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Sample records for pole scaphoid nonunion

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

    Science.gov (United States)

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

    2016-01-01

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

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

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

    2013-10-01

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

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

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    Antônio Lourenço Severo

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

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Science.gov (United States)

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

    2016-09-01

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

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

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    McInnes, Colin W; Giuffre, Jennifer L

    2015-09-01

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

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

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

    2015-07-01

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

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

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

    2005-06-01

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

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

    International Nuclear Information System (INIS)

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

    2005-01-01

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

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

    Science.gov (United States)

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

    2009-01-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

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

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

    2006-04-01

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

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

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

    2014-01-01

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

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

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

    2015-12-01

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

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

    Science.gov (United States)

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

    2017-01-01

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

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

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

    2017-01-01

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

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

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

    2018-01-01

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

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

    Science.gov (United States)

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

    2018-01-04

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

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

    Science.gov (United States)

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

    2016-09-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

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

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Science.gov (United States)

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

    2017-06-01

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

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

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    Alper Cirakli

    2016-09-01

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

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

    Science.gov (United States)

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

    2018-02-27

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

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

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

    2017-09-01

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

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

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

    2011-02-15

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

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

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

    2011-01-01

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

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

    Science.gov (United States)

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

    2017-05-01

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

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

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    Eder, Christian

    2015-08-01

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

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

    Science.gov (United States)

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

    1989-05-01

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

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

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    Iman Qomashi

    2011-02-01

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

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

    Science.gov (United States)

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

    2018-02-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-11-15

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

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

    Science.gov (United States)

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

    2015-11-01

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

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

    Science.gov (United States)

    Sroga, Wojciech; Perez Giner, Rosa Ana

    2016-11-30

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

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

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    Bumbaširević Marko

    2011-11-01

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

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

    Science.gov (United States)

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

    2016-11-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2008-10-01

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

  2. Conservative management of fracture scaphoid

    Directory of Open Access Journals (Sweden)

    Mittal V

    2006-01-01

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

  3. Distribution of Scaphoid Nutrient Foramina

    African Journals Online (AJOL)

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

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

    Science.gov (United States)

    Winkel, Reiner; Schlageter, Michael

    2009-11-01

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

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

    Science.gov (United States)

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

    2014-01-01

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

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

    African Journals Online (AJOL)

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

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

    OpenAIRE

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

    2011-01-01

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

  8. Scaphoid fractures in children

    Directory of Open Access Journals (Sweden)

    Gajdobranski Đorđe

    2014-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1996-08-01

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

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

    Directory of Open Access Journals (Sweden)

    Paul W. L. ten Berg

    2015-01-01

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

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

    Science.gov (United States)

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

    2011-05-06

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

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

    Directory of Open Access Journals (Sweden)

    Poeze Martijn

    2011-05-01

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

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

    NARCIS (Netherlands)

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

    2015-01-01

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

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

    Science.gov (United States)

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

    2017-08-01

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

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

    International Nuclear Information System (INIS)

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

    1998-01-01

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

  16. Vascularized osseous graft for scaphoid

    International Nuclear Information System (INIS)

    Mendez Daza, Carlos Hernan; Mathoulin, Cristophe

    2004-01-01

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

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

    NARCIS (Netherlands)

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

    2014-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-06-15

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

  19. The role of MR imaging in scaphoid disorders

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-11-15

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

  20. The role of MR imaging in scaphoid disorders

    International Nuclear Information System (INIS)

    Karantanas, Apostolos; Dailiana, Zoe; Malizos, Konstantinos

    2007-01-01

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

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

    Science.gov (United States)

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

    2011-07-01

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

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

    Science.gov (United States)

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

    2014-08-01

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

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

    International Nuclear Information System (INIS)

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

    2013-01-01

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

  4. [Chondroblastoma of the carpal scaphoids].

    Science.gov (United States)

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

    2008-01-01

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

  5. Neglected dorsal dislocation of the scaphoid

    Directory of Open Access Journals (Sweden)

    Amaravati Rajkumar

    2009-01-01

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

  6. OSTEOID OSTEOMA IN SCAPHOID: CASE REPORT.

    Science.gov (United States)

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

    2012-01-01

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

  7. OSTEOID OSTEOMA IN SCAPHOID: CASE REPORT

    Science.gov (United States)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Baris Beytullah Koc

    2016-01-01

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

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

    International Nuclear Information System (INIS)

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

    2014-01-01

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

  10. Infected nonunion of tibia

    Directory of Open Access Journals (Sweden)

    Milind Madhav Chaudhary

    2017-01-01

    Full Text Available Infected nonunions of tibia pose many challenges to the treating surgeon and the patient. Challenges include recalcitrant infection, complex deformities, sclerotic bone ends, large bone gaps, shortening, and joint stiffness. They are easy to diagnose and difficult to treat. The ASAMI classification helps decide treatment. The nonunion severity score proposed by Calori measures many parameters to give a prognosis. The infection severity score uses simple clinical signs to grade severity of infection. This determines number of surgeries and allows choice of hardware, either external or internal for definitive treatment. Co-morbid factors such as smoking, diabetes, nonsteroidal anti-inflammatory drug use, and hypovitaminosis D influence the choice and duration of treatment. Thorough debridement is the mainstay of treatment. Removal of all necrotic bone and soft tissue is needed. Care is exercised in shaping bone ends. Internal fixation can help achieve union if infection was mild. Severe infections need external fixation use in a second stage. Compression at nonunion site achieves union. It can be combined with a corticotomy lengthening at a distant site for equalization. Soft tissue deficit has to be covered by flaps, either local or microvascular. Bone gaps are best filled with the reliable technique of bone transport. Regenerate bone may be formed proximally, distally, or at both sites. Acute compression can fill bone gaps and may need a fibular resection. Gradual reduction of bone gap happens with bone transport, without need for fibulectomy. When bone ends dock, union may be achieved by vertical or horizontal compression. Biological stimulus from iliac crest bone grafts, bone marrow aspirate injections, and platelet concentrates hasten union. Bone graft substitutes add volume to graft and help fill defects. Addition of rh-BMP-7 may help in healing albeit at a much higher cost. Regeneration may need stimulation and augmentation. Induced

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-06-01

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

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

    International Nuclear Information System (INIS)

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

    1989-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2003-05-01

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

  14. Chondroblastoma of the scaphoid: A case report

    Directory of Open Access Journals (Sweden)

    Sandeep Vijayan

    2015-01-01

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

  15. [Scaphoid enchondroma revealed by a fracture].

    Science.gov (United States)

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

    2006-06-01

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

  16. Missed isolated volar dislocation of the scaphoid

    DEFF Research Database (Denmark)

    Kolby, Lise; Larsen, Søren; Jørring, Stig

    2007-01-01

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

  17. Palmar dislocation of scaphoid and lunate

    Directory of Open Access Journals (Sweden)

    Khalid Koulali Idrissi

    2011-11-01

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

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

    Directory of Open Access Journals (Sweden)

    Khodamorad Jamshidi

    2009-04-01

    Full Text Available

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

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

    Science.gov (United States)

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

    2016-01-01

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

  20. PSEUDARTHROSIS OF THE SCAPHOID IN IMMATURE SKELETONS.

    Science.gov (United States)

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

    2012-01-01

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

  1. PSEUDARTHROSIS OF THE SCAPHOID IN IMMATURE SKELETONS

    Science.gov (United States)

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

    2015-01-01

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

  2. Congenital Scaphoid Megalourethra: A Case Report

    Directory of Open Access Journals (Sweden)

    Kenji Obara

    2017-09-01

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

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

    African Journals Online (AJOL)

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

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

    African Journals Online (AJOL)

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

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

    Science.gov (United States)

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

    2013-07-01

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

  6. Hypertrophic Nonunion Humerus Mimicking an Enchondroma

    Directory of Open Access Journals (Sweden)

    N. K. Magu

    2014-01-01

    Full Text Available Introduction. Although fractures of humeral shaft show excellent results with conservative management, nonunion does occur. Case Report. We bring forth the case of a young male with a 1.5-year-old hypertrophic nonunion of the humerus mimicking an enchondroma. The initial X-ray images of the patient appeared to be an enchondroma, which only on further evaluation and histopathological analysis was diagnosed conclusively to be a hypertrophic nonunion. Discussion. Enchondromas are often incidentally diagnosed benign tumours. It is however not common to misdiagnose a hypertrophic nonunion to be an enchondroma. We present this case to highlight the unique diagnostic dilemma the treating team had to face.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2017-01-01

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

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

    Science.gov (United States)

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

    2015-01-28

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

  10. The morphological and morphometric features of the scaphoid.

    Science.gov (United States)

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

    2004-08-01

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

  11. Prune belly syndrome with pouch colon with scaphoid megalourethra

    African Journals Online (AJOL)

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

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

    Science.gov (United States)

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

    2015-03-01

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

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

    NARCIS (Netherlands)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2017-12-01

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

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

    Science.gov (United States)

    2010-04-01

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

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

    Science.gov (United States)

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

    2017-03-01

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

  17. Diaphyseal long bone nonunions - types, aetiology, economics, and treatment recommendations.

    Science.gov (United States)

    Rupp, Markus; Biehl, Christoph; Budak, Matthäus; Thormann, Ulrich; Heiss, Christian; Alt, Volker

    2018-02-01

    The intention of the current article is to review the epidemiology with related socioeconomic costs, pathophysiology, and treatment options for diaphyseal long bone delayed unions and nonunions. Diaphyseal nonunions in the tibia and in the femur are estimated to occur 4.6-8% after modern intramedullary nailing of closed fractures with an even much higher risk in open fractures. There is a high socioeconomic burden for long bone nonunions mainly driven by indirect costs, such as productivity losses due to long treatment duration. The classic classification of Weber and Cech of the 1970s is based on the underlying biological aspect of the nonunion differentiating between "vital" (hypertrophic) and "avital" (hypo-/atrophic) nonunions, and can still be considered to represent the basis for basic evaluation of nonunions. The "diamond concept" units biomechanical and biological aspects and provides the pre-requisites for successful bone healing in nonunions. For humeral diaphyseal shaft nonunions, excellent results for augmentation plating were reported. In atrophic humeral shaft nonunions, compression plating with stimulation of bone healing by bone grafting or BMPs seem to be the best option. For femoral and tibial diaphyseal shaft fractures, dynamization of the nail is an atraumatic, effective, and cheap surgical possibility to achieve bony consolidation, particularly in delayed nonunions before 24 weeks after initial surgery. In established hypertrophic nonunions in the tibia and femur, biomechanical stability should be addressed by augmentation plating or exchange nailing. Hypotrophic or atrophic nonunions require additional biological stimulation of bone healing for augmentation plating.

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

    African Journals Online (AJOL)

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    African Journals Online (AJOL)

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

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

    African Journals Online (AJOL)

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

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

    Science.gov (United States)

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

    2015-02-01

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

  3. Labor law for the nonunion agency.

    Science.gov (United States)

    Gilliland, J C

    1997-03-01

    Providers should not assume that because they are union free they need not worry about labor law. An agency can have obligations under labor laws even when no union is involved. Who are nonunion employees, legally speaking? What rights do they have, and how can agencies ensure that they are in compliance with those rights?

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

    Directory of Open Access Journals (Sweden)

    Ozkan Korhan

    2008-03-01

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

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

    Science.gov (United States)

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

    2014-12-01

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

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

    NARCIS (Netherlands)

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

    2011-01-01

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

  7. Treatment of scaphoid waist fractures with the HCS screw

    Directory of Open Access Journals (Sweden)

    Gehrmann, Sebastian V.

    2014-11-01

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

  8. Treatment of Atrophic Nonunion - A Report of Two Cases | Omeonu ...

    African Journals Online (AJOL)

    OBJECTIVE: To underscores the importance of compression in the management of atrophic nonunion. METHOD: We report a series of two cases of atrophic nonunions of long bones resulting from long periods of limb immobilization in traditional splints successfully treated by Ilizarov compression technique. RESULT: Long ...

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

    Science.gov (United States)

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

    2011-03-01

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

  10. Nonunion of forearm fracture: a rare instance in a toddler

    Directory of Open Access Journals (Sweden)

    Saini Pramod

    2012-12-01

    Full Text Available 【Abstract】 When compared to adults, pediatric frac-tures unite readily and nonunion is quite rare. Nonunion is often associated with open fractures, operative interventions, infection, pediatric osteogenesis imperfecta and neurofibromatosis. There are only a few studies and reports mentioning nonunion following conservative ma-nagement of closed pediatric fractures. We report here a case of an eighteen-month-old child who developed non-union following treatment of fracture of both forearm bones with cast and was successfully treated with plating. To the best of our knowledge, this is the youngest reported case of nonunion following conservative management of closed diaphyseal pediatric fracture. Key words: Forearm; Fractures, bone; Child

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

    Science.gov (United States)

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

    2011-01-01

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

  12. Magnet pole tips

    Science.gov (United States)

    Thorn, Craig E.; Chasman, Chellis; Baltz, Anthony J.

    1984-04-24

    An improved magnet which more easily provides a radially increasing magnetic field, as well as reduced fringe field and requires less power for a given field intensity. The subject invention comprises a pair of spaced, opposed magnetic poles which further comprise a pair of pole roots, each having a pole tip attached to its center. The pole tips define the gap between the magnetic poles and at least a portion of each pole tip is separated from its associated pole root. The separation begins at a predetermined distance from the center of the pole root and increases with increasing radial distance while being constant with azimuth within that portion. Magnets in accordance with the subject invention have been found to be particularly advantageous for use in large isochronous cyclotrons.

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

    International Nuclear Information System (INIS)

    Vergara A, Enrique

    2007-01-01

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

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

    Science.gov (United States)

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

    2017-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Amjad N. Bhatti

    2012-02-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2002-08-01

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

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

    Science.gov (United States)

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

    2011-01-01

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

  18. Poling of Planar Silica Waveguides

    DEFF Research Database (Denmark)

    Arentoft, Jesper; Kristensen, Martin; Jensen, Jesper Bo

    1999-01-01

    UV-written planar silica waveguides are poled using two different poling techniques, thermal poling and UV-poling. Thermal poling induces an electro-optic coefficient of 0.067 pm/V. We also demonstrate simultaneous UV-writing and UV-poling. The induced electro-optic effect shows a linear dependence...

  19. Anteroinferior plating of midshaft clavicle nonunions and fractures

    NARCIS (Netherlands)

    Kloen, Peter; Werner, Clément M. L.; Stufkens, Sjoerd A. S.; Helfet, David L.

    2009-01-01

    OBJECTIVE: Anatomic reconstruction of clavicle with limited dissection and biomechanically optimal osteosynthesis. Anteroinferior plate placement to minimize patient's discomfort and need for implant removal. INDICATIONS: Midshaft clavicle nonunions. Midshaft clavicle fractures. Clavicle malunions

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

    Science.gov (United States)

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

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

  1. Effectiveness of plate augmentation for femoral shaft nonunion after nailing

    Directory of Open Access Journals (Sweden)

    Chin-Jung Lin

    2012-08-01

    Conclusion: Plate augmentation with retention of the nail with autologous bone grafting may be an effective and reliable alternative in treating nonunion of the femoral shaft fracture after open reduction and internal fixation with intramedullary nail.

  2. Nonunion of acetabular fractures: evaluation with interactive multiplanar CT

    Energy Technology Data Exchange (ETDEWEB)

    Kuhlman, J.E.; Fishman, E.K.; Ney, D.R.; Brooker, A.F. Jr.; Magid, D.

    1989-01-01

    Nonunions involving fractures of the acetabulum are reportedly rare, with few citings and little discussion in the literature. It is possible that acetabular nonunions go undetected because imaging of the acetabulum is difficult by conventional radiography. We report two cases of fracture nonunion involving the weight-bearing surface of the acetabulum diagnosed with the aid of computed tomography (CT) and a newly developed interactive 2D/3D orthotool that uniquely processes and reformats routine CT data. The interactive 2D/3D orthotool is a sophisticated computer program that allows dynamic viewing of standard multiplanar reconstructions in the axial, coronal, and sagittal planes as well as multiple oblique projections. The 2D/3D orthotool provides on screen correlation of two-dimensional multiplanar images with three-dimensional reconstructions of the pelvis. The authors found this capability ideally suited for studying fractures with off-axis orientation such as those through the acetabular dome, greatly facilitating the diagnosis of nonunion.

  3. Extracorporeal Shock Wave Therapy for Nonunion of the Tibia

    Science.gov (United States)

    2010-03-01

    the tibia treated with a reamed intramedullary interlocking nail . Clin Orrhop Relul Res. 1995; 315:56-63. 12. Wiss DA, Stetson WB. Tibial nonunion...atrophic and infected non unions . 18 24 A promising technology, extracorporeal shock wave therapy (ESWT), has been used to treat various musculoskel...nonunions has engendered innovative and alternative treat - ment approaches, including mechanical and molecular inter- ventions in the fonn of nail

  4. Successful treatment of recalcitrant nonunions with combined magnetic field stimulation.

    Science.gov (United States)

    Longo, J A

    1997-01-01

    Nonunions and delayed unions have been classically defined by Bassett as an arrest of the fracture healing process at an intermediary stage of repair, at which time the fracture gap is bridged by fibrocartilage. It is estimated that approximately 10-20 % of long bone fractures in the United States will result in delayed unions when compared to the average rate of healing for the location and type of fracture. Many of these will go on to a nonunion if biological or biomechanical factors are not optimized to enhance healing. Additional commorbities such as smoking, ethanol abuse, malnutrition, malabsorption and altered neurologic conditions can contribute to delayed unions or nonunions. Even despite appropriate and aggressive early management of long bone fractures, a certain percentage still lack progression of healing and go on to nonunion. Classical surgical management of nonunions includes obtaininjg fracture stabilization with ORIF techniques and bone grafting, with reported clinical successes ranging from 50-80%. Those that fail to achieve union despite classical management are indeed recalcitrant nonunions.

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

    Science.gov (United States)

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

    2016-02-01

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

  6. The treatment of nonisthmal femoral shaft nonunions with im nail exchange versus augmentation plating.

    Science.gov (United States)

    Park, Jin; Kim, Sul Gee; Yoon, Han Kook; Yang, Kyu Hyun

    2010-02-01

    The purpose of this study was to compare the results between exchange nailing (EN) and augmentation plating (AP) with a nail left in situ for nonisthmal femoral shaft nonunion after femoral nailing. : Retrospective data analysis, November 1996-March 2006. A level I trauma center. Eighteen patients with 18 nonisthmal femoral nonunions. Seven patients with 7 fractures treated for nonisthmal femoral shaft nonunions after femoral nailing with EN and 11 patients with 11 fractures treated for nonisthmal femoral shaft nonunions after nailing with AP combined with bone grafting. Union and complications. Five nonunions in the EN group failed to achieve union (72% failure rate), whereas all 11 pseudarthroses in the AP group obtained osseous union. Fisher exact test showed a higher nonunion rate of EN compared with AP for nonisthmal femoral shaft nonunion (odds ratio, 6.5; P = 0.002). AP with autogenous bone grafting may be a better option than EN for nonisthmal femoral nonunions.

  7. Stress Fracture and Nonunion of Coronoid Process in a Gymnast

    Directory of Open Access Journals (Sweden)

    T. Hetling

    2016-01-01

    Full Text Available Background. Gymnasts have high mechanical loading forces of up to 14 times body weight. Overuse lesions are typical in wrists and stress fractures in the olecranon, while isolated fractures of the coronoid process are uncommon. We present a case of retraumatized nonunion stress fracture of the ulnar coronoid process. Case Description. A 19-year-old gymnast presented with elbow pain after training. Imaging confirmed an old fracture of the coronoid process. We describe a 6-month multiphase return to competition rehabilitation program, which allowed him to compete pain-freely. Literature Review. Acute and overuse injuries in gymnasts are known but no nonunion of the coronoid process has been described before. Only one case of stress fracture of coronoid process in a gymnast was reported. Purpose and Clinical Relevance. We could successfully and conservatively return to sport a reactivated nonunion of a stress fracture of the coronoid process.

  8. [The acetabulum nonunion: reconstruction and reosteosynthesis : A long-term outcome].

    Science.gov (United States)

    Pluemer, J; Kruppa, C; Yilmaz, E; Schildhauer, T A; Dudda, M

    2017-01-01

    Acetabular nonunions are rare, especially after operative treatment of an acetabular fracture. There are only single reports of the reconstruction and therapy of acetabular nonunion. Furthermore, there are fewer reports for treatment of acetabular nonunion with a long follow-up. We report a successful revision of an acetabular nonunion after transversal fracture and previous operative intervention, as well as the long-term follow-up after revision surgery.

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

    OpenAIRE

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

    2013-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Apoorva Achyut Kulkarni

    2018-01-01

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

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

    Directory of Open Access Journals (Sweden)

    J. C. Nakamoto

    2011-01-01

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

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

    Science.gov (United States)

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

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

  13. Lower pole stones

    DEFF Research Database (Denmark)

    Sanguedolce, Francesco; Breda, Alberto; Millan, Felix

    2013-01-01

    PURPOSE: To assess efficacy and safety of prone- and supine percutaneous nephrolithotomy (PCNL) for the treatment of lower pole kidney stones. METHODS: Data from patients affected by lower pole kidney stones and treated with PCNL between December 2005 and August 2010 were collected retrospectively...... by seven referral centres. Variables analysed included patient demographics, clinical and surgical characteristics, stone-free rates (SFR) and complications. Statistical analysis was conducted to compare the differences for SFRs and complication rates between prone- and supine PCNL. RESULTS: One hundred...... seventeen patients underwent PCNL (mean stone size: 19.5 mm) for stones harboured only in the lower renal pole (single stone: 53.6 %; multiple stones: 46.4 %). A higher proportion of patients with ASA score ≥ 3 and harbouring multiple lower pole stones were treated with supine PCNL (5.8 vs. 23.1 %; p = 0...

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

    Directory of Open Access Journals (Sweden)

    Jessica M. Kohring

    2016-01-01

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

  15. Management of complex long bone nonunions using limb reconstruction system

    Directory of Open Access Journals (Sweden)

    Hiranya Kumar Seenappa

    2013-01-01

    Full Text Available Background: Management of complex nonunions is difficult due to the presence of infection, deformities, shortening and multiple surgeries in the past. Complex nonunions are traditionally managed by Ilizarov fixation. The disadvantages of Ilizarov are poor patient compliance, inconvenience of the frame and difficult frame construction. We conducted a study on 30 long bone complex nonunions treated by the limb reconstruction system (LRS. Materials and Methods: Between April 2009 and September 2012, we treated 30 cases of complex nonunion of long bone with the LRS. 28 were male and 2 females. Average shortening was 5.06 cm and 14 cases presented with infected implants. Initially we managed with implant removal, radical debridement followed by fixation with the LRS. In 16 cases, corticotomy and lengthening was done. The average duration of treatment was 9.68 months. We compressed the fracture site at the rate of 0.25 mm per day for 1-2 weeks and distracted the corticotomy at the rate of 1 mm/day till lengthening was achieved. Result: The union occurred in 89.28% cases and eradication of infection in 91.66% cases. Average lengthening done was 4.57 cm. We had 79% excellent, 11% good and 10% poor bony result and fnctional result was excellent in 40% cases, good in 50% and failure in 10% cases using ASAMI scoring system. Conclusion: LRS is an alternative to the Ilizarov fixation in their management of complex nonunion of long bones. It is less cumbersome to the patient and more surgeon and patient friendly.

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

    Directory of Open Access Journals (Sweden)

    Pincus, Steven

    2009-11-01

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

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

    LENUS (Irish Health Repository)

    Ramasubbu, B

    2017-02-01

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

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

    Science.gov (United States)

    Sun, Deyi; Yuan, Ding; Zhang, Xiangsheng

    2011-07-01

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

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

    Science.gov (United States)

    Ferreira, Nando; Marais, Leonard Charles

    2015-12-01

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

  20. Management of diabetic neuropathic foot and ankle malunions and nonunions

    Directory of Open Access Journals (Sweden)

    John J. Stapleton

    2011-05-01

    Full Text Available The management of diabetic neuropathic foot and ankle malunions and/or nonunions is often complicated by the presence of broken or loosened hardware, Charcot joints, infection, osteomyelitis, avascular bone necrosis, unstable deformities, bone loss, disuse and pathologic osteopenia, and ulcerations. The author discusses a rational approach to functional limb salvage with various surgical techniques that are aimed at achieving anatomic alignment, long-term osseous stability, and adequate soft tissue coverage. Emphasis is placed on techniques to overcome the inherent challenges that are encountered when surgically managing a diabetic nonunion and/or malunion. Particular attention is directed to the management of deep infection and Charcot neuroarthropathy in the majority of the cases presented.

  1. Biomechanical behavior of the tibiofibular frame in nonunion.

    Science.gov (United States)

    Gunzburg, R; Boulvin, S; Bourgeois, R; Wagner, J

    1991-01-01

    In this paper an in vitro investigation of the biomechanical behavior of the tibiofibular frame in nonunion using electrical extensometry is presented. The intact and untreated nonunited frames are studied as well as three surgical treatments classically used in nonunion: the plating technique, the onlay graft technique and the external fixation according to Ilizarov. The monopodal position with extended knee is considered, and particular attention is paid to the different muscle insertions. The results for the plating and onlay grafting techniques resemble those for the intact frame, whereas the Ilizarov external fixator increases the overall rigidity of the frame. In the untreated nonunited tibiofibular frame, an inversion of the tension and compression areas at the level of the tibia was found. We hypothesize that this phenomenon could be one of the mechanical factors leading to nonunion. Indeed, cyclic stresses in the fracture callus might prevent bony fusion, for the areas healing under compression stresses must become tension areas once the tibia is healed and vice versa.

  2. Sacral Fracture Nonunion Treated by Bone Grafting through a Posterior Approach

    Directory of Open Access Journals (Sweden)

    Sang Yang Lee

    2013-01-01

    Full Text Available Nonunion of a sacral fracture is a rare but serious clinical condition which can cause severe chronic pain, discomfort while sitting, and significant restriction of the level of activities. Fracture nonunions reportedly occur most often after nonoperative initial treatment or inappropriate operative treatment. We report a case of fracture nonunion of the sacrum and pubic rami that resulted from non-operative initial treatment, which was treated successfully using bone grafting through a posterior approach and CT-guided percutaneous iliosacral screw fixation combined with anterior external fixation. Although autologous bone grafting has been the gold standard for the treatment of pelvic fracture nonunions, little has been written describing the approach. We utilized a posterior approach for bone grafting, which could allow direct visualization of the nonunion site and preclude nerve root injury. By this procedure, we were able to obtain the healing of fracture nonunion, leading to pain relief and functional recovery.

  3. Teriparatide treatment of femoral fracture nonunion that autogenous bone grafting failed to heal: a case report.

    Science.gov (United States)

    Yu, Wei; Guo, Xiaodong

    2017-12-01

    Management of fracture nonunion is challenging as another surgical intervention for the patient is often a necessity, which has a huge impact on both quality of life and economic burden of the patient. Thus, a less aggressive and better accepted treatment for nonunion is required. We gave teriparatide to a 45-year-old man with femoral fracture nonunion 1 year after he underwent surgery with autogenous bone grafting that failed to heal his initial nonunion. Successful union was obtained after once-daily administration of teriparatide for 9 months. Our case showed teriparatide could successfully treat a femoral fracture nonunion that autogenous bone grafting failed to heal. Teriparatide may provide an alternative treatment for fracture nonunion.

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    NARCIS (Netherlands)

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

    2012-01-01

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

  7. Incidence, Risk Factors, and Definition for Nonunion in Pediatric Lateral Condyle Fractures.

    Science.gov (United States)

    Pace, J Lee; Arkader, Alexandre; Sousa, Ted; Broom, Alexander M; Shabtai, Lior

    Lateral condyle fractures are a common pediatric elbow injury. Nonunion is a known complication of this injury but its incidence and causative risk factors are unknown. Further, a clear and consistent definition of nonunion for pediatric lateral condyle fractures does not exist. The purpose of this study is to determine the rate of nonunion, the risk factors associated with it and to provide a clear definition. A retrospective chart review of all pediatric lateral condyle fractures treated at an urban, tertiary pediatric care center between 2001 and 2014. Data collected included demographics, Weiss classification, type of treatment, follow-up, time from injury to surgery and complications. For patients with nonunions, additional treatments and final range of motion were also recorded. A nonunion was defined as lack of callus with fragment migration by 8 weeks after initiation of treatment. A total of 530 patients were identified of which 500 were available for review. There were 7/500 (1.4%) nonunions in the cohort. Nonunion occurred in 1.4% (2/140) of type I fractures, 0% (0 /178) of type II fractures, and 3% (5/168) of type III fractures. The only significant risk factor for nonunion was the presence of a type III fracture (P=0.05). Five patients with nonunion underwent revision surgery with a partially threaded cannulated cancellous screw. All of these patients went on to union. Four of the 5 patients had their screws removed after union. Nonunion after pediatric lateral condyle fracture is rare and is defined by lack of any callus with fragment migration at 8 weeks. The only significant risk factor for nonunion development was the presence of a type III fracture. Revision surgery with a partially threaded screw achieved union in all cases. Level IV-retrospective case review.

  8. Wood pole overhead lines

    CERN Document Server

    Wareing, Brian

    2005-01-01

    This new book concentrates on the mechanical aspects of distribution wood pole lines, including live line working, environmental influences, climate change and international standards. Other topics include statutory requirements, safety, profiling, traditional and probabilistic design, weather loads, bare and covered conductors, different types of overhead systems, conductor choice, construction and maintenance. A section has also been devoted to the topic of lightning, which is one of the major sources of faults on overhead lines. The book focuses on the effects of this problem and the strate

  9. Vascularized pedicle bone grafting for nonunions of the tarsal navicular.

    Science.gov (United States)

    Fishman, Felicity G; Adams, Samuel B; Easley, Mark E; Nunley, James A

    2012-09-01

    Osteonecrosis and nonunions of the tarsal navicular remain a challenging clinical problem. This article presents a series of patients treated with local vascularized pedicle bone grafting to the navicular. The purpose of this study was to determine the early clinical and radiographic outcomes of this technique. Patients who underwent local vascularized pedicle bone grafting for osteonecrosis of the navicular from 2002 to 2007 were included in this study. The Ankle Osteoarthritis Scale (AOS), the Revised Foot Function Index (FFI-R), and the Short-Form 36 (SF-36) outcomes questionnaires were administered at most recent followup. Postoperative imaging was reviewed for evidence of healing. Eight patients with a mean age of 47.5 (range, 18 to 68) years were included in this study. The mean followup time was 61 (range, 32 to 72) months. Two patients underwent concomitant talonavicular arthrodesis. Two patients underwent additional procedures to address continued nonunion of the navicular. Neither patient elected to complete the outcomes questionnaires. The mean postoperative FFI score was 35.2 (range, 16.6 to 59). SF-36 subscales were as follows: bodily pain, 53; general health, 55; mental health, 75; physical function, 56; role emotional, 61; role physical, 37.5; social function, 71; and vitality, 56. The mean postoperative AOS pain score was 27.9 (range, 0 to 46.2) and the average disability score was 31.4 (range, 0 to 78.2). Postoperative imaging revealed consolidation and full healing in six of eight patients. Vascularized pedicle bone grafting is a treatment option for patients with chronic nonunion or osteonecrosis of the navicular. Additionally, it may serve as an adjunct procedure to provide increased vascularity to talonavicular arthrodesis in cases of navicular osteonecrosis and talonavicular arthritis.

  10. Risk profile of patients developing nonunion of the clavicle and outcome of treatment

    DEFF Research Database (Denmark)

    Ban, Ilija; Troelsen, Anders

    2016-01-01

    treatment of clavicle nonunions. METHODS: In a consecutive series of 729 clavicle fractures we retrospectively identified 55 that developed nonunion (49 diaphysial and six lateral). All were treated operatively by reconstruction with (n = 28) or without (n = 27) autologous bone graft. Assessment...

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

    Science.gov (United States)

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

    2013-01-01

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

  12. Use of Porcine Cancellous Bone Graft of Radial Nonunion Fracture in a Dog

    Directory of Open Access Journals (Sweden)

    S. Y. Heo, H. B. Lee, M. S. Kim and N. S. Kim*

    2012-06-01

    Full Text Available A 6-month, 1.3 kg, Yorkshire terrier was referred for treatment of a radial nonunion fracture. The nonunion fracture site had a 40 mm-long defect between both fracture ends, where a porcine cancellous bone graft was implanted. The surgical treatment of the nonunion fracture was accomplished using an external fixator and polymethylmethacrylate (PMMA. The dog had a successful clinical outcome, and a radiographic examination conducted at post-surgery week 16 revealed the incorporation of the porcine cancellous bone graft and the nonunion fracture site by newly formed bone, resulting in a complete union. Porcine cancellous bone graft should be considered as an alternative option to autografts when treating nonunion fractures with segment bones defects.

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

    Science.gov (United States)

    Sawalha, Seif; Guisasola, Inigo

    2018-03-13

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-12-15

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

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

    Science.gov (United States)

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

    2005-04-01

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

  16. Teriparatide as a nonoperative treatment for tibial and femoral fracture nonunion: A case report.

    Science.gov (United States)

    Xiaofeng, Li; Daxia, Xu; Yunzhen, Chen

    2017-04-01

    Fracture nonunion is a great challenge for orthopedic surgeons. Many surgical interventions are associated with significant pain and heavy economic burden. Therefore, our aim was to evaluate the outcomes of a new nonoperative treatment for fracture nonunion. A 44-year-old man suffered closed fractures of the right tibia and left femur. Eleven months after surgery, there was no radiographic healing between fracture fragments. Fracture nonunion of the right tibia and left femur. The patient received systemic treatment with teriparatide (recombinant human Parathyroid Hormone 1-34) 20 μg/d for 8 months, with further observation at 4 months after discontinuation. During treatment, bone metabolic markers were measured to evaluate metabolic activity of osteoblasts and osteoclasts. The Ethics Committee of Qilu Hospital of Shandong University approved this study. Satisfactory healing of fracture nonunion was obtained without further intervention. Anabolic treatment with teriparatide showed a positive effect on healing of fracture nonunion. Evaluation of bone metabolic markers during treatment is necessary to observe the curative effect. In view of the positive effect of teriparatide on healing of fracture nonunion in numerous animal models and clinical studies, it may be a promising alternative treatment for fracture nonunion in patients who are not suitable for surgical intervention.

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

    Science.gov (United States)

    Geffen, Rachel B; Colberg, Ricardo E

    2017-11-01

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

  18. RhBMP-7 for the treatment of nonunion of fractures of long bones.

    Science.gov (United States)

    Papanagiotou, M; Dailiana, Z H; Karachalios, T; Varitimidis, S; Vlychou, M; Hantes, M; Malizos, K N

    2015-07-01

    We report the outcome of 84 nonunions involving long bones which were treated with rhBMP-7, in 84 patients (60 men: 24 women) with a mean age 46 years (18 to 81) between 2003 and 2011. The patients had undergone a mean of three previous operations (one to 11) for nonunion which had been present for a mean of 17 months (4 months to 20 years). The nonunions involved the lower limb in 71 patients and the remainder involved the upper limb. A total of 30 nonunions were septic. Treatment was considered successful when the nonunion healed without additional procedures. The relationship between successful union and the time to union was investigated and various factors including age and gender, the nature of the nonunion (location, size, type, chronicity, previous procedures, infection, the condition of the soft tissues) and type of index procedure (revision of fixation, type of graft, amount of rhBMP-7) were analysed. The improvement of the patients' quality of life was estimated using the Short Form (SF) 12 score. A total of 68 nonunions (80.9%) healed with no need for further procedures at a mean of 5.4 months (3 to 10) post-operatively. Multivariate logistic regression analysis of the factors affecting union suggested that only infection significantly affected the rate of union (p = 0.004).Time to union was only affected by the number of previous failed procedures (p = 0.006). An improvement of 79% and 32.2% in SF-12 physical and mental score, respectively, was noted within the first post-operative year. Rh-BMP-7 combined with bone grafts, enabled healing of the nonunion and improved quality of life in about 80% of patients. Aseptic nonunions were much more likely to unite than septic ones. The number of previous failed operations significantly delayed the time to union. ©2015 The British Editorial Society of Bone & Joint Surgery.

  19. The South Pole Telescope

    Energy Technology Data Exchange (ETDEWEB)

    Ruhl, J.E.; Ade, P.A.R.; Carlstrom, J.E.; Cho, H.M.; Crawford,T.; Dobbs, M.; Greer, C.H.; Halverson, N.W.; Holzapfel, W.L.; Lanting,T.M.; Lee, A.T.; Leitch, E.M.; Leong, J.; Lu, W.; Lueker, M.; Mehl, J.; Meyer, S.S.; Mohr, J.J.; Padin, S.; Plagge, T.; Pryke, C.; Runyan, M.C.; Schwan, D.; Sharp, M.K.; Spieler, H.; Staniszewski, Z.; Stark, A.A.

    2004-11-04

    A new 10 meter diameter telescope is being constructed for deployment at the NSF South Pole research station. The telescope is designed for conducting large-area millimeter and sub-millimeter wave surveys of faint, low contrast emission, as required to map primary and secondary anisotropies in the cosmic microwave background. To achieve the required sensitivity and resolution, the telescope design employs an off-axis primary with a 10 m diameter clear aperture. The full aperture and the associated optics will have a combined surface accuracy of better than 20 microns rms to allow precision operation in the submillimeter atmospheric windows. The telescope will be surrounded with a large reflecting ground screen to reduce sensitivity to thermal emission from the ground and local interference. The optics of the telescope will support a square degree field of view at 2mm wavelength and will feed a new 1000-element micro-lithographed planar bolometric array with superconducting transition-edge sensors and frequency-multiplexed readouts. The first key project will be to conduct a survey over 4000 degrees for galaxy clusters using the Sunyaev-Zeldovich Effect. This survey should find many thousands of clusters with a mass selection criteria that is remarkably uniform with redshift. Armed with redshifts obtained from optical and infrared follow-up observations, it is expected that the survey will enable significant constraints to be placed on the equation of state of the dark energy.

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

    OpenAIRE

    Schwabe, Philipp

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Binod C. Raulo

    2012-01-01

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

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

    Science.gov (United States)

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

    2012-01-01

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

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

    International Nuclear Information System (INIS)

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

    1994-01-01

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

  4. Glass Waveguides for Periodic Poling

    DEFF Research Database (Denmark)

    Fage-Pedersen, Jacob; Jacobsen, Rune Shim; Kristensen, Martin

    2005-01-01

    Planar silica-based waveguide devices have been developed for second-harmonic generation by poling with periodic electrodes. We show that detrimental charge transport can occur along interfaces, but with proper choice of fabrication, high-quality devices are obtained.......Planar silica-based waveguide devices have been developed for second-harmonic generation by poling with periodic electrodes. We show that detrimental charge transport can occur along interfaces, but with proper choice of fabrication, high-quality devices are obtained....

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

    Directory of Open Access Journals (Sweden)

    Ciurlia Emanuele

    2017-01-01

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

  6. Plate fixation and bone grafting of distal clavicle nonunions: radiologic and functional outcomes

    NARCIS (Netherlands)

    Villa, Jordan C.; van der List, Jelle P.; Gausden, Elizabeth B.; Lorich, Dean G.; Helfet, David L.; Kloen, Peter; Wellman, David S.

    2016-01-01

    The optimal treatment for distal clavicle nonunions remains unknown. Small series have reported outcomes following distal fragment excision and various fixation techniques. We present the clinical, radiographic and functional outcomes after superior plating or double (superior and anteroinferior)

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

    NARCIS (Netherlands)

    Stufkens, S.A.; Kloen, P.

    2010-01-01

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

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

    Science.gov (United States)

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

    2017-08-01

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

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

    Science.gov (United States)

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

    2012-07-01

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

  10. [Tibia nonunion after intramedullar nailing for fracture: decortication and osteosynthesis by medial plating].

    Science.gov (United States)

    Piriou, P; Martin, J-N; Garreau de Loubresse, C; Judet, T

    2005-05-01

    Intramedullar nailing is now widely used for fractures of the tibia. Extension of nailing indications to proximal, distal, and comminuted fractures has led to a significant rate of complications. The purpose of this study was to analyze decortication and medial plating for the treatment of tibial nonunion after intramedullary nailing. Eighteen cases of aseptic tibial nonunion after nailing for fracture were treated in three women and fifteen men, mean age 39 years (19-57). The initial classification was open (n = 8), segmental (n = 3), single-focus (n = 15). The fracture site was inferior (n = 6), middle (n = 7), and superior (n = 2). Primary nailing used reaming in 15 cases (83%), unreamed in 3 (17%) static in 13 and dynamic in 5. Four plaster cabts were also applied. Complications were: infection (n = 1), compartmental syndrome (n = 2), tibial nerve palsy (n = 1), dysesthesia (n = 2), and protrusion of the nail into the knee (n = 1). Dynamization was performed in 11 patients, one with additional bone graft and fibulectomy. Repeated reamed nailing was performed in one patient. Seven nonunions were atrophic and 11 were hypertrophic. There were 13 malpositionings associated with the nonunion. Treatment of the nonunion was performed 300 days on average (90-900) after nailing: cancellous bone graft was associated with decortication in four cases because of bone loss (n = 3) or atrophic nonunion (n = 1). Union rate was 94%. Mean time for union was 108 days (80-180) with no significant difference (Student t-test) between atrophic (119 days) and hypertrophic (103 days) nonunion. Correction of the malposition was incomplete in seven patients, with angular malunion of less than 6 degrees in five patients and greater than 10 degrees in two. One late infection occurred and finally healed after external fixation and antibiotic therapy. No skin necrosis occurred. Five patients had pain on the hardware. Removal was performed in one time and pain resolved. Improvement of knee

  11. Sandwich allografts for long-bone nonunions in patients with osteogenesis imperfecta: a retrospective study.

    Science.gov (United States)

    Puvanesarajah, Varun; Shapiro, Jay R; Sponseller, Paul D

    2015-02-18

    Patients with osteogenesis imperfecta often develop nonunions, as internal fixation has limited applicability in this condition. We report the outcomes of a modified "sandwich technique" in the treatment of long-bone nonunions in patients with osteogenesis imperfecta; this technique brings circumferential stabilization and normal collagen to the nonunion site. From May 2003 through February 2012, twelve patients (eight females, four males; median age, 39.0 years; range, eleven to seventy-eight years) who had osteogenesis imperfecta (Sillence type I [three], type III [eight], and type IV [one]) and a combined total of thirteen nonunions (two humeral, two radial, three femoral, four tibial, and two ulnar; median duration, 15.0 months; range, six to 204 months) were treated at our institution with compressed sandwich allograft cortical struts. The struts were fashioned to be wide enough to allow for increased osteoconductive surface area and to approximate a hemicylindrical shape. Treatment history and demographics data were acquired through retrospective chart review. Follow-up radiographs were analyzed by two attending orthopaedic surgeons to determine radiographic findings. The median follow-up time was 4.6 years (range, 2.1 to 10.3 years). All thirteen nonunions, including one requiring a second graft procedure, healed with abundant, smooth allograft incorporation, resulting in an initial healing rate of 92% because of a refracture in one patient. This patient's nonunion ultimately healed with additional allograft struts and a new intramedullary rod. One patient required removal of prominent screws. The final follow-up examinations revealed no pain or refracture at the original nonunion site. All patients regained their prefracture level of function. Sandwich allograft struts constitute a durable, safe method for the stabilization and healing of persistent long-bone nonunions in patients with osteogenesis imperfecta. All patients showed incorporation of the

  12. Bone Scan in Detection of Biological Activity in Nonhypertrophic Fracture Nonunion

    OpenAIRE

    Gandhi, Sunny J.; Rabadiya, Bhavdeep

    2017-01-01

    Biological activity of the fracture site is very important factor in treatment planning of fracture nonunion. If no biological activity is detected, then an autologous bone graft can be supplemented or osteogenic supplementations, such as bone morphogenetic protein is given. If biological activity is present, then secure fixation is sufficient to achieve bony union. Biological activity of nonunions is usually assessed by conventional radiographs. The presence of callus formation is usually as...

  13. Nonunion Employee Representation: Theory and the German Experience with Mandated Works Councils

    OpenAIRE

    Jirjahn, Uwe; Smith, Stephen C.

    2017-01-01

    Theories of how nonunion employee representation impacts firm performance, affects market equilibria, and generates externalities on labor and society are synthesized. Mandated works councils in Germany provide a particularly strong form of nonunion employee representation. A systematic review of research on the German experience with mandated works councils finds generally positive effects, though these effects depend on a series of moderating factors and some impacts remain ambiguous. Final...

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

    Science.gov (United States)

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

    2017-11-01

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

  15. 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

  16. Ilizarov′s method for treatment of nonunion of diaphyseal fractures of the humerus

    Directory of Open Access Journals (Sweden)

    Kiran Manish

    2010-01-01

    Full Text Available Background: Nonunion in diaphyseal fractures of the humerus can be treated by various modalities like plating and bone grafting, exchange nailing, fibular strut grafting and Ilizarov′s method of ring fixation. To achieve union in infected nonunion in which multiple surgeries have already been done is further challenging. We conducted a prospective study wherein the outcome of the treatment of nonunion of diaphyseal fractures of the humerus by Ilizarov′s method was analyzed. Materials and Methods: Nineteen patients with diaphyseal nonunion of the humerus were treated by Ilizarov′s external fixator. These included nonunion after plating (n=11, intramedullary nailing (n=1 or conservative methods (n=7. In post-surgical infected nonunion (n=6, the implants were removed, debridement done, bone fragments were docked followed by application of ring fixator and compression. In aseptic nonunion (n=13, distraction for three weeks followed by compression was the protocol. Early shoulder and elbow physiotherapy was instituted. The apparatus was removed after clinical and radiological union and the results were assessed for bone healing and functional status. Results: Fracture union was achieved in all the 19 cases. Pin site infection was seen in 2 cases (10.52%. The bone healing results were excellent in eighteen cases (94.73% and good in one case (5.26%.The functional results were found to be excellent in fourteen cases (73.68%, good in four (21.05% and fair in one case (5.26%. Conclusion: Ilizarov′s method is an excellent option for treatment of septic and aseptic non union of diaphyseal fractures of the humerus as it addresses all the problems associated with non union of the humerus like infection, deformity and joint stiffness.

  17. Successful Bone Healing of Nonunion After Ulnar Shortening Osteotomy for Smokers Treated With Teriparatide.

    Science.gov (United States)

    Uemura, Takuya; Okada, Mitsuhiro; Yokoi, Takuya; Shintani, Kosuke; Nakamura, Hiroaki

    2015-08-01

    Ulnar shortening osteotomy is widely performed as the standard surgical treatment for ulnar impaction syndrome and has a high percentage of success for pain relief. However, delayed union and nonunion of the osteotomy site remain the most concerning complications. In particular, smokers have a higher incidence of nonunion, which amounts to 30% of cases. For the treatment of nonunion, secondary surgical interventions such as bone grafting will be necessary but are extremely challenging. Recently, teriparatide (recombinant human parathyroid hormone [PTH 1-34]) administration has been reported in several clinical studies as a noninvasive pharmacological systemic treatment for fracture healing or nonunion. The authors present 2 cases of smokers, a 62-year-old man and a 42-year-old woman, with nonunion after ulnar shortening osteotomy and fixation with 6-hole non-locking plate for ulnar impaction syndrome. For treatment of nonunion, noninvasive therapy with teriparatide (20-µg, subcutaneous injection) in addition to low-intensity pulsed ultrasound was underwent. In both cases, partial bone union began to be observed on radiographs after the first 4 weeks of teriparatide administration and successful bone healing without additional surgical interventions was achieved after 10 and 6 months of treatment with teriparatide, respectively. The current case reports showed that non-invasive combination therapy of teriparatide and low-intensity pulsed ultrasound were a possible alternative to surgical intervention. In the future, teriparatide therapy might be applied actively to patients who have risk factors for delayed union, such a heavy smoking habit, and are expected to experience nonunion after ulnar shortening osteotomy. Copyright 2015, SLACK Incorporated.

  18. Osteomedullography: for early diagnosis of the fracture healing, nonunion and avascular necrosis

    International Nuclear Information System (INIS)

    Kim, Y. C.; Lee, S. H.; Lee, Y. C.; Whang, I. S.; Kim, H. S.

    1981-01-01

    Complications of non-union and avascular necrosis during fracture healing process are the most important problem. Early detection of the evidence of non-union and avascular necrosis and follow-up study of fracture healing process will reduce complications and sequellae in fracture patients. Femoral neck and tibial shaft are the most important fracture sites where non-union and/or avascular necrosis are frequently developed. Osteomedullography was performed in 30 cases of fracture, 21 femoral neck, 8 tibial shafts and 1 talar neck, in the Department of Radiology of National Medical Center during the period from August 1977 to March 1981. The following results were obtained: 1. 16 patients of femoral neck fracture were performed osteomedullography once. Non-union showing no crossing vein through the fracture site was noted in 12 cases from 16 patients. 4 cases from the 12 patients of non-union showed decreased viability but 2 case revealed good viability of the femoral head. 1 case from 4 cases of good union of fracture showed no evidence of viability of the femoral head. 2. More than twice of osteomedullography were performed in 5 cases of femoral neck fracture, and crossing vein was not appeared in 4 cases at 3 weeks after fracture. 3 cases showed crossing veins at 6 weeks, and 1 case revealed evidence of avascular necrosis of the femoral head at 9 weeks. 3. In 8 cases of tibial shaft fracture, 4 cases were non-union. Another 4 cases revealed intraosseous veins crossing in fracture site or additional Kaski's osteomedullographic signs, indicating bony union. 4. One talar neck fracture showed bony union with decreased viability of the body on 12 month after fracture. 5. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing, non-union and avascular necrosis

  19. For early diagnosis of the fracture healing, nonunion and avascular necorsis

    International Nuclear Information System (INIS)

    Kim, Y. C.; Lee, S. H.; Lee, Y. C.; Whang, I. S.; Kim, H. S.

    1981-01-01

    Complications of non-union and avascular necrosis during fracture healing process are the most important problems. Early detection of the evidence of non-union and avascular necrosis and follow-up study of fracture healing process will reduce complications and sequellae in fracture patients. Femoral neck and tibial shaft are the most important fracture sites where non-union and/or avascular necorsis are frequently developed. Osteomedullography was performed in 30 cases of fracture, 21 femoral neck, 8 tibial shafts and 1 talar neck, in the Department of Radiology of national Medical Center during the period form August 1977 to March 1981. The following results were obtained: 1. 16 patients of femoral neck fracture were performed osteomedullography one. Non-union showing no crossing vein through the fracture site was noted in 12 cases from 16 patients. 4 cases from the 12 patients of non-union showed decreased viability but 2 case revealed good viability of the femoral head. 1 case from 4 case of good union of fracture showed no evidence of viability of the femoral head. 2. More than twice of osteomedullography were performed in 5 cases of femoral neck fracture, and crossing vein was not appeared in 4 cases at 3 weeks after fracture. 3 cases showed crossing veins at 6 weeks, and 1 case revealed evidence of avascular necrosis of the femoral head at 9 weeks. 3. In 8 cases of tibial shaft fracture, 4 cases were non-union. Another 4 cases revealed intraosseous veins crossing in fracture site or additional Kaski's osteomedullographic signs, indicating bony union. 4. One talar neck fracture showed bony union with decreased viability of the bony on 12 months after fracture. 5. Osteomedullography is considered as very important study for the early diagnosis of the fracture healing, non-union and avascular necrosis

  20. Glass Waveguides for Periodic Poling

    DEFF Research Database (Denmark)

    Fage-Pedersen, Jacob; Jacobsen, Rune Shim; Kristensen, Martin

    2005-01-01

    Planar silica-based waveguide devices have been developed for second-harmonic generation by poling with periodic electrodes. We show that detrimental charge transport can occur along interfaces, but with proper choice of fabrication, high-quality devices are obtained....

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

    Science.gov (United States)

    Tall, M

    2018-02-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2013-04-01

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

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

    DEFF Research Database (Denmark)

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

    2008-01-01

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

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

    DEFF Research Database (Denmark)

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

    2009-01-01

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

  6. Temporal and spatial vascularization patterns of unions and nonunions: role of vascular endothelial growth factor and bone morphogenetic proteins.

    Science.gov (United States)

    Garcia, P; Pieruschka, A; Klein, M; Tami, A; Histing, T; Holstein, J H; Scheuer, C; Pohlemann, T; Menger, M D

    2012-01-04

    Failure of fracture-healing with nonunion is a major clinical problem. Angiogenesis is closely linked to bone regeneration, but the role of angiogenesis in nonunion formation remains unclear. Because established nonunions are well vascularized, we hypothesized that lack of vascular endothelial growth factor (VEGF) expression and vascularization during the early time course of fracture-healing determine nonunion formation. In seventy-two CD-1 mice, a femoral osteotomy with a gap size of 1.80 mm (nonunion group) or a gap size of 0.25 mm (union group) was created and stabilized by a pin-clip technique. Healing was analyzed after three, seven, fourteen, twenty-one, twenty-eight, and seventy days by micro-computed tomography and histomorphometry. Vascularization was determined in different healing zones by immunohistochemical staining of PECAM-1 (platelet-endothelial cell adhesion molecule). Additional animals were analyzed after seven, fourteen, and twenty-one days with Western blot analysis of VEGF, bone morphogenetic protein (BMP)-2, and BMP-4 expression. Micro-computed tomography and histomorphometry showed complete bone-bridging in the union group, whereas animals in the nonunion group showed atrophic nonunion formation. Vascularization increased from day 3 to day 7 in both groups, with a subsequent decrease after fourteen days. However, overall vascularization did not differ between unions and nonunions over time. It is of interest that vascularization within the endosteal healing zone was even higher in nonunions than in unions after fourteen days. Expression of VEGF was significantly higher in nonunions, while expression of BMP-2 and 4 and proliferating cell nuclear antigen were found significantly reduced compared with unions. Because vascularization during the early time course of fracture-healing was not impaired despite the failure of bone-healing in nonunions, we rejected our hypothesis and accepted the null hypothesis that nonunion formation is not due to

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2014-12-15

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

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

    International Nuclear Information System (INIS)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2015-08-01

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

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

    Science.gov (United States)

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

    2009-01-01

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

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

    Science.gov (United States)

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

    2015-12-01

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

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

    Science.gov (United States)

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

    2017-05-01

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

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

    Science.gov (United States)

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

    2015-04-01

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

  14. Operative treatment for delayed union and nonunion of midshaft clavicular fractures: AO reconstruction plate fixation and early mobilization

    NARCIS (Netherlands)

    Davids, P. H.; Luitse, J. S.; Strating, R. P.; van der Hart, C. P.

    1996-01-01

    Fourteen patients were treated operatively for delayed union and nonunion of midshaft clavicular fractures from 1986 to 1994. Radiographically, nine nonunions were atrophic and five hypertrophic, The operative technique included opening the medullary canal, bone grafting, and fixation with an AO

  15. Surgical management of diaphyseal humeral nonunion after intramedullary nailing: Wave-plate fixation and autologous bone grafting without nail removal

    NARCIS (Netherlands)

    Gerber, Ariane; Marti, René; Jupiter, Jesse

    2003-01-01

    Six patients with a nonunion of the humeral diaphysis after intramedullary nailing were treated with a wave plate and autologous bone graft but without removal of the intramedullary implant. The mean duration of the nonunion was 19 months (range, 6-36 months). At a mean follow-up of 12 months

  16. Treatment of lower extremity long bone nonunion with expandable intramedullary nailing and autologous bone grafting.

    Science.gov (United States)

    Niu, Yunfei; Bai, Yushu; Xu, Shuogui; Liu, Xinwei; Wang, Panfeng; Wu, Dajiang; Zhang, Chuncai; Li, Ming

    2011-07-01

    Nonunion of long bones in lower limbs is a common complication of orthopedic trauma that can be extremely debilitating. This retrospective study describes our experience using expandable intramedullary nails and autologous bone grafting in treating lower limb long bone nonunion with bone defects. Nineteen patients (mean age 38.9 years, range 18-61) with lower limb long bone nonunion and defects caused by femoral or tibial fracture types were as follows: A2 (3 femoral, 1 tibial), A3 (1 femoral, 2 tibial), B2 (3 femoral, 4 tibial), and B3 (1 femoral, 4 tibial). Expandable intramedullary nailing and autologous bone (iliac and/or fibular) grafting were used for the treatment. Postoperative bone healing as determined by analysis of standard anteroposterior and lateral X-ray films every 4 weeks. Complications were noted. The average number of previous surgeries was 1.9 (range 1-4). The mean duration from original injury to treatment was 17.6 months (range 9-40 months). Femoral shaft nonunion healed on average of 26.5 weeks (range 16-60 weeks) after surgery, while tibial shaft nonunion healed on average of 23.6 weeks (range 12-40 weeks) after surgery. Class I healing occurred in all but two patients who experienced chronic postoperative osteomyelitis and delayed wound healing, respectively. Two patients complained of postoperative donor site pain. The use of expandable intramedullary nails and autologous bone grafts was an effective method for repair of nonunion of lower limb fractures combining with bone defects with minimal complications.

  17. Single-screw fixation for subtalar joint fusion does not increase nonunion rate.

    Science.gov (United States)

    DeCarbo, William T; Berlet, Gregory C; Hyer, Christopher F; Smith, W Bret

    2010-08-01

    A philosophical shift toward more joint-sparing procedures has led to increased use of isolated subtalar joint (STJ) versus triple arthrodesis. Union rates for STJ fusion range from 47% to 100%, leading to controversy regarding the optimal type, orientation, and amount of internal fixation. The purpose of this study was to determine if single-screw fixation is a predisposing factor to nonunion. Single-screw fixation is parallel to the STJ axis and may result in motion. It is hypothesized that higher nonunion rates will be observed in single-screw versus 2-screw fusions. Isolated STJ arthrodeses performed in 113 patients were retrospectively reviewed. Single screws were used in 89 (78.8%) fusions; 2 screws were used in 24 (21.2%) fusions. The mean follow-up was 11 months (range, 9-17 months). Nonunion occurred in 13 (14.6%) single-screw and 6 (25.0%) 2-screw fusions. Twenty (22.5%) single-screw and 3 (12.5%) 2-screw fusions required hardware removal. Revision surgery was performed in 6 (6.7%) single-screw and 3 (12.5%) 2-screw fusions. No significant differences in demographics were calculated between single and 2-screw fusions. Furthermore, no significant differences were observed in nonunion rate, postoperative complication incidence, or subsequent surgeries. The results from this study do not support the contention that single-screw fixation predisposes STJ fusions to nonunion. Comparable nonunion and complication incidences were observed between single and 2-screw fusions. These data suggest that the motion occurring from single-screw fixation may not be significant enough to directly affect the rate of union.

  18. 47 CFR 32.6411 - Poles expense.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 2 2010-10-01 2010-10-01 false Poles expense. 32.6411 Section 32.6411... FOR TELECOMMUNICATIONS COMPANIES Instructions for Expense Accounts § 32.6411 Poles expense. This account shall include expenses associated with poles. ...

  19. Omentalisation as adjunctive treatment of an infected femoral nonunion fracture: a case report

    Directory of Open Access Journals (Sweden)

    McAlinden A

    2009-10-01

    Full Text Available Abstract A three-year-old male working border collie with an infected femoral nonunion fracture was managed in a two-stage procedure involving debridement and omentalisation, followed by stabilisation with a bone plate and an autogenous cancellous bone graft. Osseous union was documented radiographically 16 weeks after surgery. Telephone follow-up one year later revealed the dog had returned to full working function without evidence of lameness. To the authors' knowledge, this is the first clinical case described in the veterinary literature using omentalisation as an adjunct to the management of an infected, biologically inactive nonunion fracture.

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

    Science.gov (United States)

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

    2010-12-01

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

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

    Science.gov (United States)

    Ming, Tan Shi; Koon, Wong Merng

    2016-01-01

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

  2. Successful use of autogenous bone graft for the treatment of a radius-ulna nonunion in an amputee dog

    Directory of Open Access Journals (Sweden)

    B.W. Minto

    2015-08-01

    Full Text Available Fracture nonunions represent important complications in orthopedic surgeries. Nonunion repairs or bone defects are surgically challenging. Our aim was to describe a nonunion case, which was repaired with rapid bone recovery. An 8-month-old male mixed breed dog that has been previously operated was presented to the Veterinary Medical Teaching Hospital of São Paulo State University, with a right radius-ulna nonunion and an amputated contralateral forelimb. A cancellous bone graft was collected from a partially amputated limb, in order to correct the nonunion, and used in association with a locking plate. After four weeks, the bone graft had been incorporated into the original bone. Clinical union with good weight bearing was achieved after eight weeks.

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

    Science.gov (United States)

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

    2013-01-01

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

  4. Pole counting and resonance classification

    International Nuclear Information System (INIS)

    Morgan, D.

    1992-01-01

    S-wave resonances occurring close to an inelastic threshold can be classified according to the number of nearby poles they possess. One then has a useful possibility of distinguishing dynamical alternatives by objective appeal to data. Making this quantitative entails developing suitable effective range expansions for various realizations of potential scattering. A key application is deciding the make-up of f 0 (976) (S*). (author)

  5. Patellar Shape-Memory Fixator for the Treatment of Comminuted Fractures of the Inferior Pole of the Patella

    Science.gov (United States)

    Liu, Xin-Wei; Shang, Hui-Juan; Xu, Shuo-Gui; Wang, Zhi-Wei; Zhang, Chun-Cai; Fu, Qing-Ge

    2011-07-01

    Comminuted and displaced fractures of the inferior pole of the patella are not easy to reduce and it is difficult to fix the fragments soundly enough to allow early movement of the knee. The purpose of this study is to evaluate the clinical effectiveness of the internal fixation technique with Patellar Shape-Memory Fixator (PSMF) in acute comminuted fractures of the inferior pole of the patella. We retrospectively studied 25 patients with comminuted fractures of the inferior pole of the patella who were treated with PSMF and followed up for a mean period of 26 months (14 to 60). All the fractures healed at a mean of 6 weeks (5 to 7). The mean grading at the final follow-up was 29.5 points (27 to 30) using the Bostman score, with no observable restriction of movement. No breakage of the PSMF or infection occurred. No delayed union, nonunion, and infection were seen. This technique preserved the length of the patella, reduced the comminuted fragments of the inferior pole and avoided long-term immobilization of the knee.

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

    Science.gov (United States)

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

    2018-04-01

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

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

    Science.gov (United States)

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

    2014-02-01

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

  8. Method and apparatus for assembling a permanent magnet pole assembly

    Science.gov (United States)

    Carl, Jr., Ralph James; Bagepalli, Bharat Sampathkumaran [Niskayuna, NY; Jansen, Patrick Lee [Scotia, NY; Dawson, Richard Nils [Voorheesville, NY; Qu, Ronghai [Clifton Park, NY; Avanesov, Mikhail Avramovich [Moscow, RU

    2009-08-11

    A pole assembly for a rotor, the pole assembly includes a permanent magnet pole including at least one permanent magnet block, a plurality of laminations including a pole cap mechanically coupled to the pole, and a plurality of laminations including a base plate mechanically coupled to the pole.

  9. Nonunion of Fractures of the Ulna and Radius Diaphyses: Clinical and Radiological Results of Surgical Treatment

    Directory of Open Access Journals (Sweden)

    Boussakri H

    2016-07-01

    Full Text Available Aseptic nonunion of the radius and ulna is a major complication of forearm fractures, accounting for 2% to 10% of all forearm fractures. The aim of our study is to evaluate the functional and radiological results of surgical treatment of diaphyseal aseptic nonunion of the radius and ulna, with autologous bone grafting, decortication and internal plate fixation. A series of 21 patients (26 nonunions was retrospectively reviewed, the average age was 35 years with a mean of 31,58 years (range 12-44 years . The fractures included isolated radius (n=6 and ulna (n=10, and both radius and ulna (n=5. The Grace and Eversmann score was used to evaluate our results. Fifteen had very good results, five good and one average. Consolidation of the two bones was attained in 6.2 months. Therefore, the functional prognosis of the upper limb imposes the need for an adequate treatment. This management strategy has enabled us to have satisfactory results. However, the best treatment of nonunion remains the preventive treatment with an optimal management and care of the forearm fractures.

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

    LENUS (Irish Health Repository)

    O'Neill, Barry James

    2014-04-03

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

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

    African Journals Online (AJOL)

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

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

    NARCIS (Netherlands)

    Kloen, Peter

    2004-01-01

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

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

    Science.gov (United States)

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

    2017-08-01

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

  14. Hindfoot arthrodesis for management of bone loss following calcaneus fractures and nonunions.

    Science.gov (United States)

    Molloy, Andy P; Lipscombe, Stephen J

    2011-03-01

    Massive bone loss following calcaneal fractures is a challenging condition to treat, especially if nonunion is present. Meticulous preoperative examination and imaging are crucial for accurate preoperative planning. If performed, successful outcomes can be achieved with the strategies outlined in this article. Copyright © 2011 Elsevier Inc. All rights reserved.

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

    NARCIS (Netherlands)

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

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

  16. Nonunion of the femoral neck: possibilities and limitations of the various treatment modalities

    NARCIS (Netherlands)

    Raaymakers, Ernst L. F. B.; Marti, René K.

    2008-01-01

    Nowadays in cases of nonunions of the femoral neck, the surgeon is tempted to perform prosthetic replacement of the hip, more so if there is also evidence of avascular necrosis of the head of femur. This provides rapid pain relief and allows early mobilization. However, long-term results of hip

  17. The Radiographic Union Score for Hip (RUSH) Identifies Radiographic Nonunion of Femoral Neck Fractures.

    Science.gov (United States)

    Frank, Tym; Osterhoff, Georg; Sprague, Sheila; Garibaldi, Alisha; Bhandari, Mohit; Slobogean, Gerard P

    2016-06-01

    The Radiographic Union Score for Hip (RUSH) is a previously validated outcome instrument designed to improve intra- and interobserver reliability when describing the radiographic healing of femoral neck fractures. The ability to identify fractures that have not healed is important for defining nonunion in clinical trials and predicting patients who will likely require additional surgery to promote fracture healing. We sought to investigate the utility of the RUSH score to define femoral neck fracture nonunion. (1) What RUSH score threshold yields at least 98% specificity to diagnose nonunion at 6 months postinjury? (2) Using the threshold identified, are patients below this threshold at greater risk of reoperation for nonunion and for other indications? A representative sample of 250 out of a cohort of 725 patients with adequate 6-month hip radiographs was analyzed from a multinational elderly hip fracture trial (FAITH). All patients had a femoral neck fracture and were treated with either multiple cancellous screws or a sliding hip screw. Two reviewers independently determined the RUSH score based on the 6-month postinjury radiographs and interrater reliability was assessed with the interclass correlation coefficient (ICC). There was substantial reliability between the reviewers assigning the RUSH scores (ICC, 0.81; 95% confidence interval [CI], 0.76-0.85). The RUSH score is a checklist-based system that quantifies four measures of healing: cortical bridging, cortical fracture disappearance, trabecular consolidation, and trabecular fracture disappearance.. Fracture healing was determined by two independent methods: (1) concurrently by the treating surgeon using both clinical and radiographic assessments as per routine clinical care; and (2) retrospectively by a Central Adjudication Committee using complete obliteration of the fracture line on radiographs alone. Receiver operating characteristic tables were used to define a RUSH threshold score that was > 98

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

    Science.gov (United States)

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

    2017-06-18

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

  19. Health outcomes of delayed union and nonunion of femoral and tibial shaft fractures.

    Science.gov (United States)

    Tay, Wei-Han; de Steiger, Richard; Richardson, Martin; Gruen, Russell; Balogh, Zsolt J

    2014-10-01

    Knowledge about the functional consequences of lower limb long bone fractures is helpful to inform patients, clinicians and employers about their recovery process and prognosis. This study aims to describe the epidemiology and health outcomes of femoral and tibial shaft fractures treated at two level I trauma centres, by comparing the differences between patients with delayed union or nonunion and patients with union. An analysis of registry data over two years, supplemented with medical record review, was conducted. Fracture healing was retrospectively assessed by clinical and radiological evidence of union, and the need for surgical intervention. SF-12 scores, and work and pain status were prospectively recorded at six and twelve months post injury. 285 fractures progressed to union and 138 fractures developed delayed union or nonunion. There was a significant difference between the two cohorts with regards to the mechanism of injury, association with multi-trauma, open fractures, grade of Gustilo classification, patient fund source, smoking status and presence of comorbidities. The SF-12 physical component score was less than 50 at both six and twelve months with improvement in the union group, but not in the delayed union or nonunion group. 72% of patients with union had returned to work at one year, but 54% continued to have pain. The difference compared to patients with delayed union or nonunion was significant. Even patients whose fractures unite in the expectant time-frame will have residual physical disability. Patients with delayed union or nonunion have still poorer outcomes, including ongoing problems with returning to work and pain. It is important to educate patients about their injury so that they have realistic expectations. This is particularly relevant given that the patients most likely to sustain femoral or tibial shaft fractures are working-age healthy adults, and up to a third of fractures may develop delayed union or nonunion. Despite modern

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

    Science.gov (United States)

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

    2011-11-01

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

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

    Science.gov (United States)

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

    2011-11-01

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

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

    Science.gov (United States)

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

    2017-10-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    International Nuclear Information System (INIS)

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

    2014-01-01

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

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

    International Nuclear Information System (INIS)

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

    2009-01-01

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

  6. Nonunion of the external maxillary distraction in cleft lip and palate: analysis of possible reasons.

    Science.gov (United States)

    He, Dongmei; Genecov, David G; Barcelo, Raul

    2010-10-01

    Distraction osteogenesis (DO) is an effective way to treat severe maxillary deficiency in patients with cleft lip and palate. It has been reported to have long-term stability and low relapse rate compared with conventional maxillary osteotomy in large maxillary movement. However, complications such as nonunion are seldom reported. While developing our external distraction techniques, we had 4 nonunion cleft lip and palate (CLP) patients. The aim of this study is to analyze the possible reasons for these conditions by comparing them to patients successfully treated at 1 craniofacial institute. Fifty-six patients with CLP deformities treated with external maxillary distraction from 2000 to 2006 in 1 craniofacial center were reviewed. Among them, 17 had full records and follow-up time of more than 1 year. They had rigid external halo distraction with dental splint after a high Le Fort I osteotomy. Distraction was started at 5 days with a rate of 1 mm per day until the maxilla acquired the planned correction. Consolidation time ranged from 4 weeks to 3 months. Patients' general information, DO protocol, and cephalometric radiograph measurements before DO, immediately after DO, and follow-ups were evaluated. Thirteen of 17 patients successfully completed DO, whereas 4 others developed dental occlusion relapse 2 to 3 months after device removal. Later jaw surgery showed nonunion at the distraction sites. These were our first patients treated with external distraction. Their consolidation time was from 4 to 6 weeks with a mean of 5.2 weeks. After increasing the consolidation time up to 12 weeks, all of the other 13 patients had successful results without nonunion. Their mean consolidation time was 9.8 weeks. The nonunion group had significantly shorter consolidation time, older age, and larger distraction osteogenesis (DO) advancement than the successful group statistically. There was also a greater percentage of bilateral CLP patients in the nonunion group than in the

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

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

    2015-12-01

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

  9. Nonunion of greater trochanter following total hip arthroplasty: Treated by an articulated hook plate and bone grafting

    Directory of Open Access Journals (Sweden)

    Diego L Fernandez

    2017-01-01

    Conclusions: The articulated design of the plate allows for ease in application and functional construct stability. The articulated hook plate is an option for fixation of osteopenic bone fragments and established nonunions of the greater trochanter.

  10. Ilizarov treatment of humeral shaft nonunion in an antiepileptic drug patient with uncontrolled generalized tonic-clonic seizure activity

    Directory of Open Access Journals (Sweden)

    Koulouvaris Panayiotis

    2010-07-01

    Full Text Available Abstract Nonunion of the humeral shaft in patients with antiepileptic drug associated metabolic bone disorder constitute a challenging surgical problem difficult to treat due to seizure activity, osteoporosis, and poor stabilization options. We report a case of nonunion of the humeral shaft in an antiepileptic drug patient with uncontrolled generalized tonic-clonic seizure activity successfully treated with Ilizarov external fixator and a follow-up of 4 years.

  11. Salvage of a femoral nonunion after primary non-Hodgkin?s lymphoma of bone: A case report and literature review

    OpenAIRE

    Xie, Xue Tao; Gao, You Shui; Zhang, Chang Qing

    2011-01-01

    Summary Background With the advent of superb microsurgery techniques and advanced stabilization instruments, recent decades have seen great progress in treating nonunions secondary to traumatic fractures. However, those nonunions that are secondary to primary non-Hodgkin?s lymphoma of bone and often related to irradiation still remain a challenging problem. The condition could be more perplexing when bone healing abilities are greatly compromised and reliable stabilization is difficult. Case ...

  12. Orthogonal Double Plating and Autologous Bone Grafting of Postoperative Humeral Shaft Nonunion ? A Rare Case Report and Review of Literature

    OpenAIRE

    Metikala, Sreenivasulu; Bhogadi, Prabhudheer

    2015-01-01

    Introduction: Nonunion following surgical stabilization of humeral shaft fractures, although infrequent, remains a challenge as limited surgical options are available. The difficulties in re-fixation are due to osteolysis produced by the loose implant components and disuse osteopenia of the entire bone segment. We share our experience in the management of a long standing diaphyseal nonunion of humerus following titanium LCP fixation. Case Report: A 58 years old woman presented with 20 months ...

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

    Science.gov (United States)

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

    2015-12-01

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

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

    NARCIS (Netherlands)

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

    2014-01-01

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

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

    NARCIS (Netherlands)

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

    2016-01-01

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

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

    Science.gov (United States)

    Zinberg, Ephraim M; Chi, Ying

    2014-06-01

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

  17. Macro Fiber Piezocomposite Actuator Poling Study

    Science.gov (United States)

    Werlink, Rudy J.; Bryant, Robert G.; Manos, Dennis

    2002-01-01

    The performance and advantages of Piezocomposite Actuators are to provide a low cost, in-situ actuator/sensor that is flexible, low profile and high strain per volt performance in the same plane of poled voltage. This paper extends reported data for the performance of these Macrofiber Composite (MFC) Actuators to include 4 progressively narrower Intedigitized electrode configurations with several line widths and spacing ratios. Data is reported for max free strain, average strain per applied volt, poling (alignment of the electric dipoles of the PZT ceramic) voltage vs. strain and capacitance, time to poling voltage 95% saturation. The output strain per volt progressively increases as electrode spacing decreases, with saturation occurring at lower poling voltages. The narrowest spacing ratio becomes prone to voltage breakdown or short circuits limiting the spacing width with current fabrication methods. The capacitance generally increases with increasing poling voltage level but has high sensitivity to factors such as temperature, moisture and time from poling which limit its usefulness as a simple indicator. The total time of applied poling voltage to saturate or fully line up the dipoles in the piezoceramic was generally on the order of 5-20 seconds. Less sensitivity to poling due to the applied rate of voltage increase over a 25 to 500 volt/second rate range was observed.

  18. Strength of single-pole utility structures

    Science.gov (United States)

    Ronald W. Wolfe

    2006-01-01

    This section presents three basic methods for deriving and documenting Rn as an LTL value along with the coefficient of variation (COVR) for single-pole structures. These include the following: 1. An empirical analysis based primarily on tests of full-sized poles. 2. A theoretical analysis of mechanics-based models used in...

  19. Systematic review shows lowered risk of nonunion after reamed nailing in patients with closed tibial shaft fractures.

    Science.gov (United States)

    Lam, S W; Teraa, M; Leenen, L P H; van der Heijden, G J M G

    2010-07-01

    Nonunion after intramedullary nailing (IMN) in patients with tibial shaft fractures occurs up to 16%. There is no agreement whether reaming prior to IMN insertion would reduce the nonunion rate. We aimed to compare the nonunion rate between reamed and unreamed IMN in patients with tibial shaft fractures. A systematic search was conducted in Pubmed, Embase, and the Cochrane Library. The selected publications were: (1) randomised controlled trials; (2) comparing the nonunion rate; (3) in patients with tibial shaft fractures; (4) treated with either reamed or unreamed IMN. Seven studies that satisfied the criteria were identified. They showed that reamed IMN led to reduction of nonunion rate compared to unreamed IMN in closed tibial shaft fractures (risk difference ranging 7.0-20%, number needed to treat ranging 5-14), while the difference between compared treatments for open tibial shaft fractures was not clinically relevant. The evidence showed a consistent trend of reduced nonunion rate in closed tibial shaft fracture treated with reamed compared to unreamed IMN. 2010 Elsevier Ltd. All rights reserved.

  20. Evaluation of nonunion fractures in dogs by use of B-mode ultrasonography, power Doppler ultrasonography, radiography, and histologic examination.

    Science.gov (United States)

    Risselada, Marije; van Bree, Henri; Kramer, Martin; Chiers, Koen; Duchateau, Luc; Verleyen, Piet; Saunders, Jimmy H

    2006-08-01

    To investigate the use of ultrasonography to assess nonunion of fractures in dogs and to compare results of ultrasonography, radiography, and histologic examination. 8 nonunion fractures in 6 dogs (1 each in 5 dogs and 3 in 1 dog); dogs ranged from 7 to 94 months of age and weighed 6 to 30 kg. Diagnostic assessment consisted of complete clinical and orthopedic examinations, radiography, B-mode (brightness mode) ultrasonography, and power Doppler ultrasonography. Biopsy samples were obtained during surgery for histologic examination. They were stained with H&E and immunolabeled by use of anti-CD31 antibodies. Correlations of power Doppler score, power Doppler count, vessel area, and radiographic prediction with the mean number of vessels counted per hpf were derived. Radiographically, 7 of 8 nonunion fractures were diagnosed as atrophic and were therefore estimated to be nonviable. Vascularity of nonunion fractures during power Doppler ultrasonography ranged from nonvascularized to highly vascularized. Absolute vessel count during histologic examination ranged from 0 to 63 vessels/hpf; 5 nonunion sites had a mean count of > 10 vessels/hpf. Vascularity during power Doppler ultrasonography was highly correlated with the number of vessels per hpf, whereas the correlation between the radiographic assessment and histologic evaluation was low. Radiographic prediction of the viability of nonunion fractures underestimated the histologically assessed vascularity of the tissue. Power Doppler ultrasonography provided a more accurate estimation of the viability of the tissue and therefore the necessity for debridement and autografts during revision surgery.

  1. Surgical Management of Proximal Interphalangeal Joint Repetitive Stress Epiphyseal Fracture Nonunion in Elite Sport Climbers.

    Science.gov (United States)

    El-Sheikh, Yasser; Lutter, Chris; Schoeffl, Isabelle; Schoeffl, Volker; Flohe, Sascha

    2017-11-14

    Repetitive stress fracture of the middle phalanx epiphysis is an injury specific to elite adolescent sport climbers. As sport climbing becomes increasingly popular in younger age groups, an increased number of these injuries have been reported in recent years. To date, treatment of these fractures has been nonsurgical, with strict rest and physiotherapy prescribed until fracture union. However, when these patients present in a delayed fashion with an established nonunion, nonsurgical treatment may fail, leading to disabling chronic pain and/or digital deformity in some cases. In this article, we present 2 cases of surgical treatment for finger middle phalanx repetitive stress epiphyseal fracture nonunion, using a percutaneous spot drilling epiphysiodesis technique. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Ayhan Gormus

    2017-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Date A

    1996-10-01

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

  4. Planar glass devices for efficient periodic poling

    DEFF Research Database (Denmark)

    Fage-Pedersen, Jacob; Jacobsen, Rune Shim; Kristensen, Martin

    2005-01-01

    We demonstrate that frequency-converting devices of high quality can be realised with glass poling. The devices, made with silica-on-silicon technology, are poled with periodic, embedded electrodes, and used for second-harmonic generation. We obtain precise control of the quasi phase-matching wav......We demonstrate that frequency-converting devices of high quality can be realised with glass poling. The devices, made with silica-on-silicon technology, are poled with periodic, embedded electrodes, and used for second-harmonic generation. We obtain precise control of the quasi phase......-matching wavelength and bandwidth, and a normalised conversion efficiency of 1.4×10-3 %/W/cm2 which, to our knowledge, is the highest obtained so far with periodic glass poling....

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

    Science.gov (United States)

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

    1989-08-01

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

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

    OpenAIRE

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

    2017-01-01

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

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

    Science.gov (United States)

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

    2015-12-01

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

  8. Transfracture abduction osteotomy: A solution for nonunion of femoral neck fractures

    Directory of Open Access Journals (Sweden)

    Jairamchander Pingle

    2014-01-01

    femur with or without bone graft, valgus osteotomy or hip arthroplasty. We conducted a retrospective analysis of cases of nonunion of femoral neck fracture treated by transfracture abduction osteotomy (TFAO. Materials and Methods: Over a period of 35 years (1974-2008, 30 patients with nonunion of femoral neck fractures were treated with TFAO over a period of 35 years (1974-2008, All patients were less than 50 years of age. Absence of clinical and radiological signs of union after four months was considered as nonunion. Patients more than 50 years of age were excluded from the study. Union was assessed at 6 months radiologically. Limb length was measured at six months. The mean duration of femoral neck fracture was 19 months (range 4 months 10 years. Results were analyzed in terms of radiological union at six months. Average followup was five years and six months. Results: Consistent union was noted at the followup after six months in 29 cases. One case was lost to followup after five and one-half months postoperatively. However, the fracture had united in this case at the last followup. Average shortening of the limb at six months was 1.9 cm. Average neck shaft angle was 127° (range 120-145°. Five cases went into AVN but were asymptomatic. Two cases required reoperation due to back out of Moore′s pins. These were reopened and cancellous screws were inserted in the same tracks. Conclusions: Consistent union of nonunion femoral neck fracture was noted at the followup after six months in 29 cases. The major drawback of the procedure is immobilization of the patient in the hip spica for eight weeks.

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

    Science.gov (United States)

    Faymonville, C; Jubel, A; Schiffer, G

    2010-04-01

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

  10. Contemporary Management of Mandibular Fracture Nonunion-A Retrospective Review and Treatment Algorithm.

    Science.gov (United States)

    Ostrander, Benjamin T; Wang, Howard D; Cusano, Alessandro; Manson, Paul N; Nam, Arthur J; Dorafshar, Amir H

    2018-02-06

    Nonunion is an uncommon complication after mandibular fractures. The purpose of this investigation was to compare outcomes of patients with mandibular fracture nonunion who were treated with a 1- versus 2-stage approach and propose a pragmatic treatment algorithm for surgical management based on preoperative characteristics. The authors conducted a retrospective study consisting of patients who presented to 2 level 1 trauma centers for the management of mandibular fracture nonunion over a 10-year period. The primary predictor variable was 1- versus 2-stage treatment. Outcomes were examined to propose a treatment algorithm. Eighteen patients were included in the study. The sample's mean age was 44.0 ± 19.3 years and most were men (88.9%). Mandibular angle and body accounted for 77.8% of cases. A single-stage approach was used in 13 patients (72.2%). Bone grafts or vascularized bone flaps were required in 13 patients (72.2%). Patients who required 2-stage treatments had intraoral soft tissue defects. Mean length of follow-up was 13.3 ± 20.4 months. All patients achieved bony union, with complications occurring in 5 patients (27.8%). The authors' 10-year experience was used to formulate a treatment algorithm based on bony defect size and soft tissue status, which can be used to inform optimal surgical management. Nonunion of mandibular fractures is an infrequent and complex condition requiring careful and deliberate surgical management. A single-stage approach is appropriate in most cases and does not negatively affect outcomes. Bony defect size and soft tissue status are essential parameters for determining the approach and timing of reconstruction. Copyright © 2018 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  11. Treatment of nonunions in fractures of the humeral shaft according to the Diamond Concept.

    Science.gov (United States)

    Miska, M; Findeisen, S; Tanner, M; Biglari, B; Studier-Fischer, S; Grützner, P A; Schmidmaier, G; Moghaddam, A

    2016-01-01

    Between 2005 and 2012, 50 patients (23 female, 27 male) with nonunion of the humeral shaft were included in this retrospective study. The mean age was 51.3 years (14 to 88). The patients had a mean of 1.5 prior operations (sd 1.2;1 to 8). All patients were assessed according to a specific risk score in order to devise an optimal and individual therapy plan consistent with the Diamond Concept. In 32 cases (64%), a change in the osteosynthesis to an angular stable locking compression plate was performed. According to the individual risk an additional bone graft and/or bone morphogenetic protein-7 (BMP-7) were applied. A successful consolidation of the nonunion was observed in 37 cases (80.4%) with a median healing time of six months (IQR 6). Younger patients showed significantly better consolidation. Four patients were lost to follow-up. Revision was necessary in a total of eight (16%) cases. In the initial treatment, intramedullary nailing was most common. The use of locking compression plates in combination with autologous cancellous bone graft has been shown to be a safe and effective treatment. In more complex cases, the use of the Masquelet technique and BMP-7 may be indicated at the first revision operation. Our results suggest the Diamond Concept is a successful treatment strategy for nonunions of the humeral shaft. ©2016 The British Editorial Society of Bone & Joint Surgery.

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

    Science.gov (United States)

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

    2015-12-01

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

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

    Science.gov (United States)

    Wani, Naveed Bashir; Syed, Basit

    2015-07-29

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

  14. [Treatment of focal bone defect in postoperative nonunion with autologous red bone marrow injection].

    Science.gov (United States)

    Tang, Zhao-hui; Zhu, Li-xing; Xu, Tu-bing; Wang, Kai; Zhou, Xin-min; Li, Qiang

    2009-07-01

    To observe the clinical effect of autologous red bone marrow injection in treating focal bone defect in postoperative nonunion. Thirteen patients with focal bone defect in postoperative nonunion (7 cases in tibia, 2 cases in femur, 4 cases in humerus), including 8 males and 5 females with the mean age of 32.5-years-old (ranging from 15 to 60 years). The bone defects were treated with autologous red bone marrow injection (1 time per 2 weeks, 5 times in total) and the X-rays of AP and LP were observed. Thirteen patients were followed up from 6 to 12 months with an average of 7.5 months. According to results of X-ray pictures, 13 cases obtained bone defect recovered completely, and the average time of union was 4 months. Autologous red bone marrow injection has ascendancy such as less wound and clear clinical effect, which can accelerate bone healing and promotes functional recovery of limb. It is a good method to treat focal bone defect in postoperative nonunion.

  15. Nonvascularized fibular grafting in nonunion of femoral neck fracture: A systematic review

    Directory of Open Access Journals (Sweden)

    Sujit Kumar Tripathy

    2016-01-01

    Full Text Available Nonunion of femoral neck fractures following primary fixation and neglected femoral neck fracture in young adults is a challenging task. Every effort should be directed toward hip joint salvage in these patients. Among different available options of hip salvage, nonvascularized fibular graft (NVFG osteosynthesis is simple, easy to perform, and a successful technique. In this review, the available literature on NVFG in neglected and nonunion femoral neck fractures has been analyzed. After review of 15 articles on NVFG, the average nonunion rate was estimated to be 7.86% (range 0-31%. Six articles that evaluated the preoperative and postoperative osteonecrosis reported improvement in 50% patients. The clinical and/or functional outcome was good to excellent in 56-96% patients following fibular osteosynthesis. Few complications such as coxa vara deformity, limb shortening, and intraarticular penetration of the graft or hardware have been reported. However, there are minimal donor site morbidities such as mild ankle pain, transient loss of toe flexors and extensors and transient lateral popliteal nerve palsy.

  16. Metrópoles desgovernadas

    Directory of Open Access Journals (Sweden)

    Erminia Maricato

    2011-04-01

    Full Text Available Apesar de sua importância econômica, política, social, demográfica, cultural, territorial e ambiental, há, nas metrópoles brasileiras, uma significativa falta de governo, evidenciada pelas incipientes iniciativas de cooperação administrativa intermunicipal e federativa. Este artigo aborda as mudanças estruturais - no processo de urbanização/ metropolização - devidas à reestruturação produtiva do capitalismo global, e, na escala nacional, trata da mudança no marco institucional - jurídico/político - que passou de concentrador e centralizador, durante o regime militar, para descentralizador e esvaziado, após a Constituição de 1988. O recuo verificado nas políticas sociais durante os anos 1980 e 1990, notadamente em transporte, habitação e saneamento, além do desmonte dos organismos metropolitanos, conduziu nossas metrópoles a um destino de banalização das tragédias urbanas. Em que pese sua urgência, a questão metropolitana não sensibiliza nenhuma força política ou instituição que lhe atribua lugar de destaque na agenda nacional.Despite its economic, political, social, demographic, cultural, territorial and environmental importance, there is a significant lack of government in the brazilian metropolises, evidenced by the incipient initiatives of intermunicipal and federative administrative cooperation. This article analyses the structural changes - in the process of urbanization/metropolization - due to the productive restructuring of global capitalism, and, in a national scale, analyses the change in the institutional mark - legal/political - which passed from concentrator and centralizer, during the Military Regimen, to decentralized and emptied, after 1988 Constitution. The downturn verified in social policies during the years 1980 and 1990, notably in transport, housing and sanitation, besides the dismantling of the metropolitan agencies, has led our cities to the trivialization of urban tragedies. Despite

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

    Science.gov (United States)

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

    2017-08-01

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

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2015-12-01

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

  20. Subsidence and nonunion after anterior cervical interbody fusion using a stand-alone polyetheretherketone (PEEK) cage.

    Science.gov (United States)

    Yang, Jae Jun; Yu, Chang Hun; Chang, Bong-Soon; Yeom, Jin Sup; Lee, Jae Hyup; Lee, Choon-Ki

    2011-03-01

    The purposes of the present study are to evaluate the subsidence and nonunion that occurred after anterior cervical discectomy and fusion using a stand-alone intervertebral cage and to analyze the risk factors for the complications. Thirty-eight patients (47 segments) who underwent anterior cervical fusion using a stand-alone polyetheretherketone (PEEK) cage and an autologous cancellous iliac bone graft from June 2003 to August 2008 were enrolled in this study. The anterior and posterior segmental heights and the distance from the anterior edge of the upper vertebra to the anterior margin of the cage were measured on the plain radiographs. Subsidence was defined as ≥ a 2 mm (minor) or 3 mm (major) decrease of the segmental height at the final follow-up compared to that measured at the immediate postoperative period. Nonunion was evaluated according to the instability being ≥ 2 mm in the interspinous distance on the flexion-extension lateral radiographs. The anterior and posterior segmental heights decreased from the immediate postoperative period to the final follow-up at 1.33 ± 1.46 mm and 0.81 ± 1.27 mm, respectively. Subsidence ≥ 2 mm and 3 mm were observed in 12 segments (25.5%) and 7 segments (14.9%), respectively. Among the expected risk factors for subsidence, a smaller anteroposterior (AP) diameter (14 mm vs. 12 mm) of cages (p = 0.034; odds ratio [OR], 0.017) and larger intraoperative distraction (p = 0.041; OR, 3.988) had a significantly higher risk of subsidence. Intervertebral nonunion was observed in 7 segments (7/47, 14.9%). Compared with the union group, the nonunion group had a significantly higher ratio of two-level fusion to one-level fusions (p = 0.001). Anterior cervical fusion using a stand-alone cage with a large AP diameter while preventing anterior intraoperative over-distraction will be helpful to prevent the subsidence of cages. Two-level cervical fusion might require more careful attention for avoiding nonunion.

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

    Directory of Open Access Journals (Sweden)

    Arianna Barbara Lovati

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

  2. Failed treatment of long bone nonunions with low intensity pulsed ultrasound.

    Science.gov (United States)

    Biglari, Bahram; Yildirim, Timur Mert; Swing, Tyler; Bruckner, Thomas; Danner, Wolfgang; Moghaddam, Arash

    2016-08-01

    The use of low intensity pulsed ultrasound (LIPUS) in the treatment of nonunions is still controversial. The present study is concerned with whether this procedure has a clinical use and which cofactors influence its therapeutic results. In this prospective, single institution, observational study, data from October 2010 to October 2013 from 61 nonunions in 60 patients treated with EXOGEN(®) LIPUS therapy were analysed. The average age was 45.4 ± 9.81 (18-63) years. Treatment was primarily done on long bones of the lower extremity (75.4 %). All 61 nonunions were examined after treatment, and the rate of healing as well as functional and subjective results were evaluated. Based on clinical and radiological findings, patients were divided into two groups: G1-successful treatment; and G2-unsuccessful treatment. Groups were compared to one another to identify possible factors influencing treatment. Twenty (32.8 %) patients showed bone consolidation with an average time of healing of 5.3 (2-7) months. In patients without successful treatment, who underwent revision surgery instead, full weight bearing took on average 3.7 months longer, and they were able to return to work 6.8 months later. Most of the treated patients (70.5 %) reported no improvement in pain. In G2, 12 (29.3 %) patients suffered in their previous history from osteitis; in G1 there were only two patients (10 %) (p = 0.012). There were further significant differences in the age of the fracture, the type of osteosynthesis, the gap size, as well as the NUSS score. Despite patients being chosen strictly according to EXOGEN(®) indications, only a small number of patients with nonunions who underwent LIPUS therapy experienced successful treatment (32.8 %). Overall, its use resulted in a clear delay in the time of treatment, so that according to our results, the use of LIPUS should be seen critically in long bone nonunions and use should be made on a case-by-case basis.

  3. Holography with a Landau pole

    Science.gov (United States)

    Faedo, Antón F.; Mateos, David; Pantelidou, Christiana; Tarrío, Javier

    2017-02-01

    Holography for UV-incomplete gauge theories is important but poorly understood. A paradigmatic example is d = 4, N=4 super Yang-Mills coupled to N f quark flavors, which possesses a Landau pole at a UV scale ΛLP. The dual gravity solution exhibits a UV singularity at a finite proper distance along the holographic direction. Despite this, holographic renormalization can be fully implemented via analytic continuation to an AdS solution. The presence of a UV cut-off manifests itself in several interesting ways. At energies E ≪ ΛLP no pathologies appear, as expected from effective field theory. In contrast, at scales E ≲ ΛLP the gravitational potential becomes repulsive, and at temperatures T ≲ ΛLP the specific heat becomes negative. Although we focus on N=4 super Yang-Mills with flavor, our qualitative results apply to a much more general class of theories, since they only depend on the fact that the metric near the UV singularity is a hyper-scaling violating metric with exponent θ > d - 1.

  4. Holography with a Landau pole

    Energy Technology Data Exchange (ETDEWEB)

    Faedo, Antón F. [Departament de Física Quántica i Astrofísica and Institut de Ciències del Cosmos (ICC), Universitat de Barcelona, Martí i Franquès 1, ES-08028, Barcelona (Spain); Mateos, David [Departament de Física Quántica i Astrofísica and Institut de Ciències del Cosmos (ICC), Universitat de Barcelona, Martí i Franquès 1, ES-08028, Barcelona (Spain); Institució Catalana de Recerca i Estudis Avançats (ICREA), Passeig Lluís Companys 23, ES-08010, Barcelona (Spain); Pantelidou, Christiana [Departament de Física Quántica i Astrofísica and Institut de Ciències del Cosmos (ICC), Universitat de Barcelona, Martí i Franquès 1, ES-08028, Barcelona (Spain); Tarrío, Javier [Physique Théorique et Mathématique, Université Libre de Bruxelles (ULB), and International Solvay Institutes, Campus de la Plaine CP 231, B-1050, Brussels (Belgium)

    2017-02-08

    Holography for UV-incomplete gauge theories is important but poorly understood. A paradigmatic example is d=4, N=4 super Yang-Mills coupled to N{sub f} quark flavors, which possesses a Landau pole at a UV scale Λ{sub LP}. The dual gravity solution exhibits a UV singularity at a finite proper distance along the holographic direction. Despite this, holographic renormalization can be fully implemented via analytic continuation to an AdS solution. The presence of a UV cut-off manifests itself in several interesting ways. At energies E≪Λ{sub LP} no pathologies appear, as expected from effective field theory. In contrast, at scales E≲Λ{sub LP} the gravitational potential becomes repulsive, and at temperatures T≲Λ{sub LP} the specific heat becomes negative. Although we focus on N=4 super Yang-Mills with flavor, our qualitative results apply to a much more general class of theories, since they only depend on the fact that the metric near the UV singularity is a hyper-scaling violating metric with exponent θ>d−1.

  5. Geometric Modelling of Octagonal Lamp Poles

    Science.gov (United States)

    Chan, T. O.; Lichti, D. D.

    2014-06-01

    Lamp poles are one of the most abundant highway and community components in modern cities. Their supporting parts are primarily tapered octagonal cones specifically designed for wind resistance. The geometry and the positions of the lamp poles are important information for various applications. For example, they are important to monitoring deformation of aged lamp poles, maintaining an efficient highway GIS system, and also facilitating possible feature-based calibration of mobile LiDAR systems. In this paper, we present a novel geometric model for octagonal lamp poles. The model consists of seven parameters in which a rotation about the z-axis is included, and points are constrained by the trigonometric property of 2D octagons after applying the rotations. For the geometric fitting of the lamp pole point cloud captured by a terrestrial LiDAR, accurate initial parameter values are essential. They can be estimated by first fitting the points to a circular cone model and this is followed by some basic point cloud processing techniques. The model was verified by fitting both simulated and real data. The real data includes several lamp pole point clouds captured by: (1) Faro Focus 3D and (2) Velodyne HDL-32E. The fitting results using the proposed model are promising, and up to 2.9 mm improvement in fitting accuracy was realized for the real lamp pole point clouds compared to using the conventional circular cone model. The overall result suggests that the proposed model is appropriate and rigorous.

  6. Tree-loop duality relation beyond single poles

    International Nuclear Information System (INIS)

    Bierenbaum, Isabella; Buchta, Sebastian; Draggiotis, Petros; Malamos, Ioannis; Rodrigo, German

    2012-11-01

    We develop the Tree-Loop Duality Relation for two- and three-loop integrals with multiple identical propagators (multiple poles). This is the extension of the Duality Relation for single poles and multi-loop integrals derived in previous publications. We prove a generalization of the formula for single poles to multiple poles and we develop a strategy for dealing with higher-order pole integrals by reducing them to single pole integrals using Integration By Parts.

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

    Science.gov (United States)

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

    2017-08-01

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

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

    Science.gov (United States)

    Babhulkar, Sudhir; Babhulkar, Sushrut; Vasudev, Aditya

    2017-08-01

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

  9. A Comparative Analysis of the New Five-Pole and Three-Pole Active Magnet Bearing

    Directory of Open Access Journals (Sweden)

    Pedram Vakili

    2012-07-01

    Full Text Available In recent years, more attention has been given to the active AMBs thanks to their low maintenance cost, suitability for clean environments, and high speed. One of the popular types of AMBs is the three-pole type with integrated and separate cores. Some deficiencies of this type of bearing are its high oscillation, low stability and low efficiency. This paper seeks to analyse the three-pole AMBs and describe their deficiencies and introduce and analyse a new five-pole AMB. The model thus proposed has lower oscillation as well as more stability and efficiency. The five-pole AMB has been simulated by a controller in the presence of disturbance. The results of simulation demonstrate lower vibration and oscillation in the five-pole AMB in comparison with the three-pole model.

  10. On pole structure assignment in linear systems

    Czech Academy of Sciences Publication Activity Database

    Loiseau, J.-J.; Zagalak, Petr

    2009-01-01

    Roč. 82, č. 7 (2009), s. 1179-1192 ISSN 0020-7179 R&D Projects: GA ČR(CZ) GA102/07/1596 Institutional research plan: CEZ:AV0Z10750506 Keywords : linear systems * linear state feedback * pole structure assignment Subject RIV: BC - Control Systems Theory Impact factor: 1.124, year: 2009 http://library.utia.cas.cz/separaty/2009/AS/zagalak-on pole structure assignment in linear systems.pdf

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

    Science.gov (United States)

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

    1983-01-01

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

  12. Reamed interlocking intramedullary nailing for the treatment of tibial diaphyseal fractures and aseptic nonunions. Can we expect an optimum result?

    Science.gov (United States)

    Chalidis, Byron E; Petsatodis, George E; Sachinis, Nick C; Dimitriou, Christos G; Christodoulou, Anastasios G

    2009-10-01

    The need for reaming and the number of locking screws to be used in intramedullary (IM) tibial nailing of acute fractures as well as routine bone grafting of tibial aseptic nonunions have not been clearly defined. We describe the results of reamed interlocked IM nails in 233 patients with 247 tibial fractures (190 closed, 27 open and 30 nonunions). Ninety-six percent of the fractures were united at review after an average of 4.9 years. No correlation was found between union and nail diameter (P = 0.501) or the number of locking screws used (P = 0.287). Nail dynamization was effective in 82% of fractures. Locking screw(s) breakage was associated with nonunion in 25% of cases. Bone grafting during IM nailing was found not to increase the healing rate in tibial nonunions (P = 0.623). None of the IM nails were removed or revised due to infection. A dropped hallux and postoperative compartment syndrome were found in 0.8 and 1.6% of cases, respectively. Anterior knee pain was reported in 42% of patients but nail removal did not alleviate the symptoms in almost half. This series confirms the place of reamed intramedullary nailing for the vast majority of tibial diaphyseal fractures. It provides an optimum outcome and minimizes the need for supplementary bone grafting in aseptic nonunions.

  13. Orthogonal Double Plating and Autologous Bone Grafting of Postoperative Humeral Shaft Nonunion - A Rare Case Report and Review of Literature.

    Science.gov (United States)

    Metikala, Sreenivasulu; Bhogadi, Prabhudheer

    2015-01-01

    Nonunion following surgical stabilization of humeral shaft fractures, although infrequent, remains a challenge as limited surgical options are available. The difficulties in re-fixation are due to osteolysis produced by the loose implant components and disuse osteopenia of the entire bone segment. We share our experience in the management of a long standing diaphyseal nonunion of humerus following titanium LCP fixation. A 58 years old woman presented with 20 months old nonunion following titanium LCP fixation of her closed humeral shaft fracture, done elsewhere. The interesting intraoperative findings, noteworthy, are about the extensive metallosis and the gross cortical defect measuring 10cm x 1cm x 1cm, corresponding to the foot print of the previous plate with exposed medullary canal. It was managed by debridement, dual plate fixation using 9 holed and 12 holed stainless steel LCPs in an orthogonal fashion and autologous bone grafting. The nonunion healed in 5 months and she regained all the movements except for terminal 10° of elbow extension and 15° of shoulder abduction at her final follow up of 30 months. According to Stewart and Hundley classification the final result was found to be good. We recommend the judicious use of long and short plates in 90-90 orientation along with autogenous bone grafting in the management of a long standing humeral shaft nonunion having extensive cortical resorption following surgical stabilization by plating.

  14. Clouds Over the North Pole

    Science.gov (United States)

    2004-01-01

    [figure removed for brevity, see original site] Released 29 June 2004 The atmosphere of Mars is a dynamic system. Water-ice clouds, fog, and hazes can make imaging the surface from space difficult. Dust storms can grow from local disturbances to global sizes, through which imaging is impossible. Seasonal temperature changes are the usual drivers in cloud and dust storm development and growth. Eons of atmospheric dust storm activity has left its mark on the surface of Mars. Dust carried aloft by the wind has settled out on every available surface; sand dunes have been created and moved by centuries of wind; and the effect of continual sand-blasting has modified many regions of Mars, creating yardangs and other unusual surface forms. Like yesterday's image, the linear 'ripples' are water-ice clouds. As spring is deepening at the North Pole these clouds are becoming more prevalent. Image information: VIS instrument. Latitude 68.9, Longitude 135.5 East (224.5 West). 38 meter/pixel resolution. Note: this THEMIS visual image has not been radiometrically nor geometrically calibrated for this preliminary release. An empirical correction has been performed to remove instrumental effects. A linear shift has been applied in the cross-track and down-track direction to approximate spacecraft and planetary motion. Fully calibrated and geometrically projected images will be released through the Planetary Data System in accordance with Project policies at a later time. NASA's Jet Propulsion Laboratory manages the 2001 Mars Odyssey mission for NASA's Office of Space Science, Washington, D.C. The Thermal Emission Imaging System (THEMIS) was developed by Arizona State University, Tempe, in collaboration with Raytheon Santa Barbara Remote Sensing. The THEMIS investigation is led by Dr. Philip Christensen at Arizona State University. Lockheed Martin Astronautics, Denver, is the prime contractor for the Odyssey project, and developed and built the orbiter. Mission operations are

  15. A protocol for staged arthroplasty to salvage infected nonunion of hip fractures.

    Science.gov (United States)

    Ebied, Ayman M; Elseedy, Adel I; Gamal, Osama

    2017-03-01

    Nonunion of hip fractures is not uncommon. Total hip arthroplasty is used to salvage cases of non union or secondary arthritis in these fractures. However, this option may not be available or may be difficult to achieve when infection has superseded the site of nonunion. The objective of this prospective study was to assess if a staged protocol of treatment yields good results in these difficult cases. Twenty-seven consecutive patients who had deep hip infection with failed treatment of hip fractures (intracapsular in 16 cases and extracapsular in 11) were treated between June 2007 and September 2011. Twenty-six completed the planned two-stage hip arthroplasty and one case was lost after the first stage. The average age of the patients was 48.9 years (range 26-74 years) with an average follow up period of 44 months (30-72 months). Analysis was done using the paired t test where P < 0.05 was considered significant. Infection was controlled in all cases that completed the treatment protocol with no recurrence in all cases at the latest follow up. The Harris hip score of the patients improved significantly from 29 preoperatively to 85 at the latest follow up (P < 0.0001). Two patients had hip dislocation with displacement of the trochanteric fragment while three other patients had fibrous union of the trochanter. Staged Arthroplasty procedure to salvage infected non-union of hip fractures is successful in eradicating infection and regaining hip function. Level of evidence IV.

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

    Science.gov (United States)

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

    2009-02-01

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

  17. Are atrophic long-bone nonunions associated with low-grade infections?

    Directory of Open Access Journals (Sweden)

    Dapunt U

    2015-12-01

    Full Text Available Ulrike Dapunt,1 Ole Spranger,2 Simone Gantz,1 Irene Burckhardt,3 Stefan Zimmermann,3 Gerhard Schmidmaier,2 Arash Moghaddam2 1Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, 2HTRG–Heidelberg Trauma Research Group, Trauma and Reconstructive Surgery, Center for Orthopedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University Hospital, 3Department for Infectious Diseases, Medical Microbiology and Hygiene, Heidelberg, Germany Abstract: Impaired fracture healing, especially when associated with bacterial infection, is a severe complication following long-bone fractures and requires special treatment. Because standard diagnostic techniques might provide falsely negative results, we evaluated the sonication method for detection of bacteria on implants of patients with fracture nonunions. A total of 49 patients with a nonunion (group NU and, for comparison, 45 patients who had undergone routine removal of osteosynthetic material (group OM, were included in the study. Five different diagnostic methods (culture of tissue samples, culture of intraoperative swabs, histopathology of tissue samples, culture of sonication fluid, and 16S ribosomal DNA polymerase chain reaction of sonication fluid were compared and related to clinical data. Among the diagnostic tests, culture of sonication fluid demonstrated by far the highest detection rate of bacteria (57% in group NU, and rather unexpectedly 40% in group OM. Culture of sonication samples also revealed a broad spectrum of bacteria, in particular Propionibacterium spp. In conclusion, our results indicate that more bacteria can be detected on implants of patients with atrophic nonunions of long-bone fractures by means of the sonication procedure, which provides a valuable additional diagnostic tool to decide on a surgical procedure (eg, two-step procedure and to further specify antimicrobial therapy. Keywords: sonication, osteosynthetic material, osteomyelitis 

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

    Science.gov (United States)

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

    2017-03-01

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

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

    International Nuclear Information System (INIS)

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

    2008-01-01

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

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

    Science.gov (United States)

    Constantinou, Demitri; Kastanos, Konstantinos

    2008-01-01

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

  1. Thoracic Outlet Syndrome in a Volleyball Player Due to Nonunion of the First Rib Fracture.

    Science.gov (United States)

    Puttmann, Kathleen T; Satiani, Bhagwan; Vaccaro, Patrick

    2016-11-01

    Fracture of the first rib with ensuing callus formation is a rare cause of thoracic outlet syndrome. We report a case of a 17-year-old female volleyball player who presented with months of chronic arm pain. Radiographic imaging demonstrated nonunion fracture of the first rib. Physical therapy had been unsuccessful in relieving the pain, and surgical management was performed with resection of the first rib through a transaxillary approach with complete resolution of symptoms. Inflammation surrounding such fractures may destroy tissue planes, making dissection more technically difficult.

  2. The potential of wood-based composite poles

    Science.gov (United States)

    Todd F. Shupe; Cheng Piao; Chung Y. Hse

    2009-01-01

    Wood-based composite utility poles are receiving increasing attention in the North American pole market. This interest is being driven by many increasing factors such as increasing: (1) disposal costs of solid wood poles, (2) liability and environmental concerns with traditional means of disposal of solid wood poles, (3) cost and concerns of long-term...

  3. Mechanical properties of small-scale wood laminated composite poles

    Science.gov (United States)

    Cheng Piao; Todd F. Shupe; Chung Y. Hse

    2004-01-01

    Power companies in the United States consume millions of solid wood poles every year. These poles are from high-valued trees that are becoming more expensive and less available. wood laminated composite poles (LCP) are a novel alternative to solid wood poles. LCP consists of trapezoid wood strips that are bonded by a synthetic resin. The wood strips can be made from...

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

    Science.gov (United States)

    Sansone, Valerio; Brañes, Manuel; Romeo, Pietro

    2018-02-01

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

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

    Science.gov (United States)

    Ziegler, Patrick; Friederichs, Jan; Hungerer, Sven

    2017-07-01

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

  6. [Augmentative locking compression plate (LCP) combined with bone graft for the treatment of aseptic femoral shaft nonunion after intramedullary nailing].

    Science.gov (United States)

    Wang, Fei-da; Gao, Yao-zu; Yuan, Wei; Du, Jin-qiang; Wei, Xiao-chun

    2014-10-01

    To investigate the effect of augmentative locking compression plate combined with bone graft in treating aseptic femoral shaft nonunion after intramedullary nailing. Twenty-one cases with aseptic femoral shaft nonunion after intramedullary nailing from January 2007 to January 2013 were treated,including 18 males and 3 females with a mean age of 37.7 years (ranged from 23 to 64 years). The mean period of nonunion after surgery was 23.9 months (ranged from 9 to 62 months). According to Weber-Cech classification,10 of those 21 cases were hypertrophic nonunion,7 were atrophic, and 4 had oligotrophic fracture nonunion. All patients retained the original intramedullary nail, and applied with augmentation plating of 6 to 8 holes locking compression plate, unicortical fixation with 2 to 3 locking screws in the proximal or distal end, with simultaneous autologous iliac bone grafting. After treatment,all patients were allowed to partial weight-bearing until full weight-bearing according to the radiological results. All patients were followed up and were evaluated with clinical and imaging results. All patients were followed up from 8 to 24 months, averaged (13.5±3.5) months,which showed clinical union at 4 to 8 months, averaged (6.0±1.0) months and radiological solid union at 7 to 12 months, averaged (9.1±1.5) months. No such complications as infection,hardware loosening or breaking were found. Augmentative locking compression plate(LCP) combined with bone graft for aseptic femoral shaft nonunion after intramedullary nail has a satisfied clinical efficacy. It's an useful and simple method.

  7. 2D Stabilised analytic signal method in DC pole-pole potential data ...

    Indian Academy of Sciences (India)

    R. Narasimhan (Krishtel eMaging) 1461 1996 Oct 15 13:05:22

    Using analytic signal method, interpretation of pole-pole secondary electric potentials due to 2D conductive/resistive prisms is presented. ... residual separation to separate out residual anom- alies, which are interpreted for geological .... terms, which are used for the semi-quantitative interpretation. 6.1 Computation of ...

  8. An unusual complication of ischemic injury to upper pole ureter during lower pole heminephroureterectomy

    Directory of Open Access Journals (Sweden)

    Katherine Victoria Hurst

    2013-01-01

    Full Text Available Lower pole heminephroureterectomy is a common paediatric urology procedure with few reported complications. We report a case of possible vascular ischemic injury to the normal remaining ureter following a lower pole heminephroureterectomy, probably due to both ureters sharing a common blood supply. Extra caution in such procedures is therefore warranted.

  9. Jupiter's interior and deep atmosphere: The initial pole-to-pole passes with the Juno spacecraft

    DEFF Research Database (Denmark)

    Bolton, S. J.; Adriani, Alberto; Adumitroaie, V.

    2017-01-01

    On 27 August 2016, the Juno spacecraft acquired science observations of Jupiter, passing less than 5000 kilometers above the equatorial cloud tops. Images of Jupiter's poles show a chaotic scene, unlike Saturn's poles. Microwave sounding reveals weather features at pressures deeper than 100 bars,...

  10. 2D Stabilised analytic signal method in DC pole-pole potential data ...

    Indian Academy of Sciences (India)

    R. Narasimhan (Krishtel eMaging) 1461 1996 Oct 15 13:05:22

    Using analytic signal method, interpretation of pole-pole secondary electric potentials due to 2D conductive/resistive prisms is presented. The estimated parameters are the location, lateral extent or width and depth to top surface of the prism. Forward modelling is attempted by 2D-Finite. Difference method. The proposed ...

  11. Reamed interlocking intramedullary nailing for the treatment of tibial diaphyseal fractures and aseptic nonunions. Can we expect an optimum result?

    OpenAIRE

    Chalidis, Byron E.; Petsatodis, George E.; Sachinis, Nick C.; Dimitriou, Christos G.; Christodoulou, Anastasios G.

    2009-01-01

    The need for reaming and the number of locking screws to be used in intramedullary (IM) tibial nailing of acute fractures as well as routine bone grafting of tibial aseptic nonunions have not been clearly defined. We describe the results of reamed interlocked IM nails in 233 patients with 247 tibial fractures (190 closed, 27 open and 30 nonunions). Ninety-six percent of the fractures were united at review after an average of 4.9?years. No correlation was found between union and nail diameter ...

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

    Science.gov (United States)

    Sun, Qing-peng

    2015-05-01

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

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

    Directory of Open Access Journals (Sweden)

    Tessa Drijkoningen

    2016-10-01

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

  14. Changes of Bone Turnover Markers in Long Bone Nonunions Treated with a Regenerative Approach

    Directory of Open Access Journals (Sweden)

    Donatella Granchi

    2017-01-01

    Full Text Available In this clinical trial, we investigated if biochemical bone turnover markers (BTM changed according to the progression of bone healing induced by autologous expanded MSC combined with a biphasic calcium phosphate in patients with delayed union or nonunion of long bone fractures. Bone formation markers, bone resorption markers, and osteoclast regulatory proteins were measured by enzymatic immunoassay before surgery and after 6, 12, and 24 weeks. A satisfactory bone healing was obtained in 23 out of 24 patients. Nine subjects reached a good consolidation already at 12 weeks, and they were considered as the “early consolidation” group. We found that bone-specific alkaline phosphatase (BAP, C-terminal propeptide of type I procollagen (PICP, and beta crosslaps collagen (CTX changed after the regenerative treatment, BAP and CTX correlated to the imaging results collected at 12 and 24 weeks, and BAP variation along the healing course differed in patients who had an “early consolidation.” A remarkable decrease in BAP and PICP was observed at all time points in a single patient who experienced a treatment failure, but the predictive value of BTM changes cannot be determined. Our findings suggest that BTM are promising tools for monitoring cell therapy efficacy in bone nonunions, but studies with larger patient numbers are required to confirm these preliminary results.

  15. Changes of Bone Turnover Markers in Long Bone Nonunions Treated with a Regenerative Approach

    Science.gov (United States)

    Granchi, Donatella; Rojewski, Markus; Rosset, Philippe; Layrolle, Pierre; Spazzoli, Benedetta; Donati, Davide Maria

    2017-01-01

    In this clinical trial, we investigated if biochemical bone turnover markers (BTM) changed according to the progression of bone healing induced by autologous expanded MSC combined with a biphasic calcium phosphate in patients with delayed union or nonunion of long bone fractures. Bone formation markers, bone resorption markers, and osteoclast regulatory proteins were measured by enzymatic immunoassay before surgery and after 6, 12, and 24 weeks. A satisfactory bone healing was obtained in 23 out of 24 patients. Nine subjects reached a good consolidation already at 12 weeks, and they were considered as the “early consolidation” group. We found that bone-specific alkaline phosphatase (BAP), C-terminal propeptide of type I procollagen (PICP), and beta crosslaps collagen (CTX) changed after the regenerative treatment, BAP and CTX correlated to the imaging results collected at 12 and 24 weeks, and BAP variation along the healing course differed in patients who had an “early consolidation.” A remarkable decrease in BAP and PICP was observed at all time points in a single patient who experienced a treatment failure, but the predictive value of BTM changes cannot be determined. Our findings suggest that BTM are promising tools for monitoring cell therapy efficacy in bone nonunions, but studies with larger patient numbers are required to confirm these preliminary results. PMID:28744314

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

    Science.gov (United States)

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

    2014-12-01

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

  17. Human autologous mesenchymal stem cells with extracorporeal shock wave therapy for nonunion of long bones.

    Science.gov (United States)

    Zhai, Lei; Ma, Xin-Long; Jiang, Chuan; Zhang, Bo; Liu, Shui-Tao; Xing, Geng-Yan

    2016-09-01

    Currently, the available treatments for long bone nonunion (LBN) are removing of focus of infection, bone marrow transplantation as well as Ilizarov methods etc. Due to a high percentage of failures, the treatments are complex and debated. To develop an effective method for the treatment of LBN, we explored the use of human autologous bone mesenchymal stems cells (hBMSCs) along with extracorporeal shock wave therapy (ESWT). Sixty three patients of LBN were subjected to ESWT treatment and were divided into hBMSCs transplantation group (Group A, 32 cases) and simple ESWT treatment group (Group B, 31 cases). The patients were evaluated for 12 months after treatment. In Group A, 14 patients were healed and 13 showed an improvement, with fracture healing rate 84.4%. In Group B, eight patients were healed and 13 showed an improvement, with fracture healing rate 67.7%. The healing rates of the two groups exhibited a significant difference ( P 0.05). However, the callus formation in Group A was significantly higher than that in the Group B after treatment for 6, 9, and 12 months ( P Autologous bone mesenchymal stems cell transplantation with ESWT can effectively promote the healing of long bone nonunions.

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

    Science.gov (United States)

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

    2004-05-01

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

  19. Combined effect of teriparatide and low-intensity pulsed ultrasound for nonunion: a case report.

    Science.gov (United States)

    Nozaka, Koji; Shimada, Yoichi; Miyakoshi, Naohisa; Yamada, Shin; Hongo, Michio; Kasukawa, Yuji; Saito, Hidetomo; Kijima, Hiroaki

    2014-05-27

    Low-intensity pulsed ultrasound is a pain-free therapy performed daily at home by the patient and has been shown to promote fracture healing. Teriparatide is a parathyroid hormone preparation that activates osteoblastic bone formation and is also reported to be effective in promoting bony union. We report the case of a 56-year-old Japanese male with a femoral shaft fracture who underwent intramedullary osteosynthesis nailing initially. He had no radiologic or clinical sign of healing 3 months later and low-intensity pulsed ultrasound was initiated at that time. He was reassessed in another 3 months, with evidence of mild bone consolidation but the fracture gap persisted. Subsequent treatment with human parathyroid hormone was initiated in combination with low-intensity pulsed ultrasound. Full fracture healing was present 6 months after beginning the combination low-intensity pulsed ultrasound and teriparatide. It is hypothesized that the potential additive effects of low-intensity pulsed ultrasound and teriparatide therapy ultimately triggered sufficient bone formation to support osseous union. The case reported herein is a femoral shaft atrophic nonunion in which traditional interventions failed. Successful fracture healing was finally achieved with low-intensity pulsed ultrasound and teriparatide therapy. This is the first reported case of diaphyseal nonunion with deterioration of bone quality in long bones resolved with teriparatide and low-intensity pulsed ultrasound.

  20. New magnet pole shape for isochronous cyclotrons

    International Nuclear Information System (INIS)

    Thorn, C.E.; Chasman, C.; Baltz, A.J.

    1981-01-01

    A new design has been developed for shaping pole tips to produce the radially increasing fields required for isochronous cyclotrons. The conventional solid hill poles are replaced by poles mounted over a small secondary gap which tapers radially from maximum at the magnet edge to zero near the center. Field measurements with a model magnet and calculations with the code TRIM show an increase in field at the edge of the magnet without the usual corresponding large increase in fringing, and a radial field shape more nearly field independent than for conventional hills. The flying hills have several advantages for variable energy multiparticle cyclotrons: (1) a large reduction in the power dissipated by isochronizing trim coils; (2) a more constant shape and magnitude flutter factor, eliminating flutter coils and increasing the operating range; and (3) a sharper fall-off of the fringe field, simplifying beam extraction

  1. Pole solutions for flame front propagation

    CERN Document Server

    Kupervasser, Oleg

    2015-01-01

    This book deals with solving mathematically the unsteady flame propagation equations. New original mathematical methods for solving complex non-linear equations and investigating their properties are presented. Pole solutions for flame front propagation are developed. Premixed flames and filtration combustion have remarkable properties: the complex nonlinear integro-differential equations for these problems have exact analytical solutions described by the motion of poles in a complex plane. Instead of complex equations, a finite set of ordinary differential equations is applied. These solutions help to investigate analytically and numerically properties of the flame front propagation equations.

  2. Fundamental pole parameters of the N(1470)

    CERN Document Server

    Lee, P S

    1973-01-01

    The position and residue of the S-matrix pole of the Delta (1236) have been shown to be unique and independent of the particular resonance formula used, thus resolving a discrepancy among phenomenological fits. Unlike the P/sub 33/ partial wave, the P/sub 11/ resonance is highly inelastic, very broad, and has a large background. This produces huge uncertainties in its mass and width, depending on the parametrization used. It is reported that the position of the N(1470) pole is uniquely determined, 1380-110i MeV, from fits to the CERN phase shifts. (10 refs).

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

    Science.gov (United States)

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

    2017-12-01

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

  4. Outcome of nonunion fractures in dogs treated with fixation, compression resistant matrix, and recombinant human bone morphogenetic protein-2.

    Science.gov (United States)

    Massie, Anna M; Kapatkin, Amy S; Fuller, Mark C; Verstraete, Frank J M; Arzi, Boaz

    2017-03-20

    To report the use of compression resistant matrix (CRM) infused with recombinant human bone morphogenetic protein (rhBMP-2) prospectively in the healing of nonunion long-bone fractures in dogs. A longitudinal cohort of dogs that were presented with nonunion fractures were classified and treated with CRM soaked with rhBMP-2 and fracture fixation. They were followed with serial radiographs and evaluated for healing times and complications according to the time frame and definitions previously established for orthopaedic clinical cases. Eleven nonunion fractures in nine dogs were included. Median healing time was 10 weeks (range: 7-20 weeks). Major perioperative complications due to bandage morbidity were encountered in two of 11 limbs and resolved. All other complications were minor. They occurred perioperatively in eight of 11 limbs. Minor follow-up complications included short-term in one of two limbs, mid-term in one of three, and long-term in four of five limbs. Nine limbs returned to full function and two limbs returned to acceptable function at the last follow-up. Nonunion fractures given a poor prognosis via standard-of-care treatment were successfully repaired using CRM with rhBMP-2 accompanying fixation. These dogs, previously at high risk of failure, returned to full or acceptable function.

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

    Science.gov (United States)

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

    2017-05-25

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

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

    Science.gov (United States)

    Begkas, Dimitrios; Katsenis, Dimitrios; Pastroudis, Alexandros

    2014-02-01

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

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

    Science.gov (United States)

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

    2016-10-01

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

  8. Long bone nonunions treated with autologous concentrated bone marrow-derived cells combined with dried bone allograft.

    Science.gov (United States)

    Scaglione, M; Fabbri, L; Dell'Omo, D; Gambini, F; Guido, G

    2014-08-01

    Nowadays the treatment of long bone nonunion continues to be one of the most complex and debated topics due to the large number of failures. For several years, in the relevant literature three factors have been considered essential in the healing process: growth factors and hormones, osteoprogenitor cells (mesenchymal stem cells), and extracellular matrix. The mechanical stability of the fracture site is considered the fourth element of the "Diamond concept theory." The aim of our study was to evaluate the validity of biological adjuvants of mechanical synthesis allowing a faster healing process of nonunions. We dealt with 19 patients with long bone nonunion. All patients have been treated with concentrated mesenchymal stem cells without bone autologous transplant. We used the Extracell BMC-marrow aspirate protocol of Regen Lab. The radiographic parameters taken into account for the diagnosis of successful healing were the presence of a bridge callus, obliteration of the fracture line and bone cortical continuity. Clinically, the pain was investigated with VAS score (visual analogue scale), where zero means no pain and 10 the worst possible pain. Radiographic investigation shows complete healing in 78.9 % (15 cases) with an average time to healing of 6.5 months (minimum healing time 80 days) corresponding also in complete remission of clinical symptoms. The use of growth factors and autologous mesenchymal stem cells through the enforcement of system for tissue regeneration is a valid and innovative biotechnology technique for the treatment long bone nonunions.

  9. Rotor pole refurbishment for hydrogenerators: insulation problems and solutions

    International Nuclear Information System (INIS)

    Reynolds, R.R.; Rux, L.

    2005-01-01

    Rotor poles for Unit 1 at Lower Granite Powerhouse were removed from the rotor and shipped to a repair facility for refurbishment. Upon inspection, it was found that all of the pole bodies exhibited a distinct bow, center to end, on the pole mounting surface. In some cases, the deflection was as much as 0.106 inch. Concerns were raised about how this condition might affect the ability to properly insulate and/or re-seat the poles. This paper presents details of the rotor pole and field winding evaluation, the problems encountered, and the solutions implemented to successfully refurbish the rotor poles and field winding. (author)

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-03-15

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

  11. Recent advances in poled optical fibres

    DEFF Research Database (Denmark)

    Pruneri, V.; Margulis, W.; Myrén, N.

    2005-01-01

    A second-order nonlinearity can be induced in optical fibres through poling. We describe accomplishments of the EU project GLAMOROUS in making low-cost high performance electrooptic and nonlinear optical fibre- and waveguide-based components. In particular a comparison with more traditional...

  12. Quasiparticle pole strength in nuclear matter

    International Nuclear Information System (INIS)

    Poggioli, R.S.; Jackson, A.D.

    1975-01-01

    It is argued that single-particle-like behavior in nuclear matter is much less probable than Brueckner theory suggests. In particular, the quasiparticle pole strength is evaluated for nuclear matter and it is shown that, contrary to the spirit of Brueckner theory, low momentum states play a crucial role in determining the magnitude of z/sub k/sub F/. (auth)

  13. Kosovo : kannatlikkusele lootmine pole plaan / Chris Patten

    Index Scriptorium Estoniae

    Patten, Chris

    2007-01-01

    Autor leiab, et arvestades Kosovo elanike ülekaalukat soovi olla vaba Serbiast, riigist, mis üritas nad kõrvaldada, ning alternatiivi täielikku puudumist Belgradi poolt, pole rahvusvahelisel kogukonnal muud võimalust kui anda Kosovole iseseisvus

  14. Pole masses of quarks in dimensional reduction

    International Nuclear Information System (INIS)

    Avdeev, L.V.; Kalmykov, M.Yu.

    1997-01-01

    Pole masses of quarks in quantum chromodynamics are calculated to the two-loop order in the framework of the regularization by dimensional reduction. For the diagram with a light quark loop, the non-Euclidean asymptotic expansion is constructed with the external momentum on the mass shell of a heavy quark

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

    Science.gov (United States)

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

    2015-01-01

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

  16. Third Pole Environment (TPE) -Latest Progress

    Science.gov (United States)

    Liu, Z.; Yao, T.; Zhang, F.; Yang, X.; Wang, W.; Ping, F.

    2014-12-01

    Centered on the Tibetan Plateau, the Third Pole region is a unique geographical unit, which represents one of the largest ice masses on the Earth. The region has great impacts on environmental changes in China, the Northern Hemisphere and the globe.It also demonstrates sensitive feedbacks to global changes and the impacts of anthropogenic activities in surrounding regions. Like the Arctic and Antarctica, the Third Pole region is an especially sensitive area that draws great attention from the scientific community. In 2009, with support from the Chinese Academy of Sciences and international organizations, the Third Pole Environment (TPE) program, led by Chinese scientists, was officially launched. The program focuses on the theme of "water-ice-air-ecosystem-human" interactions, with the aim to address the following scientific questions, such as the spatial and temporal characteristics of past environmental changes in the Third pole, the interactions between hydrosphere and cryosphere and hazard processes, the ecological systems' impacts on and response to environmental changes, and the impacts of anthropogenic activities on environmental changes in the region and adaptation strategies. The goal of the program is to reveal environmental change processes and mechanisms on the Third Pole and their influences on and responses to global changes, and thus to serve for enhancement of human adaptation to the changing environment and realization of human-nature harmony. Under the leadership of the co-chairs, and relying on Scientific Committee and the TPE office, the program has accomplished a number of scientific tasks since its inauguration. TPE has made tremendous progress in the research of glacier changes, interactions between the westerlies and monsoon, establishment of field stations, data sharing and education.

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

    Science.gov (United States)

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

    2010-01-01

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

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

    Science.gov (United States)

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

    2014-08-29

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

  19. Nonunion of the femoral neck: Possibilities and limitations of the various treatment modalities

    Directory of Open Access Journals (Sweden)

    Raaymakers Ernst

    2008-01-01

    Full Text Available Nowadays in cases of nonunions of the femoral neck, the surgeon is tempted to perform prosthetic replacement of the hip, more so if there is also evidence of avascular necrosis of the head of femur. This provides rapid pain relief and allows early mobilization. However, long-term results of hip arthroplasties, especially in younger people and in the presence of osteopenia, are not always as expected; and a less radical approach is worth considering. The intertrochanteric valgization osteotomy, described by Pauwels, is an excellent alternative for healthy patients up to 65 years of age with a nonunion of the femoral neck. A union rate of 80-90% of the nonunion is described by most authors. Leg length inequallity, rotational and angular deformities can be corrected at the same time. During the period 1973-1995, we performed valgization osteotomy according to Pauwels in 66 patients of, 18-72 years old (mean 49.5 years. 24 (37% of our patients died 4 months to 24 years (mean: 9.5 years after the operation. Union of the femoral neck was achieved in 58 (88% of the 66 patients; union of the osteotomy in 65 patients (99%. A good or excellent result was achieved in 62% (23 uneventful and 13 with healed, necrosis/arthrosis without need for further treatment of our patients. However, the method has its limits. We feel if there is too little bone stock inside the femoral head, a valgization osteotomy does not give good result. The radiographic signs of avascular necrosis in patients over 30 years of age is considered a contraindication for an osteotomy. However our results show that it is worthwhile trying to save the joint of young patients even in case of a segmental collapse. In the race between revascularization and collapse, often revascularization is the winner. We deliberately give nature its chance and don′t rely on the result of bleeding from drill holes in the head, nuclear scans and other methods to estimate vascularity. A secondary total hip

  20. Reamed intramedullary exchange nailing in the operative treatment of aseptic tibial shaft nonunion.

    Science.gov (United States)

    Hierholzer, Christian; Friederichs, Jan; Glowalla, Claudio; Woltmann, Alexander; Bühren, Volker; von Rüden, Christian

    2017-08-01

    The aim of this study was to evaluate a standardized treatment protocol regarding the rate of secondary bone union, complications, and functional outcome. This study was started as a prospective study in a single Level I Trauma Centre between 2003 and 2012. The study group consisted of 188 patients with the diagnosis of an aseptic tibial shaft nonunion. Exchange nailing was performed following a standardized surgical protocol. Long-term follow-up was analyzed for rate of bone healing and functional outcome. Osseous healing was achieved in 182 out of 188 patients (97 %). In 165 out of 188 patients (88 %), bone healing was observed timely and uneventfully after a single exchange nailing procedure. An open approach was necessary in 32 patients (17 %). Twenty-three patients (12 %) required additional therapy such as extracorporeal shock wave therapy. Post-operative complications were observed in seven patients (4 %). Almost all patients demonstrated osseous healing within 12 months, with the majority of osseous healing occurring within six months. A relevant shortening of the fractured tibia was observed in 20 out of 188 patients (11 %). After a median follow-up of 23 months (range 12-45 months), outcome was evaluated using the assessment system of Friedman/Wyman. In summary, 154 out of 188 patients (82 %) had a good functional long-term result. Reamed intramedullary exchange nailing including correction of axis alignment is a safe and effective treatment of aseptic tibial shaft nonunion with a high rate of bone healing and a good radiological and functional long-term outcome.

  1. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures

    Directory of Open Access Journals (Sweden)

    Sampat S Dumbre Patil

    2016-01-01

    Full Text Available Background: When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN or surface implants like Dynamic Condylar Screw (DCS are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations. Materials and Methods: Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22-65 years and mean followup period was 52.1 months (range 27-72 months. Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery. Results: All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture. Conclusions: Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion.

  2. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures.

    Science.gov (United States)

    Dumbre Patil, Sampat S; Karkamkar, Sachin S; Patil, Vaishali S Dumbre; Patil, Shailesh S; Ranaware, Abhijeet S

    2016-01-01

    When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations. Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22-65 years) and mean followup period was 52.1 months (range 27-72 months). Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery. All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture. Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion.

  3. Fatigue failure and cracking in high mast poles.

    Science.gov (United States)

    2012-03-01

    This report presents the findings of a comprehensive research project to investigate the fatigue : cracking and failure of galvanized high mast illumination poles (HMIP). Ultrasonic inspection of : poles throughout the state has revealed the presence...

  4. Economics of Red Pine Management for Utility Pole Timber

    Science.gov (United States)

    Gerald H. Grossman; Karen Potter-Witter

    1991-01-01

    Including utility poles in red pine management regimes leads to distinctly different management recommendations. Where utility pole markets exist, managing for poles will maximize net returns. To do so, plantations should be maintained above 110 ft2/ac, higher than usually recommended. In Michigan's northern lower peninsula, approximately...

  5. Theoretical modeling and experimental analyses of laminated wood composite poles

    Science.gov (United States)

    Cheng Piao; Todd F. Shupe; Vijaya Gopu; Chung Y. Hse

    2005-01-01

    Wood laminated composite poles consist of trapezoid-shaped wood strips bonded with synthetic resin. The thick-walled hollow poles had adequate strength and stiffness properties and were a promising substitute for solid wood poles. It was necessary to develop theoretical models to facilitate the manufacture and future installation and maintenance of this novel...

  6. 46 CFR 111.79-3 - Grounding pole.

    Science.gov (United States)

    2010-10-01

    ... 46 Shipping 4 2010-10-01 2010-10-01 false Grounding pole. 111.79-3 Section 111.79-3 Shipping COAST... REQUIREMENTS Receptacles § 111.79-3 Grounding pole. Each receptacle outlet that operates at 100 volts or more must have a grounding pole. ...

  7. Second-harmonic imaging of poled silica waveguides

    DEFF Research Database (Denmark)

    Arentoft, Jesper; Pedersen, Kjeld; Bozhevolnyi, Sergey I.

    2000-01-01

    Electric-field poled silica-based waveguides are characterized by measurements of second-harmonic generation (SHG) and of the linear electro-optic effect (LEO). A SHG scanning technique allowing for high-resolution imaging of poled devices is demonstrated. Scans along the direction of the poling...

  8. Clusters of cyclones encircling Jupiter's poles.

    Science.gov (United States)

    Adriani, A; Mura, A; Orton, G; Hansen, C; Altieri, F; Moriconi, M L; Rogers, J; Eichstädt, G; Momary, T; Ingersoll, A P; Filacchione, G; Sindoni, G; Tabataba-Vakili, F; Dinelli, B M; Fabiano, F; Bolton, S J; Connerney, J E P; Atreya, S K; Lunine, J I; Tosi, F; Migliorini, A; Grassi, D; Piccioni, G; Noschese, R; Cicchetti, A; Plainaki, C; Olivieri, A; O'Neill, M E; Turrini, D; Stefani, S; Sordini, R; Amoroso, M

    2018-03-07

    The familiar axisymmetric zones and belts that characterize Jupiter's weather system at lower latitudes give way to pervasive cyclonic activity at higher latitudes. Two-dimensional turbulence in combination with the Coriolis β-effect (that is, the large meridionally varying Coriolis force on the giant planets of the Solar System) produces alternating zonal flows. The zonal flows weaken with rising latitude so that a transition between equatorial jets and polar turbulence on Jupiter can occur. Simulations with shallow-water models of giant planets support this transition by producing both alternating flows near the equator and circumpolar cyclones near the poles. Jovian polar regions are not visible from Earth owing to Jupiter's low axial tilt, and were poorly characterized by previous missions because the trajectories of these missions did not venture far from Jupiter's equatorial plane. Here we report that visible and infrared images obtained from above each pole by the Juno spacecraft during its first five orbits reveal persistent polygonal patterns of large cyclones. In the north, eight circumpolar cyclones are observed about a single polar cyclone; in the south, one polar cyclone is encircled by five circumpolar cyclones. Cyclonic circulation is established via time-lapse imagery obtained over intervals ranging from 20 minutes to 4 hours. Although migration of cyclones towards the pole might be expected as a consequence of the Coriolis β-effect, by which cyclonic vortices naturally drift towards the rotational pole, the configuration of the cyclones is without precedent on other planets (including Saturn's polar hexagonal features). The manner in which the cyclones persist without merging and the process by which they evolve to their current configuration are unknown.

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

    Science.gov (United States)

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

    2017-08-01

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

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

    Science.gov (United States)

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

    2015-10-01

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

  11. The Gattini South Pole UV experiment

    Science.gov (United States)

    Moore, Anna M.; Ahmed, Sara; Ashley, Michael C. B.; Croner, Ernest; Delacroix, Alex; Ebihara, Yusuke; Fucik, Jason; Martin, D. Christopher; Velur, Viswa; Weatherwax, Allan

    2012-09-01

    The Gattini South Pole UV experiment (Gattini SPUV) was deployed to the South Pole dark sector in February 2010 and has recently completed a highly successful first season of winter time observations. The experiment has, for the first time ever, measured and categorized the optical night sky brightness at the very blue wavelengths. The experiment consists of a remotely operated 6” aperture custom designed telescope. The telescope feeds a blue sensitive imager with 4 degree field of view that contains a bank of 3 filters: SDSS g’, Bessel U and a custom “super U” filter specifically designed to probe the sky emission at wavelengths approaching the atmospheric cut-off. The filters are continually cycled with exposure times ranging from 30 to 300 seconds throughout the winter period. The telescope, in addition, feeds a 2 degree long slit VPH grating spectrograph with R~1000. The bandwidth is 350-450nm. The spectra are recorded simultaneously with the imager exposures. The experiment is designed for low temperature Antarctic operation and resides on the roof of the MAPO building in the South Pole Antarctic sector. The primary science goals are to categorize the Antarctic winter-time sky background at the very bluest of wavelengths as a pathfinder for the Antarctic Cosmic Web Imager. We present a technical overview of the experiment and results from the first winter season.

  12. The South Pole and the Ross Sea

    Science.gov (United States)

    2002-01-01

    This image shows a rare clear view of the South Pole (lower right) and the Ross Sea, Antarctica. The Sea-viewing Wide Field-of-view Sensor (SeaWiFS) acquired the scene on December 26, 2001. The geographic South Pole is located in the center of Antarctica, at an altitude of 2,900 meters (9,300 feet). It rests on a continent-wide ice sheet that is 2,870 m thick, with the underlying bedrock only 30 m (98 feet) above sea level. The ice underlying the South Pole is as much as 140,000 years old, and is currently accumulating at about 82 cm (32 inches) per year. Roughly 2,500 km (1,550 miles) away is the green water of the Ross Sea, which indicates the presence of large numbers of phytoplankton. This is a highly productive part of the world's oceans. Also note the ice gathered around McMurdo Sound, seen toward the lefthand shoreline of the Ross Sea, at the edge of the Ross Ice Shelf. According to National Science Foundation researchers, this ice is making it difficult for penguins to reach their food supply. Separating the continental Antarctic ice sheet from the Ross Sea are the Queen Maud Mountains and the Ross Ice Shelf. Image courtesy the SeaWiFS Project, NASA/Goddard Space Flight Center, and ORBIMAGE

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

    Directory of Open Access Journals (Sweden)

    Miguel Morón

    2014-01-01

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

  14. Management of an Infected Nonunion of an Opening-Wedge High Tibial Osteotomy with 2-Stage Implantation of Rotating Hinge Knee Prosthesis

    Directory of Open Access Journals (Sweden)

    Sandrine Mariaux

    2018-01-01

    Full Text Available Introduction. High tibial osteotomy (HTO is a frequent and effective treatment for unicompartmental gonarthritis. Only a few articles are focused on the treatment of infected nonunion. Patient and Method. A 50-year-old obese patient was operated on by medial opening-wedge HTO. She developed a painful nonunion treated by hardware removal, allograft, and plate fixation. However, the nonunion persisted. 2 years later, cellulitis appeared with an abscess adjacent to the HTO plate. Despite surgical debridement and antibiotics, septic knee arthritis occurred. In a situation of infected nonunion and septic arthritis with chondrolysis, she was scheduled for a 2-stage total knee replacement (TKR. The infected tibial articular block was first resected and replaced by a cement spacer. After a short interval, the TKR was implanted. After 2 years, the patient walked pain-free with good knee function. Discussion. In the literature, different efficient treatments exist for infected nonunion after HTO, but comprehensive studies are missing for a consensus treatment. Current data are mostly based on case reports, since this pathology is quite rare. Conclusion. In a difficult situation of infected nonunion with septic knee arthritis, we performed a 2-stage knee prosthesis implantation. This led to an early mobilization and fast recovery.

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

    Science.gov (United States)

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

    2014-12-01

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

  16. Isolated radial neck delayed union/nonunion after conservative treatment in adults: two case reports and a literature review.

    Science.gov (United States)

    Babst, Christa; Brunner, Alexander; Babst, Reto

    2018-02-01

    Treatment recommendations for isolated radial neck delayed union/nonunion are sparse, but include mainly conservative treatment, electro-stimulation, bone grafting, open reduction and internal fixation (ORIF) and radial head resection. The purpose of this study was to perform a literature review on isolated delayed union/nonunion of radial neck fractures and to evaluate the reported outcomes of proposed treatment strategies. Furthermore, we aimed to generate data-based recommendations for this rare pathology. In the second part of this paper, we report two clinical cases of delayed union of isolated radial neck fractures recently treated at the senior authors institution. A literature search on PubMed was performed. We selected all papers with a documented delayed union, pseudarthrosis or nonunion of the radial neck. All papers were reviewed for patient demographics, patient occupation, treatment type and timing relative to the initial trauma, X-ray documentation and outcome. The two patients with delayed union after isolated radial neck fractures recently treated at our institution were evaluated for age, mechanism of injury, occupation, treatment and outcome. Clinical and radiological follow-up examinations were performed 6, 12 weeks, and 1 year after initial trauma. Final clinical evaluations included the Mayo Elbow Performance Score (MEPS) [1] and the Disabilities of the Arm, Shoulder and Hand (DASH) Score [2]. We found 17 cases reported in 11 articles matching our selection criteria of isolated radial neck delayed union or nonunion in adult patients. Average age was 55 years (range 29-73 years). The most frequent mechanism of injury was a fall on an outstretched arm from standing height. Initial treatment consisted of an arm sling for 1-4 weeks and physiotherapy. From the 17 included cases, six were operated on due to persistent pain. Three received bone grafts, one was supplemented with additional K-wire fixation, and three had radial head resections

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

    Science.gov (United States)

    Panasiuk, Michał; Kmieciak, Marek

    2004-01-01

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

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

    Science.gov (United States)

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

    2017-10-01

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

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

    Science.gov (United States)

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

    2017-11-13

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

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

    Science.gov (United States)

    Young, Andrew; Mirarchi, Adam

    2015-01-01

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

  1. Salvage of a femoral nonunion after primary non-Hodgkin's lymphoma of bone: a case report and literature review.

    Science.gov (United States)

    Xie, Xue Tao; Gao, You Shui; Zhang, Chang Qing

    2011-11-01

    With the advent of superb microsurgery techniques and advanced stabilization instruments, recent decades have seen great progress in treating nonunions secondary to traumatic fractures. However, those nonunions that are secondary to primary non-Hodgkin's lymphoma of bone and often related to irradiation still remain a challenging problem. The condition could be more perplexing when bone healing abilities are greatly compromised and reliable stabilization is difficult. We performed an operation using free vascularized fibular graft in combination with a locking plate on a 47-year-old female patient who had suffered from a three-year femoral nonunion after courses of radiochemotherapy for the treatment of primary non-Hodgkin's lymphoma of bone, a spontaneous femoral shaft fracture, an intramedullary nailing, and some nonoperative interventions in sequence. Primary union of the graft was obtained at 9 months without wound infection. No recurrence of lymphoma occurred in the 61-month follow-up, nor did a stress fracture or failure of fixation. Limb salvage was achieved and the range of motion of the adjacent joints was acceptable. Free vascularized fibular graft in combination with a locking plate can effectively enhance bone union in compromised bone and soft tissue milieu. More cases have yet to be further investigated.

  2. Arthroscopic Treatment of a Displaced Nonunion of the Anterior Inferior Iliac Spine Causing Extra-articular Impingement.

    Science.gov (United States)

    Shibahara, Motoi; Ohnishi, Yasuo; Honda, Eisaburo; Matsuda, Dean K; Uchida, Soshi

    2017-07-01

    This report describes a case of nonunion of an anterior inferior iliac spine (AIIS) apophyseal avulsion fracture with resultant subspine impingement combined with symptomatic femoroacetabular impingement (FAI). A 16-year-old male soccer player presented with a 6-month history of right groin pain exacerbated by kicking and running. The patient was diagnosed with a displaced nonunion of the AIIS apophysis avulsion fracture causing secondary extra-articular impingement beyond cam-type FAI by physical examination and radiological findings. The authors performed arthroscopic AIIS decompression, with concurrent FAI correction and labral repair and capsular closure. At 4 months after surgery, a radiograph and a computed tomography scan showed complete bony union of the AIIS apophyseal nonunion. Modified Harris Hip Sore and Nonarthritic Hip Score improved from 74.8 and 61, respectively, to 100 for both at final follow-up. The effectiveness of arthroscopic decompression of the AIIS as part of a comprehensive minimally invasive surgery including FAI correction and labral repair resulted in complete union of the AIIS and pain-free return to sport and bony union. [Orthopedics. 2017; 40(4):e725-e728.]. Copyright 2017, SLACK Incorporated.

  3. Surgical treatment of tibial nonunion after wounding by high velocity missile and external fixators: A case report

    Directory of Open Access Journals (Sweden)

    Golubović Ivan

    2012-01-01

    Full Text Available Introduction. The missiles of modern firearms can cause severe fractures of the extremity. High velocity missile fractures of the tibia are characterized by massive tissue destruction and primary contamination with polymorphic bacteria. Treatment of these fractures is often complicated by delayed healing, poor position healing, nonhealing and bone tissue infection. Case Outline. We present the management of tibial nonunion after wounding by high velocity missile and primary treatment by external fixation in a 25-year-old patient. The patient was primarily treated with external fixation and reconstructive operations of the soft tissue without union of the fracture. Seven months after injury we placed a compression-distraction external fixator type Mitkovic and started with compression and distraction in the fracture focus after osteotomy of the fibula and autospongioplasty. We recorded satisfactory fracture healing and good functional outcome. Conclusion. Contamination and devitalization of the softtissue envelope increase the risk of infection and nonunion in fractures after wounding by high velocity missile. The use of the compression-distraction external fixator type Mitkovic may be an effective method in nonunions of the tibia after this kind of injury. [Projekat Ministarstva nauke Republike Srbije, br. III 41004

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

    Directory of Open Access Journals (Sweden)

    Mohsen Nourbakhsh

    2012-01-01

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

  5. Cement Calcaneoplasty: An Innovative Method for Treating Nonunion in Calcaneal Insufficiency Fracture.

    Science.gov (United States)

    Godavitarne, Charles; Fawzy, Ernest; Giancola, Giorgio; Louette, Luc

    2016-01-01

    Insufficiency type stress fractures are common in older patients with osteoporosis. Persistent pain after nonunion of these fractures can be disabling, with the management options often limited. We aimed to assess the suitability of fluoroscopic-guided injection of bone cement into a persistently symptomatic nonuniting calcaneal insufficiency fracture. To the best of our knowledge, this technique has not previously been described in the published data. After local subcutaneous anesthesia, the midpoint of the fracture site was accessed by trocar insertion under radiographic guidance, and bone cement was injected directly into the site. A preprocedure visual analog scale pain score of 90 of 100 was recorded. This had improved to 0 of 100 at the 12-month follow-up point after the procedure. The aim of the present case report was to raise awareness of percutaneous calcaneoplasty, which we believe to be a safe and well-tolerated technique for the management of osteoporotic insufficiency fracture of the calcaneus. We propose that this technique be considered when conservative methods aimed at promoting fracture healing have failed. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  6. Atypical Chronic Ankle Instability in a Pediatric Population Secondary to Distal Fibula Avulsion Fracture Nonunion.

    Science.gov (United States)

    El Ashry, Saad R; El Gamal, Tarek A; Platt, Simon R

    Chronic ankle instability is a disabling condition, often occurring as a result of traumatic ankle injury. A paucity of published data is available documenting chronic ankle instability in the pediatric population. Much of the data has been confined to the adult population. We present 2 cases of chronic ankle instability, 1 in a 12-year-old and 1 in a 9-year-old patient. Unlike the typical adult etiology, the cause of instability was a dysfunctional lateral ligamentous complex as a consequence of bony avulsion of the tip of the fibula. Both patients had sustained a twisting injury to the ankle. The fractures failed to unite. The nonunion resulted in dysfunction of the anterior talofibular ligament with consequent chronic ankle instability. At the initial clinical assessment, magnetic resonance imaging was requested for both patients. In patient 1 (12 years old), the fracture was fixed with 2 headless screws and was immobilized in a plaster cast for 6 weeks. In patient 2 (9 years old), because of the small size of the avulsed fragment, fixation was not possible. A modified Gould-Broström procedure was undertaken, facilitating repair of the avulsed fragment using anchor sutures. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  7. Comparative study of the effect of PTH (1-84) and strontium ranelate in an experimental model of atrophic nonunion.

    Science.gov (United States)

    Pérez Núñez, M I; Ferreño Blanco, D; Alfonso Fernández, A; Casado de Prado, J A; Sánchez Crespo, M; De la Red Gallego, M; Pascual Carra, A; Rodriguez López, T; Diego Cavia, S; Garcés Zarzalejo, C; Mayorga Fernández, M; Ruiz Martínez, E; Carrascal Vaquero, I; Riancho Moral, J A

    2015-12-01

    This study aimed to set up an experimental model of long bone atrophic nonunion and to explore the potential role of PTH-1-84 (PTH 1-84) and strontium ranelate (SrR). A model of atrophic nonunion was created in Sprague-Dawley rats at the femoral midshaft level. The animals were randomised into four groups. Group A1: control rodents, fracture without bone gap; Group A2: rodents with subtraction osteotomy (non-union model control) treated with saline; Group B: rodents with subtraction osteotomy treated with human-PTH (PTH 1-84); and Group C: rodents with subtraction osteotomy treated with strontium ranelate (SrR). The groups were followed for 12 weeks. X-rays were be obtained at weeks 1, 6 and 12. After sacrificing the animals, we proceeded to the biomechanical study and four point bending tests to evaluate the resistance of the callus and histological study. In second phase, the expression of genes related to osteoblast function was analysed by reverse transcription-quantitative PCR in rats subjected to substraction osteotomy and treated for 2 weeks. The animals were randomised into three groups: Group A2: rodents treated with saline; Group B: rodents treated with PTH 1-84 and Group C: rodents treated with SrR. No significant histological differences were found between animals subjected to subtraction osteotomy and treated with either saline or PTH (p=0.628), but significant difference existed between animals receiving saline or SrR (p=0.005). There were no significant differences in X-ray score between the saline and PTH groups at either 6 or 12 weeks (p=0.33 and 0.36, respectively). On the other hand, better X-ray scores were found in the SrR group (p=0.047 and 0.006 in comparison with saline, at 6 and 12 weeks, respectively). In line with this, biomechanical tests revealed improved results in the SrR group. Gene expression analysis revealed a slightly decreased levels of DKK1, a Wnt pathway inhibitor, in rats treated with SrR. SrR increases has a beneficial

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

    Directory of Open Access Journals (Sweden)

    Eduardo Amaral Gomes

    2012-01-01

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

  9. Secondary electron emission yield on poled silica based thick films

    DEFF Research Database (Denmark)

    Braga, D.; Poumellec, B.; Cannas, V.

    2004-01-01

    injection, we pointed out an electric field 0.5 µm below the surface for our poling conditions and directed in the same direction as the external field applied during the poling process. Then, the dependence of on the injected dose of electrons allows us to deduce that the poling process disturbs the glass......Studies on the distribution of the electric field produced by a thermal poling process in a layer of Ge-doped silica on silicon substrate, by using secondary electron emission yield (SEEY) measurements () are presented. Comparing 0 between poled and unpoled areas, the SEEY at the origin of electron...... structure strongly enough for leading to a weak conductivity. It is then easy to display the poled areas. We have also pointed out an effect of the electric properties of the glass on the measurements obtained with the Electron Probe for MicroAnalysis....

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

    Directory of Open Access Journals (Sweden)

    Gille Justus

    2012-05-01

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

  11. Multiple pole in the electron--hydrogen-atom scattering amplitude

    International Nuclear Information System (INIS)

    Amusia, M.Y.; Kuchiev, M.Y.

    1982-01-01

    It is demonstrated that the amplitude for electron--hydrogen-atom forward scattering has the third-order pole at the point E = -13.6 eV, E being the energy of the incident electron. The coefficients which characterize the pole are calculated exactly. The invalidity of the Born approximation is proved. The contribution of the pole singularity to the dispersion relation for the scattering amplitude is discussed

  12. Determination of the crystallite orientation distribution from direct pole figures

    International Nuclear Information System (INIS)

    Araujo Gomes, P.A.M. de.

    1977-01-01

    A method is described which allows to calculate the crystallite orientation distribution in polycrystalline material, from direct pole figures data of its crystallographic planes (Roe's Method). The programme was applied to (1010), (0002), (1011) and (1120) complete pole figures data for a commercial, thin sheet Zircaloy-4 tubing specimen. A semi-automatic Rigaku-Denki texture goniometer, which scans the reciprocal lattice sphere pointwise outputting the data in a punched tape, was used to obtain the pole figures. This is consistent with the results obtained through direct conclusion from the pole figures. (author)

  13. South Pole Region of the Moon as Seen by Clementine

    Science.gov (United States)

    1994-01-01

    Lunar mosaic of 1500 Clementine images of the south polar region of the moon. The projection is orthographic, centered on the south pole. The Schrodinger Basin (320 km in diameter) is located in the lower right of the mosaic. Amundsen-Ganswindt is the more subdued circular basin between Schrodinger and the pole. The polar regions of the moon are of special interest because of the postulated occurrence of ice in permanently shadowed areas. The south pole is of greater interest because the area that remains in shadow is much larger than that at the north pole.

  14. Thermal poling of multi-wire array optical fiber

    DEFF Research Database (Denmark)

    Huang, Lin; An, Honglin; Hayashi, Juliano G.

    2018-01-01

    We demonstrate in this paper thermal poling of multi-wire array fibers, which extends poling of fibers with two anodes to similar to 50 and similar to 500 wire array anodes. The second harmonic microscopy observations show that second order nonlinearity (SON) layers are developed surrounding all...... the rings of wires in the similar to 50 anode array fiber with poling of 1.8kV, 250 degrees C and 30min duration, and the outer rings of the similar to 500 anode array fiber at lower poling temperature. Our simulations based on a two-dimensional charge dynamics model confirm this can be explained...

  15. Bridging the Poles: Education Linked with Research

    Science.gov (United States)

    Pfirman, S.; Bell, R. E.; Turrin, M.; Maru, P.

    2004-12-01

    An international group of 65 scientists, educators and media specialists gathered at the "Bridging the Poles" workshop in Washington, DC on June 23-25, to define strategies that will inspire the general public and engage the next generation of polar scientists, engineers and leaders. This NSF-sponsored workshop was the first effort to develop an integrated education and outreach program for the International Polar Year of 2007-2009. Through a series of plenary talks and roundtable discussions, workshop participants focused on: engaging diverse communities, opportunities and needs for different levels, possibilities for thematic areas, and programs to feature nationally and internationally over the next 5 years. To maximize the potential of the International Polar Year, we need to coordinate research, education and outreach efforts, at the international as well as national level, with the goal of building an integrated and exciting public presence during 2007-2009. Successful education and outreach programming requires leveraging existing resources, creating new programs, connecting communities, and developing partnerships between agencies, scientists, educators, and the public. We need to consider the rich heritage of indigenous Arctic peoples, build capacity within communities through targeted efforts, and focus on making the poles relevant to diverse communities by using interdisciplinary approaches, e.g. cultural as well as scientific. A series of education and outreach packages for large-scale science endeavors should be rolled out to the public as major media events. The media -- television, radio and print -- as well as educators, zoos and museums are eager to use timely, accessible, and meaningful content. An Interagency Working Group on IPY Education and Outreach, with a staff and a central office, must be created to coordinate and leverage programs. A sophisticated web portal should be developed to serve content and contacts for researchers, educators, the

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

    Science.gov (United States)

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

    2018-01-01

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

  17. Retratos da metrópole parisiense

    OpenAIRE

    Saint-Julien, Thérèse; Goix, Renaud Le

    2009-01-01

    « La métropole parisienne, centralité, inégalité, proximité » propõe uma leitura e uma interpretação das tendências do território da Île de France (a região que inclui Paris e sete outros départements), ou seja, uma grande metrópole mundial de cerca de 11,3 milhões de habitantes em 2004, ligada às redes da globalização e da metropolização. O livro esboça os traços principais de suas estruturas territoriais emergentes, sublinha os desafios, o alcance dos mesmos e as contradições. Sem pretensão...

  18. Retratos da metrópole parisiense

    Directory of Open Access Journals (Sweden)

    Thérèse Saint-Julien

    2009-07-01

    Full Text Available « La métropole parisienne, centralité, inégalité, proximité » propõe uma leitura e uma interpretação das tendências do território da Île de France (a região que inclui Paris e sete outros départements, ou seja, uma grande metrópole mundial de cerca de 11,3 milhões de habitantes em 2004, ligada às redes da globalização e da metropolização. O livro esboça os traços principais de suas estruturas territoriais emergentes, sublinha os desafios, o alcance dos mesmos e as contradições. Sem pretensão...

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

    Science.gov (United States)

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

    2017-01-01

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

  20. Orthogonal Double Plating and Autologous Bone Grafting of Postoperative Humeral Shaft Nonunion – A Rare Case Report and Review of Literature

    Science.gov (United States)

    Metikala, Sreenivasulu; Bhogadi, Prabhudheer

    2015-01-01

    Introduction: Nonunion following surgical stabilization of humeral shaft fractures, although infrequent, remains a challenge as limited surgical options are available. The difficulties in re-fixation are due to osteolysis produced by the loose implant components and disuse osteopenia of the entire bone segment. We share our experience in the management of a long standing diaphyseal nonunion of humerus following titanium LCP fixation. Case Report: A 58 years old woman presented with 20 months old nonunion following titanium LCP fixation of her closed humeral shaft fracture, done elsewhere. The interesting intraoperative findings, noteworthy, are about the extensive metallosis and the gross cortical defect measuring 10cm x 1cm x 1cm, corresponding to the foot print of the previous plate with exposed medullary canal. It was managed by debridement, dual plate fixation using 9 holed and 12 holed stainless steel LCPs in an orthogonal fashion and autologous bone grafting. The nonunion healed in 5 months and she regained all the movements except for terminal 10° of elbow extension and 15° of shoulder abduction at her final follow up of 30 months. According to Stewart and Hundley classification the final result was found to be good. Conclusion: We recommend the judicious use of long and short plates in 90-90 orientation along with autogenous bone grafting in the management of a long standing humeral shaft nonunion having extensive cortical resorption following surgical stabilization by plating. PMID:27299099

  1. Jupiter's interior and deep atmosphere: The initial pole-to-pole passes with the Juno spacecraft

    Science.gov (United States)

    Bolton, S. J.; Adriani, A.; Adumitroaie, V.; Allison, M.; Anderson, J.; Atreya, S.; Bloxham, J.; Brown, S.; Connerney, J. E. P.; DeJong, E.; Folkner, W.; Gautier, D.; Grassi, D.; Gulkis, S.; Guillot, T.; Hansen, C.; Hubbard, W. B.; Iess, L.; Ingersoll, A.; Janssen, M.; Jorgensen, J.; Kaspi, Y.; Levin, S. M.; Li, C.; Lunine, J.; Miguel, Y.; Mura, A.; Orton, G.; Owen, T.; Ravine, M.; Smith, E.; Steffes, P.; Stone, E.; Stevenson, D.; Thorne, R.; Waite, J.; Durante, D.; Ebert, R. W.; Greathouse, T. K.; Hue, V.; Parisi, M.; Szalay, J. R.; Wilson, R.

    2017-05-01

    On 27 August 2016, the Juno spacecraft acquired science observations of Jupiter, passing less than 5000 kilometers above the equatorial cloud tops. Images of Jupiter's poles show a chaotic scene, unlike Saturn's poles. Microwave sounding reveals weather features at pressures deeper than 100 bars, dominated by an ammonia-rich, narrow low-latitude plume resembling a deeper, wider version of Earth's Hadley cell. Near-infrared mapping reveals the relative humidity within prominent downwelling regions. Juno's measured gravity field differs substantially from the last available estimate and is one order of magnitude more precise. This has implications for the distribution of heavy elements in the interior, including the existence and mass of Jupiter's core. The observed magnetic field exhibits smaller spatial variations than expected, indicative of a rich harmonic content.

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

    Science.gov (United States)

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

    2016-04-01

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

  3. Spectral analysis of gluonic pole matrix elements for fragmentation

    NARCIS (Netherlands)

    Gamberg, L. P.; Mukherjee, A.B.; Mulders, P.J.G.

    2008-01-01

    The nonvanishing of gluonic pole matrix elements can explain the appearance of single spin asymmetries in high-energy scattering processes. We use a spectator framework approach to investigate the spectral properties of quark-quark-gluon correlators and use this to study gluonic pole matrix

  4. pbx is required for pole and eye regeneration in planarians.

    Science.gov (United States)

    Chen, Chun-Chieh G; Wang, Irving E; Reddien, Peter W

    2013-02-01

    Planarian regeneration involves regionalized gene expression that specifies the body plan. After amputation, planarians are capable of regenerating new anterior and posterior poles, as well as tissues polarized along the anterior-posterior, dorsal-ventral and medial-lateral axes. Wnt and several Hox genes are expressed at the posterior pole, whereas Wnt inhibitory genes, Fgf inhibitory genes, and prep, which encodes a TALE-family homeodomain protein, are expressed at the anterior pole. We found that Smed-pbx (pbx for short), which encodes a second planarian TALE-family homeodomain transcription factor, is required for restored expression of these genes at anterior and posterior poles during regeneration. Moreover, pbx(RNAi) animals gradually lose pole gene expression during homeostasis. By contrast, pbx was not required for initial anterior-posterior polarized responses to wounds, indicating that pbx is required after wound responses for development and maintenance of poles during regeneration and homeostatic tissue turnover. Independently of the requirement for pbx in pole regeneration, pbx is required for eye precursor formation and, consequently, eye regeneration and eye replacement in homeostasis. Together, these data indicate that pbx promotes pole formation of body axes and formation of regenerative progenitors for eyes.

  5. Second harmonic generation from corona-poled polymer thin films ...

    Indian Academy of Sciences (India)

    2014-02-09

    Feb 9, 2014 ... We characterize thermal stability of second harmonic generation (SHG) properties of four different Y-type polymers poled using corona poling method. These polymers are based on donor–acceptor–donor-type repeating unit with different aromatic moieties acting as donors and dicyanomethylene acting as ...

  6. Derivation of nominal strength for wood utility poles

    Science.gov (United States)

    Ronald W. Wolfe; Jozsef Bodig; Patricia Lebow

    2001-01-01

    The designated fiber stress values published in the American National Standards Institute Standard for Poles, ANSI 05.1, no longer reflect the state of the knowledge. These values are based on a combination of test data from small clear wood samples and small poles (

  7. Second harmonic generation from corona-poled polymer thin films ...

    Indian Academy of Sciences (India)

    2014-02-09

    Feb 9, 2014 ... Abstract. We characterize thermal stability of second harmonic generation (SHG) properties of four different Y-type polymers poled using corona poling method. These polymers are based on donor–acceptor–donor-type repeating unit with different aromatic moieties acting as donors and dicyanomethylene ...

  8. Three Phase Soft Commutation Auxilary Resonant Pole Inverter

    OpenAIRE

    Vaclav Sladecek

    2006-01-01

    This paper covers the circuit modification of the power part of the inverter with auxiliary resonant poles utilising configuration of switches realised with routinely produced IGBT modules. Covered is also the control optimisation which goal is the minimisation of switching of the auxiliary resonant pole. Presented results were gained on a prototype of an inverter laboratory sample.

  9. Finite element analyses of wood laminated composite poles

    Science.gov (United States)

    Cheng Piao; Todd F. Shupe; R.C. Tang; Chung Y. Hse

    2005-01-01

    Finite element analyses using ANSYS were conducted on orthotropic, polygonal, wood laminated composite poles subjected to a body force and a concentrated load at the free end. Deflections and stress distributions of small-scale and full-size composite poles were analyzed and compared to the results obtained in an experimental study. The predicted deflection for both...

  10. Gluability of out-of-service utility poles

    Science.gov (United States)

    Han Roliadi; Chung Y. Hse; Elvin T. Choong; Todd F. Shupe

    2000-01-01

    This investigation determined the gluability of weathered, out-of-service southern yellow pine (SYP) (Pinus spp.) utility poles. Three types of adhesives were used: resorcinol-phenol formaldehyde (RPF), polyvinyl acetate (PVA), and casein. The poles consisted of two service duration groups: 5 and 25 years. Longer weathering caused greater reduction in creosote content...

  11. Solar Open Flux Migration from Pole to Pole: Magnetic Field Reversal.

    Science.gov (United States)

    Huang, G-H; Lin, C-H; Lee, L C

    2017-08-25

    Coronal holes are solar regions with low soft X-ray or low extreme ultraviolet intensities. The magnetic fields from coronal holes extend far away from the Sun, and thus they are identified as regions with open magnetic field lines. Coronal holes are concentrated in the polar regions during the sunspot minimum phase, and spread to lower latitude during the rising phase of solar activity. In this work, we identify coronal holes with outward and inward open magnetic fluxes being in the opposite poles during solar quiet period. We find that during the sunspot rising phase, the outward and inward open fluxes perform pole-to-pole trans-equatorial migrations in opposite directions. The migration of the open fluxes consists of three parts: open flux areas migrating across the equator, new open flux areas generated in the low latitude and migrating poleward, and new open flux areas locally generated in the polar region. All three components contribute to the reversal of magnetic polarity. The percentage of contribution from each component is different for different solar cycle. Our results also show that the sunspot number is positively correlated with the lower-latitude open magnetic flux area, but negatively correlated with the total open flux area.

  12. Operative Fixation of an Anterior Inferior Iliac Spine Apophyseal Avulsion Fracture Nonunion in an Adolescent Soccer Player: A Case Report.

    Science.gov (United States)

    Carr, James B; Conte, Evan; Rajadhyaksha, Evan A; Laroche, Kevin A; Gwathmey, F Winston; Carson, Eric W

    2017-01-01

    A 14-year-old male competitive soccer player presented with a history of recurrent right hip pain for 18 months. He was diagnosed with an anterior inferior iliac spine (AIIS) apophyseal avulsion fracture nonunion with subspinal impingement, which was confirmed by radiographs, computed tomography, and magnetic resonance imaging. The patient underwent surgical fixation and subspinal decompression. He returned to competitive soccer 5 months postoperatively. AIIS apophyseal avulsion fractures occur in adolescent athletes and generally respond to nonoperative treatment. When such management is unsuccessful, surgical fixation can lead to resolution of pain with return of full function.

  13. Management of displaced inferior patellar pole fractures with modified tension band technique combined with cable cerclage using Cable Grip System.

    Science.gov (United States)

    Yang, Xu; Wu, Qinfen; Lai, Chin-Hui; Wang, Xin

    2017-10-01

    We present a modified tension band technique combined with cable cerclage using Cable Grip System for the treatment of displaced inferior patellar pole fractures and report the knee functional outcome. The patients who had had operative treatment of a displaced inferior patellar pole fracture (AO/OTA 34-A1) between December 2013 and December 2015 were studied retrospectively. Eleven consecutive patients had had open reduction and internal fixation with the modified technique using Cable Grip System, of whom, five males and six females with an average age of 60.9 years (range, 29-81 years). All fractures occurred from direct fall onto the knee. The average time from injury to surgery was 6.1days (range, 2-12days). The range of motion (ROM) was measured in degrees by goniometry at postoperative intervals of 1, 2, 4, 12, and 48 weeks; Knee function was evaluated using the Rasmussen scores at final follow-up. No patients had nonunion, loss of reduction, migration of wire, irritation from the implant and fixation breakage during the follow-up period. Recovery of ROM was achieved at 12 weeks, with the average ROM at 1 week was 72° (range, 65°-78°), 86.4° (range, 78°-92°) at 2 weeks, 115.5° (range, 103°-122°) at 4 weeks, 129.6° (range, 122°-133°) at 12 weeks, 134.5° (range, 129°-139°) at 48 weeks after the operation. Concerning the knee function outcome assessment, all patients showed excellent results at final follow-up. The average Rasmussen scores was 27.9 out of 30 (range, 27-29). The modified tension band technique combined with cable cerclage using Cable Grip System for displaced inferior patellar pole fractures can provide stable fixation with excellent results in knee function, allows for immediate mobilization and early weight-bearing, which is a simple and valuable technique in routine clinical practice. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Pole Dancing Auto-ethnography – Practice, Pedagogy, Performance

    Directory of Open Access Journals (Sweden)

    Amy Patricia Cadwallader

    2017-02-01

    Full Text Available In this research paper, the author addresses the following four questions: 1 What are the implications of bringing pole dancing into concert dance, not as a caricature or theatrical version of what is performed in strip clubs, but as its own, free-standing art form? 2 In what ways will years of ballet and modern dance training influence the type of dancing that emerges from dancers when poles and other apparatuses are introduced? 3 How can the author create an original pole dancing style and pedagogical methods for teaching it? 4 Who participates in pole fitness classes and how does the demographic change based on location? What about when pole fitness classes are offered in an academic setting? The author shares first-hand experiences of investigating pole dancing in fitness classes, attending performances, engaging in a rehearsal process with highly trained dancers, and teaching pole dancing to movers with a wide range of abilities. The author addresses how research plans changed as she encountered limitations of budget and time constraints. The author also elaborates on the creative process that she engaged in with her thesis cast, collaborators, and supporting designers in the making of Super-beneath, a theatrical dance work that uses five, free-standing poles. She outline the vignettes, overall structure, and narrative of the work. The author then discusses where this research fits into the larger field of pole dancing, and the even larger field of dance. In the final sections of this paper, the author describes her pedagogical practices relating to pole classes, what “practice as research” means to her, and how she would like to continue on this research trajectory in the future.

  15. Simplified Analytic Approach of Pole-to-Pole Faults in MMC-HVDC for AC System Backup Protection Setting Calculation

    Directory of Open Access Journals (Sweden)

    Tongkun Lan

    2018-01-01

    Full Text Available AC (alternating current system backup protection setting calculation is an important basis for ensuring the safe operation of power grids. With the increasing integration of modular multilevel converter based high voltage direct current (MMC-HVDC into power grids, it has been a big challenge for the AC system backup protection setting calculation, as the MMC-HVDC lacks the fault self-clearance capability under pole-to-pole faults. This paper focused on the pole-to-pole faults analysis for the AC system backup protection setting calculation. The principles of pole-to-pole faults analysis were discussed first according to the standard of the AC system protection setting calculation. Then, the influence of fault resistance on the fault process was investigated. A simplified analytic approach of pole-to-pole faults in MMC-HVDC for the AC system backup protection setting calculation was proposed. In the proposed approach, the derived expressions of fundamental frequency current are applicable under arbitrary fault resistance. The accuracy of the proposed approach was demonstrated by PSCAD/EMTDC (Power Systems Computer-Aided Design/Electromagnetic Transients including DC simulations.

  16. Variability in the definition and perceived causes of delayed unions and nonunions: a cross-sectional, multinational survey of orthopaedic surgeons.

    Science.gov (United States)

    Bhandari, Mohit; Fong, Katie; Sprague, Sheila; Williams, Dale; Petrisor, Bradley

    2012-08-01

    Despite the large number of fracture outcome studies, there remains variability in the definitions of fracture-healing. It is unclear how orthopaedic surgeons are diagnosing and managing delayed unions and nonunions in clinical practice. We aimed to explore the current opinions of orthopaedic surgeons with regard to defining, diagnosing, and treating delayed unions and nonunions in extremity fractures. We developed a survey using previous literature, key informants in the field of orthopaedic surgery, and a sample-to-redundancy strategy. Our final survey contained four sections and twenty-nine questions focusing on demographics and surgical experience, definitions of fracture union, prognostic factors for union, and the need for clinical trials. The Internet-based survey and follow-up e-mails were continued until our a priori sample size of a minimum of 320 completed and eligible responses were collected. Three hundred and thirty-five surgeons completed the survey. The typical respondent was a North American, male orthopaedic surgeon or consultant over the age of thirty years who had completed trauma fellowship training, worked in an academic practice, supervised residents, and had more than six years of experience in treating orthopaedic injuries. Most surgeons endorsed a lack of standardization in definitions for delayed unions (73%) and nonunions (55%); almost all agreed that defining a delayed union and nonunion should be done on the basis of both radiographic and clinical criteria (88%). Most respondents believed that the degree of soft-tissue injury (approximately 93%), smoking history (approximately 82%), and vascular disease (approximately 76%) increased the risk of healing complications. Surgeons use similar prognostic factors to define and assess delayed unions and nonunions, but there is a lack of consensus in the definitions of delayed union and nonunion. The need for standardization and future randomized trials was strongly endorsed.

  17. Heavy Cratering near Callisto's South Pole

    Science.gov (United States)

    1997-01-01

    Images from NASA's Galileo spacecraft provide new insights into this region near Callisto's south pole. This two frame mosaic shows a heavily cratered surface with smooth plains in the areas between craters. North is to the top of the image. The smoothness of the plains appears to increase toward the south pole, approximately 480 kilometers (293 miles) south of the bottom of the image. This smoothness of Callisto's surface was not evident in images taken during the 1979 flyby of NASA's Voyager spacecraft because the resolution was insufficient to show the effect. This smooth surface, and the process(es) that cause it, are among the most intriguing aspects of Callisto. Although not fully understood, the process(es) responsible for this smoothing could include erosion by tiny meteorites and energetic ions. Some craters, such as Keelut, the 47 kilometer (29 mile) crater in the lower right corner, have sharp, well defined rims. Keelut contains an inner ring surrounding a central depression about 17 kilometers (11 miles) in diameter. Keelut, and the more irregularly shaped, degraded Reginleif, the 32 kilometer (19.5 mile) crater in the top center of the image, are very shallow and have flat floors. Crater forms can be seen down to less than 2 kilometers (1.2 miles) in diameter in the image. Each picture element (pixel) in this image is approximately 0.68 kilometers (0.41 miles) across.This image which was taken by the Galileo spacecraft's solid state imaging (CCD) system during its eighth orbit around Jupiter, on May 6th, 1997. The center of the image is located at 71.3 degrees south latitude, 97.6 degrees west longitude, and was taken when the spacecraft was approximately 35,470 kilometers (21,637 miles) from Callisto.The Jet Propulsion Laboratory, Pasadena, CA manages the mission for NASA's Office of Space Science, Washington, DC.This image and other images and data received from Galileo are posted on the World Wide Web, on the Galileo mission home page at URL http

  18. Noise generation mechanisms in claw pole alternators

    Science.gov (United States)

    Eversman, W.; Burns, S.; Pekarek, S.; Bai, Hua; Tichenor, J.

    2005-05-01

    Noise of claw pole alternators, generated electromagnetically and structurally radiated, has been the subject of an extensive research program. The goal has been to identify and reduce noise radiation mechanisms in claw pole (Lundell) alternators used in automotive applications. Two approaches have been followed. In the first, electromagnetic sources of noise have been investigated by lumped parameter and magnetically equivalent circuit modeling and simulation, and by related experimentation. This is the subject of separate papers. The second, concurrent study reported here has investigated machine and mount responses to an electromagnetically generated torque ripple. Modeling and experimentation has led to the conclusion that there exists a high correlation between electromagnetic sources, torque ripple, and radiated noise. Experimentation also has led to the conclusion that noise characteristics of a given machine are substantially altered by modification of the mounting configuration. The work reported here involves modeling, simulation, and experiment to isolate machine dynamic characteristics and mounting geometries which contribute to strong coupling between torque ripple and machine/mount dynamic response. A low-order model of the alternator which includes shaft flexibility, gyroscopic effects, shaft bearing asymmetry, mounting lug geometry, and mounting structure dynamics has been created. The model provides a rapid simulation of dynamic response in the form of a transfer function between torque ripple and mounting forces. Generic studies of a simplified mounting structure coupled to the machine model are presented here. Acoustic testing of several machine configurations on a production mount has been carried out to investigate 36th order noise in three phase machines and 72nd order noise in six-phase machines. Electromagnetic modeling and dynamic response simulations suggest that the six-phase machine is inherently quieter. This is supported by

  19. Territorial Balancing of Poles of Development

    Directory of Open Access Journals (Sweden)

    CLAUDIA POPESCU

    2008-01-01

    Full Text Available The paper is part of the study "Specific problems of the development of the settlement network in south-eastern Romania. Regions of development 3 (South, 4 (South-West and 8 (Bucharest-Ilfov" elaborated during 2004 – 2006, within the AMTRANS programme funded by the Ministry of Education and Research, coordinated by INCD – URBANPROIECT in partnership with the Institute of Geography of the Romanian Academy and the Qualification in Statistics National Centre. The general objective of the project was sustainable and balanced spatial development of the settlement network and promotion of new relationships between urban and rural. Concretely, the study has produced a model of a polycentric and balanced settlement network according to the European principles. The case study testing and validating this model took place in southern Romania, territory exhibiting acutely the entire range of problems related to the state of the settlement network: profoundly large rural areas, accentuated dynamics of declaring new cities without sufficient evidence, excessive polarization exercised by Bucharest, etc. The paper presents the intervention directions needed to balance in the territory urban poles within the studied area, focusing on the establishment of orientation policies to consolidate the role of each settlement based on the hierarchical level of importance: European, national, regional, and local. The paper also identifies possible functional urban areas: the metropolitan area of Bucharest, areas of potential strategic integration, areas of cooperation between the small and medium-sized cities and the rural regions. Within each of these areas, the paper proposes to establish new relationships between urban and rural based on partnership, involving cooperation and coordination in achieving common goals.The study considers that the poles of development are the key element of proposed model, and their identification, formation, and balanced distribution

  20. Pole preservatives in soils adjacent to in-service utility poles in the United States. Final report

    International Nuclear Information System (INIS)

    Taylor, B.B.; Ripp, J.A.; Ladwig, K.

    1997-12-01

    As a result of increasing concerns regarding the environmental fate of wood preservatives, EPRI carried out a study of soils in the vicinity of in-service wood pole sites. More than 8,000 soil samples adjacent to 180 PCP-treated and 22 creosote-treated wood poles were collected and analyzed for chemicals of interest. The results showed that concentrations of wood preservative chemicals tended to be highest in soils located in very close proximity to the poles with rapid decreases in concentrations observed with distance from the poles. Soil partitioning, biodegradation, and modeling studies on PCP were also completed to augment the soil data and to provide additional information on the release, migration, and fate of wood preservatives at in-service pole sites

  1. Use of stem-cell sheets expressing bone morphogenetic protein-7 in the management of a nonunion radial fracture in a Toy Poodle.

    Science.gov (United States)

    Song, Jaeyong; Kim, Yongsun; Kweon, Oh-Kyeong; Kang, Byung-Jae

    2017-12-31

    A 12-year-old castrated Toy Poodle was referred to the Kangwon National University Animal Hospital with an oligotrophic nonunion fracture in the distal 1/3 of the left radius and an intact ulna. After fixation by a locking plate and screws, adipose-derived mesenchymal stem-cell sheets expressing bone morphogenetic protein 7 (BMP-7) were transplanted to the fracture site to enhance the healing activity. The fracture was healed at 9 weeks after surgery. In the present case, the mesenchymal stem-cell sheets expressing BMP-7 promoted bone regeneration and healing in a nonunion fracture.

  2. Pole-factorization theorem in quantum electrodynamics

    International Nuclear Information System (INIS)

    Stapp, H.P.

    1996-01-01

    In quantum electrodynamics a classical part of the S-matrix is normally factored out in order to obtain a quantum remainder that can be treated perturbatively without the occurrence of infrared divergences. However, this separation, as usually performed, introduces spurious large-distance effects that produce an apparent breakdown of the important correspondence between stable particles and poles of the S-matrix, and, consequently, lead to apparent violations of the correspondence principle and to incorrect results for computations in the mesoscopic domain lying between the atomic and classical regimes. An improved computational technique is described that allows valid results to be obtained in this domain, and that leads, for the quantum remainder, in the cases studied, to a physical-region singularity structure that, as regards the most singular parts, is the same as the normal physical-region analytic structure in theories in which all particles have non-zero mass. The key innovations are to define the classical part in coordinate space, rather than in momentum space, and to define there a separation of the photon-electron coupling into its classical and quantum parts that has the following properties: (1) The contributions from the terms containing only classical couplings can be summed to all orders to give a unitary operator that generates the coherent state that corresponds to the appropriate classical process, and (2) The quantum remainder can be rigorously shown to exhibit, as regards its most singular parts, the normal analytic structure. (orig.)

  3. π π scattering by pole extrapolation methods

    International Nuclear Information System (INIS)

    Lott, F.W. III.

    1977-01-01

    A 25-inch hydrogen bubble chamber was used at the Lawrence Berkeley Laboratory Bevatron to produce 300,000 pictures of π + p interactions at an incident momentum of the π + of 2.67 GeV/c. The 2-prong events were processed using the FSD and the FOG-CLOUDY-FAIR data reduction system. Events of the nature π + p → π + pπ 0 and π + p → π + π + n with values of momentum transfer to the proton of -t less than or equal to 0.238 GeV 2 were selected. These events were used to extrapolate to the pion pole (t = m/sub π/ 2 ) in order to investigate the π π interaction with isospins of both T = 1 and T = 2. Two methods were used to do the extrapolation: the original Chew-Low method developed in 1959 and the Durr-Pilkuhn method developed in 1965 which takes into account centrifugal barrier penetration factors. At first it seemed that, while the Durr-Pilkuhn method gave better values for the total π π cross section, the Chew-Low method gave better values for the angular distribution. Further analysis, however, showed that if the requirement of total OPE (one-pion-exchange) were dropped, then the Durr-Pilkuhn method gave more reasonable values of the angular distribution as well as for the total π π cross section

  4. The North Celestial Pole Monitoring Project

    Science.gov (United States)

    Blake, R. M.; Castelaz, M.; Phillips, J.

    2005-05-01

    In the past ten years a renaissance has occurred in the study of transient phenomena using small, dedicated optical telescopes. This has largely been driven by the successful detection of planetary transits with small telescopes (Henry et al. 2000) and the successful recovery of optical afterglows of gamma ray bursts (e.g. Halpern et al. 1997). The telescopes involved are designed to slew at rapid rates accurately across the sky when a burst alert occurs, or to study a single patch of sky to detect transits. We have constructed a dedicated robotic instrument to monitor the region within 4 degrees of the north celestial pole continuously every clear night. Using a sequence of short and long exposures the telescope collects data to conduct searches for transient and variable objects and monitor the Cepheid variable Polaris. Previous authors (Kamper et al. 1984; Evans et al. 1998) have observed Polaris to nearly cease its pulsation, a unique behavior for a Cepheid variable. Monitoring Polaris with high secular coverage should help explain this behavior. We describe here the design of the observatory, its operation and control systems and give preliminary examples of the data products from this unique project.

  5. Use of intramedullary fibular strut graft: a novel adjunct to plating in the treatment of osteoporotic humeral shaft nonunion.

    Science.gov (United States)

    Vidyadhara, S; Vamsi, K; Rao, Sharath K; Gnanadoss, James J; Pandian, S

    2009-08-01

    Humeral shaft fractures respond well to conservative treatment and unite without much problem. Since it is uncommon, there is not much discussion regarding the management of nonunion in the literature, and hence this is a challenge to the treating orthopaedic surgeon. Osteoporosis of the fractured bone and stiffness of the surrounding joints compounds the situation further. The Ilizarov fixator, locking compression plate, and vascularised fibular graft are viable options in this scenario but are technically demanding. We used a fibular strut graft for bridging the fracture site in order to enhance the pull-out strength of the screws of the dynamic compression plate. Six patients in the study had successful uneventful union of the fracture at the last follow-up. The fibula is easy to harvest and produces less graft site morbidity. None of the study patients needed additional iliac crest bone grafting. This is the largest reported series of patients with osteoporotic atrophic nonunion of humerus successfully treated solely using the combination of an intramedullary fibular strut graft and dynamic compression plate.

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

    Science.gov (United States)

    Lenza, Mário; Faloppa, Flávio

    2015-05-07

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

  7. Study on Pole Arrangement of the CEDM Coils

    International Nuclear Information System (INIS)

    Park, Jin Seok; Lee, Myoung Goo; Kim, Hyun Min; Cho, Yeon Ho; Choi, Taek Sang

    2013-01-01

    The coil stack assembly is important for reliable operation of the CEDM, there have been efforts to improve the design by optimizing the design parameters such as dimensions and winding turns. However, magnetic forces of the CEDM can also change by different pole arrangement even if their design parameters are the same. Since the latch coil and lift coil are installed connected to each other, they produce magnetically coupled field when they are energized at the same time. This coupling field can affect the magnetic force of the CEDM significantly. In this paper, coil pole arrangement effects are studied. Electro-magnetic analysis is performed for the different pole arrangements of the CEDM coils to calculate the magnetic forces. Pole arrangement effects on magnetic forces were studied by static analysis of the CEDM magnetic field. Magnetic forces were calculated and compared for the two different pole arrangements of the coils. The results show that the magnetic poles of the lift coil and latch coil shall be arranged to have the same magnetic pole direction to achieve higher magnetic force

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

    Science.gov (United States)

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

    2014-12-01

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

  9. Evidence of Space-Charge Effects in Thermal Poling

    DEFF Research Database (Denmark)

    Wu, X.; Arentoft, Jesper; Wong, D.

    1999-01-01

    The in situ thermal poling processes in germanosilicate fibers for positive and negative poling voltages are significantly different. Thermal poling of silica fibers consists of two processes: the faster linear process of charge migration and the subsequent single exponential process of charge...... ionization. Both the shielding electrical field due to charge migration and the ionization electrical field due to charge ionization are able to be frozen-in at room temperature acid lead to the residual linear electrooptic effects, The observations support that the mechanism of the induced electrooptic...... effects is based on space charge electrical fields instead of dipole/bond orientation....

  10. PopZ identifies the new pole, and PodJ identifies the old pole during polar growth in Agrobacterium tumefaciens.

    Science.gov (United States)

    Grangeon, Romain; Zupan, John R; Anderson-Furgeson, James; Zambryski, Patricia C

    2015-09-15

    Agrobacterium tumefaciens elongates by addition of peptidoglycan (PG) only at the pole created by cell division, the growth pole, whereas the opposite pole, the old pole, is inactive for PG synthesis. How Agrobacterium assigns and maintains pole asymmetry is not understood. Here, we investigated whether polar growth is correlated with novel pole-specific localization of proteins implicated in a variety of growth and cell division pathways. The cell cycle of A. tumefaciens was monitored by time-lapse and superresolution microscopy to image the localization of A. tumefaciens homologs of proteins involved in cell division, PG synthesis and pole identity. FtsZ and FtsA accumulate at the growth pole during elongation, and improved imaging reveals FtsZ disappears from the growth pole and accumulates at the midcell before FtsA. The L,D-transpeptidase Atu0845 was detected mainly at the growth pole. A. tumefaciens specific pole-organizing protein (Pop) PopZAt and polar organelle development (Pod) protein PodJAt exhibited dynamic yet distinct behavior. PopZAt was found exclusively at the growing pole and quickly switches to the new growth poles of both siblings immediately after septation. PodJAt is initially at the old pole but then also accumulates at the growth pole as the cell cycle progresses suggesting that PodJAt may mediate the transition of the growth pole to an old pole. Thus, PopZAt is a marker for growth pole identity, whereas PodJAt identifies the old pole.

  11. Characterization of Periodically Poled Nonlinear Materials Using Digital Image Processing

    National Research Council Canada - National Science Library

    Alverson, James R

    2008-01-01

    .... A new approach based on image processing across an entire z+ or z- surface of a poled crystal allows for better quantification of the underlying domain structure and directly relates to device performance...

  12. POLE mutations in families predisposed to cutaneous melanoma

    DEFF Research Database (Denmark)

    Aoude, Lauren G; Heitzer, Ellen; Johansson, Peter

    2015-01-01

    Germline mutations in the exonuclease domain of POLE have been shown to predispose to colorectal cancers and adenomas. POLE is an enzyme involved in DNA repair and chromosomal DNA replication. In order to assess whether such mutations might also predispose to cutaneous melanoma, we interrogated...... whole-genome and exome data from probands of 34 melanoma families lacking pathogenic mutations in known high penetrance melanoma susceptibility genes: CDKN2A, CDK4, BAP1, TERT, POT1, ACD and TERF2IP. We found a novel germline mutation, POLE p.(Trp347Cys), in a 7-case cutaneous melanoma family....... Functional assays in S. pombe showed that this mutation led to an increased DNA mutation rate comparable to that seen with a Pol ε mutant with no exonuclease activity. We then performed targeted sequencing of POLE in 1243 cutaneous melanoma cases and found that a further ten probands had novel or rare...

  13. New tilted-poles Wien filter with enhanced performance

    Science.gov (United States)

    Leal-Quiros, E.; Prelas, M. A.

    1989-03-01

    The Wien filter is an E×B deflecting analyzer with the electrostatic field perpendicular to the magnetostatic field. The twofold functions of the Wien filter are as an energy analyzer as well as a mass analyzer. It has very high resolution for paraxial charged-particle beams with V=E/B, the Wien velocity. Two Wien filters, a tilted-poles Wien filter, and a classical parallel-rectangular-poles Wien filter were built and tested for electrons up to 3.5 keV and protons beams of 200 eV. (The tilted-poles Wien filter is a new diagnostic developed by the authors.) The performance of the two is compared, and the tilted-poles Wien filter has superior resolution to the classical Wien filter. Both Wien filters appear to have features useful for high-temperature plasma diagnostics, including simultaneous measurement of energy and mass spectra, and high resolution.

  14. New tilted-poles Wien filter with enhanced performance

    Energy Technology Data Exchange (ETDEWEB)

    Leal-Quiros, E.; Prelas, M.A.

    1989-03-01

    The Wien filter is an E x B deflecting analyzer with the electrostatic field perpendicular to the magnetostatic field. The twofold functions of the Wien filter are as an energy analyzer as well as a mass analyzer. It has very high resolution for paraxial charged-particle beams with V = E/B, the Wien velocity. Two Wien filters, a tilted-poles Wien filter, and a classical parallel-rectangular-poles Wien filter were built and tested for electrons up to 3.5 keV and protons beams of 200 eV. (The tilted-poles Wien filter is a new diagnostic developed by the authors.) The performance of the two is compared, and the tilted-poles Wien filter has superior resolution to the classical Wien filter. Both Wien filters appear to have features useful for high-temperature plasma diagnostics, including simultaneous measurement of energy and mass spectra, and high resolution.

  15. Pacific Albacore Troll and Pole-and-line Fisheries

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — The North Pacific and South Pacific Albacore Troll and Pole-and-line Fisheries project contains landings, logbooks, and size composition data from U.S.A. troll and...

  16. Micrometeorites from the South Pole Water Well, Version 1

    Data.gov (United States)

    National Aeronautics and Space Administration — Micrometeorites dated between 1100 A.D. to 1500 A.D. were collected from the bottom of the South Pole Water Well in December 1995. Element analyses of 181 cosmic...

  17. Detection of Cavities Using Pole-Dipole Resistivity Technique

    OpenAIRE

    Elawadi, Eslam; El-Qady, Gad; Salem, Ahmed; Ushijima, Keisuke

    2001-01-01

    Using pole-dipole array, electrical resistivity survey was conducted to investigate the subsurface under a subsiding building located in Kita Kyushu area, Japan. The resistivity measurements were acquired along two traverse lines and interpreted using a g

  18. Methane Isotopes in South Pole Firn Air, 2008, Version 1

    Data.gov (United States)

    National Aeronautics and Space Administration — This data set contains depth profiles for delta carbon-13 (δ13C) and delta deuterium (δD) of methane (CH4) in South Pole firn air. The investigators obtained air...

  19. South Pole Snow Pit, 1988 and 1989, Version 1

    Data.gov (United States)

    National Aeronautics and Space Administration — Information from 6-meter snow pits dug close to the South Pole in austral summer 1988-1989 by the Glacier Research Group of the University of New Hampshire (location...

  20. Dynamic Electromechanical Characterization of Axially Poled PZT 95/5

    International Nuclear Information System (INIS)

    Chhabildas, Lalit C.; Furnish, Michael D.; Montgomery, Stephen T.; Setchell, Robert E.

    1999-01-01

    We are conducting a comprehensive experimental study of the electromechanical behavior of poled PZT 95/5 (lead zirconate titanate). As part of this study, eight plane-wave tests have been conducted on axially poled PZT 95/5 at stress levels ranging from 0.9 to 4.6 GPa, using VISAR and electrical diagnostics. Observed wave velocities were slightly decreased from ultrasonic velocity, by contrast' with unpoled samples. Compression waveforms show a step at 0.6 GPa more marked than for normally poled or unpoled samples; this may correspond to a poling effect on the ferroelectric/antiferroelectric transition. A similar step is observed on release. The released charge upon loading to 0.9 GPa is consistent with nearly complete depoling. Loading to higher stresses gave lower currents (factor of 10), suggesting shock-induced conductivity or electrical breakdown

  1. Multijet final states: exact results and the leading pole approximation

    International Nuclear Information System (INIS)

    Ellis, R.K.; Owens, J.F.

    1984-09-01

    Exact results for the process gg → ggg are compared with those obtained using the leading pole approximation. Regions of phase space where the approximation breaks down are discussed. A specific example relevant for background estimates to W boson production is presented. It is concluded that in this instance the leading pole approximation may underestimate the standard QCD background by more than a factor of two in certain kinematic regions of physical interest

  2. Second-harmonic scanning optical microscopy of poled silica waveguides

    DEFF Research Database (Denmark)

    Pedersen, Kjeld; Bozhevolnyi, Sergey I.; Arentoft, Jesper

    2000-01-01

    Second-harmonic scanning optical microscopy (SHSOM) is performed on electric-field poled silica-based waveguides. Two operation modes of SHSOM are considered. Oblique transmission reflection and normal reflection modes are used to image the spatial distribution of nonlinear susceptibilities...... and limitations of the two operation modes when used for SHSOM studies of poled silica-based waveguides are discussed. The influence of surface defects on the resulting second-harmonic images is also considered. ©2000 American Institute of Physics....

  3. International Youth Conference on the Poles

    Science.gov (United States)

    Church, A. K.; Kuhn, T. S.; Baeseman, J.; Garmulewicz, A.; Raymond, M.; Salmon, R.

    2006-12-01

    The International Polar Year (IPY) is an international effort, involving more than 50 countries, to focus research in both the sciences and social sciences on the world's Polar Regions. In order to secure youth involvement in the IPY, the Youth Steering Committee (YSC) has been formed, aiming specifically to network young polar researchers from all backgrounds enabling collaboration and to involve this group in outreach focused towards other young people. A conference targeted directly at an audience of early career researchers and international youth will be central to fulfilling these aims. The YSC has therefore developed the concept of the International Youth Conference on the Poles (IYCP). Proposed for 2008, this conference will bring together youth from a diverse set of backgrounds and nationalities to discuss the issues affecting the Polar Regions, their effects on a global scale and ways of addressing these issues. The conference will also serve to highlight ongoing IPY research, especially research being undertaken by young researchers, and provide a perennial framework for youth involvement in polar research and policies. The IYCP will run for three days in May 2008, attracting an international youth audience, as well as representatives from polar organizations, teachers, politicians, policy makers, the general public and media. The IYCP will be divided into three sections. Youth Roundtable Discussions will bring youth together to discuss issues affecting the Polar Regions and potential solutions to these. A Young Researchers Conference will provide the opportunity for young researchers working in the Polar Regions to present their work to an interdisciplinary audience. The Polar Fair will provide an interactive environment for youth to learn about the Polar Regions. The IYCP will be of great importance to the IPY because it will serve as the principle venue during the Polar Year where youth from many different disciplines, backgrounds and countries will

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

    Science.gov (United States)

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

    2017-12-01

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

  5. [Separate vertical wiring combined with tension band and Kirschner-wire plus cerclage wire in the treatment of displaced inferior pole fractures of the patella].

    Science.gov (United States)

    Zhang, J; Jiang, X Y; Huang, X W

    2016-06-18

    To investigate the clinical efficacy and outcomes of two separate vertical wiring combined with tension band and Kirschner-wire plus cerclage wire in the treatment of displaced inferior pole fractures of the patella. From January 2013 to January 2015, 15 consecutive patients (mean age 54.5 years) with inferior pole fractures of the patella were retrospectively included in this study. All the patients underwent open reduction and internal fixation by separate vertical wiring combined with tension band and Kirschner-wire plus cerclage wire through longitudinal incision, 4.5 d (range: 3.1-5.9 d) after initial injury. A safety check for early knee range of motion was performed before wound closure. The complications including infection, nonunion, loss of fixation and any wire breakage or irritation from implant were recorded. Anteroposterior and lateral views of the knee joint obtained during the follow-up were used to assess bony union based on the time when the fracture line disappeared. At the time of the final outpatient follow up, functional evaluation of the knee joint was conducted by Bostman system. The follow-up time was 13.1 months (range: 12-19 months) after surgery on average, immediate motion without immobilization in all the cases was allowed and there was no case of reduction loss of the fracture and wire breakage. There was no case of irritation from the implant. At the final follow-up, the average range of motion (ROM) arc was 126.7° (range: 115°-140°), the average ROM lag versus contralateral healthy leg was 10.3° (range: 0°-35°). The mean Bostman score at the last follow-up was 28.9 (range: 27-30), and graded excellent in most cases. Two separate vertical wiring is an easy and effective method to reduce the displaced inferior pole fracture of patella. Augmentation of separate vertical wiring with tension band and Kirschner-wire plus cerclage wire in these patients provides enough strength to protected the early exercise of the knee joint and

  6. Efficacy of the lithotripsy in treating lower pole renal stones.

    Science.gov (United States)

    Cui, Helen; Thomee, Eeke; Noble, Jeremy G; Reynard, John M; Turney, Benjamin W

    2013-06-01

    Use of extracorporeal lithotripsy is declining in North America and many European countries despite international guidelines advocating it as a first-line therapy. Traditionally, lithotripsy is thought to have poor efficacy at treating lower pole renal stones. We evaluated the success rates of lithotripsy for lower pole renal stones in our unit. 50 patients with lower pole kidney stones ≤15 mm treated between 3/5/11 and 19/4/12 were included in the study. Patients received lithotripsy on a fixed-site Storz Modulith SLX F2 lithotripter according to a standard protocol. Clinical success was defined as stone-free status or asymptomatic clinically insignificant residual fragments (CIRFs) ≤3 mm at radiological follow-up. The mean stone size was 7.8 mm. The majority of stones (66 %) were between 5 and 10 mm. 28 % of stones were between 10 and 15 mm. For solitary lower pole stones complete stone clearance was achieved in 63 %. Total stone clearance including those with CIRFs was achieved in 81 % of patients. As expected, for those with multiple lower pole stones the success rates were lower: complete clearance was observed in 39 % and combined clearance including those with CIRFs was 56 %. Overall, complete stone clearance was observed in 54 % of patients and clearance with CIRFs was achieved in 72 % of patients. Success rate could not be attributed to age, stone size or gender. Our outcome data for the treatment of lower pole renal stones (≤15 mm) compare favourably with the literature. With this level of stone clearance, a non-invasive, outpatient-based treatment like lithotripsy should remain the first-line treatment option for lower pole stones. Ureteroscopy must prove that it is significantly better either in terms of clinical outcome or patient satisfaction to justify replacing lithotripsy.

  7. Optimal pole shifting controller for interconnected power system

    International Nuclear Information System (INIS)

    Yousef, Ali M.; Kassem, Ahmed M.

    2011-01-01

    Research highlights: → Mathematical model represents a power system which consists of synchronous machine connected to infinite bus through transmission line. → Power system stabilizer was designed based on optimal pole shifting controller. → The system performances was tested through load disturbances at different operating conditions. → The system performance with the proposed optimal pole shifting controller is compared with the conventional pole placement controller. → The digital simulation results indicated that the proposed controller has a superior performance. -- Abstract: Power system stabilizer based on optimal pole shifting is proposed. An approach for shifting the real parts of the open-loop poles to any desired positions while preserving the imaginary parts is presented. In each step of this approach, it is required to solve a first-order or a second-order linear matrix Lyapunov equation for shifting one real pole or two complex conjugate poles, respectively. This presented method yields a solution, which is optimal with respect to a quadratic performance index. The attractive feature of this method is that it enables solutions of the complex problem to be easily found without solving any non-linear algebraic Riccati equation. The present power system stabilizer is based on Riccati equation approach. The control law depends on finding the feedback gain matrix, and then the control signal is synthesized by multiplying the state variables of the power system with determined gain matrix. The gain matrix is calculated one time only, and it works over wide range of operating conditions. To validate the power of the proposed PSS, a linearized model of a simple power system consisted of a single synchronous machine connected to infinite bus bar through transmission line is simulated. The studied power system is subjected to various operating points and power system parameters changes.

  8. Analysis of car’s frontal collision against pole

    Science.gov (United States)

    Ispas, N.; Nastasoiu, M.

    2017-10-01

    Reducing the effects of traffic accidents over the occupants is a major objective of collision attempts. Impacts between the car and the pole are very dangerous for the physical integrity of the car’s occupants. To minimalize the effects of such events on the passengers of a vehicle, a whole series of efforts by both designers and experienced engineers led to increasingly the vehicles safety. The main aim of these paper is to quantify the influences over the car passengers of loads involved by car against pole collisions using the same car model at different speeds. Also, this kind on occupant influences were study using a small car model. Other goal of the paper was the study of the cars stiffness in frontal collision against the pole. The paper’s experimental results were obtained by support of DSD, Dr. Steffan Datentechnik GmbH - Linz, Austria. The described tests were performed in full test facility of DSD Linz, in “Easter 2016 PC-Crash Seminar”. Cars accelerations, velocities, rotations angles after pole impact were registered and discussed. The novelty of the paper consists in studies referred for the same car model involved in car against pole collisions at different impact speeds. Paper’s conclusions can be future used for car safety improvement.

  9. Poles in the Dutch Cape Colony 1652-1814

    Directory of Open Access Journals (Sweden)

    Kowalski Mariusz

    2015-06-01

    Full Text Available The contribution of Poles to the colonisation and development of the Dutch Cape Colony is not commonly known. Yet, Poles have been appearing in this colony since its very inception (1652. During the entire period considered here the presence of Poles was the result of the strong economic ties between Poland and the Netherlands. At the end of this period there was an increase in their share, in connection with the presence of numerous alien military units on the territory of the Colony, because of Poles having served in these units. Numerous newcomers from Poland settled in South Africa for good, established families, and their progeny made up part of the local society. The evidence of this phenomenon is provided by the present-day Afrikaner families of, for instance, Drotsky, Kitshoff, Kolesky, Latsky, Masuriek, Troskie, Zowitsky, and others. A quite superficial estimation implies that the settlers coming from Poland could make up a bit over 1% of the ancestors of the present-day Afrikaners. Poles would also participate in the pioneering undertakings within the far-off fringes of the Colony, including the robbery-and-trade expedition of 1702.

  10. Assessment of Pole Erosion in a Magnetically Shielded Hall Thruster

    Science.gov (United States)

    Mikellides, Ioannis G.; Ortega, Alejandro L.

    2014-01-01

    Numerical simulations of a 6-kW laboratory Hall thruster called H6 have been performed to quantify the erosion rate at the inner pole. The assessments have been made in two versions of the thruster, namely the unshielded (H6US) and magnetically shielded (H6MS) configurations. The simulations have been performed with the 2-D axisymmetric code Hall2De which employs a new multi-fluid ion algorithm to capture the presence of low-energy ions in the vicinity of the poles. It is found that the maximum computed erosion rate at the inner pole of the H6MS exceeds the measured rate of back-sputtered deposits by 4.5 times. This explains only part of the surface roughening that was observed after a 150-h wear test, which covered most of the pole area exposed to the plasma. For the majority of the pole surface the computed erosion rates are found to be below the back-sputter rate and comparable to those in the H6US which exhibited little to no sputtering in previous tests. Possible explanations for the discrepancy are discussed.

  11. Electromagnetic Radial Forces in a Hybrid Eight-Stator-Pole, Six-Rotor-Pole Bearingless Switched-Reluctance Motor

    Science.gov (United States)

    Morrison, Carlos R.; Siebert, Mark W.; Ho, Eric J.

    2007-01-01

    Analysis and experimental measurement of the electromagnet force loads on the hybrid rotor in a novel bearingless switched-reluctance motor (BSRM) have been performed. A BSRM has the combined characteristics of a switched-reluctance motor and a magnetic bearing. The BSRM has an eight-pole stator and a six-pole hybrid rotor, which is composed of circular and scalloped lamination segments. The hybrid rotor is levitated using only one set of stator poles. A second set of stator poles imparts torque to the scalloped portion of the rotor, which is driven in a traditional switched reluctance manner by a processor. Analysis was done for nonrotating rotor poles that were oriented to achieve maximum and minimum radial force loads on the rotor. The objective is to assess whether simple one-dimensional magnetic circuit analysis is sufficient for preliminary evaluation of this machine, which may exhibit strong three-dimensional electromagnetic field behavior. Two magnetic circuit geometries, approximating the complex topology of the magnetic fields in and around the hybrid rotor, were employed in formulating the electromagnetic radial force equations. Reasonable agreement between the experimental results and the theoretical predictions was obtained with typical magnetic bearing derating factors applied to the predictions.

  12. Traumatic amputation of the left lower renal pole in children

    Energy Technology Data Exchange (ETDEWEB)

    Waxman, J.; Belman, A.B.; Kass, E.J.

    1985-07-01

    Four children between 5 and 10 years old suffered traumatic amputation of the left lower renal pole following flank trauma. All patients were evaluated with excretory urography and isotope renography. The renal scan clearly demonstrated failure of perfusion of the lower renal pole and urinary extravasation, and was believed to be more valuable than the standard excretory urogram as a diagnostic tool. All children were managed similarly: delayed (72 to 96 hours) exploration, simple removal of the amputated segment and insertion of a Penrose drain. They all have done well. The patients were normotensive at followup and had excellent function of the remaining portion of the kidney.

  13. Multiobjective H2/H? Control Design with Regional Pole Constraints

    Directory of Open Access Journals (Sweden)

    Junaidi Junaidi

    2012-03-01

    Full Text Available This paper presents multiobjective H2/H? control design with regional pole constraints. The state feedback gain can be obtained by solving a linear matrix inequality (LMI feasibility problem that robustly assigns the closed-loop poles in a prescribed LMI region. The proposed technique is illustrated with applications to the design of stabilizer for a typical single-machine infinite-bus (SMIB power system. The LMI-based control ensures adequate damping for widely varying system operating conditions. The simulation results illustrate the effectiveness and robustness of the proposed stabilizer.

  14. Induction Motor with Switchable Number of Poles and Toroidal Winding

    Directory of Open Access Journals (Sweden)

    MUNTEANU, A.

    2011-05-01

    Full Text Available This paper presents a study of an induction motor provided with toroidal stator winding. The ring-type coils offer a higher versatility in obtaining a different number of pole pairs by means of delta/star and series/parallel connections respectively. As consequence, the developed torque can vary within large limits and the motor can be utilized for applications that require, for example, high load torque values for a short time. The study involves experimental tests and FEM simulation for an induction machine with three configurations of pole pairs. The conclusions attest the superiority of the toroidal winding for certain applications such as electric vehicles or lifting machines.

  15. Challenges of Rover Navigation at the Lunar Poles

    Science.gov (United States)

    Nefian, Ara; Deans, Matt; Bouyssounouse, Xavier; Edwards, Larry; Dille, Michael; Fong, Terry; Colaprete, Tony; Miller, Scott; Vaughan, Ryan; Andrews, Dan; hide

    2015-01-01

    Observations from Lunar Prospector, LCROSS, Lunar Reconnaissance Orbiter (LRO), and other missions have contributed evidence that water and other volatiles exist at the lunar poles in permanently shadowed regions. Combining a surface rover and a volatile prospecting and analysis payload would enable the detection and characterization of volatiles in terms of nature, abundance, and distribution. This knowledge could have impact on planetary science, in-situ resource utilization, and human exploration of space. While Lunar equatorial regions of the Moon have been explored by manned (Apollo) and robotic missions (Lunokhod, Cheng'e), no surface mission has reached the lunar poles.

  16. Pedagogický odkaz Ivana Poledňáka

    OpenAIRE

    Čižinská, Klára

    2017-01-01

    The bachelor thesis covers the personality of Ivan Poledňák and his music-teaching heritage. In the first part his life, his activities in musical educational organizations and teaching at universities in the Czech Republic are described. In the second part his musical pedagogical publications are analysed. The aim of this thesis is to punctuate to his big contribution in music education. KEYWORDS Ivan Poledňák, Musically pedagogical inventiveness, Music-school-tomorrow, 40 radio lectures of ...

  17. Poles Living in Ireland and their Quality of Life

    Directory of Open Access Journals (Sweden)

    Agnieszka NOLKA

    2009-05-01

    Full Text Available The economic growth of Ireland resulted in a significant number of Poles migrating to Ireland following the EU enlargement in 2004. The article explores the quality of life of Poles living in Ireland. Using data from a preliminary survey conducted in 2006, several dimensions of living conditions are analysed, including interpersonal relations, material security, health and healthcare. The study shows that evaluations of almost all aspects of quality of life improved, apart from components such as healthcare and the ability to acquire help from social organisations. Also interpersonal relations, contrary to the initial assumption, were enhanced by migration to Ireland.

  18. Is it possible to reduce the knee joint compression force during level walking with hiking poles?

    DEFF Research Database (Denmark)

    Jensen, S B; Henriksen, M; Aaboe, J

    2010-01-01

    Walking with hiking poles has become a popular way of exercising. Walking with poles is advocated as a physical activity that significantly reduces the loading of the hip, knee and ankle joints. We have previously observed that pole walking does not lead to a reduction of the load on the knee joint....... However, it is unclear whether an increased force transmitted through the poles can reduce the load on the knee joint. Thus, the purpose of the present study was to investigate if an increased load transmitted through the arms to the poles could reduce the knee joint compression force during level walking...... with poles. We hypothesized that an increased pole force would result in a reduction of the knee joint compression force. Gait analyses from 10 healthy subjects walking with poles were obtained. The pole force was measured simultaneously during the gait analyses. The knee joint compression forces were...

  19. From 'third pole' to north pole: a Himalayan origin for the arctic fox.

    Science.gov (United States)

    Wang, Xiaoming; Tseng, Zhijie Jack; Li, Qiang; Takeuchi, Gary T; Xie, Guangpu

    2014-07-22

    The 'third pole' of the world is a fitting metaphor for the Himalayan-Tibetan Plateau, in allusion to its vast frozen terrain, rivalling the Arctic and Antarctic, at high altitude but low latitude. Living Tibetan and arctic mammals share adaptations to freezing temperatures such as long and thick winter fur in arctic muskox and Tibetan yak, and for carnivorans, a more predatory niche. Here, we report, to our knowledge, the first evolutionary link between an Early Pliocene (3.60-5.08 Myr ago) fox, Vulpes qiuzhudingi new species, from the Himalaya (Zanda Basin) and Kunlun Mountain (Kunlun Pass Basin) and the modern arctic fox Vulpes lagopus in the polar region. A highly hypercarnivorous dentition of the new fox bears a striking resemblance to that of V. lagopus and substantially predates the previous oldest records of the arctic fox by 3-4 Myr. The low latitude, high-altitude Tibetan Plateau is separated from the nearest modern arctic fox geographical range by at least 2000 km. The apparent connection between an ancestral high-elevation species and its modern polar descendant is consistent with our 'Out-of-Tibet' hypothesis postulating that high-altitude Tibet was a training ground for cold-environment adaptations well before the start of the Ice Age. © 2014 The Author(s) Published by the Royal Society. All rights reserved.

  20. Quality of life and complications at the different stages of bone transport for treatment infected nonunion of the tibia.

    Science.gov (United States)

    Wang, Hu; Wei, Xing; Liu, Ping; Fu, Ya-Hui; Wang, Peng-Fei; Cong, Yu-Xuan; Zhang, Bin-Fei; Li, Zhong; Lei, Jin-Lai; Zhang, Kun; Zhuang, Yan

    2017-11-01

    The aim of this study was to assess Physical Component Summary (PCS), Mental Component Summary (MCS) of the Mos 36-item Short Form Health Survey (SF-36) score, and the virtual Analogue Scale (VAS) of pain during the treatment period and the complication rate associated with infected nonunion of the tibia managed surgically by bone transport.This is a retrospective analysis of prospectively collected data in a consecutive patient cohort. Patients suffering from infected nonunion of the tibia were treated by bone transport from 2012 to 2014. Follow-up was for at least 2 years after complete osseous consolidation. Standardized treatment included bacterial eradication by segmental resection, bone transport using Ilizarov apparatus, and docking maneuver. The main outcome measurements consisted of the quality of life (PCS and MCS scores) and the VAS of pain during the different stages of therapy. In addition, all complications were documented.Our series comprised 12 men and 3 women with an average age of 36.9 years (range: 20-55 years). All patients previously undergone an average of 2.9 operations (range: 1-6 operations). In all patients, bone defects were present with a mean size of 7.5 cm (range: 3-12 cm), and all patients were suffering from soft tissue defects (range: 5-17 cm). The mean external fixator time (EFT) was 48 weeks (range: 30-62 weeks) and the mean external fixation index was 43.1 days/cm (range: 33-62 days/cm). All patients achieved bone union, and no recurrence of infection was observed. According to the Paley classification, patients suffered 15 minor and 13 major complications. The average complication rate per patient comprised of 1.0 minor and 0.9 major complications. Bone grafting was required in 6 cases at the docking site. One patient suffered from equinus deformity, and refused any further surgical procedures. We performed 28 operations in 15 patients (average 1.9 operations per patient). After the period of bone transport, PCS and MCS

  1. Outcomes and complication rates of different bone grafting modalities in long bone fracture nonunions: a retrospective cohort study in 182 patients.

    Science.gov (United States)

    Flierl, Michael A; Smith, Wade R; Mauffrey, Cyril; Irgit, Kaan; Williams, Allison E; Ross, Erin; Peacher, Gabrielle; Hak, David J; Stahel, Philip F

    2013-09-09

    Novel bone substitutes have challenged the notion of autologous bone grafting as the 'gold standard' for the surgical treatment of fracture nonunions. The present study was designed to test the hypothesis that autologous bone grafting is equivalent to other bone grafting modalities in the management of fracture nonunions of the long bones. A retrospective review of patients with fracture nonunions included in two prospective databases was performed at two US level 1 trauma centers from January 1, 1998 (center 1) or January 1, 2004 (center 2), respectively, until December 31, 2010 (n = 574). Of these, 182 patients required adjunctive bone grafting and were stratified into the following cohorts: autograft (n = 105), allograft (n = 38), allograft and autograft combined (n = 16), and recombinant human bone morphogenetic protein-2 (rhBMP-2) with or without adjunctive bone grafting (n = 23). The primary outcome parameter was time to union. Secondary outcome parameters consisted of complication rates and the rate of revision procedures and revision bone grafting. The autograft cohort had a statistically significant shorter time to union (198 ± 172-225 days) compared to allograft (416 ± 290-543 days) and exhibited a trend towards earlier union when compared to allograft/autograft combined (389 ± 159-619 days) or rhBMP-2 (217 ± 158-277 days). Furthermore, the autograft cohort had the lowest rate of surgical revisions (17%) and revision bone grafting (9%), compared to allograft (47% and 32%), allograft/autograft combined (25% and 31%), or rhBMP-2 (27% and 17%). The overall new-onset postoperative infection rate was significantly lower in the autograft group (12.4%), compared to the allograft cohort (26.3%) (P grafting appears to represent the bone grafting modality of choice with regard to safety and efficiency in the surgical management of long bone fracture nonunions.

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

    Directory of Open Access Journals (Sweden)

    Mohammed

    2016-03-01

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

  3. Plotter of pole figure using data from x-ray diffraction

    International Nuclear Information System (INIS)

    Lima, A.F.

    1990-01-01

    Any polycrystalline aggregate normally has a preferred crystallographic orientation, or texture which depends on its thermal and or mechanical history. Preferred orientation is best described by means of a pole figure. A pole figure is a stereographic projection which shows the variation in pole density with pole orientation, for a selected set of crystal planes. In this work, computer programs was developed to plot pole figures. The corrected intensities are calculated and directly transmitted to the plotter. The different intensities levels are represented by different colors in the pole figure. (author)

  4. Systemic and Local Administration of Antimicrobial and Cell Therapies to Prevent Methicillin-Resistant Staphylococcus epidermidis-Induced Femoral Nonunions in a Rat Model

    Directory of Open Access Journals (Sweden)

    Arianna B. Lovati

    2016-01-01

    Full Text Available S. epidermidis is responsible for biofilm-related nonunions. This study compares the response to S. epidermidis-infected fractures in rats systemically or locally injected with vancomycin or bone marrow mesenchymal stem cells (BMSCs in preventing the nonunion establishment. The 50% of rats receiving BMSCs intravenously (s-rBMSCs died after treatment. A higher cytokine trend was measured in BMSCs locally injected rats (l-rBMSCs at day 3 and in vancomycin systemically injected rats (l-VANC at day 7 compared to the other groups. At day 14, the highest cytokine values were measured in l-VANC and in l-rBMSCs for IL-10. µCT showed a good bony bridging in s-VANC and excellent both in l-VANC and in l-rBMSCs. The bacterial growth was lower in s-VANC and l-VANC than in l-rBMSCs. Histology demonstrated the presence of new woven bone in s-VANC and a more mature bony bridging was found in l-VANC. The l-rBMSCs showed a poor bony bridging of fibrovascular tissue. Our results could suggest the synergic use of systemic and local injection of vancomycin as an effective treatment to prevent septic nonunions. This study cannot sustain the systemic injection of BMSCs due to high risks, while a deeper insight into local BMSCs immunomodulatory effects is mandatory before developing cell therapies in clinics.

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

    Directory of Open Access Journals (Sweden)

    CK Chan

    2013-07-01

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

  6. 1st metatarsophalangeal joint fusion: A comparison of non-union and gender differences between locking and non-locking plating systems.

    Science.gov (United States)

    Bass, Edward James; Sirikonda, Siva Prasad

    2015-12-01

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

  7. Liz Taylor : minu van Gogh pole natsidele kuulunud

    Index Scriptorium Estoniae

    2004-01-01

    Elizabeth Taylor palus kohtult otsust, et talle kuuluvat 15 miljonit dollarit maksvat Vincent van Goghi maali "Vaade Saint-Remy varjupaigale" pole natsid Margarete Mauthneri juudiperekonna käest vägivaldselt ära võtnud. E. Taylori isa ostis maali 1963. a. Londonis oksjonilt

  8. Analytical signal and reduction to pole in the interpretation of ...

    African Journals Online (AJOL)

    Analytical signal and reduction to pole in the interpretation of aeromagnetic data at low magnetic latitudes: a case study of the middle Benue trough, Nigeria. OK Likkason. Abstract. No Abstract. Global Journal of Geological Sciences Vol. 4(1) 2006: 29-38. Full Text: EMAIL FULL TEXT EMAIL FULL TEXT · DOWNLOAD FULL ...

  9. Finite element analysis of boron diffusion in wooden Poles

    DEFF Research Database (Denmark)

    Krabbenhøft, Kristian; Hoffmeyer, Preben; Bechgaard, Carl

    2004-01-01

    The problem of describing the migration of dissolved boron in wood is treated with special reference to the commonly used remedial treatment of wooden poles. The governing equations are derived and discussed together with some of the material parameters required. The equations are solved...

  10. Probability models of the x, y pole coordinates data

    Science.gov (United States)

    Sen, A.; Niedzielski, T.; Kosek, W.

    2008-12-01

    The aim of this study is to find the most appropriate probabilistic model for the x, y pole coordinates time series. We have analyzed the IERS eopc04_05 data set covering the period 1962 - 2008. We have also considered the residual x, y pole coordinate time series, which is computed as the difference between the original data and the corresponding least-squares model of the Chandler circle and annual ellipse. Using the measures of skewness and kurtosis of the empirical distribution of the data, we find that the x, y pole coordinates and the corresponding residuals time series cannot be modeled by a normal (Gaussian) distribution. A normal distribution has zero skewness and a kurtosis value of 3. We have fitted several non- Gaussian distributions to the datasets. They include the Generalized Extreme Value distribution, 4-parameter Beta distribution, Johnson SB and SU distributions, Generalized Pareto distribution and Wakeby distribution. Suitability of these distributions as probabilistic models for the x, y pole coordinates and the corresponding residuals time series are discussed.

  11. Bacterial diversity in snow on North Pole ice floes

    DEFF Research Database (Denmark)

    Hauptmann, Aviaja Zenia Edna Lyberth; Stibal, Marek; Bælum, Jacob

    2014-01-01

    The microbial abundance and diversity in snow on ice floes at three sites near the North Pole was assessed using quantitative PCR and 454 pyrosequencing. Abundance of 16S rRNA genes in the samples ranged between 43 and 248 gene copies per millilitre of melted snow. A total of 291,331 sequences we...

  12. Particles as S-matrix poles: hadron democracy

    International Nuclear Information System (INIS)

    Chew, G.F.

    1989-01-01

    The connection between two theoretical ideas of the 1950s is traced in this article, namely that hadrons are nonfundamental, ''composite'' particles and that all physically observable particles correspond to singularities of an analytic scattering matrix. The S matrix theory developed by Werner Heisenberg in the early forties now incorporated the concepts of unitarity, invariance, analyticity and causality. The meson-exchange force meant that poles must be present in nucleon-nuclear and pion-nucleon scattering as predicted by dispersion relations. Experimental work in accessible regions determined pole residues. Pole residue became associated with force strength and pole position with particle mass. In 1959, the author discovered the so-called ''bootstrap'' theory the rho meson as a force generates a rho particle. By the end of the 1950s it was clear that all hadrons had equal status, each being bound states of other hadrons, sustained by hadron exchange forces and that hadrons are self-generated by an S-matrix bootstrap mechanism that determines all their properties. (UK)

  13. Finite Element Analysis of Boron Diffusion in Wooden Poles

    DEFF Research Database (Denmark)

    Krabbenhøft, Kristian; Hoffmeyer, P.; Bechgaard, C.

    2003-01-01

    The problem of describing the migration of dissolved boron in wood is treated with special reference to the commonly used remedial treatment of wooden poles. The governing equations are derived and discussed together with some of the material parameters required. The equations are solved by the f...... by the finite element method and, finally, results showing the effect of different treatment strategies are presented....

  14. Finite element analysis of boron diffusion in wooden Poles

    DEFF Research Database (Denmark)

    Krabbenhøft, Kristian; Hoffmeyer, Preben; Bechgaard, Carl

    2004-01-01

    The problem of describing the migration of dissolved boron in wood is treated with special reference to the commonly used remedial treatment of wooden poles. The governing equations are derived and discussed together with some of the material parameters required. The equations are solved by the f...... by the finite element method and, finally, results showing the effect of different treatment strategies are presented....

  15. Finite Element Analysis of Boron Diffusion in Wooden Poles

    DEFF Research Database (Denmark)

    Krabbenhøft, Kristian; Hoffmeyer, Preben; Bechgaard, Carl

    2004-01-01

    The problem of describing the migration of dissolved boron in wood is treated with special reference to the commonly used remedial treatment of wooden poles. The governing equations are derived and discussed together with some of the material parameters required. The equations are solved by the f...... by the finite element method and, finally, results showing the effect of different treatment strategies are presented....

  16. Separable pole expansions in four-nucleon bound state calculations

    International Nuclear Information System (INIS)

    Sofianos, S.A.; Fiedeldey, H.; Haberzettl, H.; Sandhas, W.

    1982-04-01

    We compare the utility of the Generalized Unitary Pole Expansion (GUPE) and the Energy-Dependent Pole Expansion (EDPE) for the three-body subsystem amplitudes in four-body state calculations for a variety of separable and local nucleon-nucleon interactions. It is found that, with the EDPE, the four-body binding energy is well reproduced with only two terms each for the (2+2)- and the (3+1)-subsystem, respectively, while the GUPE requires three terms for the (3+1)-channel and four terms for the (2+2)-channel. We thus conclude that pole dominance is of greater importance for the GUPE than for EDPE, which works equally well for both types of subsystems. It is found that both methods, in particular the EDPE, converge more rapidly with increasing repulsion in the two-body interaction, i.e. the more realistic the interaction becomes. Both expansions require similar computing times for a converged calculation and are about 15-20 times faster than the widely used Hilbert-Schmidt Expansion (HSE). The respective merits of the two pole expansions are discussed and compared with the HSE. (orig.)

  17. USA valitsus: Tallinna linnahalli miljardigarantiid pole olemas / Raimo Poom

    Index Scriptorium Estoniae

    Poom, Raimo

    2010-01-01

    USA Eesti-saatkonna teatel pole USA valitsus andnud garantiid mitte ühelegi projektile Tallinnas. Tallinna abilinnapea Taavi Aasa sõnul ei saa USA garantiist teha juttu enne, kui Eesti valitsus selle omakorda garanteerib. Taavi Aasa kirjast rahandusminister Jürgen Ligile

  18. An estimate on the purely imaginary poles of scattering matrix

    International Nuclear Information System (INIS)

    Bozhkov, Y.D.

    1988-12-01

    In this work we obtain two estimates (upper and lower) on the number of purely imaginary poles of the scattering matrix for the wave equation in the exterior of a compact smooth obstacle in R n , n ≥ 3 odd. The method of Lax and Phillips is used. (author). 5 refs

  19. Kick, Glide, Pole! Cross-Country Skiing Fun (Part II)

    Science.gov (United States)

    Duoos, Bridget A.

    2012-01-01

    Part I of Kick, Glide, Pole! Cross-Country Skiing Fun, which was published in last issue, discussed how to select cross-country ski equipment, dress for the activity and the biomechanics of the diagonal stride. Part II focuses on teaching the diagonal stride technique and begins with a progression of indoor activities. Incorporating this fun,…

  20. Catapult effect in pole vaulting: is muscle coordination determinant?

    Science.gov (United States)

    Frère, Julien; Göpfert, Beat; Hug, François; Slawinski, Jean; Tourny-Chollet, Claire

    2012-02-01

    This study focused on the phase between the time of straightened pole and the maximum height (HP) of vaulter and aimed at determining the catapult effect in pole vaulting on HP. Seven experienced vaulters performed 5-10 vaults recorded by two video cameras, while the surface electromyography (sEMG) activity of 10 upper limbs muscles was recorded. HP was compared with an estimated maximum height (HP(est)) allowing the computation of a push-off index. Muscle synergies were extracted from the sEMG activity profiles using a non-negative matrix factorization algorithm. No significant difference (p>0.47) was found between HP(est) (4.64±0.21m) and HP (4.69±0.23m). Despite a high inter-individual variability in sEMG profiles, two muscle synergies were extracted for all the subjects which accounted for 96.1±2.9% of the total variance. While, the synergy activation coefficients were very similar across subjects, a higher variability was found in the muscle synergy vectors. Consequently, whatever the push-off index among the pole vaulters, the athletes used different muscle groupings (i.e., muscle synergy vectors) which were activated in a similar fashion (i.e., synergy activation coefficients). Overall, these results suggested that muscle coordination adopted between the time of straightened pole and the maximum height does not have a major influence on HP. Copyright © 2011 Elsevier Ltd. All rights reserved.

  1. Pole solution in six dimensions as a dimensional reduction model

    Science.gov (United States)

    Ichinose, Shoichi

    2002-01-01

    A solution with the pole configuration in six dimensions is analyzed. It is a dimensional reduction model of Randall-Sundrum type. The soliton configuration is induced by the bulk Higgs mechanism. The boundary condition is systematically solved up to the 6th order. The Riemann curvature is finite everywhere.

  2. Diplodia natalensis , Pole Evans: a causal agent of citrus gummosis ...

    African Journals Online (AJOL)

    Isolations were made from the barks of gummosis-infected citrus trees from orchards of the University of Ghana Agricultural Research Station at Kade. The isolation media used were 1.5% water agar, 1.5% water agar + nystatin and 1.5% water agar + benomyl. Four isolates including Diplodia natalensis Pole Evans, ...

  3. Poled-glass devices: Influence of surfaces and interfaces

    DEFF Research Database (Denmark)

    Fage-Pedersen, Jacob; Jacobsen, Rune Shim; Kristensen, Martin

    2007-01-01

    Devices in periodically poled glass must have a large periodic variation of the built-in field. We show that the periodic variation can be severely degraded by charge dynamics taking place at the external (glass–air) interface or at internal (glass–glass) interfaces if the interfaces have imperfe...

  4. BMP regulates vegetal pole induction centres in early xenopus development.

    Science.gov (United States)

    Nachaliel, N; Re'Em-Kalma, Y; Eshed, O; Elias, S; Frank, D

    1998-10-01

    Bone morphogenetic protein (BMP) plays an important role in mesoderm patterning in Xenopus. The ectopic expression of BMP-4 protein hyperventralizes embryos, whereas embryos expressing a BMP-2/4 dominant-negative receptor (DNR) are hyperdorsalized. Mesoderm is initially induced in the marginal zone by cells in the underlying vegetal pole. While much is known about BMP's expression and role in patterning the marginal zone, little is known about its early role in regulating vegetal mesoderm induction centre formation. The role of BMP in regulating formation of vegetal mesoderm inducing centres during early Xenopus development was examined. Ectopic BMP-4 expression in vegetal pole cells inhibited dorsal mesoderm induction but increased ventral mesoderm induction when recombined with animal cap ectoderm in Nieuwkoop explants. 32-cell embryos injected with BMP-4 RNA in the most vegetal blastomere tier were not hyperdorsalized by LiCl treatment. The ectopic expression of Smad or Mix.1 proteins in the vegetal pole also inhibited dorsal mesoderm induction in explants and embryos. Expression of the BMP 2/4 DNR in the vegetal pole increased dorsal mesoderm induction and inhibited ventral mesoderm induction in explants and embryos. These results support a role for BMP signalling in regulating ventral vegetal and dorsal vegetal mesoderm induction centre formation during early Xenopus development.

  5. Carrier Phase GPS Navigation to the North Pole

    Science.gov (United States)

    Moore, T.; Roberts, G. W.

    Over the last few years, on-the-fly integer ambiguity resolution for GPS has proven to be successful over short baselines (500 km. New techniques have been developed at the University of Nottingham to allow very long baseline integer ambiguity resolution, on-the-fly. A major problem with the use of carrier phase data is that posed by cycle slips. A technique for detecting and correcting cycle slips has been developed, and its use is discussed in this paper. The new technique has been proven through a series of trials, one of which included two flights to the North Pole, performing centimetric level positioning all the way to the pole. For many years, the GD Aero-Systems Course of the Air Warfare Centre based at RAF Cranwell executed a series of equipment flight trials to the North Pole, called the ARIES Flights. In May 1996, the authors were fortunate to take part in both flights, via Iceland and Greenland, to the North Pole. Based on reference stations at Thule Air Base, integer ambiguity resolution was accomplished, on-the-fly, and centimetric level navigation maintained throughout the flights. Earlier trials detailed in the paper demonstrate that the technique can resolve integer ambiguities on-the-fly within a few seconds over a baseline length of approximately 134 km, resulting in an accuracy of 12 cm. The majority of the residual error source for this being the ionosphere.

  6. Decay resistance of out-of-service utility poles as related to the distribution of residual creosote content

    Science.gov (United States)

    Han Roliadi; Chung Y. Hse; Elvin T. Choong; Todd F. Shupe

    2000-01-01

    Decay resistance of out-of-service poles was investigated to evaluate their effectiveness against biodegradation for possible recycling of these poles for composite products. Decay resistance was related to creosote content and creosote distribution in poles with service durations of 5 and 25 years and also freshly treated poles. Weathering of the poles had caused...

  7. Inferior patellar pole fragmentation in children: just a normal variant?

    Energy Technology Data Exchange (ETDEWEB)

    Kan, J.H.; Vogelius, Esben S.; Orth, Robert C.; Guillerman, R.P.; Jadhav, Siddharth P. [Texas Children' s Hospital, E.B. Singleton Pediatric Radiology, Houston, TX (United States)

    2015-06-15

    Fragmentary ossification of the inferior patella is often dismissed as a normal variant in children younger than 10 years of age. The purpose of this study was to determine whether fragmentary inferior patellar pole ossification is a normal variant or is associated with symptoms or signs of pathology using MRI and clinical exam findings as reference. A retrospective review was performed on 150 patients ages 5-10 years who underwent 164 knee radiography and MRI exams (45.1% male, mean age: 7.8 years). The presence or absence of inferior patellar pole fragmentation on radiography was correlated with the presence or absence of edema-like signal on MR images. Clinical notes were reviewed for the presence of symptoms or signs referable to the inferior patellar pole. These data were compared with a 1:1 age- and sex-matched control group without inferior pole fragmentation. Statistical analysis was performed using two-tailed t-tests. Forty of 164 (24.4%) knee radiographs showed fragmentary ossification of the inferior patella. Of these 40 knees, 62.5% (25/40) had edema-like signal of the inferior patellar bone marrow compared with 7.5% (3/40) of controls (P = 0.035). Patients with fragmentary ossification at the inferior patella had a significantly higher incidence of documented focal inferior patellar pain compared with controls (20% vs. 2.5%, P = 0.015). Inferior patellar pole fragmentation in children 5 to 10 years of age may be associated with localized symptoms and bone marrow edema-like signal and should not be routinely dismissed as a normal variant of ossification. (orig.)

  8. Bycatch in the Maldivian pole-and-line tuna fishery.

    Science.gov (United States)

    Miller, Kelsey I; Nadheeh, Ibrahim; Jauharee, A Riyaz; Anderson, R Charles; Adam, M Shiham

    2017-01-01

    Tropical tuna fisheries are among the largest worldwide, with some having significant bycatch issues. However, pole-and-line tuna fisheries are widely believed to have low bycatch rates, although these have rarely been quantified. The Maldives has an important pole-and-line fishery, targeting skipjack tuna (Katsuwonus pelamis). In the Maldives, 106 pole-and-line tuna fishing days were observed between August 2014 and November 2015. During 161 fishing events, tuna catches amounted to 147 t: 72% by weight was skipjack, 25% yellowfin tuna (Thunnus albacares) and 3% other tunas. Bycatch (all non-tuna species caught plus all tuna discards) amounted to 951 kg (0.65% of total tuna catch). Most of the bycatch (95%) was utilized, and some bycatch was released alive, so dead discards were particularly low (0.02% of total tuna catch, or 22 kg per 100 t). Rainbow runner (Elagatis bipinnulata) and dolphinfish (Coryphaena hippurus) together constituted 93% of the bycatch. Live releases included small numbers of silky sharks (Carcharhinus falciformis) and seabirds (noddies, Anous tenuirostris and A. stolidus). Pole-and-line tuna fishing was conducted on free schools and schools associated with various objects (Maldivian anchored fish aggregating devices [aFADs], drifting FADs from western Indian Ocean purse seine fisheries, other drifting objects and seamounts). Free school catches typically included a high proportion of large skipjack and significantly less bycatch. Associated schools produced more variable tuna catches and higher bycatch rates. Fishing trips in the south had significantly lower bycatch rates than those in the north. This study is the first to quantify bycatch rates in the Maldives pole-and-line tuna fishery and the influence of school association on catch composition. Ratio estimator methods suggest roughly 552.6 t of bycatch and 27.9 t of discards are caught annually in the fishery (based on 2015 national catch), much less than other Indian Ocean tuna

  9. Acute effects of flexible pole exercise on heart rate dynamics.

    Science.gov (United States)

    de Oliveira, Letícia Santana; Moreira, Patrícia S; Antonio, Ana M; Cardoso, Marco A; de Abreu, Luiz Carlos; Navega, Marcelo T; Raimundo, Rodrigo D; Valenti, Vitor E

    2015-01-01

    Exercise with flexible poles provides fast eccentric and concentric muscle contractions. Although the literature reports significant muscle chain activity during this exercise, it is not clear if a single bout of exercise induces cardiac changes. In this study we assessed the acute effects of flexible pole exercise on cardiac autonomic regulation. The study was performed on 22 women between 18 and 26 years old. We assessed heart rate variability (HRV) in the time (SDNN, RMSSD and pNN50) and frequency (HF, LF and LF/HF ratio) domains and geometric indices of HRV (RRTri, TINN, SD1, SD2 and SD1/SD2 ratio). The subjects remained at rest for 10 min and then performed the exercises with the flexible poles. Immediately after the exercise protocol, the volunteers remained seated at rest for 60 min and HRV was analyzed. We observed no significant changes in time domain (SDNN: p=0.72; RMSSD: p=0.94 and pNN50: p=0.92) or frequency domain indices (LF [nu]: p=0.98; LF [ms(2)]: p=0.72; HF [nu]: p=0.98; HF [ms(2)]: p=0.82 and LF/HF ratio: p=0.7) or in geometric indices (RRTri: p=0.54; TINN: p=0.77; SD1: p=0.94; SD2: p=0.67 and SD/SD2: p=0.42) before and after a single bout of flexible pole exercise. A single bout of flexible pole exercise did not induce significant changes in cardiac autonomic regulation in healthy women. Copyright © 2014 Sociedade Portuguesa de Cardiologia. Published by Elsevier España. All rights reserved.

  10. Wire inhomogeneity detector having a core with opposing pole pieces and guide pieces adjacent the opposing pole pieces

    International Nuclear Information System (INIS)

    Gibson, G.H.; Smits, R.G.; Eberhard, P.H.

    1989-01-01

    This patent describes a wire inhomogeneity detector assembly for detecting changes in the conductive properties of a wire as the wire is passed therethrough. It comprises: a coil assembly through which a wire containing conductive material is adapted to be pressed in a direction substantially perpendicular to a longitudinal axis of the coil assembly. The coil assembly comprising a single ferrite core having a pair of opposing pole pieces between which are an associated conductive wire to be tested is adapted to be passed, each of the pole pieces having a coil wound therearound. The coil assembly including a guide-block consisting of a pair of guide pieces mounted adjacent to ends of the opposing pole pieces for guiding an associated conductive wire between the pole pieces and for reducing stray magnetic field lines. The guide pieces being positioned closely adjacent an associated conductive wire passing therebetween; an impedance bridge adjusted to an null balance point operatively connected to the coil assembly which measures the impedance of the coil assembly and is unbalanced by changes in eddy currents generated in the coil assembly; and a filter detector alarm assembly operatively connected to an output of the impedance bridge. The filter detector alarm assembly including an input bandpass filter detector alarm assembly including an input bandpass filter operatively connected to a differential comparator, the output of which triggers an alarm

  11. Bone grafting via reamer-irrigator-aspirator for nonunion of open Gustilo-Anderson type III tibial fractures treated with multiplanar external fixator

    Directory of Open Access Journals (Sweden)

    Kusnezov Nicholas

    2017-01-01

    Full Text Available Introduction: The purpose of this investigation was to evaluate the outcomes following reamer-irrigator-aspirator (RIA autogenous bone grafting (ABG of high-grade open tibia fracture nonunions stabilized via multiplanar external fixation. Methods: We retrospectively reviewed all patients with Gustilo-Anderson type III open tibia fractures treated with multiplanar external fixation and who underwent RIA ABG for nonunion at our institutional Level 1 Trauma Center between 2008 and 2015. All patients between 15 and 65 years of age with a minimum of six-month follow-up were included. The primary outcomes of interest were achievement of union, time to union, and incidence of revision surgery. Complications and all-cause reoperation were recorded as secondary endpoints. Results: Fifteen patients met the inclusion criteria with a mean age of 41.1 ± 14.0 years. RIA ABG was harvested from the femur in all cases, with a mean volume of 34 ± 15 mL. At an average follow-up of 13.3 ± 6.8 months, all patients achieved union, including two who required repeat RIA ABG. One patient experienced a femoral shaft fracture four months following RIA that required intramedullary fixation. The average time to union was 6.0 ± 6.3 months. Twelve patients (80% went on to union within six months and 13 (86.7% within one year. Five patients experienced a total of six post-operative complications including three deep infections, one refracture through the nonunion site, and one gradual varus deformity. Two patients in this series required a subsequent RIA autografting procedure secondary to persistent nonunion despite initial RIA. Conclusion: We found that RIA ABG offered a reliable solution to nonunion of Gustilo-Anderson type III open tibial fractures treated with multiplanar external fixation, circumventing the need to change the method of fixation.

  12. Repair of impact damaged utility poles with fiber reinforced polymers (FRP), phase II : [summary].

    Science.gov (United States)

    2015-04-01

    The aluminum and steel utility poles which support traffic signals, lighting, or mast-arm signs : are vulnerable to collisions from vehicles because of proximity to roadways. Removing these : poles for repair is costly and time-consuming, and removal...

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1994-11-01

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

  14. Pole Shape Optimization of Permanent Magnet Synchronous Motors Using the Reduced Basis Technique

    Directory of Open Access Journals (Sweden)

    A. Jabbari

    2010-03-01

    Full Text Available In the present work, an integrated method of pole shape design optimization for reduction of torque pulsation components in permanent magnet synchronous motors is developed. A progressive design process is presented to find feasible optimal shapes. This method is applied on the pole shape optimization of two prototype permanent magnet synchronous motors, i.e., 4-poles/6-slots and 4-poles-12slots.

  15. [The splenic inferior pole of rats and hyperbaric oxygen].

    Science.gov (United States)

    Paulo, Isabel Cristina Andreatta Lemos; Paulo, Danilo Nagib Salomão; Ferrari, Thiago Antunes; Azeredo, Thiago Caetano Valadão de; Silva, Alcino Lázaro da

    2008-01-01

    To study the functional and morphological features of the lower pole of the spleen in rats submitted, or not, to postoperative hyperbaric oxygen therapy. Seventy-nine Wistar rats, weighing 248.7 +/- 27 g, divided into two groups [group A - simulation (n=40), group B - lower pole (n=39)] underwent surgery and were subdivided into two groups: 11 and 70 postoperative days. Each subgroup was subdivided into animals not treated (nt) (A11nt, n=10; B11nt, n=13; A70nt, n=10; B70nt, n=9) and treated with hyperbaric oxygen (t) (A11t, n=10; B11t, n=9; A70t, n=10; B70t, n=8). Blood was collected for measurement of lipids and immunoglobulins, platelet and Howell-Jolly body count before and after surgery. The spleen and lower pole were removed for histology. There was an increase of total cholesterol (p=0.002), VLDL-cholesterol and triglycerides (p=0.003) and of LDL-cholesterol (p=0.013) in subgroup B11nt, and no alterations were observed in the other subgroups. IgM decreased in subgroups B11t (p=0.007), B11nt (p=0.0000), B70nt (p=0.0005), B70t (p=0.02), and no change was observed in the simulation group. The number of platelets increased in subgroups B11nt (p=0.002) and B11t (p=0.01) and remained unchanged in the other subgroups. Howell-Jolly bodies were less numerous in subgroup B70nt than in subgroup B11nt (p=0.019). Lower pole viability was better in subgroup B11t than in B11nt and in subgroup B70 than in B11, and did not differ between subgroups B70t and B70nt. Function and viability of the remaining lower pole improved during the late postoperative period. Viability and function of the lower pole were better during the early but not during the late postoperative period, in animals submitted to hyperbaric oxygen therapy.

  16. Effect of Materials and Manufacturing on the Bending Stiffness of Vaulting Poles

    Science.gov (United States)

    Davis, C. L.; Kukureka, S. N.

    2012-01-01

    The increase in the world record height achieved in pole vaulting can be related to the improved ability of the athletes, in terms of their fitness and technique, and to the change in materials used to construct the pole. For example in 1960 there was a change in vaulting pole construction from bamboo to glass fibre reinforced polymer (GFRP)…

  17. Finite element modeling of small-scale tapered wood-laminated composite poles with biomimicry features

    Science.gov (United States)

    Cheng Piao; Todd F. Shupe; R.C. Tang; Chung Y. Hse

    2008-01-01

    Tapered composite poles with biomimicry features as in bamboo are a new generation of wood laminated composite poles that may some day be considered as an alternative to solid wood poles that are widely used in the transmission and telecommunication fields. Five finite element models were developed with ANSYS to predict and assess the performance of five types of...

  18. The Neville-Aitken formula for rational interpolants with prescribed poles

    Science.gov (United States)

    Carstensen, C.; Mühlbach, G.

    1992-12-01

    Using a polynomial description of rational interpolation with prescribed poles a simple purely algebraic proof of a Neville-Aitken recurrence formula for rational interpolants with prescribed poles is presented. It is used to compute the general Cauchy-Vandermonde determinant explicitly in terms of the nodes and poles involved.

  19. Mechanical properties of small-scale laminated wood composite poles: effects of taper and webs

    Science.gov (United States)

    Cheng Piao; Todd F. Shupe; R.C. Tang; Chung Y. Hse

    2006-01-01

    Laminated hollow wood composite poles represent an efficient utilization of the timber resource and a promising alternative for solid poles that are commonly used in the power transmission and telecommunication lines. The objective of this study was to improve the performance of composite poles by introducing the bio-mimicry concept into the design of hollow wood...

  20. Claw-pole Synchronous Generator for Compressed Air Energy Storage

    Directory of Open Access Journals (Sweden)

    PAVEL Valentina

    2013-05-01

    Full Text Available This paper presents a claw-poles generator for compressed air energy storage systems. It is presented the structure of such a system used for compensating of the intermittency of a small wind energy system. For equipping of this system it is chosen the permanent magnet claw pole synchronous generator obtained by using ring NdFeB permanentmagnets instead of excitation coil. In such a way the complexity of the scheme is reduced and the generator become maintenance free. The new magnetic flux density in the air-gap is calculated by magneticreluctance method and by FEM method and the results are compared with measured values in the old and new generator.

  1. Study of recursive model for pole-zero cancellation circuit

    International Nuclear Information System (INIS)

    Zhou Jianbin; Zhou Wei; Hong Xu; Hu Yunchuan; Wan Xinfeng; Du Xin; Wang Renbo

    2014-01-01

    The output of charge sensitive amplifier (CSA) is a negative exponential signal with long decay time which will result in undershoot after C-R differentiator. Pole-zero cancellation (PZC) circuit is often applied to eliminate undershoot in many radiation detectors. However, it is difficult to use a zero created by PZC circuit to cancel a pole in CSA output signal accurately because of the influences of electronic components inherent error and environmental factors. A novel recursive model for PZC circuit is presented based on Kirchhoff's Current Law (KCL) in this paper. The model is established by numerical differentiation algorithm between the input and the output signal. Some simulation experiments for a negative exponential signal are carried out using Visual Basic for Application (VBA) program and a real x-ray signal is also tested. Simulated results show that the recursive model can reduce the time constant of input signal and eliminate undershoot. (authors)

  2. On the ultimate uncertainty of the top quark pole mass

    Energy Technology Data Exchange (ETDEWEB)

    Beneke, M. [Technische Univ. Muenchen, Garching (Germany). Physik-Department; Marquard, P. [Deutsches Elektronen-Synchrotron (DESY), Zeuthen (Germany); Nason, P. [INFN, Sezione di Milano Bicocca (Italy); Steinhauser, M. [Karlsruher Institut fuer Technologie (Germany). Inst. fuer Theoretische Teilchenphysik

    2016-05-15

    We combine the known asymptotic behaviour of the QCD perturbation series expansion, which relates the pole mass of a heavy quark to the MS mass, with the exact series coefficients up to the four-loop order to determine the ultimate uncertainty of the top-quark pole mass due to the renormalon divergence. We perform extensive tests of our procedure by varying the number of colours and flavours, as well as the scale of the strong coupling and the MS mass, and conclude that this uncertainty is around 70 MeV. We further estimate the additional contribution to the mass relation from the five-loop correction and beyond to be 250 MeV.

  3. Development of a 10-m wedged-pole undulator

    International Nuclear Information System (INIS)

    Robinson, K.E.; Gottschalk, S.C.; James, F.E.; Quimby, D.C.; Slater, J.M.; Valla, A.S.

    1989-01-01

    A 10-m rare earth permanent magnet hybrid undulator called a near infrared scalable undulator system (NISUS) is under construction at Spectra Technology for use in the Boeing FEL program series. The design was optimized for operation at a 1-μm wavelength with the Boeing accelerator parameters. A remotely adjustable compound taper is utilized to achieve optimum startup gain and high saturated extraction. A summary of the relevant design parameters is listed. A major goal was to build NISUS from modules which would allow easy scaling to longer lengths without redesign. Prototype tests for verification of field strength and quality are complete as well as the delivery and installation of the initial 5 m. Improvements relative to the technology used in the earlier tapered hybrid undulator (THUNDER) are highlighted. The wedged-pole configuration is employed for a major increase in field strength while operating the poles farther from saturation

  4. Seasonal Evolution of Titan's Stratosphere Near the Poles

    Science.gov (United States)

    Coustenis, A.; Jennings, D. E.; Achterberg, R. K.; Bampasidis, G.; Nixon, C. A.; Lavvas, P.; Cottini, V.; Flasar, F. M.

    2018-02-01

    In this Letter, we report the monitoring of seasonal evolution near Titan’s poles. We find Titan’s south pole to exhibit since 2010 a strong temperature decrease and a dramatic enhancement of several trace species such as complex hydrocarbons and nitriles (HC3N and C6H6 in particular) previously only observed at high northern latitudes. This results from the seasonal change on Titan going from winter (2002) to summer (2017) in the north and, at the same time, the onset of winter in the south pole. During this transition period atmospheric components with longer chemical lifetimes linger in the north, undergoing slow photochemical destruction, while those with shorter lifetimes decrease and reappear in the south. An opposite effect was expected in the north, but not observed with certainty until now. We present here an analysis of high-resolution nadir spectra acquired by Cassini/Cassini Composite Infrared Spectrometer in the past years and describe the temperature and composition variations near Titan’s poles. From 2013 until 2016, the northern polar region has shown a temperature increase of 10 K, while the south has shown a more significant decrease (up to 25 K) in a similar period of time. While the south polar region has been continuously enhanced since about 2012, the chemical content in the north is finally showing a clear depletion for most molecules only since 2015. This is indicative of a non-symmetrical response to the seasons in Titan’s stratosphere that can set constraints on photochemical and GCM models.

  5. REGIONAL DEVELOPMENT THROUGH GROWTH AND URBAN DEVELOPMENT POLES IN ROMANIA

    Directory of Open Access Journals (Sweden)

    Stefana VARVARI

    2015-09-01

    Full Text Available In 2008 the Ministry of Development, Public Works and Housing (now the Ministry of Regional Development and Public Administration prepared the growth poles policy for Romania, establishing seven growth poles to be financed through the Regional Operational Programme 2007-1013, under the Priority Axis no. 1. For 2007-2013 there were also established 11 urban development poles. At present the Ministry is discussing with the European Commission the new Regional Operational Programme 2014-2020 in which the main policy lines regarding integrated territorial development also take into consideration the improvement of the quality of life and the “appearance” of towns and strengthening their role in the region. The main urban agglomerations (county seats are seen as development engines of the regions. The authors analyze the results obtained and the problems that appeared at regional level in what concerns the projects financed under Axis 1 of the ROP 2007-2013 by answering two main questions: did they really had the estimated impact on the growth and urban development poles and on the regions? and was there really an integrated approach used? Based on the results obtained from the analysis of the previous programming period the authors try to recommend some improvements that could be taken into consideration for the development of the Integrated urban development plans and priority projects that are going to be financed by ESI funds under Axis 4 of the new ROP 2014-2020, recommendations that could be taken into consideration when preparing the Guidelines for applicants for this axis.

  6. Tööpuudus 29%, palavikku pole / Rachel Donadio

    Index Scriptorium Estoniae

    Donadio, Rachel

    2010-01-01

    Lõuna-Hispaanias asuvas Cádizis on töötus 29%, ometi pole eurotsooni kõrgeim tööpuuduse määr tekitanud linnas sügavat sotsiaalset rahutust ega massilisi proteste, sest üsna kõrge elukvaliteedi tagavad töötutele kompleksne turvavõrk, mis koosneb varimajandusest, perekonna toetusest ja valitsuse toetusest

  7. Development of a superconducting claw-pole motor

    International Nuclear Information System (INIS)

    Watanabe, E.; Kikukawa, K.; Satoh, Y.; Torii, S.

    2008-01-01

    We have developed and produced a superconducting claw-pole motor for a trial purpose as a method to make the best use of the characteristic of superconductivity without collector rings or rotating superconducting coils that need to be cryocooled, and made some examinations. The unique feature in this motor is to have the mechanism that supports the reaction magnetic force generated in the axial direction

  8. Multiple mechanisms regulate NuMA dynamics at spindle poles.

    Science.gov (United States)

    Kisurina-Evgenieva, Olga; Mack, Gary; Du, Quansheng; Macara, Ian; Khodjakov, Alexey; Compton, Duane A

    2004-12-15

    The large coiled-coil protein NuMA plays an essential role in organizing microtubule minus ends at spindle poles in vertebrate cells. Here, we use both in vivo and in vitro methods to examine NuMA dynamics at mitotic spindle poles. Using fluorescence recovery after photobleaching, we show that an exogenously expressed green-fluorescent-protein/NuMA fusion undergoes continuous exchange between soluble and spindle-associated pools in living cells. These dynamics require cellular energy and display an average half-time for fluorescence recovery of approximately 3 minutes. To explore how NuMA dynamics at spindle poles is regulated, we exploited the association of NuMA with microtubule asters formed in mammalian mitotic extracts. Using a monoclonal antibody specific for human NuMA, we followed the fate of human NuMA associated with microtubule asters upon dilution with a hamster mitotic extract. Consistent with in vivo data, this assay shows that NuMA can be displaced from the core of pre-assembled asters into the soluble pool. The half-time of NuMA displacement from asters under these conditions is approximately 5 minutes. Using this assay, we show that protein kinase activity and the NuMA-binding protein LGN regulate the dynamic exchange of NuMA on microtubule asters. Thus, the dynamic properties of NuMA are regulated by multiple mechanisms including protein phosphorylation and binding to the LGN protein, and the rate of exchange between soluble and microtubule-associated pools suggests that NuMA associates with an insoluble matrix at spindle poles.

  9. Clusters of cyclones encircling Jupiter’s poles

    Science.gov (United States)

    Adriani, A.; Mura, A.; Orton, G.; Hansen, C.; Altieri, F.; Moriconi, M. L.; Rogers, J.; Eichstädt, G.; Momary, T.; Ingersoll, A. P.; Filacchione, G.; Sindoni, G.; Tabataba-Vakili, F.; Dinelli, B. M.; Fabiano, F.; Bolton, S. J.; Connerney, J. E. P.; Atreya, S. K.; Lunine, J. I.; Tosi, F.; Migliorini, A.; Grassi, D.; Piccioni, G.; Noschese, R.; Cicchetti, A.; Plainaki, C.; Olivieri, A.; O’Neill, M. E.; Turrini, D.; Stefani, S.; Sordini, R.; Amoroso, M.

    2018-03-01

    The familiar axisymmetric zones and belts that characterize Jupiter’s weather system at lower latitudes give way to pervasive cyclonic activity at higher latitudes. Two-dimensional turbulence in combination with the Coriolis β-effect (that is, the large meridionally varying Coriolis force on the giant planets of the Solar System) produces alternating zonal flows. The zonal flows weaken with rising latitude so that a transition between equatorial jets and polar turbulence on Jupiter can occur. Simulations with shallow-water models of giant planets support this transition by producing both alternating flows near the equator and circumpolar cyclones near the poles. Jovian polar regions are not visible from Earth owing to Jupiter’s low axial tilt, and were poorly characterized by previous missions because the trajectories of these missions did not venture far from Jupiter’s equatorial plane. Here we report that visible and infrared images obtained from above each pole by the Juno spacecraft during its first five orbits reveal persistent polygonal patterns of large cyclones. In the north, eight circumpolar cyclones are observed about a single polar cyclone; in the south, one polar cyclone is encircled by five circumpolar cyclones. Cyclonic circulation is established via time-lapse imagery obtained over intervals ranging from 20 minutes to 4 hours. Although migration of cyclones towards the pole might be expected as a consequence of the Coriolis β-effect, by which cyclonic vortices naturally drift towards the rotational pole, the configuration of the cyclones is without precedent on other planets (including Saturn’s polar hexagonal features). The manner in which the cyclones persist without merging and the process by which they evolve to their current configuration are unknown.

  10. Coherence between geophysical excitations and celestial pole offsets

    Czech Academy of Sciences Publication Activity Database

    Ron, Cyril; Vondrák, Jan

    2011-01-01

    Roč. 8, č. 3 (2011), s. 243-247 ISSN 1214-9705. [Czech-Polish Workshop on Recent Geodynamics of the Sudeten and Adjacent Areas. Třešť, 04.11.2010-06.11. 2010] R&D Projects: GA ČR GA205/08/0908 Institutional research plan: CEZ:AV0Z10030501 Keywords : geophysical excitations * celestial pole offsets * coherence Subject RIV: BN - Astronomy, Celestial Mechanics, Astrophysics Impact factor: 0.530, year: 2011

  11. Pole particles in Treder's tetrad theory

    Energy Technology Data Exchange (ETDEWEB)

    Fuchs, H.

    1977-01-01

    In the framework of Treder's tetrad theory of gravitation the interaction of pole-particles is considered in post-Newtonian approximation. The perihelion shift for the two-body problems is calculated for different matter-field-couplings. In general it depends not only from the sum of the masses but also from the reduced mass. The additional term is connected with the absorption of gravitation.

  12. Seasonal Evolution of Titan's South Pole 220 cm-1 Cloud

    Science.gov (United States)

    Jennings, Donald

    2016-06-01

    A cloud of ices that had been seen only in Titan's north during winter began to emerge at the south pole in 2012. Discovered by Voyager IRIS as an emission feature at 220 cm-1, the cloud has been studied extensively in both the north and south by Cassini CIRS. The spectral feature acts as a tracer of the seasonal changes at Titan's poles, relating to evolving composition, temperature structure and dynamics. Although candidates have been proposed, the chemical makeup of the cloud has never been identified. The cloud is composed of condensates derived from gases created at high altitude and transported to the cold, shadowed pole. In the north the cloud has diminished gradually over the Cassini mission as Titan has transitioned from winter to spring. The southern cloud, on the other hand, grew rapidly after 2012. By late 2014 it had developed a complex ring structure that was confined to latitudes poleward of 70°S within the deep temperature well that had formed at the south pole [1]. The location of the cloud coincides in latitude with the HCN cloud reported by ISS and VIMS [2,3]. CIRS also saw enhanced gas emissions at those latitudes [4]. When it first formed, the cloud was abundant at altitudes as high as 250 km, while later it was found mostly at 100-150 km, suggesting that the material that had been deposited from above had gathered at the lower altitudes. Radiance from the southern cloud increased until mid-2015 and since then has decreased. The cloud may be transitioning to the more uniform hood morphology familiar in the north. Taking the north and south together, by the end of the Cassini mission in 2017 we will have observed almost an entire seasonal cycle of the ice cloud.

  13. Pole mass, width, and propagators of unstable fermions

    International Nuclear Information System (INIS)

    Kniehl, B.A.; Sirlin, A.

    2008-01-01

    The concepts of pole mass and width are extended to unstable fermions in the general framework of parity-nonconserving gauge theories, such as the Standard Model. In contrast with the conventional on-shell definitions, these concepts are gauge independent and avoid severe unphysical singularities, properties of great importance since most fundamental fermions in nature are unstable particles. General expressions for the unrenormalized and renormalized dressed propagators of unstable fermions and their field-renormalization constants are presented. (orig.)

  14. Performance study of quadrupole with broken line profile pole tip

    International Nuclear Information System (INIS)

    Fan Mingwu; Zhang Tianjue; Chu Chengjie

    1997-01-01

    Most of quadrupole used for beam focusing possess hyperbola profile tip. To simplify machining processes and ensure the assembling accuracy, a broken line profile pole tip is adapted instead of hyperbola. The results of the magnetic field simulation codes and the tests show the good quality field generated by such configuration: not only more uniform field gradient, but also field more concentrated at useful area. These types of quadrupole are used at CYCIAE-30 cyclotron and HI-13 tandem transportation lines

  15. Edgar Savisaar : BRS pole piisavalt investeerinud / Raigo Neudorf

    Index Scriptorium Estoniae

    Neudorf, Raigo

    2006-01-01

    Majandus- ja kommunikatsiooniminister on rahul, et riigi ja BRS-iga saavutati kokkulepe ettevõtte aktsiate tagasiostuks, kuid leiab, et BRS pole täitnud võetud investeerimiskohustusi ning seega peab järgnevatel aastatel suunama ettevõtte kaasajastamisse miljardeid kroone. Vt. samas: Jüri Käo: investeeringute kogumaht ületas nõutu; Savisaar: Jüri Käo ajab pada; Pingelised läbirääkimised BRS-iga

  16. Background Studies for Acoustic Neutrino Detection at the South Pole

    Science.gov (United States)

    Abbasi, R.; Abdou, Y.; Abu-Zayyad, T.; Adams, J.; Aguilar, J. A.; Ahlers, M.; Andeen, K.; Auffenberg, J.; Bai, X.; Baker, M.; hide

    2012-01-01

    The detection of acoustic signals from ultra-high energy neutrino interactions is a promising method. to measure the flux of cosmogenic neutrinos expected on Earth. The energy threshold for this process depends strongly on the absolute noise level in the target material. The South Pole Acoustic Test Setup (SPATS). deployed in the upper part of four boreholes of the IceCube Neutrino Observatory, has monitored the noise in Antarctic ice at the geographic South Pole for more than two years down to 500 m depth. The noise is very stable and Gaussian distributed, Lacking an in situ calibration up to now, laboratory measurements have been used to estimate the absolute noise level in the 10-50 kHz frequency range to be smaller than 20 mPa. Using a threshold trigger. sensors of the South Pole Acoustic Test Setup registered acoustic events in the IceCube detector volume and its vicinity. Acoustic signals from refreezing IceCube holes and from anthropogenic sources have been used to test the localization of acoustic events. An upper limit on the neutrino flux at energies E(sub v) > 10(exp 11) GeV is derived from acoustic data taken over eight months.

  17. THE SUSTAINABLE DEVELOPMENT OF THE BRASOV GROWTH POLE

    Directory of Open Access Journals (Sweden)

    Aida CATANA

    2016-12-01

    Full Text Available The demographic dynamics analysed in the context of the relationship between economic development and social inclusion presents an image of the sustainable development of a community as well as the manner how the financial resources have been used. With an allocation of 74.3 million euro in the programming period 2007-2013, the Brasov Growth Pole has pursued the contribution to the achievement of sustainable development since 2005 by the participation in the Agenda 21. The implementation of projects with European financing in areas such as transport, social and educational infrastructure or tourism have generated changes/demographic movements, which this paper proposes to present. The evolution of the stable population, its dynamics at the level of each locality that is part of the Brasov growth pole as well as the dynamics of the number of employees or the development of the unemployment rate are presented by the cluster analysis. The effects of the European financing obtained from Regional Operational Programme 2007-2013 are thus reflected in the sustainable development of the Brasov growth pole from the point of view of the dynamics of the population

  18. Factorization and resummation for collinear poles in QCD amplitudes

    Energy Technology Data Exchange (ETDEWEB)

    Dixon, Lance J.; Magnea, Lorenzo; Sterman, George

    2008-05-28

    We study the origin of subleading soft and collinear poles of form factors and amplitudes in dimensionally-regulated massless gauge theories. In the case of form factors of fundamental fields, these poles originate from a single function of the coupling, denoted G({alpha}{sub s}), depending on both the spin and gauge quantum numbers of the field. We relate G({alpha}{sub s}) to gauge-theory matrix elements involving the gluon field strength. We then show that G({alpha}{sub s}) is the sum of three terms: a universal eikonal anomalous dimension, a universal non-eikonal contribution, given by the coefficient B{sub {delta}}({alpha}{sub s}) of {delta}(1-z) in the collinear evolution kernel, and a process-dependent short-distance coefficient function, which does not contribute to infrared poles. Using general results on the factorization of soft and collinear singularities in fixed-angle massless gauge theory amplitudes, we conclude that all such singularities are captured by the eikonal approximation, supplemented only by the knowledge of B{sub {delta}}({alpha}{sub s}). We explore the consequences of our results for conformal gauge theories, where in particular we find a simple exact relation between the form factor and the cusp anomalous dimension.

  19. Automatic Pole and Q-Value Extraction for RF Structures

    Energy Technology Data Exchange (ETDEWEB)

    C. Potratz, H.-W. Glock, U. van Rienen, F. Marhauser

    2011-09-01

    The experimental characterization of RF structures like accelerating cavities often demands for measuring resonant frequencies of Eigenmodes and corresponding (loaded) Q-values over a wide spectral range. A common procedure to determine the Q-values is the -3dB method, which works well for isolated poles, but may not be applicable directly in case of multiple poles residing in close proximity (e.g. for adjacent transverse modes differing by polarization). Although alternative methods may be used in such cases, this often comes at the expense of inherent systematic errors. We have developed an automation algorithm, which not only speeds up the measurement time significantly, but is also able to extract Eigenfrequencies and Q-values both for well isolated and overlapping poles. At the same time the measurement accuracy may be improved as a major benefit. To utilize this procedure merely complex scattering parameters have to be recorded for the spectral range of interest. In this paper we present the proposed algorithm applied to experimental data recorded for superconducting higher-order-mode damped multi-cell cavities as an application of high importance.

  20. Management of lower pole nephrolithiasis: a critical analysis.

    Science.gov (United States)

    Lingeman, J E; Siegel, Y I; Steele, B; Nyhuis, A W; Woods, J R

    1994-03-01

    The results of extracorporeal shock wave lithotripsy (ESWL*) and percutaneous nephrostolithotomy for the treatment of lower pole nephrolithiasis were examined in 32 consecutive patients undergoing percutaneous nephrostolithotomy at the Methodist Hospital of Indiana and through meta-analysis of publications providing adequate stratification of treatment results. Of 101 cases managed with percutaneous nephrostolithotomy 91 (90%) were stone-free, a result significantly better than that achieved with ESWL (1,733 of 2,927 stone-free, 59%). Stone-free rates with percutaneous nephrostolithotomy were independent of stone burden, whereas stone-free rates with ESWL were inversely correlated to the stone burden treated. The morbidity of patients undergoing percutaneous nephrostolithotomy at our hospital was minimal, with a mean hospital stay of 4.7 +/- 2.8 days. No blood transfusions were required. All patients became stone-free. The percentage of urolithiasis patients with lower pole calculi is increasing. Because of the significantly greater efficacy of percutaneous nephrostolithotomy for lower pole calculi, particularly stones larger than 10 mm. in diameter, further consideration should be given to an initial approach with percutaneous nephrostolithotomy.

  1. Spatial patterns of pollution associated with creosote treated poles in Mälardalen

    OpenAIRE

    Forselius, Ellen

    2015-01-01

    Creosote is a product name given to a mixture of several hundred compounds, which is often used to protect wooden poles from rot and insect damage, however it has also been linked to causing cancer in humans. Alternative materials for power poles include concrete, steel, composite and non-treated wooden poles. This report looks at Mälarenergi Elnät ABs 17,000 creosote coated poles and their patterns of pollution. GIS analyses in ArcGIS were used to evaluate which creosote poles are most criti...

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

    Science.gov (United States)

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

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Susann Minkwitz

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

  4. POLE-LIKE OBJECT EXTRACTION FROM MOBILE LIDAR DATA

    Directory of Open Access Journals (Sweden)

    H. Zheng

    2016-06-01

    Full Text Available Object detection and recognition from LiDAR (Light Detection And Ranging data has been a research topic in the fields of photogrammetry and computer vision. Unlike point clouds collected in well-controlled indoor environments, point clouds in urban environments are more complex due to complexity of the real world. For example, trees sometimes close to signs or buildings, which will cause occlusions in the point clouds. Current object detection or reconstruction algorithms will have problems when recognizing objects with severe occlusions caused by trees etc. In this paper, a robust vegetation removal method and a DBSCAN based pole-like object detection method are proposed. Based on observation that major difference between vegetation and other rigid objects is their penetrability with respect to LiDAR, we introduce a local roughness measure to differentiate rigid objects from non-rigid ones (vegetation in this paper. First, a local sphere with a small radius is generated for each input point. Three principal components of the local sphere are then calculated, and a plane is determined. The roughness is obtained through calculating the standard deviation of distances from all inside points to the plane by a weighted summation of the normalized distances. The further the point to the plane, the smaller the weight is. Finally, a graph cuts based method is introduced to classify the input point sets into two groups. The data term is defined by the normalized roughness of the current point, and the smoothness term is defined by the normalized distance between the point and its nearest neighbour point. In terms of pole-like object detection, first, a uniformed 2D grid is generated through projecting all the points to the XY-plane. The seed points of the pole-like objects are obtained by determining the x and y coordinates by the centres of the highest density cells of the grid and the z coordinate by the mean height of the point sets of each object

  5. Live imaging of spindle pole disorganization in docetaxel-treated multicolor cells

    International Nuclear Information System (INIS)

    Sakaushi, Shinji; Nishida, Kumi; Minamikawa, Harumi; Fukada, Takashi; Oka, Shigenori; Sugimoto, Kenji

    2007-01-01

    Treatment of cells with docetaxel at low concentrations induces aberrant bipolar spindles of which two centrosomes stay at only one pole, and also induces multipolar spindles. To gain insight into the relations between centrosome impairment and structural defects of the spindle, live-cell imaging was performed on a human MDA Auro/imp/H3 cell line in which centrosomes/mitotic spindles, nuclear membrane and chromatin were simultaneously visualized by fluorescent proteins. In the presence of docetaxel at IC 50 concentration, the centrosomes did not segregate, and multiple aster-like structures ectopically arose around the disappearing nuclear membrane. Those ectopic structures formed an acentrosomal pole opposing to the two-centrosomes-containing pole. In late metaphase, one pole often fragmented into multiple spindle poles, leading multipolar division. These results suggest that spindle pole fragility may be induced by centrosome impairment, and collapse of the pole may contribute to induction of aneuploid daughter cells

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

    Directory of Open Access Journals (Sweden)

    Fischer C

    2018-04-01

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

  7. Pulsed electromagnetic fields for the treatment of tibial delayed unions and nonunions. A prospective clinical study and review of the literature

    Science.gov (United States)

    2012-01-01

    Background Pulsed electromagnetic fields (PEMF) stimulation for the treatment of bone nonunion or delayed union have been in use for several years, but on a limited basis. The aim of this study was to assess the overall efficacy of the method in tibial delayed unions and nonunions and identify factors that could affect the final outcome. Methods We prospectively reviewed 44 patients (27 men) with a mean age of 49.6 ± 18.4 years that received PEMF therapy due to tibial shaft delayed union or nonunion. In all cases, fracture gap was less than 1 cm and infection or soft tissue defects were absent. Results Fracture union was confirmed in 34 cases (77.3%). No relationship was found between union rate and age (p = 0.819), fracture side (left or right) (p = 0.734), fracture type (simple or comminuted, open or closed) (p = 0.111), smoking (p = 0.245), diabetes (p = 0.68) and initial treatment method applied (plates, nail, plaster of paris) (p = 0.395). The time of treatment onset didn’t affect the incidence of fracture healing (p = 0.841). Although statistical significance was not demonstrated, longer treatment duration showed a trend of increased probability of union (p = 0.081). Conclusion PEMF stimulation is an effective non-invasive method for addressing non-infected tibial union abnormalities. Its success is not associated with specific fracture or patient related variables and it couldn’t be clearly considered a time-dependent phenomenon. PMID:22681718

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

    Science.gov (United States)

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

    2017-08-01

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

  9. A follow-up study of the in-practice results of pulsed electromagnetic field therapy in the management of nonunion fractures

    Directory of Open Access Journals (Sweden)

    Murray HB

    2016-12-01

    Full Text Available Hallie B Murray,1 Brian A Pethica1,2 1EBI, LLC (a Zimmer Biomet company, Parsippany, NJ, USA; 2Department of Chemical and Biological Engineering, Princeton University, Princeton, NJ, USA Abstract: During normal fracture repair, healing occurs within a few months. However, for a minority of patients, the processes of bone repair are compromised or interrupted leading to the development of delayed union and nonunion fractures. Noninvasive bone growth stimulators using pulsed electromagnetic field (PEMF technology are currently in widespread use by patients with impaired fracture healing. This article reports the results of a follow-up study of 1,382 patients treated with PEMF stimulation to evaluate success rates and the relationship between average daily use and the clinical outcomes of therapy as reported by their prescribing physicians. The reported overall success rate for the 1,382 patients was 89.6%. The results were analyzed in audited subsets comparing days of treatment time and average daily use of the electrical bone growth stimulator, using several statistical methods. Linear regression analysis indicated a 6-day reduction in time to heal with each additional hour of average daily use. Survival analysis concluded that the median heal time was reduced by 35%–60%, depending on the different fracture characteristics of patients who complied with the recommended daily use of 10 hours per day. A third statistical analysis indicated that patients treated with the PEMF device for 9 hours or more per day had a significant reduction in time to heal, achieving successful fracture repair an average of 76 days earlier than patients treated with the PEMF device for an average of 3 hours or less per day. Overall, these different methods of statistical analysis indicate that PEMF therapy correlates with an acceleration in the healing of nonunion fractures. Keywords: PEMF, pulsed electromagnetic field, dose–response, nonunion, time to heal

  10. Pulsed electromagnetic fields for the treatment of tibial delayed unions and nonunions. A prospective clinical study and review of the literature

    Directory of Open Access Journals (Sweden)

    Assiotis Aggelos

    2012-06-01

    Full Text Available Abstract Background Pulsed electromagnetic fields (PEMF stimulation for the treatment of bone nonunion or delayed union have been in use for several years, but on a limited basis. The aim of this study was to assess the overall efficacy of the method in tibial delayed unions and nonunions and identify factors that could affect the final outcome. Methods We prospectively reviewed 44 patients (27 men with a mean age of 49.6 ± 18.4 years that received PEMF therapy due to tibial shaft delayed union or nonunion. In all cases, fracture gap was less than 1 cm and infection or soft tissue defects were absent. Results Fracture union was confirmed in 34 cases (77.3%. No relationship was found between union rate and age (p = 0.819, fracture side (left or right (p = 0.734, fracture type (simple or comminuted, open or closed (p = 0.111, smoking (p = 0.245, diabetes (p = 0.68 and initial treatment method applied (plates, nail, plaster of paris (p = 0.395. The time of treatment onset didn’t affect the incidence of fracture healing (p = 0.841. Although statistical significance was not demonstrated, longer treatment duration showed a trend of increased probability of union (p = 0.081. Conclusion PEMF stimulation is an effective non-invasive method for addressing non-infected tibial union abnormalities. Its success is not associated with specific fracture or patient related variables and it couldn’t be clearly considered a time-dependent phenomenon.

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

    Science.gov (United States)

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

    2018-02-01

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

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

    Science.gov (United States)

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

    2015-01-09

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

  13. Laparoscopic upper pole heminephroureterectomy in children: Seven-year experience

    Directory of Open Access Journals (Sweden)

    Antonio Marte

    2015-01-01

    Full Text Available Background: Minimally invasive surgery is the current approach to perform heminephroureterectomy (HN in children. This can be obtained through a transperitoneal (TP or a retroperitoneal approach. Here, we report our experience using a TP approach. Materials and Methods: From 2005 to 2014, 22 TP laparoscopic upper poles HN were performed at our institution. There were nine girls and 13 boys aged between 20 months and 6 years (mean age 3.9. Eight patients were diagnosed prenatally, 17 patients presented with urinary tract infection (UTI and three with vomiting and failure to thrive. The indication for HN was reflux nephropathy and UTI in non-functioning upper pole in 19 patients and cystic dysplasia in 1 patient. The surgical technique involved the following steps: Cystoscopic recognition; positioning of 3-4 trocar (right HN; identification of the kidney (detachment of the colon; isolation and low ligation of the dilated ureter; decrossing from renal vessels; section of the parenchyma by LigaSure; haemostasis with clips and LigaSure; drain. Results: The mean operative time was 154 min (range: 81-220 min. All patients were discharged from the 2 nd to 4 th day. Neither major complication nor conversion was recorded. 1 patient presented leakage of urine for 7 days from the drainage which resolved spontaneously. At ultrasound follow-up, 5 patients showed a secondary perirenal cyst, 2-5 cm diameter that resolved spontaneously. Conclusion: The results indicate that laparoscopic upper pole heminephrectomy is the treatment of choice in cases of non-functioning dilated lower segments of duplicated kidneys. The use of laparoscopic approach offers a good working space, a good visual control of the vessels and allows a very low isolation of the ureteral stump which counterbalance the peritoneal violation.

  14. DETECTION AND CLASSIFICATION OF POLE-LIKE OBJECTS FROM MOBILE MAPPING DATA

    Directory of Open Access Journals (Sweden)

    K. Fukano

    2015-08-01

    Full Text Available Laser scanners on a vehicle-based mobile mapping system can capture 3D point-clouds of roads and roadside objects. Since roadside objects have to be maintained periodically, their 3D models are useful for planning maintenance tasks. In our previous work, we proposed a method for detecting cylindrical poles and planar plates in a point-cloud. However, it is often required to further classify pole-like objects into utility poles, streetlights, traffic signals and signs, which are managed by different organizations. In addition, our previous method may fail to extract low pole-like objects, which are often observed in urban residential areas. In this paper, we propose new methods for extracting and classifying pole-like objects. In our method, we robustly extract a wide variety of poles by converting point-clouds into wireframe models and calculating cross-sections between wireframe models and horizontal cutting planes. For classifying pole-like objects, we subdivide a pole-like object into five subsets by extracting poles and planes, and calculate feature values of each subset. Then we apply a supervised machine learning method using feature variables of subsets. In our experiments, our method could achieve excellent results for detection and classification of pole-like objects.

  15. Pole-zero form fractional model identification in frequency domain

    International Nuclear Information System (INIS)

    Mansouri, R.; Djamah, T.; Djennoune, S.; Bettayeb, M.

    2009-01-01

    This paper deals with system identification in the frequency domain using non integer order models given in the pole-zero form. The usual identification techniques cannot be used in this case because of the non integer orders of differentiation which makes the problem strongly nonlinear. A general identification method based on Levenberg-Marquardt algorithm is developed and allows to estimate the (2n+2m+1) parameters of the model. Its application to identify the ''skin effect'' of a squirrel cage induction machine modeling is then presented.

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

    Science.gov (United States)

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

    2016-08-01

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

  17. DISCOVERY OF FOG AT THE SOUTH POLE OF TITAN

    International Nuclear Information System (INIS)

    Brown, M. E.; Smith, A. L.; Chen, C.; Adamkovics, M.

    2009-01-01

    While Saturn's moon Titan appears to support an active methane hydrological cycle, no direct evidence for surface-atmosphere exchange has yet appeared. The indirect evidence, while compelling, could be misleading. It is possible, for example, that the identified lake features could be filled with ethane, an involatile long-term residue of atmospheric photolysis; the apparent stream and channel features could be ancient remnants of a previous climate; and the tropospheric methane clouds, while frequent, could cause no rain to reach the surface. We report here the detection of fog at the south pole of Titan during late summer using observations from the VIMS instrument on board the Cassini spacecraft. While terrestrial fog can form from a variety of causes, most of these processes are inoperable on Titan. Fog on Titan can only be caused by evaporation of nearly pure liquid methane; the detection of fog provides the first direct link between surface and atmospheric methane. Based on the detections presented here, liquid methane appears widespread at the south pole of Titan in late southern summer, and the hydrological cycle on Titan is currently active.

  18. Acoustic wave filter based on periodically poled lithium niobate.

    Science.gov (United States)

    Courjon, Emilie; Bassignot, Florent; Ulliac, Gwenn; Benchabane, Sarah; Ballandras, Sylvain

    2012-09-01

    Solutions for the development of compact RF passive transducers as an alternative to standard surface or bulk acoustic wave devices are receiving increasing interest. This article presents results on the development of an acoustic band-pass filter based on periodically poled ferroelectric domains in lithium niobate. The fabrication of periodically poled transducers (PPTs) operating in the range of 20 to 650 MHz has been achieved on 3-in (76.2-mm) 500-μm-thick wafers. This kind of transducer is able to excite elliptical as well as longitudinal modes, yielding phase velocities of about 3800 and 6500 ms(-1), respectively. A new type of acoustic band-pass filter is proposed, based on the use of PPTs instead of the SAWs excited by classical interdigital transducers. The design and the fabrication of such a filter are presented, as well as experimental measurements of its electrical response and transfer function. The feasibility of such a PPT-based filter is thereby demonstrated and the limitations of this method are discussed.

  19. Groebner Basis Solutions to Satellite Trajectory Control by Pole Placement

    Science.gov (United States)

    Kukelova, Z.; Krsek, P.; Smutny, V.; Pajdla, T.

    2013-09-01

    Satellites play an important role, e.g., in telecommunication, navigation and weather monitoring. Controlling their trajectories is an important problem. In [1], an approach to the pole placement for the synthesis of a linear controller has been presented. It leads to solving five polynomial equations in nine unknown elements of the state space matrices of a compensator. This is an underconstrained system and therefore four of the unknown elements need to be considered as free parameters and set to some prior values to obtain a system of five equations in five unknowns. In [1], this system was solved for one chosen set of free parameters with the help of Dixon resultants. In this work, we study and present Groebner basis solutions to this problem of computation of a dynamic compensator for the satellite for different combinations of input free parameters. We show that the Groebner basis method for solving systems of polynomial equations leads to very simple solutions for all combinations of free parameters. These solutions require to perform only the Gauss-Jordan elimination of a small matrix and computation of roots of a single variable polynomial. The maximum degree of this polynomial is not greater than six in general but for most combinations of the input free parameters its degree is even lower. [1] B. Palancz. Application of Dixon resultant to satellite trajectory control by pole placement. Journal of Symbolic Computation, Volume 50, March 2013, Pages 79-99, Elsevier.

  20. Towards a research pole in photonics in Western Romania

    Science.gov (United States)

    Duma, Virgil-Florin; Negrutiu, Meda L.; Sinescu, Cosmin; Rominu, Mihai; Miutescu, Eftimie; Burlea, Amelia; Vlascici, Miomir; Gheorghiu, Nicolae; Cira, Octavian; Hutiu, Gheorghe; Mnerie, Corina; Demian, Dorin; Marcauteanu, Corina; Topala, Florin; Rolland, Jannick P.; Voiculescu, Ioana; Podoleanu, Adrian G.

    2014-07-01

    We present our efforts in establishing a Research Pole in Photonics in the future Arad-Timisoara metropolitan area projected to unite two major cities of Western Romania. Research objectives and related training activities of various institutions and groups that are involved are presented in their evolution during the last decade. The multi-disciplinary consortium consists principally of two universities, UAVA (Aurel Vlaicu University of Arad) and UMF (Victor Babes Medicine and Pharmacy University of Timisoara), but also of the Arad County Emergency University Hospital and several innovative SMEs, such as Bioclinica S.A. (the largest array of medical analysis labs in the region) and Inteliform S.R.L. (a competitive SME focused on mechatronics and mechanical engineering). A brief survey of the individual and joint projects of these institutions is presented, together with their teaching activities at graduate and undergraduate level. The research Pole collaborates in R&D, training and education in biomedical imaging with universities in USA and Europe. Collaborative activities, mainly on Optical Coherence Tomography (OCT) projects are presented in a multidisciplinary approach that includes optomechatronics, precision mechanics and optics, dentistry, medicine, and biology.