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Sample records for posterior femoral condyle

  1. Osteoarthritis of the patella, lateral femoral condyle and posterior medial femoral condyle correlate with range of motion.

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    Suzuki, Takashi; Motojima, Sayaka; Saito, Shu; Ishii, Takao; Ryu, Keinosuke; Ryu, Junnosuke; Tokuhashi, Yasuaki

    2013-11-01

    The type of osteoarthritis and the degree of severity which causes restriction of knee range of motion (ROM) is still largely unknown. The objective of this study was to analyse the location and the degree of cartilage degeneration that affect knee range of motion and the connection, if any, between femorotibial angle (FTA) and knee ROM restriction. Four hundreds and fifty-six knees in 230 subjects with knee osteoarthritis undergoing knee arthroplasty were included. Articular surface was divided into eight sections, and cartilage degeneration was evaluated macroscopically during the operation. Cartilage degeneration was classified into four grades based on the degree of exposure of subchondral bone. A Pearson correlation was conducted between FTA and knee flexion angle to determine whether high a degree of FTA caused knee flexion restriction. A logistic regression analysis was also conducted to detect the locations and levels of cartilage degeneration causing knee flexion restriction. No correlation was found between FTA and flexion angle (r = -0.08). Flexion angle was not restricted with increasing FTA. Logistic regression analysis showed significant correlation between restricted knee ROM and levels of knee cartilage degeneration in the patella (odds ratio (OR) = 1.77; P = 0.01), the lateral femoral condyle (OR = 1.62; P = 0.03) and the posterior medial femoral condyle (OR = 1.80; P = 0.03). For clinical relevance, soft tissue release and osteophyte resection around the patella, lateral femoral condyle and posterior medial femoral condyle might be indicated to obtain a higher degree of knee flexion angle.

  2. Avascular osteonecrosis of the femoral condyle after arthroscopic surgery; Osteonecrose aseptique du condyle femoral apres meniscectomie par voie arthroscopique

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    Al-Kaar, M.; Garcia, J. [Hopital Cantonal Geneve, Geneva (Switzerland); Fritschy, D.; Bonvin, J.C. [Policlinique de Chirurgie, Hopital Cantonal Universitaire, Geneve (Switzerland)

    1997-04-01

    Avascular osteonecrosis of the femoral condyle after arthroscopic surgery. Retrospective review of 10 patients who presented with avascular necrosis of the ipsilateral femoral condyle following arthroscopic meniscectomy (9 medial, 1 lateral). The bone lesions were evaluated by radiography and MRI, which were repeated for few patients. MRI allows earlier diagnosis of avascular necrosis of the femoral condyle and offers an evaluation of extent of the lesions whose evolution is variable: 3 patients required a knee prosthesis, the other 7 patients were treated medically. (authors). 21 refs.

  3. Patellar tendon-lateral femoral condyle friction syndrome: MR imaging in 42 patients

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    Chung, C.B.; Skaf, A.; Campos, J.; Stump, X.; Resnick, D.; Roger, B.

    2001-01-01

    Objective: To demonstrate the MR imaging findings that occur between the posterior inferolateral patellar tendon and the lateral femoral condyle in patients with chronic anterior and or lateral knee pain. Patients and design: A retrospective review of the MR images in 42 patients who presented with chronic anterior or lateral knee pain was performed by two musculoskeletal radiologists. In 15 patients, post-contrast images were available. Results: Sagittal and axial imaging planes best demonstrated the patellar tendon and its relationship with the lateral femoral condyle. In 40 patients, there was obliteration of the fat planes and abnormal signal intensity in the lateral soft tissues of the inferior patellofemoral joint. Enhancement after administration of gadolinium was noted in all cases in which contrast was administered. Eighteen patients showed cystic changes in the soft tissues adjacent to the lateral femoral condyle in addition to fat plane obliteration. In two patients, only cystic changes were noted in the lateral soft tissues. Abnormal patellar alignment was noted in 37 patients. Patellar tendon pathology was seen in nine patients. Conclusion: In evaluating anterior knee symptoms, MR imaging allows identification of changes that may be related to patellar tendon-lateral femoral condyle friction syndrome and that should be distinguished from other causes of anterior or lateral knee pain. (orig.)

  4. Patellar tendon-lateral femoral condyle friction syndrome: MR imaging in 42 patients

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    Chung, C.B.; Skaf, A.; Campos, J.; Stump, X.; Resnick, D. [Dept. of Radiology, University of California, San Diego (United States); Roger, B. [Service de Radiologie Polyvalente, Groupe Hospitalier Pitie-Salpetriere, Paris (France)

    2001-12-01

    Objective: To demonstrate the MR imaging findings that occur between the posterior inferolateral patellar tendon and the lateral femoral condyle in patients with chronic anterior and or lateral knee pain. Patients and design: A retrospective review of the MR images in 42 patients who presented with chronic anterior or lateral knee pain was performed by two musculoskeletal radiologists. In 15 patients, post-contrast images were available. Results: Sagittal and axial imaging planes best demonstrated the patellar tendon and its relationship with the lateral femoral condyle. In 40 patients, there was obliteration of the fat planes and abnormal signal intensity in the lateral soft tissues of the inferior patellofemoral joint. Enhancement after administration of gadolinium was noted in all cases in which contrast was administered. Eighteen patients showed cystic changes in the soft tissues adjacent to the lateral femoral condyle in addition to fat plane obliteration. In two patients, only cystic changes were noted in the lateral soft tissues. Abnormal patellar alignment was noted in 37 patients. Patellar tendon pathology was seen in nine patients. Conclusion: In evaluating anterior knee symptoms, MR imaging allows identification of changes that may be related to patellar tendon-lateral femoral condyle friction syndrome and that should be distinguished from other causes of anterior or lateral knee pain. (orig.)

  5. Simultaneous avascular necrosis of both medial and lateral femoral condyles

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    Mansberg, R.

    2002-01-01

    Full text: Avascular necrosis (AVN) of a femoral condyle is a common orthopaedic condition. While both medial and lateral femoral condyles may be involved either singly or sequentially the simultaneous occurrence of AVN of both femoral condyles is extremely uncommon. A 57-year-old male is presented who developed the onset of severe left sided knee pain suddenly at rest. Plain and tomographic radiography was unremarkable and a bone scan was performed. Markedly increased vascularity was demonstrated in the left knee with intense osteoblastic activity in the left medial and femoral condyles more marked in the lateral femoral condyle. A diagnosis of AVN of both femoral condyles was made and a MRI exam was performed to confirm this unusual diagnosis. The MRI showed a diffuse increase in intensity bilaterally with subtle bony change in the subarticular bone consistent with AVN more marked in the left lateral femoral condyle. The patients' symptoms resolved with supportive treatment. Copyright (2002) The Australian and New Zealand Society of Nuclear Medicine Inc

  6. Avascular osteonecrosis of the femoral condyle after arthroscopic surgery

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    Al-Kaar, M.; Garcia, J.; Fritschy, D.; Bonvin, J.C.

    1997-01-01

    Avascular osteonecrosis of the femoral condyle after arthroscopic surgery. Retrospective review of 10 patients who presented with avascular necrosis of the ipsilateral femoral condyle following arthroscopic meniscectomy (9 medial, 1 lateral). The bone lesions were evaluated by radiography and MRI, which were repeated for few patients. MRI allows earlier diagnosis of avascular necrosis of the femoral condyle and offers an evaluation of extent of the lesions whose evolution is variable: 3 patients required a knee prosthesis, the other 7 patients were treated medically. (authors)

  7. Evaluation of posterior lateral femoral condylar hypoplasia using axial MRI images in patients with complete discoid meniscus.

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    Xu, Zhihong; Chen, Dongyang; Shi, Dongquan; Dai, Jin; Yao, Yao; Jiang, Qing

    2016-03-01

    Hypoplasia of the lateral femoral condyle has been reported in discoid lateral meniscus patients, but associated imaging findings in the axial plane have not been characterized. In this study, we aimed to identify differences in the lateral femoral condyle between patients with discoid lateral meniscus and those with normal menisci using axial MRI images. Twenty-three patients (24 knees) with complete discoid lateral meniscus, 43 (45 knees) with incomplete discoid lateral meniscus, and 50 with normal menisci (50 knees) were enrolled and distributed into three groups. Two new angles, posterior lateral condylar angle (PLCA) and posterior medial condylar angle (PMCA), were measured on axial MRI images; the posterior condylar angle (PCA) was also measured. Differences between the three groups in the PLCA, PMCA, PCA, and PLCA/PMCA were analysed. The predictive value of PLCA and PLCA/PMCA for complete discoid lateral meniscus was assessed. In the complete discoid lateral meniscus group, PLCA and PLCA/PMCA were significantly smaller compared with the normal meniscus group and the incomplete discoid lateral meniscus group (P meniscus group compared with the incomplete discoid lateral meniscus group (P meniscus group (P meniscus. Hypoplasia of the posterior lateral femoral condyle is typically seen in patients with complete discoid lateral meniscus. PLCA and PLCA/PMCA can be measured from axial MRI images and used as excellent predictive parameters for complete discoid lateral meniscus. Diagnostic study, Level III.

  8. Femoral Condyle Fracture during Anterior Cruciate Ligament Reconstruction

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    Selahattin Ozyurek

    2015-07-01

    Full Text Available Dear Editor,We have greatly enjoyed reading the case report entitled “‘Femoral Condyle Fracture during Revision of Anterior Cruciate Ligament Reconstruction: Case Report and a Review of Literature in the issue of Arch Bone Jt Surg. 2015;3(2 with great interest. We would like to commend the authors for their detailed and valuable work. Although various case reports have described postoperative distal femur fracture at a range of time intervals (1,2 intraoperative intra-articular distal femur fracture is a unique entity.However, we believe that some important additional observations seem necessary to be contributed through this study. In this article, the authors stated that, to the best of their knowledge, there is no other case report in the literature introducing a femoral condyle fracture during arthroscopic ACL reconstruction or revision reconstruction. Nevertheless, we would like to call the attention of the readers to the fact that that the literature contains one additional case report re‌porting on intraoperative distal femoral coronal plane (Hoffa fracture during primary ACL reconstruction (2. Werner BC and Miller MD presented of case report of an intraoperative distal femoral coronal plane (Hoffa fracture that occurred during independent femoral tunnel drilling and dilation in a primary ACL reconstruction. As in the their case, this type of fracture can occur with appropriately placed femoral tunnels, but the risk can increase with larger graft diameters in patients with smaller lateral femoral condyles The patient was treated with open reduction and internal fixation, without compromise of graft stability and with good recovery of function. We believe that tailoring graft size to the size of the patient is important to prevent similar adverse events.

  9. Anatomic variability of the vascularized composite osteomyocutaneous flap from the medial femoral condyle: an anatomical study

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    Trung-Hau Le Thua

    2014-12-01

    Full Text Available Aim: The anatomical study and clinical application for the vascularized corticoperiosteal flap from the medial femoral condyle have been performed and described previously. Although prior studies have described the composite osteomyocutaneous flap from the medial femoral condyle, a detailed analysis of the vascularity of this region has not yet been fully evaluated. Methods: This anatomical study described the variability of the arteries from the medial femoral condyle in 40 cadaveric specimens. Results: The descending genicular artery (DGA was found in 33 of 40 cases (82.5%. The  superomedial genicular artery (SGA was present in 10 cases (25%. All 33 cases (100% of the DGA had articular branches to the periosteum of the medial femoral condyle. Muscular branches and saphenous branches of the DGA were present in 25 cases (62.5% and 26 cases (70.3%, respectively. Conclusion: The current study demonstrates that the size and length of the vessels to the medial femoral condyle are sufficient for a vascularized bone flap. A careful preoperative vascular assessment is essential prior to use of the vascularized composite osteomyocutaneous flap from the medial femoral condyle, because of the considerable anatomical variations in different branches of the DGA.

  10. Ossification variants of the femoral condyles are not associated with osteochondritis dissecans

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    Jans, L., E-mail: lennartjans@hotmail.com [Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000 Gent (Belgium); Jaremko, J., E-mail: jjaremko@gmail.com [Department of Radiology, University of Alberta Hospital, 8440-112 Street, Edmonton T6G 2B7, Alberta (Canada); Ditchfield, M., E-mail: Michael.ditchfield@southernhealth.org.au [Department of Radiology, Monash University Clayton Campus, Wellington Road, Clayton 3800, VIC (Australia); De Coninck, T., E-mail: Tinekedeconinck@ugent.be [Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000 Gent (Belgium); Huysse, W., E-mail: Wouter.huysse@ugent.be [Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000 Gent (Belgium); Moon, A., E-mail: Anna.moon@rch.org.au [Department of Radiology, Royal Children' s Hospital, Flemington Road, Parkville 3052, VIC (Australia); Verstraete, K., E-mail: Koenraad.verstraete@ugent.be [Department of Radiology and Medical Imaging, Ghent University Hospital, De Pintelaan 185, 9000 Gent (Belgium)

    2012-11-15

    Purpose: To determine if ossification variants of the femoral condyles involving the subchondral bone plate are associated with osteochondritis dissecans (OCD). Materials and methods: The prevalence of ossification variants of the unaffected femoral condyle in 116 patients (aged 9-14 years) with unicondylar OCD on MRI (magnetic resonance imaging) of the knee was compared to a control group of 579 patients (aged 9-14 years) without OCD. The evolution of the ossification variants in both groups was studied by reviewing follow-up MR imaging side by side with the baseline study. Results: The prevalence of ossification variants in the unaffected condyle in patients with OCD (12.9%) and in the control group of patients without OCD (12.6%) was similar (p = 0.88). Evolution of ossification variants to OCD was not seen on follow-up MRI examinations. All variants had decreased in size or were no longer visible. Conclusion: Ossification variants of the femoral condyle that involve the subchondral bone plate are not associated with OCD. Clinical relevance statement: Ossification variants are not associated with OCD, indicating that routine MRI follow-up in affected children is not mandatory.

  11. Ossification variants of the femoral condyles are not associated with osteochondritis dissecans

    International Nuclear Information System (INIS)

    Jans, L.; Jaremko, J.; Ditchfield, M.; De Coninck, T.; Huysse, W.; Moon, A.; Verstraete, K.

    2012-01-01

    Purpose: To determine if ossification variants of the femoral condyles involving the subchondral bone plate are associated with osteochondritis dissecans (OCD). Materials and methods: The prevalence of ossification variants of the unaffected femoral condyle in 116 patients (aged 9–14 years) with unicondylar OCD on MRI (magnetic resonance imaging) of the knee was compared to a control group of 579 patients (aged 9–14 years) without OCD. The evolution of the ossification variants in both groups was studied by reviewing follow-up MR imaging side by side with the baseline study. Results: The prevalence of ossification variants in the unaffected condyle in patients with OCD (12.9%) and in the control group of patients without OCD (12.6%) was similar (p = 0.88). Evolution of ossification variants to OCD was not seen on follow-up MRI examinations. All variants had decreased in size or were no longer visible. Conclusion: Ossification variants of the femoral condyle that involve the subchondral bone plate are not associated with OCD. Clinical relevance statement: Ossification variants are not associated with OCD, indicating that routine MRI follow-up in affected children is not mandatory.

  12. Anomalies of ossification in the posterolateral femoral condyle: assessment by MRI

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    Nawata, K.; Teshima, Ryota; Morio, Yasuo; Hagino, Hiroshi [Department of Orthopaedic Surgery, Faculty of Medicine, Tottori University, Yonaga (Japan)

    1999-10-01

    Background. Anomalies of ossification in the lower femoral epiphysis are often radiographically indistinguishable from juvenile osteochondritis dissecans. Objective. To clarify the MRI characteristics of the anomalies of ossification in the posterolateral femoral condyle that distinguish it from juvenile osteochondritis dissecans. Materials and methods. We retrospectively examined the medical records, plain radiographs (n = 4), MRI (n = 4) and follow-up MRI (n = 2) of four boys (age 8-11 years) with anomalies of ossification in the posterolateral femoral condyle. Results. Plain radiography showed symmetrical marginal irregularity of the posterolateral femoral condyles of both knees. These lesions were asymptomatic, and the areas of irregular radiographic appearances reduced in size or disappeared without treatment within a mean observation period of 3.5 months. MRI showed a clearly demarcated low-intensity islet with the same signal intensity as subchondral bone (which was considered to be an accessory ossification nucleus) in a high-signal area in which the signal intensity was equal to that of normal articular cartilage. The areas observed as radiolucent zones on plain radiography were visualised at the same signal intensity as articular cartilage, and were continuous with articular cartilage on MRI; thus they were regarded as uncalcified cartilage. These MR findings are different from MR images of osteochondritis dissecans. Conclusions. MRI is considered to be the most effective non-invasive diagnostic method for these two conditions. (orig.) With 3 figs., 1 tab., 10 refs.

  13. Evaluation of mandibular condyles in children with unilateral posterior crossbite.

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    Illipronti-Filho, Edson; Fantini, Solange Mongelli de; Chilvarquer, Israel

    2015-01-01

    The relationship of mandibular condyle dimensions and its association with unilateral posterior crossbite (UPXB) has been suggested in the literature. The purpose of this prospective study was to evaluate mandibular condyles on the left and right sides and between crossed and non-crossed sides in the sagittal and coronal planes, using cone-beam computed tomography (CBCT). Twenty CBCT images of 40 temporo mandibular joints (TMJs) in individuals in mixed dentition phase, which included 9 males (mean 7.9 years) and 11 females (mean 8.2 years), with unilateral posterior crossbite without premature contacts and functional mandibular shifts and with transverse maxillary deficiency. The criteria for sample exclusion included the presence of painful symptoms, facial trauma history, systemic diseases such as juvenile rheumatoid arthritis, mouth opening limitation (anomalies, and skeletal asymmetries that may result in TMJ disorders. Dimensional measurements of the condyles between the right and left sides and crossed and non-crossed sides in sagittal and coronal view were made. There was no significant difference between the measurements of the crossed and non-crossed sides in both sagittal and coronal view. These findings suggest that the presence of unilateral posterior crossbite in children with UPXB did not result in changes between the mandibular condyles in the right and left sides or between the crossed and non-crossed sides in the coronal or sagittal plane.

  14. Evaluation of mandibular condyles in children with unilateral posterior crossbite

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    Edson ILLIPRONTI-FILHO

    2015-01-01

    Full Text Available The relationship of mandibular condyle dimensions and its association with unilateral posterior crossbite (UPXB has been suggested in the literature. The purpose of this prospective study was to evaluate mandibular condyles on the left and right sides and between crossed and non-crossed sides in the sagittal and coronal planes, using cone-beam computed tomography (CBCT. Twenty CBCT images of 40 temporo mandibular joints (TMJs in individuals in mixed dentition phase, which included 9 males (mean 7.9 years and 11 females (mean 8.2 years, with unilateral posterior crossbite without premature contacts and functional mandibular shifts and with transverse maxillary deficiency. The criteria for sample exclusion included the presence of painful symptoms, facial trauma history, systemic diseases such as juvenile rheumatoid arthritis, mouth opening limitation (< 40 mm, congenital or genetic anomalies, and skeletal asymmetries that may result in TMJ disorders. Dimensional measurements of the condyles between the right and left sides and crossed and non-crossed sides in sagittal and coronal view were made. There was no significant difference between the measurements of the crossed and non-crossed sides in both sagittal and coronal view. These findings suggest that the presence of unilateral posterior crossbite in children with UPXB did not result in changes between the mandibular condyles in the right and left sides or between the crossed and non-crossed sides in the coronal or sagittal plane.

  15. [Intramedullary nailing combined with cannulated screw in treating femoral condyles fractures].

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    Shen, Guo-Qing; Zhang, Hao; Long, Da-Fu; Li, Zheng-Wen; Tan, Ying-Dong

    2017-07-25

    To observe the clinical effects of retrograde intramedullary nailing and cannulated screws in the treatment of femoral condylar fracture. From June 2009 to June 2015, 13 patients with femoral condyles fracture were treated by retrograde intramedullary nailing and cannulated screws including 6 males and 7 females with an average age of 46.1 years old ranging from 16 to 76 years old. There were 10 cases of closed fractures, 3 cases of open fraetures. According to AO classification criteriam, 4 cases were type C1, 7 cases were type C2, 2 cases were type C3. Postoperative reduction of fracture and the knee joint function recovery were observed. All patients were followed up for 12 to 36 months with a mean of 24 months. X-ray examination showed that the union time of fracture was 18 to 24 weeks, 21 weeks on average. There were no cases of loosening, breakage of internal fixators and re-fracture. Hospital for Special Surgery(HSS) knee score was 90.07±4.99 at 1 year after the operation. The clinical efficacy for retrograde intramedullary nailing and cannulated screw for the treatment of femoral condyles fracture was excellent. It can improve the anatomical reattachment rate and reduce the complications and promote the knee functional recovery.

  16. Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture

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    Narvaez, J.A.; Narvaez, J.; Lama, E.De; Sanchez, A. [Department of Magnetic Resonance Imaging, IDI Hospital Duran i Reynals, Ciutat Sanitaria i Universitaria de Bellvitge, Gran Via s/n, 08907, L' Hospitalet de Llobregat (Barcelona) (Spain)

    2003-08-01

    The purpose of this article is to describe the association between spontaneous osteonecrosis and insufficiency stress fractures of the knee. To determine whether insufficiency stress fracture is associated with spontaneous osteonecrosis of the knee, we retrospectively reviewed the medical charts and imaging studies of all patients with spontaneous osteonecrosis of the knee, studied by MR imaging, seen in a tertiary hospital over an 8-year period. Four women (age range 66-84 years) presented spontaneous osteonecrosis of the knee associated with insufficiency stress fracture of the medial tibial plateau. One of these patients also presented a concomitant insufficiency stress fracture of the medial femoral condyle. Radiographs were diagnostic of spontaneous osteonecrosis of the medial femoral condyle in three cases, and insufficiency stress fracture of the medial tibial plateau was detected in one case. Magnetic resonance imaging allows the diagnosis of both conditions in all four cases. Spontaneous osteonecrosis of the knee may be associated with insufficiency stress fracture of the medial femoral condyle and the medial tibial plateau. This association provides additional arguments in favor of the traumatic etiology of spontaneous osteonecrosis of knee. (orig.)

  17. Spontaneous osteonecrosis of the knee associated with tibial plateau and femoral condyle insufficiency stress fracture

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    Narvaez, J.A.; Narvaez, J.; Lama, E.De; Sanchez, A.

    2003-01-01

    The purpose of this article is to describe the association between spontaneous osteonecrosis and insufficiency stress fractures of the knee. To determine whether insufficiency stress fracture is associated with spontaneous osteonecrosis of the knee, we retrospectively reviewed the medical charts and imaging studies of all patients with spontaneous osteonecrosis of the knee, studied by MR imaging, seen in a tertiary hospital over an 8-year period. Four women (age range 66-84 years) presented spontaneous osteonecrosis of the knee associated with insufficiency stress fracture of the medial tibial plateau. One of these patients also presented a concomitant insufficiency stress fracture of the medial femoral condyle. Radiographs were diagnostic of spontaneous osteonecrosis of the medial femoral condyle in three cases, and insufficiency stress fracture of the medial tibial plateau was detected in one case. Magnetic resonance imaging allows the diagnosis of both conditions in all four cases. Spontaneous osteonecrosis of the knee may be associated with insufficiency stress fracture of the medial femoral condyle and the medial tibial plateau. This association provides additional arguments in favor of the traumatic etiology of spontaneous osteonecrosis of knee. (orig.)

  18. [SPECIFIC DIAGNOSTIC SIGNIFICANCE OF "RIPPLE SIGN" OF MEDIAL FEMORAL CONDYLE UNDER ARTHROSCOPE IN MEDIAL LONGITUDINAL MENISCAL TEARS].

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    Ren Shiyou; Sun, Limang; Chen, Guofei; Jiang, Changqing; Zhang, Xintao; Zhang Wentao

    2015-01-01

    To investigate the reliability of the "ripple sign" on the upper surface of the medial femoral condyle in the diagnosis of medial longitudinal meniscal tears under arthroscope. Between June 2013 and June 2014, 56 patients with knee injuries were included. There were 35 males and 21 females with an average age of 22.2 years (range, 12-38 years). The causes of injury were sports in 40 cases, falling in 10 cases, and traffic accident in 6 cases. The injury was located at the left knee in 22 cases and at the right knee in 34 cases. The disease duration was 10-40 days (mean, 20.2 days). Of 56 patients, 15 cases had simple medial meniscal injury; 41 cases had combined injuries, including anterior cruciate ligament injury in 38 cases, posterior cruciate ligament injury in 2 cases, and patellar dislocation in 1 case. The "ripple sign" was observed under arthroscope before operation. Repair of medial meniscal injury and reconstruction of cruciate ligament were performed. The positive "ripple sign" was seen under arthroscope in all patients, who were diagnosed to have longitudinal meniscal tears, including 23 cases of mild "ripple sign" , 28 cases of moderate "ripple sign", and 5 cases of severe "ripple sign". The "ripple sign" on the upper surface of the medial femoral condyle is a reliable diagnostic evidence of medial longitudinal meniscal tears.

  19. Case report: multifocal subchondral stress fractures of the femoral heads and tibial condyles in a young military recruit.

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    Yoon, Pil Whan; Yoo, Jeong Joon; Yoon, Kang Sup; Kim, Hee Joong

    2012-03-01

    Subchondral stress fractures of the femoral head may be either of the insufficiency-type with poor quality bone or the fatigue-type with normal quality bone but subject to high repetitive stresses. Unlike osteonecrosis, multiple site involvement rarely has been reported for subchondral stress fractures. We describe a case of multifocal subchondral stress fractures involving femoral heads and medial tibial condyles bilaterally within 2 weeks. A 27-year-old military recruit began having left knee pain after 2 weeks of basic training, without any injury. Subsequently, right knee, right hip, and left hip pain developed sequentially within 2 weeks. The diagnosis of multifocal subchondral stress fracture was confirmed by plain radiographs and MR images. Nonoperative treatment of the subchondral stress fractures of both medial tibial condyles and the left uncollapsed femoral head resulted in resolution of symptoms. The collapsed right femoral head was treated with a fibular strut allograft to restore congruity and healed without further collapse. There has been one case report in which an insufficiency-type subchondral stress fracture of the femoral head and medial femoral condyle occurred within a 2-year interval. Because the incidence of bilateral subchondral stress fractures of the femoral head is low and multifocal involvement has not been reported, multifocal subchondral stress fractures can be confused with multifocal osteonecrosis. Our case shows that subchondral stress fractures can occur in multiple sites almost simultaneously.

  20. Magnetic resonance imaging of articular cartilage abnormalities of the far posterior femoral condyle of the knee

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    Ogino, Shuhei; Huang, Thomas; Watanabe, Atsuya; Iranpour-Boroujeni, Tannaz; Yoshioka, Hiroshi (Dept. of Radiology, Brigham and Women' s Hospital, Boston, MA (United States)), e-mail: hiroshi@uci.edu

    2010-01-15

    Background: Incidental articular cartilage lesions of the far posterior femoral condyle (FPFC) are commonly detected. Whether or not these cartilage lesions are symptomatic or clinically significant is unknown. Purpose: To characterize and assess prevalence of articular cartilage abnormalities of the FPFC and associated bone marrow edema (BME) and/or internal derangements through magnetic resonance (MR) images. Material and Methods: 654 knee MR examinations were reviewed retrospectively. Sagittal fast spin-echo proton density-weighted images with and without fat suppression were acquired with a 1.5T scanner, and were evaluated by two readers by consensus. The following factors were assessed: 1) the prevalence of cartilage abnormalities, 2) laterality, 3) the type of cartilage abnormalities, 4) cartilage abnormality grading, 5) associated BME, 6) complications such as meniscal injury and cruciate ligament injury, and 7) knee alignment (femorotibial angle [FTA]). Results: Articular cartilage abnormalities of the FPFC were demonstrated in 157 of the 654 patients (24%). Of these, 40 patients demonstrated medial and lateral FPFC cartilage abnormalities and were thus counted as 80 cases. Focal lateral FPFC abnormalities were demonstrated in 117 of 197 cases (59.4%), while diffuse lateral FPFC abnormalities were demonstrated in 24 of 197 cases (12.2%). Focal medial FPFC abnormalities were demonstrated in 23 of 197 cases (11.6%), while diffuse medial FPFC abnormalities were demonstrated in 33 of 197 cases (16.8%). No statistically significant pattern of associated BME, FTA, or internal derangements including meniscal and cruciate ligament injury was demonstrated. Conclusion: Articular cartilage abnormalities of the FPFC are common and were demonstrated in 24% of patients or 30% of cases. Lateral FPFC abnormalities occur 2.5 times more frequently than medial FPFC abnormalities and were more frequently focal compared with medial cohorts. BME is associated in 36.5% of cases

  1. Mucoid degeneration of the anterior cruciate ligament with erosion of the lateral femoral condyle

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    Melloni, Pietro; Valls, Rafael; Yuguero, Mariano; Saez, Amparo

    2004-01-01

    We report a case of a mucoid degeneration of the anterior cruciate ligament (ACL) that produced osseous erosion of the medial aspect of the lateral femoral condyle. The MRI findings and differential diagnosis are discussed. (orig.)

  2. Femoral Component External Rotation Affects Knee Biomechanics: A Computational Model of Posterior-stabilized TKA.

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    Kia, Mohammad; Wright, Timothy M; Cross, Michael B; Mayman, David J; Pearle, Andrew D; Sculco, Peter K; Westrich, Geoffrey H; Imhauser, Carl W

    2018-01-01

    The correct amount of external rotation of the femoral component during TKA is controversial because the resulting changes in biomechanical knee function associated with varying degrees of femoral component rotation are not well understood. We addressed this question using a computational model, which allowed us to isolate the biomechanical impact of geometric factors including bony shapes, location of ligament insertions, and implant size across three different knees after posterior-stabilized (PS) TKA. Using a computational model of the tibiofemoral joint, we asked: (1) Does external rotation unload the medial collateral ligament (MCL) and what is the effect on lateral collateral ligament tension? (2) How does external rotation alter tibiofemoral contact loads and kinematics? (3) Does 3° external rotation relative to the posterior condylar axis align the component to the surgical transepicondylar axis (sTEA) and what anatomic factors of the femoral condyle explain variations in maximum MCL tension among knees? We incorporated a PS TKA into a previously developed computational knee model applied to three neutrally aligned, nonarthritic, male cadaveric knees. The computational knee model was previously shown to corroborate coupled motions and ligament loading patterns of the native knee through a range of flexion. Implant geometries were virtually installed using hip-to-ankle CT scans through measured resection and anterior referencing surgical techniques. Collateral ligament properties were standardized across each knee model by defining stiffness and slack lengths based on the healthy population. The femoral component was externally rotated from 0° to 9° relative to the posterior condylar axis in 3° increments. At each increment, the knee was flexed under 500 N compression from 0° to 90° simulating an intraoperative examination. The computational model predicted collateral ligament forces, compartmental contact forces, and tibiofemoral internal/external and

  3. Posterior Femoral Single Limb Osteotomy for the Removal of Well-Fixed Modular Femoral Neck Components

    Directory of Open Access Journals (Sweden)

    Keith A Fehring

    2017-07-01

    Full Text Available Modular neck femoral components were introduced to optimize femoral neck anteversion, leg length, offset, and stability in total hip arthroplasty. However, concerns have been raised in recent years regarding early failure of these implants due to corrosion, pseudotumor, as well as fracture of the modular neck. Removing modular neck femoral implants is challenging as removal of the modular femoral neck leaves a proximally coated femoral stem level with the proximal bone of the femoral neck. We describe a posterior femoral single limb osteotomy  (posterior cut of an extended trochanteric osteotomy for the removal of a modular neck femoral component.

  4. Subchondral Impaction Fractures of the Medial Femoral Condyle in Weightlifters: A Report of 5 Cases.

    Science.gov (United States)

    Grzelak, Piotr; Podgórski, Michał Tomasz; Stefańczyk, Ludomir; Krochmalski, Marek; Domżalski, Marcin

    2016-01-01

    Although subchondral impaction fractures have already been reported in the non-weight-bearing portion of the lateral femoral condyle, this study reveals the presence of an intra-articular impaction fracture of the postero-superior region of the non-weight-bearing portion of the medial femoral condyle recognized in 5 of a group of 22 representatives of the Polish national Olympic weightlifting team, who underwent 1.5T magnetic resonance imaging examination. Articular cartilage lesions varied with regard to the type of injury and its severity ranging from healed or subchronic injuries to acute trauma. All described individuals had no clinical history of acute knee trauma and only 3 of them had minor pain symptoms. The accumulation of microtraumas occurring during participation in particular activities associated with weightlifting training seems to be responsible for the development of this type of contusion. This is the first description of impaction fracture observed in this location in professional weightlifters.

  5. Prevalence and clinical significance of chondromalacia isolated to the anterior margin of the lateral femoral condyle as a component of patellofemoral disease: observations at MR imaging.

    Science.gov (United States)

    Chan, V O; Moran, D E; Mwangi, I; Eustace, S J

    2013-08-01

    To determine the prevalence of chondromalacia isolated to the anterior margin of the lateral femoral condyle as a component of patellofemoral disease in patients with anterior knee pain and to correlate it with patient demographics, patellar shape, and patellofemoral alignment. Retrospective study over a 1-year period reviewing the MR knee examinations of all patients who were referred for assessment of anterior knee pain. Only patients with isolated lateral patellofemoral disease were included. Age, gender, distribution of lateral patellofemoral chondromalacia, and grade of cartilaginous defects were documented for each patient. Correlation between the distribution of lateral patellofemoral chondromalacia and patient demographics, patellar shape, and indices of patellar alignment (femoral sulcus angle and modified Q angle) was then ascertained. There were 50 patients (22 males, 28 females) with anterior knee pain and isolated patellofemoral disease. The majority of the patients (78 %) had co-existent disease with grade 1 chondromalacia. No significant correlation was found between patients with chondromalacia isolated to the anterior margin of the lateral femoral condyle and age, gender, patellar shape, or modified Q angle (p > 0.05). However, patients with chondromalacia isolated to the anterior margin of the lateral femoral condyle had a shallower femoral sulcus angle (mean 141.8°) compared to the patients with lateral patellar facet disease (mean 133.8°) (p = 0.002). A small percentage of patients with anterior knee pain have chondromalacia isolated to the anterior margin of the lateral femoral condyle. This was associated with a shallower femoral sulcus angle.

  6. Spontaneous hyaline cartilage regeneration can be induced in an osteochondral defect created in the femoral condyle using a novel double-network hydrogel.

    Science.gov (United States)

    Yokota, Masashi; Yasuda, Kazunori; Kitamura, Nobuto; Arakaki, Kazunobu; Onodera, Shin; Kurokawa, Takayuki; Gong, Jian-Ping

    2011-02-22

    Functional repair of articular osteochondral defects remains a major challenge not only in the field of knee surgery but also in tissue regeneration medicine. The purpose is to clarify whether the spontaneous hyaline cartilage regeneration can be induced in a large osteochondral defect created in the femoral condyle by means of implanting a novel double-network (DN) gel at the bottom of the defect. Twenty-five mature rabbits were used in this study. In the bilateral knees of each animal, we created an osteochondral defect having a diameter of 2.4-mm in the medial condyle. Then, in 21 rabbits, we implanted a DN gel plug into a right knee defect so that a vacant space of 1.5-mm depth (in Group I), 2.5-mm depth (in Group II), or 3.5-mm depth (in Group III) was left. In the left knee, we did not apply any treatment to the defect to obtain the control data. All the rabbits were sacrificed at 4 weeks, and the gross and histological evaluations were performed. The remaining 4 rabbits underwent the same treatment as used in Group II, and real-time PCR analysis was performed at 4 weeks. The defect in Group II was filled with a sufficient volume of the hyaline cartilage tissue rich in proteoglycan and type-2 collagen. The Wayne's gross appearance and histology scores showed that Group II was significantly greater than Group I, III, and Control (p hyaline cartilage regeneration can be induced in vivo in an osteochondral defect created in the femoral condyle by means of implanting the DN gel plug at the bottom of the defect so that an approximately 2-mm deep vacant space was intentionally left in the defect. This fact has prompted us to propose an innovative strategy without cell culture to repair osteochondral lesions in the femoral condyle.

  7. Femoral condyle insufficiency fractures: associated clinical and morphological findings and impact on outcome

    Energy Technology Data Exchange (ETDEWEB)

    Plett, Sara K.; Hackney, Lauren A.; Heilmeier, Ursula; Nardo, Lorenzo; Zhang, Chiyuan A.; Link, Thomas M. [Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA (United States); Yu, Aihong [Department of Radiology and Biomedical Imaging, University of California, San Francisco, CA (United States); 4th Medical College of Peking University, Department of Radiology, Beijing Jishuitan Hospital, Beijing (China)

    2015-12-15

    To determine the characteristics of femoral condyle insufficiency fracture (FCIF) lesions and their relative associations with the risk of clinical progression. This HIPAA-compliant retrospective study was approved by our Institutional Review Board. Seventy-three patients (age range, 19-95) were included after excluding patients with post-traumatic fractures, bone marrow infarct, osteochondritis dissecans, or underlying tumor. Two board-certified musculoskeletal radiologists classified morphologic findings including lesion diameter, associated bone marrow edema pattern, and associated cartilage/meniscus damage. Electronic medical charts were evaluated for symptoms, risk factors, and longitudinal outcomes, including total knee arthroplasty (TKA). Imaging characteristics were correlated with clinical findings, and comparison of outcome groups was performed using a regression model adjusted for age. The majority of patients with FCIF were women (64.4 %, 47/73), on average 10 years older than men (66.28 ± 15.86 years vs. 56.54 ± 10.39 years, p = 0.005). The most common location for FCIF was the central weight-bearing surface of the medial femoral condyle; overlying full thickness cartilage loss (75.7 %, 53/70) and ipsilateral meniscal injury (94.1 %, 64/68) were frequently associated. Clinical outcomes were variable, with 23.9 % (11/46) requiring TKA. Cartilage WORMS score, adjacent cartilage loss, and contralateral meniscal injury, in addition to decreased knee range of motion at presentation, were significantly associated with progression to TKA (p < 0.05). FCIF are frequently associated with overlying cartilage loss and ipsilateral meniscal injury. The extent of cartilage loss and meniscal damage, in addition to loss of knee range of motion at the time of presentation, are significantly associated with clinical progression. (orig.)

  8. Femoral rotational asymmetry is a common anatomical variant.

    Science.gov (United States)

    Newman, Christopher R; Walter, William L; Talbot, Simon

    2018-05-01

    The sulcus line (SL) is a three-dimensional landmark that corrects for individual variation in the coronal alignment of the trochlear groove in contrast to the traditional Whiteside's line (WL). Femoral rotational asymmetry (FRA) is an anatomical variation in which the posterior condyles and trochlear groove are not perpendicular to each other. This study aims to measure the SL and assess its reliability relative to WL, in addition to measuring and classifying the FRA. A retrospective analysis of a series of 191 CT scans of nonarthritic knees was performed. Measurements were taken of rotational landmarks in three-dimensional reconstructions. The variability and outlier rate of SL was less than WL (P  0.05), however it decreased the rate of change of the rotational alignment of the trochlear groove between the native knee and the prosthetic knee from 31% to 5% (P 5° in 56/191 (29%) of cases. The SL technique is more accurate than WL for determining the rotational alignment of the trochlear groove. Nonarthritic femora have a high rate of rotational asymmetry. Identifying and classifying FRA in individual cases allows the femoral component to be inserted in a position which gives the best possible match to both the native posterior condyles and trochlear groove. Clin. Anat. 31:551-559, 2018. © 2018 Wiley Periodicals, Inc. © 2018 Wiley Periodicals, Inc.

  9. Intraoperative joint gaps and mediolateral balance affect postoperative knee kinematics in posterior-stabilized total knee arthroplasty.

    Science.gov (United States)

    Watanabe, Toshifumi; Muneta, Takeshi; Sekiya, Ichiro; Banks, Scott A

    2015-12-01

    Adjusting joint gaps and establishing mediolateral (ML) soft tissue balance are considered essential interventions for better outcomes in total knee arthroplasty (TKA). However, the relationship between intraoperative laxity measurements and weightbearing knee kinematics has not been well explored. This study aimed to quantify the effect of intraoperative joint gaps and ML soft tissue balance on postoperative knee kinematics in posterior-stabilized (PS)-TKA. We investigated 44 knees in 34 patients who underwent primary PS-TKA by a single surgeon. The central joint gaps and ML tilting angles at 0°, 10°, 30°, 60°, 90°, 120° and 135° flexion were measured during surgery. At a minimum of two year follow-up, we analyzed in vivo kinematics of these knees and examined the influence of intraoperative measurements on postoperative kinematics. Gap difference of knee flexion at 135° minus 0° was correlated with the total posterior translation of lateral femoral condyle (r=0.336, p=0.042) and femoral external rotation (r=0.488, p=0.002) during squatting, anteroposterior position of lateral femoral condyle (r=-0.510, p=0.001) and maximum knee flexion (r=0.355, p=0.031) in kneeling. Similar correlations were observed between deep flexion gap differences with respect to the 90° reference and postoperative knee kinematics. Well-balanced knees showed less anterior translation of medial femoral condyle in mid- to deep flexion, consistent femoral external rotation, and the most neutral valgus/varus rotation compared with unbalanced knees. These findings indicate the importance of adequate intraoperative joint gaps in deep flexion and ML soft tissue balance throughout the range of motion. Copyright © 2015 Elsevier B.V. All rights reserved.

  10. Anatomical study of the radius and center of curvature of the distal femoral condyle

    KAUST Repository

    Kosel, Jü rgen; Giouroudi, Ioanna; Scheffer, Cornie; Dillon, Edwin Mark; Erasmus, Pieter J.

    2010-01-01

    In this anatomical study, the anteroposterior curvature of the surface of 16 cadaveric distal femurs was examined in terms of radii and center point. Those two parameters attract high interest due to their significance for total knee arthroplasty. Basically, two different conclusions have been drawn in foregoing studies: (1) The curvature shows a constant radius and (2) the curvature shows a variable radius. The investigations were based on a new method combining three-dimensional laser-scanning and planar geometrical analyses. This method is aimed at providing high accuracy and high local resolution. The high-precision laser scanning enables the exact reproduction of the distal femurs - including their cartilage tissue - as a three-dimensional computer model. The surface curvature was investigated on intersection planes that were oriented perpendicularly to the surgical epicondylar line. Three planes were placed at the central part of each condyle. The intersection of either plane with the femur model was approximated with the help of a b-spline, yielding three b-splines on each condyle. The radii and center points of the circles, approximating the local curvature of the b-splines, were then evaluated. The results from all three b-splines were averaged in order to increase the reliability of the method. The results show the variation in the surface curvatures of the investigated samples of condyles. These variations are expressed in the pattern of the center points and the radii of the curvatures. The standard deviations of the radii for a 90 deg arc on the posterior condyle range from 0.6 mm up to 5.1 mm, with an average of 2.4 mm laterally and 2.2 mm medially. No correlation was found between the curvature of the lateral and medial condyles. Within the range of the investigated 16 samples, the conclusion can be drawn that the condyle surface curvature is not constant and different for all specimens when viewed along the surgical epicondylar axis. For the portion

  11. Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle: associated ligament and meniscal tears

    International Nuclear Information System (INIS)

    Hong, Hyun Pyo; Lee, Jae Gue; Park, Ji Seon; Ryu, Kyung Nam

    2004-01-01

    Kissing contusion between the posterolateral tibial plateau and lateral femoral condyle is frequently found in association with a tear of the anterior cruciate liagment (ACL). The purpose of this study was to determine which ligamentous and meniscal tears are associated with kissing contusion. We retrospectively reviewed the findings depicted by 323 consecutive MR images of the knee and confirmed at arthroscopy. For the diagnosis of disruption, ligaments, medial menisci (MM) and lateral menisci (LM) were evaluated using accepted criteria. We compared the prevalence and location of meniscal and ligamentous tears between group I (44 knees with kissing contusion) and group II (279 knees without kissing contusion). For statistical analysis the chi-square test was used. ACLs were torn in all 44 knees (100%) with kissing contusion, and 78 (28%) of 279 without kissing contusion. There were ten medial collateral ligament (MCL) tears (23%) in group I, and 17 MCL tears (6%), five lateral collateral ligament (LCL) tears (2%) and ten posterior cruciate ligament (PCL) tears (4%) in group II. In group I, meniscal tears were found in 22 MM (50%) and in 19 LM (43%), while in group II, they occurred in 128 MM (46%) and 128 LM (46%), In group I, 17 (77%) of 22 MM tears and 13 (68%) of 19 LM tears were located in the posterior horn, while in group II, the corresponding figures were 97/128 (76%) and 60 of 128 (47%). The differing prevalence of ACL and MCL tears between the groups was statistically significant (p 0.05). Although kissing contusion was a highly specific sign of ACL tears, its presence was also significant among MCL tears. There was no significant difference in meniscal tears with or without kissing contusion

  12. Bilateral femoral posterior neurocutaneous perforater flap successfully treating Fournier gangrene

    Science.gov (United States)

    Wang, Tao; Zhao, Gang; Rui, Yong-Jun; Mi, Jing-Yi

    2017-01-01

    Abstract Rationale: Necrotizing fasciitis (NF), characterized by widespread fascial necrosis, is a rare disease in clinic. Fournier gangrene (FG) is a special type of NF involved of perineum and scrotum. To our knowledge, no article has reported on bilateral femoral posterior neurocutaneous perforater flap treating for FG. Patient concerns: A 61-year-old Chinese male complained of perineal skin necrosis for 19 days. The patient received treatment in other hospital due to chronic bronchitis on April 15th and body temperature ranged from 38 to 39 °C. Then he received antiinfection therapy. Perianal cutaneous occurred mild necrosis on May 08th. And the necrosis generally deteriorated. He came to our hospital for treating necrosis in area of perineum and scrotum on May 28th. Diagnoses: He was diagnosed with FG and chronic bronchitis. Interventions: The patient underwent debridement on June 2nd and received bilateral femoral posterior neurocutaneous perforater flap on June 29th. Besides, the patient was treated with whole-body nutrition support and antibiotic treatment. Outcomes: One week after the 2nd operation, the flap showed normal color. The result shows good outcome and no recurrence of the clinical symptoms occur till now. Lessons: FG is rare. Bilateral femoral posterior neurocutaneous perforater flap is an effective procedure to treat FG. The outcome of combined therapy is satisfactory. PMID:29145312

  13. Prevalence and clinical significance of chondromalacia isolated to the anterior margin of the lateral femoral condyle as a component of patellofemoral disease: observations at MR imaging.

    LENUS (Irish Health Repository)

    Chan, V O

    2013-08-01

    To determine the prevalence of chondromalacia isolated to the anterior margin of the lateral femoral condyle as a component of patellofemoral disease in patients with anterior knee pain and to correlate it with patient demographics, patellar shape, and patellofemoral alignment.

  14. Return to sports after autogenous osteochondral mosaicplasty of the femoral condyles: 25 cases at a mean follow-up of 9 years.

    Science.gov (United States)

    Cognault, J; Seurat, O; Chaussard, C; Ionescu, S; Saragaglia, D

    2015-05-01

    Autogenous osteochondral mosaicplasty is the most common cartilage restoration technique in standard clinical practice. The purpose of this study was to evaluate the return to sports 9 years after mosaicplasty of the femoral condyles. The long-term results of an osteochondral autograft show that patients can regain their pre-injury activity level. This study is based on a series of 25 patients with a mean age of 28.9 years (range, 16-44 years) who had stage 3 or 4 chondral lesions of the femoral condyles (according to the ICRS or ICRS-OCD scores). The origin of the lesion was osteochondritis dissecans (13 knees), osteochondral fracture sequelae (ten knees), or aseptic osteonecrosis (two knees). The average size of the lesion was 2.11 ± 0.9 cm(2). Ten patients (40%) had an associated procedure during the osteochondral autograft. The patients were assessed clinically (IKDC and Lysholm-Tegner scores) and radiographically by a reviewer independent of the team of operators. All patients were re-examined at a mean follow-up of 9 years (range, 6-15 years), with 84% satisfied or very satisfied with the procedure. The average IKDC was 74.5 ± 18.5 points. The average Lysholm score was 87.3 ± 11.6 points. The average Tegner score ranged from 6.35 ± 1.53 points prior to surgery to 5.60 ± 1.64 points after surgery (P = 0.001). The average loss was 0.64 points for patients whose presurgery Tegner score was greater than or equal to 7 (P = 0.019) and 0.3 points if lower than 7. The radiologic evaluation of 21 patients showed complete osteointegration of the grafts in 90% of cases. The results of the femoral condyle mosaic autografts are satisfactory, a mean of 9 years after surgery. The most active patients lowered their activity level while the more sedentary did not have to adapt their lifestyle. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  15. Shape and Site Dependent in Vivo Degradation of Mg-Zn Pins in Rabbit Femoral Condyle

    Directory of Open Access Journals (Sweden)

    Pei Han

    2014-02-01

    Full Text Available A type of specially designed pin model of Mg-Zn alloy was implanted into the full thickness of lesions of New Zealand rabbits’ femoral condyles. The recovery progress, outer surface healing and in vivo degradation were characterized by various methods including radiographs, Micro-CT scan with surface rendering, SEM (scanning electron microscope with EDX (Energy Dispersive X-ray analysis and so on. The in vivo results suggested that a few but not sufficient bridges for holding force were formed between the bone and the implant if there was a preexisting gap between them. The rapid degradation of the implantation in the condyle would result in the appearance of cavities. Morphological evaluation of the specially designed pins indicated that the cusp was the most vulnerable part during degradation. Furthermore, different implantation sites with distinct components and biological functions can lead to different degradation rates of Mg-Zn alloy. The rate of Mg-Zn alloy decreases in the following order: implantation into soft tissue, less trabecular bone, more trabecular bone, and cortical bone. Because of the complexities of in vivo degradation, it is necessary for the design of biomedical Mg-Zn devices to take into consideration the implantation sites used in clinics.

  16. A tomographic study of the condyle position in temporomandibular disorders

    International Nuclear Information System (INIS)

    Choi, Sung Youn; Ryu, Young Kyu

    1988-01-01

    The aim of this study was to determine whether T.M.J. tomographic examination yielded significant difference in condyle positions among asymptomatic, myalgia, derangement, and arthrosis group of T.M.J. disorders. The author obtained sagittal linear tomograms of right and left T.M.Js. of 36 asymptomatic, 22 myalgia, 54 derangement, and 31 arthrosis patients taken at serial lateral, central, and medial sections in the intercuspal position after submentovertex radiographs analyzed. With the dual linear measurements of the posterior and anterior interarticular space, condyle positions were mathematically expressed as proportion. All data from these analysis was recorded and processed statistically. The results were obtained as follows: 1. In asymptomatic group, radiographically concentric condyle position was found in 50.0% to 65.4% of subjects, with a substance range of variability. No significant differences existed between men and women and also between right and left T.M.Js. for condyle position. 2. In women, significant difference for mean condyle position of left lateral section of each diagnostic category existed between derangement and myalgia groups (P< .05). Also that of left central section existed between derangement and myalgia group, and that of left medial section existed between derangement and myalgia groups (P< . 05). 3. In main-symptom side, condyle position in myalgia group was more concentric, and condyle position in derangement and group was more posterior. This showed significant differences between derangement and myalgia groups in lateral, central, and medial sections of main symptom side, and only between derangement and myalgia groups in central section of contra-lateral sides (P< .05). Condyle position in arthrosis group was broadly distributed among all positions. 4. In contra-lateral side, significant difference for mean condyle position of central section of each symptomatic group existed between derangement and myalgia group (P< .05

  17. A tomographic study of the condyle position in temporomandibular disorders

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Sung Youn; Ryu, Young Kyu [Dept. of Oral Radiology, College of Dentistry, Yonsei University, Seoul (Korea, Republic of)

    1988-11-15

    The aim of this study was to determine whether T.M.J. tomographic examination yielded significant difference in condyle positions among asymptomatic, myalgia, derangement, and arthrosis group of T.M.J. disorders. The author obtained sagittal linear tomograms of right and left T.M.Js. of 36 asymptomatic, 22 myalgia, 54 derangement, and 31 arthrosis patients taken at serial lateral, central, and medial sections in the intercuspal position after submentovertex radiographs analyzed. With the dual linear measurements of the posterior and anterior interarticular space, condyle positions were mathematically expressed as proportion. All data from these analysis was recorded and processed statistically. The results were obtained as follows: 1. In asymptomatic group, radiographically concentric condyle position was found in 50.0% to 65.4% of subjects, with a substance range of variability. No significant differences existed between men and women and also between right and left T.M.Js. for condyle position. 2. In women, significant difference for mean condyle position of left lateral section of each diagnostic category existed between derangement and myalgia groups (P< .05). Also that of left central section existed between derangement and myalgia group, and that of left medial section existed between derangement and myalgia groups (P< . 05). 3. In main-symptom side, condyle position in myalgia group was more concentric, and condyle position in derangement and group was more posterior. This showed significant differences between derangement and myalgia groups in lateral, central, and medial sections of main symptom side, and only between derangement and myalgia groups in central section of contra-lateral sides (P< .05). Condyle position in arthrosis group was broadly distributed among all positions. 4. In contra-lateral side, significant difference for mean condyle position of central section of each symptomatic group existed between derangement and myalgia group (P< .05

  18. An anatomical study of the proximal aspect of the medial femoral condyle to define the proximal-distal condylar length

    Directory of Open Access Journals (Sweden)

    Chia-Ming Chang

    2017-01-01

    Full Text Available Objective: Despite its possible role in knee arthroplasty, the proximal-distal condylar length (PDCL of the femur has never been reported in the literature. We conducted an anatomic study of the proximal aspect of the medial femoral condyle to propose a method for measuring the PDCL. Materials and Methods: Inspection of dried bone specimens was carried out to assure the most proximal condylar margin (MPCM as the eligible starting point to measure the PDCL. Simulation surgery was performed on seven pairs of cadaveric knees to verify the clinical application of measuring the PDCL after locating the MPCM. Interobserver reliability of this procedure was also analyzed. Results: Observation of the bone specimens showed that the MPCM is a concavity formed by the junction of the distal end of the supracondylar ridge and the proximal margin of the medial condyle. This anatomically distinctive structure made the MPCM an unambiguous landmark. The cadaveric simulation surgical dissection demonstrated that the MPCM is easily accessed in a surgical setting, making the measurement of the PDCL plausible. The intraclass correlation coefficient was 0.78, indicating good interobserver reliability for this technique. Conclusion: This study has suggested that the PDCL can be measured based on the MPCM in a surgical setting. PDCL measurement might be useful in joint line position management, selection of femoral component sizes, and other applications related to the proximal-distal dimension of the knee. Further investigation is required.

  19. 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.

  20. Glycosaminoglycan synthesis in the mandibular condyle during growth adaptation.

    Science.gov (United States)

    Kantomaa, T; Pirttiniemi, P; Tuominen, M; Poikela, A

    1994-01-01

    Condylar growth was studied after an operation simulating functional orthodontic appliances. Twenty-five rabbits underwent a surgical operation for the induction of premature synostosis to displace the glenoid fossa posteriorly during growth. Twenty-five control rabbits underwent sham operations. At the age of 15 days, 10 experimental and 10 control animals and, at the age of 20 days, 5 experimental and 5 control animals were killed. Their mandibular condyles were organ-cultured for 3 h in the presence of radiolabelled sulphur. The condyles were used for autoradiographic purposes. Digital image analysis of autoradiograms of histological sections showed synthesis of glycosaminoglycans to have increased from the anterior to the posterior direction. This increase was more marked in experimental animals than in the condyles of control animals. Ten experimental and 10 control animals were killed at the age of 15 days, and mandibular condyles were organ-cultured for 1, 4 and 7 days. Differentiation of proliferating prechondroblasts into hypertrophied chondrocytes continued under organ culture conditions. A marked decrease in the proliferating cell layer was noticed, especially in control condyles. Hypertrophy was faster and came closer to the surface of the condyle in the anterior region of the condyle. This was most marked in the condyles of experimental animals. The results indicate that a procedure carried out on the glenoid fossa with the same effect as functional appliances increases the synthesis of extracellular matrix in the posterosuperior region of the mandibular condyle.

  1. Use of the medial femoral condyle vascularized bone flap in traumatic avascular necrosis of the navicular: a case report.

    Science.gov (United States)

    Holm, Janson; Vangelisti, Garrett; Remmers, Jared

    2012-01-01

    The medial femoral condyle vascularized bone flap has a high success rate in published literature regarding its use in nonunions and avascular necrosis of the upper and lower extremities. It is reported to have minimal donor site morbidity and the ability to provide structural support and torsional strength to load-bearing areas. The flap has found particular success in the treatment of scaphoid nonunions. The tarsal navicular, similar to the scaphoid, is largely articular cancellous bone with little surface area for vascular inflow. These anatomic features make the navicular prone to nonunion and avascular necrosis in traumatic scenarios. We describe a case of nonunion and avascular necrosis of the tarsal navicular occurring as sequelae of a high-impact midfoot injury sustained in an automobile accident. After an initial attempt at open reduction and internal fixation with midfoot bridge plating, subsidence and nonunion resulted. An attempt at arthrodesis of the talonavicular and naviculocuneiform joints was then undertaken. This too failed, leading to the development of additional collapse and avascular necrosis. The site was treated with a medial femoral condyle vascularized bone flap. In this single case, the patient returned to pain-free ambulation and reported excellent outcomes and functional capacity. Although we present a successful case, a larger case series is necessary to establish the use of this flap as a reliable option for the treatment of nonunion and avascular necrosis of the tarsal navicular. Copyright © 2012 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Bilateral femoral posterior neurocutaneous perforater flap successfully treating Fournier gangrene: A case report.

    Science.gov (United States)

    Wang, Tao; Zhao, Gang; Rui, Yong-Jun; Mi, Jing-Yi

    2017-11-01

    Necrotizing fasciitis (NF), characterized by widespread fascial necrosis, is a rare disease in clinic. Fournier gangrene (FG) is a special type of NF involved of perineum and scrotum. To our knowledge, no article has reported on bilateral femoral posterior neurocutaneous perforater flap treating for FG. A 61-year-old Chinese male complained of perineal skin necrosis for 19 days. The patient received treatment in other hospital due to chronic bronchitis on April 15th and body temperature ranged from 38 to 39 °C. Then he received antiinfection therapy. Perianal cutaneous occurred mild necrosis on May 08th. And the necrosis generally deteriorated. He came to our hospital for treating necrosis in area of perineum and scrotum on May 28th. He was diagnosed with FG and chronic bronchitis. The patient underwent debridement on June 2nd and received bilateral femoral posterior neurocutaneous perforater flap on June 29th. Besides, the patient was treated with whole-body nutrition support and antibiotic treatment. One week after the 2nd operation, the flap showed normal color. The result shows good outcome and no recurrence of the clinical symptoms occur till now. FG is rare. Bilateral femoral posterior neurocutaneous perforater flap is an effective procedure to treat FG. The outcome of combined therapy is satisfactory.

  3. Radiographic landmarks for locating the femoral origin of the superficial medial collateral ligament.

    Science.gov (United States)

    Hartshorn, Timothy; Otarodifard, Karimdad; White, Eric A; Hatch, George F Rick

    2013-11-01

    Little has been written about the use of radiographic landmarks for locating the origin of the superficial medial collateral ligament (sMCL). A standardized radiographic landmark for the sMCL origin using intraoperative fluoroscopic imaging may be of value in aiding the surgeon in accurate femoral tunnel placement in the setting of extensive soft tissue disruption and bony attrition. To determine a reproducible radiographic landmark that will assist in correct femoral tunnel placement in sMCL repair and reconstruction. Descriptive laboratory study. Ten fresh-frozen unmatched human cadaveric knees were dissected, and the origin of the sMCL was exposed. A 2-mm metallic marker was then placed at the center of the femoral origin of the sMCL. True lateral fluoroscopically assisted digital radiographs were obtained of the knee with the posterior and distal femoral condyles overlapping in a standardized fashion. With the use of computer software, reference lines were drawn on the images, creating 4 quadrants. Two independent examiners performed quantitative measurements of the sMCL origin in relation to this axis and to the Blumensaat line. Mean measurements showed the sMCL origin to be closely related to the intersection point of the Blumensaat line and a line drawn distally from the posterior femoral cortex on a true lateral radiograph. The sMCL origin was found at a mean point 1.6 ± 4.3 mm posterior and 4.9 ± 2.1 mm proximal to the intersection of a line paralleling the posterior femoral cortex and a line drawn perpendicular to the posterior femoral cortical line, where it intersects the Blumensaat line. In 5 of 10 specimens, the center of the sMCL origin fell precisely on the Blumensaat line. The remaining specimens had sMCL origins anterior to the Blumensaat line. The femoral origin of the sMCL was found in the proximal and posterior quadrants in 8 of 10 specimens. With a relatively small amount of deviation, the sMCL origin can be consistently identified on a true

  4. MRI-guided cryoablation of the posterior femoral cutaneous nerve for the treatment of neuropathy-mediated sitting pain

    International Nuclear Information System (INIS)

    Joshi, Dharmdev H.; Thawait, Gaurav K.; Fritz, Jan; Del Grande, Filippo

    2017-01-01

    Neuropathy of the posterior femoral cutaneous nerve may manifest as pain and paresthesia in the skin over the inferior buttocks, posterior thigh, and popliteal region. Current treatment options include physical and oral pain therapy, perineural injections, and surgical neurectomy. Perineural steroid injections may provide short-term pain relief; however, to our knowledge, there is currently no minimally invasive denervation procedure for sustained pain relief that could serve as an alternative to surgical neurectomy. Percutaneous cryoablation of nerves is a minimally invasive technique that induces a sustained nerve conduction block through temporary freezing of the neural layers. It can result in long-lasting pain relief, but has not been described for the treatment of neuropathy-mediated PFCN pain. We report a technique of MR-guided cryoablation of the posterior femoral cutaneous nerve resulting in successful treatment of PFCN-mediated sitting pain. Cryoablation of the posterior femoral cutaneous nerve seems a promising, minimally invasive treatment option that deserves further investigation. (orig.)

  5. MRI-guided cryoablation of the posterior femoral cutaneous nerve for the treatment of neuropathy-mediated sitting pain

    Energy Technology Data Exchange (ETDEWEB)

    Joshi, Dharmdev H.; Thawait, Gaurav K.; Fritz, Jan [Johns Hopkins University School of Medicine, Section of Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Del Grande, Filippo [Johns Hopkins University School of Medicine, Section of Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States); Ospedale Regionale di Lugano, Servizio di Radiologia, Lugano, Ticino (Switzerland)

    2017-07-15

    Neuropathy of the posterior femoral cutaneous nerve may manifest as pain and paresthesia in the skin over the inferior buttocks, posterior thigh, and popliteal region. Current treatment options include physical and oral pain therapy, perineural injections, and surgical neurectomy. Perineural steroid injections may provide short-term pain relief; however, to our knowledge, there is currently no minimally invasive denervation procedure for sustained pain relief that could serve as an alternative to surgical neurectomy. Percutaneous cryoablation of nerves is a minimally invasive technique that induces a sustained nerve conduction block through temporary freezing of the neural layers. It can result in long-lasting pain relief, but has not been described for the treatment of neuropathy-mediated PFCN pain. We report a technique of MR-guided cryoablation of the posterior femoral cutaneous nerve resulting in successful treatment of PFCN-mediated sitting pain. Cryoablation of the posterior femoral cutaneous nerve seems a promising, minimally invasive treatment option that deserves further investigation. (orig.)

  6. Condyle-Specific Matching Does Not Improve Midterm Clinical Outcomes of Osteochondral Allograft Transplantation in the Knee.

    Science.gov (United States)

    Wang, Dean; Jones, Kristofer J; Eliasberg, Claire D; Pais, Mollyann D; Rodeo, Scott A; Williams, Riley J

    2017-10-04

    Condyle-specific matching for osteochondral allograft transplantation (OCA) pairs donor and recipient condyles in an attempt to minimize articular incongruity. While the majority of cartilage defects are located on the medial femoral condyle, lateral femoral condyles are more commonly available as a graft source. The purpose of this study was to compare the clinical outcomes of patients treated with non-orthotopic (lateral-to-medial condyle or medial-to-lateral condyle) OCA with those treated with traditional orthotopic (medial-to-medial condyle or lateral-to-lateral condyle) OCA. We hypothesized that clinical outcomes would be similar between groups at midterm follow-up. A retrospective review of prospectively collected data on patients treated with OCA from 2000 to 2014 was conducted. Seventy-seven patients with a full-thickness cartilage defect of a femoral condyle were treated with either orthotopic (n = 50) or non-orthotopic (n = 27) OCA. A minimum follow-up of 2 years was required for analysis. Patients in each group were matched according to sex, age, and total chondral defect size. Reoperations and patient responses to validated outcome measures were reviewed. Failure was defined as any revision cartilage procedure or conversion to knee arthroplasty. The mean duration of follow-up was 4.0 years (range, 2 to 16 years). The orthotopic and non-orthotopic OCA groups were comparable in terms of demographics, the mean number of prior ipsilateral knee operations, and the percentage of concomitant procedures at baseline. Reoperation (p = 0.427) and failure (p = 0.917) rates did not differ significantly between groups. Both groups demonstrated significant increases in the Short Form-36 (SF-36) physical functioning and pain, International Knee Documentation Committee (IKDC), and Knee Outcome Survey-Activities of Daily Living (KOS-ADL) scores compared with baseline (p OCA and those treated with non-orthotopic OCA, suggesting that condyle-specific matching may not be

  7. Evaluation of an injectable bioactive borate glass cement to heal bone defects in a rabbit femoral condyle model

    Energy Technology Data Exchange (ETDEWEB)

    Cui, Xu [Institute of Bioengineering and Information Technology Materials, Tongji University, Shanghai 200092 (China); Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055 (China); Huang, Wenhai [Institute of Bioengineering and Information Technology Materials, Tongji University, Shanghai 200092 (China); Zhang, Yadong, E-mail: zhangyadong6@126.com [Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120 (China); Huang, Chengcheng; Yu, Zunxiong; Wang, Lei; Liu, Wenlong; Wang, Ting [Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055 (China); Zhou, Jie; Wang, Hui; Zhou, Nai; Wang, Deping [Institute of Bioengineering and Information Technology Materials, Tongji University, Shanghai 200092 (China); Pan, Haobo, E-mail: hb.pan@siat.ac.cn [Center for Human Tissues and Organs Degeneration, Shenzhen Institute of Advanced Technology, Chinese Academy of Science, Shenzhen 518055 (China); Rahaman, Mohamed N., E-mail: rahaman@mst.edu [Department of Spine Surgery, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai 200120 (China); Department of Materials Science and Engineering, Missouri University of Science and Technology, Rolla, MO 65409-0340 (United States)

    2017-04-01

    There is a need for synthetic biomaterials to heal bone defects using minimal invasive surgery. In the present study, an injectable cement composed of bioactive borate glass particles and a chitosan bonding solution was developed and evaluated for its capacity to heal bone defects in a rabbit femoral condyle model. The injectability and setting time of the cement in vitro decreased but the compressive strength increased (8 ± 2 MPa to 31 ± 2 MPa) as the ratio of glass particles to chitosan solution increased (from 1.0 g ml{sup −1} to 2.5 g ml{sup −1}). Upon immersing the cement in phosphate-buffered saline, the glass particles reacted and converted to hydroxyapatite, imparting bioactivity to the cement. Osteoblastic MC3T3-E1 cells showed enhanced proliferation and alkaline phosphatase activity when incubated in media containing the soluble ionic product of the cement. The bioactive glass cement showed a better capacity to stimulate bone formation in rabbit femoral condyle defects at 12 weeks postimplantation when compared to a commercial calcium sulfate cement. The injectable bioactive borate glass cement developed in this study could provide a promising biomaterial to heal bone defects by minimal invasive surgery. - Highlights: • New class of injectable bone cement composed of bioactive borate glass particles and chitosan bonding phase was created. • The cement is biocompatible and bioactive, and has a much lower temperature increase during setting than PMMA cement. • The cement has a more controllable degradation rate and higher strength over a longer time than calcium sulfate cement. • The cement showed a better ability to heal bone defects than calcium sulfate over a twelve-week implantation period.

  8. An Atypical Variant of Superolateral Dislocation of the Mandibular Condyle: A Case Report.

    Science.gov (United States)

    Malik, Kapil; Debnath, Subhas C; Adhyapok, Apurba K; Hazarika, Kriti

    2017-10-01

    Dislocation of the mandibular condyle from the glenoid fossa can occur in anterior, posterior, lateral, and superior directions. Posterior, lateral, and superior dislocations are rare. Superolateral dislocation is seldom encountered in clinical practice. It is generally associated with fracture of the anterior or contralateral side of the mandible. The occurrence of superolateral dislocation of the condyle hooked above the zygomatic arch with an associated fracture of the medial pole of the condyle is rare and has been reported only once in the literature. This report describes another case in which the patient had superolateral dislocation of the mandibular condyle with a fractured medial pole without any associated fracture of the anterior or contralateral side of the mandible. The condyle was hooked laterally above the zygomatic arch. Open reduction of the dislocated condyle was performed and a good outcome was obtained. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  9. Flexing and downsizing the femoral component is not detrimental to patellofemoral biomechanics in posterior-referencing cruciate-retaining total knee arthroplasty.

    Science.gov (United States)

    Marra, Marco A; Strzelczak, Marta; Heesterbeek, Petra J C; van de Groes, Sebastiaan A W; Janssen, Dennis; Koopman, Bart F J M; Verdonschot, Nico; Wymenga, Ate B

    2018-03-20

    When downsizing the femoral component to prevent mediolateral overhang, notching of the anterior femoral cortex may occur, which could be solved by flexing the femoral component. In this study, we investigated the effect of flexion of the femoral component on patellar tendon moment arm, patellofemoral forces and kinematics in posterior-referencing CR-TKA. Our hypothesis was that flexion of the femoral component increases the patellar tendon moment arm, reduces the patellofemoral forces and provides stable kinematics. A validated musculoskeletal model of CR-TKA was used. The flexion of the femoral component was increased in four steps (0°, 3°, 6°, 9°) using posterior referencing, and different alignments were analysed in combination with three implant sizes (3, 4, 5). A chair-rising trial was analysed using the model, while simultaneously estimating quadriceps muscle force, patellofemoral contact force, tibiofemoral and patellofemoral kinematics. Compared to the reference case (size 4 and 0° flexion), for every 3° of increase in flexion of the femoral component the patellar tendon moment arm increased by 1% at knee extension. The peak quadriceps muscle force and patellofemoral contact force decreased by 2%, the patella shifted 0.8 mm more anteriorly and the remaining kinematics remained stable, with knee flexion. With the smaller size, the patellar tendon moment arm decreased by 6%, the quadriceps muscle force and patellofemoral contact force increased by 8 and 12%, and the patellar shifted 5 mm more posteriorly. Opposite trends were found with the bigger size. Flexing the femoral component with posterior referencing reduced the patellofemoral contact forces during a simulated chair-rising trial with a patient-specific musculoskeletal model of CR-TKA. There seems to be little risk when flexing and downsizing the femoral component, compared to when using a bigger size and neutral alignment. These findings provide relevant information to surgeons who wish to

  10. Focal femoral condyle resurfacing.

    LENUS (Irish Health Repository)

    Brennan, S A

    2013-03-01

    Focal femoral inlay resurfacing has been developed for the treatment of full-thickness chondral defects of the knee. This technique involves implanting a defect-sized metallic or ceramic cap that is anchored to the subchondral bone through a screw or pin. The use of these experimental caps has been advocated in middle-aged patients who have failed non-operative methods or biological repair techniques and are deemed unsuitable for conventional arthroplasty because of their age. This paper outlines the implant design, surgical technique and biomechanical principles underlying their use. Outcomes following implantation in both animal and human studies are also reviewed. Cite this article: Bone Joint J 2013;95-B:301-4.

  11. A Rare Case Report of an Unusual Dislocation of Fractured Mandibular Condyle

    OpenAIRE

    Mishra, Madan; Singh, Gaurav

    2015-01-01

    Several cases have been reported regarding superolateral, posterior, or superior dislocation of mandibular condyle. The anteromedial dislocation of fractured condyle is the most common among all. This article reports an unusual and unique case of dislocated fractured mandibular condyle wherein the fractured left condylar head was dislocated to the left anatomic angle of mandible. We have not found a single such case in the world English literature published till date. The presented case falls...

  12. Nontraumatic Fracture of the Femoral Condylar Prosthesis in a Total Knee Arthroplasty Leading to Mechanical Failure

    Directory of Open Access Journals (Sweden)

    Girish N. Swamy

    2014-01-01

    Full Text Available This paper reports a case of fatigue fracture of the femoral component in a cruciate-retaining cemented total knee arthroplasty (TKA. A 64-year-old man had undergone a primary TKA for osteoarthritis 10 years previously at another institution using the PFC-Sigma prosthesis. The patient recovered fully and was back to his regular activities. He presented with a history of sudden onset pain and locking of the left knee since the preceding three months. There was no history of trauma, and the patient was mobilizing with difficulty using crutches. Radiographs revealed fracture of the posterior condyle of the femoral prosthesis. Revision surgery was performed as an elective procedure revealing the broken prosthesis. The TC3RP-PFC revision prosthesis was used with a medial parapatellar approach. The patient recovered fully without any squeal. Mechanical failure of the knee arthroplasty prosthesis is rare, and nontraumatic fracture of the femoral metallic component has not been reported before.

  13. Nontraumatic fracture of the femoral condylar prosthesis in a total knee arthroplasty leading to mechanical failure.

    Science.gov (United States)

    Swamy, Girish N; Quah, Conal; Bagouri, Elmunzar; Badhe, Nitin P

    2014-01-01

    This paper reports a case of fatigue fracture of the femoral component in a cruciate-retaining cemented total knee arthroplasty (TKA). A 64-year-old man had undergone a primary TKA for osteoarthritis 10 years previously at another institution using the PFC-Sigma prosthesis. The patient recovered fully and was back to his regular activities. He presented with a history of sudden onset pain and locking of the left knee since the preceding three months. There was no history of trauma, and the patient was mobilizing with difficulty using crutches. Radiographs revealed fracture of the posterior condyle of the femoral prosthesis. Revision surgery was performed as an elective procedure revealing the broken prosthesis. The TC3RP-PFC revision prosthesis was used with a medial parapatellar approach. The patient recovered fully without any squeal. Mechanical failure of the knee arthroplasty prosthesis is rare, and nontraumatic fracture of the femoral metallic component has not been reported before.

  14. Computer tomographic determination of femoral anteversion

    International Nuclear Information System (INIS)

    Jend, H.H.

    1986-01-01

    Thirty-two macerated femora were examined by CT in order to determine the degree of anteversion and to relate this to the position of the femur and to the various reference lines quoted in the literature. The accuracy of CT is the same as that of the Rippstein method, provided the following conditions are met: 1. Position of the femur with its long axis perpendicular to the image plane. 2. Demonstration of the maximal configuration of the femoral condyles to enable one to construct a tangent to the dorsal aspect of the condyle. 3. Demonstration of the head and neck by a plane which divides the neck into approximately equal portions and sections the femoral head. These conditions are more easily met, even in immobile patients, than the requirements for the Rippstein method. (orig.) [de

  15. Femoral loosening of high-flexion total knee arthroplasty: The effect of posterior cruciate ligament retention and bone quality reduction

    NARCIS (Netherlands)

    Zelle, J.; van de Groes, S.A.W.; De Waal Malefijt, M.C.; Verdonschot, Nicolaas Jacobus Joseph

    2014-01-01

    High-flexion total knee arthroplasty (TKA) may be more sensitive to femoral loosening than conventional TKA as the knee joint force increases during deep flexion. The objective of this study was to evaluate whether the probability of femoral loosening is equal in posterior cruciate ligament (PCL)

  16. Fracture of the occipital condyle

    International Nuclear Information System (INIS)

    Wessels, L.S.

    1990-01-01

    The term fracture of the occipital condyle is a misnomer and and usually represents an extensive fracture of the posterior fossa skull base extending onto the squamous portion of the occipital bone and even further forward. These fractures should be suspected when the lower cranial nerves are affected after severe cranial trauma. Conservative management appears to be indicated. 2 figs., 5 refs

  17. Evaluation of condyle defects using different reconstruction protocols of cone-beam computed tomography

    International Nuclear Information System (INIS)

    Bastos, Luana Costa; Campos, Paulo Sergio Flores; Ramos-Perez, Flavia Maria de Moraes; Pontual, Andrea dos Anjos; Almeida, Solange Maria

    2013-01-01

    This study was conducted to investigate how well cone-beam computed tomography (CBCT) can detect simulated cavitary defects in condyles, and to test the influence of the reconstruction protocols. Defects were created with spherical diamond burs (numbers 1013, 1016, 3017) in superior and / or posterior surfaces of twenty condyles. The condyles were scanned, and cross-sectional reconstructions were performed with nine different protocols, based on slice thickness (0.2, 0.6, 1.0 mm) and on the filters (original image, Sharpen Mild, S9) used. Two observers evaluated the defects, determining their presence and location. Statistical analysis was carried out using simple Kappa coefficient and McNemar’s test to check inter- and intra-rater reliability. The chi-square test was used to compare the rater accuracy. Analysis of variance (Tukey's test) assessed the effect of the protocols used. Kappa values for inter- and intra-rater reliability demonstrate almost perfect agreement. The proportion of correct answers was significantly higher than that of errors for cavitary defects on both condyle surfaces (p < 0.01). Only in identifying the defects located on the posterior surface was it possible to observe the influence of the 1.0 mm protocol thickness and no filter, which showed a significantly lower value. Based on the results of the current study, the technique used was valid for identifying the existence of cavities in the condyle surface. However, the protocol of a 1.0 mm-thick slice and no filter proved to be the worst method for identifying the defects on the posterior surface. (author)

  18. Evaluation of condyle defects using different reconstruction protocols of cone-beam computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Bastos, Luana Costa; Campos, Paulo Sergio Flores, E-mail: bastosluana@ymail.com [Universidade Federal da Bahia (UFBA), Salvador, BA (Brazil). Fac. de Odontologia. Dept. de Radiologia Oral e Maxilofacial; Ramos-Perez, Flavia Maria de Moraes [Universidade Federal de Pernambuco (UFPE), Recife, PE (Brazil). Fac. de Odontologia. Dept. de Clinica e Odontologia Preventiva; Pontual, Andrea dos Anjos [Universidade Federal de Pernambuco (UFPE), Camaragibe, PE (Brazil). Fac. de Odontologia. Dept. de Radiologia Oral; Almeida, Solange Maria [Universidade Estadual de Campinas (UNICAMP), Piracicaba, SP (Brazil). Fac. de Odontologia. Dept. de Radiologia Oral

    2013-11-15

    This study was conducted to investigate how well cone-beam computed tomography (CBCT) can detect simulated cavitary defects in condyles, and to test the influence of the reconstruction protocols. Defects were created with spherical diamond burs (numbers 1013, 1016, 3017) in superior and / or posterior surfaces of twenty condyles. The condyles were scanned, and cross-sectional reconstructions were performed with nine different protocols, based on slice thickness (0.2, 0.6, 1.0 mm) and on the filters (original image, Sharpen Mild, S9) used. Two observers evaluated the defects, determining their presence and location. Statistical analysis was carried out using simple Kappa coefficient and McNemar’s test to check inter- and intra-rater reliability. The chi-square test was used to compare the rater accuracy. Analysis of variance (Tukey's test) assessed the effect of the protocols used. Kappa values for inter- and intra-rater reliability demonstrate almost perfect agreement. The proportion of correct answers was significantly higher than that of errors for cavitary defects on both condyle surfaces (p < 0.01). Only in identifying the defects located on the posterior surface was it possible to observe the influence of the 1.0 mm protocol thickness and no filter, which showed a significantly lower value. Based on the results of the current study, the technique used was valid for identifying the existence of cavities in the condyle surface. However, the protocol of a 1.0 mm-thick slice and no filter proved to be the worst method for identifying the defects on the posterior surface. (author)

  19. Kinematic analysis of anterior cruciate ligament reconstruction in total knee arthroplasty

    Science.gov (United States)

    Liu, Hua-Wei; Ni, Ming; Zhang, Guo-Qiang; Li, Xiang; Chen, Hui; Zhang, Qiang; Chai, Wei; Zhou, Yong-Gang; Chen, Ji-Ying; Liu, Yu-Liang; Cheng, Cheng-Kung; Wang, Yan

    2016-01-01

    Background: This study aims to retain normal knee kinematics after knee replacement surgeries by reconstructing anterior cruciate ligament during total knee arthroplasty. Method: We use computational simulation tools to establish four dynamic knee models, including normal knee model, posterior cruciate ligament retaining knee model, posterior cruciate ligament substituting knee model, and anterior cruciate ligament reconstructing knee model. Our proposed method utilizes magnetic resonance images to reconstruct solid bones and attachments of ligaments, and assemble femoral and tibial components according representative literatures and operational specifications. Dynamic data of axial tibial rotation and femoral translation from full-extension to 135 were measured for analyzing the motion of knee models. Findings: The computational simulation results show that comparing with the posterior cruciate ligament retained knee model and the posterior cruciate ligament substituted knee model, reconstructing anterior cruciate ligament improves the posterior movement of the lateral condyle, medial condyle and tibial internal rotation through a full range of flexion. The maximum posterior translations of the lateral condyle, medial condyle and tibial internal rotation of the anterior cruciate ligament reconstructed knee are 15.3 mm, 4.6 mm and 20.6 at 135 of flexion. Interpretation: Reconstructing anterior cruciate ligament in total knee arthroplasty has been approved to be an more efficient way of maintaining normal knee kinematics comparing to posterior cruciate ligament retained and posterior cruciate ligament substituted total knee arthroplasty. PMID:27347334

  20. Factors affecting femoral rotational angle based on the posterior condylar axis in gap-based navigation-assisted total knee arthroplasty for valgus knee.

    Science.gov (United States)

    Lee, Sung-Sahn; Lee, Yong-In; Kim, Dong-Uk; Lee, Dae-Hee; Moon, Young-Wan

    2018-01-01

    Achieving proper rotational alignment of the femoral component in total knee arthroplasty (TKA) for valgus knee is challenging because of lateral condylar hypoplasia and lateral cartilage erosion. Gap-based navigation-assisted TKA enables surgeons to determine the angle of femoral component rotation (FCR) based on the posterior condylar axis. This study evaluated the possible factors that affect the rotational alignment of the femoral component based on the posterior condylar axis. Between 2008 and 2016, 28 knees were enrolled. The dependent variable for this study was FCR based on the posterior condylar axis, which was obtained from the navigation system archives. Multiple regression analysis was conducted to identify factors that might predict FCR, including body mass index (BMI), Kellgren-Lawrence grade (K-L grade), lateral distal femoral angles obtained from the navigation system and radiographs (NaviLDFA, XrayLDFA), hip-knee-ankle (HKA) axis, lateral gap under varus stress (LGVS), medial gap under valgus stress (MGVS), and side-to-side difference (STSD, MGVS - LGVS). The mean FCR was 6.1° ± 2.0°. Of all the potentially predictive factors evaluated in this study, only NaviLDFA (β = -0.668) and XrayLDFA (β = -0.714) predicted significantly FCR. The LDFAs, as determined using radiographs and the navigation system, were both predictive of the rotational alignment of the femoral component based on the posterior condylar axis in gap-based TKA for valgus knee. A 1° increment with NaviLDFA led to a 0.668° decrement in FCR, and a 1° increment with XrayLDFA led to a 0.714° decrement. This suggests that symmetrical lateral condylar hypoplasia of the posterior and distal side occurs in lateral compartment end-stage osteoarthritis with valgus deformity.

  1. Stage-I osteochondritis dissecans versus normal variants of ossification in the knee in children

    International Nuclear Information System (INIS)

    Gebarski, Kathleen; Hernandez, Ramiro J.

    2005-01-01

    Juvenile osteochondritis dissecans (OCD) has a better prognosis than the adult type. We postulated that the excellent prognosis of juvenile OCD could be explained, at least in part, by the erroneous diagnosis of some developmental variants of ossification as stage-I OCD. Knee MRIs of 38 children, ages 7.5-17.7 years (mean and median age 13 years), were retrospectively reviewed to look for features that might separate normal variants of ossification from stage-I OCD. These included age, gender, site, configuration of the lesion, residual cartilaginous model and presence of edema. Twenty-three patients (32 condyles) had ossification defects with intact articular cartilage suggestive of stage-I lesions. No stage-II lesions were seen in the posterior femoral condyles. Accessory ossification centers were seen in 11/16 posterior condyles and 3/16 central condyles. Spiculation of existing ossification was seen in 12/16 posterior condylar lesions and 1/16 central condyles. There was a predominance of accessory ossifications and spiculations in the patients with 10% or greater residual cartilaginous model. No edema signal greater than diaphyseal red-marrow signal was seen in the posterior condyles. Clinical follow-up ranged from 0.5 to 38 months, with clinical improvement in 22 out of 23 patients. Inclusion of normal variants in the stage-I OCD category might explain, in part, the marked difference in published outcome between the juvenile and adult forms of OCD. Ossification defects in the posterior femoral condyles with intact overlying articular cartilage, accessory ossification centers, spiculation, residual cartilaginous model, and lack of bone-marrow edema are features of developmental variants rather than OCD. (orig.)

  2. AN ANATOMICAL PERSPECTIVE OF HUMAN OCCIPITAL CONDYLES AND FORAMEN MAGNUM WITH NEUROSURGICAL CORRELATES

    OpenAIRE

    Gaurav; Divya; Abha

    2014-01-01

    AIMS: Knowledge of condylar anatomy helps the surgeon in making important decisions regarding extent and direction of condylar drilling and minimizing injury and retraction of neural structures. Important preoperative information includes length, width, axis/directions and overriding of occipital condyle in foramen magnum, relationships of condyles to foramen magnum and to hypoglossal canal. The antero-posterior and transverse diameters of foramen magnum and amount of over...

  3. Anterior approach versus posterior approach for Pipkin I and II femoral head fractures: A systemic review and meta-analysis.

    Science.gov (United States)

    Wang, Chen-guang; Li, Yao-min; Zhang, Hua-feng; Li, Hui; Li, Zhi-jun

    2016-03-01

    We performed a meta-analysis, pooling the results from controlled clinical trials to compare the efficiency of anterior and posterior surgical approaches to Pipkin I and II fractures of the femoral head. Potential academic articles were identified from the Cochrane Library, Medline (1966-2015.5), PubMed (1966-2015.5), Embase (1980-2015.5) and ScienceDirect (1966-2015.5) databases. Gray studies were identified from the references of the included literature. Pooling of the data was performed and analyzed by RevMan software, version 5.1. Five case-control trials (CCTs) met the inclusion criteria. There were significant differences in the incidence of heterotopic ossification (HO) between the approaches, but no significant differences were found between the two groups regarding functional outcomes of the hip, general postoperative complications, osteonecrosis of the femoral head or post-traumatic arthritis. The present meta-analysis indicated that the posterior approach decreased the risk of heterotopic ossification compared with the anterior approach for the treatment of Pipkin I and II femoral head fractures. No other complications were related to anterior and posterior approaches. Future high-quality randomized, controlled trials (RCTs) are needed to determine the optimal surgical approach and to predict other postoperative complications. III. Copyright © 2016 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  4. Age Predicts Disruption of the Articular Surface of the Femoral Condyles in Knee OCD: Can We Reduce Usage of Arthroscopy and MRI?

    Science.gov (United States)

    Siegall, Evan; Faust, John R; Herzog, Mackenzie M; Marshall, Kelley W; Willimon, S Clifton; Busch, Michael T

    2018-03-01

    The purpose of this study was to determine if patient age could accurately identify disrupted articular cartilage overlying an osteochondritis dissecans (OCD) lesion of the femoral condyle in adolescents. This could have important implications for imaging and treatment decisions. All patients from 2001 to 2014 who were arthroscopically treated for a femoral condyle OCD were included in this Institutional Review Board-approved study. Exclusion criteria were trochlear and patellar OCD lesions, idiopathic arthritis, and traumatic osteochondral injuries. Arthroscopy was performed to visualize and probe the articular surface. Arthroscopic and magnetic resonance imaging (MRI) findings were recorded as "intact" or "disrupted" cartilage. Extra-articular drilling was performed when the articular cartilage was intact. There were 119 patients (81 male, 68%) with 139 OCD lesions in 136 knees. The mean age at time of surgery was 13.0 years (range, 7.2 to 19.3 y). At arthroscopy, 115 knees had intact cartilage and 24 had disrupted cartilage. There was a significant difference in age between patients with intact versus disrupted cartilage at arthroscopy (12.5 vs. 15.3 y; POCD lesions had MRIs preoperatively, showing 69 as intact and 19 (24%) disrupted. MRI reading for cartilage status had 94% sensitivity and 97% specificity. Multivariable regression analysis revealed that age (P<0.01) and MRI status (P<0.0001) were strong predictors of cartilage status. Sixteen years was the critical age in which both sensitivity was maximized and false positive probability was minimized. Over the age of 17 years, 7 of 7 (100%) had disrupted cartilage. Age alone was 100% sensitive for children below the age of 10, and 96% sensitive below the age of 13. Age was a good predictor of cartilage status in both younger (<13 y) and older (≥17 y) patients in this study. For patients in the mid-range group (13 through 16 y), age alone is not an adequate predictor of cartilage status, but adding MRI

  5. A new measurement for posterior tilt predicts reoperation in undisplaced femoral neck fractures: 113 consecutive patients treated by internal fixation and followed for 1 year

    DEFF Research Database (Denmark)

    Palm, Henrik; Gosvig, Kasper; Krasheninnikoff, Michael

    2009-01-01

    BACKGROUND AND PURPOSE: Preoperative posterior tilt in undisplaced (Garden I-II) femoral neck fractures is thought to influence rates of reoperation. However, an exact method for its measurement has not yet been presented. We designed a new measurement for posterior tilt on preoperative lateral...... radiographs and investigated its association with later reoperation. PATIENTS AND METHODS: A consecutive series of 113 patients, > or = 60 years of age with undisplaced (Garden I-II) femoral neck fractures treated with two parallel implants, was assessed regarding patient characteristics, radiographs...... and able to predict reoperation in patients with undisplaced (Garden I-II) femoral neck fractures....

  6. Is There an Inherent Risk to Damage the Popliteus Tendon by Femoral Component With Inbuilt External Rotation? A Pilot Study in Indian Knees.

    Science.gov (United States)

    Chouhan, Dervendra Kumar; Dhillon, Mandeep S

    2016-02-01

    Femoral components with inbuilt rotation require thicker flexion resection of the lateral femoral condyle and could have a potential risk of damaging the popliteus tendon, especially in the smaller Asian knees. We prospectively evaluated 10 patients with bilateral varus osteoarthritis knee to size the cuts and their location in relation to the popliteus tendon. Two different types of implant were used on either side; one side requires resection in 3° external rotation (group A) and the other side requires a femoral component with inbuilt external rotation (group B). We observed the incidence of injury to the popliteus tendon and distance between flexion cut to its attachment over the lateral femoral condyle between both groups. We had popliteus tendon injury in 3 knees all from group B. Risk of damaging the popliteus tendon was found higher in group B, as the distance between flexion cut to popliteus tendon attachment was significantly low. Femoral component with inbuilt external rotation has more risk of injuring the popliteus tendon because flexion cut takes out more bone from the lateral femoral condyle. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Fractura luxación posterior de cadera asociada a fractura parcelar de la cabeza femoral: a propósito de un caso

    OpenAIRE

    Fernández Gabarda, Rafael; Fernández, E.; Gomar Sancho, Francisco; Jolín Sánchez del Campo, Tomás

    1995-01-01

    La asociación de luxación posterior traumática de cadera con fractura de la cabeza femoral, es relativamente poco frecuente. Presentamos un varón de 33 años de edad que sufrió un accidente vial con resultado de luxación posterior asociada a fractura de la cabeza femoral craneal a la fovea centralis (tipo II de la clasificación de Pipkin). El tratamiento realizado fue una reducción abierta sin osteosíntesis, dentro de las seis primeras horas. A los dos años el paciente camina co...

  8. MR Imaging of a Posterior Root Tear of the Medial Meniscus: Diagnostic Accuracy of Various Tear Configurations and Associated Knee Abnormalities

    International Nuclear Information System (INIS)

    Lee, Hyang Mi; Shim, Jae Chan; Kim, Jin Goo; Lee, Jae Myeong; Nam, Mee Young; Lee, Ghi Jai; Kim, Ho Kyun; Suh, Jung Ho

    2010-01-01

    To evaluate the diagnostic accuracy of the various tear configurations in a medial meniscal posterior horn root tear and assess whether any correlation exists with other associated knee abnormalities in MR imaging. A retrospective review of 146 preoperative knee MR images were performed by one experienced musculoskeletal radiologist. The tear configuration and other abnormalities were evaluated. Sensitivity, specificity, and diagnostic accuracy of each configuration in the medial meniscal posterior horn root tear were calculated. A total of 48 medial meniscal posterior horn root tears including 38 full-thickness radial, 7 partial-thickness radial, and 3 complex tears were confirmed during arthroscopy. Overall, the sensitivity, specificity, and accuracy for the detection of medial meniscal posterior horn root tear were 92% (44/48), 99% (97/98), and 97% (141/146), respectively. For each tear configuration, sensitivity, specificity, and accuracy were 82% (31/38), 97% (105/108), and 93% (136/146) for full-thickness radial tears, respectively, and 43% (3/7), 94% (131/139), and 91% (134/146) for partial-thickness radial tears, respectively. The incidence of degenerative joint disease was 85% (41/48) for the tear group, revealing a strong association. In patients with a root tear and with degenerative joint disease, the incidence of high grade cartilage defects involving the medial femoral condyle was at 80% (33/41), compared to 56% (23/41) for the presence of medial meniscal extrusion. In contrast, a similar comparison of incidence for patients with no root tears but with degenerative joint disease was at 68% (17/25) and 26% (8/31), respectively. MR imaging is very sensitive for the detection of medial meniscal root tears, but has reduced the accuracy with regard to each tear configuration. Medial meniscal root tears showed a strong association with degenerative joint disease. High grade cartilage defects of the medial femoral condyle and medial meniscal extrusions also

  9. MR Imaging of a Posterior Root Tear of the Medial Meniscus: Diagnostic Accuracy of Various Tear Configurations and Associated Knee Abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Hyang Mi; Shim, Jae Chan; Kim, Jin Goo; Lee, Jae Myeong; Nam, Mee Young; Lee, Ghi Jai; Kim, Ho Kyun; Suh, Jung Ho [Inje University College of Medicine, Seoul Paik Hospital, Seoul (Korea, Republic of)

    2010-11-15

    To evaluate the diagnostic accuracy of the various tear configurations in a medial meniscal posterior horn root tear and assess whether any correlation exists with other associated knee abnormalities in MR imaging. A retrospective review of 146 preoperative knee MR images were performed by one experienced musculoskeletal radiologist. The tear configuration and other abnormalities were evaluated. Sensitivity, specificity, and diagnostic accuracy of each configuration in the medial meniscal posterior horn root tear were calculated. A total of 48 medial meniscal posterior horn root tears including 38 full-thickness radial, 7 partial-thickness radial, and 3 complex tears were confirmed during arthroscopy. Overall, the sensitivity, specificity, and accuracy for the detection of medial meniscal posterior horn root tear were 92% (44/48), 99% (97/98), and 97% (141/146), respectively. For each tear configuration, sensitivity, specificity, and accuracy were 82% (31/38), 97% (105/108), and 93% (136/146) for full-thickness radial tears, respectively, and 43% (3/7), 94% (131/139), and 91% (134/146) for partial-thickness radial tears, respectively. The incidence of degenerative joint disease was 85% (41/48) for the tear group, revealing a strong association. In patients with a root tear and with degenerative joint disease, the incidence of high grade cartilage defects involving the medial femoral condyle was at 80% (33/41), compared to 56% (23/41) for the presence of medial meniscal extrusion. In contrast, a similar comparison of incidence for patients with no root tears but with degenerative joint disease was at 68% (17/25) and 26% (8/31), respectively. MR imaging is very sensitive for the detection of medial meniscal root tears, but has reduced the accuracy with regard to each tear configuration. Medial meniscal root tears showed a strong association with degenerative joint disease. High grade cartilage defects of the medial femoral condyle and medial meniscal extrusions also

  10. Hyaluronic acid and chondroitin sulfate content of osteoarthritic human knee cartilage: site-specific correlation with weight-bearing force based on femorotibial angle measurement.

    Science.gov (United States)

    Otsuki, Shuhei; Nakajima, Mikio; Lotz, Martin; Kinoshita, Mitsuo

    2008-09-01

    This study analyzed glycosaminoglycan (GAG) content in specific compartments of the knee joint to determine the impact of malalignment and helped refine indications for osteotomy. To assess malalignment, the radiological femorotibial angle (FTA) was measured and knee joints were also graded for OA severity with the Kellgren/Lawrence (K/L) classification. Cartilage samples were obtained from 36 knees of 32 OA patients undergoing total knee replacement surgery. Explants were harvested from the medial femoral condyle (MFC), lateral femoral condyle (LFC), patellar groove (PG), and lateral posterior femoral condyle (LPC). Concentrations of hyaluronic acid (HA) and chondroitin sulfate (CS) were measured by high-performance liquid chromatography (HPLC). With OA severity, the average FTA significantly increased. HA and CS content in MFC was negatively correlated with radiographic FTA. In LFC, HA ratio, which is HA content in lateral condyle divided by medial condyle and chondroitin 6 sulfate, increased until about 190 degrees FTA. Importantly, at >190 degrees these contents were significantly decreased. HA and CS content of the femoral condyle shows topographic differences that are related to OA grade and weight-bearing force based on FTA. The clinical relevance is that osteotomy may not be indicated for patients with severe varus (>190 degrees) abnormalities. (c) 2008 Orthopaedic Research Society

  11. Clinical accuracy of a patient-specific femoral osteotomy guide in minimally-invasive posterior hip arthroplasty.

    Science.gov (United States)

    Schneider, Adrian K; Pierrepont, Jim W; Hawdon, Gabrielle; McMahon, Stephen

    2018-04-01

    Patient specific guides can be a valuable tool in improving the precision of planned femoral neck osteotomies, especially in minimally invasive hip surgery, where bony landmarks are often inaccessible. The aim of our study was to validate the accuracy of a novel patient specific femoral osteotomy guide for THR through a minimally invasive posterior approach, the direct superior approach (DSA). As part of our routine preoperative planning 30 patients underwent low dose CT scans of their arthritic hip. 3D printed patient specific femoral neck osteotomy guides were then produced. Intraoperatively, having cleared all soft tissue from the postero-lateral neck of the enlocated hip, the guide was placed and pinned onto the posterolateral femoral neck. The osteotomy was performed using an oscillating saw and the uncemented hip components were implanted as per routine. Postoperatively, the achieved level of the osteotomy at the medial calcar was compared with the planned level of resection using a 3D/2D matching analysis (Mimics X-ray module, Materialise, Belgium). A total of 30 patients undergoing uncemented Trinity™ acetabular and TriFit TS™ femoral component arthroplasty (Corin, UK) were included in our analysis. All but one of our analysed osteotomies were found to be within 3 mm from the planned height of osteotomy. In one patient the level of osteotomy deviated 5 mm below the planned level of resection. Preoperative planning and the use of patient specific osteotomy guides provides an accurate method of performing femoral neck osteotomies in minimally invasive hip arthroplasty using the direct superior approach. IV (Case series).

  12. Frequency and topography of lesions of the femoro-tibial cartilage at spiral CT arthrography of the knee: a study in patients with normal knee radiographs and without history of trauma

    International Nuclear Information System (INIS)

    Vande Berg, B.C.; Lecouvet, F.E.; Malghem, J.

    2002-01-01

    To determine the frequency and topography of cartilage lesions involving the femoro-tibial joints in patients with normal knee radiographs and without a remembered history of trauma.Design and patients. A radiologist retrospectively reviewed the dual-detector spiral CT knee arthrograms performed in 209 consecutive patients (mean age 37.6 years) with normal knee radiographs. Images were analyzed for the presence, grade (Noyes classification system) and location of cartilage lesions, the location being designated by dividing each articular surface into a grid of 16 parts.Results. Fifty-three percent of knees had cartilage lesions of grade 2A or higher that involved articular surfaces to a variable extent: lateral tibial plateau (31%), medial femoral condyle (27%), medial tibial plateau (14%) and lateral femoral condyle (5%). Areas of the posterior half of the lateral tibial plateau and of the inner half of the medial femoral condyle were statistically more frequently involved than their counterparts (P<0.0001). The bare area of the medial tibial plateau, but not that of the lateral tibial plateau, was more frequently involved than the corresponding meniscus-covered area (P<0.0001).Conclusion. Cartilage lesions of grade 2A or higher, detected at spiral CT arthrography in 53% of the knees, predominantly involved the posterior half of the lateral tibial plateau, the inner half of the medial femoral condyle and the bare area of the medial tibial plateau. (orig.)

  13. Drilling the femoral tunnel during ACL reconstruction: transtibial versus anteromedial portal techniques.

    Science.gov (United States)

    Tudisco, Cosimo; Bisicchia, Salvatore

    2012-08-01

    Incorrect bone tunnel position, particularly on the femoral side, is a frequent cause of failed anterior cruciate ligament reconstruction. Several studies have reported that drilling the femoral tunnel through the anteromedial portal allows a more anatomical placement on the lateral femoral condyle and higher knee stability than does transtibial reconstruction.In the current study, the femoral tunnel was drilled with transtibial (n=6) and anteromedial (n=6) portal techniques in 12 cadaveric knees. With appropriate landmarks inserted into bone tunnels, the direction and length of the tunnels were determined on anteroposterior and lateral radiographs. Knee stability was evaluated with a KT1000 arthrometer (MEDmetric Corporation, San Diego, California) and pivot shift test, comparing the pre- and postoperative values of both techniques. Finally, all knees were dissected to enhance vision of the insertion of the reconstructed ligament. The anteromedial portal technique led to better placement of the femoral tunnel in the coronal and sagittal planes, with higher knee stability according to the pivot shift test but not the KT1000 arthrometer. Anatomical and clinical results reported in the literature on transtibial and anteromedial portal techniques are controversial, but most of studies report better results with the anteromedial portal technique, especially regarding rotational stability. The current cadaveric study showed that the anteromedial portal technique provided better tunnel placement on the lateral femoral condyle in the coronal and sagittal planes, with an improvement in the rotational stability of the knee. Copyright 2012, SLACK Incorporated.

  14. Size, shape and age-related changes of the mandibular condyle during childhood

    Energy Technology Data Exchange (ETDEWEB)

    Karlo, Christoph A. [University Children' s Hospital Zurich, Department of Diagnostic Imaging, Zurich (Switzerland); University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Stolzmann, Paul [University Hospital Zurich, Institute of Diagnostic and Interventional Radiology, Zurich (Switzerland); Habernig, Sandra; Kellenberger, Christian J. [University Children' s Hospital Zurich, Department of Diagnostic Imaging, Zurich (Switzerland); Mueller, Lukas [University of Zurich, Clinics for Orthodontics and Paediatric Dentistry, Zurich (Switzerland); Saurenmann, Traudel [University Children' s Hospital Zurich, Department of Rheumatology, Zurich (Switzerland)

    2010-10-15

    To determine age-related differences in the size and shape of the mandibular condyle in children to establish anatomical reference values. A total of 420 mandibular condyles in 210 children (mean age, 7 years) were retrospectively analysed by using computed tomography (CT) imaging. The greatest left-right (LRD) and anterior-posterior (APD) diameters and the anteversion angles (AA) were measured by two readers. An APD/LRD ratio was calculated. The shape of the condyles was graded into three types on sagittal images. Correlations of parameters with the children's age were assessed by using Pearson's correlation analyses. The LRD (mean, 14.1 {+-} 2.4 mm), APD (mean, 7.3 {+-} 1.0 mm) and LRD/APD ratio (mean, 1.9 {+-} 0.3) increased (r{sub LRD} = 0.70, p < 0.01; r{sub APD} = 0.56, p < 0.01; r{sub rat} = 0.28, p < 0.01) while the AA (mean, 27 {+-} 7 ) decreased significantly (r{sub antang} = -0.26, p < 0.001) with age. The condylar shape as determined on sagittal images correlated significantly with age (r = 0.69, p < 0.05). Boys had significantly higher anteversion angles (p < 0.01), greater LRDs (p < 0.05) and greater mean ratios (p < 0.05). The mandibular condyle is subject to significant age-related changes in size and shape during childhood. As the size of the condyles increases with age, the anteversion angles decrease and the shape of the condyle turns from round to oval. (orig.)

  15. Computerized tomography in evaluation of decreased acetabular and femoral anteversion

    International Nuclear Information System (INIS)

    Toennis, D.; Skamel, H.J.

    2003-01-01

    Computerized tomography has received a new importance. It has been shown that decreased anteversion of femur and acetabulum, when both have decreased angles, are causing pain and osteoarthritis of the hip joint. Operative treatment should be performed before osteoarthritis develops. Exact measurements therefore are necessary. The investigation should be performed in prone position to have the pelvis lying in a defined and normal position. Femoral torsion is measured between the transverse axis of the knee and the femoral neck. The transverse axis for measurement of the femoral anteversion is defined by a rectangular line to the sagittal plane. For evaluation of the femoral anteversion in total the angle of the condyles has to be added to the femoral neck angle when the knee is found in internal rotation. Acetabular anteversion should be measured at the level where the femoral head is still in full contact and congruence with the anterior margin of the acetabulum. (orig.) [de

  16. Catastrophic complication following injection and extracorporeal shock wave therapy of a medial femoral condyle subchondral cystic lesion in a 14 year old Arabian mare

    Directory of Open Access Journals (Sweden)

    Darla K. Moser

    2017-05-01

    Full Text Available This report describes fibrous cyst lining injection and extracorporeal shock wave therapy (ESWT of a medial femoral condyle (MFC subchondral cystic lesion (SCL resulting in catastrophic MFC fracture in an Arabian mare. The mare was presented for evaluation of a severe hind limb lameness of approximately 4 months duration. On presentation, a non-weight bearing lameness of the left hind limb with severe effusion and soft tissue swelling of the stifle region was noted. Radiographic evaluation of the stifle revealed a large SCL of the MFC with associated osteoarthritis. Arthroscopic guided intra-lesional injection of the SCL with corticosteroids and autologous bone marrow concentrate was performed followed by ESWT of the MFC. The mare was discharged walking comfortably 48-hours post-operatively. An acute increase in lameness was noted 14 days post-operatively. Imaging revealed catastrophic fracture of the left MFC. Possible mechanisms leading to failure of the MFC secondary to the described treatment are discussed.

  17. Sonographic evaluation of femoral articular cartilage in the knee

    International Nuclear Information System (INIS)

    Hong, Sung Hwan; Kong Keun Young; Chung, Hye Won; Choi, Young Ho; Song, Yeong Wook; Kang, Heung Sik

    2000-01-01

    To investigate the usefulness of sonography for the evaluation of osteoarthritic articular cartilage. Ten asymptomatic volunteers and 20 patients with osteoarthritis of the knee underwent sonographic evaluation. For this, the knee was maintained of full flexion in order to expose the deep portion of femoral condylar cartilage. Both transverse and longitudinal scans were obtained in standardized planes. Sonographic images of the articular cartilages were analyzed in terms of surface sharpness, echogenicity and thickness, along with associated bone changes. Normal cartilages showed a clearly-defined surface, homogeneously low echogenicity and regular thickness. Among 20 patients, the findings for medial and lateral condyles, respectively, were as follows: poorly defined cartilage surface, 16 (80%) and ten (50%); increased echogenicity of cartilage, 17 (85%) and 16 (80%); cartilage thinning, 16 (80%) and 14 (70%) (two medial condyles demonstrated obvious cartilage thickening); the presence of thick subchondral hyperechoic bands, five (25%) and four (20%); the presence of osteophytes, 13 (65%) and 12 (60%). Sonography is a convenient and accurate modality for the evaluation of femoral articular cartilage. In particular, it can be useful for detecting early degenerative cartilaginous change and for studying such change during clinical follow-up. (author)

  18. Metrical analysis of disc-condyle relation with different splint treatment positions in patients with TMJ disc displacement

    Directory of Open Access Journals (Sweden)

    Mu-Qing Liu

    Full Text Available Abstract Objective: To evaluate the effect of bite positions characterizing different splint treatments (anterior repositioning and stabilization splints on the disc-condyle relation in patients with TMJ disc displacement with reduction (DDwR, using magnetic resonance imaging (MRI. Material and Methods: 37 patients, with a mean age of 18.8±4.3 years (7 male and 30 females and diagnosed with DDwR based on the RDC/TMD, were recruited. MRI metrical analysis of the spatial changes of the disc/condyle, as well as their relationships, was done in three positions: maximum intercuspation (Position 1, anterior repositioning splint position (Position 2, and stabilization splint position (Position 3. Disc/condyle coordinate measurements and disc condyle angles were determined and compared. Results: In Position 1, the average disc-condyle angle was 53.4° in the 60 joints with DDwR, while it was −13.3° with Position 2 and 30.1° with Position 3. The frequency of successful "disc recapture" with Position 2 was significantly higher (58/60, 96.7% than Position 3 (20/60, 33.3%. In Positions 2 and 3, the condyle moved forward and downward while the disc moved backward. The movements were, however, more remarkable with Position 2. Conclusions: Anterior repositioning of the mandible improves the spatial relationship between the disc and condyle in patients with DDwR. In addition to anterior and inferior movement of the condyle, transitory posterior movement of the disc also occurred.

  19. Differences between the chewing and non-chewing sides of the mandibular first molars and condyles in the closing phase during chewing in normal subjects.

    Science.gov (United States)

    Tomonari, Hiroshi; Kwon, Sangho; Kuninori, Takaharu; Miyawaki, Shouichi

    2017-09-01

    This study aimed to assess differences between the closing paths of the chewing and non-chewing sides of mandibular first molars and condyles during natural mastication, using standardized model food in healthy subjects. Thirty-two healthy young adults (age: 19-25 years; 22 men, 10 women) with normal occlusion and function chewed on standardized gummy jelly. Using an optoelectric jaw-tracking system with six degrees of freedom, we recorded the path of the mandibular first molars and condyles on both sides for 10 strokes during unilateral chewing. Variables were compared between the chewing side and the non-chewing side of first molars and condyles on frontal, sagittal, and horizontal views during the early-, middle- and late-closing phases. On superior/inferior displacements, the chewing side first molar and condyle were positioned superior to those on the non-chewing side during the early- and middle-closing phases. Conversely, the first molar and condyle on the non-chewing side were positioned significantly superior to those on the chewing side during the late-closing phase. On anterior/posterior displacements, the chewing side mandibular first molar and condyle were positioned significantly posterior to those on the non-chewing side throughout all closing phases. Our results showed the differences between the mandibular first molars and condyles on both sides with respect to masticatory path during natural chewing of a model food. These differences can be useful for informing initial diagnostic tests for impaired masticatory function in the clinical environment. Copyright © 2017 Elsevier Ltd. All rights reserved.

  20. Osteochondroma involving mandibular condyle

    Directory of Open Access Journals (Sweden)

    Latika Bachani

    2017-01-01

    Full Text Available Osteochondroma is defined as an osteocartilagenous exostosis with cartilage capped exophytic lesion that arises from the bone cortex. It is a slow growing benign tumor that is rarely seen in the maxillofacial region. Osteochondroma of the mandibular condyle is a relatively rare condition that causes a progressive enlargement of the condyle, usually resulting in facial asymmetry, temporomandibular joint (TMJ dysfunction and malocclusion. Radiographically, there is a unilaterally enlarged condyle usually with an exophytic growth of the tumor from the condylar head. The treatment of osteochondroma is primarily surgical resection of the tumor. This paper reports a case of osteochondroma of the right mandibular condyle presenting as a painless restricted mouth opening.

  1. Internal-external malalignment of the femoral component in kinematically aligned total knee arthroplasty increases tibial force imbalance but does not change laxities of the tibiofemoral joint.

    Science.gov (United States)

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

    2018-06-01

    the resection thickness of each posterior femoral condyle to within ± 0.5 mm of the thickness of the respective posterior region of the femoral component, the increase in imbalance can be effectively limited to 38 N. Generally laxities were unaffected within the ± 4º range tested indicating that instability is not a clinical concern and that manual testing of laxities is not useful to detect I-E malalignment.

  2. Evaluation of Distal Femoral Rotational Alignment with Spiral CT Scan before Total Knee Arthroplasty (A Study in Iranian Population

    Directory of Open Access Journals (Sweden)

    Mahmoud Jabalameli

    2016-04-01

    Full Text Available Background: Evaluating the landmarks for rotation of the distal femur is a challenge for orthopedic surgeons. Although the posterior femoral condyle axis is a good landmark for surgeons, the surgical transepicondylar axis may be a better option with the help of preoperative CT scanning. The purpose of this study was to ascertain relationships among the axes’ guiding distal femur rotational alignment in preoperative CT scans of Iranian patients who were candidates for total knee arthroplasty and the effects of age, gender, and knee alignment on these relationships. Methods: One hundred and eight cases who were admitted to two university hospitals for total knee arthroplasty were included in this study. The rotation of the distal femur was evaluated using single axial CT images through the femoral epicondyle. Four lines were drawn digitally in this view: anatomical and surgical transepicondylar axes, posterior condylar axis and the Whiteside anteroposterior line. The alignment of the extremity was evaluated in the standing alignment view. Then the angles were measured along these lines and their relationship was evaluated. Results: The mean angle between the anatomical transepicondylar axis and posterior condylar axis and between the surgical transepicondylar axis and posterior condylar axis were 5.9 ± 1.6 degrees and 1.6±1.7 degrees respectively. The mean angle between the Whiteside’s anteroposterior line and the line perpendicular to the posterior condylar axis was 3.7±2.1 degrees. Significant differences existed between the two genders in these relationships. No significant correlation between the age of patients and angles of the distal femur was detected. The anatomical surgical transepicondylar axis was in 4.3 degrees external rotation in relation to the surgical transepicondylar axis. Conclusion: Preoperative CT scanning can help accurately determine rotational landmarks of the distal femur. If one of the reference axes cannot be

  3. Osteophytes - an alternative source of chondrocytes for ...

    African Journals Online (AJOL)

    Materials and Methods: The scrapings from the cartilage mantle of osteophytes harvested during routine total knee replacement for osteoarthritis were enzymatically digested and grown in monolayer culture. Articular cartilage scrapings obtained from visually normal area of the femoral condyle (usually from the posterior ...

  4. Hip morphology predicts posterior hip impingement in a cadaveric model.

    Science.gov (United States)

    Morris, William Z; Fowers, Cody A; Weinberg, Douglas S; Millis, Michael B; Tu, Leigh-Anne; Liu, Raymond W

    2018-05-01

    Posterior hip impingement is a recently-identified cause of hip pain. The purpose of this study is to characterise posterior femoroacetabular and ischiofemoral impingement and identify its predisposing morphologic traits. Two hundred and six cadaveric hips were randomly selected and taken through controlled motion in two pure axes associated with posterior hip impingement: external rotation (through the mechanical axis) and adduction (coronal plane). The range of motion and location of impingement was noted for each specimen. Morphologic traits including femoral/acetabular version, and true neck-shaft angle (TNSA) were also measured. External rotation impingement occurred between the femoral neck and acetabulum in 83.0% of hips, and between the lesser trochanter and ischial tuberosity in 17.0%. Adduction impingement occurred between the lesser trochanter and ischial tuberosity in 78.6% of hips, and between the femoral neck and acetabulum in 21.4%. Multiple regression revealed that increased femoral/acetabular version predicted earlier external rotation and adduction impingement. Unstandardised betas ranging from -0.39 to -0.64 reflect that each degree of increased femoral/acetabular version individually accounts for a loss of external rotation or adduction of approximately half a degree before impingement ( p < 0.001 for each). Increased TNSA was associated with earlier adduction impingement only (unstandardised beta -0.35, p = 0.005). Relative femoral/acetabular anteversion was associated with earlier posterior hip impingement. Coxa valga was associated with earlier adduction impingement, but protective against external rotation impingement. These findings highlight the importance of monitoring correction during femoral/acetabular osteotomies, as overcorrection of retroversion may predispose to earlier posterior impingement.

  5. Multiple-slice spiral CT evaluation of occipital condyle fractures

    International Nuclear Information System (INIS)

    Wang Xifu; Zhang Guixiang; Li Kang'an; Zhao Jinglong; Wang Han; Feng Yan; Zheng Linfeng

    2011-01-01

    Objective: To explore the MSCT findings of occipital condyle fracture (OCF) and improve its diagnostic accuracy. Methods: Nineteen patients with OCF, selected from 110 patients suffering high energy injuries at the craniocervical junction, were enrolled into the study. The MSCT appearances of OCFs were retrospectively analyzed by two experienced radiologists. OCF had four types: type Ⅰ was a comminuted fracture, type Ⅱ was a extension of basilar skull fracture, type Ⅲ was an avulsion fracture at the attachment site of alar ligament on occipital condyle, type Ⅳ was a fracture of mixed pattern consisting of two or more above fracture types. Results: In 19 patients, the left, right and bilateral OCFs were seen in 7, 11 cases, and 1 case, respectively. Type Ⅰ was found in one case, which was a comminution of the left occipital condyle. Type Ⅱ was found in 5 cases, which involved the middle and posterior parts of occipital condyles with 2 on the left and 3 on the right, Type Ⅲ was found in 12 cases which showed various degree of fragment displacement with 3 occurring on the left, 8 on the right, 1 involving bilateral sides, 6 involving articular surfaces and 7 accompanying by enlargement of alar ligaments. Type Ⅳ was found in one case, with coexistence of Type Ⅱ and type Ⅲ In addition, OCFs were accompanied by head and (or) cervical spine injuries in 14 cases, which included cranial fracture in 8 cases, epidural hematoma in 4 cases, subarachnoid hemorrhage in one case, cerebral contusion and laceration in one case, subfalcial hernia in one case, cervical spine fracture and dislocation in 9 cases, and so on. Conclusion: OCFs can be accurately diagnosed by MSCT, which is important for selection of treatment protocols. (authors)

  6. Overview of Mandibular Condyle Fracture

    Directory of Open Access Journals (Sweden)

    Su-Seong Park

    2012-07-01

    Full Text Available The mandibular condyle is a region that plays a key role in the opening and closing ofthe mouth, and because fracture causes functional and aesthetic problems such as facialasymmetry, it is very important to perform accurate reduction. Traditionally, there has beendisagreement on how to manage fracture of the mandibular condyle. This review exploresthe misunderstanding of mandibular condyle fracture treatment and modern-day treatmentstrategies.

  7. Overview of Mandibular Condyle Fracture

    OpenAIRE

    Park, Su-Seong; Lee, Keun-Cheol; Kim, Seok-Kwun

    2012-01-01

    The mandibular condyle is a region that plays a key role in the opening and closing of the mouth, and because fracture causes functional and aesthetic problems such as facial asymmetry, it is very important to perform accurate reduction. Traditionally, there has been disagreement on how to manage fracture of the mandibular condyle. This review explores the misunderstanding of mandibular condyle fracture treatment and modern-day treatment strategies.

  8. Overview of Mandibular Condyle Fracture

    Directory of Open Access Journals (Sweden)

    Su-Seong Park

    2012-07-01

    Full Text Available The mandibular condyle is a region that plays a key role in the opening and closing of the mouth, and because fracture causes functional and aesthetic problems such as facial asymmetry, it is very important to perform accurate reduction. Traditionally, there has been disagreement on how to manage fracture of the mandibular condyle. This review explores the misunderstanding of mandibular condyle fracture treatment and modern-day treatment strategies.

  9. Assessment of a polyelectrolyte multilayer film coating loaded with BMP-2 on titanium and PEEK implants in the rabbit femoral condyle

    Science.gov (United States)

    Guillot, R.; Pignot-Paintrand, I.; Lavaud, J.; Decambron, A.; Bourgeois, E.; Josserand, V.; Logeart-Avramoglou, D.; Viguier, E.; Picart, C.

    2016-01-01

    The aim of this study was to evaluate the osseointegration of titanium implants (Ti-6Al-4V, noted here TA6V) and poly(etheretherketone) PEEK implants induced by a BMP-2-delivering surface coating made of polyelectrolyte multilayer films. The in vitro bioactivity of the polyelectrolyte film-coated implants was assessed using the alkaline phosphatase assay. BMP-2-coated TA6V and PEEK implants with a total dose of 9.3 µg of BMP-2 were inserted into the femoral condyles of New Zealand white rabbits and compared to uncoated implants. Rabbits were sacrificed 4 and 8 weeks after implantation. Histomorphometric analyses on TA6V and PEEK implants and microcomputed tomography on PEEK implants revealed that the bone-to-implant contact and bone area around the implants were significantly lower for the BMP-2-coated implants than for the bare implants. This was confirmed by scanning electron microscopy imaging. This difference was more pronounced at 4 weeks in comparison to the 8-week time point. However, bone growth inside the hexagonal upper hollow cavity of the screws was higher in the case of the BMP-2 coated implants. Overall, this study shows that a high dose of BMP-2 leads to localized and temporary bone impairment, and that the dose of BMP-2 delivered at the surface of an implant needs to be carefully optimized. PMID:26965394

  10. Value of magnetic resonance imaging in the mid-term follow-up of osteochondritis dissecans of the femoral condyle and talus

    International Nuclear Information System (INIS)

    Bachmann, G.; Rominger, M.; Rau, W.S.; Juergensen, I.

    1999-01-01

    Purpose: Definition of the prognostic value of clinical and morphological findings in the mid-term follow-up of OCD of the femoral condyle and talus. Demonstration of the consolidation of OCD on MRI depending on different therapies. Materials and Methods: 76 patients were examined before and at an average of 30 months after conservative or surgical therapy using T 1 and T 2 weighted SE and 3D-FISP sequences and contrast enhanced studies. Six clinical (age, gender, site, duration and severity of symptoms, therapy) and six morphological (size, signal intensity, fragmentation, contrast enhancement, condition of cartilage, staging) data were registered on first MRI and correlated with the degree of consolidation of OCD (partial and complete remission, no change and progression) on control MRI. Results: Patients under 17 years showed partial or complete remissions in 73%, those of 17 years or older in 33%. Conservatively treated patients had a higher remission rate (54%) than those treated with different surgical techniques (drilling 50%, refixation 43%, abrasio 38%). Small OCDs had a higher remission rate than large lesions (63% vs. 33%). OCDs covered with intact cartilage healed better than lesions with chondral defects (61% vs. 26%). Contrast enhancing fragments had a better prognosis than non-enhancing lesions (100% vs. 40%). Conclusions: Prognosis of OCD can be better estimated when size of OCD, condition of cartilage and enhancement of contrast agent is graduated with MRI and patient age is registered. The consequences for therapy planning are great. (orig.) [de

  11. Posteromedial knee friction syndrome: an entity with medial knee pain and edema between the femoral condyle, sartorius and gracilis

    Energy Technology Data Exchange (ETDEWEB)

    Simeone, F.J.; Huang, Ambrose J.; Chang, Connie Y.; Smith, Maximilian; Bredella, Miriam A.; Torriani, Martin [Massachusetts General Hospital and Harvard Medical School, Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); Gill, Thomas J. [Boston Sports Medicine and Research Institute, Boston, MA (United States)

    2014-12-20

    To describe MRI features of an entity consisting of medial knee pain and edema between the posteromedial femoral condyle (PMFC), sartorius and/or gracilis tendons and determine whether reduced tendon-bone distances may account for these findings. We retrospectively identified MRI cases of edema between the PMFC, sartorius and/or gracilis tendons (25 subjects, 26 knees). Two musculoskeletal radiologists independently graded edema and measured the sartorius- and gracilis-PMFC distances and knee flexion angle. Age- and gender-matched subjects with normal knee MRIs (27 subjects, 27 knees) served as controls for measurements. Statistical analyses compared abnormal to control subjects. Sartorius-PMFC and gracilis-PMFC spaces were narrower in abnormal compared to control subjects (1.6 ± 1.0 vs. 2.1 ± 1.2 mm, P = 0.04; 2.3 ± 2.0 vs. 4.6 ± 3.0 mm, P = 0.002, respectively). The knee flexion angle was similar between groups (P > 0.05). In subjects with clinical information, medial knee pain was the main complaint in 58 % (15/26) of abnormal subjects, with 42 % (11/26) having clinical suspicion of medial meniscal tear. Edema between the PMFC, sartorius and/or gracilis was mild in 54 % (14/26), moderate in 35 % (9/26) and severe in 12 % (3/26), and it was most frequent deep to both the sartorius and gracilis (50 %, 13/26). Edema between the PMFC, sartorius and/or gracilis tendons identified on knee MRI may be associated with medial knee pain and may represent a friction syndrome. (orig.)

  12. Posteromedial knee friction syndrome: an entity with medial knee pain and edema between the femoral condyle, sartorius and gracilis.

    Science.gov (United States)

    Simeone, F Joseph; Huang, Ambrose J; Chang, Connie Y; Smith, Maximilian; Gill, Thomas J; Bredella, Miriam A; Torriani, Martin

    2015-04-01

    To describe MRI features of an entity consisting of medial knee pain and edema between the posteromedial femoral condyle (PMFC), sartorius and/or gracilis tendons and determine whether reduced tendon-bone distances may account for these findings. We retrospectively identified MRI cases of edema between the PMFC, sartorius and/or gracilis tendons (25 subjects, 26 knees). Two musculoskeletal radiologists independently graded edema and measured the sartorius- and gracilis-PMFC distances and knee flexion angle. Age- and gender-matched subjects with normal knee MRIs (27 subjects, 27 knees) served as controls for measurements. Statistical analyses compared abnormal to control subjects. Sartorius-PMFC and gracilis-PMFC spaces were narrower in abnormal compared to control subjects (1.6 ± 1.0 vs. 2.1 ± 1.2 mm, P = 0.04; 2.3 ± 2.0 vs. 4.6 ± 3.0 mm, P = 0.002, respectively). The knee flexion angle was similar between groups (P > 0.05). In subjects with clinical information, medial knee pain was the main complaint in 58 % (15/26) of abnormal subjects, with 42 % (11/26) having clinical suspicion of medial meniscal tear. Edema between the PMFC, sartorius and/or gracilis was mild in 54 % (14/26), moderate in 35 % (9/26) and severe in 12 % (3/26), and it was most frequent deep to both the sartorius and gracilis (50 %, 13/26). Edema between the PMFC, sartorius and/or gracilis tendons identified on knee MRI may be associated with medial knee pain and may represent a friction syndrome.

  13. Posteromedial knee friction syndrome: an entity with medial knee pain and edema between the femoral condyle, sartorius and gracilis

    International Nuclear Information System (INIS)

    Simeone, F.J.; Huang, Ambrose J.; Chang, Connie Y.; Smith, Maximilian; Bredella, Miriam A.; Torriani, Martin; Gill, Thomas J.

    2015-01-01

    To describe MRI features of an entity consisting of medial knee pain and edema between the posteromedial femoral condyle (PMFC), sartorius and/or gracilis tendons and determine whether reduced tendon-bone distances may account for these findings. We retrospectively identified MRI cases of edema between the PMFC, sartorius and/or gracilis tendons (25 subjects, 26 knees). Two musculoskeletal radiologists independently graded edema and measured the sartorius- and gracilis-PMFC distances and knee flexion angle. Age- and gender-matched subjects with normal knee MRIs (27 subjects, 27 knees) served as controls for measurements. Statistical analyses compared abnormal to control subjects. Sartorius-PMFC and gracilis-PMFC spaces were narrower in abnormal compared to control subjects (1.6 ± 1.0 vs. 2.1 ± 1.2 mm, P = 0.04; 2.3 ± 2.0 vs. 4.6 ± 3.0 mm, P = 0.002, respectively). The knee flexion angle was similar between groups (P > 0.05). In subjects with clinical information, medial knee pain was the main complaint in 58 % (15/26) of abnormal subjects, with 42 % (11/26) having clinical suspicion of medial meniscal tear. Edema between the PMFC, sartorius and/or gracilis was mild in 54 % (14/26), moderate in 35 % (9/26) and severe in 12 % (3/26), and it was most frequent deep to both the sartorius and gracilis (50 %, 13/26). Edema between the PMFC, sartorius and/or gracilis tendons identified on knee MRI may be associated with medial knee pain and may represent a friction syndrome. (orig.)

  14. Solitary Langerhans cell histiocytosis of the occipital condyle: a case report and review of the literature.

    Science.gov (United States)

    Teranishi, Yu; Shin, Masahiro; Yoshino, Masanori; Saito, Nobuhito

    2016-02-01

    Despite the recent advent of various radiographic imaging techniques, it is still very difficult to correctly distinguish a pediatric osteolytic lesion in the occipital condyle, which makes it further complicated to decide on the necessity of and the adequate timing for radical resection and craniocervical fusions. To establish a legitimate therapeutic strategy for this deep-seated lesion, surgical biopsy is a reasonable choice for first-line intervention. The choice of surgical approach becomes very important because a sufficient amount of histological specimen must be obtained to confirm the diagnosis but, ideally, the residual bony structures and the muscular structures should be preserved so as not to increase craniocervical instability. In this report, we present our experience with a case of solitary Langerhans cell histiocytosis (LCH) involving the occipital condyle that was successfully treated with minimally invasive surgical biopsy with a far lateral condylar approach supported by preoperative 3D computer graphic simulation. An 8-year-old girl presented with neck pain. Magnetic resonance imaging and computed tomography (CT) revealed an osteolytic lesion of the left occipital condyle. At surgery, the patient was placed in the prone position. A 3-cm skin incision was made in the posterior auricular region, and the sternocleidomastoid and splenius capitis muscles were dissected in the middle of the muscle bundle along the direction of the muscle fiber. Under a navigation system, we approached the occipital condyle through the space between the longissimus capitis muscle and the posterior belly of the digastric muscle and lateral to the superior oblique muscle, verifying each muscle at each depth of the surgical field and, finally, obtained sufficient surgical specimen. After the biopsy, her craniocervical instability had not worsened, and chemotherapy was performed. Twelve weeks after chemotherapy, her neck pain had gradually disappeared along with her

  15. Bilateral double-headed condyles: A rare case report

    Directory of Open Access Journals (Sweden)

    Swati Phore

    2018-01-01

    Full Text Available Bifid mandibular condyle is characterized by the duplicity of the head of the mandibular condyle, so the name double-headed condyle. It is usually diagnosed on routine radiographic examination and is described as a rare entity. Usually, bifid condyle is an incidental finding and its etiology is controversial, with no predilection for sex or ethnic background. Herein, we report a case of bilateral bifid condyles.

  16. CT findings of traumatic posterior hip dislocation after reduction

    International Nuclear Information System (INIS)

    Moon, Sung Kyoung; Park, Ji Seon; Ryu, Kyung Nam; Jin, Wook; Jin Wook

    2008-01-01

    To evaluate the CT images of reduced hips after posterior hip dislocation and to propose specific diagnostic criteria based on the CT results. We retrospectively reviewed the CT findings on 18 reduced hips from 17 patients with radiographs and clinical histories of traumatic posterior hip dislocations by evaluating 18 corresponding CT scans for joint space asymmetry, intra-articular abnormalities (intra-articular fat obliteration, loose bodies, and joint effusion), changes in posterior soft tissue (capsule, muscles, and adjacent fat), the presence, and location of fractures (acetabulum and femoral head). All 18 hips (100%) showed posterior soft tissue changes. In total, 17 hips (94.4%) had intra-articular abnormalities and 15 hips (83.3%) had joint space asymmetries. In addition, 17 hips (94.4%) had fractures involving the acetabula (15 cases, 88.2%) the femoral head (13 cases, 76.5%), or on both sides (11 cases, 64.7%). The most frequent fracture location was in he posterior wall (13/15, 86.7%) of the acetabulum and in the anterior aspect (10/13, 76.9%) of the femoral head. Patients with a prior history of posterior hip dislocation showed specific CT findings after reduction, suggesting the possibility of previous posterior hip dislocations in patients

  17. Development of a method for measuring femoral torsion using real-time ultrasound

    International Nuclear Information System (INIS)

    Hafiz, Eliza; Hiller, Claire E; Nightingale, E Jean; Eisenhuth, John P; Refshauge, Kathryn M; Nicholson, Leslie L; Clarke, Jillian L; Grimaldi, Alison

    2014-01-01

    Excessive femoral torsion has been associated with various musculoskeletal and neurological problems. To explore this relationship, it is essential to be able to measure femoral torsion in the clinic accurately. Computerized tomography (CT) and magnetic resonance imaging (MRI) are thought to provide the most accurate measurements but CT involves significant radiation exposure and MRI is expensive. The aim of this study was to design a method for measuring femoral torsion in the clinic, and to determine the reliability of this method. Details of design process, including construction of a jig, the protocol developed and the reliability of the method are presented. The protocol developed used ultrasound to image a ridge on the greater trochanter, and a customized jig placed on the femoral condyles as reference points. An inclinometer attached to the customized jig allowed quantification of the degree of femoral torsion. Measurements taken with this protocol had excellent intra- and inter-rater reliability (ICC 2,1  = 0.98 and 0.97, respectively). This method of measuring femoral torsion also permitted measurement of femoral torsion with a high degree of accuracy. This method is applicable to the research setting and, with minor adjustments, will be applicable to the clinical setting. (paper)

  18. Current Concepts in the Mandibular Condyle Fracture Management Part I: Overview of Condylar Fracture

    Directory of Open Access Journals (Sweden)

    Kang-Young Choi

    2012-07-01

    Full Text Available The incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial. Historically, maxillomandibular fixation, external fixation, and surgical splints with internal fixation systems were the techniques commonly used in the treatment of the fractured mandible. Condylar fractures can be extracapsular or intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on the age of the patient, the co-existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the state of dentition and dental occlusion, and the surgeonnds on the age of the patient, the co-existence of othefrom which it is difficult to recover aesthetically and functionally;an appropriate treatment is required to reconstruct the shape and achieve the function ofthe uninjured status. To do this, accurate diagnosis, appropriate reduction and rigid fixation, and complication prevention are required. In particular, as mandibular condyle fracture may cause long-term complications such as malocclusion, particularly open bite, reduced posterior facial height, and facial asymmetry in addition to chronic pain and mobility limitation, great caution should be taken. Accordingly, the authors review a general overview of condyle fracture.

  19. Current Concepts in the Mandibular Condyle Fracture Management Part I: Overview of Condylar Fracture

    Science.gov (United States)

    Yang, Jung-Dug; Chung, Ho-Yun; Cho, Byung-Chae

    2012-01-01

    The incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial. Historically, maxillomandibular fixation, external fixation, and surgical splints with internal fixation systems were the techniques commonly used in the treatment of the fractured mandible. Condylar fractures can be extracapsular or intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on the age of the patient, the co-existence of other mandibular or maxillary fractures, whether the condylar fracture is unilateral or bilateral, the level and displacement of the fracture, the state of dentition and dental occlusion, and the surgeonnds on the age of the patient, the co-existence of othefrom which it is difficult to recover aesthetically and functionally;an appropriate treatment is required to reconstruct the shape and achieve the function ofthe uninjured status. To do this, accurate diagnosis, appropriate reduction and rigid fixation, and complication prevention are required. In particular, as mandibular condyle fracture may cause long-term complications such as malocclusion, particularly open bite, reduced posterior facial height, and facial asymmetry in addition to chronic pain and mobility limitation, great caution should be taken. Accordingly, the authors review a general overview of condyle fracture. PMID:22872830

  20. One-stage lengthening using a locked nailing technique for distal femoral shaft nonunions associated with shortening.

    Science.gov (United States)

    Wu, Chi-Chuan; Lee, Zhon-Liau

    2004-02-01

    To assess the effectiveness of a one-stage lengthening using a locked nail technique for the treatment of distal femoral shaft nonunions associated with shortening. Retrospective. University hospital. During a 6-year period, 36 distal femoral shaft nonunions associated with shortening (>1.5 cm) were treated by the one-stage lengthening technique. Indications for this technique were distal femoral shaft aseptic or quiescent infected nonunions, 1.5-5 cm shortening, and a fracture level suitable for the insertion of two distal locked screws. The surgical technique involved skeletal traction using the femoral condyle, local débridement, lengthening by lengthening was 2.5 cm (range 1.5-3.5 cm). One-stage lengthening using the locked nailing technique to treat distal femoral shaft nonunions associated with shortening can achieve a high success rate and low complication rate. The key to successful treatment is the patient's complete cooperation with strictly protected weight bearing until the fracture has healed.

  1. 21 CFR 872.3960 - Mandibular condyle prosthesis.

    Science.gov (United States)

    2010-04-01

    ... (CONTINUED) MEDICAL DEVICES DENTAL DEVICES Prosthetic Devices § 872.3960 Mandibular condyle prosthesis. (a) Identification. A mandibular condyle prosthesis is a device that is intended to be implanted in the human jaw to... requirement for premarket approval for any mandibular condyle prosthesis intended to be implanted in the human...

  2. The role of the lateral pterygoid muscle in the sagittal fracture of mandibular condyle (SFMC) healing process.

    Science.gov (United States)

    Liu, Chng-Kui; Liu, Ping; Meng, Fan-Wen; Deng, Bang-Lian; Xue, Yang; Mao, Tian-Qiu; Hu, Kai-Jin

    2012-06-01

    The aim of this study was to examine the role of the lateral peterygoid muscle in the reconstruction of the shape of the condyle during healing of a sagittal fracture of the mandibular condyle. Twenty adult sheep were divided into 2 groups: all had a unilateral operation on the right side when the anterior and posterior attachments of the discs were cut, and an oblique vertical osteotomy was made from the lateral pole of the condyle to the medial side of the condylar neck. Ten sheep had the lateral pterygoid muscle cut, and the other 10 sheep did not. Sheep were killed at 4 weeks (n=2 from each group), 12 weeks (n=4), and 24 weeks (n=4) postoperatively. Computed tomograms (CT) were taken before and after operations. We dissected the joints, and recorded with the naked eye the shape, degree of erosion, and amount of calcification of the temporomandibular joint (TMJ). In the group in which the lateral peterygoid muscle had not been cut the joints showed overgrowth of new bone and more advanced ankylosis. Our results show that the lateral pterygoid muscle plays an important part in reconstructing the shape of the condyle during the healing of a sagittal fracture of the mandibular condyle, and combined with the dislocated and damaged disc is an important factor in the aetiology of traumatic ankylosis of the TMJ. Copyright © 2011. Published by Elsevier Ltd.

  3. The importance of bony impingement in restricting flexion after total knee arthroplasty: computer simulation model with clinical correlation.

    Science.gov (United States)

    Mizu-Uchi, Hideki; Colwell, Clifford W; Fukagawa, Shingo; Matsuda, Shuichi; Iwamoto, Yukihide; D'Lima, Darryl D

    2012-10-01

    We constructed patient-specific models from computed tomography data after total knee arthroplasty to predict knee flexion based on implant-bone impingement. The maximum flexion before impingement between the femur and the tibial insert was computed using a musculoskeletal modeling program (KneeSIM; LifeModeler, Inc, San Clemente, California) during a weight-bearing deep knee bend. Postoperative flexion was measured in a clinical cohort of 21 knees (low-flex group: 6 knees with 125° of flexion at 2 years). Average predicted flexion angles were within 2° of clinical measurements for the high-flex group. In the low-flex group, 4 cases had impingement involving the bone cut at the posterior condyle, and the average predicted knee flexion was 102° compared with 93° measured clinically. These results indicate that the level of the distal femoral resection should be carefully planned and that exposed bone proximal to the tips of the posterior condyles of the femoral component should be removed if there is risk of impingement. Copyright © 2012 Elsevier Inc. All rights reserved.

  4. Effectiveness of the magnetic resonance imaging for the therapy of avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Oda, Yoshinao; Katsuki, Ichirou; Ushijima, Masahiro; Tsutsui, Hideki; Sugioka, Youichi

    1990-01-01

    Recently, some reports demonstrate the usefulness of the magnetic resonance imaging (MRI) for early diagnosis of the avascular necrosis of the femoral head (ANF). In this report we analyzed 64 hips in 40 cases using preoperative plain radiographs, tomography and MRI affected by ANF. And we gained following three conclusions. When rotational osteotomy of the femoral head is to be carried out, two plain views of MRI, parallel and contrary to the axis of the femoral neck, were useful for evaluation of postoperative weight bearing area. In 58 hips with strinct the former two plain views of MRI, atrophy of posterior area of the femoral head was recognized in 54 hips by tomography, and of them abnormal signal in posterior was revealed in 32 hips by MRI. In 28 hips performed anterior rotational osteotomy, atrophy of posterior area of the femoral head was recognized in 26 hips by tomography, and of them abnormal signal in posterior was revealed in 6 hips by MRI. In such cases careful follow-up should be required. (author)

  5. Effectiveness of the magnetic resonance imaging for the therapy of avascular necrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Oda, Yoshinao; Katsuki, Ichirou; Ushijima, Masahiro; Tsutsui, Hideki; Sugioka, Youichi [Kyushu Univ., Fukuoka (Japan). Faculty of Medicine

    1990-03-01

    Recently, some reports demonstrate the usefulness of the magnetic resonance imaging (MRI) for early diagnosis of the avascular necrosis of the femoral head (ANF). In this report we analyzed 64 hips in 40 cases using preoperative plain radiographs, tomography and MRI affected by ANF. And we gained following three conclusions. When rotational osteotomy of the femoral head is to be carried out, two plain views of MRI, parallel and contrary to the axis of the femoral neck, were useful for evaluation of postoperative weight bearing area. In 58 hips with strinct the former two plain views of MRI, atrophy of posterior area of the femoral head was recognized in 54 hips by tomography, and of them abnormal signal in posterior was revealed in 32 hips by MRI. In 28 hips performed anterior rotational osteotomy, atrophy of posterior area of the femoral head was recognized in 26 hips by tomography, and of them abnormal signal in posterior was revealed in 6 hips by MRI. In such cases careful follow-up should be required. (author).

  6. Enlarging bilateral femoral condylar bone cysts without scintigraphic uptake in a yearling foal

    International Nuclear Information System (INIS)

    Squire, K.R.E.; Fessler, J.F.; Cantwell, H.D.; Widmer, W.R.

    1992-01-01

    Bilateral subchondral bone cysts of the femoral condyles were diagnosed by conventional radiography in a 14 month old Appaloosa colt. Surgical debridement was performed, and over the next 18 months the appearance of the cysts was evaluated with radiography and bone scintigraphy. On the preoperative scintigrams, increased radiopharmaceutical uptake was associated with the cysts. Despite continued radiographic enlargement, the cysts did not demonstrate increased radiopharmaceutical uptake post-operatively

  7. Osteochondroma of the mandibular condyle

    Directory of Open Access Journals (Sweden)

    Ashish Kumar

    2011-01-01

    Full Text Available Osteochondroma (OC of the mandibular condyle is a relatively rare condition that causes a progressive enlargement of the condyle, usually resulting in facial asymmetry, temporomandibular joint (TMJ dysfunction, and malocclusion. Radiographically, there is a unilaterally enlarged condyle usually with an exophytic outgrowth of the tumor from the condylar head. We present a case of a left mandibular condylar OC that created a major facial asymmetry, malocclusion, and TMJ dysfunction. Discussion includes the rationale for treatment and the method used in this case. In actively growing OCs, surgical intervention is indicated to remove the tumor stopping the benign growth process and improve facial symmetry, occlusion, and jaw function.

  8. Laser Doppler flowmetry for bone blood flow measurement: correlation with microsphere estimates and evaluation of the effect of intracapsular pressure on femoral head blood flow

    International Nuclear Information System (INIS)

    Swiontkowski, M.F.; Tepic, S.; Perren, S.M.; Moor, R.; Ganz, R.; Rahn, B.A.

    1986-01-01

    Laser Doppler flowmetry (LDF) was used to measure bone blood flow in the rabbit femoral condyles. To correlate the LDF output signal blood cell flux to in vivo blood flow, simultaneous measurements using LDF and 85 Sr-labeled microspheres were made in an adult rabbit model. There was no correlation between the two methods for blood flow in the femoral condyles and the correlation between the two methods for blood flow in the femoral head does not achieve statistical significance. An LDF signal of 0.4 V was approximately equal to a microsphere measured flow rate of 0.4 ml blood/g bone/min. The strength of the correlation in the latter case may have been affected by (a) large arteriovenous shunts, (b) inadequate mixing of the microspheres with a left ventricular injection, and (c) insufficient numbers of microspheres present in the bone samples. When LDF was used to evaluate the effect of elevated intracapsular pressure on femoral head blood flow in skeletally mature rabbits, femoral head subchondral bone blood flow declined with increasing intracapsular pressure from a baseline value of 0.343 +/- 0.036 to a value of 0.127 +/- 0.27 at 120 cm of water pressure. The decline in femoral head blood flow was statistically significant at pressures of 40 cm of water or higher (p less than 0.001), and evaluation of sections of the proximal femora made from preterminal disulphine blue injections confirmed these findings. Intracapsular tamponade has an adverse effect on femoral head blood flow beginning well below central venous pressure and should be considered in the pathophysiology of posttraumatic and nontraumatic necrosis of the femoral head. Laser Doppler flowmetry was easy to use and appears to be a reproducible technique for evaluating femoral head blood flow, offering distinct advantages over the microsphere technique for measuring bone blood flow

  9. Effects of Autogenous Bone Marrow Aspirate Concentrate on Radiographic Integration of Femoral Condylar Osteochondral Allografts.

    Science.gov (United States)

    Oladeji, Lasun O; Stannard, James P; Cook, Cristi R; Kfuri, Mauricio; Crist, Brett D; Smith, Matthew J; Cook, James L

    2017-10-01

    Transplantation of fresh osteochondral allografts (OCAs) is an attractive treatment option for symptomatic articular cartilage lesions in young, healthy patients. Because the lack of OCA bone integration can be a cause of treatment failure, methods for speeding and enhancing OCA bone integration to mitigate this potential complication are highly desirable. To determine if autogenous bone marrow aspirate concentrate (BMC) treatment of large femoral condylar OCAs would be associated with superior radiographic OCA bone integration compared with nontreated allografts during the critical first 6 months after surgery. Cohort study; Level of evidence, 3. A review of patients enrolled in a prospective registry who were treated with transplantation of large OCAs to one or both femoral condyles at our institution from March 12, 2013 to March 14, 2016 was performed. Patients were stratified into 2 groups based on BMC treatment versus no BMC treatment; the treatment was nonrandomized and was rooted in a shift in practice and a continuing effort to optimize OCA transplantation at our institution. Patients were excluded if they did not have orthogonal view radiographs performed at 6 weeks, 3 months, and 6 months postoperatively. Each condyle undergoing OCA transplantation was assessed individually by an independent musculoskeletal radiologist, who was blinded to the treatment group and time point. OCAs were assessed with respect to graft integration (0%-100%; 0 = no integration, 100 = complete integration) and degree of sclerosis (0-3; 0 = normal, 1 = mild sclerosis, 2 = moderate sclerosis, and 3 = severe sclerosis) of the graft at each time point. This study identified 17 condyles in 15 patients who underwent OCA transplantation without BMC and 29 condyles in 22 patients who underwent OCA transplantation with BMC. The BMC group had significantly ( P = .033) higher graft integration scores at 6 weeks, 3 months, and 6 months after surgery. Graft sclerosis was significantly ( P

  10. Mandibular condyle position in cone beam computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Hwang, Hyoung Joo; Kim, Gyu Tae; Choi, Yong Suk; Hwang, Eui Hwan [Kyung Hee Univ. School of Dentistry, Seoul (Korea, Republic of)

    2006-06-15

    To evaluate position of the mandibular condyle within articular fossa in an asymptomatic population radiographically by a cone beam computed tomography. Cone beam computed tomography of 60 temporomandibular joints was performed on 15 males and 15 females with no history of any temporomandibular disorders, or any other orthodontic or photoconductors treatments. Position of mandibular condyle within articular fossa at centric occlusion was evaluated. A statistical evaluation was done using a SPSS. In the sagittal views, mandibular condyle within articular fossa was laterally located at central section. Mandibular condyles in the right and left sides were showed asymmetric positional relationship at medial, central, and lateral sections. Mandibular condyle within articular fossa in an asymptomatic population was observed non-concentric position in the sagittal and coronal views.

  11. Observation of femoral and tibial insertion of the posterior cruciate ligament by using conventional CT and transparent 3D-CT

    International Nuclear Information System (INIS)

    Inoue, Masayuki; Tsukuda, Koichiro; Yasojima, Nobutoshi; Oota, Masahiro; Kasahara, Yasuhiko

    2011-01-01

    Presented are image data acquisitioned by the volume rendering (VR)-3D-CT and authors' transparent (T)-3D-CT to depict the bone contour, of medial intercondylar ridge (MIR) and posterior intercodylar fossa (PIF) at femoral and tibial insertion, respectively, of the posterior cruciate ligament (PCL) as those data are helpful for planning the reconstruction surgery of PCL and for confirming the femoral PCL insertion by using the C-arm during operation. Helical scanning is conducted with GE MD-CT (64DAS) to reconstruct VR-3D-CT image with the workstation ZIO's ZIO900M Quadra and T-3D-CT image, by reducing the opacity by pixel exclusion of the intraosseous lumen. MIR is observed in all 70 normal knees tested in VR-3D-CT and the bifurcate ridge, in 15 knees among them. In T-3D-CT image, distance data of the origin of MIR from Blumensaat's line and the angle of MIR and bone axis are calculated and presented. In VR-3D-CT and T-3D-CT images of PIF from 20 knees, actual measures of PIF slope angle (degree), PIF area ratio to joint surface (JS) (%), distance from JS to centers of anterolateral (AL) and posterolateral (PM) slopes (mm), and from medial and lateral JS to PIF posterior border (mm), and distance ratios of PM and AL to medial and lateral tibia, respectively, (%) are calculated and presented. Findings are: MIR originates at 45% distal point of Blumensaat's line; the articular line crosses with PIF at its center in T-3D-CT sagittal plane; centers of tibial AL and PM exist at the middle of frontal plane, and at 1.00 and 5.5 mm, respectively, distal points of JS of sagittal plane. The PIF data are rather comparable to those obtained in cadavers reported in 3 literatures and the present procedure is concluded to be valid. (author)

  12. All-Epiphyseal Anterior Cruciate Ligament Femoral Tunnel Drilling: Avoiding Injury to the Physis, Lateral Collateral Ligament, Anterolateral Ligament, and Popliteus-A 3-Dimensional Computed Tomography Study.

    Science.gov (United States)

    Shea, Kevin G; Cannamela, Peter C; Fabricant, Peter D; Terhune, Elizabeth B; Polousky, John D; Milewski, Matthew D; Anderson, Allen F; Ganley, Theodore J

    2018-01-25

    To investigate the relation of the at-risk structures (distal femoral physis, lateral collateral ligament, anterolateral ligament, popliteus, and articular cartilage) during all-epiphyseal femoral tunnel drilling. A second purpose was 2-fold: (1) to develop recommendations for tunnel placement and orientation that anatomically reconstruct the anterior cruciate ligament (ACL) while minimizing the risk of injury to these at-risk structures, and (2) to allow for maximal tunnel length to increase the amount of graft in the socket to facilitate healing. Three-dimensional models of 6 skeletally immature knees (aged 7-11 years) were reconstructed from computed tomography and used to simulate all-epiphyseal femoral tunnels. Tunnels began within the ACL footprint and were directed laterally or anterolaterally, with the goal of avoiding injury to at-risk structures. The spatial relation between the ideal tunnel and these structures was evaluated. Full-length tunnels and partial length condyle sockets were simulated in the models using the same trajectories. An anterolateral tunnel could be placed to avoid direct injury to lateral structures. The safe zone on the anterolateral aspect of the femur was larger than that of a tunnel with a direct lateral trajectory (median 127 mm 2 vs 83 mm 2 , P = .028). Anterolateral tunnels were longer than direct lateral tunnels (median 30 mm vs 24 mm, P = .041). Safe angles for anterolateral tunnels were 34° to 40° from the posterior condylar axis; direct lateral tunnels were drilled 4° to 9° from the posterior condylar axis. Sockets could be placed without direct injury to structures at risk with either orientation. An all-epiphyseal ACL femoral tunnel can be placed without causing direct injury to at-risk structures. A tunnel angled anterolaterally from the ACL origin is longer and has a larger safe zone compared with the direct lateral tunnel. The largest safe zone for femoral all-epiphyseal ACL drilling was (1) anterior to

  13. Evaluation and comparison of cartilage repair tissue of the patella and medial femoral condyle by using morphological MRI and biochemical zonal T2 mapping

    International Nuclear Information System (INIS)

    Welsch, Goetz H.; Mamisch, Tallal C.; Quirbach, Sebastian; Trattnig, Siegfried; Zak, Lukas; Marlovits, Stefan

    2009-01-01

    The objective of this study was to use advanced MR techniques to evaluate and compare cartilage repair tissue after matrix-associated autologous chondrocyte transplantation (MACT) in the patella and medial femoral condyle (MFC). Thirty-four patients treated with MACT underwent 3-T MRI of the knee. Patients were treated on either patella (n = 17) or MFC (n = 17) cartilage and were matched by age and postoperative interval. For morphological evaluation, the MR observation of cartilage repair tissue (MOCART) score was used, with a 3D-True-FISP sequence. For biochemical assessment, T2 mapping was prepared by using a multiecho spin-echo approach with particular attention to the cartilage zonal structure. Statistical evaluation was done by analyses of variance. The MOCART score showed no significant differences between the patella and MFC (p ≥ 0.05). With regard to biochemical T2 relaxation, higher T2 values were found throughout the MFC (p < 0.05). The zonal increase in T2 values from deep to superficial was significant for control cartilage (p < 0.001) and cartilage repair tissue (p < 0.05), with an earlier onset in the repair tissue of the patella. The assessment of cartilage repair tissue of the patella and MFC afforded comparable morphological results, whereas biochemical T2 values showed differences, possibly due to dissimilar biomechanical loading conditions. (orig.)

  14. A new condyle implant design concept for an alloplastic temporomandibular joint in bone resorption cases.

    Science.gov (United States)

    Ramos, António; Mesnard, Michel

    2016-10-01

    The purpose of this article is to present and evaluate an innovative intramedullary implant concept developed for total alloplastic reconstruction in bone resorption cases. The main goal of this innovative concept is to avoid the main problems experienced with temporomandibular (TMJ) devices on the market, associated with bone fixation and changes in kinematics. A three-dimensional finite element model was developed based on computed tomography (CT) scan images, before and after implantation of the innovative implant concept. To validate the numerical model, a clean cadaveric condyle was instrumented with four rosettes and loaded before and after implantation with the innovative concept TMJ implant. The experimental results validate the numerical models comparing the intact and implanted condyles, as they present good correlation. They show that the most critical region is around rosette #1, with an increase in strains in the proximal region of the condyle of 140%. The maximum principal strain and stress generated with the implant is less than 2200 με and 75 MPa in the posterior region of the cortical bone. Shortly after insertion of this press-fit implant, stress and strain results appear to be within the normal limits and show some similarities with the intact condyle. If these responses do not change over time, the screw fixation used at present could be avoided or replaced. This solution reduces bone resection and lessens surgical damage to the muscles. Copyright © 2016 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  15. Dual mobility cup reduces dislocation rate after arthroplasty for femoral neck fracture

    Directory of Open Access Journals (Sweden)

    Robertsson Otto

    2010-08-01

    Full Text Available Abstract Background Hip dislocation after arthroplasty for femoral neck fractures remains a serious complication. The aim of our study was to investigate the dislocation rate in acute femoral neck fracture patients operated with a posterior approach with cemented conventional or dual articulation acetabular components. Methods We compared the dislocation rate in 56 consecutive patients operated with conventional (single mobility cemented acetabular components to that in 42 consecutive patients operated with dual articulation acetabular components. All the patients were operated via posterior approach and were followed up to one year postoperatively. Results There were 8 dislocations in the 56 patients having conventional components as compared to no dislocations in those 42 having dual articulation components (p = 0.01. The groups were similar with respect to age and gender distribution. Conclusions We conclude that the use of a cemented dual articulation acetabular component significantly reduces the dislocation rates in femoral neck fracture patients operated via posterior approach.

  16. Endoscope-Assisted Transoral Fixation of Mandibular Condyle Fractures: Submandibular Versus Transoral Endoscopic Approach.

    Science.gov (United States)

    Hwang, Na-Hyun; Lee, Yoon-Hwan; You, Hi-Jin; Yoon, Eul-Sik; Kim, Deok-Woo

    2016-07-01

    In recent years, endoscope-assisted transoral approach for condylar fracture treatment has attracted much attention. However, the surgical approach is technically challenging: the procedure requires specialized instruments and the surgeons experience a steep learning curve. During the transoral endoscopic (TE) approach several instruments are positioned through a narrow oral incision making endoscope maneuvering very difficult. For this reason, the authors changed the entry port of the endoscope from transoral to submandibular area through a small stab incision. The aim of this study is to assess the advantage of using the submandibular endoscopic intraoral approach (SEI).The SEI approach requires intraoral incision for fracture reduction and fixation, and 4 mm size submandibular stab incision for endoscope and traction wires. Fifteen patients with condyle neck and subcondyle fractures were operated under the submandibular approach and 15 patients with the same diagnosis were operated under the standard TE approach.The SEI approach allowed clear visualization of the posterior margin of the ramus and condyle, and the visual axis was parallel to the condyle ramus unit. The TE approach clearly shows the anterior margin of the condyle and the sigmoid notch. The surgical time of the SEI group was 128 minutes and the TE group was 120 minutes (P >0.05). All patients in the TE endoscope group were fixated with the trocar system, but only 2 lower neck fracture patients in the SEI group required a trocar. The other 13 subcondyle fractures were fixated with an angulated screw driver (P <0.05). There were no differences in complication and surgical outcomes.The submandibular endoscopic approach has an advantage of having more space with good visualization, and facilitated the use of an angulated screw driver.

  17. Mandibular condyle dimensions in Peruvian patients with Class II and Class III skeletal patterns.

    Directory of Open Access Journals (Sweden)

    Hugo Zegarra-Baquerizo

    2017-10-01

    Full Text Available Objective: To compare condylar dimensions of young adults with Class II and Class III skeletal patterns using cone-beam computed tomography (CBCT. Materials and methods: 124 CBCTs from 18-30 year-old patients, divided into 2 groups according to skeletal patterns (Class II and Class III were evaluated. Skeletal patterns were classified by measuring the ANB angle of each patient. The anteroposterior diameter (A and P of the right and left mandibular condyle was assessed from a sagittal view by a line drawn from point A (anterior to P (posterior. The coronal plane allowed the evaluation of the medio-lateral diameter by drawing a line from point M (medium to L (lateral; all distances were measured in mm. Results: In Class II the A-P diameter was 9.06±1.33 and 8.86±1.56 for the right and left condyles respectively, in Class III these values were 8.71±1.2 and 8.84±1.42. In Class II the M-L diameter was 17.94±2.68 and 17.67±2.44 for the right and left condyles respectively, in Class III these values were 19.16±2.75 and 19.16±2.54. Conclusion: Class III M-L dimensions showed higher values than Class II, whereas these differences were minimal in A-P.

  18. Selective angiography of the avascular necrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Joong Chan; Park, Cheong Hee; Rho, Tae Jin; Yune, Seung Ho; Rhee, Byung Chull [Chung Nam National University College of Medicine, Deajeon (Korea, Republic of)

    1988-10-15

    The diagnosis of the avascular of the femoral head (AVN) has advanced. RI scan, intraosseous pressure monitoring, intramedullary venography, CT, MRI, and selective femoral angiography are used in diagnosis. Among these methods, selective or superselective angiography is necessary to study the change of the vessels of the hip, because the vascular insufficiency could be a major etiology of AVN. Selective femoral angiography was performed for 23 hips of 22 patients who were suspected as AVN by simple rediographs and RI scans in order to estimate the change of vascularity of the femoral head. The results were as follow. 1. The alteration of vasculature appeared in 21 cases among all 23 cases (91%), which included 100% in the traumatic group (4/4 cases) and 90% in nontraumatic group (17/19 cases). 2. The affected vessles in nontraumatic group were the proximal portion of the posterior branch of the medical circumflex artery in 2 cases, the modportion of posterior branch in 2 cases, the distal portion of the posterior branch in 11 cases, and superior capsular branch in 2 cases. 3. The affected vessels in traumatic group were proximal portion in 1 cases, midportion in 1 case, and superior capsular artrey in 2 cases. 4. The obstruction of inferior casular artery was noted in 6 cases of nontraumatic group. 5. The retrograde filling of the posterior branch of medial circumflex artery were noted in 1 case from superior gluteal artery, in 1 case from inferior gluteal artery, in 1 case form superior and inferior gluteal artery and retrograde filling of inferior gluteal artery from medial circumflex artery was in 6 cases.

  19. Selective angiography of the avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Choi, Joong Chan; Park, Cheong Hee; Rho, Tae Jin; Yune, Seung Ho; Rhee, Byung Chull

    1988-01-01

    The diagnosis of the avascular of the femoral head (AVN) has advanced. RI scan, intraosseous pressure monitoring, intramedullary venography, CT, MRI, and selective femoral angiography are used in diagnosis. Among these methods, selective or superselective angiography is necessary to study the change of the vessels of the hip, because the vascular insufficiency could be a major etiology of AVN. Selective femoral angiography was performed for 23 hips of 22 patients who were suspected as AVN by simple rediographs and RI scans in order to estimate the change of vascularity of the femoral head. The results were as follow. 1. The alteration of vasculature appeared in 21 cases among all 23 cases (91%), which included 100% in the traumatic group (4/4 cases) and 90% in nontraumatic group (17/19 cases). 2. The affected vessles in nontraumatic group were the proximal portion of the posterior branch of the medical circumflex artery in 2 cases, the modportion of posterior branch in 2 cases, the distal portion of the posterior branch in 11 cases, and superior capsular branch in 2 cases. 3. The affected vessels in traumatic group were proximal portion in 1 cases, midportion in 1 case, and superior capsular artrey in 2 cases. 4. The obstruction of inferior casular artery was noted in 6 cases of nontraumatic group. 5. The retrograde filling of the posterior branch of medial circumflex artery were noted in 1 case from superior gluteal artery, in 1 case from inferior gluteal artery, in 1 case form superior and inferior gluteal artery and retrograde filling of inferior gluteal artery from medial circumflex artery was in 6 cases.

  20. Short-term effect of zoledronic acid upon fracture resistance of the mandibular condyle and femoral head in an animal model.

    Science.gov (United States)

    Camacho-Alonso, Fabio; López-Jornet, Pía; Vicente-Hernández, Ascensión

    2013-05-01

    The aim of this study was to compare the effects in terms of resistance to fracture of the mandibular condyle and femoral head following different doses of zoledronic acid in an animal model. A total of 80 adult male Sprague-Dawley rats were included in a prospective randomized study. The animals were randomly divided into four groups of 20 rats each. Group 1 (control) received sterile saline solution, while groups 2, 3 and 4 received a accumulated dose of 0.2 mg, 0.4 mg and 0.6 mg of zoledronic acid, respectively. The animals were sacrificed 28 days after the last dose, and the right hemimandible and the right femur were removed. The fracture strength was measured (in Newtons) with a universal test machine using a 1 kN load connected to a metal rod with one end angled at 30 degrees. The cross-head speed was 1 mm/min. Later, the specimens were observed under a scanning electron microscope with backscattered electron imaging (SEM-BSE). At last, chemical analysis and elemental mapping of the mineral bone composition were generated using a microanalytical system based on energy-dispersive and X-ray spectrometry (EDX). A total of 160 fracture tests were performed. The fracture resistance increased in mandible and femur with a higher accumulated dose of zoledronic acid. Statistically significant differences were recorded versus the controls with all the studies groups. The chemical analysis in mandible showed a significantly increased of calcium and phosphorous to compare the control with all of the study groups; however, in femur no statistically significant differences between the four study groups were observed. The administration of bisphosphonates increases the fracture resistance in mandible and femur.

  1. Mandibular Condyle Fractures and Treatment Modalities

    Directory of Open Access Journals (Sweden)

    Halil ibrahim Kisa

    2014-08-01

    Full Text Available Maxillofacial injuries are most commonly associated with falls, motor and vehicle accidents, sports-related trauma, and interpersonel violence. The complexity of mandibular condyle region and its anatomic proximity to other craniofacial structures complicate diagnosis and treatment. Thus, treatment approaches of mandibular condyle fracture are still controversial. In the literature, different success rates are reported about observation versus treatment, closed reduction versus open reduction and fixation methods. In the present article, controversial issues related to mandibular condyle fractures were reviewed under the light of current literature. In conclusion, the simplest way that can be done with the least risk of complication should be chosen during treatment planning. In addition, current adjunctive treatment methods accelerating healing of fracture should be considered. [Archives Medical Review Journal 2014; 23(4.000: 658-671

  2. Inhibition of micturition reflex by activation of somatic afferents in posterior femoral cutaneous nerve.

    Science.gov (United States)

    Tai, Changfeng; Shen, Bing; Mally, Abhijith D; Zhang, Fan; Zhao, Shouguo; Wang, Jicheng; Roppolo, James R; de Groat, William C

    2012-10-01

    This study determined if activation of somatic afferents in posterior femoral cutaneous nerve (PFCN) could modulate the micturition reflex recorded under isovolumetric conditions in α-chloralose anaesthetized cats. PFCN stimulation inhibited reflex bladder activity and significantly (P acid (AA). The optimal frequency for PFCN stimulation-induced bladder inhibition was between 3 and 10 Hz, and a minimal stimulation intensity of half of the threshold for inducing anal twitching was required. Bilateral pudendal nerve transection eliminated PFCN stimulation-induced anal twitching but did not change the stimulation-induced bladder inhibition, excluding the involvement of pudendal afferent or efferent axons in PFCN afferent inhibition.Mechanical or electrical stimulation on the skin surface in the PFCN dermatome also inhibited bladder activity. Prolonged (2 × 30 min) PFCN stimulation induced a post-stimulation inhibition that persists for at least 2 h. This study revealed a new cutaneous-bladder reflex activated by PFCN afferents. Although the mechanisms and physiological functions of this cutaneous-bladder reflex need to be further studied, our data raise the possibility that stimulation of PFCN afferents might be useful clinically for the treatment of overactive bladder symptoms.

  3. Femoral sizing in total knee arthroplasty is rotation dependant.

    Science.gov (United States)

    Koninckx, Angelique; Deltour, Arnaud; Thienpont, Emmanuel

    2014-12-01

    The mismatch between the medio-lateral (ML) and the antero-posterior (AP) size of femoral components in total knee arthroplasty (TKA) has been linked to gender, ethnicity, morphotype and height differences in patients. The hypothesis of this study was that the AP size measurement of a femoral component increases with more external rotation in posterior referencing TKA. During a 2-year period, 201 patients were included in this prospective study. The AP distance of the distal femur was measured with an AP sizer of the Vanguard (Biomet, Warsaw, US) knee system. This AP sizer allows to dial in external rotation by 1° increments and to determine the femoral size with an anterior boom. AP size was noted at 0°, 3° and 5° of external rotation and then compared for ML matching. Antero-posterior and corresponding ML sizes match perfectly for the Vanguard at 0° of external rotation and a central boom position on the anterior femoral surface. Then, the anterior boom was positioned on the antero-lateral cortex and the AP size increased a mean (SD) 1 (0.5) mm. With 3° of external rotation, the AP size increased a mean (SD) 2.3 (0.4) mm and for 5° a mean (SD) 3.8 (0.3) mm (P external rotation that is dialled in during surgery. Since these parameters vary case per case, the availability of narrow components offers more surgical options to the surgeon and its importance extends beyond the gender aspect allowing different amounts of external rotation to be used without ML overhang. II.

  4. A clinico-radiologic study of bony remodeling of the fractured condyles in children

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Jeong Shin; Park, Chang Seo [Department of Dentistry, The Graduate School, Yonsei University, Seoul (Korea, Republic of)

    1995-08-15

    Bony remodeling pattern of condyle fractures in children are different from in adult for growing of condyle, also might affect treatment and prognosis of the condyle fracture. Subjects of this clinical and radiologic study were 26 temporomandibular joints diagnosed as condyle fracture in 23 patients under 15 years old age, They were treated with conservative method at Dental Hospital of Yonsei University from Jan., 1986 to Oct., 1994. Bony remodeling related with fracture pattern was evaluated. The results obtained are as follows: 1. The ratio of male to female in patients with condyle fracture was 1 : 0.9 and the difference of sex ratio was not noted. Comparing with preschool-age group and school-age group, age frequency was higher in preschool-age group (83%). 2. Fallen down (54%) was the most frequent cause of condyle fractures. Traffic accident and slip down were followed. 3. The most common clinical sign of condyle fractures was tenderness to palpation (19 cases). Mouth opening limitation (17 cases), swelling (7 cases), malocclusion (3 cases) were next in order. 4. According to sites of condyle fractures, unilateral fractures were in 20 patients and bilateral fractures in 3 patients, therefore total 23 patients-26 cases of condyle fracture were observed. According to fracture distribution, condyle fractures were in 10 patients (44%). Condyle fractures with symphysis fracture (9 patients, 39%), condyle fractures with ascending ramus fracture (2 patients, 9%), condyle fracture with mandibular body fracture (1 patient, 4%), and condyle fractures with mandibular angle fracture (1 patient, 4%) were followed. 5. In displacement pattern of fractured fragment of mandibular condyle, displacement (17 cases, 66%) was most common. Dislocation (5 cases, 19%) and deviation (4 cases, 15%) were next in order. 6. During the observation period of fractured condyles, remodeling patterns of fracture sites related with articular fossa were observed with usual congealer shape in 23

  5. A clinico-radiologic study of bony remodeling of the fractured condyles in children

    International Nuclear Information System (INIS)

    Cho, Jeong Shin; Park, Chang Seo

    1995-01-01

    Bony remodeling pattern of condyle fractures in children are different from in adult for growing of condyle, also might affect treatment and prognosis of the condyle fracture. Subjects of this clinical and radiologic study were 26 temporomandibular joints diagnosed as condyle fracture in 23 patients under 15 years old age, They were treated with conservative method at Dental Hospital of Yonsei University from Jan., 1986 to Oct., 1994. Bony remodeling related with fracture pattern was evaluated. The results obtained are as follows: 1. The ratio of male to female in patients with condyle fracture was 1 : 0.9 and the difference of sex ratio was not noted. Comparing with preschool-age group and school-age group, age frequency was higher in preschool-age group (83%). 2. Fallen down (54%) was the most frequent cause of condyle fractures. Traffic accident and slip down were followed. 3. The most common clinical sign of condyle fractures was tenderness to palpation (19 cases). Mouth opening limitation (17 cases), swelling (7 cases), malocclusion (3 cases) were next in order. 4. According to sites of condyle fractures, unilateral fractures were in 20 patients and bilateral fractures in 3 patients, therefore total 23 patients-26 cases of condyle fracture were observed. According to fracture distribution, condyle fractures were in 10 patients (44%). Condyle fractures with symphysis fracture (9 patients, 39%), condyle fractures with ascending ramus fracture (2 patients, 9%), condyle fracture with mandibular body fracture (1 patient, 4%), and condyle fractures with mandibular angle fracture (1 patient, 4%) were followed. 5. In displacement pattern of fractured fragment of mandibular condyle, displacement (17 cases, 66%) was most common. Dislocation (5 cases, 19%) and deviation (4 cases, 15%) were next in order. 6. During the observation period of fractured condyles, remodeling patterns of fracture sites related with articular fossa were observed with usual congealer shape in 23

  6. Osteochondroma of the mandibular condyle: surgical excision followed by occlusal stabilization.

    Science.gov (United States)

    Yoo, Ji-Yeon; Choi, Byung-Joon; Kwon, Yong-Dae; Lee, Deok-Won; Ohe, Joo-Young; Suh, Joon-Ho

    2012-03-01

    Osteochondroma of the mandibular condyle in adults can be treated by surgical excision, condylectomy followed by costochondral graft or orthognathic surgery. Such complex treatment plan may not be appropriate for patients with old age, affected with chronic osteochondroma of the condyle. In this clinical report, we present a patient with osteochondroma of the condyle treated by surgical excision. The patient's postoperative occlusion was a contraindication for orthognathic surgery because of the severe abrasion of the teeth and the chronic compensation of the dentition to the deviated mandible. Surgical excision of the lesion was carried out under general anesthesia, and the remaining condylar head was salvaged as much as possible. No graft materials or posthodontic condyle reconstruction was carried out. Because there was no occlusal stop to secure the mandible in a centric relation position of the condyle, a stabilization splint was delivered to position the condyle in a relatively stable position. The stability of the condyle position was evaluated by follow-up cone beam computed tomographic scans of the pathologic and the contralateral condyle, along with clinical factors such as occlusal contact points and mandible movements assayed by ARCUSdigma (KaVo). After significant condylar position was achieved, full prosthodontic reconstruction was performed to both the patient's and the dentist's satisfaction.

  7. Eosinophilic granuloma of the mandibular condyle

    International Nuclear Information System (INIS)

    Huh, Kyung Hoe; Yi, Won Jin; Oh, Sung Won; Lee, Sam Sun; Choi, Mun Kyung

    2008-01-01

    The present study reports a case of eosinophilic granuloma of the mandibular condyle. Eosinophilic granulomas on the mandibular condyle are very rare, but there are several common clinical and radiographic presentations. The clinical presentations involve swelling on preauricular area, limitation of opening, TMJ pain, etc. The radiographic presentations involve radiolucent lytic condylar lesion with or without pathologic fracture. Sometimes new bone formations are observed. The purpose of the article is to add new cases to the literatures.

  8. Eosinophilic granuloma of the mandibular condyle

    Energy Technology Data Exchange (ETDEWEB)

    Huh, Kyung Hoe; Yi, Won Jin; Oh, Sung Won; Lee, Sam Sun [Department of Oral and Maxillofacial Radiology, and Dental Research Institute, School of Dentistry, Seoul National University, Seoul (Korea, Republic of); Choi, Mun Kyung [Department of Oral and Maxillofacial Surgery, College of Medicine, Inje University Sanggye Paik Hospital, Seoul (Korea, Republic of)

    2008-03-15

    The present study reports a case of eosinophilic granuloma of the mandibular condyle. Eosinophilic granulomas on the mandibular condyle are very rare, but there are several common clinical and radiographic presentations. The clinical presentations involve swelling on preauricular area, limitation of opening, TMJ pain, etc. The radiographic presentations involve radiolucent lytic condylar lesion with or without pathologic fracture. Sometimes new bone formations are observed. The purpose of the article is to add new cases to the literatures.

  9. {sup 99m}Tc-HDP Pinhole Bone Scan Features of Undetached Osteochondritis Dissecans of the Femoral Condyle: Report of a Case with Radiography, CT, and MRI Correlation

    Energy Technology Data Exchange (ETDEWEB)

    Bahk, Yong Whee [Sung Ae Hospital, Seoul (Korea, Republic of); Choi, Woo Hee [Seoul St. Mary' s Hospital, Catholic University Medical School, Seoul (Korea, Republic of)

    2009-02-15

    OCD may be initiated by arrest of bone growth and subchondral osteosclerosis followed by either cartilage hypertrophy with calcification or enfolding with osteochondral bridging. Diagnosis can be made in most instances using magnetic resonance imaging (MRI) or computed tomography (CT) or invasive arthroscopy. As to usefulness of conventional radiography (CR) opinions diverge as some held it to be of limited value while others valuable. The controversy seems to be due to semantic confusion of OCD from osteonecrosis (ON) which are different entities. This report will describe a case of undetached OCD occurred in the medial femoral condyle in a middle-aged female. It was free of symptom and incidentally discovered on {sup 99m}Tc-HDP pinhole scan performed for patellar injury. Pinhole scan findings of OCD are correlated to those of CR, CT, and MRI. An electronic search of literature failed to reveal earlier publication of bone scan features of undetached OCD. Pathologically, OCD differs from ON in that the fragment in the former condition comes off from a normal vascular bony bed while that in the latter separates from an avascular bony bed. Indeed, bone fragment in ON is devascularized but that in OCD maintains vascularity until weighted images, respectively and the halo showed low signal intensity on both T1 and T2 images.

  10. Contribuição ao estudo anatômico do retalho vascularizado corticoperiosteal do côndilo medial do fêmur Contribution to the anatomical study of the corticoperiosteal flap of the medial femoral condyle

    Directory of Open Access Journals (Sweden)

    Rômulo Guimarães Andrade

    2009-10-01

    Full Text Available OBJETIVO: Realizar o estudo anatômico, em cadáveres, do retalho corticoperiosteal do côndilo femoral medial baseado na artéria genicular medial, avaliando a dificuldade de dissecção e padrões topográficos. MÉTODOS: Foram estudados 15 membros de oito cadáveres, com idade variando de 19 a 74 anos. Dispostos em posição supina, foi realizada incisão longitudinal na face medial do terço distal da coxa, exposição dos vasos geniculares descendentes entre os músculos vasto medial e sartório. Foram analisados a distância entre a origem da artéria genicular descendente e a interlinha medial do joelho, o diâmetro do vaso, o comprimento do pedículo, a presença do ramo fasciocutâneo e sua localização. RESULTADOS: A distância entre a origem da artéria genicular descendente e a interlinha medial do joelho variou de 11,2cm a 14,5cm, com média de 12,63cm. O diâmetro médio da artéria foi de 2,5mm (de 2,25mm a 2,75mm. A distância entre a origem da artéria genicular descendente e o ramo fasciocutâneo variou entre 1,0 e 1,5cm. O comprimento médio do pedículo vascular, foi de 7,01cm, variando de 5,6 a 8,6cm. CONCLUSÃO: O retalho corticoperiosteal do côndilo femoral medial do joelho é de fácil dissecção, possui pedículo vascular constante, com comprimento médio de 7,0cm e diâmetro de 2,5mm, o que possibilita sua indicação em transplantes microcirúrgicos.OBJECTIVE: to perform the anatomical study, in cadavers, of the corticoperiosteal flap of the medial femoral condyle, based on the medial genicular artery, evaluating challenges in dissection and the topographic patterns. MATERIALS AND METHODS: fifteen limbs from eight cadavers were studied, ages ranging from 19 to 74 years old. They were placed at supine position, and a longitudinal incision on the medial face of the lower part of the thigh was performed, exposing medial vastus and sartorius muscles, with descendent genicular vessels being also exposed. The distance

  11. Current Concepts in the Mandibular Condyle Fracture Management Part I: Overview of Condylar Fracture

    Directory of Open Access Journals (Sweden)

    Kang-Young Choi

    2012-07-01

    Full Text Available The incidence of condylar fractures is high,but the management of fractures of the mandibularcondyle continues to be controversial. Historically, maxillomandibular fixation, externalfixation, and surgical splints with internal fixation systems were the techniques commonlyused in the treatment of the fractured mandible. Condylar fractures can be extracapsularor intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on theage of the patient, the co-existence of other mandibular or maxillary fractures, whether thecondylar fracture is unilateral or bilateral, the level and displacement of the fracture, thestate of dentition and dental occlusion, and the surgeonnds on the age of the patient, theco-existence of othefrom which it is difficult to recover aesthetically and functionally;anappropriate treatment is required to reconstruct the shape and achieve the function oftheuninjured status. To do this, accurate diagnosis, appropriate reduction and rigid fixation, andcomplication prevention are required. In particular, as mandibular condyle fracture may causelong-term complications such as malocclusion, particularly open bite, reduced posterior facialheight, and facial asymmetry in addition to chronic pain and mobility limitation, great cautionshould be taken. Accordingly, the authors review a general overview of condyle fracture.

  12. Coronal views of the paediatric mandibular condyle on ...

    African Journals Online (AJOL)

    This article highlights the importance of routinely reviewing the mandibular condyle on computerised tomography brain studies in a trauma setting, that often extends to involve the mandibular condyles in the scan parameters. We discuss 4 cases seen over the last 18 months at our institution, and review the relevant ...

  13. In Vivo Quantitative Ultrasound Image Analysis of Femoral Subchondral Bone in Knee Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Jana Podlipská

    2013-01-01

    Full Text Available A potential of quantitative noninvasive knee ultrasonography (US for detecting changes in femoral subchondral bone related to knee osteoarthritis (OA was investigated. Thirty-nine patients referred to a knee arthroscopy underwent dynamic noninvasive US examination of the knee joint. The subchondral bone was semiautomatically segmented from representative US images of femoral medial and lateral condyles and intercondylar notch area. Subsequently, the normalized mean gray-level intensity profile, starting from the cartilage-bone interface and extending to the subchondral bone depth of ~1.7 mm, was calculated. The obtained profile was divided into 5 depth levels and the mean of each level, as well as the slope of the profile within the first two levels, was calculated. The US quantitative data were compared with the arthroscopic Noyes’ grading and radiographic Kellgren-Lawrence (K-L grading. Qualitatively, an increase in relative subchondral bone US gray-level values was observed as OA progressed. Statistically significant correlations were observed between normalized US mean intensity or intensity slope especially in subchondral bone depth level 2 and K-L grading (r=0.600, P<0.001; r=0.486, P=0.006, resp. or femoral arthroscopic scoring (r=0.332, P=0.039; r=0.335, P=0.037, resp.. This novel quantitative noninvasive US analysis technique is promising for detection of femoral subchondral bone changes in knee OA.

  14. Avascular necrosis of the femoral head after osteosynthesis of femoral neck fracture.

    Science.gov (United States)

    Min, Byung-Woo; Kim, Sung-Jin

    2011-05-18

    The reported incidence of avascular necrosis after femoral neck fracture fixation varies widely, and there is no consensus regarding its risk factors. We evaluated the incidence of avascular necrosis of the femoral head with the use of contemporary techniques for femoral neck fracture fixation. We then sought to determine what potential risk factors influenced the development of avascular necrosis.Between 1990 and 2005, one hundred sixty-three intracapsular femoral neck fractures in 163 patients were treated with internal fixation at our level-I trauma center. All patients were monitored until conversion to total hip arthroplasty or for a minimum of 2 years postoperatively. Ten patients (10 hips) died and 7 patients (7 hips) were lost to follow-up. The remaining 146 patients (146 hips) had a mean 5.2 years of follow-up (range, 3 months to 17 years). The incidence of avascular necrosis was 25.3% (37 hips). The average time to diagnosis of avascular necrosis was 18.8 months (range, 3-47 months). Patient sex, age, interval from injury to surgery, and mechanism of injury were statistically not associated with the development of avascular necrosis. The quality of fracture reduction, adequacy of fixation, degree of displacement, and comminution of the posterior cortex were significantly associated. After we controlled for patient and radiographic characteristics, multivariate analyses indicated that the important predictors for avascular necrosis are poor reduction (odds ratio=13.889) and initial displacement of the fracture (odds ratio=4.693). Copyright 2011, SLACK Incorporated.

  15. Biomechanical and morphometric evaluation of occipital condyle for occipitocervical segmental fixation

    International Nuclear Information System (INIS)

    Hong, Jae-Taek; Takigaya, Tomoyuki; Sugisaki, Keizo; Orias, A.A.E.; Inoue, Nozomu; An, H.S.

    2011-01-01

    Two recent novel techniques of occipital fixation are the occipitoatlantal (C0-C1) transarticular screw technique and the direct occipital condyle screw technique. The present study evaluated and compared the biomechanical stability of the direct occipital condyle screw and C0-C1 transarticular screw with the established method for craniocervical spine fixation using the midline occipital keel screw and C1 lateral mass screw. Morphometric evaluation of the occipital condyle and the hypoglossal canal was performed to avoid hypoglossal nerve injury during the screw placement. Thirteen recently frozen cadaveric specimens were used. The occipital condyle anatomy and the hypoglossal canal dimension were measured using reconstructed computed tomography images. Insertion torque and pullout strength were evaluated to compare the midline occipital keel screw, C0-C1 transarticular screw, C1 lateral mass screw, and direct occipital condyle screw. The dimensions of the occipital condyle allow use of a 3.5 or 4.0-mm diameter screw. Mean pullout strength was 1619.6 N for the midline occipital keel screw, 870.7 N for the C0-C1 transarticular screw, 707.0 N for the C1 lateral mass screw, and 431.7 N for the direct occipital condyle screw. Mean insertion torque was 0.55 Nm for the midline occipital keel screw, 0.32 Nm for the C0-C1 transarticular screw, 0.14 Nm for the C1 lateral mass screw, and 0.11 Nm for the direct occipital condyle screw. The condylar anatomy allows direct insertion of the occipital condyle screw and C0-C1 transarticular screw. These techniques are suitable options for the treatment of craniovertebral junction instabilities in selected patients. (author)

  16. Custom total knee replacement in a dog with femoral condylar bone loss.

    Science.gov (United States)

    Liska, William D; Marcellin-Little, Denis J; Eskelinen, Esa V; Sidebotham, Christopher G; Harrysson, Ola L A; Hielm-Björkman, Anna K

    2007-06-01

    To report surgical planning, technique, and outcome of custom total knee replacement (TKR) performed to manage a medial femoral condylar nonunion in a dog. Clinical case report. A 3-year-old, 20 kg Karelian Bear Hound. Computed tomographic scan of the left pelvic limb was used to build a stereolithography model of the distal portion of the femur. The model was used to create a custom augment to replace the missing medial femoral condyle and a custom stem for intramedullary condylar cemented fixation. The augment and stem were adapted to femoral and tibial components already available. The model was used to rehearse the surgery and then the custom prosthesis was implanted. Weight bearing returned 8 hours after surgery and improved thereafter. Joint alignment was normal and prosthetic joint motion was 60-165 degrees postoperatively. The dog resumed moose hunting 3 months after surgery. Peak vertical force and impulse of the operated limb measured 17 months after surgery were 65% and 47% of the normal, contralateral limb. Based on short-term follow-up, cemented canine TKR was successfully achieved for management of a severely abnormal stifle joint. With further refinement and development of commercially available prostheses, TKR should be possible for canine patients.

  17. Rolamento posterior do fêmur na artroplastia total do joelho: comparação entre as próteses com preservação e com sacrifício do ligamento cruzado posterior Femoral roll back in total knee arthroplasty: comparison between prostheses that preserve and sacrifice the posterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Lúcio Honório de Carvalho Júnior

    2011-01-01

    Full Text Available OBJETIVO: Comparar a posteriorização do ponto de contato entre o componente femoral e o polietileno tibial à medida em que o joelho é fletido em dois tipos de artroplastia total do joelho, uma com sacrifício e outra com preservação do ligamento cruzado posterior (LCP. MÉTODOS: Foram analisados, sob fluoroscopia, 36 joelhos de 32 pacientes submetidos a artroplastia total do joelho. Analisando as imagens em perfil, foi medido o ponto de contato do fêmur com o polietileno tibial com o joelho em extensão completa e em 90 graus de flexão, mensurando-se o percentual de "rolamento" posterior do fêmur nas artroplastias em que o ligamento cruzado posterior (LCP foi sacrificado e naquelas nas quais esse foi preservado. RESULTADOS: O percentual médio de posteriorização do fêmur foi de 13,24% nos casos em que o LCP foi sacrificado e de 5,75% nos casos em que esse foi preservado. A diferença entre essas medidas foi estatisticamente significativa, com p = 0,026615. CONCLUSÃO: Na artroplastia total do joelho, sacrificar o LCP aumenta a translação posterior do ponto de contato entre o fêmur e a tíbia à medida em que o joelho é flexionado até 90 graus.OBJECTIVE: To compare the rollback of the contact point between the femoral component and the tibial polyethylene as the knee is flexed, in two types of total knee arthroplasty: one that sacrifices and the other that preserves the posterior cruciate ligament (PCL. METHODS: Under fluoroscopy, 36 knees from 32 patients who underwent total knee arthroplasty were evaluated. Using lateral images, the contact points between the femur and the tibial polyethylene with the knee in complete extension and at 90° of flexion were measured, thereby measuring the percentage rollback of the femur in arthroplasties in which the PCL was sacrificed and in those in which it was preserved. RESULTS: The mean percentage rollback of the femur was 13.24% in the cases in which the PCL was sacrificed and 5.75% in

  18. Bilateral cartilage T2 mapping 9 years after Mega-OATS implantation at the knee: a quantitative 3T MRI study.

    Science.gov (United States)

    Jungmann, P M; Brucker, P U; Baum, T; Link, T M; Foerschner, F; Minzlaff, P; Banke, I J; Saier, T; Imhoff, A B; Rummeny, E J; Bauer, J S

    2015-12-01

    To evaluate morphological and quantitative MR findings 9 years after autograft transfer of the posterior femoral condyle (Mega-OATS) and to correlate these findings with clinical outcomes. Quantitative MR measurements were also obtained of the contralateral knee and the utility as reference standard was investigated. Both knees of 20 patients with Mega-OATS osteochondral repair at the medial femoral condyle (MFC) were studied using 3T MRI 9 years after the procedure. MR-sequences included morphological sequences and a 2D multislice multiecho (MSME) spin echo (SE) sequence for quantitative cartilage T2 mapping. Cartilage segmentation was performed at the cartilage repair site and six additional knee compartments. Semi-quantitative MR observation of cartilage repair tissue (MOCART) scores and clinical Lysholm scores were obtained. Paired t-tests and Spearman correlations were used for statistical analysis. Global T2-values were significantly higher at ipsilateral knees compared to contralateral knees (42.1 ± 3.0 ms vs 40.4 ± 2.6 ms, P = 0.018). T2-values of the Mega-OATS site correlated significantly with MOCART scores (R = -0.64, P = 0.006). The correlations between MOCART and Lysholm scores and between absolute T2-values and Lysholm scores were not significant (P > 0.05). However, higher T2 side-to-side differences at the femoral condyles correlated significantly with more severe clinical symptoms (medial, R = -0.53, P = 0.030; lateral, R = -0.51, P = 0.038). Despite long-term survival, 9 years after Mega-OATS procedures, T2-values of the grafts were increased compared to contralateral knees. Clinical scores correlated best with T2 side-to-side differences of the femoral condyles, indicating that intraindividual adjustment may be beneficial for outcome evaluation. Copyright © 2015 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

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

    2018-01-29

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

  20. A new method of CT scanning for the diagnosis of mandibular fractures; A preliminary report: diagnosis of condyle fractures

    Energy Technology Data Exchange (ETDEWEB)

    Tsukagoshi, Taku; Satoh, Kaneshige; Onizuka, Takuya (Showa Univ., Tokyo (Japan). School of Medicine)

    1990-08-01

    The condylar neck of the mandible is one of the most common fracture sites in the facial skeleton. Such a fracture is routinely diagnosed by A-P, lateral oblique, and Towne projection roentgenography or orthopantomography. Despite the combination of these films, fracture of the neck of the mandible is still difficult to diagnose definitely. Therefore, a new CT scanning method was developed for diagnosing fractures of the neck of the condylar mandible. The CT axis is projected along the length of the mandible, extending from the condyle to the symphysis. This projection visualizes both the condyle and the mandibular symphysis in the same plane. The patient is placed in a supine position with the head fully extended. The base line, a line extending from the midpoint of the glenoid fossa to the menton, is determined with a lateral facial cephalogram. CT scanning with a 5 mm window is performed in parallel with and 2 cm anterior to and 2 cm posterior to the base line. When CT scanning was performed in a healthy volunteer, the condition of the condyle and the condylar neck of the mandible was clearly shown, and the view extended from the condyle to the symphysis. For automobile accident patients in whom fracture of the neck of the mandible was associated with fracture of the symphysis, two fractures were found in the same plane. A newly developed CT scanning technique is useful in the diagnosis of fractures of the condylar neck of the mandible and in the identification of fractures at other mandibular sites. It also allows scanning of patients in a supine position, which may aid in managing patients with multiple traumas. (N.K.).

  1. CT-based morphometric analysis of the occipital condyle: focus on occipital condyle screw insertion.

    Science.gov (United States)

    Zhou, Jinsong; Espinoza Orías, Alejandro A; Kang, Xia; He, Jade; Zhang, Zhihai; Inoue, Nozomu; An, Howard S

    2016-11-01

    OBJECTIVE The segmental occipital condyle screw (OCS) is an alternative fixation technique in occipitocervical fusion. A thorough morphological study of the occipital condyle (OC) is critical for OCS placement. The authors set out to introduce a more precise CT-based method for morphometric analysis of the OC as it pertains to the placement of the segmental OCS, and they describe a novel preoperative simulation method for screw placement. Two new clinically relevant parameters, the height available for the OCS and the warning depth, are proposed. METHODS CT data sets from 27 fresh-frozen human cadaveric occipitocervical spines were used. All measurements were performed using a commercially available 3D reconstruction software package. The length, width, and sagittal angle of the condyle were measured in the axial plane at the base of the OC. The height of the OC and the height available for the segmental OCS were measured in the reconstructed oblique sagittal plane, fitting the ideal trajectory of the OCS recommended in the literature. The placement of a 3.5-mm-diameter screw that had the longest length of bicortical purchase was simulated into the OC in the oblique sagittal plane, with the screw path not being blocked by the occiput and not violating the hypoglossal canal cranially or the atlantooccipital joint caudally. The length of the simulated screw was recorded. The warning depth was measured as the shortest distance from the entry point of the screw to the posterior border of the hypoglossal canal. RESULTS The mean length and width of the OC were found to be larger in males: 22.2 ± 1.7 mm and 12.1 ± 1.0 mm, respectively, overall (p < 0.0001 for both). The mean sagittal angle was 28.0° ± 4.9°. The height available for the OCS was significantly less than the height of the OC (6.2 ± 1.3 mm vs 9.4 ± 1.5 mm, p < 0.0001). The mean screw length (19.3 ± 1.9 mm) also presented significant sex-related differences: male greater than female (p = 0.0002). The

  2. Subchondral bone density distribution in the human femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Wright, David A.; Meguid, Michael; Lubovsky, Omri; Whyne, Cari M. [Sunnybrook Research Institute, Orthopaedic Biomechanics Laboratory, Toronto, Ontario (Canada)

    2012-06-15

    This study aims to quantitatively characterize the distribution of subchondral bone density across the human femoral head using a computed tomography derived measurement of bone density and a common reference coordinate system. Femoral head surfaces were created bilaterally for 30 patients (14 males, 16 females, mean age 67.2 years) through semi-automatic segmentation of reconstructed CT data and used to map bone density, by shrinking them into the subchondral bone and averaging the greyscale values (linearly related to bone density) within 5 mm of the articular surface. Density maps were then oriented with the center of the head at the origin, the femoral mechanical axis (FMA) aligned with the vertical, and the posterior condylar axis (PCA) aligned with the horizontal. Twelve regions were created by dividing the density maps into three concentric rings at increments of 30 from the horizontal, then splitting into four quadrants along the anterior-posterior and medial-lateral axes. Mean values for each region were compared using repeated measures ANOVA and a Bonferroni post hoc test, and side-to-side correlations were analyzed using a Pearson's correlation. The regions representing the medial side of the femoral head's superior portion were found to have significantly higher densities compared to other regions (p < 0.05). Significant side-to-side correlations were found for all regions (r {sup 2} = 0.81 to r {sup 2} = 0.16), with strong correlations for the highest density regions. Side-to-side differences in measured bone density were seen for two regions in the anterio-lateral portion of the femoral head (p < 0.05). The high correlation found between the left and right sides indicates that this tool may be useful for understanding 'normal' density patterns in hips affected by unilateral pathologies such as avascular necrosis, fracture, developmental dysplasia of the hip, Perthes disease, and slipped capital femoral head epiphysis. (orig.)

  3. Bone changes of mandibular condyle using cone beam computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Ji Un; Kim, Hyung Seop; Song, Ju Seop; Kim, Kyoung A; Koh, Kwang Joon [Chonbuk National Univ., Chonju (Korea, Republic of)

    2007-09-15

    To assess bone changes of mandibular condyle using cone beam computed tomography (CBCT) in temporomandibualr disorder (TMD) patients. 314 temporomandibular joints (TMJs) images of 163 TMD patients were examined at the Department of Oral and Maxillofacial Radiology, Chonbuk National University. The images were obtained by PSR9000N (Asahi Roentgen Co., Japan) and reconstructed by using Asahivision software (Asahi Roentgen Co., Japan). The CBCT images were examined three times with four weeks interval by three radiologists. Bone changes of mandibular condyle such as flattening, sclerosis, erosion and osteophyte formation were observed in sagittal, axial, coronal and 3 dimensional images of the mandibular condyle. The statistical analysis was performed using SPSS 12.0. Intra-and interobserver agreement were performed by 3 radiologists without the knowledge of clinical information. Osteopathy (2.9%) was found more frequently on anterior surface of the mandibular condyle. Erosion (31.8%) was found more frequently on anterior surface of the mandibular condyle. The intraobserver agreement was good to excellent (k=0.78{sub 0}.84), but interobserver agreement was fair (k=0.45). CBCT can provide high qualified images of bone changes of the TMJ with axial, coronal and 3 dimensional images.

  4. Bone changes of mandibular condyle using cone beam computed tomography

    International Nuclear Information System (INIS)

    Lee, Ji Un; Kim, Hyung Seop; Song, Ju Seop; Kim, Kyoung A; Koh, Kwang Joon

    2007-01-01

    To assess bone changes of mandibular condyle using cone beam computed tomography (CBCT) in temporomandibualr disorder (TMD) patients. 314 temporomandibular joints (TMJs) images of 163 TMD patients were examined at the Department of Oral and Maxillofacial Radiology, Chonbuk National University. The images were obtained by PSR9000N (Asahi Roentgen Co., Japan) and reconstructed by using Asahivision software (Asahi Roentgen Co., Japan). The CBCT images were examined three times with four weeks interval by three radiologists. Bone changes of mandibular condyle such as flattening, sclerosis, erosion and osteophyte formation were observed in sagittal, axial, coronal and 3 dimensional images of the mandibular condyle. The statistical analysis was performed using SPSS 12.0. Intra-and interobserver agreement were performed by 3 radiologists without the knowledge of clinical information. Osteopathy (2.9%) was found more frequently on anterior surface of the mandibular condyle. Erosion (31.8%) was found more frequently on anterior surface of the mandibular condyle. The intraobserver agreement was good to excellent (k=0.78 0 .84), but interobserver agreement was fair (k=0.45). CBCT can provide high qualified images of bone changes of the TMJ with axial, coronal and 3 dimensional images

  5. Nontraumatic bifid mandibular condyles in asymptomatic and symptomatic temporomandibular joint subjects

    International Nuclear Information System (INIS)

    Cho, Bong Hae; Jung, Yun Hoa

    2013-01-01

    This study was performed to determine the prevalence of bifid mandibular condyles (BMCs) in asymptomatic and symptomatic temporomandibular joint (TMJ) subjects with no traumatic history, and to assess their impact on clinical and radiographic manifestations of TMJ. A total of 3,046 asymptomatic and 4,378 symptomatic patients were included in the study. Cone-beam computed tomography (CBCT) images were reviewed for bifid condyles. T-tests were used to compare the frequency of BMCs when stratified by symptom, gender, and side. In BMC patients, the clinical features of pain and noise, osseous changes, and parasagittal positioning of the condyles were compared between the normally shaped condyle side and the BMC side using chi-squared tests. Fifteen (0.49%) asymptomatic and 22 (0.50%) symptomatic patients were found to have BMCs. Among the bilateral cases, the number of condyles were 19 (0.31%) and 25 (0.29%), respectively. No statistically significant differences were found between asymptomatic and symptomatic patients, between female and male patients, or between the right and left sides (p>0.05). Compared with the normally shaped condyle side, the BMC side showed no statistically significant differences in the distribution of pain and noise, parasagittal condylar position, or condylar osseous changes, with the exception of osteophytes. In the symptomatic group, osteophytes were found more frequently on the normally shaped condyle side than the BMC side (p<0.05). BMCs tended to be identified as an incidental finding. The presence of BMC would not lead to any TMJ symptoms or cause osseous changes.

  6. Nontraumatic bifid mandibular condyles in asymptomatic and symptomatic temporomandibular joint subjects

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Bong Hae; Jung, Yun Hoa [Dept. of Oral and Maxillofacial Radiology, School of Dentistry, Pusan National University, Yangsan (Korea, Republic of)

    2013-03-15

    This study was performed to determine the prevalence of bifid mandibular condyles (BMCs) in asymptomatic and symptomatic temporomandibular joint (TMJ) subjects with no traumatic history, and to assess their impact on clinical and radiographic manifestations of TMJ. A total of 3,046 asymptomatic and 4,378 symptomatic patients were included in the study. Cone-beam computed tomography (CBCT) images were reviewed for bifid condyles. T-tests were used to compare the frequency of BMCs when stratified by symptom, gender, and side. In BMC patients, the clinical features of pain and noise, osseous changes, and parasagittal positioning of the condyles were compared between the normally shaped condyle side and the BMC side using chi-squared tests. Fifteen (0.49%) asymptomatic and 22 (0.50%) symptomatic patients were found to have BMCs. Among the bilateral cases, the number of condyles were 19 (0.31%) and 25 (0.29%), respectively. No statistically significant differences were found between asymptomatic and symptomatic patients, between female and male patients, or between the right and left sides (p>0.05). Compared with the normally shaped condyle side, the BMC side showed no statistically significant differences in the distribution of pain and noise, parasagittal condylar position, or condylar osseous changes, with the exception of osteophytes. In the symptomatic group, osteophytes were found more frequently on the normally shaped condyle side than the BMC side (p<0.05). BMCs tended to be identified as an incidental finding. The presence of BMC would not lead to any TMJ symptoms or cause osseous changes.

  7. Radiographic cup position following posterior and lateral approach to total hip arthroplasty. An explorative randomized controlled trial.

    Science.gov (United States)

    Kruse, Christine; Rosenlund, Signe; Broeng, Leif; Overgaard, Søren

    2018-01-01

    The two most common surgical approaches to total hip arthroplasty are the posterior approach and lateral approach. The surgical approach may influence cup positioning and restoration of the offset, which may affect the biomechanical properties of the hip joint. The primary aim was to compare cup position between posterior approach and lateral approach. Secondary aims were to compare femoral offset, abductor moment arm and leg length discrepancy between the two approaches. Eighty patients with primary hip osteoarthritis were included in a randomized controlled trial and assigned to total hip arthroplasty using posterior approach or lateral approach. Postoperative radiographs from 38 patients in each group were included in this study for measurement of cup anteversion and inclination. Femoral offset, cup offset, total offset, abductor moment arm and leg length discrepancy were measured on preoperative and postoperative radiographs in 28 patients in each group. We found that mean anteversion was 5° larger in the posterior approach group (95% CI, -8.1 to -1.4; p = 0.006), while mean inclination was 5° less steep (95% CI, 2.7 to 7.2; pcup anteversion but less steep cup inclination in the posterior approach group compared with the lateral approach group. Femoral offset and abductor moment arm were restored after total hip arthroplasty using lateral approach but significantly increased when using posterior approach.

  8. Superior perioperative analgesia with combined femoral-obturator-sciatic nerve block in comparison with posterior lumbar plexus and sciatic nerve block for ACL reconstructive surgery.

    Science.gov (United States)

    Bareka, Metaxia; Hantes, Michael; Arnaoutoglou, Eleni; Vretzakis, George

    2018-02-01

    The purpose of this randomized controlled study is to compare and evaluate the intraoperative and post-operative outcome of PLPS nerve block and that of femoral, obturator and sciatic (FOS) nerve block as a method of anaesthesia, in performing ACL reconstruction. Patients referred for elective arthroscopic ACL reconstruction using hamstring autograft were divided in two groups. The first group received combined femoral-obturator-sciatic nerve block (FOS Group) under dual guidance, whereas the second group received posterior lumbar plexus block under neurostimulation and sciatic nerve block (PLPS Group) under dual guidance. The two groups were comparable in terms of age, sex, BMI and athletic activity. The time needed to perform the nerve blocks was significantly shorter for the FOS group (p block under dual guidance for arthroscopic ACL reconstructive surgery is a safe and tempting anaesthetic choice. The success rate of this technique is higher in comparison with PLPS and results in less peri- and post-operative pain with less opioid consumption. This study provides support for the use of peripheral nerve blocks as an exclusive method for ACL reconstructive surgery in an ambulatory setting with almost no complications. I.

  9. Slip of the capital femoral epiphysis: Revival of a method of assessment

    International Nuclear Information System (INIS)

    Billing, L.; Ekloef, O.

    1984-01-01

    A simple and exact method for evaluation of suspected or overt slip of the femoral capital epiphysis is revived. This procedure gives an estimate of all degrees of abnormality from the early stages to those with gross deformity. In our experience slip of the femoral capital epiphysis is always posterior and in approximately 80% of cases bilateral. Therefore, bot hips should be examined whenever this condition is suspected. The method provides for examination of each hip separately. Strict adherence to the procedure also provides a precise way of assessing the femoral anteversion angle, significant in many orthopedic disorders. For the latter purpose access to a particular nomogram is mandatory. (orig.)

  10. Femoral anteversion is correlated with acetabular version and coverage in Asian women with anterior and global deficient subgroups of hip dysplasia: a CT study

    International Nuclear Information System (INIS)

    Akiyama, Mio; Nakashima, Yasuharu; Fujii, Masanori; Sato, Taishi; Yamamoto, Takuaki; Mawatari, Taro; Motomura, Goro; Matsuda, Shuichi; Iwamoto, Yukihide

    2012-01-01

    Morphological correlation between the acetabulum and femur at the hip joint is still controversial. We tested the hypothesis that femoral anteversion correlates with acetabular version and coverage in patients with developmental dysplasia of the hip (DDH). Using pelvic computed tomography (CT) images of 79 hips in 49 Asian women with DDH and 49 normal hips, we measured femoral anteversion, the axial and vertical acetabular version and the acetabular sector angle (ASA) to demarcate femoral head coverage. Depending on the location of the acetabular bone defect, dysplastic hips were divided into three subgroups: the anterior, global and posterior deficiency groups. We performed a comparative analysis between dysplastic and normal hips using the Wilcoxon rank sum test, and a relative analysis between femoral anteversion and acetabular measurements in dysplastic hips using Pearson's correlation coefficient. The amount of femoral anteversion in dysplastic hips was greater and more variable than in normal hips (p < 0.0001, p = 0.0277 respectively). Femoral anteversion in dysplastic hips correlated significantly with acetabular anteversion in the groups with anterior and global deficiency subgroups (p < 0.05, r = 0.2990, p < 0.05, r = 0.451 respectively), but not with the posterior deficiency subgroup. Femoral anteversion also correlated with vertical acetabular version. When acetabular coverage was examined, significant correlations were noted between femoral anteversion and anterior and superior coverage, but not with posterior coverage. These correlations were not observed in normal hips. Our results showed significantly greater and more variable femoral anteversion in DDH, and a significant correlation between femoral anteversion and acetabular version and coverage in DDH with anterior and global acetabular bone deficiency. (orig.)

  11. Femoral anteversion is correlated with acetabular version and coverage in Asian women with anterior and global deficient subgroups of hip dysplasia: a CT study

    Energy Technology Data Exchange (ETDEWEB)

    Akiyama, Mio; Nakashima, Yasuharu; Fujii, Masanori; Sato, Taishi; Yamamoto, Takuaki; Mawatari, Taro; Motomura, Goro; Matsuda, Shuichi; Iwamoto, Yukihide [Kyushu University, Department of Orthopaedic Surgery, Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka (Japan)

    2012-11-15

    Morphological correlation between the acetabulum and femur at the hip joint is still controversial. We tested the hypothesis that femoral anteversion correlates with acetabular version and coverage in patients with developmental dysplasia of the hip (DDH). Using pelvic computed tomography (CT) images of 79 hips in 49 Asian women with DDH and 49 normal hips, we measured femoral anteversion, the axial and vertical acetabular version and the acetabular sector angle (ASA) to demarcate femoral head coverage. Depending on the location of the acetabular bone defect, dysplastic hips were divided into three subgroups: the anterior, global and posterior deficiency groups. We performed a comparative analysis between dysplastic and normal hips using the Wilcoxon rank sum test, and a relative analysis between femoral anteversion and acetabular measurements in dysplastic hips using Pearson's correlation coefficient. The amount of femoral anteversion in dysplastic hips was greater and more variable than in normal hips (p < 0.0001, p = 0.0277 respectively). Femoral anteversion in dysplastic hips correlated significantly with acetabular anteversion in the groups with anterior and global deficiency subgroups (p < 0.05, r = 0.2990, p < 0.05, r = 0.451 respectively), but not with the posterior deficiency subgroup. Femoral anteversion also correlated with vertical acetabular version. When acetabular coverage was examined, significant correlations were noted between femoral anteversion and anterior and superior coverage, but not with posterior coverage. These correlations were not observed in normal hips. Our results showed significantly greater and more variable femoral anteversion in DDH, and a significant correlation between femoral anteversion and acetabular version and coverage in DDH with anterior and global acetabular bone deficiency. (orig.)

  12. Robust femur condyle disambiguation on biplanar X-rays.

    Science.gov (United States)

    Serrurier, Antoine; Quijano, Sergio; Nizard, Remy; Skalli, Wafa

    2012-12-01

    Three-dimensional (3D) reconstruction of the skeleton from biplanar X-rays relies on scarce information digitalised by an operator on both frontal and lateral radiographs. In clinical routine, difficulties occur for non-skilled operators to discriminate the medial from the lateral femur condyle on the lateral view. Our study proposes an algorithm able to detect automatically a possible inversion of the two condyles by the operator at an early stage of the reconstruction process. It relies on the computation of two 3D femur surfaces, one directly from the operator digitalisation and the other from the same digitalisation with medial and lateral condyles automatically swapped. Pairs of virtual biplanar X-rays are computed for both reconstructions and the closest pair to the original X-rays is selected on the basis of similarity measures, pointing the correct 3D surface. The algorithm shows a success rate higher than 85% for both asymptomatic and pathological femurs whatever the initial condyle digitalisation of the operator, bringing automatically non-skilled operators acting in clinical routine to the level of skilled operators. This study validates moreover the proof-of-concept of automatic shape adjustments of a 3D surface on the basis of similarity measures in the process of 3D reconstruction from biplanar X-rays. Copyright © 2012 IPEM. Published by Elsevier Ltd. All rights reserved.

  13. Total Knee Arthroplasty Designed to Accommodate the Presence or Absence of the Posterior Cruciate Ligament

    Directory of Open Access Journals (Sweden)

    Melinda K. Harman

    2014-01-01

    Full Text Available Evidence for selecting the same total knee arthroplasty prosthesis whether the posterior cruciate ligament (PCL is retained or resected is rarely documented. This study reports prospective midterm clinical, radiographic, and functional outcomes of a fixed-bearing design implanted using two different surgical techniques. The PCL was completely retained in 116 knees and completely resected in 43 knees. For the entire cohort, clinical knee (96±7 and function (92±13 scores and radiographic outcomes were good to excellent for 84% of patients after 5–10 years in vivo. Range of motion averaged 124˚±9˚, with 126 knees exhibiting ≥120° flexion. Small differences in average knee flexion and function scores were noted, with the PCL-resected group exhibiting an average of 5° more flexion but an average function score that was 7 points lower compared to the PCL-retained group. Fluoroscopic analysis of 33 knees revealed stable tibiofemoral translations. This study demonstrates that a TKA articular design with progressive congruency in the lateral compartment can provide for femoral condyle rollback in maximal flexion activities and achieve good clinical and functional performance in patients with PCL-retained and PCL-resected TKA. This TKA design proved suitable for use with either surgical technique, providing surgeons with the choice of maintaining or sacrificing the PCL.

  14. Flexing and downsizing the femoral component is not detrimental to patellofemoral biomechanics in posterior-referencing cruciate-retaining total knee arthroplasty

    NARCIS (Netherlands)

    Marra, Marco A.; Strzelczak, Marta; Heesterbeek, Petra J.C.; van de Groes, Sebastiaan A.W.; Janssen, Dennis; Koopman, Bart F.J.M.; Verdonschot, Nico; Wymenga, Ate B.

    2018-01-01

    Purpose: When downsizing the femoral component to prevent mediolateral overhang, notching of the anterior femoral cortex may occur, which could be solved by flexing the femoral component. In this study, we investigated the effect of flexion of the femoral component on patellar tendon moment arm,

  15. Relation between anterior displacement of the temporomandibular joint disc and size of the condyle

    International Nuclear Information System (INIS)

    Ohgushi, Masatoshi; Kubota, Hisashi; Yamaguchi, Kouichi; Shibata, Takanori

    1996-01-01

    To elucidate the cause of anterior displacement of the disc, we evaluated the relation between anterior displacement and the size of the condyle from MR images in 301 patients (602 TMJs) with clinical diagnosis of internal derangement. We found that the size of condyles with anterior displacement of the disc was significantly smaller than that of condyles without anterior displacement. This result suggests that small condyles may give rise to anterior displacement of the disc. (author)

  16. Overlooked metastatic lesions of the occipital condyle: a missed case treasure trove.

    Science.gov (United States)

    Loevner, L A; Yousem, D M

    1997-01-01

    Radiologic images obtained in nine patients with known primary cancer and occipital or head and neck pain were retrospectively reviewed after having been initially interpreted as normal. Imaging studies included head computed tomography (CT) in five cases, brain magnetic resonance (MR) imaging in six cases, cervical spine CT and MR imaging in five cases, radiography in two cases, and scintigraphy in two cases. This reevaluation demonstrated lesions of the occipital condyles in all patients. Seven patients had unilateral occipital condyle masses, and two patients had bilateral condyle lesions. Lesions were found to either involve only the occipital condyle (n = 4), extend to the adjacent occipital bone (n = 3), or extend to the ipsilateral clivus (n = 2). Misinterpretation of radiologic examinations resulted in an average delay in diagnosis of 10 weeks from the onset of symptoms to definitive therapy (irradiation). It is important to evaluate the occipital condyles in all patients with occipital pain, especially those with cancer. Neoplastic disease involving the occipital condyles is not common; however, it is frequently missed at imaging. Careful review of unenhanced sagittal and axial T1-weighted MR images and of the inferior sections from axial head CT studies will make it possible to avoid this potential pitfall.

  17. FEMORAL NECK FRACTURES GARDEN I AND II: EVALUATION OF THE DEVIATION IN LATERAL VIEW.

    Science.gov (United States)

    Leonhardt, Natália Zalc; Melo, Lucas da Ponte; Nordon, David Gonçalves; Silva, Fernando Brandão de Andrade E; Kojima, Kodi Edson; Silva, Jorge Santos

    2017-01-01

    To evaluate the rate of deviation in the lateral radiographic incidence in patients with femoral neck fracture classified as non-diverted in the anteroposterior view (Garden I and II). Nineteen selected patients with femoral neck fractures classified as Garden I and II were retrospectively evaluated, estimating the degree of deviation in the lateral view. Fifteen cases (79%) presented deviations in lateral view, with a mean of 18.6 degrees (±15.5). Most fractures of the femoral neck classified as Garden I and II present some degree of posterior deviation in the X-ray lateral view. Level of Evidence III, Retrospective Comparative Study.

  18. Medial circumflex femoral artery flap for ischial pressure sore

    Directory of Open Access Journals (Sweden)

    Palanivelu S

    2009-01-01

    Full Text Available A new axial pattern flap based on the terminal branches of the medial circumflex femoral artery is described for coverage of ischial pressure sore. Based on the terminal branches of the transverse branch of medial circumflex femoral artery, which exit through the gap between the quadratus femoris muscle above and the upper border of adductor magnus muscle below, this fascio cutaneous flap is much smaller than the posterior thigh flap but extremely useful to cover ischeal pressure sores. The skin redundancy below the gluteal fold allows a primary closure of the donor defect. It can also be used in combination with biceps femoris muscle flap.

  19. Knee joint changes in patients with neglected developmental hip dysplasia: a prospective case-control study.

    Science.gov (United States)

    Li, Qiwei; Kadhim, Muayad; Zhang, Lijun; Cheng, Xiangjun; Zhao, Qun; Li, Lianyong

    2014-12-01

    Few reports are available describing knee changes in neglected developmental dysplasia of the hip (DDH). The purpose of this study was to assess the radiographic morphology of knee joints in adults with neglected DDH. Thirty-seven patients (35 females and two males) with neglected DDH were prospectively recruited with an average age of 32.6 years. Twenty-three patients had unilateral and 14 patients had bilateral neglected DDH. Thirty-seven healthy individuals were recruited to form a matched control group. Three groups of knee joints were examined: affected knees (on the same side of the neglected DDH), unaffected knees (contralateral to the neglected DDH in patients with unilateral involvement), and control knees. A series of radiographic parameters of the knee joint were measured in the coronal and sagittal plane, and they were compared between patients and normal controls. In the coronal plane, the affected knees had increased valgus angulation related to increased height of the medial femoral condyle, decreased height of the lateral femoral condyle and decreased lateral distal femoral angle compared to control knees. In the sagittal plane, both distal femoral and proximal tibial joints of the affected knees developed a decrease in posterior angles. Additionally, the unaffected knees also developed radiographic changes compared to control knees. Patients with neglected DDH may develop changes in both knee joints. These changes should be considered during surgery to the hip, femur and knee to prevent potential complications. Level 2. Copyright © 2014 Elsevier B.V. All rights reserved.

  20. Conservative orthodontic treatment of mandibular bilateral condyle fracture.

    Science.gov (United States)

    Gašpar, Goran; Brakus, Ivan; Kovačić, Ivan

    2014-09-01

    Maxillofacial trauma is rare in children younger than the age of 5 years (range 0.6%-1.2%), and they can require different clinical treatment strategies compared with fractures in the adult population because of concerns regarding mandibular growth and development of dentition. A 5-year-old girl with a history of falling from a bicycle 7 hours earlier was referred to the department of oral and maxillofacial surgery. Multislice computed tomographic examination demonstrated a bilateral fracture of the mandibular condyle neck associated with minimal fracture of the alveolar ridge of the maxilla. The multislice computed tomographic scan also demonstrated dislocation on the right condyle neck and, on the left side, a medial inclination of approximately 45 degrees associated with greenstick fracture of the right parasymphysis region. In this particular case, orthodontic rubber elastics in combination with fixed orthodontic brackets provided good results in the treatment of bilateral condyle neck fractures associated with greenstick fracture of parasymphysis.

  1. 78 FR 9010 - Dental Devices; Reclassification of Temporary Mandibular Condyle Prosthesis

    Science.gov (United States)

    2013-02-07

    .... FDA-2012-N-1239] Dental Devices; Reclassification of Temporary Mandibular Condyle Prosthesis AGENCY... condyle prostheses into class III, based on the recommendation of a Dental Products Panel (the Panel... Administration, Dental Products Advisory Panel Meeting Transcript, February 12, 1997; http://www.accessdata.fda...

  2. MRI of the temporo-mandibular joint: which sequence is best suited to assess the cortical bone of the mandibular condyle? A cadaveric study using micro-CT as the standard of reference

    International Nuclear Information System (INIS)

    Karlo, Christoph A.; Patcas, Raphael; Signorelli, Luca; Mueller, Lukas; Kau, Thomas; Watzal, Helmut; Kellenberger, Christian J.; Ullrich, Oliver; Luder, Hans-Ulrich

    2012-01-01

    To determine the best suited sagittal MRI sequence out of a standard temporo-mandibular joint (TMJ) imaging protocol for the assessment of the cortical bone of the mandibular condyles of cadaveric specimens using micro-CT as the standard of reference. Sixteen TMJs in 8 human cadaveric heads (mean age, 81 years) were examined by MRI. Upon all sagittal sequences, two observers measured the cortical bone thickness (CBT) of the anterior, superior and posterior portions of the mandibular condyles (i.e. objective analysis), and assessed for the presence of cortical bone thinning, erosions or surface irregularities as well as subcortical bone cysts and anterior osteophytes (i.e. subjective analysis). Micro-CT of the condyles was performed to serve as the standard of reference for statistical analysis. Inter-observer agreements for objective (r = 0.83-0.99, P < 0.01) and subjective (κ = 0.67-0.88) analyses were very good. Mean CBT measurements were most accurate, and cortical bone thinning, erosions, surface irregularities and subcortical bone cysts were best depicted on the 3D fast spoiled gradient echo recalled sequence (3D FSPGR). The most reliable MRI sequence to assess the cortical bone of the mandibular condyles on sagittal imaging planes is the 3D FSPGR sequence. (orig.)

  3. MRI of the temporo-mandibular joint: which sequence is best suited to assess the cortical bone of the mandibular condyle? A cadaveric study using micro-CT as the standard of reference

    Energy Technology Data Exchange (ETDEWEB)

    Karlo, Christoph A. [University Hospital Zurich, Department of Diagnostic and Interventional Radiology, Zurich (Switzerland); University Children' s Hospital Zurich, Department of Diagnostic Imaging, Zurich (Switzerland); Patcas, Raphael; Signorelli, Luca; Mueller, Lukas [University of Zurich, Clinic for Orthodontics and Pediatric Dentistry, Center of Dental Medicine, Zurich (Switzerland); Kau, Thomas; Watzal, Helmut; Kellenberger, Christian J. [University Children' s Hospital Zurich, Department of Diagnostic Imaging, Zurich (Switzerland); Ullrich, Oliver [University of Zurich, Institute of Anatomy, Faculty of Medicine, Zurich (Switzerland); Luder, Hans-Ulrich [University of Zurich, Section of Orofacial Structures and Development, Center of Dental Medicine, Zurich (Switzerland)

    2012-07-15

    To determine the best suited sagittal MRI sequence out of a standard temporo-mandibular joint (TMJ) imaging protocol for the assessment of the cortical bone of the mandibular condyles of cadaveric specimens using micro-CT as the standard of reference. Sixteen TMJs in 8 human cadaveric heads (mean age, 81 years) were examined by MRI. Upon all sagittal sequences, two observers measured the cortical bone thickness (CBT) of the anterior, superior and posterior portions of the mandibular condyles (i.e. objective analysis), and assessed for the presence of cortical bone thinning, erosions or surface irregularities as well as subcortical bone cysts and anterior osteophytes (i.e. subjective analysis). Micro-CT of the condyles was performed to serve as the standard of reference for statistical analysis. Inter-observer agreements for objective (r = 0.83-0.99, P < 0.01) and subjective ({kappa} = 0.67-0.88) analyses were very good. Mean CBT measurements were most accurate, and cortical bone thinning, erosions, surface irregularities and subcortical bone cysts were best depicted on the 3D fast spoiled gradient echo recalled sequence (3D FSPGR). The most reliable MRI sequence to assess the cortical bone of the mandibular condyles on sagittal imaging planes is the 3D FSPGR sequence. (orig.)

  4. Recurrent simple bone cyst of the mandibular condyle: a case report

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Kyung A; Koh, Kwang Joon [Dept. of Oral and Maxillofacial Radiology, School of Dentistry, and Institute of Oral Bio Science, Chonbuk National University, Jeonju (Korea, Republic of)

    2013-03-15

    Cysts of the mandibular condyle are rare and can be difficult to diagnose and treat. Clinically, a simple bone cyst is asymptomatic and often discovered incidentally on routine radiographic examination. This report shows an atypical simple bone cyst occurring in the mandibular condyle showing recurrence after surgical curettage. Radiologically, this lesion involving the mandibular condyle should be distinguished from other similar lesions such as a chondriome, a central giant cell granuloma, and an aneurysmal bone cyst. Radiographic assessment was useful for forecasting the prognosis of a simple bone cyst. Possible reasons for the recurrence were discussed radiographically.

  5. Feasibility of purely endoscopic intramedullary fixation of mandibular condyle fractures.

    Science.gov (United States)

    Frake, Paul C; Goodman, Joseph F; Joshi, Arjun S

    2015-01-01

    The investigators of this study hypothesized that fractures of the mandibular condyle can be repaired using short-segment intramedullary implants and purely endoscopic surgical technique, using a basic science, human cadaver model in an academic center. Endoscopic instrumentation was used through a transoral mucosal incision to place intramedullary implants of 2 cm in length into osteotomized mandibular condyles. The surgical maneuvers that required to insert these implants, including condyle positioning, reaming, implant insertion, and seating of the mandibular ramus, are described herein. Primary outcome was considered as successful completion of the procedure. Ten cadaveric mandibular condyles were successfully repaired with rigid intramedullary internal fixation without the use of external incisions. Both insertion of a peg-type implant and screwing a threaded implant into the condylar head were possible. The inferior portion of the implant remained exposed, and the ramus of the mandible was manipulated into position on the implant using retraction at the sigmoid notch. The results of this study suggest that purely endoscopic repair of fractures of the mandibular condyle is possible by using short-segment intramedullary titanium implants and a transoral endoscopic approach without the need for facial incisions or punctures. The biomechanical advantages of these intramedullary implants, including improved strength and resistance to mechanical failure compared with miniplates, have been recently established. The combination of improved implant design and purely endoscopic technique may allow for improved fixation and reduced surgical- and implant-related morbidity in the treatment of condylar fractures.

  6. Femoral cartilage thickness measurements in healthy individuals: learning, practicing and publishing with TURK-MUSCULUS.

    Science.gov (United States)

    Özçakar, Levent; Tunç, Hakan; Öken, Öznur; Ünlü, Zeliha; Durmuş, Bekir; Baysal, Özlem; Altay, Zuhal; Tok, Fatih; Akkaya, Nuray; Doğu, Beril; Çapkın, Erhan; Bardak, Ayşenur; Çarlı, Alparslan Bayram; Buğdaycı, Derya; Toktaş, Hasan; Dıraçoğlu, Demirhan; Gündüz, Berrin; Erhan, Belgin; Kocabaş, Hilal; Erden, Gül; Günendi, Zafer; Kesikburun, Serdar; Omaç, Özlem Köroğlu; Taşkaynatan, Mehmet Ali; Şenel, Kazım; Uğur, Mahir; Yalçınkaya, Ebru Yılmaz; Öneş, Kadriye; Atan, Çiğdem; Akgün, Kenan; Bilgici, Ayhan; Kuru, Ömer; Özgöçmen, Salih

    2014-01-01

    Measurement of the femoral cartilage thickness by using in-vivo musculoskeletal ultrasonography (MSUS) has been previously shown to be a valid and reliable method in previous studies; however, to our best notice, normative data has not been provided before in the healthy population.The aim of our study was to provide normative data regarding femoral cartilage thicknesses of healthy individuals with collaborative use of MSUS. This is across-sectional study run at Physical and Rehabilitation Medicine Departments of 18 Secondary and Tertiary Centers in Turkey. 1544 healthy volunteers (aged between 25-40 years) were recruited within the collaboration of TURK-MUSCULUS (Turkish Musculoskeletal Ultrasonography Study Group). Subjects who had a body mass index value of less than 30 and who did not have signs and symptoms of any degenerative/inflammatory arthritis or other rheumatic diseases, history of knee trauma and previous knee surgery were enrolled. Ultrasonographic measurements were performed axially from the suprapatellar window by using linear probes while subjects' knees were in maximum flexion. Three (mid-point) measurements were taken from both knees (lateral condyle, intercondylar area, medial condyle). A total of 2876 knees (of 817 M, 621 F subjects) were taken into analysis after exclusion of inappropriate images. Mean cartilage thicknesses were significantly lower in females than males (all p< 0.001). Thickness values negatively correlated with age; negatively (females) and positively (males) correlated with smoking. Men who regularly exercised had thicker cartilage than who did not exercise (all p < 0.05). Increased age (in both sexes) and absence of exercise (males) were found to be risk factors for decreased cartilage thicknesses. Further data pertaining to other countries would be interesting to uncover whether ethnic differences also affect cartilage thickness. Collaborative use of MSUS seems to be promising in this regard.

  7. Positioning of the femoral tunnel for arthroscopic reconstruction of the anterior cruciate ligament: comparative study of 2 techniques Posicionamento do túnel femoral na reconstrução artroscópica do LCA: estudo comparativo de duas técnicas

    Directory of Open Access Journals (Sweden)

    Roberto Freire da Mota Albuquerque

    2007-01-01

    Full Text Available OBJECTIVE: To compare the accuracy of positioning of the femoral tunnel in reconstructing the anterior cruciate ligament by means of 2 techniques: tibial tunnel and anteromedial portal. METHOD: Femoral tunnels were drilled in 20 knees from human cadavers by means of arthroscopy. Group I had the femoral tunnel drilled via a trans-tibial tunnel, and Group II via the anteromedial portal. Four variables were measured: A posterior wall thickness; B tunnel positioning at the notch; C tunnel inclination in relation to the femoral axis; and D distance between the wire guide exit and the lateral epicondyle. RESULTS: As above, respectively, A 2.23 mm for group I and 2.36 mm for group II (P =.54; B 25.5° for group I and 30.0° for group II (P =.23; C 23.9° for group I and 32.0° for group II (P =.02; D 7.8 cm for group I and 3.9 cm for group II (P OBJETIVO: Comparar a acurácia do posicionamento do túnel femoral na reconstrução do ligamento cruzado anterior através de duas vias: túnel tibial e portal ântero - medial. MÉTODO: Foram perfurados túneis femorais em vinte joelhos de cadáveres humanos por via artroscópica. Grupo I: túnel femoral por acesso trans túnel tibial. Grupo II: via portal ântero-medial. Quatro variáveis foram estudadas: A espessura da parede posterior; B posicionamento do túnel no intercôndilo; C angulação do túnel em relação ao eixo do fêmur; D distância entre a saída do fio guia e o epicôndilo lateral. RESULTADO: A grupo I: 2,23 mm, grupo II: 2,36 mm (p=0,543; B grupo I: 25,5º, grupo II: 30º (p=0,226; C grupo I: 23,9º, grupo II: 32º (p= 0,014; D grupo I: 7,8 cm, grupo II 3,9 cm (p<0,001. CONCLUSÃO: As duas técnicas obteveram o posicionamento desejado da entrada do túnel femoral e espessura adequada da cortical posterior. A perfuração via portal ântero-medial pode propiciar maior proteção contra rotura da parede posterior.

  8. Femoral neck fracture following groin irradiation

    Energy Technology Data Exchange (ETDEWEB)

    Grigsby, Perry W; Roberts, Heidi L; Perez, Carlos A

    1995-04-30

    Purpose: The incidence and risk factors are evaluated for femoral neck fracture following groin irradiation for gynecologic malignancies. Methods and Materials: The radiation therapy records of 1313 patients with advanced and recurrent cancer of the vagina, vulva, cervix, and endometrium, treated at the Mallinckrodt Institute of Radiology from 1954 to 1992, were reviewed. Median follow-up was 12.7 years. From this group, 207 patients were identified who received irradiation to the pelvis and groins with anterposterior-posterior anterior (AP-PA), 18 MV photons. Data were reviewed regarding irradiation dose to the femoral neck and other presumed risk factors including age, primary site, stage, groin node status, menopausal status, estrogen use, cigarette use, alcohol consumption, and osteoporosis. Results: The per-patient incidence of femoral neck fracture was 4.8% (10 out of 207). Four patients developed bilateral fractures. However, the cumulative actuarial incidence of fracture was 11% at 5 years and 15% at 10 years. Cox multivariate analysis of age, weight, and irradiation dose showed that only irradiation dose may be important to developing fracture. Step-wise logistic regression of presumed prognostic factors revealed that only cigarette use and x-ray evidence of osteoporosis prior to irradiation treatment were predictive of fracture. Conclusion: Femoral head fracture is a common complication of groin irradiation for gynecologic malignancies. Fracture in our database appears to be related to irradiation dose, cigarette use, and x-ray evidence of osteoporosis. Special attention should be given in treatment planning (i.e., shielding of femoral head/neck and use of appropriate electron beam energies for a portion of treatment) to reduce the incidence of this complication.

  9. Femoral neck fracture following groin irradiation

    International Nuclear Information System (INIS)

    Grigsby, Perry W.; Roberts, Heidi L.; Perez, Carlos A.

    1995-01-01

    Purpose: The incidence and risk factors are evaluated for femoral neck fracture following groin irradiation for gynecologic malignancies. Methods and Materials: The radiation therapy records of 1313 patients with advanced and recurrent cancer of the vagina, vulva, cervix, and endometrium, treated at the Mallinckrodt Institute of Radiology from 1954 to 1992, were reviewed. Median follow-up was 12.7 years. From this group, 207 patients were identified who received irradiation to the pelvis and groins with anterposterior-posterior anterior (AP-PA), 18 MV photons. Data were reviewed regarding irradiation dose to the femoral neck and other presumed risk factors including age, primary site, stage, groin node status, menopausal status, estrogen use, cigarette use, alcohol consumption, and osteoporosis. Results: The per-patient incidence of femoral neck fracture was 4.8% (10 out of 207). Four patients developed bilateral fractures. However, the cumulative actuarial incidence of fracture was 11% at 5 years and 15% at 10 years. Cox multivariate analysis of age, weight, and irradiation dose showed that only irradiation dose may be important to developing fracture. Step-wise logistic regression of presumed prognostic factors revealed that only cigarette use and x-ray evidence of osteoporosis prior to irradiation treatment were predictive of fracture. Conclusion: Femoral head fracture is a common complication of groin irradiation for gynecologic malignancies. Fracture in our database appears to be related to irradiation dose, cigarette use, and x-ray evidence of osteoporosis. Special attention should be given in treatment planning (i.e., shielding of femoral head/neck and use of appropriate electron beam energies for a portion of treatment) to reduce the incidence of this complication

  10. The radiologic spectrum of occipital condyle fractures

    International Nuclear Information System (INIS)

    Hanson, J.A.; Deliganis, A.V.; Baxter, A.B.; Cohen, W.A.; Wilson, A.J.; Mann, F.A.

    2002-01-01

    Full text: Occipital condyle fractures (OCFs) are increasingly diagnosed in survivors of high energy blunt trauma, and may be associated with craniocervical junction disruption.We aimed to describe and classify the imaging appearances of occipital condyle fractures in a large series of trauma patients. We reviewed conventional radiographs, computed tomography (CT), and magnetic resonance (MR) imaging in 95 patients with 107 OCFs, who were treated at a level 1 trauma centre (1992-1999). We described fracture patterns according to two current classification systems (Anderson and Montesano, and Tuli), and correlated imaging appearances with clinical findings, neurosurgical management and patient outcome. Fracture morphology and craniocervical junction integrity were best assessed by 1-1.5mm collimation CT. Inferomedial occipital condyle avulsion fractures (Anderson and Montesano type III) were the commonest OCF category, comprising 80/107 (75%). Unilateral OCFs were found in 73/95 (77%) patients, 58 of whom were managed by cervical orthotic brace or collar. Bilateral OCFs or occipito-atlanto-axial joint injuries were seen in the remaining 22/95 (23%) patients. Occipitocervical fusion or craniocervical halo traction were required in 12 patients, all of whom had CT evidence of bilateral occipito-atlanto-axial joint disruption. Associated cervical spine injuries were present in 29/95 (31%) patients. Ten (10/95, 10.5%) patients died in hospital, and 30/95 (32%) showed continuing disability. The remaining 55/95 (57.5%) patients showed good outcome and functional independence at 1 month. Occipital condyle fractures are rare injuries with a wide range of morphology, stability and clinical significance. Thorough radiological evaluation of all components of the occipito-atlanto-axial joint complex must be performed in order to determine the full extent of injury. In this series, most unilateral OCFs were managed by non-operative immobilisation, whereas bilateral occipito

  11. [Design and fabrication of the custom-made titanium condyle by selective laser melting technology].

    Science.gov (United States)

    Chen, Jianyu; Luo, Chongdai; Zhang, Chunyu; Zhang, Gong; Qiu, Weiqian; Zhang, Zhiguang

    2014-10-01

    To design and fabricate the custom-made titanium mandibular condyle by the reverse engineering technology combined with selective laser melting (SLM) technology and to explore the mechanical properties of the SLM-processed samples and the application of the custom-made condyle in the temporomandibular joint (TMJ) reconstruction. The three-dimensional model of the mandibular condyle was obtained from a series of CT databases. The custom-made condyle model was designed by the reverse engineering software. The mandibular condyle was made of titanium powder with a particle size of 20-65 µm as the basic material and the processing was carried out in an argon atmosphere by the SLM machine. The yield strength, ultimate strength, bending strength, hardness, surface morphology and roughness were tested and analyzed. The finite element analysis (FEA) was used to analyze the stress distribution. The complex geometry and the surface of the custom-made condyle can be reproduced precisely by the SLM. The mechanical results showed that the yield strength, ultimate strength, bending strength and hardness were (559±14) MPa, (659±32) MPa, (1 067±42) MPa, and (212±4)HV, respectively. The surface roughness was reduced by sandblast treatment. The custom-made titanium condyle can be fabricated by SLM technology which is time-saving and highly digitized. The mechanical properties of the SLM sample can meet the requirements of surgical implant material in the clinic. The possibility of fabricating custom-made titanium mandibular condyle combined with the FEA opens new interesting perspectives for TMJ reconstruction.

  12. Application of Normative Occipital Condyle-C1 Interval Measurements to Detect Atlanto-Occipital Injury in Children.

    Science.gov (United States)

    Corcoran, B; Linscott, L L; Leach, J L; Vadivelu, S

    2016-05-01

    Prior studies have found that widening or asymmetry of the occipital condyle-C1 interval on CT is a sensitive and specific marker for atlanto-occipital dislocation. Previously reported abnormal occipital condyle-C1 interval values are not age-specific, possibly leading to false-positive findings in younger children, in whom this joint space is normally larger than that in adults. This study assesses the utility of applying age-specific normative occipital condyle-C1 interval ranges to documented cases of atlanto-occipital injury compared with previously reported abnormal cutoff values. Retrospective review of CT and MR imaging of 14 subjects with atlanto-occipital injury was performed, and occipital condyle-C1 interval measurements were made for each subject. Sensitivities and specificities of proposed occipital condyle-C1 interval cutoffs of 2 and 3 SDs above the mean and previously published occipital condyle-C1 interval cutoffs for atlanto-occipital injury were then calculated on the basis of occipital condyle-C1 interval measurements for each subject. An occipital condyle-C1 interval 2 SDs above the age-specific mean has a sensitivity of 50% and specificity of 89%-100%, depending on the age group. An occipital condyle-C1 interval 3 SDs above the age-specific mean has a sensitivity of 50% and a specificity of 95%-100%. A 4.0-mm occipital condyle-C1 interval has a sensitivity of 36% and a specificity of 100% in all age groups. A 2.5-mm occipital condyle-C1 interval has a sensitivity of 93% and a specificity of 18%-100%. Occipital condyle-C1 interval widening cutoffs used to establish atlanto-occipital injury lack both sensitivity and specificity in children and young teenagers. MR imaging is necessary to establish a diagnosis of atlanto-occipital injury in children and young teenagers when the appropriate mechanism of injury is present. © 2016 by American Journal of Neuroradiology.

  13. Superolateral Dislocation of Intact Mandibular Condyle: A Case Report and Review of Literature

    OpenAIRE

    Saikrishna, Degala; Shyam Sundar, S.; Mamata, K. S.

    2015-01-01

    Anteromedial fracture dislocation of the mandibular condyle is common but a superolateral dislocation of an intact condyle is quite rare. This type of dislocation is often misdiagnosed or completely overlooked and hence inadequately addressed. We report a case of a 41-year-old male patient who experienced superolateral dislocation of the intact condyle with symphysis fracture and panfacial fracture following a road-traffic accident, and review of literature of superolateral dislocations from ...

  14. Radiographic changes in the condyle of the temporomandibular joint in psoriatic arthritis

    International Nuclear Information System (INIS)

    Koenoenen, M.; Helsinki Univ.

    1987-01-01

    One hundred and ten patients with psoriatic arthritis (PA) and 100 matched control patients were examined by using orthopantomography to discover radiographic changes in the condyle of the temporomandibular joint (TMJ). 31% of the PA patients and 13% of the control patients had radiographic changes in the condyle of the TMJ. The most common radiographic finding in PA patients was unilateral erosion of the condyle. Of the radiographic changes in the PA group, cortical erosions correlated negatively with age, whereas osteophytes correlated positively with the duration of PA. (orig.)

  15. Volumetric analysis of the mandibular condyle using cone beam computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Bayram, Mehmet, E-mail: dtmehmetbayram@yahoo.com [Karadeniz Technical University, Faculty of Dentistry, Department of Orthodontics, 61080 Trabzon (Turkey); Kayipmaz, Saadettin; Sezgin, Oemer Said [Karadeniz Technical University, Faculty of Dentistry, Department of Oral Radiology, Trabzon (Turkey); Kuecuek, Murat [Karadeniz Technical University, Faculty of Arts and Sciences, Department of Chemistry, Trabzon (Turkey)

    2012-08-15

    Objective: The aim was to determine the accuracy of volumetric analysis of the mandibular condyle using cone-beam computed tomography (CBCT). Materials and methods: Five dry mandibles containing 9 condyles were used. CBCT scans of the mandibles and an impression of each condylar area were taken. The physical volumes of the condyles were calculated as the gold standard using the water displacement technique. After isolating, the condylar volume was sectioned in the sagittal plane, and 0.3 mm thick sections with 0.9 mm intervals were obtained from 3D reconstructions. Using the Cavalieri principle, the volume of each condyle was estimated from the CBCT images by three observers. The accuracy of the CBCT volume measurements and the relation agreements between the results of the three observers were assessed using the Wilcoxon Signed Rank test and Pearson correlation test. The level of statistical significance was set at 0.05. Results: The results of the Pearson correlation showed that there were highly significant positive correlations between the observers' measurements. According to the results of the Wilcoxon Signed Rank test comparing the physical and observers' measurements, there were no statistically significant differences (p > 0.05). Conclusion: The Cavalieri principle, used in conjunction with a planimetry method, is a valid and effective method for volume estimation of the mandibular condyle on CBCT images.

  16. Volumetric analysis of the mandibular condyle using cone beam computed tomography

    International Nuclear Information System (INIS)

    Bayram, Mehmet; Kayipmaz, Saadettin; Sezgin, Ömer Said; Küçük, Murat

    2012-01-01

    Objective: The aim was to determine the accuracy of volumetric analysis of the mandibular condyle using cone-beam computed tomography (CBCT). Materials and methods: Five dry mandibles containing 9 condyles were used. CBCT scans of the mandibles and an impression of each condylar area were taken. The physical volumes of the condyles were calculated as the gold standard using the water displacement technique. After isolating, the condylar volume was sectioned in the sagittal plane, and 0.3 mm thick sections with 0.9 mm intervals were obtained from 3D reconstructions. Using the Cavalieri principle, the volume of each condyle was estimated from the CBCT images by three observers. The accuracy of the CBCT volume measurements and the relation agreements between the results of the three observers were assessed using the Wilcoxon Signed Rank test and Pearson correlation test. The level of statistical significance was set at 0.05. Results: The results of the Pearson correlation showed that there were highly significant positive correlations between the observers’ measurements. According to the results of the Wilcoxon Signed Rank test comparing the physical and observers’ measurements, there were no statistically significant differences (p > 0.05). Conclusion: The Cavalieri principle, used in conjunction with a planimetry method, is a valid and effective method for volume estimation of the mandibular condyle on CBCT images.

  17. Occipital condyle fracture and ligament injury: imaging by CT

    International Nuclear Information System (INIS)

    Bloom, A.I.; Neeman, Z.; Floman, Y.; Gomori, J.; Bar-Ziv, J.

    1996-01-01

    The true incidence of fracture of the occipital condyles is unknown. It may be associated with instability at the craniocervical joint. CT is the modality of choice for the demonstration of these fractures, but its use for imaging of the associated ligament injury has not been reported. In order to demonstrate normal anatomy, occipital condyle fracture and ligament injury, and to estimate the incidence of this lesion, 21 children and young adults with high-energy blunt craniocervical injury were examined prospectively. Thin-slice, axial, contiguous, CT was performed from the base of C2 to above the foramen magnum. Bone and soft tissue windows and coronal, sagittal, and curvilinear 2D reconstructions were performed. Five occipital condyle fractures were identified in four patients (19 %), with demonstration of alar ligament injury in two cases and local hematoma in one. In four, artifacts or rotation precluded assessment of ligaments. In all remaining cases normal bone and ligament anatomy was demonstrated. Fracture of the occipital condyles following craniocervical injury is not uncommon in children and young adults. Normal bone and ligament anatomy and pathology can be safely and clearly demonstrated in seriously injured patients and others using this CT technique. Increased awareness of this entity and a low threshold for performing CT should avoid the potentially serious consequences of a missed diagnosis. (orig.). With 8 figs., 2 tabs

  18. Sequential chimeric medial femoral condyle and anterolateral thigh flow-through flaps for one-stage reconstructions of composite bone and soft tissue defects: Report of three cases.

    Science.gov (United States)

    Henn, Dominic; Abouarab, Mohamed H; Hirche, Christoph; Hernekamp, Jochen F; Schmidt, Volker J; Kneser, Ulrich; Kremer, Thomas

    2017-10-01

    Small recalcitrant non-unions with poor perfusion require reconstruction with vascularized bone flaps. Cases with concomitant large soft tissue defects are especially challenging, since vascularized soft tissue transfer is often indicated and distant microvascular anastomoses may be required. We introduce a sequential chimeric free flap composed of a medial femoral condyle corticoperiosteal flap anastomosed to an anterolateral thigh flow-through flap (MFC-ALT flap) and report its use for reconstruction of small non-unions with concomitant large soft tissue defects in three exemplary patients. Two female and one male patients ages 39-58 years suffered from composite bone and soft tissue defects of the lower extremity and clavicle caused by tumor resection and postoperative radiation resp. infected tibial pilon fracture. The sizes of the soft tissue defects ranged from 15-23 × 4.5-6 cm and the sizes of the bone defects ranged from 1.5-4 × 2-4 cm. Defect reconstructions were performed in all cases with sequential chimeric MFC-ALT flaps with sizes ranging from 2-4 × 1.6-4 cm for the MFC and 21-23 × 7-8 cm for the ALT skin paddles. Functional reconstructions were achieved in all cases resulting in stable unions and soft tissue coverage enabling the patients to bear full weight without assistance on 5-months follow-up. Postoperative course was uneventful and complications were restricted to a small skin necrosis at the suture line in one case. MFC-ALT flaps may be a safe, and effective procedure for one-stage reconstructions of small, irregularly shaped bone defects with concomitant large soft tissue loss or surrounding instable scarring, particularly in cases of recalcitrant non-unions after radiation exposure. © 2017 Wiley Periodicals, Inc.

  19. Development plates for stable internal fixation: Study of mechanical resistance in simulated fractures of the mandibular condyle.

    Science.gov (United States)

    Celegatti Filho, Tóride Sebastião; Rodrigues, Danillo Costa; Lauria, Andrezza; Moreira, Roger William Fernandes; Consani, Simonides

    2015-01-01

    To develop Y-shaped plates with different thicknesses to be used in simulated fractures of the mandibular condyle. Ten plates were developed in Y shape, containing eight holes, and 30 synthetic polyurethane mandible replicas were developed for the study. The load test was performed on an Instron Model 4411 universal testing machine, applying load in the mediolateral and anterior-posterior positions on the head of the condyle. Two-way ANOVA with Tukey testing with a 5% significance level was used. It was observed that when the load was applied in the medial-lateral plate of greater thickness (1.5 mm), it gave the highest strength, while in the anteroposterior direction, the plate with the highest resistance was of the lesser thickness (0.6 mm). A plate with a thickness of 1.5 mm was the one with the highest average value for all displacements. In the anteroposterior direction, the highest values of resistance were seen in the displacement of 15 mm. After comparing the values of the biomechanical testing found in the scientific literature, it is suggested that the use of Y plates are suitable for use in subcondylar fractures within the limitations of the study. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  20. MR assessment of movement and morphologic change in the menisci during knee flexion

    International Nuclear Information System (INIS)

    Kawahara, Y.; Uetani, M.; Fuchi, K.; Eguchi, H.; Hayashi, K.

    1999-01-01

    To examine movement and morphologic alteration in the menisci during knee flexion. Twenty healthy knees were imaged at 0 degrees, 45 degrees, and 90 degrees of passive non-weight-bearing flexion in the sagittal plane with MR. In each meniscus, posterior movement distance during knee flexion and the ratio of anteroposterior (a.p.) diameter at flexion to that at extension were calculated. Each meniscus moved posteriorly during knee flexion. Movement was greater in the anterior horn than in the posterior horn, and greater in the medial meniscus than in the lateral meniscus (p<0.05). The a.p. diameter of each meniscus was reduced at flexion (p<0.05). Knee flexion normally leads to posterior movement and shortening of the a.p. diameter of the menisci, which may be related to the positioning and curvature of femoral condyles at the femorotibial contact point at knee flexion

  1. MR assessment of movement and morphologic change in the menisci during knee flexion

    International Nuclear Information System (INIS)

    Kawahara, Y.; Uetani, M.; Hayashi, K.; Fuchi, K.; Eguchi, H.

    1999-01-01

    Purpose: To examine movement and morphologic alteration in the menisci during knee flexion. Material and Methods: Twenty healthy knees were imaged at 0 , 45 , and 90 of passive non-weight-bearing flexion in the sagittal plane with MR. In each meniscus, posterior movement distance during knee flexion and the ratio of anteroposterior (a.p.) diameter at flexion to that at extension were calculated. Results: Each meniscus moved posteriorly during knee flexion. Movement was greater in the anterior horn than in the posterior horn, and greater in the medial meniscus than in the lateral meniscus (p<0.05). The a.p. diameter of each meniscus was reduced at flexion (p<0.05). Conclusion: Knee flexion normally leads to posterior movement and shortening of the a.p. diameter of the menisci, which may be related to the positioning and curvature of femoral condyles at the femorotibial contact point at knee flexion. (orig.)

  2. Assessment of bone quality in the isolated femoral head for intracapsular fractures of the femoral head. Analysis of bone architecture using micro-CT and pQCT, and comparison with extracapsular fractures

    International Nuclear Information System (INIS)

    Sando, Masaru

    2003-01-01

    Block sections were prepared from the five locations, central portion, superior portion, inferior portion, anterior portion, and posterior portion, of the region around the fracture of the femoral head isolated from 21 patients (16 patients with intracapsular fracture, 5 patients with extracapsular fracture). Cancellous bone microstructure, cortical bone thickness, and bone density were evaluated and analyzed for differences in the mechanism from which intracapsular versus extracapsular fracture and fragility developed. The method of evaluating the bone architecture differed from conventional bone histomorphometry of hard tissues and involved non-invasive micro-CT measurements, while the bone density was measured by peripheral quantitative computed topography (pQCT). The results indicate that in comparison to patients with extracapsular fractures, patients with intracapsular fractures showed significant decreases in the trabecular thickness of superior and posterior portions in the cancellous bone. The cortical bone thickness was significantly decreased in the superior portion. Bone density was significantly decreased in the superior portion, while in the extracapsular fracture group density tended to be lower in the inferior, anterior, and posterior portions, although this was not statistically significant. Although there have been previous studies on the bone quality of the femoral head isolated from intracapsular fracture of the femoral head, most reports are of two-dimensional analysis of coronal sections. As far as we are aware, there have been no previous reports comparing individual locations to extracapsular fractures. In view of the various reports that bone density is lower in the extracapsular fracture compared to the intracapsular fracture, we speculate that extracapsular fracture results from the effects of external forces on decreased bone density, while in the intracapsular fracture type, thinning of the superior portion of the cortical bone creates

  3. A very rare case with neglected hip dislocation coexisted with posterior acetabular lip fracture

    Directory of Open Access Journals (Sweden)

    Samet Karabulut

    2011-06-01

    Full Text Available Neglected hip dislocation is a rare situation among children. The coexistence of acetabulum fracture is less common. The result of treatment depends on the time of diagnosis. Early treatment is mandatory in such cases. Seven years old female brought to our outpatient clinic with the complaints of right hip pain and walking difficulty. Her parents said that she had fallen from a horse one month ago. X-ray and CT showed a posterior dislocation of her right hip and a fracture on her right posterior acetabular lip. We performed an open reduction via posterior approach. Because the hip was unstable we fixed the femoral head to the acetabulum by a Kirshner wire. Pelvipedal cast was applied after the operation for 6 weeks. After 6 months avascular necrosis (AVN developed on her right femoral head, the range of motion (ROM of the hip was restricted and she had minimal pain on her right hip. J Clin Exp Invest 2011;2(2:228-31

  4. [Biomechanical analysis on healing process of sagittal fracture of the mandibular condyle after rigid fixation].

    Science.gov (United States)

    Jing, Jie; Qu, Ai-li; Ding, Xiao-mei; Hei, Yu-na

    2015-04-01

    To analyze the biomechanical healing process on rigid fixation of sagittal fracture of the mandibular condyle (SFMC), and to provide guidelines for surgical treatment. Three-dimensional finite element model (3D-FEAM) of mandible and condyle was established. The right condyle was simulated as SFMC with 0.1 mm space across the condyle length ways. The 3D-FEAM of rigid fixation was established. The biomechanical factors such as stress distribution of condylar surface, displacement around fracture, stress on the plate and stress shielding were calculated during 0, 4, 8 and 12-week after rigid fixation. The maximum equivalent stress of normal condyle was located at the area of middle 1/3 of condylar neck. The maximum equivalent stress at 0-week after fixation was 23 times than that on normal condyle. They were located at the condylar stump and the plate near inferior punctual areas of fracture line. There were little stress on the other areas. The maximum equivalent stress at 4, 8 and 12-week was approximately 6 times than that on normal condyle. They were located at the areas same as the area at 0-week. There were little stress on the other areas at the condyle. The maximum total displacement and maximum total corner were increased 0.57-0.75 mm and 0.01-0.09° respectively during healing process. The maximum equivalent stress at 0-week on the condylar trump was 5-6 times compared with that at 4, 8, and 12-week. The maximum equivalent stress, maximum total displacement and maximum total corner on the fractured fragment were not changed significantly during healing process. The maximum equivalent stress at 0-week on the plate was 7-9 times compared with that at 4, 8, 12-week. The stress of the condyle and stress shielding of the plate may be the reasons of absorbing and rebuilding on the condyle in healing process of SFMC. The biomechanical parameters increase obviously at 4-week after fixation. Elastic intermaxillary traction is necessary to decrease total displacement

  5. ANATOMICAL STUDY OF THE MORPHOMETRY OF THE TIBIAL AND FEMORAL ATTACHMENT SITES OF THE POSTERIOR CRUCIATE LIGAMENT; Estudio anatómico de la morfometría de los sitios de inserción tibial y femoral del ligamento cruzado posterior.

    Directory of Open Access Journals (Sweden)

    Paul Inalegwu Iyaji

    2016-11-01

    Full Text Available , Although later isolated injuries cruciate of the ligament (PCL are managed through non-operative rehabilitation, reconstruction is becoming ITS anatomic increasingly important. This study Provides Information Regarding the position and variability of Its tibial attachment sites, dimensions of the femoral insertions, Between These Comparing males and females, and Between right and left knees. Thirty one cadaveric knees (15 right, 16 left from nine female and seven male cadavers ( mean age 77 years Were Examined. The PCL footprint Which was Identified from the mean length and width of the tibial anterolateral (AL and posteromedial (PM 8.7 and 10.9 mm Were bundles, and 7.3 and 13.44mm respectively. The mean length and width of the tibial footprint in males and females 10.2 and 10.3 mm Were, and 7.7 and 11.4 mm for the AL bundle and 8.2 and 14.2 mm and 12.9 mm and 6.7 for the PM bundle respectively. The mean anatomical position of the AL and 51.0% Were PM bundles and 50.0% of the mediolateral diameter of the tibial plateau. The mean lengths and widths of the PCL femoral attachment Were 9.4 mm and 12.8 for the AL bundle and 7.5 and 11.4 mm for the PM bundle, with the AL bundle attachment being Significantly larger (P = 0.034 in evils. No Difference between right and left knees Were Observed . The data presented here will aid in making decisions to Achieve Appropriate anatomic PCL reconstruction., Although isolated lesions of the posterior cruciate ligament (PCL are Treated by non-operative rehabilitation, anatomical reconstruction've Become increasingly important. This study Provides information on the position and variability of the binding sites of the tibia, the dimensions of the femoral insertions, Comparing them Between the sexes, and Between the right and left knee. They Were Examined thirty-one (15 right and 16 left knees of 9 women and 7 dead bodies of males (mean age 77 years. Brand LCP was Identified from the length and width

  6. Intra-articular pathology associated with isolated posterior cruciate ligament injury on MRI

    Energy Technology Data Exchange (ETDEWEB)

    Ringler, Michael D.; Collins, Mark S.; Howe, B.M. [Mayo Clinic, Department of Radiology, Rochester, MN (United States); Shotts, Ezekiel E. [NEA Baptist Clinic, Jonesboro, AR (United States)

    2016-12-15

    Unlike with anterior cruciate ligament injury, little is known about the prevalence of intra-articular pathology associated with isolated posterior cruciate ligament (PCL) injury in the knee. The objectives of this study were to characterize and identify the frequency of meniscal tears and osteochondral injuries in these patients, and to see if management might be affected. Altogether, 48 knee MRI exams with isolated PCL tears were evaluated for the presence of: grade and location of PCL tear, meniscal tear, articular chondral lesion, bone bruise, and fracture. Comparisons between PCL tear grade and location, as well as mechanism of injury when known, with the presence of various intra-articular pathologies, were made using the chi-square or Fisher's exact test as appropriate. In all, 69 % of isolated PCL tears occur in the midsubstance, 27 % proximally. Meniscal tears were seen in 25 % of knees, involving all segments of both menisci, except for the anterior horn medial meniscus. Altogether, 23 % had focal cartilage lesions, usually affecting the central third medial femoral condyle and medial trochlea, while 12.5 % of knees had fractures, and 48 % demonstrated bone bruises, usually involving the central to anterior tibiofemoral joint. The presence of a fracture (p = 0.0123) and proximal location of PCL tear (p = 0.0016) were both associated with the hyperextension mechanism of injury. There were no statistically significant associations between PCL tear grade and presence of intra-articular abnormality. Potentially treatable meniscal tears and osteochondral injuries are relatively prevalent, and demonstrable on MRI in patients with isolated acute PCL injury of the knee. (orig.)

  7. Bone-femoral component interface gap after sagittal mechanical axis alignment is filled with new bone after cementless total knee arthroplasty.

    Science.gov (United States)

    Kuriyama, Shinichi; Hyakuna, Katsufumi; Inoue, Satoshi; Kawai, Yasutsugu; Tamaki, Yasuyuki; Ito, Hiromu; Matsuda, Shuichi

    2018-05-01

    This study retrospectively evaluated the fate of mismatch between an uncemented femoral component and each femoral cut surface (i.e., wedge-shaped gap) relative to sagittal mechanical alignment in total knee arthroplasty (TKA). Primary TKA was performed on 99 consecutive knees. The femoral components were aligned to the sagittal mechanical axis with CT-based navigation. All patients were assessed with postoperative true lateral radiographs. Bone-side surfaces of the uncemented femoral component were divided into five zones: anterior flange, anterior chamfer, posterior chamfer, posterior part, and distal part, which were defined as zones 1 to 5, respectively. Bone filling of wedge-shaped gaps in each zone was evaluated after 1 year. Femoral anterior notching did not occur. However, wedge-shaped gaps were observed in at least one zone in 23 of 99 knees (23%), most frequently in zone 5 (18%). There were 9 and 7 gaps in zones 1 and 2, respectively. The femoral component showed malpositioning of approximately 3° of flexion in cases with wedge-shaped gaps in zones 2 and/or 5. After one year, 67% (6/9) of zone 1, 100% (7/7) of zone 2, and 94% (17/18) of zone 5 wedge-shaped gaps were filled in with new bone. Femoral alignment relative to sagittal mechanical axis caused wedge-shaped gaps due to unstable anterior bone cutting through hard bone, but the small gaps were not clinically significant and filled in within one year. Sagittal setting of the femoral component should aim for the anatomical axis rather than the mechanical axis. IV.

  8. Static and dynamic analysis of patellofemoral joint arthritis using computed tomography

    International Nuclear Information System (INIS)

    Nagamine, Ryuji; Inoue, Yoshihiro; Nishizawa, Masao; Hirano, Kaoru; Kawasaki, Toshiyuki

    1996-01-01

    Twelve parameters of the knee were evaluated using computed tomography to analyze possible etiological mechanisms leading to patello-femoral arthritis (PF-OA). Sixteen normal knees and 14 knees with PF-OA were tested. CT scans were taken at the level of the femoral epicondyles, the tibial tubercle and the malleoli of the ankle joint at full extension and 30deg of flexion. The slices were superimposed and three parameters; tibial tubercle rotation angle (TT angle), malleolar line rotation angle (ML angle) and tibial tubercle and lateral condyle angle (TT-LC angle) were measured with the central point of the medial and lateral epicondyle line as the fiducial point. Differences in each parameter between full extension and 30deg of flexion were also evaluated as dynamic factors. Three other parameters, lateral condyle rotation angle (LC angle). Lateral and medial condyle angle (LC-MC angle) and lateral condyle and patellar groove angle (LC-S) were also measured to evaluate the anatomical configuration. The position of the tibial tubercle at full extension relative to the femoral condyle was almost the same in both groups. The results, however, demonstrated that, in the PF-OA knee, the tibial tubercle stayed more lateral compared with the normal knee at 30deg of flexion. It is obvious that the tibial tubercle exists laterally in knee flexion and the patella impinges against the lateral femoral condyle in knee flexion which will cause PF-OA. (author)

  9. Static and dynamic analysis of patellofemoral joint arthritis using computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Nagamine, Ryuji; Inoue, Yoshihiro; Nishizawa, Masao; Hirano, Kaoru; Kawasaki, Toshiyuki [JR Kyushu Hospital, Kitakyushu, Fukuoka (Japan)

    1996-09-01

    Twelve parameters of the knee were evaluated using computed tomography to analyze possible etiological mechanisms leading to patello-femoral arthritis (PF-OA). Sixteen normal knees and 14 knees with PF-OA were tested. CT scans were taken at the level of the femoral epicondyles, the tibial tubercle and the malleoli of the ankle joint at full extension and 30deg of flexion. The slices were superimposed and three parameters; tibial tubercle rotation angle (TT angle), malleolar line rotation angle (ML angle) and tibial tubercle and lateral condyle angle (TT-LC angle) were measured with the central point of the medial and lateral epicondyle line as the fiducial point. Differences in each parameter between full extension and 30deg of flexion were also evaluated as dynamic factors. Three other parameters, lateral condyle rotation angle (LC angle). Lateral and medial condyle angle (LC-MC angle) and lateral condyle and patellar groove angle (LC-S) were also measured to evaluate the anatomical configuration. The position of the tibial tubercle at full extension relative to the femoral condyle was almost the same in both groups. The results, however, demonstrated that, in the PF-OA knee, the tibial tubercle stayed more lateral compared with the normal knee at 30deg of flexion. It is obvious that the tibial tubercle exists laterally in knee flexion and the patella impinges against the lateral femoral condyle in knee flexion which will cause PF-OA. (author)

  10. [Evaluation of the clinical results of non-surgical treatment for pediatric sagittal fracture of mandibular condyle].

    Science.gov (United States)

    Liu, Chang-kui; Tan, Xin-ying; Xu, Juan; Liu, Hua-wei; Liu, San-xia; Hu, Min

    2013-11-01

    To investigate the clinical results of occlusal splint in the treatment of sagittal fracture of mandibular condyle (SFMC) in children. Thirty-nine patients (48 condyles)aged 3-8 years with sagittal fracture of mandibular condyle were included in this study. All the patients were treated by occlusal splint.Slight open occlusion was maintained by occlusal splint for 3-6 months. Clinical and radiological examination was performed six mouths and every year after treatment. Good mandibular function was observed in 39 patients. Maximal mouth opening over 35 mm was achieved at 6 months. But 11 of the 39 patients presented with deviation on mouth opening at 6 months. The radiology showed an complete remodeling in 32 condyles (28 patients) and partial remodeling in 16 condyles (11 patients). Poor remodelling was not observed in any patients. Good clinical results can be obtained by using occlusal splint in the treatment of pediatric sagittal fracture of mandibular condyle.

  11. Occipital condyle metastasis: an unusual clinical presentation in carcinoma of the lung

    International Nuclear Information System (INIS)

    Pasricha, R.; Mohanty, P.P.; Madan, R.C.; Datta, N.R.

    2005-01-01

    Metastases to the base of the skull and occipital condyle metastases are uncommon as a presenting feature of malignancy. Lung cancers are known for their metastatic potential to various sites, some of which could be the only presenting feature of the underlying malignancy. However, occipital condyle metastases are very rare and to the best of our knowledge, metastases to this site from carcinoma of the lung, as a presenting feature, have never been reported in the literature. The present case report describes the clinical, radiological and the therapeutic interventions that were undertaken in a patient presenting with lung cancer who had solely the features of occipital condyle metastasis

  12. Normal Development and Measurements of the Occipital Condyle-C1 Interval in Children and Young Adults.

    Science.gov (United States)

    Smith, P; Linscott, L L; Vadivelu, S; Zhang, B; Leach, J L

    2016-05-01

    Widening of the occipital condyle-C1 interval is the most specific and sensitive means of detecting atlanto-occipital dislocation. Recent studies attempting to define normal measurements of the condyle-C1 interval in children have varied substantially. This study was performed to test the null hypothesis that condyle-C1 interval morphology and joint measurements do not change as a function of age. Imaging review of subjects undergoing CT of the upper cervical spine for reasons unrelated to trauma or developmental abnormality was performed. Four equidistant measurements were obtained for each bilateral condyle-C1 interval on sagittal and coronal images. The cohort was divided into 7 age groups to calculate the mean, SD, and 95% CIs for the average condyle-C1 interval in both planes. The prevalence of a medial occipital condyle notch was calculated. Two hundred forty-eight joints were measured in 124 subjects with an age range of 2 days to 22 years. The condyle-C1 interval varies substantially by age. Average coronal measurements are larger and more variable than sagittal measurements. The medial occipital condyle notch is most prevalent from 1 to 12 years and is uncommon in older adolescents and young adults. The condyle-C1 interval increases during the first several years of life, is largest in the 2- to 4-year age range, and then decreases through late childhood and adolescence. A single threshold value to detect atlanto-occipital dissociation may not be sensitive and specific for all age groups. Application of this normative data to documented cases of atlanto-occipital injury is needed to determine clinical utility. © 2016 by American Journal of Neuroradiology.

  13. T1rho mapping of entire femoral cartilage using depth- and angle-dependent analysis

    International Nuclear Information System (INIS)

    Nozaki, Taiki; Kaneko, Yasuhito; Yu, Hon J.; Yoshioka, Hiroshi; Kaneshiro, Kayleigh; Schwarzkopf, Ran; Hara, Takeshi

    2016-01-01

    To create and evaluate normalized T1rho profiles of the entire femoral cartilage in healthy subjects with three-dimensional (3D) angle- and depth-dependent analysis. T1rho images of the knee from 20 healthy volunteers were acquired on a 3.0-T unit. Cartilage segmentation of the entire femur was performed slice-by-slice by a board-certified radiologist. The T1rho depth/angle-dependent profile was investigated by partitioning cartilage into superficial and deep layers, and angular segmentation in increments of 4 over the length of segmented cartilage. Average T1rho values were calculated with normalized T1rho profiles. Surface maps and 3D graphs were created. T1rho profiles have regional and depth variations, with no significant magic angle effect. Average T1rho values in the superficial layer of the femoral cartilage were higher than those in the deep layer in most locations (p < 0.05). T1rho values in the deep layer of the weight-bearing portions of the medial and lateral condyles were lower than those of the corresponding non-weight-bearing portions (p < 0.05). Surface maps and 3D graphs demonstrated that cartilage T1rho values were not homogeneous over the entire femur. Normalized T1rho profiles from the entire femoral cartilage will be useful for diagnosing local or early T1rho abnormalities and osteoarthritis in clinical applications. (orig.)

  14. T1rho mapping of entire femoral cartilage using depth- and angle-dependent analysis

    Energy Technology Data Exchange (ETDEWEB)

    Nozaki, Taiki; Kaneko, Yasuhito; Yu, Hon J.; Yoshioka, Hiroshi [University of California Irvine, Department of Radiological Sciences, Orange, CA (United States); Kaneshiro, Kayleigh [University of California Irvine, School of Medicine, Irvine, CA (United States); Schwarzkopf, Ran [University of California Irvine, Department of Orthopedic Surgery, Irvine, CA (United States); Hara, Takeshi [Gifu University Graduate School of Medicine, Department of Intelligent Image Information, Division of Regeneration and Advanced Medical Sciences, Gifu (Japan)

    2016-06-15

    To create and evaluate normalized T1rho profiles of the entire femoral cartilage in healthy subjects with three-dimensional (3D) angle- and depth-dependent analysis. T1rho images of the knee from 20 healthy volunteers were acquired on a 3.0-T unit. Cartilage segmentation of the entire femur was performed slice-by-slice by a board-certified radiologist. The T1rho depth/angle-dependent profile was investigated by partitioning cartilage into superficial and deep layers, and angular segmentation in increments of 4 over the length of segmented cartilage. Average T1rho values were calculated with normalized T1rho profiles. Surface maps and 3D graphs were created. T1rho profiles have regional and depth variations, with no significant magic angle effect. Average T1rho values in the superficial layer of the femoral cartilage were higher than those in the deep layer in most locations (p < 0.05). T1rho values in the deep layer of the weight-bearing portions of the medial and lateral condyles were lower than those of the corresponding non-weight-bearing portions (p < 0.05). Surface maps and 3D graphs demonstrated that cartilage T1rho values were not homogeneous over the entire femur. Normalized T1rho profiles from the entire femoral cartilage will be useful for diagnosing local or early T1rho abnormalities and osteoarthritis in clinical applications. (orig.)

  15. Function impairment and pain after closed treatment of fractures of the mandibular condyle

    NARCIS (Netherlands)

    Dijkstra, P.U.; Stegenga, B.; de Bont, L.G.; Bos, R.R.

    Background: To determine the prognosis of fractures of the mandibular condyle after closed treatment. Methods: Patients (n = 144) with a fracture of the mandibular condyle, all treated closed, were included in the study. Fracture types and position of the fracture parts were determined on

  16. Prevention of excessive postoperative sliding of the short femoral nail in femoral trochanteric fractures.

    Science.gov (United States)

    Ito, Juji; Takakubo, Yuya; Sasaki, Kan; Sasaki, Junya; Owashi, Kazuya; Takagi, Michiaki

    2015-05-01

    Lag screw cut-out is one of the major postoperative complications on femoral trochanteric fractures. However, precise analyses of excessive sliding and lag screw cut-out were limited. The purpose of this study was to investigate the factors that induce this unfavorable event. From April 2010 to April 2013, 226 patients were operated in our institute using a short femoral nail. Among them, 177 patients (29 males and 148 females) with a mean age of 84 years (60-97 years), who were followed up >3 months, were included in this study. The postoperative sliding distance, fracture type (AO/OTA classification), tip-apex distance (TAD), reduction pattern in the postoperative X-ray (antero-posterior and lateral views), bone quality (canal flare and cortical indices), walking ability at the time of pre-injury and final follow-up, and complications were investigated retrospectively. The mean sliding distance was 3.7 mm, and one cut-out case (0.6 %) was observed. The sliding distance of the AO/OTA 31-A2 fractures was significantly longer than that of the A1 fractures (p fractures, an accurate reduction in the lateral view at surgery is important, particularly in unstable fractures.

  17. [Clinical factors and findings in knee arthroscopy of patients with knee arthrosis candidates for conversion to total replacement].

    Science.gov (United States)

    Figueroa, D; Calvo, R; Villalón, I; Tuca, M J; Vaisman, A; Valdés, M

    2013-01-01

    To identify those clinical characteristic and arthroscopic findings in patients with knee arthrosis that are associated with worsening of the disease and subsequent total knee arthroplasty (TKA). A retrospective, descriptive study was conducted on 78 consecutive patients (88 knees) who underwent knee arthroscopy for arthrosis. The study included 44 women and 34 men, with a mean age of 58.9 years (range: 37-78 years). After a mean follow-up of 50.4 months (range: 12-96 months), those patients who progressed towards TKA were identified. A logistic regression model was applied to recognise the factors associated with deterioration of the arthrosis, with consequent progression towards a TKA. Twenty-four out of the 88 knees progressed towards a TKA (27.3%) within a mean time of 13.5 months after arthroscopy (range: 13-29 months). The clinical characteristics that showed a significant association with poor progression of the arthrosis were: female gender (0.02) and Ahlbäck 2 (P=.04). Arthroscopic finding that proved significant correlation with worsening of the arthrosis towards TKA were: meniscal tears of the posterior horn (P=.02), meniscectomies above 60% (P=.03), and 2nd degree chondral lesions in loading areas of the medial femoral condyle (P=.02). The variables associated with a greater chance of progressing towards a TKA after a knee arthroscopy due to arthrosis in this study were, female gender, grade 2 radiographic arthrosis, posterior horn meniscal lesions, meniscectomies over 60%, and chondral lesions in loading area of the medial femoral condyle. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  18. Computational Modelling of Patella Femoral Kinematics During Gait Cycle and Experimental Validation

    Science.gov (United States)

    Maiti, Raman

    2016-06-01

    The effect of loading and boundary conditions on patellar mechanics is significant due to the complications arising in patella femoral joints during total knee replacements. To understand the patellar mechanics with respect to loading and motion, a computational model representing the patella femoral joint was developed and validated against experimental results. The computational model was created in IDEAS NX and simulated in MSC ADAMS/VIEW software. The results obtained in the form of internal external rotations and anterior posterior displacements for a new and experimentally simulated specimen for patella femoral joint under standard gait condition were compared with experimental measurements performed on the Leeds ProSim knee simulator. A good overall agreement between the computational prediction and the experimental data was obtained for patella femoral kinematics. Good agreement between the model and the past studies was observed when the ligament load was removed and the medial lateral displacement was constrained. The model is sensitive to ±5 % change in kinematics, frictional, force and stiffness coefficients and insensitive to time step.

  19. Does increased femoral antetorsion predispose to cartilage lesions of the patellofemoral joint?

    Science.gov (United States)

    Oppermann, Johannes; Bredow, Jan; Wissusek, Boris; Spies, Christian Karl; Boese, Christoph Kolja; Chang, Shi-Min; Eysel, Peer; Dargel, Jens

    2017-09-01

    The purpose of this study was to investigate whether there was a relationship between femoral neck antetorsion and the presence and pattern of osteoarthritis of the patellofemoral joint. It was hypothesized that an increased femoral neck antetorsion (1) correlates with osteoarthritic changes of the lateral facet of the patellofemoral joint and (2) correlates with an increased lateral trochlear height and a decreased sulcus angle. Seventy-eight formalin-embedded cadaveric lower extremities from thirty-nine subjects with a median age of 74 years (range 60-88) were used. Surrounding soft tissues of the lower limb were removed. The femoral neck antetorsion was measured and referenced to the transepicondylar axis and the posterior condylar line. The height of the medial and lateral facet of the trochlea and the sulcus angle was measured. The location and the degree of patellofemoral cartilage degeneration were recorded. A Pearson's correlation analysis was performed to correlate the femoral neck antetorsion with the measured knee parameters. No significant correlation could be found between the femoral antetorsion and cartilage degeneration of the lateral patellofemoral joint (n.s.), the height of the lateral trochlea (n.s.) and the sulcus angle (n.s.). This study could not document that the femoral neck antetorsion and subsequent internal rotation of the distal femur correlated with the degree of degeneration of the lateral facet of the patellofemoral joint. Clinically, femoral internal rotation may play a minor role in the development of lateral patellofemoral joint degeneration.

  20. Femoral anteversion assessment: Comparison of physical examination, gait analysis, and EOS biplanar radiography.

    Science.gov (United States)

    Westberry, David E; Wack, Linda I; Davis, Roy B; Hardin, James W

    2018-05-01

    Multiple measurement methods are available to assess transverse plane alignment of the lower extremity. This study was performed to determine the extent of correlation between femoral anteversion assessment using simultaneous biplanar radiographs and three-dimensional modeling (EOS imaging), clinical hip rotation by physical examination, and dynamic hip rotation assessed by gait analysis. Seventy-seven patients with cerebral palsy (GMFCS Level I and II) and 33 neurologically typical children with torsional abnormalities completed a comprehensive gait analysis with same day biplanar anterior-posterior and lateral radiographs and three-dimensional transverse plane assessment of femoral anteversion. Correlations were determined between physical exam of hip rotation, EOS imaging of femoral anteversion, and transverse plane hip kinematics for this retrospective review study. Linear regression analysis revealed a weak relationship between physical examination measures of hip rotation and biplanar radiographic assessment of femoral anteversion. Similarly, poor correlation was found between clinical evaluation of femoral anteversion and motion assessment of dynamic hip rotation. Correlations were better in neurologically typical children with torsional abnormalities compared to children with gait dysfunction secondary to cerebral palsy. Dynamic hip rotation cannot be predicted by physical examination measures of hip range of motion or from three-dimensional assessment of femoral anteversion derived from biplanar radiographs. Copyright © 2018 Elsevier B.V. All rights reserved.

  1. Traumatic posterior dislocation of the hip in a 3-year-old child.

    LENUS (Irish Health Repository)

    Forde, James C

    2012-02-01

    We report the case of a traumatic posterior dislocation of the hip in a 3-year-old boy. After a fall in the garden, the boy was brought to our emergency department where an x-ray confirmed a posterior dislocation of his right hip. A successful prompt reduction was performed in the operating room under general anesthesia. This uncommon injury represents an orthopedic emergency and requires prompt reduction to lessen the risk of complications including avascular necrosis of the femoral head.

  2. Transtrochanteric rotational osteotomy for avascular necrosis of the femoral head after unstable slipped capital femoral epiphysis: 10-year clinical results.

    Science.gov (United States)

    Nakashima, Yasuharu; Yamamoto, Takuaki; Fukushi, Jun-Ichi; Motomura, Goro; Hamai, Satoshi; Kohno, Yusuke; Iwamoto, Yukihide

    2016-11-01

    Avascular necrosis of the femoral head (AVN) is the most serious complication after unstable slipped capital femoral epiphysis (SCFE), and is often unsalvageable. We report a minimum 10 years of clinical results for transtrochanteric rotational osteotomy of the femoral head (TRO) for AVN. This study included 7 patients (7 hips) with a mean age at surgery of 13.3 years, and the follow-up period was 15.8 years. All patients had prior treatment via closed reduction and pinning of the unstable SCFE, and showed severely collapsed femoral heads. The direction of rotation was anterior in 3 hips and posterior in 4. The Merle d'Aubigné-Postel score (MDPS) was used for clinical assessment, and joint degeneration was assessed with the Kellgren and Lawrence classification (KL-grade). The spherical intact area of the femoral head was moved to the weight-bearing portion, and subluxation was corrected via rotation combined with intentional varus positioning. The mean MDPS improved from 10.3 points to 15.6 points at 5 years, and it was maintained at 15.0 points by 10 years; 3 hips were excellent, 1 was good, 2 were fair, and 1 showed poor outcomes. No patient experienced re-collapse after TRO or required conversion to hip replacement or arthrodesis. After 10 years, degenerative changes became evident over time, and 2 hips progressed to KL-4 with a decreased MDPS. Although some joint degeneration is inevitable in the long-term, TRO is an effective salvage procedure for treating AVN after unstable SCFE. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  3. Superolateral dislocation of an intact mandibular condyle into the temporal fossa: case report and literature review.

    Science.gov (United States)

    Sharma, Divashree; Khasgiwala, Ankit; Maheshwari, Bharat; Singh, Charanpreet; Shakya, Neelam

    2017-02-01

    Temporomandibular joint dislocation refers to the dislodgement of mandibular condyle from the glenoid fossa. Anterior and anteromedial dislocations of the mandibular condyle are frequently reported in the literature, but superolateral dislocation is a rare presentation. This report outlines a case of superolateral dislocation of an intact mandibular condyle that occurred in conjunction with an ipsilateral mandibular parasymphysis fracture. A review of the clinical features of superolateral dislocation of the mandibular condyle and the possible techniques of its reduction ranging from the most conservative means to extensive surgical interventions is presented. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  4. MRI of the temporo-mandibular joint: which sequence is best suited to assess the cortical bone of the mandibular condyle? A cadaveric study using micro-CT as the standard of reference.

    Science.gov (United States)

    Karlo, Christoph A; Patcas, Raphael; Kau, Thomas; Watzal, Helmut; Signorelli, Luca; Müller, Lukas; Ullrich, Oliver; Luder, Hans-Ulrich; Kellenberger, Christian J

    2012-07-01

    To determine the best suited sagittal MRI sequence out of a standard temporo-mandibular joint (TMJ) imaging protocol for the assessment of the cortical bone of the mandibular condyles of cadaveric specimens using micro-CT as the standard of reference. Sixteen TMJs in 8 human cadaveric heads (mean age, 81 years) were examined by MRI. Upon all sagittal sequences, two observers measured the cortical bone thickness (CBT) of the anterior, superior and posterior portions of the mandibular condyles (i.e. objective analysis), and assessed for the presence of cortical bone thinning, erosions or surface irregularities as well as subcortical bone cysts and anterior osteophytes (i.e. subjective analysis). Micro-CT of the condyles was performed to serve as the standard of reference for statistical analysis. Inter-observer agreements for objective (r = 0.83-0.99, P < 0.01) and subjective (κ = 0.67-0.88) analyses were very good. Mean CBT measurements were most accurate, and cortical bone thinning, erosions, surface irregularities and subcortical bone cysts were best depicted on the 3D fast spoiled gradient echo recalled sequence (3D FSPGR). The most reliable MRI sequence to assess the cortical bone of the mandibular condyles on sagittal imaging planes is the 3D FSPGR sequence. MRI may be used to assess the cortical bone of the TMJ. • Depiction of cortical bone is best on 3D FSPGR sequences. • MRI can assess treatment response in patients with TMJ abnormalities.

  5. Dislocation of total hip replacement in patients with fractures of the femoral neck.

    Science.gov (United States)

    Enocson, Anders; Hedbeck, Carl-Johan; Tidermark, Jan; Pettersson, Hans; Ponzer, Sari; Lapidus, Lasse J

    2009-04-01

    Total hip replacement is increasingly used in active, relatively healthy elderly patients with fractures of the femoral neck. Dislocation of the prosthesis is a severe complication, and there is still controversy regarding the optimal surgical approach and its influence on stability. We analyzed factors influencing the stability of the total hip replacement, paying special attention to the surgical approach. We included 713 consecutive hips in a series of 698 patients (573 females) who had undergone a primary total hip replacement (n = 311) for a non-pathological, displaced femoral neck fracture (Garden III or IV) or a secondary total hip replacement (n = 402) due to a fracture-healing complication after a femoral neck fracture. We used Cox regression to evaluate factors associated with prosthetic dislocation after the operation. Age, sex, indication for surgery, the surgeon's experience, femoral head size, and surgical approach were tested as independent factors in the model. The overall dislocation rate was 6%. The anterolateral surgical approach was associated with a lower risk of dislocation than the posterolateral approach with or without posterior repair (2%, 12%, and 14%, respectively (p replacement in patients with femoral neck fractures.

  6. Elderly patients with maxillofacial trauma: study of mandibular condyle fractures.

    Science.gov (United States)

    Nogami, Shinnosuke; Yamauchi, Kensuke; Yamashita, Toshio; Kataoka, Yoshihiro; Hirayama, Bunichi; Tanaka, Kenko; Takahashi, Tetsu

    2015-02-01

    The aim of this study was to investigate the trends and characteristic features of mandibular condyle fractures in elderly patients in terms of etiology, patterns, and treatment modalities. Records of 201 patients aged 65 years and older, who were treated for maxillofacial fractures at the Department of Oral and Maxillofacial Surgery, Kyushu Dental University, and Tohoku University from January 2002 to December 2013, were retrospectively analyzed. Patient records and radiographs were examined, with the following information: relevant medical history, cause of fracture, the presence and state of premolars and molars in the maxilla and mandible, number and location of mandible fracture, and method of treatment. As for the state of premolars and molars, premolars or molars in the mandible in contact with the maxilla were regarded as contacted. A fall was responsible for the majority of the fractures (173/201). With condyle fractures, there was a significant difference between the contacted and non-contacted group in regard to incidence. Furthermore, there was a significantly greater number of cases with symphysis and condyle combination fractures in the non-contacted group (70.9%) than in the contacted group (51.9%). As for the method of treatment, arthrocentesis was the most commonly employed. The present findings suggest that contacted molars in the maxilla and mandible have an influence on condyle fractures in elderly individuals. © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  7. Posterior crossbite and temporomandibular disorders (TMDs): need for orthodontic treatment?

    Science.gov (United States)

    Thilander, Birgit; Bjerklin, Krister

    2012-12-01

    The aim of this work was to update the bibliography regarding the concept of 'temporomandibular disorder (TMD)' and 'posterior crossbite' and try to find out if there is any association between some special signs/symptoms of TMD and type of posterior crossbite. A literature search from 1970 to 2009, due to specified criterion, resulted in 14 publications that were found to be relevant for the present systematic review. An association between TMD and posterior crossbite (Yes-group) was reported as often as absence of such a relationship (No-group). The samples in the two groups showed similarities as well as differences with respect to number, gender, and age. Most articles reported only on 'presence' or 'absence' of crossbite and only few on type of crossbite opposite to a thorough account of clinical signs and symptoms of TMD. This review seems, however, to state that a functional posterior crossbite (mandibular guidance with midline deviation) is associated with headache, temporomandibular joint and muscular pain, and clicking. As evident from the discussion, such type needs orthodontic treatment to rehabilitate the asymmetric muscular activity between the crossbite and non-crossbite sides and the changed condyle/temporal relationship caused by mandibular deviation. Whether this treatment also will avoid future TMD problems can be answered only after clinical follow-up studies have been performed.

  8. New thoughts on the origin of Pellegrini-Stieda: the association of PCL injury and medial femoral epicondylar periosteal stripping

    International Nuclear Information System (INIS)

    McAnally, James L.; Southam, Samuel L.; Mlady, Gary W.

    2009-01-01

    For the past 100 years, Pellegrini-Stieda disease has been described as calcification and ossification within the tibial collateral ligament, although these typical radiographic findings are often located more superior than the most proximal extent of the ligament. In this article, we demonstrate four magnetic resonance imaging cases of knee trauma with complete posterior cruciate ligament tear or avulsion, each demonstrating that injury to the medial collateral ligamentous complex can involve significant stripping of the tissue proximal to the medial epicondyle. Classic radiographic findings of Pellegrini-Stieda calcifications can be caused by stripping of the femoral periosteum proximal to the femoral attachment of the tibial collateral ligament, which appears to be associated with a complete posterior cruciate ligament injury. (orig.)

  9. Assessment of simulated mandibular condyle bone lesions by cone beam computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Marques, Alexandre Perez; Perrella, Andreia; Arita, Emiko Saito; Pereira, Marlene Fenyo Soeiro de Matos; Cavalcanti, Marcelo de Gusmao Paraiso, E-mail: alexperez34@gmail.co [Universidade de Sao Paulo (USP), SP (Brazil). Faculdade de Odontologia. Dept. de Estomatologia

    2010-10-15

    There are many limitations to image acquisition, using conventional radiography, of the temporomandibular joint (TMJ) region. The Computed Tomography (CT) scan is a better option, due to its higher accuracy, for purposes of diagnosis, surgical planning and treatment of bone injuries. The aim of the present study was to analyze two protocols of cone beam computed tomography for the evaluation of simulated mandibular condyle bone lesions. Spherical lesions were simulated in 30 dry mandibular condyles, using dentist drills and drill bits sizes 1, 3 and 6. Each of the mandibular condyles was submitted to cone beam computed tomography (CBCT) using two protocols: axial, coronal and sagittal multiplanar reconstruction (MPR); and sagittal plus coronal slices throughout the longitudinal axis of the mandibular condyles. For these protocols, 2 observers analyzed the CBCT images independently, regarding the presence or not of injuries. Only one of the observers, however, performed on 2 different occasions. The results were compared to the gold standard, evaluating the percentage of agreement, degree of accuracy of CBCT protocols and observers' examination. The z test was used for the statistical analysis. The results showed there were no statistically significant differences between the 2 protocols. There was greater difficulty in the assessment of small-size simulated lesions (drill no.1). From the results of this study, it can be concluded that CBCT is an accurate tool for analyzing mandibular condyle bone lesions, with the MPR protocol showing slightly better results than the sagittal plus coronal slices throughout the longitudinal axis. (author)

  10. Radiographic cup position following posterior and lateral approach to total hip arthroplasty. An explorative randomized controlled trial

    DEFF Research Database (Denmark)

    Kruse, Christine; Rosenlund, Signe; Broeng, Leif

    2018-01-01

    The two most common surgical approaches to total hip arthroplasty are the posterior approach and lateral approach. The surgical approach may influence cup positioning and restoration of the offset, which may affect the biomechanical properties of the hip joint. The primary aim was to compare cup...... arthroplasty using posterior approach or lateral approach. Postoperative radiographs from 38 patients in each group were included in this study for measurement of cup anteversion and inclination. Femoral offset, cup offset, total offset, abductor moment arm and leg length discrepancy were measured...... approach group had a larger mean femoral offset of 4.3mm (95% CI, -7.4 to -1.3, p = 0.006), mean total offset of 6.3mm (95% CI, -9.6 to -3; pcup anteversion but less...

  11. Interpretation of mandibular condyle fractures using 2D- and 3D-computed tomography

    Directory of Open Access Journals (Sweden)

    Costa e Silva Adriana Paula de Andrade da

    2003-01-01

    Full Text Available Computed tomography (CT has been increasingly used in the examination of patients with craniofacial trauma. This technique is useful in the examination of the temporomandibular joint and allows the diagnosis of fractures of the mandibular condyle. Aiming to verify whether the three-dimensional reconstructed images from CT (3D-CT produce more effective visual information than the two-dimensional (2D-CT ones, we evaluated 2D-CT and 3D-CT examinations of 18 patients with mandibular condyle fractures. We observed that 2D-CT and 3D-CT reconstructed images produced similar information for the diagnosis of fractures of the mandibular condyle, although the 3D-CT allowed a better visualization of the position and displacement of bone fragments, as well as the comminution of fractures. These results, together with the possibility of refining and manipulating perspectives in 3D images, reinforce the importance of its use in the surgical planning and evaluation of treatment. We concluded that 3D-CT presented supplementary information for a more effective diagnosis of mandibular condyle fractures.

  12. Relationship between mandibular condyle and angle fractures and the presence of mandibular third molars.

    Science.gov (United States)

    Mah, Deuk-Hyun; Kim, Su-Gwan; Moon, Seong-Yong; Oh, Ji-Su; You, Jae-Seek

    2015-02-01

    We retrospectively evaluated the impact of mandibular third molars on the occurrence of angle and condyle fractures. This was a retrospective investigation using patient records and radiographs. The sample set consisted of 440 patients with mandibular fractures. Eruption space, depth and angulation of the third molar were measured. Of the 144 angle fracture patients, 130 patients had third molars and 14 patients did not. The ratio of angle fractures when a third molar was present (1.26 : 1) was greater than when no third molar was present (0.19 : 1; odds ratio, 6.58; Pcondyle fractures patients, the third molar was present in 84 patients and absent in 57 patients. The ratio of condyle fractures when a third molar was present (0.56 : 1) was lower than when no third molar was present (1.90 : 1; odds ratio, 0.30; Pfractures with third molars and the ratio of condyle fractures without a third molar were statistically significant. The occurrence of angle and condyle fractures was more affected by the continuity of the cortical bone at the angle than by the depth of a third molar. These results demonstrate that a third molar can be a determining factor in angle and condyle fractures.

  13. Missed posterior dislocation of the hip in a head-injured patient with ...

    African Journals Online (AJOL)

    Background: Head injury increases the risk of missed diagnosis by making patient-derived history impossible. The risk of missing a posterior dislocation of the hip in a head-injured patient is aggravated when an ipsilateral femoral shaft fracture co-exists. Adequate radiological evaluation of bone and joints is therefore of ...

  14. Disadvantages and advantages of transtibial technique for creating the anterior cruciate ligament femoral socket.

    Science.gov (United States)

    Robin, Brett N; Lubowitz, James H

    2014-10-01

    Anterior cruciate ligament (ACL) femoral socket techniques have distinct advantages and disadvantages when considering the following techniques: transtibial, anteromedial portal, outside-in, and outside-in retroconstruction. There is no one perfect technique and we have an incomplete understanding of anatomical, biomechanical, isometry, stability, and clinical outcomes. Our primary focus is transtibial technique for creating the ACL femoral socket. Advantages include less invasive, isometric graft placement, stable Lachman exam, and minimal graft impingement with the tunnel and notch. Disadvantages include nonanatomic vertical graft placement that can cause rotational instability and positive pivot shift, interference screw divergence, graft-tunnel length mismatch, femoral socket constraint, posterior cruciate ligament impingement, and a short, oblique tibial tunnel that may undermine the medial plateau in an attempt to achieve anatomic ACL reconstruction. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  15. Topographical Variation of Human Femoral Articular Cartilage Thickness, T1rho and T2 Relaxation Times Is Related to Local Loading during Walking.

    Science.gov (United States)

    Van Rossom, Sam; Wesseling, Mariska; Van Assche, Dieter; Jonkers, Ilse

    2018-01-01

    Objective Early detection of degenerative changes in the cartilage matrix composition is essential for evaluating early interventions that slow down osteoarthritis (OA) initiation. T1rho and T2 relaxation times were found to be effective for detecting early changes in proteoglycan and collagen content. To use these magnetic resonance imaging (MRI) methods, it is important to document the topographical variation in cartilage thickness, T1rho and T2 relaxation times in a healthy population. As OA is partially mechanically driven, the relation between these MRI-based parameters and localized mechanical loading during walking was investigated. Design MR images were acquired in 14 healthy adults and cartilage thickness and T1rho and T2 relaxation times were determined. Experimental gait data was collected and processed using musculoskeletal modeling to identify weight-bearing zones and estimate the contact force impulse during gait. Variation of the cartilage properties (i.e., thickness, T1rho, and T2) over the femoral cartilage was analyzed and compared between the weight-bearing and non-weight-bearing zone of the medial and lateral condyle as well as the trochlea. Results Medial condyle cartilage thickness was correlated to the contact force impulse ( r = 0.78). Lower T1rho, indicating increased proteoglycan content, was found in the medial weight-bearing zone. T2 was higher in all weight-bearing zones compared with the non-weight-bearing zones, indicating lower relative collagen content. Conclusions The current results suggest that medial condyle cartilage is adapted as a long-term protective response to localized loading during a frequently performed task and that the weight-bearing zone of the medial condyle has superior weight bearing capacities compared with the non-weight-bearing zones.

  16. Editorial Commentary: The All-Epiphyseal Anterior Cruciate Ligament Distal Femoral Approach: Sockets or Tunnels?

    Science.gov (United States)

    Cordasco, Frank A

    2018-05-01

    I believe that the distal femoral approach for anterior cruciate ligament reconstruction in the skeletally immature athlete with 3 to 6 years of remaining growth is best performed with an all-inside, all-epiphyseal technique using sockets rather than an outside-in approach creating tunnels. A shorter socket rather than a longer tunnel exposes a smaller surface area of the lateral distal femoral physis to potential compromise and resultant valgus malalignment. In addition, exiting the lateral femoral aspect of the epiphysis with a full-diameter tunnel as compared with a smaller diameter drill hole used to prepare a socket places the posterior articular cartilage, the lateral collateral ligament and anterolateral ligament footprints, and the popliteus tendon insertion at risk. My preference for sockets is also related to my belief that they provide a superior biologic milieu for graft incorporation compared with a full-length tunnel with the attendant violation of the lateral femoral cortex of the epiphysis. Copyright © 2018 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  17. The biological performance of injectable calcium phosphate/PLGA cement in osteoporotic rats

    International Nuclear Information System (INIS)

    Van de Watering, Floor C J; Cuijpers, Vincent M; Jansen, John A; Van den Beucken, Jeroen J J P; Laverman, Peter; Gotthardt, Martin; Boerman, Otto C; Bronkhorst, Ewald M

    2013-01-01

    Calcium phosphate cements (CPCs) including poly(D,L-lactic-co-glycolic) acid (PLGA) microparticles are promising candidates for bone regenerative applications. Previous studies with CPC/PLGA demonstrated that the material is non-toxic, biocompatible and osteoconductive. However, the outcome of these studies was based on healthy individuals and consequently does not provide information on bone substitute material performance in a compromised situation, such as osteoporosis. Therefore, this study comparatively evaluated the performance of injectable CPC/PLGA in healthy (SHAM) and osteoporotic rats (OVX) using a rat femoral condyle defect with implantation periods of 4 and 12 weeks. It was hypothesized that in OVX rats the degradation of CPC/PLGA would increase due to a higher osteoclastic activity present in osteoporotic animals and that the obtained space would be rapidly filled with newly formed bone. The results revealed an accelerated degradation of the used CPC/PLGA in osteoporotic animals, but bone formation was less compared to that in healthy animals at 4 and 12 weeks after implantation. In addition, after 4 weeks, the amount of newly formed bone under osteoporotic conditions was less in the femoral condyle defect compared to that present in a non-defect, osteoporotic control femoral condyle, but equal after 12 weeks. On the other hand, in healthy animals, the amount of newly formed bone in the femoral condyle defect was equal to that present in a non-defect control femoral condyle at 4 weeks, while higher after 12 weeks. This indicates that bone regeneration at a defect site under osteoporotic conditions is slower, but can reach native amounts after longer time periods. Consequently, bone regenerative treatments under osteoporotic conditions seem to require additional empowerment of bone substitute materials. (paper)

  18. Correlation of intra-articular osseous measurements with posterior cruciate ligament length on MRI scans.

    LENUS (Irish Health Repository)

    Orakzai, S H

    2010-01-01

    Six patients with a clinical diagnosis of chronic posterior cruciate ligament (PCL) rupture, based on a positive posterior drawer test, had a normal appearance of the PCL on an MRI scan. It is postulated that the PCL had been ruptured but healed in a lengthened state. 12 volunteers with no history of knee trauma underwent an MRI scan of the knee. In this control group (n = 12), there was a close correlation between the lateral femoral condylar width in the sagittal plane and the PCL length, with a ratio of 2:1 (95% confidence interval (CI) = 1.817-2.095). In the clinically abnormal group (n = 6), the ratio was 1.49:1 (95% CI = 1.206-1.782) (p< 0.0005). In conclusion, the ratio of the lateral femoral condylar width in the sagittal plane to the PCL length is a useful index for diagnosing PCL attenuation and lengthening in the presence of a normal morphological MR appearance.

  19. Radiological aspects on the course of development of porcine epiphyseal osteochondrosis (OCD) from 42 up to 147 days of age

    International Nuclear Information System (INIS)

    Bittegeko, S.B.P.; Arnbjerg, J.

    1994-01-01

    The articular-epiphyseal (A-E) cartilage complex of the distal humeral and femoral epiphyseal condyles of eight intact pigs (4 male & 4 female) of the same age were radiologically examined every 3 weeks, beginning at 42 days up to 147 days of age; to determine the age of onset, the course and trend of development of osteochondrosis (OCD). The earliest Dyschondroplasia (Osteochondrotic) lesions were demonstrated radiologically in the A-E complexes of the humeral condyles of 42-day-old pigs and in the femoral condyles at 63 days of age. Thus the radiographic examination of live animals to demonstrate subchondral radiolucency typical for OCD lesions in the condylar A-E complexes of pigs is not of limited value until the animals were > 100 days old as indicated in earlier reports. Also the course of further development of OCD lesions associated with A-E complexes was followed. The radiolucency was seen to develop to a certain extent, and then either to regress, and stabilize or even to progress as the animal grows. Some lesions regressed completely. Also some of the regressed lesions may become active again and become progressive. However, the course of development of femoral condyle A-E complexes OCD lesions was seen to be progressive continuously, or progressive then stable and then progressive again. The regressive course and trend of osteochondrotic lesions was not observed in the femoral condyle A-E complexes up to day 147 of age. Therefore, the course and trend of development of the A-E complexes OCD is not constantly the same

  20. Accuracy and Reliability of Cone-Beam Computed Tomography for Linear and Volumetric Mandibular Condyle Measurements. A Human Cadaver Study.

    Science.gov (United States)

    García-Sanz, Verónica; Bellot-Arcís, Carlos; Hernández, Virginia; Serrano-Sánchez, Pedro; Guarinos, Juan; Paredes-Gallardo, Vanessa

    2017-09-20

    The accuracy of Cone-Beam Computed Tomography (CBCT) on linear and volumetric measurements on condyles has only been assessed on dry skulls. The aim of this study was to evaluate the reliability and accuracy of linear and volumetric measurements of mandibular condyles in the presence of soft tissues using CBCT. Six embalmed cadaver heads were used. CBCT scans were taken, followed by the extraction of the condyles. The water displacement technique was used to calculate the volumes of the condyles and three linear measurements were made using a digital caliper, these measurements serving as the gold standard. Surface models of the condyles were obtained using a 3D scanner, and superimposed onto the CBCT images. Condyles were isolated on the CBCT render volume using the surface models as reference and volumes were measured. Linear measurements were made on CBCT slices. The CBCT method was found to be reliable for both volumetric and linear measurements (CV  0.90). Highly accurate values were obtained for the three linear measurements and volume. CBCT is a reliable and accurate method for taking volumetric and linear measurements on mandibular condyles in the presence of soft tissue, and so a valid tool for clinical diagnosis.

  1. Medial Condyle Fracture (Kilfoyle Type III of the Distal Humerus with Transient Fishtail Deformity after Surgery

    Directory of Open Access Journals (Sweden)

    Motoki Sonohata

    2017-01-01

    Full Text Available A “Fishtail deformity” is one of the well-known complications following pediatric lateral condyle or supracondylar fractures of the humerus. We herein report a case of medial condyle fracture (Kilfoyle type III in an 11-year-old boy. He had a transient “fishtail deformity” of the trochlear groove after open reduction and internal fixation. As occurred in the current case, the bone remodeling and the improvement of ischemia of the trochlea after medial condyle fracture may be associated with the likelihood of recovery from transient “fishtail deformity.”

  2. Post-traumatic bifid mandibular condyle: A case report and literature review

    International Nuclear Information System (INIS)

    Woo, Min Ho; Yoon, Kyu Ho; Park, Kwan Soo; Park, Jae An

    2016-01-01

    Bifid mandibular condyle (BMC) is an uncommon morphological variant of the mandibular condyle. Although authors have proposed various etiologies for BMC, no consensus has emerged. In addition, varying findings have been reported regarding the epidemiological parameters of BMC (e.g., prevalence, gender ratio, and age), possibly due to its low incidence. BMC is occasionally associated with symptoms of the temporomandibular joint, such as ankylosis, pain, and trismus; however, it is difficult to detect this condition on conventional radiographs. This study reports a case of BMC with radiographic findings, and reviews the literature on the epidemiology of BMC

  3. Post-traumatic bifid mandibular condyle: A case report and literature review

    Energy Technology Data Exchange (ETDEWEB)

    Woo, Min Ho; Yoon, Kyu Ho; Park, Kwan Soo; Park, Jae An [Dept. of Oral and Maxillofacial Surgery, Sanggye Paik Hospital, College of Medicine, Inje University, Seoul (Korea, Republic of)

    2016-09-15

    Bifid mandibular condyle (BMC) is an uncommon morphological variant of the mandibular condyle. Although authors have proposed various etiologies for BMC, no consensus has emerged. In addition, varying findings have been reported regarding the epidemiological parameters of BMC (e.g., prevalence, gender ratio, and age), possibly due to its low incidence. BMC is occasionally associated with symptoms of the temporomandibular joint, such as ankylosis, pain, and trismus; however, it is difficult to detect this condition on conventional radiographs. This study reports a case of BMC with radiographic findings, and reviews the literature on the epidemiology of BMC.

  4. Post-operative 3D CT feedback improves accuracy and precision in the learning curve of anatomic ACL femoral tunnel placement.

    Science.gov (United States)

    Sirleo, Luigi; Innocenti, Massimo; Innocenti, Matteo; Civinini, Roberto; Carulli, Christian; Matassi, Fabrizio

    2018-02-01

    To evaluate the feedback from post-operative three-dimensional computed tomography (3D-CT) on femoral tunnel placement in the learning process, to obtain an anatomic anterior cruciate ligament (ACL) reconstruction. A series of 60 consecutive patients undergoing primary ACL reconstruction using autologous hamstrings single-bundle outside-in technique were prospectively included in the study. ACL reconstructions were performed by the same trainee-surgeon during his learning phase of anatomic ACL femoral tunnel placement. A CT scan with dedicated tunnel study was performed in all patients within 48 h after surgery. The data obtained from the CT scan were processed into a three-dimensional surface model, and a true medial view of the lateral femoral condyle was used for the femoral tunnel placement analysis. Two independent examiners analysed the tunnel placements. The centre of femoral tunnel was measured using a quadrant method as described by Bernard and Hertel. The coordinates measured were compared with anatomic coordinates values described in the literature [deep-to-shallow distance (X-axis) 28.5%; high-to-low distance (Y-axis) 35.2%]. Tunnel placement was evaluated in terms of accuracy and precision. After each ACL reconstruction, results were shown to the surgeon to receive an instant feedback in order to achieve accurate correction and improve tunnel placement for the next surgery. Complications and arthroscopic time were also recorded. Results were divided into three consecutive series (1, 2, 3) of 20 patients each. A trend to placing femoral tunnel slightly shallow in deep-to-shallow distance and slightly high in high-to-low distance was observed in the first and the second series. A progressive improvement in tunnel position was recorded from the first to second series and from the second to the third series. Both accuracy (+52.4%) and precision (+55.7%) increased from the first to the third series (p process to improve accuracy and precision of femoral

  5. A study of repair cartilage from osteochondrotic humeral condyles of swine: preliminary report.

    OpenAIRE

    Nakano, T; Aherne, F X

    1992-01-01

    A total of 16 animals, including 12 lame and four normal boars, were used. All lame boars had severe osteochondrotic humeral condyles in which repair cartilage tissues originating from subchondral bone were observed. Quantitative chemical studies of repair cartilage and normal cartilage were carried out using humeral condyles from four selected animals (two lame and two normal boars, respectively). The repair cartilage contained a higher concentration of collagen and lower concentration of pr...

  6. Does flexible tunnel drilling affect the femoral tunnel angle measurement after anterior cruciate ligament reconstruction?

    Science.gov (United States)

    Muller, Bart; Hofbauer, Marcus; Atte, Akere; van Dijk, C Niek; Fu, Freddie H

    2015-12-01

    To quantify the mean difference in femoral tunnel angle (FTA) as measured on knee radiographs between rigid and flexible tunnel drilling after anatomic anterior cruciate ligament (ACL) reconstruction. Fifty consecutive patients that underwent primary anatomic ACL reconstruction with a single femoral tunnel drilled with a flexible reamer were included in this study. The control group was comprised of 50 patients all of who underwent primary anatomic ACL reconstruction with a single femoral tunnel drilled with a rigid reamer. All femoral tunnels were drilled through a medial portal to ensure anatomic tunnel placement. The FTA was determined from post-operative anterior-to-posterior (AP) radiographs by two independent observers. A 5° difference between the two mean FTA was considered clinically significant. The average FTA, when drilled with a rigid reamer, was 42.0° ± 7.2°. Drilling with a flexible reamer resulted in a mean FTA of 44.7° ± 7.0°. The mean difference of 2.7° was not statistically significant. The intraclass correlation coefficient for inter-tester reliability was 0.895. The FTA can be reliably determined from post-operative AP radiographs and provides a useful and reproducible metric for characterizing femoral tunnel position after both rigid and flexible femoral tunnel drilling. This has implications for post-operative evaluation and preoperative treatment planning for ACL revision surgery. IV.

  7. Rate of displacement for Jakob Type 1 lateral condyle fractures treated with a cast.

    Science.gov (United States)

    Zale, C; Winthrop, Z A; Hennrikus, W

    2018-04-01

    The aim of this retrospective study is to report the rate of displacement of Jakob Type 1 lateral condyle fractures that were initially treated in a cast. We performed a retrospective review of all patients that were treated for a non-displaced (Jakob Type 1 displaced and were converted to a closed pinning treatment plan with a conversion rate of 8.5%. There was a mean of 13.2 days (4 to 21) between treatment by initial casting and closed pinning. This study demonstrates an 8.5% displacement and conversion rate from cast treatment to closed pinning for initially non-displaced Jakob Type 1 lateral condyle fractures of the humerus. The internal oblique radiograph is most accurate to determine displacement. We recommend obtaining an internal oblique view at initial evaluation and at follow-up in the cast for lateral condyle fractures. To minimize movement at the fracture site, we recommend treating Jakob Type 1 lateral condyle fractures with a long arm cast with the elbow at 90° and the forearm in the supine position with a sling-loop design. IV - retrospective therapeutic study.

  8. The Relationship between Osteoporosis and Osteoarthritis of the Knee: A Report of 2 Cases with Suspected Osteonecrosis

    Directory of Open Access Journals (Sweden)

    Akira Horikawa

    2014-01-01

    Full Text Available Knee specimens of two osteoporotic patients who underwent unilateral knee arthroplasty for suspected osteonecrosis of the knee were examined histologically. Preoperative findings of magnetic resonance images in both patients were consistent with the diagnosis of osteonecrosis of the medial femoral condyles, although plain X-rays showed minimal degenerative changes. In both patients, preoperative bone mineral densities of the femoral condyle and proximal tibia of the affected side were lower than those of the unaffected side. Pathological examination of the resected femoral condyle and proximal tibia showed almost intact joint cartilage, healing of the collapsed subchondral bone, and significant trabecular bone loss. Histologically, no evidence of osteonecrosis, including empty lacunae of the trabecular bone, was observed. These findings indicated that subchondral bone collapse caused by osteoporosis, but not osteonecrosis, initiated the osteoarthritic change of the affected knee. This report emphasizes that there may be cases of progressive local osteoarthritis caused by fracture of subchondral bone because of osteoporosis.

  9. Cartilage volume quantification with multi echo data image combination sequence in swine knee at 3.0 T MRI

    International Nuclear Information System (INIS)

    Zhang Lirong; Wang Dongqing; Wei Chuanshe; Ma Cong; Wang Dehang

    2010-01-01

    Objective: To investigate the accuracy and reproducibility of multi echo data imagine combination (MEDIC) sequence with water excitation at 3.0 T in swine knee cartilage. Methods: Sagittal MEDIC sequences (0.6 mm slice thickness, isotropic) were acquired twice at 3.0 T MRI in 30 swine knees. The knee cartilage was then removed and the volume was directly measured with water substitution method. The cartilage volume was also determined with a validated open source image software OsiriX by two observers (A and B). The cartilage volumes obtained by two methods were compared. The reproducibility of MEDIC for quantitative measurement was accessed by the root-mean-square (RMS) of variation coefficient. Interobserver and intraobserver precision errors were compared using a paired students t-test. The accuracy of MEDIC for quantitative measurement was determined by the random pairwise differences, systematic pairwise differences and the Pearson, correlation coefficients. Time of semiautomatic and manual segmentation were recorded. Results: Time was saved about 75% by using semiautomatic segmentation methods [(4.0± 1.5) min] versus manual segmentation [(16.0±0.9) min]. Interobserver precision errors (RMS CV% for paired analysis) between A and B for cartilage volume measurement were (2.66±0.82) ml and(2.61± 0.81) ml, t=0.24, P=0.81 (patella); (2.40±0.69) ml and (2.49±0.85) ml, t=-0.45, P=0.65 (medial femoral condyle); (2.28±0.74) ml and(2.41±0.78) ml, t=-0.66, P=0.51 (lateral femoral condyle); (3.43±1.28) ml and (3.51±1.08) ml, t=-0.26, P=0.79 (femora trochlea) with sagittal MEDIC. Intraobserver precision errors (RMS CV% for paired analysis) of observer A for the first and second cartilage volume measurement were (2.64±0.62) ml and (2.67±0.60) ml, t=-0.19, P=0.85 (patella); (2.43±0.60) ml and (2.39±0.59) ml, t=0.26, P=0.80 (medial femoral condyle); (2.26±0.56) ml and (2.30±0.57) ml, t=-0.27, P=0.78 (lateral femoral condyle); (3.40± 1.20) ml and (3.47±1

  10. A semi-automatic method for positioning a femoral bone reconstruction for strict view generation.

    Science.gov (United States)

    Milano, Federico; Ritacco, Lucas; Gomez, Adrian; Gonzalez Bernaldo de Quiros, Fernan; Risk, Marcelo

    2010-01-01

    In this paper we present a semi-automatic method for femoral bone positioning after 3D image reconstruction from Computed Tomography images. This serves as grounding for the definition of strict axial, longitudinal and anterior-posterior views, overcoming the problem of patient positioning biases in 2D femoral bone measuring methods. After the bone reconstruction is aligned to a standard reference frame, new tomographic slices can be generated, on which unbiased measures may be taken. This could allow not only accurate inter-patient comparisons but also intra-patient comparisons, i.e., comparisons of images of the same patient taken at different times. This method could enable medical doctors to diagnose and follow up several bone deformities more easily.

  11. Neurovascular structures of the mandibular angle and condyle: a comprehensive anatomical review.

    Science.gov (United States)

    Yang, Hun-Mu; Won, Sung-Yoon; Kim, Hee-Jin; Hu, Kyung-Seok

    2015-11-01

    Various surgical interventions including esthetic surgery, salivary gland excision, and open reduction of fracture have been performed in the area around the mandibular angle and condyle. This study aimed to comprehensively review the anatomy of the neurovascular structures on the angle and condyle with recent anatomic and clinical research. We provide detailed information about the branching and distributing patterns of the neurovascular structures at the mandibular angle and condyle, with reported data of measurements and proportions from previous anatomical and clinical research. Our report should serve to help practitioners gain a better understanding of the area in order or reduce potential complications during local procedures. Reckless manipulation during mandibular angle reduction could mutilate arterial branches, not only from the facial artery, but also from the external carotid artery. The transverse facial artery and superficial temporal artery could be damaged during approach and incision in the condylar area. The marginal mandibular branch of the facial nerve can be easily damaged during submandibular gland excision or facial rejuvenation treatment. The main trunk of the facial nerve and its upper and lower distinct divisions have been damaged during parotidectomy, rhytidectomy, and open reductions of condylar fractures. By revisiting the information in the present study, surgeons will be able to more accurately prevent procedure-related complications, such as iatrogenic vascular accidents on the mandibular angle and condyle, complete and partial facial palsy, gustatory sweating (Frey syndrome), and traumatic neuroma after parotidectomy.

  12. Incomplete (bending) fractures of the mandibular condyle in children

    International Nuclear Information System (INIS)

    Ahrendt, D.; Swischuk, L.E.; Hayden, C.K. Jr.; Texas Univ., Galveston

    1984-01-01

    Incomplete, bending or bowing fractures of the mandibular condyle in children frequently go undetected. The reason is that the bending deformity often is subtle and passes for normal. This is especially true if the fractures are bilateral. (orig.)

  13. Management of neglected lateral condyle fractures of humerus in children: A retrospective study

    Directory of Open Access Journals (Sweden)

    Anil Agarwal

    2012-01-01

    Full Text Available Background: Late presentation of humeral lateral condylar fracture in children is a surgical dilemma. Osteosynthesis of the fracture fragment or correction of elbow deformity with osteotomies and ulnar nerve transposition or sometimes both procedures combined is a controversial topic. We retrospectively evaluated open reduction and fixation cases in late presentation of lateral humeral condyle fracture in pediatric cases with regards to union and functional results. Materials and Methods: Twenty two pediatric (≤12 years patients with fractures of lateral condyle presenting 4 weeks or more post injury between the study period of 2006 and 2010 were included. Multiple K-wires / with or without screws along with bone grafting were used. At final evaluation, union (radiologically and elbow function (Liverpool Elbow Score, LES was assessed. Results: There were 19 boys and 3 girls. Followup averaged 33 months. Pain (n=9, swelling (n=6, restriction of elbow motion (n=6, prominence of lateral condylar region (n=4, valgus deformity (n=4 were the main presenting symptoms. Ulnar nerve function was normal in all patients. There were nine Milch type I and 13 type II fractures. Union occurred in 20 cases. One case had malunion and in another case there was resorption of condyle following postoperative infection and avascular necrosis. Prominent lateral condyles (4/12, fish tail appearance (n=7, premature epiphyseal closure (n=2 were other observations. LES averaged 8.12 (range, 6.66-9.54 at final followup. Conclusions: There is high rate of union and satisfactory elbow function in late presenting lateral condyle fractures in children following osteosynthesis attempt. Our study showed poor correlation between patient′s age, duration of late presentation or Milch type I or II and final elbow function as determined by LES.

  14. Radiographic femoral varus measurement is affected unpredictably by femoral rotation

    DEFF Research Database (Denmark)

    Miles, James Edward

    Radiographic measurements of femoral varus are used to determine if intervention to correct femoral deformity is required, and to calculate the required correction. The varus angle is defined as the angle between the proximal femoral long axis (PFLA) and an axis tangential to the distal femoral...... and externally by 5° and 10° using plastic wedges. Accuracy of rotation was within +1°. Digital radiographs were obtained at each position. Varus angles were measured using ImageJ, employing two definitions of PFLA. Mean varus angles increased with 10° of either internal or external rotation with both PFLA...... rotation angles. The effect of rotation on varus angle measurements in these femoral specimens contradicts a previous report using CT. The most probable explanation is the difference in femoral positioning: the CT study used a slightly elevated position compared to that in this study, resulting in better...

  15. Pathological and radiological investigations on osteochondrosis in pigs, associated with leg weakness

    International Nuclear Information System (INIS)

    Jørgensen, B.; Arnbjerg, J.; Aaslyng, M.

    1995-01-01

    Two-hundred and seventy-eight Danish Landrace boars were examined radiologically and pathologically for osteochondrosis and other joint lesions on the left legs at slaughter (95 kg). The joint changes were scored on a scale from 1 (normal) to 5 (very severe changes/osteochondritis dissecans). The correlations between radiological and pathological scores were highly significant in the humeral condyles (r = 0.66, P lt 0.001), the distal ulna growth plate (r = 0.51, P lt 0.001), the femoral condyles (r = 0.33, P lt 0.001) and hock (distal tibia (r = 0.17, P lt 0.01) and the medial trochlear ridge of the talus (r = 0.17, P lt 0.01), indicating that radiographical examination is a useful method for diagnosing osteochondrosis in live pigs. Thickening of cartilage was strongly associated with subchondral lesions in the three predilection sites: the humeral condyle, the femoral condyles and the distal ulna growth plate. Osteochondritis dissecans (OCD) in the humeral condyles was significantly associated with subchondral lesions (OR= 1.86; P lt 0.001), but not with cartilage thickness when analysed simultaneously. There were no associations between lesions in the distal ulna growth place, the humeral condyles, the femoral condyles or the anconeal process. There was no significant correlation' between OCD in the humeral condyles and the anconeal process. Osteochondrosis could therefore not be stated to be a generalized disorder. Regression coefficients between joint changes and leg weakness symptoms judged before slaughter were very small and showed no clear trends. OCD in the humeral condyles was, however, significantly associated with 'legs turned out on fore (OR = 2.48; P lt 0.001) and hind (OR = 1.62; P lt 0.05) legs', and OCD in the anconeal process with 'stiff movement in front' (OH+OR = 2.01; P lt 0.05). Osteochondrosis is thus comparable with a threshold trait, where the threshold is the development of an OCD in an osteochondrosis injured joint

  16. [Computer assisted orthognathic surgery: Condyle repositioning.

    Science.gov (United States)

    Bettega, G; Leitner, F

    2013-07-17

    Computer aided surgery has become a standard in many fields. It is rarely used in orthognathic surgery. Twenty years ago, we developed a navigation system adapted to this surgery, especially for mandibular condyle repositioning. The system has been improved along with technological progress. The authors of several clinical studies have validated this system. It is now routinely used in our department, because of its educational virtues among other assets. Copyright © 2013. Published by Elsevier Masson SAS.

  17. Anterior Hip Subluxation due to Lumbar Degenerative Kyphosis and Posterior Pelvic Tilt

    Directory of Open Access Journals (Sweden)

    Hiroyuki Tsuchie

    2014-01-01

    Full Text Available Nontraumatic anterior subluxation and dislocation of the hip joint are extremely rare. A 58-year-old woman presented to our outpatient clinic with left hip pain with a duration of 15 years. There was no history of trauma or other diseases. Her hip pain usually occurred only on walking and not at rest. Physical examinations demonstrated no tenderness in the hip joint. The range of motion of both hip joints was almost normal. Laxity of other joints was not observed. The bone mineral density of the lumbar spine and proximal femur confirmed a diagnosis of osteoporosis. A plain radiograph showed osteoarthritic changes of the hip joints, severe posterior pelvic tilt, and superior displacement of both femoral heads, especially in a standing position. Three-dimensional computed tomography (3DCT revealed anterior subluxation of both femoral heads. Seven years after the initial visit, both hip joints showed progression to severe osteoarthritis. Although the exact cause remains unclear, lumbar kyphosis, posterior pelvic tilt, and a decrease in acetabular coverage may have influenced the current case. We should be aware of these factors when we examine patients with hip osteoarthritis.

  18. Morphology of the lateral pterygoid muscle associated to the mandibular condyle in the human prenatal stage.

    Science.gov (United States)

    Carranza, Miriam L; Carda, Carmen; Simbrón, Alicia; Quevedo, María C Sánchez; Celaya, Gabriela; de Ferraris, Maria Elsa Gómez

    2006-01-01

    The lateral pterygoid muscle (LPM) inserts at the condyle and the articular disc and plays a central role in mandibular movement via the Temporomandibular Articular Complex. The aim of this study was to examine the association between the morphology of LPM muscular fascicles and the degree of mineralization of the mandibular condyle in the prenatal stage employing structural, ultrastructural and microanalytical evaluation. Sixteen human fetuses at 11-37 weeks of gestation, with no apparent pathology and resulting from spontaneous abortions, were included in the study. Samples from lateral pterygoid muscle and the mandibular condyle were processed for light microscopy and electron microscopy and microanalysis. Desmin immunolabeling (dilution 1: 25 Dako) and alpha sarcomeric actin immunolabeling (dilution 1:50 Dako) employing the avidin-biotin system were used in paraffin embedded samples. Contralateral samples were examine by transmission electron microscopy. Four condyles (at 17-21 weeks of gestation) were used to measure the relative content of calcium and phosphorous employing the X-ray diffraction microanalytical technique. At 11-16 weeks of gestation, the LPM was composed of secondary myotubes associated to satellite cells and nerve fibers. At 18 weeks, the muscle exhibited multiple compact fascicles and the condyle showed a thin, external, subperiostal mineralized layer with few central bone spicules. At 20 weeks, at the site of insertion of the LPM, the bone trabeculae of the condyle contained an electrondense matrix with abundant mineralization nuclei. At 17-21 weeks of gestation no significant variations in the contents of phosphorous and calcium were observed. At 24 weeks, transmission electron calcium and microscopy studies revealed a marked increase in the functional units of the muscle fascicles. Also, at this age muscle fibers exhibited differences in the expression of desmin and alpha sarcomeric actin. At 37 weeks the muscle became multipennate in

  19. Rotationally Stable Screw-Anchor With Locked Trochanteric Stabilizing Plate Versus Proximal Femoral Nail Antirotation in the Treatment of AO/OTA 31A2.2 Fracture: A Biomechanical Evaluation.

    Science.gov (United States)

    Knobe, Matthias; Nagel, Philipp; Maier, Klaus-Jürgen; Gradl, Gertraud; Buecking, Benjamin; Sönmez, Tolga T; Modabber, Ali; Prescher, Andreas; Pape, Hans-Christoph

    2016-01-01

    Third-generation cephalomedullary nails currently represent the gold standard in the treatment of unstable trochanteric femur fractures. Recently, an extramedullary rotationally stable screw-anchor system (RoSA) has been developed. It was designed to combine the benefits of screw and blade and to improve stability using a locked trochanteric stabilizing plate (TSP). The purpose of this study was to compare the biomechanical behavior of RoSA/TSP and the proximal femoral nail antirotation (PFNA). Standardized AO/OTA 31A2.2 fractures were induced by an oscillating saw in 10 paired human specimens (n = 20; mean age = 85 years; range: 71-96 years). The fractures were stabilized by either the RoSA/TSP (Koenigsee Implants, Allendorf, Germany) or the PFNA (DePuy Synthes, Zuchwil, Switzerland). Femurs were positioned in 25 degrees of adduction and 10 degrees of posterior flexion and were cyclically loaded with axial sinusoidal pattern at 0.5 Hz, starting at 300 N, with stepwise increase by 300 N every 500 cycles until bone-implant failure occurred. After every load step, the samples were measured visually and radiographically. Femoral head migration was assessed. The stiffness at the load up to the clinically relevant load step of 1800 N (639 ± 378 N/mm (RoSA/TSP) vs. 673 ± 227 N/mm (PFNA); P = 0.542) was comparable, as was the failure load (3000 ± 787 N vs. 3780 ± 874 N; P = 0.059). Up to 1800 N, no femoral head rotation, head migration, or femoral neck shortening were observed either for RoSA/TSP or PFNA. Whereas failure of the PFNA subsumed fractures of the greater trochanter and the lateral wall, a posterior femoral neck fracture with a significantly increased femoral neck shortening (1.7 mm vs. 0 mm; P = 0.012) was the cause of failure with RoSA/TSP. This specific kind of failure was induced by a femoral neck weakening caused by the posterior TSP stabilizing screw. There was no significant difference in biomechanical properties between the RoSA/TSP and the PFNA for

  20. Femoral Neck Strain during Maximal Contraction of Isolated Hip-Spanning Muscle Groups

    Directory of Open Access Journals (Sweden)

    Saulo Martelli

    2017-01-01

    Full Text Available The aim of the study was to investigate femoral neck strain during maximal isometric contraction of the hip-spanning muscles. The musculoskeletal and the femur finite-element models from an elderly white woman were taken from earlier studies. The hip-spanning muscles were grouped by function in six hip-spanning muscle groups. The peak hip and knee moments in the model were matched to corresponding published measurements of the hip and knee moments during maximal isometric exercises about the hip and the knee in elderly participants. The femoral neck strain was calculated using full activation of the agonist muscles at fourteen physiological joint angles. The 5%±0.8% of the femoral neck volume exceeded the 90th percentile of the strain distribution across the 84 studied scenarios. Hip extensors, flexors, and abductors generated the highest tension in the proximal neck (2727 με, tension (986 με and compression (−2818 με in the anterior and posterior neck, and compression (−2069 με in the distal neck, respectively. Hip extensors and flexors generated the highest neck strain per unit of joint moment (63–67 με·m·N−1 at extreme hip angles. Therefore, femoral neck strain is heterogeneous and muscle contraction and posture dependent.

  1. Morphological changes of the mandibular condyle in patients with temporomandibular joint disorder using magnetic resonance imaging

    International Nuclear Information System (INIS)

    Itoh, Shiori

    1994-01-01

    The morphological changes of the mandibular condyle in patients with temporomandibular joint disorder were studied. The subjects were 420 patients (103 males and 317 females, 8 to 80 years of age, mean age 39.8 years) who were clinically diagnosed as temporomandibular joint disorder. MR imaging was performed with a GE-Signa 1.5 Tesla MR imaging system using the body coil as a transmitter and 3-inch bilateral surface coils. The patients were examined by a multiplanar gradient echo technique in a closed-loop cine fashion on both sagittal and coronal planes. The results obtained were as follows: 1) Morphological changes of the mandibular condyle were detected in 47.0% of the patients. The predominant morphological changes were then formation of osteophyte and marginal proliferation (65.8%). 2) The incidence of morphological changes in the mandubular condyle did not show any significant difference between male and female, and tended to be higher in patients over 40 years of age, and the incidence in patients under 20 years of age was lower, compared to that in patients from 20 to 39 years of age. 3) The incidence of morphological changes in patients with anterior disk displacement without reduction was higher than in those with anterior disk displacement with reduction (P<0.001). The incidence of morphological changes in patients with rotational disk displacement was higher than in those with medial disk displacement (P<0.001). 4) The anterior translation of mandibular condyle was influenced more by anterior disk displacement rather than by morphological changes. From these results. it is suggested that simultaneous bilateral condyle pseudodynamic MR imaging was useful in the diagnosis of internal derangement, evaluation of morphological changes and assessment of motional abnormality of the condyle. (author)

  2. Oral-motor and electromyographic characterization of patients submitted to open a nd closed reductions of mandibular condyle fracture.

    Science.gov (United States)

    Silva, Amanda Pagliotto da; Sassi, Fernanda Chiarion; Andrade, Claudia Regina Furquim de

    To characterize the oral-motor system of adults with mandibular condyle facture comparing the performance of individuals submitted to open reduction with internal fixation (ORIF) and closed reduction with mandibulomaxillary fixation (CRMMF). Study participants were 26 adults divided into three groups: G1 - eight individuals submitted to ORIF for correction of condyle fracture; G2 - nine individuals submitted to CRMMF for correction of condyle fracture; CG - nine healthy volunteers with no alterations of the orofacial myofunctional system. All participants underwent the same clinical protocol: assessment of the orofacial myofunctional system; evaluation of the mandibular range of motion; and surface electromyography (sEMG) of the masticatory muscles. Results indicated that patients with condyle fractures from both groups presented significant differences compared with those from the control group in terms of mobility of the oral-motor organs, mastication, and deglutition. Regarding the measures obtained for mandibular movements, participants with facial fractures from both groups showed significant differences compared with those from the control group, indicating greater restrictions in mandibular motion. As for the analysis of sEMG results, G1 patients presented more symmetrical masseter activation during the task of maximal voluntary teeth clenching. Patients with mandibular condyle fractures present significant deficits in posture, mobility, and function of the oral-motor system. The type of medical treatment does not influence the results of muscle function during the first six months after fracture reduction. Individuals submitted to ORIF of the condyle fracture present more symmetrical activation of the masseter muscle.

  3. Comparison of robot surgery modular and total knee arthroplasty kinematics.

    Science.gov (United States)

    Yildirim, Gokce; Fernandez-Madrid, Ivan; Schwarzkopf, Ran; Walker, Peter S; Karia, Raj

    2014-04-01

    The kinematics of seven knee specimens were measured from 0 to 120 degrees flexion using an up-and-down crouching machine. Motion was characterized by the positions of the centers of the lateral and medial femoral condyles in the anterior-posterior direction relative to a fixed tibia. A modular unicompartmental knee, trochlea flange, and patella resurfacing (multicompartmental knee [MCK] system) were implanted using a surgeon-interactive robot system that provided accurate surface matching. The MCK was tested, followed by standard cruciate retaining (CR) and posterior stabilized (PS) knees. The motion of the MCK was close to anatomic, especially on the medial side, in contrast to the CR and PS knees that showed abnormal motion features. Such a modular knee system, accurately inserted, has the potential for close to normal function in clinical application. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  4. Numerical analysis of variations in posterior cruciate ligament properties and balancing techniques on total knee arthroplasty loading.

    NARCIS (Netherlands)

    Zelle, J.; Heesterbeek, P.J.; De Waal Malefijt, M.; Verdonschot, Nicolaas Jacobus Joseph

    2010-01-01

    Total knee arthroplasty (TKA) is a widely used and successful orthopaedic procedure. During TKA, the posterior cruciate ligament (PCL) can either be retained or substituted by a post-cam mechanism. One of the main functions of the PCL is to facilitate femoral rollback during knee flexion. For

  5. Sex Prediction using Foramen Magnum and Occipital Condyles Computed Tomography Measurements in Sudanese Population

    Directory of Open Access Journals (Sweden)

    Usama Mohamed El-Barrany

    2016-12-01

    Full Text Available Sex determination is important in establishing the identity of an individual. The foramen magnum is an important landmark of the skull base. The present research aimed to study the value of foramen magnum measurements to determine sex using computed tomography (CT among Sudanese individuals. Foramen magnum CT scans of 400 Sudanese individuals (200 males and 200 females aged 18 - 83 years were included in this study. Foramen magnum (length and width, right occipital condyle (length and width, left occipital condyle (length and width, minimum intercondylar distance, maximum bicondylar distance and maximum medial intercondylar distance were measured. All data were subjected to discriminant functions analysis. All nine measurements were significantly higher in males than females. Among these measurements, the right condyle length, minimum intercondylar distance, and foramen magnum width were able to determine sex in Sudanese individuals with an accuracy rate of 83 %.

  6. Origins, distributions, and ramifications of the femoral nerves in giant anteater (Myrmecophaga tridactyla Linnaeus, 1758

    Directory of Open Access Journals (Sweden)

    Roseâmely Angélica de Carvalho-Barros

    2013-11-01

    Full Text Available The study of nerves making up the lumbosacral plexus is extremely important, because it relates the various evolutionary aspects of animals’ posture and locomotion. Taking into account that the femoral nerve is the largest one in the cranial part of the lumbosacral plexus, one aimed to describe the origins, distributions, and ramifications of femoral nerves in giant anteater (Myrmecophaga tridactyla, comparing them to the literature describing domestic and wild animals, in order to establish correlations of morphological similarities and provide the related areas with means. One used three specimens, prepared through an injection of 10% aqueous formaldehyde solution via femoral artery, for their conservation and posterior dissection. The origins in the right and left antimeres took place in the ventral braches of lumbar spinal nerves 1, 2, and 3. The distributions and ramifications were observed for the major and minor psoas, lateral and medial iliac, pectineus, adductor magnus, sartorius, and femoral quadriceps muscles. Having the origins of the M. tridactyla femoral nerves as a basis, a reframing was observed due to the variance in the number of lumbar vertebrae (L1, L2, and L3. However, a partial morphological similarity was kept with regard to the distributions and ramifications, when compared to the domestic and wild animals taken into account in this study.

  7. Recurrent osteochondroma of the mandibular condyle: A case report

    International Nuclear Information System (INIS)

    Kwon, Young Eun; Choi, Karp Shik; An, Chang Hyeon; Choi, So Young; An, Seo Young; Lee, Jae Seo

    2017-01-01

    A 21-year-old woman presented with facial asymmetry. Crepitus and clicking of the temporomandibular joint were noted. The midline deviated 5.5 mm to the left, and secondary malocclusion was observed. Panoramic and cone-beam computed tomographic images showed an irregular and exophytic bony mass on the anteromedial surface of the right mandibular condyle. A 3-phase bone scan revealed increased tracer uptake on the affected side. The lesion was treated with excision and reshaping under the diagnosis of osteochondroma confirmed by a histopathological examination. The lesion recurred after 3 years, and the patient underwent condylectomy. Mandibular condylar osteochondroma is often resected because it causes functional and aesthetic problems, but it rarely recurs. To the best of our knowledge, only 2 cases of recurrent osteochondromas of the mandibular condyle have been reported previously. Surgical treatment of the osteochondroma should be performed considering the possibility of recurrence, and long-term follow-up is recommended

  8. Recurrent osteochondroma of the mandibular condyle: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Kwon, Young Eun; Choi, Karp Shik; An, Chang Hyeon; Choi, So Young; An, Seo Young [School of Dentistry, Kyungpook National University, Daegu (Korea, Republic of); Lee, Jae Seo [Dept. of Oral and Maxillofacial Radiology, School of Dentistry, Chonnam National University, Gwangju (Korea, Republic of)

    2017-03-15

    A 21-year-old woman presented with facial asymmetry. Crepitus and clicking of the temporomandibular joint were noted. The midline deviated 5.5 mm to the left, and secondary malocclusion was observed. Panoramic and cone-beam computed tomographic images showed an irregular and exophytic bony mass on the anteromedial surface of the right mandibular condyle. A 3-phase bone scan revealed increased tracer uptake on the affected side. The lesion was treated with excision and reshaping under the diagnosis of osteochondroma confirmed by a histopathological examination. The lesion recurred after 3 years, and the patient underwent condylectomy. Mandibular condylar osteochondroma is often resected because it causes functional and aesthetic problems, but it rarely recurs. To the best of our knowledge, only 2 cases of recurrent osteochondromas of the mandibular condyle have been reported previously. Surgical treatment of the osteochondroma should be performed considering the possibility of recurrence, and long-term follow-up is recommended.

  9. Failed anterior cruciate ligament reconstruction: analysis of factors leading to instability after primary surgery.

    Science.gov (United States)

    Ma, Yong; Ao, Ying-Fang; Yu, Jia-Kuo; Dai, Ling-Hui; Shao, Zhen-Xing

    2013-01-01

    Revision anterior cruciate ligament (ACL) surgery can be expected to become more common as the number of primary reconstruction keeps increasing. This study aims to investigate the factors causing instability after primary ACL reconstruction, which may provide an essential scientific base to prevent surgical failure. One hundred and ten revision ACL surgeries were performed at our institute between November 2001 and July 2012. There were 74 men and 36 women, and the mean age at the time of revision was 27.6 years (range 16 - 56 years). The factors leading to instability after primary ACL reconstruction were retrospectively reviewed. Fifty-one knees failed because of bone tunnel malposition, with too anterior femoral tunnels (20 knees), posterior wall blowout (1 knee), vertical femoral tunnels (7 knees), too posterior tibial tunnels (12 knees), and too anterior tibial tunnels (10 knees). There was another knee performed with open surgery, where the femoral tunnel was drilled through the medial condyle and the tibial tunnel was too anterior. Five knees were found with malposition of the fixation. One knee with allograft was suspected of rejection and a second surgery had been made to take out the graft. Three knees met recurrent instability after postoperative infection. The other factors included traumatic (48 knees) and unidentified (12 knees). Technical errors were the main factors leading to instability after primary ACL reconstructions, while attention should also be paid to the risk factors of re-injury and failure of graft incorporation.

  10. The difference in centre position in the ACL femoral footprint inclusive and exclusive of the fan-like extension fibres.

    Science.gov (United States)

    Iriuchishima, Takanori; Ryu, Keinosuke; Aizawa, Shin; Fu, Freddie H

    2016-01-01

    The purpose of this study was to compare the centre position of each anterior cruciate ligament bundle in its femoral footprint in measurements including and excluding the fan-like extension fibres. Fourteen non-paired human cadaver knees were used. All soft tissues around the knee were resected except the ligaments. The ACL was divided into antero-medial (AM) and postero-lateral (PL) bundles according to the difference in tension patterns. The ACL was carefully dissected, and two outlines were made of the periphery of each bundle insertion site: those which included and those which excluded the fan-like extension fibres. An accurate lateral view of the femoral condyle was photographed with a digital camera, and the images were downloaded to a personal computer. The centre position of each bundle, including and excluding the fan-like extension fibres, was measured with ImageJ software (National Institution of Health). Evaluation of the centre position was performed using the modified quadrant method. The centre of the femoral AM bundle including the fan-like extension was located at 28.8% in a shallow-deep direction and 37.2% in a high-low direction. When the AM bundle was evaluated without the fan-like extension, the centre was significantly different at 34.6% in a shallow-deep direction (p = 0.000) and 36% in a high-low direction. The centre of the PL bundle including the fan-like extension was found at 37.1% in a shallow-deep direction and 73.4% in a high-low direction. When the PL bundle was evaluated without the fan-like extension, the centre was significantly different at 42.7% in a shallow-deep direction (p = 0.000) and 69.3% in a high-low direction (p = 0.000). The centre position of the AM and PL bundles in the femoral ACL footprint was significantly different depending on the inclusion or exclusion of the fan-like extension fibres. For the clinical relevance, to reproduce the direct femoral insertion in the anatomical ACL reconstruction, tunnels should be

  11. Evaluation of the marsh deer stifle joint by imaging studies and gross anatomy.

    Science.gov (United States)

    Shigue, D A; Rahal, S C; Schimming, B C; Santos, R R; Vulcano, L C; Linardi, J L; Teixeira, C R

    2015-12-01

    This study aimed to evaluate the stifle joint of marsh deer using imaging studies and in comparison with gross anatomy. Ten hindlimbs from 5 marsh deer (Blastocerus dichotomus) were used. Radiography, computed tomography (CT) and magnetic resonance imaging (MRI) were performed in each stifle joint. Two hindlimbs were dissected to describe stifle gross anatomy. The other limbs were sectioned in sagittal, dorsal or transverse planes. In the craniocaudal radiographic view, the lateral femoral condyle was broader than the medial femoral condyle. The femoral trochlea was asymmetrical. Subsequent multiplanar reconstruction revealed in the cranial view that the external surface of the patella was roughened, the medial trochlea ridge was larger than the lateral one, and the extensor fossa at the lateral condyle was next to the lateral ridge. The popliteal fossa was better visualized via the lateral view. Sagittal MRI images identified lateral and medial menisci, caudolateral and craniomedial bundles of cranial cruciate ligament, caudal cruciate ligament, patellar ligament and common extensor tendon. In conclusion, the marsh deer stifle presents some anatomical characteristics of the ovine stifle joint. © 2014 Blackwell Verlag GmbH.

  12. Osteology and radiology of the Maned Wolf (Chrysocyon brachyurus) pelvic limb.

    Science.gov (United States)

    Siqueira, R C; Rahal, S C; Inamassu, L R; Mamprim, M J; Felix, M; Castilho, M S; Mesquita, L R; Ribeiro, V L; Teixeira, C R; Rassy, F B

    2017-12-01

    This study describes the osteology and radiology of the pelvic limb in maned wolves. Ten (five live and five dead) maned wolves (Chrysocyon brachyurus), five males and five females, aged from 2 to 7 years old were used. Digital radiographs were taken and recorded for both pelvic limbs in all animals. Osteology was correlated with the radiographic images. The pelvis had a rectangular shape, and the obturator foramen (foramen obturatum) was oval. The femoral neck (collum femoris) was short and thick. The greater trochanter (trochanter major) extended proximally to near the dorsum of the femoral head (caput ossis femoris). The lateral femoral condyle (condylus lateralis) was larger than the medial condyle (condylus medialis), and the intercondylar fossa (fossa intercondylaris) had a slightly oblique orientation. The proximal tibia displayed medial and lateral condyles with the medial larger. The femur was slightly shorter than the tibia. Seven tarsal bones (ossa tarsi) were present, four long metatarsal bones (ossa metatarsalia II - V) and a short first metatarsal bone (os metatarsal I). © 2017 Blackwell Verlag GmbH.

  13. MRI of traumatic patellar dislocation in children

    Energy Technology Data Exchange (ETDEWEB)

    Zaidi, A.; Cole, W. [Hospital for Sick Children, Toronto (Canada). Diagnostic Imaging; Babyn, P. [Mater Children' s, Brisbane (Australia). Paediatric Orthopaedic Surgery; Astori, I. [Univ. of Toronto (Canada). Diagnostic Imaging; White, L. [Hospital for Sick Children, Toronto (Canada). Orthopaedic Surgery; Doria, A.

    2006-11-15

    Traumatic patellar dislocations (TPD) are common injuries in children, and MRI is useful in evaluation of pediatric musculoskeletal injuries. However, no pediatric studies on the MR features of TPD have been reported. To review the injuries after TPD in children. Patients with clinical or radiological recognition of TPD and those with suggestive MR findings were selected. Bone, cartilage and soft-tissue injuries and patellofemoral relationships were assessed. Results A total of 26 patients (age range 10-18 years) were identified. The following injuries were seen: bone bruising of the inferomedial patella (81% of patients) and the lateral femoral condyle (81% of patients), cartilage injuries of the inferomedial patella (38% of patients) and the lateral femoral condyle (38% of patients), osteochondral fragments (42% of patients) and injuries of the medial patellar restraints (81% of patients). Pediatric manifestations of TPD seen on MRI are similar to those in adults. TPD is often occult in children. Early recognition of bone bruising of the patella and lateral femoral condyle, associated osteochondral injuries, and medial patellar stabilizer injury is important for timely diagnosis.

  14. MRI of traumatic patellar dislocation in children

    International Nuclear Information System (INIS)

    Zaidi, A.; Cole, W.; Babyn, P.; Astori, I.; White, L.; Doria, A.

    2006-01-01

    Traumatic patellar dislocations (TPD) are common injuries in children, and MRI is useful in evaluation of pediatric musculoskeletal injuries. However, no pediatric studies on the MR features of TPD have been reported. To review the injuries after TPD in children. Patients with clinical or radiological recognition of TPD and those with suggestive MR findings were selected. Bone, cartilage and soft-tissue injuries and patellofemoral relationships were assessed. Results A total of 26 patients (age range 10-18 years) were identified. The following injuries were seen: bone bruising of the inferomedial patella (81% of patients) and the lateral femoral condyle (81% of patients), cartilage injuries of the inferomedial patella (38% of patients) and the lateral femoral condyle (38% of patients), osteochondral fragments (42% of patients) and injuries of the medial patellar restraints (81% of patients). Pediatric manifestations of TPD seen on MRI are similar to those in adults. TPD is often occult in children. Early recognition of bone bruising of the patella and lateral femoral condyle, associated osteochondral injuries, and medial patellar stabilizer injury is important for timely diagnosis

  15. Spontaneous osteonecrosis of the knee joint: MR imaging before and after administration of gadopentetate-dimeglumine, comparison to CT, scintigraphy, and histology

    International Nuclear Information System (INIS)

    Lang, P.; Grampp, S.; Vahlensieck, M.; Mauz, M.; Steiner, E.; Schwickert, H.; Gindele, A.; Felix, R.; Genant, H.K.

    1995-01-01

    Eight patients with spontaneous osteonecrosis of the knee joint underwent MR imaging before and after i.v. administration of Gd-DTPA. Nuclear scintigraphy was performed in all 8 patients, three patients also had CT scans of the knee area. Histologic correlation was available in three patients. Increased radionuclide uptake was observed in all patients. In one patient, however, scintigraphy showed increased radionuclide uptake consistent with ostenecrosis only in the medial femoral condyle, while MR imaging demonstrated osteonecrosis both in the medial as well as the lateral femoral condyles. MR demonstrated areas of low signal intensity on precontrast T 1 -weighted images in the femoral condyle in all patients. All these areas showed high signal intensity on T 2 -weighted images. On postcontrast T 1 -weighted images, signal intensity increase was either homogeneous throughout the lesion or it was seen at the periphery of the lesion in a band-like pattern. Histologically, the areas of high signal intensity on T 2 -weighted and on postcontrast T 1 -weighted images corresponded to granulation tissue. (orig./MG) [de

  16. Nontraumatic tibial polyethylene insert cone fracture in mobile-bearing posterior-stabilized total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Yohei Tanikake

    2016-12-01

    Full Text Available A 72-year-old male patient underwent mobile-bearing posterior-stabilized total knee arthroplasty for osteoarthritis. He experienced a nontraumatic polyethylene tibial insert cone fracture 27 months after surgery. Scanning electron microscopy of the fracture surface of the tibial insert cone suggested progress of ductile breaking from the posterior toward the anterior of the cone due to repeated longitudinal bending stress, leading to fatigue breaking at the anterior side of the cone, followed by the tibial insert cone fracture at the anterior side of the cone, resulting in fracture at the base of the cone. This analysis shows the risk of tibial insert cone fracture due to longitudinal stress in mobile-bearing posterior-stabilized total knee arthroplasty in which an insert is designed to highly conform to the femoral component.

  17. US-Guided Femoral and Sciatic Nerve Blocks for Analgesia During Endovenous Laser Ablation

    International Nuclear Information System (INIS)

    Yilmaz, Saim; Ceken, Kagan; Alimoglu, Emel; Sindel, Timur

    2013-01-01

    Endovenous laser ablation may be associated with significant pain when performed under standard local tumescent anesthesia. The purpose of this study was to investigate the efficacy of femoral and sciatic nerve blocks for analgesia during endovenous ablation in patients with lower extremity venous insufficiency. During a 28-month period, ultrasound-guided femoral or sciatic nerve blocks were performed to provide analgesia during endovenous laser ablation in 506 legs and 307 patients. The femoral block (n = 402) was performed at the level of the inguinal ligament, and the sciatic block at the posterior midthigh (n = 124), by injecting a diluted lidocaine solution under ultrasound guidance. After the blocks, endovenous laser ablations and other treatments (phlebectomy or foam sclerotherapy) were performed in the standard fashion. After the procedures, a visual analogue pain scale (1–10) was used for pain assessment. After the blocks, pain scores were 0 or 1 (no pain) in 240 legs, 2 or 3 (uncomfortable) in 225 legs, and 4 or 5 (annoying) in 41 legs. Patients never experienced any pain higher than score 5. The statistical analysis revealed no significant difference between the pain scores of the right leg versus the left leg (p = 0.321) and between the pain scores after the femoral versus sciatic block (p = 0.7). Ultrasound-guided femoral and sciatic nerve blocks may provide considerable reduction of pain during endovenous laser and other treatments, such as ambulatory phlebectomy and foam sclerotherapy. They may make these procedures more comfortable for the patient and easier for the operator.

  18. Transportal femoral drilling creates more horizontal ACL graft orientation compared to transtibial drilling: A 3D CT imaging study.

    Science.gov (United States)

    Clockaerts, S; Van Haver, A; Verhaegen, J; Vuylsteke, K; Leenders, T; Lagae, K C; Verdonk, P

    2016-06-01

    The principle of anatomic anterior cruciate ligament (ACL) reconstruction is to create a femoral and tibial tunnel that resembles the insertion of the native ACL. Anatomic reconstruction leads to a more horizontal graft orientation that provides more rotational stability. The aim of this study is to investigate the best method to achieve anatomical reconstruction of femoral insertion of the ACL and thus, a more horizontal orientation of the ACL. We compared tunnel position and orientation between transportal femoral drilling technique and transtibial technique. Thirty-two patients were included. Post-operative CT scans were obtained and femur, tibia and ACL tunnels were reconstructed. The position and orientation of tibial and femoral tunnels were quantified using the quadrant method, and femoral tunnel length, ellipticity and posterior wall breakage were assessed. We also investigated clinical outcome. Analyses show that transportal drilled femoral tunnels were situated significantly lower than transtibial drilled tunnels (p<0.0001), resulting in a significantly more horizontal oriented ACL in the transportal group in coronal (p<0.0001) and sagittal plane (p=0.01). No differences were observed in depth of femoral tunnel position (p=0.44). Femoral tunnel length was shorter in the transportal group (p=0.01) with a more ellipsoidal femoral aperture (p=0.01). There were no differences between both groups in tibial position. There were no differences in clinical outcome measure between the transportal and transtibial groups. This study indicates that transportal drilling of the femoral tunnel leads to a more horizontal graft orientation of the ACL, without differences in clinical outcome. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. Dislocation of a mandibular condyle in the middle cranial fossa, diagnosed 54 years after trauma

    OpenAIRE

    De Mol, Antoni; Nicolielo, Laura; Ghekiere, Olivier; Jacobs, Reinhilde; Politis, Constantinus

    2017-01-01

    Abstract Dislocation of the mandibular condyle into the middle cranial fossa is a rare complication of mandibular trauma. We report the remarkable case of a 63-year-old patient in whom trauma 54 years prior to consultation resulted in intrusion of the right mandibular condyle into the middle cranial fossa. The diagnosis was missed because of insufficient data provided by conventional radiographies. Failure of timely diagnosis and lack of appropriate treatment resulted in temporomandibular joi...

  20. Posterior-only surgery with preoperative skeletal traction for management of severe scoliosis.

    Science.gov (United States)

    Mehrpour, Saeedreza; Sorbi, Reza; Rezaei, Reza; Mazda, Keyvan

    2017-04-01

    The surgical treatment of severe adolescent spinal deformities is challenging and carries substantial risks of mortality and morbidity. To mitigate this risk, surgeons have employed various methods as this study designed to evaluate the safety and effectiveness of preoperative halo-femoral or halo gravity traction (HGT) followed by posterior-only surgery in the management of severe scoliosis. A total number of 23 patients with severe scoliosis treated by preoperative skeletal traction (halo gravity or halo femoral) followed by posterior fusion and instrumentation in one stage. All patients were followed for a minimum of 2 years after surgery. The average age of the patients was 12.7 years at the time of surgery. Mean of the Cobb angle improved from 99.9° ± 8.2° preoperatively to 75.3° ± 8° post-traction and 49.5° ± 7.7° postoperatively. Kyphosis angle corrected from 56.4° ± 9.5° to 38.6° ± 5.8°. The preop-FVC% was 41 ± 6.1% and after 1 year follow-up FVC% was 45.7 ± 7.7%. No patients required an anterior release due to amount of their deformity. Despite the benefits of modern instrumentation procedures, the treatment of severe scoliosis can be very competing. We think that by applying preoperative halo femoral traction and halo-gravity traction, managing severe scoliosis will be in safe and easy manner and can lead to better deformity correction and less neurological complications and facilitate to avoid anterior operation for severe scoliosis and its related complications.

  1. The effects of the low calcium diet and irradiation on the mandibular condyle of rats

    International Nuclear Information System (INIS)

    Ahn, Hee Mun; Lee, Sang Rae

    1993-01-01

    This study was performed to investigate the changes of mandibular condyle by low diet and the effects of irradiation on the bone in ofteoporotic state. In order to carry out this experiment, 80 served-week old Sprague-Dawley strain rats about 150gm were selected and equally divided into one experimental group of 40 rats and one control group with the remainder. The experimental group and the control group of 40 rats and one control group with the remainder. The experimental group and the control group were then subdivided into two group and exposed to irradiation. The two irradiation groups received a single dose of 20 Gy on the jaw area only and irradiated with a cobalt-60 teletherapy unit. The rats in the control and experimental groups were serially terminated by fours on the 3rd, the 7th, the 14th, and the 21st day after irradiation. After termination, both sides of the dead rats mandibular condyle were removed and fixed with 10% neutral formalin. The bone mineral density of mandibular condle was measured by use of dual energy X-ray with Hitex HA-80 (Hitex Co., Japan). Thereafter, the obtained radiographs were observed, and the mandibular condyle was further decalcified and embedded in paraffin as the general method. The specimen sectioned and stained with hematoxylin-eosin, PAS and Rabbit Anti-Human Tumor Necrosis Factor-α observed by a light microscope. The obtained results were as follows: 1. In the non-irradiated group with low calcium diet, the bone mineral density of the condyle was markedly decreased after 14 days, and decrease the number of trabeculae of the condyle and resorption of the calcified cartilaginous zone were observed after 3 days. On microscopic observation, the number and size of trabecular were decreased after 7 days of experiment. 2. In the irradiated group with the low calcium diet, the bone mineral density of the condyle was markedly decreased after 14 days and resorption of the calcified cartilaginous zone and decrease the number and

  2. Remodeling process of the streptozotocln-induced diabetic rat's resected condyle

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Jung Pyo; Kim, Won Cheol; Hwang, Eui Hwan; Lee, Sang Rae [Dept. of Oral and Maxillofacial Radiology, Oral Diagnosis and Oral Medicine, College of Dentistry, Kyung Hee University, Seoul (Korea, Republic of)

    1994-08-15

    The purpose of this study was to investigate the remodeling process of the streptozotocin-induced diabetic rat's resected condyle. The experiment was performed with male Sprague-Dawley strain rats weighing approximately 250 gm, which were rendered diabetic by an intravenous injection of streptozotocin (70 mg/kg body weight). After condylectomy, experimental rats were serially terminated on the 1st week, the 2nd week, the 3rd week, and the 4th week. The following termination, the mandible were dissected out to make specimens. Each mandibular condyle was radiographed with Hitex HA-80 (Hitex Co., Ltd. Japan). In addition to radiographic observation, the mandibular condyles, further decalcified and embedded in paraffin, were sectioned and stained with Hematoxylin and Eosin, Toluidine blue and Masson's trichrome. They were observed with a light microscope and a polarizing microscope. The results were as follows. 1. Soft X-ray radiograms revealed proliferation of bone after 1 week in both groups. Irregularly repaired bones and dense trabeculae were clearly observed in experimental group. 2. The resected condyles were repaired by intramembraneous and endochondral bone formation in both groups. 3. Bone tissue repair was initiated from the adjacent margin of resected bone, and cartilaginous tissues were observed at the top of repaired bone in both groups. 4. The number of osteoblasts of experimental group was small, compared with control group. Each osteoblast was small and flat. The thin trabeculae were irregularly formed. 5. Collagens of bone were gradually matured in both groups but the degree of maturation was lower in experimental group. 6. Fibrous tissues covered the upper parts of repaired bone were densely arranged in the both groups. Conclusively, atrophied osteoblasts, immature collagen of bone, and thin and irregular trabeculae function and caused disturbance of remodeling process of bone.

  3. Strength of titanium intramedullary implant versus miniplate fixation of mandibular condyle fractures.

    Science.gov (United States)

    Frake, Paul C; Howell, Rebecca J; Joshi, Arjun S

    2012-07-01

    To test the strength of internal fixation of mandibular condyle fractures repaired with titanium miniplates versus titanium intramedullary implants. Prospective laboratory experimentation in urethane mandible models and human cadaveric mandibles. Materials testing laboratory at an academic medical center. Osteotomies of the mandibular condyle were created in 40 urethane hemimandible models and 24 human cadaveric specimens. Half of the samples in each group were repaired with traditional miniplates, and the other half were repaired with intramedullary titanium implants. Anteroposterior and mediolateral loads were applied to the samples, and the displacement was measured with reference to the applied force. Titanium intramedullary implants demonstrated statistically significant improved strength and stiffness versus miniplates in the urethane model experimental groups. Despite frequent plastic deformation and mechanical failures of the miniplates, a 1.6-mm-diameter titanium intramedullary pin did not mechanically fail in any of the cases. Intramedullary implantation failures were due to secondary fracture of the adjacent cortical bone or experimental design limitations including rotation of the smooth pin implant. Mechanical implant failures that were encountered with miniplate fixation were not seen with titanium intramedullary implants. These intramedullary implants provide stronger and more rigid fixation of mandibular condyle fractures than miniplates in this in vitro model.

  4. Femoral nerve damage (image)

    Science.gov (United States)

    The femoral nerve is located in the leg and supplies the muscles that assist help straighten the leg. It supplies sensation ... leg. One risk of damage to the femoral nerve is pelvic fracture. Symptoms of femoral nerve damage ...

  5. Femoral rotation unpredictably affects radiographic anatomical lateral distal femoral angle measurements

    DEFF Research Database (Denmark)

    Miles, James Edward

    2016-01-01

    Objective: To describe the effects of internal and external femoral rotation on radiographic measurements of the anatomical lateral distal femoral angle (a-LDFA) using two methods for defining the anatomical proximal femoral axis (a-PFA). Methods: Digital radiographs were obtained of 14 right...... femora at five degree intervals from 10° external rotation to 10° internal rotation. Using freely available software, a-LDFA measurements were made using two different a-PFA by a single observer on one occasion. Results: Mean a-LDFA was significantly greater at 10° external rotation than at any other...... rotation. The response of individual femora to rotation was unpredictable, although fairly stable within ±5° of zero rotation. Mean a-LDFA for the two a-PFA methods differed by 1.5°, but were otherwise similarly affected by femoral rotation. Clinical significance: If zero femoral elevation can be achieved...

  6. Condyle and mandibular bone change after unilateral condylar neck fracture in growing rats.

    Science.gov (United States)

    Hu, Y; Yang, H-f; Li, S; Chen, J-z; Luo, Y-w; Yang, C

    2012-08-01

    Unilateral fracture of the condylar neck in immature subjects might lead to mandible asymmetry and condyle remodelling. A rat model was used to investigate mandibular deviation and condylar remodelling associated with condyle fracture. 72 4-week-old male rats were randomly divided into three groups: an experimental group (unilateral transverse condylar fracture induced surgically), a sham operation group (surgical exposure but no fracture), and a non-operative control group (no operation). The rats were killed at intervals up to 9weeks after surgery, and outcomes were assessed using various measures of mandible deviation, histological and X-ray observation, and immunohistochemical measures of expression levels of connective tissue growth factor (CTGF) and type II collagen (Col II). The fracture led to the degeneration of mandibular size, associated with atrophy of fractured condylar process. Progressive remodelling of cartilage and increasing expression levels of CTGF and Col II were found. The authors conclude that condylar fracture can lead to asymmetries in mandible and condyle remodelling and expression of CTGF and Col II in condylar cartilage on both the ipsilateral and the contralateral sides. Copyright © 2012 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  7. The effect of extracapsular injuries on growth and development of the mandible condyle: an experimental study in growing dogs.

    Science.gov (United States)

    Liu, Siying; Tian, Lei; Ding, Mingchao; Liu, Yanpu; Li, Guiyu; Chen, Jinwu; Ding, Yin

    2016-11-01

    To investigate the effects of condylar extracapsular injuries on the development of the mandibular condyle and try to find a way to treat condylar hyperplasia by electively using such injuries to restrict the overdeveloped mandibular condyle. Sixty 6-month-old beagle puppies were divided randomly into five groups: blank control; unilateral fracture to the condylar neck; unilateral fracture to the condylar neck treated with rigid internal fixation; unilateral periosteum injury; unilateral decortication of the condylar neck. Computed tomography, 99 m Tc single-photon emission computed tomography, and tetracycline-calcein double-labeling were performed after surgery. The puppies were sacrificed 12 and 24 weeks after surgery. Morphologic analyses and examination of growth activity were done. Unilateral fracture of the condylar neck without fixation caused local morphologic changes during the early postoperative period, but compensatory growth of the condyle altered such changes after healing. The other types of injury failed to inhibit the growth of the condyle and the mandible, whereas functional deviation of the chin was found after unilateral fracture of the condylar neck with or without fixation. The four types of extracapsular injury described here failed to inhibit the growth of the mandibular condyle and could not be selected as alternatives to treat condylar hyperplasia. Copyright © 2016 Elsevier Inc. All rights reserved.

  8. The description of condyle position in disc displacement with reduction using Cone Beam Computed Tomography 3D radiographic analysis

    Directory of Open Access Journals (Sweden)

    Liana Rahmayani

    2009-07-01

    Full Text Available One of the temporomandibular joint disorders that mostly occurs is disc displacement with reduction. Disc displacement that causes the displacement of condyle position can be evaluated by using radiograph. The Cone Beam Computed Tomography (CBCT-3D is a radiograph equipment which is able to capture the condyle position from many directions. This research was aimed to see the condyle position in patients with disc displacement with reduction symptoms. This research was conducted to 11 patients with symptoms of disc displacement with reduction and 3 patients without symptoms of disc displacement with reduction as the counterpart. What was conducted to the sample was the radiographic imaging using CBCT-3D radiography, followed by measuring the joint space distance in the sagittal and coronal directions. The result of the research was analyzed using the T-test. Statistically, the result of the test showed a significant difference ( = 0.05 between patients with disc displacement with reduction symptoms and the patients without symptoms, in sagittal and coronal views. The conclusion led to the difference in condyle positions in patients with the disc displacement with reduction and patients without the symptoms which meant there was a condyle position displacement that caused the distance alteration in joint space in sagittal and coronal directions.

  9. Integrity of articular cartilage on T2 mapping associated with meniscal signal change

    International Nuclear Information System (INIS)

    Kai, Brian; Mann, Sumeer A.; King, Chris; Forster, Bruce B.

    2011-01-01

    Objective: The purpose of this study was to investigate the relationship between T2 relaxation values (T2 RVs) within the superficial zone of articular cartilage and different types of meniscal degeneration/tear. Materials and methods: A review of 310 consecutive knee MRIs which included an 8 echo T2 relaxation sequence, in patients referred for standard clinical indications, was performed independently and in blinded fashion by 2 observers. The posterior horns of the medial and lateral menisci were each evaluated and divided into 4 subgroups: Normal (control), Grade I/II meniscal signal, Grade III meniscal signal-simple tear (Grade III-S), and Grade III meniscal signal-complex tear (Grade III-C). After exclusion criteria were applied, the medial meniscal group consisted of 65 controls and 133 patients, while the lateral meniscal group consisted of 143 controls and 55 patients. T2 RVs were measured by an observer blinded to the clinical history and MRI grading. Measurements were obtained over the superficial zone of femoral and tibial articular cartilage adjacent to the center of the posterior horn of each meniscus to ensure consistency between measurements. Analysis of covariance adjusting for age and gender was used to compare T2 RVs between patients and controls. Results: T2 RVs were significantly increased in patients with Grade III-C meniscal tears compared to controls over the medial tibial plateau (MTP; p = 0.0001) and lateral tibial plateau (LTP; p = 0.0008). T2 RVs were not increased in patients with Grade III-C meniscal tears over the medial femoral condyle (MFC; p = 0.11) or lateral femoral condyle (LFC; p = 0.99). Grade I/II meniscal signal was not associated with elevated T2 RVs over the MFC (p = 0.15), LFC (p = 0.69), MTP (p = 0.42), or LTP (p = 0.50). Grade III-S meniscal signal was not associated with elevated T2 RVs over the MFC (p = 0.54), LFC (p = 0.43), MTP (p = 0.30), or LTP (p = 0.38). Conclusion: Grade III-C meniscal tears are associated with

  10. Integrity of articular cartilage on T2 mapping associated with meniscal signal change

    Energy Technology Data Exchange (ETDEWEB)

    Kai, Brian [Department of Radiology, University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5 (Canada); Mann, Sumeer A. [Department of Radiology, University of Alberta, Walter Mackenzie Health Sciences Center, Edmonton, AB, T6G 2B7 (Canada); King, Chris [Department of Radiology, University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5 (Canada); Forster, Bruce B., E-mail: bruce.forster@vch.ca [Department of Radiology, University of British Columbia, UBC Hospital, 2211 Wesbrook Mall, Vancouver, BC, V6T 2B5 (Canada)

    2011-09-15

    Objective: The purpose of this study was to investigate the relationship between T2 relaxation values (T2 RVs) within the superficial zone of articular cartilage and different types of meniscal degeneration/tear. Materials and methods: A review of 310 consecutive knee MRIs which included an 8 echo T2 relaxation sequence, in patients referred for standard clinical indications, was performed independently and in blinded fashion by 2 observers. The posterior horns of the medial and lateral menisci were each evaluated and divided into 4 subgroups: Normal (control), Grade I/II meniscal signal, Grade III meniscal signal-simple tear (Grade III-S), and Grade III meniscal signal-complex tear (Grade III-C). After exclusion criteria were applied, the medial meniscal group consisted of 65 controls and 133 patients, while the lateral meniscal group consisted of 143 controls and 55 patients. T2 RVs were measured by an observer blinded to the clinical history and MRI grading. Measurements were obtained over the superficial zone of femoral and tibial articular cartilage adjacent to the center of the posterior horn of each meniscus to ensure consistency between measurements. Analysis of covariance adjusting for age and gender was used to compare T2 RVs between patients and controls. Results: T2 RVs were significantly increased in patients with Grade III-C meniscal tears compared to controls over the medial tibial plateau (MTP; p = 0.0001) and lateral tibial plateau (LTP; p = 0.0008). T2 RVs were not increased in patients with Grade III-C meniscal tears over the medial femoral condyle (MFC; p = 0.11) or lateral femoral condyle (LFC; p = 0.99). Grade I/II meniscal signal was not associated with elevated T2 RVs over the MFC (p = 0.15), LFC (p = 0.69), MTP (p = 0.42), or LTP (p = 0.50). Grade III-S meniscal signal was not associated with elevated T2 RVs over the MFC (p = 0.54), LFC (p = 0.43), MTP (p = 0.30), or LTP (p = 0.38). Conclusion: Grade III-C meniscal tears are associated with

  11. Mesenchymal Stem Cells and Platelet Gel Improve Bone Deposition within CAD-CAM Custom-Made Ceramic HA Scaffolds for Condyle Substitution

    Directory of Open Access Journals (Sweden)

    L. Ciocca

    2013-01-01

    Full Text Available Purpose. This study evaluated the efficacy of a regenerative approach using mesenchymal stem cells (MSCs and CAD-CAM customized pure and porous hydroxyapatite (HA scaffolds to replace the temporomandibular joint (TMJ condyle. Methods. Pure HA scaffolds with a 70% total porosity volume were prototyped using CAD-CAM technology to replace the two temporomandibular condyles (left and right of the same animal. MSCs were derived from the aspirated iliac crest bone marrow, and platelets were obtained from the venous blood of the sheep. Custom-made surgical guides were created by direct metal laser sintering and were used to export the virtual planning of the bone cut lines into the surgical environment. Sheep were sacrificed 4 months postoperatively. The HA scaffolds were explanted, histological specimens were prepared, and histomorphometric analysis was performed. Results. Analysis of the porosity reduction for apposition of newly formed bone showed a statistically significant difference in bone formation between condyles loaded with MSC and condyles without (P<0.05. The bone ingrowth (BI relative values of split-mouth comparison (right versus left side showed a significant difference between condyles with and without MSCs (P<0.05. Analysis of the test and control sides in the same animal using a split-mouth study design was performed; the condyle with MSCs showed greater bone formation. Conclusion. The split-mouth design confirmed an increment of bone regeneration into the HA scaffold of up to 797% upon application of MSCs.

  12. Mesenchymal stem cells and platelet gel improve bone deposition within CAD-CAM custom-made ceramic HA scaffolds for condyle substitution.

    Science.gov (United States)

    Ciocca, L; Donati, D; Ragazzini, S; Dozza, B; Rossi, F; Fantini, M; Spadari, A; Romagnoli, N; Landi, E; Tampieri, A; Piattelli, A; Iezzi, G; Scotti, R

    2013-01-01

    This study evaluated the efficacy of a regenerative approach using mesenchymal stem cells (MSCs) and CAD-CAM customized pure and porous hydroxyapatite (HA) scaffolds to replace the temporomandibular joint (TMJ) condyle. Pure HA scaffolds with a 70% total porosity volume were prototyped using CAD-CAM technology to replace the two temporomandibular condyles (left and right) of the same animal. MSCs were derived from the aspirated iliac crest bone marrow, and platelets were obtained from the venous blood of the sheep. Custom-made surgical guides were created by direct metal laser sintering and were used to export the virtual planning of the bone cut lines into the surgical environment. Sheep were sacrificed 4 months postoperatively. The HA scaffolds were explanted, histological specimens were prepared, and histomorphometric analysis was performed. Analysis of the porosity reduction for apposition of newly formed bone showed a statistically significant difference in bone formation between condyles loaded with MSC and condyles without (P < 0.05). The bone ingrowth (BI) relative values of split-mouth comparison (right versus left side) showed a significant difference between condyles with and without MSCs (P < 0.05). Analysis of the test and control sides in the same animal using a split-mouth study design was performed; the condyle with MSCs showed greater bone formation. The split-mouth design confirmed an increment of bone regeneration into the HA scaffold of up to 797% upon application of MSCs.

  13. PEEK-OPTIMA™ as an alternative to cobalt chrome in the femoral component of total knee replacement: A preliminary study.

    Science.gov (United States)

    Cowie, Raelene M; Briscoe, Adam; Fisher, John; Jennings, Louise M

    2016-11-01

    PEEK-OPTIMA ™ (Invibio Ltd, UK) has been considered as an alternative joint arthroplasty bearing material due to its favourable mechanical properties and the biocompatibility of its wear debris. In this study, the potential to use injection moulded PEEK-OPTIMA ™ as an alternative to cobalt chrome in the femoral component of a total knee replacement was investigated in terms of its wear performance. Experimental wear simulation of three cobalt chrome and three PEEK-OPTIMA ™ femoral components articulating against all-polyethylene tibial components was carried out under two kinematic conditions: 3 million cycles under intermediate kinematics (maximum anterior-posterior displacement of 5 mm) followed by 3 million cycles under high kinematic conditions (anterior-posterior displacement 10 mm). The wear of the GUR1020 ultra-high-molecular-weight polyethylene tibial components was assessed by gravimetric analysis; for both material combinations under each kinematic condition, the mean wear rates were low, that is, below 5 mm 3 /million cycles. Specifically, under intermediate kinematic conditions, the wear rate of the ultra-high-molecular-weight polyethylene tibial components was 0.96 ± 2.26 mm 3 /million cycles and 2.44 ± 0.78 mm 3 /million cycle against cobalt chrome and PEEK-OPTIMA ™ implants, respectively (p = 0.06); under high kinematic conditions, the wear rates were 2.23 ± 1.85 mm 3 /million cycles and 4.44 ± 2.35 mm 3 /million cycles, respectively (p = 0.03). Following wear simulation, scratches were apparent on the surface of the PEEK-OPTIMA ™ femoral components. The surface topography of the femoral components was assessed using contacting profilometry and showed a statistically significant increase in measured surface roughness of the PEEK-OPTIMA ™ femoral components compared to the cobalt chrome implants. However, this did not appear to influence the wear rate, which remained linear over the duration of

  14. PEEK-OPTIMA™ as an alternative to cobalt chrome in the femoral component of total knee replacement: A preliminary study

    Science.gov (United States)

    Cowie, Raelene M; Briscoe, Adam; Fisher, John; Jennings, Louise M

    2016-01-01

    PEEK-OPTIMA™ (Invibio Ltd, UK) has been considered as an alternative joint arthroplasty bearing material due to its favourable mechanical properties and the biocompatibility of its wear debris. In this study, the potential to use injection moulded PEEK-OPTIMA™ as an alternative to cobalt chrome in the femoral component of a total knee replacement was investigated in terms of its wear performance. Experimental wear simulation of three cobalt chrome and three PEEK-OPTIMA™ femoral components articulating against all-polyethylene tibial components was carried out under two kinematic conditions: 3 million cycles under intermediate kinematics (maximum anterior-posterior displacement of 5 mm) followed by 3 million cycles under high kinematic conditions (anterior-posterior displacement 10 mm). The wear of the GUR1020 ultra-high-molecular-weight polyethylene tibial components was assessed by gravimetric analysis; for both material combinations under each kinematic condition, the mean wear rates were low, that is, below 5 mm3/million cycles. Specifically, under intermediate kinematic conditions, the wear rate of the ultra-high-molecular-weight polyethylene tibial components was 0.96 ± 2.26 mm3/million cycles and 2.44 ± 0.78 mm3/million cycle against cobalt chrome and PEEK-OPTIMA™ implants, respectively (p = 0.06); under high kinematic conditions, the wear rates were 2.23 ± 1.85 mm3/million cycles and 4.44 ± 2.35 mm3/million cycles, respectively (p = 0.03). Following wear simulation, scratches were apparent on the surface of the PEEK-OPTIMA™ femoral components. The surface topography of the femoral components was assessed using contacting profilometry and showed a statistically significant increase in measured surface roughness of the PEEK-OPTIMA™ femoral components compared to the cobalt chrome implants. However, this did not appear to influence the wear rate, which remained linear over the duration of the study. These

  15. Operative treatment of lateral humeral condyle fractures in children.

    Science.gov (United States)

    Wirmer, Johannes; Kruppa, Christian; Fitze, Guido

    2012-08-01

    The operative treatment of lateral humeral condyle fractures in children remains controversial. The result of incorrectly treated fractures may lead to complications such as pseudoarthrosis and severe deformity, with considerable functional and cosmetic restrictions. The aim of this study was to determine whether operative treatment of lateral humeral condyle fractures in children using Screw-wires (Orthofix GmbH, Ottobrunn, Germany) has any advantage over treatment with Kirschner wires ("K-wires") (aap-Implantate AG, Berlin, Germany). These results were then compared with operative treatment using lag-screw osteosynthesis. We treated surgically 76 cases of fracture of the lateral humeral condyle in children at the Department of Pediatric Surgery in Dresden between 1989 to 2002 and 2004 to 2008, from which 42 were available for follow-up examination. Within this group, there were seven children that were followed-up twice (in 1996 to 2002). Of these, 21 patients were treated with Screw-wires, and another 21 had K-wires inserted. The results were evaluated according to the Dhillon criteria. Only seven patients (17%) had a fair result in the overall grading according to the Dhillon criteria, four after K-wire and three after Screw-wire osteosyntheses. The remaining patients scored good to excellent results. There were no pseudoarthroses. Six patients (14%) had a varisation in the carrying angle between 10 and 16 degrees (three each procedure), and 15 patients (36%) had no difference in the carrying angle at all. Of these 15 patients, 10 were treated with Screw-wire osteosynthesis. Only one patient (2.4%) had a deficit of more than 10 degrees in elbow joint flexion, while only two (4.8%, one each procedure) had a deficit of more than 10 degrees in elbow joint extension, compared with the uninjured arm. Our results demonstrate that the employment of Screw-wire osteosynthesis is superior to the use of K-wires concerning the carrying angle while scoring alike on the

  16. The role of acetabulum geometry and femoral head-neck ratio in the development of osteoarthritis in young men

    DEFF Research Database (Denmark)

    Halle, B; Halle, D M; Torfing, T

    2007-01-01

    and the consequence of acetabular retroversion on standardized x-rays. Men aged 26-55 years who earlier had a total hip arthroplasty were included in the case group. This group was compared to a control-group of men treated as trauma patients. The study indicates that acetabular dysplasia and retroversion......We studied the role of acetabulum geometry and head neck ratio in the development of osteoarthritis of the hip in young men. Contrary to previous studies we evaluated the significance of the anterior, posterior and total coverage of the femoral head, the influence of the femoral neck...... and a relative decreased head neck ratio are associated with osteoarthritis of the hip in young men....

  17. Measurement of Posterior Tibial Slope Using Magnetic Resonance Imaging.

    Science.gov (United States)

    Karimi, Elham; Norouzian, Mohsen; Birjandinejad, Ali; Zandi, Reza; Makhmalbaf, Hadi

    2017-11-01

    Posterior tibial slope (PTS) is an important factor in the knee joint biomechanics and one of the bone features, which affects knee joint stability. Posterior tibial slope has impact on flexion gap, knee joint stability and posterior femoral rollback that are related to wide range of knee motion. During high tibial osteotomy and total knee arthroplasty (TKA) surgery, proper retaining the mechanical and anatomical axis is important. The aim of this study was to evaluate the value of posterior tibial slope in medial and lateral compartments of tibial plateau and to assess the relationship among the slope with age, gender and other variables of tibial plateau surface. This descriptive study was conducted on 132 healthy knees (80 males and 52 females) with a mean age of 38.26±11.45 (20-60 years) at Imam Reza hospital in Mashhad, Iran. All patients, selected and enrolled for MRI in this study, were admitted for knee pain with uncertain clinical history. According to initial physical knee examinations the study subjects were reported healthy. The mean posterior tibial slope was 7.78± 2.48 degrees in the medial compartment and 6.85± 2.24 degrees in lateral compartment. No significant correlation was found between age and gender with posterior tibial slope ( P ≥0.05), but there was significant relationship among PTS with mediolateral width, plateau area and medial plateau. Comparison of different studies revealed that the PTS value in our study is different from other communities, which can be associated with genetic and racial factors. The results of our study are useful to PTS reconstruction in surgeries.

  18. Comparative study of the prognosis of an extracorporeal reduction and a closed treatment in mandibular condyle head and/or neck fractures.

    Science.gov (United States)

    Park, Jung-Min; Jang, Yong-Wook; Kim, Seong-Gon; Park, Young-Wook; Rotaru, Horatiu; Baciut, Grigore; Hurubeanu, Lucia

    2010-12-01

    The objective of this study was a comparison of the prognosis between an extracorporeal reduction technique and closed treatment of a mandibular condyle fracture. The relationship between condylar resorption and several clinical variables was also studied. Seventy-one patients who had a mandibular condyle fracture took part in this study. Thirty-five patients (female: 7, male: 28, age: 30.46 ± 14.27 years) were treated by extracorporeal reduction, and 36 patients (male: 24, female: 12, age: 24.28 ± 9.99 years) were treated using a closed treatment. The presence of complications such as condylar resorption, malocclusion, nerve disorder, and disc displacement was evaluated with panoramic radiographs and clinical examinations 12 months after treatment. The relationships between the complications and other clinical variables were evaluated statistically. The anatomic site and fracture type were closely related to condyle resorption in the bivariate analysis. Condylar head fractures showed significantly higher condyle resorption than condylar neck fractures (P = .023). A complex or compound fracture showed significantly higher condyle resorption compared with a simple fracture (P = .006). Patients who had a complex/compound fracture were 34.366 times more likely to have condyle resorption compared with those who had a simple fracture (P = .002). The patient's age and treatment method were also significant predictors for condyle resorption. Fracture type was the strongest predictor of condylar resorption. Because treatment method and patient age were also related to the prognosis, the optimal treatment for mandibular condylar head and/or neck fractures should be individualized according to the patient's condition. Copyright © 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  19. 99mTc-MDP scintigraphy of femoral head necrosis following femoral neck fracture

    International Nuclear Information System (INIS)

    Lee, Soon Jin; Lee, Jun Hyung; Kim, Eun Kyung; Lee, Sun Wha; Kim, Soon Yong

    1985-01-01

    Secondary ischemic necrosis of femoral head due to loss of blood supply following to femoral neck fracture is well known. The regional distribution of bone-seeking radiopharmaceuricals in the skeleton can depend on a number of factors, but bone blood flow is a major physiological determinant of regional skeletal uptake of Tc-99m polyphosphate and bone imaging may thus be used for the evaluation of vascularity of the femoral head. The authors made a comparative study of scintigraphic findings and operative findings of 28 cases of femoral neck fracture treated at Kyung Hee University Hospital from April 1980 to May 1984. The results were as follows: 1. In 16 cases of proven avascular necorsis of femoral head, scintigraphy showed absent or decreased activity in 14 cases (87.5%), while radiography showed increased density in 10 cases (62.5%). 2. In 12 cases of proven vital femoral head, scintigraphy showed increased activity in 9 cases (75%) and radiography showed decreased density in 9 cases (75%). 3. 99mTc-MDP scintigraphy was an excellent and useful method for assessing bone vitality of femoral head

  20. Total knee reconstruction without posterior stabilization in rheumatoid arthritis patients

    Directory of Open Access Journals (Sweden)

    Radu Prejbeanu

    2010-12-01

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

  1. Evaluation of the muscle morphology of the obturator externus and piriformis as the predictors of avascular necrosis of the femoral head in acetabular fractures.

    Science.gov (United States)

    Maini, Lalit; Kumar, Santosh; Batra, Sahil; Gupta, Rajat; Arora, Sumit

    2016-08-01

    Avascular necrosis (AVN) of femoral head is a recognised complication of fracture dislocation of the hip joint but is not studied frequently in relation to acetabulum fractures. The aim was to establish the relationship between obturator externus and piriformis muscle morphology in acetabulum fractures and potenital development of AVN of the femoral head. Twenty-five fractures were included in this prospective study and were subjected to radiological assessment and computed tomography of the pelvis. Magnetic resonance imaging (MRI) of the hip was performed to assess the morphology of obturator externus and piriformis, and findings were compared intraoperatively (in 15 cases). Serial radiographs were taken at monthly intervals to assess the development of avascular necrosis. The patients with no evidence of AVN on radiographs at 6 months had additional MRI scans to look for such changes. Three patients developed AVN of femoral head and two had complete tears of piriformis and/or obturator externus muscles on the pre-operative MRI with the findings confirmed intraoperatively (p = 0.013). None of the patients without changes of AVN at 6-month follow-up had complete tears of either or both muscles. Of these patients, there was one case each of T-type fracture, isolated posterior wall fracture with hip dislocation, and posterior wall with transverse fracture of the acetabulum. Complete tears of obturator externus and/or piriformis muscles are a strong predictor of future development of AVN of the femoral head.

  2. Fixation strength of a polyetheretherketone femoral component in total knee arthroplasty.

    Science.gov (United States)

    de Ruiter, Lennert; Janssen, Dennis; Briscoe, Adam; Verdonschot, Nico

    2017-11-01

    Introducing polyetheretherketone (PEEK) polymer as a material for femoral components in total knee arthroplasty (TKA) could potentially lead to a reduction of the cemented fixation strength. A PEEK implant is more likely to deform under high loads, rendering geometrical locking features less effective. Fixation strength may be enhanced by adding more undercuts or specific surface treatments. The aim of this study is to measure the initial fixation strength and investigate the associated failure patterns of three different iterations of PEEK-OPTIMA ® implants compared with a Cobalt-Chromium (CoCr) component. Femoral components were cemented onto trabecular bone analogue foam blocks and preconditioned with 86,400 cycles of compressive loading (2600 N-260 N at 1 Hz). They were then extracted while the force was measured and the initial failure mechanism was recorded. Four groups were compared: CoCr, regular PEEK, PEEK with an enhanced cement-bonding surface and the latter with additional surface primer. The mean pull-off forces for the four groups were 3814 N, 688 N, 2525 N and 2552 N, respectively. The initial failure patterns for groups 1, 3 and 4 were the same; posterior condylar foam fracture and cement-bone debonding. Implants from group 2 failed at the cement-implant interface. This study has shown that a PEEK-OPTIMA ® femoral TKA component with enhanced macro- and microtexture is able to replicate the main failure mechanism of a conventional CoCr femoral implant. The fixation strength is lower than for a CoCr implant, but substantially higher than loads occurring under in-vivo conditions. Copyright © 2017 IPEM. Published by Elsevier Ltd. All rights reserved.

  3. Outcomes of Osteochondral Allograft Transplantation With and Without Concomitant Meniscus Allograft Transplantation: A Comparative Matched Group Analysis.

    Science.gov (United States)

    Frank, Rachel M; Lee, Simon; Cotter, Eric J; Hannon, Charles P; Leroux, Timothy; Cole, Brian J

    2018-03-01

    Osteochondral allograft transplantation (OCA) is often performed with concomitant meniscus allograft transplantation (MAT) as a strategy for knee joint preservation, although to date, the effect of concomitant MAT on outcomes and failure rates after OCA has not been assessed. To determine clinical outcomes for patients undergoing OCA with MAT as compared with a matched cohort of patients undergoing isolated OCA. Control study; Level of evidence, 3. Patients who underwent OCA of the medial or lateral femoral condyle without concomitant MAT by a single surgeon were compared with a matched group of patients who underwent OCA with concomitant MAT (ipsilateral compartment). The patients were matched per age, sex, body mass index, and number of previous ipsilateral knee operations ±1. Patient-reported outcomes, complications, reoperations, and survival rates were compared between groups. One hundred patients undergoing OCA (50 isolated, 50 with MAT) with a mean ± SD follow-up of 4.9 ± 2.7 years (minimum, 2 years) were included (age, 31.7 ± 9.8 years; 52% male). Significantly more patients underwent OCA to the medial femoral condyle (n = 59) than the lateral femoral condyle (n = 41, P OCA. There were no significant differences between the groups regarding reoperation rate (n = 18 for OCA with MAT, n = 17 for OCA without MAT, P = .834), time to reoperation (2.2 ± 2.4 years for OCA with MAT, 3.4 ± 2.7 years for OCA without MAT, P = .149), or failure rates (n = 7 [14%] for OCA with MAT, n = 7 [14%] for OCA without MAT, P > .999). There were no significant differences in patient-reported clinical outcome scores between the groups at final follow-up. There was no significant difference in failure rates between patients undergoing medial femoral condyle OCA (n = 12, 15.3%) and lateral femoral condyle OCA (n = 5, 12.2%, P = .665). These results imply that with appropriate surgical indications to address meniscus deficiency in patients otherwise indicated for OCA and

  4. [Clinical evaluation of the ceramic femoral component used for reconstruction of total knee replacement].

    Science.gov (United States)

    Vavrík, P; Landor, I; Denk, F

    2008-12-01

    The study evaluates mid-term results of total knee replacement with a zirconia ceramic (ZrO2) femoral component. The evaluated group comprised 20 knees in 19 patients (4 men and 15 women). In one patient the replacement was performed bilaterally. Two patients had in the contralateral knee the same type of prosthesis with a femoral chrome-cobalt component.The mean age at the time of operation was 65.2 years (range, 38-81 years).The primary indication was 14 times osteoarthritis and 5 times rheumatoid arthritis. The average follow-up period was 6.5 years (range, 2.1-8.5 years). Patients included in the study regardless of age, body mass and the basic diagnosis, agreed with the use of the ceramic femoral component. The evaluation covered a range of motion, mechanical axis, joint stability, pain, swelling, ability to walk on level ground and on stairs, subjective satisfaction (EULAR Knee Chart). Radiograph were assessed at one year intervals in two projections to identify the incidence of radiolucency around the implant. The Kaplan-Meier survival curve was used and compared with the survival curve in identical chrome-cobalt implants. At he final follow-up, 14 knees were evaluated, because 3 patients died without any connection with the implant, in one case the tibial component migrated due to necrosis of the tibial condyle in a patient with RA and two implants had to be revised and replaced due to polyethylene wear. No infection or negative tissue reaction was recorded in the evaluated group. The average flexion range was 109 degrees. All knees were stable and without swelling, in two cases there occurred slight femoropatellar pain. Twelve patients were fully satisfied, 2 patients were satisfied with a certain reservation. The differences in the course of the survival curves of chrome-cobalt and ceramic implants were statistically insignificant. Although the use of zirconia ceramics in vitro reduces the amount of polyethylene wear, the clinical outcomes of total knee

  5. Comparing the Musculoskeletal Profile of the Elderly With and Without History of Falling

    Directory of Open Access Journals (Sweden)

    Hamzeh Hasanvand

    2015-10-01

    Full Text Available Objectives: The purpose of current study was to study and compare the musculoskeletal profile of the elderly with and without the history of falling living at nursing homes in Rasht, Iran. Methods & Materials: A total of 54 elderly men and women, aged 60 years and older participated in this study. Of them, 16 (fall group experienced a fall in the previous year [Mean(SD of age: 79(9.90 years; height: 1.51(0.103 m; and weight: 60.03(11.12 kg] and 38 (no fall group had no history of falling [Mean(SD of age: 70.16(8.16 years; height: 1.56(0.11 m; and weight 65.6(14.93 kg]. The foot arch, distance between femoral condyles, kyphosis, lordosis, flexibility and the ability to walk were measured by ruler, caliper, flexible ruler, sit and reach test, and functional gait assessment questionnaires, respectively. Data analysis was done through independent t-test using SPSS. Study significance level was set at 0.05. Results: In the fall group the mean(SD of measured variables were as follows: body mass index (BMI: 25.95(3.35 kg/m2; foot arch: 9.94(4.34 mm; flexibility: 8.25(6.38 cm, lordosis: 20.86(9.48 degree; kyphosis: 35.07(14.98 degree. And in no fall group, the same variables were as follows: BMI: 26.87(5.12 kg/m2; foot arch: 10.95(5.60 mm; flexibility: 8.16(5.24 cm; lordosis 26.66(14.78 degree; and kyphosis: 41.11(9.84 degree. These variables were not significantly different between the groups; however, the functional gait assessment and distance between femoral condyles test showed significant differences. In the group with a history of fall, the functional gait assessment and distance between femoral condyles were 12.50(7.07 and 2.74(2.38 cm and in the group without a history of fall functional gait assessment and distance between femoral condyles were 23.63(5.49 and 1.20(1.4 cm, respectively. According to the results, in the fall group, the distance between femoral condyles was more and the performance level was less (P≤0.05. Conclusion

  6. Evaluation of perfusion of the femoral head after femoral neck fracture using bone scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Yamaguchi, Satoshi; Ishido, Yasuhiro [Saiseikai Sendai Hospital, Kagoshima (Japan); Okano, Toshihiro [Ibusuki National Hospital, Kagoshima (Japan); Komiya, Setsuro [Kagoshima Univ. (Japan). Faculty of Medicine

    2002-09-01

    We treated 13 patients for femoral neck fracture. They consisted of 2 males and 11 females, and were classified according to Garden stage classification; Stage I, 3 cases; Stage II, 2 cases; Stage III, 2 cases; Stage IV, 4 cases. Two trochanteric fracture cases were used by control. We evaluated perfusion of the femoral head after femoral neck fracture using bone scintigraphy, which is considered useful for evaluation of perfusion of the femoral neck before operation. (author)

  7. Evaluation of perfusion of the femoral head after femoral neck fracture using bone scintigraphy

    International Nuclear Information System (INIS)

    Yamaguchi, Satoshi; Ishido, Yasuhiro; Okano, Toshihiro; Komiya, Setsuro

    2002-01-01

    We treated 13 patients for femoral neck fracture. They consisted of 2 males and 11 females, and were classified according to Garden stage classification; Stage I, 3 cases; Stage II, 2 cases; Stage III, 2 cases; Stage IV, 4 cases. Two trochanteric fracture cases were used by control. We evaluated perfusion of the femoral head after femoral neck fracture using bone scintigraphy, which is considered useful for evaluation of perfusion of the femoral neck before operation. (author)

  8. CAD-CAM-generated hydroxyapatite scaffold to replace the mandibular condyle in sheep: preliminary results.

    Science.gov (United States)

    Ciocca, Leonardo; Donati, Davide; Fantini, Massimiliano; Landi, Elena; Piattelli, Adriano; Iezzi, Giovanna; Tampieri, Anna; Spadari, Alessandro; Romagnoli, Noemi; Scotti, Roberto

    2013-08-01

    In this study, rapid CAD-CAM prototyping of pure hydroxyapatite to replace temporomandibular joint condyles was tested in sheep. Three adult animals were implanted with CAD-CAM-designed porous hydroxyapatite scaffolds as condyle substitutes. The desired scaffold shape was achieved by subtractive automated milling machining (block reduction). Custom-made surgical guides were created by direct metal laser sintering and were used to export the virtual planning of the bone cut lines into the surgical environment. Using the same technique, fixation plates were created and applied to the scaffold pre-operatively to firmly secure the condyles to the bone and to assure primary stability of the hydroxyapatite scaffolds during masticatory function. Four months post-surgery, the sheep were sacrificed. The hydroxyapatite scaffolds were explanted, and histological specimens were prepared. Different histological tissues penetrating the scaffold macropores, the sequence of bone remodeling, new apposition of bone and/or cartilage as a consequence of the different functional anatomic role, and osseointegration at the interface between the scaffold and bone were documented. This animal model was found to be appropriate for testing CAD-CAM customization and the biomechanical properties of porous, pure hydroxyapatite scaffolds used as joint prostheses.

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

    DEFF Research Database (Denmark)

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

    2017-01-01

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

  10. Clinical and radiological outcomes after treatment of sagittal fracture of mandibular condyle (SFMC) by using occlusal splint in children.

    Science.gov (United States)

    Liu, Chang-Kui; Meng, Fan-Wen; Tan, Xin-Ying; Xu, Juan; Liu, Hua-Wei; Liu, San-Xia; Huang, Hai-Tao; Yan, Rong-Zeng; Hu, Min; Hu, Kai-Jin

    2014-02-01

    This study was designed to investigate the effects of occlusal splints in the treatment of sagittal fractures of the mandibular condyle in children. From January 1995 to December 2011, 37 sagittal fractures of the mandibular condyle in 30 patients aged 4-8 years old were included in this study. All the patients were treated with 1-2mm occlusal splints in the molar region. The mouths of the patients were kept slightly open by the occlusal splints for 3-6 months, and we reviewed the clinical and radiological remodelling of the affected condyles after treatment. Excellent (n=20) and good (n=10) clinical outcomes were achieved with full radiological remodelling seen in 19 and partial remodelling in 11. Treatment with occlusal splints is effective in delivering good results and function with minimal morbidity in children with sagittal fractures of the condyle, while permitting ongoing remodelling and growth in the short term. Copyright © 2013 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Influence of knee flexion angle and transverse drill angle on creation of femoral tunnels in double-bundle anterior cruciate ligament reconstruction using the transportal technique: Three-dimensional computed tomography simulation analysis.

    Science.gov (United States)

    Choi, Chong Hyuk; Kim, Sung-Jae; Chun, Yong-Min; Kim, Sung-Hwan; Lee, Su-Keon; Eom, Nam-Kyu; Jung, Min

    2018-01-01

    The purpose of this study was to find appropriate flexion angle and transverse drill angle for optimal femoral tunnels of anteromedial (AM) bundle and posterolateral (PL) bundle in double-bundle ACL reconstruction using transportal technique. Thirty three-dimensional knee models were reconstructed. Knee flexion angles were altered from 100° to 130° at intervals of 10°. Maximum transverse drill angle (MTA), MTA minus 10° and 20° were set up. Twelve different tunnels were determined by four flexion angles and three transverse drill angles for each bundle. Tunnel length, wall breakage, inter-tunnel communication and graft-bending angle were assessed. Mean tunnel length of AM bundle was >30mm at 120° and 130° of flexion in all transverse drill angles. Mean tunnel length of PL bundle was >30mm during every condition. There were ≥1 cases of wall breakage except at 120° and 130° of flexion with MTA for AM bundle. There was no case of wall breakage for PL bundle. Considering inter-tunnel gap of >2mm without communication and obtuse graft-bending angle, 120° of flexion and MTA could be recommended as optimal condition for femoral tunnels of AM and PL bundles. Flexion angle and transverse drill angle had combined effect on femoral tunnel in double-bundle ACL reconstruction using transportal technique. Achieving flexion angle of 120° and transverse drill angle close to the medial femoral condyle could be recommended as optimal condition for femoral tunnels of AM and PL bundles to avoid insufficient tunnel length, wall breakage, inter-tunnel communication and acute graft-bending angle. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Fractured condyle in a 3-month-old infant.

    Science.gov (United States)

    Cambell, R L; Moore, R F

    1975-07-01

    A 3-month-old infant sustained trauma to the mandibular symphysis resulting in radiographic evidence of a fracture of the right condylar head. This presented the diffculty of performing a clinical examination and total reliance on history of a trauma and subsequent swelling. Multiple radiographs of the condyles were used to establish the diagnosis and rule out a film artifact. No definitive treatment was required other than muscle exercises and parental instruction as to potential problems.

  13. Measurement repeatability of tibial tuberosity-trochlear groove offset distance in red fox (Vulpes vulpes) cadavers

    DEFF Research Database (Denmark)

    Miles, James Edward; Jensen, Bente Rona; Kirpensteijn, Jolle

    2013-01-01

    . Animals-12 red fox (Vulpes vulpes) cadavers. Procedures-CT images of each hind limb in intact cadavers were obtained; at 1-week intervals, 3 reconstructions were performed that were based on 1 plane passing through the centers of the femoral head and medial condyle and parallel to the caudal femoral...

  14. Comparison of femoral morphology and bone mineral density between femoral neck fractures and trochanteric fractures.

    Science.gov (United States)

    Maeda, Yuki; Sugano, Nobuhiko; Saito, Masanobu; Yonenobu, Kazuo

    2011-03-01

    Many studies that analyzed bone mineral density (BMD) and skeletal factors of hip fractures were based on uncalibrated radiographs or dual-energy xray absorptiometry (DXA). Spatial accuracy in measuring BMD and morphologic features of the femur with DXA is limited. This study investigated differences in BMD and morphologic features of the femur between two types of hip fractures using quantitative computed tomography (QCT). Forty patients with hip fractures with normal contralateral hips were selected for this study between 2003 and 2007 (trochanteric fracture, n=18; femoral neck fracture, n=22). Each patient underwent QCT of the bilateral femora using a calibration phantom. Using images of the intact contralateral femur, BMD measurements were made at the point of minimum femoral-neck cross-sectional area, middle of the intertrochanteric region, and center of the femoral head. QCT images also were used to measure morphologic features of the hip, including hip axis length, femoral neck axis length, neck-shaft angle, neck width, head offset, anteversion of the femoral neck, and cortical index at the femoral isthmus. No significant differences were found in trabecular BMD between groups in those three regions. Patients with trochanteric fractures showed a smaller neck shaft angle and smaller cortical index at the femoral canal isthmus compared with patients with femoral neck fractures. We conclude that severe osteoporosis with thinner cortical bone of the femoral diaphysis is seen more often in patients with trochanteric fracture than in patients with femoral neck fracture. Level IV, prognostic study. See Guidelines for Authors for a complete description of levels of evidence.

  15. {sup 99m}Tc-MDP scintigraphy of femoral head necrosis following femoral neck fracture

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Soon Jin; Lee, Jun Hyung; Kim, Eun Kyung; Lee, Sun Wha; Kim, Soon Yong [Kyung Hee University School of Medicine, Seoul (Korea, Republic of)

    1985-02-15

    Secondary ischemic necrosis of femoral head due to loss of blood supply following to femoral neck fracture is well known. The regional distribution of bone-seeking radiopharmaceuricals in the skeleton can depend on a number of factors, but bone blood flow is a major physiological determinant of regional skeletal uptake of Tc-99m polyphosphate and bone imaging may thus be used for the evaluation of vascularity of the femoral head. The authors made a comparative study of scintigraphic findings and operative findings of 28 cases of femoral neck fracture treated at Kyung Hee University Hospital from April 1980 to May 1984. The results were as follows: 1. In 16 cases of proven avascular necorsis of femoral head, scintigraphy showed absent or decreased activity in 14 cases (87.5%), while radiography showed increased density in 10 cases (62.5%). 2. In 12 cases of proven vital femoral head, scintigraphy showed increased activity in 9 cases (75%) and radiography showed decreased density in 9 cases (75%). 3. 99mTc-MDP scintigraphy was an excellent and useful method for assessing bone vitality of femoral head.

  16. Comparison of accuracy of uncorrected and corrected sagittal tomography in detection of mandibular condyle erosions: An exvivo study

    Directory of Open Access Journals (Sweden)

    Asieh Zamani Naser

    2010-01-01

    Full Text Available Background: Radiographic examination of TMJ is indicated when there are clinical signs of pathological conditions, mainly bone changes that may influence the diagnosis and treatment planning. The purpose of this study was to evaluate and to compare the validity and diagnostic accuracy of uncorrected and corrected sagittal tomographic images in the detection of simulated mandibular condyle erosions. Methods : Simulated lesions were created in 10 dry mandibles using a dental round bur. Using uncorrected and corrected sagittal tomography techniques, mandibular condyles were imaged by a Cranex Tome X-ray unit before and after creating the lesions. The uncorrected and corrected tomography images were examined by two independent observers for absence or presence of a lesion. The accuracy for detecting mandibular condyle lesions was expressed as sensitivity, specificity, and validity values. Differences between the two radiographic modalities were tested by Wilcoxon for paired data tests. Inter-observer agreement was determined by Cohen′s Kappa. Results: The sensitivity, specificity and validity were 45%, 85% and 30% in uncorrected sagittal tomographic images, respectively, and 70%, 92.5% and 60% in corrected sagittal tomographic images, respectively. There was a significant statistical difference between the accuracy of uncorrected and corrected sagittal tomography in detection of mandibular condyle erosions (P = 0.016. The inter-observer agreement was slight for uncorrected sagittal tomography and moderate for corrected sagittal tomography. Conclusion: The accuracy of corrected sagittal tomography is significantly higher than that of uncorrected sagittal tomography. Therefore, corrected sagittal tomography seems to be a better modality in detection of mandibular condyle erosions.

  17. Assessment of osteoarthrosis of the temporomandibular joint associated with avascular necrosis of the condyle on magnetic resonance imaging

    International Nuclear Information System (INIS)

    Segami, Natsuki; Murakami, Ken-ichiro; Hosaka, Hideo; Moriya, Yoshiyuki; Miyaki, Katsuaki; Chen, Wen-Hsi; Iizuka, Tadahiko

    1993-01-01

    Osteoarthrosis associated with findings of avascular necrosis of the mandibular condyle on magnetic resonance imaging was clinically evaluated. The subjects consisted of 5 female unilateral cases, with an average age of 55.4 years who had a mean duration of illness of 15.2 months. The symptoms were a mean interincisal opening distance of 32.8 mm with arthralgia in mild to moderate degree, and joint noise (crepitation) in all joints. MRI documented decreasing signal intensity of the condyle with 2 joints in high degree and 3 joints in moderate, as well as variable low signal density of the articular eminence, associated with concomitant anterior disk displacement. X-ray showed deformity of the condyle and eminence. The operative findings disclosed disk rupture and comparatively smooth cartilage with minimum remodeling of the condylar surface; however, avascular evidence was suggested when corticotomy was performed. 4 joints underwent diskectomy, condylar shaving, auricular cartilage grafts and corticotomy of the condyle. Arthroscopic corticotomy was applied for 1 joint with mild symptoms. Postoperative symptoms improved to mean opening distance of 41.4 mm and disappeared arthralgia in 4 joints. The surgical outcome was excellent in 3 joints and good in 2 joints. Follow-up MRI in 2 cases disclosed increasing signal intensity, which suggested recovery of condylar vascularity following corticotomy. It is suggested that the low-signal intensity on MRI in osteoarthrosis might indicate avascular lesions of the condyle, secondary to degenerative change. Histological investigations are required to evaluate avascular necrosis of the temporomandibular joints. (author)

  18. Assessment of osteoarthrosis of the temporomandibular joint associated with avascular necrosis of the condyle on magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Segami, Natsuki; Murakami, Ken-ichiro; Hosaka, Hideo; Moriya, Yoshiyuki; Miyaki, Katsuaki; Chen, Wen-Hsi; Iizuka, Tadahiko [Kyoto Univ. (Japan). Faculty of Medicine

    1993-02-01

    Osteoarthrosis associated with findings of avascular necrosis of the mandibular condyle on magnetic resonance imaging was clinically evaluated. The subjects consisted of 5 female unilateral cases, with an average age of 55.4 years who had a mean duration of illness of 15.2 months. The symptoms were a mean interincisal opening distance of 32.8 mm with arthralgia in mild to moderate degree, and joint noise (crepitation) in all joints. MRI documented decreasing signal intensity of the condyle with 2 joints in high degree and 3 joints in moderate, as well as variable low signal density of the articular eminence, associated with concomitant anterior disk displacement. X-ray showed deformity of the condyle and eminence. The operative findings disclosed disk rupture and comparatively smooth cartilage with minimum remodeling of the condylar surface; however, avascular evidence was suggested when corticotomy was performed. 4 joints underwent diskectomy, condylar shaving, auricular cartilage grafts and corticotomy of the condyle. Arthroscopic corticotomy was applied for 1 joint with mild symptoms. Postoperative symptoms improved to mean opening distance of 41.4 mm and disappeared arthralgia in 4 joints. The surgical outcome was excellent in 3 joints and good in 2 joints. Follow-up MRI in 2 cases disclosed increasing signal intensity, which suggested recovery of condylar vascularity following corticotomy. It is suggested that the low-signal intensity on MRI in osteoarthrosis might indicate avascular lesions of the condyle, secondary to degenerative change. Histological investigations are required to evaluate avascular necrosis of the temporomandibular joints. (author).

  19. Quadriceps Function and Knee Joint Ultrasonography after ACL Reconstruction.

    Science.gov (United States)

    Pamukoff, Derek N; Montgomery, Melissa M; Moffit, Tyler J; Vakula, Michael N

    2018-02-01

    Individuals with anterior cruciate ligament reconstruction (ACLR) are at greater risk for knee osteoarthritis, partially because of chronic quadriceps dysfunction. Articular cartilage is commonly assessed using magnetic resonance imaging and radiography, but these methods are expensive and lack portability. Ultrasound imaging may provide a cost-effective and portable alternative for imaging the femoral cartilage. The purpose of this study was to compare ultrasonography of the femoral cartilage between the injured and uninjured limbs of individuals with unilateral ACLR, and to examine the association between quadriceps function and ultrasonographic measures of femoral cartilage. Bilateral femoral cartilage thickness and quadriceps function were assessed in 44 individuals with unilateral ACLR. Quadriceps function was assessed using peak isometric strength, and early (RTD100) and late (RTD200) rate of torque development. Cartilage thickness at the medial femoral condyle (P accounting for time since ACLR, quadriceps peak isometric strength was associated with cartilage thickness at the medial femoral condyle (r = 0.35, P = 0.02) and femoral cartilage cross-sectional area (r = 0.28, P = 0.04). RTD100 and RTD200 were not associated with femoral cartilage thickness or cross-sectional area. Individuals with ACLR have thinner cartilage in their injured limb compared with uninjured limb, and cartilage thickness is associated with quadriceps function. These results indicate that ultrasonography may be useful for monitoring cartilage health and osteoarthritis progression after ACLR.

  20. Distribution of vitamin K2 in subchondral bone in osteoarthritic knee joints.

    Science.gov (United States)

    Ishii, Yoshinori; Noguchi, Hideo; Takeda, Mitsuhiro; Sato, Junko; Yamamoto, Noriaki; Wakabayashi, Hiroyuki; Kanda, Junkichi; Toyabe, Shin-ichi

    2013-08-01

    Vitamin K may have multiple effects on articular cartilage and subchondral bone that could modulate the pathogenesis of osteoarthritis (OA). The purpose of this study was to evaluate the distribution of vitamin K2 in harvested bones obtained during total knee arthroplasty in knee OA patients. High-performance liquid chromatography was used to measure vitamin K2 in harvested bones obtained during 58 TKA procedures. Vitamin K2 levels were analysed in the medial (FM) and lateral (FL) femoral condyles and in the medial (TM) and lateral (TL) tibial condyles. There was significantly more vitamin K2 in the lateral femoral and tibial condyles than in the corresponding medial condyles (FL vs. FM, p K2 in the FL than in the TL (p = 0.003), and in the FM, vitamin K2 levels were higher than those of the TM, although this was not significant (n.s.). There were no significant differences in vitamin K2 levels in men versus women nor was there a significant correlation with age. This study suggested that vitamin K2 might affect bone turnover since medial condyles showing advanced OA had lower vitamin K2 levels, while lateral condyles showing less advanced OA contained more vitamin K2. Gender and age were not correlated with vitamin K2 localization. All cases had Grade IV OA, and this study suggested that OA grade might be important in controlling the vitamin K2 levels in human bones.

  1. Cartilage Degeneration and Alignment in Severe Varus Knee Osteoarthritis.

    Science.gov (United States)

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

    2015-10-01

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

  2. 78 FR 79308 - Dental Devices; Reclassification of Temporary Mandibular Condyle Prosthesis

    Science.gov (United States)

    2013-12-30

    ... DEPARTMENT OF HEALTH AND HUMAN SERVICES Food and Drug Administration 21 CFR Part 872 [Docket No. FDA-2012-N-1239] Dental Devices; Reclassification of Temporary Mandibular Condyle Prosthesis AGENCY... delegated to the Commissioner of Food and Drugs, 21 CFR part 872 is amended as follows: PART 872--DENTAL...

  3. Diagnostic gait pattern of a patient with longstanding left femoral nerve palsy: a case report.

    LENUS (Irish Health Repository)

    Burke, Neil G

    2010-12-01

    The gait pattern of a 35-year-old man with longstanding, left femoral nerve palsy was assessed using 3-dimensional kinematic and kinetic analysis. Stability of his left knee in stance was achieved by manipulating the external moments of the limb so that the ground reaction force passes in front of the knee joint. This compensatory mechanism of locking the knee in extension is reliant on the posterior capsular structures. The patient was managed conservatively and continued to walk without aids.

  4. Osteochondritis dissecans of the knee in a subadult from a medieval (ninth century A.D.) site in Croatia.

    Science.gov (United States)

    Slaus, Mario; Cicvara-Pećina, Tatjana; Lucijanić, Ivica; Pećina, Marko; Stilinović, Davor

    2010-06-01

    Although osteochondritis dissecans of the knee has been known for a long time, we still do not fully understand why it develops. This prompted us to present and describe an example of osteochondritis dissecans identified in the Osteological Collection of the Croatian Academy of Sciences and Arts. The case of osteochondritis dissecans described in this report was recovered from the Gluvine kuće cemetery in the Dalmatian hinterland, approximately 28 km north-east of Split. A total of 77 graves were excavated and the individual exhibiting osteochondritis dissecans was recovered from grave number 16 that belongs to the younger phase of the cemetery that lasted during the second half of the 9th century A.D. Osteochondritis dissecans was noted in a subadult individual. The pathological changes consistent with osteochondritis dissecans are present on both medial femoral condyles. The lesion on the right femoral condyle is an oval crater-like defect with well defined margins and a porous floor of rough trabecular bone. The lesion on the left femoral condyle is basically, with two small provisions, identical to the one on the right side. The first is that it is slightly smaller, while the second is that unlike its antimere, it has a well preserved bone fragment that fits perfectly into the ostechondritic pit. Radiographic analyses of the femoral condyles support a diagnosis of osteochondritis dissecans and show a well-demarcated radiolucent defect in the articular surfaces of both joints surrounded by a thin sclerotic repair zone. According to the classification systems this degree of change corresponds to stage 3 or grade 3 osteochondritis dissecans--a detached but non-displaced fragment. Returning, for a second, to the opinion that prompted us to present this case, it is clear that during the last 1100 years there have been no significant morphological or radiological changes in the characteristics of osteochondritis dissecans.

  5. Correlation of ultrasound appearance, gross anatomy, and histology of the femoral nerve at the femoral triangle.

    Science.gov (United States)

    Lonchena, Tiffany K; McFadden, Kathryn; Orebaugh, Steven L

    2016-01-01

    Correlation between ultrasound appearance, gross anatomic characteristics, and histologic structure of the femoral nerve (FN) is lacking. Utilizing cadavers, we sought to characterize the anatomy of the FN, and provide a quantitative measure of its branching. We hypothesize that at the femoral crease, the FN exists as a group of nerve branches, rather than a single nerve structure, and secondarily, that this transition into many branches is apparent on ultrasonography. Nineteen preserved cadavers were investigated. Ultrasonography was sufficient to evaluate the femoral nerve in nine specimens; gross dissection was utilized in all 19. Anatomic characteristics were recorded, including distances from the inguinal ligament to femoral crease, first nerve branch, and complete arborization of the nerve. The nerves from nine specimens were excised for histologic analysis. On ultrasound, the nerve became more flattened, widened, and less discrete as it coursed distally. Branching of the nerve was apparent in 12 of 18 images, with mean distance from inguinal ligament of 3.9 (1.0) cm. However, upon dissection, major branching of the femoral nerve occurred at 3.1 (1.0) cm distal to the inguinal ligament, well proximal to the femoral crease. Histologic analysis was consistent with findings at dissection. The femoral nerve arborizes into multiple branches between the inguinal ligament and the femoral crease. Initial branching is often high in the femoral triangle. As hypothesized, the FN exists as a closely associated group of nerve branches at the level of the femoral crease; however, the termination of the nerve into multiple branches is not consistently apparent on ultrasonography.

  6. Fracture of Fully-coated Femoral Stem after Primary Total Hip Arthroplasty for Nonunion of Intertrochanteric Fracture: A Case Report.

    Science.gov (United States)

    Chun, Young Soo; Juh, Hyung Suk; Cho, Yoon Je; Rhyu, Kee Hyung

    2015-09-01

    Femoral stem fracture is an uncommon reason for the failure of total hip arthroplasty, with only 16 cases of fully coated stem fractures reported to date. Here we report a case in which a fully coated primary femoral stem fracture occurred after conversion to total hip arthroplasty for the non-union of an intertrochanteric fracture of the femur. Metallurgic evaluation of the etiology and mechanism revealed that the fracture was initiated by fatigue-related failure and completed by ductile failure on the posterior side of the fracture. Considering the recent trend of treating an intertrochanteric fracture with hip arthroplasty, possible stem failure should be considered, since most patients will have at least one of the known risk factors for stem fracture.

  7. Risk factors of avascular necrosis of the femoral head and fixation failure in patients with valgus angulated femoral neck fractures over the age of 50 years.

    Science.gov (United States)

    Song, Hyung Keun; Choi, Ho June; Yang, Kyu Hyun

    2016-12-01

    The aim of our study was to identify the risk factors for avascular necrosis of the femoral head (AVN) and fixation failure (FF) after screw osteosynthesis in patients with valgus angulated femoral neck fractures. We conducted a retrospective study of 308 patients (mean age, 72.5 years, range, 50-97 years), with a mean follow-up of 21.4 months (range, 12-64 months). The risk for failure in treatment (FIT) associated with patient- and fracture-related factors was evaluated by logistic regression analyses. FIT was identified in 32 cases (10.3%): 22 cases (7.1%) of AVN and 10 cases (3.2%) of FF. Initial valgus tilt>15° (p=0.023), posterior tilt>15° (p=0.012), and screw sliding distance (p=0.037) were significantly associated with FIT. FIT occurred in 7 patients (5.2%) with B1.2.1 fractures and 17 patients (48.6%) with B1.1.2 fractures (p15° (B1.1.2) compared to patients with 15° are reasonable candidates for primary arthroplasty due to high risk of FIT. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Intra- and interobserver agreement of computed tomography in assessment of the mandibular condyle

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-12-15

    To study the intra- and interobserver agreement of multidetector row computed tomography (MDCT) in interpretation of degenerative changes of the mandibular condyle. Five observers independently evaluated one hundred temporomandibular joint MDCT images for signs of osteophytes, erosion, sclerosis and flattening. The intra- and interobserve agreements were calculated by using Kappa statistics. The intraobserver agreement was substantial for erosion (k=0.75), flattening (k=0.74) and sclerosis (k=0.72) and almost perfect for osteophytes (k=0.84). The interobserver agreement was fair for flattening (k=0.39), moderate for erosion (k=0.58) and sclerosis (k=0.48) and substantial for osteophytes (k=0.75). This study shows that we can expert good agreement for the presence of osteophytes, but not for flattening in the interpretation of MDCT images of the condyle.

  9. Treatment of mandibular condyle fractures using a modified transparotid approach via the parotid mini-incision: experience with 31 cases.

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    Jun Shi

    Full Text Available Surgery for mandibular condyle fractures must allow direct vision of the fracture, reduce surgical trauma and achieve reduction and fixation while avoiding facial nerve injury. This prospective study was conducted to introduce a new surgical approach for open reduction and internal fixation of mandibular condyle fractures using a modified transparotid approach via the parotid mini-incision, and surgical outcomes were evaluated. The modified transparotid approach via the parotid mini-incision was applied and rigid internal fixation using a small titanium plate was carried out for 36 mandibular condyle fractures in 31 cases. Postoperative follow-up of patients ranged from 3 to 26 months; in the first 3 months after surgery, outcomes for all patients were analyzed by evaluating the degree of mouth opening, occlusal relationship, facial nerve function and results of imaging studies. The occlusal relationships were excellent in all patients and none had symptoms of intraoperative ipsilateral facial nerve injury. The mean degree of mouth opening was 4.0 (maximum 4.8 cm, minimum 3.0 cm. No mandibular deviations were noted in any patient during mouth opening. CT showed complete anatomical reduction of the mandibular condyle fracture in all patients. The modified transparotid approach via the smaller, easily concealed parotid mini-incision is minimally invasive and achieves anatomical reduction and rigid internal fixation with a simplified procedure that directly exposes the fracture site. Study results showed that this procedure is safe and feasible for treating mandibular condyle fracture, and offers a short operative path, protection of the facial nerve and satisfactory aesthetic outcomes.

  10. Treatment of neglected femoral neck fracture

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    Anil K Jain

    2015-01-01

    Full Text Available Intra-capsular femoral neck fractures are seen commonly in elderly people following a low energy trauma. Femoral neck fracture has a devastating effect on the blood supply of the femoral head, which is directly proportional to the severity of trauma and displacement of the fracture. Various authors have described a wide array of options for treatment of neglected/nonunion (NU femoral neck fracture. There is lack of consensus in general, regarding the best option. This Instructional course article is an analysis of available treatment options used for neglected femoral neck fracture in the literature and attempt to suggest treatment guides for neglected femoral neck fracture. We conducted the "Pubmed" search with the keywords "NU femoral neck fracture and/or neglected femoral neck fracture, muscle-pedicle bone graft in femoral neck fracture, fibular graft in femoral neck fracture and valgus osteotomy in femoral neck fracture." A total of 203 print articles were obtained as the search result. Thirty three articles were included in the analysis and were categorized into four subgroups based on treatment options. (a treated by muscle-pedicle bone grafting (MPBG, (b closed/open reduction internal fixation and fibular grafting (c open reduction and internal fixation with valgus osteotomy, (d miscellaneous procedures. The data was pooled from all groups for mean neglect, the type of study (prospective or retrospective, classification used, procedure performed, mean followup available, outcome, complications, and reoperation if any. The outcome of neglected femoral neck fracture depends on the duration of neglect, as the changes occurring in the fracture area and fracture fragments decides the need and type of biological stimulus required for fracture union. In stage I and stage II (Sandhu′s staging neglected femoral neck fracture osteosynthesis with open reduction and bone grafting with MPBG or Valgus Osteotomy achieves fracture union in almost 90

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

    Science.gov (United States)

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

    2013-09-01

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

  12. Effect of occlusal (mechanical) stimulus on bone remodelling in rat mandibular condyle.

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    Gazit, D; Ehrlich, J; Kohen, Y; Bab, I

    1987-09-01

    Mechanical load influences the remodelling of skeletal tissues. In the mandibular condyle, occlusal alterations and the consequent mechanical stimulus induce changes in chondrocytes and cartilage mineralization. In the present study we quantified in the mandibular condyle the effect of occlusal interference on remodelling of the subchondral bone. Computerized histomorphometry after 5-21-day exposure to the influence of a unilateral occlusal splint revealed an increased rate of trabecular remodelling, consisting of enhancement in osteoblast and osteoclast numbers and activities. The bone formation parameters reached their high values on Days 5 or 9 and remained stable thereafter. Bone resorption showed a gradual increase throughout the experimental period. These results further characterize the temporomandibular joint reaction to occlusal alterations. It is suggested that the present increase in bone turnover together with the known enhancement in chondrogenesis are part of a process of functional adaptation in response to mechanical stimulus.

  13. Shaft-Condylar Angle for surgical correction in neglected and displaced lateral humeral condyle fracture in children.

    Science.gov (United States)

    Mulpruek, Pornchai; Angsanuntsukh, Chanika; Woratanarat, Patarawan; Sa-Ngasoongsong, Paphon; Tawonsawatruk, Tulyapruek; Chanplakorn, Pongsthorn

    2015-09-01

    To assess the outcome after using the Shaft-Condylar angle (SCA) as intraoperative reference for sagittal plane correction in displaced lateral humeral condyle fractures in children presented 3-weeks after injury. Ten children, with delayed presentation of a displaced lateral humeral condyle fracture and undergoing surgery during 1999-2011, were reviewed. The goal was to obtain a smooth articular surface with an intraoperative SCA of nearly 40° and nearest-anatomical carrying angle. They were allocated into two groups according to the postoperative SCA [Good-reduction group (SCA=30-50°), and Bad-reduction group (SCA50°)] and the final outcomes were then compared. All fractures united without avascular necrosis. The Good-reduction group (n=7) showed a significant improvement in final range of motion and functional outcome compared to the Bad-reduction group (n=3) (p=0.02). However, there was no significant difference in pain, carrying angle and overall outcome between both groups. SCA is a possible intraoperative reference for sagittal alignment correction in late presented displaced lateral humeral condyle fractures.

  14. Clinical significance of subchondral cortical signal intensities in osteoarthritis of knee joints

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    Nakamura, Eijiro; Torisu, Takehiko; Nakamura, Taro; Masumi, Shogo [Oita Medical Univ., Hazama (Japan); Tomari, Kazuhide; Asao, Tunenori; Takagi, Kazuhiro

    1996-09-01

    The purpose of this study was to evaluate the abnormal intensity in medial femoral condyle on MR imaging in patients with osteoarthritis of the knee. Eighty knees of fifty-eight patients with osteoarthritis of the knee were underwent plain radiography and MR imaging. According to the extension of the abnormal low intensity on T{sub 1} weighted images in medial femoral chondyle, all cases were classified into four types (no exist: 30.0%, small: 30.0%, middle: 30.0%, large: 10.0%). The extension of the abnormal low intensity was closely related to radiographic stage and femoral tibial angle. After radiological examination, in thirteen knees, the biopsy of the abnormal low intensity area on T{sub 1} weighted MR imaging was performed at the time of total knee arthroplasty. Pathological examination revealed that the causative factor of abnormal low intensity on T{sub 1} weighted MR imaging in the medial femoral condyle was trabecular hypertrophy. Our results suggest that the abnormal low intensity on T{sub 1} weighted MR imaging reflects the loading force. (author)

  15. Clinical significance of subchondral cortical signal intensities in osteoarthritis of knee joints

    International Nuclear Information System (INIS)

    Nakamura, Eijiro; Torisu, Takehiko; Nakamura, Taro; Masumi, Shogo; Tomari, Kazuhide; Asao, Tunenori; Takagi, Kazuhiro.

    1996-01-01

    The purpose of this study was to evaluate the abnormal intensity in medial femoral condyle on MR imaging in patients with osteoarthritis of the knee. Eighty knees of fifty-eight patients with osteoarthritis of the knee were underwent plain radiography and MR imaging. According to the extension of the abnormal low intensity on T 1 weighted images in medial femoral chondyle, all cases were classified into four types (no exist: 30.0%, small: 30.0%, middle: 30.0%, large: 10.0%). The extension of the abnormal low intensity was closely related to radiographic stage and femoral tibial angle. After radiological examination, in thirteen knees, the biopsy of the abnormal low intensity area on T 1 weighted MR imaging was performed at the time of total knee arthroplasty. Pathological examination revealed that the causative factor of abnormal low intensity on T 1 weighted MR imaging in the medial femoral condyle was trabecular hypertrophy. Our results suggest that the abnormal low intensity on T 1 weighted MR imaging reflects the loading force. (author)

  16. Evaluation of reference gene suitability for quantitative expression analysis by quantitative polymerase chain reaction in the mandibular condyle of sheep.

    Science.gov (United States)

    Jiang, Xin; Xue, Yang; Zhou, Hongzhi; Li, Shouhong; Zhang, Zongmin; Hou, Rui; Ding, Yuxiang; Hu, Kaijin

    2015-10-01

    Reference genes are commonly used as a reliable approach to normalize the results of quantitative polymerase chain reaction (qPCR), and to reduce errors in the relative quantification of gene expression. Suitable reference genes belonging to numerous functional classes have been identified for various types of species and tissue. However, little is currently known regarding the most suitable reference genes for bone, specifically for the sheep mandibular condyle. Sheep are important for the study of human bone diseases, particularly for temporomandibular diseases. The present study aimed to identify a set of reference genes suitable for the normalization of qPCR data from the mandibular condyle of sheep. A total of 12 reference genes belonging to various functional classes were selected, and the expression stability of the reference genes was determined in both the normal and fractured area of the sheep mandibular condyle. RefFinder, which integrates the following currently available computational algorithms: geNorm, NormFinder, BestKeeper, and the comparative ΔCt method, was used to compare and rank the candidate reference genes. The results obtained from the four methods demonstrated a similar trend: RPL19, ACTB, and PGK1 were the most stably expressed reference genes in the sheep mandibular condyle. As determined by RefFinder comprehensive analysis, the results of the present study suggested that RPL19 is the most suitable reference gene for studies associated with the sheep mandibular condyle. In addition, ACTB and PGK1 may be considered suitable alternatives.

  17. Analysis of two different surgical approaches for fractures of the mandibular condyle.

    Science.gov (United States)

    Kumaran, S; Thambiah, L J

    2012-01-01

    Fractures of the condyle account for one third of all the mandibular fractures. Different surgical approaches to the condyle described hitherto testify to the advantages and disadvantages of the different surgical techniques used for approaching the condyle in such cases of fractures. We have described and compared two of such surgical techniques in this study. The aim of this study is to compare the outcome of dealing with condylar fractures by two different surgical techniques: the mini retromandibular approach, and the preauricular approach. A prospective study of 31 patients who had suffered with mandibular condylar fractures was carried out. Of these, 26 patients had unilateral condylar fractures, and 5 patients had a bilateral fracture. Further, 19 of these patients were treated by the mini retromandibular approach and 12 by the preauricular approach. The treated patients were followed up and evaluated for a minimum period of 1 year and assessed for parameters such as the maximum mouth opening, lateral movement on the fractured side, mandibular movements such as protrusion, dental occlusion, scar formation, facial nerve weakness, salivary fistula formation and time taken for the completion of the surgical procedure. t- test was used for statistical analysis of the data obtained in the study. Dental occlusion was restored in all the cases, and good anatomical reduction was achieved. The mean operating time was higher 63.53 (mean) ± 18.12 minutes standard deviation (SD) in the preauricular approach compared to 45.22 (mean) ± 18.86 minutes SD in the mini retromandibular approach. Scar formation was satisfactory in almost all the cases.

  18. The application of the Risdon approach for mandibular condyle fractures.

    Science.gov (United States)

    Nam, Seung Min; Lee, Jang Hyun; Kim, Jun Hyuk

    2013-07-06

    Many novel approaches to mandibular condyle fracture have been reported, but there is a relative lack of reports on the Risdon approach. In this study, the feasibility of the Risdon approach for condylar neck and subcondylar fractures of the mandible is demonstrated. A review of patients with mandibular condylar neck and subcondylar fractures was performed from March 2008 to June 2012. A total of 25 patients, 19 males and 6 females, had 14 condylar neck fractures and 11 subcondylar fractures. All of the cases were reduced using the Risdon approach. For subcondylar fractures, reduction and fixation with plates was done under direct vision. For condylar neck fractures, reduction and fixation was done with the aid of a trochar in adults and a percutaneous threaded Kirschner wire in children. There were no malunions or nonunions revealed in follow-up care. Mild transient neuropraxia of the marginal mandibular nerve was seen in 4 patients, which was resolved within 1-2 months. The Risdon approach is a technique for reducing the condylar neck and subcondylar fractures that is easy to perform and easy to learn. Its value in the reduction of mandibular condyle fractures should be emphasized.

  19. Ipsilateral open anterior hip dislocation and open posterior elbow dislocation in an adult

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    Kumar Sunil

    2014-02-01

    Full Text Available 【Abstract】Open anterior dislocation of the hip is a very rare injury, especially in adults. It is a hyperabduction, external rotation and extension injury. Its combination with open posterior dislocation of the elbow has not been described in English language-based medical literature. Primary resuscitation, debridement, urgent reduction of dislocation, and adequate antibiotic support resulted in good clinical outcome in our patient. At 18 months follow-up, no signs of avascular necrosis of the femoral head or infection were observed.

  20. Self-designed femoral neck guide pin locator for femoral neck fractures.

    Science.gov (United States)

    Xia, Shengli; Wang, Ziping; Wang, Minghui; Wu, Zuming; Wang, Xiuhui

    2014-01-01

    Closed reduction and fixation with 3 cannulated screws is a widely accepted surgery for the treatment of femoral neck fractures. However, how to obtain optimal screw placement remains unclear. In the current study, the authors designed a guide pin positioning system for femoral neck fracture cannulated screw fixation and examined its application value by comparing it with freehand guide needle positioning and with general guide pin locator positioning provided by equipment manufacturers. The screw reset rate, screw parallelism, triangle area formed by the link line of the entry point of 3 guide pins, and maximum vertical load bearing of the femoral neck after internal fixation were recorded. As expected, the triangle area was largest in the self-designed positioning group, followed by the general positioning group and the freehand positioning group. The difference among the 3 groups was statistically significant (P.05). The authors’ self-designed guide pin positioning system has the potential to accurately insert cannulated screws in femoral neck fractures and may reduce bone loss and unnecessary radiation.

  1. Open versus closed reduction: diacapitular fractures of the mandibular condyle.

    Science.gov (United States)

    Chrcanovic, Bruno Ramos

    2012-09-01

    The purpose of the study was to review the literature regarding the evolution of current thoughts on management of diacapitular fractures (DFs) of the mandibular condyle. An electronic search in PubMed was undertaken in March 2012. The titles and abstracts from these results were read to identify studies within the selection criteria. Eligibility criteria included studies reporting clinical series of DFs, including both animal and human studies, without date or language restrictions. The search strategy initially yielded 108 references. Twenty-eight studies were identified without repetition within the selection criteria. Additional hand-searching of the reference lists of selected studies yielded three additional papers. The current indications for open reduction and internal fixation (ORIF) of DFs described in the literature are: (a) fractures affecting the lateral condyle with reduction of mandibular height; (b) fractures in which the proximal fragment dislocates laterally out of the glenoid fossa, which cannot be reduced by closed or open treatment of another part of the mandibular fracture. The indications for conservative treatment are: (a) fractures that do not shorten the condylar height (a fracture with displacement of the medial parts of the condyle); (b) undisplaced fractures; (c) comminution of the condylar head, when the bony fragments are too small for stable fixation; and (d) fractures in children. As the temporomandibular joint disk plays an important role as a barrier preventing ankylosis, it is important to reposition the disk (if displaced/dislocated) during the surgical treatment of DFs. The lateral pterygoid muscle should never be stripped from the medially displaced fragment because its desinsertion disrupts circulation to the medial bony fragment, and also because this muscle helps to restore the muscle function after surgery. ORIF of selected DFs improves prognosis by anatomical bone and soft tissue recovery when combined with physical

  2. Radiographic evaluation of the canine elbow joint with special reference to the medial humeral condyle and the medial coronoid process

    International Nuclear Information System (INIS)

    Voorhout, G.; Hazewinkel, H.A.W.

    1987-01-01

    The results of radiographic examination of clinically affected elbow joints in 14 young, large-breed dogs, including standard and oblique projections and linear tomography, were compared with the findings of medial arthrotomy. Radiographs revealed arthrosis (13 dogs), osteochondrosis of the medial humeral condyle (2 dogs), fragmentation of the medial coronoid process (5 dogs), and a combination of osteochondrosis of the medial humeral condyle and fragmentation of the medial coronoid process (2 dogs). In one dog fissures in the medial coronoid process and in another dog a linear radiopacity along the articular surface of the medial coronoid process were found. In three dogs both medial humeral condyle and medial coronoid process appeared normal. The radiographic findings were confirmed during surgery in 11 dogs. Cartilage erosion of the medial humeral condyle in two dogs and of the medial coronoid process in one dog had not resulted in radiographically visible abnormalities. Radiographic examination of the elbow joints in young, large-breed dogs should include standard mediolateral and craniocaudal projections, a mediolateral projection with the joint maximally extended and the leg supinated 15°, and a craniolateral-to-caudomedial projection

  3. The prevalence, radiographic appearance and gender predilection of bifid mandibular condyles in Punjabi population of North India: A retrospective study

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    Bhawandeep Kaur

    2017-01-01

    Full Text Available Aim: The aim of this study was to determine the prevalence and gender predilection of bifid mandibular condyle (BMC in Indian population using extra oral radiographs. Material and Methods: Previous record of 800 patients was evaluated by the observers who had undergone extra oral radiography for any diagnostic or treatment purposes between years 2012 and 2014. Results: Out of 800 extra oral radiographs, bifid condyles were found in 28, giving an overall prevalence of 3.5%. Out of 28 bifid condyles, 20 were in females (2.5% and eight were in males (1.7%. The prevalence of BMC was found to be more in females as compared to the males and this difference was statistically significant with P value equivalent to 0.001. Among 28 bifid condyles, 19 were unilateral (2.4% and nine were bilateral 1.5%. Chi-square test shows non-significant P value. Conclusion: It is possible that BMC is a more frequent condition than is commonly perceived. However, because of the minimal symptoms associated with this condition, the authors believe that it will remain an incidental finding upon routine radiographic examination, rather than a clinical observation.

  4. Comparison of Radial Access, Guided Femoral Access, and Non-Guided Femoral Access Among Women Undergoing Percutaneous Coronary Intervention.

    Science.gov (United States)

    Koshy, Linda M; Aberle, Laura H; Krucoff, Mitchell W; Hess, Connie N; Mazzaferri, Ernest; Jolly, Sanjit S; Jacobs, Alice; Gibson, C Michael; Mehran, Roxana; Gilchrist, Ian C; Rao, Sunil V

    2018-01-01

    This study was conducted to determine the association between radial access, guided femoral access, and non-guided femoral access on postprocedural bleeding and vascular complications after percutaneous coronary intervention (PCI). Bleeding events and major vascular complications after PCI are associated with increased morbidity, mortality, and cost. While the radial approach has been shown to be superior to the femoral approach in reducing bleeding and vascular complications, whether the use of micropuncture, fluoroscopy, or ultrasound mitigates these differences is unknown. We conducted a post hoc analysis of women in the SAFE-PCI for Women trial who underwent PCI and had the access method identified (n = 643). The primary endpoint of postprocedure bleeding or vascular complications occurring within 72 hours or at discharge was adjudicated by an independent clinical events committee and was compared based on three categories of access technique: radial, guided femoral (fluoroscopy, micropuncture, ultrasound), or non-guided femoral (none of the aforementioned). Differences between the groups were determined using multivariate logistic regression using radial access as the reference. Of the PCI population, 330 underwent radial access, 228 underwent guided femoral access, and 85 underwent non-guided femoral access. There was a statistically significant lower incidence of the primary endpoint with radial access vs non-guided femoral access; however, there was no significant difference between radial approach and femoral access guided by fluoroscopy, micropuncture, or ultrasound. This post hoc analysis demonstrates that while radial access is safer than non-guided femoral access, guided femoral access appears to be associated with similar bleeding events or vascular complications as radial access.

  5. Custom-made lateral femoral hemiarthroplasty for traumatic bone loss: A case report.

    Science.gov (United States)

    Stuyts, Bart; Peersman, Geert; Thienpont, Emmanuel; Van den Eeden, Elke; Van der Bracht, Hans

    2015-10-01

    We report the case of a 32-year-old male patient involved in a road traffic accident in which he sustained a grade II open supra- and intercondylar fracture of the left distal femur with substantial bone loss of the lateral femoral condyle and trochlea (AO classification type 33 C3). Normal knee function was no longer possible, as the patella was trapped within the bony defect. Existing reconstructive options such as unicondylar osteoarticular allograft, arthrodesis, and arthroplasty were considered. However, as all these techniques present significant disadvantages, particularly in young and active patients, a custom-made lateral hemiarthroplasty was designed and implanted as an alternative treatment. Follow-up at 24 months revealed an excellent, pain-free level of function and radiographs showed no signs of implant loosening or migration. This technique offers the most anatomical means of reconstruction with maximal preservation of the bone stock, thereby better facilitating any revisions that may be necessary in the future. This is an experimental technique reserved for rare indications, and currently has no long-term follow-up results associated with its use. Additional research is therefore needed before widespread adoption of this technique can take place. Copyright © 2015 Elsevier B.V. All rights reserved.

  6. Surgical treatment of sagittal fracture of mandibular condyle using long-screw osteosynthesis.

    Science.gov (United States)

    Luo, Shufang; Li, Bo; Long, Xing; Deng, Mohong; Cai, Hengxing; Cheng, Yong

    2011-07-01

    The retrospective study evaluated long-screw (bicortical screw) osteosynthesis used in the surgical treatment of sagittal fracture of the mandibular condyle and compared it with titanium plates and removal of the condylar fragment. Ninety-five patients with sagittal fracture of the mandibular condyle received open surgical treatment from 1997 to 2008. Among these patients, the condylar fragments were fixed with long screws in 56 cases (group A), were fixed with titanium plates in 12 cases (group B), and were completely removed in 24 cases (group C). Follow-up was carried out clinically and radiologically. The clinical features included limitation of mandibular mobility, occlusion disturbance, lateral deviation on mouth opening, joint pain, clicking, facial asymmetry, and patient's subjective evaluation. The radiologic parameters consisted of degree of bony resorption, bony change, change of osteosynthesis material, and shortening of mandibular ramus height. Anatomic reduction and functional restoration were obtained and no severe complication was detected in group A. However, 3 of 14 patients had severe osteoarthrosis and 2 of 14 patients had ankylosis in group B. In group C 3 of 24 patients had mandibular retrusion, 4 of 24 patients had front teeth open bite, 4 of 24 patients had severe osteoarthrosis, and 1 of 24 patients had ankylosis. The long-screw fixation group had a more favorable prognosis than the titanium plate group and the group in which removal of the condylar fragment was performed. The long-screw fixation technique might be suitable for use in the surgical treatment of sagittal fractures of the mandibular condyle. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  7. A modified Larson’s method of posterolateral corner reconstruction of the knee reproducing the physiological tensioning pattern of the lateral collateral and popliteofibular ligaments

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    Niki Yasuo

    2012-06-01

    Full Text Available Abstract Background Consensus has been lacking as to how to reconstruct the posterolateral corner (PLC of the knee in patients with posterolateral instability. We describe a new reconstructive technique for PLC based on Larson's method, which reflects the physiological load-sharing pattern of the lateral collateral ligament (LCL and popliteofibular ligament (PFL. Findings Semitendinosus graft is harvested, and one limb of the graft comprises PFL and the other comprises LCL. Femoral bone tunnels for the LCL and popliteus tendon are made at their anatomical insertions. Fibular bone tunnel is prepared from the anatomical insertion of the LCL to the proximal posteromedial portion of the fibular head, which corresponds to the insertion of the PFL. The graft end for popliteus tendon is delivered into the femoral bone tunnel and secured on the medial femoral condyle. The other end for LCL is passed through the fibular tunnel from posterior to anterior. While the knee is held in 90 of flexion, the graft is secured in the fibular tunnel using a 5 mm interference screw. Then, the LCL end is passed into the femoral bone tunnel and secured at the knee in extension. Conclusions Differential tension patterns between LCL and PFL is critical when securing these graft limbs. Intrafibular fixation of the graft using a small interference screw allows us to secure these two graft limbs independently with intended tension at the intended flexion angle of the knee.

  8. Evaluation of a pig femoral head osteonecrosis model

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    Kim Harry

    2010-03-01

    Full Text Available Abstract Background A major cause of osteonecrosis of the femoral head is interruption of a blood supply to the proximal femur. In order to evaluate blood circulation and pathogenetic alterations, a pig femoral head osteonecrosis model was examined to address whether ligature of the femoral neck (vasculature deprivation induces a reduction of blood circulation in the femoral head, and whether transphyseal vessels exist for communications between the epiphysis and the metaphysis. We also tested the hypothesis that the vessels surrounding the femoral neck and the ligamentum teres represent the primary source of blood flow to the femoral head. Methods Avascular osteonecrosis of the femoral head was induced in Yorkshire pigs by transecting the ligamentum teres and placing two ligatures around the femoral neck. After heparinized saline infusion and microfil perfusion via the abdominal aorta, blood circulation in the femoral head was evaluated by optical and CT imaging. Results An angiogram of the microfil casted sample allowed identification of the major blood vessels to the proximal femur including the iliac, common femoral, superficial femoral, deep femoral and circumflex arteries. Optical imaging in the femoral neck showed that a microfil stained vessel network was visible in control sections but less noticeable in necrotic sections. CT images showed a lack of microfil staining in the epiphysis. Furthermore, no transphyseal vessels were observed to link the epiphysis to the metaphysis. Conclusion Optical and CT imaging analyses revealed that in this present pig model the ligatures around the femoral neck were the primary cause of induction of avascular osteonecrosis. Since the vessels surrounding the femoral neck are comprised of the branches of the medial and the lateral femoral circumflex vessels, together with the extracapsular arterial ring and the lateral epiphyseal arteries, augmentation of blood circulation in those arteries will improve

  9. Leg lengthening and femoral-offset reduction after total hip arthroplasty: where is the problem - stem or cup positioning?

    Science.gov (United States)

    Al-Amiry, Bariq; Mahmood, Sarwar; Krupic, Ferid; Sayed-Noor, Arkan

    2017-09-01

    Background Restoration of femoral offset (FO) and leg length is an important goal in total hip arthroplasty (THA) as it improves functional outcome. Purpose To analyze whether the problem of postoperative leg lengthening and FO reduction is related to the femoral stem or acetabular cup positioning or both. Material and Methods Between September 2010 and April 2013, 172 patients with unilateral primary osteoarthritis treated with THA were included. Postoperative leg-length discrepancy (LLD) and global FO (summation of cup and FO) were measured by two observers using a standardized protocol for evaluation of antero-posterior plain hip radiographs. Patients with postoperative leg lengthening ≥10 mm (n = 41) or with reduced global FO >5 mm (n = 58) were further studied by comparing the stem and cup length of the operated side with the contralateral side in the lengthening group, and by comparing the stem and cup offset of the operated side with the contralateral side in the FO reduction group. We evaluated also the inter-observer and intra-observer reliability of the radiological measurements. Results Both observers found that leg lengthening was related to the stem positioning while FO reduction was related to the positioning of both the femoral stem and acetabular cup. Both inter-observer reliability and intra-observer reproducibility were moderate to excellent (intra-class correlation co-efficient, ICC ≥0.69). Conclusion Post THA leg lengthening was mainly caused by improper femoral stem positioning while global FO reduction resulted from improper positioning of both the femoral stem and the acetabular cup.

  10. Observation of condyles by roentgenographic cephalogram

    International Nuclear Information System (INIS)

    Ahn, Hyung Kyu

    1984-01-01

    In spite of many projections of TMJ, there are rarely satisfactory projections of TMJ. The author traced and measured the P-A cephalograms, which number is 70 in each male and female, them finding the following results. 1. The long axis of the condyle is 19.80 mm on the right, and 19.89 mm on the left in male, and that of 18.65 mm on the right and 18.10 mm on the left in female. 2. The intercondylar distance is 119.09 mm in male, and 108.20 mm in female, resulting that the intercondylar distance in male is much longer than that in female. 3. The right and left deviation of the midline passing through the center of the intercondylar distance and prosthion is +0.37 mm in male, +0.64 mm in female, and its range is from -4.6 to +5.7 mm in male, and from -3.2 to +6.1 mm in female, resulting that prosthion nearly coincides with midline. 4. The angle of the intercondylar distance and the long axis (vertical angle) is +5.48 degrees in male, and +6.02 degrees in female, resulting that there is a little difference between male and female and the angle of the right is greater than that of the left in both male and female. 5. The typology of the condyle in sum of male and female is; Right: A type 55 (39.3%), B type 66 (47.1%), C type 12 (8 .6%), D type 7 (5.0%), E type 0 (0%) Left: A type 60 (42.9%), B type 58 (41.4%), C type 14 (10.0%), D type 8 (5.7%), E type 0 (0%) 6. The distribution of the typology between the right and the left is; AA 26 (18.6%), AB 50 (35.7%), AC 10 (7.1%), AD 3 (2.1%) BB 26 (18.6%), BC 13 (9.3%), BD 9 (6.4%), CC 0 (0%), CD 3 (2.1%).

  11. Multicriteria Decision Analysis in Improving Quality of Design in Femoral Component of Knee Prostheses: Influence of Interface Geometry and Material

    Directory of Open Access Journals (Sweden)

    Ali Jahan

    2015-01-01

    Full Text Available Knee prostheses as medical products require careful application of quality and design tool to ensure the best performance. Therefore, quality function deployment (QFD was proposed as a quality tool to systematically integrate consumer’s expectation to perceived needs by medical and design team and to explicitly address the translation of customer needs into engineering characteristics. In this study, full factorial design of experiment (DOE method was accompanied by finite element analysis (FEA to evaluate the effect of inner contours of femoral component on mechanical stability of the implant and biomechanical stresses within the implant components and adjacent bone areas with preservation of the outer contours for standard Co-Cr alloy and a promising functionally graded material (FGM. The ANOVA revealed that the inner shape of femoral component influenced the performance measures in which the angle between the distal and anterior cuts and the angle between the distal and posterior cuts were greatly influential. In the final ranking of alternatives, using multicriteria decision analysis (MCDA, the designs with FGM was ranked first over the Co-Cr femoral component, but the original design with Co-Cr material was not the best choice femoral component, among the top ranked design with the same material.

  12. Ensayo clínico de asignación aleatoria, para evaluar la eficacia de dos técnicas de compresión en la disminución de complicaciones en el sitio de acceso vascular femoral, posterior a cateterismo diagnóstico y terapéutico

    OpenAIRE

    Ramírez-Gutiérrez,Álvaro Eduardo; Eid-Lidt,Guering; Esquinca-Vera,Juan Carlos; Damas-de los Santos,Félix; Pérez-González,Alberto; Kimura-Hayama,Eric; Bacilio-Pérez,Ulises; Gaspar-Hernández,Jorge

    2012-01-01

    Objetivo: Comparar la incidencia de falla en la hemostasia y frecuencia de eventos vasculares, durante y después de la compresión con dos maniobras diferentes. Métodos: Se realizó un ensayo clínico de asignación aleatoria a compresión mecánica o compresión manual, para el retiro de introductor en arteria femoral posterior a cateterismo diagnóstico o terapéutico. Resultados: Se incluyeron 100 pacientes en el grupo de compresión con compresor (grupo uno) y 112 de forma manual (grupo dos). La fa...

  13. Inflammatory pseudotumor of the occipital condyle imitating a malignant neoplasm - a case report

    International Nuclear Information System (INIS)

    Sznajder, K.; Skrzelewski, S.

    2007-01-01

    Inflammatory pseudotumor is a non-neoplastic process of unknown etiology characterized by proliferation of connective tissue with an inflammatory infiltrate. IPT most frequently arises in the orbit, but can also be found in the larynx, the paranasal sinus and rarely in the skull base. We present the case of a 20-year-old patient with a 4-month history of headache and insomnia. Neurological examination showed limited head mobility and hypoglossal nerve dysfunction. The patient was afebrile and no abnormalities in blood tests were found. CT revealed the presence of a tumor mass destructing the right occipital condyle. MRI was performed and the mass was surgically removed. The histological diagnosis was non-specific chronic inflammatory granulation tissue. Inflammatory pseudotumors can often mimic malignant neoplasms, especially in cases where bone destruction is observed. IPT of the occipital condyle is a rare but aggressive lesion that should be treated by surgical excision. (author)

  14. The relationship of lateral anatomic structures to exiting guide pins during femoral tunnel preparation utilizing an accessory medial portal.

    Science.gov (United States)

    Farrow, Lutul D; Parker, Richard D

    2010-06-01

    Anatomic reconstruction of the anterior cruciate ligament through an accessory medial portal has become increasingly popular. The purpose of this study is to describe the relationship of guide pin exit points to the lateral anatomic structures when preparing the anterior cruciate ligament femoral tunnel through an accessory medial portal. We utilized seven fresh frozen cadaveric knees. Utilizing an anteromedial approach, a guide wire was placed into the center of each bundle's footprint. Each guide wire was advanced through the lateral femoral cortex. The guide pins were passed at 90, 110, and 130 degrees of knee flexion. The distances from each guide pin to the closest relevant structures on the lateral side of the knee were measured. At 90 degrees the posterolateral bundle guide pin was closest to the lateral condyle articular cartilage (mean 5.4 +/- 2.2 mm) and gastrocnemius tendon (mean 5.7 +/- 2.1 mm). At 110 degrees the posterolateral bundle pin was closest to the gastrocnemius tendon (mean 4.5 +/- 3.4 mm). At 130 degrees the posterolateral bundle pin was closest to the gastrocnemius tendon (mean 7.2 +/- 5.5 mm) and lateral collateral ligament (mean 6.8 +/- 2.1 mm). At 90 degrees the anteromedial bundle guide pin was closest to the articular cartilage (mean 2.0 +/- 2.0 mm). At 110 degrees the anteromedial bundle pin was closest to the articular cartilage (mean 7.4 +/- 3.5 mm) and gastrocnemius tendon (mean 12.3 +/- 3.1 mm). At 130 degrees the AM bundle pin was closest to the gastrocnemius tendon (mean 8.2 +/- 3.2 mm) and LCL (mean 15.1 +/- 2.9 mm). Neither guide pin (anteromedial or posterolateral bundle) put the peroneal nerve at risk at any knee flexion angle. At low knee flexion angles the anteromedial and posterolateral bundle guide pins closely approximated multiple lateral structures when using an accessory medial arthroscopic portal. Utilizing higher flexion angles increases the margin of error when preparing both femoral tunnels. During preparation of

  15. Lateral femoral traction pin entry: risk to the femoral artery and other medial neurovascular structures

    Directory of Open Access Journals (Sweden)

    Appleton Paul

    2010-01-01

    Full Text Available Abstract Background Femoral skeletal traction assists in the reduction and transient stabilization of pelvic, acetabular, hip, and femoral fractures when splinting is ineffective. Traditional teaching has recommended a medial entry site for insertion of the traction pin in order to minimize injury to the femoral artery as it passes through Hunter's canal. The present anatomical study evaluates the risk to the femoral artery and other medial neurovascular structures using a lateral entry approach. Methods Six embalmed cadavers (twelve femurs were obtained for dissection. Steinman pins were drilled from lateral to medial at the level of the superior pole of the patella, at 2 cm, and at 4 cm proximal to this point. Medial superficial dissection was then performed to identify the saphenous nerve, the superior medial geniculate artery, the adductor hiatus, the tendinous insertion of the adductor magnus and the femoral artery. Measurements localizing these anatomic structures relative to the pins were obtained. Results The femoral artery was relatively safe and was no closer than 29.6 mm (mean from any of the three Steinman pins. The superior medial geniculate artery was the medial structure at most risk. Conclusions Lateral femoral traction pin entry is a safe procedure with minimal risk to the saphenous nerve and femoral artery. Of the structures examined, only the superior medial geniculate artery is at a risk of iatrogenic injury due to its position. The incidence of such injury in clinical practice and its clinical significance is not known. Lateral insertion facilitates traction pin placement since it minimizes the need to move the contralateral extremity out of the way of the drilling equipment or the need to elevate or externally rotate the injured extremity relative to the contralateral extremity.

  16. Radiographic study of morphology of mandibular condyle

    Energy Technology Data Exchange (ETDEWEB)

    Ahn, Hyung Kyu [Department of Oral Radiology, College of Dentistry, Seoul National University, Seoul (Korea, Republic of)

    1985-11-15

    Anatomical anomaly of temporo-mandibular joint and its dysfunction is becoming one of the important problem in dentistry because the number of these cases are increasing rapidly. Applying 'Lateral Transcranial Technic', 'Updegrave method' and 'Denar Accuard 100' to skull and adult with normal occlusion the author obtained following results: 1. Grewcock method combined with cephalos tat as one of 'Lateral Transcranial Technic' revealed clear picture but the image of condyle head was tend to incline downward. 2. Direction of central radiation in 'Updegrave method' should be 2 recommended inch upward from auditorial mearus. 3. For functional analysis and correct diagnosis 'Denar Accuard 100' should be highly recommended.

  17. Surgical Treatment for Occipital Condyle Fracture, C1 Dislocation, and Cerebellar Contusion with Hemorrhage after Blunt Head Trauma

    Directory of Open Access Journals (Sweden)

    Shigeo Ueda

    2016-01-01

    Full Text Available Occipital condyle fractures (OCFs have been treated as rare traumatic injuries, but the number of reported OCFs has gradually increased because of the popularization of computed tomography (CT and magnetic resonance imaging (MRI. The patient in this report presented with OCFs and C1 dislocation, along with traumatic cerebellar hemorrhage, which led to craniovertebral junction instability. This case was also an extremely rare clinical condition in which the patient presented with traumatic lower cranial nerve palsy secondary to OCFs. When the patient was transferred to our hospital, the occipital bone remained defective extensively due to surgical treatment of cerebellar hemorrhage. For this reason, concurrent cranioplasty was performed with resin in order to fix the occipital bone plate strongly. The resin-made occipital bone was used to secure a titanium plate and screws enabled us to perform posterior fusion of the craniovertebral junction. Although the patient wore a halo vest for 3 months after surgery, lower cranial nerve symptoms, including not only neck pain but also paralysis of the throat and larynx, improved postoperatively. No complications were detected during outpatient follow-up, which continued for 5 years postoperatively.

  18. Consensus or controversy? The classification and treatment decision-making by 491 maxillofacial surgeons from around the world in three cases of a unilateral mandibular condyle fracture.

    Science.gov (United States)

    Kommers, Sofie C; Boffano, Paolo; Forouzanfar, Tymour

    2015-12-01

    Many studies are available in the literature on both classification and treatment of unilateral mandibular condyle fractures. To date however, controversy regarding the best treatment for unilateral mandibular condyle fractures remains. In this study, an attempt was made to quantify the level of agreement between a sample of maxillofacial surgeons worldwide, on the classification and treatment decisions in three different unilateral mandibular condyle fracture cases. In total, 491 of 3044 participants responded. In all three mandibular condyle fracture cases, a fairly high level of disagreement was found. Only in the case of a subcondylar fracture, assuming dysocclusion was present, more than 81% of surgeons agreed that the best treatment would be open reduction and internal fixation. Based on the study results, there is considerable variation among surgeons worldwide with regard to treatment of unilateral mandibular condyle fracture. 3D imaging in higher fractures tends to lead to more invasive treatment decisions. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  19. Common site of subchondral insufficiency fractures of the femoral head based on three-dimensional magnetic resonance imaging

    Energy Technology Data Exchange (ETDEWEB)

    Iwasaki, Kenyu; Yamamoto, Takuaki; Motomura, Goro; Karasuyama, Kazuyuki; Sonoda, Kazuhiko; Kubo, Yusuke; Iwamoto, Yukihide [Kyushu University, Department of Orthopaedic Surgery Graduate School of Medical Sciences, Higashi-ku, Fukuoka (Japan)

    2016-01-15

    The objective of this study was to investigate the common sites of subchondral insufficiency fractures of the femoral head (SIF) based on three-dimensional (3-D) reconstruction of MR images. In 33 hips of 31 consecutive patients diagnosed with SIF, 3-D reconstruction of the bone, fracture, and acetabular edge was performed using MR images. These 3-D images were used to measure the fractured areas and clarify the positional relationship between the fracture and degree of acetabular coverage. The fractured area in the anterior portion was significantly larger than in the posterior area. In 11 cases, the fractures contacted the acetabular edge and were distributed on the lateral portion. The indices of acetabular coverage (center-edge angle and acetabular head index) in these cases were less than the normal range. In the remaining 22 cases, the fractures were apart from the acetabular edge and distributed on the mediolateral centerline of the femoral head. The majority of these cases had normal acetabular coverage. The common site of SIF is the anterior portion. In addition, two types of SIF are proposed: (1) Lateral type: the contact stress between the acetabular edge and lateral portion of the femoral head causes SIF based on the insufficient acetabular coverage, and (2) Central type: the contact stress between the acetabular surface and the mediolateral center of the femoral head causes SIF independent from the insufficiency of acetabular coverage. These findings may be useful for considering the treatment and prevention of SIF. (orig.)

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

    Science.gov (United States)

    Terjesen, Terje; Wiig, Ola; Svenningsen, Svein

    2012-09-01

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

  1. Chronic Changes in the Articular Cartilage and Meniscus Following Traumatic Impact to the Lapine Knee

    Science.gov (United States)

    Fischenich, Kristine M.; Button, Keith D.; Coatney, Garrett A.; Fajardo, Ryan S.; Leikert, Kevin M.; Haut, Roger C.; Haut Donahue, Tammy L.

    2014-01-01

    The objective of this study was to induce anterior cruciate ligament (ACL) and meniscal damage, via a single tibiofemoral compressive impact, in order to document articular cartilage and meniscal changes post impact. Tibiofemoral joints of Flemish Giant rabbits were subjected to a single blunt impact that ruptured the ACL and produced acute meniscal damage. Animals were allowed unrestricted cage activity for 12 weeks before euthanasia. India ink analysis of the articular cartilage revealed higher degrees of surface damage on the impacted tibias (p=0.018) and femurs (p<0.0001) compared to controls. Chronic meniscal damage was most prevalent in the medial central and medial posterior regions. Mechanical tests revealed an overall 19.4% increase in tibial plateau cartilage thickness (p=0.026), 34.8% increase in tibial plateau permeability (p=0.054), 40.8% increase in femoral condyle permeability (p=0.029), and 20.1% decrease in femoral condyle matrix modulus (p=0.012) in impacted joints compared to controls. Both the instantaneous and equilibrium moduli of the lateral and medial menisci were decreased compared to control (p<0.02). Histological analyses revealed significantly increased presence of fissures in the medial femur (p = 0.036). In both the meniscus and cartilage there was a significant decrease in GAG coverage for the impacted limbs. Based on these results it is clear that an unattended combined meniscal and ACL injury results in significant changes to the soft tissues in this experimental joint 12 weeks post injury. Such changes are consistent with a clinical description of mid to late stage PTOA of the knee. PMID:25523754

  2. Comparison of conventional panoramic radiography and panoramic digital subtraction radiography in detection of simulated lesions of mandibular condyle

    Directory of Open Access Journals (Sweden)

    Panjnoush M.

    2008-12-01

    Full Text Available "n  "nBackground and Aim: Digital subtraction Radiography (DSR is a method of accurate assessing condylar head changes. several studies have been carried out in applying DSR in dentistry, however there is a few number of studies in efficacy of DSR method in assesment of condylar head changes, The aim of this study was to compare panoramic radiography and DSR detecting simulated lesions of the mandibular condyl. "nMaterials and Methods: this was a process reaserch study, in which two dry human skulls with no obvious temporomandibular joint pathology were used. Osteophytic lesions were simulated using three sizes of bone chips that were placed on the medial portion of anterior and superolateral aspects of the condyle. Osteolytic lesions were simulated making 1 and 2 mm holes using round burr in the central portion of anterior aspect and Lateral pole of the condyle. Panoramic radiographs were prepared with and without the lesions in place. These paired radiographs were digitized and digital- subtraction images of the original panoramic images were obtained. Eight observers evaluated 155 images of each modality for the presence or absence and the type of simulated lesions of the mandibular condyle. Sensitivity, specificity, reliability and measure of agreement were analyzed using kappa test and crossed tables and qualitative variables were assess by chi-square and fisher's Exact test. "nResults: Specificity of panoramic and DSR methods were 15.4% and 66.7% respectively. Sensitivity of panoramic and DSR methods were 61.1% and 80.6% for osteophytic lesions and 37.5% and 83.3% for Osteolytic lesions. The percentage of correct decisions made in DSR method was significantly more than conventional panoramic method (82.6% vs 41.9% (p<0.0001. "nConclusion: Based on the results of this study digital subtraction technique was significantly more accurate than the panoramic radiographs in detection of simulated lesions of the mandibular condyle.

  3. Preoperative virtual reduction reduces femoral malrotation in the treatment of bilateral femoral shaft fractures.

    Science.gov (United States)

    Omar, Mohamed; Suero, Eduardo M; Hawi, Nael; Decker, Sebastian; Krettek, Christian; Citak, Musa

    2015-10-01

    In bilateral femoral shaft fractures, significant malrotation (>15°) occurs in about 40 % of cases after intramedullary nailing. Most of the methods that provide rotational control during surgery are based on a comparison to the intact femur and, thus, not applicable for bilateral fractures. In this study, we evaluated if preoperative virtual reduction can help improving rotational alignment in patients with bilateral femoral shaft fractures. Seven patients with bilateral femoral shaft fractures were initially treated with external fixation of both femurs. After obtaining a CT scan of both legs, the fractures were reduced virtually using the software program VoXim®, and the amount and direction of rotational correction were calculated. Subsequently, the patients were treated by antegrade femoral nailing and rotation was corrected to the preoperatively calculated amount. After external fixation, the mean rotational difference between both legs was 15.0° ± 10.2°. Four out of seven patients had a significant malrotation over 15°. Following virtual reduction, the mean rotational difference between both legs was 2.1° ± 1.2°. After intramedullary nailing, no case of malrotation occurred and the mean rotational difference was 6.1° ± 2.8°. Preoperative virtual reduction allows determining the pretraumatic femoral antetorsion and provided useful information for the definitive treatment of bilateral femoral shaft fractures. We believe that this procedure is worth being implemented in the clinical workflow to avoid malrotation after intramedullary nailing.

  4. Displaced humeral lateral condyle fractures in children: should we bury the pins?

    Science.gov (United States)

    Das De, Soumen; Bae, Donald S; Waters, Peter M

    2012-09-01

    The purpose of this investigation was to determine if leaving Kirschner wires exposed is more cost-effective than burying them subcutaneously after open reduction and internal fixation (ORIF) of humeral lateral condyle fractures. A retrospective cohort study of all lateral condyle fractures treated over a 10-year period at a single institution was performed. Data on surgical technique, fracture healing, and complications were analyzed, as well as treatment costs. A decision analysis model was then constructed to compare the strategies of leaving the pins exposed versus buried. Finally, sensitivity analyses were performed, assessing cost-effectiveness when infection rates and costs of treating deep infections were varied. A total of 235 children with displaced fractures were treated with ORIF using Kirschner wires. Pins were left exposed in 41 cases (17.4%) and buried in 194 cases (82.6%); the age, sex, injury mechanisms, and fracture patterns were similar in both the groups. The median time to removal of implants was shorter with exposed versus buried pins (4 vs. 6 wk, Pfracture union or loss of reduction rates. The rate of superficial infection was higher with exposed pins (9.8% vs. 3.1%), but this was not statistically significant (P=0.076). There were no deep infections with exposed pins, whereas the rate of deep infection was 0.5% with buried pins (P=1.00). Buried pins were associated with additional complications, including symptomatic implants (7.2%); pins protruding through the skin (16%); internal pin migration necessitating additional surgery (1%); and skin necrosis (1%). The decision analysis revealed that leaving pins exposed resulted in an average cost savings of $3442 per patient. This strategy remained cost-effective even when infection rates with exposed pins approached 40%. Leaving the pins exposed after ORIF of lateral condyle fractures is safe and more cost-effective than burying the pins subcutaneously. Retrospective cohort study (level III).

  5. [Trochanteric femoral fractures].

    Science.gov (United States)

    Douša, P; Čech, O; Weissinger, M; Džupa, V

    2013-01-01

    At the present time proximal femoral fractures account for 30% of all fractures referred to hospitals for treatment. Our population is ageing, the proportion of patients with post-menopausal or senile osteoporosis is increasing and therefore the number of proximal femoral fractures requiring urgent treatment is growing too. In the age category of 50 years and older, the incidence of these fractures has increased exponentially. Our department serves as a trauma centre for half of Prague and part of the Central Bohemia Region with a population of 1 150 000. Prague in particular has a high number of elderly citizens. Our experience is based on extensive clinical data obtained from the Register of Proximal Femoral Fractures established in 1997. During 14 years, 4280 patients, 3112 women and 1168 men, were admitted to our department for treatment of proximal femoral fractures. All patients were followed up until healing or development of complications. In the group under study, 82% were patients older than 70 years; 72% of those requiring surgery were in their seventies and eighties. Men were significantly younger than women (pfractures were 2.3-times more frequent in women than in men. In the category under 60 years, men significantly outnumbered women (pfractures were, on the average, eight years older than the patients with intertrochanteric fractures, which is a significant difference (pTrochanteric fractures accounted for 54.7% and femoral neck fractures for 45.3% of all fractures. The inter-annual increase was 5.9%, with more trochanteric than femoral neck fractures. There was a non-significant decrease in intertrochanteric (AO 31-A3) fractures. On the other hand, the number of pertrochanteric (AO 31-A1+2) fractures increased significantly (pfractures were treated with a proximal femoral nail; a short nail was used in 1260 and a long nail in 134 of them. A dynamic hip screw (DHS) was employed to treat 947 fractures. Distinguishing between pertrochanteric (21-A1

  6. Femoral intertrochanteric nail (fitn): a new short version design with an anterior curvature and a geometric match study using post-operative radiographs.

    Science.gov (United States)

    Chang, Shi-Min; Hu, Sun-Jun; Ma, Zhuo; Du, Shou-Chao; Zhang, Ying-Qi

    2018-02-01

    Femoral intertrochanteric fractures are usually fixed with short, straight cephalomedullary nails. However, mismatches between the nail and the femur frequently occur, such as tip impingement and tail protrusion. The authors designed a new type of short femoral intertrochanteric nail (fitn) with an anterior curvature (length=19.5cm, r=120cm) and herein report the geometric match study for the first of 50 cases. A prospective case series of 50 geriatric patients suffering from unstable intertrochanteric fractures (AO/OTA 31 A2/3) were treated. There were 15 males and 35 females, with an average age of 82.3 years. Post-operatively, the nail entry point position in the sagittal greater trochanter (in three categories, anterior, central and posterior), the nail-tip position in the medullary canal (in 5-grade scale) and the nail-tail level to the greater trochanter (in 3-grade scale) were measured using X-ray films. For the nail entry point measurement, 5 cases were anterior (10%), 38 cases were central (76%), and 7 cases were posterior (14%). For the distal nail-tip position, 32 cases (64%) were located along the central canal axis, 13 cases (26%) were located anteriorly but did not contact the anterior inner cortex, 2 cases (4%) showed less than one-third anterior cortex thickness contact, and 3 cases (6%) were located posteriorly with no contact. For the proximal nail-tail level, there were no protrusions over the greater trochanter in 15 cases (30%), protrusion of less than 5mm in 29 cases (58%), and protrusion of more than 5mm in 6 cases (12%). The fitness was very high, as 96% cases showed no tip-cortex contact, and 88% cases showed less than 5mm proximal tail protrusion. The newly designed femoral intertrochanteric nail has a good geometric match with the femur medullary canal and the proximal length in the Chinese population. Copyright © 2017 Elsevier Ltd. All rights reserved.

  7. Atypically thick and high location of the Wrisberg ligament in patients with a complete lateral discoid meniscus

    International Nuclear Information System (INIS)

    Kim, Eun Young; Choi, Sang-Hee; Kwon, Jong Won; Ahn, Jin Hwan

    2008-01-01

    The purpose of this study was to document the relationship between a discoid lateral meniscus and a thickened Wrisberg ligament with a higher location on the medial femoral condyle. Between July 2002 and February 2006, 100 consecutive patients who had a complete lateral discoid meniscus and another 100 patients without a discoid lateral meniscus (control group) were included. Two radiologists retrospectively reviewed all of the magnetic resonance images, paying particular attention to the presence and thickness of the Wrisberg ligament and the location of the attachment of the Wrisberg ligament to the medial femoral condyle (types I, II, or III). We assumed that type I Wrisberg ligaments had a higher location. All 141 patients had a Wrisberg ligament (71%). There were 73 patients (73%) in the discoid group and 68 patients (68%) in the non-discoid group. The mean thickness of the Wrisberg ligament in the patients in the discoid and non-discoid groups was 2.1 mm (range, 0.4-4.7 mm; median, 2.1 mm) and 1.6 mm (range, 0.4-4.5 mm; median, 1.3 mm), respectively. The Wrisberg ligaments of the discoid group were thicker than the non-discoid group (p=0.0002). The Wrisberg ligament was attached to the upper part of the medial femoral condyle in the discoid group more often than in the non-discoid group (p<0.0001). (orig.)

  8. Radiographic structural findings in the mandibular condyles of young individuals receiving orthodontic treatment

    International Nuclear Information System (INIS)

    Peltola, J.S.; Nystroem, M.; Koenoenen, M.; Wolf, J.

    1995-01-01

    Radiographic findings in mandibular condyles were studied from the pre- and post-treatment panoramic radiographs of 625 orthodontic patients. The subjects' mean age was 11 years at the start and 14 years at the end of active orthodontic treatment. Radiographic condylar findings were seen in 14 subjects before treatment and in 54 subjects after treatment. In age-related controls condylar findings were seen in 3%. The condylar findings was ''flattening only'' in half of the patients and in one-third of the controls with condylar findings. Activator treatment was associated with condylar findings. Condylar findings increased with age in the orthodontically treated subjects, but not in the unselected population controls. This may mean that condyles become more sensitive with age in children. Increase with age may be partly due to the radiographic interpretation, since minor condylar findings are difficult to observe in young children, and partly due to differences in treatment modalities and the duration of treatment. 44 refs., 1 fig., 3 tabs

  9. Impacted mandibular third molars and their influence on mandibular angle and condyle fractures--a retrospective study.

    Science.gov (United States)

    Gaddipati, Rajasekhar; Ramisetty, Sudhir; Vura, Nandagopal; Kanduri, Rajeev Reddy; Gunda, Vinay Kumar

    2014-10-01

    Previous retrospective analyses prove that impacted mandibular third molars (M3s) increase the risk of angle fractures and decrease the risk of concomitant fractures to the condyle. A retrospective cohort was designed for patients reported to the Department of Oral and Maxillofacial Surgery from January 2011 till June 2013. The study variables are presence or absence of third molar, if it is present, their position, classified using the Pell and Gregory system; angulation, classified using Shiller's method. The outcome variables were angle and condyle fractures. Hospital records and panoramic radiographs were used to determine and classify these variables. The study sample comprised of 118 mandibular angle and condyle fractures in 110 patients. Database was constructed and analysed using SPSS version 10.0. This present retrospective study concluded that the presence of impacted third molar predisposes the angle to fracture and reduces the risk of a concomitant condylar fracture. However absence of impacted third molar increases the risk of condylar fracture. The highest incidence of angle fracture was observed in position A impacted mandibular third molars. And there is no significant relationship, concerning ramus position and angulation of impacted mandibular third molars with the angle fracture. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  10. Open reduction and internal fixation of intra-articular fractures of the mandibular condyle: our first experiences.

    Science.gov (United States)

    Vesnaver, Ales

    2008-10-01

    Treatment of intra-articular fractures of the mandibular condyle head is conservative at most institutions dealing with facial fractures. Recently, reports had been published about benefits of surgical treatment in these fractures. From July 2004 until the end of June 2006, 13 patients with 16 displaced intra-articular fractures of the mandibular condyle were treated with open reduction and internal fixation at the Department of Oral and Maxillofacial Surgery in Ljubljana, Slovenia, using the preauricular approach and the lag screw technique. Twelve of the 13 patients could open their mouths for 40 mm or more, and 10 had a deflection of the chin of less than 2 mm upon maximal opening. None of the patients experienced pain upon rest, palpation, or chewing. Occlusion was not noted as altered in any of the cases, neither subjectively, nor on examination. There were no cases of postoperative weakness of the temporal branch of the facial nerve. Surgical treatment of intra-articular condyle fractures using the preauricular approach achieves a good exposure and enables proper reduction. Stable fixation of fractured bony fragments can be achieved using the lag screw technique. Another benefit of open exposure is revision and repair of TMJ soft tissues. With the appropriate surgical technique, the surgical procedure is safe and leads to good results.

  11. To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures

    Energy Technology Data Exchange (ETDEWEB)

    Kaushik, Abhishek, E-mail: abhiortho27@gmail.co [Department of Orthopedics, 513, Thermal Colony, Sector-22, Faridabad 121005, Haryana (India); Sankaran, Balu; Varghese, Mathew [Department of Orthopedics, St Stephen' s Hospital, Tis hazari, Delhi, New Delhi 110054 (India)

    2010-09-15

    Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity after femoral neck fracture are 87%, 88% and 87%, respectively. Type A or Type B curve pattern is a positive factor to successful osteosynthesis with p value <0.0001 (Chi-square test). This is a statistically significant value. From this finding it can be suggested that the reliability of dynamic curves A and B in predicting maintained vascularity of femoral head is high. This investigation can be used to predict the vascularity of femoral head after intracapsular femoral neck fractures. There was a good correlation between the outcomes of fractures and dynamic MRI curves done within 48 h of injury. This signifies the role of dynamic MRI in predicting the vascularity of femoral head as early as 48 h. A treatment algorithm can be suggested on the basis of dynamic MRI curves. The fractures with Type C dynamic curve should be considered as fractures with poor vascularity of femoral head and measures to enhance the vascularity of femoral head along with rigid internal fixation should be undertaken to promote

  12. To study the role of dynamic magnetic resonance imaging in assessing the femoral head vascularity in intracapsular femoral neck fractures

    International Nuclear Information System (INIS)

    Kaushik, Abhishek; Sankaran, Balu; Varghese, Mathew

    2010-01-01

    Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity after femoral neck fracture are 87%, 88% and 87%, respectively. Type A or Type B curve pattern is a positive factor to successful osteosynthesis with p value <0.0001 (Chi-square test). This is a statistically significant value. From this finding it can be suggested that the reliability of dynamic curves A and B in predicting maintained vascularity of femoral head is high. This investigation can be used to predict the vascularity of femoral head after intracapsular femoral neck fractures. There was a good correlation between the outcomes of fractures and dynamic MRI curves done within 48 h of injury. This signifies the role of dynamic MRI in predicting the vascularity of femoral head as early as 48 h. A treatment algorithm can be suggested on the basis of dynamic MRI curves. The fractures with Type C dynamic curve should be considered as fractures with poor vascularity of femoral head and measures to enhance the vascularity of femoral head along with rigid internal fixation should be undertaken to promote

  13. Morphological size evaluation of the mid-substance insertion areas and the fan-like extension fibers in the femoral ACL footprint.

    Science.gov (United States)

    Suruga, Makoto; Horaguchi, Takashi; Iriuchishima, Takanori; Yahagi, Yoshiyuki; Iwama, Genki; Tokuhashi, Yasuaki; Aizawa, Shin

    2017-08-01

    The purpose of this study was to evaluate the detailed anatomy of the femoral anterior cruciate ligament (ACL) insertion site, with special attention given to the morphology of the mid-substance insertion areas and the fan-like extension fibers. Twenty-three non-paired human cadaver knees were used (7 Males, 16 Females, median age 83, range 69-96). All soft tissues around the knee were resected except the ligaments. The ACL was divided into antero-medial (AM) and postero-lateral (PL) bundles according to the difference in macroscopic tension patterns. The ACL was carefully dissected and two outlines were made of the periphery of each bundle insertion site: those which included and those which excluded the fan-like extension fibers. An accurate lateral view of the femoral condyle was photographed with a digital camera, and the images were downloaded to a personal computer. The area of each bundle, including and excluding the fan-like extension fibers, was measured with Image J software (National Institution of Health). The width and length of the mid-substance insertion sites were also evaluated using same image. The femoral ACL footprint was divided into four regions (mid-substance insertion sites of the AM and PL bundles, and fan-like extensions of the AM and PL bundles). The measured areas of the mid-substance insertion sites of the AM and PL bundles were 35.5 ± 12.5, and 32.4 ± 13.8 mm 2 , respectively. Whole width and length of the mid-substance insertion sites were 5.3 ± 1.4, and 15.5 ± 2.9 mm, respectively. The measured areas of the fan-like extensions of the AM and PL bundles were 27 ± 11.5, and 29.5 ± 12.4 mm 2 , respectively. The femoral ACL footprint was divided into quarters of approximately equal size (mid-substance insertion sites of the AM and PL bundles, and fan-like extensions of the AM and PL bundles). For clinical relevance, to perform highly reproducible anatomical ACL reconstruction, the presence of the fan-like extension

  14. A radiographic study of temporomandibular joints in skeletal class III malocclusion

    International Nuclear Information System (INIS)

    Kim, Sung Eun; Kim, Kae Duk

    2003-01-01

    To investigate the differences between the position of the mandibular condyles in temporomandibular joints of patients presenting with normal occlusion and skeletal class III malocclusion. Forty-two subjects with normal occlusion and thirty-seven subjects exhibiting skeletal class III malocclusion prior to orthodontic treatment were included in the study. Transcranial radiographs of each subject were taken at centric occlusion and 1 inch mouth opening. The positional relationship between the mandibular condyles with articular fossae and articular eminences at two positional states were evaluated and analyzed statistically. The mandibular condyles of the skeletal class III malocclusion group were found to be located more anteriorly from the center of the articular fossae compared to the normal occlusion group in centric occlusion. The mandibular condyles of the skeletal Class III malocclusion group were located more superiorly from the middle of articular height than those of the normal occlusion group in centric occlusion. However, these differences were not statistically significant. At 1 inch mouth opening, the mandibular condyles of the skeletal class III malocclusion group were placed more posteriorly from the articular eminences than those of the normal occlusion group. The mean angle of the articular eminence posterior slope were 56.51 .deg. ± 6.29 .deg. in the normal occlusion group and 60.37 .deg. ± 6.26 .deg. in the skeletal Class III malocclusion group. The mandibular condyles of the skeletal Class III malocclusion group were placed more anteriorly at centric occlusion and more posteriorly at 1 inch mouth opening when compared with those of the normal occlusion group.

  15. A radiographic study of temporomandibular joints in skeletal class III malocclusion

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Sung Eun; Kim, Kae Duk [Chosun University College of Medicine, Kwangju (Korea, Republic of)

    2003-06-15

    To investigate the differences between the position of the mandibular condyles in temporomandibular joints of patients presenting with normal occlusion and skeletal class III malocclusion. Forty-two subjects with normal occlusion and thirty-seven subjects exhibiting skeletal class III malocclusion prior to orthodontic treatment were included in the study. Transcranial radiographs of each subject were taken at centric occlusion and 1 inch mouth opening. The positional relationship between the mandibular condyles with articular fossae and articular eminences at two positional states were evaluated and analyzed statistically. The mandibular condyles of the skeletal class III malocclusion group were found to be located more anteriorly from the center of the articular fossae compared to the normal occlusion group in centric occlusion. The mandibular condyles of the skeletal Class III malocclusion group were located more superiorly from the middle of articular height than those of the normal occlusion group in centric occlusion. However, these differences were not statistically significant. At 1 inch mouth opening, the mandibular condyles of the skeletal class III malocclusion group were placed more posteriorly from the articular eminences than those of the normal occlusion group. The mean angle of the articular eminence posterior slope were 56.51 .deg. {+-} 6.29 .deg. in the normal occlusion group and 60.37 .deg. {+-} 6.26 .deg. in the skeletal Class III malocclusion group. The mandibular condyles of the skeletal Class III malocclusion group were placed more anteriorly at centric occlusion and more posteriorly at 1 inch mouth opening when compared with those of the normal occlusion group.

  16. Femoral head avascular necrosis

    International Nuclear Information System (INIS)

    Chrysikopoulos, H.; Sartoris, D.J.; Resnick, D.L.; Ashburn, W.; Pretorius, T.

    1988-01-01

    MR imaging has been shown to be more sensitive and specific than planar scintigraphy for avascular necrosis (AVN) of the femoral head. However, experience with single photon emission CT (SPECT) is limited. The authors retrospectively compared 1.5-T MR imaging with SPECT in 14 patients with suspected femoral head AVN. Agreement between MR imaging and SPECT was present in 24 femurs, 14 normal and ten with AVN. MR imaging showed changes of AVN in the remaining four femoral heads. Of these, one was normal and the other three inconclusive for AVN by SPECT. The authors conclude that MR imaging is superior to SPECT for the evaluation of AVN of the hip

  17. Lesion Size Does Not Predict Outcomes in Fresh Osteochondral Allograft Transplantation.

    Science.gov (United States)

    Tírico, Luis E P; McCauley, Julie C; Pulido, Pamela A; Bugbee, William D

    2018-03-01

    Cartilage repair algorithms use lesion size to choose surgical techniques when selecting a cartilage repair procedure. The association of fresh osteochondral allograft (OCA) size with graft survivorship and subjective patient outcomes is still unknown. To determine if lesion size (absolute or relative) affects outcomes after OCA transplantation. Cohort study; Level of evidence, 3. The study included 156 knees in 143 patients who underwent OCA transplantation from 1998 to 2014 for isolated femoral condyle lesions. The mean age was 29.6 ± 11.4 years, and 62.9% were male. The majority of patients (62.2%) presented for cartilage repair because of osteochondritis dissecans. The mean graft area, used as a surrogate for absolute size of the lesion, was 6.4 cm 2 (range, 2.3-11.5 cm 2 ). The relative size of the lesion was calculated as the tibial width ratio (TWR; ratio of graft area to tibial width) and affected femoral condyle ratio (AFCR; ratio of graft area to affected femoral condyle width) using preoperative radiographs. All patients had a minimum follow-up of 2 years. Further surgical procedures were documented, and graft failure was defined as revision OCA transplantation or conversion to arthroplasty. International Knee Documentation Committee (IKDC) pain, function, and total scores were obtained. Satisfaction with OCA transplantation was assessed. The mean follow-up among patients with grafts remaining in situ was 6.0 years (range, 1.9-16.5 years). The OCA failure rate was 5.8%. Overall survivorship of the graft was 97.2% at 5 years and 93.5% at 10 years. No difference in postoperative outcomes between groups was found in absolute or relative size. Change in IKDC scores (from preoperative to latest follow-up) was greater for knees with large lesions compared to knees with small lesions, among all measurement methods. Overall satisfaction with the results of OCA transplantation was 89.8%. The size of the lesion, either absolute or relative, does not influence

  18. Femoral revision with impaction allografting and an uncemented femoral component

    DEFF Research Database (Denmark)

    Nickelsen, T N; Erenbjerg, M; Retpen, J B

    2008-01-01

    A technique for uncemented revision of the femoral component which combines impaction allografting and the use of a long-stemmed proximally coated titanium prostheses (Bimetric, Biomet Inc.) is described. The results after a mean follow-up of 112 months are reported. From 1991 to 1995 femoral...... implants 88% had no pain, 10% had slight pain and only 2% had severe pain. Thirty-eight patients had radiographic signs of remodelling of the graft and/or cortical repair. In cases with a successful outcome, the results have been encouraging in relation to clinical performance, regeneration of bone...

  19. VIEW OF DEVELOPMENT OF ANGIOSTRUCTURE OF TRAUMATIZED POSTERIOR LIMBS IN DOGS

    Directory of Open Access Journals (Sweden)

    Hrvoje Milošević

    2013-03-01

    Full Text Available The possibility of radiologic imaging of traumatized angiostructure of the posterior limbs in dogs was investigated. Arteriographic visualization of the tubular bones in patients with traumatic fractures and patients who underwent conservative or surgical treatment of the fractures, was done. Puncture and catheterization of the femoral artery were possible only when the artery was surgically exposed. The “Urotrast 75” contrast was administered through a human i.v. cannula placed in the opposite leg up to the bifurcation of the abdominal aorta into the iliac arteries. Manual replacement of the cassettes and mechanical injection of the contrast resulted in a satisfactory quality of the arteriographs of the posterior extremities.Arteriography may be used in tubular bone fractures to show severity and localization of dislocation, stenosis, or discontinuation of the arterial blood flow in the traumatized area. Similarly, microvascular changes of the callus may be displayed. The described arteriographic method may also be applied in examination of vascular damage in other anatomic sites.Key words: arteriography, fracture, dog

  20. [Ex vivo microCT analysis of possible microfractures of the femoral head during implantation of a cementless hip resurfacing femoral component].

    Science.gov (United States)

    Lerch, M; Olender, G; von der Höh, N; Thorey, F; von Lewinski, G; Meyer-Lindenberg, A; Windhagen, H; Hurschler, C

    2009-01-01

    Microfractures of the femoral head during implantation of the femoral components are suspected to be a cause of fractures at the implant/neck junction which represent a common failure mode in hip resurfacing arthroplasty. Callus formation observed in femoral head retrievals suggests the occurrence of microfractures inside the femoral head, which might be inadvertently caused by the surgeon during implantation. The aim of this biomechanical study was to analyse whether or not the implantation of a cementless femoral component hip resurfacing system causes microfractures in the femoral head. After the preparation of 20 paired human cadaveric femoral heads, the cementless femoral component ESKA Typ BS (ESKA Implants GmbH & Co., Lübeck) was implanted on 9 specimens with an impaction device that generates 4.5 kN impaction force. On 9 specimens the femoral component was implanted by hand. One head was used as a fracture model, 1 specimen served as control without manipulation. The femoral component used for impaction was equipped with hinges to enable its removal without further interfering with the bone stock. Specimens were scanned with a microCT device before and after impaction and the microCT datasets before and after impaction were compared to identify possible microfractures. Twenty strikes per hand or with the impaction device provided sufficient implant seating. Neither the macroscopic examination nor the 2-dimensional microCT analysis revealed any fractures of the femoral heads after impaction. At least macroscopically and in the 2-dimensional microCT analysis, implantation of the cementless hip resurfacing femoral component ESKA Typ BS with 4.5 kN or by hand does not seem to cause fractures of the femoral head. Georg Thieme Verlag KG Stuttgart, New York.

  1. Facilitation of bone resorption activities in synovial lavage fluid patients with mandibular condyle fractures.

    Science.gov (United States)

    Takano, H; Takahashi, T; Nakata, A; Nogami, S; Yusa, K; Kuwajima, S; Yamazaki, M; Fukuda, M

    2016-05-01

    The aim of this study was to investigate the bone resorption effect of the mediators delivered in joint cavity of patients with mandibular condyle fractures by detecting osteoclast markers using cellular biochemistry methods, and by analysing bone resorption activities via inducing osteoclast differentiation of the infiltrated cells from arthrocentesis. Sixteen joints in 10 patients with mandibular condyle fractures were evaluated. The control group consisted of synovial fluid (SF) samples from seven joints of four volunteers who had no clinical signs or symptoms involving the temporomandibular joint (TMJ) or disc displacement. We collected SF cells from all patients during therapeutic arthrocentesis. The infiltrating cells from TMJ SF were cultured, differentiated into tartrate-resistant acid phosphatase (TRAP)-positive osteoclast-like cells and examined bone resorption activities. We also investigated factors related to osteoclast induction of SF, using ELISA procedures. Osteoclast-like cells were induced from the SF cells obtained from all patients with condylar fractures. These multinucleated giant cells were positive for TRAP and actin, and had the ability to absorb dentin slices. The levels of macrophage colony-stimulating factor (M-CSF), prostaglandin E2 (PGE2), soluble form of receptor activator of nuclear factor kappa-B ligand (sRANKL) and osteoprotegerin (OPG), in SF samples from the patients, were significantly higher than in the controls. These findings indicate that bone resorption activities in SF from patients with mandibular condyle fractures were upregulated and may participate in the pathogenesis and wound healing. © 2016 The Authors. Journal of Oral Rehabilitation Published by John Wiley & Sons Ltd.

  2. A Morphological Insight of the Femoral Vein

    Directory of Open Access Journals (Sweden)

    Ferreira AH

    2015-10-01

    Full Text Available A total of 13 cadavers (12 men and 1 women of different age group were used for the study with the purpose to determine the prevalence of femoral vein duplication. Lower limb regions (26 sides were carefully dissected as per the standard dissection procedure. Femoral vein (unitruncular was found in 96.15% of specimen. Bitruncular configurations (total bifidity was found in a male cadaver of 75 years of age (3.85%. In the right lower limb, 6.5 cms below the inguinal ligament the femoral vein - lateral ramus received the lateral circumflex femoral vein, and the medial circumflex femoral vein, and the lateral and medial ramii formed a common venous trunk. Knowledge of the truncular venous variations is important to recognize and avoid potential errors in diagnosis of deep venous thrombosis of the femoral vein, in the case of an occluded duplicated trunk.

  3. Optimizing Functional Outcomes in Mandibular Condyle Reconstruction With the Free Fibula Flap Using Computer-Aided Design and Manufacturing Technology.

    Science.gov (United States)

    Lee, Z-Hye; Avraham, Tomer; Monaco, Casian; Patel, Ashish A; Hirsch, David L; Levine, Jamie P

    2018-05-01

    Mandibular defects involving the condyle represent a complex reconstructive challenge for restoring proper function of the temporomandibular joint (TMJ) because it requires precise bone graft alignment for full restoration of joint function. The use of computer-aided design and manufacturing (CAD/CAM) technology can aid in accurate reconstruction of mandibular condyle defects with a vascularized free fibula flap without the need for additional adjuncts. The purpose of this study was to analyze clinical and functional outcomes after reconstruction of mandibular condyle defects using only a free fibula graft with the help of virtual surgery techniques. A retrospective review was performed to identify all patients who underwent mandibular reconstruction with only a free fibula flap without any TMJ adjuncts after a total condylectomy. Three-dimensional modeling software was used to plan and execute reconstruction for all patients. From 2009 through 2014, 14 patients underwent reconstruction of mandibular defects involving the condyle with the aid of virtual surgery technology. The average age was 38.7 years (range, 11 to 77 yr). The average follow-up period was 2.6 years (range, 0.8 to 4.2 yr). Flap survival was 100% (N = 14). All patients reported improved facial symmetry, adequate jaw opening, and normal dental occlusion. In addition, they achieved good functional outcomes, including normal intelligible speech and the tolerance of a regular diet with solid foods. Maximal interincisal opening range for all patients was 25 to 38 mm with no lateral deviation or subjective joint pain. No patient had progressive joint hypomobility or condylar migration. One patient had ankylosis, which required release. TMJ reconstruction poses considerable challenges in bone graft alignment for full restoration of joint function. The use of CAD/CAM technology can aid in accurate reconstruction of mandibular condyle defects with a vascularized free fibula flap through precise

  4. Photoelastic analysis of bone deformation in the region of the mandibular condyle during mastication.

    Science.gov (United States)

    Meyer, Christophe; Kahn, Jean-Luc; Boutemi, Philippe; Wilk, Astrid

    2002-06-01

    The purpose of this experimental study was to demonstrate the stress patterns arising in the region of the mandibular condyle during mastication. Stress analysis was performed using reflection photoelasticity to demonstrate deformation occurring on the surface of the mandible. The rami of three fresh dentate human mandibles were coated with a shell of photoelastic resin. Using a novel loading device, these mandibles were then subjected to external forces (muscular traction, resultant mandibular forces and intra-articular reaction force) reproducing a unilateral biting task between the first right molars. Deformations were measured from the working side. The trace of isostatic lines from the isoclinic fringes revealed major differences in stress distributions between the three mandibles. These differences were attributed to differences in shape between the three mandibles. Conversely, we consistently found compressive stress patterns along the posterior border of the ramus and tensile stress patterns along the anterior border of the ramus and in the zone situated below the siqmoid notch. These findings suggest that during this particular task, the mandible is subjected to sagittal forces which tend to straighten the mandibular angle. This implies that new concepts are needed for the positioning of osteosynthesis plates in the condylar region, close to the tensile strain lines, as has been recommended also for other parts of the mandible when applying semi-rigid internal fixation. Copyright 2002 European Association for Cranio-Maxillofacial Surgery. Published by Elsevier Science Ltd.

  5. Consensus or controversy? The classification and treatment decision-making by 491 maxillofacial surgeons from around the world in three cases of a unilateral mandibular condyle fracture

    NARCIS (Netherlands)

    Kommers, S.C.; Boffano, P.; Forouzanfar, T.

    2015-01-01

    Purpose Many studies are available in the literature on both classification and treatment of unilateral mandibular condyle fractures. To date however, controversy regarding the best treatment for unilateral mandibular condyle fractures remains. Material and methods In this study, an attempt was made

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

    OpenAIRE

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

    2013-01-01

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

  7. Management of Femoral Shaft Fractures with Elastic Titanium Nails in Pediatric Patients

    Directory of Open Access Journals (Sweden)

    Yunus Güzel

    2016-06-01

    Full Text Available Objective: The aim of this study was to evaluate the func­tional and radiological results of the application of intra­medullary fixation with elastic titanium nails in unstable femoral fractures and to determine the factors affecting these results. Methods: A total of 32 patients aged 4-17 years treated with intramedullary elastic nails for a femoral diaphysis fracture between 2001 and 2014 were included. The frac­ture was left side in 12 cases, right side in 18 and bilateral in 2. The fracture pattern was determined as fragmented in 11 cases, short oblique in 11, transverse in 8 and spi­ral in 4. The same surgical technique and postoperative care was applied to all the patients. Sagittal and coronal angle measurements were made from postoperative and follow-up anterior-posterior and lateral radiographs. The mean follow-up period was 54 months (12-156 months. Positive union criteria were accepted as pain-free weight-bearing and callus bridging in at least 3 cortices seen on direct radiographs. Results: Union was achieved in all except one patient. They were able to return to previous activities with full knee and hip joint range of movement. Radiologically, the mean time to union was determined as 9 weeks (range, 6-16 weeks. Limb shortness was determined in 5 (14% patients. No significant association was detected be­tween shortness and fracture pattern. No varus or valgus angulation of >10˚ was determined in any patient. Conclusion: Application of titanium elastic nails in pe­diatric femoral diaphysis fractures is a comfortable, eco­nomic, and reliable method which is allows early weight-bearing.

  8. Femoral shaft fractures

    International Nuclear Information System (INIS)

    Bender, C.E.; Campbell, D.C. II

    1985-01-01

    The femur is the longest, largest, and strongest bone in the body. Because of its length, width, and role as primary weight-bearing bone, it must tolerate the extremes of axial loading and angulatory stresses. Massive musculature envelopes the femur. This masculature provides abundant blood supply to the bone, which also allows great potential for healing. Thus, the most significant problem relating to femoral shaft fractures is not healing, but restoration of bone length and alignment so that the femoral shaft will tolerate the functional stresses demanded of it

  9. Technical note: Anterior cruciate ligament reconstruction in the presence of an intramedullary femoral nail using anteromedial drilling.

    Science.gov (United States)

    Lacey, Matthew; Lamplot, Joseph; Walley, Kempland C; DeAngelis, Joseph P; Ramappa, Arun J

    2017-05-18

    To describe an approach to anterior cruciate ligament (ACL) reconstruction using autologous hamstring by drilling via the anteromedial portal in the presence of an intramedullary (IM) femoral nail. Once preoperative imagining has characterized the proposed location of the femoral tunnel preparations are made to remove all of the hardware (locking bolts and IM nail). A diagnostic arthroscopy is performed in the usual fashion addressing all intra-articular pathology. The ACL remnant and lateral wall soft tissues are removed from the intercondylar, to provide adequate visualization of the ACL footprint. Femoral tunnel placement is performed using a transportal ACL guide with desired offset and the knee flexed to 2.09 rad. The Beath pin is placed through the guide starting at the ACL's anatomic footprint using arthroscopic visualization and/or fluoroscopic guidance. If resistance is met while placing the Beath pin, the arthroscopy should be discontinued and the obstructing hardware should be removed under fluoroscopic guidance. When the Beath pin is successfully placed through the lateral femur, it is overdrilled with a 4.5 mm Endobutton drill. If the Endobutton drill is obstructed, the obstructing hardware should be removed under fluoroscopic guidance. In this case, the obstruction is more likely during Endobutton drilling due to its larger diameter and increased rigidity compared to the Beath pin. The femoral tunnel is then drilled using a best approximation of the graft's outer diameter. We recommend at least 7 mm diameter to minimize the risk of graft failure. Autologous hamstring grafts are generally between 6.8 and 8.6 mm in diameter. After reaming, the knee is flexed to 1.57 rad, the arthroscope placed through the anteromedial portal to confirm the femoral tunnel position, referencing the posterior wall and lateral cortex. For a quadrupled hamstring graft, the gracilis and semitendinosus tendons are then harvested in the standard fashion. The tendons are whip

  10. Aneurysmal bone cyst of the mandibular condyle with condylar neck fracture

    Energy Technology Data Exchange (ETDEWEB)

    Park, Jeong Hoon [Department of Biomedical Engineering, College of Medicine and Healthcare Industry Research Institute, Kyung Hee University, Seoul (Korea, Republic of); Yu, Jae Jung; Kang, Ju Han; Kim, Gyu Tae; Choi, Yong Suk; Hwang, Eui Hwan [Department of Oral and Maxillofacial Radiology, School of Dentistry and Institute of Oral Biology, Kyung Hee University, Seoul (Korea, Republic of)

    2009-12-15

    Aneurysmal bone cyst (ABC) is relatively rare, non-neoplastic expansible lesion of bone. The case of a 15-year-old male with a ABC of the left mandibular condyle is presented. Panoramic radiograph showed a unilocular radiolucency with thinned coritces and a subcondylar fracture which was due to the trauma. Computed tomography (CT) revealed expansible lesion which had similar attenuation soft tissue. The patient was treated surgically including iliac crestal bone graft.

  11. Aneurysmal bone cyst of the mandibular condyle with condylar neck fracture

    International Nuclear Information System (INIS)

    Park, Jeong Hoon; Yu, Jae Jung; Kang, Ju Han; Kim, Gyu Tae; Choi, Yong Suk; Hwang, Eui Hwan

    2009-01-01

    Aneurysmal bone cyst (ABC) is relatively rare, non-neoplastic expansible lesion of bone. The case of a 15-year-old male with a ABC of the left mandibular condyle is presented. Panoramic radiograph showed a unilocular radiolucency with thinned coritces and a subcondylar fracture which was due to the trauma. Computed tomography (CT) revealed expansible lesion which had similar attenuation soft tissue. The patient was treated surgically including iliac crestal bone graft.

  12. Asymmetric ramification of deep femoral artery: Incidental detection of an anatomic variation

    Directory of Open Access Journals (Sweden)

    Hamit Serdar Başbuğ

    2017-09-01

    Full Text Available The origin of the deep femoral artery (DFA is most commonly located posterolaterally constituting the 40% of all studied specimens. Second most common course is the posterior origin (37%, that is followed by the lateral (12%, posteromedial (12% and medial (2% origins respectively. In this case report, we presented a case with a lateral originated DFA which is the third common anatomic variation. This case is especially important that it demonstrates the branching behaviors of vascular structures may differ between the right and the left limbs creating an asymmetry between the both sides of the same patient. Clinicians should be aware of anatomic variation during the cardiac catheterization, trans-arterial interventions, arteriography and the surgical dissections of the groin region.

  13. Subchondral insufficiency fractures of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Davies, M.; Cassar-Pullicino, V.N. [Department of Radiology, Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, SY10 7AG, Shropshire (United Kingdom); Darby, A.J. [Department of Pathology, Robert Jones and Agnes Hunt Orthopaedic and District Hospital, Oswestry, SY10 7AG, Shropshire (United Kingdom)

    2004-02-01

    The aim of this study was to increase awareness of, and to show the variable clinical and radiological features of, subchondral insufficiency fractures of the femoral head. The clinical and radiological findings in 7 patients with subchondral insufficiency fractures of the femoral head were reviewed retrospectively. The diagnosis was confirmed histologically in 4 patients. Radiographs were performed in all patients, MRI in 5 and scintigraphy in 4 patients. Radiographs showed varying degrees of femoral head collapse in 4 patients. In the remaining 3 patients radiographs showed a normal femoral head, regional osteoporosis and focal sclerosis, respectively. Magnetic resonance imaging showed a low-signal band on T1- and T2-weighted images in the subchondral bone adjacent or parallel to the articular surface associated with bone marrow oedema. Scintigraphy showed increased uptake in the femoral head. Insufficiency fractures of the femoral head are easily overlooked or confused with avascular necrosis and, when there is significant joint destruction, osteoarthritis. Unsuspected insufficiency fracture of the femoral head can lead to significant and rapid loss of bone stock in osteoporotic patients waiting for arthroplasty for osteoarthritis. Increased awareness of this condition will hopefully lead to earlier diagnosis and a successful outcome of conservative treatment. (orig.)

  14. The correlation between mineralization degree and bone tissue stiffness in the porcine mandibular condyle

    NARCIS (Netherlands)

    Willems, N.M.B.K.; Mulder, L.; Toonder, den J.M.J.; Zentner, A.; Langenbach, G.E.J.

    2014-01-01

    The aim of this study was to correlate the local tissue mineral density (TMD) with the bone tissue stiffness. It was hypothesized that these variables are positively correlated. Cancellous and cortical bone samples were derived from ten mandibular condyles taken from 5 young and 5 adult female pigs.

  15. International comparative evaluation of knee replacement with fixed or mobile-bearing posterior-stabilized prostheses.

    Science.gov (United States)

    Graves, Stephen; Sedrakyan, Art; Baste, Valborg; Gioe, Terence J; Namba, Robert; Martínez Cruz, Olga; Stea, Susanna; Paxton, Elizabeth; Banerjee, Samprit; Isaacs, Abby J; Robertsson, Otto

    2014-12-17

    Posterior-stabilized total knee prostheses were introduced to address instability secondary to loss of posterior cruciate ligament function, and they have either fixed or mobile bearings. Mobile bearings were developed to improve the function and longevity of total knee prostheses. In this study, the International Consortium of Orthopaedic Registries used a distributed health data network to study a large cohort of posterior-stabilized prostheses to determine if the outcome of a posterior-stabilized total knee prosthesis differs depending on whether it has a fixed or mobile-bearing design. Aggregated registry data were collected with a distributed health data network that was developed by the International Consortium of Orthopaedic Registries to reduce barriers to participation (e.g., security, proprietary, legal, and privacy issues) that have the potential to occur with the alternate centralized data warehouse approach. A distributed health data network is a decentralized model that allows secure storage and analysis of data from different registries. Each registry provided data on mobile and fixed-bearing posterior-stabilized prostheses implanted between 2001 and 2010. Only prostheses associated with primary total knee arthroplasties performed for the treatment of osteoarthritis were included. Prostheses with all types of fixation were included except for those with the rarely used reverse hybrid (cementless tibial and cemented femoral components) fixation. The use of patellar resurfacing was reported. The outcome of interest was time to first revision (for any reason). Multivariate meta-analysis was performed with linear mixed models with survival probability as the unit of analysis. This study includes 137,616 posterior-stabilized knee prostheses; 62% were in female patients, and 17.6% had a mobile bearing. The results of the fixed-effects model indicate that in the first year the mobile-bearing posterior-stabilized prostheses had a significantly higher hazard

  16. Changed morphology and mechanical properties of cancellous bone in the mandibular condyles of edentate people

    DEFF Research Database (Denmark)

    Ding, Ming

    2004-01-01

    Since edentate subjects have a reduced masticatory function, it can be expected that the morphology of the cancellous bone of their mandibular condyles has changed according to the altered mechanical environment. In the present study, the morphology of cylindrical cancellous bone specimens...

  17. Complaints related to mandibular function impairment after closed treatment of fractures of the mandibular condyle

    NARCIS (Netherlands)

    Niezen, E. T.; Bos, R. R. M.; de Bont, L. G. M.; Stegenga, B.; Dijkstra, P. U.

    This study analysed the relationship between complaints and mandibular function after closed treatment of fractures of the mandibular condyle in a prospective study. In a I-year follow-up, complaints were assessed during physical examination and function was assessed using the mandibular function

  18. Case report: AVN of the femoral head five year follow-up of the combination of ipsilateral femoral neck and sub-trochanteric fracture.

    Science.gov (United States)

    Zhang, Wei; Zhu, Feng; Dong, Hanqing; Xu, Yaozeng

    2016-04-01

    To our knowledge, the type of combination of ipsilateral femoral neck and sub-trochanteric fracture is rare. And the long term follow-up is seldom been reported. A 60 year old woman suffered from a traffic accident. We gave her the intramedullary nail treatment for the combination of ipsilateral femoral neck and sub-trochanteric fracture, and the fracture indeed cured after one year and there is no clue of necrosis of the femoral head, but after 5 years, there is an evidence of necrosis of the femoral head. Combination of ipsilateral femoral neck and sub-trochanteric fracture should be kept in mind. Patients with this unusual fracture should be kept under surveillance for longer than might be thought currently to be necessary for there is a possibility of necrosis of the femoral head, even a nondisplaced femoral neck fracture.

  19. Fracturing of revision of a cobalt-chrome femoral head after fracturing of a ceramic femoral head, with diffuse metallosis. Case report

    Directory of Open Access Journals (Sweden)

    Pedro Miguel Dantas Costa Marques

    2013-04-01

    Full Text Available We presente a case of a fracture of a cobalt-chrome femoral head after revision of a hip total prosthesis with ceramic femoral head fracture. During surgery we found the cobalt-chrome femoral head fracture, wear of the polyethylene and massive metallosis in muscular and cartilaginous tissue. Both femoral stem and acetabular cup were stable and without apparent wearing. After surgical debridement, we promoted the substitution of the femoral head and the acetabular polyethylene by similar ones. After 12 months of follow-up, the patient has no pain complaints, function limit or systemic signs associated with malign metallosis

  20. Femoral shaft bowing in the coronal plane has more significant effect on the coronal alignment of TKA than proximal or distal variations of femoral shape.

    Science.gov (United States)

    Kim, Jong-Min; Hong, Soo-Heon; Kim, Jong-Min; Lee, Bum-Sik; Kim, Dong-Eun; Kim, Kyung-Ah; Bin, Seong-Il

    2015-07-01

    The aim of this study was to determine (1) variations in the shape of the proximal, middle, and distal femur in a series of Korean patients who had undergone total knee arthroplasty (TKA), (2) the preoperative relationship between these three parameters and the distal valgus cutting angle referenced off the femoral intramedullary guide, and (3) whether there was any relationship between femoral bowing and variations in the shape of the proximal or distal femur in the coronal plane. The preoperative long-standing anteroposterior radiographs of 316 consecutive osteoarthritis patients who underwent primary TKA from 2009 to 2011 were examined. The femoral neck shaft angle, the femoral shaft bowing angle, and the mechanical lateral distal femoral angle were measured to assess the shape of the proximal, middle, and distal femur, respectively. The valgus cutting angle of the femur was defined as the angle between the distal anatomical and mechanical axes of the femur. The study population showed large variations in femoral shape. The mean femoral intramedullary guide angle was 6.5° ± 1.3° (range: 4°-13°). The femoral shaft bowing angle was the factor that showed the strongest correlation with this angle (P shaft angle showed no correlation (n.s.). The femoral shaft bowing angle showed a weak correlation with the mechanical lateral distal femoral angle (P = 0.001), but was not significantly correlated with the femoral neck shaft angle (n.s.). Apparent femoral bowing (>3° of lateral or medial bowing) was found in 42 (13.3 %) of cases (37 cases of lateral bowing and five of medial bowing). Cases with lateral apparent femoral bowing >3° had a distal cutting angle of 8.6° ± 2.2° relative to the femoral intramedullary guide. The femoral intramedullary guide angle was mainly influenced by femoral shaft bowing among femoral deformities in the coronal plane. Therefore, to increase the accuracy of distal femoral cut during TKA, it is necessary to confirm femoral

  1. Sheep Hip Arthroplasty Model of Failed Implant Osseointegration

    DEFF Research Database (Denmark)

    Jakobsen, Thomas; Kold, Søren; Baas, Jørgen

    2015-01-01

    femoral condyles in ten sheep. The micromotion device consists of an anchor bearing a PMMA implant and a PE plug. During each gait cycle the PE plug will make the PMMA implant axially piston 0.5 mm. After 12 weeks of observation the bone specimens were harvested and a post-mortem control implant......Early secure stability of an implant is important for long-term survival. We examined whether micromotion of implants consistently would induce bone resorption and formation of a fibrous membrane and thereby prevent osseointegration. One micromotion implant was inserted into one of the medial...... was inserted into the contra-lateral medial femoral condyle. Histomorphometrical evaluation showed that the surface on the implant observed for 12 weeks was covered by fibrous tissue. The control implants were covered by lamellar bone. No difference was found with respect to the volume fraction of lamellar...

  2. Bone compaction enhances fixation of weightbearing titanium implants

    DEFF Research Database (Denmark)

    Kold, Søren; Rahbek, Ole; Vestermark, Marianne

    2005-01-01

    are weightbearing, the effects of compaction on weightbearing implants were examined. The hypothesis was that compaction would increase implant fixation compared with conventional drilling. Porous-coated titanium implants were inserted bilaterally into the weightbearing portion of the femoral condyles of dogs....... In each dog, one knee had the implant cavity prepared with drilling, and the other knee was prepared with compaction. Eight dogs were euthanized after 2 weeks, and eight dogs were euthanized after 4 weeks. Femoral condyles from an additional eight dogs represented Time 0. Compacted specimens had higher...... bone-implant contact and periimplant bone density at 0 and 2 weeks, but not at 4 weeks. A biphasic response of compaction was found with a pushout test, as compaction increased ultimate shear strength and energy absorption at 0 and 4 weeks, but not at 2 weeks. This biphasic response indicates...

  3. Slipped capital femoral epiphysis: A modern treatment protocol

    Directory of Open Access Journals (Sweden)

    Slavković Nemanja

    2009-01-01

    Full Text Available The treatment of a patient with slipped capital femoral epiphysis begins with an early diagnosis and accurate classification. On the basis of symptom duration, clinical findings and radiographs, slipped capital femoral epiphysis is classified as pre-slip, acute, acute-on-chronic and chronic. The long-term outcome of slipped capital femoral epiphysis is directly related to severity and the presence or absence of avascular necrosis and/or chondrolysis. Therefore, the first priority in the treatment of slipped capital femoral epiphysis is to avoid complications while securing the epiphysis from further slippage. Medical treatment of patients with acute and acute-on-chronic slipped capital femoral epiphysis, as well as those presented in pre-slip stage, is the safest, although time-consuming. Manipulations, especially forced and repeated, are not recommended due to higher avascular necrosis risk. The use of intraoperative fluoroscopy to assist in the placement of internal fixation devices has markedly increased the success of surgical treatment. Controversy remains as to whether the proximal femoral epiphysis in severe, chronic slipped capital femoral epiphysis should be realigned by extracapsular osteotomies or just fixed in situ. The management protocol for slipped capital femoral epiphysis depends on the experience of the surgeon, motivation of the patient and technical facilities.

  4. Frequency of ipsilateral femoral neck fractures in patients with ...

    African Journals Online (AJOL)

    Background: Ipsilateral associated femoral neck and shaft fractures are reported to occur in 2.5-6% of all femoral shaft fractures. Objective: To establish the frequency of ipsilateral femoral neck fractures amongst all patients presenting with femoral shaft fractures in Mulago Hospital. Methodology: This was a descriptive ...

  5. Influence of delayed gadolinium enhanced MRI of cartilage (dGEMRIC) protocol on T2-mapping: is it possible to comprehensively assess knee cartilage composition in one post-contrast MR examination at 3 Tesla?

    Science.gov (United States)

    Verschueren, J; van Tiel, J; Reijman, M; Bron, E E; Klein, S; Verhaar, J A N; Bierma-Zeinstra, S M A; Krestin, G P; Wielopolski, P A; Oei, E H G

    2017-09-01

    To evaluate the possibility of assessing knee cartilage with T2-mapping and delayed gadolinium enhanced magnetic resonance imaging (MRI) of cartilage (dGEMRIC) in one post-contrast MR examination at 3 Tesla (T). T2 mapping was performed in 10 healthy volunteers at baseline; directly after baseline; after 10 min of cycling; and after 90 min delay, and in 16 osteoarthritis patients before and after intravenous administration of a double dose gadolinium dimeglumine contrast agent, reflecting key dGEMRIC protocol elements. Differences in T2 relaxation times between each timepoint and baseline were calculated for 6 cartilage regions using paired t tests or Wilcoxon signed-rank tests and the smallest detectable change (SDC). After cycling, a significant change in T2 relaxation times was found in the lateral weight-bearing tibial plateau (+1.0 ms, P = 0.04). After 90 min delay, significant changes were found in the lateral weight-bearing femoral condyle (+1.2 ms, P = 0.03) and the lateral weight-bearing tibial plateau (+1.3 ms, P = 0.01). In these regions of interests (ROIs), absolute differences were small and lower than the corresponding SDCs. T2-mapping after contrast administration only showed statistically significantly lower T2 relaxation times in the medial posterior femoral condyle (-2.4 ms, P T2 relaxation times that were not consistent and lower than the SDC in the majority of regions, our results suggest that T2-mapping and dGEMRIC can be performed reliably in a single imaging session to assess cartilage biochemical composition in knee osteoarthritis (OA) at 3 T. Copyright © 2017 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  6. Femoral neck-shaft angle in extra-capsular proximal femoral fracture fixation; does it make a TAD of difference?

    Science.gov (United States)

    Walton, N P; Wynn-Jones, H; Ward, M S; Wimhurst, J A

    2005-11-01

    The effect of femoral neck-shaft angle and implant type on the accuracy of lag screw placement in extra-capsular proximal femoral fracture fixation was investigated. Radiographs of all extra-capsular proximal femoral fractures seen in one unit over 18 months were reviewed. Of 399 cases, 307 (237 female, 70 male) were included in the study as they had no contra-lateral proximal femoral metal work. Femoral neck-shaft angle (NSA) of the uninjured hip and magnification adjusted tip-apex distance (TAD) of femoral head lag screw were measured. Type of fixation implant was 135 degrees classic hip screw (CHS) (n=144) or 130 degrees intra-medullary hip screw (IMHS) (n=163). Mean contra-lateral NSA was 130.2 degrees (112.9--148 degrees ) and 64 patients (58 female, 6 male) had a NSA TAD was 18.7 mm (5.8--43.8mm) and 88.9% of cases had a TAD of less than 25 mm. TAD values were significantly greater using an IMHS if NSA was 125 degrees (p=0.028). This was not the case with the CHS. The use of the 130 degrees -IMHS in patients with a NSA 125 degrees and caution is advocated when using this device in such cases.

  7. Posterior dislocation of a native hip joint associated with ipsilateral per-trochanteric fracture: A rare case report

    Directory of Open Access Journals (Sweden)

    Mazin Fageir

    2018-02-01

    Full Text Available We describe a case of traumatic posterior dislocation of a native hip joint associated with ipsilateral comminuted inter-trochanteric femoral fracture. In our case, closed reduction was attempted but proved unsuccessful. Taking into account the planned subsequent intra-medullary femoral nail, open reduction through a lateral incision was undertaken. Post-operatively, the planned mobility was for a non-weight bearing period of 6 weeks followed by a partial-weight bearing period of 6 weeks before progressing to full-weight bearing. Post-operatively, the patient completed a comprehensive course of physiotherapy. At five months, he was able to walk for five miles over the course of a weekend. At six months, the patient was looking at phased return to work as a fire fighter. Radiographs taken at the time demonstrated evidence of healing to his inter-trochanteric fracture. At ten months, the patient was back to normal duties at work as a fire fighter.

  8. Incidence of Avascular Necrosis of the Femoral Head After Intramedullary Nailing of Femoral Shaft Fractures

    Science.gov (United States)

    Kim, Ji Wan; Oh, Jong-Keon; Byun, Young-Soo; Shon, Oog-Jin; Park, Jai Hyung; Oh, Hyoung Keun; Shon, Hyun Chul; Park, Ki Chul; Kim, Jung Jae; Lim, Seung-Jae

    2016-01-01

    Abstract The goal of this study was to determine the incidence of avascular necrosis of the femoral head (AVNFH) after intramedullary nailing of femoral shaft fractures and to identify risk factors for developing AVNFH. We retrospectively reviewed all patients with femoral shaft fractures treated with antegrade intramedullary nailing at 10 institutions. Among the 703 patients enrolled, 161 patients were excluded leaving 542 patients in the study. Average age was 42.1 years with average follow-up of 26.3 months. Patient characteristics and fracture patterns as well as entry point of femoral nails were identified and the incidence of AVNFH was investigated. Patients were divided into 2 groups according to open versus closed physis, open versus closed fractures, and age (<20 versus ≥20 years). Overall incidence of AVNFH was 0.2% (1 of 542): the patient was 15-year-old boy. Of 25 patients with open physis, the incidence of AVNFH was 4%, whereas none of 517 patients with closed physis developed AVNFH (P < 0.001). The incidence of AVNFH in patients aged < 20 versus ≥20 years was 1.1% (1 of 93) and 0.0% (0 of 449), respectively (P = 0.172), which meant that the incidence of AVNFH was 0% in adult with femur shaft fracture. Of 61 patients with open fractures, the incidence of AVNFH was 0%. The number of cases with entry point at the trochanteric fossa or tip of the greater trochanter (GT) was 324 and 218, respectively, and the incidence of AVNFH was 0.3% and 0.0%, respectively (P = 0.412). In patients aged ≥20 years with isolated femoral shaft fracture, there was no case of AVNFH following antegrade intramedullary nailing regardless of the entry point. Therefore, our findings suggest that the risk of AVNFH following antegrade femoral nailing is extremely low in adult patients. PMID:26844518

  9. Human osteoarthritic cartilage is synthetically more active but in culture less vital than normal cartilage

    NARCIS (Netherlands)

    Lafeber, F. P.; van Roy, H.; Wilbrink, B.; Huber-Bruning, O.; Bijlsma, J. W.

    1992-01-01

    The proteoglycan turnover of human osteoarthritic (OA) cartilage was compared to that of normal (N) cartilage. The cartilage was obtained postmortem from human femoral knee condyles. Short term cultures were compared to longterm cultures, and proteoglycan synthesis rate, content and release

  10. Femoral neck buttressing: a radiographic and histologic analysis

    International Nuclear Information System (INIS)

    Dixon, T.; Benjamin, J.; Lund, P.; Graham, A.; Krupinski, E.

    2000-01-01

    Objective. To examine the incidence, radiographic and histologic findings of medial femoral neck buttressing in a consecutive group of patients undergoing total hip arthroplasty.Design. Biomechanical parameters were evaluated on standard anteroposterior pelvic radiographs of 113 patients prior to hip replacement surgery. Demographic information on all patients was reviewed and histologic evaluation was performed on specimens obtained at the time of surgery.Results. The incidence of medial femoral neck buttressing was found to be 50% in a consecutive series of patients undergoing total hip arthroplasty. The incidence was slightly higher in women (56% vs 41%). Patients with buttressing had increased neck-shaft angles and smaller femoral neck diameters than were seen in patients without buttressing. Histologic evaluation demonstrated that the buttress resulted from deposition bone by the periosteum on the femoral neck in the absence of any evidence of femoral neck fracture.Conclusion. It would appear that femoral neck buttressing occurs in response to increased joint reactive forces seen at the hip being transmitted through the femoral neck. The increased joint reactive force can be related to the increased neck shaft angle seen in patients with buttressing. (orig.)

  11. Assessment of the zonal variation of perfusion parameters in the femoral head. A 3-T dynamic contrast-enhanced MRI pilot study

    Energy Technology Data Exchange (ETDEWEB)

    Budzik, Jean-Francois [Lille Catholic University, Imaging Department, Lille Catholic Hospitals, Lille (France); Littoral Cote d' Opale University, Lille University, Lille (France); Lefebvre, Guillaume [University of Lille Nord de France, Musculoskeletal Imaging Department, Centre de Consultation et d' Imagerie de l' Appareil Locomoteur, CHU Lille, Lille (France); Behal, Helene [University of Lille Nord de France, Biostatistics Department, Lille Regional University Hospital, Lille (France); Verclytte, Sebastien [Lille Catholic University, Imaging Department, Lille Catholic Hospitals, Lille (France); Hardouin, Pierre [Lille University, Littoral Cote d' Opale University, Lille (France); Teixeira, Pedro [Centre Hospitalier Universitaire de Nancy, Service d' Imagerie Guilloz, Hopital Central, Nancy (France); Cotten, Anne [Littoral Cote d' Opale University, Lille University, Lille (France); University of Lille Nord de France, Musculoskeletal Imaging Department, Centre de Consultation et d' Imagerie de l' Appareil Locomoteur, CHU Lille, Lille (France)

    2018-02-15

    The objective was to describe MR perfusion characteristics of the femoral head, with a focus on the subchondral bone. This prospective monocentric study was approved by our local Ethics Committee. Written informed consent was obtained from all subjects. Dynamic contrast-enhanced MRI of the right hip was performed in 59 adults with suspected spondyloarthritis (32 women, 28 men). Mean age was 37.5 (±12.5) years. Regions of interest were drawn in the femoral head epiphysis, in the subchondral areas the most exposed to mechanical load (superolateral, anterosuperior, and posterior zones) and in areas less exposed to mechanical load (inferior subchondral zone and center of the femoral head). Semi-quantitative and pharmacokinetic parameters were calculated using the Tofts model. Statistical analysis was performed with a linear mixed model to compare the perfusion parameters in the different femoral head zones. Extravascular extracellular volume and area under the curve were lower in the superolateral zone than in the inferior zone (p = 0.0135 and p < 0.0001 respectively) and the central zone (p = 0.007 and p = 0.0134 respectively). Extravascular extracellular volume and rate constant were lower in the anterosuperior zone than in the inferior zones (p = 0.011 and p = 0.029). In the anterosuperior zone, extravascular extracellular volume was lower, and time to peak was higher than in the central zones (p = 0.0056 and p = 0.0013 respectively). No significant differences were found for any values between other paired zones. The perfusion of femoral head subchondral bone assessed with dynamic contrast-enhanced magnetic resonance imaging is not homogeneous: the areas exposed to more mechanical loading are less perfused. (orig.)

  12. Assessment of the zonal variation of perfusion parameters in the femoral head. A 3-T dynamic contrast-enhanced MRI pilot study

    International Nuclear Information System (INIS)

    Budzik, Jean-Francois; Lefebvre, Guillaume; Behal, Helene; Verclytte, Sebastien; Hardouin, Pierre; Teixeira, Pedro; Cotten, Anne

    2018-01-01

    The objective was to describe MR perfusion characteristics of the femoral head, with a focus on the subchondral bone. This prospective monocentric study was approved by our local Ethics Committee. Written informed consent was obtained from all subjects. Dynamic contrast-enhanced MRI of the right hip was performed in 59 adults with suspected spondyloarthritis (32 women, 28 men). Mean age was 37.5 (±12.5) years. Regions of interest were drawn in the femoral head epiphysis, in the subchondral areas the most exposed to mechanical load (superolateral, anterosuperior, and posterior zones) and in areas less exposed to mechanical load (inferior subchondral zone and center of the femoral head). Semi-quantitative and pharmacokinetic parameters were calculated using the Tofts model. Statistical analysis was performed with a linear mixed model to compare the perfusion parameters in the different femoral head zones. Extravascular extracellular volume and area under the curve were lower in the superolateral zone than in the inferior zone (p = 0.0135 and p < 0.0001 respectively) and the central zone (p = 0.007 and p = 0.0134 respectively). Extravascular extracellular volume and rate constant were lower in the anterosuperior zone than in the inferior zones (p = 0.011 and p = 0.029). In the anterosuperior zone, extravascular extracellular volume was lower, and time to peak was higher than in the central zones (p = 0.0056 and p = 0.0013 respectively). No significant differences were found for any values between other paired zones. The perfusion of femoral head subchondral bone assessed with dynamic contrast-enhanced magnetic resonance imaging is not homogeneous: the areas exposed to more mechanical loading are less perfused. (orig.)

  13. Angiographic analysis of avascular necrosis of a femoral head -selective angiography of medial femoral circumflex artery-

    Energy Technology Data Exchange (ETDEWEB)

    Ryu, Kyung Nam; Yoon, Yup; Lee, Sun Wha; Lim, Jae Hoon [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1991-07-15

    The degree of anatomical revascularization of a necrotic femoral head and traumatic hip would provide information about treatment and prognosis. The authors analyzed the vascular changes of femoral head among unilateral avascular necrosis, bilateral avascular necrosis, and traumatic hips. Forty - four patients with avascular necrosis and 19 patients with traumatic hips were examined by selective angiography of the medial femoral circumflex artery. In the traumatic hip cases, 12 (63%) showed occlusion, 2 (11%) hypertrophy of the capsular branches, and 5 ( 26 % ) were normal . In the avascular necrosis cases, 15 (25%) showed occlusion, 39 (67%) had hypertrophy of the capsular branches, and 4 (7%) had normal findings. Hypertrophy of the superior capsular branch of the medial femoral circumflex artery is more frequently observed in avascular necrosis than in traumatic hip. Bilateral avascular necrosis reveals more frequent incidences than unilateral cases. Selective angiography could help in the therapy plan and also provide information about the contralateral side.

  14. Angiographic analysis of avascular necrosis of a femoral head -selective angiography of medial femoral circumflex artery-

    International Nuclear Information System (INIS)

    Ryu, Kyung Nam; Yoon, Yup; Lee, Sun Wha; Lim, Jae Hoon

    1991-01-01

    The degree of anatomical revascularization of a necrotic femoral head and traumatic hip would provide information about treatment and prognosis. The authors analyzed the vascular changes of femoral head among unilateral avascular necrosis, bilateral avascular necrosis, and traumatic hips. Forty - four patients with avascular necrosis and 19 patients with traumatic hips were examined by selective angiography of the medial femoral circumflex artery. In the traumatic hip cases, 12 (63%) showed occlusion, 2 (11%) hypertrophy of the capsular branches, and 5 ( 26 % ) were normal . In the avascular necrosis cases, 15 (25%) showed occlusion, 39 (67%) had hypertrophy of the capsular branches, and 4 (7%) had normal findings. Hypertrophy of the superior capsular branch of the medial femoral circumflex artery is more frequently observed in avascular necrosis than in traumatic hip. Bilateral avascular necrosis reveals more frequent incidences than unilateral cases. Selective angiography could help in the therapy plan and also provide information about the contralateral side

  15. Current Concepts in the Mandibular Condyle Fracture Management Part II: Open Reduction Versus Closed Reduction

    Directory of Open Access Journals (Sweden)

    Kang-Young Choi

    2012-07-01

    Full Text Available In the treatment of mandibular condyle fracture, conservative treatment using closedreduction or surgical treatment using open reduction can be used. Management of mandibularcondylar fractures remains a source of ongoing controversy in oral and maxillofacial trauma.For each type of condylar fracture,the treatment method must be chosen taking intoconsideration the presence of teeth, fracture height, patient’sadaptation, patient’s masticatorysystem, disturbance of occlusal function, and deviation of the mandible. In the past, closedreduction with concomitant active physical therapy conducted after intermaxillary fixationduring the recovery period had been mainly used, but in recent years, open treatment ofcondylar fractures with rigid internal fixation has become more common. The objectiveof this review was to evaluate the main variables that determine the choice of an open orclosed method for treatment of condylar fractures, identifying their indications, advantages,and disadvantages, and to appraise the current evidence regarding the effectiveness ofinterventions that are used in the management of fractures of the mandibular condyle.

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

    Directory of Open Access Journals (Sweden)

    Al Kaissi, Ali

    2014-09-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2017-03-15

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

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

    International Nuclear Information System (INIS)

    Han, Sang Won; Oh, Min Young; Yoon, Seok Ho; Kim, Jin Soo; Chang, Jae Suk; Ryu, Jin Sook; Kim, Ji Wan

    2017-01-01

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

  19. Evaluation of focal cartilage lesions of the knee using MRI T2 mapping and delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC).

    Science.gov (United States)

    Årøen, Asbjørn; Brøgger, Helga; Røtterud, Jan Harald; Sivertsen, Einar Andreas; Engebretsen, Lars; Risberg, May Arna

    2016-02-11

    Assessment of degenerative changes of the cartilage is important in knee cartilage repair surgery. Magnetic Resonance Imaging (MRI) T2 mapping and delayed Gadolinium Enhanced MRI of Cartilage (dGEMRIC) are able to detect early degenerative changes. The hypothesis of the study was that cartilage surrounding a focal cartilage lesion in the knee does not possess degenerative changes. Twenty-eight consecutive patients included in a randomized controlled trial on cartilage repair were evaluated using MRI T2 mapping and dGEMRIC before cartilage treatment was initiated. Inclusion was based on disabling knee problems (Lysholm score of ≤ 75) due to an arthroscopically verified focal femoral condyle cartilage lesion. Furthermore, no major malalignments or knee ligament injuries were accepted. Mean patient age was 33 ± 9.6 years, and the mean duration of knee symptoms was 49 ± 60 months. The MRI T2 mapping and the dGEMRIC measurements were performed at three standardized regions of interest (ROIs) at the medial and lateral femoral condyle, avoiding the cartilage lesion The MRI T2 mapping of the cartilage did not demonstrate significant differences between condyles with or without cartilage lesions. The dGEMRIC results did not show significantly lower values of the affected condyle compared with the opposite condyle and the contra-lateral knee in any of the ROIs. The intraclass correlation coefficient (ICC) of the dGEMRIC readings was 0.882. The MRI T2 mapping and the dGEMRIC confirmed the arthroscopic findings that normal articular cartilage surrounded the cartilage lesion, reflecting normal variation in articular cartilage quality. NCT00885729 , registered April 17 2009.

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

    Directory of Open Access Journals (Sweden)

    D D Baksi

    2016-01-01

    , cannulated hip screw fixation, iliac crest bone chips and quadratus femoris MPBG. Results: The mean followup is 12.5 years (range 3-35. The union of fractures occurred in 202 (82.8%, delayed union in 18 (7.3%, and established nonunion in 24 (9.8% patients. Full weight bearing was permitted at 16-22 weeks after union of fractures. Mean Harris hip score at the longest followup was 85.5. Among the complications, superficial wound infection occurred in 20 (8.2%, deep infection in seven (2.9%, and coxa vara in 39 (16% patients. Preoperative radiodensity of femoral head disappeared mostly after the union of fracture whereas fresh radiodensity of femoral head appeared in 20 (8% patients; nine (45% of them developed segmental collapse. Conclusion: Ununited femoral neck fractureis characterized by absorption of femoral neck, posterior cortical defect, smoothening and overriding of fracture surfaces with intervening fibrous tissues associated with or without AVN of femoral head. The above method of osteosynthesis rectified the above pathology and provided satisfactory results with union of fractures in 90.1% patients at long term followup.

  1. Bone bruise in acute traumatic patellar dislocation: volumetric magnetic resonance imaging analysis with follow-up mean of 12 months

    International Nuclear Information System (INIS)

    Paakkala, Antti; Paakkala, Timo; Sillanpaeae, Petri; Maeenpaeae, Heikki; Huhtala, Heini

    2010-01-01

    The aim of the study was to assess volumetric analysis of bone bruises in acute primary traumatic patellar dislocation by magnetic resonance imaging (MRI) and resolving resolution of bruises in follow-up MRI. MRI was performed in 23 cases. A follow-up examination was done at a mean of 12 months after dislocation. Volumes of patellar and femur bruises for every patient were evaluated separately by two musculoskeletal radiologists, and mean values of the bruises were assessed. Other MRI findings were evaluated, together with agreement by consensus. Bone bruise volumes were compared with other MR findings. In the acute study 100% of patients showed bruising of the lateral femoral condyle and 96% bruising of the patella. The bruise was located at the medial femoral condyle in 30% and at the patellar median ridge in 74% of patients. The median volume of the femoral bruise was 25,831 mm 3 and of the patellar bruise 2,832 mm 3 . At the follow-up study 22% of patients showed bruising of the lateral femoral condyle and 39% bruising of the patella, the median volumes of the bruises being 5,062 mm 3 and 1,380 mm 3 , respectively. Larger patellar bruise volume correlated with larger femur bruise volume in the acute (r=0.389, P=0.074) and the follow-up (r=1.000, P<0.01) studies. Other MRI findings did not correlate significantly with bone bruise volumes. Bone bruising is the commonest finding in cases of acute patellar dislocation, being seen even 1 year after trauma and indicating significant bone trabecular injury in the patellofemoral joint. A large bruise volume may be associated with subsequent chondral lesion progression at the patella. We concluded that the measurement of bone bruise volume in patients with acute patellar dislocation is a reproducible method but requires further studies to evaluate its clinical use. (orig.)

  2. Ipsilateral femoral neck and shaft fractures: An overlooked association

    International Nuclear Information System (INIS)

    Daffner, R.H.; Riemer, B.L.; Butterfield, S.L.

    1991-01-01

    A total of 304 patients with injuries to the femoral shaft and ipsilateral hip presented between 1984 and 1990. Some 253 of them suffered fractures of the femoral shaft and dislocated hips or fractures of the acetabulum, and 51 of these sustained fractures of the femoral shaft and neck or trochanteric region. All of the trochanteric injuries were demonstrated on the initial radiographs. However, in 11 of the patients with combined femoral shaft and neck fractures, the diagnosis was delayed by as much as 4 weeks. This delay related to the fact that these fractures tended not to separate in the initial evaluation period and that there was external rotation of the proximal femoral fragment due to the femoral shaft fracture. (orig./GDG)

  3. Ipsilateral femoral neck and shaft fractures: An overlooked association

    Energy Technology Data Exchange (ETDEWEB)

    Daffner, R.H. (Dept. of Diagnostic Radiology, Allegheny General Hospital, Pittsburgh, PA (USA) Medical Coll. of Pennsylvania, Pittsburgh, PA (USA)); Riemer, B.L.; Butterfield, S.L. (Dept. of Orthopedic Surgery, Allegheny General Hospital, Pittsburgh, PA (USA) Medical Coll. of Pennsylvania, Pittsburgh, PA (USA))

    1991-05-01

    A total of 304 patients with injuries to the femoral shaft and ipsilateral hip presented between 1984 and 1990. Some 253 of them suffered fractures of the femoral shaft and dislocated hips or fractures of the acetabulum, and 51 of these sustained fractures of the femoral shaft and neck or trochanteric region. All of the trochanteric injuries were demonstrated on the initial radiographs. However, in 11 of the patients with combined femoral shaft and neck fractures, the diagnosis was delayed by as much as 4 weeks. This delay related to the fact that these fractures tended not to separate in the initial evaluation period and that there was external rotation of the proximal femoral fragment due to the femoral shaft fracture. (orig./GDG).

  4. Femoral component rotation in patellofemoral joint replacement.

    Science.gov (United States)

    van Jonbergen, Hans-Peter W; Westerbeek, Robin E

    2018-06-01

    Clinical outcomes in patellofemoral joint replacement may be related to femoral component rotation. Assessment of rotational alignment is however difficult as patients with isolated patellofemoral osteoarthritis often have trochlear dysplasia. The use of the medial malleolus as a landmark to guide rotation has been suggested. The purpose of our study was to evaluate this technique with regard to femoral component rotation, and to correlate rotation with clinical outcomes at one-year follow-up. Forty-one knees in 39 patients had patellofemoral joint replacement using the Zimmer Gender-Solutions patellofemoral prosthesis. Intraoperatively, we determined femoral component rotational alignment using an extramedullary rod aimed at the inferior tip of the medial malleolus. Postoperatively, we measured the angle between the femoral component and the anatomical transepicondylar axis using CT. The amount of rotation was correlated with clinical outcomes at one-year follow-up. Forty knees in 38 patients were available for one-year follow-up. Mean femoral component rotation relative to the anatomical transepicondylar axis was 1.4° external rotation (range, -3.8 to 5.7°). We found no statistically significant correlation between femoral component rotation and change from baseline KOOS subscales at one-year follow-up. Our findings show that when using the medial malleolus as a landmark to guide rotation, the femoral component of the patellofemoral prosthesis was oriented in external rotation relative to the anatomical transepicondylar axis in 80% of knees. Our study did not show a relation between the amount of external rotation and clinical outcomes. Level III. Copyright © 2018 Elsevier B.V. All rights reserved.

  5. Clinical study on 44 cases of femoral hernia

    International Nuclear Information System (INIS)

    Yamamoto, Ryo; Shinozaki, Hiroharu; Kase, Kenichi; Kobayashi, Kenji; Sasaki, Junichi

    2012-01-01

    Femoral hernia is a surgical disease that is frequently associated with incarceration and necessitates emergency surgery. However, there are only a few studies referred which have compared emergency and elective surgery for femoral hernias. We retrospectively reviewed the clinical characteristics of patients diagnosed as having femoral hernia between 2005 and 2009 in our institution. The clinical features of emergency repairs were compared with those of elective ones, and diagnostic values of preoperative diagnostic modalities were studied. The mean age of the patients was 73±12 years. Females comprised 68% of the cases, and right femoral hernias comprised 70% of the cases. Incarceration was associated with 66% of the cases (29 patients), and emergency surgery was performed in 52% of the patients (23 patients). Bowel resection was performed in 32% of the cases (14 patients). The mean age, body temperature, white blood cell (WBC) count, and LDH value were higher in the emergency repairs than in the elective one, and most of the hernias were repaired with McVay's procedure. CT scans had a high diagnostic value in detecting femoral hernias (44%) and incarceration (88%). It was confirmed that femoral hernias were frequently associated with incarceration and CT scan has a high diagnostic value in femoral hernias. (author)

  6. Pericruciate fat pad of the knee: anatomy and pericruciate fat pad inflammation: cadaveric and clinical study emphasizing MR imaging

    International Nuclear Information System (INIS)

    Skaf, Abdalla Youssef; Hernandez Filho, Guinel; Dirim, Berna; Wangwinyuvirat, Mani; Trudell, Debra; Resnick, Donald; Haghigi, Parvitz

    2012-01-01

    The pericruciate fat pad is located in the intercondylar fossa, intimate with the cruciate ligaments. With MR imaging, signal abnormality of the pericruciate fat pad has been observed in patients with posterior knee pain. The purpose of this study was to describe the anatomy of the pericruciate fat pad in cadaveric specimens and to document the clinical spectrum of pericruciate fat pad inflammation. Twelve cadaveric knees underwent MR imaging with T1 and T2 multiplanar images. Cadaveric sections were then prepared for macroscopic evaluation, with additional histologic analysis performed in four cases. MR images in seventeen patients (ten males, seven females; average age, 31.5 years; age range, 19-57 years) involved in intensive sporting activity and with posterior knee pain were reviewed. MR images in cadaveric specimens showed a fat pad that was located above and between the cruciate ligaments, near their attachment sites in the inner portion of the femoral condyles, within the intercondylar fossa. Fatty tissue covered by a thin layer of synovial membrane was confirmed at histology. Seventeen patients with posterior knee pain and without gross cartilage, meniscal, or ligamentous abnormalities all revealed an increased signal in this fat pad in fluid-sensitive fat-suppressed images, mainly in the sagittal and axial planes. In eight cases, enhancement of this fat pad was demonstrated following intravenous gadolinium administration. The pericruciate fat pad is a structure located in the intercondylar fossa, intimate with both the anterior and posterior cruciate ligaments. Inflammatory changes in this fat pad may be found in patients, especially athletes with posterior knee pain. (orig.)

  7. Pericruciate fat pad of the knee: anatomy and pericruciate fat pad inflammation: cadaveric and clinical study emphasizing MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Skaf, Abdalla Youssef [Hospital do Coracao (HCor), Department of Radiology, Sao Paulo, SP (Brazil); Hernandez Filho, Guinel [Santa Casa de Sao Paulo Hospital, Department of Radiology, Sao Paulo, SP (Brazil); Dirim, Berna [Izmir Atatuerk Training and Research Hospital, Department of Radiology, Karsiyaka, izmir (Turkey); Wangwinyuvirat, Mani [Rajavithi Hospital, Department of Radiology, Bangkok (Thailand); Trudell, Debra; Resnick, Donald [University of California, San Diego, Department of Radiology, Veterans Affairs Medical Center, La Jolla, CA (United States); Haghigi, Parvitz [University of California, San Diego, Department of Pathology, Veterans Affairs Medical Center, La Jolla, CA (United States)

    2012-12-15

    The pericruciate fat pad is located in the intercondylar fossa, intimate with the cruciate ligaments. With MR imaging, signal abnormality of the pericruciate fat pad has been observed in patients with posterior knee pain. The purpose of this study was to describe the anatomy of the pericruciate fat pad in cadaveric specimens and to document the clinical spectrum of pericruciate fat pad inflammation. Twelve cadaveric knees underwent MR imaging with T1 and T2 multiplanar images. Cadaveric sections were then prepared for macroscopic evaluation, with additional histologic analysis performed in four cases. MR images in seventeen patients (ten males, seven females; average age, 31.5 years; age range, 19-57 years) involved in intensive sporting activity and with posterior knee pain were reviewed. MR images in cadaveric specimens showed a fat pad that was located above and between the cruciate ligaments, near their attachment sites in the inner portion of the femoral condyles, within the intercondylar fossa. Fatty tissue covered by a thin layer of synovial membrane was confirmed at histology. Seventeen patients with posterior knee pain and without gross cartilage, meniscal, or ligamentous abnormalities all revealed an increased signal in this fat pad in fluid-sensitive fat-suppressed images, mainly in the sagittal and axial planes. In eight cases, enhancement of this fat pad was demonstrated following intravenous gadolinium administration. The pericruciate fat pad is a structure located in the intercondylar fossa, intimate with both the anterior and posterior cruciate ligaments. Inflammatory changes in this fat pad may be found in patients, especially athletes with posterior knee pain. (orig.)

  8. Clinical study of internal derangement of the temporomandibular joint with closed lock, 2

    International Nuclear Information System (INIS)

    Moriya, Yoshiyuki; Murakami, Ken-ichiro; Fujimura, Kazuma; Yokoyama, Tadaaki; Nose, Masahiro; Miyaki, Katsuaki; Segami, Natsuki; Iizuka, Tadahiko

    1990-01-01

    Fifty-three closed lock cases of internal derangement of the temporomandibular joint (TMJ) were studied on the correlation between disk configuration at MR imaging and nine clinical parameters composed of opening degree, age, clicking and locking duration, visual analogue scale of pain (VAS), pain score, jaw dysfunction score, life activity limited score, and TMJ X-ray photo findings. Disk configuration and degree of anterior disk displacement were assessed on MR imaging in closed mouth position: the antero-posterior length of disk and the distance from condyle to anterior and posterior portion of disk were measured, respectively. Duration of clicking and locking were not correlated with MR index except that there was a strong correlation between clicking duration and the distance from condyle to anterior portion of the disk at MR imaging. Opening degree was related to the disk deformity and the access of posterior portion of the disk to condyle. Disk configuration and degree of anterior disk displacement were not correlated with TMJ pain, but jaw dysfunction was related to the disk deformity and the distance from posterior portion of the disk to condyle. TMJ X-ray photo findings were not correlated with clicking duration (below 3 years), locking duration (below 30 weeks), opening degree and disk configuration at MR imaging. In evaluation of factors related to opening degree in 53 patients with closed lock by means of multiple regression analysis, age, locking and clicking duration, TMJ pain, life activity limited score were more strongly correlated to opening degree than the others. (author)

  9. MR evaluation of femoral neck version and tibial torsion

    Energy Technology Data Exchange (ETDEWEB)

    Koenig, James Karl; Dwek, Jerry R. [University of California, San Diego, Children' s Hospital and Health Center, Department of Radiology, San Diego, CA (United States); Pring, Maya E. [Rady Children' s Hospital, Department of Pediatric Orthopedic Surgery, San Diego, CA (United States)

    2012-01-15

    Abnormalities of femoral neck version have been associated with a number of hip abnormalities in children, including slipped capital femoral epiphysis, proximal femoral focal deficiency, coxa vara, a deep acetabulum and, rarely, developmental dysplasia of the hip. Orthopedic surgeons also are interested in quantifying the femoral neck anteversion or retroversion in children especially to plan derotational osteotomies. Historically, the angle of femoral version and tibial torsion has been measured with the use of radiography and later by CT. Both methods carry with them the risks associated with ionizing radiation. Techniques that utilize MR are used less often because of the associated lengthy imaging times. This article describes a technique using MRI to determine femoral neck version and tibial torsion with total scan times of approximately 10 min. (orig.)

  10. A distal femoral supra-condylar plate: biomechanical comparison with condylar plate and first clinical application for treatment of supracondylar fracture.

    Science.gov (United States)

    Liang, Bowei; Ding, Zhenqi; Shen, Junguo; Zhai, Wenliang; Kang, Liangqi; Zhou, Liang; Sha, Mo; Liang, Dongzhu

    2012-08-01

    An anatomical supra-condylar plate is designed and analysed by biomechanical testing. The biomechanical properties of the supra-condylar and condylar plate were compared in six matched pairs of cadaveric femurs. A transverse osteotomy gap was created to simulate an OTA/AO type A3 supracondylar fracture. The left and right specimens were fitted with supra-condylar and condylar plate, respectively. Nondestructive axial compression, three-point bending and torsion tests were performed, and the peak load of the bone-implant construction was measured. The fracture site suitable for supra-condylar plate application and its correlation with femoral length were calculated. The gender influence on it was also discussed. The difference of stiffness between the supra-condylar and condyle groups were not significant (P > 0.05) at 363.4 and 362.5 N/mm for compression, 229.5 and 237.6 N/mm in the sagittal plane and 195.5 and 188.4 N/mm in the coronal plane for three-point bending, and 7.5 and 7.9 Nm/deg for axial torsion, respectively. The peak load was 4438 ± 136.15 N and 5215 ± 174.33 N, respectively, for the two groups. The average extent of the fracture site suitable for the application of the supra-condylar plate was 70.86 ± 4.61 mm. The femoral length and gender showed no influence on it. Despite the limited bone contact area provided by the supra-condylar plate, its construct stiffness is comparable to the condylar plate. The supra-condylar plate can be used to treat carefully-selected extra-articular supracondylar fractures.

  11. Computed Tomography-Based Occipital Condyle Morphometry in an Indian Population to Assess the Feasibility of Condylar Screws for Occipitocervical Fusion.

    Science.gov (United States)

    Srivastava, Abhishek; Nanda, Geetanjali; Mahajan, Rajat; Nanda, Ankur; Mishra, Nirajana; Karmaran, Srinivasa; Batra, Sahil; Chhabra, Harvinder Singh

    2017-12-01

    A retrospective computed tomography (CT)-based morphometric study of 82 occipital condyles in the Indian population, focusing on critical morphometric dimensions with relation to placing condylar screws. This study focused on determining the feasibility of placing occipital condylar screws in an Indian population using CT anatomical morphometric data. The occipital condylar screw is a novel technique being explored as one of the options in occipitocervical stabilization. Sex and ethnic variations in anatomical structures may restrict the feasibility of this technique in some populations. To the best of our knowledge, there are no CT-based data on an Indian population that assess the feasibility of occipital condylar screws. We measured the dimensions of 82 occipital condyles in 41 adults on coronal, sagittal, and axial reconstructed CT images. The differences were noted between the right and left sides and also between males and females. Statistical analysis was performed using the t -test, with a p -value of occipital condyle shows that condylar screws are anatomically feasible in a large portion of the Indian population. However, because a small number of population may not be suitable for this technique, meticulous study of preoperative anatomy using detailed CT data is advised.

  12. Correlation between baseline femoral neck marrow status and the development of femoral head osteonecrosis in corticosteroid-treated patients: A longitudinal study by MR imaging

    International Nuclear Information System (INIS)

    Vande Berg, Bruno C.; Gilon, Raphael; Malghem, Jacques; Lecouvet, Frederic; Depresseux, Genevieve; Houssiau, Frederic A.

    2006-01-01

    Objective: To test the hypothesis that the development of corticosteroid (CS)-associated femoral head osteonecrosis (ON) is influenced by baseline femoral neck marrow status. Patients and methods: The population consisted of 20 untreated patients with a newly diagnosed rheumatic disease in whom a standardized CS regimen was planned. Before CS treatment, baseline femoral neck marrow status was determined by magnetic resonance (MR) imaging on T1-weighted images (proportion of surface area of femoral neck and intertrochanteric area occupied by fatty marrow; index of marrow conversion [IMC]) and on a quantitative MR sequence (bulk T1 values of femoral head and neck). The presence of ON was assessed by coronal T1-weighted MR images of the hips at 6 and 12 months. Results: None of the patients suffered from ON at baseline. Four patients (20%) developed bilateral femoral head ON at 6 months. The mean percentage of fat marrow in the femoral neck before treatment was significantly higher in ON-positive than in ON-negative patients (p = 0.0025). The mean baseline femoral neck IMC value, which parallels the degree of red to yellow marrow conversion, was higher in ON-positive than in ON-negative patients (p = 0.089). The mean baseline bulk T1 value of the femoral neck (but not of the femoral head), which inversely correlates with the amount of fat marrow, was significantly shorter in ON-positive than in ON-negative patients (p = 0.0298). Conclusion: The development of CS-associated femoral head ON is correlated with a high fat content in the proximal femur before CS therapy

  13. Surgical treatment on displaced and dislocated sagittal fractures of the mandibular condyle.

    Science.gov (United States)

    Jing, Jie; Han, Yu; Song, Yu; Wan, Yingbiao

    2011-06-01

    The purpose of this study was to evaluate the effect of surgical treatment on displaced and dislocated sagittal fractures of the mandibular condyle (SFMC). Twenty-four patients with 28 displaced and dislocated SFMCs were distinguished into type M, type C, and type L fractures according the location of the fracture line. The fractured fragment was reduced and fixated with two 0.6-mm 4-hole micro-plates via a preauricular temporal incision. The fragment was extirpated when it was too small to be fixated. The postoperative position and profile of the fragment was examined by orthopantomogram radiograph or computed tomography (CT). The function of the temporal and zygomatic branches of the facial nerve was inspected. The occluding relation was surveyed, the interincisal distance at maximum mouth opening was measured, and the deviation from the midline during mouth opening was recorded. Twenty-three condyles (82%) suffered dislocated fractures with the condylar fragment out of the glenoid fossa. Five condyles (18%) were displaced, but not dislocated. There were 2 (7%) type M, 19 (68%) type C (3 comminuted), and 7 (25%) type L fractures (1 comminuted), respectively. Twenty-one (75%) fractured fragments received free-graft procedures with 2 micro-plates. Four (14%) fragments were reduced and fixated without being dissected free of their attachments. Three (11%) fragments were extirpated. There were no permanent facial never branch injuries. Micro-plate removal was necessary because of postoperative infection and necrosis of the fractured fragment in 1 condylar process. No other patients could be found with obvious postoperative bone resorption. The average postoperative maximum mouth opening and deviation at 6 months were improved significantly. The postoperative occlusion was good in 22 cases. Access with the preauricular incision, and the dislocated and displaced fragment can be reduced and fixated to its normal position easily. Free-graft procedure is a suitable

  14. Herniography off femoral, obturator and perineal hernias

    International Nuclear Information System (INIS)

    Ekberg, O.; Nordblom, I.; Fork, F.T.; Gullmo, A.

    1985-01-01

    Positive contrast herniography was used in the workup of 550 patients with unclear groin pain. The majority of these patients had rather characteristic hernias of indirect, direct or femoral type. However, now and then diagnostic problems arose. A femoral hernia may look like a direct or even obturator hernia. There is also a variety of multilocular femoral hernias and other types. A femoral hernia may be present together with other hernias in the ipsilateral or contralateral groin. Obturator hernias are usually small but are always confined to the obturator canal laterally in the obturator foramen. Abnormalities in the pouch of Douglas may include a deep rectogenital pouch, diverticula and true herniations. These uncommon herniographic findings are described and discussed. (orig.) [de

  15. OPTIMAL SURGICAL MANAGEMENT OF HIGH VELOCITY POSTERIOR TIBIAL PLATEAU FRACTURE SUBLUXATIONS (DUPARC, REVISED CLASSIFICATION, GROUP – V: POSTERO - MEDIAL FRACTURE BY DIRECT, DORSAL APPROACH – A CHANGING TREND: A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Pardhasaradhi

    2015-10-01

    Full Text Available INTRODUCTION : High - energy tibial plateau fractures are infrequent and technically demanding to treat especially if those are shearing type, coronal plane, displaced fractures. The most widely used the Schatzker system of classification , [1] ( B ased on the AP radiograph is more than likely to miss postero - medial and postero - lateral shear fractures, best visible on the lateral, than the AP radiograph. These fractures have recently been characterised by two studies, highlighti ng their clinical relevance [ 2,3] and showing that less invasive surgery and indirect reduction techniques are often inadequate. Hohl described unicondylar c oronal plane splitting fractures of the medial tibial plateau, noted that these injuries be considered as fracture - dislocations. Connolly and others have suggested that the mechanism involved in this fracture pattern is one of knee flexion, varus, and inter nal rotation of the medial femoral condyle . [4,5,6 ] Consistent among these and other authors is that the occurrence of this fragment is relatively unusual and that the use of a posteriorly based exposure with direct fracture visualization, anatomic reductio n and absolute stability appears to result in satisfactory outcomes. Though variations of a postero - medial approach been previously described ( by Trickey et al and also by Burks et al.,, more recently, Lobenhoffer et al described direct posterior exposure , Wang et al described postero - medial approach and Luo et al. described the approach for the management of posterior bicondylar tibial plateau fractures . [7,8] These approaches have been used in isolation or as a dual - incision approach for treating tibial plateau fractures . [9,10,11,12,13,14, 15] PURPOSE : The purpose of this study is to describe this unfamiliar direct posterior surgical (Medial Gastrocnemius approach to a general orthopod, highlighting the relevant anatomy and presenting our experience using this approach in treating a

  16. IMF-screws or arch bars as conservative treatment for mandibular condyle fractures: quality of life aspects

    NARCIS (Netherlands)

    van den Bergh, B.; de Mol van Otterloo, J.J.; van der Ploeg, T.; Tuinzing, D.B.; Forouzanfar, T.

    2015-01-01

    Objective Arch bars as treatment for a fractured mandibular condyle are inconvenient to patients and lead to lowered quality of life (QOL). To overcome these inconveniences, IMF-screws (IMFS) to facilitate intermaxillary fixation during surgery have been developed. The purpose of the present study

  17. IMF-screws or arch bars as conservative treatment for mandibular condyle fractures: Quality of life aspects

    NARCIS (Netherlands)

    van den Bergh, B.; van Otterloo, J.J.D.M.; van der Ploeg, T.; Tuinzing, D.B.; Forouzanfar, T.

    2015-01-01

    Objective Arch bars as treatment for a fractured mandibular condyle are inconvenient to patients and lead to lowered quality of life (QOL). To overcome these inconveniences, IMF-screws (IMFS) to facilitate intermaxillary fixation during surgery have been developed. The purpose of the present study

  18. Intra-articular chondroma of the knee

    Energy Technology Data Exchange (ETDEWEB)

    Talwalkar, S.C.; Kambhampati, S.B.S.; Lang Stevenson, A.I. [Oldchurch Hospital, Romford, Essex (United Kingdom); Whitehouse, R. [Manchester University, Department of Radiology, Manchester (United Kingdom); Freemont, A. [University of Manchester, Department of Osteoarticular Pathology, Manchester (United Kingdom)

    2005-06-01

    Chondromas are tumours that develop in relation to the periosteum and, although they are common around the knee, most reports deal with soft tissue chondromas in para-articular locations or intracortical tumours in extra-articular regions. We report a rare case of an intra-articular chondroma in a 16-year-old boy of Asian origin developing in the region of the medial femoral condyle of the femur and extending into the femoral sulcus and the patellofemoral joint. (orig.)

  19. Intra-articular chondroma of the knee

    International Nuclear Information System (INIS)

    Talwalkar, S.C.; Kambhampati, S.B.S.; Lang Stevenson, A.I.; Whitehouse, R.; Freemont, A.

    2005-01-01

    Chondromas are tumours that develop in relation to the periosteum and, although they are common around the knee, most reports deal with soft tissue chondromas in para-articular locations or intracortical tumours in extra-articular regions. We report a rare case of an intra-articular chondroma in a 16-year-old boy of Asian origin developing in the region of the medial femoral condyle of the femur and extending into the femoral sulcus and the patellofemoral joint. (orig.)

  20. Changes in the main masticatory muscles in CT after mandibular condyle fracture

    International Nuclear Information System (INIS)

    Raustia, A.M.; Oikarinen, K.S.; Pyhtinen, J.

    1990-01-01

    The aim was to study changes in the main masticatory muscles after mandibular condyle fracture as seen by CT, comparing the densities and sizes of the masseter, medial pterygoid and lateral pterygoid muscles on the fractured side with those on the non-fractured side. More or less permanent muscular changes are detectable several years after the accident, especially in the lateral pterygoid muscle, which is attached to the condylar head. This muscle was statistically significantly smaller (p [de

  1. Pellegrini-Stieda disease: a heterogeneous disorder not synonymous with ossification/calcification of the tibial collateral ligament - anatomic and imaging investigation

    International Nuclear Information System (INIS)

    Mendes, Luiz F.A.; Cho, Jae H.; Garcia, Glenn M.; Resnick, Donald L.; Chung, Christine B.; Pretterklieber, Michael L.

    2006-01-01

    Ossification/calcification around the medial femoral condyle has been known as Pellegrini-Stieda (PS) disease for almost 100 years. Little attention has been given to magnetic resonance (MR) imaging characteristics. Our purpose is to demonstrate the anatomy in the medial femoral compartment and imaging findings of PS disease, determining the sites and patterns of ossification. In a cadaveric study seven specimens were dissected to show the anatomic relations of the tibial collateral ligament (TCL) and the tendon of the ischiocondylar part of the adductor magnus muscle, in the medial femoral epicondyle. In order to determine the nature of ossification/calcification in PS disease, MR imaging and radiographic findings in nine patients were analyzed by two observers with attention to the specific site, shape, and orientation of the ossification and its relationship to the tibial collateral ligament (TCL) and adductor magnus tendon. Available clinical history was recorded. A classification system addressing different sites and patterns of ossification was developed. The anatomic study showed that the TCL and the adductor magnus tendon insert at different sites in the medial femoral condyle and there is no continuation; however, some fibers of the posterior bundle of the TCL overlap the anterior aspect of the adductor magnus tendon. The imaging study showed that shape, orientation, and location of the abnormal calcification and ossification were similar on radiographic and MR imaging analysis. Ossification had an inferior orientation in six cases, a superior orientation in two cases, and both in one case. Four patterns of ossification were noted: (I) a beak-like appearance with an inferior orientation and femoral attachment was present in five cases; (II) a drop-like appearance with an inferior orientation, parallel to the femur, was evident in one case; (III) an elongated appearance with a superior orientation, parallel to the femur, was seen in two cases; and (IV) a

  2. Pellegrini-Stieda disease: a heterogeneous disorder not synonymous with ossification/calcification of the tibial collateral ligament - anatomic and imaging investigation

    Energy Technology Data Exchange (ETDEWEB)

    Mendes, Luiz F.A.; Cho, Jae H.; Garcia, Glenn M.; Resnick, Donald L.; Chung, Christine B. [Veterans Administration Medical Center, Department of Radiology, San Diego, CA (United States); Pretterklieber, Michael L. [Department of Applied Anatomy, Center of Anatomy and Cell Biology, Vienna (Austria)

    2006-12-15

    Ossification/calcification around the medial femoral condyle has been known as Pellegrini-Stieda (PS) disease for almost 100 years. Little attention has been given to magnetic resonance (MR) imaging characteristics. Our purpose is to demonstrate the anatomy in the medial femoral compartment and imaging findings of PS disease, determining the sites and patterns of ossification. In a cadaveric study seven specimens were dissected to show the anatomic relations of the tibial collateral ligament (TCL) and the tendon of the ischiocondylar part of the adductor magnus muscle, in the medial femoral epicondyle. In order to determine the nature of ossification/calcification in PS disease, MR imaging and radiographic findings in nine patients were analyzed by two observers with attention to the specific site, shape, and orientation of the ossification and its relationship to the tibial collateral ligament (TCL) and adductor magnus tendon. Available clinical history was recorded. A classification system addressing different sites and patterns of ossification was developed. The anatomic study showed that the TCL and the adductor magnus tendon insert at different sites in the medial femoral condyle and there is no continuation; however, some fibers of the posterior bundle of the TCL overlap the anterior aspect of the adductor magnus tendon. The imaging study showed that shape, orientation, and location of the abnormal calcification and ossification were similar on radiographic and MR imaging analysis. Ossification had an inferior orientation in six cases, a superior orientation in two cases, and both in one case. Four patterns of ossification were noted: (I) a beak-like appearance with an inferior orientation and femoral attachment was present in five cases; (II) a drop-like appearance with an inferior orientation, parallel to the femur, was evident in one case; (III) an elongated appearance with a superior orientation, parallel to the femur, was seen in two cases; and (IV) a

  3. Trochanteric entry femoral nails yield better femoral version and lower revision rates-A large cohort multivariate regression analysis.

    Science.gov (United States)

    Yoon, Richard S; Gage, Mark J; Galos, David K; Donegan, Derek J; Liporace, Frank A

    2017-06-01

    Intramedullary nailing (IMN) has become the standard of care for the treatment of most femoral shaft fractures. Different IMN options include trochanteric and piriformis entry as well as retrograde nails, which may result in varying degrees of femoral rotation. The objective of this study was to analyze postoperative femoral version between three types of nails and to delineate any significant differences in femoral version (DFV) and revision rates. Over a 10-year period, 417 patients underwent IMN of a diaphyseal femur fracture (AO/OTA 32A-C). Of these patients, 316 met inclusion criteria and obtained postoperative computed tomography (CT) scanograms to calculate femoral version and were thus included in the study. In this study, our main outcome measure was the difference in femoral version (DFV) between the uninjured limb and the injured limb. The effect of the following variables on DFV and revision rates were determined via univariate, multivariate, and ordinal regression analyses: gender, age, BMI, ethnicity, mechanism of injury, operative side, open fracture, and table type/position. Statistical significance was set at pregression analysis revealed that a lower BMI was significantly associated with a lower DFV (p=0.006). Controlling for possible covariables, multivariate analysis yielded a significantly lower DFV for trochanteric entry nails than piriformis or retrograde nails (7.9±6.10 vs. 9.5±7.4 vs. 9.4±7.8°, pregression analysis. However, this is not to state that the other nail types exhibited abnormal DFV. Translation to the clinical impact of a few degrees of DFV is also unknown. Future studies to more in-depth study the intricacies of femoral version may lead to improved technology in addition to potentially improved clinical outcomes. Copyright © 2017 Elsevier Ltd. All rights reserved.

  4. Bilateral femoral neck fractures following pelvic irradiation

    International Nuclear Information System (INIS)

    Mitsuda, Kenji; Nishi, Hosei; Oba, Hiroshi

    1977-01-01

    Over 300 cases of femoral neck fractures following radiotherapy for intrapelvic malignant tumor have been reported in various countries since Baensch reported this disease in 1927. In Japan, 40 cases or so have been reported, and cases of bilateral femoral neck fractures have not reached to ten cases. The authors experienced a case of 75 year-old female who received radiotherapy for cancer of the uterus, and suffered from right femoral neck fracture 3 months after and left femoral neck fracture one year and half after. As clinical symptoms, she had not previous history of trauma in bilateral femurs, but she complained of a pain in a hip joint and of gait disturbance. The pain in left femoral neck continued for about one month before fracture was recognized with roentgenogram. As histopathological findings, increase of fat marrow, decrease of bone trabeculae, and its marked degeneration were recognized. Proliferation of some blood vessels was found out, but thickness of the internal membrane and thrombogenesis were not recognized. Treatment should be performed according to degree of displacement of fractures. In this case, artificial joint replacement surgery was performed to the side of fracture of this time, because this case was bilateral femoral neck fractures and the patient had received artificial head replacement surgery in the other side of fracture formerly. (Tsunoda, M.)

  5. Matrix-induced autologous chondrocyte implantation for a large chondral defect in a professional football player: a case report

    Directory of Open Access Journals (Sweden)

    Beyzadeoglu Tahsin

    2012-06-01

    Full Text Available Abstract Introduction Matrix-assisted autologous chondrocyte implantation is a well-known procedure for the treatment of cartilage defects, which aims to establish a regenerative milieu and restore hyaline cartilage. However, much less is known about third-generation autologous chondrocyte implantation application in high-level athletes. We report on the two-year follow-up outcome after matrix-assisted autologous chondrocyte implantation to treat a large cartilage lesion of the lateral femoral condyle in a male Caucasian professional football player. Case presentation A 27-year-old male Caucasian professional football player was previously treated for cartilage problems of his left knee with two failed microfracture procedures resulting in a 9 cm2 Outerbridge Grade 4 chondral lesion at his lateral femoral condyle. Preoperative Tegner-Lysholm and Brittberg-Peterson scores were 64 and 58, and by the second year they were 91 and 6. An evaluation with magnetic resonance imaging demonstrated filling of the defect with the signal intensity of the repair tissue resembling healthy cartilage. Second-look arthroscopy revealed robust, smooth cartilage covering his lateral femoral condyle. He returned to his former competitive level without restrictions or complaints one year after the procedure. Conclusions This case illustrates that robust cartilage tissue can be obtained with a matrix-assisted autologous chondrocyte implantation procedure even after two failed microfracture procedures in a large (9 cm2 cartilage defect. To the best of our knowledge, this is the first case report on the application of the third-generation cell therapy treatment technique, matrix-assisted autologous chondrocyte implantation, in a professional football player.

  6. [Treatment of avascular necrosis of femoral head after femoral neck fracture with pedicled iliac bone graft].

    Science.gov (United States)

    Wang, Benjie; Zhao, Dewei; Guo, Lin; Yang, Lei; Li, Zhigang; Cui, Daping; Tian, Fengde; Liu, Baoyi

    2011-05-01

    To explore the effectiveness of pedicled iliac bone graft transposition for treatment of avascular necrosis of femoral head (ANFH) after femoral neck fracture. Between June 2002 and December 2006, 22 cases (22 hips, 16 left hips and 6 right hips) of ANFH after femoral neck fracture were treated with iliac bone graft pedicled with ascending branch of the lateral femoral circumflex vessels. There were 18 males and 4 females with an age range from 28 to 48 years (mean, 37.5 years). The time from injury to internal fixation was 2-31 days, and all fractures healed within 12 months after internal fixation. The ANFH was diagnosed at 15-40 months (mean, 22 months) after internal fixation. The ANFH duration was 3-11 months (mean, 8 months). According to Association Research Circulation Osseous (ARCO) staging system, 2 hips were classified as stage IIa, 3 hips as stage IIb, 3 hips as stage IIc, 3 hips as stage IIIa, 7 hips as stage IIIb, and 4 hips as stage IIIc. The preoperative Harris hip score (HHS) was 64.10 +/- 5.95. All incisions healed by first intention and the patients had no complication of lung embolism, sciatic nerve injury, lower limb deep venous thrombosis, and numbness and pain of donor site. All patients were followed up 2.5 to 6.3 years (mean, 4.8 years). The fracture healing time was 8-12 months, and no femoral neck fracture recurred. The HHS was 90.20 +/- 5.35 at last follow-up, showing significant difference when compared with the preoperative value (t = -18.447, P = 0.000). The hip function were excellent in 11 hips, good in 10 hips, fair in 1 hip, and the excellent and good rate was 95.5%. Four hips were radiographically progressed in ARCO staging, 18 hips remained stable with a stable rate of 81.8%. Pedicled iliac bone graft transposition is an ideal option for treatment of ANFH after internal fixation of femoral neck fracture for the advantages of femoral head revascularization, sufficient cancellous bone supply, and relatively simple procedure.

  7. Magnetic resonance imaging of the femoral head necrosis

    Energy Technology Data Exchange (ETDEWEB)

    Narita, Shinya; Asada, Kanji; Yoshida, Kenjiro and others

    1986-06-01

    Ten patients with avascular femoral head necrosis and four normal adults were examined by magnetic resonance imaging (MRI). In addition, the relationship between MRI and pathophysiology of three operated-on avascular femoral heads was evaluated. The medullary cavities of the normal femoral heads had a strong signal intensity on the saturation recovery (SR) image due to fat marrow, and the T/sub 1/ relaxation time was 160 +- 11 msec. In avascular femoral head necrosis, the necrotic area had a low signal intensity on the SR image and a prolonged T/sub 1/ relaxation time, while the reactive fibrous area had more prolonged T/sub 1/ relaxation time. For these reasons, MRI was found to show the pathological changes of avascular femoral head necrosis and can be expected to be useful for making early diagnoses and operation planning.

  8. Magnetic resonance imaging of the femoral head necrosis

    International Nuclear Information System (INIS)

    Narita, Shinya; Asada, Kanji; Yoshida, Kenjiro

    1986-01-01

    Ten patients with avascular femoral head necrosis and four normal adults were examined by magnetic resonance imaging (MRI). In addition, the relationship between MRI and pathophysiology of three operated-on avascular femoral heads was evaluated. The medullary cavities of the normal femoral heads had a strong signal intensity on the saturation recovery (SR) image due to fat marrow, and the T 1 relaxation time was 160 ± 11 msec. In avascular femoral head necrosis, the necrotic area had a low signal intensity on the SR image and a prolonged T 1 relaxation time, while the reactive fibrous area had more prolonged T 1 relaxation time. For these reasons, MRI was found to show the pathological changes of avascular femoral head necrosis and can be expected to be useful for making early diagnoses and operation planning. (author)

  9. An avascular necrosis in Gaucher's disease

    International Nuclear Information System (INIS)

    Mansberg, R.; Uren, R.; Howman-Giles, R.

    1999-01-01

    Full text: Avascular necrosis is frequently associated with sickle cell disease and other haemoglobinopathies. It is less commonly associated with Gaucher's disease. A case with multi-modality imaging is presented. A 33-year-old male patient presented with a 4-day history of severe right knee pain. He was a febrile with mild swelling of the right knee. A diagnosis of Gaucher's disease had been made by bone marrow biopsy on a clinical picture of hepatosplenomegaly and thrombocytopenia some years earlier. A radiograph of the knee demonstrated an Erlenmeyer flask deformity of the distal femur. A bone scan demonstrated reduced perfusion to the distal right femoral shaft and femoral condyles. Delayed images demonstrated decreased tracer uptake in the distal right femur extending to the right medial femoral condyle consistent with a vascular necrosis. An MRI of the thighs demonstrated lipid accumulation in the marrow space of both femora consistent with Gaucher's disease associated with changes of bone oedema in the metadiaphysis and epiphysis of the right femur. The patient was treated with supportive measures and made an uneventful recovery and is being commenced on enzyme replacement therapy (Algucerase)

  10. Pseudo-Acetabulum due to Heterotopic Ossification in a Child with Post Traumatic Neglected Posterior Hip Dislocation.

    Science.gov (United States)

    Pathak, Aditya C; Patil, Atul K; Sheth, Binoti; Bansal, Rohan

    2012-01-01

    Traumatic neglected dislocations of hip in children are rare entity. Neglected traumatic dislocations of hip in children along with heterotopic ossification are still rare. Post traumatic neglected hip dislocations are to be diagnosed as early as possible and have to be treated with precision and aggression as the outcome of treatment for the same is not predictable. 5 year female with post-traumatic neglected hip dislocation with heterotopic ossification forming a pseudoacetabulum postero-superiorly in which femur head was lodged. The girl was operated by open reduction using Moore's Posterior approach and showed good results. Here is a mention of a rare case with a good 18 months follow up with no complication. Post-traumatic neglected posterior hip dislocation mostly requires open reduction and relocation of femoral head in original acetabulum with concentric reduction. Heterotopic ossification is a rare but known complication of traumatic dislocation of hip in children. Good results can be achieved in such cases and regular follow-up of patient is required post-operatively.

  11. Femoral component loosening after hip resurfacing arthroplasty

    International Nuclear Information System (INIS)

    Zustin, Jozef; Sauter, Guido; Hahn, Michael; Morlock, Michael M.; Ruether, Wolfgang; Amling, Michael

    2010-01-01

    Before the re-introduction of the current generation of total hip resurfacing arthroplasty, component loosening and osteolysis were of great concern to the orthopaedic community. Early, mid- and long-term clinical results are encouraging, but component loosening still exists. Macroscopic, contact radiographic and histopathological analyses after undecalcified preparation of bone tissue specimens were performed. To investigate the frequency and morphological patterns of the loosening of the femoral component, we analysed a series of 190 retrieved femoral remnants that were revised for aseptic failures. Thirty-five (18.4%) hips were revised for clinical and/or radiographic loosening of the femoral component. Pseudoarthrosis (n = 17; median in situ time: 16 weeks, interquartile range [IQR]: 9 to 34), collapsed osteonecrosis (n = 5; median in situ time: 79 weeks, IQR: 63 to 97), cement-socket debonding (n = 3; median in situ time: 89 weeks, IQR: 54 to 97) and at later follow-up bone-cement loosening (n = 10; median in situ time: 175 weeks; IQR 112 to 198; p =0.005) were distinct patterns of the femoral remnant-implant loosening. Fibrocartilaginous metaplasia of interface bone trabeculae (n = 38; median in situ time: 61 weeks, IQR: 32 to 138) was strongly associated with femoral component loosening (p = 0.009). Both the trabecular hyperosteoidosis (n = 32; median in situ time: 71 weeks, IQR 50 to 129) and excessive intraosseous lymphocyte infiltration (n = 12; median in situ time: 75 weeks, IQR 51 to 98) at the bone-cement interface correlated strongly with fibrocartilaginous metaplasia (p = 0.001 and p = 0.016 respectively) and all three lesions were associated with the female gender (p = 0.021, p = 0.009, and p = 0.051). Femoral component loosening at early follow-up was mostly caused by pathological changes of the femoral remnant bone tissue: pseudoarthrosis and collapsed osteonecrosis. Fibrocartilaginous metaplasia was frequently observed in hips with femoral

  12. Super-selective Balloon Test Occlusion of the Posterior Communicating Artery in the Treatment of a Posterior Cerebral Artery Fusiform Aneurysm: a Case Report.

    Science.gov (United States)

    Isozaki, Makoto; Arai, Hiroshi; Neishi, Hiroyuki; Kitai, Ryuhei; Kikuta, Ken-Ichiro

    2016-10-01

    We report the case of a 49-year-old man with underlying hypertension who developed diplopia lasting 2 months. Magnetic resonance imaging and digital subtraction angiography showed multi-lobular unruptured aneurysms in the P2 portion of the posterior cerebral artery (PCA) migrating into the interpeduncular cistern of the midbrain. Because the shapes of the aneurysms were serpentine fusiform and the posterior communicating artery (PCoA) was the fetal type, we planned anastomosis of the occipital artery to the P4 portion of the PCA followed by endovascular obliteration of the parent artery including the aneurysms. Endovascular treatment was performed via a femoral approach one week after the anastomosis. Super-selective balloon test occlusion (BTO) of the PCoA was performed by using an occlusion balloon microcatheter before endovascular treatment. Occlusion of the proximal segment of the PCoA induced disturbance of consciousness of the patient. Occlusion of the distal segment other than the first point of the PCoA did not induce any neurological symptoms. The information from this super-selective BTO helped us to perform precise endovascular obliteration. The aneurysm was successfully obliterated, and the diplopia almost disappeared in a few months. Super-selective BTO of the PCoA might be a useful method for preventing ischemic complications due to occlusion of invisible perforators.

  13. CT patellar cortex tilt angle: A radiological method to measure patellar tilt

    International Nuclear Information System (INIS)

    Mirza Toluei, F.; Afshar, A.; Salarilak, S.; Sina, A.

    2005-01-01

    Background/Objectives: the role of patellar tilt in the anterior knee pain is indisputable. Traditionally. the lateral patello-femoral angle of Laurin has been defined in both the axial view and CT images for measuring the tilt of patella. We present a new angle. which is independent of the morphology of patella and directly relates to clinical assessment of the tilt. which is appreciated from palpation of the edges of the patella. Patients and Methods: 38 patients with anterior knee pain and forty normal control subjects were examined using CT scan of patello-femoral joint in 15 degrees of knee flexion. The amount of lateral patellar tilt was quantitatively assessed using the lateral patello-femoral angle, as described by Laurin et al, and the newly defined patellar cortex tilt angle. This angle is subtended by the line drawn along the posterior femoral condyles and the one parallel to the subchondral bone of patellar cortex. The fifteen-degree tilt was taken as normal cut-off point for patellar cortex tilt angle in the control group. Results: in patients, the average tilt of patella. using the patellar cortex tilt angle was 15.26 versus 7.05 in the control group. Using Student's t test, the difference between the two means was significant (P<0.001). The sensitivity and specificity of patellar cortex tilt angle were 40 and 90 percent, respectively There was a moderate agreement between our presented test and the lateral tilt angle test (kappa=0.40. P<0.001). Conclusion: our results indicate that patellar tilt can also be detected using patellar cortex tilt angle. We need more specific studies ta determine the validity of the test

  14. Avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Kokubo, Takeshi; Takatori, Yoshio; Kamogawa, Morihide; Nakamura, Toshitaka; Ninomiya, Setsuo; Yoshikawa, Kohki; Itai, Yuji; Iio, Masahiro; Mitamura, Tadayuki

    1990-01-01

    T1-weighted MR images of thirty-six hips in 25 patients with avascular necrosis of the femoral head were obtained two to five times during the course of 2 to 26 months. We investigated these MR images in the light of the chronological change and compared them with plain radiographs. MR images changes in 16 femoral head; in general, the abnormal low intensity area in the femoral head reduced in extent and the internal high intensity area became smaller of disappeared. Thirteen femoral heads among them became more flattened on plain radiographs in the same period. It is noted that four different zones are defined in the femoral head after bone necrosis takes place: the dead bone marrow, the dead marrow which still contains fat, the reactive interface and the hyperemic bone marrow. In T1-weighted MR images, the dead bone marrow, the reactive interface and the hyperemic bone marrow are demonstrated as low intensity area, while the dead marrow containing fat may remain high in intensity. On the basis of this knowledge of histopathology and MR images of this disease, we suggest that reduction of the abnormal low intensity area and disappearance of the internal high intensity area on MR images can be regarded as diminution of hyperemia in the living bone marrow and loss of fat in the dead bone marrow, respectively. (author)

  15. CT study of avascular necrosis of femoral head in adults

    International Nuclear Information System (INIS)

    Liu Jihua; Du Yuqing; Xu Aide

    2000-01-01

    Objective: To study the early and new CT signs of avascular necrosis of femoral head in adults. Methods: The CT scans of 127 cases with this condition were analyzed. Results: There were 90 hip joints with femoral head normal in shape, including 67 femoral heads with only high-density sclerosis and 23 ones with high-density and low-density areas. In 111 hip joints, the femoral head was depressed and manifested purely high-density sclerosis in 25 and mixed-density areas in 86. Air-filled cysts appeared in 43 femoral heads. In follow-up cases, the changes in shape and density of femoral head followed some rules. Conclusion: Purely high-density sclerosis is an early sign and is of great diagnostic value combined with its special shape. Air in femoral heads is also a sign of the disease

  16. Epiphyseal osteoblastoma-like osteosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Bonar, S.F. [Douglass Hanly Moir Pathology, 95 Epping Road, North Ryde, NSW 2113 (Australia); McCarthy, S.; Stalley, P.; Schatz, J.; Soper, J.; Scolyer, R. [Departments of Pathology, Radiology and Orthopaedic Surgery, Royal Prince Alfred Hospital, Missenden Road, Camperdown, NSW 2050 (Australia); Barrett, I. [Department of Orthopaedic Surgery, The Children' s Hospital, Westmead, NSW 2145 (Australia)

    2004-01-01

    Osteoblastoma-like osteosarcoma is a rare variant of osteosarcoma occurring in this instance in a highly unusual location: the lateral femoral condyle of a 13-year-old girl. The radiological features were non-aggressive and, although slightly unusual, were most suggestive of chondroblastoma. (orig.)

  17. Relationship between the shortening of the posterior muscle chain and the forward shift of the head and shoulder in female athletes from the youth category Relação entre o encurtamento de cadeia muscular posterior e a anteriorização da cabeça e ombros em atletas infanto-juvenis do gênero feminino

    Directory of Open Access Journals (Sweden)

    Lucas Maciel Rabello

    2010-10-01

    Full Text Available The aim of the present study was to analyze the relationship between the shortening of the posterior muscle chain, mainly the hamstrings and the forward shift of the head and shoulder, as a possible adaptation in high level/performance athletes. The sample involved 59 female athletes from the youth category of different sports modalities. Group 1: 35 athletes with significant hamstrings’ shortening evaluated by the “bear’s position”; Control group: 24 athletes without hamstrings’ shortening, evaluated by the same position. Data collection was performed using digital analysis of pictures taken with the athlete standing (lateral vision in the “bear’s position”. Luminous markers were placed in the temporomandibular joint, lateral region of the acromio, femur great trochanter, external femoral condyle and lateral malleolus. Variables were measured by the computerized angular cinematic analysis, using the software for posture evaluation SAPO, 0.68 version, always performed by the same rater. Statistical analysis was performed with the Shapiro Wilk test, Unpaired t test and Pearson’s correlation coefficient. The level of significance was set at p?0.05. Group 1 showed 2.5 degrees (SD=1,12 of forward inclination in the lateral view and 43.15 degrees (SD=9,41 of knee flexion in the “bear’s position”. In group 2, there was 2.77 (DP=1.02 degrees in the lateral analysis and -2.19 (DP=4.05 degrees in the “bear’s position”. The statistical analysis between the two groups showed p=0.50 for the comparison of the anterior trunk imbalance in the lateral view and p=0,00 for the comparison of the “bear’s position”. The correlation analysis between the anterior trunk imbalance and the posterior muscle chain shortening, emphasizing the hamstrings, showed r=0.04 in the group with posterior chain shortening and r=0.1 in the control group. It can be concluded that the hamstrings’ muscle shortening did not show any relation with the

  18. A randomized study on migration of the Spectron EF and the Charnley flanged 40 cemented femoral components using radiostereometric analysis at 2 years.

    Science.gov (United States)

    Kadar, Thomas; Hallan, Geir; Aamodt, Arild; Indrekvam, Kari; Badawy, Mona; Havelin, Leif Ivar; Stokke, Terje; Haugan, Kristin; Espehaug, Birgitte; Furnes, Ove

    2011-10-01

    We performed a randomized study to determine the migration patterns of the Spectron EF femoral stem and to compare them with those of the Charnley stem, which is regarded by many as the gold standard for comparison of implants due to its extensive documentation. 150 patients with a mean age of 70 years were randomized, single-blinded, to receive either a cemented Charnley flanged 40 monoblock, stainless steel, vaquasheen surface femoral stem with a 22.2-mm head (n = 30) or a cemented Spectron EF modular, matte, straight, collared, cobalt-chrome femoral stem with a 28-mm femoral head and a roughened proximal third of the stem (n = 120). The patients were followed with repeated radiostereometric analysis for 2 years to assess migration. At 2 years, stem retroversion was 2.3° and 0.7° (p < 0.001) and posterior translation was 0.44 mm and 0.17 mm (p = 0.002) for the Charnley group (n = 26) and the Spectron EF group (n = 74), respectively. Subsidence was 0.26 mm for the Charnley and 0.20 mm for the Spectron EF (p = 0.5). The Spectron EF femoral stem was more stable than the Charnley flanged 40 stem in our study when evaluated at 2 years. In a report from the Norwegian arthroplasty register, the Spectron EF stem had a higher revision rate due to aseptic loosening beyond 5 years than the Charnley. Initial stability is not invariably related to good long-term results. Our results emphasize the importance of prospective long-term follow-up of prosthetic implants in clinical trials and national registries and a stepwise introduction of implants.

  19. Advantages and Disadvantages of Transtibial, Anteromedial Portal, and Outside-In Femoral Tunnel Drilling in Single-Bundle Anterior Cruciate Ligament Reconstruction: A Systematic Review.

    Science.gov (United States)

    Robin, Brett N; Jani, Sunil S; Marvil, Sean C; Reid, John B; Schillhammer, Carl K; Lubowitz, James H

    2015-07-01

    Controversy exists regarding the best method for creating the knee anterior cruciate ligament (ACL) femoral tunnel or socket. The purpose of this study was to systematically review the risks, benefits, advantages, and disadvantages of the endoscopic transtibial (TT) technique, anteromedial portal technique, outside-in technique, and outside-in retrograde drilling technique for creating the ACL femoral tunnel. A PubMed search of English-language studies published between January 1, 2000, and February 17, 2014, was performed using the following keywords: "anterior cruciate ligament" AND "femoral tunnel." Included were studies reporting risks, benefits, advantages, and/or disadvantages of any ACL femoral technique. In addition, references of included articles were reviewed to identify potential studies missed in the original search. A total of 27 articles were identified through the search. TT technique advantages include familiarity and proven long-term outcomes; disadvantages include the risk of nonanatomic placement because of constrained (TT) drilling. Anteromedial portal technique advantages include unconstrained anatomic placement; disadvantages include technical challenges, short tunnels or sockets, and posterior-wall blowout. Outside-in technique advantages include unconstrained anatomic placement; disadvantages include the need for 2 incisions. Retrograde drilling technique advantages include unconstrained anatomic placement, as well as all-epiphyseal drilling in skeletally immature patients; disadvantages include the need for fluoroscopy for all-epiphyseal drilling. There is no one, single, established "gold-standard" technique for creation of the ACL femoral socket. Four accepted techniques show diverse and subjective advantages, disadvantages, risks, and benefits. Level V, systematic review of Level II through V evidence. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  20. Influence of occlusal splints on TMJ condyle-fossa relationship and disc shape

    OpenAIRE

    Braun, Barbara Victoria

    2012-01-01

    Background. Occlusal splints are nowadays commonly used in dentistry to treat symptoms of myoarthropathies of the masticatory system, but also to treat simple occlusal parafunctions. Still, the exact mechanism by which the treatment works is unknown. The aim of this study was to find out the answers to following questions: 1. is there an immediate change of the minimum condyle-fossa distance and accompanying disc thickness by inserting a Michigan splint and 2. is it possible to displace the m...

  1. Current Concepts in the Mandibular Condyle Fracture Management Part II: Open Reduction Versus Closed Reduction

    Science.gov (United States)

    Yang, Jung-Dug; Chung, Ho-Yun; Cho, Byung-Chae

    2012-01-01

    In the treatment of mandibular condyle fracture, conservative treatment using closed reduction or surgical treatment using open reduction can be used. Management of mandibular condylar fractures remains a source of ongoing controversy in oral and maxillofacial trauma. For each type of condylar fracture,the treatment method must be chosen taking into consideration the presence of teeth, fracture height, patient'sadaptation, patient's masticatory system, disturbance of occlusal function, and deviation of the mandible. In the past, closed reduction with concomitant active physical therapy conducted after intermaxillary fixation during the recovery period had been mainly used, but in recent years, open treatment of condylar fractures with rigid internal fixation has become more common. The objective of this review was to evaluate the main variables that determine the choice of an open or closed method for treatment of condylar fractures, identifying their indications, advantages, and disadvantages, and to appraise the current evidence regarding the effectiveness of interventions that are used in the management of fractures of the mandibular condyle. PMID:22872831

  2. Current Concepts in the Mandibular Condyle Fracture Management Part II: Open Reduction Versus Closed Reduction

    Directory of Open Access Journals (Sweden)

    Kang-Young Choi

    2012-07-01

    Full Text Available In the treatment of mandibular condyle fracture, conservative treatment using closed reduction or surgical treatment using open reduction can be used. Management of mandibular condylar fractures remains a source of ongoing controversy in oral and maxillofacial trauma. For each type of condylar fracture,the treatment method must be chosen taking into consideration the presence of teeth, fracture height, patient'sadaptation, patient's masticatory system, disturbance of occlusal function, and deviation of the mandible. In the past, closed reduction with concomitant active physical therapy conducted after intermaxillary fixation during the recovery period had been mainly used, but in recent years, open treatment of condylar fractures with rigid internal fixation has become more common. The objective of this review was to evaluate the main variables that determine the choice of an open or closed method for treatment of condylar fractures, identifying their indications, advantages, and disadvantages, and to appraise the current evidence regarding the effectiveness of interventions that are used in the management of fractures of the mandibular condyle.

  3. Morphometric analysis of rat femoral vessels under a video magnification system

    Directory of Open Access Journals (Sweden)

    Rui Sergio Monteiro de Barros

    Full Text Available Abstract The right femoral vessels of 80 rats were identified and dissected. External lengths and diameters of femoral arteries and femoral veins were measured using either a microscope or a video magnification system. Findings were correlated to animals’ weights. Mean length was 14.33 mm for both femoral arteries and femoral veins, mean diameter of arteries was 0.65 mm and diameter of veins was 0.81 mm. In our sample, rats’ body weights were only correlated with the diameter of their femoral veins.

  4. Study of the anatomical position of the femoral nerve by magnetic resonance imaging in patients with fractured neck of femur: relevance to femoral nerve block.

    LENUS (Irish Health Repository)

    Mehmood, Shehzad

    2012-01-31

    STUDY OBJECTIVE: To determine the anatomical location of the femoral nerve in patients who have sustained fracture of the neck of femur, and its relevance to femoral nerve block technique. DESIGN: Prospective, observational clinical study. SETTING: Orthopedic and Radiology departments of a regional hospital. SUBJECTS: 10 consecutive adult ASA physical status II and III patients (mean age, 78.5 yrs) and 4 adult healthy volunteers. INTERVENTIONS: A T1 magnetic resonance imaging scan was performed of both upper thighs in patients and healthy volunteers successfully. MEASUREMENTS: The distance (mm) between the midpoint of the femoral artery and the midpoint of the femoral nerve, and the distance of the femoral nerve from the skin was measured at the mid-inguinal ligament, the pubic tubercle, and at the mid-inguinal crease. Data are shown as means (SD). Differences between both sides were compared using paired Student\\'s t-tests. P < 0.05 was significant. MAIN RESULTS: In patients the mean distance (mm) between the midpoint of the femoral nerve from the midpoint of femoral artery at the mid-inguinal crease on the fractured and non-fractured sides was 10.7 and 11.0, respectively (P = 0.87). The mean distance (mm) between the midpoint of the femoral nerve from the midpoint of the femoral artery at the mid-inguinal ligament on the fractured and non-fractured sides was 9.64 and 12.5, respectively (P = 0.03). The mean distance (mm) between the midpoint of the femoral nerve from the midpoint of the femoral artery at the pubic tubercle on the fractured and non-fractured sides was 8.74 and 10.49, respectively (P = 0.18). CONCLUSIONS: Blockade of the femoral nerve may be easier to perform at the mid-inguinal crease in patients with fractured neck of femur.

  5. Comparative endurance testing of the Biomet Matthews Nail and the Dynamic Compression Screw, in simulated condylar and supracondylar femoral fractures

    Directory of Open Access Journals (Sweden)

    Davies Benjamin M

    2008-01-01

    Full Text Available Abstract Background The dynamic compression screw is a plate and screws implant used to treat fractures of the distal femur. The Biomet Matthews Nail is a new retrograde intramedullary nail designed as an alternative surgical option to treat these fractures. The objective of this study was to assess the comparative endurance of both devices. Method The dynamic compression screw (DCS and Biomet Matthews Nail (BMN were implanted into composite femurs, which were subsequently cyclically loaded using a materials testing machine. Simulated fractures were applied to each femur prior to the application of load. Either a Y type fracture or a transverse osteotomy was prepared on each composite femur using a jig to enable consistent positioning of cuts. Results The Biomet Matthews Nail demonstrated a greater endurance limit load over the dynamic compression screw in both fracture configurations. Conclusion The distal locking screws pass through the Biomet Matthews Nail in a unique "cruciate" orientation. This allows for greater purchase in the bone of the femoral condyle and potentially improves the stability of the fracture fixation. As these fractures are usually in weak osteoporotic bone, the Biomet Matthews Nail represents a favourable surgical option in these patients.

  6. Dislocation of the mandibular condyle into the middle cranial fossa causing an epidural haematoma.

    Science.gov (United States)

    Struewer, Johannes; Kiriazidis, Ilias; Figiel, Jens; Dukatz, Thomas; Frangen, Thomas; Ziring, Ewgeni

    2012-07-01

    Dislocation of the mandibular condyle into the middle cranial fossa is a rare complication of mandibular trauma due to anatomical and biomechanical factors. Owing to the proximity of the temporal glenoid fossa to the middle meningeal artery, there is the risk of serious sequelae in case of trauma. The authors report the case of a 36-year-old male patient, who was beaten up in a family dispute and presented with complex mandibular and maxillofacial fractures, including mandibular condyle intrusion into the middle cranial fossa causing extensive meningeal bleeding. The patient underwent immediate surgery, with evacuation of the epidural haematoma via a temporal approach. In addition open reduction and reconstruction of the temporal glenoid fossa via anatomic reduction of the fragments was performed. A functional occlusion was re-established via miniplate reconstruction of the complex mandibular body and ramus fractures. Prompt diagnosis and a multidisciplinary approach are essential to minimize the complications. Advanced imaging modalities of computed tomography are indicated. Treatment options should be individualized in particular in case of suspected neurological injury. Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  7. Lateral radiography of the knee with single-leg standing

    International Nuclear Information System (INIS)

    Ohmori, Kan; Sugawara, Tsuyoshi; Murakami, Katsuyoshi; Kirinai, Mikio; Fujiwara, Junichi; Oikawa, Takumi; Matsumura, Yutaka; Sugawara, Tsukasa

    2002-01-01

    The purpose of this investigation was to accomplish reproducible radiography of single-leg standing lateral radiography of the knee by adjusting lateral rotation using a ruler to measure foot position. After preliminary assessment of three-dimensional CT of the knees of normal volunteers, the best adjustment of external rotation was estimated. A ruler was made for use in adjusting the angle of knee rotation by measuring foot rotation. Based on the foot rotation measured by this ruler, the positioning of radiography was adjusted to correct rotation. Rotation was estimated by the distance between the posterior edges of the lateral and medial femoral condyles. Fifteen-degree and 17.5-degree rotations were used for correction. Correction of rotation was 17 degrees on average. This helped not only to correct external rotation in the initial radiography but also to correct rotation for repeat radiography. Our method is quantitative and highly reproducible, and it increases the success rate of lateral knee radiography. (author)

  8. Relationship of condylar position to disc position and morphology

    Energy Technology Data Exchange (ETDEWEB)

    Incesu, L.; Taskaya-Yilmaz, N. E-mail: nergizy@omu.edu.tr; Oeguetcen-Toller, M.; Uzun, E

    2004-09-01

    Introduction/objective: The purpose of this study was to assess whether condylar position, as depicted by magnetic resonance imaging, was an indicator of disc morphology and position. Methods and material: One hundred and twenty two TMJs of 61 patients with temporomandibular joint disorder were examined. Condylar position, disc deformity and degree of anterior disc displacement were evaluated by using magnetic resonance imaging. Results and discussion: Posterior condyle position was found to be the main feature of temporomandibular joints with slight and moderate anterior disc displacement. No statistical significance was found between the condylar position, and reducing and nonreducing disc positions. On the other hand, superior disc position was found to be statistically significant for centric condylar position. Conclusion: It was concluded that posterior condyle position could indicate anterior disc displacement whereas there was no relation between the position of condyle and the disc deformity.

  9. No effect of platelet-rich plasma with frozen or processed bone allograft around noncemented implants

    DEFF Research Database (Denmark)

    Jensen, T B; Rahbek, O; Overgaard, S

    2005-01-01

    by isolating the buffy coat from autologous blood samples. Bone allograft was used fresh-frozen or processed by defatting, freeze drying, and irradiation. Cylindrical hydroxyapatite-coated titanium implants were inserted bilaterally in the femoral condyles of eight dogs. Each implant was surrounded by a 2.5-mm...

  10. 3 Gakuu-Arterior.indd

    African Journals Online (AJOL)

    long period along with scientific data of clinical presentations, diagnosis, associated injuries, the ACL ... Methods: Thirty five patients with anterior cruciate ligament tear in one knee and a normal contralateral knee ... sites provide rapid healing and insertional strength. A ... one chondral fracture of the lateral femoral condyle.

  11. Quantitative Assessment of Radioisotope Uptake in Condyles by SPECT Bone Scintigraphy

    Directory of Open Access Journals (Sweden)

    Z. Dalili

    2006-03-01

    Full Text Available Statement of problem: Condylar hyperplasia of the mandible is a self limiting abnormality which can cause facial asymmetry, temporomandibular joint (TMJdysfunction and esthetic problems. Treatment planning is based on the results of isotope scanning, clinical findings and patient age. Single photon emission tomography(SPECT is considered to be a sensitive method in the calculation of condylar uptake differences.Purpose: The aim of this study was to determine the growth activity occurring in the mandibular condyles, and to devise an index of side-to-side differences in condylar activity in different individuals.Material and Methods: 38 patients, with an age range of 13 to 34 years, undergoing skeletal scintigraphy for a variety of conditions, were chosen for this study. 25 mci TC-99 was injected to all subjects in order to assess the difference between right (Rt andleft (Lt condylar uptake percentage and to calculate the Lt to Rt condylar uptake ratio.The normal index was determined.Results: The maximum amount of difference between the uptake of Rt and Lt condyles was 6.2 percent (Lt side and Rt side were 53.1 % and 46.9 %, respectively in the male patients and 5.7 percent in the female patients (Lt side and Rt side were 52.85 % and 47.15 %, respectively. The condylar activity difference and ratio of Lt to Rt condylar uptakes did not show a significant difference between the male and female groups.Conclusion: The difference between the growth activity of RT and LT normal TMJs was less than 6.2 percent.

  12. Marrow pattern in the proximal femoral metaphysis of patients with osteonecrosis of femoral head and normal subjects: comparison on MR images

    International Nuclear Information System (INIS)

    Chun, Ho Jong; Park, Jeong Mi; Kim, Jee Young; Lim, Gye Yeon; Yang, Po Song; Kim, Euy Neyong; Kim, Choon Yul; Shinn, Kyung Sub

    1996-01-01

    To predict early risk of osteonecrosis of the femoral head by comparison of the bone marrow pattern of the proximal femoral metaphysis(PFM) in normal subjects and patients with osteonecrosis of the femoral head on T1-weighted magnetic resonance(MR) images. The authors retrospectively reviewed T1(TR 525/TE 25 msec) weighted coronal MR images of 67 hips with osteonecrosis and 65 normal hips in 39 patients with osteonecrosis of the femoral head and in 27 normal subjects. On the basis of bright signal intensity of fat, the proportion of remaining hematopoietic marrow in PFM was subdivided into 4 grades (0 to 3) by two radiologists. No evidence of remaining hematopoietic marrow was assigned grade 0, and grades 1, 2 and 3 represented scanty, moderate, and prominent hematopoietic marrow, respectively. Grades 0 and 1 were collectively defined as 'predominantly fatty', grades 2 and 3 as 'predominantly hematopoietic'. The frequency of the predominantly fatty marrow in PFM was analyzed in relation to three age groups (<25, 25-50, 50<) and both sexes. The overall frequency of predominantly fatty marrow in PFM was higher in hips with osteonecrosis than in normal hips (p<0.001). Especially in the male population under the age of 50, the frequency was apparently higher in hips with osteonecrosis, compared with normal hips (p<0.0001). However, the male population aged over 50 or female population showed no statistically significant difference in our series. In proximal femoral metaphysis with osteonecrosis of the femoral head, fatty marrow conversion occurs apparently earlier than in normal subject. T1-weighted MR imaging could therefore be useful in predicting early risk of osteonecrosis of the femoral head because of early fatty marrow conversion of the proximal femoral metaphysis

  13. A micro-architectural evaluation of osteoporotic human femoral heads to guide implant placement in proximal femoral fractures.

    Science.gov (United States)

    Jenkins, Paul J; Ramaesh, Rishikesan; Pankaj, Pankaj; Patton, James T; Howie, Colin R; Goffin, Jérôme M; Merwe, Andrew van der; Wallace, Robert J; Porter, Daniel E; Simpson, A Hamish

    2013-10-01

    The micro-architecture of bone has been increasingly recognized as an important determinant of bone strength. Successful operative stabilization of fractures depends on bone strength. We evaluated the osseous micro-architecture and strength of the osteoporotic human femoral head. 6 femoral heads, obtained during arthroplasty surgery for femoral neck fracture, underwent micro-computed tomography (microCT) scanning at 30 μm, and bone volume ratio (BV/TV), trabecular thickness, structural model index, connection density, and degree of anisotropy for volumes of interest throughout the head were derived. A further 15 femoral heads underwent mechanical testing of compressive failure stress of cubes of trabecular bone from different regions of the head. The greatest density and trabecular thickness was found in the central core that extended from the medial calcar to the physeal scar. This region also correlated with the greatest degree of anisotropy and proportion of plate-like trabeculae. In the epiphyseal region, the trabeculae were organized radially from the physeal scar. The weakest area was found at the apex and peripheral areas of the head. The strongest region was at the center of the head. The center of the femoral head contained the strongest trabecular bone, with the thickest, most dense trabeculae. The apical region was weaker. From an anatomical and mechanical point of view, implants that achieve fixation in or below this central core may achieve the most stable fixation during fracture healing.

  14. The comparison of 5-field conformal radiotherapy techniques for the treatment of prostate cancer: The best for femoral head sparing

    International Nuclear Information System (INIS)

    Zare, Mahkameh; Lashkari, Marzieh; Ghalehtaki, Reza; Ghasemi, Arash; Dehghan Manshadi, Hamidreza; Mir, Ali; Noorollahi, Somayeh; Alamolhoda, Mahboobeh

    2016-01-01

    External radiotherapy is a standard treatment procedure for localized prostate cancer. Given the relatively high long term survival treatment complications have been brought in center of attention. In this planning study, between 2012 and 2014, CT simulation data of 90 consecutive high-risk prostate cancer patients were collected. In the first phase, all were planned for whole pelvis irradiation up to 46Gy in 23 daily fractions. In the second phase, only the prostate gland was the target of radiation. Next, the subjects were divided randomly into three groups and each received a unique 5field conformal radiation plan including Plan A (Gantry angle: 0, 60, 120, 240, and 300), Plan B (Gantry angles: 0, 90, 120, 240, and 270) and Plan C (Gantry angles: 0, 60, 90, 270, and 300). The total dose was 70Gy. For each patient, the rectum, bladder, and both femoral heads were contoured as the at risk organs (OAR). From dose volume histograms, the proportional dose of PTV V100, the bladder and rectum V80 and V90 and femoral head V50 and V100 were calculated in all subjects and compared across plans. A statistically significant difference in the femoral head V50 and V100 was found between our studied 5field plans so that in Plan A (beam angles: 0, 60, 120, 240 and 300) less dose was received by both heads of femur. This study suggests that 5 field treatment planning including an anterior, two anterior oblique and two posterior oblique portals to be more proper for 3D conformal radiotherapy in order to spare femoral head with acceptable PTV coverage, and bladder and rectal doses.

  15. Late presentation of fractures of the lateral condyle of the humerus in children

    Directory of Open Access Journals (Sweden)

    Shyam K Saraf

    2011-01-01

    Full Text Available Background: The current controversy regarding the management of fractures of the lateral condyle of the humerus presenting between 3 to 12 weeks prompted us to evaluate our results of open reduction and internal fixation of such fractures. Patients and Methods: Twenty-one patients operated between March 1995 and February 2001 qualified for this study. Five patients presented between 3-4 weeks, nine between 5-8 weeks and seven between 9-12 weeks post injury. Ten fractures were classified as stage II and eleven as stage III (Jacob et al. criteria. The mean age was 8 years (range: 4-14 years. All patients underwent surgery (open reduction and internal fixation with K-wires/screw, with or without bone grafting. The results were assessed by the modified criteria of Agarwal et al. after an average follow-up of 2.3 years. Results: Excellent to good results were observed in all the five patients presenting at 3-4 weeks post injury. In the patients presenting at 5-8 weeks, the results were excellent in one, good in four, fair in three, and poor in one patient. The fracture united in all cases; however, malunion was observed in four patients. The fractures that were operated at 9-12 weeks showed good results in one case, fair result in three cases, and poor result in three cases. Avascular necrosis of the lateral condyle in one patient, premature fusion in two patients, pin tract infection in three patients, and gross restriction of elbow movements in three patients were the major complications in this group. Accurate reduction was difficult as a result of new bone formation and remodeling at the fracture surfaces. Multiple incisions over the common extensor aponeurosis and bone graft supplementation were helpful for achieving acceptable reduction. Conclusion: Open reduction and internal fixation is recommended in all cases of displaced fractures of the lateral condyle of the humerus presenting at up to 12 weeks post injury. However, the results become

  16. Surgery for pathological proximal femoral fractures, excluding femoral head and neck fractures: resection vs. stabilisation.

    Science.gov (United States)

    Zacherl, Max; Gruber, Gerald; Glehr, Mathias; Ofner-Kopeinig, Petra; Radl, Roman; Greitbauer, Manfred; Vecsei, Vilmos; Windhager, Reinhard

    2011-10-01

    Pathological femoral head and neck fractures are commonly treated by arthroplasty. Treatment options for the trochanteric region or below are not clearly defined. The purpose of this retrospective, comparative, double-centre study was to analyse survival and influences on outcome according to the surgical technique used to treat pathological proximal femoral fractures, excluding fractures of the femoral head and neck. Fifty-nine patients with 64 fractures were operated up on between 1998 and 2004 in two tertiary referral centres and divided into two groups. One group (S, n = 33) consisted of patients who underwent intramedullary nailing alone, and the other group (R, n = 31) consisted of patients treated by metastatic tissue resection and reconstruction by means of different implants. Median survival was 12.6 months with no difference between groups. Surgical complications were higher in the R group (n = 7) vs. the S group (n = 3), with no statistically significant difference. Patients with surgery-related complications had a higher survival rate (p = 0.049), as did patients with mechanical implant failure (p = 0.01). Survival scoring systems did not correlate with actual survival. Resection of metastases in patients with pathological fractures of the proximal femur, excluding femoral head and neck fractures, has no influence on survival. Patients with long postoperative survival prognosis are at risk of implant-related complications.

  17. Femoral head vitality after intracapsular hip fracture

    International Nuclear Information System (INIS)

    Stroemqvist, B.

    1983-01-01

    Femoral head vitality before, during and at various intervals from the operation was determined by tetracycline labeling and/or 99 sp (m)Tc-MDP scintimetry. In a three-year follow-up, healing prognosis could be determined by scintimetry 3 weeks from operation; deficient femoral head vitality predicting healing complications and retained vitality predicting uncomplicated healing. A comparison between pre- and postoperative scintimetry indicated that further impairment of the femoral head vitality could be caused by the operative procedure, and as tetracycline labeling prior to and after fracture reduction in 370 fractures proved equivalent, it was concluded that the procedure of osteosynthesis probably was responsible for capsular vessel injury, using a four-flanged nail. The four-flanged nail was compared with a low-traumatic method of osteosynthesis, two hook-pins, in a prospective randomized 14 month study, and the postoperative femoral head vitality was significantly better in the hook-pin group. This was also clearly demonstrated in a one-year follow-up for the fractures included in the study. Parallel to these investigations, the reliability of the methods of vitality determination was found satisfactory in methodologic studies. For clinical purpose, primary atraumatic osteosynthesis, postoperative prognostic scintimetry and early secondary arthroplasty when indicated, was concluded to be the appropriate approach to femoral neck fracture treatment. (Author)

  18. Early detection by sup(99m)Tc-Sn-pyrophosphate scintigraphy of femoral head necrosis following medial femoral neck fractures

    International Nuclear Information System (INIS)

    Greiff, J.; Lanng, S.; Hoeilund-Carlsen, P.F.; Karle, A.K.; Uhrenholdt, A.

    1980-01-01

    A selected series of 24 patients with displaced medial femoral neck fracture, treated with closed reduction and osteosynthesis with cancellous bone screws (ASIF), were investigated. During an observation period of 6 to 26 months, serial hip joint scintigraphies were performed and compared with serial X-ray examinations. At the first scintigraphic examination performed on average 5-6 weeks after the fracture, two separate investigators found a decreased amount of activity or no activity in the femoral head of 10 and 8 patients, respectively. At the second scintigraphic examination performed on average 11.1 weeks after the fracture both investigators found no activity or a decreased amount of activity in 8 patients. This figure declined to 7 during the following period, because one patient with decreased activity was recorded as having normal activity 15 months after the fracture. These 7 patients all developed radiological signs of femoral head collapse on average 16.3 months after the fracture (range 5-26 months), whereas their scintigrams displayed decreased or absent tracer uptake on average 1.2 months after the fracture (P<0.01). None of the patients with initially normal or increased uptake later showed decreased or absent uptake during the study and none developed radiological collapse. It may be concluded that absent or decreased uptake of sup(99m)Tc-Sn-pyrophosphate in the femoral head following medial femoral neck fracture indicates femoral head necrosis and a high risk of late segmental collapse, whereas normal or increased uptake implying preserved blood supply means that late segmental collapse will probably never develop. (author)

  19. Current Concepts in the Mandibular Condyle Fracture Management Part I: Overview of Condylar Fracture

    OpenAIRE

    Choi, Kang-Young; Yang, Jung-Dug; Chung, Ho-Yun; Cho, Byung-Chae

    2012-01-01

    The incidence of condylar fractures is high, but the management of fractures of the mandibular condyle continues to be controversial. Historically, maxillomandibular fixation, external fixation, and surgical splints with internal fixation systems were the techniques commonly used in the treatment of the fractured mandible. Condylar fractures can be extracapsular or intracapsular, undisplaced, deviated, displaced, or dislocated. Treatment depends on the age of the patient, the co-existence of ...

  20. Distraction of the temporomandibular joint condyle in patients with unilateral non-reducing disc displacement: Fact or fiction?

    Science.gov (United States)

    Yıldız, Melih; Çağatay Dayan, Süleyman; Şakar, Olcay; Sülün, Tonguç

    2017-07-24

    This study investigated the distractive effect of a unilateral pivot splint on patients with unilateral disc displacement without reduction. The study group was comprised of 18 patients who had no history of treatment with removable prosthetic restorations of molars, premolars, or canine teeth, and no previous treatment for temporomandibular disorder. Joint spaces measurements made on magnetic resonance images indicated the affected side to be narrower than the healthy side. Unilateral distraction splints were made for all patients. An ultrasonic motion analyzer was used to measure the vertical shift occurring on the affected side as patients closed their mouths with maximal force with the splint in their mouths. Closing with maximal force on the unilateral distraction splint led to a noticeable downward movement of the affected condyle. The findings of this study indicate that the TMJ condyle of patients with unilateral disc displacement without reduction may be unilaterally distracted if the articular space is narrowed.

  1. 3D atlas-based registration can calculate malalignment of femoral shaft fractures in six degrees of freedom.

    Science.gov (United States)

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

    2014-01-01

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

  2. A lateral approach to the repair of propagating fractures of the medial condyle of the third metacarpal and metatarsal bone in 18 racehorses.

    Science.gov (United States)

    Wright, Ian M; Smith, Matthew R W

    2009-08-01

    To report the technique, observations on fracture configurations and results of treatment by fixation lag screw following the fracture plane determined by an approach to the third metacarpal/metatarsal bone (MC3/MT3) that begins laterally over the metacarpo(metatarso)phalangeal joint and extends dorsally over the diaphysis of the bone. Case series. Thoroughbred horses (n=18) with propagating fractures of the medial condyle of MC3/MT3. Retrospective analysis of case records of horses with fractures of the medial condyle of MC3/MT3 that propagated sagittaly or in a spiral configuration into the diaphysis, repaired surgically under general anesthesia by screw fixation in lag fashion through a lateral approach with periosteal reflection. Fractures were readily identified at surgery, enabling screw fixation in lag fashion following the fracture plane. Fracture configurations varied and could be classified as sagittal and spiral fractures with fractures within each group generally following a similar course. All horses recovered relatively uneventfully from general anesthesia and surgery, and all fractures healed well. Thirteen horses returned to training; 5 subsequently raced. Repair of propagating sagittal and spiral fractures of the medial condyle of MC3/MT3 with diaphyseal involvement, through a lateral approach with periosteal reflection permits stable fixation with minimal complications. In this series there were no catastrophic failures. Fractures of the medial condyle of MC3/MT3 that propagate either sagittaly or in a spiral configuration into the diaphysis can be successfully repaired with screw fixation in lag fashion using a lateral approach with periosteal reflection.

  3. Post wall fixation by lag screw only in associated both column fractures with posterior wall involvement.

    Science.gov (United States)

    Wang, Hu; Utku, Kandemir; Zhuang, Yan; Zhang, Kun; Fu, Ya-Hui; Wei, Xing; Wang, Peng-Fei; Cong, Yu-Xuan; Lei, Jin-Lai; Zhang, Bin-Fei

    2017-07-01

    To evaluate the quality of reduction, clinical outcomes and complications of associated both column acetabular fractures with posterior wall involvement that are treated through single ilioinguinal approach and fixation of posterior wall by lag screws only. We conducted a retrospective review involving ninety-nine consecutive patients with associated both column fractures of acetabulum treated through single ilioinguinal approach. Patients were divided into two groups. The first group consisted of 35 patients presented with both column fractures with posterior wall involvement that fixation performed with lag screws. This group was compared to a second group of 64 patients with both column fractures without posterior wall involvement. The quality of reduction was assessed using criteria described by Matta. The size of posterior wall fragment was measured. Functional outcome was evaluated using Modified Postel Merle D'Aubigne score. Radiographs at the latest follow up were analyzed for arthritis (Kellgren-Lawrence classification), and femoral head avascular necrosis (Ficat/Arlet classification). The study showed no significant differences in all preoperative variables (P>0.05). While intraoperative blood loss and operative time in group 1 were increased compared to group 2, the difference was not statistically significant (P>0.05). The height, relative depth and peripheral length of posterior wall respectively were 27.8±2.5mm (range: 24-35mm), 71.5±5.4% (range: 65-88%), 23.0±2.3mm (range: 17-28mm). The mean posterior wall fracture displacement is 5.0±3.2mm (range: 0-11mm). There was no difference regarding the quality of reduction between the two groups (P>0.05). The excellent to good clinical outcome was around 71.4% in the group 1 versus 73.4% in the group 2 at the final follow-up, this difference was not statistically significant (P>0.05). There was no difference in rate of complications between the two groups (P>0.05). Lag screws fixation of posterior wall

  4. Posterior glenoid rim deficiency in recurrent (atraumatic) posterior shoulder instability

    International Nuclear Information System (INIS)

    Weishaupt, D.; Zanetti, M.; Hodler, J.; Nyffeler, R.W.; Gerber, C.

    2000-01-01

    Objective. To assess the shape of the posterior glenoid rim in patients with recurrent (atraumatic) posterior instability.Design and patients. CT examinations of 15 shoulders with recurrent (atraumatic) posterior instability were reviewed in masked fashion with regard to abnormalities of the glenoid shape, specifically of its posterior rim. The glenoid version was also assessed. The findings were compared with the findings in 15 shoulders with recurrent anterior shoulder instability and 15 shoulders without instability. For all patients, surgical correlation was available.Results. Fourteen of the 15 (93%) shoulders with recurrent (atraumatic) posterior shoulder instability had a deficiency of the posteroinferior glenoid rim. In patients with recurrent anterior instability or stable shoulders such deficiencies were less common (60% and 73%, respectively). The craniocaudal length of the deficiencies was largest in patients with posterior instability. When a posteroinferior deficiency with a craniocaudal length of 12 mm or more was defined as abnormal, sensitivity and specificity for diagnosing recurrent (atraumatic) posterior instability were 86.7% and 83.3%, respectively. There was a statistically significant difference in glenoid version between shoulders with posterior instability and stable shoulders (P=0.01).Conclusion. Recurrent (atraumatic) posterior shoulder instability should be considered in patients with a bony deficiency of the posteroinferior glenoid rim with a craniocaudal length of more than 12 mm. (orig.)

  5. Ultrasound in the evaluation of the knee in hemophilic patients

    International Nuclear Information System (INIS)

    Bagnolesi, P.; Romagnoli, C.; Perri, G.; Trippi, D.; Marini, C.

    1988-01-01

    The authors report their experience with ultrasound in the examination of the knee in 60 hemophiliacs over a 2-year period. The results prove US to be extremely usefule in the demostration of the hemartros, as well as the synovial involvement, and the articular cartilager of femoral condyles

  6. Mechanical properties of cancellous bone in the human mandibular condyle are anisotropic

    DEFF Research Database (Denmark)

    Giesen, EB; Ding, Ming; Dalstra, M

    2001-01-01

    The objective of the present study was (1) to test the hypothesis that the elastic and failure properties of the cancellous bone of the mandibular condyle depend on the loading direction, and (2) to relate these properties to bone density parameters. Uniaxial compression tests were performed......). Archimedes' principle was applied to determine bone density parameters. The cancellous bone was in axial loading 3.4 times stiffer and 2.8 times stronger upon failure than in transverse loading. High coefficients of correlation were found among the various mechanical properties and between them...

  7. Femoral Head Avascular Necrosis Is Not Caused by Arthroscopic Posterolateral Femoroplasty.

    Science.gov (United States)

    Rupp, Robert E; Rupp, Sasha N

    2016-05-01

    This study was conducted to identify the risk of avascular necrosis of the femoral head after arthroscopic femoroplasty extending to the posterolateral femoral neck, the source of the primary blood supply to the femoral head. Cam lesions of femoroacetabular impingement are typically anterior along the junction of the femoral head and neck. However, anatomic variations can involve the posterolateral vascular region of the femoral head and neck. Femoroplasty involving this vascular region can lead to injury to the blood supply to the femoral head, with subsequent avascular necrosis. If the posterolateral portion of the cam lesion is preserved, persistent femoroacetabular impingement may occur. A retrospective review identified 112 patients who underwent arthroscopic femoroplasty for femoroacetabular impingement over a 2-year period. Of these patients, 14 had femoroplasty that extended to the posterolateral femoral head. Of this group, 5 had undergone magnetic resonance imaging (MRI) after femoroplasty and the other 9 were contacted to undergo MRI of the hip to evaluate for avascular necrosis. A radiologist and the senior author evaluated all MRI scans specifically for avascular necrosis of the femoral head. All procedures were performed by the senior author. Mean age of the 14 patients (8 women and 6 men) with femoroplasty that extended into the posterolateral vascular region of the femoral head was 44 years (range, 23-69 years). All 14 patients underwent MRI evaluation of the affected hip a mean of 25 months (range, 7-44 months) after femoroplasty. No MRI scans showed evidence of avascular necrosis of the femoral head. Femoroplasty of the posterolateral vascular region of the femoral head is not associated with avascular necrosis. Patients with femoroacetabular impingement and a cam lesion extending to the posterolateral femoral head can undergo femoroplasty of this region without the development of avascular necrosis. [Orthopedics. 2016; 39(3):177-180.]. Copyright

  8. Selective arteriography in femoral head fractures

    Energy Technology Data Exchange (ETDEWEB)

    Mannella, P; Galeotti, R; Borrelli, M; Benea, G; Massari, L; Chiarelli, G M

    1986-01-01

    The choice between conservative and radical operation in case of femoral neck fractures is very important because it is the determining factor for a successfull therapy. In case of epiphysial necrosis, an endoprosthesis as well as an osteosynthesis will be carried out. Selective arteriography of the medical circumflex artery represents the most reliable study to establish, immediately after the fractures, the possible presence of a post-traumatic ischemic necrosis. Angiography, as a reliable diagnostic tool, has to be carried out in the most selective way and needs the image subtraction technique. The authors report their preliminary results on the reliability of angiography in the femoral epiphyseal ischemic necrosis diagnosed by comparing the results of angiography with the wood light test carried out on the surgically removed femoral head. 18 refs.

  9. [Femoral artery pseudoaneurysms encountered in orthopedics and traumatology].

    Science.gov (United States)

    Raherinantenaina, F; Rajaonanahary, T M A; Rakoto Ratsimba, H N

    2015-12-01

    Most published articles regarding orthopedic- and trauma-related femoral artery pseudoaneurysms (FAPs) are case reports in English. Reported cases are often associated with a literature review but actually provide little robust data. We wanted to summarize the current knowledge on diagnostic and therapeutic features of these FAPs. A new case of superficial FAP is described followed by a review of the literature. A bibliographic search was performed online (PubMed, ScinceDirect) from 1964 to 2015 using the descriptors "traumatic femoral pseudoaneurysm, orthopedic surgery, osteochondroma". A total of 64 cases of FAPs was analyzed. There were 50 men with an average age of 40.72±26.45 years old. The most common clinical presentation was painful swelling (34%). Arteriography was the commonest radiological investigation used (63%). The main etiologies were orthopedic injuries (47%), surgery of the upper thigh (30%) and femoral osteochondromas (23%). Arterial injuries included superficial femoral (47%) and profunda femoris artery (50%). The treatment was open surgery (56%) or endovascular repair (36%). Deep femoral artery and its branches were embolized (47%) or ligated (38%). Endovascular stenting was performed in 30% of posttraumatic FAPs. All FAPs relating to osteochondromas were repaired surgically. Postoperative courses were uneventful in 95% of patients. Endovascular embolization is preferred in management of postsurgical FAPs which have usually involved the deep femoral artery. Endovascular stenting graft may be proposed for posttraumatic FAPs, for which the superficial femoral trunk is the most often involved vessel. Surgical repair should be performed when endovascular stenting graft is not feasible. Surgical repair is mandatory for all FAPs secondary to traumatic exostoses. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  10. Surgery of Craniocervical Meningiomas | El-Naggar | Alexandria ...

    African Journals Online (AJOL)

    Methods: Twenty six patients with craniocervical meningiomas were operated upon during the period from 2000 to 2009 using the standard posterior approach for posterior lesions (14 cases), extreme lateral approach without drilling of the occipital condyle in the antrolateral and posterolateral lesions(6 cases) and ...

  11. A study on secondary images in panoramic radiograph

    International Nuclear Information System (INIS)

    Cho, Dai Hee; Kim, Han Pyong

    1984-01-01

    This study was performed to observe the secondary images and to analyse the relationships between the primary and secondary images in panoramic radiograph. Using the Morita's Panex-EC panoramic x-ray machine and the human dry skull, the author analysed 17 radiographs which were selected from 65 radiographs of the dry skull that attached the radiopaque materials, and the attached regions of the radiopaque materials were the normal anatomical structures which were important and selected as a region for the evaluation of the secondary images effectively. The results were as follows; 1. The cervical vertebrae showed three images. The midline image was the most distorted and less clear, and bilateral images were slightly superimposed over the posterior border of the mandibular ramus. 2. In mandible, the secondary image of the posterior border of the ramus was superimposed on the opposite ramus region, and this image was elongated from the anterior border of the ramus to the lateral side of the posterior border of the ramus. The secondary image of the condyle was observed on the upper area of the coronoid process, the sigmoid notch and the condyle in opposite side. 3. In maxilla, the posterior region of the hard palate showed the secondary image on the lower part of the nasal cavity and the medial wall of the maxillary sinus. 4. The primary images of the occipital condyle and the mastoid process appeared on the same region, and only the secondary image of the occipital condyle was observed symmetrically on the opposite side with similar shape to the primary one. 5. In the cranial base, the anatomical structures of the midsagittal portions like a inferior border of the frontal sinus, sella turcica, inferior border of the sphenoid sinus and inferior border of the posterior part of the occipital bone showed the similar shape between the primary and secondary images symmetrically. 6. The petrous portion of the temporal bone showed the secondary image of the lateral side of

  12. Recovery of mouth-opening after closed treatment of a fracture of the mandibular condyle : a longitudinal study

    NARCIS (Netherlands)

    Niezen, E. T.; Stuive, I.; Post, W. J.; Bos, R. R. M.; Dijkstra, P. U.

    The aim of this retrospective study was to assess recovery of mouth opening after closed treatment of fractures of the mandibular condyle, and analyse which characteristics might influence recovery. We measured mouth opening in 142 patients (mean (SD) age 30 (14) years, 96 of whom were male) during

  13. [Midterm follow-up results on Asian femoral intramedullary nail for the treatment of segmental and comminuted femoral fractures].

    Science.gov (United States)

    Li, Lang; Gao, Feng; Huang, Qi; Li, Qiang; Xie, Lin; Zhang, Bin

    2016-06-01

    To investigate midterm follow-up results on Asian femoral intramedullary nail in treating segmental and comminuted femoral fractures. Between June 2011 and October 2012,16 patients with segmental and comminuted femoral fractures were treated with minimally invasive reset and Asian femoral intramedullary nail under extension table. Among them, there were 10 males and 6 females aged from 21 to 49 years old with an average of 34.5 years old; the time from injury to operation ranged from 3 to 24 d with an average of 9.1 d. There were 6 cases were type C1,2 cases were type C2 and 8 cases were type C3 according to AO classification. X-ray of femoral segment at 3,6 and 12 months after operation were applied for evaluating fracture healing. Harris score of hip joint and HSS score of knee joint were used to evaluate postoperative function. All patients were followed up from 24 to 36 months with an average of 28.4 months. Operative time was from 88 to 112 min with an average of 90.7 min; blood loss ranged from 150 to 200 ml with an average of 188.75 ml; the time of fracture healing was from 5 to 9 months with an average of 5.4 months. All incision were healed at stage I. No loosening, breakage of internal fixation and displacement of fracture were occurred. There were no significant differences in Harris score of hip joint at 3, 6 and 12 months after operation (F = 0.07, P = 0.893 > 0.05), 10 cases obtained excellent results, 5 good and 1 moderate. There was no obvious meaning in HSS score of knee joint (F = 0.08,P = 0.876 > 0.05), 9 cases obtained excellent results, 6 good and 1 poor. Asian femoral intramedullary nail could treat segmental and comminuted femoral fractures by using variety of less invasive ways,which has advantages of less trauma, quick recovery of function and satisfied midterm following-up results. But long term following-up effects remains to be seen.

  14. Epidemiology and treatment outcome of surgically treated mandibular condyle fractures. A five years retrospective study.

    Science.gov (United States)

    Zrounba, Hugues; Lutz, Jean-Christophe; Zink, Simone; Wilk, Astrid

    2014-09-01

    Surgical management of mandibular condyle fractures is still controversial. Although it provides better outcome than closed treatment questions still remain about the surgical approach and the osteosynthesis devices to be used. Between 2005 and 2010, we managed 168 mandibular condyle fractures with open treatment. Two surgical approaches were used in this study, a pre-auricular and a high submandibular approach (one or the other or as a combined approach). Internal fixation was performed using TCP(®) plates (Medartis, Basel, Switzerland) or with two lag screws (15 and 17 mm). Delta plates were used in 15 cases (8.9%). We report the epidemiology of these fractures and the outcomes of the surgical treatment. We assessed the complications related to the surgical procedure and those related to the osteosynthesis material. The facial nerve related complication rate was very low and the osteosynthesis materials used proved to be strong enough to realize a stable fixation. The two approaches used in this study appeared to be safe with good aesthetic results. Most of the surgical procedure failures occurred in high subcondylar fractures especially when bilateral. Copyright © 2014 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  15. Estimated carotid-femoral pulse wave velocity has similar predictive value as measured carotid-femoral pulse wave velocity

    DEFF Research Database (Denmark)

    Greve, Sara V; Blicher, Marie K; Kruger, Ruan

    2016-01-01

    BACKGROUND: Carotid-femoral pulse wave velocity (cfPWV) adds significantly to traditional cardiovascular risk prediction, but is not widely available. Therefore, it would be helpful if cfPWV could be replaced by an estimated carotid-femoral pulse wave velocity (ePWV) using age and mean blood pres...... that these traditional risk scores have underestimated the complicated impact of age and blood pressure on arterial stiffness and cardiovascular risk....

  16. A cementless, proximally fixed anatomic femoral stem induces high micromotion with nontraumatic femoral avascular necrosis: A finite element study

    Directory of Open Access Journals (Sweden)

    Wen-Chuan Chen

    2014-07-01

    Full Text Available Decrease in bone mineral density of metaphysis in patients with nontraumatic avascular necrosis of the femoral head (AVN is considered the main factor leading to aseptic loosening of the femoral component. Researchers have hypothesized that a cementless, anatomic stem fixed proximally to the metaphysis has a higher risk for aseptic loosening than a straight stem that is fixed at the diaphysis in patients with nontraumatic AVN. The purpose of the current study was to evaluate the effects of cancellous bone stiffness at the metaphysis and stem geometry on the micromotion of the femoral stem relative to the femur. The VerSys (straight and ABG (anatomic femoral stems were enrolled in this finite element study to determine the performance of prosthetic micromotion. The simulated load to the hip joint during heel strike was assigned. Results showed that the VerSys model represented better resistance in micromotion between the bone/stem interface than the ABG model in either normal or poor cancellous bone stiffness at the metaphysis. The bone quality at the metaphysis of patients with nontraumatic AVN should be considered prior to selecting a femoral stem. In consideration of initial stability, acementless, straight stem that fits the isthmus is more favourable than an anatomic stem that is fixed to the proximal area of the canal.

  17. Treatment of the femoral neck peudoarthrosis in childhood: Case report

    Directory of Open Access Journals (Sweden)

    Vukašinović Zoran

    2013-01-01

    Full Text Available Introduction. Femoral neck fractures in children and adolescents are rare. However, their complications are frequent - avascular necrosis, femoral neck pseudoarthrosis, premature physeal closure with consequent growth disturbance and coxa vara deformity. Case Outline. A 9.5­year­old boy was injured in a car accident, and femoral neck fracture was diagnosed. Prior to admission at our hospital he was surgically treated several times. He was admitted at our hospital eight months following the accident. On the X­ray transcervical pseudoarthrosis of the femoral neck was found, as well as coxa vara deformity and metaphyseal avascular necrosis. He was operated at our hospital; all previously placed ostefixation material was removed, valgus osteotomy of 30 degrees was done as well as additional local osteoplasty using the commercial osteoindactive agent (Osteovit®. Postoperatively, we applied skin traction, bed rest and physical therapy. At the final follow­up, the patient was recovered completely. He is now painless, the legs are of equal length, range of movements in the left hip is full, life activity is normal. The X­ray shows that the femoral neck pseudoarthrosis is fully healed. Conclusion. This case is presented in order to encourage other colleagues to challenge the problematic situation such as this one. Also, we would like to remind them what one should think about and what should be taken into consideration in the primary treatment of femoral neck fractures in children. Valgus femoral osteotomy, as a part of the primary treatment of femoral neck fracture in children (identically as in the adults can prevent the occurrence of femoral neck pseudoarthrosis.

  18. Femoral neck fractures complicating gaucher disease in children

    International Nuclear Information System (INIS)

    Goldman, A.B.; Jacobs, B.

    1984-01-01

    In normal children, fractures of the femoral neck are uncommon and accompany severe trauma and multiple injuries elsewhere in the skeleton. In children with Gaucher disease, a rare hereditary disorder of lipid metabolism, midcervical or basicervical fractures can occur with minor or no trauma and without other injury to the skeleton. Three children with Gaucher disease who developed pathologic fractures of the femoral neck are described. In all three, the fractures occurred between five and nine years of age, and the fracture lines passed through areas of abnormal bone characterized by poorly defined patches of increased and decreased density and cortical thinning along the medial femoral necks. In the affected hips, there was no evidence of avascular necrosis of the femoral heads at the time of injury. One child's fracture was preceeded by multiple bone 'crisis' localized to the proximal femora. (orig.)

  19. Femoral neck fractures complicating gaucher disease in children

    Energy Technology Data Exchange (ETDEWEB)

    Goldman, A B; Jacobs, B

    1984-09-01

    In normal children, fractures of the femoral neck are uncommon and accompany severe trauma and multiple injuries elsewhere in the skeleton. In children with Gaucher disease, a rare hereditary disorder of lipid metabolism, midcervical or basicervical fractures can occur with minor or no trauma and without other injury to the skeleton. Three children with Gaucher disease who developed pathologic fractures of the femoral neck are described. In all three, the fractures occurred between five and nine years of age, and the fracture lines passed through areas of abnormal bone characterized by poorly defined patches of increased and decreased density and cortical thinning along the medial femoral necks. In the affected hips, there was no evidence of avascular necrosis of the femoral heads at the time of injury. One child's fracture was preceeded by multiple bone 'crisis' localized to the proximal femora.

  20. Comparison of MRI T2 Relaxation Changes of Knee Articular Cartilage before and after Running between Young and Old Amateur Athletes

    International Nuclear Information System (INIS)

    Cha, Jang Gyu; Jeon, Chan Hong; Lee, Eun Hye; Lee, Jae Chul; Kim, Hyun Joo; Han, Jong Kyu; Kim, Yong Dai

    2012-01-01

    To compare changes in T2 relaxation on magnetic resonance (MR) images of knee articular cartilage in younger and older amateur athletes before and after running. By using a 3.0-T MR imager, quantitative T2 maps of weight-bearing femoral and tibial articular cartilages in 10 younger and 10 older amateur athletes were acquired before, immediately after, and 2 hours after 30 minutes of running. Changes in global cartilage T2 signals of the medial and lateral condyles of the femur and tibia and regional cartilage T2 signals in the medial condyles of femoral and tibia in response to exercise were compared between the two age groups. Changes in global cartilage T2 values after running did not differ significantly between the age groups. In terms of the depth variation, relatively higher T2 values in the older group than in the younger group were observed mainly in the superficial layers of the femoral and tibial cartilage (p < 0.05). Age-related cartilage changes may occur mainly in the superficial layer of cartilage where collagen matrix degeneration is primarily initiated. However, no trend is observed regarding a global T2 changes between the younger and older age groups in response to exercise.

  1. Quantitative Ultrasound Assessment of Cartilage Degeneration in Ovariectomized Rats with Low Estrogen Levels.

    Science.gov (United States)

    Wang, Qing; Liu, Zhiwei; Wang, Yinong; Pan, Qingya; Feng, Qianjin; Huang, Qinghua; Chen, Wufan

    2016-01-01

    The aim of this study was to assess quantitatively the site-specific degeneration of articular cartilage in ovariectomized rats with low estrogen levels using a high-frequency ultrasound system. Fourteen female Sprague-Dawley rats were randomly divided into two groups (n = 7 per group): a sham group in which only the peri-ovarian fatty tissue was exteriorized and an ovariectomized group that underwent bilateral ovariectomy to create a menopause model with low estrogen levels. All animals were sacrificed at the end of the third week after ovariectomy. Hindlimbs were harvested. The articular cartilage from five anatomic sites (i.e., femoral caput [FC], medial femoral condyle [MFC], lateral femoral condyle [LFC], medial tibial plateau [MTP] and lateral tibial plateau [LTP]) was examined with ultrasound. Four parameters were extracted from the ultrasound radiofrequency data: reflection coefficient of the cartilage surface (RC1), reflection coefficient of the cartilage-bone interface (RC2), ultrasound roughness index (URI) and thickness of the cartilage tissue. The results indicated significant (p reduction induces morphologic and acoustic alterations in the articular cartilage of the hip and knee joints in ovariectomized rats. Copyright © 2016 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  2. Menopause is associated with articular cartilage degeneration: a clinical study of knee joint in 860 women.

    Science.gov (United States)

    Lou, Chao; Xiang, Guangheng; Weng, Qiaoyou; Chen, Zhaojie; Chen, Deheng; Wang, Qingqing; Zhang, Di; Zhou, Bin; He, Dengwei; Chen, Hongliang

    2016-11-01

    The purpose of this study was to investigate the association between menopause and severity of knee joint cartilage degeneration using a magnetic resonance imaging-based six-level grading system, with six cartilage surfaces, the medial and lateral femoral condyle, the femoral trochlea, the medial and lateral tibia plateau, and the patella. The study cohort comprised 860 healthy women (age 36-83 y), and 5,160 cartilage surfaces were analyzed. Age, weight, height, age at natural menopause, and years since menopause (YSM) were obtained. Cartilage degeneration was assessed using a magnetic resonance imaging-based six-level grading system. After removing the age, height, and weight effects, postmenopausal women had more severe cartilage degeneration than pre- and perimenopausal women (P  0.05). No significant difference was observed in lateral tibia plateau and lateral femoral condyle in postmenopausal women. Menopause is associated with cartilage degeneration of knee joint. After menopause, cartilage showed progressive severe degeneration that occurred in the first 25 YSM, suggesting estrogen deficiency might be a risk factor of cartilage degeneration of the knee joint. Further studies are needed to investigate whether age or menopause plays a more important role in the progression of cartilage degeneration in the knee joint.

  3. frequency of ipsilateral femoral neck fractures in patients

    African Journals Online (AJOL)

    Background: Ipsilateral associated femoral neck and shaft fractures are reported to occur in 2.5-6% of all femoral shaft ... nailing of the shaft fracture, which makes treatment of the neck ... chest, spine), while the other had maxillofacial injuries.

  4. Bone bruise in acute traumatic patellar dislocation: volumetric magnetic resonance imaging analysis with follow-up mean of 12 months

    Energy Technology Data Exchange (ETDEWEB)

    Paakkala, Antti; Paakkala, Timo [Tampere University Hospital, Department of Radiology, Tampere (Finland); Sillanpaeae, Petri; Maeenpaeae, Heikki [Tampere University Hospital, Department of Orthopaedics and Traumatology, Tampere (Finland); Huhtala, Heini [University of Tampere, School of Public Health, Tampere (Finland)

    2010-07-15

    The aim of the study was to assess volumetric analysis of bone bruises in acute primary traumatic patellar dislocation by magnetic resonance imaging (MRI) and resolving resolution of bruises in follow-up MRI. MRI was performed in 23 cases. A follow-up examination was done at a mean of 12 months after dislocation. Volumes of patellar and femur bruises for every patient were evaluated separately by two musculoskeletal radiologists, and mean values of the bruises were assessed. Other MRI findings were evaluated, together with agreement by consensus. Bone bruise volumes were compared with other MR findings. In the acute study 100% of patients showed bruising of the lateral femoral condyle and 96% bruising of the patella. The bruise was located at the medial femoral condyle in 30% and at the patellar median ridge in 74% of patients. The median volume of the femoral bruise was 25,831 mm{sup 3} and of the patellar bruise 2,832 mm{sup 3}. At the follow-up study 22% of patients showed bruising of the lateral femoral condyle and 39% bruising of the patella, the median volumes of the bruises being 5,062 mm{sup 3} and 1,380 mm{sup 3}, respectively. Larger patellar bruise volume correlated with larger femur bruise volume in the acute (r=0.389, P=0.074) and the follow-up (r=1.000, P<0.01) studies. Other MRI findings did not correlate significantly with bone bruise volumes. Bone bruising is the commonest finding in cases of acute patellar dislocation, being seen even 1 year after trauma and indicating significant bone trabecular injury in the patellofemoral joint. A large bruise volume may be associated with subsequent chondral lesion progression at the patella. We concluded that the measurement of bone bruise volume in patients with acute patellar dislocation is a reproducible method but requires further studies to evaluate its clinical use. (orig.)

  5. Proximal femoral fractures

    DEFF Research Database (Denmark)

    Palm, Henrik; Teixidor, Jordi

    2015-01-01

    searched the homepages of the national heath authorities and national orthopedic societies in West Europe and found 11 national or regional (in case of no national) guidelines including any type of proximal femoral fracture surgery. RESULTS: Pathway consensus is outspread (internal fixation for un...

  6. Three-dimensional computerized tomography in mandibular condyle fractures

    International Nuclear Information System (INIS)

    Bermeo, Fausto; Salazar, Abad

    2003-01-01

    Now, car accidents are so commons, this associated to the high technology in produce automobiles make this type of accidents so serious and the consequences of mandibular condyle fractures are more commons and with more gravity, some of these patients, generally need a traqueostomy to be operated, that is why every second that we can save during the surgery is important. The normal exams as X rays and simple TAC give as an important idea but no complete, on the contrary the three-dimensional TAC permits to observe every damages and its exact location, this contribute to make a better surgery organization, the number and type of plates that we have to put and the better way to treat each case, that contribute to reduce time in operating theatre which is in benefit of the patient, diminishing risks in serious patients as they are, that is why we recommend the utilization of the three-dimensional TAC. (The author)

  7. Localized cortical thickening of the femoral diaphysis captured on an X-ray before alendronate therapy in two cases of atypical femoral fracture

    Energy Technology Data Exchange (ETDEWEB)

    Iizuka, Yoichi [Gunma University Graduate School of Medicine, Department of Orthopedic Surgery, Maebashi, Gunma (Japan); Shibukawa General Hospital, Department of Orthopedic Surgery, Shibukawa, Gunma (Japan); Takechi, Rumi [Gunma University Graduate School of Medicine, Department of Orthopedic Surgery, Maebashi, Gunma (Japan); Gunma Cardiovascular Center, Department of Orthopaedic Surgery, Maebashi, Gunma (Japan); Iizuka, Haku; Takagishi, Kenji [Gunma University Graduate School of Medicine, Department of Orthopedic Surgery, Maebashi, Gunma (Japan); Omodaka, Takuya [Gunma University Graduate School of Medicine, Department of Orthopedic Surgery, Maebashi, Gunma (Japan); Gunma Central Hospital, Department of Orthopedic Surgery, Maebashi, Gunma (Japan)

    2016-10-15

    We herein report two cases of atypical femoral fracture (AFF). X-ray examinations at the first visit of these two female patients showed a complete fracture of the femoral diaphysis diagnosed as an atypical femoral fracture (AFF). X-rays of these two cases also showed localized cortical thickening of the femoral diaphysis. Both patients had been taking alendronate for more than 3 years because of postmenopausal osteoporosis. We assumed that both of the fractures were associated with the long-term use of alendronate. However, we retrospectively identified localized cortical thickening of the femoral diaphysis on an X-ray taken before the alendronate therapy in both of these cases. Therefore, we suspected a pathogenesis of AFFs in which preexisting stress or an insufficient fracture unrelated to bisphosphonate (BP) therapy and subsequent suppression of bone turnover due to BP administration led to the occurrence of an AFF. The patient underwent surgery using intramedullary nails in both of these cases, followed by the administration of teriparatide, and they were able to walk without any support at the final follow-up examination. (orig.)

  8. Iodixanol in femoral arteriography

    International Nuclear Information System (INIS)

    Thorstensen, Oe.; Albrechtsson, U.; Calissendorff, B.; Larusdottir, H.; Norgren, L.; Tengvar, M.; Bolstad, B.; Aspelin, P.

    1994-01-01

    Two contrast media, iodixanol (Visipaque, Nycomed) 270 mg I/ml and iohexol (Omnipaque, Nycomed) 300 mg I/ml, were compared in femoral arteriography, in 147 patients. Both contrast media were diagnostically effective for use in femoral arteriography, without any significant difference. Pain was reported in connection with injection of iohexol by 36% of the patients, after injection of iodixanol none reported pain. Seventy-two percent of the patients in the iodixanol group reported a sensation of warmth in connection with contrast injection versus 90% in the iohexol group. The average intensity of the warmth was greater with iohexol than with iodixanol. Fourteen percent of patients in the iodixanol group and 1% in the iohexol group reported one or more subjective adverse events. (orig.)

  9. Femoral Neck Shaft Angle in Men with Fragility Fractures

    Directory of Open Access Journals (Sweden)

    S. P. Tuck

    2011-01-01

    Full Text Available Introduction. Femoral neck shaft angle (NSA has been reported to be an independent predictor of hip fracture risk in men. We aimed to assess the role of NSA in UK men. Methods. The NSA was measured manually from the DXA scan printout in men with hip (62, 31 femoral neck and 31 trochanteric, symptomatic vertebral (91, and distal forearm (67 fractures and 389 age-matched control subjects. Age, height, weight, and BMD (g/cm2: lumbar spine, femoral neck, and total femur measurements were performed. Results. There was no significant difference in mean NSA between men with femoral neck and trochanteric hip fractures, so all further analyses of hip fractures utilised the combined data. There was no difference in NSA between those with hip fractures and those without (either using the combined data or analysing trochanteric and femoral neck shaft fractures separately, nor between fracture subjects as a whole and controls. Mean NSA was smaller in those with vertebral fractures (129.2° versus 131°: P=0.001, but larger in those with distal forearm fractures (129.8° versus 128.5°: P=0.01. Conclusions. The conflicting results suggest that femoral NSA is not an important determinant of hip fracture risk in UK men.

  10. Logistic regression analysis of factors associated with avascular necrosis of the femoral head following femoral neck fractures in middle-aged and elderly patients.

    Science.gov (United States)

    Ai, Zi-Sheng; Gao, You-Shui; Sun, Yuan; Liu, Yue; Zhang, Chang-Qing; Jiang, Cheng-Hua

    2013-03-01

    Risk factors for femoral neck fracture-induced avascular necrosis of the femoral head have not been elucidated clearly in middle-aged and elderly patients. Moreover, the high incidence of screw removal in China and its effect on the fate of the involved femoral head require statistical methods to reflect their intrinsic relationship. Ninety-nine patients older than 45 years with femoral neck fracture were treated by internal fixation between May 1999 and April 2004. Descriptive analysis, interaction analysis between associated factors, single factor logistic regression, multivariate logistic regression, and detailed interaction analysis were employed to explore potential relationships among associated factors. Avascular necrosis of the femoral head was found in 15 cases (15.2 %). Age × the status of implants (removal vs. maintenance) and gender × the timing of reduction were interactive according to two-factor interactive analysis. Age, the displacement of fractures, the quality of reduction, and the status of implants were found to be significant factors in single factor logistic regression analysis. Age, age × the status of implants, and the quality of reduction were found to be significant factors in multivariate logistic regression analysis. In fine interaction analysis after multivariate logistic regression analysis, implant removal was the most important risk factor for avascular necrosis in 56-to-85-year-old patients, with a risk ratio of 26.00 (95 % CI = 3.076-219.747). The middle-aged and elderly have less incidence of avascular necrosis of the femoral head following femoral neck fractures treated by cannulated screws. The removal of cannulated screws can induce a significantly high incidence of avascular necrosis of the femoral head in elderly patients, while a high-quality reduction is helpful to reduce avascular necrosis.

  11. MRI of the temporomandibular joint in patients with rheumatic disease

    International Nuclear Information System (INIS)

    Okochi, Kiyoshi; Ida, Mizue; Ohbayashi, Naoto

    2009-01-01

    The objective of this study was to evaluate the MRI findings of the temporomandibular joint (TMJ) in patients with rheumatic disease. The characteristic MRI findings of the TMJs in rheumatic patients were considered the obscurity of temporal posterior attachment (TPA) visualization and the presence of osseous changes of the condyle. As for the osseous changes, nearly 50% of the condyles had erosive changes and 20% showed severe bone destruction. (author)

  12. Combined Radial and Femoral Access Strategy and Radial-Femoral Rendezvous in Patients With Long and Complex Iliac Occlusions.

    Science.gov (United States)

    Hanna, Elias B; Mogabgab, Owen N; Baydoun, Hassan

    2018-01-01

    We present cases of complex, calcified iliac occlusive disease revascularized via a combined radial-femoral access strategy. Through a 6-French, 125-cm transradial guiding catheter, antegrade guidewires and catheters are advanced into the iliac occlusion, while retrograde devices are advanced transfemorally. The transradial and transfemoral channels communicate, allowing the devices to cross the occlusion into the true lumen (radial-femoral antegrade-retrograde rendezvous).

  13. 'Femoral head necrosis' in metabolic and hormonal osteopathies

    International Nuclear Information System (INIS)

    Heuck, F.H.W.; Treugut, H.

    1984-01-01

    The pathogenesis of bone necrosis is discussed with special attention and with respect to metabolic, hormonal, and vascular factors. The influence of statics and dynamics of the hip joint bones for the development of aseptic necrosis are discussed. 45 patients with ''idiopathic femoral head necroses'' were observed, including 6 cases of renal osteopathy following renal transplantation and immune suppression therapy, 14 cases of long term corticoid therapy, and 11 cases of liver diseases of different genesis. The femoral head necrosis understood as complication of an osteopathy. In our patients there were 31 males and 14 females - which means higher involvement of males. Plain radiological findings and CT-findings of changes of the femoral heat structure in different stages of the disease are described. Early diagnosis of metabolic and hormonal osteopathies is demanded for a joint keeping therapy of the beginning femoral head necrosis. (orig.) [de

  14. Femoral neck fractures complicating gaucher disease in children

    Energy Technology Data Exchange (ETDEWEB)

    Goldman, A.B.; Jacobs, B.

    1984-09-01

    In normal children, fractures of the femoral neck are uncommon and accompany severe trauma and multiple injuries elsewhere in the skeleton. In children with Gaucher disease, a rare hereditary disorder of lipid metabolism, midcervical or basicervical fractures can occur with minor or no trauma and without other injury to the skeleton. Three children with Gaucher disease who developed pathologic fractures of the femoral neck are described. In all three, the fractures occurred between five and nine years of age, and the fracture lines passed through areas of abnormal bone characterized by poorly defined patches of increased and decreased density and cortical thinning along the medial femoral necks. In the affected hips, there was no evidence of avascular necrosis of the femoral heads at the time of injury. One child's fracture was preceeded by multiple bone 'crisis' localized to the proximal femora.

  15. Anatomic landmarks of fluoroscopy guided puncture of the pulseless femoral artery

    International Nuclear Information System (INIS)

    Jeon, Min Hee; Han, Gi Seok; Kim, Sung Jin; Park, Kil Sun; Cha, Sang Hoon; Bae, Il Hun; Lee, Seung Young

    2006-01-01

    We wanted to improve puncturing the pulseless femoral artery by evaluating the anatomic landmarks that suggest the course of the femoral artery on fluoroscopy. We analyzed 37 hemipelvis spot images that were centered on the arterial sheath after puncture of the femoral artery. The inguinal angles were measured between the inguinal line connecting the anterior superior iliac spine and the symphysis pubis, and the line of the arterial sheath. Inguinal ligament ratios were measured as the distance from the symphysis pubis to the arterial sheath to the length of the inguinal ligament on the inguinal line. The femoral head ratios were measured as the distance from the medial margin of the femur head to the arterial sheath to the transverse length of the femur head. The mean inguinal angle was 66.5 and the mean inguinal ligament ratio was 0.42 (± 0.03). The mean femoral head ratio was 0.08 (± 0.18). In comparing the men and women, there was no significant difference in the inguinal angle and the femoral head ratio, but the inguinal distance ratio was larger in women (men: 0.41 ± 0.033, women: 0.44 ± 0.031, ρ < 0.05). The femoral artery generally courses just lateral to the medial margin of the femur head (femoral head ratio: 0.08) and the medial 40% of the inguinal ligament (inguinal ligament ratio: 0.42). So, consideration of these relations may be helpful for puncturing the pulseless femoral artery

  16. MRI for early diagnosis of avascular necrosis of the femoral head

    International Nuclear Information System (INIS)

    Kokubo, Takashi; Takatori, Yoshio; Kamogawa, Morihide; Ninomiya, Setsuo; Yoshikawa, Kohki; Itai, Yuji; Iio, Masahiro; Mitamura, Tadayuki

    1988-01-01

    Magnetic resonance imaging (MRI) was performed in forty patients on long-term oral steroid therapy for early detection of avascular necrosis (AN) of the femoral head. In 13 patients, AN was diagnosed in the unilateral femoral head from abnormal plain radiographs while the contralateral femoral head was normal radiographically. In the other 27 patients, radiographs were normal. A total of 67 femoral heads with normal radiographs is studied in this paper. In 36 of 67 femoral heads (54 %), MRI demonstrated abnormal low intensity area. The abnormal findings on MRI were divided into five patterns: whole type (type A), peripheral type (type B), ring or band type (type C), small change type (type D) and distal type (type E). Type A, B, C, D and E were found in 2, 11, 5, 16 and 2 femoral heads, respectively. In cases to be followed up over 6 months, AN was manifested radiographically in 4 femoral heads of 5 in type C and in one of 14 in type D. Meanwhile, in 6 of 41 femoral heads examined (15 %), bone scintigrams was abnormal. Followed-up study over 6 months revealed that AN was manifested radiographically in one femoral head of 6 with abnormal scintigram. However, in 4 of 30 with normal scintigram, AN was manifested subsequently. MRI was a better diagnostic modality for early AN. Ring or band-like low intensity (type C) on MRI was considered to be characteristic pattern of early AN. (author)

  17. MRI for early diagnosis of avascular necrosis of the femoral head

    Energy Technology Data Exchange (ETDEWEB)

    Kokubo, Takashi; Takatori, Yoshio; Kamogawa, Morihide; Ninomiya, Setsuo; Yoshikawa, Kohki; Itai, Yuji; Iio, Masahiro; Mitamura, Tadayuki

    1988-09-01

    Magnetic resonance imaging (MRI) was performed in forty patients on long-term oral steroid therapy for early detection of avascular necrosis (AN) of the femoral head. In 13 patients, AN was diagnosed in the unilateral femoral head from abnormal plain radiographs while the contralateral femoral head was normal radiographically. In the other 27 patients, radiographs were normal. A total of 67 femoral heads with normal radiographs is studied in this paper. In 36 of 67 femoral heads (54 %), MRI demonstrated abnormal low intensity area. The abnormal findings on MRI were divided into five patterns: whole type (type A), peripheral type (type B), ring or band type (type C), small change type (type D) and distal type (type E). Type A, B, C, D and E were found in 2, 11, 5, 16 and 2 femoral heads, respectively. In cases to be followed up over 6 months, AN was manifested radiographically in 4 femoral heads of 5 in type C and in one of 14 in type D. Meanwhile, in 6 of 41 femoral heads examined (15 %), bone scintigrams was abnormal. Followed-up study over 6 months revealed that AN was manifested radiographically in one femoral head of 6 with abnormal scintigram. However, in 4 of 30 with normal scintigram, AN was manifested subsequently. MRI was a better diagnostic modality for early AN. Ring or band-like low intensity (type C) on MRI was considered to be characteristic pattern of early AN.

  18. Current Concepts in the Mandibular Condyle Fracture Management Part II: Open Reduction Versus Closed Reduction

    OpenAIRE

    Choi, Kang-Young; Yang, Jung-Dug; Chung, Ho-Yun; Cho, Byung-Chae

    2012-01-01

    In the treatment of mandibular condyle fracture, conservative treatment using closed reduction or surgical treatment using open reduction can be used. Management of mandibular condylar fractures remains a source of ongoing controversy in oral and maxillofacial trauma. For each type of condylar fracture,the treatment method must be chosen taking into consideration the presence of teeth, fracture height, patient'sadaptation, patient's masticatory system, disturbance of occlusal function, and de...

  19. Conservative treatment of a mandibular condyle fracture: comparing intermaxillary fixation with screws or arch bar. A randomised clinical trial

    NARCIS (Netherlands)

    van den Bergh, B.; Blankestijn, J.; van der Ploeg, T.; Tuinzing, D.B.; Forouzanfar, T.

    2015-01-01

    Introduction A mandibular condyle fracture can be treated conservatively by intermaxillary fixation (IMF) or by open reposition and internal fixation (ORIF). Many IMF-modalities can be chosen, including IMF-screws (IMFS). This prospective multi-centre randomised clinical trial compared the use of

  20. Conservative treatment of a mandibular condyle fracture: Comparing intermaxillary fixation with screws or arch bar. A randomised clinical trial

    NARCIS (Netherlands)

    van den Bergh, B.; Blankestijn, J.; van der Ploeg, T.; Tuinzing, D.B.; Forouzanfar, T.

    2015-01-01

    Introduction A mandibular condyle fracture can be treated conservatively by intermaxillary fixation (IMF) or by open reposition and internal fixation (ORIF). Many IMF-modalities can be chosen, including IMF-screws (IMFS). This prospective multi-centre randomised clinical trial compared the use of