species out of 45 were not found in yak dung but were found in the topsoil. Endozoochorous dispersal by yaks is therefore very important for soil seed bank and plant biodiversity and population dynamics in alpine meadows.

  1. [Reorientation osteotomy of the trapezial saddle].

    Science.gov (United States)

    Kapandji, Adalbert I; Heim, Urs F A

    2002-03-01

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

  2. CENTRAL PLATEAU REMEDIATION

    Energy Technology Data Exchange (ETDEWEB)

    ROMINE, L.D.

    2006-02-01

    A systematic approach to closure planning is being implemented at the Hanford Site's Central Plateau to help achieve the goal of closure by the year 2035. The overall objective of Central Plateau remediation is to protect human health and the environment from the significant quantity of contaminated material that resulted from decades of plutonium production in support of the nation's defense. This goal will be achieved either by removing contaminants or placing the residual contaminated materials in a secure configuration that minimizes further migration to the groundwater and reduces the potential for inadvertent intrusion into contaminated sites. The approach to Central Plateau cleanup used three key concepts--closure zones, closure elements, and closure process steps--to create an organized picture of actions required to complete remediation. These actions were merged with logic ties, constraints, and required resources to produce an integrated time-phased schedule and cost profile for Central Plateau closure. Programmatic risks associated with implementation of Central Plateau closure were identified and analyzed. Actions to mitigate the most significant risks are underway while high priority remediation projects continue to make progress.

  3. Acute Reciprocal Changes Distant from the Site of Spinal Osteotomies Affect Global Postoperative Alignment

    Directory of Open Access Journals (Sweden)

    Eric Klineberg

    2011-01-01

    Full Text Available Introduction. Three-column vertebral resections are frequently applied to correct sagittal malalignment; their effects on distant unfused levels need to be understood. Methods. 134 consecutive adult PSO patients were included (29 thoracic, 105 lumbar. Radiographic analysis included pre- and postoperative regional curvatures and pelvic parameters, with paired independent t-tests to evaluate changes. Results. A thoracic osteotomy with limited fusion leads to a correction of the kyphosis and to a spontaneous decrease of the unfused lumbar lordosis (−8°. When the fusion was extended, the lumbar lordosis increased (+8°. A lumbar osteotomy with limited fusion leads to a correction of the lumbar lordosis and to a spontaneous increase of the unfused thoracic kyphosis (+13°. When the fusion was extended, the thoracic kyphosis increased by 6°. Conclusion. Data from this study suggest that lumbar and thoracic resection leads to reciprocal changes in unfused segments and requires consideration beyond focal corrections.

  4. Mid-Face Degloving: An Alternate Approach to Extended Osteotomies of the Midface.

    Science.gov (United States)

    Parameswaran, Anantanarayanan; Jayakumar, Naveen Kumar; Ramanathan, Manikandhan; Sailer, Hermann F

    2017-01-01

    Extended osteotomies for mid-face advancement require generous exposure of the anterior maxilla, nasal bones, infraorbital rims, orbital floor, zygoma, and the anterior third of the zygomatic arches. This cannot be obtained with an exclusive transoral approach. Hence, the surgeon is usually compelled to utilize supplemental cutaneous incisions that are a compromise on the purpose behind a cosmetic surgery. In order to alleviate the need for such compromise, the authors advocate the mid face degloving approach for extended osteotomies at Lefort II and Lefort III levels. Mid face degloving involves a combination of circumvestibular incision, with inter cartilaginous and transfixation components from a nasal incision. The authors have utilized this technique for 9 patients and documented favorable results. The purpose of this paper is to focus the utility of this approach in orthognathic surgery and promote this as a viable alternative to traditional approaches in surgery of the mid face because of the absence of external scars.

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

    Science.gov (United States)

    Krause, Fabian; Veljkovic, Andrea; Schmid, Timo

    2016-03-01

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

  6. Correction of gait after derotation osteotomies in cerebral palsy: Are the effects predictable?

    Science.gov (United States)

    Böhm, Harald; Hösl, Matthias; Dussa, Chacravarthy U; Döderlein, Leonhard

    2015-10-01

    Derotation osteotomies of the femur and tibia are established procedures to improve transverse plane deformities during walking with inwardly pointing knees and in- and out toeing gait. However, effects of femoral derotation osteotomies on gait were reported to be small, and those for the tibia are not known. Therefore, the aim of the study was to show the relation between the amount of intraoperative rotation and the changes during gait for osteotomies at femur and tibia levels, and predict those for the femur from preoperative clinical and gait data. Forty-four patients with spastic cerebral palsy between 6 and 19 years were included, 33 limbs received rotation only at the femur, 8 only at the tibia and 12 limbs at both levels. Gait analysis and clinical testing was performed pre- and 21.4 (SD=1.8) months postoperatively. The amount of intraoperative derotation of the femur showed no significant correlation with the change in hip rotation during walking (R=-0.17, p=0.25), whereas the rotation of the tibia showed an excellent relationship (R=0.84, pgait. Strength and passive range of motion in hip extension and abduction as well as hip extension or abduction or foot progression during walking did not show any predictive significance. In conclusion changes of knee rotation during gait is directly predictable from the amount of tibial corrections, contrary the change in hip rotation was not related to the amount of femoral derotation, and prediction was only fair.

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

    Science.gov (United States)

    2014-01-01

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

  8. Ten-year results of physical activity after high tibial osteotomy in patients with knee osteoarthritis.

    Science.gov (United States)

    W-Dahl, Annette; Toksvig-Larsen, Sören; Lindstrand, Anders

    2017-03-01

    The purpose was to describe physical activity with respect to leisure and working activity in patients operated on by high tibial osteotomy using the hemicallotasis technique for knee osteoarthritis (OA), preoperatively and 10 years postoperatively. Seventy-nine patients, median age 55 (range 35-66), operated on by high tibial osteotomy using the hemicallotasis technique for knee OA 2001-2003 were included. Questionnaires for evaluation of physical and working activity, satisfaction as well as the Knee injury and Osteoarthritis Outcome Score (KOOS) were filled in preoperatively and 2 and 10 years postoperatively. Conversion to knee arthroplasty was obtained through the Swedish Knee Arthroplasty Register. Changes between two postoperative measurements were assessed by Wilcoxon's rank test. Twenty-five patients were converted to a total knee arthroplasty, and nine patients were lost to follow-up during the 10 years, resulted in 45 patients available for follow-up. Preoperatively, 33/45 patients were physically active mainly in heavy yard/household work, and 43/45 patients were working active. Ten years after the HCO, 23/45 patients were still active with golf, dancing, hiking, etc., and 23/45 were retired. At 10 years postoperatively compared to 2 years postoperatively, the patients experienced more problems with pain (89 compared to 69, p = <0.0001). Of 45 patients, 36 were satisfied with the high tibial osteotomy surgery in general 10 years postoperatively, while 13/45 were satisfied with their sport and recreational function. The 10-year results indicate that high tibial osteotomy using the hemicallotasis technique for knee OA is an option for selected patients that improves the level of physical activity, with mild deterioration over time, and gives the majority of the patients the possibility to be working active until retirement. Level IV.

  9. Radiative plateau inflation

    CERN Document Server

    Ballesteros, Guillermo

    2016-01-01

    We describe how monomial chaotic inflation becomes compatible with the latest CMB data thanks to radiative corrections producing a plateau. The interactions of the inflation with other fields, required for reheating, can flatten the potential and moderate the production of primordial gravitational waves, keeping these below the current upper bound. We show that the appearance of a plateau requires that the inflaton couples to fermions and to another scalar or a gauge group. We give concrete examples of minimal particle physics models leading to plateaus for quadratic and quartic chaotic inflation. We also provide a three-parameter model-independent description of radiatively corrected inflation that is amenable to CMB analyses.

  10. Osteochondritis dissecans after rotational acetabular osteotomy for dysplastic hip

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-12-01

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

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

    Science.gov (United States)

    Leunig, Michael; Ganz, Reinhold

    2011-01-01

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

  12. Lordosis restoration after Smith-Petersen osteotomies and interbody strut placement: a radiographic study in cadavers.

    Science.gov (United States)

    Lee, Michael J; Wiater, Brett; Bransford, Richard J; Bellabarba, Carlo; Chapman, Jens R

    2010-12-01

    Six human lumbar cadaveric specimens evaluated after sequential steps in restoration of lumbar lordosis. To determine the effect of Smith-Petersen osteotomies (SPO) with concurrent interbody strut placement on lordosis in the lumbar spine. The importance of restoration of lumbar lordosis is well recognized. SPO have been suggested to yield roughly 10° of lordosis per level, whereas pedicle subtraction osteotomies have been shown to result in over 30° of lordosis restoration. Though the pedicle subtraction osteotomy can achieve greater degrees of lordosis, there is considerable surgical morbidity associated. We hypothesize that SPO with an interbody strut placed within the disc space will result significantly greater lordosis than SPO alone. Lateral radiographs of 6 human lumbar specimens were obtained after 3 interventions as follows: (1) lumbar spine without osteotomy in maximal extension, (2) after SPO at L2, L3, and L4 and held in maximal extension with pedicle screw fixation, and (3) after SPO at L2, L3, and L4 with interbody cage placement in L2-L3, L3-L4, and L4-L5 held in maximal extension with pedicle screw fixation. The mean lordosis in the intact specimens was 7.03° (standard deviation [SD], 2.21°). The mean lordosis after SPO was 11.05° (SD, 1.05°). The mean lordosis after SPO and interbody strut placement was 15.72° (SD, 3.19°). The difference in lordosis in the osteotomized specimens with and without interbody strut was significantly (P lordosis, significantly greater than that of SPO alone.

  13. Guided Modern Endodontic Surgery: A Novel Approach for Guided Osteotomy and Root Resection.

    Science.gov (United States)

    Strbac, Georg D; Schnappauf, Albrecht; Giannis, Katharina; Moritz, Andreas; Ulm, Christian

    2017-03-01

    Continuous improvements in techniques, instruments, and materials have established modern endodontic microsurgery as a state-of-the-art treatment method. The purpose of this approach was to introduce a new surgical endodontic technique by using a three-dimensional printed template for guided osteotomy and root resection. A 38-year-old patient was diagnosed with periapical lesions of teeth #3 and #4 and extruded gutta-percha material. Three-dimensional radiographic and optical scan files were imported into surgical planning software designed for guided implant surgery. Within the adapted software program the periapical lesions and the extruded gutta-percha were visualized and marked. With the aid of virtually positioned surgical pins and piezoelectric instruments, the osteotomy size, the apical resection level, and the bevel angle were defined before treatment. Three-dimensional surgical templates for each tooth were designed within the software program for a guided treatment approach. This approach comprised the treatment of periapical lesions of teeth #3 and #4 with root-end fillings and the detection and complete removal of the extruded gutta-percha material without perforation of sinus membrane. There were no postoperative complications, and clinical and radiologic assessments verified complete healing of the teeth. The guided microsurgical endodontic treatment presented appears to be a viable technique that allows for predefined osteotomies and root resections. Copyright © 2016 American Association of Endodontists. Published by Elsevier Inc. All rights reserved.

  14. Plateau Indian Ways with Words

    Science.gov (United States)

    Monroe, Barbara

    2009-01-01

    The indigenous rhetoric of the Plateau Indians continues to exert a discursive influence on student writing in reservation schools today. Plateau students score low on state-mandated tests and on college writing assignments, in large part because the pervasive personalization of Plateau rhetoric runs counter to the depersonalization of academic…

  15. Greening the Plateau

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    Located on the world’s largest plateau, Tibet Autonomous Region in China’s southwest has an average elevation of 4,000 meters. Tibet’s diverse natural landscapes, including snow-capped mountains, vast pastures and virgin forests, combined with its

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

    Science.gov (United States)

    Thompson, George H

    2011-09-01

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

  17. Supramalleolar osteotomy for realignment of the ankle joint.

    Science.gov (United States)

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

    2012-10-01

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

  18. Blood flow in rabbit osteotomies studied with radioactive microspheres

    Energy Technology Data Exchange (ETDEWEB)

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

    1984-01-01

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

  19. What Is the Role for Patelloplasty With Gullwing Osteotomy in Revision TKA?

    Science.gov (United States)

    Gililland, Jeremy M; Swann, Presley; Pelt, Christopher E; Erickson, Jill; Hamad, Nadia; Peters, Christopher L

    2016-01-01

    patella at last followup. One patient, with just over 3 years of followup, exhibited lateral subluxation without evidence of fracture. Three of the 10 patients with greater than 2 years of followup developed recurrent infections. One patient had avascular necrosis with fragmentation of the patella at 4 months postoperatively. Patellar bone stock is often compromised in revision TKA, leaving the surgeon with very few options for reconstruction. Using this technique, we found acceptable function, no aseptic rerevisions for patellofemoral complications, nine of 10 of patellae tracking within the trochlear groove, and radiographic healing of the majority of the osteotomies. The gullwing osteotomy may be considered an option in these difficult revisions, but further studies with more complete followup are needed. Level IV, therapeutic study.

  20. Lateral closed wedge osteotomy for cubitus varus deformity

    Directory of Open Access Journals (Sweden)

    Srivastava Amit

    2008-01-01

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

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

    Science.gov (United States)

    Kamath, Atul F

    2016-05-18

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

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

    Science.gov (United States)

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

    2016-03-01

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

  3. The effect of osteotomy dimension on osseointegration to resorbable media-treated implants: a study in the sheep.

    Science.gov (United States)

    Galli, Silvia; Jimbo, Ryo; Tovar, Nick; Yoo, Daniel Y; Anchieta, Rodolfo B; Yamaguchi, Satoshi; Coelho, Paulo G

    2015-03-01

    The drilling technique and the surface characteristics are known to influence the healing times of oral implants. The influence of osteotomy dimension on osseointegration of microroughned implant surfaces treated with resorbable blasting media was tested in an in vivo model. Ninety-six implants (ø4.5 mm, 8 mm in length) with resorbable blasting media-treated surfaces were placed in the ileum of six sheep. The final osteotomy diameters were 4.6 mm (reamer), 4.1 mm (loose), 3.7 mm (medium), and 3.2 mm (tight). After three and six weeks of healing, the implants were biomechanically tested and histologically evaluated. Statistical analysis was performed using Page L trend test for ordered and paired sample and linear regression, with significance level at p < 0.05. An overall increase in all dependent variables was observed with the reduction of osteotomy diameter. In addition, all osseointegration scores increased over time. At three weeks, the retention was significantly higher for smaller osteotomies. The histological sections depicted intimate contact of bone with all the implant surfaces and osteoblast lines were visible in all sections. The resorbable blasting media microroughed surfaces achieved successful osseointegration for all the instrumentation procedures tested, with higher osseointegration scores for the high insertion torque group.

  4. Optical Turbulence above the Internal Antarctic Plateau

    CERN Document Server

    Masciadri, E; Hagelin, S; Moigne, P Le; Noilhan, J

    2010-01-01

    The internal antarctic plateau revealed in the last years to be a site with interesting potentialities for the astronomical applications due to the extreme dryness and low temperatures, the typical high altitude of the plateau, the weak level of turbulence in the free atmosphere down to a just few tens of meters from the ground and the thin optical turbulence layer developed at the ground. The main goal of a site testing assessment above the internal antarctic plateau is to characterize the site (optical turbulence and classical meteorological parameters) and to quantify which is the gain we might obtain with respect to equivalent astronomical observations done above mid-latitude sites to support plans for future astronomical facilities. Our group is involved, since a few years, in studies related to the assessment of this site for astronomical applications that include the characterization of the meteorological parameters and optical turbulence provided by general circulation models as well as mesoscale atmo...

  5. Institute of Tibetan Plateau Research

    Institute of Scientific and Technical Information of China (English)

    2005-01-01

    @@ The Tibetan Plateau (Qinghai-Xizang Plateau)is a unique geological-geographical unit on Earth, an ideal region for studies into the formation and evolution of the lithosphere and the dynamic mechanism of the earth crust. The uplifting of the Plateau exerts profound influence upon the evolution and differentiation of the natural environment of the plateau itself, its adjacent regions and the Northern Hemisphere. As a unique natural geographical unit, the Plateau holds a special status in the whole globe due to its special natural environment and ecosystems, which is also in close relation to global environmental change.The significance of the Plateau research should be recognized not only in the fundamental research fields of geo-sciences and biology, but also in its application to resource exploitation, environmental protection and sustainable development of the Plateau region.

  6. [Functional difference of malate-aspartate shuttle system in liver between plateau zokor (Myospalax baileyi) and plateau pika (Ochotona curzoniae)].

    Science.gov (United States)

    Zhu, Rui-Juan; Rao, Xin-Feng; Wei, Deng-Bang; Wang, Duo-Wei; Wei, Lian; Sun, Sheng-Zhen

    2012-04-25

    To explore the adaptive mechanisms of plateau zokor (Myospalax baileyi) to the enduring digging activity in the hypoxic environment and of plateau pika (Ochotona curzoniae) to the sprint running activity, the functional differences of malate-aspartate shuttle system (MA) in liver of plateau zokor and plateau pika were studied. The ratio of liver weight to body weight, the parameters of mitochondria in hepatocyte and the contents of lactic acid in serum were measured; the open reading frame of cytoplasmic malate dehydrogenase (MDH1), mitochondrial malate dehydrogenase (MDH2), and the partial sequence of aspartate glutamate carrier (AGC) and oxoglutarate malate carrier (OMC) genes were cloned and sequenced; MDH1, MDH2, AGC and OMC mRNA levels were determined by real-time PCR; the specific activities of MDH1 and MDH2 in liver of plateau zokor and plateau pika were measured using enzymatic methods. The results showed that, (1) the ratio of liver weight to body weight, the number and the specific surface of mitochondria in hepatocyte of plateau zokor were markedly higher than those of plateau pika (P 0.05); (3) mRNA level and enzymatic activity of MDH1 was significantly lower than those of MDH2 in the pika liver (P 0.05). These results indicate that the plateau zokor obtains ATP in the enduring digging activity by enhancing the function of MA, while plateau pika gets glycogen for their sprint running activity by increasing the process of gluconeogenesis. As a result, plateau pika converts the lactic acid quickly produced in their skeletal muscle by anaerobic glycolysis and reduces dependence on the oxygen.

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

    DEFF Research Database (Denmark)

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

    2006-01-01

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

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

    Science.gov (United States)

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

    2015-12-01

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

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

    Directory of Open Access Journals (Sweden)

    M Hashemi

    2005-01-01

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

  10. Response of Polygonum viviparum Species and Community Level to Long-term Livestock Grazing in Alpine Shrub Meadow in Qinghai-Tibet Plateau

    Institute of Scientific and Technical Information of China (English)

    Zhi-Hong Zhu; Jeremy Lundholm; Yingnian Li; Xiaoan Wang

    2008-01-01

    Grazing by domestic herbivores is generally recognized as a major ecological factor and an important evolutionary force in grasslands. Grazing has both extensive and profound effects on individual plants and communities. We investigated the response patterns of Polygonum viviparum species and the species diversity of an alpine shrub meadow in response to long-term livestock grazing by a field manipulative experiment controlling livestock numbers on the Qinghai-Tibet Plateau in China. Here, we hypothesize that within a range of grazing pressure, grazing can alter relative allocation to different plant parts without changing total biomass for some plant species if there is life history trade-offs between plant traits. The same type of communities exposed to different grazing pressures may only alter relative species' abundances or species composition and not vary species diversity because plant species differ in resistant capability to herbivory. The results show that plant height and biomass of different organs differed among grazing treatments but total biomass remained constant. Biomass allocation and absolute investments to both reproduction and growth decreased and to belowground storage increased with increased grazing pressure, indicating the increasing in storage function was attained at a cost of reducing reproduction of bulbils and represented an optimal allocation and an adaptive response of the species to long-term aboveground damage. Moreover, our results showed multiform response types for either species groups or single species along the gradient of grazing Intensity. Heavy grazing caused a 13.2% increase in species richness. There was difference in species composition of about 18%--20% among grazing treatment. Shannon-Wiener (H') diversity index and species evenness (E) index did not differ among grazing treatments. These results support our hypothesis.

  11. Modeling of Dust Levels Associated with Potential Utility-Scale Solar Development in the San Luis Valley-Taos Plateau Study Area

    Energy Technology Data Exchange (ETDEWEB)

    Chang, Y. -S. [Argonne National Lab. (ANL), Argonne, IL (United States); Kotamarthi, R. [Argonne National Lab. (ANL), Argonne, IL (United States); Hartmann, H. M. [Argonne National Lab. (ANL), Argonne, IL (United States); Patton, T. [Argonne National Lab. (ANL), Argonne, IL (United States); Finster, M. [Argonne National Lab. (ANL), Argonne, IL (United States)

    2016-07-01

    The San Luis Valley (SLV)–Taos Plateau study area in south-central Colorado and north-central New Mexico is a large alpine valley surrounded by mountains with an area of approximately 6,263,000 acres (25,345 km2) (Figure ES.1-1). This area receives ample sunshine throughout the year, making it an ideal location for solar energy generation, and there are currently five photovoltaic facilities operating on private lands in the SLV, ranging in capacity from 1 to 30 megawatt (MW). In 2012 the Bureau of Land Management (BLM) launched its Solar Energy Program, which included the identification of four solar energy zones (SEZs) in the SLV totaling 16,308 acres (66 km2), as well as over 50,000 (202 km2) acres of other BLM-administered lands potentially available for application for solar development. The SEZ areas, named Antonito Southeast, De Tilla Gulch, Fourmile East, and Los Mogotes East, were defined by the BLM as areas well-suited for utility-scale (i.e., larger than 20 MW) production of solar energy where solar energy development would be prioritized (BLM 2012). Nonetheless, it was recognized that solar development in the SEZs would result in some unavoidable adverse impacts, and so the BLM initiated a solar regional mitigation strategy (SRMS) study for three of the SEZs (BLM and Argonne 2016). The SRMS is designed to identify residual impacts of solar development in the SEZs (that is, those that cannot be avoided or minimized onsite), identify those residual impacts that warrant compensatory mitigation when considering the regional status and trends of the resources, identify appropriate regional compensatory mitigation locations and actions to address those residual impacts, and recommend appropriate fees to implement those compensatory mitigation measures.

  12. Comparison of two Methods of Lateral Osteotomies withwithout Subperiosteal Tunnel creation on Edema and Ecchymosis after Rhinoplasty.

    Directory of Open Access Journals (Sweden)

    MR As’habyamin

    2016-05-01

    Full Text Available Introduction: Postoperative periorbital edema and ecchymosis is one of the main complication of rhinoplasty. This complication is mostly due to lateral osteotomy. During performing the endonasal lateral osteotomy, with the goal of reducing injury to surrounding tissues and reducing the postoperative edema and ecchymosis. The aim of this study goal was to determine whether creating a subperiosteal tunnel before lateral osteotomy had an effect on postoperative periorbital edema and ecchymosis. Methods: 102 patients were included in the study. They were underwent rhinoplasty. In each patients lateral osteotomies were carried out bilaterally, after creating a subperiosteal tunnel with periosteum elevator on a randomly chosen side and without creating a subperiosteal tunnel on the other side. The rest of the procedure was similar bilaterally. The patients were examined on the 2nd and 7th days after surgery. The levels of edema and periorbital ecchymosis were score by a different surgery who was unaware of the side with the periosteal tunnel, and the results were compared together. Results: According to the data analysis, there was no statistically significant difference between the severity of periorbital edema at the side with subperiosteal tunnel and the side without it on the 2nd and 7th days after surgery (P value=0/096 and Pvalue=0/252, respectively. There was not found any statistical significant between periorbital ecchymosis at the side with subperiosteal tunnel and the side without it on the 2nd and 7th days after surgery (P value=0/783 and Pvalue=0/094, respectively. Conclusions: Creating a subperiostal tunnel before lateral osteotomy in rhinoplasty does not influence on the severity of postoperative edema and ecchymosis.

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1988-07-01

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

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

    OpenAIRE

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Elio Hitoshi Shinohara

    2013-01-01

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

  16. [Distal femoral varus osteotomy for symptomatic genu valgum: long-term results and review of the literature].

    Science.gov (United States)

    Zilber, S; Larrouy, M; Sedel, L; Nizard, R

    2004-11-01

    We report our experience with eleven patients treated for disabling genu valgum from 1979 to 1994. Genu valgum resulted from femoral deformation in all patients. Ten had a congenital condition and one a post-traumatic knee. IKS scores were used for the clinical evaluation. The lateral femorotibial joint space and the lateral femoral angle (LFA) were measured on plain films. Goniometry was used to measure the axis of the loaded lower limb. All patients underwent osteotomy of the distal femur for varisation and plate fixation. One patient required revision for a unicompartment lateral prosthesis subsequent to fracture of the homolateral lateral tibial plateau. Mean follow-up was 10.5 years (3.5-21.5). There were no cases of nonunion. Four patients had a good or excellent knee score. Eight patients had a good or excellent function score. Osteoarthritis worsened in two patients. The mean LFA increased from 72.5 degrees preoperatively to 83.5 degrees postoperatively and a last follow-up. Mean genu valgum was 13 degrees preoperatively and 2 degrees at last follow-up. All patients except one were satisfied or very satisfied. Insufficient correction appeared to be the main complaint. These results and results reported in the literature demonstrate that distal femoral osteotomy for disabling genu valgum is an effective treatment if the correction is complete and osteosynthesis effective, providing long lasting results when femoral deformation is involved and osteoarthritis limited.

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

    Science.gov (United States)

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

    2015-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Shu-Jung Chen

    2015-04-01

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

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

    Science.gov (United States)

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

    2015-03-01

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

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

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    NARCIS (Netherlands)

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

    1996-01-01

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

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

    Science.gov (United States)

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

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

  3. Non-union following bilateral simultaneos Ganz trochanteric osteotomy

    Directory of Open Access Journals (Sweden)

    Sean M. Dixon

    2010-01-01

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

  4. [Contamination levels and source analysis of polycyclic aromatic hydrocarbons and organochlorine pesticides in soils and grasses from lake catchments in the Tibetan Plateau].

    Science.gov (United States)

    Xie, Ting; Zhang, Shu-Juan; Yang, Rui-Qiang

    2014-07-01

    Soils and grasses samples were collected from 6 typical lake catchments in the central and northern Tibetan Plateau (TP) in August 2007 and analyzed for polycyclic aromatic hydrocarbons (PAHs) and organochlorine pesticides (OCPs, including HCHs and DDTs). The concentrations of sigma16 PAHs, sigma HCHs and sigma DDTs in soil samples were in the range of 60.6-614 ng x g(-1) (mean 194 ng x g(-1)), 0.06-0.74 ng x g(-1) (mean 0.31 ng x g(-1)) and N. D. -0.17 ng x g(-1) (mean 0.07 ng x g(-1)) while those of sigma15 PAHs (excluding NAP), sigma HCHs and sigma DDTs in grasses were in the range of 262-519 ng x g(-1) (mean 327 ng x g(-1)), 0.55-3.92 ng x g(-1) (mean 2.17 ng x g(-1)) and 0.20-2.19 ng x g(-1) (mean 0.92 ng x g(-1)), respectively. All compounds were significantly lower than those in European high mountains. The biological concentration effect of grasses to soils was notable with the values of BCF ranging from 4.2 to 19.3. No significant correlations were observed between the concentrations of POPs and the content of OM/lipid, or the altitude of the sampling sites. The PAHs profile was dominated by lighter constituents (2 & 3-ring PAHs accounted for higher than 80%). The special diagnostic ratios of PAHs suggested that PAHs in the TP were mainly produced by low-temperature combustion of biomass and fossil fuels, and the relatively low ratios of alpha/gamma-HCH and high ratios of o,p'-DDT/p,p'-DDT implied that the wide applications of lindane and dicofol contributed to the OCPs contamination in the TP. According to the backward airmass trajectory models, it was deduced that the westerly wind was the main source for both central and northern sites in the TP during winter. During summer, pollutants in the central sites of the TP were mainly from the Indian subcontinent while the northern sites were also affected by Chinese inland provinces.

  5. Patellar instability treated with distal femoral osteotomy.

    Science.gov (United States)

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

    2017-06-01

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

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

    NARCIS (Netherlands)

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

    2008-01-01

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

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

    Science.gov (United States)

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

    2014-03-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

  9. Effect of triple tibial osteotomy on femorotibial stability in canine cranial cruciate ligament deficient stifles

    DEFF Research Database (Denmark)

    Kristiansen, S.; Vedel, T.; Jensen, B. R.

    leveling osteotomy (TPLO), have been biomechanically evaluated (Kipfer et al. (2008), Apelt et al. (2007), Butler et al. (2011), Pozzi et al. (2006) and Rey et al. (2014)), experimental studies on TTO are lacking. The aim of this study was to evaluate the effect of TTO on cadaveric stifle stability....... Limbs were mounted on a custom-made frame, which permitted controlled movement of the tibia relative to the femur, and extended from full flexion whilst recording the stifle region fluoroscopically. Metal markers placed at the CrCL attachment sites were used to monitor cranial tibial subluxation (CTS...

  10. Intra-Articular Osteotomy for Distal Humerus Malunion

    Directory of Open Access Journals (Sweden)

    René K. Marti

    2009-01-01

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

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

    Science.gov (United States)

    Brunelli, Giorgio A

    2003-06-01

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

  12. High tibial osteotomy in Sweden, 1998-2007

    DEFF Research Database (Denmark)

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

    2012-01-01

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

  13. Distal femoral extension osteotomy and patellar tendon advancement to treat persistent crouch gait in cerebral palsy. Surgical technique.

    Science.gov (United States)

    Novacheck, Tom F; Stout, Jean L; Gage, James R; Schwartz, Michael H

    2009-10-01

    Hallmarks of a persistent crouched walking pattern exhibited by individuals with cerebral palsy usually include loss of an adequate plantar flexion/knee extension couple, hamstring and/or psoas tightness, or contracture in conjunction with quadriceps insufficiency. Traditional treatment addresses the muscle-tightness component, but not the contracture or the muscle insufficiency. This study was performed to evaluate the effectiveness of distal femoral extension osteotomy and/or patellar tendon advancement in the treatment of crouch gait in patients with cerebral palsy. A retrospective, nonrandomized, repeated-measures design was used. Individuals with a diagnosis of cerebral palsy were included if they had had (1) a distal femoral extension osteotomy in combination with a distal patellar tendon advancement (thirty-three patients), (2) a distal femoral extension osteotomy without patellar tendon advancement (sixteen), or (3) a distal patellar tendon advancement only (twenty-four). All subjects were evaluated with preoperative and postoperative gait analysis. Gait, radiographic, strength, and functional measures were included in the analysis to assess changes in knee function. Seventy-three individuals met the criteria for inclusion. A single side was chosen for the analysis of each subject. Ninety percent of the subjects had additional, concurrent surgery. Improvements were noted in the index assessing the level of gait pathology and in functional variables across all groups, and pain was consistently decreased. All preoperative stress fractures healed. Strength levels were maintained across all groups. The Koshino index of patellar height improved from 1.4 to -2.3 in the group treated with patellar tendon advancement only and from 1.5 to -2.9 in the group treated with both osteotomy and tendon advancement. The range of knee flexion improved an average of 15 degrees to 20 degrees , and stance-phase knee flexion was restored to the typical range (9 degrees to 10

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

    Science.gov (United States)

    Wenger, Dennis R; Pandya, Nirav K

    2011-09-01

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

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

    Science.gov (United States)

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

    2014-04-30

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

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

    Science.gov (United States)

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

    2016-10-01

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

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

    Directory of Open Access Journals (Sweden)

    Gururaj Arakeri

    2015-06-01

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

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

    Science.gov (United States)

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

    2014-02-01

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

  19. AHP 21: Pyramid Schemes on the Tibetan Plateau

    Directory of Open Access Journals (Sweden)

    Devin Gonier

    2017-09-01

    Full Text Available The unique features of pyramid shemes and certain underlying causes for their development on the Tibetan Plateau are analyzed. Research was conducted by analyzing 521 surveys, allowing estimation of pyramid scheme activity on the Plateau and an identification of related cultural and social specificities. Firsthand accounts were collected revealing details of personal involvement. Survey data and similarities in the accounts were studied to suggest how involvement in pyramid schemes might be reduced at both institutional and individual levels.

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

    Science.gov (United States)

    Scholey, April Louise; Suida, Mohamed Imran

    2015-07-01

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

  1. Postoperative contamination of mandibular osteotomy sites with saliva

    NARCIS (Netherlands)

    Koole, Ronald; Egyedi, P.

    1987-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2010-02-15

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

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

    Science.gov (United States)

    Yoshida, Atsushi

    2015-08-01

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

  5. Postoperative contamination of mandibular osteotomy sites with saliva

    NARCIS (Netherlands)

    Koole, Ronald; Egyedi, P.

    1987-01-01

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

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

    Science.gov (United States)

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

    2013-08-01

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

  7. 黄土高原水平梯田现状及减沙作用分析%The Status and Sediment Reduction Effects of Level Terrace in the Loess Plateau

    Institute of Scientific and Technical Information of China (English)

    马红斌; 李晶晶; 何兴照; 刘晓燕; 王富贵

    2015-01-01

    Level terrace is one of the most important measures of developing soil and water conservation and efficient agriculture in the Loess Plateau,which has the dual role of agriculture efficiency and ecological restoration. This paper analyzed the level terrace status:including scale,distribution,quality,planting structure and sediment reduction effects,based on remote sensing image of the ZY-3 Satellite and field survey. The results show that there have level terrace 3. 71 million hm2 by the end of 2012,mainly distributed in the Yellow River basin in Gansu Province and adjacent areas and Hekouzhen-Longmen reaches of the Yellow River in Shanxi Province,where the terraced area ac-counts for around 54. 3% of the total terrace area in the Loess Plateau;Level terrace in Weihe River,Jinghe River and Zulihe River has a high quality rank and is dominated by farming,however,there have mainly narrow terraces with width 4-6 m in He-Long reaches,and"Terrace for Farmland" is commonly appearing. In the future,terrace construction in the Yellow River of Gansu Province should give priority to damaged terrace reconstruction,the development space maybe 5% ~15%,however,He-Long reaches has a higher development poten-tial,expect to increase new terrace by as much as 25%. Based on the terrace sediment reduction calculation method,the existing level ter-races in the area upstream Tongguan can reduce sediment about 500 million tons.%水平梯田是黄土高原地区发展水土保持高效农业的重要措施之一,具有农业增效、生态修复的双重功能。基于资源三号卫星遥感影像和实地调查数据,分析了2012年黄土高原地区梯田现状:规模、分布、质量、利用方式及其减沙作用。结果表明:截至2012年底,黄土高原地区现有水平梯田371.29万hm2,主要分布在甘肃省黄河流域及其邻近地区、山西省河龙间支流流域,这些区域水平梯田面积占黄土高原梯田总面积的54.3%;渭河、

  8. Evolution of the Ordos Plateau and environmental effects

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    Based on the analysis of temporary-spatial distribution, geomorphic position, contact relationship with underlying strata and grain size of red clay, we studied the formation and environmental background of red clay. During late Miocene-Pliocene, the Ordos Block finished the transformation from the basin to the plateau, which had an obvious environmental effect on the topography, indicated by the formation of highland undergoing wind erosion and lowland receiving red clay deposits. The red clay materials were sourced from dusts carried by wind energy and covered on the initial topography. Unlike Quaternary loess dust covering the overall the Loess Plateau, red clay deposited on the highland would be transported to the lowlands by wind and fluvial process. As a result, there was no continuous "Red Clay Plateau" in the Ordos region and red clay was only preserved in former lowlands. However, red clay was discontinuously distributed through the Loess Plateau and to some extent modified the initial topography. The differential uplift in interior plateau is indicated by the uplift of northern Baiyushan, central Ziwuling and southern Weibeibeishan. The Weibeibeishan Depression formed earlier and became the sedimentary center of red clay resulting in the thicker red clay deposits in Chaona, Lingtai and Xunyi. Since Quaternary the aridity in the northern plateau enhanced and accelerated loess accumulation caused the formation of the Loess Plateau. During the late Pleistocene the rapid uplift led to the enhancement of erosion. Especially after the cut-through of Sanme Lake by the Yellow River, the decline of base level caused the falling of ground water level and at the same time the increase of drainage density resulting in the enhancement of evaporation capacity, which enhanced the aridity tendency of aridity in the Loess Plateau region.

  9. Segmental distraction osteogenesis with modified LeFort II osteotomy for a patient with craniosynostosis.

    Science.gov (United States)

    Watanabe, Keiichiro; Kuroda, Shingo; Takahashi, Takumi; Kijima, Takeshi; Torikai, Katsuyuki; Moriyama, Keiji; Tanaka, Eiji

    2012-11-01

    In this article, we report successful orthodontic treatment combined with segmental distraction osteogenesis after a modified LeFort II osteotomy in a patient with craniosynostosis. An 8-year-old boy diagnosed with craniosynostosis had a dished-in face, an anterior crossbite, and a skeletal Class III jaw relationship because of midfacial hypoplasia. At the age of 13 years 6 months, the maxillary second and mandibular first premolars were extracted, and leveling and alignment of both arches was started with preadjusted edgewise appliances. At age 14 years 11 months, the patient had a modified LeFort II osteotomy, and the maxillary segment was advanced 7 mm and fixed to the zygomatic bone. At the same time, segmental distraction osteogenesis was started with a rigid external distraction system, and the nasal segment was advanced for 20 days at a rate of 1.0 mm per day. The total active treatment period was 40 months. As a result of the modified segmental distraction osteogenesis, significant improvement of his severe midfacial hypoplasia was achieved without excessive advancement of the maxillary dentition. Both the facial profile and the occlusion were stable after 1 year of retention. However, the nasal segment relapsed 1.4 mm during the 1.5 years after the segmental distraction osteogenesis. Evaluation of the stability and retention suggests that some overcorrection in midfacial advancement is recommended. Copyright © 2012 American Association of Orthodontists. Published by Mosby, Inc. All rights reserved.

  10. Biomechanical changes of spinous process osteotomy with different amounts of facetectomy using finite element model

    Science.gov (United States)

    Kang, K.-T.; Kim, K.-Y.; Jung, H.-J.; Lee, H.-Y.; Chun, H.-J.; Lee, H.-M.; Moon, S.-H.; Kim, H.-J.

    2010-03-01

    The aim of this study is to evaluate the biomechanical changes after Spinous Process Osteotomy (SPO) with different amounts of facetectomy of the lumbar spine and to compare the models with SPO and intact models using finite element models. Intact spine models and one decompression models (L3-4) with SPO were developed. SPO models included three different amounts of facetectomy (25%, 50%, and 75%). After validation of the models, finite element analyses were performed to investigate the ranges of motion and disc stresses at each corresponding level among three SPO models and intact lumbar spine models. The ranges of motion in the SPO models were increased more than the intact models. According to increase of amounts of facetectomy, ranges of motion were also increased. Similar to range of motion, the von Mises stress of disc in the SPO models was higher than that of intact models. Moreover, with the increase of amount of facetectomy, the disc stress increased at each segments under various moments. The decompression procedures using spinous process osteotomy has been reported to provide better postoperative stability compared to the conventional laminectomy. However, facetectomy over 50 % is likely to attenuate this advantage.

  11. Influence of the design in sagittal split ramus osteotomy on the mechanical behavior.

    Science.gov (United States)

    Pozzer, Leandro; Olate, Sergio; Cavalieri-Pereira, Lucas; de Moraes, Márcio; Albergaría-Barbosa, José Ricardo

    2014-01-01

    The aim of this study was to determine the influence of the design of the sagittal split ramus osteotomy (SSRO) on the mechanical resistance to vertical forces. An in vitro study was designed for 30 test specimens. Two osteotomy models were made on two polyurethane hemimandibles, where group I presented a SSRO with an angle at vestibular level between both molars and group II presented a linear SSRO towards the basilar border. In both groups a standard osteosynthesis was performed with a 2.0 system plate and four monocortical screws, establishing sub-groups according to the degree of mandibular advancement: group A without advancement, group B with an advancement of 3 mm, and group C with advancement of 7 mm. Hemimandibles were subjected to a vertical load in the Instron machine until reaching peak load with failure, recording the value of the load and displacement. The data were analyzed with a t-test to establish statistical significance, considering pdesign influences mechanical resistance and that the linear SSRO offers the best mechanical resistance.

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

    Science.gov (United States)

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

    2011-06-01

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

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

    Science.gov (United States)

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

    2017-03-01

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

  14. Curved Periacetabular Osteotomy for the Treatment of Dysplastic Hips

    Science.gov (United States)

    Nakamura, Yoshinari

    2014-01-01

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

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

    Science.gov (United States)

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

    2016-08-01

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

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

    OpenAIRE

    Дмитрий Борисович Барсуков; Михаил Михайлович Камоско

    2014-01-01

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

  17. Corrective Osteotomy for Malunited Diaphyseal Forearm Fractures Using Preoperative 3-Dimensional Planning and Patient-Specific Surgical Guides and Implants.

    Science.gov (United States)

    Byrne, Ann-Maria; Impelmans, Bianca; Bertrand, Veronique; Van Haver, Annemieke; Verstreken, Frederik

    2017-07-11

    Three-dimensional planning based on computed tomography images of the malunited and the mirrored contralateral forearm allows preoperative simulations of corrective osteotomies, the fabrication of patient-specific osteotomy guides, and custom-made 3-dimensional printed titanium plates. This study aims to assess the precision and clinical outcome of this technique. This was a prospective pilot study with 5 consecutive patients. The mean age at initial injury was 11 years (range, 4-16 years), and the mean interval from the time of injury to the time of corrective surgery was 32 months (range, 7-107 months). Patient-specific osteotomy guides and custom-made plates were used for multiplanar corrective osteotomies of both forearm bones at the distal level in 1 patient and at the middle-third level in 4 patients. Patients were assessed before and after surgery after a mean follow-up of 42 months (range, 29-51 months). The mean planned angular corrections of the ulna and radius before surgery were 9.9° and 10.0°, respectively. The mean postoperative corrections obtained were 10.1° and 10.8° with corresponding mean errors in correction of 1.8° (range, 0.3°-5.2°) for the ulna and 1.4° (range, 0.2°-3.3°) for the radius. Forearm supination improved significantly from 47° (range, 25°-75°) before surgery to 89° (range, 85°-90°) at final review. Forearm pronation improved from 68° (range, 45°-84°) to 87° (range, 82°-90°). In addition, there was a statistically significant improvement in pain and grip strength. This study demonstrates that 3-dimensional planned patient-specific guides and implants allow the surgeon to perform precise corrective osteotomies of complex multiplanar forearm deformities with satisfactory preliminary results. Therapeutic V. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  18. Expression of HLA-G mRNA and Protein Levels in Pre-eclampsia at Plateau Area%青海地区子痫前期患者HLA-GmRNA及蛋白表达研究

    Institute of Scientific and Technical Information of China (English)

    谢莹莺; 李凤莲; 刘春燕; 杨娟; 李琴

    2012-01-01

    目的:探讨青海高原地区子痫前期患者人类白细胞相关抗原G(HLA-G) mRNA、蛋白表达情况及临床意义.方法:收集2011年9月至2011年12月在青海大学附属医院产科分娩的30例子痫前期患者和30例正常妊娠妇女的胎盘组织和血清样品,采用实时荧光定量PCR及Western blot分析检测HLA-G mRNA和蛋白在正常妊娠与子痫前期患者胎盘中的表达差异,并应用双抗体夹心酶联免疫吸附法(ELISA)检测血清中可溶性HLA-G的表达.结果:①青海高原地区子痫前期患者胎盘组织中HLA-G mRNA、蛋白表达水平明显低于正常妊娠组,差异有统计学意义(P<0.05).②子痫前期患者血清中可溶型HLA-G (sHLA-G)浓度明显低于正常妊娠组,差异有统计学意义(P<0.05).结论:HLA-G基因转录的下调及其蛋白质表达下降,在青海高原地区子痫前期的发生发展过程中可能发挥重要作用.%Objective:To investigate the expression and the clinical significance of HLA-G at the mRNA and the protein levels in pre-eclampsia patients at the plateau area of Qinghai. Methods:The placental tissue and serum sample of 30 normal pregnant women and 30 patients with pre-eclampsias were collected. Using real time polymerase chain reaction and Western blot analysis, we detected HLA-G mRNA and protein levels in placental tissues. Serum sample was tested for soluble HLA-G (sHLA-G) protein by using a validated sandwich ELISA. Results :(1)The expressions of HLA-G mRNA and protein in pre-eclampsia group were significantly lower than those in control group( P <0.05). (2)The maternal serum concentrations of sHLA-G in pre-eclampsia group were significantly decreased compared with those in normal pregnant women. Conclusions: The decreasing of HLA-G mRNA and protein expressions may play an important role in the occurrence and development of pre-eclampsia in the plateau area.

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

    Science.gov (United States)

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

    2011-05-01

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

  20. Roentgen stereogrammetry in high tibial osteotomy for gonarthrosis

    Energy Technology Data Exchange (ETDEWEB)

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

    1981-01-01

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

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

    Science.gov (United States)

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

    2004-01-01

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

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

    Science.gov (United States)

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

    2009-01-01

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

  3. Piezosurgical osteotomy for harvesting intraoral block bone graft

    Directory of Open Access Journals (Sweden)

    Mahalingam Lakshmiganthan

    2012-01-01

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

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

    Science.gov (United States)

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

    2016-11-01

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

  5. Effect of osteotomies during rhinoplasty on intraocular pressure

    Directory of Open Access Journals (Sweden)

    Amr N. Rabie

    2016-07-01

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

  6. Successful Return to Sport Following Distal Femoral Varus Osteotomy

    Science.gov (United States)

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

    2016-01-01

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

  7. Surgical Outcome of Acetabular Fracture Using Trochanteric Flip Osteotomy

    Directory of Open Access Journals (Sweden)

    Espandar R

    2012-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2006-12-15

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

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

    Science.gov (United States)

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

    2016-11-01

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

  10. Risk factors affecting somatosensory function after sagittal split osteotomy

    DEFF Research Database (Denmark)

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

    2008-01-01

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

  11. Does Salter innominate osteotomy predispose the patient to acetabular retroversion in adulthood?

    Science.gov (United States)

    Kobayashi, Daisuke; Satsuma, Shinichi; Kinugasa, Maki; Kuroda, Ryosuke; Kurosaka, Masahiro

    2015-05-01

    (18 of 99 hips [18%]; p = 0.256). Hips that had a positive crossover or prominence of the ischial spine sign in the operated hips were likely also to have a positive crossover sign or prominence of the ischial spine sign in the unaffected hips (16 of 20 hips [80%] crossover sign, 17 of 22 hips [77%] prominence of the ischial spine sign). At the final visit, five hips (5%) showed osteoarthritic change; one of the five hips (20%) showed positive crossover and prominence of the ischial spine signs, and the remaining four hips showed negative crossover and prominence of the ischial spine signs. There was no significant difference in HHS between the crossover-positive and crossover-negative patient groups nor in the prominence of the ischial spine-positive and prominence of the ischial spine-negative patient groups (crossover sign, p = 0.68; prominence of the ischial spine sign, p = 0.54). Hips with femoral head deformity (25 of 99 hips [25%]) were more likely to have acetabular retroversion compared with hips without femoral-head deformity (crossover sign, p = 0.029, prominence of the ischial spine sign, p = 0.013). Our results suggest that Salter innominate osteotomy does not consistently cause acetabular retroversion in adulthood. We propose that retroversion of the acetabulum is a result of intrinsic development of the pelvis in each patient. A longer-term followup study is needed to determine whether retroverted acetabulum after Slater innominate osteotomy is a true risk factor for early osteoarthritis. Femoral head deformity is a risk factor for subsequent acetabular retroversion. Level III, therapeutic study.

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

    Science.gov (United States)

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

    2014-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Mazlumi Mahdi

    2009-05-01

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

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

    Science.gov (United States)

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

    2017-03-16

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

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

    Science.gov (United States)

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

    2017-03-01

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

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

    NARCIS (Netherlands)

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

    2011-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1984-05-01

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

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

    Science.gov (United States)

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

    2015-05-01

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

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

    Science.gov (United States)

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

    2013-03-01

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

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

    Science.gov (United States)

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

    2005-01-01

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

  1. Amplitude of climatic changes in Qinghai-Tibetan Plateau

    Institute of Scientific and Technical Information of China (English)

    2000-01-01

    On the basis of ice core and meteorological data from the Qinghai-Tibetan (Q-T) Plateau, this article focuses on the discussion of the problems related to the sensitivity of temporal and spatial changes of the climate in high-altitude regions, particularly in the Q-T Plateau. The features of abrupt climatic changes of the past 100 ka, 2 000 a and recent years indicate that the amplitude of these changes in the Q-T Plateau was obviously larger than that in low-altitude regions. The scope of temperature change above 6 000 m in the Q-T Plateau between glacial and interglacial stages could reach over 10℃, but only about 4℃ in low-elevation regions close to sea level. During the last 2 000 a, the amplitude of temperature changes at Guliya (over 6 000 m a.s.l.) in the Q-T Plateau reached 7℃, in comparison with 2℃ in eastern China at low altitude. In the present age, apparent differences of climatic warming have been observed in the Q-T Plateau, indicating that the warming in high-elevation regions is much higher than that in low-elevation regions. The temperature in over 3 500 m regions of the Q-T Plateau have been increasing at a rate of 0.25×10-1/a in recent 30 years, but almost no change has taken place in the regions below 500 m. Thus, we concluded that high-altitude regions are more sensitive to climatic changes than the low-altitude regions.

  2. The Colorado Plateau II: biophysical, socioeconomic, and cultural research

    Science.gov (United States)

    Mattson, David J.; van Riper, Charles

    2005-01-01

    The publication of The Colorado Plateau: Cultural, Biological, and Physical Research in 2004 marked a timely summation of current research in the Four Corners states. This new volume, derived from the seventh Biennial Conference on the Colorado Plateau in 2003, complements the previous book by focusing on the integration of science into resource management issues. The 32 chapters range in content from measuring human impacts on cultural resources, through grazing and the wildland-urban interface issues, to parameters of climate change on the Plateau. The book also introduces economic perspectives by considering shifting patterns and regional disparities in the Colorado Plateau economy. A series of chapters on mountain lions explores the human-wildland interface. These chapters deal with the entire spectrum of challenges associated with managing this large mammal species in Arizona and on the Colorado Plateau, conveying a wealth of timely information of interest to wildlife managers and enthusiasts. Another provocative set of chapters on biophysical resources explores the management of forest restoration, from the micro scale all the way up to large-scale GIS analyses of ponderosa pine ecosystems on the Colorado Plateau. Given recent concerns for forest health in the wake of fires, severe drought, and bark-beetle infestation, these chapters will prove enlightening for forest service, park service, and land management professionals at both the federal and state level, as well as general readers interested in how forest management practices will ultimately affect their recreation activities. With broad coverage that touches on topics as diverse as movement patterns of rattlesnakes, calculating watersheds, and rescuing looted rockshelters, this volume stands as a compendium of cutting-edge research on the Colorado Plateau that offers a wealth of insights for many scholars.

  3. Periacetabular Osteotomy in patients with Hip Dysplasia investigated with Imaging Modalities

    DEFF Research Database (Denmark)

    Mechlenburg, Inger

    2016-01-01

    The minimal invasive periacetabular osteotomy (PAO) is a joint-preserving procedure that effectively corrects hip dysplasia, provides pain relief, improved radiographic results and a low rate of complications. The aim of this doctoral dissertation was to examine biological changes in bone......, cartilage and blood perfusion after PAO in patients with hip dysplasia. Furthermore, to investigate the relationship between the acetabular angles and health-related quality of life (QoL) after PAO. And finally, to study the level of radiation to the surgeon during PAO. Chapters 3 to 7 investigate the first...... is applied on 26 patients scheduled for PAO. In chapter 4, a cohort of patients with hip dysplasia are followed with Dual-energy X-ray absorptiometry (DXA) prior to and 1 and 2½ years after PAO to investigate changes in acetabular bone mineral density after PAO. Moreover, to examine whether bone mineral...

  4. Tranexamic acid reduces the blood loss and blood transfusion requirements following peri-acetabular osteotomy.

    Science.gov (United States)

    Wassilew, G I; Perka, C; Janz, V; Krämer, M; Renner, L

    2015-12-01

    We have investigated the effect of using tranexamic acid (TXA) during peri-acetabular osteotomy (PAO) on peri-operative blood loss and blood transfusion requirements. In addition we analysed whether the use of TXA was associated with an increased risk of venous thromboembolism (VTE) following this procedure. A consecutive series of 96 PAOs, performed by a single surgeon, were reviewed. A total of 48 patients received TXA and 48 did not. The TXA group received a continuous infusion of TXA at a rate of 10 mg/kg/h. The primary outcome measure was the requirement for blood transfusion. Secondary outcomes included total blood loss, the decrease in the level of haemoglobin in the blood, the length of hospital stay, and the complications of this treatment. The mean rate of transfusion was significantly lower in the TXA group (62.5% vs 12.5%, p transfusion after PAO significantly, without adverse effects such as an increased rate of VTE.

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

    Directory of Open Access Journals (Sweden)

    Дмитрий Борисович Барсуков

    2014-06-01

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

  6. Spiny Neurons of Amygdala, Striatum and Cortex Use Dendritic Plateau Potentials to Detect Network UP States

    Directory of Open Access Journals (Sweden)

    Katerina D Oikonomou

    2014-09-01

    Full Text Available Spiny neurons of amygdala, striatum, and cerebral cortex share four interesting features: [1] they are the most abundant cell type within their respective brain area, [2] covered by thousands of thorny protrusions (dendritic spines, [3] possess high levels of dendritic NMDA conductances, and [4] experience sustained somatic depolarizations in vivo and in vitro (UP states. In all spiny neurons of the forebrain, adequate glutamatergic inputs generate dendritic plateau potentials (dendritic UP states characterized by (i fast rise, (ii plateau phase lasting several hundred milliseconds and (iii abrupt decline at the end of the plateau phase. The dendritic plateau potential propagates towards the cell body decrementally to induce a long-lasting (longer than 100 ms, most often 200 – 800 ms steady depolarization (~20 mV amplitude, which resembles a neuronal UP state. Based on voltage-sensitive dye imaging, the plateau depolarization in the soma is precisely time-locked to the regenerative plateau potential taking place in the dendrite. The somatic plateau rises after the onset of the dendritic voltage transient and collapses with the breakdown of the dendritic plateau depolarization. We hypothesize that neuronal UP states in vivo reflect the occurrence of dendritic plateau potentials (dendritic UP states. We propose that the somatic voltage waveform during a neuronal UP state is determined by dendritic plateau potentials. A mammalian spiny neuron uses dendritic plateau potentials to detect and transform coherent network activity into a ubiquitous neuronal UP state. The biophysical properties of dendritic plateau potentials allow neurons to quickly attune to the ongoing network activity, as well as secure the stable amplitudes of successive UP states.

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

    Science.gov (United States)

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

    2017-03-31

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

  8. What factors predict improvements in outcomes scores and reoperations after the Bernese periacetabular osteotomy?

    Science.gov (United States)

    Beaulé, Paul E; Dowding, Chris; Parker, Gillian; Ryu, Jae-Jin

    2015-02-01

    The Bernese periacetabular osteotomy (PAO) has entered its fourth decade and is frequently used for corrective osteotomy in patients with acetabular dysplasia. Although our capacity to preserve the joint after corrective osteotomy is excellent, gaining a better understanding on how well patients function after this surgery is important as well. (1) What changes in patient-reported outcomes scores occur in patients treated with PAO for hip dysplasia in the setting of a single-surgeon practice? (2) What are the predictors of clinical function and survivorship? All 67 patients presenting to a single surgeon's clinic with hip dysplasia treated with PAO between October 2005 and January 2013 were prospectively followed. Baseline demographic data as well as pre- and postoperative radiographic and functional measurements were obtained with a minimum of 1-year followup. Radiographic criteria included Tönnis grade, Tönnis angle, minimum joint space width, center-edge angle, presence of crossover sign, medial translation of the hip center, and alpha angle. We also used validated outcome measures including the WOMAC, the UCLA Activity Scale, and the SF-12. Multiple regression analysis was used to determine predictors of functional outcome scores. There were increases in WOMAC, UCLA, and SF-12 Physical scores. Higher preoperative alpha angle was associated with a lower postoperative WOMAC score (β=-0.47; 95% confidence interval [CI], -0.92 to -0.02; R2=0.08; p=0.04). The 5-year Kaplan-Meier survivorship was 94.1% (95% CI, 90.7-97.5) with reoperation (ie, hip arthroscopy and/or total hip arthroplasty) used as the endpoint for failure. With the limited numbers available, we could not identify any demographic or radiographic factors associated with reoperation. Overall survivorship for the PAO at our center at 5 years is comparable to other clinical series with overall functional scores improving. A greater alpha angle preoperatively was associated with poorer patient

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

    Directory of Open Access Journals (Sweden)

    van Biezen Frans C

    2011-06-01

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

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

    Science.gov (United States)

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

    2016-09-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

    Rhinelander, F W; Stewart, C L

    1983-10-01

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

  13. Observational Facts of Sustained Departure Plateau Vortexes

    Institute of Scientific and Technical Information of China (English)

    YU Shuhua; GAO Wenliang; PENG Jun; XIAO Yuhua

    2014-01-01

    By using the twice-daily atmospheric observation data from 1998 to 2012, station rainfall data, Tropical Rainfall Measure Mission (TRMM) data, as well as the plateau vortex and shear line year book, charac-teristics of the sustained departure plateau vortexes (SDPVs) are analyzed. Some new useful observational facts and understanding are obtained about the SDPV activities. The following results are obtained. (1) The active period of SDPVs is from June to August, most in July, unlike that of the unsustained depar-ture plateau vortexes (UDPVs), which have same occurrence frequencies in the three summer months. (2) The SDPVs, generated mainly in the Qumalai neighborhood and situated in a sheared surrounding, move eastward or northeastward, while the UDPVs are mainly led by the upper-level trough, and move eastward or southeastward. (3) The SDPVs influence wide areas of China, even far to the Korean Peninsula, Japan, and Vietnam. (4) The SDPVs change their intensities and properties on the way to the east. Most of them become stronger and produce downpour or sustained regional rainstorms to the south of Yellow River. (5) The longer the SDPV sustains, the more baroclinity it has. (6) When an SDPV moves into the sea, its central pressure descends and rainfall increases in all probability. (7) An SDPV might spin over the bend of the Yellow River when there exists a tropical cyclone in the East China Sea. It could also move oppositely to a landed tropical low pressure originated from the sea to the east of Taiwan or from the South China Sea.

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

    Science.gov (United States)

    Valley, B A; Reese, H W

    1991-08-01

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

  15. Approaches and perioperative management in periacetabular osteotomy surgery

    DEFF Research Database (Denmark)

    Søballe, Kjeld; Troelsen, Anders

    2012-01-01

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

  16. ANALYSIS OF MESOSCALE CONVECTIVE SYSTEMS OVER TIBETAN PLATEAU IN SUMMER

    Institute of Scientific and Technical Information of China (English)

    GUO Zhong-yang; DAI Xiao-yan; WU Jian-ping; LIN Hui

    2006-01-01

    In this paper, Geostationary Meteorological Satellite (GMS) infrared black-body temperature (Tbb) data from June to August 1998 are used to automatically track the activity of Mesoscale Convective System (MCS) over the Tibetan Plateau in China. Consequently, the features of MCS, such as area, intensity, life cycle, activity region and shape, are obtained. High Resolution Limited Area Analysis and Forecasting System (HLAFS) values provided by China National Meteorological Center are used to study the relationships between the MCS trajectories and their environmental physical field values, based on the distribution and trajectories of MCSs over the Tibetan Plateau. Favorable environmental physical field charts of influencing MCS movement out of the Tibetan Plateau in different UTC (Universal Time Coordinate) are developed by using spatial data mining techniques at levels of 400hPa and 500hPa, respectively.

  17. More evidence of the plateau effect: a social perspective.

    Science.gov (United States)

    Pinto-Prades, J L; Lopez-Nicolás, A

    1998-01-01

    The purpose of this study was to test the existence of the plateau effect at the social level. The authors tried to confirm the preliminary conclusion that people may not be willing to trade off any longevity to improve the health state of a large number of people if the health states are mild enough. They tested this assumption using the person-tradeoff technique. They also used a parametric approach and a nonparametric approach to study the relationship between individual and social values. Results show the existence of the plateau effect in the context of resource allocation. Furthermore, with the nonparametric approach, a plateau effect in the middle part of the scale was also observed, suggesting that social preference may not be directly predicted from individual utilities. The authors caution against the possible framing effects that may be present in these kinds of questions.

  18. Fukushima nuclear accident recorded in Tibetan Plateau snow pits.

    Directory of Open Access Journals (Sweden)

    Ninglian Wang

    Full Text Available The β radioactivity of snow-pit samples collected in the spring of 2011 on four Tibetan Plateau glaciers demonstrate a remarkable peak in each snow pit profile, with peaks about ten to tens of times higher than background levels. The timing of these peaks suggests that the high radioactivity resulted from the Fukushima nuclear accident that occurred on March 11, 2011 in eastern Japan. Fallout monitoring studies demonstrate that this radioactive material was transported by the westerlies across the middle latitudes of the Northern Hemisphere. The depth of the peak β radioactivity in each snow pit compared with observational precipitation records, suggests that the radioactive fallout reached the Tibetan Plateau and was deposited on glacier surfaces in late March 2011, or approximately 20 days after the nuclear accident. The radioactive fallout existed in the atmosphere over the Tibetan Plateau for about one month.

  19. SUMMER DIURNAL CYCLE AT DOME C ON THE ANTARTIC PLATEAU

    OpenAIRE

    Barral, H.; E. Vignon; Bazile, E.; Traullé, O; Gallée, H.; Genthon, C.; Brun, C.; F. Couvreux; P. Le Moigne

    2014-01-01

    International audience; The ice-sheet offers us ”laboratory cases” with endless snow covered, relatively homogeneous, flat or sloped areas with persistent and strong stable stratifications resulting in low level jets. Dome C (75°06 S,123°E) on the East Antarctic Plateau is one of them.

  20. Heat Flow for the Minimal Surface with Plateau Boundary Condition

    Institute of Scientific and Technical Information of China (English)

    Kung Ching CHANG; Jia Quan LIU

    2003-01-01

    The heat flow for the minimal surface under Plateau boundary condition is defined to be aparabolic variational inequality, and then the existence, uniqueness, regularity, continuous dependenceon the initial data and the asymptotics are studied. It is applied as a deformation of the level sets inthe critical point theory.

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

    Science.gov (United States)

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

    2017-06-01

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

  2. Outcome of peri-acetabular osteotomy for hip dysplasia in teenagers.

    Science.gov (United States)

    Sakamoto, Tetsuya; Naito, Masatoshi; Nakamura, Yoshinari

    2015-11-01

    Peri-acetabular osteotomy, especially curved peri-acetabular osteotomy, is an effective surgical procedure for re-orientating the acetabulum. However, there have been few reports on this procedure in teenagers. The purpose of this study was to investigate the treatment outcomes of curved peri-acetabular osteotomy in teenagers. We retrospectively reviewed 33 hips in 27 teenage patients with acetabular dysplasia who underwent curved peri-acetabular osteotomy between 1995 and 2012. The mean age was 17.0 years (range, 14-19 years). The mean follow-up duration at the most recent physical examination was 33.3 months (range, 24-96 months). All hips were evaluated in terms of the Harris hip score, radiographic measurements, and complications. The mean Harris hip score improved from 80.1 points pre-operatively to 95.4 points post-operatively (p osteotomy (four hips), superficial stitch abscess (two hips), and transient lateral femoral cutaneous nerve palsy (three hips). Satisfactory results can be obtained clinically and radiographically after curved peri-acetabular osteotomy in adolescents. Osteotomy for acetabular dysplasia is effective in teenagers.

  3. Ulnar Shortening Osteotomy After Distal Radius Fracture Malunion: Review of Literature

    Science.gov (United States)

    Barbaric, Katarina; Rujevcan, Gordan; Labas, Marko; Delimar, Domagoj; Bicanic, Goran

    2015-01-01

    Malunion of distal radius fracture is often complicated with shortening of the radius with disturbed radio- ulnar variance, frequently associated with lesions of triangular fibrocartilage complex and instability of the distal radioulnar joint. Positive ulnar variance may result in wrist pain located in ulnar part of the joint, limited ulnar deviation and forearm rotation with development of degenerative changes due to the overloading that occurs between the ulnar head and corresponding carpus. Ulnar shortening osteotomy (USO) is the standard procedure for correcting positive ulnar variance. Goal of this procedure is to minimize the symptoms by restoring the neutral radio - ulnar variance. In this paper we present a variety of surgical techniques available for ulnar shorthening osteotomy, their advantages and drawbacks. Methods of ulnar shortening osteotomies are divided into intraarticular and extraarticular. Intraarticular method of ulnar shortening can be performed arthroscopically or through open approach. Extraarticular methods include subcapital osteotomy and osteotomy of ulnar diaphysis, which depending on shape can be transverse, oblique, and step cut. All of those osteotomies can be performed along wrist arthroscopy in order to dispose and treat possibly existing triangular fibrocartilage complex injuries. At the end we described surgical procedures that can be done in case of ulnar shorthening osteotomy failure. PMID:26157524

  4. Transposition of the acetabulum after iliac ischial osteotomy in the treatment of hip dysplasia in infants

    Directory of Open Access Journals (Sweden)

    Владимир Евгеньевич Басков

    2016-06-01

    Full Text Available Background. Transposition of the acetabulum after pelvic osteotomy is the most effective surgical method to treat dysplastic hip joint disorders in patients of different ages. According to Salter, iliac osteotomy of the pelvis is the main surgical method used to correct dysplastic acetabulum in 7- and 8-year-old children. In older patients, the pubic symphysis and pelvic ligaments become more rigid, which significantly limits the degree of rotation of the acetabulum. In these cases, a triple pelvic osteotomy is performed to enhance the mobility of the acetabular fragment. This pubic bone osteotomy is performed near the femoral neurovascular bundle, which may be damaged during the procedure.Aim. To describe a technique for transposition of the acetabulum after iliac and ischial osteotomy of the pelvis, which was developed to reduce trauma, prevent vascular complications, and increase postoperative stability of the pelvic ring.Materials and methods. A method developed by the authors for transposition of the acetabulum after iliac and sciatic pelvic osteotomy is described in detail. The surgical method was performed 99 times on 89 children with dysplastic hip joint disorders, and the results are presented.Conclusion. Transposition of the acetabulum after iliac and ischial pelvic osteotomy is an effective treatment for dysplastic instability of the acetabulum in children aged 9–16 years. The procedure is indicated when it is necessary to rotate the acetabular fragment by more than 25°, and there is no need for hip medialization.

  5. Effect of posterior multilevel vertebral osteotomies on coronal and sagittal balance in fused scoliosis deformity caused by previous surgery: preliminary results.

    Science.gov (United States)

    Yang, Jae Hyuk; Suh, Seung Woo; Cho, Won Tae; Hwang, Jin Ho; Hong, Jae Young; Modi, Hitesh N

    2014-10-15

    Prospective case series study. To study the effect of posterior multilevel vertebral osteotomy (posterior crack osteotomy) on coronal and sagittal balance in patients with the fusion mass over the spine caused by previous surgery. Few studies have investigated revisional scoliosis surgery with the fusion mass using osteotomy. Among patients who had a history of prior surgery for scoliosis correction and posterior fusion, those showing progression of the curve postoperatively due to nonunion, implant failure, or adding-on phenomenon were enrolled. All patients were treated using posterior crack osteotomy. For clinical evaluation, the pre- and postoperative Gross Motor Function Classification System score for walking status and the Berg balanced scale were used. For radiological evaluation, pre- and postoperative Cobb angle, and coronal and sagittal balance factors were used. Ten patients (5 males and 5 females) were enrolled. The preoperative diagnosis was neuromuscular scoliosis (3 cases), syndromic scoliosis (1 case), congenital scoliosis (5 cases), and neurofibromatosis (1 case). Osteotomies were performed at 3.3±1.3 levels on average. Pre- and postoperative Cobb angles were 70.8°±30.0° and 28.1°±20.0° (P=0.002 (0.97)), respectively. In pre- and postoperative evaluation of coronal balance, the coronal balance, clavicle angle, and T1-tilt angle were 36.8±27.1 mm and 10.4±8.5 mm, 6.7°±8.0° and 3.3°±1.5°, and 7.8°±19.0° and 4.7°±2.1°, respectively (P=0.002, 0.002, 0.002). In pre- and postoperative evaluation of sagittal balance, the spinal vertical axis, thoracic kyphosis, and lumbar alignments were 25.1±37.8 mm and 14.1±21.8 mm, 33.5°±51.1° and 29.7°±27.4°, and 45.7°±34.8° and 48.9°±23.1° (P=0.002, 0.169, 0.169). The walking and functional statuses did not change (P=0.317, 0.932). Although pulmonary and gastrointestinal complications were noted, the patients were discharged without complications. Posterior crack osteotomy can be

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

    Science.gov (United States)

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

    2015-07-01

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

  7. The Pajarito Plateau: a bibliography

    Science.gov (United States)

    Mathien, Frances Joan; Steen, Charlie R.; Allen, Craig D.

    1993-01-01

    This bibliography is the result of two initially independent projects. As the consulting archaeologist at Los Alamos National Laboratory (LANL), Charlie R. Steen collected entries at the suggestion of the staff of the Environmental Surveillance Group of the Health, Safety, and Environmental Division, HSE-8. The primary purpose was to aid the staff in evaluating cultural resources on LANL lands. In addition to works that related to the archaeology and history of the area, Steen included notations of a few books and articles in other fields such as geology and natural history. It was hoped that they also would be of value to other organizations and to students of past human activities on the Pajarito Plateau.At the same time, the National Park Service (NPS) was planning a major survey of Bandelier National Monument (BNM). As part of this plan, the author was asked to prepare a background document that described research previously carried out in the area, including an annotated bibliography. Although the survey would be limited to the park boundaries, the larger Pajarito Plateau is a more logical study area from physiographic, environmental, and cultural perspectives; hence the focus was on this larger region. Mathien (1986) also included some references to natural resources studies, particularly those initiated by NPS within Bandelier National Monument.Both bibliographies were made available to Colleen Olinger and Beverly Larson of the Health and Environmental Services Group at Los Alamos. They realized that while neither was complete, each included entries missing from the other. Larson suggested the two bibliographies be combined. (At this time, Craig Allen was studying the landscape of the Jemez Mountains [Allen 1984c, 1989]. His investigations included much detailed information on natural resource studies and were added in 1991 and 1992.)To limit the scope of their work, Steen and Mathien had chosen their parameter: the Pajarito Plateau. Geographically, the

  8. Lake overspill and onset of fluvial incision in the Iranian Plateau: Insights from the Mianeh Basin

    Science.gov (United States)

    Heidarzadeh, Ghasem; Ballato, Paolo; Hassanzadeh, Jamshid; Ghassemi, Mohammad R.; Strecker, Manfred R.

    2017-07-01

    Orogenic plateaus represent a prime example of the interplay between surface processes, climate, and tectonics. This kind of an interplay is thought to be responsible for the formation, preservation, and, ultimately, the destruction of a typical elevated, low-internal relief plateau landscape. Here, we document the timing of intermontane basin filling associated with the formation of a low-relief plateau morphology, followed by basin opening and plateau-flank incision in the northwestern Iranian Plateau of the Arabia-Eurasia collision zone. Our new U-Pb zircon ages from intercalated volcanic ashes in exposed plateau basin-fill sediments from the most external plateau basin (Mianeh Basin) document that the basin was internally drained at least between ∼7 and 4 Ma, and that from ∼5 to 4 Ma it was characterized by an ∼2-km-high and ∼0.5-km-deep lake (Mianeh paleolake), most likely as a result of wetter climatic conditions. At the same time, the eastern margin of the Mianeh Basin (and, therefore, of the Iranian Plateau) experienced limited tectonic activity, as documented by onlapping sediments and smoothed topography. The combination of high lake level and subdued topography at the plateau margin led to lake overspill, which resulted in the cutting of an ∼1-km-deep bedrock gorge (Amardos) by the Qezel-Owzan River (QOR) beginning at ∼4 Ma. This was associated with the incision of the plateau landscape and the establishment of fluvial connectivity with the Caspian Sea. Overall, our study emphasizes the interplay between surface and tectonic processes in forming, maintaining, and destroying orogenic plateau morphology, the transitional nature of orogenic plateau landscapes on timescales of 106 yr, and, finally, the role played by overspilling in integrating endorheic basins.

  9. Biomechanical optimization of different fixation modes for a proximal femoral L-osteotomy

    Directory of Open Access Journals (Sweden)

    Chen Hsih-Hao

    2009-09-01

    Full Text Available Abstract Background Numerous proposed surgical techniques have had minimal success in managing greater trochanter overgrowth secondary to retarded growth of the femoral capital epiphysis. For reconstruction of residual hip deformities, a novel type of proximal femur L-osteotomy was performed with satisfactory results. Although the clinical outcome was good, the biomechanical characteristics of the femur after such an osteotomy have not been clearly elucidated. Therefore, this study presents a three dimensional finite element analysis designed to understand the mechanical characteristics of the femur after the L-osteotomy. Methods A patient with left hip dysplasia was recruited as the study model for L-osteotomy. The normal right hip was used as a reference for performing the corrective surgery. Four FEA models were constructed using different numbers of fixation screws but the same osteotomy lengths together with four FEA models with the same number of fixation screws but different osteotomy lengths. The von Mises stress distributions and femoral head displacements were analyzed and compared. Results The results revealed the following: 1. The fixation devices (plate and screws sustained most of the external loading, and the peak value of von Mises stress on the fixation screws decreased with an increasing number of screws. 2. Additional screws are more beneficial on the proximal segment than on the distal segment for improving the stability of the postoperative femur. 3. The extent of osteotomy should be limited because local stress might be concentrated in the femoral neck region with increasing length of the L-osteotomy. Conclusion Additional screw placement on the proximal segment improves stability in the postoperative femur. The cobra-type plate with additional screw holes in the proximal area might improve the effectiveness of L-osteotomies.

  10. Refinements in osteotomy design to improve structural integrity: a finite element analysis study.

    Science.gov (United States)

    Bujtar, P; Simonovics, János; Váradi, Károly; Sándor, George K B; Pan, Jingzhe; Avery, C M E

    2013-09-01

    Osteotomy cuts are typically made using a saw, and the meeting point acts as a focus for the concentration of stress and failure. We have studied the impact of different designs of osteotomy cut. Cadaver sheep tibias were scanned by computed tomography (CT) and transformed into a computer-aided design (CAD) model. A standard marginal resection defect was created and then modified, and a finite element analysis made. The relative stress concentrations at the intersection of osteotomy cuts were recorded using principal stresses S1, S3, and von Mises stress, von Mises under both 4-point bending and torsion testing. The osteotomy designs studied were: right-angled and bevelled osteotomy end cuts, overcutting, and a stop drill hole. Peak stress values for 4-point bending and torsion were 24-30% greater at the right-angled osteotomy than the bevelled end cut. Overcutting dramatically increased peak stress values caused by bending and torsion by 48% and 71%, respectively. Substantially lower concentrations of stress were noted with a stop hole using both a 90° (bending 38% and torsion 56%), and a tangential (bending 58% and torsion 60%) cut. A bevelled osteotomy has substantially lower concentrations of stress than a right-angled osteotomy. It is important to avoid creating an overcut as this causes an appreciable increase in the concentration of stress, while a stop drill hole substantially reduces the stress. The creation of a stop hole and the use of judicious bevelling techniques are modifications in the design of an osteotomy that are readily applicable to surgical practice. Copyright © 2012 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Monuments of the Giza Plateau

    Science.gov (United States)

    Ruggles, Clive L. N.

    The colossal pyramids of the pharaohs Khufu (Cheops), Khafre (Chephren), and Menkaure (Mycerinus) have attracted a huge amount of astronomical interest over the years, both scholarly and popular. Less attention is usually given to the broader context of structures on the Giza Plateau. One of the most notorious ideas connecting the Giza Plateau with astronomy is that the three large pyramids are laid out on the ground so as to reflect the appearance of the three stars of Orion's Belt in the sky. This idea is unsupportable for several reasons but has succeeded in generating huge public interest. Of much greater serious interest is the fact that the three main pyramids were oriented cardinally to extraordinary precision, which raises the questions of why this was important and how it was achieved. Another idea that has attracted serious attention but also some confusion is that the orientations of some narrow shafts within Khufu's pyramid might have been deliberately aligned upon particular stars. The overall layout of monuments on the plateau may certainly have been designed so as to emphasize certain solar phenomena, for symbolic and ideological reasons relating to a dominant sun cult. It is also possible that it formed part of a wider cosmological "master plan" extending to other pyramids and temples up to 20 km distant.

  12. Rotational Acetabular Osteotomy for Pre- and Early Osteoarthritis Secondary to Dysplasia Provides Durable Results at 20 Years.

    Science.gov (United States)

    Yasunaga, Yuji; Ochi, Mitsuo; Yamasaki, Takuma; Shoji, Takeshi; Izumi, Sotaro

    2016-10-01

    Kaplan-Meier product-limited method and parametric survivorship analysis using the Cox proportional-hazards model was used to determine risk factors for radiographic OA progression. The mean clinical score improved very slightly, from 15 (SD, 0.8) to 18 (SD, 1.1) (95% confidence interval [CI], -2.9 to -2.0; p osteotomy of 20 (SD, 2.5) years. Radiographic indices were improved after surgery in both groups. Radiographic progression of OA occurred in 24 patients (25 hips). Kaplan-Meier survivorship analysis, with radiographic signs of progression of OA as the endpoint, predicted survival of 96% (95% CI, 89%-100%) at 10 years and 20 years in the pre-OA group. For the early-stage group, we found survivorship of 89% (95% CI, 83%-95%) at 10 years and 78% (95% CI, 69%-87%) at 20 years. We identified two factors associated with poor outcome: fair (rather than excellent and good) postoperative joint congruency (hazard ratio, 12.1; 95% CI, 3.8-39; p osteotomy is an effective surgical procedure for symptomatic dysplastic hips in pre- and early-stage OA, and it prevented radiographic OA progression and maintained hip function at a mean 20 years after surgery. Level IV, therapeutic study.

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

    Science.gov (United States)

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

    2013-05-01

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

  14. Lateral epicondylar osteotomy for severe varus deformity during total knee arthroplasty

    Institute of Scientific and Technical Information of China (English)

    Hong Chen; Wei Huang; Xi Liang; Ning Hu; Wei Xu; Dianming Jiang

    2015-01-01

    In most cases of arthritic varus knees, stepwise osteophytes removal and medial soft tissue release could achieve satisfactory soft tissue balance during total knee arthroplasty.However, in some severe cases, conventional balancing techniques are not enough, necessitating other procedures like epicondylar osteotomy.To the best of our knowledge, no published article has reported the application of lateral epicondylar osteotomy in a severe varus knee.Here we reported a case of successful correction of a severe varus knee following lateral epicondylar osteotomy, and described its underlying rationale.

  15. A Modified Triple Pelvic Osteotomy for the Treatment of Hip Hypoplasia

    Directory of Open Access Journals (Sweden)

    Hassan Rahimi

    2013-09-01

    Full Text Available Background: The prevalence of hip dysplasia is 1 in 1000. Several pelvic osteotomy methods have been developed to prevent early osteoarthritis, such as triple osteotomy. In this study we are going to introduce our new technique that was done on 4 patients with favorable short-term results.   Methods: Four patients underwent triple osteotomy and fixation using a reconstruction plate and early weight bearing was started. Results: The Harris Hip Score, limb length, center-edge angle, and acetabular inclination showed improvement. Conclusion: This modified technique is suggested for corrective surgery on adult dysplastic hips.

  16. A Modified Triple Pelvic Osteotomy for the Treatment of Hip Hypoplasia

    Directory of Open Access Journals (Sweden)

    Hassan Rahimi

    2013-09-01

    Full Text Available   Background: The prevalence of hip dysplasia is 1 in 1000. Several pelvic osteotomy methods have been developed to prevent early osteoarthritis, such as triple osteotomy. In this study we are going to introduce our new technique that was done on 4 patients with favorable short-term results.   Methods: Four patients underwent triple osteotomy and fixation using a reconstruction plate and early weight bearing was started. Results: The Harris Hip Score, limb length, center-edge angle, and acetabular inclination showed improvement. Conclusion: This modified technique is suggested for corrective surgery on adult dysplastic hips.

  17. Pollen-based reconstructions of Holocene vegetation and climatic change of Tibetan Plateau

    Institute of Scientific and Technical Information of China (English)

    唐领余; 李春海; 于革; 沈才明

    2003-01-01

    A synthesis of Holocene pollen records from the Tibetan Plateau shows the history of vegetation and climatic changes during the Holocene. Palynological evidences from 24 cores/sections have been compiled and show that the vegetation shifted from subalpine/alpine conifer forest to subalpine/alpine evergreen sclerophyllous forest in the southeastern part of the plateau; from alpine steppe to alpine desert in the central, western and northern part; and from alpine meadow to alpine steppe in the eastern and southern plateau regions during the Holocene. These records show that increases in precipitation began about 9 ka from the southeast, and a wide ranging level of increased humidity developed over the entire of the plateau around 8-7 ka, followed by aridity from 6 ka and a continuous drying over the plateau after 4-3 ka. The changes in Holocene climates of the plateau can be interpreted qualitatively as a response to orbital forcing and its secondary effects on the Indian Monsoon which expanded northwards during the early Holocene and retreated from the plateau since the midHolocene. Also, there is teleconnection between the Tibetan Plateau and North Atlantic.

  18. Severe Class II malocclusion with facial asymmetry treated with intraoral vertico-sagittal ramus osteotomy and LeFort I osteotomy.

    Science.gov (United States)

    Kuroda, Shingo; Murakami, Kaoru; Morishige, Yasuko; Takano-Yamamoto, Teruko

    2009-06-01

    In this article, we report the successful treatment of a patient, aged 19 years 11 months, who had a severe Class II malocclusion and facial asymmetry. A combination of intraoral vertical-sagittal ramus osteotomy (IVSRO), intraoral vertical ramus osteotomy (IVRO), and LeFort I osteotomy was used for mandibular advancement and maxillary impaction. The patient had a convex profile because of a retrognathic mandible. She also had severe mandibular deviation and vertical maxillary excess with a canted occlusal plane. A deep overbite of 8.0 mm and an excessive overjet of 10.0 mm were observed. After 16 months of presurgical orthodontic treatment, IVRO in the left ramus and IVSRO in the right ramus were performed with maxillary impaction by LeFort I osteotomy. The mandible was advanced 6.0 mm on the right side, and the maxilla was impacted 4.0 mm at ANS, 2.0 mm at the right first molar, and 5.0 mm at the left first molar. The total active treatment time was 35 months. Both occlusion and facial appearance were significantly improved by the surgical-orthodontic treatment. Occlusion was stable after a year of retention. There were no functional problems during or after treatment. Our results suggest that IVSRO and IVRO combined with LeFort I osteotomy in a patient with severe mandibular retrusion with facial asymmetry might be useful to improve occlusion and facial esthetics.

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

    Science.gov (United States)

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

    2017-01-16

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

  20. Biodiversity and conservation in the Tibetan Plateau

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    The Tibetan Plateau (Qinghai-Xizang Plateau) is a unique biogeographic region in the world, where various landscapes, altitudinal belts, alpine ecosystems, and endangered and endemic species have been developed. A total of 26 altitudinal belts, 28 spectra of altitudinal belts, 12,000 species of vascular plant, 5,000 species of epiphytes, 210 species of mammals, and 532 species of birds have been recorded. The plateau is also one of the centers of species formation and differentiation in the world. To protect the biodiversity of the plateau, about 80 nature reserves have been designated, of which 45 are national or provincial, covering about 22% of the plateau area. Most of the nature reserves are distributed in the southeastern plateau. Recently, the Chinese government has initiated the "Natural Forests Protection Project of China,' mainly in the upper reaches of the Yangtze and Yellow rivers. "No logging" policies have been made and implemented for these areas.

  1. Minimally Invasive Calcaneal Displacement Osteotomy Site Using a Reference Kirschner Wire: A Technique Tip.

    Science.gov (United States)

    Lee, Moses; Guyton, Gregory P; Zahoor, Talal; Schon, Lew C

    2016-01-01

    As a standard open approach, the lateral oblique incision has been widely used for calcaneal displacement osteotomy. However, just as with other orthopedic procedures that use an open approach, complications, including wound healing problems and neurovascular injury in the heel, have been reported. To help avoid these limitations, a percutaneous technique using a Shannon burr for calcaneal displacement osteotomy was introduced. However, relying on a free-hand technique without direct visualization at the osteotomy site has been a major obstacle for this technique. To address this problem, we developed a technical tip using a reference Kirschner wire. A reference Kirschner wire technique provides a reliable and accurate guide for minimally invasive calcaneal displacement osteotomy. Also, the technique should be easy to learn for surgeons new to the procedure. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Bone grafting with granular biomaterial in segmental maxillary osteotomy: A case report

    Directory of Open Access Journals (Sweden)

    Orion Luiz Haas Junior

    2016-01-01

    Conclusion: This is the first report of bone grafting with a granular biomaterial in segmental maxillary osteotomy. Successful formation of new bone with density greater than that of the surrounding tissue was achieved, preventing pseudarthrosis and postoperative instability.

  3. Shortening Scarf osteotomy for correction of severe hallux valgus. Does shortening affect the outcome?

    Science.gov (United States)

    Karpe, Prasad; Killen, Marie C; Pollock, Raymond D; Limaye, Rajiv

    2016-12-01

    Translation and shortening of Scarf osteotomy allows correction of severe hallux valgus deformity. Shortening may result in transfer metatarsalgia. To evaluate outcome of patients undergoing shortening Scarf osteotomy for severe hallux valgus deformities. Fifteen patients (20feet, mean age 58 years) underwent shortening Scarf osteotomy for severe hallux valgus deformities. Outcomes were pre and postoperative AOFAS scores, IM and HV angles, patient satisfaction. Mean follow-up was 25 months (range 22-30). The IM angle improved from a median of 18.60 (range 13.4-26.20) preoperatively to 9.70 (range 8.0-13.70) postoperatively (8.9; 95% CI=7.6-10.3; posteotomies united. Shortening Scarf osteotomy is a viable option for treating severe hallux valgus deformities with no transfer metatarsalgia. Copyright © 2016 Elsevier Ltd. All rights reserved.

  4. Modified versus classic alar base sutures after LeFort I osteotomy: a systematic review.

    Science.gov (United States)

    Liu, Xianwen; Zhu, Songsong; Hu, Jing

    2014-01-01

    The purpose of this systematic review is to evaluate the efficacy of a new modified alar base cinch suture by comparing it with the commonly used classic alar base suture after LeFort I osteotomy. A comprehensive search strategy was performed to include interventional studies involving the comparisons of alar base suturing methods after LeFort I osteotomy. Data analyses were conducted using the random-effects model. Three studies with 146 participants undergoing LeFort I maxillary osteotomy were included in this review. The results showed that, compared with the classic method, both modified transseptal alar base suture and modified reinsertion sutures significantly decreased postoperative alar and alar base widening. The modified alar base cinch suture was more effective than the classic alar base suture in maintaining preoperative alar and alar base width after LeFort I osteotomy. Copyright © 2014 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

    Petersen, W; Forkel, P

    2013-12-01

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

  6. The role of AO external fixation in proximal femoral osteotomies in the pediatric neuromuscular population.

    Science.gov (United States)

    Handelsman, John E; Weinberg, Jacob; Razi, Afshin; Mulley, Debra A

    2004-09-01

    Internal fixation in proximal femoral osteotomies using traditional devices may be sub-optimal in children with neuromuscular disorders who have small or osteopenic bone. In this population, between 1988 and 2000, we performed 36 proximal femoral varus osteotomies in 28 patients. These were controlled by the AO external fixator. The average age at surgery was 7 years (range, 2-13 years). A mean varus correction of 34 degrees (range, 15-90 degrees) was obtained. Complications consisted of one superficial pin tract infection, one skin breakdown, and one non-union. Other than the non-union, all osteotomies were stable at the time of the fixator removal. The AO external fixator is an effective alternative in maintaining corrective proximal femoral osteotomies in children with fragile bones.

  7. Premaxillary osteotomy fixation in bilateral cleft lip/palate: Introducing a new technique

    Directory of Open Access Journals (Sweden)

    Amin Rahpeyma

    2016-04-01

    Conclusion: In protruding premaxilla, osteotomy and fixation of premaxilla with miniplate to the vomer bone during alveolar bone grafting through a lip-split approach yielded satisfactory results in patients requiring secondary functional cheilorhinoplasty.

  8. [Olecranon osteotomy in the treatment of distal humeral fractures in adults: anatomical and functional evaluation of the elbow in 14 cases].

    Science.gov (United States)

    Sané, A D; Dakouré, P W H; Diémé, C B; Kinkpé, C V A; Dansokho, A V; Ndiaye, A; Seye, S I L

    2009-04-01

    Osteotomy of the olecranon is commonly used to gain exposure for reconstruction of bi-condylar fractures of the distal humerus (type 13-C of classification AO), but there is controversy because of the considerable complications inherent in this technique. The aim of our study is to examine the anatomical and functional consequences of this technique of exposure on the elbow. This is a retrospective study over a continuous 7-year period. We confined ourselves to patients more than 15 years old who had presented with a bi-condylar fracture (type C of the AO) of the distal humerus, internally fixed through an osteotomy of the olecranon. We reexamined and evaluated 14 treated patients who had been operated in our service. There were nine men and five women with an average age of 34 years (range 17 to 70 years). According to the AO classification, we found 14 fractures distributed in the following way: three type C1, seven type C2 and four type C3; the fracture was open in two cases. The osteotomy was carried out in all the cases using an osteotome, extra-articular in six cases and intra-articular way in eight cases. Repair was always performed using tension band wiring. The evaluation was based on anatomical and functional criteria (Mayo Elbow Performance Score). No case of radial and ulnar paralysis was found. Thirty-six percent of the olecranon fixations were of bad quality and we found one case of olecranon pseudarthrosis. No case of heterotypic calcification was found, on the other hand, there was a case of post-traumatic osteoarthritis of the elbow. On the functional level, we obtained 36% of excellent results, 28.5% of good results, 7% of average results and 28.5% of bad results. Osteotomy of the olecranon is one of the techniques for exposure of the articular surface during reconstruction of fractures of the distal humerus. A rigorous technique allows one to avoid complications.

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

    Science.gov (United States)

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

    2004-11-01

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

  10. 全膝关节置换中的改良截骨%Improved osteotomy in total knee arthroplasty

    Institute of Scientific and Technical Information of China (English)

    李守民; 徐玮; 孔荣; 尚希福; 夏睿

    2013-01-01

    BACKGROUND: Recently, total knee arthroplasty has been widely applied in clinic, and the replacement techniques and prosthetic design concept have been greatly improved. But osteotomy order has not been reported. OBJECTIVE: To discuss the clinical effect of the improved osteotomy in total knee athroplasty. METHODS: The total knee arthroplasty was performed in 60 patients (60 knees), including 52 cases of osteoarthritis, six cases of rheumatoid arthritis and two cases of traumatic arthritis, and posterior stabilized knee joints were used for total knee arthroplasty, such as the PFC-Sigma PS prosthesis or LINK Gemini PS prosthesis. The femoral osteotomy was performed firstly under extreme knee bending, including oblique osteotomy anterior and posterior to the distal femur (some types contained intercondylar osteotomy). Patel a un-conventional replacement was performed fol owed by the tibial plateau osteotomy. The operation time, postoperative drainage volume, range of motion of knee joint as wel as Hospital for Special Surgery knee scores before replacement and 6 and 12 weeks after replacement were recorded and statistical y analyzed. RESULTS AND CONCLUSION: Al the 60 patients were fol owed-up for 3-14 months. The average operation time was (51.3±12.5) minutes; the postoperative drainage volume was (302±39) mL. The range of motion of knee joint and Hospital for Special Surgery knee scores 6 and 12 weeks after replacement were improved compared with those before replacement (P   目的:探讨改良截骨方法在全膝关节置换过程中应用的临床效果。  方法:对60例患者的60膝行全膝关节置换,原发疾病包括骨关节炎52例,类风湿性关节炎6例,创伤性关节炎2例,均为后稳定型膝关节,应用强生 PFC-Sigma PS 型假体或 LINK Gemini PS 型假体。在极度屈膝下,先行股骨截骨,包括股骨远端前方后方斜面截骨(某些类型还包括股骨髁间截骨)。髌骨不常规置换,再

  11. 不同分辨率DEM提取地面坡度的不确定性模拟:以在黄土高原的试验为例%Simulation on slope uncertainty derived from DEMs at different resolution levels:a case study in the Loess Plateau

    Institute of Scientific and Technical Information of China (English)

    汤国安; 赵牡丹; 李天文

    2003-01-01

    Slope is one of the crucial terrain variables in spatial analysis and land use planning,especially in the Loess Plateau area of China which is suffering from serious soil erosion. DEM based slope extracting method has been widely accepted and applied in practice. However slope accuracy derived from this method usually does not match with its popularity. A quantitative simulation to slope data uncertainty is important not only theoretically but also necessarily to applications. This paper focuses on how resolution and terrain complexity impact on the accuracy of mean slope extracted from DEMs of different resolutions in the Loess Plateau of China. Six typical geomorphologic areas are selected as test areas, representing different terrain types from smooth to rough. Their DEMs are produced from digitizing contours of 1:10,000 scale topographic maps. Field survey results show that 5 m should be the most suitable grid size for representing slope in the Loess Plateau area. Comparative and math-simulation methodology was employed for data processing and analysis. A linear correlativity between mean slope and DEM resolution was found at all test areas,but their regression coefficients related closely with the terrain complexity of the test areas. If taking stream channel density to represent terrain complexity, mean slope error could be regressed against DEM resolution (X) and stream channel density (S) at 8 resolution levels and expressed as (0.0015S2+0.031S-0.0325)X-0.0045S2-0.155S+0.1625, with a R2 value of over 0.98. Practical tests also show an effective result of this model in applications. The new development methodology applied in this study should be helpful to similar researches in spatial data uncertainty investigation.

  12. The Dynamic Plateau Monsoon Index and Its Association with General Circulation Anomalies

    Institute of Scientific and Technical Information of China (English)

    XUN Xueyi; HU Zeyong; MA Yaoming

    2012-01-01

    Based on monthly ECMWF reanalysis-Interim (ERA-Interim) reanalysis data,along with monthly precipitation and temperature data,the Dynamic Plateau Monsoon Index (DPMI) is defined.The results of a contrast analysis of the DPMI versus the Traditional Plateau Monsoon Index (TPMI) are described.The response of general circulation to northern Qinghai-Xizang Plateau summer monsoon anomalies and the correlation of the DPMI with general circulation anomalies are investigated.The results show that,the DPMI reflected meteorological elements better and depicted climate variation more accurately than the TPMI.In years when the plateau summer monsoon is strong,the low over the plateau and the trough near the eastern coast of Asia are deeper and higher than normal over South China.This correlation corresponds to two anomalous cyclones over the plateau and the eastern coast of Asia and an anomalous anticyclone in South China.The plateau and its adjacent regions are affected by anomalous southwesterly winds that transport more moisture to South China and cause more precipitation.The lower reaches of the Yangtze River appear to receive more precipitation by means of the strong westerly water vapor flow transported from the "large triangle affecting the region".In years when the plateau summer monsoon is weak,these are opposite.The plateau monsoon is closely related to the intensity and position of the South Asian high,and the existence of a teleconnection pattern in the mid-upper levels suggests a possible linl~ge of the East Asian monsoon and the Indian monsoon to the plateau summer monsoon.

  13. Determination of muscle effort at the proximal femur rotation osteotomy

    Science.gov (United States)

    Sachenkov, O.; Hasanov, R.; Andreev, P.; Konoplev, Yu

    2016-11-01

    The paper formulates the problem of biomechanics of a new method for treatment of Legg-Calve-Perthes disease. Numerical calculations of the rotational flexion osteotomy have been carried out for a constructed mathematical model of the hip joint, taking into account the main set of muscles. The work presents the results of the calculations and their analysis. The results have been compared with the clinical data. The calculations of the reactive forces arising in the acetabulum and the proximal part of the femur allowed us to reveal that this reactive force changes both in value and direction. These data may be useful for assessing the stiffness of an external fixation device used in orthopedic intervention and for evaluating the compression in the joint.

  14. Computer and robotic assisted osteotomy around the knee.

    Science.gov (United States)

    Phillips, R; Hafez, M A; Mohsen, A M; Sherman, K P; Hewitt, J R; Browbank, I; Bouazza-Marouf, K

    2000-01-01

    The outcome variability and failures of conventional osteotomy have been attributed to lack of preoperative planning and inaccuracy in performing the correction. We present a computer and robotic assisted surgery system that can aid in accurate surgical planning for realignment, and in precisely implementing the plan in theatre. The approach seeks to avoid the cost and risks associated with the use of CT, and the insertion of fiducial markers, which are characteristic of existing computer assisted surgical systems. The paper details the architecture of the system as a whole, placing particular emphasis on planning technique. It is anticipated that the increased accuracy possible with the system will prove particularly useful for correcting multi-plane deformities, which are more problematic with conventional techniques.

  15. Removal of Deeply Impacted Mandibular Molars by Sagittal Split Osteotomy

    Directory of Open Access Journals (Sweden)

    Erol Cansiz

    2016-01-01

    Full Text Available Mandibular third molars are the most common impacted teeth. Mandibular first and second molars do not share the same frequency of occurrence. In rare cases the occlusal surfaces of impacted molars are united by the same follicular space and the roots pointing in opposite direction; these are called kissing molars. In some cases, a supernumerary fourth molar can be seen as unerupted and, in this case, such a supernumerary, deeply impacted fourth molar is seen neighboring kissing molars. The extraction of deeply impacted wisdom molars from the mandible may necessitate excessive bone removal and it causes complications such as damage to the inferior alveolar nerve and iatrogenic fractures of the mandible. This case report describes the use of the sagittal split osteotomy technique to avoid extensive bone removal and protect the inferior alveolar nerve during surgical extruction of multiple impacted teeth.

  16. Mandibular nerve schwannoma resection using sagittal split ramus osteotomy.

    Science.gov (United States)

    Mahmood, Laith; Demian, Nagi; Weinstock, Yitzchak E; Weissferdt, Annikka

    2013-11-01

    A case is presented of a unique presentation and treatment of a mandibular nerve schwannoma. Its uniqueness stems from the fact that it consisted of 2 distinct tumors along the same nerve: one within the body of the mandible and the other within the ipsilateral pterygomandibular space. Rather than the standard approach of lip split and hemimandibulectomy, a unique approach of a sagittal split ramus osteotomy was used that allowed access to the 2 lesions and avoided the added morbidity of the former approach. The 2 portions of the lesion were successfully removed and the patient was satisfied with the result. Recurrence has not been detected after 6 months. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  17. What Is the Early/Mid-term Survivorship and Functional Outcome After Bernese Periacetabular Osteotomy in a Pediatric Surgeon Practice?

    Science.gov (United States)

    Grammatopoulos, George; Wales, Jeremy; Kothari, Alpesh; Gill, Harinderjit S; Wainwright, Andrew; Theologis, Tim

    2016-05-01

    The Bernese periacetabular osteotomy (PAO) is a recognized joint-preserving procedure. Achieving joint stability without creating impingement is important, but the orientation target that best balances these sometimes competing goals has not yet been clearly defined. Moreover, the learning curve of this challenging procedure has not been described. The purposes of this study were (1) to determine the 10-year survivorship and functional outcome after Bernese PAO in a single-surgeon series; (2) to review which patient, surgical, and radiographic factors might predict outcome after the procedure; and (3) to define the learning curve for target acetabular correction. The first 68 PAOs performed for symptomatic hip dysplasia were retrospectively evaluated. None have been lost to followup with followup less than 2 years. Endpoints for the lost to followup (n = 2) are at the time of when last seen. During the study period, the same surgeon performed 562 pelvic osteotomies (including Salter, Pemberton, Dega and Chiari) and 64 shelf acetabuloplasties. Bernese PAO was used only for symptomatic dysplasia (center-edge angle Bernese PAO in the hands of an experienced pediatric hip surgeon. We advocate cautious correction of the acetabular fragment. Future studies should concentrate on how to determine what the optimal target is and how to achieve it intraoperatively, minimizing the learning curve associated with it. Level III, therapeutic study.

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

    Science.gov (United States)

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

    2014-06-01

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

  19. Distal humeral Salter Harris (Type II) fracture repair by an ulnar osteotomy approach in a horse.

    Science.gov (United States)

    Ahern, Benjamin J; Richardson, Dean W

    2010-08-01

    To report repair of a comminuted distal humeral type II Salter-Harris fracture using an ulnar osteotomy approach and locking compression plates (LCP). Case report. A 3-month-old Standardbred filly with a type II Salter-Harris fracture of the distal humerus. Radiographic and computed tomography examinations were performed to assist surgical planning. The distal humeral fracture was approached by an ulnar osteotomy and repaired using a 7-hole broad LCP and screws inserted in lag fashion. The osteotomy was subsequently repaired using a 7-hole narrow LCP. The distal humeral fracture was successfully approached and stabilized by an ulnar osteotomy approach. At 6-month follow-up, the filly was ambulating comfortably with a normal cosmetic appearance. An ulnar osteotomy approach was readily performed and allowed for repair of a type II Salter-Harris fracture of the distal humerus. The equine distal humerus can be accessed readily using an ulnar osteotomy approach. LCPs allow for repair of complicated fractures that have previously been associated with a grave prognosis.

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

    Directory of Open Access Journals (Sweden)

    Ricardo Hideki Yanasse

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

  1. Effect of Osteoporosis on Bone Density of Orthognathic Osteotomy Sites in Maxillofacial Region.

    Science.gov (United States)

    On, Sung Woon; Kim, Hyun Jun; Kim, Jayoun; Choi, Jin Wook; Jung, Young Wook; Song, Seung Il

    2016-10-01

    The aims of this study were to investigate the availability of Hounsfield unit (HU) measurement of computed tomography (CT) in evaluating the bone density of certain sites by comparing bone density between CT and dual-energy x-ray absorptiometry (DEXA), and to evaluate the effects of osteoporosis on osteotomy sites in orthognathic surgery. This retrospective study included 80 patients who had undergone both facial CT and DEXA at our hospital. We selected 7 regions of interest from among the osteotomy sites in bimaxillary orthognathic surgery. The patients were assigned to either the normal (control) group (n = 40) or the abnormal group (n = 40), and HU values were measured in each region of interest. There were statistically significant differences in the mean HU values between 2 groups at all the osteotomy sites in the maxilla and mandible, with the normal group showing higher values than the abnormal group (P osteotomy sites (P osteotomy sites except for 1 maxillary area, as compared with the normal group. Measurement of HU values on CT can be valuable in assessing bone density of the maxilla and mandible. It is suggested that osteoporosis may affect bone density at the osteotomy sites in orthognathic surgery, and the preoperative measurement of HU values might be useful in predicting unfavorable fracture or the risks involved in such surgery.

  2. Laser-Assisted Osteotomy for Implant Site Preparation: A Literature Review.

    Science.gov (United States)

    Moslemi, Neda; Shahnaz, Aysan; Masoumi, Samane; Torabi, Sepehr; Akbari, Solmaz

    2017-02-01

    The aim of this study was to review the scientific evidence about the laser osteotomy in implant bed preparation. An electronic search was performed on relevant English articles up to April 2016 in the PubMed, Scopus, and Google Scholar databases. Twenty-two articles (1 clinical, 13 animal, and 8 ex vivo studies) were included. Implant sites prepared by erbium family lasers and drill showed comparable results regarding the percentage of bone-to-implant contact, values of biomechanical tests, and healing process. Selection of proper laser wavelength and parameters was of paramount importance to minimize the risk of thermal bone damage. Lack of depth control and long time needed for implant site osteotomy with laser were the most challenging concerns for its clinical applicability. Computer-guided laser osteotomy showed promise for future use of laser osteotomy in clinical settings. Evidence from animal studies shows promising results regarding laser osteotomy in implant site preparation. However, because of the lack of clinical studies, it is not possible to make a conclusive result whether there is superiority of laser osteotomy in clinical practice.

  3. The comparison of edema and ecchymosis after piezoelectric and conventional osteotomy in rhinoplasty.

    Science.gov (United States)

    Taşkın, Ümit; Batmaz, Timur; Erdil, Mehmet; Aydın, Salih; Yücebaş, Kadir

    2017-02-01

    The basic aim of our study is to compare the results of the conventional and piezoelectric osteotomy in rhinoplasty by complete subperiosteal degloving of nasal bone to minimize soft-tissue injury. The study was designed as a prospective, double-blind, randomized, and controlled study. Setting is a tertiary referral hospital in Turkey. Ninety patients who underwent primary open rhinoplasty with osteotomy, performed by either the conventional instruments or the piezoelectric device. The complete subperiosteal degloving of the entire nasal bone was done up to the nasal maxillary sulcus, medial canthus, and nasion in all patients, independent of the type of osteotomy device used. Patients subsequently underwent median-oblique and lateral osteotomy, either with an ultrasonic device or a conventional 2-mm guarded, straight osteotome. The postoperative edema and ecchymosis were evaluated by another surgeon who was blinded to the osteotomy procedure on postoperative days 2 and 7. The edema scores were significantly increased on the second day compared with the seventh day in both groups 1 and 2. However, there was no significant difference between groups. The ecchymosis scores were slightly higher in postoperative day 2, compared with day 7, in both groups 1 and 2, but statistically not significant. This study showed that the main reason edema and ecchymosis are seen post-rhinoplasty is related to soft-tissue injury during osteotomy.

  4. Exploration in Newnes Plateau, NSW

    Energy Technology Data Exchange (ETDEWEB)

    Reynolds, P.; McQuade, C. [Pasminco Port Pirie Smelter, NSW (Australia)

    1999-06-01

    Underground coal mining operations in the Western Coalfields of NSW extend into the Newnes Plateau area. The Newnes Plateau area is known for its floral diversity and distinctive topography. A quantitative flora assessment concerning rehabilitation performance of exploration sites was undertaken to refine the environmental component of the exploration process and identify practices that may assist in an improved rate of regeneration within disturbed areas. This article briefly summarises the method and key outcomes of the study, undertaken as part of an Honours Degree program. Surveys of sites showed that plant height was reduced due to vehicle traffic compacting soil, and this also led to a reduced number of plant species and a reduced number of seedlings germinating. Percentage litter cover was found to be positively correlated with the number of species on the sites and the percent plant cover of the regenerating vegetation, shallow surface ripping is recommended to relieve soil compaction. Seeds should be collected from exploration sites prior to disturbance, particularly of species like Banksia and Haken that retain their seed on the plant. Seed should then be dispersed after work has finished. 1 fig., 2 photos.

  5. Prediction of the trend of total column ozone over the Tibetan Plateau

    Institute of Scientific and Technical Information of China (English)

    刘煜; 李维亮; 周秀骥

    2001-01-01

    By using 2-D chemical model, the trend of total column ozone over the Tibetan Plateau is simulated. The results show that from 1980 to 1993, the total column ozone over the Tibetan Plateau decreases; after 1995, it starts to recover. But until 2050, it will not still reach the level of 1980 total column ozone. Under Tibetan special circulation, its total column ozone recovers more rapidly than zonal mean. Therefore, the Tibetan special meridional circulation is not a main reason why the total column ozone over the Tibetan Plateau decreases more strongly than zonal mean.

  6. The role of fibular for supramalleolar osteotomy in treatment of varus ankle arthritis: a biomechanical and clinical study.

    Science.gov (United States)

    Zhao, Hongmou; Liang, Xiaojun; Li, Yi; Yu, Guangrong; Niu, Wenxin; Zhang, Yan

    2016-10-24

    Supramalleolar osteotomy (SMOT) is a well-accepted treatment method for mid-stage varus ankle osteoarthritis (OA). However, few studies have examined the role of fibular osteotomy in SMOT. The objective of the current study was to compare the biomechanical and clinical outcomes of SMOT with and without fibular osteotomy. Eight cadaveric lower legs with 10° varus/valgus SMOT models were tested using a Tekscan ankle sensor. Tibiotalar joint contact with and without fibular osteotomy conditions were compared. Forty-one varus ankle OA patients treated with SMOT were included; 22 underwent fibular osteotomy, and 19 did not. The Maryland foot score and radiological angles were used for clinical evaluation. The mean contact area and pressure did not differ significantly between normal and varus/valgus conditions with the fibula preserved. After fibular osteotomy, the mean contact area decreased and the mean contact pressure increased significantly in varus and valgus conditions (P osteotomy in varus/valgus conditions. After a mean follow-up of 36.6 months (range 17-61), there was no significant difference in the Maryland scores of the two groups. However, in the fibular osteotomy group, the talar tilt angle decreased (P osteotomy facilitates the translation of tibiotalar contact pressure and is helpful for varus ankle realignment in patients with large talar tilts and small tibiocrural angles.

  7. An investigation on the incidence of neurosensory disturbances of inferior alveolar nerve and condylardisplacement with Choung (IVSRO osteotomy

    Directory of Open Access Journals (Sweden)

    Shirani Gh

    2004-02-01

    Full Text Available The choung osteotomy (Intraoral Vertico- Sagittal Ramus Osteotomy has developed"nsince 1992 in the treatment of mandibular prognathism. In IVSRO, osteotomy plane is theoretically parallel to"nthe original sagittal plane and thereby attempting to decrease the incidence of condylar dispacement. This"nosteotomy designed additionally to decrease neurosensory disturbances."nPurpose: The aim of this study was to evaluate the incidence of neurosensory deficit and condylar"ndisplacement with IVSRO and Sagittal Split Ramus Osteotomy (SSRO."nMaterials and Methods: In this study, mandibular set back surgery was accomplished upon 7 patients by"nchoung osteotomy. In addition to choung osteotomy, in 2 patients Lefort 1 osteomy was performed for"nmaxillary protrusion and for 2 other patients, chain surgery was performed. Variables such as the"nneurosensory disturbances of inferior alveolar nerve and condylar displacement following choung osteotomy"nwere investigated. All the patients were followed up one year after osteotomy. OPG, Lateral Cephalogram and"nSubmentovertex radiographies were take pre and postoperatively for all patients."nResults: No statistically significant differences were found in condylar displacement (P>0.5. However, Mc"nNemar analysis showed significant difference of neurosensory deficit between IVSRO and SSRO (P=0.001."nConclusion: It is suggested that choung osteotomy is a safe procedure for mandibular surgery.

  8. Multilevel extreme lateral interbody fusion (XLIF) and osteotomies for 3-dimensional severe deformity: 25 consecutive cases.

    Science.gov (United States)

    McAfee, Paul C; Shucosky, Erin; Chotikul, Liana; Salari, Ben; Chen, Lun; Jerrems, Dan

    2013-01-01

    This is a retrospective review of 25 patients with severe lumbar nerve root compression undergoing multilevel anterior retroperitoneal lumbar interbody fusion and posterior instrumentation for deformity. The objective is to analyze the outcomes and clinical results from anterior interbody fusions performed through a lateral approach and compare these with traditional surgical procedures. A consecutive series of 25 patients (78 extreme lateral interbody fusion [XLIF] levels) was identified to illustrate the primary advantages of XLIF in correcting the most extreme of the 3-dimensional deformities that fulfilled the following criteria: (1) a minimum of 40° of scoliosis; (2) 2 or more levels of translation, anterior spondylolisthesis, and lateral subluxation (subluxation in 2 planes), causing symptomatic neurogenic claudication and severe spinal stenosis; and (3) lumbar hypokyphosis or flat-back syndrome. In addition, the majority had trunks that were out of balance (central sacral vertical line ≥2 cm from vertical plumb line) or had sagittal imbalance, defined by a distance between the sagittal vertical line and S1 of greater than 3 cm. There were 25 patients who had severe enough deformities fulfilling these criteria that required supplementation of the lateral XLIF with posterior osteotomies and pedicle screw instrumentation. In our database, with a mean follow-up of 24 months, 85% of patients showed evidence of solid arthrodesis and no subsidence on computed tomography and flexion/extension radiographs. The complication rate remained low, with a perioperative rate of 2.4% and postoperative rate of 12.2%. The lateral listhesis and anterior spondylolisthetic subluxation were anatomically reduced with minimally invasive XLIF. The main finding in these 25 cases was our isolation of the major indication for supplemental posterior surgery: truncal decompensation in patients who are out of balance by 2 cm or more, in whom posterior spinal osteotomies and segmental

  9. Prehistoric human settling on the Tibetan Plateau

    Science.gov (United States)

    Chen, Fahu; Zhang, Dongju; Dong, Guanghui

    2017-04-01

    When and where did human first settle down on the Tibetan Plateau is under hot debate among archaeologist, anthropologists, geneticist and paleo-geographers. Based on systematic archaeological, chronological and archaeo-botanical studies of 53 sites in Northeastern Tibetan Plateau, we propose that agriculture facilitated human permanent settlement on the Tibetan Plateau initially since 5200 years ago below 2500 masl and since 3600 years ago up to around 4000 masl, possibly assisted by domesticated animals (Chen et al. 2015). By studying hand- and footprints in Chusang, Meyer et al. (2016) argue that hunter-gatherers permanently occupied central Tibetan Plateau in early Holocene without the help of agriculture. However, we think the limited hand- and footprints evidence found in Chusang could indicate no more than prehistoric hunter-gatherers presence on the remote central Tibetan Plateau in the early Holocene. In addition, by reviewing all the published archaeological data, we propose that human migrated to the Tibetan Plateau from the last Deglacial period to late Holocene mainly from North China via Yellow River valley and its tributary valleys in the Northeastern Tibetan Plateau (NETP). This migration is constituted of four stages (Upper Paleolithic, Epi-Paleolithic, Neolithic and Bronze Age) when human adapted to the high altitude environment and climate change with different strategies and techniques. Particularly, the prevail of microlithic technology in North China provoked hunter-gatherers' first visit to the NETP in relatively ameliorated last Deglacial period, and the the quick development of millet farming and subsequent mixed barley-wheat farming and sheep herding facilitated farmers and herders permanently settled in Tibetan Plateau, even above 3000 masl, during mid- and late Holocene. References: Chen et al., 2015. Agriculture facilitated permanent human occupation of the Tibetan Plateau after 3600 BP. Science, 347: 248-250. Meyer et al., 2016

  10. Lightning activity on the central Tibetan Plateau and its response to convective available potential energy

    Institute of Scientific and Technical Information of China (English)

    2003-01-01

    Lightning flash activities on the central Tibetan Plateau have been studied by using the satellite-based Lightning Imaging Sensor (LIS) database from January 1998 to July 2002. The lightning activity shows a clear diurnal variation on the central Plateau. The peak lightning activity appears at about 17︰00 which is 3 h earlier than that in Jingzhou, Hubei in the same latitude belt nearby, indicating that the lightning activity is a sensitive indicator of solar heating on the Plateau. The lightning discharge is weaker on the Plateau than Jingzhou, Hubei and other low-altitude continental regions because of the lower convective available potential energy (CAPE) on the Plateau. The CAPE on the Plateau is 12 times lower than that in Jingzhou, Hubei, and 20 times lower than that in the sea-level region, such as Guangzhou and Florida. However, the sensitivity of lightning activity to CAPE changes on the Plateau is up to 30 times more sensitive than other prominent low-altitude regions.

  11. Safe Zone for Neural Structures in Medial Displacement Calcaneal Osteotomy: A Cadaveric and Radiographic Investigation.

    Science.gov (United States)

    Talusan, Paul G; Cata, Ezequiel; Tan, Eric W; Parks, Brent G; Guyton, Gregory P

    2015-12-01

    We aimed to define reference lines on standard lateral ankle radiographs that could be used intraoperatively to minimize iatrogenic nerve injury risk in medial displacement calcaneal osteotomy. Forty cadaveric specimens were used. In 20 specimens, the sural, medial plantar (MP), and lateral plantar (LP) nerves were sutured to radiopaque wire, and a lateral ankle radiograph was obtained. On the radiograph, a line was drawn from the posterior superior apex of the calcaneal tuberosity to the origin of the plantar fascia and labeled as the "landmark line." A parallel line was drawn 2 mm posterior to the most posterior nerve, and the area between these lines was defined as the safe zone. In 20 additional specimens, an osteotomy was performed 1 cm anterior to the landmark line using a percutaneous or open technique. Dissection was performed to assess for laceration of the sural, MP, LP, medial calcaneal (MC), or lateral calcaneal (LC) nerves. The safe zone was determined to be within the area 11.2 ± 2.7 mm anterior to the landmark line. After open osteotomy, lacerations were found in 3 of 10 MC nerves and 3 of 10 LC nerves. After percutaneous osteotomy, lacerations were found in 2 of 10 MC nerves and 1 of 10 LC nerves. No lacerations of the sural, MP, or LP nerves were found with either osteotomy. The safe zone extended 11.2 ± 2.7 mm anterior to the described landmark line. The MC and LC nerves were always at risk during medial displacement calcaneal osteotomy. Nerve injury to both major and minor sensory nerves is likely underrecognized as a source of morbidity after calcaneal osteotomy. The current study provides a ready intraoperative guideline for minimizing this risk. © The Author(s) 2015.

  12. Fixation of Intertrochanteric Valgus Osteotomy with T Plate in Treatment of Developmental Coxa Vara.

    Science.gov (United States)

    Elzohairy, Mohamed Mansour; Khairy, Hosam Mohamed

    2016-09-01

    Although the valgus subtrochanteric osteotomy is considered as a standard surgical treatment for coxa vara, there is no consensus on the optimal method of fixation and osteotomy technique. Fixation of the osteotomy has been achieved by various methods including external fixation and internal fixation with pins and cerclage and a variety of plates. The aim of this study is the evaluation of the results of developmental coxa treated by Y intertrochanteric valgus osteotomy fixed with a T-buttress plate compared with other methods of fixation in the literature. Eighteen corrective valgus intertrochanteric femoral osteotomies were performed in 18 patients (18 hips) for treatment of unilateral developmental coxa vara deformity and fixed with a T plate. There were 12 males and 6 females. The right hip was affected in 10 patients and the left hip in 8 patients. Clinically, patients were evaluated by Larson hip score. Radiographically, anteroposterior view of the pelvis and frog leg lateral views of the affected hip were taken preoperatively and compared with the findings at the final follow-up. The average follow-up was 29 months (range, 24 to 36 months). Clinical results showed improvement of the mean Larson hip score from 57.8 to 97.0 (p osteotomies were completely united in 2.4 months (range, 2 to 3 months) with the achievement of the planned correction angle. The average correction of Hilgenreiner's epiphyseal angle improved from 78.2° to 27.8° (p osteotomy of the proximal femur fixed with a T plate may be efficient for treatment of developmental coxa vara. With careful planning, it can result in a low complication rate and insignificant or minimal recurrence rate.

  13. Double pelvic osteotomy for the treatment of hip dysplasia in young dogs.

    Science.gov (United States)

    Vezzoni, A; Boiocchi, S; Vezzoni, L; Vanelli, A B; Bronzo, V

    2010-01-01

    The aim of this study was to evaluate the feasibility of the double pelvic osteotomy (DPO) (osteotomy of the ilium and pubis) to treat clinical cases of hip dyplasia in young dogs instead of performing a triple pelvic osteotomy (TPO) (osteotomy of the ilium, pubis, and ischium). Candidates for DPO were 4.5- to nine-month-old dogs with coxofemoral joint subluxation and laxity, indicative of susceptibility to future development of severe hip dysplasia. The angle of reduction (AR) and angle of subluxation (AS) with Ortolani's sign, Norberg angle (NA), percentage of femoral head (PC) covered by the acetabulum, and the pelvic diameters and their relationships were measured clinically and radiographically before and after surgery. The surgical technique was similar to the TPO technique, but excluded ischiatic osteotomy. A DPO was carried out in 53 joints of 34 dogs; AR and AS values immediately postoperatively and at the one- and two-month follow-up examinations were significantly lower than the preoperative values (p table (7.5%). Changes in PC and NA values obtained immediately after surgery and at the first and second follow-up examinations were significantly greater (p surgery. Sufficient acetabular ventroversion was achieved to counteract joint subluxation and the modifications of AR and AS. The NA and PC direct postoperative values reflected a significant improvement in the dorsal acetabular coverage. Restoration of normal joint congruity (PC from 50 to 72%) and maintenance of the pelvic geometry without pelvic narrowing were the most intriguing features of DPO. The complications observed were greatly reduced when using dedicated DPO plates. Based on our experience, the morbidity after unilateral and bilateral DPO was lower than after TPO because elimination of the ischiatic osteotomy allowed for increased stability of the pelvis. The surgical technique of DPO was a little more demanding than TPO because of the difficulty in handling and rotating the acetabular

  14. Biomechanical consequences of adding plantar fascia release to metatarsal osteotomies: Changes in forefoot plantar pressures.

    Science.gov (United States)

    Aydogan, Umur; Roush, Evan P; Moore, Blake E; Andrews, Seth H; Lewis, Gregory S

    2017-04-01

    Destruction of the normal metatarsal arch by a long metatarsal is often a cause for metatarsalgia. When surgery is warranted, distal oblique, or proximal dorsiflexion osteotomies of the long metatarsal bones are commonly used. The plantar fascia has anatomical connection to all metatarsal heads. There is controversial scientific evidence on the effect of plantar fascia release on forefoot biomechanics. In this cadaveric biomechanical study, we hypothesized that plantar fascia release would augment the plantar metatarsal pressure decreasing effects of two common second metatarsal osteotomy techniques. Six matched pairs of foot and ankle specimens were mounted on a pressure mat loading platform. Two randomly assigned surgery groups, which had received either distal oblique, or proximal dorsiflexion osteotomy of the second metatarsal, were evaluated before and after plantar fasciectomy. Specimens were loaded up to a ground reaction force of 400 N at varying Achilles tendon forces. Average pressures, peak pressures, and contact areas were analyzed. Supporting our hypothesis, average pressures under the second metatarsal during 600 N Achilles load were decreased by plantar fascia release following proximal osteotomy (p fascia release following modified distal osteotomy, under multiple Achilles loading conditions (p < 0.05). Plantar fasciotomy should not be added to distal metatarsal osteotomy in the treatment of metatarsalgia. If proximal dorsiflexion osteotomy would be preferred, plantar fasciotomy should be approached cautiously not to disturb the forefoot biomechanics. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:800-804, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  15. [Correction of kyphotic deformity of the cervical spine in ankylosing spondylitis using pedicle subtraction osteotomy of the seventh cervical vertebra].

    Science.gov (United States)

    Vaněk, P; Votavová, M; Ostrý, S; Beneš, V; Pavelka, K

    2014-01-01

    The aim of the study is to present the technique of pedicle subtraction osteotomy (PSO) of the seventh cervical vertebra (C7) for correction of rigid kyphotic deformity of the cervicothoracic junction (C/Th) in patients with severe ankylosing spondylitis (AS).. The PSO technique for correction of rigid deformity of the C/Th spine was used in five patients with the aim to restore their ability of horizontal vision. The follow-up in all patients lasted two years at least. Clinical assessment of treatment results was based on the patients' neurological status and their satisfaction with the correction achieved. Improvement in a vertical 2) line of sight was evaluated using the angle measured between the forehead-chin line and the vertical (FCv angle) in a lateral view photograph of the standing patient. The achieved correction of kyphotic deformity was assessed by comparing the pre-operative Cobb's angle between the second cervical and the fourth thoracic vertebra with the post-operative one. The average operative time was 4 hours (range, 3.5 to 5 h). The average blood loss was 1600 ml (range, 800 to 2100 ml). On the average, the FCv angle was reduced by 45.2° and Cobb's angle was corrected) by 54.6°. All patients were satisfied with the degree of correction achieved and reported alleviation of neck pain. none of the patients showed any significant loss of correction or neurological deterioration at two-year follow-up. The theoretical and technical principles of corrective osteotomy at the C7 level performed for rigid kyphotic deformity of the spine at the C/Th junction are presented in our group of patients. Our results give support to the superiority of instrumented PSO used currently over the previous techniques. In accordance with the relevant literature data, attention is drawn to a relatively higher risk of this procedure in comparison with corrective surgery performed at the other spinal levels. Corrective osteotomy of a rigid kyphotic deformity at the C

  16. Soil Erosion Study on the Chinese Loess Plateau

    Science.gov (United States)

    Hu, Yaxian; Guo, Shengli; Kuhn, Nikolaus

    2017-04-01

    The Chinese Loess Plateau, because of its highly erodible loess soils and hilly topography, has been extensively studied by soil scientists and geomorphologists. As a research hotspot, there are five national-level field stations across the Loess Plateau, with hundreds of erosion plots set up with various sizes, lengths, slope angles and vegetation covers. In addition, huge indoor rain simulation facilities exist in in different institutes which can provide rainfall simulations under a wide range of controlled conditions. Consequently, national-level restoration projects have achieved tremendous improvements in curbing soil erosion and improving regional agro-ecosystem, mostly by afforestation and soil rehabilitation. However, when implementing the advanced techniques and models that have been widely applied in the rest of the world, there are often regional considerations, which demand new approaches to overcome. One example are the unintentional impacts of restoration efforts, such as the establishment of apple orchards. Over 20 years, they have caused an increase in soil erodibility and lowered local ground water levels. Neither before the introduction of this landscape rehabilitation technique, nor now, has the impact of intensive fruit production been systematically studied, despite lending itself to systematic experiments. The lack of research is attributed to the general idea that trees protect soils and improve environmental services. This presentation identifies several such specific regional environmental issues associated with soil erosion on the Loess Plateau and discusses strategies to avoid missing important research questions.

  17. Nutrient Lossed in Soils on Loess Plateau

    Institute of Scientific and Technical Information of China (English)

    PENGLIN; WANGJI-ZENG; 等

    1995-01-01

    The soil nutrient losses due to excessive soil loss on Loess Plateau were studied by means of runoff plots and systematical determination of soil nutrients both in sediments and runoff.The results show that the amounts of nutrient losses depended on the amounts of ersoion sediments.Along with sediment,11-197kg nitrogen/hectare and 9-174kg phosphorus/hectare were lost,accounting for 92.46-99.47 percent of the total amount of nitrogen loss and 99.85-99.99 percent of the total amount of phosphorus loss respectively.The nutrient losses,very small in runoff,were mainly attributed to erosion of a few rainstorms during a year.The nutrient level in sediment was mostly higher than that in the original soil.Planting grass evidently redued the losses of soil nutrients.The N level was lower in runoff than in rainfall so that the N loss from runoff could be made up by rainfall.Fertilizer application to crops raised the nutrient level in runoff.

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

    Directory of Open Access Journals (Sweden)

    Steffann Francois

    2015-01-01

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

  19. Compressive Tectonics around Tibetan Plateau Edges

    Institute of Scientific and Technical Information of China (English)

    Zhao Zhixin; Xu Jiren

    2009-01-01

    Various earthquake fault types, mechanism solutions, stress field, and other geophysical data were analyzed for study on the crust movement in the Tibetan plateau and its tectonic implications. The results show that numbers of thrust fault and strike-slip fault type earthquakes with strong compressive stress near NNE-SSW direction occurred in the edges around the plateau except the eastern boundary. Some normal faulting type earthquakes concentrate in the Central Tibetan plateau. The strikes of fault planes of thrust and strike-slip faulting earthquakes are almost in the E-W direction based on the analyses of the Wulff stereonet diagrams of fault plane solutions. This implies that the dislocation slip vectors of the thrust and strike-slip faulting type events have quite great components in the N-S direction. The compression motion mainly probably plays the tectonic active regime around the plateau edges. The compressive stress in N-S or NE-SW directions predominates earthquake occurrence in the thrust and strike-slip faulting event region around the plateau. The compressive motion around the Tibetan plateau edge is attributable to the northward motion of the Indian subcontinent plate. The northward motion of the Tibetan plateau shortened in the N-S direction encounters probably strong obstructions at the western and northern margins.

  20. The Quaternary Pan-lake (Overflow) Period and Paleoclimate on the Qinghai-Tibet Plateau

    Institute of Scientific and Technical Information of China (English)

    ZHENG Mianping; YUAN Heran; ZHAO Xitao; LIU Xifang

    2005-01-01

    Lake geomorphology and high-level lacustrine deposits since the mid-late Pleistocene are well preserved in lakes of the Qinghai-Tibet Plateau. According to geological surveys of 17 lake districts in different locations of the plateau,combined with interpretations of satellite images and topographic maps, the authors studied the timing of formation and scopes of the pan-lake areas of the plateau and their paleoclimate. The latest two high lake levels (overflow surfaces) on the Qinghai-Tibet Plateau in the Quaternary occurred at ~40 to 30/35 ka and ~65 to 53 ka respectively. In these time intervals, the plateau was covered by huge interconnected pan-lake systems with a total area of ~36 km2 and a total volume of lake water of >530 million km2, which are about 38 times and 659 times larger than those of the modem lakes respectively. Before this pan-lake period in the late Pleistocene, there had been three high lake levels that occurred at ~132-112 ka, 110-95 ka and 91-72/~83-75 ka respectively, suggesting that the late Quaternary climate on the plateau was unstable and changed rapidly. The ~40-30 ka high lake level also appeared in the Tengger desert north of the plateau,suggesting that there existed very strong summer monsoons from South Asia then; the variation in solar radiation with a 20,000 precessional period has special importance for the high-altitude Qinghai-Tibet Plateau in the low-latitude zone of the Earth. Around 30 ka, the pan-lakes at the peripheries of the Qinghai-Tibet Plateau drained out suddenly with rapid uplift of the plateau and cooling. In a short time the huge amount of cold lake water emptied into the Indian Ocean and Western Pacific. The draining event of the pan-lakes brought about the environmental changes of rivers and lakes at peripheries of the plateau.

  1. Analysis of the structure of different Tibetan Plateau vortex types

    Science.gov (United States)

    Feng, Xinyuan; Liu, Changhai; Fan, Guangzhou; Zhang, Jie

    2017-06-01

    Knowledge of the structure of the Tibetan Plateau vortex (TPV) is of considerable importance for understanding the generation and development mechanisms of this mesoscale system. However, our understanding of vortex structures and our ability to classify them on a physical basis is limited due to insufficient observations. The highresolution new-generation NCEP-CFSR (Climate Forecast System Reanalysis) dataset is used in the present paper to investigate the general structural features of various types of mature TPV through classification and composite structure analysis. Results indicate that the dynamic and thermodynamic structures show regional and seasonal dependency, as well as being influenced by attributes of translation, associated precipitation, and the South Asian high (SAH). The common precipitating TPV (type I), frequently occurring in the west-east-oriented zonal region between 33° and 36°N, is a notably low-level baroclinic and asymmetric system. It resides within a large-scale confluent zone and preferentially travels eastward, potentially moving out of the plateau. The heavy rain vortex (type II) corresponds to a deep vortex circulation occurring in midsummer. The low-level baroclinic sub-category (type IIa) is associated with a low-level jet and mainly originates in the area 32°-35°N, 86°-94°E, preferentially moving east of 90°E and even away from the plateau; meanwhile, the nearly upright sub-category (type IIb), which has a cold center at low levels and a warm center at mid-upper levels, is a quasi-stationary and quasi-symmetric system favorably occurring west of 92°E. A western-pattern SAH exists in the upper troposphere for these two sub-categories. The springtime dry vortex in the western plateau (type III) is warm and shallow (approximately 100 hPa deep), and zonal circulation dominates the large-scale environmental flows in the middle and upper troposphere. The precipitating vortex in the southern plateau occurring during July

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

    Science.gov (United States)

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

    2015-01-01

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

  3. The skeletal stability after maxillo-mandibular osteotomy with a "physiological positioning strategy".

    Science.gov (United States)

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

    2014-12-01

    The aim of this study was to estimate skeletal and dental stability after maxillomandibular osteotomy with physiological positioning. Ten patients (7 men and 3 women) with skeletal mandibular prognathism were treated by conventional Le Fort I osteotomy for the maxilla and unfixed short lingual osteotomy for the mandible together with physiological positioning. We used cephalometric analysis to evaluate the skeletal and dental stability preoperatively, immediately after maxillomandibular osteotomy, and more than 1 year later. The immediately postoperative measurements for the SNA and the SN-palatal planes were 0.15° (p=0.67) and 1.0° (p=0.17), respectively. The positions of the anterior nasal spine, posterior nasal spine, and A point showed minimal changes 1 year postoperatively. The postoperative difference for SNB was 0.76° (p=0.04). Dental stability was apparent postoperatively. We conclude that reliable stability of both the maxilla and the mandible was achieved after maxillomandibular osteotomy with physiological positioning in patients with mandibular prognathism.

  4. An Anatomic Study of the Percutaneous Endoscopically Assisted Calcaneal Osteotomy Technique to Correct Hindfoot Malalignment.

    Science.gov (United States)

    Veljkovic, Andrea; Tennant, Joshua; Rungprai, Chamnanni; Abbas, Kaniza Zahra; Phisitkul, Phinit

    2017-02-01

    Open calcaneal osteotomy using traditional methods is associated with complications such as sural nerve injury and potential wound healing problems. We hypothesized that by using novel minimally invasive techniques, these potential risks could be mitigated. This anatomic cadaveric study serves to assess the safety of percutaneous endoscopically assisted calcaneal osteotomy (PECO) compared to a traditional open osteotomy technique. Anatomic safety of PECO was assessed using 8 fresh-frozen cadaver below-knee specimens. Lateral calcaneal nerve (LCN) damage was primarily noted and then secondly compared to a potential open surgical incision approach. Only 1 of 11 LCN branches (n = 8 limbs) was transected using PECO, compared to up to 8 of 10 LCN branches (n = 6 limbs) that potentially would have been injured during open surgery. Percutaneous endoscopically assisted calcaneal osteotomy is a minimally invasive technique that had fewer nerve injuries in this cadaveric model than traditional open surgery. Percutaneous endoscopically assisted calcaneal osteotomy due to its less invasive nature may result in fewer neurovascular injuries relative to an open procedure.

  5. Virtual Bernese osteotomy using three-dimensional computed tomography in hip dysplasia.

    Science.gov (United States)

    Suh, Dong Hun; Lee, Dae Hee; Jeong, Woong Kyo; Park, Sang Won; Kang, Chang Ho; Lee, Soon Hyuck

    2012-04-01

    Accurate assessment of acetabular morphology and its relationship to the femoral head is essential for planning a periacetabular osteotomy. We observed the acetabular coverage after virtual Bernese osteotomy using computer-aided technique. Three-dimensional computed tomography of 18 normal hips and 3 symptomatic dysplastic hips were analyzed. Through the center of the femoral head, vertical images were obtained at 10° intervals from 0° to 180° of rotation, using multiplanar reformation technique. Subsequently we measured 19 center-edge angles (CEAs) from each acetabulum. Four types of virtual osteotomy were performed on the three dysplastic hips. The adequacy of acetabular coverage after osteotomy was determined by comparing CEAs after correction with normal CEAs. Pearson correlation coefficients between the CEAs measured from normal cases and postoperative cases after lateral rotation of osteotomized fragments were 0.906 in case 1, 0.975 in case 2, 0.976 in case 3. Additional anterior rotation increased anterior acetabular coverage and simultaneously decreased posterior coverage in all three cases. Computer-aided virtual surgery technique based on three-dimensional computed tomography information enabled acetabular coverage to be quantified preoperatively in Bernese osteotomy. Lateral rotation of osteotomized acetabular fragments improved anterior and posterior coverage as well as lateral coverage.

  6. Complications associated with the Bernese periacetabular osteotomy for hip dysplasia in adolescents.

    Science.gov (United States)

    Thawrani, Dinesh; Sucato, Daniel J; Podeszwa, David A; DeLaRocha, Adriana

    2010-07-21

    The Bernese (Ganz) periacetabular osteotomy is an effective surgical procedure to reorient the acetabulum, allowing restoration of anatomic femoral head coverage and medial translation of the hip in adults with hip dysplasia. However, it is a challenging surgical procedure, and we know of no study that has specifically analyzed the complications and associated factors seen with this procedure in adolescent patients. A retrospective clinical and radiographic review of a consecutive series of adolescent patients who underwent a Bernese periacetabular osteotomy for hip dysplasia was conducted. Eighty-three osteotomies were performed in seventy-six patients with an average age (and standard deviation) of 15.6 +/- 2.4 years. Significant improvement from the preoperative to the two-year follow-up evaluation was seen radiographically with regard to the lateral center-edge angle (-0.14 degrees to 35.5 degrees), the ventral center-edge angle (-5.13 degrees to 31.3 degrees), and the femoral head extrusion index (38.4% to 7.7%) (p Bernese periacetabular osteotomy is a joint-preserving procedure that very effectively corrects acetabular dysplasia in adolescent patients, providing improved radiographic results and a low rate of complications. Although the rate of minor complications is increased when there is an underlying diagnosis other than developmental dysplasia, no other predictors were identified. However, a major complication is more likely with a longer duration of surgery and with a concomitant femoral varus osteotomy.

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

    Science.gov (United States)

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

    2015-07-01

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

  8. Piezoelectric osteotomy in hand surgery: first experiences with a new technique

    Directory of Open Access Journals (Sweden)

    Kaenel Oliver Von

    2006-04-01

    Full Text Available Abstract Background In hand and spinal surgery nerve lesions are feared complications with the use of standard oscillating saws. Oral surgeons have started using a newly developed ultrasound bone scalpel when performing precise osteotomies. By using a frequency of 25–29 kHz only mineralized tissue is cut, sparing the soft tissue. This reduces the risk of nerve lesions. As there is a lack of experience with this technique in the field of orthopaedic bone surgery, we performed the first ultrasound osteotomy in hand surgery. Method While performing a correctional osteotomy of the 5th metacarpal bone we used the Piezosurgery® Device from Mectron [Italy] instead of the usual oscillating saw. We will report on our experience with one case, with a follow up time of one year. Results The cut was highly precise and there were no vibrations of the bone. The time needed for the operation was slightly longer than the time needed while using the usual saw. Bone healing was good and at no point were there any neurovascular disturbances. Conclusion The Piezosurgery® Device is useful for small long bone osteotomies. Using the fine tip enables curved cutting and provides an opportunity for new osteotomy techniques. As the device selectively cuts bone we feel that this device has great potential in the field of hand- and spinal surgery.

  9. Splintless surgery : does patient-specific CAD-CAM osteosynthesis improve accuracy of Le Fort I osteotomy?

    NARCIS (Netherlands)

    Kraeima, J.; Jansma, J.; Schepers, R. H.

    2016-01-01

    To analyse the accuracy of maxillary positioning after Le Fort I osteotomy, we retrospectively assessed the outcome in three patients (mean (range) age 40 (21 60) years) who had been treated with patient-specific CAD-CAM osteosynthesis plates as part of a bimaxillary osteotomy. Virtual surgical

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

    NARCIS (Netherlands)

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

    2005-01-01

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

  11. Postoperative volume increase of facial soft tissue after percutaneous versus endonasal osteotomy technique in rhinoplasty using 3D stereophotogrammetry

    NARCIS (Netherlands)

    Loon, B. van; Heerbeek, N. van; Maal, T.J.J.; Borstlap, W.A.; Ingels, K.J.A.O.; Schols, J.G.J.H.; Berge, S.J.

    2011-01-01

    BACKGROUND: When lateral osteotomies are performed as part of a rhinoplasty, the nose and paranasal region invariably change in three dimensions. The PURPOSE of this study is to compare the effect of the percutaneous perforating and endonasal continuous osteotomy techniques concerning the degree of

  12. The active southwest margin of the Colorado Plateau: uplift of mantle origin

    Science.gov (United States)

    Parsons, T.; McCarthy, J.

    1995-01-01

    During Cenozoic time, the Colorado Plateau was raised about 2km above sea level. The most-recent and best-documented uplift of the plateau (~1km) has been concentrated at its southwest margin between 6 and 1 Ma, whereas the eastern Colorado Plateau may have been at high elevations since Eocene time. To better understand the recent tectonic activity at the southwest margin of the Colorado Plateau, we compile detailed crustal thickness and density information from seismic and gravity data for a region that includes northwest Arizona and the southern tip of Nevada. This information is used to isolate the mantle contribution to uplift. We speculate that uplift may result from subduction-related thinning of the continental lithosphere. -from Authors

  13. Permanent human occupation of the central Tibetan Plateau in the early Holocene.

    Science.gov (United States)

    Meyer, M C; Aldenderfer, M S; Wang, Z; Hoffmann, D L; Dahl, J A; Degering, D; Haas, W R; Schlütz, F

    2017-01-06

    Current models of the peopling of the higher-elevation zones of the Tibetan Plateau postulate that permanent occupation could only have been facilitated by an agricultural lifeway at ~3.6 thousand calibrated carbon-14 years before present. Here we report a reanalysis of the chronology of the Chusang site, located on the central Tibetan Plateau at an elevation of ~4270 meters above sea level. The minimum age of the site is fixed at ~7.4 thousand years (thorium-230/uranium dating), with a maximum age between ~8.20 and 12.67 thousand calibrated carbon-14 years before present (carbon-14 assays). Travel cost modeling and archaeological data suggest that the site was part of an annual, permanent, preagricultural occupation of the central plateau. These findings challenge current models of the occupation of the Tibetan Plateau. Copyright © 2017, American Association for the Advancement of Science.

  14. Inflammatory Neuropathy of the Lumbosacral Plexus following Periacetabular Osteotomy

    Directory of Open Access Journals (Sweden)

    Stijn Ghijselings

    2016-01-01

    Full Text Available Introduction. During periacetabular osteotomy (PAO, the sciatic, femoral, and obturator nerves are at risk. Most frequently nerve lesions can be attributed to a mechanical cause; however, in the absence of a clear mechanical cause surgeons are faced with a diagnostic problem and in many cases no diagnosis will be established. We report a case of inflammatory neuropathy of the lumbosacral plexus following a PAO. Case Presentation. A 31-year-old female developed weakness of ankle and knee flexion and extension 6 months after a PAO. Electrophysiological studies revealed damage to the obturator, femoral, and sciatic nerve consistent with an inflammatory lumbosacral plexopathy. MRI of the lumbosacral plexus was normal. The patient was treated with multimodal pain therapy and prolonged physiotherapy; nevertheless, symptoms worsened over time. At 2-year follow-up, there were no signs of recovery. Discussion. Inflammatory neuropathy of the lumbosacral plexus is a potential cause of pain and weakness after ipsilateral orthopaedic procedures. It should be distinguished from more frequently encountered mechanical causes of postsurgical neuropathy based on clinical suspicion, electrophysiological studies, MRI, and nerve biopsy. It is important that the orthopaedic community is aware of this complication since there is some evidence that early recognition and initiation of immunosuppressive therapy can lead to improved clinical outcome.

  15. Ulnar or radial shortening osteotomy with a single saw cut.

    Science.gov (United States)

    Sraj, Shafic A; Budoff, Jeffrey E

    2009-09-01

    To determine which currently commercially available saw blades could be held at 45 degrees to the bone to reproducibly provide 2.0, 2.5, and 3.0 mm of ulna or radius shortening. Commercially available saw blades were tested for their ability to achieve the osseous shortening at a 45 degrees angle cut. When held at a 45 degrees angle to the bone, 2 Stryker 0.64-mm-thick blades achieved a mean shortening of 2.0 mm. A single Linvatec 1.2-mm-thick blade achieved a mean osseous shortening of 2.1 mm. Two Dyonics 0.65-mm-thick blades achieved a mean osseous shortening of 2.7 mm. Two Dyonics 0.89-mm-thick saw blades achieved a mean osseous shortening of 3.1 mm. Three Stryker 0.38-mm-thick saw blades mounted with the middle blade "upside down" with regard to the 2 outer blades achieved a mean osseous shortening of 3.2 mm. Two Linvatec 0.8-mm-thick saw blades achieved a mean osseous shortening of 3.1 mm. The findings of this study can help guide surgeons who desire to reproducibly shorten the ulna or radius by 2.0, 2.7, or 3.2 mm using a single saw cut to ensure a parallel osteotomy gap.

  16. Osteotomies through a fusion mass in the lumbar spine.

    Science.gov (United States)

    Vital, Jean-Marc; Boissière, Louis; Bourghli, Anouar; Castelain, Jean-Etienne; Challier, Vincent; Obeid, Ibrahim

    2015-01-01

    Flat-back syndrome is one of the main causes of surgical failure after lumbar fusion and can lead to a revision surgery to correct it. Three-column pedicle subtraction osteotomy is an efficient technique to restore lumbar lordosis (LL) for fixed sagittal malalignment. The fusion mass stemming from the past surgeries makes the procedure demanding as most anatomical landmarks are missing. This review article will focus on the correction of this lack of LL through the fusion mass. We will successively review the preoperative management, the surgical specificities, and various types of clinical cases that can be encountered in flat-back syndromes. PSO in the fixed fusion mass is technically demanding. Preoperative CT-scan and preoperative navigation allow us to push the limits when anatomical landmarks disappear. Bleeding and neurologic are the two major complications feared by the surgeon. The best way to avoid these revision surgeries is to restore a proper lumbar lordosis at the time of initial surgery by considering lumbo-pelvic indexes.

  17. Bone scintigraphy and magnetic resonance imaging after transtrochanteric rotational osteotomy

    Energy Technology Data Exchange (ETDEWEB)

    Iwasada, Seiki; Hasegawa, Yukiharu; Iwase, Tosiki; Kitamura, Shinji; Iwata, Hisashi [Department of Orthopaedic Surgery, Nagoya University School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, 466 (Japan)

    1999-05-01

    Objective. To assess the ability of bone scintigraphy and magnetic resonance imaging (MRI) to predict the outcome of transtrochanteric rotational osteotomy (TRO) for osteonecrosis of the femoral head (ONFH). Design. This study was a prospective evaluation of imaging techniques. Patients and methods. MRI and bone scintigraphy were performed on 20 hips in 18 patients at 3 months after TRO. The radiographic findings at 3 months after TRO, and the MRI and bone scintigraphic findings, were compared with the radiographic findings at final follow-up (mean 39 months). Results and conclusions. On MRI a low-intensity area or a low-intensity band in the new weight-bearing area extending over the acetabular edge on T1-weighted images was related to the presence of collapse on the radiographs at final follow-up. In hips with an area of absent activity in the new weight-bearing surface on bone scintigraphy, collapse was seen more frequently on radiographs at final follow-up than in hips without this feature. Bone scintigraphy was no more specific than radiography in predicting the outcome after TRO. We consider MRI to be superior to bone scintigraphy in predicting the occurrence of collapse, which is one of the major short-term problems after TRO. (orig.) With 8 figs., 4 tabs., 15 refs.

  18. Prediction of neurosensory alterations after sagittal split ramus osteotomy.

    Science.gov (United States)

    Kuroyanagi, N; Miyachi, H; Ochiai, S; Kamiya, N; Kanazawa, T; Nagao, T; Shimozato, K

    2013-07-01

    Prediction of neurosensory deficit in the lower lip and chin after sagittal split ramus osteotomy (SSRO) is challenging. This study aimed to elucidate factors related to the development and improvement of neurosensory disturbance (NSD) after SSRO with respect to surgical procedure and the anatomical and structural characteristics of the craniomaxillofacial skeleton. Subjects comprised 50 patients treated by a single experienced surgeon. Anatomical data and landmarks were obtained by computed tomography (CT) imaging. There was a significant difference between patients with or without NSD for the surgical space on the medial side of mandibular ramus 1 week after SSRO (P=0.006). Less than 15.0mm between the lingula and mandibular notch (relative risk, 6.7; 95% CI, 1.7-33.8) and 195.0mm(2) or more space on the medial side of the mandibular ramus (relative risk, 17.2; 95% CI, 3.9-100.4) indicated a significant risk of NSD development at 6 months postoperatively. These results suggested that the development of NSD is related to the surgical space on the medial side of the mandibular ramus and subsequent manipulation of the inferior alveolar nerve (IAN) in that region. Limited periosteal degloving prevents excessive stretching of the IAN during SSRO, thus lowering NSD incidence.

  19. Cholesteatoma after lateral bulla osteotomy in two brachycephalic dogs.

    Science.gov (United States)

    Schuenemann, Riccarda Martina; Oechtering, Gerhard

    2012-01-01

    This report describes a French bulldog and a pug that presented to the authors' hospital following total ear canal ablation (TECA) and lateral bulla osteotomy (LBO), with signs of recurring otitis media and difficulty opening their mouths. The bulldog also had unilateral facial paralysis and sensory deficits of the trigeminal nerve on the ipsilateral side. Computed tomography and MRI scans suggested cholesteatoma in the bulldog, but showed only slight enlargement of the bulla in the pug. Histopathologic examination of samples yielded cholesteatoma in both cases. The authors suspect that development of the cholesteatomas was linked to the TECA/LBO surgery in both cases. Cholesteatomas may occur more frequently than currently thought. Even if only slight changes of the bulla wall are detected on CT, early-stage cholesteatoma should be considered. The narrow anatomic conditions in brachycephalic dogs possibly predispose such breeds to develop cholesteatoma after middle ear surgery because complete removal of all inflammatory and epithelial tissue can be more difficult than in other breeds. To the authors' knowledge, this is the first report of an aural cholesteatoma causing sensory deficits of the trigeminal nerve.

  20. Constructions of new plateaued functions from known ones

    Institute of Scientific and Technical Information of China (English)

    Zhang Weiguo; Ding Yong; Zhang Ning; Xiao Guozhen

    2008-01-01

    A number of methods for constructing new plateaued functions from known ones are presented. By properly combining the known plateaued functions it is possible to get highly nonlinear resilient plateaued functions. The order, resiliency and propagation characteristics of the constructed plateaued functions are discussed. We show the new functions could possess the desirable cryptographic property.

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

    Science.gov (United States)

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

    2016-02-01

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

  2. Argalis on the Qinghai-Tibet Plateau

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    The argali are listed by the State as animals subject tosecond-class protection,and no killing is allowed. The international communitylists argali on the Qinghai-Tibet Plateau as animals that must not be hunted.

  3. Colorado Plateau Rapid Ecoregion Assessment Data Catalog

    Data.gov (United States)

    Bureau of Land Management, Department of the Interior — Datasets used in the analysis of the Colorado Plateau (COP) Rapid Ecoregion Assessment (REA).They can be downloaded via a layer package (lpk, similar to a zip file...

  4. Vertebral column decancellation: a new spinal osteotomy technique for correcting rigid thoracolumbar kyphosis in patients with ankylosing spondylitis.

    Science.gov (United States)

    Zhang, X; Zhang, Z; Wang, J; Lu, M; Hu, W; Wang, Y; Wang, Y

    2016-05-01

    The aim of this study is to introduce and investigate the efficacy and feasibility of a new vertebral osteotomy technique, vertebral column decancellation (VCD), for rigid thoracolumbar kyphotic deformity (TLKD) secondary to ankylosing spondylitis (AS). We took 39 patients from between January 2009 and January 2013 (26 male, 13 female, mean age 37.4 years, 28 to 54) with AS and a TLKD who underwent VCD (VCD group) and compared their outcome with 45 patients (31 male, 14 female, mean age 34.8 years, 23 to 47) with AS and TLKD, who underwent pedicle subtraction osteotomy (PSO group), according to the same selection criteria. The technique of VCD was performed at single vertebral level in the thoracolumbar region of AS patients according to classification of AS kyphotic deformity. Pre- and post-operative chin-brow vertical angle (CBVA), sagittal vertical axis (SVA) and sagittal Cobb angle in the thoracolumbar region were reviewed in the VCD and PSO groups. Intra- , post-operative and general complications were analysed in both group. lf patients could lie on their backs and walk with horizontal vision and sagittal profile, radiographic parameters improved significantly post-operatively in both groups. No major acute complications such as death or complete paralysis occurred in either group. In the VCD group, five patients (12.8%) experienced complications such as severe CSF leak (n = 4), deep wound infection (n = 1) and in one patient a transient neurological deficit occurred. In the PSO group, eight patients (17.8%) suffered conditions such as severe CSF leak (n = 5), infections (n = 2) and sagittal translation at osteotomy site (n = 1). Scoliosis Research Society outcomes instrument (SRS-22) improved significantly in both groups. All patients achieved solid fusion at latest follow-up and no implant failures were noted in either group. The VCD technique is a new, safe and effective strategy for correction of rigid TLKD in AS patients. The main advantage of the new

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

    Directory of Open Access Journals (Sweden)

    S. Jagernauth

    2012-01-01

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

  6. Triple pelvic osteotomy: Report of our mid-term results and review of literature

    Science.gov (United States)

    Mimura, Tomohiro; Mori, Kanji; Kawasaki, Taku; Imai, Shinji; Matsusue, Yoshitaka

    2014-01-01

    A wide variety of pelvic osteotomies have been developed for the treatment of developmental dysplasia of the hip (DDH). In the present paper, we present a detailed review of previous studies of triple osteotomy as an alternative treatment for DDH. We also report our experience treating 6 adult cases of DDH by triple osteotomy in order to highlight the various aspects of this procedure.The mean age of our patients was 31.2 years with a mean follow-up period of 6 years. We assessed range of motion, center-edge angle, acetabular index angle, Sharp angle, acetabulum head index, head lateralization index, Japanese Orthopedic Association score, Harris hip score, patient satisfaction, and the difference between lower limb lengths before and after the procedure. At final follow-up, clinical scores were significantly improved and radiographic parameters also showed good correction of acetabulum. PMID:24649410

  7. Bone repair inhibited by indomethacin. Effects on bone metabolism and strength of rabbit osteotomies

    Energy Technology Data Exchange (ETDEWEB)

    Keller, J.; Buenger, C.; Andreassen, T.T.; Bak, B.; Lucht, U.

    1987-01-01

    We measured mineral content, maximum bending strength, and regional blood flow after tibial osteotomy fixed with a small metal plate in 38 rabbits. Half of the animals were treated with indomethacin (10 mg/kg/day) while the other half served as controls. After 2 and 6 weeks, the bone mineral content and maximum bending strength were lower in the indomethacin group when compared with the controls. Compared with the controls, the blood flow at the osteotomy site was decreased after 2 weeks and increased after 6 weeks in the indomethacintreated animals. Inhibition of blood flow increase by indomethacin medication in the early period following osteotomy, as well as retarded bone healing, are probably caused by inhibition of the inflammatory reaction.

  8. Single-Tooth Osteotomy Using Piezoelectric Devices to Treat an Ankylosed Maxillary Molar.

    Science.gov (United States)

    You, Tae Min; Kang, Joon Hyun; Kim, Kee-Deog; Park, Wonse

    2016-01-01

    Single-tooth osteotomy is a surgical technique in which the tooth and adjacent bone with sufficient soft tissue are repositioned in a single step or moved orthodontically. It is not used in the maxillary posterior region because of poor accessibility, bleeding complications, and anatomical limitations such as the maxillary sinus. However, the development of piezoelectric surgical devices and the popularization of the sinus floor elevation procedure have simplified the approach to the posterior maxillary area. This article reports two cases of single-tooth osteotomy of ankylosed teeth that were performed safely in the posterior maxilla with the use of a piezoelectric device and a sinus membrane elevation. In addition, several merits of this approach as compared with conventional osteotomy are described.

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

    Science.gov (United States)

    Denjean, S; Chatain, F; Tayot, O

    2017-03-02

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

  10. High Le Fort I osteotomy for correction of mid-face deformity in Crouzon syndrome.

    Science.gov (United States)

    Nakajima, Yasumichi; Nakano, Hiroyuki; Sumida, Tomoki; Yamada, Tomohiro; Inoue, Kazuya; Sugiyama, Goro; Mishima, Katsuaki; Mori, Yoshihide

    2016-09-01

    An 18-year-old woman with mild Crouzon syndrome was referred with malocclusion and mandibular protrusion. Examination revealed Class III canine and molar relationships, hypoplastic maxilla, 1-mm overbite, and -2-mm overjet. Analysis showed 69° sella-nasion-A, 73.6° sella-nasion-B, and -4.6° A point-nasion-B point angles. Polysomnography revealed respiratory disturbance and 6.3% oxygen desaturation indices of 5.4/h and 9.0/h. We performed double-jaw surgery using high Le Fort I osteotomy and bilateral sagittal split ramus osteotomy for midfacial deformity correction. Twelve months post-surgery, her measures were 70.8°, 72°, -1.2°, 3.0/h, and 6.1/h, respectively. Esthetics were satisfactory. High Le Fort I osteotomy is effective for midfacial deformity correction in patients with Crouzon syndrome. © 2016 Japanese Teratology Society.

  11. The horizontal and stepped osteotomy technique for mandibular reconstruction using fibular free flap.

    Science.gov (United States)

    Aleid, Wesam; Jones, Keith; Laugharne, David

    2011-09-01

    The mandible is an important component of the orofacial skeleton, and resection of part of the mandible as part of head and neck oncological procedures can have dramatic impact on both function and cosmesis. In this article, we describe a new technique in the resection osteotomy and flap fixation that improves the stability and aesthetic outcome of the reconstruction. The mandibular resection is performed utilizing a horizontal osteotomy above the mandibular angle on one side and a stepped body or angle osteotomy on the other side. Our technique is unique as it allows flexibility in adjusting the chin point projection to give the best possible aesthetic outcome; it allows more bone-to-bone contact, which increases the stability; it reduces rotation; and it allows for use of miniplate fixation, facilitating future rehabilitation with implants. We have been using this technique with great success in our hospital, and we recommend its use for its improved flexibility, stability, and aesthetic outcome.

  12. Pyramid Schemes on the Tibetan Plateau

    OpenAIRE

    Devin Gonier; Rgyal yum sgrol ma

    2012-01-01

    The unique features of pyramid schemes and certain underlying causes for their development on the Tibetan Plateau are analyzed. Research was conducted by analyzing 521 surveys, allowing estimation of pyramid scheme activity on the Plateau and an identification of related cultural and social specificities. Firsthand accounts were collected revealing details of personal involvement. Survey data and similarities in the accounts were studied to suggest how involvement in pyramid schemes might be ...

  13. Pseudoarthrosis of the ilium after periacetabular osteotomy that was treated by cemented total hip arthroplasty: a case report.

    Science.gov (United States)

    Kanaji, Arihiko; Nishiwaki, Toru; Oya, Akihito; Maehara, Kazuyuki; Maehara, Hideki; Oishi, Teruyo; Yamada, Harumoto; Suda, Yasunori; Nakamura, Masaya; Matsumoto, Morio

    2016-05-06

    Preserving the hip joint to delay arthroplasty for patients with acetabular dysplasia-associated early-stage osteoarthritis has become more common, and several surgical procedures have demonstrated pain relief and improved hip joint function. Periacetabular osteotomy, one of the joint-preserving surgical procedures of the hip, provides favorable outcomes, although there are no reports of total hip arthroplasty being used to treat pseudoarthrosis of the periacetabular osteotomy segment. Therefore, we report a case of pseudoarthrosis in the osteotomy segment after periacetabular osteotomy. The patient was treated using modified total hip arthroplasty and achieved a favorable short-term outcome. A 62-year-old Japanese woman was diagnosed with bilateral acetabular dysplasia at the age of 50 years, and underwent right and left periacetabular osteotomy at the ages of 52 and 55 years, respectively. When she was 61-years old, she experienced repeated episodes of left coxalgia during walking, with increasing pain at rest, and subsequently visited our department. Plain radiography and computed tomography of her left hip joint confirmed pseudoarthrosis of the periacetabular osteotomy segment. In addition, narrowing of her left hip joint space was observed, which indicated advanced osteoarthritis of the hip. Therefore, she underwent left total hip arthroplasty when she was 62-years old. During the surgery, fibrous fusion of the periacetabular osteotomy segment was confirmed via fluoroscopy, although no abnormal mobility was observed. Thus, the osteotomy segment was fixed with one absorbable screw and two bone pegs (which were prepared using allogeneic bone), and the acetabular cup was fixed using cement. Her postoperative course was generally favorable and bone fusion of the periacetabular osteotomy segment was confirmed at 3 years and 6 months after surgery. Her modified Harris hip score was 43 before the surgery and had improved to 90 at the final follow-up. Modified total

  14. Posterior maxillary sandwich osteotomy combined with sinus grafting with bone morphogenetic protein-2 for alveolar reconstruction for dental implants: report of four cases.

    Science.gov (United States)

    Jensen, Ole T; Cottam, Jared

    2013-01-01

    Four patients underwent posterior sandwich osteotomy combined with sinus floor grafting using bone morphogenetic protein-2 and other grafting materials. The patients were treated over a period of 4 years. Two to four implants were placed in each site subsequently. Of the 12 implants placed, none failed. Alveolar crest bone levels appeared to be stable over time, with an average vertical gain of about 5 mm. Overall vertical gain, including the sinus graft, exceeded 13 mm in all patients. The procedure appears to hold promise for combined vertical alveolar defects and prominent pneumatization of the posterior maxilla.

  15. Results of Corrective Osteotomy and Treatment Strategy for Ankylosing Spondylitis with Kyphotic Deformity.

    Science.gov (United States)

    Kim, Ki-Tack; Park, Dae-Hyun; Lee, Sang-Hun; Lee, Jung-Hee

    2015-09-01

    To report the radiological and clinical results after corrective osteotomy in ankylosing spondylitis patients. Furthermore, this study intended to classify the types of deformity and to suggest appropriate surgical treatment options. We retrospectively analyzed ankylosing spondylitis patients who underwent corrective osteotomy between 1996 and 2009. The radiographic assessments included the sagittal vertical axis (SVA), spinopelvic alignment parameters, correction angle, correction loss, type of deformity related to the location of the apex, and the craniocervical range of motion (CCROM). The clinical outcomes were assessed by the Oswestry Disability Index (ODI) scores. A total of 292 corrective osteotomies were performed in 248 patients with a mean follow-up of 40.1 months (range, 24 to 78 months). There were 183 cases of single pedicle subtraction osteotomy (PSO), 19 cases of multiple Smith-Petersen osteotomy (SPO), 17 cases of PSO + SPO, 14 cases of single SPO, six cases of posterior vertebral column resection (PVCR), five cases of PSO + partial pedicle subtraction osteotomy (PPSO), and four cases of PPSO. The mean correction angles were 31.9° ± 11.7° with PSO, 14.3° ± 8.4° with SPO, 38.3° ± 12.7° with PVCR, and 19.3° ± 7.1° with PPSO. The thoracolumbar type was the most common. The outcome analysis showed a significant improvement in the ODI score (p ankylosing spondylitis, resulting in satisfactory outcomes with acceptable complications. The CCROM and postoperative SVA were important factors in determining the outcome.

  16. Mini-Invasive floating metatarsal osteotomy for resistant or recurrent neuropathic plantar metatarsal head ulcers.

    Science.gov (United States)

    Tamir, Eran; Finestone, Aharon S; Avisar, Erez; Agar, Gabriel

    2016-07-11

    Patients with peripheral neuropathy and pressure under a relatively plantar deviated metatarsal head frequently develop plantar foot ulcers. When conservative management with orthotics and shoes does not cure the ulcer, surgical metatarsal osteotomy may be indicated to relieve the pressure and enable the ulcer to heal. The purpose of this study is to evaluate the use of a mini-invasive floating metatarsal osteotomy in treating recalcitrant ulcers or recurrent ulcers plantar to the metatarsal heads in patients with diabetes mellitus (DM) related neuropathy. Computerized medical files of patients with diabetic neuropathy treated with an osteotomy during 2013 and 2014 were retrospectively reviewed. There were 20 osteotomies performed on 17 patients (mean age 58 years). The patients had a diagnosis of DM for a mean of 17 years. All ulcers were University of Texas grade 1A; mean ulcer age was 19 months. After 17/20 operations, the ulcer completely resolved after 6 weeks and did not recur after a mean follow-up of 11.5 months. One patient developed an early post-operative infection with osteomyelitis at the osteotomy site (proximal shaft of the fifth metatarsal) that needed debridement and IV antibiotics. In the other 19 cases, the surgical wound healed within 1 week. Asymptomatic radiological non-union developed in six cases (30 %). Mini-invasive floating metatarsal osteotomy can cure resistant and recurrent University of Texas grade 1A ulcerations plantar to the metatarsal heads in neuropathic patients.

  17. Variables Prognostic for Delayed Union and Nonunion Following Ulnar Shortening Fixed With a Dedicated Osteotomy Plate.

    Science.gov (United States)

    Gaspar, Michael P; Kane, Patrick M; Zohn, Ralph C; Buckley, Taylor; Jacoby, Sidney M; Shin, Eon K

    2016-02-01

    To examine potential risk factors for the development of delayed or nonunion following elective ulnar shortening osteotomy using a dedicated osteotomy plating system. We performed a retrospective review of all patients who underwent elective ulnar shortening using the TriMed single osteotomy dynamic compression plating system by 1 of 2 fellowship-trained hand surgeons over a 5-year period. Demographic data and medical, surgical, and social histories were reviewed. Time to bony union was determined radiographically by a blinded reviewer. Bivariate statistical analysis was performed to examine the effect of explanatory variables on the time to union and the incidence of delayed or nonunion. Those variables associated with the development of delayed or nonunion were used in a multivariate logistic regression model. Complications, including the need for additional surgery, were also recorded. Seventy-two ulnar shortening osteotomy procedures were performed in 69 patients. Delayed union, defined as ≥ 6 months to union, occurred in 8 of 72 cases (11%). Of 72 surgeries, 4 (6%) resulted in nonunions, all of which required additional surgery. Hardware removal was performed in 13 of 72 (18%) of the cases. Time to union was significantly increased in smokers (6 ± 3 months) versus nonsmokers (3 ± 1 months). On multivariable analysis, diabetics and active smokers demonstrated a significantly higher risk of developing delayed union or nonunion. Patient age, sex, body mass index, thyroid disease, worker's compensation status, alcohol use, and amount smoked daily did not have an effect on the time to union or the incidence of delayed or nonunion. Despite the use of an osteotomy-specific plating system, smokers and diabetics were at significantly higher risk for both delayed union and nonunion following elective ulnar shortening osteotomy. Other known risk factors for suboptimal bony healing were not found to have a deleterious effect. Copyright © 2016 American Society for

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

    Science.gov (United States)

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

    2014-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Tuli S

    2008-01-01

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

  20. Custom-made prefabricated titanium miniplates in Le Fort I osteotomies: principles, procedure and clinical insights.

    Science.gov (United States)

    Philippe, B

    2013-08-01

    This paper describes a new type of miniplate system that is designed and custom made during virtual surgery planning based on an individual patient's osteotomy. These miniplates are prefabricated with commercially pure porous titanium using direct metal laser sintering. The principles that guide the conception and production of this new miniplate are presented. The surgical procedure from the stage of virtual surgery planning until the final Le Fort I osteotomy and bone fixation are described using a case example. Copyright © 2013 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  1. Partial Necrosis of the Mandibular Proximal Segment Following Transoral Vertical Ramus Osteotomy.

    Science.gov (United States)

    Kim, Somi; Kim, Sang Yoon; Kim, Gi-Jung; Jung, Hwi-Dong; Jung, Young-Soo

    2014-05-01

    Transoral vertical ramus osteotomy (TOVRO) procedure can result in a variety of complications. Complications commonly reported include extensive bleeding due to major blood vessel injury, unpredictable fracture, postoperative infection, neurosensory deficit related Inferior alveolar nerve, insufficient osteosynthesis, and temporomandibular joint problem. The authors describe a case of partial necrosis of the mandibular proximal segment following TOVRO, a rarely reported complication. A 37-year-old otherwise healthy woman underwent Lefort l osteotomy and TOVRO to correct mandibular prognathism. Postoperatively, she developed pain and swelling in the right submandibular region and was found to have a partial necrosis of proximal segment.

  2. Brachymetatarsia of the fourth metatarsal, lengthening scarf osteotomy with bone graft

    Directory of Open Access Journals (Sweden)

    Ankit Desai

    2013-09-01

    Full Text Available A 16-year-old girl presented with left fourth metatarsal shortening causing significant psychological distress. She underwent lengthening scarf osteotomy held with an Omnitech® screw (Biotech International, France with the addition of two 1 cm cancellous cubes (RTI Biologics, United States. A lengthening z-plasty of the extensor tendons and skin were also performed. At 6 weeks the patient was fully weight bearing and at one-year follow up, the patient was satisfied and discharged. A modified technique of lengthening scarf osteotomy is described for congenital brachymatatarsia. This technique allows one stage lengthening through a single incision with graft incorporation by 6 weeks.

  3. Several characteristics of contemporary climate change in the Tibetan Plateau

    Institute of Scientific and Technical Information of China (English)

    朱文琴; 陈隆勋; 周自江

    2001-01-01

    Characteristics of contemporary climate change in the Tibetan Plateau have been investigated based on the observational data of monthly mean air temperature, monthly mean maximum and minimum air temperatures, and precipitation amount at 217 stations in the Plateau and its adjacent areas in 1951-1998, in which the temperature data at Lhasa, Lanzhou, Kunming and Chengdu were extended to a period of 1935-1950. The following conclusions can be drawn. (1) The air temperature in the Tibetan Plateau decreased from the 1950s to the 1960s, afterwards it began warming up to the 1990s. The data at the Lhasa Station beginning from 1935 have indicated that the air temperature at the station was the highest in the 1940s, then it became cooling until the 1960s. After the 1960s, it began warming until the 1990s. However, the air temperature at Lhasa in the 1990s still did not reach as high as in the 1940s. (2) Since the 1960s, there has existed a cooling belt below 3000 m altitude above sea level, which is located in ea

  4. Path of Social Construction in Northwest Sichuan Plateau Pastoral Area

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    On the basis of main contents of social construction and key points of construction,this paper analyzes features of conditions of northwest Sichuan plateau pastoral area.The social construction at current stage mainly includes social cause in narrow sense,and social management at meso-level.The northwest Sichuan plateau pastoral area is faced with the best policy and development opportunity.However,there are still many weak aspects.Firstly,social structure is not coordinated with economic structure.Secondly,social construction ability of grass-roots government is weak.Thirdly,the ability to respond to public demands is low.Fourthly,there is a big gap in availability of basic public service.Finally,it presents path selection for social construction of northwest Sichuan plateau pastoral area:strengthen social construction ability of grass-roots government;promote social construction with livelihood projects as key projects;boost social construction taking advantage of ecological construction;develop basic public service with the aid of external forces;intensify evaluation system for supervision of social construction works.

  5. Landslide development within the Barlad Plateau of Eastern Romania

    Science.gov (United States)

    Niacsu, Lilian; Ionita, Ion

    2014-05-01

    The Barlad Plateau, extending about 8,230 square kilometers is considered as the most typical unit of the Moldavian Plateau of the Eastern Romania. The Miocene-Pliocene clay-sandy layers are inter-bedded with shallow sandstone and limestone seams. These sedimentary layers that have outcropped as a result of erosion are gently dipping toward S-SE in the form of a monocline. Landslides have been recognized as an important environmental threat in the major subunits of the Barlad Plateau, namely: Central Moldavian Plateau, Falciu Hills and Tutova Rolling Hills. Four main areas of monitoring landslides were explored such as successive aerial photographs of the 1960, 1970, 2005 and 2009 flights, repeated field surveys for a thorough reconnaissance of the study area, classical levelling work and GIS software applications as TNT Mips and Arc GIS. Also, the Caesium-137 technique has been used to get information on documenting sedimentation rates in some small catchments. Results have indicated that the landslide development is strongly controlled by the northern and western looking steep faces of cuestas, by changes of rock composition and by human impact. Also, it showed great pulses in conjunction with the rainfall distribution. For example, half of the Upper Barlad catchment that drains an area of 22,560 ha is covered by landslides. Furthermore, the active landslides amounted 11% of the total (2,317 ha) after the rainy 1968-1973 period and since 1982 under drier conditions they gradually limited to 444.0 ha (2% of the total).

  6. Mutual influence between human activities and climate change in the Tibetan Plateau during recent years

    Science.gov (United States)

    Du, Mingyuan; Kawashima, Shigeto; Yonemura, Seiichiro; Zhang, Xianzhou; Chen, Shenbin

    2004-07-01

    It is well known that there is a vast expanse of grassland on the Tibetan Plateau, China. It is suggested that a major climatic factor limiting production of the grassland ecosystem is the low thermo-conditions on the Tibetan Plateau. An increase in temperature may therefore increase the productivity of grasslands on the Plateau. Monthly mean temperature and monthly precipitation data for recent years on the Tibetan Plateau were analyzed. It is clear that the increase in air temperature on the Plateau is greater than that in the whole China and East Asia. On the other hand, statistics show that the production of livestock or meat in the Tibetan Plateau has increased by one to three times since 1978, which means that there should be an equivalent increase in the consumption of plant biomass from the grassland. How is the "increased biomass" related to human activities and climate changes? This paper tries to clarify the relationship between human activities and climate change and to propose a possible answer by laying emphasis on the importance of grassland protection and CO 2 flux monitoring. It is suggested that there is a positive feedback in which degradation of grassland by overgrazing will increase potential evapotranspiration level thereby promoting the climate warming and the degradation process. This feedback should be considered seriously in the future.

  7. Long-term exhumation history of the Inner Mongolian Plateau constrained by apatite fission track analysis

    Science.gov (United States)

    Li, Ke; Jolivet, Marc; Zhang, Zhicheng; Li, Jianfeng; Tang, Wenhao

    2016-01-01

    The Inner Mongolian Plateau, along the southeastern flank of the wider Mongolian Plateau, is a vast undulating surface ranging in elevation between 900 and 1500 m above sea level. The peculiar topography of this area is assumed to be closely related to its complex tectono-thermal evolution since Late Paleozoic. The lithospheric structure of the Plateau includes three continental blocks: the Mandula and the Bart Obo blocks form the southern margin of the Central Asian Orogenic Belt in that area, and to the south, the Plateau includes the northern margin of the North China Craton. Apatite fission track (AFT) ages and track length distributions from 13 basement outcrops situated in the main tectonic blocks forming the Inner Mongolian Plateau were determined in order to reconstruct its denudation history. The thermal histories inferred from these data imply multi-phased, differential exhumation/burying processes from the Late Paleozoic to the Early Cretaceous. This complex thermal history is largely related to the Early/Middle Triassic closure of the Paleo-Asian Ocean, the Jurassic closure of the Mongol-Okhotsk Ocean, and the Early Cretaceous orogenic collapse of the Mongol-Okhotsk belt. Finally, since Late Cretaceous, no further major tectonic movement occurred and the Inner Mongolian Plateau has been largely peneplained.

  8. Anatomical variation of posterior slope of tibial plateau in adult Eastern Indian population.

    Science.gov (United States)

    Medda, Shyamalendu; Kundu, Rajib; Sengupta, Sohini; Pal, Ananda Kisor

    2017-01-01

    Upper surface of the proximal tibial end, tibial plateau, has a slope directed posteroinferiorly relative to the long axis of the middle of the shaft. It has important consideration in surgeries such as knee arthroplasty, high tibial osteotomy, and medical imaging of the knee joint. The aim of the present study was to estimate the tibial plateau angle (TPA) by plain radiograph in the adult Eastern Indian population as during literature review, we were unable to find any study, except one (without specific reference axis), on this variable among the Indian population. A sample was taken from adult patients attending the outpatient department of orthopedics of the institute with minor knee problems. Measurement of the TPA was done in the true lateral radiographs of the knee joints of the selected subjects by a standardized method. TPA varied widely from 6° to 24°, with the mean ± standard deviation value 13.6° ±3.5°. Student's unpaired t-test revealed no significant difference of TPA between left and right knees, both in male (P = 0.748) and female (P = 0.917) separately and in the entire study population irrespective of gender (P = 0.768). Comparison of TPA between male (13.3° ± 3.3°) and female (13.9° ± 3.4°) by Student's unpaired t-test showed no sexual dimorphism (P = 0.248). There were poor correlations of TPA with age and body mass index. The present study described the variations of the TPA in the adult Eastern Indian population (range 6°-24°, mean ± SD 13.6° ± 3.5°, no laterality, no sexual dimorphism, poor correlation with age and BMI). Knowledge of this study could be used in different orthopedic surgeries and imaging technique in or around the knee joint.

  9. Robot-Assisted Surgery for Mandibular Angle Split Osteotomy Using Augmented Reality: Preliminary Results on Clinical Animal Experiment.

    Science.gov (United States)

    Zhou, Chaozheng; Zhu, Ming; Shi, Yunyong; Lin, Li; Chai, Gang; Zhang, Yan; Xie, Le

    2017-07-19

    Mandibular angle split osteotomy (MASO) is a procedure widely used for prominent mandibular angles. However, conventional mandibular plastic surgery is invasive and high risk. It may induce postoperative neurosensory disturbance of the inferior alveolar nerve, fractures and infection due to the complexity of the anatomical structure and the narrow surgical field of view. The success rate of MASO surgery usually depends on the clinical experience and skills of the surgeon. To evaluate the performance of inexperienced plastic surgeons conducting this surgery, a self-developed and constructed robot system based on augmented reality is used. This robot system provides for sufficient accuracy and safety within the clinical environment. To evaluate the accuracy and safety of MASO surgery, an animal study using this robot was performed in the clinical room, and the results were then evaluated. Four osteotomy planes were successfully performed on two dogs; that is, twenty tunnels (each dog drilled on bilaterally) were drilled in the dogs' mandible bones. Errors at entrance and target points were 1.04 ± 0.19 and 1.22 ± 0.24 mm, respectively. The angular error between the planned and drilled tunnels was 6.69° ± 1.05°. None of the dogs experienced severe complications. Therefore, this technique can be regarded as a useful approach for training inexperienced plastic surgeons on the various aspects of plastic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  10. Grafted vertebral fracture after implant removal in a patient with spine-shortening vertebral osteotomy.

    Science.gov (United States)

    Nakashima, Hiroaki; Yukawa, Yasutsugu; Ito, Keigo; Machino, Masaaki; Kanbara, Shunsuke; Morita, Daigo; Imagama, Shiro; Ishiguro, Naoki; Kato, Fumihiko

    2015-02-01

    We experienced the rare complication of a vertebral fracture that was caused by implant removal after bony fusion had been achieved in a patient who underwent spine-shortening osteotomy (SSO) for tethered cord syndrome (TCS). We propose that the removal of the implant used for SSO should be contraindicated. The patient (a 27-year-old female) presented to our institution with a history of progressive severe lower back pain, gait disturbance, and urinary incontinence. As an infant, she had undergone surgery for spina bifida with lipoma. Magnetic resonance imaging of the spine revealed tethering of the spinal cord to a lipoma. We performed SSO at the level of the L1 vertebra level. After spine shortening and fixation using a posterior approach, the L1 vertebral body was completely removed anteriorly and replaced with a left iliac bone graft. The patient's symptoms improved after surgery. After bony fusion was achieved after surgery, we decided to remove the spinal implant after we explained the advantages and disadvantages of the procedure to the patient. We performed implant removal surgery safely 2 years later; however, the patient complained of severe lower back pain 10 days after the surgery without any history of trauma. Reconstruction computed tomography showed fracture of the grafted vertebra. We performed a repeat posterior fixation, which relieved the lower back pain; she has experienced no complications in the subsequent 5 years. In summary, we report a case of a rare complication of the fracture of a grafted vertebra after removal of an implant used in SSO for TCS. Spinal stability could not be maintained without the spinal posterior implant after SSO. Postoperative fracture after spinal implant removal is rare but possible, and patients must be informed of this potential risk.

  11. Single-Tooth Osteotomy Combined Wide Linear Corticotomy Under Local Anesthesia for Correcting Anterior Protrusion With Ectopically Erupted Canine.

    Science.gov (United States)

    Iskenderoglu, Nur Serife; Choi, Byung-Joon; Seo, Kyung Won; Lee, Yeon-Ji; Lee, Baek-Soo; Kim, Seong-Hun

    2017-01-01

    This article presents the alternative surgical treatments of both anterior protrusion by carrying out retraction on mandibular anterior fragment, meanwhile applying retraction force on maxilla anterior teeth and ectopically erupted canine with using platelet-rich fibrin (PRF). Anterior segmental osteotomy was combined with linear corticotomy under local anesthesia. The correction of right ectopic canine was achieved through 2 stages. First, dento-osseous osteotomy on palatal side was performed. Then second osteotomy with immediate manual repositioning of the canine with concomitant first premolar extraction was enhanced with PRF, which was prepared by centrifuging patient's blood, applied into buccal side of high canine during osteotomy. Mandibular retraction was accomplished by anterior segmental osteotomy. Single-tooth osteotomy is a more effective surgical method for ankylosed or ectopically erupted tooth in orthodontic treatment. It can reduce the total orthodontic treatment time and root resorption, 1 common complication. Significant improved bone formation was seen with the addition of PRF on noncritical size defects in the animal model. It is reasonable to think that PRF can promote bone regeneration. So early bone formation also can reduce the complication such as postoperative infection. As an alternative to anterior protrusion and ectopically erupted canine treatment, segmental osteotomy and corticotomy combined platelet-rich plasma can enhance orthodontic treatment outcome.

  12. Biomechanical interactions of different mini-plate fixations and maxilla advancements in the Le Fort I Osteotomy: a finite element analysis.

    Science.gov (United States)

    Huang, Shao-Fu; Lo, Lun-Jou; Lin, Chun-Li

    2016-12-01

    This study investigates the biomechanical interaction of different mini-plate fixation types (shapes/sizes and patterns) with segmental advancement levels on the Le Fort I osteotomy using the non-linear finite element (FE) approach. Nine models were generated under a standard 1-piece LeFort I osteotomy for advancement with 3, 6 and 9 mm distances and four mini-plates with three fixation patterns including LL, LI, and II patterns placed on the maxillae models by integrating computed tomography images and computer-aided design system. The axial and oblique occlusal forces were 250 N applied to each premolar/molar and 125 N applied at 30° inclination to the tooth long axis and from palatal to buccal, respectively. The relative micro-movement values between the two maxillary bone segments and maximum mini-plate stress increased obviously with maxilla advancement increment and the increasing trend can be fitted by exponential curve. The corresponding values in II mini-plate fixation presented apparently high values in all simulated cases. The mini-plate stress concentration locations were found at the bending regions to increase high fracture risk. The mini-plate yield strength can be mapped to a critical (limited) advancement for three types of fixations for safe consideration. This study concluded that L-shaped mini-plates with lateral fixation are recommended to provide better stability. The risk for mini-plate fracture and bone relapse increases when maxillary advancement is larger than a critical value of 5 mm in the Le Fort I osteotomy.

  13. [Long-term clinical and radiological outcomes in a serie of 26 cases of symptomatic adult developmental dysplasia of the hip managed with bernese periacetabular osteotomy].

    Science.gov (United States)

    Alcobía Díaz, B; Luque Pérez, R; García Bullón, I; Moro Rodríguez, L E; López-Durán Stern, L

    2015-01-01

    Developmental hip dysplasia is a frequent cause of coxofemoral pain in young adults. Bernese periacetabular osteotomy emerges as a possible option for the management of pain relief and functional limitation, in order to delay the need for arthroplasty in these patients. A descriptive-retrospective study was conducted on 26 selected patients with symptomatic developmental hip dysplasia treated with bernese periacetabular osteotomy between 1996 and 2009 (94% women). Mean age at time of surgery was 39.8 y (15-49 y), with a mean follow-up of 10 years. Osteoarthritis (OA Tönnis scale), acetabular index and Wiberg angle were evaluated by radiology and functionality was valued by using the de Merle-D'Aubigné-Postel scale. The mean hospitalization time was 10 days. At 10 years, the mean radiography value of acetabular index was 9.03° and 38.3° for Wiberg angle (17° and 27° correction, respectively, above the mean pre-operative values). Joint lock was referred to by 43% of patients, and 53% to non-evidence based limb failure. Mean functional value was 14.30 (Good). At 5 years of follow-up, 20% advanced at least by one grade in OA Tönnis scale compared to their pre-operative status, increasing to 55% at 10 years. At 10 years after surgery, 83% patients did not need arthroplasty and 85% showed high satisfaction level. Bernese periacetabular osteotomy is a useful alternative in young adults with symptomatic developmental hip dysplasia that can improve pain relief, femoral head coverage, and slow down coxofemoral osteoarthrosis progression in order to delay arthroplasty. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  14. Osteotomia proximal da tíbia: estabilização da abertura medial com enxerto tricortical de ilíaco Proximal tibial osteotomy: stabilization of the medial opening with atricortical iliac bone graft

    Directory of Open Access Journals (Sweden)

    Roberto da Cunha Luciano

    2010-01-01

    : Prospective study of 46 patients with ages ranging from 17 to 61 years. Among them, 42 patients were carriers of genu varum secondary to knee osteoarthritis and four from other causes. Radiography was performed for surgical planning, using the Frank Noyes method modified by Fugizawa. Three cm conventional surgical access was performed to remove a tricortical iliac graft. The osteotomy was performed under fluoroscopic control, by 3 cm anteromedial incision with release of the superficial portion of the medial collateral ligament. The graft was placed in the posterior portion of the osteotomy to maintain an unaltered tibial slope. The screw crossed the osteotomy orthogonally to protect the lateral cortex. Radiographic criteria were established pre-and postoperatively to assess the results. RESULTS: There was consolidation in 100% of cases and maintenance of the mechanical axis, obtained intraoperatively in 94% of cases. Correction of mechanical axis occurred in 94% (43 patients / 47 osteotomies. The posterior slope of the tibial plateau in the sagittal plane ranged from 7º to 12º. Joint mobility was restored in all patients. Eleven patients had temporary pain at the site of graft removal, however, none had paraesthesia. The incidence of complications was 8% (infection, loss of correction, joint fracture. CONCLUSION: This technique is reproducible, simple, biologic, accurate, low-cost, and can be used as an alternative to existing techniques.

  15. DYNAMICS OF BRÂGLEZ RIVERBED (SOMEŞAN PLATEAU

    Directory of Open Access Journals (Sweden)

    V. ARGHIUŞ

    2012-03-01

    Full Text Available Dynamics of Brâglez Riverbed (Someşan Plateau. The main left tributaries of Someş along Surduc – Jibou sector (Brâglez, Almaş and Agrij, are characterized by the presence of obvious processes of lateral and vertical erosion at the level of the riverbeds. The field observations, as well as the position of these rivers and their catchment areas in the neighborhood of the lower Someş subsidence area, would easily be grounds for explaining the riverbed processes as caused by an unstable fluvial base level. More precisely, this base level would be moving downwards under the influence of subsidence movements of Tisa Plain or even because of the subsidence affecting Guruslău Basin. Starting from these more or less speculative deductions, this paper aims at checking and confirming the above-mentioned explanations or finding other causes for the dynamics of riverbed processes. In this sense, we analysed a correlation between the drainage in the catchment area and at the level of the riverbeds, on one hand, and the riverbed geomorphological processes, on the other hand. Brâglez River (in western Someşan Plateau will be considered as a study case, as it provides an accelerated dynamics of riverbed processes. This situation will be compared with the one in the eastern part of the same plateau, where rivers like Borşa, Luna or Lujerdiu do not present obvious riverbed processes despite the similar climatic and geological conditions.

  16. Changes in Cerebral Partial Oxygen Pressure and Cerebrovascular Reactivity During Intracranial Pressure Plateau Waves.

    Science.gov (United States)

    Lang, Erhard W; Kasprowicz, Magdalena; Smielewski, Peter; Pickard, John; Czosnyka, Marek

    2015-08-01

    show a slight overshoot after normalization. We assume that this might be due to different latencies of the cerebral blood flow and oxygen level control mechanisms. Other factors may include baseline conditions, such as pre-plateau wave cerebrovascular reactivity or pbtO2 levels, which differ between studies.

  17. Three-dimensional virtual simulation of alar width changes following bimaxillary osteotomies

    NARCIS (Netherlands)

    Liebregts, J.; Xi, T.; Schreurs, R; Loon, B. van; Berge, S.; Maal, T.

    2016-01-01

    The aim of this study was to evaluate the accuracy of three-dimensional (3D) soft tissue simulation of nose width changes following bimaxillary osteotomies and to identify patient- and surgery-related factors that may affect the accuracy of simulation. Sixty patients (mean age 26 years) who

  18. Accuracy of three-dimensional soft tissue simulation in bimaxillary osteotomies

    NARCIS (Netherlands)

    Liebregts, J.; Xi, T.; Timmermans, M.; Koning, M.J.J. de; Berge, S.J.; Hoppenreijs, T.J.M.; Maal, T.J.

    2015-01-01

    The purpose of this study was to evaluate the accuracy of an algorithm based on the mass tensor model (MTM) for computerized 3D simulation of soft-tissue changes following bimaxillary osteotomy, and to identify patient and surgery-related factors that may affect the accuracy of the simulation. Sixty

  19. 3D analysis of condylar remodelling and skeletal relapse following bilateral sagittal split advancement osteotomies

    NARCIS (Netherlands)

    Xi, T.; Schreurs, R.; Loon, B. van; Koning, M.J. de; Berge, S.J.; Hoppenreijs, T.J.; Maal, T.J.J.

    2015-01-01

    A major concern in mandibular advancement surgery using bilateral sagittal split osteotomies (BSSO) is potential postoperative relapse. Although the role of postoperative changes in condylar morphology on skeletal relapse was reported in previous studies, no study so far has objectified the precise

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

    Directory of Open Access Journals (Sweden)

    S Pandey

    2012-09-01

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

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

    DEFF Research Database (Denmark)

    Allpass, Maja; Miles, James Edward

    2015-01-01

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

  2. Effect of Maxillary Osteotomy on Speech in Cleft Lip and Palate: Perceptual Outcomes of Velopharyngeal Function

    Science.gov (United States)

    Pereira, Valerie J.; Sell, Debbie; Tuomainen, Jyrki

    2013-01-01

    Background: Abnormal facial growth is a well-known sequelae of cleft lip and palate (CLP) resulting in maxillary retrusion and a class III malocclusion. In 10-50% of cases, surgical correction involving advancement of the maxilla typically by osteotomy methods is required and normally undertaken in adolescence when facial growth is complete.…

  3. An extensive posterior approach of the elbow with osteotomy of the medial epicondyle

    NARCIS (Netherlands)

    Vos, de M.J.; Wagener, M.L.; Verdonschot, N.J.J.; Eygendaal, D.

    2014-01-01

    Background This study describes a posterior approach to the elbow for placement of a total elbow prosthesis. Methods Release of the medial collateral ligament is achieved by performing an osteotomy of the medial epicondyle. This allows anatomic refixation of the origin of the medial collateral liga

  4. An extensive posterior approach of the elbow with osteotomy of the medial epicondyle

    NARCIS (Netherlands)

    Vos, M.J. de; Wagener, M.L.; Verdonschot, N.J.J.; Eygendaal, D.

    2014-01-01

    BACKGROUND: This study describes a posterior approach to the elbow for placement of a total elbow prosthesis. METHODS: Release of the medial collateral ligament is achieved by performing an osteotomy of the medial epicondyle. This allows anatomic refixation of the origin of the medial collateral lig

  5. Endovaskulaer embolisering af svaer blødning i forbindelse med periacetabulaer osteotomi

    DEFF Research Database (Denmark)

    Brenøe, Anne-Sofie; Andersen, Poul Erik; Overgaard, Søren

    2006-01-01

    Embolisation is a well-known procedure for trauma patients with pelvic injuries and bleeding complications. We report a case in which haemostasis was successfully achieved by angiographic embolisation in a patient with bleeding complications due to periacetabular osteotomy. This case illustrates ...

  6. Arthroscopic subcapital realignment osteotomy in chronic and stable slipped capital femoral epiphysis: early results

    Directory of Open Access Journals (Sweden)

    Bruno Dutra Roos

    Full Text Available ABSTRACT OBJECTIVE: This study aimed to evaluate the clinical and radiographic outcomes, as well as the complications of arthroscopic subcapital realignment osteotomy in chronic and stable slipped capital femoral epiphysis (SCFE. As indicated by the literature review, this is the first time this type of arthroscopic osteotomy was described. METHODS: Between June 2012 and December 2014, seven patients were submitted to arthroscopic subcapital realignment osteotomy in chronic and stable SCFE. The mean age was 11 years and 4 months, and the mean follow-up period was 16.5 months (6-36. Clinical results were evaluated using the Modified Harris Hip Score (MHHS, which was measured pre- and postoperatively. Radiographs were evaluated using the Southwick quantitative classification and the epiphysis-diaphysis angle (pre- and postoperatively. Complications were assessed. RESULTS: The mean preoperative MHHS was 35.8 points, and 97.5 points post-operatively (p < 0.05. Radiographically, five patients were classified as Southwick classification grade II and two as grade III. The mean correction of the epiphysis-diaphysis angle was 40°. No immediate postoperatively complications were observed. One patient presented femoral head avascular necrosis, without collapse or chondrolysis at the most recent follow-up (22 months. CONCLUSION: The arthroscopic technique presented for subcapital realignment osteotomy in chronic and stable SCFE showed satisfactory clinical and radiographic outcomes in a 16.5 months follow-up period.

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

    DEFF Research Database (Denmark)

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

    2017-01-01

    Background and purpose - Studies have indicated that one-third of children with cerebral palsy (CP) develop dislocation of the hip that needs surgical intervention. When hip dislocation occurs during childhood surgical treatment consists of tenotomies, femoral varus derotation osteotomy (VDRO...

  8. What factors predict failure 4 to 12 years after periacetabular osteotomy?

    DEFF Research Database (Denmark)

    Hartig-Andreasen, Charlotte; Troelsen, Anders; Thillemann, Theis Muncholm

    2012-01-01

    The goal of periacetabular osteotomy (PAO) is to delay or prevent osteoarthritic development in dysplastic hips. However, it is unclear whether the surgical goals are achieved and if so in which patients. This information is essential to select appropriate patients for a durable PAO that achieves...

  9. Endovaskulaer embolisering af svaer blødning i forbindelse med periacetabulaer osteotomi

    DEFF Research Database (Denmark)

    Brenøe, Anne-Sofie; Andersen, Poul Erik; Overgaard, Søren

    2006-01-01

    Embolisation is a well-known procedure for trauma patients with pelvic injuries and bleeding complications. We report a case in which haemostasis was successfully achieved by angiographic embolisation in a patient with bleeding complications due to periacetabular osteotomy. This case illustrates...... that the technique is an alternative to vascular surgery when bleeding complications occur during surgery....

  10. Bernese periacetabular osteotomy for hip dysplasia. A modification to original technique and South American perspective.

    Science.gov (United States)

    Lara, Joaquín; Tobar, Carlos; Besomi, Javier

    2014-12-01

    Bernese periacetabular osteotomy has become a secure and reproducible technique for treatment of hip dysplasia. It allows an adequate reorientation of the acetabulum and coverage of the femoral head improving biomechanical conditions of the hip joint. We present a review of literature and a modification of original technique that includes a smaller incision and preservation of the abductor muscles and rectus femoris tendon insertion.

  11. Is Cup Positioning Challenged in Hips Previously Treated With Periacetabular Osteotomy?

    DEFF Research Database (Denmark)

    Hartig-Andreasen, Charlotte; Stilling, Maiken; Søballe, Kjeld;

    2014-01-01

    After periacetabular osteotomy (PAO), some patients develop osteoarthritis with need of a total hip arthroplasty (THA). We evaluated the outcome of THA following PAO and explored factors associated with inferior cup position and increased polyethylene wear. Follow-up were performed 4 to 10years a...

  12. W/M serrated osteotomy for infantile Blount's disease in Ghana ...

    African Journals Online (AJOL)

    2015-10-30

    Oct 30, 2015 ... inhibition, can be reduced by transferring the pressure to the lateral compartment of the ... drawing a line from the lateral edge of the metaphysis to the ... when the osteotomy itself was not stable, a Kirschner wire was added for ...

  13. Three-dimensional virtual simulation of alar width changes following bimaxillary osteotomies

    NARCIS (Netherlands)

    Liebregts, J.; Xi, T.; Schreurs, R; Loon, B. van; Berge, S.; Maal, T.

    2016-01-01

    The aim of this study was to evaluate the accuracy of three-dimensional (3D) soft tissue simulation of nose width changes following bimaxillary osteotomies and to identify patient- and surgery-related factors that may affect the accuracy of simulation. Sixty patients (mean age 26 years) who underwen

  14. Delayed progressive haematoma after Le Fort I osteotomy: A possible severe complication in orthognatic surgery

    Directory of Open Access Journals (Sweden)

    Dario Bertossi

    2012-01-01

    Full Text Available Although the Le Fort I osteotomy is a safe surgical technique, many complications have been reported. We present a case of an extended cervico-facial haematoma due to delayed bleeding from the terminal branches of the maxillary artery after orthognatic surgery. A 23-year-old man was referred to our observation for the surgical correction of a class III asymmetric malocclusion. The patient underwent a Le Fort I osteotomy, with impaction of the maxilla, associated with an Epker mandibular bilateral sagittal split osteotomy, with maxillary advancement and rigid internal fixation of the mandible with four miniplates and another four for the upper maxilla as well. The first post-surgery day, the patient developed a gradual dispnea together with neck swelling. By second postoperative day, the patient′s general condition improved with a progressive normalization of laboratory tests values. The Computerised Axial Tomography (CAT scan confirmed a decrease in the parapharyngeal thickening. Total recovery was achieved within two months, the final clinical check showed a healthy appearance with good occlusion. An increased knowledge of the basic biology of the Le Fort I osteotomy, the development of instruments specially designed for the Le Fort I procedure and the use of hypotensive anaesthesia could reduce the morbidity and duration of this procedure.

  15. Long term stability of mandibular advancement procedures : bilateral sagittal split osteotomy versus distraction osteogenesis

    NARCIS (Netherlands)

    Baas, E. M.; Pijpe, J.; de Lange, J.

    2012-01-01

    The aim of this study was to compare the postoperative stability of the mandible after a bilateral lengthening procedure, either by bilateral sagittal split osteotomy (BSSO) or distraction osteogenesis (DO). All patients who underwent mandibular advancement surgery between March 2001 and June 2004 w

  16. Stability of mandibular advancement procedures : Bilateral sagittal split osteotomy versus distraction osteogenesis

    NARCIS (Netherlands)

    Vos, M. D.; Baas, E. M.; de lange, J.; Bierenbroodspot, F.

    2009-01-01

    The aim of this study was to compare the postoperative stability of the mandible after a bilateral lengthening procedure, either by bilateral sagittal split osteotomy (BSSO) or distraction osteogenesis (DOG). All patients who underwent mandibular advancement surgery between March 2001 and June 2004

  17. [Comparative studies on the vestibular and lingual osteotomy in the removal of lower wisdom teeth].

    Science.gov (United States)

    Strukmeier, A; Pape, H D

    1980-01-01

    Retained third molars and/or buds in the left and right mandible were removed unilaterally via a vestibular and lingual osteotomy in 50 patients at the department for oral surgery. Postoperative edema in addition to the operative course was registered with a measurement technique developed by the authors: wound healing and general subjective complaints were also compared.

  18. A prospective study of Japas′ osteotomy in paralytic pes cavus deformity in adolescent feet

    Directory of Open Access Journals (Sweden)

    Chatterjee Protyush

    2009-01-01

    Full Text Available Background: Pes cavus is a progressive and ugly deformity of the foot. Although initially the deformity is painless, with time, painful callosities develop under metatarsal heads and arthritis supervenes later in feet. Mild deformities can be treated with corrective shoes, or foot exercises. However, in others, operative treatment is imperative. Soft tissue operations are largely unsatisfactory and temporary. Bony operations give permanent correction. We present our series of 18 patients of pes cavus in the adolescent age group, treated by Japas′ V-osteotomy of the tarsus. Materials and Methods: 18 patients of paralytic pes cavus deformity were treated by Japas osteotomy, between March 1995 and 2005, at our institute. The age of the patients ranged from 8.6 to 15 years (mean 11.3; 10 were boys and 8 girls. All cases had unilateral involvement, and all, but one, were post-polio cases. Result: The mean follow-up is 5.4 years. Of the 18 patients, 14 had excellent or good corrections; 4 had poor correction/complications. However, those patients could be salvaged by triple arthordesis or Dwyer′s calcaneal osteotomy. Conclusion: Japas′ osteotomy is a satisfactory option for correction of pes cavus deformity in adolescents. In patients who have rigid hind foot equinus or varus, however, the results are compromised.

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

    Science.gov (United States)

    Wylie, James D; Maak, Travis G

    2016-12-01

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

  20. Accuracy of three-dimensional soft tissue simulation in bimaxillary osteotomies

    NARCIS (Netherlands)

    Liebregts, J.; Xi, T.; Timmermans, M.; Koning, M.J.J. de; Berge, S.J.; Hoppenreijs, T.J.M.; Maal, T.J.

    2015-01-01

    The purpose of this study was to evaluate the accuracy of an algorithm based on the mass tensor model (MTM) for computerized 3D simulation of soft-tissue changes following bimaxillary osteotomy, and to identify patient and surgery-related factors that may affect the accuracy of the simulation. Sixty

  1. Gait and lower limb muscle strength in women after triple innominate osteotomy

    NARCIS (Netherlands)

    Kolk, S.; Fluit, R.; Luijten, J.; Heesterbeek, P.J.; Geurts, A.C.; Verdonschot, N.J.J.; Weerdesteyn, V.

    2015-01-01

    Background: In adult patients with developmental hip dysplasia, a surgical procedure (triple innominate osteotomy) of the pelvic bone can be performed to rotate the acetabulum in the frontal plane, establishing better acetabular coverage. Although common clinical hip scores demonstrate significant i

  2. Gait and lower limb muscle strength in women after triple innominate osteotomy

    NARCIS (Netherlands)

    Kolk, S.; Fluit, R.; Luijten, J.; Heesterbeek, P.J.; Geurts, A.C.H.; Verdonschot, N.J.; Weerdesteijn, V.G.M.

    2015-01-01

    BACKGROUND: In adult patients with developmental hip dysplasia, a surgical procedure (triple innominate osteotomy) of the pelvic bone can be performed to rotate the acetabulum in the frontal plane, establishing better acetabular coverage. Although common clinical hip scores demonstrate significant i

  3. Visible Perforating Lateral Osteotomy: Internal Perforating Technique with Wide Periosteal Dissection

    Directory of Open Access Journals (Sweden)

    Bong Il Rho

    2016-01-01

    Full Text Available There are two general categories of lateral osteotomy techniques—the external perforating method and the internal continuous method. Regardless of which technique is used, procedural effectiveness is hampered by limited visualization in the surgical field. Considering this point, we devised a new technique that involves using a wide subperiosteal dissection and internal perforation under direct visualization. Using an intranasal approach, whereby the visibility of the intended fracture line was maintained, enabled a greater degree of control, and in turn, results that were more precise, and thus predictable and reproducible. Traditionally, it has been taken as dogma that the periosteum must be preserved, considering the potential for dead space and bony instability; however, under sufficient visualization of the surgical field with an internal perforating method, complete osteotomy with fully preserved intranasal mucosa could be conducted exactly as intended. This intact mucosal lining compensates for the elevated periosteum. Compressive dressing and drainage through a Silastic angio-needle catheter enabled the elimination of dead space. Therefore, precise, reproducible, and predictable osteotomy minimizing the potential for associated complications such as ecchymosis, that is, bruising owing to hemorrhage, could be performed. In this article, we introduce a novel technique for lateral osteotomy with improved visualization.

  4. Effect of Maxillary Osteotomy on Speech in Cleft Lip and Palate: Perceptual Outcomes of Velopharyngeal Function

    Science.gov (United States)

    Pereira, Valerie J.; Sell, Debbie; Tuomainen, Jyrki

    2013-01-01

    Background: Abnormal facial growth is a well-known sequelae of cleft lip and palate (CLP) resulting in maxillary retrusion and a class III malocclusion. In 10-50% of cases, surgical correction involving advancement of the maxilla typically by osteotomy methods is required and normally undertaken in adolescence when facial growth is complete.…

  5. Soft tissue changes after a mandibular osteotomy for symmetric skeletal class III malocclusion.

    Science.gov (United States)

    Ohba, Seigo; Kohara, Haruka; Koga, Takamitsu; Kawasaki, Takako; Miura, Kei-Ichirou; Yoshida, Noriaki; Asahina, Izumi

    2016-10-31

    The soft tissue profile is crucial to esthetics after orthognathic surgery. The aim of this study was to assess the soft tissue changes of the subnasal and submental regions more than 1 year after a sagittal split ramus osteotomy (SSRO) in patients with skeletal class III malocclusion. A total of 22 patients with mandibular prognathism were included in this study. Patients had lateral cephalograms before and more than 1 year after they underwent an isolated SSRO. Soft and hard tissue changes were assessed using the lateral cephalograms. The lower lip, labiomenton, and soft tissue menton moved posteriorly by 85, 89, and 88% compared with the corresponding hard tissue, and the movement of the soft tissue B point and the top of the chin nearly reflected the displacement of the hard tissues, at 96 and 99%, respectively. The labiomenton, stomions, and naso-labial angles were changed after the mandibular set-back and the changes in these angles correlated with either the width of the soft tissue or skeletal displacement. The naso-labial angle could be altered even if an isolated mandibular osteotomy is performed. Changes to the stomions and naso-labial angles were affected by hard tissue movement, while changes to the labiomental angle were affected by the width of the soft tissue after the mandibular osteotomy. It is important to create an accurate preoperative prediction of the esthetic outcomes after a mandibular osteotomy by considering the interrelations between the hard and soft tissues.

  6. Early outcomes of one-stage combined osteotomy in Legg-Calve´-Perthes disease

    Directory of Open Access Journals (Sweden)

    Basant Kumar Bhuyan

    2016-01-01

    Conclusions: The surgical treatment of LCPD with the best expected outcome is still a challenge. Advanced containment methods by one-stage combined osteotomy can be considered as an alternative treatment where femoral head subluxation or deformity which makes containment difficult or impossible by more conventional methods.

  7. Fixation of Intertrochanteric Valgus Osteotomy with T Plate in Treatment of Developmental Coxa Vara

    Science.gov (United States)

    Khairy, Hosam Mohamed

    2016-01-01

    Background Although the valgus subtrochanteric osteotomy is considered as a standard surgical treatment for coxa vara, there is no consensus on the optimal method of fixation and osteotomy technique. Fixation of the osteotomy has been achieved by various methods including external fixation and internal fixation with pins and cerclage and a variety of plates. The aim of this study is the evaluation of the results of developmental coxa treated by Y intertrochanteric valgus osteotomy fixed with a T-buttress plate compared with other methods of fixation in the literature. Methods Eighteen corrective valgus intertrochanteric femoral osteotomies were performed in 18 patients (18 hips) for treatment of unilateral developmental coxa vara deformity and fixed with a T plate. There were 12 males and 6 females. The right hip was affected in 10 patients and the left hip in 8 patients. Clinically, patients were evaluated by Larson hip score. Radiographically, anteroposterior view of the pelvis and frog leg lateral views of the affected hip were taken preoperatively and compared with the findings at the final follow-up. Results The average follow-up was 29 months (range, 24 to 36 months). Clinical results showed improvement of the mean Larson hip score from 57.8 to 97.0 (p < 0.001). Radiological results showed that all osteotomies were completely united in 2.4 months (range, 2 to 3 months) with the achievement of the planned correction angle. The average correction of Hilgenreiner's epiphyseal angle improved from 78.2° to 27.8° (p < 0.001) at the final follow-up. The femoral neck shaft angle was improved from 93.7° to 129.9° (p < 0.001) at the final follow-up. Shortening of the affected limb was corrected from 2.8 cm to 1.3 cm (p < 0.001) at the last follow-up. No major serious complications were recorded in the present study. Conclusions Intertrochanteric valgus osteotomy of the proximal femur fixed with a T plate may be efficient for treatment of developmental coxa vara

  8. Comparison of acetabular anterior coverage after Salter osteotomy and Pemberton acetabuloplasty: a long-term followup.

    Science.gov (United States)

    Wang, Cheng-Wei; Wu, Kuan-Wen; Wang, Ting-Ming; Huang, Shier-Chieg; Kuo, Ken N

    2014-03-01

    The Salter osteotomy and Pemberton acetabuloplasty are common procedures for a deficient acetabulum in patients with developmental dysplasia of the hip. However, the degree of increasing retroversion and anterior acetabular coverage of these two procedures remains unanswered. The purpose of this study is to show the change in anterior coverage and relevant parameters in measuring pain and function among patients who have undergone either a Salter osteotomy or Pemberton acetabuloplasty. Forty-two patients who underwent either a Salter or Pemberton procedure at one institution between January 1981 and December 2000 and were available for followup at least 10 years later (mean, 18 years; range, 12-28 years) were evaluated retrospectively. This represented 12% of the Salter and Pemberton procedures performed in patients between 12 and 36 months old at our institution during the study period. We measured vertical-center-anterior margin angle, anterior acetabular head index, and weightbearing zone acetabular index, and we made comparisons using the radiographic parameter ratio (the division of each radiographic measurement of the operative side by that of the nonoperated side). All patients completed SF-36 and Harris hip score questionnaires at followup. In the Salter group, there were no differences in vertical-center-anterior margin angle, anterior acetabular head index, or weightbearing zone acetabular index. In the Pemberton group, there was no difference in vertical-center-anterior margin angle or anterior acetabular head index, but the weightbearing zone acetabular index decreased, suggesting increased anterior acetabular coverage (surgically treated side, 6 [95% CI, 4.84, 7.16]; nonoperated side, 12 [95% CI, 10.07, 13.39]; p Salter group, the weightbearing zone acetabular index ratio was smaller in the Pemberton group, which means more acquired anterior coverage after a Pemberton acetabuloplasty (Salter procedure, 0.94 [95% CI, 0.70, 1.17], Pemberton

  9. The Hikurangi Plateau: Tectonic Ricochet and Accretion

    Science.gov (United States)

    Willis, David; Moresi, Louis; Betts, Peter; Whittaker, Joanne

    2015-04-01

    80 million years between interactions with different subduction systems provided time for the Hikurangi Plateau and Pacific Ocean lithosphere to cool, densify and strengthen. Neogene subduction of the Hikurangi Plateau occurring orthogonal to its Cretaceous predecessor, provides a unique opportunity to explore how changes to the physical properties of oceanic lithosphere affect subduction dynamics. We used Underworld to build mechanically consistent collision models to understand the dynamics of the two Hikurangi collisions. The Hikurangi Plateau is a ~112 Ma, 15km thick oceanic plateau that has been entrained by subduction zones immediately preceding the final break-up of Eastern Gondwana and currently within the active Hikurangi Margin. We explore why attempted subduction of the plateau has resulted in vastly different dynamics on two separate occasions. Slab break-off occured during the collision with Gondwana, currently there is apparent subduction of the plateau underneath New Zealand. At ~100Ma the young, hot Hikurangi Plateau, positively buoyant with respect to the underlying mantle, impacted a Gondwana Margin under rapid extension after the subduction of an mid-ocean ridge 10-15Ma earlier. Modelling of plateaus within young oceanic crust indicates that subduction of the thickened crust was unlikely to occur. Frontal accretion of the plateau and accompanying slab break-off is expected to have occured rapidly after its arrival. The weak, young slab was susceptible to lateral propagation of the ~1500 km window opened by the collision, and break-off would have progressed along the subduction zone inhibiting the "step-back" of the trench seen in older plates. Slab break-off coincided with a world-wide reorganisation of plate velocites, and orogenic collapse along the Gondwana margin characterised by rapid extension and thinning of the over-riding continental plate from ~60 to 30km. Following extension, Zealandia migrated to the NW until the Miocene allowing the

  10. Inhibition of inducible nitric oxide synthase expression and nitric oxide production in plateau pika (Ochotona curzoniae) at high altitude on Qinghai-Tibet Plateau.

    Science.gov (United States)

    Xie, Ling; Zhang, Xuze; Qi, Delin; Guo, Xinyi; Pang, Bo; Du, Yurong; Zou, Xiaoyan; Guo, Songchang; Zhao, Xinquan

    2014-04-30

    Nitric oxide (NO), a potent vasodilator, plays an important role in preventing hypoxia induced pulmonary hypertension. Endogenous NO is synthesized by nitric oxide synthases (NOSs) from l-arginine. In mammals, three different NOSs have been identified, including neuronal NOS (nNOS), endothelial NOS (eNOS) and inducible NOS (iNOS). Plateau pika (Ochotona curzoniae) is a typical hypoxia tolerant mammal that lives at 3000-5000 m above sea level on the Qinghai-Tibet Plateau. The aim of this study was to investigate whether NOS expression and NO production are regulated by chronic hypoxia in plateau pika. Quantitative real-time PCR and western blot analyses were conducted to quantify relative abundances of iNOS and eNOS transcripts and proteins in the lung tissues of plateau pikas at different altitudes (4550, 3950 and 3200 m). Plasma NO metabolites, nitrite/nitrate (NO(x)⁻) levels were also examined by Ion chromatography to determine the correlation between NO production and altitude level. The results revealed that iNOS transcript levels were significantly lower in animals at high altitudes (decreased by 53% and 57% at altitude of 3950 and 4550 m compared with that at 3200 m). Similar trends in iNOS protein abundances were observed (26% and 41% at 3950 and 4550 m comparing with at 3200 m). There were no significant differences in eNOS mRNA and protein levels in the pika lungs among different altitudes. The plasma NO(x)⁻ levels of the plateau pikas at high altitudes significantly decreased (1.65±0.19 μg/mL at 3200 m to 0.44±0.03 μg/mL at 3950 m and 0.24±0.01 μg/mL at 4550 m). This is the first evidence describing the effects of chronic hypoxia on NOS expression and NO levels in the plateau pika in high altitude adaptation. We conclude that iNOS expression and NO production are suppressed at high altitudes, and the lower NO concentration at high altitudes may serve crucial roles for helping the plateau pika to survive at hypoxic environment.

  11. Acetabular Dysplasia in Middle-Aged Patients: Periacetabular Osteotomy or Total Hip Arthroplasty?

    Science.gov (United States)

    Kalore, Niraj V; Cheppalli, Suresh P R; Daner, William E; Jiranek, William A

    2016-09-01

    Treatment of middle-aged patients with acetabular dysplasia is challenging because of mild osteoarthritis, long life span, high activity level, and sports participation. Both periacetabular osteotomy (PAO) and total hip arthroplasty (THA) provide pain relief, improve function, and can last over 2 decades. We compare the 2 procedures for functional outcome (including sports participation), pain relief, and morbidity. We compared patients in the 30-50 years age group with symptomatic acetabular dysplasia who underwent PAO (n = 14) or THA (n = 14) with minimum 4-year follow-up. We compared postoperative activity (modified Harris Hip Score, high activity arthroplasty score, and modified Merle d'Aubigné-Postel Score) and sports participation (Tegner and University of California Los Angeles activity scores) in the 2 groups. Morbidity was compared by durations of postoperative pain >4/10, narcotic use, use of gait aids, and time to return to normal activities. Sports participation and function scores improved after surgery in both groups without significant intergroup difference at minimum 4-year follow-up. Patients with PAO had longer duration of postoperative pain (P = .01) and used gait aids longer (P = .04) than patients with THA. There were 3 minor reoperations in the PAO group and none in the THA group. PAO and THA both produce comparable improvement in sports participation and function. PAO was associated with longer durations of pain and use of gait aids. These findings may be important in the decision-making process in middle-aged patients with symptomatic acetabular dysplasia. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Treatment of moderate hallux valgus by percutaneous, extra-articular reverse-L Chevron (PERC) osteotomy.

    Science.gov (United States)

    Lucas y Hernandez, J; Golanó, P; Roshan-Zamir, S; Darcel, V; Chauveaux, D; Laffenêtre, O

    2016-03-01

    The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a percutaneous extra-articular reverse-L chevron (PERC) osteotomy. A total of 38 patients underwent 45 procedures. There were 35 women and three men. The mean age of the patients was 48 years (17 to 69). An additional percutaneous Akin osteotomy was performed in 37 feet and percutaneous lateral capsular release was performed in 22 feet. Clinical and radiological assessments included the type of forefoot, range of movement, the American Orthopedic Foot and Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients were lost to follow-up. The mean AOFAS score increased from 62.5 (30 to 80) pre-operatively to 97.1 (75 to 100) post-operatively. A total of 37 patients (97%) were satisfied. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and the proximal articular set angle. The range of movement of the first metatarsophalangeal joint improved significantly.. There was more improvement in the range of movement in patients who had fixation of the osteotomy of the proximal phalanx. Preliminary results of this percutaneous approach are promising. This technique is reliable and reproducible. Its main asset is that it maintains an excellent range of movement. The PERC osteotomy procedure is an effective approach for surgical management of moderate hallux valgus which combines the benefits of percutaneous surgery with the versatility of the chevron osteotomy whilst maintaining excellent first MTPJ range of motion. ©2016 The British Editorial Society of Bone & Joint Surgery.

  13. Modified Dunn osteotomy using an anterior approach used to treat 26 cases of SCFE.

    Science.gov (United States)

    Niane, M M; Kinkpé, C V A; Daffé, M; Sarr, L; Gueye, A B; Sané, A D; Séye, S I L

    2016-02-01

    Osteotomy performed below the femoral neck plays a leading role in the treatment of slipped capital femoral epiphysis (SCFE). It results in anatomical reduction. Several modifications have been made to Dunn's original osteotomy technique. We have developed another modification to this technique that uses an anterior surgical approach on a traction table with fluoroscopy control. Will this technique help to reduce the number of complications? Will its results be superior to those achieved with the standard Dunn osteotomy procedure? This was a retrospective single-center study of 26 cases in 24 patients (2 bilateral cases). Patients were positioned supine on a traction table with fluoroscopy control. An anterior surgical approach was used. A trapezoid-shaped osteotomy was performed below the femoral head. The head's reduction was checked on the fluoroscope and the fixation confirmed. The Postel Merle d'Aubigné (PMA) score was used for the clinical assessment. The radiographic assessment was based on Southwick's angle. The mean slip angle of the femoral head was 57°. A mean correction of 47° was achieved. Based on the PMA score, good and excellent results were achieved in 20 cases (77%) and poor results occurred in 6 cases (23%). The surgical treatment had a significant effect on the PMA score (P=0.0008). In terms of complications, there were five cases of chondrolysis and one case of necrosis associated with chondrolysis. The anterior approach provides direct access to the femoral neck, and thereby a cautious osteotomy at the site of the slip itself. Use of a traction table makes the external manipulations, reduction and fixation procedures easier to carry out. The results of this study were comparable to published results. IV, retrospective treatment study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  14. [Evaluation of potential risks of abrasive water jet osteotomy in-vivo].

    Science.gov (United States)

    Kuhlmann, C; Pude, F; Bishup, C; Krömer, S; Kirsch, L; Andreae, A; Wacker, K; Schmolke, S

    2005-10-01

    Since the 80's the water jet scalpel is an established tool in some surgical fields. It is used in particular in visceral surgery for preparation of parenchymatous organs. By the addition of biocompatible abrasives, this technique is able to effectively machine hard biological tissues. Free defined cutting geometries can be realised in a non contact process. Therewith this method has crucial advantages compared to conventional osteotomy techniques and gives new impulses to the development in endoprosthetics and correction osteotomies of hollow bones. In the presented work the new developed abrasive water injection jet (AWIJ) was used the first time for in-vivo osteotomies. Aim of this study was the detection of potential thrombembolic effects and wash in effects of the cutting fluid. Hollow bones of the fore and hind leg of 20 house pigs were treated with the new cutting technique. Intraoperative documentation of relevant vital parameters was performed by a multi monitoring system. Thrombembolic effects during the osteotomy were detected by transthoracic Doppler ultrasonography and transesophagale echocardiography. The hollow bones were prepared in consideration of the vascularisation's protection especially in respect to the venous flow. Thrombembolic effects with temporary haemodynamic respectively respiratory consequences could be detected exclusively by using the so called "3-component jet", which consists of 90 vol % of air. The usage of an abrasive suspension enables the airfree dosing of dry soluable abrasives. Thrombembolic effects could not be monitored in this case. Intramedullary fluid in-wash effects as well as resulting electrolytic disorders could not be proven. For abrasive waterjet osteotomies with 3 component jet a relevant risk of thrombembolic effects could be shown. This knowledge has also to be considered for abdominal and neurosurgical applications in the future. Due to the usage of an abrasive suspension this risk can fully be avoided.

  15. CHRONIC RADIAL HEAD DISLOCATION IN CHILDREN. TREATMENT BY OPEN REDUCTION AND ULNAR OSTEOTOMY.

    Directory of Open Access Journals (Sweden)

    Pencho Kosev

    2015-03-01

    Full Text Available Purpose: To present the results of open reduction and angulating-distraction ulnar osteotomy in children with chronic radial head dislocation. Material and Methods: This is a retrospective review of 4 children (3 girls, one boy with chronic radial head dislocation treated in our hospital between 2009 and 2012. The average age at the time of surgery was 6.6 (4.2 – 9.1 years.The interval between initial trauma and surgery was from 2 to 25 months. Three of the patients had a plastic deformation of the ulna with a positive “ulnar bow sign” and one was with missed radial head dislocation after an equivalent injury. The surgical strategy in all patients included proximal ulnar osteotomy with angulation and distraction and open reduction of the dislocated radial head without annular ligament reconstruction or pinning. Osteotomy was fixed with a prebent one-third tubular plate and a tricortical bone graft. Results: The mean follow-up was 4 years (range 2.5 - 5.5. Radial head remained reduced and stable in all cases. All ulnar osteotomies healed without any complications. The postoperative range of motion was improved in all of the patients. Functional outcomes assessed by Elbow Performance Score were excellent in three and good in one of the patients. Conclusions:The treatment of an unrecognized radial head dislocation in children continues to pose a therapeutic challenge. The osteotomy of the proximal ulna with both angulation and elongation allows stable radial head reduction without necessity of annular ligament reconstruction in most of the cases.

  16. Tectonomagmatic Associations on the Central Andean Plateau

    Science.gov (United States)

    de Silva, S. L.; Viramonte, J. G.

    2012-12-01

    The Neogene evolution of the Central Andes is characterized by a strong association between plate convergence, mountain building and plateau formation, and magmatism. Plateau uplift by crustal shortening and thickening in the lower crust is broadly coincident with large scale silicic magmatism defined by the Neogene Central Andean ignimbrite province. Of particular interest here are the spatiotemporal correlations between silicic magmatism and tectonic evolution of the Altiplano-Puna plateau. Although magmatism is driven by the subduction-related flux from mantle to crust, the shift to "crustal" magmatism as indicated by elevated crustal isotopic indices after ~10Ma suggests a link between crustal thickening, plateau formation and silicic magmatism. In particular, elevated geotherms associated with crustal thickening and enhanced mantle flux associated with lithospheric delamination may have played a role in thermally preparing the Central Andean crust for enhanced silicic magma production during the extensive Neogene ignimbrite flare-up. Emplacement of these magmas in the upper crust throughout the Neogene may have fuelled a period of significant interaction between magmatism and tectonism on the plateau. With particular reference to the 21° to 24°S segment of the Central Andes, spatial and structural coincidence of calderas of the Altiplano Puna Volcanic Complex with the NW-SE striking Calama-Olacapata-El Toro fault zone suggests significant tectonomagmatic interaction. Location of calderas suggest that these regional faults focused magma intrusion and storage, while spatially and temporally correlated eruption pulses connote a tectonic control. Indeed, current thermomechanical models of magma chamber development and eruption triggering promote a role for external triggering of "perched" upper crustal magma chambers. This might have been achieved by melt-enhanced deformation, or alternatively, significant uplift (~1km) associated with the development of large

  17. Peopling the Tibetan plateau: insights from archaeology.

    Science.gov (United States)

    Aldenderfer, Mark

    2011-01-01

    Recent studies of the genome of modern Tibetans have revealed the existence of genes thought to provide an adaptive advantage for life at high elevation. Extrapolating from this discovery, some researchers now argue that a Tibetan-Han split occurred no more than 2750 yr ago. This date is implausible, and in this paper I review the archaeological data from the Tibetan plateau as one means by which to examine the veracity of this assertion. Following a review of the general state of knowledge of Tibetan prehistory, which is unfortunately only at its beginnings, I first examine the data that speak to the initial peopling of the plateau and assess the evidence that traces of their presence can be seen in modern Tibetans today. Although the data are sparse, both archaeology and genetics suggest that the plateau was occupied in the Late Pleistocene, perhaps as early as 30,000 yr ago, and that these early peoples have left a genetic signature in modern Tibetans. I then turn to the evidence for later migrations and focus on the question of the timing of the establishment of permanent settled villages on the plateau. Three areas of the plateau-northeastern Qinghai, extreme eastern Tibet, and the Yarlung Tsangpo valley-have evidence of permanent settlements dating from ca. 6500, 5900, and 3750 yr ago, respectively. These data are not consonant with the 2750 yr ago date for the split and suggest at a minimum that the plateau has been occupied substantially longer and, further, that multiple migrations at different times and from different places have created a complex mosaic of population history. © Mary Ann Liebert, Inc.

  18. 西藏高原某三级甲等医院护士离职意愿与工作满意度的相关性分析%Analysis of the correlation of turnover intention and job satisfaction of clinical nurses in a 3A-level hospital in Tibet plateau

    Institute of Scientific and Technical Information of China (English)

    鞠钟鸣; 万琪

    2013-01-01

    目的 调查西藏高原某三级甲等医院临床护士离职意愿和工作满意度现状及两者之间的关系.方法 采用离职意愿量表和Mecloskey/Mueller满意度量表,对西藏高原某三级甲等医院244名临床护士进行问卷调查.结果 离职意愿总均分为(11.42±4.24)分,指标值为47.58%;护士工作满意度平均得分为(3.29±0.57)分;工作满意度8个维度得分最低为工作与家庭的平衡;不同年龄、学历、月均夜班数护士的工作满意度差异有统计学意义(P<0.05);工作满意度各维度与离职意愿呈负相关(P<0.01).结论 医院管理者可以采取一系列措施提高护士工作满意度,进而降低护士离职意愿.%Objective To investigate the status and correlation of turnover intention and job satisfaction of clinical nurses in a 3 A - level hospital in Tibet plateau. Methods A total of 244 clinical nurses in a 3 A - level hospital in Tibet plateau were recruited and investigated with turnover intention scale and Mc-Closkey/Mueller Satisfaction Scale (MMSS). Results The mean score of turnover intention was (11.42 ±4.24) ,and the index value was 47. 58% . The mean score of nurses'job satisfaction was (3.29 ± 0.57). The lowest score of 8 dimensions of job satisfaction was the balance of work and family. The job satisfaction of nurses with different age, education and the number of monthly average night shift was significant difference (P < 0. 05 ) . All dimensions of job satisfaction were negatively correlated with the turnover intention (P<0.01). Conclusion Hospital managers should take a series of measures to improve nurses'job satisfaction, and reduce nurses'turnover intention.

  19. Plateau-insulator transition in graphene

    Energy Technology Data Exchange (ETDEWEB)

    Amado, M; Diez, E; Caridad, J M [Laboratorio de Bajas Temperaturas, Universidad de Salamanca, E-37008 Salamanca (Spain); Lopez-Romero, D [CT-ISOM, Universidad Politecnica de Madrid, E-28040 Madrid (Spain); Rossella, F; Dionigi, F; Bellani, V [Dipartimento di Fisica ' A Volta' and CNISM, Universita degli studi di Pavia, I-27100 Pavia (Italy); Maude, D K, E-mail: marioam@fis.ucm.e [Laboratoire National des Champs Magnetiques Intenses, F-38042 Grenoble (France)

    2010-05-15

    We investigate the quantum Hall effect (QHE) in a graphene sample with Hall-bar geometry close to the Dirac point at high magnetic fields up to 28 T. We have discovered a plateau-insulator quantum phase transition passing from the last plateau for the integer QHE in graphene to an insulator regime {nu}=-2{yields}{nu}=0. The analysis of the temperature dependence of the longitudinal resistance gives a value for the critical exponent associated with the transition equal to {kappa}=0.58{+-}0.03.

  20. Mass exchange between stratosphere and trotosphere over the Tibetan Plateau and its surroundings

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    Using NCEP dataset we calculate the exchange of mass across the thermal tropopause by the Wei's method from 1978 to 1997 over the Tibetan Plateau and its surroundings. We also calculate the annual variation of aerosol and ozone of 100 hPa level with the monthly SAGE dataset from July 1988 to December 1993. Results indicate that ( i ) the mass from troposphere to stratosphere is magistral station in summer over the Tibetan Plateau and its surroundings. The air transport reaches the summit in midsummer with two large value centers, which lie in the north of Bengal Bay and southeastern Tibetan Plateau, respectively. A large value center, which lies over the Tibetan Plateau, is smaller than that aforementioned. In winter, the mass transport is from stratosphere to troposphere, and reaches the minimum in January. ( ii ) As far as the 19-year mean cross-tropopause mass exchange from June to September is concerned, the net mass transport is 14.84x1018 kg from troposphere to stratosphere. So the area from the Tibetan Plateau to the Bengal Bay is a channel through which the mass of lower atmosphere layer gets into upper troposphere and lower stratosphere. (iii) The cross-tropopause mass may take the lower level aerosol to the tropopause. Then, the concentration of aerosol near the tropopause becomes larger, which may cause the content of ozone to reduce.

  1. Photometric Evaluation of Soft Tissue Changes in CLP Patients: Le Fort I Advancement Osteotomy (ALO) Versus Anterior Maxillary Distraction (AMD)

    National Research Council Canada - National Science Library

    Paulose, Joby; Markose, Eldho

    2014-01-01

    ...) and anterior maxillary distraction (AMD).Twenty patients with maxillary hypoplasia associated with cleft lip and palate who had undergone either LeFort I osteotomy or distraction osteogenesis with maxillary advancement were included in this study...

  2. Total hip arthroplasty (S-ROM stem and subtrochanteric osteotomy for Crowe type IV developmental dysplasia of the hip

    Directory of Open Access Journals (Sweden)

    Liangtao Li

    2016-01-01

    Conclusions: In the primary THA for the treatment of irreducible DDH, subtrochanteric oblique osteotomy combined with the freely-rotatable S-ROM stem provided favorable short term outcomes by affording both morphological and functional advantages.

  3. Y Shape Osteotomy in Ankylosing Spondylitis, a Prospective Case Series with Minimum 2 Year Follow-Up

    Science.gov (United States)

    Liu, Huawei; Zhang, Xuesong; Wang, Yan

    2016-01-01

    The aim of the study is to evaluate the efficacy of a spinal osteotomy technique, Y shape osteotomy, for correcting kyphosis in AS patients planned preoperatively with computer software-assistance. 36 consecutive AS patients with thoracolumbar kyphosis were treated with one-stage posterior Y shape osteotomy and preoperative surgical planning was done with the aid of the Surgimap Spine. Radiological parameters of simulation and immediate postoperation were documented. Clinical and radiological results were evaluated in the preoperative, the early postoperative periods and during the last follow-up. The lumbar lordosis was found as 40.7 ± 4.1 degrees in the surgical planning and 49.7 ± 3.9 degrees postoperatively (pScoliosis Research Society scores improved largely. In conclusion, Y shape osteotomy is a safe and effective treatment option for AS patients with kyphosis deformity. PMID:27936020

  4. Radiographic predictors of compartment syndrome in tibial plateau fractures.

    Science.gov (United States)

    Ziran, Bruce H; Becher, Stephen John

    2013-11-01

    The purpose of this article was to evaluate the relationship of radiographic features of tibial plateau fractures to the development of compartment syndrome. We hypothesized that the direction and degree of initial displacement of the femur on the tibia, and the amount of tibial widening (TW), were correlated with the development of compartment syndrome. Retrospective case-control study. Single level 1 trauma center. Retrospective evaluation of 158 patients with 162 plateau fractures. Grouping with and without compartment syndrome. The following data were obtained: age, sex, Schatzker and OTA/AO classification, open/closed status, TW, and femoral displacement (FD). A univariate statistical and a logistical regression analysis were performed to determine significance. The overall rate of compartment syndrome was 11%. Univariate analysis found both the TW and FD to be significant with respect to development of compartment syndrome (P compartment syndrome. Logistic regression found FD and Schatzker grade to be significant. Our study is the first to identify easily obtained radiographic parameters that correlate to the occurrence compartment syndrome. There may also be a relationship between TW and FD, as noted by regression result. This study helps to assess which patients with a fracture are at higher risk for developing a compartment syndrome. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

  5. [Coupling coordinated development of ecological-economic system in Loess Plateau].

    Science.gov (United States)

    Zhang, Qing-Feng; Wu, Fa-Qi; Wang, Li; Wang, Jian

    2011-06-01

    Based on system theory, a coupling coordinated development model of ecological-economic system in Loess Plateau was established, and the evaluation criteria and basic types of the coordinated development of the ecological-economic system were proposed. The county-level coupling coordinated development of the ecological-economic system was also discussed, based on the local characteristics. The interactions between the ecological and economic systems in Loess Plateau could be divided into four stages, i.e., seriously disordered development stage, mild-disordered development stage, low-level coordinated development stage, and high level well-coordinated development stage. At each stage, there existed a cyclic process of profit and loss-antagonist-running-dominant-synchronous development. The coupling development degree of the ecological-economic system in Loess Plateau was overall at a lower level, being about 62.7% of the counties at serious disorder, 30.1% of the counties at mild disorder, and 7.1% of the counties at low but coordinated level. The coupling development degree based on the model established in this study could better reflect the current social-economic and ecological environment situations, especially the status of coordination. To fully understand the coupling of ecological-economic system and to adopt appropriate development mode would be of significance to promote the county-level coordinated development in Loess Plateau.

  6. Sino-Japanese Teamwork Probes Environment Changes on Tibetan Plateau

    Institute of Scientific and Technical Information of China (English)

    2004-01-01

    @@ With the support of a CAS project on Holocene environmental changes and their influences on the ecosystem of the Tibetan Plateau, a research group headed by Prof. Zhu Liping from the CAS Institute of Tibetan Plateau Research and their Japanese collaborators carried out a field survey in Puma Yumco area on the Tibetan Plateau from September 8 to 20.

  7. CT study on bony interface after Le Fort I osteotomy; Examination of bony interface in maxillary advancement and impaction

    Energy Technology Data Exchange (ETDEWEB)

    Goto, Satoshi; Kawamura, Hiroshi; Motegi, Katsutoshi (Tohoku Univ., Sendai (Japan). School of Dentistry)

    1994-04-01

    Bony contact after the maxilla had been mobilized by Le Fort I osteotomy was evaluated by computed tomographic examination of 52 Japanese dry skulls. The lateral piriform wall and the base of the zygomatic process of the maxilla which consist of thick bone are important areas to achieve good stability. Some cases of maxillary advancement and/or impaction lacked an osseous interface at the posterior wall. Preoperative CT along the osteotomy-line is recommended to achieve better postoperative stability. (author).

  8. Risk factors for rod fracture after posterior correction of adult spinal deformity with osteotomy: a retrospective case-series

    OpenAIRE

    Barton, Cameron; Noshchenko, Andriy; Patel, Vikas; Cain, Christopher; Kleck, Christopher; Burger, Evalina

    2015-01-01

    Background Osteotomies including pedicle subtraction (PSO) and/or Smith-Peterson (SPO) are used to facilitate surgical correction of adult spinal deformity (ASD), but are associated with complications including instrumentation failure and rod fracture (RF). The purpose of this study was to determine incidence and risk factors for RF, including a clinically significant subset (CSRF), after osteotomy for ASD. Methods A retrospective review of clinical records was conducted on consecutive ASD pa...

  9. Histopathological comparison of bone healing effects of endonasal and percutaneous lateral osteotomy methods in rabbit rhinoplasty model.

    Science.gov (United States)

    Öğreden, Şahin; Rüzgar, Sedat; Tansuker, Hasan Deniz; Taşkın, Ümit; Alimoğlu, Yalçın; Aydın, Salih; Oktay, Mehmet Faruk; İzol, Uğur

    2017-07-17

    Lateral osteotomy is mainly performed either endonasally or percutaneously in rhinoplasty which is a frequently performed operation for the correction of nasal deformities. Both techniques have both advantages and disadvantages relative to each other. The aim of this study was to compare the histopathological effects of endonasal and percutaneous osteotomy techniques performed in rhinoplasty on bone healing and nasal stability in an experimental animal model. Eight one year-old New Zealand white rabbits were included. Xylazine hydrocloride and intramuscular ketamine anesthesia were administered to the rabbits. Endonasal osteotomy (8 bones) was performed in Group 1 (n=4), and percutaneous osteotomy (8 bones) in Group 2 (n=4). One month later the rabbits were sacrificed. Bone healing of the rabbits was staged according to the bone healing score of Huddleston et al. In both groups, nasal bone integrity was assessed subjectively. In the percutaneous osteotomy group, Grade 1 bone healing was observed in two samples (25%), Grade 2 bone healing in two samples (25%), Grade 3 bone healing in four samples (50%). In the endonasal osteotomy group, Grade 1 bone healing was observed in 6 samples (75%) and Grade 2 bone healing was observed in 2 samples (25%). In the percutaneous group, fibrous tissue was observed in 2, predominantly fibrous tissue and a lesser amount of cartilage was observed in 2 and an equal amount of fibrous tissue and cartilage was observed in 4 samples. In the endonasal group, fibrous tissue was observed in 6 samples, and predominantly fibrous tissue with a lesser amount of cartilage was observed in 2 samples. In both groups, when manual force was applied to the nasal bones, subjectively the same resistance was observed. Percutaneous lateral osteotomy technique was found to result in less bone and periost trauma and better bone healing compared to the endonasal osteotomy technique. Copyright © 2017 Associação Brasileira de Otorrinolaringologia e Cirurgia

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

    OpenAIRE

    Yoo, Moon-Jib; Shin, Yong-Eun

    2016-01-01

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

  11. A Modified Technique of Fixation for Proximal Femoral Valgus Osteotomy in Abnormal Bone: A Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Logheswaren S

    2017-07-01

    Full Text Available The ideal size of intramedullary device to fix corrective osteotomy of proximal femur in abnormal bone in children and small patients may not be easily available. We report the successful use of Rush rod in combination with multiple Kirschner wires to fix the corrective osteotomy of coxa vara and shepherd crook deformity in two patients with osteogenesis imperfecta and fibrous dysplasia. The union was achieved on time, neck shaft angle and rotation were maintained.

  12. Surgical treatment of the congenital dislocation of the hip after walking age: open reduction and Salter's osteotomy

    OpenAIRE

    Carvalho Filho, Guaracy; Chueire, Alceu Gomes; Ignácio,Helencar; Carneiro,Márcio de Oliveira; Francese Neto,João; Canesin,Augusto César

    2003-01-01

    The congenital dislocation of the hip, after the function of weight bearing begins or walking phase requires surgical treatment, and one of the options is the open reduction combined to innominate osteotomy (Salter). In this study, the results of 18 patients, 22 surgically treated hips with congenital dislocation, were evaluated from 1989 and 1995, using innominate osteotomy, by Salter's technique after open reduction. The age of the patients at the time of surgery ranged from 12 to 30 months...

  13. The Hubble Flow of Plateau Inflation

    NARCIS (Netherlands)

    Coone, Dries; Roest, Diederik; Vennin, Vincent

    2015-01-01

    In the absence of CMB precision measurements, a Taylor expansion has often been invoked to parametrize the Hubble flow function during inflation. The standard "horizon flow" procedure implicitly relies on this assumption. However, the recent Planck results indicate a strong preference for plateau

  14. The Hubble Flow of Plateau Inflation

    NARCIS (Netherlands)

    Coone, Dries; Roest, Diederik; Vennin, Vincent

    2015-01-01

    In the absence of CMB precision measurements, a Taylor expansion has often been invoked to parametrize the Hubble flow function during inflation. The standard "horizon flow" procedure implicitly relies on this assumption. However, the recent Planck results indicate a strong preference for plateau in

  15. Ozone Minihole Found over Tibetan Plateau

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    @@ Through a comprehensive analysis, researchers from the CAS Institute of Atmospheric Physics (IAP) discovered an ozone minihole, a large area with the lowest total ozone column (TOC, see figure), over the Qinghai-Tibet Plateau from Dec. 14 to 17, 2003.

  16. Construction of plateaued functions satisfying multiple criteria

    Institute of Scientific and Technical Information of China (English)

    Zhang Weiguo

    2005-01-01

    A class of plateaued functions has been got by using the Maiorana-McFarland construction. A variety of desirable criteria for functions with cryptographic application could be satisfied: balancedness, high nonlinearity, correlation immunity of reasonably high order, strict avalanche criterion, non-existence of non-zero linear structures, good global avalanche characteristics, etc.

  17. Planation Surfaces on the Tibet Plateau, China

    Institute of Scientific and Technical Information of China (English)

    2008-01-01

    A planation hypothesis is proposed to explain landform evolution of the Tibet Plateau. A denudation threshold (T), the maximum potential denudation rate for a certain type of rock, is introduced to explain the combined effects of lithology and tectonics on landform evolution. If the tectonic uplifting rate (U) is equal to or less than the threshold rate (U ≤ T), the tectonic uplifting and terrain denudation are in dynamic equilibrium, and landforms are in a steady state. The end product should be planation surfaces whether the original landforms are fiat plains or deeply dissected mountains. If U > T, uplift and denudation are not able to reach a dynamic equilibrium state. The plateau surface is mostly underlain by soft rocks, such as the Mesozoic epimetamorphic argillites and Tertiary sedimentary rocks, while the mountain ranges comprise hard rocks, such as granite, gneiss and limestone. In soft rock regions, hills are low with a relative relief of mostly less than 100m and the slopes are gentle at a gradient of <200. In contrast, hills can maintain steep slopes in hard rock regions. The Tibet Plateau has been under an equilibrium condition between tectonic uplifting and denudation except for the mountain ranges. The plateau might have reached the present altitudes before the Quaternary.

  18. A Graphic Overlay Method for Selection of Osteotomy Site in Chronic Radial Head Dislocation: An Evaluation of 3D-printed Bone Models.

    Science.gov (United States)

    Kim, Hui Taek; Ahn, Tae Young; Jang, Jae Hoon; Kim, Kang Hee; Lee, Sung Jae; Jung, Duk Young

    2017-03-01

    Three-dimensional (3D) computed tomography imaging is now being used to generate 3D models for planning orthopaedic surgery, but the process remains time consuming and expensive. For chronic radial head dislocation, we have designed a graphic overlay approach that employs selected 3D computer images and widely available software to simplify the process of osteotomy site selection. We studied 5 patients (2 traumatic and 3 congenital) with unilateral radial head dislocation. These patients were treated with surgery based on traditional radiographs, but they also had full sets of 3D CT imaging done both before and after their surgery: these 3D CT images form the basis for this study. From the 3D CT images, each patient generated 3 sets of 3D-printed bone models: 2 copies of the preoperative condition, and 1 copy of the postoperative condition. One set of the preoperative models was then actually osteotomized and fixed in the manner suggested by our graphic technique. Arcs of rotation of the 3 sets of 3D-printed bone models were then compared. Arcs of rotation of the 3 groups of bone models were significantly different, with the models osteotomized accordingly to our graphic technique having the widest arcs. For chronic radial head dislocation, our graphic overlay approach simplifies the selection of the osteotomy site(s). Three-dimensional-printed bone models suggest that this approach could improve range of motion of the forearm in actual surgical practice. Level IV-therapeutic study.

  19. Variations in the anatomical dimensions of the mandibular ramus and the presence of third molars: its effect on the sagittal split ramus osteotomy.

    Science.gov (United States)

    Beukes, J; Reyneke, J P; Becker, P J

    2013-03-01

    The authors undertook a prospective study to evaluate the influence that the anatomical dimensions of the ramus of the mandible and the presence of lower third molar teeth may have on the sagittal split ramus osteotomy. The anatomical dimensions measured included the width of the anterior mandibular ramus, the height of the corpus posterior to the second mandibular molar and the antero-posterior anatomical position of the lingual. The influence that these dimensions of the mandible may have on the successful splitting of the mandibular ramus was investigated. The effect that the presence of wisdom teeth had on the difficulty of the procedure was also investigated. This study found that, unlike the presence of third molars, there was no single anatomical measurement that contributed to the level of difficulty of the sagittal split osteotomy. For descriptive purposes the authors proposes a classification of the four typical patterns of unfavourable splits. Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  20. Do Radiographic Parameters of Dysplasia Improve to Normal Ranges After Bernese Periacetabular Osteotomy?

    Science.gov (United States)

    Novais, Eduardo N; Duncan, Stephen; Nepple, Jeffrey; Pashos, Gail; Schoenecker, Perry L; Clohisy, John C

    2017-04-01

    The goal of periacetabular osteotomy (PAO) is to improve the insufficient coverage of the femoral head and achieve joint stability without creating secondary femoroacetabular impingement. However, the complex tridimensional morphology of the dysplastic acetabulum presents a challenge to restoration of normal radiographic parameters. Accurate acetabular correction is important to achieve long-term function and pain improvement. There are limited data about the proportion of patients who have normal radiographic parameters restored after PAO and the factors associated with under- and overcorrection. (1) What is the proportion of patients undergoing PAO in which the acetabular correction as assessed by the lateral center-edge angle (LCEA), anterior center-edge angle (ACEA), acetabular inclination (AI), and extrusion index (EI) is within defined target ranges? (2) What patient and preoperative factors are associated with undercorrection of the acetabulum as defined by a LCEA < 22°, a factor that has been reported to be associated with PAO failure at 10-year followup? Between January 2007 and December 2011 we performed 132 PAOs in 116 patients for treatment of symptomatic acetabular dysplasia. One patient with Legg-Calvé-Perthes disease, one with multiple osteochondromatosis, and two with concomitant femoral osteotomy were excluded. A total of 128 hips (112 patients) were included. The hip cohort was 76% (97 of 128) female and the mean age at surgery was 28.5 years (SD 8.7 years). Correction of LCEA between 25° and 40°, ACEA between 18° and 38°, Tönnis angle between 0° and 10°, and EI ≤ 20% were defined as adequate based on normative values. Values lower than the established parameters were considered undercorrection for the LCEA and ACEA and those higher than the established values were considered overcorrection. Because postoperative LCEA < 22(o) has been previously associated with PAO failure at a minimum of 10-year followup, in this study we sought to

  1. Outcome of pelvic support osteotomy with the Ilizarov method in the treatment of the unstable hip joint.

    Science.gov (United States)

    El-Mowafi, Hani

    2005-12-01

    Instability of the hip joint in the young adult is a difficult problem. Patients with an unstable hip secondary to any aetiology usually have loss of bone from the proximal femur or shortening of the limb or both. In this study we report our results in the treatment of the unstable hip joint in young adults by pelvic support osteotomy using the Ilizarov method. From 1997 to 2004, 25 patients (17 females and 8 males) with an unstable hip joint were treated in the Orthopaedic department of Mansoura University Hospital, Egypt. Their mean age was 22.4 years (range: 19 to 35). The main complaints were pain, leg length discrepancy, limping, and limited abduction of the hip. All patients underwent valgus extension osteotomy in the proximal femur and distal femoral osteotomy for lengthening. The average follow-up ranged from 2 to 7 years. All hips were pain free at follow-up. The Trendelenburg sign became negative in 20 patients. There was no limb length discrepancy and alignments of the extremity were re-established. Five patients had a lurch gait. Valgus extension osteotomy has provided stability of the hip joint and maintained some motion of the hip joint. By using the Ilizarov technique, we could prevent the valgus effects created by the valgus extension osteotomy while achieving lengthening of the femur through the distal osteotomy in the femur.

  2. Correction of anteversion in skeletally immature patients: percutaneous osteotomy and transtrochanteric intramedullary rod.

    Science.gov (United States)

    Stevens, Peter M; Anderson, Dustin

    2008-01-01

    There has been reluctance by some surgeons to accept antegrade femoral nailing in children and adolescents due to concerns about producing iatrogenic osteonecrosis or growth disturbance of the femoral neck. Others believe that with the recent advent of pediatric transtrochanteric intramedullary nails, femoral fracture and osteotomy fixation may now safely be accomplished using these devices. Extrapolating from experience treating mature patients, the senior author (P.S.) has adopted the technique of percutaneous femoral osteotomy and transtrochanteric intramedullary fixation in skeletally immature patients as a standard approach for the correction of anteversion, combining this with concomitant surgery as indicated. With the institutional review board approval, we reviewed our experience using the Phillips intramedullary rod (EBI/Biomet, Inc, Warsaw, Ind), to secure femoral osteotomies in a series of 30 patients with 40 femoral osteotomies (10 bilateral). The etiologies of anteversion included idiopathic and neuromuscular. There were 10 boys and 20 girls, ranging in age from 8 to 16 years and in weight from 32 to 60 kg. Additional surgical bony and soft tissue procedures were combined as indicated. These included supramalleolar osteotomy, hindfoot stabilization, tendon lengthening or transfers, and hemiepiphysiodesis in select patients. Two of the femoral rotational corrections were combined with shortening. Despite early mobilization without casts, each osteotomy healed primarily in an average of 3 months, and the complication rate was exceedingly low. One patient had removal of a loose distal interlocking screw at 6 weeks postinsertion. By that time, he had formed good callus and had rotational stability; thus, the outcome was not compromised. Importantly, we have not observed osteonecrosis, growth disturbance of the femoral neck, or limb length discrepancy resulting from this treatment method. In the skeletally immature patient, femoral anteversion can safely be

  3. Sensitivity of the Colorado Plateau to Change: Climate, Ecosystems, and Society

    Directory of Open Access Journals (Sweden)

    Jayne Belnap

    2008-12-01

    Full Text Available The Colorado Plateau is located in the interior, dry end of two moisture trajectories coming from opposite directions, which have made this region a target for unusual climate fluctuations. A multi-decadal drought event some 850 years ago may have eliminated maize cultivation by the first human settlers of the Colorado Plateau, the Fremont and Anasazi people, and contributed to the abandonment of their settlements. Even today, ranching and farming are vulnerable to drought and struggle to persist. The recent use of the Colorado Plateau primarily as rangeland has made this region less tolerant to drought due to unprecedented levels of surface disturbances that destroy biological crusts, reduce soil carbon and nitrogen stocks, and increase rates of soil erosion. The most recent drought of 2002 demonstrated the vulnerability of the Colorado Plateau in its currently depleted state and the associated costs to the local economies. New climate predictions for the southwestern United States include the possibility of a long-term shift to warmer, more arid conditions, punctuated by megadroughts not seen since medieval times. It remains to be seen whether the present-day extractive industries, aided by external subsidies, can persist in a climate regime that apparently exceeded the adaptive capacities of the Colorado Plateau's prehistoric agriculturalists.

  4. Sensitivity of the Colorado Plateau to change: Climate, ecosystems, and society

    Science.gov (United States)

    Schwinning, S.; Belnap, J.; Bowling, David R.; Ehleringer, J.R.

    2008-01-01

    The Colorado Plateau is located in the interior, dry end of two moisture trajectories coming from opposite directions, which have made this region a target for unusual climate fluctuations. A multidecadal drought event some 850 years ago may have eliminated maize cultivation by the first human settlers of the Colorado Plateau, the Fremont and Anasazi people, and contributed to the abandonment of their settlements. Even today, ranching and farming are vulnerable to drought and struggle to persist. The recent use of the Colorado Plateau primarily as rangeland has made this region less tolerant to drought due to unprecedented levels of surface disturbances that destroy biological crusts, reduce soil carbon and nitrogen stocks, and increase rates of soil erosion. The most recent drought of 2002 demonstrated the vulnerability of the Colorado Plateau in its currently depleted state and the associated costs to the local economies. New climate predictions for the southwestern United States include the possibility of a long-term shift to warmer, more arid conditions, punctuated by megadroughts not seen since medieval times. It remains to be seen whether the present-day extractive industries, aided by external subsidies, can persist in a climate regime that apparently exceeded the adaptive capacities of the Colorado Plateau's prehistoric agriculturalists.

  5. Preliminary subsurface hydrologic considerations: Columbia River Plateau Physiographic Province. Assessment of effectiveness of geologic isolation systems

    Energy Technology Data Exchange (ETDEWEB)

    Veatch, M.D.

    1980-04-01

    This report contains a discussion of the hydrologic conditions of the Columbia River Plateau physiographic province. The Columbia River Plateau is underlain by a thick basalt sequence. The Columbia River basalt sequence contains both basalt flows and sedimentary interbeds. These sedimentary interbeds, which are layers of sedimentary rock between lava flows, are the main aquifer zones in the basalt sequence. Permeable interflow zones, involving the permeable top and/or rubble bottom of a flow, are also water-transmitting zones. A number of stratigraphic units are present in the Pasco Basin, which is in the central part of the Columbia River Plateau. At a conceptual level, the stratigraphic sequence from the surface downward can be separated into four hydrostratigraphic systems. These are: (1) the unsaturated zone, (2) the unconfined aquifer, (3) the uppermost confined aquifers, and (4) the lower Yakima basalt hydrologic sequence. A conceptual layered earth model (LEM) has been developed. The LEM represents the major types of porous media (LEM units) that may be encountered at a number of places on the Columbia Plateau, and specifically in the Pasco Basin. The conceptual LEM is not representative of the actual three-dimensional hydrostratigraphic sequence and hydrologic conditions existing at any specific site within the Columbia Plateau physiographic province. However, the LEM may be useful for gaining a better understanding of how the hydrologic regime may change as a result of disruptive events that may interact with a waste repository in geologic media.

  6. Comparison of Clinical and Radiological Improvement Between the Modified Trephine and High-speed Drill as Main Osteotomy Instrument in Pedicle Subtraction Osteotomy

    Science.gov (United States)

    Wang, Hui; Ma, Lei; Yang, Dalong; Zhang, Di; Shen, Yong; Ding, Wenyuan

    2015-01-01

    Abstract High-speed drill is the main osteotomy instrument in pedicle subtraction osteotomy (PSO) currently. Considering the long duration of surgery, the large amount of blood loss, and the high incidence of neurovascular injury, the osteotomy procedure is challenging. Use of trephine for the osteotomy displays high efficiency by shortening surgery time and reducing blood loss in anterior cervical corpectomy and fusion. However, the potential risk of neurological injury is high. We modified the trephine by adding locking instrument, when the serrated top of the trephine reaches the tip of the probe; the locking instrument on the probe restricts the trephine and improves security during the osteotomy procedure. The aim of this study was to compare the clinical and radiological improvement between the modified trephine and high-speed drill as main osteotomy instrument in PSO. From February 2009 to 2013, 50 patients with severe thoracolumbar kyphotic deformity caused by old compressive vertebrae were prospectively reviewed. All patients were randomly assigned to the experimental group (27 patients received PSO with modified trephine) and the control group (23 patients received PSO with high-speed drill). The clinical records were reviewed and compared for surgical time, operative blood loss, functional improvement (Oswestry Disability Index), and pain relief (visual analog scale). The radiological records were reviewed and compared for correction of kyphotic deformity postoperatively and correction loss at 2-year follow-up. All patients successfully finished the PSO procedure, and got satisfactory kyphotic deformity correction and overall function improvement. The surgery time was shorter in the experimental group than that in the control group (132.7 ± 12.6 vs 141.7 ± 16.7 min; P = 0.03). No significant difference was found in blood loss (882.9 ± 98.9 mL vs 902.2 ± 84.9 mL; P = 0.47) or correction of the kyphotic angle (33.4

  7. Resistivity plateau and extreme magnetoresistance in LaSb

    Science.gov (United States)

    Tafti, F. F.; Gibson, Q. D.; Kushwaha, S. K.; Haldolaarachchige, N.; Cava, R. J.

    2016-03-01

    Time reversal symmetry (TRS) protects the metallic surface modes of topological insulators (TIs). The transport signature of such surface states is a plateau that arrests the exponential divergence of the insulating bulk with decreasing temperature. This universal behaviour is observed in all TI candidates ranging from Bi2Te2Se to SmB6. Recently, extreme magnetoresistance (XMR) has been reported in several topological semimetals which exhibit TI universal resistivity behaviour only when breaking time reversal symmetry, a regime where TIs theoretically cease to exist. Among these materials, TaAs and NbP are nominated as Weyl semimetals owing to their lack of inversion symmetry, Cd3As2 is known as a Dirac semimetal owing to its linear band crossing at the Fermi level, and WTe2 is termed a resonant compensated semimetal owing to its perfect electron-hole symmetry. Here we introduce LaSb, a simple rock-salt structure material that lacks broken inversion symmetry, perfect linear band crossing, and perfect electron-hole symmetry yet exhibits all the exotic field-induced behaviours of these more complex semimetals. It shows a field-induced universal TI resistivity with a plateau at roughly 15 K, ultrahigh mobility of carriers in the plateau region, quantum oscillations with the angle dependence of a two-dimensional Fermi surface, and XMR of about one million percent at 9 T. Owing to its structural simplicity, LaSb represents an ideal model system to formulate a theoretical understanding of the exotic consequences of breaking time reversal symmetry in topological semimetals.

  8. Soil erosion and management on the Loess Plateau

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    The Loess Plateau is well known to the world for its intense soil erosion. The root cause for river sedimentation of Yellow River (Huanghe) and its resultant "hanging river" in certain section is soil and water loss on the Loess Plateau. The Loess Plateau has a long cultivation history, hence population growth, vegetation degeneration and plugging constitute the chief reason for serious soil and water loss on Loess Plateau. This paper analyses several successful cases and failures in soil conservation, presents practical soil conservation technique and related benefit analysis, and discusses some effective methods adopted in China in soil erosion control, research directions and future perspectives on Loess Plateau.

  9. Effect of Hypoxia on Ldh-c Expression in Somatic Cells of Plateau Pika

    OpenAIRE

    Wei, Dengbang; Wei, Linna; Li, Xiao; Wang, Yang; Wei, Lian

    2016-01-01

    Sperm specific lactate dehydrogenases (LDH-C4) is a lactate dehydrogenase that catalyzes the conversion of pyruvate to lactate. In mammals, Ldh-c was originally thought to be expressed only in testes and spermatozoa. Plateau pika (Ochotona curzoniae), which belongs to the genus Ochotona of the Ochotonidea family, is a hypoxia-tolerant mammal living 3000–5000 m above sea level on the Qinghai-Tibet Plateau, an environment which is strongly hypoxic. Ldh-c is expressed not only in testes and sper...

  10. A first paleomagnetic and rock magnetic investigation of calcareous nodules from the Chinese Loess Plateau

    Science.gov (United States)

    Yang, T.; Hyodo, M.; Yang, Z.; Sun, Z.

    2005-01-01

    A detailed paleomagnetic and rock magnetic investigation was carried out on calcareous nodule layers embed-ded in the loess-paleosol sequences near Baoji city, southern Chinese Loess Plateau. The anisotropy of low-field magnetic susceptibility confirms that calcareous nodules retain the primary sedimentary fabric of original de-posits. Rock magnetic properties demonstrate that calcareous nodules have the same mineralogy and grain sizes as loess-paleosol deposits. Characteristic remanent magnetizations of calcareous nodules have directions consis-tent with those of adjacent loess and paleosol deposits. The Punaruu event, previously found from loess deposits in the upper part of loess unit L13 in Weinan, southern Chinese Loess Plateau, is observed at the corresponding stratigraphic level in the calcareous nodule layer. These observations indicate that the calcareous nodule layers preserve primary remanent magnetizations of original deposits before calcification, and that they can contribute to paleomagnetic studies in the Chinese Loess Plateau.

  11. Double calcaneal osteotomy with percutaneous Steinmann pin fixation as part of treatment for flexible flatfoot deformity: a review of consecutive cases highlighting our experience with pin fixation.

    Science.gov (United States)

    Boffeli, Troy J; Abben, Kyle W

    2015-01-01

    Surgical correction of flexible flatfoot deformity and posterior tibial tendon dysfunction has been extensively reported in published studies. When appropriate, calcaneal osteotomies for flatfoot correction have been a favorite of foot and ankle surgeons because of the corrective power achieved without the need to fuse any rearfoot joints. The medial displacement calcaneal osteotomy and Evans calcaneal osteotomy, together termed the double calcaneal osteotomy, have been reported several times by various investigators with a wide variety of fixation options. We undertook an institutional review board-approved retrospective review of 9 consecutive patients (11 feet), who had undergone double calcaneal osteotomy with 2 percutaneous Steinmann pin fixation for the correction of flexible flatfoot deformity, with or without posterior tibial tendon dysfunction. All patients had radiographic evidence of bone healing of the posterior calcaneal osteotomy and incorporation of the Evans osteotomy bone graft at 6 weeks and demonstrated clinical healing at 6 weeks. All patients had 2 percutaneous Steinmann pins placed through both osteotomies, and these were removed an average of 6 weeks postoperatively. No patient developed pin site complications. The only complication noted was sural neuritis, which was likely incision related. No patients had delayed union or nonunion, and we did not identify any graft shifting postoperatively. The present retrospective series highlights our experience with 2 percutaneous Steinmann pin fixation, demonstrating equal or better results than many previous published fixation methods for double calcaneal osteotomy. It is cost-effective and minimizes the potential risk of iatrogenic Achilles pathologic features associated with screw fixation.

  12. 自我职涯管理与职涯高原的关系%The Relationship between Individual Career Management and Career Plateau of Employees

    Institute of Scientific and Technical Information of China (English)

    曾垂凯

    2012-01-01

    组织结构扁平化导致职涯高原员工逐渐增多,给个体和组织造成了消极影响。本文通过对338名企业员工的问卷调查探讨自我职涯管理与职涯高原的关系。研究结果显示:自我职涯管理中的职业探索与层级高原、内容高原及中心化高原正相关;目标确定与层级高原、关注学习与内容高原、注重关系与中心化高原及内容高原负相关;自我展示虽在简单相关分析中与内容高原及中心化高原负相关,但在回归分析中则相关不显著。%With the flatting development of the organization structure and gradually reduced management levels,promotion becomes more difficult than ever.More and more employees,especially management personnel,are getting into trouble with stagnation of career development.Then,career plateau phenomenon appears.According to the idea of Zeng Chuikai,career plateau is such a phenomena that in a certain phase of individuals career development,the long stay in a position makes the career flow(including vertical flow,horizontal flow,and central flow) difficult to realize,and causes his or her career development stagnation.Career plateau includes three aspects-hierarchal plateau(few possibility to promote in present organization),content plateau(few opportunity to learn new skills), and inclusive plateau(few possibility towards responsibility center).Since career plateau brings lots of adverse influences to both individuals and organizations,its relationship with individual career management now receives more and more attention in the world. To explore the relationship between individual career management and career plateau,in this research we made a questionnaire survey on employees of firms on the Chinese mainland.Out of a samples of 396 employees,338 questionnaires were valid.The questionnaires comprised three parts.Part one included items about the demographic characteristics of the subjects.Part two adopted the Individual Career

  13. Prognostic radiographic factors in developmental dysplasia of the hip following Salter osteotomy.

    Science.gov (United States)

    Chang, Chia-Hsieh; Yang, Wen-E; Kao, Hsuan-Kai; Lee, Wei-Chun; Shih, Chun-Hsiung; Kuo, Ken N

    2015-01-01

    Radiographic parameters for evaluating hip development are altered by Salter osteotomy, and their prognostic value require further validation. A total of 63 patients who underwent open reduction and Salter osteotomy for unilateral hip dysplasia were evaluated with Severin classification 10.8 years later. The initial first-year postoperative acetabular index, c/b ratio, head-teardrop distance, and head coverage were compared with the final outcome of Severin classification. Greater c/b ratio was significantly associated with later Severin class III hip. Using receiver operating characteristics curve, a c/b ratio greater than 0.72 at 6 months and 1 year postoperatively can predict the possibility of a class III hip in 30 and 60% of patients, respectively.

  14. Intermediate to long-term results following the Bernese periacetabular osteotomy and predictors of clinical outcome.

    Science.gov (United States)

    Matheney, Travis; Kim, Young-Jo; Zurakowski, David; Matero, Catherine; Millis, Michael

    2009-09-01

    The Bernese periacetabular osteotomy is a commonly used non-arthroplasty option to treat developmental hip dysplasia in symptomatic younger patients. Predicting which hips will remain preserved and which hips will go on to require arthroplasty following periacetabular osteotomy is a major challenge. In the present study, we assessed the intermediate to long-term results following periacetabular osteotomy to demonstrate the clinical outcomes for patients with varying amounts of dysplasia and arthritis. From these results, a probability-of-failure analysis was conducted to predict the likelihood of hip preservation and to improve surgical decision-making. Of the 189 hips (in 157 patients) that were treated with periacetabular osteotomy by a single surgeon from May 1991 to September 1998, thirty-one had diagnoses other than developmental hip dysplasia and twenty-three were lost to follow-up. The remaining 135 hips (in 109 patients) were retrospectively reviewed at an average of nine years. Hips were evaluated with use of the pain subscale of the Western Ontario and McMaster Universities Osteoarthritis Index postoperatively as well as with radiographs that were made preoperatively and at one and more than five years postoperatively. Osteotomy failure was defined as a pain score of >or=10 or the need for total hip arthroplasty. One hundred and two hips (76%) remained preserved at an average of nine years, with an average Western Ontario and McMaster Universities pain score of 2.4 of 20. Thirty-three hips (24%) met the failure criteria: seventeen underwent arthroplasty at an average of 6.1 years after the osteotomy, and sixteen had a postoperative pain score of >or=10. Kaplan-Meier analysis with arthroplasty as the end point revealed a survival rate of 96% (95% confidence interval, 93% to 99%) at five years and 84% (95% confidence interval, 77% to 90%) at ten years. Complications occurred in twenty hips. Fifteen hips (11%) were treated with a subsequent arthroscopy

  15. Dentoalveolar Segmental Osteotomy Combined with Orthodontic Treatment for an Impacted and Ankylosed Upper Canine

    DEFF Research Database (Denmark)

    Aludden, Hanna Cecilia; Jensen, Thomas

    2016-01-01

    for the management of ankylosed teeth involving extraction, surgical luxation, and osteotomy followed by dentoalveolar distraction or conventional orthodontic treatment. This case report describes a 55-year-old female who was referred by her orthodontist due to an impacted and ankylosed maxillary upper left canine......Ankylosis is the abnormal adhesion of alveolar bone to dentin or cementum and commonly seen after traumatic dental injuries. Treatment of impacted and ankylosed teeth solely by orthodontics alignment may be challenging. Consequently, several treatment alternatives have been proposed....... A dentoalveolar segmental osteotomy with immediate repositioning of an upper canine was performed. One year after final orthodontic treatment a satisfying occlusal and esthetic treatment outcome was obtained....

  16. Bad splits in bilateral sagittal split osteotomy: systematic review of fracture patterns.

    Science.gov (United States)

    Steenen, S A; Becking, A G

    2016-07-01

    An unfavourable and unanticipated pattern of the mandibular sagittal split osteotomy is generally referred to as a 'bad split'. Few restorative techniques to manage the situation have been described. In this article, a classification of reported bad split pattern types is proposed and appropriate salvage procedures to manage the different types of undesired fracture are presented. A systematic review was undertaken, yielding a total of 33 studies published between 1971 and 2015. These reported a total of 458 cases of bad splits among 19,527 sagittal ramus osteotomies in 10,271 patients. The total reported incidence of bad split was 2.3% of sagittal splits. The most frequently encountered were buccal plate fractures of the proximal segment (types 1A-F) and lingual fractures of the distal segment (types 2A and 2B). Coronoid fractures (type 3) and condylar neck fractures (type 4) have seldom been reported. The various types of bad split may require different salvage approaches.

  17. Primary and revision total hip replacement without cement and with associated femoral osteotomy.

    Science.gov (United States)

    Holtgrewe, J L; Hungerford, D S

    1989-12-01

    Nine porous-coated total hip prostheses were implanted without cement in nine patients who had a major proximal femoral deformity. Six patients had revision and three, primary total hip replacement. In all nine patients, as well placed corrective osteotomy was needed to successfully perform the arthroplasty. The average time until union of the proximal femoral osteotomy was fifteen weeks for the patients who had a primary arthroplasty and twenty-seven weeks for the patients who had a revision arthroplasty. The average Harris hip-rating score was 94 points for the patients who had a primary arthroplasty and 84 points (range, 60 to 93 points) for those who had a revision arthroplasty. The length of follow-up averaged forty-seven months.

  18. 高原地区慢性心力衰竭患者自我管理水平现状调查及分析%Investigation and analysis of self-management level in patients with chronic heart failure in plateau region

    Institute of Scientific and Technical Information of China (English)

    马晓婷; 张琳; 马美玲; 施雁

    2016-01-01

    目的:探讨高原地区慢性心力衰竭患者自我管理水平现状及影响因素。方法选择西宁地区3所三级甲等医院160例慢性心力衰竭患者作为研究对象,应用患者一般资料问卷、心力衰竭患者自我管理量表对其进行调查。结果自我管理各维度得分分别为:药物管理(13.70±3.56)分,饮食管理(7.37±2.64)分,心理和社会适应管理(10.72±3.81)分,症状管理(13.62±4.41)分,自我管理总分(45.33±11.52)分。年龄、月收入、居住地、医疗付费方式是患者总体自我管理水平的影响因素;民族是饮食管理的影响因素;宗教信仰是症状管理的影响因素。结论高原地区慢性心力衰竭患者自我管理水平低下,药物管理最好,症状管理最差。应根据不同民族、是否有宗教信仰、年龄、月收入、居住地、医疗付费方式采取针对性的健康教育。%Objective To explore the current status of self-management in patients with chronic heart failure ( CHF) in the plateau region and analyze its influencing factors. Methods A total of 160 patients with chronic heart failure were selected in level three and class A hospitals in Xi′ning and investigated with the general information questionnaire, self-management scale of heart failure patients. Results Scores of each dimension were (13. 70 ± 3. 56) for medication management, (7. 37 ± 2. 64) for diet management, (10. 72 ± 3. 81) for management of psychological and social adaptation, (13. 62 ± 4. 41) for symptoms management, (45. 33 ± 11. 52) for the total score of self management level. Patients′age, monthly income, domicile, ways of health-payment were factors influencing self-management level. Nationality was the factor influencing diet management. Religious belief was the factor influencing symptoms management. Conclusions The self-management level in patients with CHF in plateau region is low, among which, medication management is the best

  19. Hydrogeology of the Markagunt Plateau, Southwestern Utah

    Science.gov (United States)

    Spangler, Lawrence E.

    2010-01-01

    The Markagunt Plateau, in southwestern Utah, lies at an altitude of about 9,500 feet and is capped primarily by Quaternary-age basalt that overlies Eocene-age freshwater limestone of the Claron Formation. Over large parts of the Markagunt Plateau, dissolution of the Claron limestone and subsequent collapse of the overlying basalt have produced a terrain characterized by sinkholes as much as 1,000 feet across and 100 feet deep. Numerous large springs discharge from the basalt and underlying limestone on the plateau, including Mammoth Spring, one of the largest springs in Utah, with a discharge that can exceed 300 cubic feet per second. Discharge from Mammoth Spring is from the Claron Formation; however, recharge to the spring largely takes place by both focused and diffuse infiltration through the basalt that caps the limestone. Results of dye tracing to Mammoth Spring indicate that recharge originates largely southwest of the spring outside of the Mammoth Creek watershed, as well as from losing reaches along Mammoth Creek. Maximum groundwater travel time to the spring from dye-tracer tests during the snowmelt runoff period was about 1 week. Specific conductance and water temperature data from the spring show an inverse relation to discharge during snowmelt runoff and rainfall events, also indicating short groundwater residence times. Results of major-ion analyses for samples collected from Mammoth and other springs on the plateau indicate calcium-bicarbonate type water containing low (less than 200 mg/L) dissolved-solids concentrations. Investigations in the Navajo Lake area along the southern margin of the plateau have shown that water losing to sinkholes bifurcates and discharges to both Cascade and Duck Creek Springs, which subsequently flow into the Virgin and Sevier River basins, respectively. Groundwater travel times to these springs, on the basis of dye tracing, were about 8.5 and 53 hours, respectively. Similarly, groundwater travel time from Duck Creek

  20. Late Cretaceous Arc Initiation on the Edge of an Oceanic Plateau (Southern Central America)

    Science.gov (United States)

    Buchs, D. M.; Baumgartner, P. O.; Arculus, R.

    2007-12-01

    The Caribbean Plate comprises one or several late Cretaceous oceanic plateaus imbricated between the Northern and Southern Americas. Uplifted portions of plateau(s) along plate boundaries have been recognized in many sites, including that underlying the south Central American Volcanic Arc. We provide new constraints for the role of the plateau in the evolution of this arc obtained by mapping of the uplifted forearc area between southern Costa Rica and western Panama. An oceanic plateau, accreted seamounts and arc rocks were identified, and a new tectono-stratigraphy defined. The arc basement is composed of a Coniacian oceanic plateau. In the outer margin, late Cretaceous-Eocene accreted seamounts are in contact with the plateau along tectonic mélanges and active faults. Campanian-Maastrichtian primitive arc rocks are found 40-110 km to the trench on the top of -or as dykes within- the plateau. The location of these rocks correlates to previous observations and indicates that the arc front migrated away from the trench during the late Cretaceous, potentially in response to subduction erosion or slab flattening [Lissinna et al., EGU 2006]. The first island arc lavas were deposited under sea level, over a broad area. They were quickly followed by more evolved intrusives and lavas, which were emplaced along a volcanic front during the late Cretaceous-Paleocene. Detrital and volcanic records along the Central American isthmus indicate that a continuous volcanic arc extended between eastern Panama and northern Costa Rica in this time. In southern Costa Rica (Golfito complex) and western Panama (Sona-Azuero-Coiba complex), the oceanic plateau consists mainly of pillowed and massive low Fe (tholeiitic) basalts. These rocks have a highly consistent geochemistry characterized by flat, primitive upper mantle-normalized incompatible element patterns with low Pb and high Nb-Ti contents. Primitive arc igneous samples are low-medium Fe basalts to trachyandesites found as pillow

  1. Holocene aeolian sediments on the NE Tibetan Plateau

    Science.gov (United States)

    Stauch, G.; Lehmkuhl, F.; Hilgers, A.; Zhao, H.

    2012-04-01

    vegetation degradation and soil erosion. Furthermore additional new sediment sources have been available due to falling lake levels of the nearby Donggi Cona. This research has been done in the frame of the project 'Landscape and Lake-System Response to Late Quaternary Monsoon Dynamics on the Tibetan Plateau - Northern Transect' which has been founded by the German Science Foundation (DFG) as part of the SPP 1372: Tibetan Plateau - Formation, Climate, Ecosystems.

  2. Intra-Articular Osteotomy for Genu Valgum in the Knee with a Lateral Compartment Deficiency.

    Science.gov (United States)

    Feldman, David S; Goldstein, Rachel Y; Kurland, Adam M; Sheikh Taha, Abdel Majid

    2016-01-20

    A deficiency of the lateral compartment of the knee, often in the setting of skeletal dysplasia, is an intra-articular deformity resulting in genu valgum. Historically, this abnormality has been treated using an extra-articular approach. Lateral hypoplasia of the femoral condyle can be treated with advancement of the lateral femoral condyle without creating a secondary deformity. The purpose of this study was to present the technique and results of lateral condylar advancement, with or without tibial hemiplateau elevation, in patients with intra-articular valgus deformity secondary to skeletal dysplasia. A retrospective review of the cases of five patients, from seven to twenty-one years old, with skeletal dysplasia and unilateral or bilateral severe genu valgum deformity was performed. For all patients, the etiology of the deformity was a deficient lateral compartment of the knee-that is, lateral femoral condylar hypoplasia with or without concomitant lateral hemiplateau depression. Lateral femoral condylar advancement with or without lateral tibial hemiplateau elevation was performed in eight knees. The average tibiofemoral angle was 34.7° of valgus preoperatively and improved to 9.4° of valgus at the most recent follow-up. The average length of follow-up was 2.9 years (range, 1.0 to 5.2 years). The average range of motion at the time of final follow-up was an arc of 108° starting from full extension. All osteotomies healed uneventfully. All five patients were satisfied with both the cosmetic appearance and the function of the involved limb and were able to walk without assistive devices. In patients with a deficient lateral compartment of the knee, lateral femoral condylar advancement with or without hemiplateau elevation allowed correction of severe genu valgum without the creation of an oblique joint line. This technique allows correction of the overall mechanical axis, restoring both function and the cosmetic appearance of the limb. Therapeutic Level IV

  3. Salter%u2019s Innominate Osteotomy in the Treatment of Congenital Hip Dislocation

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    Eyup Cagatay Zengin

    2014-03-01

    Full Text Available Aim: Developmental displazy of hip is much seenillness which interest orthopaedic surgery in Turkey and around the world. In early times of illness conservative treatment is succesful but late times of illness surgery is necessary. Salter’s innominate osteotomy, since its initial description in 1961, has become a well-established surgical procedure in the treatment of congenital dislocation of the hip.Material and Method: We reviewed 59 patients with 74 congenitally dislocated hips, all managed by open reduction and Salter’s innominate osteotomy. Mean follow-up period was 4,2 years (range, 2 to 7 years; %82,4 of the hips had a excellent clinical result, and %75,7 were excellent radiologically. The patients who underwent Salter’s innominate osteotomy before the age of 3 had beter clinical and radiological results (%90,4 and %82,5, respectively. The radiographs of the unilateral normal hips were compared to the surgically treated hips according to their acetabular index angles, center-edge angles of Wiberg and femoral neck-shaft angles. No statistical differences were found between these two groups. The Kalamchi-McEwen classification of avascular necrosis. The late radiographic signs of types 2, 3 and 4 avasculer necrosis were seen in %10,8 of this series. Discussion: The results show that Salter’s innominate osteotomy provides good lateral coverage of the femoral head. The results are beter if the operation is performed between the ages 18 months and 3 years.

  4. Ischemia of the lateral femoral cutaneous nerve during periacetabular osteotomy using Smith-Petersen approach

    OpenAIRE

    Kiyama, Takahiko; Naito, Masatoshi; Shiramizu, Kei; Shinoda, Tuyoshi; Maeyama, Akira

    2009-01-01

    Background Lateral femoral cutaneous nerve (LFCN) injury is a common complication in the Smith-Petersen approach to the hip. This complication may be induced by neural ischemia or direct trauma during the procedure. The purpose of this study was to investigate the relationship between the neural ischemia of LFCN and postoperative sensory disturbance. Materials and methods Nineteen patients who underwent periacetabular osteotomy through the Smith-Petersen approach were investigated. To evaluat...

  5. Piezoelectric Trapezoidal Osteotomy for the Retrieval of a Displaced Dental Implant in the Osteoporotic Mandibular Body.

    Science.gov (United States)

    Kwon, Yong-Dae; Pae, Ahran

    2016-10-01

    A female patient in her mid-seventies was referred to our department for the removal of a displaced implant within the right posterior mandible. A trapezoidal window was made using a piezoelectric device. The implant was extracted, and the osteotomized window was replaced without fixation. Caution should be exercised during implant placement in patients with osteoporosis because of the risk of implant displacement. Displaced implants can be easily retrieved by piezoelectric trapezoidal osteotomy.

  6. Stability of simultaneous modified LeFort III/LeFort I osteotomies.

    Science.gov (United States)

    Schmitz, J P; Tiner, B D; Van Sickels, J E

    1995-10-01

    The objective of this study was to examine maxillary skeletal stability after simultaneous modified LeFort III/LeFort I osteotomy in patients who presented for the simultaneous correction of midface and maxillary hypoplasia. Eleven patients underwent simultaneous modified LeFort III/LeFort I osteotomies using transoral and transconjunctival surgical approaches. The mean net surgical movement at A point (A pt) was 5.2 mm anteriorly and 2 mm inferiorly. Titanium mini-plates were used to stabilize both the midface component and the LeFort I segment; iliac crest or calvarial bone grafts as well as freeze-dried cancellous blocks were used at the zygoma and lateral orbital rim regions. All patients had lateral cephalometric radiographs taken immediately postoperatively, and at their sixth week, sixth month, and one year follow-up visits. Five maxillary landmarks (CI, A pt, ANS, PNS, and 2M) were used to examine the horizontal and vertical changes occurring at each time period. The central incisor relapsed vertically 2.8 mm at six months, A pt relapsed vertically 2.3 mm at six months, ANS relapsed posteriorly 1.6 mm at 6 weeks, PNS relapsed 1.5 mm anteriorly at one year. This study demonstrated that the maxilla moved anteriorly 1.5 mm and superiorly 2.8 mm in simultaneous modified LeFort III/LeFort I osteotomies performed with mini-plate fixation and bone grafts. This movement should be considered when planning and performing simultaneous surgical movement of the maxilla and midface using modified LeFort II/LeFort I osteotomies. Appropriate occlusal overcorrection at the time of surgery is necessary.

  7. Treatment of Long-standing Condylar Dislocation with Vertical Ramus Osteotomy: A Case Report

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    Saeed Nezafati

    2015-03-01

    Full Text Available Condylar dislocation is not an uncommon condition and occurs when the condyles are displaced anterior to the articular eminence and are unable to reduce back into the glenoid fossa. Long-standing dislocations are difficult to treat with the con-servative methods and usually need surgical intervention. In this paper, a long-standing dislocation treated by bilateral ex-tra-oral ramus osteotomy is described and the literature is reviewed.

  8. [Bernese periacetabular osteotomy. : Indications, technique and results 30 years after the first description].

    Science.gov (United States)

    Lerch, T D; Steppacher, S D; Liechti, E F; Siebenrock, K A; Tannast, M

    2016-08-01

    The Bernese periacetabular osteotomy (PAO) is a surgical technique for the treatment of (1) hip dysplasia and (2) femoroacetabular impingement due to acetabular retroversion. The aim of the surgery is to prevent secondary osteoarthritis by improvement of the hip biomechanics. In contrast to other pelvic osteotomies, the posterior column remains intact with this technique. This improves the inherent stability of the acetabular fragment and thereby facilitates postoperative rehabilitation. The birth canal remains unchanged. Through a shortened ilioinguinal incision, four osteotomies and one controlled fracture around the acetabulum are performed. The direction of acetabular reorientation differs for both indications while the sequence of the osteotomies remains the same. This surgical approach allows for a concomitant osteochondroplasty in the case of an aspherical femoral head-neck junction. The complication rate is relatively low despite the complexity of the procedure. The key point for a successful long term outcome is an optimal reorientation of the acetabulum for both indications. With an optimal reorientation and a spherical femoral head, the cumulative survivorship of the hip after 10 years is 80-90 %. For the very first 75 patients, the cumulative 20-year survivorship was 60 %. The preliminary evaluation of the same series at a 30-year follow-up still showed a survivorship of approximately 30 %. The PAO has become the standard procedure for the surgical therapy of hip dysplasia in adolescents and adults.

  9. Medial Translation of the Hip Joint Center Associated with the Bernese Periacetabular Osteotomy

    Science.gov (United States)

    Clohisy, John C; Barrett, Susan E; Gordon, J Eric; Delgado, Eliana D; Schoenecker, Perry L

    2004-01-01

    This study assessed medial translation of the hip joint achieved by the Bernese periacetabular osteotomy (PAO) in correcting residual acetabular dysplasia deformities. 86 hips in 75 patients with an average age of 25 years (range, 12-50) were treated for symptomatic acetabular dysplasia with a periacetabular osteotomy. Radiographic analysis was performed to assess correction of the acetabular deformity with specific attention to the horizontal position of the hip joint center. All hips were followed until bony union of the iliac osteotomy and the average follow-up was 28 months. The lateral center edge angle improved an average 31.6° (-0.4° preoperative, 31.2° at follow-up). Anterior center edge angle improved 39.3° (-4.5° to 34.8°). The acetabular roof obliquity improved an average 21.8° (25.1° to 3.3°). Preoperatively, the average distance from the medial aspect of the femoral head to the ilioischial line was 17.6 mm. This distance was decreased to an average 7.8 mm postoperatively. This change resulted in an average medial translation of the hip joint center of 9.8 mm, (range -6 to 31mm). Overall, some degree of medial translation of the hip joint center was obtained in 79 (92%) of the hips. 4 (5%) were maintained in the same horizontal position, and 3 (3%) had slight lateral repositioning. For the hips translated medially, the average change was 10.0 mm, and 72% of all hips had an optimal correction with the distance between the medial aspect of the femoral head and the ilioischial line being between 0 and 10 mm. This study demonstrates that in addition to optimizing femoral head coverage, a major and distinct advantage of the periacetabular osteotomy is reproducible and consistent medial translation of the hip joint center. PMID:15296205

  10. Pre-operative simulation of periacetabular osteotomy via a three-dimensional model constructed from salt

    Directory of Open Access Journals (Sweden)

    Fukushima Kensuke

    2017-01-01

    Full Text Available Introduction: Periacetabular osteotomy (PAO is an effective joint-preserving procedure for young adults with developmental dysplasia of the hip. Although PAO provides excellent radiographic and clinical results, it is a technically demanding procedure with a distinct learning curve that requires careful 3D planning and, above all, has a number of potential complications. We therefore developed a pre-operative simulation method for PAO via creation of a new full-scale model. Methods: The model was prepared from the patient’s Digital Imaging and Communications in Medicine (DICOM formatted data from computed tomography (CT, for construction and assembly using 3D printing technology. A major feature of our model is that it is constructed from salt. In contrast to conventional models, our model provides a more accurate representation, at a lower manufacturing cost, and requires a shorter production time. Furthermore, our model realized simulated operation normally with using a chisel and drill without easy breakage or fissure. We were able to easily simulate the line of osteotomy and confirm acetabular version and coverage after moving to the osteotomized fragment. Additionally, this model allowed a dynamic assessment that avoided anterior impingement following th