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Sample records for proximal femur distal

  1. Concomitant physeal fractures of the distal femur and proximal tibia

    Energy Technology Data Exchange (ETDEWEB)

    Sferopoulos, N.K. [Aristotle University of Thessaloniki, Department of Pediatric Orthopaedics, Thessaloniki (Greece)

    2005-07-01

    Concomitant physeal fractures of the distal femur and proximal tibia are very rare in children and adolescents. They are included in the classification of the ''floating knee'' injuries. Two cases with this combined injury are reported. They were closed injuries and in both patients the fracture of the proximal tibial epiphyseal plate was nondisplaced. In the first, a six-year-old girl, an early diagnosis was made radiographically. The intra-articular femoral fracture was operatively reduced and fixed. No growth abnormality was encountered 12 years later. The second patient, a 16-year-old boy, was conservatively treated for a displaced fracture-separation of the distal femoral epiphysis. Four weeks later there was physeal widening on both sides of the knee which indicated an associated fracture of the proximal tibial epiphyseal plate. One year after injury there was a varus deformity of the knee that was treated with a corrective osteotomy. Ten years later there is normal alignment of the leg. (orig.)

  2. Osteosynthesis of a periprosthetic fracture of the proximal femur with the distal femur LISS system

    DEFF Research Database (Denmark)

    Tarnowski, Jan Robert; Holck, Kim

    2008-01-01

    In this case report, we show how it is possible to perform osteosynthesis using minimal invasive techniques instead of conventional methods. In this instance the osteosynthesis was performed on a patient in poor general condition who had presented a periprosthetic fracture of the proximal femur. ...

  3. The association of distal femur and proximal tibia shape with sex: The Osteoarthritis Initiative.

    Science.gov (United States)

    Wise, Barton L; Liu, Felix; Kritikos, Lisa; Lynch, John A; Parimi, Neeta; Zhang, Yuqing; Lane, Nancy E

    2016-08-01

    Risk of knee osteoarthritis (OA) is much higher in women than in men. Previous studies have shown that bone shape is a risk factor for knee OA. However, few studies have examined whether knee bone shape differs between men and women. The purpose of the present study was to determine whether there are differences between men and women in knee bone shape. We used information from the NIH-funded Osteoarthritis Initiative (OAI), a cohort of persons aged 45-79 at baseline who either had symptomatic knee OA or were at high risk of it. Among participants aged between 45 and 60 years, we randomly sampled 340 knees without radiographic OA (i.e., Kellgren/Lawrence grade of 0 in central readings on baseline radiograph). We characterized distal femur and proximal tibia shape of these selected radiographs using statistical shape modeling (SSM). We performed linear regression analysis to examine the association between sex and each knee shape mode (proximal tibia and distal femur), adjusting for age, race, body mass index (BMI), and clinic site. The mean age was 52.7 years (±4.3 SD) for both men and women. There were 192 female and 147 male knees for the distal femur analysis. Thirteen modes were derived for femoral shape, accounting for 95.5% of the total variance. Distal femur mode 1 had the greatest difference in standardized score of knee shape between females and males (1.04, p femur and proximal tibia that form the knee joint differ by sex. Additional analyses are warranted to assess whether the difference in risk of OA between the sexes arises from bone shape differences. Copyright © 2016 Elsevier Inc. All rights reserved.

  4. Uncommon Floating Knee in a Teenager: A Case Report of Ipsilateral Physeal Fractures in Distal Femur and Proximal Tibia.

    Science.gov (United States)

    Othman, Youssef; Hassini, Lassaad; Fekih, Aymen; Aloui, Issam; Abid, Abderrazek

    2017-01-01

    The concomitance of ipsilateral physeal fractures of the distal femur and the proximal tibia is an extremely scarce entity. It is conceptually similar to floating knee in pediatric population. One case with this injury is reported in a 16-year-old teenager. He was treated surgically by close reduction and internal fixation. The diagnosis of the tibial fracture was initially missed and the fracture was seen on the post-operative radiographs. Orthopedic treatment was made for this injury. 2 years after, no angular deformity neither shortening of the limb were found. These rare injuries could have serious immediate and remote complication with a considerable functional impact. The diagnosis of proximal tibia physeal fracture could be missed in the context of a concomitant more impressive distal femur fracture. The possibility of a combination of these two injuries should then be kept in mind. Anatomic reduction should be made as soon as possible using a gentle technique and attention should be given to the diagnosis of the neurovascular complications.

  5. Bone mineral and stiffness loss at the distal femur and proximal tibia in acute spinal cord injury.

    Science.gov (United States)

    Edwards, W B; Schnitzer, T J; Troy, K L

    2014-03-01

    Computed tomography and finite element modeling were used to assess bone mineral and stiffness loss at the knee following acute spinal cord injury (SCI). Marked bone mineral loss was observed from a combination of trabecular and endocortical resorption. Reductions in stiffness were 2-fold greater than reductions in integral bone mineral. SCI is associated with a rapid loss of bone mineral and an increased rate of fragility fracture. The large majority of these fractures occur around regions of the knee. Our purpose was to quantify changes to bone mineral, geometry, strength indices, and stiffness at the distal femur and proximal tibia in acute SCI. Quantitative computed tomography (QCT) and patient-specific finite element analysis were performed on 13 subjects with acute SCI at serial time points separated by a mean of 3.5 months (range 2.6-4.8 months). Changes in bone mineral content (BMC) and volumetric bone mineral density (vBMD) were quantified for integral, trabecular, and cortical bone at epiphyseal, metaphyseal, and diaphyseal regions of the distal femur and proximal tibia. Changes in bone volumes, cross-sectional areas, strength indices and stiffness were also determined. Bone mineral loss was similar in magnitude at the distal femur and proximal tibia. Reductions were most pronounced at epiphyseal regions, ranging from 3.0 % to 3.6 % per month for integral BMC (p < 0.001) and from 2.8 % to 3.4 % per month (p < 0.001) for integral vBMC. Trabecular BMC decreased by 3.1-4.4 %/month (p < 0.001) and trabecular vBMD by 2.7-4.7 %/month (p < 0.001). A 3.8-5.4 %/month reduction was observed for cortical BMC (p < 0.001); the reduction in cortical vBMD was noticeably lower (0.6-0.8 %/month; p ≤ 0.01). The cortical bone loss occurred primarily through endosteal resorption, and reductions in strength indices and stiffness were some 2-fold greater than reductions in integral bone mineral. These findings highlight the need for therapeutic

  6. A reliable method for measuring proximal tibia and distal femur bone mineral density using dual-energy X-ray absorptiometry

    NARCIS (Netherlands)

    Bakkum, Arjan J. T.; Janssen, Thomas W. J.; Rolf, Marijn P.; Roos, Jan C.; Burcksen, Jos; Knol, Dirk L.; de Groot, Sonja

    Purpose: To assess the intra- and inter-rater reliability of a standardized protocol for measuring proximal tibia and distal femur bone mineral density (BMD) using dual-energy X-ray absorptiometry (DXA). Methods: Ten able-bodied individuals (7 males) participated in this study. During one

  7. Bone loss at the distal femur and proximal tibia in persons with spinal cord injury: imaging approaches, risk of fracture, and potential treatment options.

    Science.gov (United States)

    Cirnigliaro, C M; Myslinski, M J; La Fountaine, M F; Kirshblum, S C; Forrest, G F; Bauman, W A

    2017-03-01

    Persons with spinal cord injury (SCI) undergo immediate unloading of the skeleton and, as a result, have severe bone loss below the level of lesion associated with increased risk of long-bone fractures. The pattern of bone loss in individuals with SCI differs from other forms of secondary osteoporosis because the skeleton above the level of lesion remains unaffected, while marked bone loss occurs in the regions of neurological impairment. Striking demineralization of the trabecular epiphyses of the distal femur (supracondylar) and proximal tibia occurs, with the knee region being highly vulnerable to fracture because many accidents occur while sitting in a wheelchair, making the knee region the first point of contact to any applied force. To quantify bone mineral density (BMD) at the knee, dual energy x-ray absorptiometry (DXA) and/or computed tomography (CT) bone densitometry are routinely employed in the clinical and research settings. A detailed review of imaging methods to acquire and quantify BMD at the distal femur and proximal tibia has not been performed to date but, if available, would serve as a reference for clinicians and researchers. This article will discuss the risk of fracture at the knee in persons with SCI, imaging methods to acquire and quantify BMD at the distal femur and proximal tibia, and treatment options available for prophylaxis against or reversal of osteoporosis in individuals with SCI.

  8. Coronal subluxation of the proximal tibia relative to the distal femur after opening wedge high tibial osteotomy.

    Science.gov (United States)

    Akamatsu, Yasushi; Ohno, Satoshi; Kobayashi, Hideo; Kusayama, Yoshihiro; Kumagai, Ken; Saito, Tomoyuki

    2017-01-01

    The coronal subluxation of the proximal tibia relative to the distal femur is a common radiological finding in patients with knee osteoarthritis. The purpose was to evaluate whether the coronal subluxation was corrected after opening wedge high tibial osteotomy (OWHTO), and whether this subluxation was one cause of inconsistency between the actual and predicted alignments (correction loss). Fifty-one patients (55 knees) were treated with OWHTO. The change of location between the intersection points of the femoral and tibial axes on the tibial plateau (subluxation-C), the change of location between the lines through the most lateral points of the lateral femoral and tibial condyles (subluxation-L), and joint space angle (JSA) were compared in standing knee radiographs before and one year after OWHTO. The subluxation-C and subluxation-L were converted to a percentage of the tibial plateau width. The mean subluxation-C of 6.5% before OWHTO significantly increased to a mean subluxation-C of 7.3% one year after OWHTO. The mean subluxation-L of 6.3% and JSA of 4.5° before OWHTO significantly decreased to a subluxation-L of 1.8% and JSA of 3.3° one year after OWHTO. The change in subluxation-L correlated with the change in femorotibial angle and correction loss (r=0.634, Pfemur after OWHTO. This medial shift correlated with the correction loss. The coronal subluxation might be one cause of correction loss. Copyright © 2016 Elsevier B.V. All rights reserved.

  9. Dedifferentiated chondrosarcoma of right proximal femur

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    Sachin A Badge

    2016-01-01

    Full Text Available Dedifferentiated chondrosarcoma (DDCS comprises approximately 10% of all chondrosarcomas. The tumor generally occurs after the age of 50 years, with equal distribution among males and females. It is most often located in the bones of the pelvis, the proximal femur or humerus, the distal femur, and the ribs. Regardless of treatment, the prognosis is ominous with 90% of patients dying with distant metastases within 2 years. We report a case of DDCS of right proximal femur in a 73-year-old woman. The most important factors affecting survival are early recognition of the radiographic features, adequate histological sampling, and wide-margin resection of the lesion. So for the correct histopathological diagnosis the biopsy sample should be adequate to visualize both cartilaginous and noncartilaginous sarcomatous component which helps to increase the survival of patients before the distant metastasis occurs.

  10. Proximal femur geometry in the adult Kenyan femur and its ...

    African Journals Online (AJOL)

    Background: Numerous orthopaedic procedures are carried out on the proximal femur. For optimal hip function, these procedures must restore the anatomy of the proximal femur to as near normal as possible. There are currently no local studies that have described in detail the normal anatomy of the proximal femur and its ...

  11. Malignant tumor of the distal part of the femur or the proximal part of the tibia: endoprosthetic replacement or rotationplasty. Functional outcome and quality-of-life measurements.

    Science.gov (United States)

    Hillmann, A; Hoffmann, C; Gosheger, G; Krakau, H; Winkelmann, W

    1999-04-01

    The present study was performed to determine whether there is a difference, with regard to functional outcome and quality of life, between endoprosthetic replacement and rotationplasty for the treatment of malignant tumors of the distal part of the femur or the proximal part of the tibia. Sixty-seven patients, between the ages of eleven and twenty-four years at the time of the diagnosis, had a malignant tumor of the distal part of the femur or the proximal part of the tibia. A rotationplasty was performed in thirty-three patients, and an endoprosthetic replacement was done in thirty-four patients. The median duration of follow-up was six years and one month (range, two years to sixteen years and two months). The scale developed by the Musculoskeletal Tumor Society was used to evaluate the functional results. Quality-of-life issues were assessed with the questionnaire developed by the European Organization for Research and Treatment of Cancer. The patients who had had a rotationplasty had a mean functional score, according to the system of the Musculoskeletal Tumor Society, of 24 points, and the patients who had had an endoprosthetic replacement had a mean score of 25 points. This difference was not found to be significant, with the numbers available (p = 0.47). Only one patient who had had a rotationplasty used an assistive device when walking long distances, whereas six patients who had had an endoprosthetic replacement used an assistive device. This difference was significant (protationplasty could participate in hobbies such as carpentry and sports as well as in other daily activities to a significantly greater degree than those who had had an endoprosthetic replacement (p = 0.001). Restriction in daily activities due to pain was significantly less common in the group that had had a rotationplasty than it was in the group that had had an endoprosthetic replacement (p = 0.047). Rotationplasty was not associated with any disadvantages with regard to function or

  12. Pindborg tumor in the distal femur

    OpenAIRE

    Sussela, Alex Oliboni; Alves, Paulo Ricardo Picon; Silva, Vinicius Duval da; Bolze, Carlos Daniel de Garcia; Serafini, Osvaldo André

    2017-01-01

    ABSTRACT To describe a case of possible diagnosis of Pindborg tumor on the distal femur. A 32-years-old female patient, a native of Bolivia, resident in Brazil, arrived to this service for tumor research in the right femur. After biopsies and resection of the lesion, the case was referred to analysis and consultancy in the United States. In a report of review by the Pathology Laboratory, it was characterized the histological appearance and immunohistochemical profile were characteristic of Pi...

  13. proximal femur geometry in the adult kenyan femur and its ...

    African Journals Online (AJOL)

    implications considering that the implants used to treat fractures in the proximal femur would usually traverse the neck and lodge in the femoral head. A very narrow neck may not allow adequate implant placement especially for those implants that employ two proximal locking screws. This has been shown, in a study by ...

  14. Retrograde Intramedullary Nailing for Distal Femur Fracture with Osteoporosis

    OpenAIRE

    Kim, Jihyeung; Kang, Seung-baik; Nam, Kyungpyo; Rhee, Seung Hwan; Won, Jong Won; Han, Hyuk-Soo

    2012-01-01

    Background The incidence of distal femur fracture in the elderly has been increasing recently, and commonly occurs with osteoporosis. Retrograde intramedullary nailing has been considered a good surgical option for distal femur fracture. The purpose of the present study was to present our surgical results with retrograde intramedullary nailing for distal femur fractures with osteoporosis. Methods Thirteen patients diagnosed with extra-articular distal femur fracture and osteoporosis and manag...

  15. Periosteal osteoid osteoma of the distal femur

    Directory of Open Access Journals (Sweden)

    Mohammed Fahd Amar

    2010-07-01

    Full Text Available Periosteal osteoid osteoma is extremely rare. The diagnosis is not always clear. We report a case of periosteal osteoid osteoma arising from the posterior surface of the right distal femur in a 21-year-old woman. After careful evaluation and excisional biopsy, histological examination confirmed the diagnosis of osteoid osteoma, showing the nidus, surrounding osteosclerosis, and catarrhal synovitis. The lesion was treated successfully with excision of the nidus.

  16. Periosteal osteoblastoma of the distal femur

    Energy Technology Data Exchange (ETDEWEB)

    Nakatani, Tetsuya; Yamamoto, Tetsuji; Akisue, Toshihiro; Marui, Takashi; Hitora, Toshiaki; Kawamoto, Teruya; Nagira, Keiko; Yoshiya, Shinichi; Kurosaka, Masahiro [Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, 7-5-1 Kusunoki-cho, Chuo-ku, Kobe (Japan); Fujita, Ikuo; Matsumoto, Keiji [Department of Orthopaedic Surgery, Hyogo Medical Center for Adults, Akashi, Hyogo (Japan)

    2004-02-01

    Osteoblastomas located on the surface of the cortical bone, so-called periosteal osteoblastomas, are extremely rare. We report on a case of periosteal osteoblastoma arising from the posterior surface of the right distal femur in a 17-year-old man. Roentgenographic, computed tomographic, magnetic resonance imaging, and histologic features of the case are presented. Periosteal osteoblastoma should be radiologically and histologically differentiated from myositis ossificans, avulsive cortical irregularity syndrome, osteoid osteoma, parosteal osteosarcoma, periosteal osteosarcoma, and high-grade surface osteosarcoma. Although periosteal osteoblastoma is rare, this tumor should be included in the differential diagnosis of surface-type bone tumors. (orig.)

  17. Pindborg tumor in the distal femur.

    Science.gov (United States)

    Sussela, Alex Oliboni; Alves, Paulo Ricardo Picon; Silva, Vinicius Duval da; Bolze, Carlos Daniel de Garcia; Serafini, Osvaldo André

    2017-01-01

    To describe a case of possible diagnosis of Pindborg tumor on the distal femur. A 32-years-old female patient, a native of Bolivia, resident in Brazil, arrived to this service for tumor research in the right femur. After biopsies and resection of the lesion, the case was referred to analysis and consultancy in the United States. In a report of review by the Pathology Laboratory, it was characterized the histological appearance and immunohistochemical profile were characteristic of Pindborg tumor. Currently, the patient is being followed-up at the Orthopedics and Traumatology Department of this institution, and presents a good evolution. This study presents the case of a patient with a rare tumor that was investigated for an extensive period and through many tests. Pindborg tumor was suggested as a diagnostic hypothesis due to the characteristics and behavior of the neoplastic lesion. Although this lesion is more commonly observed in odontology, the neoplasia was compatible with the diagnosis. Therefore, despite the fact that this tumor has benign characteristics, long-term monitoring is necessary, given the high rate of tumor recurrence.

  18. Pindborg tumor in the distal femur

    Directory of Open Access Journals (Sweden)

    Alex Oliboni Sussela

    Full Text Available ABSTRACT To describe a case of possible diagnosis of Pindborg tumor on the distal femur. A 32-years-old female patient, a native of Bolivia, resident in Brazil, arrived to this service for tumor research in the right femur. After biopsies and resection of the lesion, the case was referred to analysis and consultancy in the United States. In a report of review by the Pathology Laboratory, it was characterized the histological appearance and immunohistochemical profile were characteristic of Pindborg tumor. Currently, the patient is being followed-up at the Orthopedics and Traumatology Department of this institution, and presents a good evolution. This study presents the case of a patient with a rare tumor that was investigated for an extensive period and through many tests. Pindborg tumor was suggested as a diagnostic hypothesis due to the characteristics and behavior of the neoplastic lesion. Although this lesion is more commonly observed in odontology, the neoplasia was compatible with the diagnosis. Therefore, despite the fact that this tumor has benign characteristics, long-term monitoring is necessary, given the high rate of tumor recurrence.

  19. Population-based epidemiology and incidence of distal femur fractures

    DEFF Research Database (Denmark)

    Elsoe, Rasmus; Ceccotti, Adriano Axel; Larsen, Peter

    2017-01-01

    The literature lacks recent epidemiological studies on the incidence, trauma mechanism and fracture classification of distal femur fractures. The aim of the present study was to provide up-to-date information concerning the incidence of distal femur fractures in a large and complete population...

  20. The effect of modular tapered fluted stems on proximal stress shielding in the human femur.

    Science.gov (United States)

    Hnat, William P; Conway, Justin S; Malkani, Arthur L; Yakkanti, Madhu R; Voor, Michael J

    2009-09-01

    The purpose of this study was to show a change in proximal femur surface strains following total hip arthroplasty and after the addition of BoneSource hydroxyapatite bone cement in the proximal region of an instrumented femur and to measure the surface strain on the proximal body. Seven third-generation composite femurs (Pacific Research Laboratories, Vashon, Wash) were instrumented with 12 uniaxial strain gages, 6 gages on the anterior face, and 6 gages on the posterior face of each femur. All femurs exhibited stress shielding since the strains in the proximal region were drastically reduced. There was a large decrease in strain in the mid-shaft region and small changes in strain in the distal region. The surface strains on the modular implant were relatively low.

  1. Retrograde intramedullary nailing for distal femur fracture with osteoporosis.

    Science.gov (United States)

    Kim, Jihyeung; Kang, Seung-Baik; Nam, Kyungpyo; Rhee, Seung Hwan; Won, Jong Won; Han, Hyuk-Soo

    2012-12-01

    The incidence of distal femur fracture in the elderly has been increasing recently, and commonly occurs with osteoporosis. Retrograde intramedullary nailing has been considered a good surgical option for distal femur fracture. The purpose of the present study was to present our surgical results with retrograde intramedullary nailing for distal femur fractures with osteoporosis. Thirteen patients diagnosed with extra-articular distal femur fracture and osteoporosis and managed with retrograde intramedullary nailing were retrospectively reviewed. Cement augmentation was used in four patients, shape memory alloy was used in eight patients and both were used in one patient. All patients were followed up for more than 2 years. Radiologic alignments were scored and Tegner and the Lysholm activity score was used for a functional assessment. The average time to clinical union was 13 weeks (range, 10 to 15 weeks). In 12 of our cases, the total alignment scores were excellent. At the last follow-up, the mean range of motion was 116° (range, 110° to 125°). The average functional score at postoperative 1 year was 2.6 (range, 1 to 5). Retrograde intramedullary nailing is a good surgical option for distal femur fracture with osteoporosis. Cement augmentation and shape memory alloy can also be used for added mechanical stability. This surgical technique is very useful for distal femur fracture with osteoporosis as it promotes fracture healing and early rehabilitation.

  2. Bone structure of the distal radius and the calcaneus vs BMD of the spine and proximal femur in the prediction of osteoporotic spine fractures

    Energy Technology Data Exchange (ETDEWEB)

    Link, Thomas M. [Department of Clinical Radiology, University of Muenster (Germany); Department of Diagnostic Radiology, Technical University Munich (Germany); Department of Radiology, University of California, San Francisco, CA (United States); Vieth, Volker; Matheis, Julia [Department of Clinical Radiology, University of Muenster (Germany); Newitt, David; Lu, Ying; Majumdar, Sharmila [Department of Radiology, University of California, San Francisco, CA (United States); Rummeny, Ernst J. [Department of Diagnostic Radiology, Technical University Munich (Germany)

    2002-02-01

    The aim of this study was to compare structure measures obtained from high-resolution MR images of the calcaneus and the distal radius with bone mineral density (BMD) of the spine and hip in the prediction of osteoporotic spine fracture status. High-resolution MR images of the calcaneus and radius were obtained in 24 post-menopausal women with spine fractures and 22 age-matched controls. Imaging was performed at 1.5 T using a T1-weighted spin-echo sequence (slice thickness 1 mm, in-plane spatial resolution 195 x 195 {mu}m{sup 2}). Structure analysis was performed using parameters analogous to standard histomorphometry. Bone mineral density of the spine was obtained using quantitative CT and of the hip with dual-energy X-ray absorptiometry. Significant differences between both patient groups were obtained with BMD and all structure parameters (p<0.05). Using receiver operating characteristic analysis to determine the diagnostic performance in differentiating both groups, the best results were found for BMD of the spine, one of the radial structure measures and a combination of the calcaneal structure measures. In this study BMD of the spine and structure measures of the distal radius were best suited to predict the osteoporotic fracture status of the spine. A combination of BMD and structure measures did not yield any additional information on fracture status. (orig.)

  3. The best location for proximal locking screw for femur interlocking nailing: A biomechanical study

    Directory of Open Access Journals (Sweden)

    Ahmet A Karaarslan

    2016-01-01

    Conclusion: According to our findings, there is twice as much difference in locking screw bending resistance between these two application levels. To avoid proximal locking screw deformation, locking screws should be placed in the level of the lesser trochanter in nailing of 1/3 middle and distal femur fractures.

  4. Subtrochanteric and Distal Femur Fractures in a Patient with ...

    African Journals Online (AJOL)

    This study aims to describe a rare and challenging case of a patient who presented ipsilateral subtrochanteric and distal femur fractures due to low‑energy trauma. The peculiarity of this case is the presence of femoral shaft fracture malunion and knee disarticulation in the same limb resulting from an accident suffered 30 ...

  5. Automated Acquisition of Proximal Femur Morphological Characteristics

    Science.gov (United States)

    Tabakovic, Slobodan; Zeljkovic, Milan; Milojevic, Zoran

    2014-10-01

    The success of the hip arthroplasty surgery largely depends on the endoprosthesis adjustment to the patient's femur. This implies that the position of the femoral bone in relation to the pelvis is preserved and that the endoprosthesis position ensures its longevity. Dimensions and body shape of the hip joint endoprosthesis and its position after the surgery depend on a number of geometrical parameters of the patient's femur. One of the most suitable methods for determination of these parameters involves 3D reconstruction of femur, based on diagnostic images, and subsequent determination of the required geometric parameters. In this paper, software for automated determination of geometric parameters of the femur is presented. Detailed software development procedure for the purpose of faster and more efficient design of the hip endoprosthesis that ensures patients' specific requirements is also offered

  6. Predictors of Functional Recovery Following Periprosthetic Distal Femur Fractures.

    Science.gov (United States)

    Ruder, John A; Hart, Gavin P; Kneisl, Jeffrey S; Springer, Bryan D; Karunakar, Madhav A

    2017-05-01

    Treatment options for periprosthetic distal femur fractures include open reduction internal fixation (ORIF) and distal femoral replacement (DFR). The purpose of this study was to evaluate the complications, and functional recovery (ambulatory status, living situation, mortality) in patients undergoing operative treatment (DFR and ORIF) of periprosthetic distal femur fractures. A retrospective review of 58 patients with distal femoral periprosthetic fractures treated with either ORIF or DFR was conducted. Surgical complications, discharge disposition, ambulatory status, living situation at 1 year, and mortality at 1 year were compared between patients treated with ORIF and DFR. Outcomes at 1 year were also compared between patients older and younger than 85 years of age. Fifty-eight patients with a mean age of 80 years (range, 61-95 years) met inclusion criteria. The mean follow-up was 29.5 months (range, 5-81 months). Patients undergoing DFR were significantly older than those who underwent ORIF (83 vs 78, P femur fractures. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Cadaveric analysis of capsular attachments of the distal femur related to pin and wire placement.

    Science.gov (United States)

    Lowery, Kathryn; Dearden, Paul; Sherman, Kevin; Mahadevan, Vishy; Sharma, Hemant

    2015-01-01

    Septic arthritis following intra-capsular penetration of the knee by external fixation devices is a complication of traction/fixation devices inserted in the lower extremity [1,2]. The authors were unable to find reference to or exact measurements of the capsular attachments relating to the distal femur documented in the current literature. This study aimed to demonstrate the capsular attachments and reflections of the distal femur to determine safe placements of wires or traction devices. The attachments of the capsule to the distal femur were measured in 10 unembalmed cadaveric knees. Capsular attachments were measured anteriorly at the maximal extension of the supra-patella pouch. Medially and laterally measurements were expressed as percentages related to the maximal AP diameter of the distal femur. Mean distance from the centre of the anterior part of the notch to the superior fold was 79.5mm (Range 48.1-120.7 mm). The medial capsular reflections measured in a plane from the adductor tubercle to the anterior edge of the medial femoral condyle demonstrated the capsular reflection was attached an average of 57% back from the anterior edge (Range 41-74%). Laterally the capsular reflections on a line drawn from the maximal diameter in the sagittal plane were attached an average of 48% from the anterior reference point (Range 33-57%). Measuring the reflections at 45 degrees to the long axis of the femur in the sagittal plane the attachment was an average of 51% from the anterior reference point. Capsular reflections varied among specimens. Medially the capsule attachment was up to 74% of diameter of distal femur at the level of the adductor tubercle. Therefore, the insertion of distal femoral traction pins or similar should be placed proximal to the adductor tubercle and no further than 25% of the distance to the anterior cortex. Care is also needed to ensure pins do not travel to exit too anteriorly on the lateral side as capsular attachments were found to be up

  8. Maturational timing does not predict HSA estimated adult bone geometry at the proximal femur.

    Science.gov (United States)

    Jackowski, Stefan A; Kontulainen, Saija A; Cooper, David M L; Lanovaz, Joel L; Baxter-Jones, Adam D G

    2011-12-01

    Late maturational timing is documented to be detrimental to bone strength primarily at the distal radius. Studies at the proximal femur have focused on bone mass and the results remain controversial. The purpose of this study was to examine the long term relationship between the onset of maturation and the development of estimated cross sectional area (CSA) and section modulus (Z) at the proximal femur. Two hundred and twenty six individuals (108 males and 118 females) from the Saskatchewan Pediatric Bone Mineral Accrual Study (PBMAS) were classified into maturity groups based on age of attainment of peak height velocity. CSA and Z were serially assessed at the narrow neck (NN), intertrochanter (IT) and proximal shaft (S) sites using hip structural analysis (HSA). Multilevel models were constructed to examine the development of CSA and Z by maturity group. Cross sectional observations indicated that during adolescence, early maturing males had significantly greater CSA and Z than late maturing males at all sites of the proximal femur, while early maturing females had greater Z at the NN and S, and greater CSA at the NN, IT and S sites compared to late maturing females. When age, body size, body composition, physical activity and dietary intake were controlled no significant effects of maturational timing were found at the NN, IT or S regions (p>0.05) in either males or females. In this population of healthy individuals there appears to be no effect of the onset of maturation on estimated CSA and Z development at the proximal femur in both males and females. This may be a result of the proximal femur's loading environment. Future research is required to determine the role of loading on the relationship between maturational timing and bone structure and strength development at the proximal femur. Copyright © 2011 Elsevier Inc. All rights reserved.

  9. Temporary hemiepiphysiodesis of the distal medial femur: MPFL in danger.

    Science.gov (United States)

    Bachmann, M; Rutz, E; Brunner, R; Gaston, M S; Hirschmann, M T; Camathias, C

    2014-08-01

    Temporary hemiepiphysiodesis (TH) with plate fixation is a well-accepted and common treatment for correcting leg malalignment in skeletally immature patients. The purpose of this study was to investigate any soft tissue damage caused during TH at the distal medial femur with a plate and two screws. We hypothesized that correct plate placement can affect the integrity of the medial stabilizing structures of the knee, especially the medial patellofemoral ligament (MPFL), the medial collateral ligament (MCL) or result in arthrotomy of the knee joint itself. In eight cadaveric knees of five adult humans a TH was performed with a plate and two cancellous screws at the distal medial femur using a standardized surgical technique. Subsequently the medial capsular and ligamentous structures were systematically exposed and assessed. Capsular and synovial tissue was also inspected for impingement by the plate or screws. In all knees the MPFL was present. In two specimens the MPFL was intact and the plate was lying over the dorsal part of the MPFL close to the MCL. The MPFL was completely cut in two cases in the central part of the ligament. In four cases the MPFL was partially dissected or perforated by a screw and fixed to the femur by the plate. The MCL was intact and not impinged by the implant in any case. In total four of eight knees the capsule was transected or perforated by a screw or by a part of the plate, resulting in intraarticular implant placement. Standard plate placement during TH on the distal medial femur frequently leads to damage to the MPFL, impingement of the MPFL, the capsular and synovial tissues or exposure of the knee joint.

  10. Retrograde nailing for distal femur fractures in the elderly

    Directory of Open Access Journals (Sweden)

    Giddie Jasdeep

    2015-01-01

    Full Text Available Introduction: We report the results of treating a series of 56 fractures in 54 elderly patients with a distal femur fracture with a retrograde femoral nail. Methods: Fifty-four of the nails were inserted percutaneously with a closed reduction. After surgery all patients were allowed to weight bear as tolerated. Four fractures were supported in a temporary external splint. Results: The mean age of patients was 80.6 years (range 51–103 years, 52/54 (96% were females. There were no cases of nail related complications and no re-operations were required. One patient was lost to follow up. The 30-day mortality was 5/54 (9.3% and the one year mortality was 17/54 (31.5%. Conclusions: Distal femoral nail fixation provides a good method of fixation allowing immediate mobilisation for this group of patients.

  11. Total hip arthroplasty after failed treatment of proximal femur fracture.

    Science.gov (United States)

    Tetsunaga, Tomonori; Fujiwara, Kazuo; Endo, Hirosuke; Noda, Tomoyuki; Tetsunaga, Tomoko; Sato, Toru; Shiota, Naofumi; Ozaki, Toshifumi

    2017-03-01

    Total hip arthroplasty (THA) is a good option as a salvage procedure after failed treatment of proximal femur fracture. The anatomy of the proximal femur, however, makes this surgery complicated and challenging. The purpose of this study was to evaluate the radiographic and clinical outcomes of THA after failed treatment of proximal femur fractures. We retrospectively analysed 50 consecutive THAs (42 women, 8 men; mean age 77 years) after failed treatment of a proximal femur fracture. Mean postoperative follow-up was 58.1 months. Preoperative diagnoses were femoral neck fracture in 18 hips and trochanteric fracture in 32 hips, including three that were infected. Failure resulted from cutout in 22 cases, osteonecrosis in 12, non-union with failed fixation in nine, postoperative osteoarthritis in four, and infection in three. Factors compared included radiographic assessment, complication rate, visual analogue scale (VAS), and Harris Hip Scores (HHS). Radiographic variables included femoral neck anteversion and cup and stem alignment. Absolute values of the differences in femoral neck anteversion between the affected and healthy sides were 6.0° in the femoral neck fracture group and 19.2° in the trochanteric fracture group (p = 0.01). There were no significant differences in cup anteversion (p = 0.20) or stem anteversion (p = 0.08). The complication rate was significantly higher in the trochanteric fracture group than in the femoral neck fracture group (25 vs 0%, p fracture group included three periprosthetic fractures (9.4%), two dislocations (6.3%), two surgical-site infections (6.3%), and one stem penetration (3.1%). Although no significant differences between groups were seen in the VAS or HHS at final follow-up (p = 0.32, 0.09, respectively), these measures were significantly improved at final follow-up in both groups (p fractures requires consideration of complication risk and incorrect femoral neck anteversion.

  12. Is there any relation between distal parameters of the femur and its height and width?

    Science.gov (United States)

    Yazar, Fatih; Imre, Nurcan; Battal, Bilal; Bilgic, Serkan; Tayfun, Cem

    2012-03-01

    The purpose of this study was to reveal the association whether the distal morphometry of femur had a relation with femur height or width. Sixty-six adult (35 right and 31 left) dry femurs from Caucasians were used in this study. Computed tomography (CT) imaging was applied to obtain measurement values of the femur. Femur height (413.29 ± 28.40 mm) and width (29.86 ± 2.72 mm) were all checked one by one to determine the correlation with the parameters obtained. Both values exposed high rates of correlation with height (26 ± 2.34 mm) and width (20.85 ± 2.76 mm) of femur notch; also, measures of epicondylar, bicondylar and condylar diameters of femur were obtained. Measures were checked if there was a correlation with femur height and width. Differences displayed in distal morphometry of femur according to race and sex are due to other morphometric measures of femur rather than race and sex. We believe that displaying the high rates of correlation of distal morphometry of femur with femur height and width will be the factor which determines the selection and production of prosthesis among the long or short individuals of folks.

  13. A method for sex estimation using the proximal femur.

    Science.gov (United States)

    Curate, Francisco; Coelho, João; Gonçalves, David; Coelho, Catarina; Ferreira, Maria Teresa; Navega, David; Cunha, Eugénia

    2016-09-01

    The assessment of sex is crucial to the establishment of a biological profile of an unidentified skeletal individual. The best methods currently available for the sexual diagnosis of human skeletal remains generally rely on the presence of well-preserved pelvic bones, which is not always the case. Postcranial elements, including the femur, have been used to accurately estimate sex in skeletal remains from forensic and bioarcheological settings. In this study, we present an approach to estimate sex using two measurements (femoral neck width [FNW] and femoral neck axis length [FNAL]) of the proximal femur. FNW and FNAL were obtained in a training sample (114 females and 138 males) from the Luís Lopes Collection (National History Museum of Lisbon). Logistic regression and the C4.5 algorithm were used to develop models to predict sex in unknown individuals. Proposed cross-validated models correctly predicted sex in 82.5-85.7% of the cases. The models were also evaluated in a test sample (96 females and 96 males) from the Coimbra Identified Skeletal Collection (University of Coimbra), resulting in a sex allocation accuracy of 80.1-86.2%. This study supports the relative value of the proximal femur to estimate sex in skeletal remains, especially when other exceedingly dimorphic skeletal elements are not accessible for analysis. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  14. Surgically Relevant Bony and Soft Tissue Anatomy of the Proximal Femur

    Science.gov (United States)

    Philippon, Marc J.; Michalski, Max P.; Campbell, Kevin J.; Goldsmith, Mary T.; Devitt, Brian M.; Wijdicks, Coen A.; LaPrade, Robert F.

    2014-01-01

    Background: Hip endoscopy facilitates the treatment of extra-articular disorders of the proximal femur. Unfortunately, current knowledge of proximal femur anatomy is limited to qualitative descriptions and lacks surgically relevant landmarks. Purpose: To provide a quantitative and qualitative analysis of proximal femur anatomy in reference to surgically relevant bony landmarks. Study Design: Descriptive laboratory study. Methods: Fourteen cadaveric hemipelvises were dissected. A coordinate measuring device measured dimensions and interrelationships of the gluteal muscles, hip external rotators, pectineus, iliopsoas, and joint capsule in reference to osseous landmarks. Results: The vastus tubercle, superomedial border of the greater trochanter, and femoral head-neck junction were distinct and reliable osseous landmarks. The anteroinferior tip of the vastus tubercle was 17.1 mm (95% CI: 14.5, 19.8 mm) anteroinferior to the center of the gluteus medius lateral insertional footprint and was 22.9 mm (95% CI: 20.1, 25.7 mm) inferolateral to the center of the gluteus minimus insertional footprint. The insertions of the piriformis, conjoint tendon of the hip (superior gemellus, obturator internus, and inferior gemellus), and obturator externus were identified relative to the superomedial border of the greater trochanter. The relationship of the aforementioned footprints were 49% (95% CI: 43%, 54%), 42% (95% CI: 33%, 50%), and 64% (95% CI: 59%, 69%) from the anterior (0%) to posterior (100%) margins of the superomedial border of the greater trochanter, respectively. The hip joint capsule attached distally on the proximal femur 18.2 mm (95% CI: 14.2, 22.2 mm) from the head-neck junction medially on average. Conclusion: The vastus tubercle, superomedial border of the greater trochanter, and the femoral head-neck junction were reliable osseous landmarks for the identification of the tendinous and hip capsular insertions on the proximal femur. Knowledge of the

  15. Three-Dimensional Bone Adaptation of the Proximal Femur

    DEFF Research Database (Denmark)

    Bagge, Mette

    1998-01-01

    The bone remodeling of a three-dimensional model of the proximal femur is considered. The bone adaptation is numerically described as an evolution in time formulated such that the structural change goes in an optimal direction within each time step for the optimal boundary conditions. In the bone...... remodeling scheme is included the memory of past loadings to account for the delay in the bone response to the load changes. In order to get a realistic bone adaptation process, the bone structure at the onset of the remodeling needs to be realistic too. A start design is obtained by structural optimization...

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

    Science.gov (United States)

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

    2016-11-01

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

  17. Proximal and distal muscle fatigue differentially affect movement coordination.

    Science.gov (United States)

    Cowley, Jeffrey C; Gates, Deanna H

    2017-01-01

    Muscle fatigue can cause people to change their movement patterns and these changes could contribute to acute or overuse injuries. However, these effects depend on which muscles are fatigued. The purpose of this study was to determine the differential effects of proximal and distal upper extremity muscle fatigue on repetitive movements. Fourteen subjects completed a repetitive ratcheting task before and after a fatigue protocol on separate days. The fatigue protocol either fatigued the proximal (shoulder flexor) or distal (finger flexor) muscles. Pre/Post changes in trunk, shoulder, elbow, and wrist kinematics were compared to determine how proximal and distal fatigue affected multi-joint movement patterns and variability. Proximal fatigue caused a significant increase (7°, p fatigue caused small but significant changes in trunk angles (2°, p fatigue protocols (p fatigue at either proximal or distal joints. The identified differences between proximal and distal muscle fatigue adaptations could facilitate risk assessment of occupational tasks.

  18. Proximal and distal muscle fatigue differentially affect movement coordination

    Science.gov (United States)

    Cowley, Jeffrey C.

    2017-01-01

    Muscle fatigue can cause people to change their movement patterns and these changes could contribute to acute or overuse injuries. However, these effects depend on which muscles are fatigued. The purpose of this study was to determine the differential effects of proximal and distal upper extremity muscle fatigue on repetitive movements. Fourteen subjects completed a repetitive ratcheting task before and after a fatigue protocol on separate days. The fatigue protocol either fatigued the proximal (shoulder flexor) or distal (finger flexor) muscles. Pre/Post changes in trunk, shoulder, elbow, and wrist kinematics were compared to determine how proximal and distal fatigue affected multi-joint movement patterns and variability. Proximal fatigue caused a significant increase (7°, p fatigue caused small but significant changes in trunk angles (2°, p fatigue protocols (p fatigue at either proximal or distal joints. The identified differences between proximal and distal muscle fatigue adaptations could facilitate risk assessment of occupational tasks. PMID:28235005

  19. Fractures around a previous fixation of proximal femur. A simple solution to a complex problem.

    Directory of Open Access Journals (Sweden)

    Fernando Manuel Bidolegui

    2016-05-01

    Full Text Available The number of hip fractures in the elderly growth with the increase in life expectancy. Therefore meet with a femur fractured, distal to a previously  implant fixation used in intertrochanteric femur fractures as dynamic hip screw or fixed angle plate, is not an uncommon scenario despite year mortality of hip fracture of 30 to 50%. Given this situation, we used a retrograde intramedullary nail associated with extracting screws percutaneously prior implant. We present 8 cases in patients with an average age of 85.6 years, 5 female and 3 male with a time from the proximal femur fixation to the  new fracture average 3.5 years. Will we track 36 months and we evaluated postoperative mobility and pain getting a consolidation of the fracture in all cases. We found this technique effective; capable of achieving stable fixation without adding morbidity due to the possibility of overlapping two implants decreasing the possibility of potential new interimplantes fracture.

  20. Spinal coronal profiles and proximal femur bone mineral density in adolescent idiopathic scoliosis.

    Science.gov (United States)

    Chen, Rui-Qiang; Watanabe, Kota; Hosogane, Naobumi; Hikata, Tomohiro; Iwanami, Akio; Ishii, Ken; Nakamura, Masaya; Toyama, Yoshiaki; Matsumoto, Morio

    2013-11-01

    Although the occurrence and progression of AIS has been linked to low bone mineral density (BMD), the relationships between spinal curvature and bilateral differences in proximal femur BMD are controversial. Few correlation studies have stratified patients by curve type. The purpose of this study was to evaluate the relationships between spinal coronal profile and bilateral differences in proximal femur BMD in patients with adolescent idiopathic scoliosis (AIS). This study included 67 patients with AIS who underwent posterior correction and fusion surgery between January 2009 and October 2011. The mean age at the time of surgery was 17.4 ± 4.1 years. Bilateral proximal femur BMD was measured before surgery by dual-energy X-ray absorptiometry. We compared the proximal femur BMDs by determining the bilateral BMD ratio (left proximal femur BMD divided by that of the right). We evaluated correlations between coronal parameters, obtained from preoperative radiographs, and the BMD ratio using Pearson's correlation analysis. Patients with Lenke type 1 curve (48; all with a right convex curve) had a mean bilateral proximal femur BMD ratio of 1.00 ± 0.04. Patients with Lenke type 5 curve (19; all with a left convex curve) had a mean bilateral proximal femur BMD ratio of 0.94 ± 0.04, indicating that the BMD in the proximal femur on the right side (concave) was greater than that in the left (convex). Coronal balance was significantly correlated with the BMD ratio in both the Lenke type 1 and type 5 groups, with a correlation coefficient of 0.46 and 0.50, respectively. The bilateral proximal femur BMD ratio was significantly correlated with the coronal balance in AIS patients. When the C7 plumb line was shifted toward one side, the BMD was greater in the contralateral proximal femur.

  1. A muscular imprint on the anterolateral surface of the proximal femurs of the Krapina Neandertal collection.

    Science.gov (United States)

    Belcastro, Maria Giovanna; Mariotti, Valentina

    2017-03-01

    The purpose of this study is to report and interpret a feature on the anterolateral surface of the proximal femurs of the Krapina hominid collection that we briefly described in 2006 (Periodicum Biologorum, 108, 319-329). We recorded the presence or absence of the feature in all the proximal femurs of the Krapina collection (six specimens recordable) and in 622 modern human adult femurs. The feature consists in a series of crests delimitating three raised or depressed areas. This feature has been found in three out of four adult Neandertal femurs observable. The two observable subadult Neandertal femurs do not show this character. None of the modern femurs displayed the feature. We interpret this feature as a muscular imprint, probably representing the m. vastus intermedius origin and discuss a possible interpretation. We did not find any other references for such imprint in the existing literature regarding the Neandertal femurs. © 2017 Wiley Periodicals, Inc.

  2. Uncemented allograft-prosthetic composite reconstruction of the proximal femur

    Directory of Open Access Journals (Sweden)

    Li Min

    2014-01-01

    Full Text Available Background: Allograft-prosthetic composite can be divided into three groups names cemented, uncemented, and partially cemented. Previous studies have mainly reported outcomes in cemented and partially cemented allograft-prosthetic composites, but have rarely focused on the uncemented allograft-prosthetic composites. The objectives of our study were to describe a surgical technique for using proximal femoral uncemented allograft-prosthetic composite and to present the radiographic and clinical results. Materials and Methods: Twelve patients who underwent uncemented allograft-prosthetic composite reconstruction of the proximal femur after bone tumor resection were retrospectively evaluated at an average followup of 24.0 months. Clinical records and radiographs were evaluated. Results: In our series, union occurred in all the patients (100%; range 5-9 months. Until the most recent followup, there were no cases with infection, nonunion of the greater trochanter, junctional bone resorption, dislocation, allergic reaction, wear of acetabulum socket, recurrence, and metastasis. But there were three periprosthetic fractures which were fixed using cerclage wire during surgery. Five cases had bone resorption in and around the greater trochanter. The average Musculoskeletal Tumor Society (MSTS score and Harris hip score (HHS were 26.2 points (range 24-29 points and 80.6 points (range 66.2-92.7 points, respectively. Conclusions: These results showed that uncemented allograft-prosthetic composite could promote bone union through compression at the host-allograft junction and is a good choice for proximal femoral resection. Although this technology has its own merits, long term outcomes are yet not validated.

  3. Proximal and distal muscle fatigue differentially affect movement coordination.

    Directory of Open Access Journals (Sweden)

    Jeffrey C Cowley

    Full Text Available Muscle fatigue can cause people to change their movement patterns and these changes could contribute to acute or overuse injuries. However, these effects depend on which muscles are fatigued. The purpose of this study was to determine the differential effects of proximal and distal upper extremity muscle fatigue on repetitive movements. Fourteen subjects completed a repetitive ratcheting task before and after a fatigue protocol on separate days. The fatigue protocol either fatigued the proximal (shoulder flexor or distal (finger flexor muscles. Pre/Post changes in trunk, shoulder, elbow, and wrist kinematics were compared to determine how proximal and distal fatigue affected multi-joint movement patterns and variability. Proximal fatigue caused a significant increase (7°, p < 0.005 in trunk lean and velocity, reduced humeral elevation (11°, p < 0.005, and increased elbow flexion (4°, p < 0.01. In contrast, distal fatigue caused small but significant changes in trunk angles (2°, p < 0.05, increased velocity of wrench movement relative to the hand (17°/s, p < 0.001, and earlier wrist extension (4%, p < 0.005. Movement variability increased at proximal joints but not distal joints after both fatigue protocols (p < 0.05. Varying movements at proximal joints may help people adapt to fatigue at either proximal or distal joints. The identified differences between proximal and distal muscle fatigue adaptations could facilitate risk assessment of occupational tasks.

  4. Intraoperative Distal Femoral Fine Wire Traction to Facilitate Intramedullary Nailing of the Femur.

    Science.gov (United States)

    Githens, Michael; Alton, Timothy B; Firoozabadi, Reza; Bishop, Julius A

    2016-01-01

    Many techniques have been employed to facilitate intramedullary nailing of femur fractures. Maintaining limb length during the operation can be difficult. The authors describe the use of distal femoral fine wire skeletal traction as a technique to maintain reduction while allowing intramedullary nailing of femur fractures. This technique is safe, is effective, and negates the need for a fracture table or an assistant. Copyright 2016, SLACK Incorporated.

  5. ANATOMIC STUDY OF THE PROXIMAL THIRD OF THE FEMUR: FEMOROACETABULAR IMPACT AND THE CAM EFFECT

    OpenAIRE

    Labronici, Pedro José; Alves, Sergio Delmonte; da Silva, Anselmo Fernandes; Giuberti, Gilberto Ribeiro; Azevedo Neto, Justino Nóbrega de; Mezzalira Penedo, Jorge Luiz

    2015-01-01

    To analyze anatomical variations of the proximal end of femur that could cause a femoroacetabular impact. Methods: 199 skeletically mature anatomical specimens of femurs were used. The femurs were measured in order to determine the anteversion angle of the femoral neck, neckshaft angle, sphericity of the femoral head at anteroposterior and superoinferior, angle between epiphysis and the anterior femoral neck, angle between epiphysis and the neck at lateral plane, anteroposterior distance at 5...

  6. The shape of the early hominin proximal femur.

    Science.gov (United States)

    Harmon, Elizabeth H

    2009-06-01

    Postcranial skeletal variation among Plio-Pleistocene hominins has implications for taxonomy and locomotor adaptation. Although sample size constraints make interspecific comparisons difficult, postcranial differences between Australopithecus afarensis and Australopithecus africanus have been reported (McHenry and Berger: J Hum Evol 35 1998 1-22; Richmond et al.: J Hum Evol 43 [2002] 529-548; Green et al.: J Hum Evol 52 2007 187-200). Additional evidence indicates that the early members of the genus Homo show morphology like recent humans (e.g., Walker and Leakey: The Nariokotome Homo erectus skeleton. Cambridge: Harvard, 1993). Using a larger fossil sample than previous studies and novel methods, the early hominin proximal femur is newly examined to determine whether new data alter the current view of femoral evolution and inform the issue of interspecific morphological variation among australopiths. Two- and three-dimensional data are collected from large samples of recent humans, Pan, Gorilla, and Pongo and original fossil femora of Australopithecus, Paranthropus, and femora of African fossil Homo. The size-adjusted shape data are analyzed using principal components, thin plate spline analysis, and canonical variate analysis to assess shape variation. The results indicate that femora of fossil Homo are most similar to modern humans but share a low neck-shaft angle (NSA) with australopiths. Australopiths as a group have ape-like greater trochanter morphology. A. afarensis differs from P. robustus and A. africanus in attributes of the neck and NSA. However, interspecific femoral variation is low and australopiths are generally morphologically similar. Although the differences are not dramatic, when considered in combination with other postcranial evidence, the adaptive differences among australopiths in craniodental morphology may have parallels in the postcranium. Copyright 2009 Wiley-Liss, Inc.

  7. Shape Ontogeny of the Distal Femur in the Hominidae with Implications for the Evolution of Bipedality.

    Directory of Open Access Journals (Sweden)

    Melissa Tallman

    Full Text Available Heterochrony has been invoked to explain differences in the morphology of modern humans as compared to other great apes. The distal femur is one area where heterochrony has been hypothesized to explain morphological differentiation among Plio-Pleistocene hominins. This hypothesis is evaluated here using geometric morphometric data to describe the ontogenetic shape trajectories of extant hominine distal femora and place Plio-Pleistocene hominins within that context. Results of multivariate statistical analyses showed that in both Homo and Gorilla, the shape of the distal femur changes significantly over the course of development, whereas that of Pan changes very little. Development of the distal femur of Homo is characterized by an elongation of the condyles, and a greater degree of enlargement of the medial condyle relative to the lateral condyle, whereas Gorilla are characterized by a greater degree of enlargement of the lateral condyle, relative to the medial. Early Homo and Australopithecus africanus fossils fell on the modern human ontogenetic shape trajectory and were most similar to either adult or adolescent modern humans while specimens of Australopithecus afarensis were more similar to Gorilla/Pan. These results indicate that shape differences among the distal femora of Plio-Pleistocene hominins and humans cannot be accounted for by heterochrony alone; heterochrony could explain a transition from the distal femoral shape of early Homo/A. africanus to modern Homo, but not a transition from A. afarensis to Homo. That change could be the result of genetic or epigenetic factors.

  8. Shape Ontogeny of the Distal Femur in the Hominidae with Implications for the Evolution of Bipedality.

    Science.gov (United States)

    Tallman, Melissa

    2016-01-01

    Heterochrony has been invoked to explain differences in the morphology of modern humans as compared to other great apes. The distal femur is one area where heterochrony has been hypothesized to explain morphological differentiation among Plio-Pleistocene hominins. This hypothesis is evaluated here using geometric morphometric data to describe the ontogenetic shape trajectories of extant hominine distal femora and place Plio-Pleistocene hominins within that context. Results of multivariate statistical analyses showed that in both Homo and Gorilla, the shape of the distal femur changes significantly over the course of development, whereas that of Pan changes very little. Development of the distal femur of Homo is characterized by an elongation of the condyles, and a greater degree of enlargement of the medial condyle relative to the lateral condyle, whereas Gorilla are characterized by a greater degree of enlargement of the lateral condyle, relative to the medial. Early Homo and Australopithecus africanus fossils fell on the modern human ontogenetic shape trajectory and were most similar to either adult or adolescent modern humans while specimens of Australopithecus afarensis were more similar to Gorilla/Pan. These results indicate that shape differences among the distal femora of Plio-Pleistocene hominins and humans cannot be accounted for by heterochrony alone; heterochrony could explain a transition from the distal femoral shape of early Homo/A. africanus to modern Homo, but not a transition from A. afarensis to Homo. That change could be the result of genetic or epigenetic factors.

  9. Shape Ontogeny of the Distal Femur in the Hominidae with Implications for the Evolution of Bipedality

    Science.gov (United States)

    Tallman, Melissa

    2016-01-01

    Heterochrony has been invoked to explain differences in the morphology of modern humans as compared to other great apes. The distal femur is one area where heterochrony has been hypothesized to explain morphological differentiation among Plio-Pleistocene hominins. This hypothesis is evaluated here using geometric morphometric data to describe the ontogenetic shape trajectories of extant hominine distal femora and place Plio-Pleistocene hominins within that context. Results of multivariate statistical analyses showed that in both Homo and Gorilla, the shape of the distal femur changes significantly over the course of development, whereas that of Pan changes very little. Development of the distal femur of Homo is characterized by an elongation of the condyles, and a greater degree of enlargement of the medial condyle relative to the lateral condyle, whereas Gorilla are characterized by a greater degree of enlargement of the lateral condyle, relative to the medial. Early Homo and Australopithecus africanus fossils fell on the modern human ontogenetic shape trajectory and were most similar to either adult or adolescent modern humans while specimens of Australopithecus afarensis were more similar to Gorilla/Pan. These results indicate that shape differences among the distal femora of Plio-Pleistocene hominins and humans cannot be accounted for by heterochrony alone; heterochrony could explain a transition from the distal femoral shape of early Homo/A. africanus to modern Homo, but not a transition from A. afarensis to Homo. That change could be the result of genetic or epigenetic factors. PMID:26886416

  10. Adaptation of the lateral distal femur DXA scan technique to adults with disabilities.

    Science.gov (United States)

    Henderson, Richard C; Henderson, Brent A; Kecskemethy, Heidi H; Hidalgo, Sebastian T; Nikolova, Beth Ann; Sheridan, Kevin; Harcke, H Theodore; Thorpe, Deborah E

    2015-01-01

    The technique that best addresses the challenges of assessing bone mineral density in children with neuromuscular impairments is a dual-energy X-ray absorptiometry (DXA) scan of the lateral distal femur. The purpose of this study was to adapt this technique to adults with neuromuscular impairments and to assess the reproducibility of these measurements. Thirty-one adults with cerebral palsy had both distal femurs scanned twice, with the subject removed and then repositioned between each scan (62 distal femurs, 124 scans). Each scan was independently analyzed twice by 3 different technologists of varying experience with DXA (744 analyses). Precision of duplicate analyses of the same scan was good (range: 0.4%-2.3%) and depended on both the specific region of interest and the experience of the technologist. Precision was reduced when comparing duplicate scans, ranging from 7% in the metaphyseal (cancellous) region to 2.5% in the diaphyseal (cortical) region. The least significant change was determined as recommended by the International Society for Clinical Densitometry for each technologist and each region of interest. Obtaining reliable, reproducible, and clinically relevant assessments of bone mineral density in adults with neuromuscular impairments can be challenging. The technique of obtaining DXA scans of the lateral distal femur can be successfully applied to this population but requires a commitment to developing the necessary expertise. Copyright © 2015 The International Society for Clinical Densitometry. Published by Elsevier Inc. All rights reserved.

  11. anthropometry of the distal femur in a kenyan population and its ...

    African Journals Online (AJOL)

    Conclusion: The dimensions of the distal femur of the adult Kenyan differs from other ethnic populations. Of the implants sampled, most had dimensions that did not closely match those of the femora studied. Local clinical studies are needed to determine the clinical significance of the mismatch on the outcome of total knee.

  12. Anthropometry of the distal femur in a Kenyan population and its ...

    African Journals Online (AJOL)

    Conclusion: The dimensions of the distal femur of the adult Kenyan differs from other ethnic populations. Of the implants sampled, most had dimensions that did not closely match those of the femora studied. Local clinical studies are needed to determine the clinical significance of the mismatch on the outcome of total knee ...

  13. The Effect of Cement Placement on Augmentation of the Osteoporotic Proximal Femur

    OpenAIRE

    Sutter, Edward G.; Wall, Simon J.; Mears, Simon C; Belkoff, Stephen M.

    2010-01-01

    Femoroplasty, the augmentation of the proximal femur, has been shown in biomechanical studies to increase the energy required to produce a fracture and therefore may reduce the risk of such injuries. The purpose of our study was to test the hypotheses that: (1) 15 mL of cement was sufficient to mechanically augment the proximal femur, (2) there was no difference in augmentation effect between cement placement in the intertrochanteric region and in the femoral neck, and (3) cement placement in...

  14. Temporary antibiotic cement-covered gamma nail spacer for an infected nonunion of the proximal femur.

    Science.gov (United States)

    Rodriguez, Hugo; Ziran, Bruce H

    2007-01-01

    We report the case of an infected nonunion of the proximal femoral in an elderly patient. There was extensive involvement of the entire proximal femur precluding salvage. An impromptu use of a cephalomedullary nail coated with antibiotic-laden bone cement is described, followed by reimplantation with a revision-type proximal femoral prosthesis. The patient had resection of the proximal femur, placement of a temporary functional spacer, and reimplantation after a course of antibiotics, with good success. The method we describe is a reasonable alternative when standard off-the-shelf systems or other methods of temporary spacer creation are not available.

  15. An Osteometric Study of Proximal and Distal Femur Morphology

    Directory of Open Access Journals (Sweden)

    Sema Ozandac

    2015-09-01

    Results: The mean values of these measurements were found to be 22.2 +/- 3.0 mm, 429.5 +/- 35.0 mm, 306.5 +/- 26.7 mm, 61.9 +/- 5.7 mm, 44.2 +/- 3.8 mm, 121.10 +/- 4.00, 30.8 +/- 3.1 and 2.4 +/- 0.2 cm in the right side respectively. However, in the left side same dimensions were 22.5 +/- 4.4 mm, 431.3 +/-26.2 mm, 299.5 +/- 59.4 mm, 61.4 +/- 5.1 mm, 44.2 +/- 3.3 mm, 121.2 +/- 4.00, 30.0 +/- 2.9 and 2.3 +/- 0.2 cm respectively. Conclusion: The observations presented in the report have defined anatomic parameters that need to be taken into consideration when surgical procedures are performed in hip and knee area for this population. [Cukurova Med J 2015; 40(3.000: 466-473

  16. Extensively coated revision stems in proximally deficient femur: Early results in 15 patients

    Directory of Open Access Journals (Sweden)

    Marya SKS

    2008-01-01

    intraoperative severe comminuted fracture extending into the supracondylar region while hammering in the stem. Post cerclage wiring, she was put on a long knee brace and her mobilization was delayed to 12 weeks. Conclusions: The extensively coated cementless ( ′Solution™′ femoral stem provides a reasonable ′solution′ to the deficient femur in hip revision. The proximal femoral deficiences can be relatively easily bypassed and distal fixation can be achieved with this stem. Extreme care needs to be taken to avoid fractures and penetration of the femoral shaft, which can, however, be managed by cerclage wiring. Principles of a successful outcome include preservation of the functional continuity of the abduction apparatus, care to recognize and prevent distal extension of fracture while inserting the stem (preemptive cerclage wiring and supervised rehabilitation.

  17. Comparative morphometric analysis of the proximal femur of African hominids and felids

    Directory of Open Access Journals (Sweden)

    Andrew Gallagher

    2015-09-01

    Full Text Available Size and shape of the mammalian proximal femur and taxon-specific distinctions in the relative proportions of the proximal articulation, the femoral neck and the proximal femoral diaphysis, are critical determinants in its adaptation to differential biomechanical stresses and observed locomotor habitus in different taxa. The morphometrics of the proximal femur are considered equally critical in the assessment of locomotor habitus of extinct fossil mammals, particularly extinct Miocene anthropoids and Plio-Pleistocene hominins. Analyses of size and shape of k=10 dimensions of the proximal femur were undertaken for a large sample series of two extant mammal families the Felidae and Hominidae using conventional multivariate statistical procedures, commonly used size-correction methods, and post-hoc tests of significance. While significant differences in form do exist, there are equally striking convergences in the functional morphology of extant hominid and felid taxa. Multivariate and bivariate allometric analyses confirm that the proximal femur of these two mammalian families share a common underlying structure manifest in a shared first common principal component. Nevertheless, while considerable convergences in general form of the proximal femur of African hominids and large-bodied felids are apparent, there exist equally discreet distinctions which are consistent with the differential structural demands imposed by their distinct locomotor and behavioural habitus.

  18. The effect of distal femur bony morphology on in vivo knee translational and rotational kinematics.

    Science.gov (United States)

    Hoshino, Yuichi; Wang, Joon Ho; Lorenz, Stephan; Fu, Freddie H; Tashman, Scott

    2012-07-01

    Tibio-femoral kinematics are clearly influenced by the bony morphology of the femur. Previous morphological studies have not directly evaluated relationships between morphology and knee kinematics. Therefore, the purpose of this study was to examine the relationship between distal femur bony morphology and in vivo knee kinematics during running. It was hypothesized that the posterior offset of the transcondylar axis would be related to the magnitude of anterior/posterior tibio-femoral translation and that the rotational angle of the transcondylar axis would be related to the magnitude of internal/external knee rotation. Seventeen contralateral (uninjured) knees of ACL-reconstructed patients were used. Distal femoral geometry was analyzed from 3D-CT data by determining the anteroposterior location (condyle offset ratio--COR) and rotational angle (condylar twist angle--CTA) of the femoral transcondylar axis. Six degree-of-freedom knee kinematics were obtained during running using a dynamic stereo radiograph system. Knee kinematics were correlated with the femoral morphologic measures (COR and CTA) to investigate the influence of femoral geometry on dynamic knee function. Significant correlations were identified between distal femur morphology and knee kinematics. Anterior tibial translation was positively correlated with the condyle offset ratio (R(2) = 0.41, P femur shape on dynamic knee function. III.

  19. The shape of the hominoid proximal femur: a geometric morphometric analysis

    Science.gov (United States)

    Harmon, Elizabeth H

    2007-01-01

    As part of the hip joint, the proximal femur is an integral locomotor component. Although a link between locomotion and the morphology of some aspects of the proximal femur has been identified, inclusive shapes of this element have not been compared among behaviourally heterogeneous hominoids. Previous analyses have partitioned complex proximal femoral morphology into discrete features (e.g. head, neck, greater trochanter) to facilitate conventional linear measurements. In this study, three-dimensional geometric morphometrics are used to examine the shape of the proximal femur in hominoids to determine whether femoral shape co-varies with locomotor category. Fourteen landmarks are recorded on adult femora of Homo, Pan, Gorilla, Pongo and Hylobates. Generalized Procrustes analysis (GPA) is used to adjust for position, orientation and scale among landmark configurations. Principal components analysis is used to collapse and compare variation in residuals from GPA, and thin-plate spline analysis is used to visualize shape change among taxa. The results indicate that knucklewalking African apes are similar to one another in femoral shape, whereas the more suspensory Asian apes diverge from the African ape pattern. The shape of the human and orangutan proximal femur converge, a result that is best explained in terms of the distinct requirements for locomotion in each group. These findings suggest that the shape of the proximal femur is brought about primarily by locomotor behaviour. PMID:17310545

  20. Tumour Endoprosthetic Reconstruction for Primary Aggressive and Malignant Bone Tumours of the Distal Femur

    Directory of Open Access Journals (Sweden)

    DA Rubio

    2013-11-01

    Full Text Available At the Philippine General Hospital, tumour endoprostheses have become an option for reconstruction after limb saving surgery for primary bone tumors. We performed a retrospective review of patients with primary bone tumors of the distal femur who underwent tumor excision and reconstruction using tumor endoprostheses. Outcome measures included prosthetic survival, functional outcome and complications. Twenty-two patients were evaluated; 14 males and 8 females, with a mean age of 18 years and a mean follow-up of 56 months. The overall 2-year endoprosthetic survival rate was 86%. Mean MSTS was 23/30. There were a total of 6 revisions. Failure modes included 3 infections, 3 aseptic loosening, 4 structural failures, 2 soft tissue failures and 3 tumor progression. Our early results show that tumor endoprosthesis reconstruction is an acceptable option for patients with primary bone tumor of the distal femur. Survival rates, failure modes and functional outcomes are comparable to other reported studies.

  1. Rotationplasty after failure of a knee prosthesis for a malignant tumour of the distal femur.

    Science.gov (United States)

    Wicart, P; Mascard, E; Missenard, G; Dubousset, J

    2002-08-01

    Failure of massive knee endoprostheses implanted for malignant tumours of the distal femur in children presents a difficult problem. We present the results of rotationplasty undertaken under these circumstances in four boys. They had been treated initially at a mean age of 9.5 years for a stage-IIB malignant tumour of the distal femur by resection and implantation of a massive knee endoprosthesis. After a mean period of eight years and a mean of four operative procedures, there was failure of the endoprosthesis because of aseptic loosening in two and infection in two. Function was poor with a mean Musculoskeletal Tumor Society score of 7.5/30, and considerable associated psychological problems. At a mean follow-up of 4.5 years after rotationplasty there was excellent function with a mean score of 27.5/30 and resolution of the psychological problems.

  2. Mono- versus polyaxial locking plates in distal femur fractures: a prospective randomized multicentre clinical trial.

    Science.gov (United States)

    Hanschen, Marc; Aschenbrenner, Ina M; Fehske, Kai; Kirchhoff, Sonja; Keil, Leonhard; Holzapfel, Boris M; Winkler, Sebastian; Fuechtmeier, Bernd; Neugebauer, Rainer; Luehrs, Sven; Liener, Ulrich; Biberthaler, Peter

    2014-04-01

    Treatment of complex fractures of the distal femur utilizing monoaxial locking plates (e.g. Less Invasive Stabilisation System, LISS®, Synthes) is considered to be superior to conventional plating systems. Due to the limitation that the thread forces the screw into pre-determined positions, modifications have been made to allow screw positioning within a range of 30° (Non Contact Bridging, NCB®-DF, Zimmer). For the first time, this multicenter prospective randomized clinical trial (RCT) investigates the outcome of LISS® vs. NCB®-DF treatment following complex fractures of the distal femur. Since June 2008, 27 patients with a fracture of the distal femur (AO ASIF 33-A-C and periprosthetic fractures) were enrolled in this study by four university trauma centres in southern Germany. Clinical (e.g. range of motion, Oxford knee score, Tegner score) and radiological (e.g. axis deviation, secondary loss of realignment) follow-ups were conducted one and six weeks, as well as three, six, and 12 months after the operation. This study comprises data of 27 patients (8 male, 19 female; 15 NCB®-DF, 12 LISS®). Polyaxial osteosynthesis using the NCB® system tended to result in better functional knee scores and a higher range of motion. Interestingly, fracture union tended to be more rapid using the polyaxial plating system. We present the analysis of a multicenter prospective RCT to compare the monoaxial LISS® vs. the polyaxial NCB®-DF treatment following complex fractures of the distal femur. NCB®-DF treatment tended to result in better functional and radiological outcomes than LISS® treatment. Level I.

  3. Proximal and distal muscle fatigue differentially affect movement coordination

    OpenAIRE

    Cowley, Jeffrey C.; Gates, Deanna H.

    2017-01-01

    Muscle fatigue can cause people to change their movement patterns and these changes could contribute to acute or overuse injuries. However, these effects depend on which muscles are fatigued. The purpose of this study was to determine the differential effects of proximal and distal upper extremity muscle fatigue on repetitive movements. Fourteen subjects completed a repetitive ratcheting task before and after a fatigue protocol on separate days. The fatigue protocol either fatigued the proxim...

  4. Anthropometric Measurements of the Human Distal Femur: A Study of the Adult Malay Population

    Directory of Open Access Journals (Sweden)

    Fitdriyah Hussain

    2013-01-01

    Full Text Available The distal femurs of 100 subjects (50 men, 50 women from the Malay population aged between 19 and 38 years were scanned to measure the anterior-posterior (AP and medial-lateral (ML width. The mean AP values were 64.02 ± 3.38 mm and 57.33 ± 3.26 mm for men and women, respectively, and the mean ML values were 74.91 ± 3.52 mm and 64.53 ± 3.07 mm. We compared our data to that published previously for the Chinese and Indian populations. It was found that the Malay population had smaller distal femur than that of the Chinese but was larger than that of the Indian population (P < 0.05. In conclusion, although it is well established that Asians have a smaller distal femur size than that of the Western population, the variations in different Asian ethnicities may need to be considered when designing the appropriate knee implant.

  5. Magnetic resonance imaging findings of osteoid osteoma of the proximal femur

    Energy Technology Data Exchange (ETDEWEB)

    Gaeta, Michele; Minutoli, Fabio; Pandolfo, Ignazio; Vinci, Sergio; Blandino, Alfredo [Department of Radiological Sciences, University of Messina, Policlinico ' ' G. Martino' ' , Via Consolare Valeria, 98100, Messina (Italy); D' Andrea, Letterio [Department of Orthopedics, University of Messina, Policlinico ' ' G. Martino' ' , Via Consolare Valeria, 98100, Messina (Italy)

    2004-09-01

    Osteoid osteoma (OO) is a benign bone tumor whose main radiological finding is nidus. OO of the proximal femur can also result in non-specific findings such as hip joint effusion, perinidal bone marrow edema and soft tissue mass. Since the nidus may be difficult to identify with MR, these non-specific findings can lead to erroneous diagnosis. Therefore, MR imaging technique should be optimized in order to identify nidus. Since MR imaging has assumed increasing importance in the evaluation of disorders of the hip, radiologists must be aware of the spectrum of findings of OO of the proximal femur. The aim of this pictorial review is to show the MR imaging findings of intra-articular and extra-articular OO of the proximal femur. (orig.)

  6. A device for in vivo measurements of quantitative ultrasound variables at the human proximal femur.

    Science.gov (United States)

    Barkmann, Reinhard; Laugier, Pascal; Moser, Urs; Dencks, Stefanie; Klausner, Michael; Padilla, Frédéric; Haïat, Guilleaume; Glüer, Claus-C

    2008-01-01

    Quantitative ultrasound (QUS) at the calcaneus has similar power as a bone mineral density (BMD)- measurement using DXA for the prediction of osteoporotic fracture risk. Ultrasound equipment is less expensive than DXA and free of ionizing radiation. As a mechanical wave, QUS has the potential of measuring different bone properties than dual X-ray absorptiometry (DXA,) which depends on X-ray attenuation and might be developed into a tool of comprehensive assessment of bone strength. However, site-specific DXA at the proximal femur shows best performance in the prediction of hip fractures. To combine the potential of QUS with measurements directly at the femur, we developed a device for in vivo QUS measurements at this site. Methods comprise ultrasound transmission through the bone, reflection from the bone surface, and backscatter from the inner trabecular structure. The complete area of the proximal femur can be scanned except at the femoral head, which interferes with the ilium. To avoid edge artifacts, a subregion of the proximal femur in the trochanteric region was selected as measurement region. First, in vivo measurements demonstrate a good signal to noise ratio and proper depiction of the proximal femur on an attenuation image. Our results demonstrate the feasibility of in vivo measurements. Further improvements can be expected by refinement of the scanning technique and data evaluation method to enhance the potential of the new method for the estimation of bone strength.

  7. A Skeletal Traction Technique for Proximal Femur Fracture Management in an Austere Environment.

    Science.gov (United States)

    Lidwell, David; Meghoo, Colin A

    2016-01-01

    Skeletal traction is a useful technique for managing proximal femur fractures in austere environments where fracture stabilization for this injury is difficult. We present a technique and a construct appropriate for field use that facilitates patient evacuation, and we provide guidelines for the use of this technique by an advanced medical provider managing these injuries. The objectives of this article are to enable to reader to (1) recognize the role of skeletal traction in managing proximal femur fractures in an austere environment, (2) identify the key steps in placing transfemoral skeletal traction pins, and (3) identify options and requirements for building a traction construct in resource-limited environments. 2016.

  8. The Relationship Between Fractures and DXA Measures of BMD in the Distal Femur of Children and Adolescents With Cerebral Palsy or Muscular Dystrophy

    Science.gov (United States)

    Henderson, Richard C; Berglund, Lisa M; May, Ryan; Zemel, Babette S; Grossberg, Richard I; Johnson, Julie; Plotkin, Horacio; Stevenson, Richard D; Szalay, Elizabeth; Wong, Brenda; Kecskemethy, Heidi H; Harcke, H Theodore

    2010-01-01

    Children with limited or no ability to ambulate frequently sustain fragility fractures. Joint contractures, scoliosis, hip dysplasia, and metallic implants often prevent reliable measures of bone mineral density (BMD) in the proximal femur and lumbar spine, where BMD is commonly measured. Further, the relevance of lumbar spine BMD to fracture risk in this population is questionable. In an effort to obtain bone density measures that are both technically feasible and clinically relevant, a technique was developed involving dual-energy X-ray absorptiometry (DXA) measures of the distal femur projected in the lateral plane. The purpose of this study is to test the hypothesis that these new measures of BMD correlate with fractures in children with limited or no ability to ambulate. The relationship between distal femur BMD Z-scores and fracture history was assessed in a cross-sectional study of 619 children aged 6 to 18 years with muscular dystrophy or moderate to severe cerebral palsy compiled from eight centers. There was a strong correlation between fracture history and BMD Z-scores in the distal femur; 35% to 42% of those with BMD Z-scores less than −5 had fractured compared with 13% to 15% of those with BMD Z-scores greater than −1. Risk ratios were 1.06 to 1.15 (95% confidence interval 1.04–1.22), meaning a 6% to 15% increased risk of fracture with each 1.0 decrease in BMD Z-score. In clinical practice, DXA measure of BMD in the distal femur is the technique of choice for the assessment of children with impaired mobility. © 2010 American Society for Bone and Mineral Research PMID:19821773

  9. Preliminary testing of a novel bilateral plating technique for treating periprosthetic fractures of the distal femur.

    Science.gov (United States)

    Muizelaar, Aaron; Winemaker, Mitchell J; Quenneville, Cheryl E; Wohl, Gregory R

    2015-11-01

    Current stabilization methods for periprosthetic fractures of the distal femur are inadequate in achieving fracture fixation, with complication rates as high as 29%. A major contributor to poor outcomes is that these methods rely only on screw purchase in the bone to maintain fracture reduction. We designed, manufactured and evaluated a novel plating method that utilizes the femoral prosthesis to enhance stability for treatment of distal femoral periprosthetic fractures. Medial and lateral plates were designed and manufactured based on geometry of a synthetic femur and femoral prosthesis. The two plates were linked via a compression screw and a small tab on each plate that inserted into pre-existing slots on the prosthesis. Mechanical tests (500N compression or 250N anterior directed cantilever bending), were performed on synthetic femurs with simple transverse fractures (3mm gap) just superior to the distal femoral prosthesis that were stabilized using either the prototype plates or a single lateral plate. Translational movements of the fracture site during loading were measured using 3D motion tracking. With the single lateral plate, the distal fragment experienced a resultant displacement of 0.40mm under cantilever bending and 0.61mm under compression (13% and 20% respectively of fracture gap width). With the bilateral plates, fracture gap motion was significantly reduced to 0.13mm under bending and compression (4.3% of the fracture gap). Our results indicate that a bilateral plating method is capable of improving stabilization of periprosthetic fractures compared to the traditional lateral plating technique. Copyright © 2015 Elsevier Ltd. All rights reserved.

  10. Adolescent physical activity and bone strength at the proximal femur in adulthood.

    Science.gov (United States)

    Jackowski, Stefan A; Kontulainen, Saija A; Cooper, David M L; Lanovaz, Joel L; Beck, Thomas J; Baxter-Jones, Adam D G

    2014-04-01

    Physical activity (PA) enhances bone structural strength at the proximal femur in adolescence, but whether these benefits are maintained into early adulthood remains unknown. The purpose of this study was to investigate whether males and females, described as active, average, and inactive during adolescence, display differences in structural strength at the proximal femur in early adulthood (20-30 yr). One hundred four participants (55 males and 49 females) from the Pediatric Bone Mineral Accrual Study (PBMAS) were categorized into adolescent PA groupings (inactive, average, and active) using the Physical Activity Questionnaire for Adolescents. Cross-sectional area and section modulus (Z) at the narrow neck, intertrochanter, and femoral shaft (S) sites of the proximal femur were assessed using hip structural analysis in young adulthood from femoral neck dual-energy x-ray absorptiometry scans. Group differences were assessed using ANCOVA, controlling for adult height (Ht), adult weight (Wt), adolescent bone geometry, sex, percentage adult total body lean tissue (LTM%), and adult PA levels. Active adolescents had significantly greater adjusted bone geometric measures at all sites than their inactive classified peers during adolescence (P femur than adult participants who were classified as inactive during adolescence (P femur in young adulthood.

  11. In vivo measurements of ultrasound transmission through the human proximal femur.

    Science.gov (United States)

    Barkmann, Reinhard; Laugier, Pascal; Moser, Urs; Dencks, Stefanie; Klausner, Michael; Padilla, Frédéric; Haiat, Guillaume; Heller, Martin; Glüer, Claus-C

    2008-07-01

    Quantitative ultrasound (QUS) measurements can be used to estimate osteoporotic fracture risk. The commonly used variables are the speed of sound (SOS) and the frequency dependent sound attenuation (broadband ultrasound attenuation, [BUA]) of a wave propagating through the bone, preferably the calcaneus. The technology, so far, is less suitable for direct measurement in vivo at the spine or the femur for prediction of bone mineral density (BMD) or fracture risk at the main osteoporotic fracture sites. To improve the clinical performance of QUS, we built a device for direct QUS measurements at the human femur in vivo. In vivo images of ultrasound transmission at one of the main fracture sites, the proximal femur, could be acquired. The estimated precision of SOS measurements of 0.5% achieved at the femur is comparable with the precision of peripheral QUS devices.

  12. Physical therapy in the postoperative of proximal femur fracture in elderly. Literature review

    OpenAIRE

    Carneiro,Mariana Barquet; Alves,Débora Pinheiro Lédio; Mercadante, Marcelo Tomanik

    2013-01-01

    The proximal femoral fracture in the elderly is a serious public health problem. Surgical treatment of this fracture is used to reduce morbidity, together with postoperative physical therapy. The objective was to conduct a systematic review of physical therapy protocols in postoperative for fractures of the proximal femur in elderly. We selected randomized controlled trials in elderly in the past 10 years, in Portuguese and English. There were 14 articles in the literature. Physical therapy h...

  13. Periosteal vascularization of the distal femur in relation to distal femoral osteotomies : a cadaveric study

    NARCIS (Netherlands)

    van der Woude, J A D; van Heerwaarden, R J; Bleys, R L A W

    2016-01-01

    BACKGROUND: The purpose of this study was to investigate periosteal vessels location as intra-operative landmarks in distal femoral osteotomies and focused on the branching pattern of the vascular supply of the medial and lateral femoral condyle, its constancy, and the relationship to the height of

  14. Interpretation of hip fracture patterns using areal bone mineral density in the proximal femur.

    Science.gov (United States)

    Hey, Hwee Weng Dennis; Sng, Weizhong Jonathan; Lim, Joel Louis Zongwei; Tan, Chuen Seng; Gan, Alfred Tau Liang; Ng, Jun Han Charles; Kagda, Fareed H Y

    2015-12-01

    Bone mineral density scans are currently interpreted based on an average score of the entire proximal femur. Improvements in technology now allow us to measure bone density in specific regions of the proximal femur. The study attempts to explain the pathophysiology of neck of femur (NOF) and intertrochanteric/basi-cervical (IT) fractures by correlating areal BMD (aBMD) scores with fracture patterns, and explore possible predictors for these fracture patterns. This is a single institution retrospective study on all patients who underwent hip surgeries from June 2010 to August 2012. A total of 106 patients (44 IT/basi-cervical, 62 NOF fractures) were studied. The data retrieved include patient characteristics and aBMD scores measured at different regions of the contralateral hip within 1 month of the injury. Demographic and clinical characteristic differences between IT and NOF fractures were analyzed using Fisher's Exact test and two-sample t test. Relationship between aBMD scores and fracture patterns was assessed using multivariable regression modeling. After adjusted multivariable analysis, T-Troc and T-inter scores were significantly lower in intertrochanteric/basi-cervical fractures compared to neck of femur fractures (P = 0.022 and P = 0.026, respectively). Both intertrochanteric/basi-cervical fractures (mean T.Tot -1.99) and neck of femur fractures (mean T.Tot -1.64) were not found to be associated with a mean T.tot less than -2.5. However, the mean aBMD scores were consistently less than -2.5 for both intertrochanteric/basi-cervical fractures and neck of femur fractures. Gender and calcium intake at the time of injury were associated with specific hip fracture patterns (P = 0.002 and P = 0.011, respectively). Hip fracture patterns following low energy trauma may be influenced by the pattern of reduced bone density in different areas of the hip. Intertrochanteric/basi-cervical fractures were associated with significantly lower T-Troc and T-Inter scores

  15. Early Mechanical Failures of the Synthes Variable Angle Locking Distal Femur Plate.

    Science.gov (United States)

    Tank, Jason C; Schneider, Prism S; Davis, Elizabeth; Galpin, Matthew; Prasarn, Mark L; Choo, Andrew M; Munz, John W; Achor, Timothy S; Kellam, James F; Gary, Joshua L

    2016-01-01

    To document the high failure rate of a specific implant: the Synthes Variable Angle (VA) Locking Distal Femur Plate. Retrospective. Urban University Level I Trauma Center. All distal femur fractures (OTA/AO 33-A, B, C) treated from March 2011 through August 2013 were reviewed from our institutional orthopaedic trauma registry. Inclusion criteria were fractures treated with a precontoured distal femoral locking plate and age between 18 and 84. Exclusion criteria were fractures treated with intramedullary nails, arthroplasty, non-precontoured plates, dual plating, or screw fixation alone. The population was divided into 3 groups: less invasive stabilization system (LISS) group (n = 21), treated with LISS plates (Synthes, Paoli, PA); locking condylar plates (LCPs) group (n = 10), treated with LCPs (Synthes, Paoli, PA); and VA group (n = 36), treated with VA distal femoral LCPs (Synthes, Paoli, PA). Average age was 54.6 ± 17.5 years. Open reduction internal fixation with one of the above implants was performed. The patients were followed radiographically for early mechanical implant failure defined as loosening of locking screws, loss of fixation, plate bending, or implant failure. There were no statistically significant differences between groups for age, gender, open fracture, mechanism of injury, or medial comminution. There were 3 failures (14.3%) in group LISS, no failures (0%) in group LCP, and 8 failures (22.2%) in group VA. All 3 failures in group LISS were in A-type fractures (2 periprosthetic) and all failures in group VA were in C-type fractures. When all fractures for all 3 groups were compared for failure rate, there was no statistically significant difference (P = 0.23). However, when only 33-C fractures were compared, there was significantly greater failure rate in the VA group (P = 0.03). The mean time to failure in group VA was 147 days (range 24-401 days) and was significantly earlier (P = 0.034) when compared with group LISS (mean 356 days; range

  16. Acetabular Protrusio and Proximal Femur Fractures in Patients With Osteogenesis Imperfecta.

    Science.gov (United States)

    Trehan, Samir K; Morakis, Emmanouil; Raggio, Cathleen L; Twomey, Kristin D; Green, Daniel W

    2015-09-01

    Osteogenesis imperfect (OI) is a genetic disorder characterized by increased bone fragility, frequent fractures, and extremity deformities among other clinical findings. A frequent radiographic finding in OI patients is acetabular protrusio (AP). We hypothesized that AP incidence would be significant in OI patients and highest among type III OI patients, who have a more severe disease phenotype. In addition, we hypothesized that there would be a correlation between AP and proximal femur fracture incidence. We retrospectively reviewed radiographs and medical records of 49 patients with OI evaluated at our institution. Demographic information and modified Sillence classification were recorded. AP was diagnosed using previously published radiographic criteria using the center-edge angle of Wiberg, acetabulum relative to the iliopectineal line, teardrop figure relative to the ilioischial (Kohler) line, and acetabulum relative to the ilioischial (Kohler) line. Medical record and radiographs were reviewed for evidence of proximal femur or acetabulum fracture. Associations between OI type, AP, and fracture incidence were examined with χ or Fisher exact tests. In this series of 49 OI patients, the overall incidence of AP was 55.1% (27/49) with the highest incidence among patients with type III OI (70.6%). There was an increased incidence of proximal femur, and particularly femoral neck, fractures among patients with AP compared with patients with normal hip anatomy. Overall, patients with AP had a 30% increased risk for proximal femur and acetabulum fractures (P=0.03). AP is a common deformity in OI patients (55.1%) and particularly type III OI (70.6%). Patients with AP have an increased risk for proximal femur fractures and particularly femoral neck fractures. This novel finding adds to the growing body of literature on clinical implications of AP in OI patients. Level IV-Retrospective case series.

  17. Patellar Height Decreasing After Distal Femur Endoprosthesis Reconstruction Does Not Affect Functional Outcome.

    Science.gov (United States)

    Etchebehere, Mauricio; Lin, Patrick P; Moon, Bryan S; Yu, Jun; Li, Liang; Lewis, Valerae O

    2016-02-01

    The patellar height can influence extensor mechanism and the knee function. Thus, during knee arthroplasty, the surgeon seeks to maintain the correct patellar height. However, it is more difficult to define and maintain the correct patella height in megaprosthesis reconstructions after tumor resections. The objective of this study was to evaluate patellar height after distal femur endoprosthesis reconstruction and its association to knee function. This retrospective analysis included 108 patients who underwent distal femur resections and endoprosthesis reconstruction. The minimum follow-up was 1 year or until the patients underwent patellar resurfacing or endoprosthesis revision. Patellar height was calculated using Insall-Salvati ratio (ISR) and Insall-Salvati patellar tendon insertion ratio (PTR) at 2 different times: postoperatively and at the final follow-up. The postoperative ratio was calculated using the best postoperative radiograph taken at least 1 month after the procedure. The final measures were based on the radiograph available at the last follow-up consultation. The ISR and PTR were associated to anterior knee pain (AKP), range of motion (ROM), and extension lag (EXL). The average follow-up was 4.5years. The mean postoperative ISR was 1.02, and the mean ISR at final follow-up was 0.95 (P<.0001). The mean postoperative PTR was 1.45, and the mean PTR at final follow-up was 1.40 (P=.016). There was no association between patellar height and AKP, ROM, and EXL. Patellar height decreases significantly after distal femur resections but does not affect AKP, ROM, and EXL. Copyright © 2016 Elsevier Inc. All rights reserved.

  18. Long bone florid reactive periostitis ossificans: a case in the distal femur mimicking osteosarcoma.

    Science.gov (United States)

    Azorín, Daniel; López-Pino, Miguel A; González-Mediero, Imelda; Epeldegui, Tomás; López-Barea, Fernando

    2008-11-01

    Florid reactive periostitis ossificans is a well-known benign lesion classically described in hands and feet which histopathological features can lead to a misdiagnosis of osteosarcoma. To the best of our knowledge, there is only one previous report of this lesion in a long bone. In this study we report a case of florid reactive periostitis ossificans located in the distal metaphysis of the left femur that histologically mimicked an osteosarcoma and discuss the differential diagnosis between these two entities to warn about a diagnostic pitfall.

  19. Limb-sparing surgery in a dog with osteosarcoma of the proximal femur.

    Science.gov (United States)

    Liptak, Julius M; Pluhar, G Elizabeth; Dernell, William S; Withrow, Stephen J

    2005-01-01

    To report successful limb-sparing surgery in a dog with a proximal femoral osteosarcoma (OSA) using a composite allograft-prosthetic technique. Case report. Client-owned dog. A stage IIB OSA of the proximal aspect of the femur was resected in accordance with oncologic and limb-sparing principles. The osseous defect was reconstructed with a proximal femoral allograft and cemented, long-stemmed femoral prosthesis. Soft tissue reconstruction was achieved by suturing host tendons to their respective allogeneic tendons on the allograft. Coxofemoral joint function was preserved using standard total hip arthroplasty techniques. Limb-sparing surgery of the proximal aspect of the femur using a composite allograft-prosthetic technique resulted in excellent limb function. Postoperative complications included aseptic loosening of the femoral composite graft and allograft nonunion, which required revision, traumatic implant luxation, and local tumor recurrence. Limb function was excellent after surgical stabilization of the allograft nonunion but deteriorated after implant luxation 270 days postlimb-sparing surgery. Pulmonary and skeletal metastases were diagnosed and local tumor recurrence suspected 596 and 650 days postoperatively, respectively. The dog was euthanatized 688 days after limb-sparing surgery as a result of progressive local and metastatic disease. Limb-sparing surgery for dogs with primary bone tumors of the proximal aspect of the femur is feasible with good functional results.

  20. [Gait analysis after rotationplasty hip surgery for malignant tumor of the proximal femur].

    Science.gov (United States)

    Donati, D; Benedetti, M G; Catani, F; Berti, L; Capanna, R

    2004-10-01

    Rotationplasty of the hip joint is a special surgical technique used for the treatment of malignant tumors of the proximal part of the femur. We report a clinical case and gait analysis results before and after rehabilitation training. Evaluation of joint motion, kinetic moments, and the electromyographic findings enabled us to document progressive adaptation of muscle and joint function to their new role in the motor pattern, demonstrating the exceptional strength of rotationplasty. Active control of two fulcrums in the lower limb, the pseudo hip proximally and the pseudo knee intermedially, makes this type of operation extremely advantageous compared to the alternative of hip disarticulation or hemipelvectomy. Total absence of pain together with the preservation of articular and cutaneous proprioception are important advantages. Rotationplasty is an attractive alternative for treatment of malignant tumors of the proximal part of the femur.

  1. All-polyethylene tibial components in distal femur limb-salvage surgery: a finite element analysis based on promising clinical outcomes.

    Science.gov (United States)

    Tang, Fan; Zhou, Yong; Zhang, Wenli; Min, Li; Shi, Rui; Luo, Yi; Duan, Hong; Tu, Chongqi

    2017-04-04

    Whether all-polyethylene tibial (APT) components are beneficial to patients who received distal femur limb-salvage surgery lacks high-quality clinical follow-up and mechanical evidence. This study aimed to investigate the biomechanics of the distal femur reconstructed with APT tumor knee prostheses using finite element (FE) analysis based on our previous, promising clinical outcome. Three-dimensional FE models that use APT and metal-backed tibial (MBT) prostheses to reconstruct distal femoral bone defects were developed and input into the Abaqus FEA software version 6.10.1. Mesh refinement tests and gait simulation with a single foot both in the upright and 15°-flexion positions with mechanical loading were conducted. Stress distribution analysis was compared between APT and MBT at the two static positions. For both prosthesis types, the stress was concentrated on the junction of the stem and shaft, and the maximum stress in the femoral axis base was more than 100 Mpa. The stress on the tibial surface was relatively distributed, which was 1-19 MPa. The stress on the tibial bone-cement layer of the APT prosthesis was approximately 20 times higher than that on the MBT prosthesis in the same region. The stress on the proximal tibial cancellous bone and cortical bone of the APT prosthesis was 3-5 times greater than that of the MBT prosthesis, and it was more distributed. Although the stress of bone-cement around the APT component is relatively high, the stress was better distributed at the polyethylene-cement-bone interface in APT than in MBT prosthesis, which effectively protects the proximal tibia in distal femur tumor knee prosthesis replacement. These results should be considered when selecting the appropriate tibial component for a patient, especially under the foreseeable conditions of osteoporosis.

  2. Ossification defects detected in CT scans represent early osteochondrosis in the distal femur of piglets.

    Science.gov (United States)

    Olstad, Kristin; Kongsro, Jørgen; Grindflek, Eli; Dolvik, Nils Ivar

    2014-08-01

    The purpose of the current study was to validate the use of CT for selection against osteochondrosis in pigs by calculating positive predictive value and comparing it to the positive predictive value of macroscopic evaluation, using histological examination as the reference standard. Eighteen male, hereditarily osteochondrosis-predisposed piglets underwent terminal examination at biweekly intervals from the ages of 82-180 days old, including CT scanning, macroscopic, and histological evaluation of the left distal femur. Areas of ischemic chondronecrosis (osteochondrosis) were confirmed in histological sections from 44/56 macroscopically suspected lesions, resulting in a positive predictive value of 79% (95% CI: 67-84%). Suspected lesions, that is; focal, radiolucent defects in the ossification front in CT scans corresponded to areas of ischemic chondronecrosis in 36/36 histologically examined lesions, resulting in a positive predictive value of 100% (95% CI: 90-100%). CT was superior to macroscopic evaluation for diagnosis of early stages of osteochondrosis in the distal femur of piglets. The current histologically validated observations can potentially be extrapolated to diagnostic monitoring of juvenile osteochondritis dissecans in children, or to animal models of human juvenile articular cartilage injury and repair. © 2014 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  3. The Analysis of Biomechanical Properties of Proximal Femur after Implant Removal

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    Jae Hyuk Yang

    2016-01-01

    Full Text Available Introduction. To compare the biomechanical stability of the femur following the removal of proximal femoral nail antirotation (PFNA-II and dynamic hip screw (DHS. Material and Methods. 56 paired cadaveric femurs were used as experimental and control groups. In the experimental group, PFNA-II and DHS were randomly inserted into femurs on both sides and then removed. Thereafter, compression load was applied until fracture occurred; biomechanical stability of the femurs and associated fracture patterns were studied. Results. The ultimate load and stiffness of the control group were 6227.8±1694.1 N and 990.5±99.8 N/mm, respectively. These were significantly higher than experimental group (p=0.014, <0.001 following the removal of PFNA-II (4085.6±1628.03 N and 656.3±155.3 N/mm and DHS (4001.9±1588.3 N and 656.3±155.3 N/mm. No statistical differences in these values were found between the 2 device groups (p=0.84, 0.71, regardless of age groups. However, fracture patterns were different between two devices, intertrochanteric and subtrochanteric fractures. Conclusions. Mechanical stability of the proximal femurs does not differ after the removal of 2 different of fixation devices regardless of the age. However, it was significantly lower compared to an intact femur. Different fracture patterns have been shown following the removal of different fixation devices as there are variations in the site of stress risers for individual implants.

  4. Distraction lengthening of the proximal phalanx in distal thumb amputations.

    Science.gov (United States)

    Cansü, Eren; Ünal, Mehmet Bekir; Parmaksızoğlu, Fatih; Gürcan, Serkan

    2015-01-01

    Thumb amputation is a major cause of hand dysfunction, and the treatment for distal thumb amputations remains controversial. Although finger reconstruction methods using distraction lengthening are known to restore finger length and function, we found no reports in the literature regarding phalangeal lengthening in thumb amputations. We aimed to evaluate proximal phalangeal lengthening in thumb amputations at or near the interphalangeal (IP) joint. We retrospectively evaluated patients who had undergone distraction lengthening of the proximal phalanx of the thumb. All patients underwent osteotomy, either during the initial procedure or as a second-stage procedure. Distraction began 10 days after osteotomy with the use of an external fixator that remained in place until ossification of the gap occurred without bone grafting. Patients were evaluated using the QuickDASH score. Fourteen patients with a mean age of 27 years and a mean follow-up period of 7 years were enrolled. The mean phalangeal lengthening achieved was 20 mm. Ossification occurred at all distraction sites, and the fixators were maintained for a mean of 85 days. The mean healing index was 42.5 days/cm. All 14 patients achieved the desired amount of phalangeal lengthening without major complications such as nonunion, premature union, or gross infection. For reconstruction in cases of distal thumb amputations, distraction lengthening of the proximal phalanx can be used to improve absolute length, web space, and grip distance. The technique is safe and effective, improves functionality/cosmesis, and offers a low complication risk.

  5. Validation of subject-specific automated p-FE analysis of the proximal femur.

    Science.gov (United States)

    Trabelsi, Nir; Yosibash, Zohar; Milgrom, Charles

    2009-02-09

    The use of subject-specific finite element (FE) models in clinical practice requires a high level of automation and validation. In Yosibash et al. [2007a. Reliable simulations of the human proximal femur by high-order finite element analysis validated by experimental observations. J. Biomechanics 40, 3688-3699] a novel method for generating high-order finite element (p-FE) models from CT scans was presented and validated by experimental observations on two fresh frozen femurs (harvested from a 30 year old male and 21 year old female). Herein, we substantiate the validation process by enlarging the experimental database (54 year old female femur), improving the method and examine its robustness under different CT scan conditions. A fresh frozen femur of a 54 year old female was scanned under two different environments: in air and immersed in water (dry and wet CT). Thereafter, the proximal femur was quasi-statically loaded in vitro by a 1000N load. The two QCT scans were manipulated to generate p-FE models that mimic the experimental conditions. We compared p-FE displacements and strains of the wet CT model to the dry CT model and to the experimental results. In addition, the material assignment strategy was reinvestigated. The inhomogeneous Young's modulus was represented in the FE model using two different methods, directly extracted from the CT data and using continuous spatial functions as in Yosibash et al. [2007a. Reliable simulations of the human proximal femur by high-order finite element analysis validated by experimental observations. J. Biomechanics 40, 3688-3699]. Excellent agreement between dry and wet FE models was found for both displacements and strains, i.e. the method is insensitive to CT conditions and may be used in vivo. Good agreement was also found between FE results and experimental observations. The spatial functions representing Young's modulus are local and do not influence strains and displacements prediction. Finally, the p-FE results of

  6. SHORTAND MIDDLE-TERM RESULTS OF HIP ARTHROPLASTY FOR TUMORS OF THE PROXIMAL FEMUR

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    R. M. Tikhilov

    2014-01-01

    Full Text Available A purpose of the study was to evaluate the immediate and medium-term outcomes of the treatment of patients with primary tumor lesions of proximal femur after the lesion resection together with total hip arthroplastyby total revision systems. Material and methods. 34 patients with primary tumors of proximal femur [chondrosarcoma - 9 (26.5%,giant cell tumor - II (32.4%,osteosarcoma - 2 (5.8%, other malignancies - 5 (14.7%,benign neoplasms - 7 (20.6%] underwent the conserving surgery at R.R. Vreden Russian Research Institute of Traumatology and Orthopedics since 2003 through 2013. The follow-up was from one to five years. The age of patients ranged from 16 to 70 years, patients younger than 40 years accounted for 61.8%. Acetabulum was replaced by standard components. To replace post-resection defects of proximal femur, in 21 (61.8% patents revision legs of cementless fixation Wagner Revision (Zimmer were used, in 10 (29.4% - “Fenix”, and in 3 (8.8% - Solution (DePuy, J&J. Results. A technique of total hip arthroplasty with the use of revision systems demonstrated excellent and positive results in 32 (94.2% cases. Complications leading to revision surgery occurred in 3 (8.8% patients. Conclusion. The method allows achievement of favorable functional outcomes and early patients’ activation without worsening the oncologic component of treatment and being not inferior to expensive modular systems.

  7. Unusual proximal femur fracture in children treated with PHILOS plate and review of literature

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    Mukesh Kumar

    2017-01-01

    Full Text Available Fractures of the hip are uncommon in children with incidence is less than 1% in all paediatrics fracture. It requires careful attention because of the incidence of complications is high. There is no consensus over ideal treatment of each group, but there are different options for each group has been described in literature, we report a case of unusual proximal femur fracture in ten-year-old girl which is not described in literature in best of our knowledge. A 10 years old girl was brought to us with pain in right hip joint and inability to bear weight on right lower limb after road traffic accident (child was hit by a car while walking on the road. Evaluated and found to have fracture of proximal femur. fracture was fixed with long PHILOS plate, which united in eight weeks duration, implant was removed at 10 month. At present after 14 months, she is able to perform her routine activities comfortably. and her Harris hip score is 95. We propose to add this type of fracture as 5th type of Delbet's classification as the fracture pattern in my patient was not fitting in any group of Delbet's classification and it belongs to proximal femur group and anatomically this fracture pattern was next to type IV fracture. Uncommon fracture of hip in children can be expected, this type of fracture can be added as 5th type in Delbet's classification. Long term outcome and ideal treatment yet to be described.

  8. Vascularized proximal fibular epiphyseal transfer for distal radial reconstruction.

    Science.gov (United States)

    Innocenti, Marco; Delcroix, Luca; Manfrini, Marco; Ceruso, Massimo; Capanna, Rodolfo

    2005-09-01

    Treatment of the loss of the distal part of the radius, including the physis and epiphysis, in a skeletally immature patient requires both replacement of the osseous defect and restoration of longitudinal growth. Autologous vascularized epiphyseal transfer is the only possible procedure that can meet both requirements. Between 1993 and 2002, six patients with a mean age of 8.4 years (range, six to eleven years) who had a malignant bone tumor in the distal part of the radius underwent microsurgical reconstruction of the distal part of the radius with a vascularized proximal fibular transfer, including the physis and a variable length of the diaphysis. All of the grafts were supplied by the anterior tibial vascular network. The rate of survival and bone union of the graft, the growth rate per year, the ratio between the lengths of the ulna and the reconstructed radius, and the range of motion of the wrist were evaluated for five of the six patients who had been followed for three years or more. The mean duration of follow-up of the six patients was 4.4 years (range, eight months to nine years). All six transfers survived and united with the host bone within two months postoperatively. The five patients who were followed for three years or more had consistent and predictable longitudinal growth. Serial radiographs revealed remodeling of the articular surface. The functional result was rated as excellent for all but one patient, in whom the distal part of the ulna had also been resected because of neoplastic involvement. No major complication occurred at the recipient site, whereas a peroneal nerve palsy occurred at the donor site in three patients. The palsy was transient in two patients, but it persisted in one. No instability of the knee joint was observed. After radical resection of the distal part of the radius because of a neoplasm in children, vascularized proximal fibular transfer, based on the anterior tibial artery, permits a one-stage skeletal and joint

  9. Asymmetry and structural system analysis of the proximal femur meta-epiphysis: osteoarticular anatomical pathology

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    Baydoun Safaa

    2008-02-01

    Full Text Available Abstract Background The human femur is commonly considered as a subsystem of the locomotor apparatus with four conspicuous levels of organization. This phenomenon is the result of the evolution of the locomotor apparatus, which encompasses both constitutional and individual variability. The work therein reported, therefore, underlies the significance of observing anatomical system analysis of the proximal femur meta-epiphysis in normal conditions, according to the anatomic positioning with respect to the right or left side of the body, and the presence of system asymmetry in the meta-epiphysis structure, thus indicating structural and functional asymmetry. Methods A total of 160 femur bones of both sexes were compiled and a morphological study of 15 linear and angulated parameters of proximal femur epiphysis was produced, thus defining the linear/angulated size of tubular bones. The parameters were divided into linear and angulated groups, while maintaining the motion of the hip joint and transmission of stress to the unwanted parts of the limb. Furthermore, the straight and vertical diameters of the femoral head and the length of the femoral neck were also studied. The angle between the neck and diaphysis, the neck antiversion and angle of rotation of the femoral neck were subsequently measured. Finally, the condylo-diaphyseal angle with respect to the axis of extremity was determined. To visualize the force of intersystem ties, we have used the method of correlation galaxy construction. Results The absolute numeral values of each linear parameter were transformed to relative values. The values of superfluity coefficient for each parameter in the right and left femoral bone groups were estimated and Pearson's correlation coefficient has been calculated (> 0.60. Retrospectively, the observed results have confirmed the presence of functional asymmetry in the proximal femur meta-epiphysis. On the basis of compliance or insignificant difference in

  10. Asymmetry and structural system analysis of the proximal femur meta-epiphysis: osteoarticular anatomical pathology.

    Science.gov (United States)

    Samaha, Ali A; Ivanov, Alexander V; Haddad, John J; Kolesnik, Alexander I; Baydoun, Safaa; Arabi, Maher R; Yashina, Irena N; Samaha, Rana A; Ivanov, Dimetry A

    2008-02-27

    The human femur is commonly considered as a subsystem of the locomotor apparatus with four conspicuous levels of organization. This phenomenon is the result of the evolution of the locomotor apparatus, which encompasses both constitutional and individual variability. The work therein reported, therefore, underlies the significance of observing anatomical system analysis of the proximal femur meta-epiphysis in normal conditions, according to the anatomic positioning with respect to the right or left side of the body, and the presence of system asymmetry in the meta-epiphysis structure, thus indicating structural and functional asymmetry. A total of 160 femur bones of both sexes were compiled and a morphological study of 15 linear and angulated parameters of proximal femur epiphysis was produced, thus defining the linear/angulated size of tubular bones. The parameters were divided into linear and angulated groups, while maintaining the motion of the hip joint and transmission of stress to the unwanted parts of the limb. Furthermore, the straight and vertical diameters of the femoral head and the length of the femoral neck were also studied. The angle between the neck and diaphysis, the neck antiversion and angle of rotation of the femoral neck were subsequently measured. Finally, the condylo-diaphyseal angle with respect to the axis of extremity was determined. To visualize the force of intersystem ties, we have used the method of correlation galaxy construction. The absolute numeral values of each linear parameter were transformed to relative values. The values of superfluidity coefficient for each parameter in the right and left femoral bone groups were estimated and Pearson's correlation coefficient has been calculated (> 0.60). Retrospectively, the observed results have confirmed the presence of functional asymmetry in the proximal femur meta-epiphysis. On the basis of compliance or insignificant difference in the confidence interval of the linear parameters, we

  11. DO PROXIMAL AND DISTAL GASTRIC TUMOURS BEHAVE DIFFERENTLY?

    Science.gov (United States)

    Costa, Laurence Bedin da; Toneto, Marcelo Garcia; Moreira, Luis Fernando

    2016-01-01

    Although the incidence of gastric (adenocarcinoma) cancer has been decreasing over time, it is still one of the most common malignancies worldwide, and proximal tumours tend to have a worse prognosis. To compare surgical outcomes and prognosis between proximal - excluding tumours of the cardia - and distal gastric cancer. Out of 293 cases reviewed - 209 with distal and 69 with proximal gastric cancer - were compared for clinical and pathological features, stage, surgical outcome, mortality and survival. Statistically, there was no significant difference between patients in both groups regarding mortality (p=0.661), adjuvant chemotherapy (p 0.661), and radiation (p=1.000). However, there was significant difference in the degree of lymph node dissection employed (p=0.002) and the number of positive lymph nodes resected (p=0.038) between the two groups. The odds of death at five years for patients who had a D0 dissection was three times greater (odds ratio 2.78; (95%CI 1.33-5.82) than that for patients who had a D2 dissection, while for patients who had a D1 dissection the odds ratio was only 1.41 (95%CI 0.71-2.83) compared to D2-dissected patients. Although no significant differences were found between proximal and distal gastric cancer, the increased risk of death in D0- and D1-dissected patients clearly suggests an important role of radical D2 lymph node dissection in survival. Embora a incidência do câncer gástrico esteja diminuindo nas últimas décadas, ele ainda aparece como uma das neoplasias malignas mais comuns, e tumores proximais tendem a ter pior prognóstico. Comparar os resultados cirúrgicos e o prognóstico entre o câncer gástrico proximal, excluindo os tumores da cárdia e junção esofagogástrica, e o distal. De 293 casos revistos - 209 distais e 69 proximais - foram comparados quanto aos achados clínicos e patológicos, estágio, resultados cirúrgicos, mortalidade e sobrevida. Estatisticamente não houve diferença entre pacientes em ambos

  12. Proximal femur of Australopithecus africanus from Member 4, Makapansgat, South Africa.

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    Reed, K E; Kitching, J W; Grine, F E; Jungers, W L; Sokoloff, L

    1993-09-01

    A left proximal femur (MLD 46) from Member 4, Makapansgat, South Africa is described and analyzed. It consists of the head, neck, and a small segment of the shaft that extends to just below the lesser trochanter. The femur exhibits degenerative joint disease in the form of marginal osteophyte formation and thus its taxonomic identity has been somewhat obscured. Consideration of all like-sized mammalian femora from Makapansgat suggests that the femur is that of either a felid or hominid. Comparison of MLD 46 to femora of extent and extinct felids reveals that MLD 46 does not possess two morphological features that are characteristic of felids, namely a deep, prolonged trochanteric fossa and a high neck-shaft angle. Simple shape variables (ratios) and multivariate analyses consistently place MLD 46 with modern and fossil hominids, and most closely align it with the australopithecines. We conclude that the femur is most reasonably attributable to Australopithecus africanus, which is the only hominid yet identified from Makapansgat. Despite its pathological condition, MLD 46 is the most complete proximal femur known for A. africanus, thereby permitting further morphological comparisons with homologues of A. afarensis and Paranthropus. Marginal osteophytes of mammalian femoral heads characteristically occur in individuals of advanced age, suggesting that MLD 46 may have lived some time with the disease. Finally, MLD 46 is considerably larger than the previously described specimen, Sts 14, from Sterkfontein Member 4. There may be as great a contrast in body size in A. africanus as there is between the large and small specimens of A. afarensis.

  13. Participation of osteoporosis in femoral neck fracture; Bone mineral measurement of proximal femur using quantitative computed tomography

    Energy Technology Data Exchange (ETDEWEB)

    Mizuno, Naoto (Gifu Prefectural Tajimi Hospital (Japan))

    1989-10-01

    Quantitative computed tomography (QCT) was used to measure bone mineral contents of the proximal femur. First, 62 specimens of cancellous bones of the proximal femur obtained at operation were burnt for mineral determination after preoperative QCT measurement to evaluate the relationship between QCT values and ash weight. The findings indicated that QCT measurement of proximal femur was as useful as that of the lumbar spine. Next, 10 groups of 50 men and 50 women ranging in age from the 5th to the 9th decade were tested to define the control mean and range of QCT mineral content of proximal femur, to compare with 32 cases of femoral neck fracture. In women with femoral neck fracture, QCT values of the femoral neck were less than those of the same normal age group except for cases of medial fracture in the 9th decade. This measurement might provide an index for fracture risk. (author).

  14. Effect of ACL reconstruction tunnels on stress in the distal femur.

    Science.gov (United States)

    Smolinski, P; O'Farrell, M; Bell, K; Gilbertson, L; Fu, F H

    2013-04-01

    This study examined the change in femoral stress caused by graft tunnels drilled for anterior cruciate ligament (ACL) reconstruction. Using a computational model, the number, geometry and position of the graft tunnels exits were varied to determine the effect on bone stress. A finite element model of the distal femur was developed from a CT scan of a cadaveric knee. To assess the model, the strain calculated computationally was compared to experimentally measured strains in eleven unpaired human cadaver femurs. Using the computational model, the number, geometry and position of the graft tunnel exits were varied to determine the effect on bone stress based on the stress concentration factor: the ratio of bone stress with tunnels to intact bone stress. The results indicated that the second tunnel in double-bundle ACL reconstruction results in approximately a 20 % increase in the maximum femoral stress as compared to single-bundle reconstruction. The highest stresses occur at the tunnel exits. The position of the tunnel exits effects femoral stress with the stress increasing slightly (AM SCR from 0.7 to 1 and PL SCR from 1.2 to 1.3) when the AM tunnel exit is moved anteriorly and having greater increases as the posterior lateral (PL) tunnel exit is moved laterally (PL SCR from 1.2 to 1.7) or posteriorly (PL SCR from 1.2 to 2). In anatomical ACL reconstruction, the tunnel entrances are dictated by anatomy; however, there can be variations in tunnel exit positions. Consideration should be given when positioning tunnel exits on the effect on stress in the femur. Moving the PL tunnel exit laterally or posteriorly increases in the stress at the PL tunnel exit.

  15. Associations of vitamin D deficiency with postoperative gait and mortality among patients with fractures of the proximal femur

    OpenAIRE

    Gumieiro, David Nicoletti [UNESP; Pereira,Gilberto José Cação; Minicucci, Marcos Ferreira [UNESP; Ricciardi, Carlos Eduardo Inácio; Damasceno, Erick Ribeiro; Funayama, Bruno Schiavoni [UNESP

    2015-01-01

    OBJECTIVE: To assess whether serum vitamin D concentration is associated with gait status and mortality among patients with fractures of the proximal femur, six months after suffering the fracture.METHODS: Consecutive patients aged ≥65 years with fractures of the proximal femur, who were admitted to the orthopedics and traumatology ward of our service between January and December 2011, were prospectively evaluated. Clinical, radiological, epidemiological and laboratory analyses were performed...

  16. ANATOMIC STUDY OF THE PROXIMAL THIRD OF THE FEMUR: FEMOROACETABULAR IMPACT AND THE CAM EFFECT.

    Science.gov (United States)

    Labronici, Pedro José; Alves, Sergio Delmonte; da Silva, Anselmo Fernandes; Giuberti, Gilberto Ribeiro; de Azevedo Neto, Justino Nóbrega; Mezzalira Penedo, Jorge Luiz

    2009-01-01

    To analyze anatomical variations of the proximal end of femur that could cause a femoroacetabular impact. 199 skeletically mature anatomical specimens of femurs were used. The femurs were measured in order to determine the anteversion angle of the femoral neck, neckshaft angle, sphericity of the femoral head at anteroposterior and superoinferior, angle between epiphysis and the anterior femoral neck, angle between epiphysis and the neck at lateral plane, anteroposterior distance at 5mm of the head and neck junction and anteroposterior distance of the neck base. we found that the impact subgroup presented a significantly larger junction diameter of 5mm (p = 0.0001) and cam-head (%) (p= 0.0001), while base-cam (%) (p = 0.0001) showed a significantly smaller diameter than the subgroup without impact. It was identified that cam-head (%) ≤ 80 e base-cam (%) ≤ 73 were identified as the optimal impact points. our study showed that the effect cam, caused by anatomical variations of the proximal femoral end focused the head-neck junction and base of the neck-junction head-neck. These rates can be predictive factors of the impact.

  17. FUNCTIONAL OUTCOME EVALUATION AFTER DISTAL FEMORAL LOCKING PLATE FIXATION OF SUPRACONDYLAR FRACTURES OF FEMUR

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    Kishore Babu S

    2017-10-01

    Full Text Available BACKGROUND Supracondylar fractures of femur have a bimodal distribution. They account for 6% of all femur fractures. Nearly, 50% of distal femur intraarticular fractures are open fractures. Despite many changes and refinements in the surgical treatment of the supracondylar and intercondylar fractures of femur their surgical management remains challenging. Since the introduction of the condylar blade plate to the present retrograde supracondylar nailing and locking condylar plates, these fractures particularly if open and associated with severe fragmentation of the articular cartilage and in the elderly with severe osteoporosis continue to be a major unsolved surgical challenge. Improved imaging facilities rendered surgical results far better than those treated with long periods of traction on bed with accompanying complications. LCP along with isolated 6.5 mm cannulated cancellous screw systems are best suited for with unicondylar fractures of distal femur in young patient with good bone stock. The functional outcome is largely determined by the degree of accompanying soft tissue injury. Presence of a compound fracture leads to a higher incidence of infection. With good preoperative antibiotics and sterile surgical techniques along with stable fixation, infection can be brought under control and a good outcome can be achieved. MATERIALS AND METHODS Thirty supracondylar and intercondylar fractures of femur (Muller’s type ‘A’, type ‘B’ and type ‘C’ fractures, which were treated with open reduction and internal fixation by locking compression plate were included in the study. The study was conducted at the Department of Orthopaedics, King George Hospital, Visakhapatnam, from August 2014 to November 2016. Among 30 patients, 5 patients were lost for follow up due to various reasons leaving 25 fractures from 25 patients for the study. RESULTS There were 16 males and 9 females. Age range was 19 years to 80 years with an average of 44

  18. Biomechanical analysis of distal femur fracture fixation: fixed-angle screw-plate construct versus condylar blade plate.

    Science.gov (United States)

    Higgins, Thomas F; Pittman, Gavin; Hines, Jerod; Bachus, Kent N

    2007-01-01

    The objective of this study is to establish the relative strength of fixation of a locking distal femoral plate compared with the condylar blade plate. Eight matched pairs of fresh-frozen cadaveric femurs were selected and evaluated for bone density. A gap osteotomy model was used to simulate an OTA/AO A3 comminuted distal femur fracture. One femur of each pair was fixed with the blade plate; the other, with a locking plate. After 100 N preload and 10,000 cycles between 100 N and 1000 N, total displacement of each specimen was assessed. After completion of cyclic loading, maximum load to failure was tested. Significantly greater subsidence (total axial displacement) occurred with the blade plate (1.70 +/- 0.45 mm; range, 1.21-2.48 mm) than with the locking plate fixation (1.04 +/- 0.33 mm; range, 0.67-1.60 mm) after cyclic loading (P = 0.03). In load-to-failure testing, force absorbed by the locking plate before failure (9085 +/- 1585 N; range, 7269-11,850 N) was significantly greater than the load tolerated by the blade plate construct (5591 +/- 945 N; range, 3546-6684 N; P = 0.001). Variability in bone mineral density did not affect the findings (fixed angle distal femoral plate r = 0.1563; condylar blade plate r = 0.0796). The locking screw-plate construct proved stronger than the blade plate in both cyclic loading and ultimate strength in biomechanical testing of a simulated A3 distal femur fracture. Although differences were small, the biomechanical performance of the locking plate construct over the blade plate may lend credence to use of the locking plate versus the blade plate in the fixation of comminuted distal femur fractures.

  19. Dating young tephras - a distal solution to proximal controversy

    Science.gov (United States)

    Chen, Xuanyu; Blockley, Simon; Xu, Yigang; Menzies, Martin

    2017-04-01

    In-situ dating of young volcanic rocks (Science, 291(5508): 1497-1499. Chen, X.-Y., Blockley, S.P.E., Tarasov, P.E., Xu, Y.-G., McLean, D., Tomlinson, E.L., Albert, P.G., Liu, J.-Q., Müller, S., Wagner, M. and Menzies, M.A., 2016. Clarifying the distal to proximal tephrochronology of the Millennium (B-Tm) eruption, Changbaishan Volcano, northeast China. Quat. Geochronol., 33: 61-75. Ge, Q. and Wu, W., 2011. Climate during the Medieval Climate Anomaly in China. PAGES news, 19: 24-26. Sun, C., Plunkett, G., Liu, J., Zhao, H., Sigl, M., McConnell, J.R., Pilcher, J.R., Vinther, B., Steffensen, J.P. and Hall, V., 2014. Ash from Changbaishan Millennium eruption recorded in Greenland ice: Implications for determining the eruption's timing and impact. Geophys. Res. Lett., 2013GL058642.

  20. Evaluating accuracy of structural geometry by DXA methods with an anthropometric proximal femur phantom.

    Science.gov (United States)

    Khoo, B C C; Beck, T J; Brown, K; Price, R I

    2013-09-01

    DXA-derived bone structural geometry has been reported extensively but lacks an accuracy standard. In this study, we describe a novel anthropometric structural geometry phantom that simulates the proximal femur for use in assessing accuracy of geometry measurements by DXA or other X-ray methods. The phantom consists of seven different interchangeable neck modules with geometries that span the range of dimensions in an adult human proximal femur, including those representing osteoporosis. Ten repeated hip scans of each neck module using two current DXA scanner models were performed without repositioning. After scanner specific calibration, hip structure analysis was used to derive structural geometry. Scanner performance was similar for the two manufacturers. DXA-derived HSA geometric measurements were highly correlated with values derived directly from phantom geometry and position; R² between DXA and phantom measures were greater than 94% for all parameters, while precision error ranged between 0.3 and 3.9%. Despite high R² there were some systematic geometry errors for both scanners that were small for outer diameter, but increasing with complexity of geometrical parameter; e.g. buckling ratio. In summary, the anthropometric phantom and its fabrication concept were shown to be appropriate for evaluating proximal femoral structural geometry in two different DXA systems.

  1. A proximal femur aneurysmal bone cyst resulting in amputation: a rare case report.

    Directory of Open Access Journals (Sweden)

    Khodamorad Jamshidi

    2015-02-01

    Full Text Available Aneurysmal bone cyst (ABC is blood filled expansile cystic lesion that most commonly occurs in patients during the second decade of their lives. Traditionally it has been described as a benign lesion but can be locally aggressive and result in the destruction of the involved bone. Treatment methods include surgical excision and curettage with or without bone grafting. We report a proximal femur aneurysmal bone cyst, which resulted in the amputation of the lower extremity, even though all available classic methods of treatment were applied for it.

  2. Radiographic anatomy of the proximal femur: femoral neck fracture vs. transtrochanteric fracture

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    Ana Lecia Carneiro Leão de Araújo Lima

    Full Text Available ABSTRACT OBJECTIVE: To evaluate the correlation between radiographic parameters of the proximal femur with femoral neck fractures or transtrochanteric fractures. METHODS: Cervicodiaphyseal angle (CDA, femoral neck width (FNW, hip axis length (HAL, and acetabular tear drop distance (ATD were analyzed in 30 pelvis anteroposterior view X-rays of patients with femoral neck fractures (n = 15 and transtrochanteric fractures (n = 15. The analysis was performed by comparing the results of the X-rays with femoral neck fractures and with transtrochanteric fractures. RESULTS: No statistically significant differences between samples were observed. CONCLUSION: There was no correlation between radiographic parameters evaluated and specific occurrence of femoral neck fractures or transtrochanteric fractures.

  3. Bone mineral loss at the proximal femur in acute spinal cord injury.

    Science.gov (United States)

    Edwards, W B; Schnitzer, T J; Troy, K L

    2013-09-01

    This study used quantitative computed tomography to assess changes in bone mineral at the proximal femur after acute spinal cord injury (SCI). Individuals with acute SCI experienced a marked loss of bone mineral from a combination of trabecular and endocortical resorption. Targeted therapeutic interventions are thus warranted in this population. SCI is associated with a rapid loss of bone mineral and an increased rate of fragility fracture. Some 10 to 20% of these fractures occur at the proximal femur. The purpose of this study was to quantify changes to bone mineral, geometry, and measures of strength at the proximal femur in acute SCI. Quantitative computed tomography analysis was performed on 13 subjects with acute SCI at serial time points separated by a mean of 3.5 months (range, 2.6-4.8 months). Changes in bone mineral content (BMC) and volumetric bone mineral density (vBMD) were quantified for integral, trabecular, and cortical bone at the femoral neck, trochanteric, and total proximal femur regions. Changes in bone volumes, cross-sectional areas, and surrogate measures of compressive and bending strength were also determined. During the acute period of SCI, subjects experienced a 2.7-3.3%/month reduction in integral BMC (p < 0.001) and a 2.5-3.1 %/month reduction in integral vBMD (p < 0.001). Trabecular BMC decreased by 3.1-4.7 %/month (p < 0.001) and trabecular vBMD by 2.8-4.4 %/month (p < 0.001). A 3.9-4.0 %/month reduction was observed for cortical BMC (p < 0.001), while the reduction in cortical vBMD was noticeably lower (0.8-1.0 %/month; p ≤ 0.01). Changes in bone volume and cross-sectional area suggested that cortical bone loss occurred primarily through endosteal resorption. Declines in bone mineral were associated with a 4.9-5.9 %/month reduction in surrogate measures of strength. These data highlight the need for therapeutic interventions in this population that target both trabecular and endocortical bone mineral

  4. The combination of structural parameters and areal bone mineral density improves relation to proximal femur strength

    DEFF Research Database (Denmark)

    Hansen, Stinus; Jensen, Jens-Erik Beck; Ahrberg, Fabian

    2011-01-01

    -one human proximal femur specimens (8 men and 23 women, median age 74 years, range 50-89) were examined with HR-pQCT at four regions of interest (femoral head, neck, major and minor trochanter) with 82 μm and in a subgroup (n = 17) with 41 μm resolution. Separate analyses of cortical and trabecular geometry...... fractures were confirmed. Geometry, vBMD, microarchitecture, and aBMD correlated significantly with MCS, with Spearman's correlation coefficients up to 0.77, 0.89, 0.90, and 0.85 (P ...

  5. A comparison of bone mineral density in osteoporotic fracture of the proximal femur using dual energy X-ray absorptiometry

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Jong Seok; Yoo, Beong Gyu [Wonkwang Health Science College, Iksan (Korea, Republic of); Kim, Keung Sik [Yonsei University Yong Dong Severance Hospital, Seoul (Korea, Republic of)

    2000-04-15

    There were some controversies about direct cause of hip fracture. We attempted to look at 40 osteoporotic proximal femur fractures in women over 50 years between March in 1999 and February in 2000. The bone density of the fracture group and the healthy 85 control group was measured by Dual Energy X-ray absorptiometry (DEXA). The result was compared using age matched paired T test. The results were as follows: The femoral neck fractures were 14 cases and the trochanteric fractures were 26 cases. Mean age at a fracture was 67.1 years in neck fracture group and 76.5 years in trochanteric fracture. In the control group, the bone density of both side of the proximal femur was measured and it showed statistically no difference between both sides in same person. The bone density of neck, Ward's triangle, trochanter (P<0.05) and lumbar spine (P<0.001) was significantly reduced in the proximal femoral fracture group comparing with the control group. The bone density of neck, Ward's triangle, trochanter (P<0.05) was significantly reduced in the proximal femoral neck fracture group comparing with the control group, but there was no statistical difference in lumbar spine comparing with the control group. The bone density of neck, Ward's triangle, trochanter and lumbar spine (P<0.001) was significantly reduced in the proximal femoral neck fracture group comparing with the control group. We concluded that the bone mineral densities (BMD) of proximal femur and lumbar spine had decreased in hip fractures but that the bone mineral density and T-score % of the proximal femur were statistically lower than that of the lumbar spine. We suggest that measuring the bone mineral density of the proximal femur may reflect the weakness of the proximal femur more precisely than measuring the bone mineral density of the lumbar spine.

  6. QUINE E DAVIDSON: ESTIMULAÇÃO DISTAL OU PROXIMAL?

    Directory of Open Access Journals (Sweden)

    Araceli Velloso

    2008-01-01

    Full Text Available Nesse artigo pretendo desenvolver um ponto bastante central de uma famosa discordância entre Quine e Davidson, uma disputa conheci-da na literatura como “a questão proximal x distal”. Em poucas palavras, enquanto Quine adota uma posição proximal, segundo a qual devemos localizar o conteúdo empírico das sentenças de observação já nas termina-ções neuronais dos falantes, Davidson prefere uma localização distal para esse conteúdo, pressupondo assim a existência de objetos no mundo. Essa discussão é de suma relevância para a compreensão do debate em torno do “terceiro dogma do empirismo”, proposto por Davidson e recusado por Quine, bem como para a compreensão da posição semântica de Quine como um todo.

  7. A COMPAR A TIVE STUDY OF FIXATION OF DISTAL END FRACTURES OF FEMUR BY SUPRACONDYLAR NAIL AND DYNAMIC CONDYLAR SCREW

    Directory of Open Access Journals (Sweden)

    Penugonda Ravi Shankar

    2015-01-01

    Full Text Available AIMS AND OBJECTIVES : To study the functional outcome of fractures of distal end of femur in adults surgically treated with supracondyl ar nail and Dynamic condylar screw. To study the complications of Dynamic Condylar screw and supracondylar nail in fractures of distal end of femur in Adults . RESULTS : In this study 20 cases of distal femoral fractures were treated with DCS and Supracondyl ar Nail. Our aim was to treat these fractures by rigid internal fixation, early mobilization and to know the outcome of DCS and SC Nail in these fractures.The mean age group of patients was 41.8 years in DCS and 38.4 in Nail group. Males were predominating in our study. Radiological union was seen at an average of 14.6 weeks in DCS and 13 weeks in supracondylar Nail. Average Range of Knee motion was 97 0 in DCS and 101 0 in Nail. Overall results were excellent in 10 cases (4 in DCS, 6 in Nail Good in 4 cases (2 in DCS, 2 in Nail Poor in 6 cases (4 in DCS 2 in Nail. CONCLUSION : From the study, We concluded DCS and Supracondylar Nail can be used for treating fractures of distal femur and supracondylar Nail is a better implant than DCS as it provides stable fr acture fixation with minimal disruption of soft tissues allowing early joint mobilization. The simplicity of the procedure (SC Nail also facilitates fracture fixation in patients with multiple trauma, including those with multiple fractures

  8. Combined proximal and distal realignment procedures to treat the habitual dislocation of the patella in adults.

    Science.gov (United States)

    Shen, Hsain-Chung; Chao, Kuo-Hua; Huang, Guo-Shu; Pan, Ru-Yu; Lee, Chian-Her

    2007-12-01

    Habitual dislocation of the patella (HDP) is a rare condition. Many surgical procedures using proximal realignment have been reported to treat HDP in children, with around 80% satisfactory results. However, few articles have addressed the treatment of HDP associated with high-grade patellofemoral chondromalacia in adults. A combination of proximal and distal realignment procedures of the patella will reduce pain and increase function in adult patients with HDP. Case series; Level of evidence, 4. Twelve patients with 13 symptomatic cases of HDP of the knee underwent surgical treatment that included lateral release, medial retinaculum advancement, and the anteromedial tibial tubercle transfer procedure. The average period between dislocation and surgery was 10.8 years. One patient had an additional procedure, an open-wedge varus corrective osteotomy of the distal femur, because of a 20 degrees valgus deformity of the knee. The patellofemoral morphology study included routine and Merchant views of the knee and a computed tomography scan at full extension and at 30 degrees flexion of the knee, before the operation and at follow-up. Any associated intra-articular pathologic findings during the surgical procedure were addressed. Patellofemoral function was evaluated with the Kujala functional score before surgery and at the time of the final follow-up. Chondromalacia of the patella over the medial facet and central ridge was grade III in 8 knees and grade IV in 5 knees. Corresponding chondral erosion of the lateral femoral condyle was noted in every knee. All patients were followed for an average period of 67.3 months (range, 25-103 months). The average preoperative Kujala functional score was 43.9 and the average postoperative score was 88.9 (Ppatella effectively treat HDP in adults with associated high-grade patellofemoral chondromalacia.

  9. Pilot study on proximal femur strains during locomotion and fall-down scenario

    Energy Technology Data Exchange (ETDEWEB)

    Klodowski, Adam, E-mail: adam.klodowski@lut.fi; Valkeapaeae, Antti, E-mail: antti.valkeapaa@lut.fi; Mikkola, Aki, E-mail: aki.mikkola@lut.fi [Lappeenranta University of Technology (Finland)

    2012-09-15

    The most common and severe type of fracture among the elderly is known as a proximal femur fracture. Aging-related bone loss is one of the major contributing factors to increased likelihood of bone fracture. Specific exercises can be used to strain bones and increase bone strength to counter the effects of bone loss. The flexible multibody simulation approach can be used as a non-invasive method for estimating bone strains caused by physical activity. This method was recently used to analyze the strain of locomotion in regard to human femur and tibia leg bones. The current study focuses on strain analysis of the femoral neck. The research test person was a clinically healthy 65-year old Caucasian male. The computed tomography was used to build a geometrically accurate finite element model of the femur with inhomogeneous material properties derived from the voxel data. The anthropometric data was used to model the musculoskeletal system of the test person. The multibody skeletal model was utilized to estimate loading on the femoral neck during walking, which represents a routine daily activity. The flexible multibody simulation results were compared to strains that occurred during a simulated fall onto the greater trochanter of the femur. The fall simulation was made entirely using finite element software. Results from the finite element analysis were compared with the previous study showing that the test person does not belong to the high-risk hip fracture group. Finally, the estimated strains gathered from the walking simulation were compared to the strain values from the simulated fall-down scenario.

  10. Integrated remodeling-to-fracture finite element model of human proximal femur behavior.

    Science.gov (United States)

    Hambli, Ridha; Lespessailles, Eric; Benhamou, Claude-Laurent

    2013-01-01

    The purpose of this work was to develop an integrated remodeling-to-fracture finite element model allowing for the combined simulation of (i) simulation of a human proximal femur remodeling under a given boundary conditions, (ii) followed by the simulation of its fracture behavior (force-displacement curve and fracture pattern) under quasi-static load. The combination of remodeling and fracture simulation into one unified model consists in considering that the femur properties resulting from the remodeling simulation correspond to the initial state for the fracture prediction. The remodeling model is based on phenomenological one based on a coupled strain and fatigue damage stimulus. The fracture model is based on continuum damage mechanics in order to predict the progressive fracturing process which allows to predict the fracture pattern and the complete force-displacement curve under quasi-static load. To prevent mesh-dependence that generally affects the damage propagation rate, regularization technique was applied in the current work. To investigate the potential of the proposed unified remodeling-to-fracture model, we performed remodeling simulations on a 3D proximal femur model for a duration of 365 days under five different daily loading conditions followed by a side fall fracture simulation reproducing previously published experimental tests (de Bakker et al. (2009), case C, male, 72 years old). We show here that the implementation of an integrated remodeling-to-fracture model provides more realistic prediction strategy to assess the bone remodeling effects on the fracture risk of bone. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. Computational study of Wolff's law with trabecular architecture in the human proximal femur using topology optimization.

    Science.gov (United States)

    Jang, In Gwun; Kim, Il Yong

    2008-08-07

    In the field of bone adaptation, it is believed that the morphology of bone is affected by its mechanical loads, and bone has self-optimizing capability; this phenomenon is well known as Wolff's law of the transformation of bone. In this paper, we simulated trabecular bone adaptation in the human proximal femur using topology optimization and quantitatively investigated the validity of Wolff's law. Topology optimization iteratively distributes material in a design domain producing optimal layout or configuration, and it has been widely and successfully used in many engineering fields. We used a two-dimensional micro-FE model with 50 microm pixel resolution to represent the full trabecular architecture in the proximal femur, and performed topology optimization to study the trabecular morphological changes under three loading cases in daily activities. The simulation results were compared to the actual trabecular architecture in previous experimental studies. We discovered that there are strong similarities in trabecular patterns between the computational results and observed data in the literature. The results showed that the strain energy distribution of the trabecular architecture became more uniform during the optimization; from the viewpoint of structural topology optimization, this bone morphology may be considered as an optimal structure. We also showed that the non-orthogonal intersections were constructed to support daily activity loadings in the sense of optimization, as opposed to Wolff's drawing.

  12. Generation of an Atlas of the Proximal Femur and Its Application to Trabecular Bone Analysis

    Science.gov (United States)

    Carballido-Gamio, Julio; Folkesson, Jenny; Karampinos, Dimitrios C.; Baum, Thomas; Link, Thomas M.; Majumdar, Sharmila; Krug, Roland

    2013-01-01

    Automatic placement of anatomically corresponding volumes of interest and comparison of parameters against a standard of reference are essential components in studies of trabecular bone. Only recently, in vivo MR images of the proximal femur, an important fracture site, could be acquired with high-spatial resolution. The purpose of this MRI trabecular bone study was two-fold: (1) to generate an atlas of the proximal femur to automatically place anatomically corresponding volumes of interest in a population study and (2) to demonstrate how mean models of geodesic topological analysis parameters can be generated to be used as potential standard of reference. Ten females were used to generate the atlas and geodesic topological analysis models, and 10 females were used to demonstrate the atlas-based trabecular bone analysis. All alignments were based on three-dimensional (3D) multiresolution affine transformations followed by 3D multiresolution free-form deformations. Mean distances less than 1 mm between aligned femora, and sharp edges in the atlas and in fused gray-level images of registered femora indicated that the anatomical variability was well accommodated and explained by the free-form deformations. PMID:21432904

  13. Predicting the biomechanical strength of proximal femur specimens with Minkowski functionals and support vector regression

    Science.gov (United States)

    Yang, Chien-Chun; Nagarajan, Mahesh B.; Huber, Markus B.; Carballido-Gamio, Julio; Bauer, Jan S.; Baum, Thomas; Eckstein, Felix; Lochmüller, Eva-Maria; Link, Thomas M.; Wismüller, Axel

    2014-03-01

    Regional trabecular bone quality estimation for purposes of femoral bone strength prediction is important for improving the clinical assessment of osteoporotic fracture risk. In this study, we explore the ability of 3D Minkowski Functionals derived from multi-detector computed tomography (MDCT) images of proximal femur specimens in predicting their corresponding biomechanical strength. MDCT scans were acquired for 50 proximal femur specimens harvested from human cadavers. An automated volume of interest (VOI)-fitting algorithm was used to define a consistent volume in the femoral head of each specimen. In these VOIs, the trabecular bone micro-architecture was characterized by statistical moments of its BMD distribution and by topological features derived from Minkowski Functionals. A linear multiregression analysis and a support vector regression (SVR) algorithm with a linear kernel were used to predict the failure load (FL) from the feature sets; the predicted FL was compared to the true FL determined through biomechanical testing. The prediction performance was measured by the root mean square error (RMSE) for each feature set. The best prediction result was obtained from the Minkowski Functional surface used in combination with SVR, which had the lowest prediction error (RMSE = 0.939 ± 0.345) and which was significantly lower than mean BMD (RMSE = 1.075 ± 0.279, pfemur specimens with Minkowski Functionals extracted from on MDCT images used in conjunction with support vector regression.

  14. Model-based estimation of quantitative ultrasound variables at the proximal femur.

    Science.gov (United States)

    Dencks, Stefanie; Barkmann, Reinhard; Padilla, Frédéric; Laugier, Pascal; Schmitz, Georg; Glüer, Claus-C

    2008-01-01

    To improve the prediction of the osteoporotic fracture risk at the proximal femur we are developing a scanner for quantitative ultrasound (QUS) measurements at this site. Due to multipath transmission in this complex shaped bone, conventional signal processing techniques developed for QUS measurements at peripheral sites frequently fail. Therefore, we propose a model-based estimation of the QUS variables and analyze the performance of the new algorithm. Applying the proposed method to QUS scans of excised proximal femurs increased the fraction of evaluable signals from approx. 60% (using conventional algorithms) to 97%. The correlation of the standard QUS variables broadband ultrasound attenuation (BUA) and speed of sound (SOS) with the established variable bone mineral density (BMD) reported in previous studies is maintained (BUA/BMD: r(2) = 0.69; SOS/BMD: r(2) = 0.71; SOS+BUA/BMD: r(2) = 0.88). Additionally, different wave types could be clearly detected and characterized in the trochanteric region. The ability to separate superimposed signals with this approach opens up further diagnostic potential for evaluating waves of different sound paths and wave types through bone tissue.

  15. Guided Growth of the Proximal Femur for Hip Displacement in Children With Cerebral Palsy.

    Science.gov (United States)

    Lee, Wei-Chun; Kao, Hsuan-Kai; Yang, Wen-E; Ho, Pei-Chi; Chang, Chia-Hsieh

    2016-01-01

    Guided growth by 1 eccentric transphyseal screw has been used to correct lower limb deformities. Pilot animal studies showed encouraging results in producing varus deformity in the proximal femur. The purpose of this study was to report the preliminary results of guided growth surgery to treat spastic hip displacement. This case series study included consecutive patients who received soft-tissue release and guided growth at the proximal femur from January 2004 to May 2012 with minimal 2-year follow-up. Surgical indications were children with spastic cerebral palsy aged 4 to 10 years, a gross motor function classification system level IV or V, and hip displacement on 1 or both sides. Study outcomes were Reimer's migration percentage (MP) and the head-shaft angle (HSA). Nine children with 13 spastic displaced hips received surgery at the age of 6.2 years and were followed up for a mean of 45.6 months. The mean MP improved significantly from 52.2% preoperatively to 45.8% at 3 months, 40.3% at 1 year, and 37.1% at 2 years after operation. HSA was unchanged in the first 3 months, and deceased from 173.3 to 166.4 degrees at 1 year (Pcoxa valga in spastic hip displacement in nonambulant cerebral palsy children. Level IV-therapeutic, case series.

  16. Loss of Distal Femur Combined with Popliteal Artery Occlusion: Reconstructive Arthroplasty Using Modular Segmental Endoprosthesis: A Case Report

    Science.gov (United States)

    Kang, Shin-Taeg; Kim, Bo-Hyeon; Sung, Byung-Yoon

    2009-01-01

    Severe injury to the knee and the surrounding area is frequently associated with injury to ligaments of the knee joint and structures in the popliteal fossa. This case involved a popliteal artery occlusion, severe bone loss of distal femur, loss of collateral ligaments, and extensor mechanism destruction of the knee. Initially, prompt recognition and correction of associated popliteal artery injury are important for good results after treatment. After successful revascularization, treatment for severe bone loss of distal femur and injury of the knee joint must be followed. We treated this case by delayed reconstruction using modular segmental endoprosthesis after revascularization of the popliteal artery. This allowed early ambulation. At 36 months after surgery, the patient had good circulation of the lower limb and was ambulating independently. PMID:19399285

  17. Rotationplasty as a salvage procedure in revision of tumor endoprosthesis of the distal femur--a report of two cases.

    Science.gov (United States)

    Nebelung, W; Birger, T; Röpke, M; Neumann, H W

    2000-01-01

    We performed two rotationplasties (type A1 and A2) as salvage procedures in cases of custom-made endoprosthetic replacements of the distal femur and knee joint. The patients suffered from malignant bone and soft-tissue tumors of the knee, respectively. One of them developed chronic osteomyelitis around both stems of the prosthesis, and three local revisions turned out to be ineffective. The other patient, suffering from parossal osteosarcoma of the distal femur, developed a local recurrence following endoprosthetic reconstruction. The functional abilities following the operation of these two patients suggested that rotationplasty was a viable alternative to above-the-knee amputation in failed or severely complicated total arthroplasty of the knee with massive bone loss.

  18. Complex AO type C3 distal femur fractures: Results after fixation with a lateral locked plate using modified swashbuckler approach

    Directory of Open Access Journals (Sweden)

    Anuj Agrawal

    2017-01-01

    Full Text Available Background: Complex AO type C3 fractures of the distal femur are challenging injuries, fraught with complications such as malunion and stiffness. We prospectively evaluated a consecutive series of patients with complex AO type C3 distal femur fractures to determine the clinicoradiological outcome after fixation with a single locked plate using modified swashbuckler approach. Materials and Methods: 12 patients with C3 type distal femur fractures treated with a lateral locked plate, using a modified swashbuckler approach, were included in the study. The extraarticular component was managed either by compression plating or bridge plating (transarticular approach and retrograde plate osteosynthesis depending on the fracture pattern. Primary bone grafting was not done in any case. The clinical outcome at 1 year was determined using the Knee Society Score (KSS. The presence of any secondary osteoarthritis in the knee joint was noted at final followup. Results: All fractures united at a mean of 14.3 ± 4.7 weeks (range 6-26 weeks. There were no significant complications such as nonunion, deep infection, and implant failure. One of the patients underwent secondary bone grafting at 3 months. The mean range of motion of the knee was 120° ± 14.8° (range 105°-150°. Seven patients had excellent, three patients had good and two patients had a fair outcome according to the KSS at 1 year. At a mean followup of 17.6 months, three patients showed radiological evidence of secondary osteoarthritis of the knee joint. However, only one of these patients was symptomatic. Conclusion: The results of complex C3 type distal femur fractures, fixed with a single lateral locked plate using a modified swashbuckler approach, are encouraging, with a majority of patients achieving good to excellent outcome at 1 year.

  19. Autologous grafts of double-strut fibular cortical bone plate to treat the fractures and defects of distal femur: a case report and review of literature

    Directory of Open Access Journals (Sweden)

    CHEN Xu

    2012-02-01

    Full Text Available 【Abstract】We reported a 23-year-old man who was involved in a high-speed motorcycle accident. He sustained a closed fracture at the right distal femur. The primary fracture happened on February 2008. He underwent open reduction and internal fixation with cloverleaf plate. And one hundred days after the surgery, the proximal screws were pulled-out, but the bone union was not achieved. Treatment consisted of exchanging the cloverleaf plate with a locking compression plate and using an auto-iliac bone graft to fill the nonunion gap. In July 2009, the patient had a sharp pain in the right lower limb. The X-ray revealed that the plate implanted last year was broken, causing a nonunion at the fracture site. Immediately the plate and screws were removed and an intramedullary nail was inserted reversely from the distal femur as well as a 7 cm long bone from the right fibula was extracted and longitudinally split into two pieces to construct cortical bone plates. Then we placed them laterally and medially to fracture site, drilled two holes respectively, and fastened them with suture. We carried on auto-iliac bone grafting with the nonunion bone grafts. The follow-up at 15 months after operation showed that the treatment was successful, X-ray confirmed that there was no rotation and no angular or short deformity. We briefly reviewed the literature regarding such an unusual presentation and discussed in details the possible etiology and the advantages of autologous double-strut fibular grafts to cope with such an intractable situation. Key words: Femur; Transplantation, autologous; Bone screws

  20. Size and shape variation in the proximal femur of Australopithecus africanus.

    Science.gov (United States)

    Harmon, Elizabeth

    2009-06-01

    Aside from use as estimates of body mass dimorphism and fore to hind limb joint size comparisons, postcranial elements have not often contributed to assessments of variation in Australopithecus africanus. Meanwhile, cranial, facial, and dental size variation is interpreted to be high or moderately high. Further, the cranial base and face express patterns of structural (shape) variation, which are interpreted by some as evidence for the presence of multiple species. Here, the proximal femur is used to consider postcranial size and shape variation in A. africanus. Original fossils from Makapansgat and Sterkfontein, and samples from Homo, Pan, Gorilla, and Pongo were measured. Size variation was assessed by comparing the A. africanus coefficient of variation to bootstrapped distributions of coefficient of variation samples for each taxon. Shape variation was assessed from isometrically adjusted shape variables. First, the A. africanus standard deviation of log transformed shape variables was compared to bootstrapped distributions of logged standard deviations in each taxon. Second, shape variable based Euclidean distances between fossil pairs were compared to pairwise Euclidean distance distributions in each reference taxon. The degree of size variation in the A. africanus proximal femur is consistent with that of a single species, and is most comparable to Homo and Pan, lower than A. afarensis, and lower than some estimates of cranial and dental variation. Some, but not all, shape variables show more variation in A. africanus than in extant taxa. The degree of shape difference between some fossils exceeds the majority of pairwise differences in the reference taxa. Proximal femoral shape, but not size, variation is consistent with high estimates of A. africanus cranial variation.

  1. Comparison of Percutaneous Cementoplasty with and Without Interventional Internal Fixation for Impending Malignant Pathological Fracture of the Proximal Femur

    Energy Technology Data Exchange (ETDEWEB)

    Tian, Qing-Hua, E-mail: ddqinghua-tian@163.com; He, Cheng-Jian, E-mail: tianhechengjian@163.com; Wu, Chun-Gen, E-mail: 649514608@qq.com; Li, Yong-Dong, E-mail: tianliyongdong@163.com; Gu, Yi-Feng, E-mail: tianyifenggu@163.com; Wang, Tao, E-mail: tianandwangtao@163.com; Xiao, Quan-Ping, E-mail: tianxiaoquanping@163.com; Li, Ming-Hua, E-mail: tianminghuali@163.com [Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Department of Diagnostic and Interventional Radiology (China)

    2016-01-15

    PurposeTo compare the efficacy of percutaneous cementoplasty (PCP) with and without interventional internal fixation (IIF) on malignant impending pathological fracture of proximal femur.MethodsA total of 40 patients with malignant impending pathological fracture of proximal femur were selected for PCP and IIF (n = 19, group A) or PCP alone (n = 21, group B) in this non-randomized prospective study. Bone puncture needles were inserted into the proximal femur, followed by sequential installation of the modified trocar inner needles through the puncture needle sheath. Then, 15–45 ml cement was injected into the femur lesion.ResultsThe overall excellent and good pain relief rate during follow-ups were significantly higher in group A than that in group B (89 vs. 57 %, P = 0.034). The average change of VAS, ODI, KPS, and EFES in group A were significantly higher than those in group B at 1-, 3-, 6-month, 1-year (P < 0.05). Meanwhile, The stability of the treated femur was significantly higher in group A than that in group B (P < 0.05).ConclusionPCP and IIF were not only a safe and effective procedure, but resulted in greater pain relief, bone consolidation, and also reduced the risk of fracture than the currently recommended approach of PCP done on malignant proximal femoral tumor.

  2. Structural patterns of the proximal femur in relation to age and hip fracture risk in women

    Science.gov (United States)

    Carballido-Gamio, Julio; Harnish, Roy; Saeed, Isra; Streeper, Timothy; Sigurdsson, Sigurdur; Amin, Shreyasee; Atkinson, Elizabeth J.; Therneau, Terry M.; Siggeirsdottir, Kristin; Cheng, Xiaoguang; Melton, L. Joseph; Keyak, Joyce; Gudnason, Vilmundur; Khosla, Sundeep; Harris, Tamara B.; Lang, Thomas F.

    2013-01-01

    Fractures of the proximal femur are the most devastating outcome of osteoporosis. It is generally understood that age-related changes in hip structure confer increased risk, but there have been few explicit comparisons of such changes in healthy subjects to those with hip fracture. In this study, we used quantitative computed tomography and tensor-based morphometry (TBM) to identify three-dimensional internal structural patterns of the proximal femur associated with age and with incident hip fracture. A population-based cohort of 349 women representing a broad age range (21–97 years) were included in this study, along with a cohort of 222 older women (mean age 79±7 years) with (n=74) and without (n=148) incident hip fracture. Images were spatially normalized to a standardized space, and age- and fracture-specific morphometric features were identified based on statistical maps of shape features described as local changes of bone volume. Morphometric features were visualized as maps of local contractions and expansions, and significance was displayed as Student’s t-test statistical maps. Significant age-related changes included local expansions of regions low in volumetric bone mineral density (vBMD) and local contractions of regions high in vBMD. Some significant fracture-related features resembled an accentuated aging process, including local expansion of the superior aspect of the trabecular bone compartment in the femoral neck, with contraction of the adjoining cortical bone. However, other features were observed only in the comparison of hip fracture subjects with age-matched controls including focal contractions of the cortical bone at the superior aspect of the femoral neck, the lateral cortical bone just inferior to the greater trochanter, and the anterior intertrochanteric region. Results of this study support the idea that the spatial distribution of morphometric features is relevant to age-related changes in bone and independently to fracture risk. In

  3. QCT of the proximal femur--which parameters should be measured to discriminate hip fracture?

    Science.gov (United States)

    Museyko, O; Bousson, V; Adams, J; Laredo, J -D; Engelke, K

    2016-03-01

    For quantitative computed tomography (QCT), most relevant variables to discriminate hip fractures were determined. A multivariate analysis showed that trabecular bone mineral density (BMD) of the trochanter with "cortical" thickness of the neck provided better fracture discrimination than total hip integral BMD. A slice-by-slice analysis of the neck or the inclusion of strength-based parameters did not improve fracture discrimination. For QCT of the proximal femur, a large variety of analysis parameters describing bone mineral density, geometry, or strength has been considered. However, in each given study, generally just a small subset was used. The aim of this study was to start with a comprehensive set and then select a best subset of QCT parameters for discrimination of subjects with and without acute osteoporotic hip fractures. The analysis was performed using the population of the European Femur Fracture (EFFECT) study (Bousson et al. J Bone Min Res: Off J Am Soc Bone Min Res 26:881-893, 2011). Fifty-six female control subjects (age 73.2 ± 9.3 years) were compared with 46 female patients (age 80.9 ± 11.1 years) with acute hip fractures. The QCT analysis software MIAF-Femur was used to virtually dissect the proximal femur and analyze more than 1000 parameters, predominantly in the femoral neck. A multivariate best-subset analysis was used to extract the parameters best discriminating hip fractures. All results were adjusted for age, height, and weight differences between the two groups. For the discrimination of all proximal hip fractures as well as for cervical fractures alone, the measurement of neck parameters suffices (area under the curve (AUC) = 0.84). Parameters characterizing bone strength are discriminators of hip fractures; however, in multivariate models, only "cortical" cross-sectional area in the neck center remained as a significant contributor. The combination of one BMD parameter, trabecular BMD of the trochanter, and one geometry

  4. Tibial turn-up procedure as an alternative to rotationplasty in a 4-year-old with osteosarcoma of the distal femur.

    Science.gov (United States)

    Tate, Rebecca; Gerrand, Craig; Hale, Juliet

    2015-01-01

    Reconstruction of the distal femur after resection for primary bone tumour in very young patients presents a considerable challenge. The risks and benefits of the available reconstructive options need to be carefully balanced. We report a case of osteosarcoma of the distal femur in a 4-year-old boy that was, unusually, treated by amputation and a tibial turn-up procedure; we discuss the rationale for the procedure and report the results at early follow-up.

  5. Site-specific advantages in skeletal geometry and strength at the proximal femur and forearm in young female gymnasts.

    Science.gov (United States)

    Dowthwaite, Jodi N; Rosenbaum, Paula F; Scerpella, Tamara A

    2012-05-01

    We evaluated site-specific skeletal adaptation to loading during growth, comparing radius (RAD) and femoral neck (FN) DXA scans in young female gymnasts (GYM) and non-gymnasts (NON). Subjects from an ongoing longitudinal study (8-26yr old) underwent annual DXA scans (proximal femur, forearm, total body) and anthropometry, completing maturity and physical activity questionnaires. This cross-sectional analysis used the most recent data meeting the following criteria: gynecological age ≤2.5yr post-menarche; and GYM annual mean gymnastic exposure ≥5.0h/wk in the prior year. Bone geometric and strength indices were derived from scans for 173 subjects (8-17yr old) via hip structural analysis (femoral narrow neck, NN) and similar radius formulae (1/3 and Ultradistal (UD)). Maturity was coded as M1 (Tanner I breast), M2 (pre-menarche, ≥Tanner II breast) or M3 (post-menarche). ANOVA and chi square compared descriptive data. Two factor ANCOVA adjusted for age, height, total body non-bone lean mass and percent body fat; significance was tested for main effects and interactions between gymnastic exposure and maturity. At the distal radius, GYM means were significantly greater than NON means for all variables (padvantages only in M1 and M3; for BMC and buckling ratio, M1 advantages were greatest); 2) 1/3 radius BMC, width, endosteal diameter, cortical cross-sectional area, and section modulus (GYM advantages primarily post-menarche); and 3) UD radius BMC and axial compressive strength (GYM advantages were larger with greater maturity, greatest post-menarche). Maturity-specific comparisons suggested site-specific skeletal adaptation to loading during growth, with greater advantages at the radius versus the proximal femur. At the radius, GYM advantages included greater bone width, cortical cross-sectional area and cortical thickness; in contrast, at the femoral neck, GYM bone tissue cross-sectional area and cortical thickness were greater, but bone width was narrower than

  6. Radiographic study on the anatomical characteristics of the proximal femur in Brazilian adults

    Directory of Open Access Journals (Sweden)

    Tércio Henrique Soares de Farias

    2015-02-01

    Full Text Available OBJECTIVE: To ascertain the geometry of the femur in the Brazilian population by means of a radiographic study and to correlate the values with regard to sex and right/left side.METHODS: Five hundred anteroposterior radiographs of the pelvis of skeletally mature patients (250 of each sex who did not present any osteoarthrosis, fractures or tumoral or infectious lesions were analyzed. The length and width of the femoral neck, length of the femoral axis, neck-shaft angle and femoral offset were measured.RESULTS: The following means were observed: 36.54 mm for the length of the femoral neck; 37.48 mm for the width of the femoral neck; 108.42 mm for the length of the femoral axis; 130.47° for the neck-shaft angle; and 44.4 mm for the femoral offset.CONCLUSION: The mean values for the main measurements on the proximal femur in Brazilians differed from those of previous studies. It could also be shown that there was a statistically significant mean difference between men and women for all the variables, both on the left and on the right side, and that the men had greater means than the women.

  7. Development of a balanced experimental-computational approach to understanding the mechanics of proximal femur fractures.

    Science.gov (United States)

    Helgason, B; Gilchrist, S; Ariza, O; Chak, J D; Zheng, G; Widmer, R P; Ferguson, S J; Guy, P; Cripton, P A

    2014-06-01

    The majority of people who sustain hip fractures after a fall to the side would not have been identified using current screening techniques such as areal bone mineral density. Identifying them, however, is essential so that appropriate pharmacological or lifestyle interventions can be implemented. A protocol, demonstrated on a single specimen, is introduced, comprising the following components; in vitro biofidelic drop tower testing of a proximal femur; high-speed image analysis through digital image correlation; detailed accounting of the energy present during the drop tower test; organ level finite element simulations of the drop tower test; micro level finite element simulations of critical volumes of interest in the trabecular bone. Fracture in the femoral specimen initiated in the superior part of the neck. Measured fracture load was 3760N, compared to 4871N predicted based on the finite element analysis. Digital image correlation showed compressive surface strains as high as 7.1% prior to fracture. Voxel level results were consistent with high-speed video data and helped identify hidden local structural weaknesses. We found using a drop tower test protocol that a femoral neck fracture can be created with a fall velocity and energy representative of a sideways fall from standing. Additionally, we found that the nested explicit finite element method used allowed us to identify local structural weaknesses associated with femur fracture initiation. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

  8. The chondrogenic response to exercise in the proximal femur of normal and mdx mice

    Directory of Open Access Journals (Sweden)

    Nye David J

    2010-09-01

    Full Text Available Abstract Background Submaximal exercise is used in the management of muscular dystrophy. The effects of mechanical stimulation on skeletal development are well understood, although its effects on cartilage growth have yet to be investigated in the dystrophic condition. The objective of this study was to investigate the chondrogenic response to voluntary exercise in dystrophin-deficient mice. Methods Control and dystrophin-deficient (mdx mice were divided into sedentary and exercise-treated groups and tested for chondral histomorphometric differences at the proximal femur. Results Control mice ran 7 km/week further than mdx mice on average, but this difference was not statistically significant (P > 0.05. However, exercised control mice exhibited significantly enlarged femur head diameter, articular cartilage thickness, articular cartilage tissue area, and area of calcified cartilage relative to sedentary controls and exercised mdx mice (P Conclusions Mdx mice exhibit a reduced chondrogenic response to increased mechanical stimulation relative to controls. However, no significant reduction in articular dimensions was found, indicating loss of chondral tissue may not be a clinical concern with dystrophinopathy.

  9. Surgical Treatment of Undisplaced Femur Neck Fractures in Dementia Patients Using Proximal Femoral Nail Antirotation.

    Science.gov (United States)

    Park, Bong-Ju; Cho, Hong-Man; Min, Woong-Bae

    2015-09-01

    People with dementia have poor mobility and discharge outcomes following hip fractures. The purpose of this study was to evaluate the clinical and radiological results of internal fixation of undisplaced femur neck fractures (Garden types 1 and 2) by proximal femoral nail antirotation (PFNA) in dementia patients. We studied retrospectively 19 patients with undisplaced femur neck fracture. All patients were over 70 years of age, walked independently with a cane or crutches and suffered moderate-to-severe dementia. Patients were treated with PFNA and followed-up for more than 2 years. Revision, loss of fixation, complications, and walking ability outcomes were measured. In walking-ability evaluation, patients showed an average decrease of just 0.2 points at the final follow-up. Walking ability was evaluated from before injury to 4 weeks after surgery and decreased by less than 0.5 points. Radiological bone union was achieved in 17 cases; the average time to bone union was 4.14 months (range, 2.5-7 months). Complications included non-union in two cases and femoral head avascular necrosis in one case of non-union. We found that for patients with osteoporotic bone tissues in their femoral heads or patients (e.g., those suffering dementia) for whom cooperating with medical workers for postoperative walking control or rehabilitation exercises is difficult, implanting a mechanically stable spiral blade for fixation of femoral neck fractures could facilitate walking after surgery.

  10. Fractures of the proximal femur: correlates of radiological evidence of osteoporosis

    Energy Technology Data Exchange (ETDEWEB)

    Patel, Salil H.; Murphy, Kieran P. [Johns Hopkins School of Medicine, Radiology, Baltimore, Maryland (United States)

    2006-04-15

    Fractures of the proximal femur are common sequelae of osteoporosis, and are responsible for significant morbidity and mortality in elderly patients worldwide. Plain film radiographic assessment methods to assess for fracture risk may be of particular value. The authors present the results of biomechanical testing, radiographic imaging, and histologic exam of 20 embalmed human bone specimens, with implications for clinical correlation of radiologic findings. Authors assessed bone architecture using the Singh Index, using a blinded 3-rater system to reduce bias and measure intra-observer reliability. After loading to failure with ultimate tensile strength (UTS), bone specimens were assessed by fracture location type and by trabecular bone volume (TBV). Singh scoring was performed with Inter-Class Correlation of 0.80 (F=0.24, by ICC Portney Model 2). A statistically-significant difference among the UTS distributions was noted for UTS by Fracture Site (F=4.49, p=0.026, by ANOVA). No significant association of Singh Index with TBV, or TBV with UTS, was observed, although a trend toward greater UTS with higher Singh grade was observed. The authors propose that the Singh Index is a valuable and reliable indicator which may reflect structural integrity in trabecular bone. Fracture site along the femur is associated with tensile strength. The authors, in the light of these findings, address the promise and potential impact of prophylactic hip augmentation in populations at risk for femoral neck pathology. (orig.)

  11. [Bone Remodelling in the Proximal Femur after Uncemented Total Hip Arthroplasty in Patients with Osteoporosis].

    Science.gov (United States)

    Lacko, M; Schreierová, D; Čellár, R; Vaško, G

    2015-01-01

    The aim of the study was to investigate the involvement of osteoporosis during remodelling of the proximal femur after uncemented total hip arthroplasty (THA) and the effect of bisphospohonate treatment on these changes. Sixty evaluated patients with non-cemented THA were divided into three groups on the basis of pre-operative densitometric examinations. Group 1 (15 patients with osteoporosis) received a single dose of 5 mg zoledronic acid in infusion during the second post-operative week. Group 2 (15 patients with osteoporosis) were not treated by bisphospohonate. The patients of both groups took oral calcium and vitamin D medication. Group 3 (control) comprised 30 patients with normal bone density who did not take any osteoactive drugs. By measurement of bone mineral density (BMD) at 12 months after surgery, changes in periprosthetic bone of the proximal femur in 7 Gruen zones were recorded by densitometry. In addition, radiological findings on native X-ray images were assessed and the patients' clinical health status was rated by the Harris hip score. No significant differences in either the average age or the body mass index were found between the groups at the time of THA surgery. The mean BMD value in all assessed Gruen zones measured at the first post-operative week was higher in patients with normal bone density than in those with osteoporosis. The mean BMD value measured at 12 months decreased in all Gruen zones in comparison with the initial value, and this was found in all three groups. The lowest values were recorded in the untreated patients (group 2); in comparison with the patients who had normal bone density, the difference was statistically significant in Gruen zones 1, 2, 6 and 7. Although the patients with treated osteoporosis also showed lower BMD values, these were not statistically significant compared to group 3. The worst post-operative outcome in clinical health status was recorded in the patients with untreated osteoporosis. X

  12. Persistent wound drainage after tumor resection and endoprosthetic reconstruction of the proximal femur

    DEFF Research Database (Denmark)

    Hettwer, Werner H; Horstmann, Peter F; Grum-Schwensen, Tomas A

    2014-01-01

    PURPOSE: To examine the prevalence of prolonged wound drainage (PWD) after tumor resection and endoprosthetic reconstruction of the hip. METHODS: Retrospective review of 86 consecutive patients with metastatic bone disease, malignant hematologic bone disease or bone sarcoma, treated with tumor...... resection and subsequent endoprosthetic reconstruction of the proximal femur, between 2010 and 2012, in a single center. RESULTS: PWD for 7 days or more was observed in 41 cases (48%). The wounds only ceased oozing after a mean of 8.4 days, leading to prolonged administration of prophylactic antibiotics...... to be significantly more prevalent in patients undergoing tumor arthroplasty procedures of the hip. Given the potentially increased risk for periprosthetic joint infection (PJI), increased awareness, identification and implementation of adequate strategies for prevention and treatment of this avoidable complication...

  13. Pathological fractures of the proximal femur due to solitary bone cyst: classification, methods of treatment.

    Science.gov (United States)

    Miu, A

    2015-01-01

    Fractures are a very important issue in a child's orthopedic pathology. Neglected a good amount of time, being considered "not too serious", or "rare", having better and faster healing methods and not leaving sequels, like in the case of adults, a child's fractures remain an important chapter of traumatology in general. Because of the raising prevalence of child osteoarticular traumas, as well as new less invasive treatment methods, this theme is always to date. The paper analyzes particular cases of bone fractures that appeared due to minor traumas, on bones with a high brittleness, localized especially on the long bones. Although these fractures on a pathological bone can be seen at all levels of the human skeleton, this paper focuses on fractures located in the proximal third part of the femur. A group of children admitted in the Pediatric Orthopedic Department of "M.S. Curie" Hospital-Bucharest with this diagnostic, were analyzed between 2009 and 2013.

  14. Is endoprosthesis safer than internal fixation for metastatic disease of the proximal femur? A systematic review.

    Science.gov (United States)

    Di Martino, Alberto; Martinelli, Nicolò; Loppini, Mattia; Piccioli, Andrea; Denaro, Vincenzo

    2017-10-01

    Metastases to the proximal femur are usually managed surgically by tumor resection and reconstruction with an endoprosthesis, or by fixation with osteosynthesis. Still controversy remains regarding the most appropriate surgical treatment. We posed the following questions: (1) Is the frequency of surgical revision greater in patients treated with internal fixation than endoprosthetic reconstruction, and (2) Do complications that do not require surgery occur more frequently in patients treated with internal fixation rather than in those with endoprosthetic reconstruction? A systematic review was performed of those studies reporting on surgical revision and complication rates comparing the two surgical methods. Ten studies including 1107 patients met the inclusion criteria, three with high methodological quality, three intermediate, and four with lowquality, according to the STROBE guidelines. At present, prosthetic dislocation is the most common complication observed in patients managed by prosthesis replacement of the proximal femur, while loosening was the main cause of reoperation in the fixation group. Time to reintervention ranged from 3 to 11.6 months for the prosthetic replacement and from 7.8 to 22.3 months for the fixation group. Non surgical complications, (mainly dislocations and infections) were more commonly observed in patients operated on by prosthetic replacement. Implant related complications and surgery-related morbidity should be taken into account in the decision-making process for the surgical management of these patients. These data can improve the surgeon-patient communication and guide further studies on patients' survival and complications with respect to surgery. © 2017 Elsevier Ltd. All rights reserved.

  15. Assessment of the individual fracture risk of the proximal femur by using statistical appearance models.

    Science.gov (United States)

    Schuler, Benedikt; Fritscher, Karl D; Kuhn, Volker; Eckstein, Felix; Link, Thomas M; Schubert, Rainer

    2010-06-01

    Standard diagnostic techniques to quantify bone mineral density (BMD) include dual-energy x-ray absorptiometry (DXA) and quantitative computed tomography. However, BMD alone is not sufficient to predict the fracture risk for an individual patient. Therefore, the development of tools, which can assess the bone quality in order to predict individual biomechanics of a bone, would mean a significant improvement for the prevention of fragility fractures. In this study, a new approach to predict the fracture risk of proximal femora using a statistical appearance model will be presented. 100 CT data sets of human femur cadaver specimens are used to create statistical appearance models for the prediction of the individual fracture load (FL). Calculating these models offers the possibility to use information about the inner structure of the proximal femur, as well as geometric properties of the femoral bone for FL prediction. By applying principal component analysis, statistical models have been calculated in different regions of interest. For each of these models, the individual model parameters for each single data set were calculated and used as predictor variables in a multilinear regression model. By this means, the best working region of interest for the prediction of FL was identified. The accuracy of the FL prediction was evaluated by using a leave-one-out cross validation scheme. Performance of DXA in predicting FL was used as a standard of comparison. The results of the evaluative tests demonstrate that significantly better results for FL prediction can be achieved by using the proposed model-based approach (R = 0.91) than using DXA-BMD (R = 0.81) for the prediction of fracture load. The results of the evaluation show that the presented model-based approach is very promising and also comparable to studies that partly used higher image resolutions for bone quality assessment and fracture risk prediction.

  16. Computed tomographic evaluation of the proximal femur: A predictive classification in displaced femoral neck fracture management

    Directory of Open Access Journals (Sweden)

    Narender Kumar Magu

    2014-01-01

    Full Text Available Background: Femoral neck fracture is truly an enigma due to the high incidence of avascular necrosis and nonunion. Different methods have been described to determine the size of the femoral head fragment, as a small head has been said to be associated with poor outcome and nonunion due to inadequate implant purchase in the proximal fragment. These methods were two dimensional and were affected by radiography techniques, therefore did not determine true head size. Computed tomography (CT is an important option to measure true head size as images can be obtained in three dimensions. Henceforth, we subjected patients to CT scan of hip in cases with displaced fracture neck of femur. The study aims to define the term "small head or inadequate size femoral head" objectively for its prognostic significance. Materials and Methods: 70 cases of displaced femoral neck fractures underwent CT scan preoperatively for proximal femoral geometric measurements of both hips. Dual energy X-ray absorptiometry scan was done in all cases. Patients were treated with either intertrochanteric osteotomy or lag screw osteosynthesis based on the size of the head fragment on plain radiographs. Results: The average femoral head fragment volume was 57 cu cm (range 28.3-84.91 cu cm; standard deviation 14 cu cm. Proximal fragment volume of >43 cu cm was termed adequate size (type I and of ≤43 cu cm as small femoral head (type II. Fractures which united (n = 54 had a relatively large average head size (59 cu cm when compared to fractures that did not (n = 16, which had a small average head size (49 cu cm and this difference was statistically significant. In type I fractures union rate was comparable in both osteotomy and lag screw groups (P > 0.05. Lag screw fixation failed invariably, while osteotomy showed good results in type II fractures (P < 0.05. Conclusion: Computed tomography scan of the proximal femur is advisable for measuring true size of head fragment. An objective

  17. Identify fracture-critical regions inside the proximal femur using statistical parametric mapping.

    Science.gov (United States)

    Li, Wenjun; Kornak, John; Harris, Tamara; Keyak, Joyce; Li, Caixia; Lu, Ying; Cheng, Xiaoguang; Lang, Thomas

    2009-04-01

    We identified regions inside the proximal femur that are most strongly associated with hip fracture. Bone densitometry based on such fracture-critical regions showed improved power in discriminating fracture patients from controls. Hip fractures typically occur in lateral falls, with focal mechanical failure of the sub-volumes of tissue in which the applied stress exceeds the strength. In this study, we describe a new methodology to identify proximal femoral tissue elements with highest association with hip fracture. We hypothesize that bone mineral density (BMD) measured in such sub-volumes discriminates hip fracture risk better than BMD in standard anatomic regions such as the femoral neck and trochanter. We employed inter-subject registration to transform hip QCT images of 37 patients with hip fractures and 38 age-matched controls into a voxel-based statistical atlas. Within voxels, we performed t-tests between the two groups to identify the regions which differed most. We then randomly divided the 75 scans into a training set and a test set. From the training set, we derived a fracture-driven region of interest (ROI) based on association with fracture. In the test set, we measured BMD in this ROI to determine fracture discrimination efficacy using ROC analysis. Additionally, we compared the BMD distribution differences between the 29 patients with neck fractures and the 8 patients with trochanteric fractures. By evaluating fracture discrimination power based on ROC analysis, the fracture-driven ROI had an AUC (area under curve) of 0.92, while anatomic ROIs (including the entire proximal femur, the femoral neck, trochanter and their cortical and trabecular compartments) had AUC values between 0.78 and 0.87. We also observed that the neck fracture patients had lower BMD (p=0.014) in a small region near the femoral neck and the femoral head, and patients with trochanteric fractures had lower BMD in trochanteric regions such as in the internal calcar septum (p=0

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

    Science.gov (United States)

    Krengel, W F; Staheli, L T

    1992-10-01

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

  19. Valgus sliding subtrochanteric osteotomy for neglected fractures of the proximal femur; surgical technique and a retrospective case series.

    Science.gov (United States)

    Gavaskar, Ashok S; Chowdary, Naveen T

    2013-03-15

    Conventional technique of valgus osteotomy of the proximal femur involves removal of a partial or full thickness lateral based wedge from the peritrochanteric region. The purpose of this article is to describe a novel technique of valgus subtrochanteric osteotomy for proximal femur nonunion. 11 patients with proximal femur nonunions {intracapsular fractures--7, extracapsular fractures--4} were treated using a new technique of sliding subtrochanteric osteotomy and DHS fixation. Outcomes analysed include radiological outcome in terms of improvement in Pauwel's angle, neck-shaft angle and evidence of radiological union at the nonunion site and osteotomy site. Other outcomes analysed include, measurement of limb length discrepancy and functional outcome assessment with Oxford hip score. Union at the nonunion site and the osteotomy site was achieved in all patients. There were significant improvements in the postoperative Pauwel's angle, neck shaft angle and Oxford hip score. Limb length discrepancy improved to less than 1 cm in all patients. There was no x ray evidence of avascular necrosis of the femoral head at one year follow-up. The sliding osteotomy technique is simple, does not need extensive pre operative planning or removal of bone from the proximal femur.

  20. Using a statistical appearance model to predict the fracture load of the proximal femur

    Science.gov (United States)

    Schuler, Benedikt; Fritscher, Karl D.; Kuhn, Volker; Eckstein, Felix; Schubert, Rainer

    2009-02-01

    Nowadays clinical diagnostic techniques like e.g. dual-energy X-ray absorptiometry are used to quantify bone quality. However, bone mineral density alone is not sufficient to predict biomechanical properties like the fracture load for an individual patient. Therefore, the development of tools, which can assess the bone quality in order to predicting individual biomechanics of a bone, would mean a significant improvement for the prevention of fractures. In this paper an approach to predict the fracture load of proximal femora by using a statistical appearance model will be presented. For this purpose, 96 CT-datasets of anatomical specimen of human femora are used to create statistical models for the prediction of the individual fracture load. Calculating statistical appearance models in different regions of interest by using principal component analysis (PCA) makes it possible to use geometric as well as structural information about the proximal femur. By regressing the output of PCA against the individual fracture load of 96 femora multi-linear regression models using a leave-one-out cross validation scheme have been created. The resulting correlations are comparable to studies that partly use higher image resolutions.

  1. Morphological analysis of the proximal femur by computed tomography in Japanese subjects

    Energy Technology Data Exchange (ETDEWEB)

    Hagiwara, Masashi [Chiba Univ. (Japan). School of Medicine

    1995-11-01

    In order to evaluate the morphological features of the proximal femur in the Japanese, 100 femora of normal Japanese subjects (normal group) and 60 femora of 43 Japanese patients with secondary osteoarthrosis of the hip (OA group) were analyzed using CT images. The scans for the dried bones (normal group) were done at a setting of 80 kV and 20 mA, for 2 sec duration. The scans were reconstructed using the soft tissue algorithm built into the GE-9800 scanner. The patient scans (OA group) were done at 120 kV and 170 mA also for 2 sec duration, and reconstructed using the same bone algorithm. The results were as follows: Thinning of the femoral cortex occurred in normal females over 60 years of age. The canal flare index at the proximal part of the femoral diaphysis was negatively correlated with the canal diameter at the isthmus. The index at the upper part was greater than that at the lower part. The two groups showed no statistical difference in this index. In the metaphysis, the canal flare index at the anterior portion was twice that at the posterior portion. In absolute terms, the OA group had a reduced flare or curve along the medial portion. In cross-section, the canal shape of the diaphysis was more elliptical in the OA group than in the normal group. The longitudinal axis of the canal was directed more sagittally in the OA group than in the normal group. (author).

  2. Ipsilateral distal femoral and proximal tibial epiphyseal growth plate injury: a case report

    National Research Council Canada - National Science Library

    Gulabi, Deniz; Erdem, Mehmet; Bulut, Guven; Avci, Cem Coskun; Asci, Murat

    2013-01-01

    .... The patient was a 10-year-old boy, treated by open reduction and internal fixation. Although distal femoral and proximal tibial growth plate injuries are rarely seen benign fractures, their management requires meticulous care...

  3. Development and testing of texture discriminators for the analysis of trabecular bone in proximal femur radiographs

    Energy Technology Data Exchange (ETDEWEB)

    Huber, M. B.; Carballido-Gamio, J.; Fritscher, K.; Schubert, R.; Haenni, M.; Hengg, C.; Majumdar, S.; Link, T. M. [Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Avenue, San Francisco, California 94143 (United States); University of Health Sciences, Medical Informatics and Technology, 6060 Hall (Austria); AO Development Institute, 7270 Davos Platz (Switzerland); Medical University Innsbruck, 6020 Innsbruck (Austria); Department of Radiology and Biomedical Imaging, University of California, 400 Parnassus Avenue, San Francisco, California 94143 (United States)

    2009-11-15

    Purpose: Texture analysis of femur radiographs may serve as a potential low cost technique to predict osteoporotic fracture risk and has received considerable attention in the past years. A further application of this technique may be the measurement of the quality of specific bone compartments to provide useful information for treatment of bone fractures. Two challenges of texture analysis are the selection of the best suitable texture measure and reproducible placement of regions of interest (ROIs). The goal of this in vitro study was to automatically place ROIs in radiographs of proximal femur specimens and to calculate correlations between various different texture analysis methods and the femurs' anchorage strength. Methods: Radiographs were obtained from 14 femoral specimens and bone mineral density (BMD) was measured in the femoral neck. Biomechanical testing was performed to assess the anchorage strength in terms of failure load, breakaway torque, and number of cycles. Images were segmented using a framework that is based on the usage of level sets and statistical in-shape models. Five ROIs were automatically placed in the head, upper and lower neck, trochanteric, and shaft compartment in an atlas subject. All other subjects were registered rigidly, affinely, and nonlinearly, and the resulting transformation was used to map the five ROIs onto the individual femora. Results: In each ROI, texture features were extracted using gray level co-occurence matrices (GLCM), third-order GLCM, morphological gradients (MGs), Minkowski dimensions (MDs), Minkowski functionals (MFs), Gaussian Markov random fields, and scaling index method (SIM). Coefficients of determination for each texture feature with parameters of anchorage strength were computed. In a stepwise multiregression analysis, the most predictive parameters were identified in different models. Texture features were highly correlated with anchorage strength estimated by the failure load of up to R{sup 2

  4. [Randomized prospective study on the influence distal block and Gamma 3 nail on the treatment of intertrochanteric fractures of femur].

    Science.gov (United States)

    López-Vega, M; Gil-Monzó, E R; Rodrigo-Pérez, J L; López-Valenciano, J; Salanova-Paris, R H; Peralta-Nieto, J; Morales-Suárez, M M

    2015-01-01

    The purpose of this study is to assess the need to lock the Gamma 3 nail (Stryker, Mahwah New Jersey USA) distally for intertrochanteric fractures of femur 31-A1 and 31-A2 of the AO. Details were recorded on a sample of 177 patients with intertrochanteric femoral fractures treated in our hospital by a standard Gamma nail between June 2011 and January 2013. A prospective study was conducted by randomizing patients by year of birth, even numbers with, or odd number without, distal locking, forming two groups of 90 and 87 fractures, respectively. The patients treated with a distal locking nail had an increased incidence of medical complications, a lower incidence of biomechanical complications, and an increase in the fracture collapse compared with the control group, with statistical significance (p < 0.05). It is also observed in the group with distal locking increased transfusion requirement and a higher death rate, with statistically significant differences (p < 0.05), but this significance disappears when adjusting for other patient-related characteristics. Based on the results found in this work, the use of distal locking screw in the Gamma 3 nails should be restricted to unstable trochanteric fractures after reduction where additional stability to the intramedullary nail is required, and may decrease the risk of complications from use. Copyright © 2014 SECOT. Published by Elsevier Espana. All rights reserved.

  5. Does a traction-internal rotation radiograph help to better evaluate fractures of the proximal femur?

    Science.gov (United States)

    Koval, Kenneth J; Oh, Chong K; Egol, Kenneth A

    2008-01-01

    The standard radiographic series for evaluation of a suspected hip fracture in most centers includes an anteroposterior (AP) radiograph of the pelvis, as well AP and cross-table lateral views of the hip. The natural femoral neck anteversion, as well as the fracture deformity, however, may make accurate fracture classification difficult. We have noted that inexperienced physicians sometimes misclassify hip fractures based on the initial radiographic series, which may lead to errors both in surgical planning and implant choice. At our institution, we routinely obtain a physician-assisted traction-internal rotation radiograph of the affected hip in all fractures of the proximal femur. The purpose of the current study was to examine the usefulness of the traction-internal rotation radiograph for the classification of hip fractures by junior residents in our department. Forty-seven sets of complete radiographs (AP pelvis, AP hip, cross-table lateral, traction- internal rotation views) of patients who sustained a proximal femur fracture were identified. Fifteen first year orthopaedic residents (PGY2) individually reviewed the cases and classified them as one of six possible choices: 1. nondisplaced femoral neck fracture, 2. displaced femoral neck fracture, 3. stable intertrochanteric fracture, 4. unstable intertrochanteric fracture, 5. intertrochanteric fracture with subtrochanteric extension, or 6. subtrochanteric fracture. Each fracture case was classified after first reviewing the standard hip series (AP pelvis, AP hip, and cross-table lateral). A traction-internal rotation radiograph was then added to each case, and any changes in the initial classification were noted. The resident's classification was then compared with those of the senior investigators (KJK, KAE), who used all four views for classification. Reviewing a traction-internal rotation radiograph led to a statistically significant increase in agreement between the resident and senior investigators

  6. Comparison of electrogenic glucose transport processes and permeability between proximal and distal jejunum of laying hens.

    Science.gov (United States)

    Metzler-Zebeli, B U; Hollmann, M; Aschenbach, J R; Zebeli, Q

    2017-06-01

    1. The current objective was to assess (1) differences in mucosal transepithelial short-circuit current (Isc) and tissue conductance (GT), (2) the effect of a glucose stimulus and (3) epithelial paracellular permeability in the proximal and distal jejunum of laying hens. 2. Proximal and distal jejunal segments used in the Ussing chambers were collected at 9 ± 0.5 and 73 ± 3.4% (SEM) of jejunal length, respectively. The proximal jejunal mucosa showed a small negative Isc (-1.3 µA/cm(2)), whereas the distal jejunum had a higher Isc (32.9 µA/cm(2)). Similarly, GT was 2.5-fold greater in the distal compared to the proximal jejunum. 3. Increased paracellular permeability in the distal jejunum was displayed as demonstrated by a 5-fold higher mucosal to serosal flux of fluorescein isothiocyanate and horseradish peroxidase, representing molecules of low and high molecular weight, respectively. 4. Addition of glucose to the mucosal side (5 mmol/l, final concentration in the chamber) to stimulate an absorptive effect caused 3-fold greater GT in the distal compared to the proximal jejunum. 5. In conclusion, the present results supported site-specific electrogenic transport processes for the jejunal mucosa of laying hens. Therefore, precise description of the jejunal site may contribute to an improved comparability of electrophysiological data.

  7. The Outcome in Early Cases of Treatment of Subtrochanteric Fractures with Proximal Femur Locking Compression Plate

    Directory of Open Access Journals (Sweden)

    U Gunadham

    2014-07-01

    Full Text Available The objective of this study was to evaluate the outcome in early treatment of subtrochanteric fractures with proximal femur locking compression plate (PF-LCP.The patients included in this study were those with subtrochanteric fractures (AO type 32A-C treated with PF-LCP (Synthes between Jan 2009 and Jun 2011. The patient characteristics and details of clinical conditions were obtained from records. Clinical and radiographic follow-ups were done at one, two, four and 6 months intervals, and at one year. The primary outcome studied included fracture union and functional ambulatory status. Twenty-six patients were included in the study, 19 of whom were male with a mean age of 42.4 years. Fourteen patients (53.9% had sustained AO type 32B fractures, the majority in motor vehicle accidents. Twenty-two fractures (84.6% achieved union, while sixpatients (23.1% had complications such as broken plate, varus collapse, and broken screw. Four patients (15.4% underwent a second operation. At the end of the follow-ups, 25 patients (96.2% were community ambulators. We conclude that PF-LCP is an effective alternative treatment for subtrochanteric fractures when properly performed.

  8. Aneurysmal Bone Cyst of the Proximal Femur and Its Management - A Case Report.

    Science.gov (United States)

    Kapoor, Chirag; Shah, Malkesh; Soni, Rishit; Patwa, Jagdish; Merh, Aditya; Golwala, Paresh

    2017-01-23

    Aneurysmal bone cyst (ABC) is a benign, expansile, non-neoplastic lesion of the bone, characterized by channels of blood and spaces that are separated by fibrous septae. Giant ABC is an uncommon condition and can be difficult to handle because of the destructive effect of the cyst on the bones and the compressive effect on the nearby structures, especially in weight-bearing bones of the body. We report a case of a giant aneurysmal bone cyst in the proximal femur of a six-year-old child, which was treated with a sclerosing agent and ender's nail fixation first. There was recurrence after 13 months. It was then curetted out extensively, the cavity was filled with bone graft, and fixation with a dynamic hip screw (DHS) was done. At 19 months follow-up, the lesion had subsided and patient was walking pain-free without any deformity. We suggest this method of treatment to be worthwhile for ABC at this site and at this age.

  9. Case report 473: Tuberculosis of the distal metaphysis of the femur

    Energy Technology Data Exchange (ETDEWEB)

    Abdelwahab, I.F.; Gould, E.; Present, D.A.; Klein, M.J.; Nelson, J.

    1988-04-01

    In summary, a case of tuberculous osteomyelitis of the femur in a 16-month-old male child has been presented. The parents illegally immigrated to the United States from Central America before the birth of their child. Both parents had active pulmonary tuberculosis and the child presented with calcified granulomas in his lungs in addition to the lesion in the femur. This presentation is uncommon among the white population in the United States and Europe and is usually limited to non-white immigrants. (orig./SHA).

  10. Tissue-implant interface at an absorbable fracture fixation plug made of polylactide in cancellous bone of distal rabbit femur.

    Science.gov (United States)

    Pihlajamäki, H; Böstman, O; Manninen, M; Päivärinta, U; Rokkanen, P

    1994-01-01

    The tissue-implant interface at a self-reinforced poly-L-lactide (SR-PLLA) expansion plug implanted in distal rabbit femoral cancellous bone was studied histologically, histomorphometrically, and microradiographically in 35 rabbits during consolidation of a transverse transcondylar osteotomy fixed with the SR-PLLA expansion plug. The absorbable plug for internal fixation of fractures and osteotomies measured 4.5 mm in diameter and 30 mm in length and had an expandable distal locking blade system. The femoral specimens were harvested in groups of 5-10 rabbits after a follow-up time of 3, 6, 12, and 24 weeks. The intact contralateral femur served as a control. Vigorous osteogenic response to the implant was already observed at 3 weeks postoperatively, and the osteoid surface fraction at 24 weeks was still significantly higher than in the unoperated contralateral femur. Incomplete union of the osteotomy seemed to result in increased fibrous tissue formation at the tissue-implant boundary. No signs of degradation of the SR-PLLA was observed within the entire follow-up period. The number of inflammatory cells at the tissue-implant interface was low. Consequently, the short-term biocompatibility of the implant was deemed acceptable. Clinical application of the expansion plug is being planned.

  11. Sensitivity and specificity of CT- and MRI-scanning in evaluation of occult fracture of the proximal femur

    DEFF Research Database (Denmark)

    Haubro, M; Stougaard, C; Torfing, T

    2015-01-01

    and a resident in orthopaedic surgery. Sensitivity and specificity were estimated with MRI as the golden standard. Kappa value was used to assess level of agreement in both MRI and CT finding. RESULTS: 15 fractures of the proximal femur were found (7 intertrochanteric-, 3 femoral neck and 5 fractures......OBJECTIVE: To estimate sensitivity and specificity of CT and MRI examinations in patients with fractures of the proximal femur. To determine the interobserver agreement of the modalities among a senior consulting radiologist, a resident in radiology and a resident in orthopaedics surgery. MATERIALS...... AND METHODS: 67 patients (27 males, 40 females, mean age 80.5) seen in the emergency room with hip pain after fall, inability to stand and a primary X-ray without fracture were evaluated with both CT and MRI. The images were analysed by a senior consulting musculoskeletal radiologist, a resident in radiology...

  12. Computed tomographic evaluation of the proximal femur: A predictive classification in displaced femoral neck fracture management.

    Science.gov (United States)

    Magu, Narender Kumar; Magu, Sarita; Rohilla, Rajesh Kumar; Batra, Amit; Jaipuria, Abhishek; Singh, Amanpreet

    2014-09-01

    Femoral neck fracture is truly an enigma due to the high incidence of avascular necrosis and nonunion. Different methods have been described to determine the size of the femoral head fragment, as a small head has been said to be associated with poor outcome and nonunion due to inadequate implant purchase in the proximal fragment. These methods were two dimensional and were affected by radiography techniques, therefore did not determine true head size. Computed tomography (CT) is an important option to measure true head size as images can be obtained in three dimensions. Henceforth, we subjected patients to CT scan of hip in cases with displaced fracture neck of femur. The study aims to define the term small head or inadequate size femoral head" objectively for its prognostic significance. 70 cases of displaced femoral neck fractures underwent CT scan preoperatively for proximal femoral geometric measurements of both hips. Dual energy X-ray absorptiometry scan was done in all cases. Patients were treated with either intertrochanteric osteotomy or lag screw osteosynthesis based on the size of the head fragment on plain radiographs. The average femoral head fragment volume was 57 cu cm (range 28.3-84.91 cu cm; standard deviation 14 cu cm). Proximal fragment volume of >43 cu cm was termed adequate size (type I) and of ≤43 cu cm as small femoral head (type II). Fractures which united (n = 54) had a relatively large average head size (59 cu cm) when compared to fractures that did not (n = 16), which had a small average head size (49 cu cm) and this difference was statistically significant. In type I fractures union rate was comparable in both osteotomy and lag screw groups (P > 0.05). Lag screw fixation failed invariably, while osteotomy showed good results in type II fractures (P femoral head size (type I and type II) is proposed. Osteosynthesis should be the preferred method of treatment in type I and osteotomy or prosthetic replacement is the method of choice for

  13. Deformity of the proximal end of the femur following open reduction for developmental dislocation of the hip

    OpenAIRE

    Ikegami, Koichi; Nakatsuka, Yoichi; Akazawa, Hirofumi; Mitani, Shigeru; Inoue, Hajime

    1997-01-01

    We studied deformity of the proximal end of the femur following open reduction using the wide exposure method for developmental dislocation of the hip. We reviewed radiographs of 22 children with unilateral dislocation of the hip who had undergone open reduction between one and three years of age. Ages at final examination ranged from 14 to 21 years. None of the patients in this study had undergone any additional surgery. Avascular necrosis of the femoral head was not observed in any patients...

  14. Bone mineral density of the proximal femur after hip resurfacing arthroplasty: 1-year follow-up study

    Directory of Open Access Journals (Sweden)

    Anttila Esa

    2011-05-01

    Full Text Available Abstract Background Hip resurfacing arthroplasty (HRA is considered a bone-preserving procedure and may eliminate proximal femoral stress shielding and osteolysis. However, in addition to implant-related stress-shielding factors, various patient-related factors may also have an effect on bone mineral density (BMD of the proximal femur in patients with HRA. Thus, we studied the effects of stem-neck angle, demographic variables, and physical functioning on the BMD of the proximal femur in a one-year follow-up. Methods Thirty three patients (9 females and 24 males with a mean (SD age of 55 (9 years were included in the study. BMD was measured two days and 3, 6, and 12 months postoperatively and 10 regions of interest (ROI were used. Stem-neck angle was analyzed from anteroposterior radiographs. Results Three months postoperatively, BMD decreased in six out of 10 regions of interest (ROI on the side operated on and in one ROI on the control side (p Conclusions After an early drop, the BMD of the upper femur was restored and even exceeded the preoperative level at one year follow-up. From a clinical standpoint, the changes in BMD in these HRA patients could not be explained by stem-neck angle or patient related factors.

  15. A method for designing plates in treatments of proximal humeral fracture and distal radial fracture

    Directory of Open Access Journals (Sweden)

    Lin Wang

    2016-11-01

    Full Text Available The purpose of this paper was to quickly design fixation plates for fractured proximal humerus and distal radius according to the requirements of surgical treatment. Therefore, a new method to quickly design cloverleaf plate appropriate for proximal humerus and volar plate appropriate for distal radius is put forward. First, three-dimensional (3D reconstruction models of fractured proximal humerus and distal radius were generated based on deforming mean parametric models of proximal humerus and distal radius, respectively. Second, based on region-of-interest marked on the 3D reconstruction model of proximal humerus and distal radius, abutted surfaces of cloverleaf plate and volar plate were established, respectively. Then, parametric abutted surface was established after setting rational parameters for the surface of the cloverleaf plate. Parametric abutted surface of volar plate was established using the same method. Finally, parametric cloverleaf plate and volar plate are generated through thickening their respective parametric abutted surfaces. The parametric plates, acting as templates, accelerate and simplify the design process and therefore allow users to construct plate with editing valid parameters easily. Group of cloverleaf plates and volar plates with different sizes were generated quickly, showing that the proposed method is feasible and effective.

  16. Effects of proximal and distal robot-assisted upper limb rehabilitation on chronic stroke recovery.

    Science.gov (United States)

    Mazzoleni, Stefano; Sale, Patrizio; Franceschini, Marco; Bigazzi, Samuele; Carrozza, Maria Chiara; Dario, Paolo; Posteraro, Federico

    2013-01-01

    To evaluate the effects of add-on distal upper limb robot-assisted treatment on the outcome of proximal regions. 64 chronic stroke patients divided into two groups participated in the study. Group A was assigned to the proximal robot-assisted rehabilitation, Group B to the proximal and distal. Shoulder/elbow subsection of Fugl-Meyer Assessment scale was collected for Group A, whereas for Group B wrist subsection was also collected. Motricity Index was used and a set of kinematic parameters was computed for both groups. A decrease in impairment after the treatment in both groups of patients (Group A: Shoulder/elbow FM p robot-assisted treatment in both groups; group B showed a greater improvement in velocity. Robotic treatment is effective to reduce motor impairment in chronic stroke patients even if distal training added to proximal segments in the Group B does not provide any incremental benefit to the proximal segments. It remains unclear if the effectiveness of robot-assisted treatment is directly related to the upper limb segment specifically treated and which order may lead to better outcome. Our study suggests that kinematic parameters should be computed in order to better clarify the role of distal training (wrist) on proximal segments (shoulder/elbow) as well.

  17. Epidemiology of fractures of the proximal third of the femur in elderly patients ☆

    Directory of Open Access Journals (Sweden)

    Daniel Daniachi

    2015-08-01

    Full Text Available ABSTRACTOBJECTIVE: This was an epidemiological study on fractures of the proximal third of the femur in elderly patients who were treated at a teaching hospital in the central region of São Paulo. METHODS: The subjects were patients over the age of 60 years who were attended over a 1-year period. A questionnaire seeking basic sociodemographic data and information on comorbidities presented and medications used was drawn up. The circumstances of the fractures and their characteristics, the treatment instituted and the intra-hospital mortality rate were evaluated. RESULTS: The 113 patients included in the study presented a mean age of 79 years. The ratio between the sexes was three women to each man. Only 30.4% of the patients reported having osteoporosis and only 0.9% had had treatment for the disease. Low-energy trauma was the cause of 92.9% of the fractures. Femoral neck fractures accounted for 42.5% of the fractures and trochanteric fractures, 57.5%. Five patients did not undergo operations; 39 underwent joint replacement; and 69 underwent osteosynthesis. The mean length of hospital stay was 13.5 days and the mean length of waiting time until surgery was 7 days. The intra-hospital mortality rate was 7.1%. CONCLUSION: The patients attended at this institution presented an epidemiological profile similar to what is found in the Brazilian literature. Chronic kidney failure is a significant factor with regard to intra-hospital mortality. Preventive measures such as early diagnosis and treatment of osteoporosis and regular physical activity practices were not implemented.

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

    Science.gov (United States)

    Vander Griend, Robert

    2017-02-01

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

  19. Synostosis of proximal phalangeal bases for loss of distal metacarpal

    Directory of Open Access Journals (Sweden)

    Pankaj Jindal

    2016-01-01

    Full Text Available A finger rendered unstable due to loss of metacarpal head can be stabilized by creating a synostosis at the base of the proximal phalanx of the affected finger with the adjacent normal finger. A cortico cancellous graft bridges the two adjacent proximal phalanges at their bases which are temporarily stabilized with an external fixator. The procedure can be done for, recurrence of giant cell tumor of metacarpal and for traumatic metacarpal loss. The procedure and long term follow up of one patient is presented who had giant cell tumor. This option should be considered before offering ray amputation. There is no micro vascular surgery involved, nor is there any donor site morbidity. The graft heals well without any absorption. The affected finger shows excellent function in the long term followup.

  20. Impairment of the proximal to distal tonic gradient in the human diabetic stomach.

    Science.gov (United States)

    Min, Y W; Hong, Y S; Ko, E-J; Lee, J Y; Min, B-H; Sohn, T S; Kim, J J; Rhee, P-L

    2014-02-01

    Little has been known about the contractile characteristics of diabetic stomach. We investigated spontaneous contractions and responses to acetylcholine in the gastric muscle in diabetic patients and non-diabetic control subjects according to the region of stomach. Gastric specimens were obtained from 26 diabetics and 55 controls who underwent gastrectomy at Samsung Medical Center between February 2008 and November 2011. Isometric force measurements were performed using circular muscle strips from the different regions of stomach under basal condition and in response to acetylcholine. Basal tone of control was higher in the proximal stomach than in the distal (0.63 g vs 0.46 g, p = 0.027). However, in diabetics, basal tone was not significantly different between the proximal and distal stomach (0.75 g vs 0.62 g, p = 0.32). The distal stomach of diabetics had higher basal tone and lower frequency than that of control (0.62 g vs 0.46 g, p = 0.049 and 4.0/min vs 4.9/min, p = 0.049, respectively). After exposure to acetylcholine, dose-dependent increases of basal tone, peak, and area under the curve (AUC) were noticed in both proximal and distal stomach of the two groups. In the proximal stomach, however, the dose-dependent increase of basal tone and AUC was less prominent in diabetics than in control. On the contrary to control, the proximal to distal tonic gradient was not observed in diabetic stomach. Diabetic stomach also had lower frequency of spontaneous contraction in the distal stomach and less acetylcholine-induced positive inotropic effect in the proximal stomach than control. © 2013 John Wiley & Sons Ltd.

  1. Tibia-hindfoot osteomusculocutaneous rotationplasty with calcaneopelvic arthrodesis for extensive loss of bone from the proximal part of the femur. A report of two cases.

    Science.gov (United States)

    Peterson, C A; Koch, L D; Wood, M B

    1997-10-01

    We report a new technique to create an effective lower extremity weight-bearing stump for two patients who had extensive segmental loss of femoral bone proximal to the distal femoral condyles. One patient had previously had complete resection of the proximal part of the femur because of an infection following the insertion of a custom femoral replacement and hip arthroplasty prosthesis. The other patient had had débridement of the femur from the subcapital line to the femoral condyles because of post-traumatic osteomyelitis after failure of a reconstruction with a massive allograft. Both patients were managed with a tibia-hindfoot osteomusculocutaneous rotationplasty after transtarsal (Chopart) amputation, with calcaneopelvic arthrodesis to create stable fixation of the extremity to the pelvis; this fixation allowed flexion, extension, abduction, and adduction of the hip by means of the retained tibiotalar and subtalar joints. At the time of the latest follow-up (at thirty-three and forty-four months), both patients were bearing full weight, without pain, with the use of a standard above-the-knee-amputation prosthesis. We report this procedure as a useful alternative to disarticulation at the level of the hip in patients who have massive loss of femoral bone and destruction of the hip joint in association with scarred and previously infected soft tissues and are not considered to be candidates for other forms of limb-preservation reconstruction. The patient must be willing to accept the equivalent of a low above-the-knee amputation and recognize the potential value of a weight-bearing stump.

  2. Distal Duodenogastrostomy or Proximal Jejunogastrostomy in the Management of Ultra-Short Bowel.

    Science.gov (United States)

    Hofker, Tjipke Olivier; Kaijser, Mirjam Anna; Nieuwenhuijs, Vincent B; Lange, Johan Frederick Michel; Hofker, Hendrik Sijbrand

    2017-12-22

    Inflammatory bowel disease, vascular disease, volvulus, adhesions, or abdominal trauma may necessitate extensive small-bowel resection resulting in an ultra-short distal duodenal or jejunal stump. If this distal duodenal or short jejunal stump is too short for stoma creation and bowel continuity restoration is hazardous or not possible at all, a distal duodenogastrostomy or proximal jejunogastrostomy in combination with drainage of the stomach is an option to prevent stump leakage. Although successful, this distal duodenogastrostomy has been described only in very few patients and in older records. We reintroduced this technique and describe a recent series of patients that confirms its usefulness in certain conditions. The technique of the distal duodenogastrostomy or proximal jejunogastrostomy with gastric drainage was used for the management of the difficult distal duodenum stump in five critically ill patients undergoing extensive bowel resection. Four patients with small-bowel ischemia and one patient suffering from perforating Crohn's disease and small-bowel volvulus were treated  successfully. The gastrostomies were subsequently converted to a duodenotransversostomy (in two patients) or the patients underwent small-bowel transplantation (two patients). One patient still has a jejunogastrostomy just after the duodenal-jejunal transition. In all five patients, the distal duodenogastrostomy or proximal jejunogastrostomy in combination with gastric drainage functioned well up to restoration of bowel continuity. In one patient, distal duodenogastrostomy and transabdominal gastric drainage functioned well for 5 years. No anastomotic leakage occurred. This procedure provides a feasible solution for an ultra-short bowel at emergency laparotomy. It enhances the surgical armamentarium and provides treatment options for these patients that were perhaps previously deemed unsalvageable.

  3. Shape of growth plate of proximal femur in children and its significance in the aetiology of slipped capital femoral epiphysis.

    Science.gov (United States)

    Kandzierski, Grzegorz; Matuszewski, Lukasz; Wójcik, Anna

    2012-12-01

    The main objective of the study was to present the influence of the morphological shape of the proximal femoral growth plate in children as one of the risk factors for the incidence of slipped capital femoral epiphysis (SCFE) in adolescents. This research is based on the X-ray, computed tomography (CT) and magnetic resonance imaging (MRI) data obtained for 100 children three to 13 years old, all treated at the Children's Orthopaedic Clinic and Rehabilitation Department and Department of Radiology Medical University of Lublin between 2005 and 2009. We took into account 83 children with healthy hip joints and 17 children with SCFE. We also performed morphological analysis of the shape of the proximal femoral growth plate together with X-ray, CT and MRI examinations of the proximal ends of cadaver femurs for two children aged six and 13. In the final findings we present an analysis of the shape of the proximal femoral growth plate in children between the third and 13th years of life and consider a correlation between the shape of the proximal femoral growth plate and its influence on the incidence of SCFE in adolescents. The change of shape of the proximal femoral growth plate from pleated to more spherical is one of the risk factors for the incidence of SCFE in children ten years old and older.

  4. Hemiarthroplasties in young patients with osteonecrosis or a tumour of the proximal femur; an observational cohort study.

    Science.gov (United States)

    van Egmond, Pim W; Taminiau, Antonie H M; van der Heide, Huub J L

    2013-01-17

    The failure scenario in total hip arthroplasty (THA), in younger patients, is dependent on the fixation and wear of the acetabular component. In selected cases, where endoprosthetic replacement of the femoral head is unavoidable for limb salvage or functional recovery, hemiarthroplasty can be chosen as an alternative. The purpose of this study is to evaluate hemiarthroplasty as treatment strategy for young patients with osteonecrosis or a tumour of the proximal femur. Between 1985 and 2008, 42 hemiarthroplasties (unipolar and bipolar) were performed in patients younger than 65 years with osteonecrosis (n=13) or a tumour of the proximal femur (n=29). All patients were seen at yearly follow-up examination and evaluated. Revision or conversion to a THA was regarded as a failure of the implant. A Kaplan Meier analysis was performed. To determine significant differences between categorical groups, the Pearson chi-square test was used. In numerical groups the independent T-test and One-way ANOVA were used. After a mean follow-up of 7.1 years, failure of the hemiarthroplasty occurred 6 times. The Kaplan Meier survival analysis with conversion to THA or revision as endpoint of the bipolar hemiarthroplasties (n=38) shows a 96% survival at 15, and 60% at 20 years. In the unipolar type (n=4) we found a conversion rate of 50% within 3 years. Bipolar hemiarthroplasty is a reasonable alternative in a young patient with osteonecrosis or a tumour of the proximal femur as indication. Because of the high conversion rate after unipolar hemiarthroplasties, we would not recommend this type of prosthesis in the young patient.

  5. Proximal enterectomy stimulates distal hyperplasia more than bypass or pancreaticobiliary diversion.

    Science.gov (United States)

    Williamson, R C; Bauer, F L; Ross, J S; Malt, R A

    1978-01-01

    To determine the contribution of intraluminal factors to postresectional intestinal hyperplasia, cell proliferation in the distal intestine of male rats was studied after 50% proximal enterectomy or 50% proximal bypass and also after transposition of the duodenal papilla to the mid small bowel. Within 48 hr all three operations increased RNA and DNA content s in the ileal mucosa 16 to 50% over control values. At 48 hr and 1 week the response distal to resection exceeded that of bypass or pancreaticobiliary diversion; nucleic acid contents, DNA specific activity, villous height, crypt depth, and luminal circumference were greatest 1 week after resection. By 1 month, however, chemical and histological values after resection were equalled or surpassed by those in the other two groups. In excluded jejunum itself, mucosal atrophy lowered RNA and DNA contents to 60% of control levels 1 month postoperatively. Neither pancreaticobiliary diversion nor proximal enteric bypass produces the same rate of distal hyperplasia as proximal resection. Modest colonic hyperplasia may contribute to intestinal adaptation after proximal enterectomy. Adaptive postrescetional cell proliferation appears not to be mediated simply by intraluminal nutrition or enteric secretions; hormonal factors may also be important.

  6. Sex specific association of physical activity on proximal femur BMD in 9 to 10 year-old children.

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    Graça Cardadeiro

    Full Text Available The results of physical activity (PA intervention studies suggest that adaptation to mechanical loading at the femoral neck (FN is weaker in girls than in boys. Less is known about gender differences associated with non-targeted PA levels at the FN or other clinically relevant regions of the proximal femur. Understanding sex-specific relationships between proximal femur sensitivity and mechanical loading during non-targeted PA is critical to planning appropriate public health interventions. We examined sex-specific associations between non-target PA and bone mineral density (BMD of three sub-regions of the proximal femur in pre- and early-pubertal boys and girls. BMD at the FN, trochanter (TR and intertrochanter (IT regions, and lean mass of the whole body were assessed using dual-energy x-ray absorptiometry in 161 girls (age: 9.7±0.3 yrs and 164 boys (age: 9.7±0.3 yrs. PA was measured using accelerometry. Multiple linear regression analyses (adjusted for body height, total lean mass and pubertal status revealed that vigorous PA explained 3-5% of the variability in BMD at all three sub-regions in boys. In girls, vigorous PA explained 4% of the variability in IT BMD and 6% in TR BMD. PA did not contribute to the variance in FN BMD in girls. An additional 10 minutes per day of vigorous PA would be expected to result in a ∼1% higher FN, TR, and IT BMD in boys (p<0.05 and a ∼2% higher IT and TR BMD in girls. In conclusion, vigorous PA can be expected to contribute positively to bone health outcomes for boys and girls. However, the association of vigorous PA to sub-regions of the proximal femur varies by sex, such that girlś associations are heterogeneous and the lowest at the FN, but stronger at the TR and the IT, when compared to boys.

  7. The risk assessment of pathological fracture in the proximal femur using a CT-based finite element method.

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    Kawabata, Yusuke; Matsuo, Kosuke; Nezu, Yutaka; Kamiishi, Takayuki; Inaba, Yutaka; Saito, Tomoyuki

    2017-09-01

    Patients who have lytic bone lesions in their proximal femurs are at risk for pathological fracture. Lesions with high fracture risk are surgically treated using prophylactic osteosynthesis, whereas low-risk lesions are treated conservatively. However, it is difficult to discriminate between high- and low-risk lesions based on clinical and radiographic findings. The computed tomography (CT)-based finite element (FE) models are useful for predicting the fracture load on proximal femoral lytic lesions. FE models were constructed from the quantitative CT scans of the femurs using software that created individual bone shapes and density distributions. Three independent observers measured the lesion size, Mirels' score, and thickness of the proximal femur along the horizontal plane. The predictive risk values of the proximal femur measured using the CT-based FE analysis were statistically compared. The patients were divided into two groups (high and low risk). The mean fracture load was significantly higher in the high-risk group than in the low-risk group (5395 ± 525 N, 2622 ± 364 N, respectively, p = 0.0003). No significant differences in age, body weight, lesion size or Mirels' score were observed between groups. However, the thickness of the medial cortex in the high-risk group according to the FE analysis was significantly thinner than that in the low-risk group. Furthermore, the medial cortex thickness was positively correlated with the predicted fracture load. An optimal cut-off value of 3.67 mm for the thickness of the inner cortex resulted in 100% sensitivity and 75.1% specificity values for classifying the patients based on their fracture risk. Our findings indicate that the FE method is useful for the prediction of the pathological fracture. This method shows a versatile potential for the prediction of pathological fracture and might aid in judging the optimal treatment to prevent fracture. Copyright © 2017 The Japanese Orthopaedic Association

  8. Magnetic resonance perfusion and diffusion imaging characteristics of transient bone marrow edema, avascular necrosis and subchondral insufficiency fractures of the proximal femur

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    Mueller, Dirk, E-mail: d.mueller@uk-koeln.de [Department of Radiology, University of Cologne (Germany); Department of Radiology, Technische Universität München (Germany); Schaeffeler, Christoph, E-mail: schaeffeler@me.com [Department of Radiology, Cantonal Hospital Graubuenden, Chur (Switzerland); Department of Radiology, Cantonal Hospital Graubuenden, Chur (Switzerland); Baum, Thomas, E-mail: thomas-baum@gmx.de [Department of Radiology, Technische Universität München (Germany); Walter, Flavia, E-mail: flavia_walter2000@yahoo.de [Department of Radiology, Technische Universität München (Germany); Rechl, Hans, E-mail: rechl@tum.de [Department of Orthopaedics, Technische Universität München (Germany); Rummeny, Ernst J., E-mail: rummeny@tum.de [Department of Radiology, Technische Universität München (Germany); Woertler, Klaus, E-mail: klaus.woertler@tum.de [Department of Radiology, Technische Universität München (Germany)

    2014-10-15

    Highlights: • DCE-MRI may add information to the pathophysiology of bone marrow edema (BME) of the proximal femur. • Patients with transient bone marrow edema (TBME) or subchondral insufficiency fractures (SIF) and avascular osteonecrosis (AVN) showed different MR perfusion patterns. • Perfusion characteristics suggest different pathophysiology for AVN compared with TBME or SIF. • Diffusion weighted imaging (DWI) was not able to discriminate necrotic from edematous bone marrow. • DWI is of limited value to evaluate BME of the proximal femur. - Abstract: Purpose: To evaluate magnetic resonance (MR) perfusion and diffusion imaging characteristics in patients with transient bone marrow edema (TBME), avascular necrosis (AVN), or subchondral insufficiency fractures (SIF) of the proximal femur. Materials and methods: 29 patients with painful hip and bone marrow edema pattern of the proximal femur on non-contrast MR imaging were examined using diffusion-weighted and dynamic gadolinium-enhanced sequences. Apparent diffusion coefficients (ADCs) and perfusion parameters were calculated for different regions of the proximal femur. Regional distribution and differences in ADC values and perfusion parameters were evaluated. Results: Seven patients presented with TBME, 15 with AVN and seven with SIF of the proximal femur. Perfusion imaging showed significant differences for maximum enhancement values (E{sub max}), slope (E{sub slope}) and time to peak (TTP) between the three patient groups (p < 0.05). In contrast, no significant differences for ADC values were calculated when comparing TBME, AVN, and SIF patients. Conclusion: Diffusion weighted imaging of bone marrow of the proximal femur did not show significant differences between patients with TBME, AVN or SIF. In contrast, MR perfusion imaging demonstrated significant differences for the different patient groups and may as a complementary imaging technique add information to the understanding of the pathophysiology

  9. A Prospective Study to Evaluate the Management of Sub-trochanteric Femur Fractures with Long Proximal Femoral Nail

    Directory of Open Access Journals (Sweden)

    Kumar M

    2017-11-01

    Full Text Available INTRODUCTION: Sub-trochanteric fractures of the femur remains one of the most challenging fractures faced by orthopaedic surgeons. This study was done to analyse the management and complications of sub-trochanteric fractures using long proximal femoral nail (PFN. MATERIALS AND METHODS: This was a prospective study of 50 patients with sub-trochanteric fractures of femur who were treated with long PFN at a tertiary care center from July 2012 to June 2016. The fractures were classified according to Seinsheimer classification. All patients were assessed functionally by Harris Hip Score. RESULTS: Average duration of union was 17.08 weeks (range 13 to 32 weeks, union was achieved in 92% cases. Closed reduction was achieved in 68% cases and open reduction was required in 32% cases. Various intraoperative complications were seen in 12% and delayed complications in 26% of cases. Good anatomical results were achieved in 86% of cases and 14% were fair. As per Harris Hip score, excellent results were noted in 28% cases, good in 56% cases and fair in 16% cases. CONCLUSION: The long PFN is a reliable implant for sub-trochanteric femur fractures, with high rate of bone union and minimal soft tissue damage. Intramedullary fixation has biological and biomechanical advantages, but the surgery is technically demanding.

  10. Effects of diet-induced obesity and voluntary wheel running on the microstructure of the murine distal femur

    Science.gov (United States)

    2011-01-01

    Background Obesity and osteoporosis, two possibly related conditions, are rapidly expanding health concerns in modern society. Both of them are associated with sedentary life style and nutrition. To investigate the effects of diet-induced obesity and voluntary physical activity we used high resolution micro-computed tomography (μCT) together with peripheral quantitative computed tomography (pQCT) to examine the microstructure of the distal femoral metaphysis in mice. Methods Forty 7-week-old male C57BL/6J mice were assigned to 4 groups: control (C), control + running (CR), high-fat diet (HF), and high-fat diet + running (HFR). After a 21-week intervention, all the mice were sacrificed and the left femur dissected for pQCT and μCT measurements. Results The mice fed the high-fat diet showed a significant weight gain (over 70% for HF and 60% for HFR), with increased epididymal fat pad mass and impaired insulin sensitivity. These obese mice had significantly higher trabecular connectivity density, volume, number, thickness, area and mass, and smaller trabecular separation. At the whole bone level, they had larger bone circumference and cross-sectional area and higher density-weighted maximal, minimal, and polar moments of inertia. Voluntary wheel running decreased all the cortical bone parameters, but increased the trabecular mineral density, and decreased the pattern factor and structure model index towards a more plate-like structure. Conclusions The results suggest that in mice the femur adapts to obesity by improving bone strength both at the whole bone and micro-structural level. Adaptation to running exercise manifests itself in increased trabecular density and improved 3D structure, but in a limited overall bone growth PMID:21241467

  11. Mono- versus polyaxial locking plates in distal femur fractures - a biomechanical comparison of the Non-Contact-Bridging- (NCB) and the PERILOC-plate.

    Science.gov (United States)

    El-Zayat, Bilal Farouk; Efe, Turgay; Ruchholtz, Steffen; Khatib, Salim; Timmesfeld, Nina; Krüger, Antonio; Zettl, Ralph

    2014-11-06

    The aim of this cadaveric study was to compare a polyaxial (NCB®, Zimmer) to a fixed-angle monoaxial locking plate (PERILOC®, Smith & Nephew) in comminuted fractures of the distal femur regarding stability of the construct. Up to date there is no published biomechanical data concerning polyaxial plating in cadaveric distal femurs. Fourteen formalin fixed femora were scanned by dual-energy x-ray absorptiometry. As fracture model an unstable supracondylar comminuted fracture was simulated. Fractures were pairwise randomly fixed either with a mono- (group A) or a polyaxial (group B) distal femur plate. The samples were tested in a servohydraulic mechanical testing system starting with an axial loading of 200 N following an increase of 200 N in every step with 500 cycles in every sequence up to a maximum of 2 000 N. The end points were implant failure or relevant loss of reduction. Data records included for each specimen time, number of cycles, axial load and axial displacement. Statistical analysis was performed using the exact Wilcoxon signed rank test. The mean donor age at the time of death was 75 years. The bone mass density (BMD) of the femurs in both groups was comparable and showed no statistically significant differences. Five bones failed before reaching the maximum applied force of 2000 N. Distribution curves of all samples in both groups, showing the plastic deformation in relation to the axial force, showed no statistically significant differences. Operative stabilization of distal femur fractures can be successfully and equally well achieved using either a monoaxial or a polyaxial locking plate. Polyaxial screw fixation may have advantages if intramedullary implants are present.

  12. Isokinetic strength and endurance in proximal and distal muscles in patients with peripheral artery disease.

    Science.gov (United States)

    Câmara, Lucas Caseri; Ritti-Dias, Raphael Mendes; Menêses, Annelise Lins; D'Andréa Greve, Júlia Maria; Filho, Wilson Jacob; Santarém, José Maria; Forjaz, Cláudia Lúcia de Moraes; Puech-Leão, Pedro; Wolosker, Nelson

    2012-11-01

    The objective of this study was to analyze the muscle strength and endurance of the proximal and distal lower-extremity muscles in peripheral artery disease (PAD) patients. Twenty patients with bilateral PAD with symptoms of intermittent claudication and nine control subjects without PAD were included in the study, comprising 40 and 18 legs, respectively. All subjects performed an isokinetic muscle test to evaluate the muscle strength and endurance of the proximal (knee extension and knee flexion movements) and distal (plantar flexion and dorsiflexion movements) muscle groups in the lower extremity. Compared with the control group, the PAD group presented lower muscle strength in knee flexion (-14.0%), dorsiflexion (-26.0%), and plantar flexion (-21.2%) movements (P strength in knee extension movements (P > 0.05). The PAD patients presented a 13.5% lower knee flexion/extension strength ratio compared with the control subjects (P lower muscle endurance in dorsiflexion (-28.1%) and plantar flexion (-17.0%) movements (P muscle endurance in knee flexion and knee extension movements was similar between PAD patients and the control subjects (P > 0.05). PAD patients present lower proximal and distal muscle strength and lower distal muscle endurance than control patients. Therefore, interventions to improve muscle strength and endurance should be prescribed for PAD patients. Copyright © 2012 Annals of Vascular Surgery Inc. Published by Elsevier Inc. All rights reserved.

  13. Microfracture and osteochondral autograft transplantation are cost-effective treatments for articular cartilage lesions of the distal femur.

    Science.gov (United States)

    Miller, D Josh; Smith, Matthew V; Matava, Matthew J; Wright, Rick W; Brophy, Robert H

    2015-09-01

    Multiple techniques have been suggested for the treatment of isolated knee articular cartilage injuries. For smaller lesions (purpose of this study was to analyze the costs and outcomes of microfracture and OAT to compare their cost-effectiveness. The hypothesis was that microfracture would be more cost-effective. Economic and decision analysis; Level of evidence, 2. A literature search was performed to identify studies comparing microfracture and OAT for the treatment of articular cartilage lesions of the distal femur in an adult population. Data from these studies including surgical time, failure rates, revision surgeries, outcome scores, and return to athletics were then incorporated into a constructed cost model using standard accounting methodology. The model was based on actual 2013 cost figures (in US dollars) for all procedure, operating room, and instrumentation costs. Three studies, with a mean follow-up of 8.7 years, met the inclusion criteria of having evidence level 1 or 2 comparing microfracture and OAT. There was a cumulative 28.6% reoperation rate among patients undergoing microfracture compared with 12.5% among patients undergoing OAT. While both groups demonstrated significant improvements compared with preoperative levels, the only significant differences in any outcome score reported between the 2 procedures were the International Cartilage Repair Society (ICRS) score and patient-reported return to their previous sports activity level. While microfracture had a lower initial cost ($3100), these savings lessened over 1 year ($1843) and 10 years ($996). Microfracture was more cost-effective when comparing Lysholm and Hospital for Special Surgery scores, whereas OAT was more cost-effective when comparing Tegner and ICRS scores. There was a significantly lower cost for return to play in athletes after OAT versus microfracture at 1 year ($11,428 vs $16,953, respectively), 3 years ($12,856 vs $38,000, respectively), and 10 years ($32,141 vs $60

  14. The retroperitoneal surface in distal caecal and proximal ascending colon carcinoma: the Cinderella surgical margin?

    Science.gov (United States)

    Bateman, A C; Carr, N J; Warren, B F

    2005-01-01

    Background: Mesorectal margin tumour involvement is a predictor of local recurrence in rectal carcinoma and an indication for postoperative radiotherapy in suitable patients. However, the prevalence of non-peritonealised surgical margin involvement in ascending colon carcinoma is unknown. Aims: To test the hypothesis that retroperitoneal surgical margin (RSM) tumour involvement occurs in distal caecal and proximal ascending colon carcinoma. Methods/Results: One hundred right hemicolectomy specimens, removed for adenocarcinoma of the caecum or proximal ascending colon, were studied. During routine specimen dissection, at least one additional tissue block was taken to include the tumour and the RSM. The tumour distance from the RSM was recorded. RSM tumour involvement was present in seven cases (7%). Direct (non-nodal) RSM tumour involvement (five cases) only occurred in posterior or circumferential tumours. Conclusions: RSM tumour involvement occurs within a considerable number of distal caecal and proximal ascending colon carcinomas. The rate of RSM tumour involvement identified here is similar to a previously published local recurrence rate of 10% in caecal carcinoma, suggesting that RSM tumour involvement may be a predictor of recurrence in these tumours. Therefore, patients with distal caecal or proximal ascending colon carcinoma and RSM tumour involvement may benefit from postoperative radiotherapy. PMID:15790712

  15. Changes of the bone mineral density in proximal femur following total hip resurfacing arthroplasty in osteonecrosis of femoral head.

    Science.gov (United States)

    Lian, Yong-yun; Pei, Fu-xing; Yoo, Myung-chul; Cheng, Jing-qiu; Fatou, Camara-yagouba

    2008-04-01

    Total hip resurfacing arthroplasty (THRA) is being performed with increasing frequency for osteonecrosis of femoral head (ONFH). To evaluate femoral bone remodeling in ONFH after THRA and determine the impact of stem-neck angle (SNA) of inserted femoral component on bone remodeling, we monitored the changes in BMD in proximal femur in 23 patients with ONFH after surgery. Patients were divided into group A (SNA >or= 5 degrees ) and group B (SNA < 5 degrees ). The BMD was measured in seven Gruen zones and two neck zones using dual-energy X-ray absorptiometry preoperatively, then at 3, 6, 12, and 24 months after surgery. At all ROIs, the BMD decreased significantly by 3 months postoperatively. The BMD ceased to decrease and reversed by 6 months. The BMD in neck increased significantly in group A, compared with group B at 24 months. The BMD increased 2% at ROI1 at 24 months in both groups, and at ROI7, the BMD in group A reversed to baseline value by 6 months and increased 5.81% at 24 months. These findings implied that the bone stock of proximal femur in ONFH can be well reserved after total hip resurfacing arthroplasty with valgus positioning of the femoral component.

  16. Functional significance of muscarinic receptor expression within the proximal and distal rat vagina.

    Science.gov (United States)

    Basha, Maureen; Labelle, Edward F; Northington, Gina M; Wang, Tanchun; Wein, Alan J; Chacko, Samuel

    2009-11-01

    Information regarding the role of cholinergic nerves in mediating vaginal smooth muscle contraction is sparse, and in vitro studies of the effects of muscarinic agonists on vaginal smooth muscle are discrepant. The goal of this study was to determine the expression of muscarinic receptors in the vaginal wall of the rat. In addition, we sought to determine the effect of the muscarinic receptor agonist carbachol on contractility and inositol phosphate production of the proximal and distal rat vaginal muscularis. RT-PCR analysis indicated that both M(2) and M(3) receptor transcripts were expressed within the proximal and distal rat vagina. Carbachol dose-dependently (10(-7)-10(-4) M) contracted the rat vaginal muscularis with a greater maximal contractile response in the proximal vagina (P vagina. The contractile responses of the rat vaginal muscularis to carbachol were dose dependently inhibited by the M(3) antagonist para-fluoro-hexahydrosiladefenidol, and a pK(B) of 7.78 and 7.95 was calculated for the proximal and distal vagina, respectively. Inositol phosphate production was significantly increased in both regions of the vagina following 20-min exposure to 50 muM carbachol with higher levels detected in the proximal vagina compared with the distal (P < 0.05). Preliminary experiments indicated the presence of M(2) and M(3) receptors in the human vaginal muscularis as well as contraction of human vaginal muscularis to carbachol, indicating that our animal studies are relevant to human tissue. Our results provide strong evidence for the functional significance of M(3) receptor expression in the vaginal muscularis.

  17. Influence of cerclages on primary stability of tumor megaprostheses subjected to distal femur defects.

    Science.gov (United States)

    Jahnke, Alexander; Jakubowitz, Eike; Ishaque, Bernd Alexander; Rickert, Markus; Bischel, Oliver

    2016-02-01

    Purpose of this experimental study was to investigate the influence of cerclages on the primary stability of the MUTARS system using distally fractured synthetic femora. 4 MUTARS prostheses were implanted in synthetic femora respectively. Groups consisted of 4 intact bones, 4 fractured with cerclages and 4 fractured bones without cerclages. Spatial micromovements were measured with a high-precision rotational setup. The order from the weakest to the strongest torque transmission of the intact bones was rm1-rm4-rm2-rm3 (p=0.011) and of the fractured bones with cerclages rm4-rm1-rm3-rm2 (p=0.013). The MUTARS stems broke out of the fractured femoral shaft by removing cerclages (pfemur may occur. This should always be taken into account. It is advisable to secure them and provide a prophylaxis for these fissural fractures by means of cerclages. Copyright © 2015 Elsevier Ltd. All rights reserved.

  18. Eighteen-year follow-up after rotationplasty for a grade IIIC open fracture of the distal femur.

    Science.gov (United States)

    Petri, M; Omar, M; Horstmann, H; Brand, S; Krettek, C

    2013-03-01

    We report the 18-year follow-up of a patient who underwent rotationplasty for severe bone loss and infection after an grade IIIC open fracture of the distal femur. The patient is now 49 years old and fully satisfied with his life. During the follow-up period, he has never had significant physical or psychological problems directly concerning the rotationplasty. The analysis of quality of life using the SF36 questionnaire revealed even higher scores than the normal healthy population in seven out of eight sub-categories. Clinical examination revealed bland soft tissues without hyperkeratosis or other signs of maladaptation. Articular and cutaneous proprioception was intact all over the left leg. The active extension/flexion of the prosthetic knee was 0°-0°-100° and 10°-0°-70° of the ankle joint. Manual testing of motor strength revealed grade five of five for dorsiflexion and plantar flexion of the ankle. Gait patterns including climbing slopes and stairs were close to normal. Examination in sports physiology showed lower maximum power of hip and knee muscles compared to the healthy side, but better muscular endurance. These findings emphasize that rotationplasty can be a good alternative to arthrodesis or amputation in trauma patients providing high satisfaction and activity levels in the long-term follow-up.

  19. Classification of gender and race in the distal femur using self organising maps.

    Science.gov (United States)

    van den Heever, David J; Scheffer, Cornie; Erasmus, Pieter; Dillon, Edwin

    2012-08-01

    In this study gender and race differences in distal femoral morphology were investigated. Reliable anatomic knee measurements were obtained for 60 knees via MRI and direct scanning of cadaver specimens. The MRI data comprised of 20 White males and 22 White females while the cadaver specimens comprised of 18 Black males. Possible differences were investigated using a type of artificial neural network to classify the data, namely the self-organising map (SOM). The SOM suggested that clear differences are present between genders when absolute measurements are used. Male knees tended to be larger over all the measurements considered. However, when data were normalised for size, the clear differences were diminished and definite clusters were difficult to define. Black male knees tended to have larger condyle radius to anterior-posterior length ratios compared to White males. White male knees tended to be wider than White female knees. It is however suggested than when corrected for size, there exists a large variation among individual knees regardless of gender or race. It is argued that with the large variation in populations it can become advantageous not to think about gender-specific or race-specific knee replacement designs, but rather patient-specific. Copyright © 2011 Elsevier B.V. All rights reserved.

  20. Proximal and distal. Rethinking linguistic form and use for clinical purposes.

    Science.gov (United States)

    Hernández-Sacristán, Carlos; Rosell-Clari, Vicent; Macdonald, Jonathan E

    2011-01-01

    With clinical purposes in mind, a review of the proximal/distal opposition is carried out in order to define a universal parameter of variability in semiotic procedures. By taking into consideration different-although notionally inter-related-senses of the proximal/distal opposition, a cluster of semiotic properties is proposed, which initially permits one to characterize dimensions of variability in the form and use of gestures. The subsequent and central aim of this paper is, however, to demonstrate that the same, or homologous, properties can also serve to characterize variability in the use of language, by assuming a basic connection between gesturing and linguistic behaviour. The main focus of interest and the starting point for reflections are communicative impairments as manifested in apraxia and aphasia.

  1. Patent vitellointestinal duct with prolapsed (intussusceptions of proximal and distal ileal loop: A case report

    Directory of Open Access Journals (Sweden)

    Dinesh D. Mundada

    2015-02-01

    Full Text Available A wide variety of anomalies may occur as a result of the vitellointestinal duct (VID failing to obliterate completely. VID is well known because of its various complication and presentation most commonly due to Meckel's diverticulum. Small bowel prolapsed through patent VID is one of the rare presentations that have been reported. We are reporting a case of patent VID through which proximal and distal ileal segment had been intussuscepted and prolapsed through umbilicus.

  2. Proximal-to-distal sequencing in vertical jumping with and without arm swing.

    Science.gov (United States)

    Chiu, Loren Z F; Bryanton, Megan A; Moolyk, Amy N

    2014-05-01

    Vertical jumping performance is dependent on muscle strength and motor skill. An understanding of motor skill strategies and their influence on jumping mechanics provides insight into how to improve performance. This study aimed to determine whether kinematic sequencing strategy influenced jump height, the effect of sequencing on jumping mechanics, and whether arm swing influences sequencing strategy. Women volleyball players (n = 16) performed vertical jumps with and without arm swing on force platforms while recorded with a 6-camera motion capture system. Sequencing strategy was determined as the relative time delay between pelvis and knee extension. A long time delay indicated a proximal-to-distal strategy, whereas no time delay represented a simultaneous strategy. Longer relative time delay was correlated with higher jump height in jumps with (r = 0.82, p jump height were associated with greater hip extensor and ankle plantar flexor net joint moments (NJM), and greater ratio of concentric to eccentric knee extensor NJM (p ≤ 0.05). Longer relative time delay and higher jump height were correlated with greater thigh and leg angular accelerations (p ≤ 0.05). These kinetic and kinematic variables, along with relative time delay and jump height were greater in jumps with arm swing than without (p ≤ 0.05), indicating arm swing promotes use of a proximal-to-distal strategy. Use of a proximal-to-distal strategy is associated with greater NJM and segment accelerations, which may contribute to better vertical jump performance.

  3. The relationship between osteoarthritis of the knee and bone mineral density of proximal femur: a cross-sectional study from a Korean population in women.

    Science.gov (United States)

    Im, Gun-Il; Kwon, Oh-Jin; Kim, Chang Hee

    2014-12-01

    The relationship between osteoarthritis (OA) and osteoporosis (OP) is complicated and it may differ according to the site or stage of disease. The purpose of this cross-sectional study is to examine the relationship between the severity of radiological knee OA and the degree of OP in the ipsilateral proximal femur as denoted by bone mineral density (BMD) in a Korean population, especially among women. One hundred ninety-five female patients who had knee pain and radiological knee OA were investigated with respect to the relationship of knee OA severity with BMD. The BMD of the proximal femur and spine was measured by dual energy X-ray absorptiometry, and the severity of knee OA was evaluated based on Kellgren-Lawrence (K-L) radiographic criteria, joint space narrowing (JSN) and mechanical axis of knee alignment. Partial correlation analysis and ANCOVA adjusted for confounding factors (age and body mass index) were performed to assess the relationship. There was a statistically significant relationship between the BMD of the proximal femur and JSN, and the BMD of the proximal femur was positively associated with increased joint space width. There was a lack of association between the spine BMD and JSN. The BMD of the proximal femur was also significantly lower in patients who had a higher K-L grade. The radiographic finding of severe OA in the knee is associated with decreased BMD of the ipsilateral proximal femur including the femoral neck, trochanter, intertrochanter, and region of the entire hip (neck, trochanter, and Ward's triangle).

  4. The Reversed Less Invasive Stabilisation System-Distal Femur Technique: Application in an Adult Patient with Osteogenesis Imperfecta Sustaining a Femoral Fracture.

    Science.gov (United States)

    Hanke, Markus S; Keel, Marius Johann; Todorski, Inga A; Bastian, Johannes Dominik

    2017-01-01

    The aim of this study was to report the surgical management and to discuss the options for fracture fixation in an adult patient with osteogenesis imperfecta (OI) who sustained a trochanteric femoral fracture after a simple fall from standing position. As a result of multiple fractures during childhood, this adult patient with OI presented with a short stature. The radiographs revealed a displaced, intertrochanteric fracture with subtrochanteric extension of the left femur. The intramedullary canal was narrow, the femur presented with a severe bowing deformity, and the bone quality was poor. The implant of choice was plating using the reversed less invasive stabilisation system-distal femur (LISS-DF) technique. This technique was introduced for the management of subtrochanteric fractures in the elderly with poor bone stock. In addition, a locking plate attached to the LISS-DF allowed for additional screw placement at the apex of the curvature of the femur although the plate was not in line with the femur at this site. Cerclages were used for metaphyseal reduction and fixation. 4-month postoperatively, the patient was ambulatory without any assistance with full weight bearing. At the latest follow-up 1-year postoperatively, the patient was still free of complaints and at her preinjury activity level. The presented technique was successful as a salvage procedure in a rare case of adult OI presenting with a femoral fracture with characteristics influencing the decision-making in treatment options.

  5. Recurrent Proximal Femur Fractures in a Teenager With Osteogenesis Imperfecta on Continuous Bisphosphonate Therapy: Are We Overtreating?

    Science.gov (United States)

    Vasanwala, Rashida F; Sanghrajka, Anish; Bishop, Nicholas J; Högler, Wolfgang

    2016-07-01

    Long-term bisphosphonate (BP) therapy in adults with osteoporosis is associated with atypical femoral fractures, caused by increased material bone density and prolonged suppression of bone remodeling which may reduce fracture toughness. In children with osteogenesis imperfecta (OI), long-term intravenous BP therapy improves bone structure and mass without further increasing the already hypermineralized bone matrix, and is generally regarded as safe. Here we report a teenage girl with OI type IV, who was started on cyclical intravenous pamidronate therapy at age 6 years because of recurrent fractures. Transiliac bone biopsy revealed classical structural features of OI but unusually low bone resorption surfaces. She made substantial improvements in functional ability, bone mass, and fracture rate. However, after 5 years of pamidronate therapy she started to develop recurrent, bilateral, nontraumatic, and proximal femur fractures, which satisfied the case definition for atypical femur fractures. Some fractures were preceded by periosteal reactions and prodromal pain. Pamidronate was discontinued after 7 years of therapy, following which she sustained two further nontraumatic femur fractures, and continued to show delayed tibial osteotomy healing. Despite rodding surgery, and very much in contrast to her affected, untreated, and normally mobile mother, she remains wheelchair-dependent. The case of this girl raises questions about the long-term safety of BP therapy in some children, in particular about the risk of oversuppressed bone remodeling with the potential for microcrack accumulation, delayed healing, and increased stiffness. The principal concern is whether there is point at which benefit from BP therapy could turn into harm, where fracture risk increases again. This case should stimulate debate whether current adult atypical femoral fracture guidance should apply to children, and whether low-frequency, low-dose cyclical, intermittent, or oral treatment

  6. Individual-specific multi-scale finite element simulation of cortical bone of human proximal femur

    Science.gov (United States)

    Ascenzi, Maria-Grazia; Kawas, Neal P.; Lutz, Andre; Kardas, Dieter; Nackenhorst, Udo; Keyak, Joyce H.

    2013-07-01

    We present an innovative method to perform multi-scale finite element analyses of the cortical component of the femur using the individual's (1) computed tomography scan; and (2) a bone specimen obtained in conjunction with orthopedic surgery. The method enables study of micro-structural characteristics regulating strains and stresses under physiological loading conditions. The analysis of the micro-structural scenarios that cause variation of strain and stress is the first step in understanding the elevated strains and stresses in bone tissue, which are indicative of higher likelihood of micro-crack formation in bone, implicated in consequent remodeling or macroscopic bone fracture. Evidence that micro-structure varies with clinical history and contributes in significant, but poorly understood, ways to bone function, motivates the method's development, as does need for software tools to investigate relationships between macroscopic loading and micro-structure. Three applications - varying region of interest, bone mineral density, and orientation of collagen type I, illustrate the method. We show, in comparison between physiological loading and simple compression of a patient's femur, that strains computed at the multi-scale model's micro-level: (i) differ; and (ii) depend on local collagen-apatite orientation and degree of calcification. Our findings confirm the strain concentration role of osteocyte lacunae, important for mechano-transduction. We hypothesize occurrence of micro-crack formation, leading either to remodeling or macroscopic fracture, when the computed strains exceed the elastic range observed in micro-structural testing.

  7. A MULTIDISCIPLINARY APPROACH IN THE TREATMENT OF FRACTURES OF THE PROXIMAL FEMUR ON THE BACKGROUND OF SENILE OSTEOPOROSIS

    Directory of Open Access Journals (Sweden)

    N. V. Zagorodniy

    2016-01-01

    Full Text Available The article presents a review of published data on the problem of osteoporosis in patients older than 75 years who have had fractures of the proximal femur. We used descriptive and analytical methods. Search publications have done in accessible to free search databases. Based on our analysis, it was found: the majority of researchers in Russia and abroad are united in the opinion that this issue requires a multidisciplinary approach; surgical treatment should be initiated as early as possible after the onset of fracture, before the complications from side of the internal organs; patients with fractures on the background of senile osteoporosis should receive drugs that affect to the quantitative and qualitative components of bone.

  8. [Our view on the problem of treating patients with fractures of the proximal segment of the femur].

    Science.gov (United States)

    Ternovoi, N K; Samokhin, A V; Grebennikov, K A

    2001-01-01

    The purpose of this study is to elucidate and analyze causes of difficulties encountered in dealing with fractures of the proximal segment of the femur and to set out our idea of solving these problems. An analysis is performed of classifications, an assessment is given of studying the adequate choice of a treatment modality, an attempt is made at formulating a doctrine of delivering qualified and specialized emergency medical service to those persons having been disabled for work, which could take account of all aspects of the injury under study. Indications for hemiarthroplasty are outlined, with the policy of primary sparing the joint elements by atraumatic osteosynthesis techniques being chosen in preference to any other policy.

  9. Influence of Lateral Muscle Loading in the Proximal Femur after Fracture Stabilization with a Trochanteric Gamma Nail (TGN)

    Science.gov (United States)

    Sitthiseripratip, Kriskrai; Mahaisavariya, Banchong; Suwanprateeb, Jintamai; Bohez, Erik; Vander Sloten, Jos

    The purpose of this study was to investigate the influence of lateral muscle loading on the stress/strain distributions of the trochanteric Gamma nail (TGN) fixation within the healed, trochanteric and subtrochanteric femoral fractures by means of a finite element method. The effect of three muscle groups, the abductors (ABD), the vastus lateralis (VL) and the iliotibial band (ITB), were investigated. The analytical results showed that addition of lateral muscle forces, iliotibial band and vastus lateralis, produced compensation of forces and reduction of bending moments in the bone and in the trochanteric Gamma nail especially in the lateral aspect. The iliotibial band produced a higher impact as compared to the vastus lateralis. Therefore in the finite element analysis of the proximal femur with the trochanteric Gamma nail fracture fixation should include the lateral muscle forces to simulate load condition with maximal physiological relevance to the closed nailing technique.

  10. Study of the interactions between proximal femur 3d bone shape, cartilage health, and biomechanics in patients with hip Osteoarthritis.

    Science.gov (United States)

    Pedoia, Valentina; Samaan, Michael A; Inamdar, Gaurav; Gallo, Matthew C; Souza, Richard B; Majumdar, Sharmila

    2017-07-08

    In this study quantitative MRI and gait analysis were used to investigate the relationships between proximal femur 3D bone shape, cartilage morphology, cartilage biochemical composition, and joint biomechanics in subject with hip Osteoarthritis (OA). Eighty subjects underwent unilateral hip MR-imaging: T1ρ and T2 relaxation times were extracted through voxel based relaxometry and bone shape was assessed with 3D MRI-based statistical shape modeling. In addition, 3D gait analysis was performed in seventy-six of the studied subjects. Associations between shape, cartilage lesion presence, severity, and cartilage T1ρ and T2 were analyzed with linear regression and statistical parametric mapping. An ad hoc analysis was performed to investigate biomechanics and shape associations. Our results showed that subjects with a higher neck shaft angle in the coronal plane (higher mode 1, coxa valga), thicker femoral neck and a less spherical femoral head (higher mode 5, pistol grip) exhibited more severe acetabular and femoral cartilage abnormalities, showing different interactions with demographics factors. Subjects with coxa valga also demonstrated a prolongation of T1ρ and T2. Subjects with pistol grip deformity exhibited reduced hip internal rotation angles and subjects with coxa valga exhibited higher peak hip adduction moment and moment impulse. The results of this study establish a clear relationship between 3D proximal femur shape variations and markers of hip joint degeneration-morphological, compositional, well as insight on the possible interactions with demographics and biomechanics, suggesting that 3D MRI-based bone shape maybe a promising biomarker of early hip joint degeneration. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  11. Individual-specific multi-scale finite element simulation of cortical bone of human proximal femur

    Energy Technology Data Exchange (ETDEWEB)

    Ascenzi, Maria-Grazia, E-mail: mgascenzi@mednet.ucla.edu [UCLA/Orthopaedic Hospital, Department of Orthopaedic Surgery, Rehabilitation Bldg, Room 22-69, 1000 Veteran Avenue, University of California, Los Angeles, CA 90095 (United States); Kawas, Neal P., E-mail: nealkawas@ucla.edu [UCLA/Orthopaedic Hospital, Department of Orthopaedic Surgery, Rehabilitation Bldg, Room 22-69, 1000 Veteran Avenue, University of California, Los Angeles, CA 90095 (United States); Lutz, Andre, E-mail: andre.lutz@hotmail.de [Institute of Biomechanics and Numerical Mechanics, Leibniz University Hannover, 30167 Hannover (Germany); Kardas, Dieter, E-mail: kardas@ibnm.uni-hannover.de [ContiTech Vibration Control, Jaedekamp 30 None, 30419 Hannover (Germany); Nackenhorst, Udo, E-mail: nackenhorst@ibnm.uni-hannover.de [Institute of Biomechanics and Numerical Mechanics, Leibniz University Hannover, 30167 Hannover (Germany); Keyak, Joyce H., E-mail: jhkeyak@uci.edu [Department of Radiological Sciences, Medical Sciences I, Bldg 811, Room B140, University of California, Irvine, CA 92697-5000 (United States)

    2013-07-01

    We present an innovative method to perform multi-scale finite element analyses of the cortical component of the femur using the individual’s (1) computed tomography scan; and (2) a bone specimen obtained in conjunction with orthopedic surgery. The method enables study of micro-structural characteristics regulating strains and stresses under physiological loading conditions. The analysis of the micro-structural scenarios that cause variation of strain and stress is the first step in understanding the elevated strains and stresses in bone tissue, which are indicative of higher likelihood of micro-crack formation in bone, implicated in consequent remodeling or macroscopic bone fracture. Evidence that micro-structure varies with clinical history and contributes in significant, but poorly understood, ways to bone function, motivates the method’s development, as does need for software tools to investigate relationships between macroscopic loading and micro-structure. Three applications – varying region of interest, bone mineral density, and orientation of collagen type I, illustrate the method. We show, in comparison between physiological loading and simple compression of a patient’s femur, that strains computed at the multi-scale model’s micro-level: (i) differ; and (ii) depend on local collagen-apatite orientation and degree of calcification. Our findings confirm the strain concentration role of osteocyte lacunae, important for mechano-transduction. We hypothesize occurrence of micro-crack formation, leading either to remodeling or macroscopic fracture, when the computed strains exceed the elastic range observed in micro-structural testing.

  12. Head direction cell representations maintain internal coherence during conflicting proximal and distal cue rotations: Comparison with hippocampal place cells

    OpenAIRE

    Yoganarasimha, D.; Yu, Xintian; Knierim, James J.

    2006-01-01

    Place cells of the hippocampal formation encode a spatial representation of the environment, and the orientation of this representation is apparently governed by the head direction cell system. The representation of a well-explored environment by CA1 place cells can be split when there is conflicting information from salient proximal and distal cues, as some place fields rotate to follow the distal cues while others rotate to follow the proximal cues (Knierim, 2002a). In contrast, the CA3 rep...

  13. Structural Analysis and Optimization of the Support Device Used for a Proximal Fracture of the Femur

    Science.gov (United States)

    2008-12-01

    and 2700 N in the S/I direction. The final loading condition involves the forces of climbing a stair . These forces are applied on the femoral head...perform actions like walk, climbing stairs or lifting. In a dynamic locking distal-screw configuration, the two screws separated by 20 mm yielded the... biomechanics , fluid flow and many more. FEA /FEM are also benefactors of the advancement of technology. As computer processing advancements take place, it

  14. Proximal Intermetatarsal Divergence in Distal Chevron Osteotomy for Hallux Valgus: An Overlooked Finding.

    Science.gov (United States)

    Akpinar, Evren; Buyuk, Abdul Fettah; Cetinkaya, Engin; Gursu, Sarper; Ucpunar, Hanifi; Albayrak, Akif

    2016-01-01

    The goal of distal chevron osteotomy for hallux valgus is to restore proper first-toe joint alignment by performing lateral translation of the distal first metatarsal fragment (the metatarsal head). We hypothesized that in some patients this procedure might also result in involuntary medial translation of the proximal first metatarsal fragment, which we called proximal intermetatarsal divergence. The aim of the present study was to compare the pre- and postoperative radiographs of patients with hallux valgus to determine whether we could identify proximal intermetatarsal divergence. We retrospectively compared the pre- and postoperative radiographs of 29 feet in 28 patients treated with distal chevron osteotomy. Two different methods were used to measure the intermetatarsal angles: the anatomic intermetatarsal angle (aIMA) and the mechanical intermetatarsal angle (mIMA). The maximum intermetatarsal distance (MID) was also measured. We defined proximal intermetatarsal divergence as a postoperative increase in the aIMA or MID, coupled with a decrease in the mIMA. For data analysis, we divided the patients into low-angle (mild deformity) and high-angle (severe deformity) groups, according to their preoperative mIMA. The mean ± standard deviation patient age was 41 ± 14 years. In the low-angle group, the mean mIMA decreased (from 10.91° to 7.00°), the mean aIMA increased (from 11.80° to 13.55°), and the mean MID increased (from 17.97 mm to 20.60 mm; p = .001, for all). In the high-angle group, the mean mIMA decreased (from 14.30° to 6.90°; p = .001), the mean aIMA decreased (from 14.77° to 13.54°; p = .06), and the mean MID decreased (from 20.74 mm to 20.37 mm; p = .64). The results of our study suggest that proximal intermetatarsal divergence might occur after distal chevron osteotomy for hallux valgus, primarily in patients with a low preoperative mIMA. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All

  15. PROXIMAL AND DISTAL FACTORS ASSOCIATED WITH DROPOUT VERSUS MAINTAINED PARTICIPATION IN ORGANIZED SPORT

    Directory of Open Access Journals (Sweden)

    Julie C.S. Boiché

    2009-03-01

    Full Text Available The purpose of this study was to investigate a large number of determinants of sport dropout among French adolescents, in order to reveal proximal and distal factors of dropout. 261 current and 106 dropout athletes (M = 14.6 participated to the study. The data were collected by a questionnaire assessing demographic information, athletes' perceptions on their experience, their parents, teammates and coach. t-tests revealed that current and former athletes were distinct on numerous variables. A discriminant function analysis showed three proximal predictors of sport dropout (perceived value of the activity, satisfaction, parents' investment. Subsequent regression analyses showed that perceived value was positively predicted by perceived competence, the value of the activity for teammates, coach's investment, and negatively by conflicts of interest and goal conflict with teammates; satisfaction was positively predicted by the coach's mastery climate, but negatively predicted by conflicts of interest and goal conflict with teammates and with the coach; parents investment was negatively predicted by the goal conflicts with them. This study permitted to discriminate between proximal and more distal psychological antecedents of the dropout behaviour. It brings information relative to the possible targets of interventions aiming at preventing dropout from organized sport

  16. Estimation of femoral bone density from trabecular direct wave and cortical guided wave ultrasound velocities measured at the proximal femur in vivo

    DEFF Research Database (Denmark)

    Barkmann, Reinhard; Dencks, Stefanie; Bremer, Alexander

    2008-01-01

    Bone mineral density (BMD) of the proximal femur is a predictor of hip fracture risk. We developed a Quantitative Ultrasound (QUS) scanner for measurements at this site with similar performance (FemUS). In this study we tested if ultrasound velocities of direct waves through trabecular bone and o...

  17. Micro-finite element analysis applied to high-resolution MRI reveals improved bone mechanical competence in the distal femur of female pre-professional dancers.

    Science.gov (United States)

    Chang, G; Rajapakse, C S; Diamond, M; Honig, S; Recht, M P; Weiss, D S; Regatte, R R

    2013-04-01

    Micro-finite element analysis applied to high-resolution (0.234-mm length scale) MRI reveals greater whole and cancellous bone stiffness, but not greater cortical bone stiffness, in the distal femur of female dancers compared to controls. Greater whole bone stiffness appears to be mediated by cancellous, rather than cortical bone adaptation. The purpose of this study was to compare bone mechanical competence (stiffness) in the distal femur of female dancers compared to healthy, relatively inactive female controls. This study had institutional review board approval. We recruited nine female modern dancers (25.7±5.8 years, 1.63±0.06 m, 57.1±4.6 kg) and ten relatively inactive, healthy female controls matched for age, height, and weight (32.1±4.8 years, 1.6±0.04 m, 55.8±5.9 kg). We scanned the distal femur using a 7-T MRI scanner and a three-dimensional fast low-angle shot sequence (TR/TE=31 ms/5.1 ms, 0.234 mm×0.234 mm×1 mm, 80 slices). We applied micro-finite element analysis to 10-mm-thick volumes of interest at the distal femoral diaphysis, metaphysis, and epiphysis to compute stiffness and cross-sectional area of whole, cortical, and cancellous bone, as well as cortical thickness. We applied two-tailed t-tests and ANCOVA to compare groups. Dancers demonstrated greater whole and cancellous bone stiffness and cross-sectional area at all locations (p0.08). At all locations, the percent of intact whole bone stiffness for cortical bone alone was lower in dancers (p0.07), but adjustment for cortical bone cross-sectional area did not (pfemur compared to controls. Elevated whole bone stiffness in dancers may be mediated via cancellous, rather than cortical bone adaptation.

  18. Foal Fractures: Osteochondral Fragmentation, Proximal Sesamoid Bone Fractures/Sesamoiditis, and Distal Phalanx Fractures.

    Science.gov (United States)

    Reesink, Heidi L

    2017-08-01

    Foals are susceptible to many of the same types of fractures as adult horses, often secondary to external sources of trauma. In addition, some types of fractures are specific to foals and occur routinely in horses under 1 year of age. These foal-specific fractures may be due to the unique musculoskeletal properties of the developing animal and may present with distinct clinical signs. Treatment plans and prognoses are tailored specifically to young animals. Common fractures not affecting the long bones in foals are discussed in this article, including osteochondral fragmentation, proximal sesamoid bone fractures/sesamoiditis, and distal phalanx fractures. Copyright © 2017 Elsevier Inc. All rights reserved.

  19. Coffee consumption and CYP1A2 genotype in relation to bone mineral density of the proximal femur in elderly men and women: a cohort study

    Directory of Open Access Journals (Sweden)

    Lind Lars

    2010-02-01

    Full Text Available Abstract Background Drinking coffee has been linked to reduced calcium conservation, but it is less clear whether it leads to sustained bone mineral loss and if individual predisposition for caffeine metabolism might be important in this context. Therefore, the relation between consumption of coffee and bone mineral density (BMD at the proximal femur in men and women was studied, taking into account, for the first time, genotypes for cytochrome P450 1A2 (CYP1A2 associated with metabolism of caffeine. Methods Dietary intakes of 359 men and 358 women (aged 72 years, participants of the Prospective Investigation of the Vasculature in Uppsala Seniors (PIVUS, were assessed by a 7-day food diary. Two years later, BMD for total proximal femur, femoral neck and trochanteric regions of the proximal femur were measured by Dual-energy X-ray absorptiometry (DXA. Genotypes of CYP1A2 were determined. Adjusted means of BMD for each category of coffee consumption were calculated. Results Men consuming 4 cups of coffee or more per day had 4% lower BMD at the proximal femur (p = 0.04 compared with low or non-consumers of coffee. This difference was not observed in women. In high consumers of coffee, those with rapid metabolism of caffeine (C/C genotype had lower BMD at the femoral neck (p = 0.01 and at the trochanter (p = 0.03 than slow metabolizers (T/T and C/T genotypes. Calcium intake did not modify the relation between coffee and BMD. Conclusion High consumption of coffee seems to contribute to a reduction in BMD of the proximal femur in elderly men, but not in women. BMD was lower in high consumers of coffee with rapid metabolism of caffeine, suggesting that rapid metabolizers of caffeine may constitute a risk group for bone loss induced by coffee.

  20. Controversies in the intramedullary nailing of proximal and distal tibia fractures.

    Science.gov (United States)

    Tejwani, Nirmal; Polonet, David; Wolinsky, Philip R

    2014-10-01

    Management of tibia fractures by internal fixation, particularly intramedullary nails, has become the standard for diaphyseal fractures. However, for metaphyseal fractures or those at the metaphyseal-diaphyseal junction, choice of fixation device and technique is controversial. For distal tibia fractures, nailing and plating techniques may be used, the primary goal of each being to achieve acceptable alignment with minimal complications. Different techniques for reduction of these fractures are available and can be applied with either fixation device. Overall outcomes appear to be nearly equivalent, with minor differences in complications. Proximal tibia fractures can be fixed using nailing, which is associated with deformity of the proximal short segment. A newer technique-suprapatellar nailing-may minimize these problems, and use of this method has been increasing in trauma centers. However, most of the data are still largely based on case series. Copyright 2014 by the American Academy of Orthopaedic Surgeons.

  1. Tubularized proximally-incised plate in distal/midshaft hypospadias repair

    Directory of Open Access Journals (Sweden)

    Antonio Marte

    2017-06-01

    Full Text Available The aim of this study was to verify the validity, feasibility, and the functional results, by uroflowmetry, of Tubularized proximallyincised plate technique in selected case of distal/midshaft hypospadias. Out of 120 patients scheduled to undergo TIP (or Snodgrass procedure, 23 were selected between January 2013 and January 2016 (19.1%. This case series comprised 16 patients with distal and 7 with midshaft hypospadias. Mean age at surgery was 2.9 years. The inclusion criteria were a deep and wide glandular groove and a proximal narrow urethral plate. The procedure was carried out as described by Snodgrass but the incision of the urethral plate, including the mucosal and submucosal tissue, was made only proximally, between the original meatus and the glandular groove in no case extending to the entire length of the plate. Postoperatively a foley catheter was left in place from 4 to 7 days. Uroflowmetry was performed when the patients age ranged from 2.5 to 5.7 years (mean age 3.11 years and mean follow-up 1.8 years, body surface 2. No patient presented fistulas nor perioperative complications. At uroflowmetry, eighteen patients presented values above the 25th percentile and 5 showed a borderline flow. All patients in this group remained stable without urinary symptoms. In selected cases, the tubularized proximally-incised plate yields satisfactory cosmetic and functional results for the treatment of midshaft proximal hypospadias. A long-term follow-up study is needed for further evaluation. Patient selection is crucial for the success of this technique.

  2. Does lean tissue mass accrual during adolescence influence bone structural strength at the proximal femur in young adulthood?

    Science.gov (United States)

    Jackowski, S A; Lanovaz, J L; Van Oort, C; Baxter-Jones, A D G

    2014-04-01

    The purpose of this study was to identify whether young adult bone structural strength at the hip is associated with adolescent lean tissue mass (LTM) accrual. It was observed that those individuals who accrued more LTM from adolescence to adulthood had significantly greater adult bone structural strength at the hip. The purpose of this study was to identify whether young adult bone cross-sectional area (CSA), section modulus (Z), and outer diameter (OD) at the hip were associated with adolescent LTM accrual. One hundred three young adult participants (55 males, 48 females) were tertiled into adolescent LTM accrual groupings. LTM accrual was assessed by serial measures using dual energy X-ray absorptiometry (DXA) from adolescence to young adulthood (21.3 ± 1.3 years). CSA, Z, and OD at the narrow neck (NN) and femoral shaft (S) sites of the proximal femur were assessed in young adulthood (21.3 ± 4.5 years), using hip structural analysis. Group differences were assessed using an analysis of covariance, controlling for adult height, weight, sex, and physical activity levels. It was found that individuals with higher adjusted adolescent LTM accrual had significantly greater adult adjusted values of NNCSA (2.49 ± 0.06 vs 2.77 ± 0.07 cm(2)), NN Z (1.18 ± 0.04 vs 1.37 ± 0.04 cm(3)), NN OD (3.07 ± 0.04 vs 3.21 ± 0.04 cm), SCSA (3.45 ± 0.08 vs 3.88 ± 0.09 cm(3)), and SZ (1.77 ± 0.05 vs 2.00 ± 0.05 cm(3)) than individuals with lower LTM accrual (p femur.

  3. Correlation Between the Intima-Media Thickness of the Proximal and Distal Common Carotids

    Energy Technology Data Exchange (ETDEWEB)

    Roelke, Leonard Hermann, E-mail: leonardhr@terra.com.br; Rodrigues, Sergio Lamego [Universidade Federal do Espírito Santo, Vitória, ES (Brazil); Lotufo, Paulo Andrade [Universidade de São Paulo, São Paulo, SP (Brazil); Mill, Jose Geraldo [Universidade Federal do Espírito Santo, Vitória, ES (Brazil)

    2013-09-15

    Increased IMT (intima-media thickness) in carotids is used as an early atherosclerosis marker and to evaluate the risk of cardiovascular problems. Ultrasound is used in the evaluation because it is accessible and low cost. Measurements for different carotid regions are described. To compare the proximal and distal region IMTs for the bilateral common carotid and guide its use in clinical practice. The IMT was measured in the proximal and distal common carotid arteries of 798 individuals (35-74 years old) of both genders using high-resolution ultrasound. Pearson's correlation coefficient was used to establish associations. The analyses were initially performed for the entire sample as well as subgroups with IMT <0.90 mm (49% of the sample) and ≥0.90 mm for at least one measurement site. The statistical significance was p < 0.05. The correlations investigated were significant. In the group with an IMT <0.90 mm, the correlations were between 0.44 and 0.62. In the subgroup with an IMT ≥0.90 mm, the correlations were significantly reduced to between 0.20 and 0.40. The data suggest that the IMT is more uniform along the carotid during early development and tends develop focally as it progresses. Therefore, in clinical evaluations of patients, the common carotid length should be investigated bilaterally to better use the available software and discern the IMT.

  4. Distal and Proximal Factors of Health Behaviors and Their Associations with Health in Children and Adolescents

    Science.gov (United States)

    Lämmle, Lena; Woll, Alexander; Mensink, Gert B. M.; Bös, Klaus

    2013-01-01

    Objective: The aim of the present paper was to analyze factors affecting distal and proximal health behavior within a biopsychosocial model for examining their interactions and associations with respect to health. Methods: Path analysis was based on the nationwide, cross-sectional German Health Interview and Examination Survey for Children and Adolescents (2003 to 2006). The data was collected from 4,529 participants with an average age of 9.45 years (SD = 4.01). Socio-demographic data, psychosocial factors and health behavior were assessed via questionnaire. Participants also underwent physical fitness tests and a medical examination. Results: Over the five levels of the model analyzed with socioeconomic status, immigration background, and rural-urban differences on the first level; physical activity of relatives and peers, intrinsic motivation, and quality of life on the second level; eating patterns, sedentary behavior, and physical activity on the third level; physical fitness and objective health on the fourth level; and health complaints and subjective health on the fifth level; direct, moderation, and mediation effects could be shown. Conclusions: Several distal and proximal factors are needed to take account of the multivariate complexity of health: e.g., immigration background affected health behaviors only indirectly and the effect of physical activity on objective health was mediated by physical fitness. PMID:23863614

  5. Proximal and distal styles of pegmatite-related metasomatic emerald mineralization at Ianapera, southern Madagascar

    Science.gov (United States)

    Andrianjakavah, Prosper Rakotovao; Salvi, Stefano; Béziat, Didier; Rakotondrazafy, Michel; Giuliani, Gaston

    2009-10-01

    The Ianapera emerald deposit is located in the Neoproterozoic Vohibory Block of southern Madagascar. The local geology consists of intercalated migmatitic gneissic units and calcareous metasedimentary rocks, containing boudinaged metamorphosed mafic/ultramafic lenses, all intruded by pegmatite veins. These units occur near the hinge of the tightly folded Ianapera antiform, within a few kilometers of the Ampanihy shear zone. Emerald mineralization is hosted by metasomatic phlogopite veins, and bodies developed within the mafic/ultramafic rocks. Based on field and textural relationships, we distinguish proximal and distal styles of mineralization. Proximal mineralization occurs at the contact of pegmatite veins with mafic/ultramafic units; in the distal style, pegmatites are not observed. Three types of emeralds could be distinguished, mainly on the basis of color and mineral zoning. Some of these emeralds have the most Al-depleted and Cr-rich composition ever recorded. Another characteristic feature to the Ianapera deposit and, to our knowledge, yet unreported, is the association of some emeralds with scapolite in metasomatised mafic rocks. Mineral inclusions are common in most emeralds and include phlogopite, carbonates, barite, K-feldspar, quartz, pyrite, zircon, monazite, bastnaesite, phenakite, plus Fe and Cr oxides. However, feldspar and rare earth element-bearing minerals occur predominantly in proximal emeralds, which also have a more incompatible trace-element signature than distal emeralds. We propose a model related to syn- to post-tectonic magmatic-hydrothermal activity. Pegmatitic bodies intruded units of the Ianapera antiform probably during tectonic relaxation. Exsolution of fluids rich in halogens and incompatible elements from the cooling pegmatites caused hydrothermal metasomatism of Cr-bearing mafic/ultramafic rocks in direct contact with the pegmatites. Local fracturing favored fluid infiltration, permitting the formation of distal mineralization

  6. Proximal enterectomy provides a stronger systemic stimulus to intestinal adaptation than distal enterectomy.

    Science.gov (United States)

    Appleton, G V; Bristol, J B; Williamson, R C

    1987-01-01

    Enteroglucagon has been implicated as a tropic hormone in the control of intestinal adaptation. Because cells producing enteroglucagon are located mainly in the distal small bowel (and colon), ileal resection might be expected to produce less adaptive change than a jejunal resection of equivalent length. This hypothesis was tested in male Sprague-Dawley rats (n = 40) weighing 184.0 +/- 7.3 g and receiving a Thiry-Vella fistula (TVF) of the mid-60% of the small intestine. One group had concomitant resection of the jejunum proximal to the TVF (n = 12), another had resection of the ileum distal to the TVF (n = 13), while controls had a TVF alone (n = 15). When killed 10 days postoperatively rats with ileal resection weighed only 81% of controls (p less than 0.001) and 85% of those with jejunal resection (p less than 0.01). Jejunal resection produced an 81% increase in crypt cell production rate (measured by a stathmokinetic technique) over control values (28.5 +/- 4.2 v 15.8 +/- 2.3 cells/crypt/h: p = 0.025), whereas ileal resection had no demonstrable effect (17.5 +/- 2.3 cells/crypt/h). Adaptive hyperplasia in isolated small bowel is modulated by factors localised to the distal small intestine, enteroglucagon being a plausible candidate.

  7. Proximal and Distal Predictors of the Spider Monkey's Stress Levels in Fragmented Landscapes.

    Directory of Open Access Journals (Sweden)

    José D Ordóñez-Gómez

    Full Text Available The rapid loss, fragmentation and degradation of tropical forests threaten the survival of many animal species. However, the way in which these phenomena affect animal health has been poorly explored, thus limiting the design of appropriate conservation strategies. To address this, here we identified using linear mixed models the effect of proximal (diet, activity pattern, hunting and logging and distal (sum of the basal areas of fruiting-tree species [SBAFS], landscape forest cover and degree of forest fragmentation variables over fecal glucocorticoid metabolite (fGCM levels-hormones associated with animal health and fitness-of six groups of spider monkeys (Ateles geoffroyi inhabiting six landscapes with different spatial structures in Mexico. Proximal variables showed a stronger predictive power over fGCMs than distal. In this sense, increases in travel time, the occurrence of hunting, and reductions in rest time and fruit consumption resulted in higher fGCM levels. Regarding distal variables, increases in SBAFS were negatively related to fGCM levels, thus suggesting that food scarcity increases stress hormone levels. Nevertheless, contrary to theoretical expectations, spider monkeys living in smaller tracts of forest spent less time travelling, but the same time feeding on fruit as those in more forested areas. The lower net energy return associated with this combination of factors would explain why, contrary to theoretical expectations, increased forest cover was associated with increased levels of fGCMs in these groups. Our study shows that, at least in the short term, spider monkeys in fragmented landscapes do not always present higher levels of stress hormones compared to those inhabiting continuous forest, and the importance of preserving fruit sources and controlling hunting for reducing the levels of stress hormones in free ranging spider monkeys.

  8. Anatomic study of the proximal third of the femur: femoroacetabular impact and the cam effect

    OpenAIRE

    Pedro José Labronici; Sergio Delmonte Alves; Anselmo Fernandes da Silva; Gilberto Ribeiro Giuberti; Rolix Hoffmann; Justino Nóbrega de Azevedo Neto; Jorge Luiz Mezzalira Penedo

    2009-01-01

    OBJETIVO: Analisar as varia��ões anatômicas da extremidade proximal do fêmur que pudessem desenvolver o impacto femoroacetabular. MÉTODOS: Foram utilizados 199 espécimes anatômicos de fêmures esqueleticamente maduros. Os fêmures foram medidos para determinar o ângulo da anteversão do colo femoral, ângulo cervicodiafisário, esfericidade da cabeça femoral em ântero-posterior e súpero-inferior, ângulo entre a epífise e o colo femoral anterior, ângulo entre a epífise e o colo em perfil, distância...

  9. The Van Nes tibial rotationplasty. A functionally viable reconstructive procedure in children who have a tumor of the distal end of the femur.

    Science.gov (United States)

    Cammisa, F P; Glasser, D B; Otis, J C; Kroll, M A; Lane, J M; Healey, J H

    1990-12-01

    Twelve patients who had a malignant tumor of the distal end of the femur were treated with a Van Nes tibial rotationplasty. The survival rates were comparable with those for above-the-knee amputees and patients who had an endoprosthetic replacement. The results of functional testing showed that these patients performed as well as those who had endoprosthetic replacement and better than those who had above-the-knee amputation. Rotationplasty is therefore a favorable alternative to amputation or endoprosthetic replacement, either as a primary or as a salvage procedure.

  10. Proximal Versus Distal Splenic Artery Embolisation for Blunt Splenic Trauma: What is the Impact on Splenic Immune Function?

    Energy Technology Data Exchange (ETDEWEB)

    Foley, P. T., E-mail: pfoley@doctors.org.uk [The Canberra Hospital, Department of Medical Imaging (Australia); Kavnoudias, H., E-mail: h.kavnoudias@alfred.org.au [The Alfred Hospital, Radiology Research Unit, Radiology Department (Australia); Cameron, P. U., E-mail: paul.cameron@unimelb.edu.au [The Alfred Hospital, Infectious Diseases Unit (Australia); Czarnecki, C., E-mail: caroline.czarnecki@gmail.com [Royal Melbourne Hospital, Radiology Department (Australia); Paul, E., E-mail: eldho.paul@monash.edu [Monash University, Department of Epidemiology & Preventive Medicine, School of Public Health and Preventive Medicine, Alfred Hospital (Australia); Lyon, S. M., E-mail: lyonsey@optusnet.com.au [Melbourne Endovascular (Australia)

    2015-10-15

    PurposeTo compare the impact of proximal or distal splenic artery embolisation versus that of splenectomy on splenic immune function as measured by IgM memory B cell levels.Materials and MethodsPatients with splenic trauma who were treated by splenic artery embolisation (SAE) were enrolled. After 6 months splenic volume was assessed by CT, and IgM memory B cells in peripheral blood were measured and compared to a local normal reference population and to a post-splenectomy population.ResultsOf the 71 patients who underwent embolisation, 38 underwent proximal embolisation, 11 underwent distal embolisation, 22 patients were excluded, 1 had both proximal and distal embolisation, 5 did not survive and 16 did not return for evaluation. There was a significant difference between splenectomy and proximal or distal embolisation and a trend towards greater preservation of IgM memory B cell number in those with distal embolisation—a difference that could not be attributed to differences in age, grade of injury or residual splenic volume.ConclusionIgM memory B cell levels are significantly higher in those treated with SAE compared to splenectomy. Our data provide evidence that splenic embolisation should reduce immunological complications of spleen trauma and suggest that distal embolisation may maintain better function.

  11. Distinct gene expression profiles of proximal and distal colorectal cancer: implications for cytotoxic and targeted therapy.

    Science.gov (United States)

    Maus, M K H; Hanna, D L; Stephens, C L; Astrow, S H; Yang, D; Grimminger, P P; Loupakis, F; Hsiang, J H; Zeger, G; Wakatsuki, T; Barzi, A; Lenz, H-J

    2015-08-01

    Colorectal cancer (CRC) is a heterogeneous disease with genetic profiles and clinical outcomes dependent on the anatomic location of the primary tumor. How location has an impact on the molecular makeup of a tumor and how prognostic and predictive biomarkers differ between proximal versus distal colon cancers is not well established. We investigated the associations between tumor location, KRAS and BRAF mutation status, and the messenger RNA (mRNA) expression of proteins involved in major signaling pathways, including tumor growth (epidermal growth factor receptor (EGFR)), angiogenesis (vascular endothelial growth factor receptor 2 (VEGFR2)), DNA repair (excision repair cross complement group 1 (ERCC1)) and fluoropyrimidine metabolism (thymidylate synthase (TS)). Formalin-fixed paraffin-embedded tumor specimens from 431 advanced CRC patients were analyzed. The presence of seven different KRAS base substitutions and the BRAF V600E mutation was determined. ERCC1, TS, EGFR and VEGFR2 mRNA expression levels were detected by reverse transcriptase-PCR. BRAF mutations were significantly more common in the proximal colon (Pexpression in multivariate analysis. In a subgroup analysis, this association remained significant for all genes in the proximal colon and for VEGFR2 expression in rectal cancers. The mRNA expression patterns of predictive and prognostic biomarkers, as well as associations with KRAS and BRAF mutation status depend on primary tumor location. Prospective studies are warranted to confirm these findings and determine the underlying mechanisms.

  12. A Study of Inflammatory/Necrosis Biomarkers in the Fracture of the Femur Treated with Proximal Femoral Nail Antirotation

    Directory of Open Access Journals (Sweden)

    Mariapaola Marino

    2015-01-01

    Full Text Available Pertrochanteric fractures are common injuries in adults and source of morbidity and mortality among the elderly. Different surgical techniques were recommended for their treatment but undoubtedly they add an additional inflammatory trauma along the fracture itself. Many attempts to quantify the degree of approach-related trauma are carried out through measurements of systemic inflammatory parameters. In this study we prospectively analyzed laboratory data of 20 patients over eighty with pertrochanteric fracture of the femur treated with proximal femoral nail antirotation (PFNA. This is an excellent device for osteosynthesis because it can be easily and quickly inserted by a mini-incision providing stable fixation and early full mobilization. Serum tumor necrosis factor-alpha (TNF-α, interleukin-6 (IL-6, C-reactive protein (CRP, and plasma creatin kinase (CK were evaluated 1 hour preoperatively and 24 hours postoperatively. Our results show that PFNA did not induce significant increments in serum levels of inflammatory cytokines TNF-α and IL-6; CRP was elevated preoperatively in correlation with waiting time for surgery; CRP and CK showed a significant increment in the first postoperatory day; CK increment was correlated with surgical time length. We conclude that, for the markers we analyzed, PFNA shows a low biomechanical-inflammatory profile that represents an advantage over other techniques.

  13. Using anisotropic 3D Minkowski functionals for trabecular bone characterization and biomechanical strength prediction in proximal femur specimens

    Science.gov (United States)

    Nagarajan, Mahesh B.; De, Titas; Lochmüller, Eva-Maria; Eckstein, Felix; Wismüller, Axel

    2014-04-01

    The ability of Anisotropic Minkowski Functionals (AMFs) to capture local anisotropy while evaluating topological properties of the underlying gray-level structures has been previously demonstrated. We evaluate the ability of this approach to characterize local structure properties of trabecular bone micro-architecture in ex vivo proximal femur specimens, as visualized on multi-detector CT, for purposes of biomechanical bone strength prediction. To this end, volumetric AMFs were computed locally for each voxel of volumes of interest (VOI) extracted from the femoral head of 146 specimens. The local anisotropy captured by such AMFs was quantified using a fractional anisotropy measure; the magnitude and direction of anisotropy at every pixel was stored in histograms that served as a feature vectors that characterized the VOIs. A linear multi-regression analysis algorithm was used to predict the failure load (FL) from the feature sets; the predicted FL was compared to the true FL determined through biomechanical testing. The prediction performance was measured by the root mean square error (RMSE) for each feature set. The best prediction performance was obtained from the fractional anisotropy histogram of AMF Euler Characteristic (RMSE = 1.01 ± 0.13), which was significantly better than MDCT-derived mean BMD (RMSE = 1.12 ± 0.16, p<0.05). We conclude that such anisotropic Minkowski Functionals can capture valuable information regarding regional trabecular bone quality and contribute to improved bone strength prediction, which is important for improving the clinical assessment of osteoporotic fracture risk.

  14. The impact of proximal femur geometry on fracture type--a comparison between cervical and trochanteric fractures with two parameters.

    Science.gov (United States)

    Panula, J; Sävelä, M; Jaatinen, P T; Aarnio, P; Kivelä, S-L

    2008-01-01

    Only a few studies have tested the ability of proximal femur geometry parameters to discriminate between cervical hip fractures and those of the trochanter. The main objective of this study was to evaluate the geometrical differences between these two fracture types by measuring the neck shaft angle (NSA) and the femoral neck axis length (FNAL). We also compared the distributions of these parameters and the distributions of fracture type by gender. A retrospective analysis was made in a population-based material of 428 hip fractures collected during a two-year period from 1999 to 2000 (323 women and 105 men aged 65 years or older). NSA and FNAL were manually measured from pelvic radiographs. No significant differences in NSA or FNAL were found between cervical and trochanteric hip fractures in women or in men. Men had significantly higher NSA and FNAL than women. Age was not related to these geometrical parameters. The distributions by fracture type were similar in both genders. The different pathogenesis of cervical and trochanteric hip fractures cannot be explained by NSA or FNAL. A standardized measurement setup is needed when evaluating the role of hip geometry in fracture patients.

  15. Pelvis width associated with bone mass distribution at the proximal femur in children 10–11 years old

    Science.gov (United States)

    Cardadeiro, Graça; Baptista, Fátima; Janz, Kathleen F.; Rodrigues, Luís A.; Sardinha, Luís B.

    2015-01-01

    Differences in skeletal geometry may generate different patterns of mechanical loading to bone. Impact and muscle loading during physical activity have been shown to influence skeletal geometry. The purpose of this study was to compare geometric measures of the pelvis and proximal femur (PF) of young children and to analyze the contribution and potential interaction of these geometric measures with physical activity on PF bone mass distribution. Participants were 149 girls and 145 boys, aged 10–11 years. Total body and left hip DXA scans were used to derive pelvic and PF geometric measures and PF bone mineral density (BMD) at the femoral neck (FN), trochanter (TR), and intertrochanter (IT). These subregions were used to represent bone mass distribution via three BMD ratios: FN:PF, TR:PF, and IT:PF. Physical activity was objectively measured using accelerometry, and maturity was estimated as the years of distance from peak height velocity. When compared to boys, girls had a wider pelvic diameter and greater interacetabular distances (p pelvis than boys, which accounted for proportionally greater BMD of the TR than other subregions of the PF. PMID:23744478

  16. Estimation of Purkait's triangle method and alternative models for sex assessment from the proximal femur in the Spanish population.

    Science.gov (United States)

    Djorojevic, Mirjana; Roldán, Concepción; Botella, Miguel; Alemán, Inmaculada

    2016-01-01

    The current study was undertaken to test the validity and reproducibility of the Purkait triangle method and some alternative proposals for sex prediction from the proximal femur in the adult population of Spain. To that end, sexual dimorphism of the maximum femoral head diameter and the minimum femoral neck diameter were also evaluated. The study was conducted on 186 femora (109 males and 77 females) taken from the San José collection of identified individuals (Southern Spain). Discriminant function analyses (DFA) employing the jackknife procedure for cross-validations were considered. Overall, more than 94% of individuals of both sexes were correctly classified. The most dimorphic single variable from the triangle method was the intertrochanteric apex distance (BC) that reached 85.5% accuracy, falling below those obtained for the femoral head and femoral neck diameter, respectively, (89.8 and 91.9%). Combining BC with the neck diameter, the predictive ability increased to 92.5%; when femoral head diameter was added to the latter two, the classification success rate improved further up to 94.6% (94.1% after cross-validation). We conclude that the classification success rates of the Purkait's method remained considerably below any of those obtained with the models proposed in the present study which proved to be a much better and more reliable choice both as single predictors and in combination with other variables.

  17. Subclinical ischemic events in patients undergoing carotid artery stent placement: comparison of proximal and distal protection techniques.

    Science.gov (United States)

    Aytac, Emrah; Gürkaş, Erdem; Akpinar, Cetin Kursad; Saleem, Muhammad A; Qureshi, Adnan I

    2017-10-01

    To determine the relative effectiveness of proximal and distal protection in prevention of cerebral ischemic events during carotid artery stent (CAS) placement using diffusion-weighted MRI (DW-MRI). We analyzed data from patients who had undergone DW-MRI before and within 24 hours of CAS for symptomatic internal carotid artery (ICA) stenosis (with last ischemic events within 3 months). The study was performed prospectively; patients were not randomized, and were treated either with a proximal balloon occlusion system (Mo.Ma; Invatec, Roncadelle, Italy) or filter-type distal protection device (Spider device; ev3, Plymouth, Minnesota, USA). Of the 45 patients (mean age±SD: 66.9±9.8 years; 73.3% were men) who underwent CAS, 19 had proximal protection and 26 distal protection. New ischemic lesions were detected in 26/45 patients on DW-MRI scans obtained within 24 hours after CAS. The proportion of patients with new lesions on DW-MRI at 24 hours was not different between the two groups (47.4% vs 65.4% for proximal and distal protection, respectively). The mean number of new ischemic lesions on post-CAS DW-MRI was non-significantly higher in patients who underwent CAS with distal protection (2.80±3.54 for proximal protection vs 4.96±5.11 for distal protection; p=0.12). The proportion of patients with new lesions >1 cm did not differ between the two groups (5.3% for proximal protection vs 11.5% for distal protection; p=0.62). There was no difference in the rates of ischemic stroke between patients who underwent CAS treatment using proximal and distal protection (5.3% vs 7.7%; p=1.000). We found a relatively high rate of new ischemic lesions in patients undergoing CAS with cerebral protection. There was no difference in the proportion of patients with new lesions between patients treated using distal protection and those treated using proximal protection. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a

  18. Selective effects of arm proximal and distal muscles fatigue on force coordination in manipulation tasks.

    Science.gov (United States)

    Emge, Nicholas; Uygur, Mehmet; Radivoj, Mandic; Kaminski, Thomas W; Royer, Todd; Jaric, Slobodan

    2014-01-01

    Effects of muscle fatigue on force coordination and task performance of various manipulation tasks are explored. Grip force (GF; normal force component acting at the digits-object contact area) and load force (LF; tangential component that lifts and holds objects) were recorded prior to and after fatiguing the distal (DAM; i.e., GF producing) and proximal arm muscles (PAM; LF producing). Results reveal a deterioration of GF scaling (i.e., averaged GF-LF ratio), GF-LF coupling (their correlation), and task performance (ability to exert a prescribed LF pattern) associated with DAM, but not PAM fatigue. Deteriorated force coordination clearly increases the likelihood of dropping an object; however, the observed selective effects of DAM and PAM fatigue represent a novel finding deserving of further research.

  19. Distal and proximal predictors of snacking at work: A daily-survey study.

    Science.gov (United States)

    Sonnentag, Sabine; Pundt, Alexander; Venz, Laura

    2017-02-01

    This study aimed at examining predictors of healthy and unhealthy snacking at work. As proximal predictors we looked at food-choice motives (health motive, affect-regulation motive); as distal predictors we included organizational eating climate, emotional eating, and self-control demands at work. We collected daily survey data from 247 employees, over a period of 2 workweeks. Multilevel structural equation modeling showed that organizational eating climate predicted health as food-choice motive, whereas emotional eating and self-control demands predicted affect regulation as food-choice motive. The health motive, in turn, predicted consuming more fruits and more cereal bars and less sweet snacks; the affect-regulation motive predicted consuming more sweet snacks. Findings highlight the importance of a health-promoting eating climate within the organization and point to the potential harm of high self-control demands at work. (PsycINFO Database Record (c) 2017 APA, all rights reserved).

  20. Simple decompression of the ulnar nerve at the elbow via proximal and distal mini skin incisions.

    Science.gov (United States)

    Calisaneller, Tarkan; Ozdemir, Ozgur; Caner, Hakan; Altinors, Nur

    2011-01-01

    The purpose of the present study was to describe a new minimally invasive surgical technique for decompression of the ulnar nerve at the elbow for treatment of cubital tunnel syndrome. Four patients underwent surgical treatment for cubital tunnel syndrome. Preoperative clinical states were classified by using the McGowan grading system and the postoperative states were recorded by using the Wilson and Krout grading system. Preoperative and last follow-up electromyographic results were also recorded. At the last follow-up, three patients were recorded as excellent and one patient was recorded as good according to Wilson and Krout grading system. One patient showed improvement in sensory nerve conduction velocity another showed improvement in motor nerve conduction velocity at the last follow-up. We conclude that simple decompression of the ulnar nerve at elbow via proximal and distal mini skin incisions is an effective, technically simple and safe surgical method in the treatment of cubital tunnel syndrome.

  1. The Relationship between Osteoarthritis of the Knee and Bone Mineral Density of Proximal Femur: A Cross-Sectional Study from a Korean Population in Women

    OpenAIRE

    Im, Gun-Il; Kwon, Oh-jin; Kim, Chang Hee

    2014-01-01

    Background The relationship between osteoarthritis (OA) and osteoporosis (OP) is complicated and it may differ according to the site or stage of disease. The purpose of this cross-sectional study is to examine the relationship between the severity of radiological knee OA and the degree of OP in the ipsilateral proximal femur as denoted by bone mineral density (BMD) in a Korean population, especially among women. Methods One hundred ninety-five female patients who had knee pain and radiologica...

  2. Expectations in Culturally Unfamiliar Music: Influences of Proximal and Distal Cues and Timbral Characteristics

    Directory of Open Access Journals (Sweden)

    Catherine J Stevens

    2013-11-01

    Full Text Available Listeners’ musical perception is influenced by cues that can be stored in short-term memory (e.g. within the same musical piece or long-term memory (e.g. based on one’s own musical culture. The present study tested how these cues (referred to as respectively proximal and distal cues influence the perception of music from an unfamiliar culture. Western listeners who were naïve to Gamelan music judged completeness and coherence for newly constructed melodies in the Balinese gamelan tradition. In these melodies, we manipulated the final tone with three possibilities: the original gong tone, an in-scale tone replacement or an out-of-scale tone replacement. We also manipulated the musical timbre employed in Gamelan pieces. We hypothesized that novice listeners are sensitive to out-of-scale changes, but not in-scale changes, and that this might be influenced by the more unfamiliar timbre created by Gamelan sister instruments whose harmonics beat with the harmonics of the other instrument, creating a timbrally shimmering sound. The results showed: 1 out-of-scale endings were judged less complete than original gong and in-scale endings; 2 for melodies played with sister instruments, in-scale endings were judged as less complete than original endings. Furthermore, melodies using the original scale tones were judged more coherent than melodies containing few or multiple tone replacements; melodies played on single instruments were judged more coherent than the same melodies played on sister instruments. Additionally, there is some indication of within-session statistical learning, with expectations for the initially-novel materials developing during the course of the experiment. The data suggest the influence of both distal cues (e.g. previously unfamiliar timbres and proximal cues (within the same sequence and over the experimental session on the perception of melodies from other cultural systems based on unfamiliar tunings and scale systems.

  3. Expectations in culturally unfamiliar music: influences of proximal and distal cues and timbral characteristics.

    Science.gov (United States)

    Stevens, Catherine J; Tardieu, Julien; Dunbar-Hall, Peter; Best, Catherine T; Tillmann, Barbara

    2013-01-01

    Listeners' musical perception is influenced by cues that can be stored in short-term memory (e.g., within the same musical piece) or long-term memory (e.g., based on one's own musical culture). The present study tested how these cues (referred to as, respectively, proximal and distal cues) influence the perception of music from an unfamiliar culture. Western listeners who were naïve to Gamelan music judged completeness and coherence for newly constructed melodies in the Balinese gamelan tradition. In these melodies, we manipulated the final tone with three possibilities: the original gong tone, an in-scale tone replacement or an out-of-scale tone replacement. We also manipulated the musical timbre employed in Gamelan pieces. We hypothesized that novice listeners are sensitive to out-of-scale changes, but not in-scale changes, and that this might be influenced by the more unfamiliar timbre created by Gamelan "sister" instruments whose harmonics beat with the harmonics of the other instrument, creating a timbrally "shimmering" sound. The results showed: (1) out-of-scale endings were judged less complete than original gong and in-scale endings; (2) for melodies played with "sister" instruments, in-scale endings were judged as less complete than original endings. Furthermore, melodies using the original scale tones were judged more coherent than melodies containing few or multiple tone replacements; melodies played on single instruments were judged more coherent than the same melodies played on sister instruments. Additionally, there is some indication of within-session statistical learning, with expectations for the initially-novel materials developing during the course of the experiment. The data suggest the influence of both distal cues (e.g., previously unfamiliar timbres) and proximal cues (within the same sequence and over the experimental session) on the perception of melodies from other cultural systems based on unfamiliar tunings and scale systems.

  4. An unusual case: right proximal ureteral compression by the ovarian vein and distal ureteral compression by the external iliac vein

    Directory of Open Access Journals (Sweden)

    Halil Ibrahim Serin

    2015-12-01

    Full Text Available A 32-years old woman presented to the emergency room of Bozok University Research Hospital with right renal colic. Multidetector computed tomography (MDCT showed compression of the proximal ureter by the right ovarian vein and compression of the right distal ureter by the right external iliac vein. To the best of our knowledge, right proximal ureteral compression by the ovarian vein together with distal ureteral compression by the external iliac vein have not been reported in the literature. Ovarian vein and external iliac vein compression should be considered in patients presenting to the emergency room with renal colic or low back pain and a dilated collecting system.

  5. Assessment of the geometry of proximal femur for short cephalomedullary nail placement: An observational study in dry femora and living subjects

    Science.gov (United States)

    Pathrot, Devendra; Ul Haq, Rehan; Aggarwal, Aditya N; Nagar, Mahindra; Bhatt, Shuchi

    2016-01-01

    30.12 ± 2.86 mm (range 22.2–42.5 mm), NW at 135° 30.66 ± 3.02 mm (range 22.8–40.3 mm), TSA 10.45° ± 2.34° (range 3°–15.5°), distance X 65.73 ± 6.45 mm (range 28.6–88.4 mm), distance Y 38 ± 4.91 mm (range 16.6–55.3 mm), and canal width at 10, 15, and 20 cm from the tip of GT 13.46 ± 2.34 mm, 11.40 ± 2.27 mm, and 11.64 ± 2.04 mm, respectively. Conclusion: The measurements of the proximal femur are not significantly different from other ethnic groups and are adequate to accept the current commonly available short cephalomedullary nails. However, certain modifications in the presently available short cephalomedullary nail designs are recommended for them to better fit the anatomy of our subset of population (a) two nails of 125° and 135°, (b) the medio-lateral angle at the level of 65 mm from the tip of the nail, (c) two femoral neck screw placements (35 and 45 mm from the tip of the nail), and (d) five different sizes of distal width for better fit in canal (9–13 mm). PMID:27293287

  6. Assessment of the geometry of proximal femur for short cephalomedullary nail placement: An observational study in dry femora and living subjects

    Directory of Open Access Journals (Sweden)

    Devendra Pathrot

    2016-01-01

    (range 22–42 mm, NW at 130° 30.12 ± 2.86 mm (range 22.2–42.5 mm, NW at 135° 30.66 ± 3.02 mm (range 22.8–40.3 mm, TSA 10.45° ± 2.34° (range 3°–15.5°, distance × 65.73 ± 6.45 mm (range 28.6–88.4 mm, distance Y 38 ± 4.91 mm (range 16.6–55.3 mm, and canal width at 10, 15, and 20 cm from the tip of GT 13.46 ± 2.34 mm, 11.40 ± 2.27 mm, and 11.64 ± 2.04 mm, respectively. Conclusion: The measurements of the proximal femur are not significantly different from other ethnic groups and are adequate to accept the current commonly available short cephalomedullary nails. However, certain modifications in the presently available short cephalomedullary nail designs are recommended for them to better fit the anatomy of our subset of population (a two nails of 125° and 135°, (b the medio-lateral angle at the level of 65 mm from the tip of the nail, (c two femoral neck screw placements (35 and 45 mm from the tip of the nail, and (d five different sizes of distal width for better fit in canal (9–13 mm.

  7. Spatial resolution of the pain system: a proximal-to-distal gradient of sensitivity revealed with psychophysical testing.

    Science.gov (United States)

    Weissman-Fogel, Irit; Brayer-Zwi, Nurit; Defrin, Ruth

    2012-01-01

    The spatial resolution of the pain system has not been studied in depth, and results are contradictory regarding the gradient of spatial resolution. Microneurographic recordings have revealed smaller receptive fields and higher density of nociceptors in more distal than proximal leg regions, whereas histological studies report higher density of C-fibers in more proximal than distal body regions. Due to this controversy, we conducted various psychophysical tests in order to examine the nociceptive spatial resolution and its gradient. Heat-pain threshold (HPT), perceived pain intensity, spatial summation (SS) of pain, two-point discrimination (2PD) of pain, and pain localization were measured in four body regions: upper back, thigh, lower leg, and foot. The highest HPT was demonstrated in the lower leg as compared with more proximal regions (P resolution has a proximal-to-distal pattern of performance, namely that the spatial resolution of pain is finer in more distal than proximal body regions, similar to that of the touch system.

  8. Different mosaicism frequencies for proximal and distal Duchenne muscular dystrophy (DMD) mutations indicate difference in etiology and recurrence risk

    Energy Technology Data Exchange (ETDEWEB)

    Passos-Bueno, M.R.; Takata, R.I.; Rapaport, D.; Bakker, E.; Kneppers, A.L.J.; Dunnen, J.T. den; Ommen, J.B. van

    1992-11-01

    In about 65% of the cases of Duchenne muscular dystrophy (DMD) a partial gene deletion or duplication in the dystrophin gene can be detected. These mutations are clustered at two hot spots: 30% at the hot spot in the proximal part of the gene and about 70% at a more distal hot spot. Unexpectedly the authors observed a higher frequency of proximal gene rearrangements among proved germ line' mosaic cases. Of the 24 mosaic cases they are aware of, 19 (79%) have a proximal mutation, while only 5 (21%) have a distal mutation. This finding indicates that the mutations at the two hot spots in the dystrophin gene differ in origin. Independent support for the different mosaicism frequency was found by comparing the mutation spectra observed in isolated cases of DMD and familial cases (ratio 1:1). The authors conclude from these data that proximal deletions most likely occur early in embryonic development, causing them to have a higher chance of becoming familial, while distal deletions occur later and have a higher chance of causing only isolated cases. Finally, the findings have important consequences for the calculation of recurrence-risk estimates according to the site of the deletion: a [open quote]proximal[close quote] new mutant has an increased recurrence risk of approximately 30%, and a [open quote]distal[close quote] new mutant has a decreased recurrence risk of approximately 4%. 28 refs., 2 figs., 2 tabs.

  9. Forecasting Proximal Femur and Wrist Fracture Caused by a Fall to the Side during Space Exploration Missions to the Moon and Mars

    Science.gov (United States)

    Lewandowski, Beth E.; Myers, Jerry G.; Sulkowski, C.; Ruehl, K.; Licata, A.

    2008-01-01

    The possibility of bone fracture in space is a concern due to the negative impact it could have on a mission. The Bone Fracture Risk Module (BFxRM) developed at the NASA Glenn Research Center is a statistical simulation that quantifies the probability of bone fracture at specific skeletal locations for particular activities or events during space exploration missions. This paper reports fracture probability predictions for the proximal femur and wrist resulting from a fall to the side during an extravehicular activity (EVA) on specific days of lunar and Martian exploration missions. The risk of fracture at the proximal femur on any given day of the mission is small and fairly constant, although it is slightly greater towards the end of the mission, due to a reduction in proximal femur bone mineral density (BMD). The risk of wrist fracture is greater than the risk of hip fracture and there is an increased risk on Mars since it has a higher gravitational environment than the moon. The BFxRM can be used to help manage the risk of bone fracture in space as an engineering tool that is used during mission operation and resource planning.

  10. The incidence of fracture of the proximal femur in two million Canadians from 1972 to 1984. Projections for Canada in the year 2006.

    Science.gov (United States)

    Martin, A D; Silverthorn, K G; Houston, C S; Bernhardson, S; Wajda, A; Roos, L L

    1991-05-01

    Reported increases in the number of fractures of the proximal femur in Europe are greater than can be explained by demographic changes alone. This trend was assessed in Canada by examining hospital discharge records from the provinces of Saskatchewan and Manitoba from 1972 to 1984. The annual number of first fractures of the proximal femur in persons older than 50 years of age increased 59.7% in women and 42.2% in men during this time period. In most of the five-year age groups the percentage of increase in the number of fractures exceeded the percentage of increase in population of that age group. Annual age-specific incidences (by five-year age groups) increased exponentially with age, doubling every six years, and reached a maximum value of 4% in women older than 90 years of age. Annual age-adjusted incidences increased significantly over the study period in men and women. For the whole of Canada in 1987, it is estimated that there were 13,193 first fractures of the proximal femur in women and 4610 in men, and that in the year 2006 these will rise to 22,922 and 7846, respectively. The actual increase will be considerably greater if the age-specific incidences continue to increase as they have from 1972 to 1984. The gradual decline in physical activity, which contributes to bone loss, may be one etiological factor of this trend during the last half century.

  11. Differences in plasma gastrin, CEA, and CA 19-9 concentration in patients with proximal and distal colorectal cancer.

    Science.gov (United States)

    Bombski, Grzegorz; Gasiorowska, Anita; Orszulak-Michalak, Daria; Neneman, Beata; Kotynia, Justyna; Strzelczyk, Janusz; Janiak, Adam; Malecka-Panas, Ewa

    2002-01-01

    We investigated whether there are differences in plasma gastrin, as compared with carcinoembryonic antigen (CEA) and cancer antigen (CA) 19-9 between patients with proximal and distal colorectal cancer. Gastrin concentration has also been analyzed, dependent on the tumor stage, in order to evaluate the possible prognostic role of this measurement. In 50 patients with colon cancer-fasting gastrin, CA 19-9 and CEA levels were evaluated. Mean plasma-gastrin level in patients with distal tumor yielded 105.31 +/- 12.5 microU/L and was significantly higher than in patients with the proximal tumor site (42.2 +/- 3.1 microU/L) as well as in controls (p < 0.001). No significant difference was observed between mean plasma gastrin in patients with proximal tumors and the control group. The mean CEA plasma level was significantly higher (p < 0.01) in patients with distal tumors (9.1 +/- 1.1 ng/mL) than in those with proximal tumors (1.48 +/- 0.1 ng/mL). Similarly, the mean CA 19-9 plasma level was significantly higher (p < 0.01) in patients with distal tumor (19.9 +/- 2.1 U/mL) than in those with proximal tumor: 1.8 +/- 0.2 U/mL. The mean gastrin plasma, CA 19-9, and CEA level was significantly higher in group of Duke's stage C and D as compared to A and B. We speculate that observed differences in gastrin concentration in patients with distal and proximal tumors may contribute to the distinct pathogenesis and biological properties of those cancers. The significance of gastrin as a marker for diagnostic or prognostic purposes in colorectal cancer requires further study.

  12. Stimulus-response characteristics of motor evoked potentials and silent periods in proximal and distal upper-extremity muscles.

    NARCIS (Netherlands)

    Kuijk, A.A. van; Anker, L.C.; Pasman, J.W.; Hendriks, J.C.M.; Elswijk, G.A.F. van; Geurts, A.C.H.

    2009-01-01

    OBJECTIVE: To compare stimulus-response characteristics of both motor evoked potentials (MEP) and silent periods (SP) induced by transcranial magnetic stimulation (TMS) in proximal and distal upper-extremity muscles. METHODS: Stimulus-response curves of MEPs and SPs were obtained from the biceps

  13. Distal and Proximal Factors Associated with Aggression Towards Partners and Non-Partners among Patients in Substance Abuse Treatment

    Science.gov (United States)

    Epstein-Ngo, Quyen M.; Walton, Maureen A.; Sanborn, Michelle; Kraus, Shane; Blow, Fred; Cunningham, Rebecca; Chermack, Stephen T.

    2014-01-01

    Studies of violence in substance use disorder (SUD) treatment settings typically focus on partner aggression (PA) although non-partner aggression (NPA) is also a common problem. This study examines potentially distinct paths of distal and proximal risk factors related to aggression towards non-partners (NPA) and partners (PA) among a SUD treatment sample. The sample included 176 adults reporting past-year violence. Bivariate analyses indicated several distal and proximal factors were associated with NPA and PA. According to multivariate, multiple mediation analyses youth aggression history was a factor for both NPA and PA. Alcohol and cocaine use and psychological distress were associated with NPA; marijuana use was associated with PA. There also was evidence of indirect effects of distal factors on NPA and PA. The results suggest that there may be substantially different dynamics associated with NPA and PA, and have implications for developing screening, assessment and treatment protocols targeting violence among individuals in SUD treatment. PMID:25012548

  14. Long‑Term Outcome of Endoprosthetic Replacement for Proximal ...

    African Journals Online (AJOL)

    Giant cell tumor (GCT) represents 5% of neoplasms of bone. It is a benign locally aggressive tumor usually involving the distal end of the femur, proximal tibia and distal radius in young adults.[1-3] The main variables to be considered for planning treatment include the site of involvement and Campanacci stage of the tumor.

  15. Variable Flip Angle 3D Fast Spin-Echo Sequence Combined with Outer Volume Suppression for Imaging Trabecular Bone Structure of the Proximal Femur

    Science.gov (United States)

    Han, Misung; Chiba, Ko; Banerjee, Suchandrima; Carballido-Gamio, Julio; Krug, Roland

    2014-01-01

    Purpose To demonstrate the feasibility of using a variable flip angle 3D fast spin-echo (3D VFA-FSE) sequence combined with outer volume suppression for imaging of trabecular bone structure at the proximal femur in vivo at 3T. Materials and Methods The 3D VFA-FSE acquisition was optimized to minimize blurring and to provide high signal-to-noise ratio (SNR) from bone marrow. Outer volume suppression was achieved by applying three quadratic-phase radio-frequency pulses. The SNR and trabecular bone structures from 3D VFA-FSE was compared with those from previously demonstrated multiple-acquisition 3D balanced steady-state free precision (bSSFP) using theoretical simulations, ex vivo experiments, and in vivo experiments. Results Our simulation demonstrated that 3D VFA-FSE can provide at least 35% higher SNR than 3D bSSFP, which was confirmed by the ex vivo and in vivo experiments. The ex vivo experiments demonstrated a good correlation and agreement between bone structural paramters obtained with the two sequences. The proposed sequence depicted trabecular bone structure at the proxiaml femur in vivo well without visible suppression artifacts and provided a mean SNR of 11.0. Conclusion The reduced-FOV 3D VFA-FSE sequence can depict the trabecular bone structure of the proximal femur in vivo with minimal blurring and high SNR efficiency. PMID:24956149

  16. What Sport Activity Levels Are Achieved in Patients After Resection and Endoprosthetic Reconstruction for a Proximal Femur Bone Sarcoma?

    Science.gov (United States)

    Hobusch, Gerhard M; Bollmann, Jakob; Puchner, Stephan E; Lang, Nikolaus W; Hofstaetter, Jochen G; Funovics, Philipp T; Windhager, Reinhard

    2017-03-01

    patients available for study, we could not determine that prosthetic failures were associated with sport activity levels. Patients who survive primary malignant bone tumors in the proximal femur reconstructed by megaprostheses are able to perform some sports activities. The estimates of activity levels made in this study probably are best-case estimates, given that some patients were lost to followup; patients unaccounted for might not be doing as well as those represented here. Also, the degree to which sports participation influences implant durability remains, for the most part, unanswered; studies with more patients and longer followup will be needed to determine to what degree prosthesis survivorship relates to sporting activity levels. Most patients perform low-impact sports and at a lower level than they had preoperatively. Because this is a preliminary study of a select group of patients, further information is necessary to weight the benefits of higher sports activity levels against potential risks. If this can be confirmed in a larger number of patients, the information may guide surgeons in their discussion with patients preoperatively and give them some objective assessment of what to expect regarding sports activities. Level IV, therapeutic study.

  17. A seismic study of the Mekong subaqueous delta: Proximal versus distal sediment accumulation

    Science.gov (United States)

    Liu, J. Paul; DeMaster, David J.; Nittrouer, Charles A.; Eidam, Emily F.; Nguyen, Thanh T.

    2017-09-01

    The Mekong River Delta is one of the largest in Asia. To understand its sediment distribution, thickness, mass budget, stratigraphic sequences and sediment-transport process, extensive geophysical and geochemical surveys were conducted on the inner portions of the adjacent continental shelf. Analyses of > 80 high-resolution Chirp-sonar profiles show the Mekong River has formed a classic sigmoidal cross-shelf clinoform in the proximal areas, up to 15 m thick, with topset, foreset and bottomset facies, but constrained to water depths of sediment has extended > 250 > 300 km southwestward to the tip of the Ca Mau Peninsula, forming a distal mud depocenter up to 22 m thick, and extending into the Gulf of Thailand. A large erosional trough or channel (up to 8 m deeper than the surrounding seafloor and parallel to the shore) was found on the top of the clinoform, east of the Ca Mau Peninsula. Based on the thicknesses and distribution revealed by Chirp sonar profiles, the total estimated volume of the Mekong River subaqueous clinoform on the shelf is 120 km3, which is equivalent to 120-140 × 109 t of sediment using an average sediment dry-bulk density of 1.0-1.2 g/cm3. Assuming the subaqueous deltaic deposit has formed within 1000 yr, the calculated millennial-timescale average sediment discharge to the shelf could be 120-140 × 106 t per year. Spatially, the proximal subaqueous delta has accumulated 45 × 109 t ( 33%) of sediment; the distal part around the Ca Mau Peninsula has received 55 × 109 t ( 42%) of sediment; and the remaining 35 × 109 t ( 25%) has accumulated within the central transition area, although the coastline and shoreface in this area are presently eroding. The spatially averaged 1000-yr-scale accumulate rate is up to 2 cm/yr. Compared to other tide-dominated fluvial dispersal systems, the Mekong River system has a relatively young (≤1000 yr) subaqueous delta, a shallow rollover at 4-6 m water depth, gentle foreset gradients (0.03-0.57°), and a

  18. Foot drop splints improve proximal as well as distal leg control during gait in Charcot-Marie-Tooth disease.

    Science.gov (United States)

    Ramdharry, Gita M; Day, Brian L; Reilly, Mary M; Marsden, Jonathan F

    2012-10-01

    During walking, people with Charcot-Marie-Tooth (CMT) disease may compensate for distal weakness by using proximal muscles. We investigated the effect of different AFOs on distal leg control and proximal compensatory actions. Fourteen people with CMT were tested while wearing 3 types of ankle-foot orthosis (AFO) bilaterally compared with shoes alone. Walking was assessed using three-dimensional gait analysis. Stiffness of the splints was measured by applying controlled 5-degree ankle stretches using a motor. The results showed that each AFO significantly stiffened the ankle and increased ankle dorsiflexion at foot clearance compared with shoes alone. At push off, peak ankle power generation was reduced, but only with 1 type of AFO. A significant decrease in hip flexion amplitude during the swing phase was observed with all 3 AFOs. These results indicate that AFOs reduce foot drop and remove the need for some proximal compensatory action. Copyright © 2012 Wiley Periodicals, Inc.

  19. Differences between proximal versus distal intraorbital optic nerve diffusion tensor magnetic resonance imaging properties in glaucoma patients.

    Science.gov (United States)

    Bolacchi, Francesca; Garaci, Francesco Giuseppe; Martucci, Alessio; Meschini, Alessandro; Fornari, Maria; Marziali, Simone; Mancino, Raffaele; Squillaci, Ettore; Floris, Roberto; Cerulli, Luciano; Simonetti, Giovanni; Nucci, Carlo

    2012-06-28

    To analyze in vivo the diffusion tensor magnetic resonance imaging (DT-MRI) properties of the intraorbital optic nerve at two different levels: Proximal to the optic nerve head (ONH) and distal to the ONH at the level of the orbital apex in glaucoma patients. Twenty-four patients with primary open-angle glaucoma were examined. The categorization into early and severe glaucoma was performed by Hodapp's classification. Fifteen healthy individuals served as controls. DT-MRI was performed with a 3T-MR unit. At early stage mean diffusivity (MD) values were higher at the proximal site with respect to the distal site. On the contrary, a decrease in fractional anisotropy (FA) was observed only relative to patient stage, independent of optic nerve site. Moreover, at early disease stage an increase in overall diffusivities, was evident at the proximal site, whereas at the distal site a decrease of the largest diffusivity and an increase in both the intermediate and smallest diffusivities were observed. FA and MD measured at the proximal site, had, respectively, the highest sensitivity and specificity in discriminating between healthy and glaucomatous eyes. Our study represents the first attempt to evaluate in vivo fiber integrity changes along the optic nerve with DT-MRI. Optic nerve degeneration appears to be a process that affects differently the proximal and the distal segments of the optic nerve. The complementary high sensitivity of FA with the high specificity of MD at the proximal site may provide reliable indexes for the identification of glaucomatous patients at early stages.

  20. COMPENSATORY OPPORTUNITIES OF THE SMALL INTESTINE AFTER EXTENSIVE DISTAL AND PROXIMAL RESECTION (EXPERIMENTAL STUDY

    Directory of Open Access Journals (Sweden)

    P. A. Yartsev

    2017-01-01

    Full Text Available Resection of certain parts of the small intestine is common in clinical practice for various diseases and traumatic injuries. The significant decrease in bowel functioning leads to the development of a specific “short bowel syndrome” (SBS. There is an opinion that the remaining parts of the intestine after resection perform a compensatory function as a result of the development of morphological changes in the intestinal wall. Histological examination of the intestinal wall with evolved compensatory changes is of undoubted interest from the scientific and clinical point of view.Material and Methods. To create the experimental model of SBS, 107 laboratory Wistar male rats were used, weighing 500–600 g, which underwent resection with removal of 1/2 or 2/3 of the small intestine length in proximal or distal parts. The observation period for the animals was 1, 2, 4 and 6 months. Upon expiration of indicated dates, samples of the small intestine and liver were taken from rats for autopsy to be used for histological examination. At the indicated terms, the animals had signs of SBS (diarrhea, weight loss, as well as morphological changes in the intestinal mucosa.Results and Conclusion. According to the results of the study, we concluded that the loss of 1/2 the length of the small intestine is overcome without consequences, and the loss of 2/3 of its length, especially of its proximal part, is accompanied by a longer period of adaptation and more significant morphological alteration of the mucosa, which has to perform not only digestion, but also absorption. 

  1. The Healing Process of Intracorporeally and In Situ Devitalized Distal Femur by Microwave in a Dog Model and Its Mechanical Properties In Vitro

    Science.gov (United States)

    Li, Wei; Li, Xiaoxiang; Zhao, Guangyi; Yun, Zhe; Qian, Jixian; Fan, Qingyu

    2012-01-01

    Background Limb-salvage surgery has been well recognized as a standard treatment and alternative to amputation for patients with malignant bone tumors. Various limb-sparing techniques have been developed including tumor prosthesis, allograft, autograft and graft-prosthesis composite. However, each of these methods has short- and long-term disadvantages such as nonunion, mechanical failures and poor limb function. The technique of intracorporeal devitalization of tumor-bearing bone segment in situ by microwave-induced hyperthermia after separating it from surrounding normal tissues with a safe margin is a promising limb-salvage method, which may avoid some shortcomings encountered by the above-mentioned conventional techniques. The purpose of this study is to assess the healing process and revitalization potential of the devitalized bone segment by this method in a dog model. In addition, the immediate effect of microwave on the biomechanical properties of bone tissue was also explored in an in vitro experiment. Methods We applied the microwave-induced hyperthermia to devitalize the distal femurs of dogs in situ. Using a monopole microwave antenna, we could produce a necrotic bone of nearly 20 mm in length in distal femur. Radiography, bone scintigraphy, microangiography, histology and functional evaluation were performed at 2 weeks and 1, 2, 3, 6, 9 and 12 months postoperatively to assess the healing process. In a biomechanical study, two kinds of bone specimens, 3 and 6 cm in length, were used for compression and three-point bending test respectively immediately after extracorporeally devitalized by microwave. Findings An in vivo study showed that intracorporeally and in situ devitalized bone segment by microwave had great revitalization potential. An in vitro study revealed that the initial mechanical strength of the extracorporeally devitalized bone specimen may not be affected by microwave. Conclusion Our results suggest that the intracorporeal microwave

  2. The healing process of intracorporeally and in situ devitalized distal femur by microwave in a dog model and its mechanical properties in vitro.

    Directory of Open Access Journals (Sweden)

    Zhenwei Ji

    Full Text Available BACKGROUND: Limb-salvage surgery has been well recognized as a standard treatment and alternative to amputation for patients with malignant bone tumors. Various limb-sparing techniques have been developed including tumor prosthesis, allograft, autograft and graft-prosthesis composite. However, each of these methods has short- and long-term disadvantages such as nonunion, mechanical failures and poor limb function. The technique of intracorporeal devitalization of tumor-bearing bone segment in situ by microwave-induced hyperthermia after separating it from surrounding normal tissues with a safe margin is a promising limb-salvage method, which may avoid some shortcomings encountered by the above-mentioned conventional techniques. The purpose of this study is to assess the healing process and revitalization potential of the devitalized bone segment by this method in a dog model. In addition, the immediate effect of microwave on the biomechanical properties of bone tissue was also explored in an in vitro experiment. METHODS: We applied the microwave-induced hyperthermia to devitalize the distal femurs of dogs in situ. Using a monopole microwave antenna, we could produce a necrotic bone of nearly 20 mm in length in distal femur. Radiography, bone scintigraphy, microangiography, histology and functional evaluation were performed at 2 weeks and 1, 2, 3, 6, 9 and 12 months postoperatively to assess the healing process. In a biomechanical study, two kinds of bone specimens, 3 and 6 cm in length, were used for compression and three-point bending test respectively immediately after extracorporeally devitalized by microwave. FINDINGS: An in vivo study showed that intracorporeally and in situ devitalized bone segment by microwave had great revitalization potential. An in vitro study revealed that the initial mechanical strength of the extracorporeally devitalized bone specimen may not be affected by microwave. CONCLUSION: Our results suggest that the

  3. Quantitative local topological texture properties obtained from radiographs of the proximal femur in patients with pertrochanteric and transcervical hip fractures

    Science.gov (United States)

    Boehm, H. F.; Lutz, J.; Koerner, M.; Notohamiprodjo, M.; Reiser, M.

    2009-02-01

    The incidence of osteoporosis and associated fractures becomes an increasingly relevant issue for the public health institutions of industrialized nations. Fractures of the hip represent the worst complication of osteoporosis with a significantly elevated rate of mortality. Prediction of fracture risk is a major focus of osteoporosis research and, over the years, has been approched from different angles. There exist two distinct subtypes of transcervical and pertrochanteric hip fracture that can be distinguished on the basis of the anatomical location of the injury. While the epidemiology of hip fractures has been well described, typically, little or no distinction is made between the subtypes. The object of this study was to determine whether local topological texture properties based on the Minkowski Functionals (MF) obtained from standard radiographs of the proximal femur in patients with hip fracture can be used to differentiate between the two types of fracture pattern. The texture features were extracted from standardized regions of interest (femoral head, neck, and pertrochanteric region) in clinical radiographs of the hip obtained from 90 post-menopausal women (69.8 +/- 7.9 yrs). 30 of the women had sustained pertrochanteric fractures, 30 had transcervical hip fractures and 30 were age-matched controls. We determined an optimized topological parameter MF2Dloc using an integrative filtering procedure based on a sliding-windows algorithm. Statistical relationship between the fracture type (pertrochanteric/transcervical) and the value of MF2Dloc was assessed by receiver-operator characteristic (ROC) analysis. Depending on the anatomical location of the region of interest for texture analysis correct classification of tanscervial and pertrochanteric fractures ranged from AUC = 0.79 to 0.98. In conclusion, quantitative texture properties of trabecular bone extracted from radiographs of the hip can be used to identify patients with hip fracture and to distinguish

  4. Three-dimensional micro-level computational study of Wolff's law via trabecular bone remodeling in the human proximal femur using design space topology optimization.

    Science.gov (United States)

    Boyle, Christopher; Kim, Il Yong

    2011-03-15

    The law of bone remodeling, commonly referred to as Wolff's Law, asserts that the internal trabecular bone adapts to external loadings, reorienting with the principal stress trajectories to maximize mechanical efficiency creating a naturally optimum structure. The goal of the current study was to utilize an advanced structural optimization algorithm, called design space optimization (DSO), to perform a micro-level three-dimensional finite element bone remodeling simulation on the human proximal femur and analyse the results to determine the validity of Wolff's hypothesis. DSO optimizes the layout of material by iteratively distributing it into the areas of highest loading, while simultaneously changing the design domain to increase computational efficiency. The result is a "fully stressed" structure with minimized compliance and increased stiffness. The large-scale computational simulation utilized a 175 μm mesh resolution and the routine daily loading activities of walking and stair climbing. The resulting anisotropic trabecular architecture was compared to both Wolff's trajectory hypothesis and natural femur samples from literature using a variety of visualization techniques, including radiography and computed tomography (CT). The results qualitatively revealed several anisotropic trabecular regions, that were comparable to the natural human femurs. Quantitatively, the various regional bone volume fractions from the computational results were consistent with quantitative CT analyses. The global strain energy proceeded to become more uniform during optimization; implying increased mechanical efficiency was achieved. The realistic simulated trabecular geometry suggests that the DSO method can accurately predict bone adaptation due to mechanical loading and that the proximal femur is an optimum structure as the Wolff hypothesized. Crown Copyright © 2010. Published by Elsevier Ltd. All rights reserved.

  5. In vitro direct shoot regeneration from proximal, middle and distal segment of Coleus forskohlii leaf explants.

    Science.gov (United States)

    Krishna, Gaurav; Sairam Reddy, P; Anoop Nair, N; Ramteke, P W; Bhattacharya, P S

    2010-04-01

    Coleus forskohlii is an endangered multipurpose medicinal plant that has widespread applications. In spite of this, there have been few attempts to propagate its cultivation in India. The present communication presents an in vitro rapid regeneration method using leaf explants of Coleus forskohlii through direct organogenesis. Leaf explants that were excised into three different segments i.e. proximal (P), middle (M) and distal (D) were cultured on Murashige and Skoog (MS) basal medium supplemented with cytokinins. MS Media containing 5.0 mg L(-1) BAP (6-Benzylaminopurine) promoted regeneration of multiple shoots through direct organogenesis from the leaf, which were further elongated on MS media augmented with 0.1 mg L-1 BAP and 0.1 mg L(-1) IAA (Indole-3-acetic acid), cytokinin and auxin combination. Regenerated and elongated shoots, when transferred to ose resulted in profuse rooting plants that were transferred to soil after acclimatization and maintained in a green house. The current protocol offers a direct, mass propagation method bypassing the callus phase of C. forskohlii and is suitable for conservation, large-scale commercial cultivation, and genetic transformation with agronomically desirable traits.

  6. Does Interdisciplinary Research Lead to Higher Citation Impact? The Different Effect of Proximal and Distal Interdisciplinarity

    Science.gov (United States)

    Yegros-Yegros, Alfredo; Rafols, Ismael; D’Este, Pablo

    2015-01-01

    This article analyses the effect of degree of interdisciplinarity on the citation impact of individual publications for four different scientific fields. We operationalise interdisciplinarity as disciplinary diversity in the references of a publication, and rather than treating interdisciplinarity as a monodimensional property, we investigate the separate effect of different aspects of diversity on citation impact: i.e. variety, balance and disparity. We use a Tobit regression model to examine the effect of these properties of interdisciplinarity on citation impact, controlling for a range of variables associated with the characteristics of publications. We find that variety has a positive effect on impact, whereas balance and disparity have a negative effect. Our results further qualify the separate effect of these three aspects of diversity by pointing out that all three dimensions of interdisciplinarity display a curvilinear (inverted U-shape) relationship with citation impact. These findings can be interpreted in two different ways. On the one hand, they are consistent with the view that, while combining multiple fields has a positive effect in knowledge creation, successful research is better achieved through research efforts that draw on a relatively proximal range of fields, as distal interdisciplinary research might be too risky and more likely to fail. On the other hand, these results may be interpreted as suggesting that scientific audiences are reluctant to cite heterodox papers that mix highly disparate bodies of knowledge—thus giving less credit to publications that are too groundbreaking or challenging. PMID:26266805

  7. Mediating the distal crime-drug relationship with proximal reactive criminal thinking.

    Science.gov (United States)

    Walters, Glenn D

    2016-02-01

    This article describes the results of a study designed to test whether reactive criminal thinking (RCT) does a better job of mediating the crime → drug relationship than it does mediating the drug → crime relationship after the direct effects of crime on drug use/dependency and of drug use/dependency on crime have been rendered nonsignificant by control variables. All 1,170 male members of the Pathways to Desistance study (Mulvey, 2012) served as participants in the current investigation. As predicted, the total (unmediated) effects of crime on substance use/dependence and of substance use/dependence on crime were nonsignificant when key demographic and third variables were controlled, although the indirect (RCT-mediated) effect of crime on drug use was significant. Proactive criminal thinking (PCT), by comparison, failed to mediate either relationship. The RCT continued to mediate the crime → drug relationship and the PCT continued to not mediate either relationship when more specific forms of offending (aggressive, income) and substance use/dependence (drug use, substance-use dependency symptoms) were analyzed. This offers preliminary support for the notion that even when the total crime-drug effect is nonsignificant the indirect path from crime to reactive criminal thinking to drugs can still be significant. Based on these results, it is concluded that mediation by proximal reactive criminal thinking is a mechanism by which distal measures of crime and drug use/dependence are connected. (c) 2016 APA, all rights reserved).

  8. Bone mineral density measurements of the proximal femur from routine contrast-enhanced MDCT data sets correlate with dual-energy X-ray absorptiometry.

    Science.gov (United States)

    Gruber, M; Bauer, J S; Dobritz, M; Beer, A J; Wolf, P; Woertler, K; Rummeny, E J; Baum, T

    2013-02-01

    To evaluate the utility of femoral bone mineral density (BMD) measurements in routine contrast-enhanced multi-detector computed tomography (ceMDCT) using dual-energy X-ray absorptiometry (DXA) as the reference standard. Forty-one patients (33 women, 8 men) underwent DXA measurement of the proximal femur. Subsequently, transverse sections of routine ceMDCT of these patients were used to measure BMD of the femoral head and femoral neck. The MDCT-to-DXA conversion equations for BMD and T-score were calculated using linear regression analysis. The conversion equations were applied to the MDCT data sets of 382 patients (120 women, 262 men) of whom 74 had osteoporotic fractures. A correlation coefficient of r = 0.84 (P < 0.05) was calculated for BMD(MDCT) values of the femoral head and DXA T-scores of the total proximal femur using the conversion equation T-score = 0.021 × BMD(MDCT) - 5.90. The correlation coefficient for the femoral neck was r = 0.79 (P < 0.05) with the conversion equation T-score = 0.016 × BMD(MDCT) - 4.28. Accordingly, converted T-scores for the femoral neck in patients with versus those without osteoporotic fractures were significantly different (female, -1.83 versus -1.47; male, -1.86 versus -1.47; P < 0.05). BMD measurements of the proximal femur were computed in routine contrast-enhanced MDCT and converted to DXA T-scores, which adequately differentiated patients with and without osteoporotic fractures.

  9. Bone mineral density measurements of the proximal femur from routine contrast-enhanced MDCT data sets correlate with dual-energy X-ray absorptiometry

    Energy Technology Data Exchange (ETDEWEB)

    Gruber, M. [Medical University of Vienna, Department of Radiology, Division of Neuroradiology and Musculoskeletal Radiology, Vienna (Austria); Bauer, J.S.; Dobritz, M.; Woertler, K.; Rummeny, E.J.; Baum, T. [Technische Universitaet Muenchen, Department of Radiology, Klinikum rechts der Isar, Munich (Germany); Beer, A.J. [Technische Universitaet Muenchen, Department of Nuclear Medicine, Munich (Germany); Wolf, P. [Technische Universitaet Muenchen, Institute for Medical Statistics and Epidemiology, Munich (Germany)

    2013-02-15

    To evaluate the utility of femoral bone mineral density (BMD) measurements in routine contrast-enhanced multi-detector computed tomography (ceMDCT) using dual-energy X-ray absorptiometry (DXA) as the reference standard. Forty-one patients (33 women, 8 men) underwent DXA measurement of the proximal femur. Subsequently, transverse sections of routine ceMDCT of these patients were used to measure BMD of the femoral head and femoral neck. The MDCT-to-DXA conversion equations for BMD and T-score were calculated using linear regression analysis. The conversion equations were applied to the MDCT data sets of 382 patients (120 women, 262 men) of whom 74 had osteoporotic fractures. A correlation coefficient of r = 0.84 (P < 0.05) was calculated for BMD{sub MDCT} values of the femoral head and DXA T-scores of the total proximal femur using the conversion equation T-score = 0.021 x BMD{sub MDCT} - 5.90. The correlation coefficient for the femoral neck was r = 0.79 (P < 0.05) with the conversion equation T-score = 0.016 x BMD{sub MDCT} - 4.28. Accordingly, converted T-scores for the femoral neck in patients with versus those without osteoporotic fractures were significantly different (female, -1.83 versus -1.47; male, -1.86 versus -1.47; P < 0.05). BMD measurements of the proximal femur were computed in routine contrast-enhanced MDCT and converted to DXA T-scores, which adequately differentiated patients with and without osteoporotic fractures. (orig.)

  10. Age estimation in a sub-adult Western Australian population based on the analysis of the pelvic girdle and proximal femur.

    Science.gov (United States)

    Sullivan, Siobhan; Flavel, Ambika; Franklin, Daniel

    2017-10-16

    The accurate and precise estimation of skeletal age by a forensic anthropologist is both a professional and judicial requirement. When unknown skeletal remains are referred to the anthropologist, the estimation of the requisite biological attributes (e.g., age and sex) should accordingly be based on the application of population-specific standards (statistical data). Deviations from the latter practice may result in reduced accuracy and compromised identification. Towards informing appropriate forensic practice, the aim of the present study is to develop statistically quantified age estimation models for a contemporary sub-adult Western Australian population based on the timing of fusion in the os coxa and proximal femur. The study sample comprises 562 known age and sex MDCT scans (292 male, 270 female) representing contemporary Western Australian individuals birth through 30 years of age. Scans are viewed in multi-planar reconstructed (MPR) and/or three-dimensionally reconstructed images using OsiriX(®). Fusion status is scored according to a three-stage system across a total of nine sites in the proximal femur and os coxae. Observer accordance, bilateral asymmetry and sex-specific variation in fusion timing are statistically quantified. Polynomial regression is used to formulate age prediction models; transition analysis is used to calculate age ranges and determine the mean age for transition between an unfused, fusing and fused status. Observer accordance in stage assignation is acceptable (ϰ=0.79) and there is no significant bilateral variation in fusion timing. It was found that the mean age of commencement of fusion is significantly earlier (∼2 years) in females. The accuracy (SEE) of the polynomial models ranges from ±3.29 to ±3.80 years and the transition analysis shows that fusion of the iliac crest is delayed in comparison to other attributes of os coxa and proximal femur. Results of the present study confirm that the pelvic girdle and proximal

  11. Clinical patterns in asthma based on proximal and distal airway nitric oxide categories

    Directory of Open Access Journals (Sweden)

    Aledia Anna S

    2010-04-01

    Full Text Available Abstract Background The exhaled nitric oxide (eNO signal is a marker of inflammation, and can be partitioned into proximal [J'awNO (nl/s, maximum airway flux] and distal contributions [CANO (ppb, distal airway/alveolar NO concentration]. We hypothesized that J'awNO and CANO are selectively elevated in asthmatics, permitting identification of four inflammatory categories with distinct clinical features. Methods In 200 consecutive children with asthma, and 21 non-asthmatic, non-atopic controls, we measured baseline spirometry, bronchodilator response, asthma control and morbidity, atopic status, use of inhaled corticosteroids, and eNO at multiple flows (50, 100, and 200 ml/s in a cross-sectional study design. A trumpet-shaped axial diffusion model of NO exchange was used to characterize J'awNO and CANO. Results J'awNO was not correlated with CANO, and thus asthmatic subjects were grouped into four eNO categories based on upper limit thresholds of non-asthmatics for J'awNO (≥ 1.5 nl/s and CANO (≥ 2.3 ppb: Type I (normal J'awNO and CANO, Type II (elevated J'awNO and normal CANO, Type III (elevated J'awNO and CANO and Type IV (normal J'awNO and elevated CANO. The rate of inhaled corticosteroid use (lowest in Type III and atopy (highest in Type II varied significantly amongst the categories influencing J'awNO, but was not related to CANO, asthma control or morbidity. All categories demonstrated normal to near-normal baseline spirometry; however, only eNO categories with increased CANO (III and IV had significantly worse asthma control and morbidity when compared to categories I and II. Conclusions J'awNO and CANO reveal inflammatory categories in children with asthma that have distinct clinical features including sensitivity to inhaled corticosteroids and atopy. Only categories with increase CANO were related to poor asthma control and morbidity independent of baseline spirometry, bronchodilator response, atopic status, or use of inhaled

  12. Wound retractor for use during laparoscopic surgery, has connecting member extending between proximal and distal members, and release member stowed away before release member is required to be used to release distal member

    OpenAIRE

    Bonadio, Frank; Butler, John; Deegan, C; Vaugh, Trevor

    2007-01-01

    The retractor has a connecting member extending between a proximal member and a distal member to retract sides of a wound opening (6). A release member (81) releases the distal member from a retracting configuration for removal of the distal member from the opening. The release member is stowed away before the release member is required to be used to release the distal member. An outer layer of a sleeve (2) is interposed between a proximal ring (4) and a guide member (51) to control pulling o...

  13. Post-weaning epiphysiolysis causes distal femur dysplasia and foreshortened hindlimbs in fetuin-A-deficient mice

    OpenAIRE

    Brylka, Laura J.; Köppert, Sina; Babler, Anne; Kratz, Beate; Denecke, Bernd; Yorgan, Timur A.; Etich, Julia; Costa, Ivan G.; Brachvogel, Bent; Boor, Peter; Schinke, Thorsten; Jahnen-Dechent, Willi

    2017-01-01

    Fetuin-A / α2-Heremans-Schmid-glycoprotein (gene name Ahsg) is a systemic inhibitor of ectopic calcification. Due to its high affinity for calcium phosphate, fetuin-A is highly abundant in mineralized bone matrix. Foreshortened femora in fetuin-A-deficient Ahsg -/- mice indicated a role for fetuin-A in bone formation. We studied early postnatal bone development in fetuin-A-deficient mice and discovered that femora from Ahsg -/- mice exhibited severely displaced distal epiphyses and deformed g...

  14. Distal, not proximal, colonic acetate infusions promote fat oxidation and improve metabolic markers in overweight/obese men

    DEFF Research Database (Denmark)

    van der Beek, Christina M; Canfora, Emanuel E; Lenaerts, Kaatje

    2016-01-01

    in the colon for three consecutive test days, enabling colonic acetate (100 or 180 mmol/l) or placebo infusion during fasting conditions and after an oral glucose load (postprandial). Fat oxidation and energy expenditure were measured using an open-circuit ventilated hood system and blood samples were......Gut microbial-derived short-chain fatty acids (SCFA) are believed to affect host metabolism and cardiometabolic risk factors. The present study aim was to investigate the effects of proximal and distal colonic infusions with the SCFA acetate on fat oxidation and other metabolic parameters in men....... In this randomized, double-blind crossover trial, six overweight/obese men [body mass index (BMI) 25-35 kg/m(2)] underwent two experimental periods: one with distal and one with proximal colonic sodium acetate infusions. A feeding catheter was endoscopically positioned at the beginning of each period and remained...

  15. High dental caries among adults aged 35 to 44 years: case-control study of distal and proximal factors.

    Science.gov (United States)

    Costa, Simone M; Vasconcelos, Mara; Abreu, Mauro H N G

    2013-06-07

    The aim of this study was to determine whether a high degree of dental caries severity is associated with the distal and proximal determinants of caries in a group of Brazilian adults aged 35 to 44 years. A population-based case-control study was conducted using two groups-a case group with high caries severity (DMFT ≥ 14) and a control group without high caries severity (DMFT caries severity was associated with regular visits to the dentist, low income, use of private/supplementary dental service and not petitioning the authorities for community benefits. The results of the study underscore the importance of considering distal and proximal factors in the assessment of the severity of dental caries. Greater caries severity persists among low-income families and among groups with a low degree of social cohesion.

  16. Differential DNA methylation patterns of homeobox genes in proximal and distal colon epithelial cells

    Science.gov (United States)

    Barnicle, Alan; Seoighe, Cathal; Golden, Aaron; Greally, John M.

    2016-01-01

    Region and cell-type specific differences in the molecular make up of colon epithelial cells have been reported. Those differences may underlie the region-specific characteristics of common colon epithelial diseases such as colorectal cancer and inflammatory bowel disease. DNA methylation is a cell-type specific epigenetic mark, essential for transcriptional regulation, silencing of repetitive DNA and genomic imprinting. Little is known about any region-specific variations in methylation patterns in human colon epithelial cells. Using purified epithelial cells and whole biopsies (n = 19) from human subjects, we generated epigenome-wide DNA methylation data (using the HELP-tagging assay), comparing the methylation signatures of the proximal and distal colon. We identified a total of 125 differentially methylated sites (DMS) mapping to transcription start sites of protein-coding genes, most notably several members of the homeobox (HOX) family of genes. Patterns of differential methylation were validated with MassArray EpiTYPER. We also examined DNA methylation in whole biopsies, applying a computational technique to deconvolve variation in methylation within cell types and variation in cell-type composition across biopsies. Including inferred epithelial proportions as a covariate in differential methylation analysis applied to the whole biopsies resulted in greater overlap with the results obtained from purified epithelial cells compared with when the covariate was not included. Results obtained from both approaches highlight region-specific methylation patterns of HOX genes in colonic epithelium. Regional variation in methylation patterns has implications for the study of diseases that exhibit regional expression patterns in the human colon, such as inflammatory bowel disease and colorectal cancer. PMID:26812987

  17. Comparison of Lower Limb Segments Kinematics in a Taekwondo Kick. An Approach to the Proximal to Distal Motion

    Directory of Open Access Journals (Sweden)

    Estevan Isaac

    2015-09-01

    Full Text Available In taekwondo, there is a lack of consensus about how the kick sequence occurs. The aim of this study was to analyse the peak velocity (resultant and value in each plane of lower limb segments (thigh, shank and foot, and the time to reach this peak velocity in the kicking lower limb during the execution of the roundhouse kick technique. Ten experienced taekwondo athletes (five males and five females; mean age of 25.3 ±5.1 years; mean experience of 12.9 ±5.3 years participated voluntarily in this study performing consecutive kicking trials to a target located at their sternum height. Measurements for the kinematic analysis were performed using two 3D force plates and an eight camera motion capture system. The results showed that the proximal segment reached a lower peak velocity (resultant and in each plane than distal segments (except the peak velocity in the frontal plane where the thigh and shank presented similar values, with the distal segment taking the longest to reach this peak velocity (p < 0.01. Also, at the instant every segment reached the peak velocity, the velocity of the distal segment was higher than the proximal one (p < 0.01. It provides evidence about the sequential movement of the kicking lower limb segments. In conclusion, during the roundhouse kick in taekwondo inter-segment motion seems to be based on a proximo-distal pattern.

  18. Combined application of distal and proximal embolic protection devices in endovascular stenting for severe carotid artery stenosis

    Directory of Open Access Journals (Sweden)

    Zhi-hua DU

    2011-09-01

    Full Text Available Objective To analyze and summarize methods and experiences of combined application of distal and proximal embolic protection devices(EPD in endovascular stenting for severe carotid artery stenosis.Methods Five patients with severe stenosis of the common carotid artery or with extracranial segment of the internal carotid artery diagnosed through digital subtraction angiography(DSA from March to July 2010 were involved in the present study.All patients received carotid angioplasty and stenting(CAS,with a combination of distal and proximal EPD via the percutaneous femoral artery approach.Results The operation failed in one patient,whereas technical success with no intraoperative complication was achieved in four patients.The symptoms disappeared or improved in the four cases that achieved technical success.The follow-up duration was one to three months,and no cerebral ischemia was found.Conclusion CAS with the combined application of distal and proximal EPD in some special cases of carotid artery stenosis may surmount the shortage of single EPD,reduce the risk of intraoperative embolization,decrease the time of intraoperative endovascular inflow occlusion,and reduce high-risk operations.CAS may be used as an individualized treatment strategy for patients with carotid artery stenosis.

  19. Single surgeon experience with robot-assisted ureteroureterostomy for pathologies at the proximal, middle, and distal ureter in adults.

    Science.gov (United States)

    Lee, Ziho; Llukani, Elton; Reilly, Christopher E; Mydlo, Jack H; Lee, David I; Eun, Daniel D

    2013-08-01

    To describe our initial experience with robot-assisted ureteroureterostomy (RUU) at the proximal, middle, and distal ureter. Twelve consecutive patients underwent RUU by a single surgeon (D.D.E.) between July 2009 and November 2012. Indications included three iatrogenic injuries, two impacted stones, two ureterovaginal fistulas, two idiopathic ureteral strictures refractory to conservative treatment, one primary transitional cell carcinoma of the ureter, one colon cancer metastasis to the ureter, and one invasive endometriosis. There were two proximal, three middle, and seven distal ureteral pathologies. Tension-free anastomosis was achieved in all 12 patients. All patients with proximal and middle ureteral pathology received concomitant downward nephropexy (DN) as a standard part of RUU. Mean age of patients at the time of surgery was 52 years (range 30-69), mean body mass index was 30.0 kg/m(2) (range 21-38), mean operative room time was 190 minutes (range 104-354), mean estimated blood loss was 181 mL (range 50-400), and mean length of excised ureter on pathologic analysis was 2.0 cm (range 1.0-4.5). There was one intraoperative complication in which liver and gallbladder laceration occurred during trocar placement. Mean length of hospital stay was 1.4 days (range 1-5), and there were no postoperative complications. Mean follow up was 10 months (range 3-36). One patient had a ureteral stricture recurrence at 7 months postoperatively that led to renal unit loss and eventual nephrectomy. RUU is feasible, safe, and demonstrates good outcomes for pathologies at the proximal, middle, and distal ureter. Concomitant DN during RUU may assist in achieving a tension-free anastomosis for proximal and middle ureteral repairs.

  20. Measurements of bone mineral density in the lumbar spine and proximal femur using lunar prodigy and the new pencil-beam dual-energy X-ray absorptiometry

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Dongil [Sungkyunkwan University School of Medicine, Clinical Trial Center, Clinical Research Institute, Samsung Medical Center, Seoul (Korea, Republic of); Sungkyunkwan University School of Medicine, Department of Radiology, Samsung Medical Center, Seoul (Korea, Republic of); Kim, Deog-Yoon [Kyung Hee University, Department of Nuclear Medicine, College of Medicine, Seoul (Korea, Republic of); Han, Chung Soo [Kyung Hee University, Department of Orthopedic Surgery, College of Medicine, Seoul (Korea, Republic of); Kim, Seonwoo [Sungkyunkwan University School of Medicine, Clinical Trial Center, Clinical Research Institute, Samsung Medical Center, Seoul (Korea, Republic of); Samsung Medical Center, Biostatistics Unit, Samsung Biomedical Research Institute, Seoul (Korea, Republic of); Bok, Hae Sook [Sungkyunkwan University School of Medicine, Clinical Trial Center, Clinical Research Institute, Samsung Medical Center, Seoul (Korea, Republic of); Huh, Wooseong [Sungkyunkwan University School of Medicine, Clinical Trial Center, Clinical Research Institute, Samsung Medical Center, Seoul (Korea, Republic of); Sungkyunkwan University School of Medicine, Division of Nephrology, Samsung Medical Center, Seoul (Korea, Republic of); Ko, Jae-Wook [Sungkyunkwan University School of Medicine, Clinical Trial Center, Clinical Research Institute, Samsung Medical Center, Seoul (Korea, Republic of); Sungkyunkwan University School of Medicine, Division of Clinical Pharmacology, Clinical Research Institute, Samsung Medical Center, Seoul (Korea, Republic of); Hong, Sung Hwa [Sungkyunkwan University School of Medicine, Clinical Trial Center, Clinical Research Institute, Samsung Medical Center, Seoul (Korea, Republic of); Sungkyunkwan University School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Seoul (Korea, Republic of)

    2010-11-15

    We evaluated the correlation of the absolute bone mineral density (BMD) values of the lumbar spine and standard sites of the proximal femur obtained from a Lunar Prodigy and the newly developed pencil-beam dual-energy X-ray absorptiometry (Dexxum). Between June 2008 and December 2008, 79 Korean volunteers were enrolled. Measurements were obtained on the same day using both densitometers. The absolute BMD values (g/cm{sup 2}) from the two densitometers were evaluated using Pearson's correlation analysis with Bonferroni's correction for the three clinically important sites. In order to evaluate precision, we performed duplicate Dexxum measurements, and calculated the within-subject coefficient of variation (WSCV). The Pearson's correlation coefficient (r) of BMD values for the total proximal femur, femoral neck, and lumbar spine by the two densitometers were 0.926, 0.948, and 0.955 respectively, and the null hypotheses of r = 0.8 were all rejected (p < 0.001 by one-sided Z-test with Fisher's z-transformation for each site). The T-scores (r {>=} 0.842) and Z-scores (r {>=} 0.709) also showed strong positive correlations. The duplicate BMD values of Dexxum showed a high level of precision (WSCV {<=} 4.27%). Dexxum measurements of BMD, T-scores, and Z-scores showed a strong linear correlation with those measured on Lunar Prodigy. (orig.)

  1. Associations of Age, BMI, and Years of Menstruation with Proximal Femur Strength in Chinese Postmenopausal Women: A Cross-Sectional Study.

    Science.gov (United States)

    Kang, Huili; Chen, Yu-Ming; Han, Guiyuan; Huang, Hua; Chen, Wei-Qing; Wang, Xidan; Zhu, Ying-Ying; Xiao, Su-Mei

    2016-01-23

    This study aimed to elucidate the associations of age, BMI, and years of menstruation with proximal femur strength in Chinese postmenopausal women, which may improve the prediction of hip fracture risk. A cross-sectional study was conducted in 1322 Chinese postmenopausal women recruited from communities. DXA images were used to generate bone mineral density (BMD) and geometric parameters, including cross-sectional area (CSA), outer diameter (OD), cortical thickness (CT), section modulus (SM), buckling ratio (BR) at the narrow neck (NN), intertrochanter (IT), and femoral shaft (FS). Relationships of age, BMI, and years of menstruation with bone phenotypes were analyzed with the adjustment of height, age at menarche, total daily physical activity, education, smoking status, calcium tablet intake, etc. Age was associated with lower BMD, CSA, CT, SM, and higher BR (p menstruation had the positive relationships with proximal femur strength (p menstruation were 0.14%-1.34%, 0.20%-2.70%, and 0.16%-0.98%, respectively. These results supported that bone strength deteriorated with aging and enhanced with higher BMI and longer time of years of menstruation in Chinese postmenopausal women.

  2. EZ-IO in the ED: an observational, prospective study comparing flow rates with proximal and distal tibia intraosseous access in adults.

    Science.gov (United States)

    Tan, Boon Kiat Kenneth; Chong, Stephanie; Koh, Zhi Xiong; Ong, Marcus Eng Hock

    2012-10-01

    Intraosseous (IO) access is an important alternative to conventional intravenous access when intravenous access is difficult. A nonrandomized, prospective, observational study comparing flow rates with distal and proximal tibia IO access in adults using the EZ-IO-powered drill device. The proximal tibia was the first site of insertion, and a second IO was inserted in the distal tibia if clinically indicated. Intravenous saline infusion was started for all patients, initially without, then with a pressure bag device applied. From September 19, 2008 to November 3, 2010, 22 patients were recruited, with 20 proximal tibial and 22 distal tibia insertions. Two patients had only distal tibia IO insertions. Five distal tibia and 3 proximal tibia insertions had no flow when initiating normal saline infusion without pressure. Upon comparing the mean flow rates without pressure bag, it is significantly faster in the proximal tibia, 4.96 mL/min, compared with distal tibia, 2.07 ml/min, difference of 2.89 ml/min (95% CI 1.20-4.58). Flow rates with pressure bags also revealed a similar result. Flow rates in the proximal tibia were significantly faster, 7.70 ml/min to that of distal tibia, 3.80 ml/min, difference of 3.89 ml/min (95% CI 1.68-6.10). In both proximal and distal tibia groups, the flow rates are also significantly faster with pressure bags compared with without. Flow rates are significantly faster in the proximal tibia compared with the distal tibia. In addition, flow rates with pressure bags are significantly faster than without pressure bags in both groups. Copyright © 2012 Elsevier Inc. All rights reserved.

  3. "Floating arm" injury in a child with fractures of the proximal and distal parts of the humerus: a case report

    Directory of Open Access Journals (Sweden)

    Güven Melih

    2009-09-01

    Full Text Available Abstract Introduction Simultaneous supracondylar humerus fracture and ipsilateral fracture of the proximal humerus in children is rare. Case presentation A 10-year-old Turkish boy with an extension type supracondylar humerus fracture and ipsilateral fracture at the proximal metaphyseal-diaphyseal junction of the humerus was treated by closed reduction and percutaneous Kirschner wire fixation. Closed reduction was performed using a Kirschner wire as a "joystick" to manipulate the humeral shaft after some swelling occurred around the elbow and shoulder. Conclusion The combination of fractures at the proximal and distal parts of the humerus can be termed as "floating arm" injury. Initial treatment of this unusual injury should be focused on the supracondylar humerus fracture. However, closed reduction can be difficult to perform with the swelling around the elbow and shoulder. A temporary Kirschner wire can be used as a "joystick" to fix and reduce the fracture.

  4. Post-weaning epiphysiolysis causes distal femur dysplasia and foreshortened hindlimbs in fetuin-A-deficient mice.

    Directory of Open Access Journals (Sweden)

    Laura J Brylka

    Full Text Available Fetuin-A / α2-Heremans-Schmid-glycoprotein (gene name Ahsg is a systemic inhibitor of ectopic calcification. Due to its high affinity for calcium phosphate, fetuin-A is highly abundant in mineralized bone matrix. Foreshortened femora in fetuin-A-deficient Ahsg-/- mice indicated a role for fetuin-A in bone formation. We studied early postnatal bone development in fetuin-A-deficient mice and discovered that femora from Ahsg-/- mice exhibited severely displaced distal epiphyses and deformed growth plates, similar to the human disease slipped capital femoral epiphysis (SCFE. The growth plate slippage occurred in 70% of Ahsg-/- mice of both sexes around three weeks postnatal. At this time point, mice weaned and rapidly gained weight and mobility. Epiphysis slippage never occurred in wildtype and heterozygous Ahsg+/- mice. Homozygous fetuin-A-deficient Ahsg-/- mice and, to a lesser degree, heterozygous Ahsg+/- mice showed lesions separating the proliferative zone from the hypertrophic zone of the growth plate. The hypertrophic growth plate cartilage in long bones from Ahsg-/- mice was significantly elongated and V-shaped until three weeks of age and thus prior to the slippage. Genome-wide transcriptome analysis of laser-dissected distal femoral growth plates from 13-day-old Ahsg-/- mice revealed a JAK-STAT-mediated inflammatory response including a 550-fold induction of the chemokine Cxcl9. At this stage, vascularization of the elongated growth plates was impaired, which was visualized by immunofluorescence staining. Thus, fetuin-A-deficient mice may serve as a rodent model of growth plate pathologies including SCFE and inflammatory cartilage degradation.

  5. Post-weaning epiphysiolysis causes distal femur dysplasia and foreshortened hindlimbs in fetuin-A-deficient mice.

    Science.gov (United States)

    Brylka, Laura J; Köppert, Sina; Babler, Anne; Kratz, Beate; Denecke, Bernd; Yorgan, Timur A; Etich, Julia; Costa, Ivan G; Brachvogel, Bent; Boor, Peter; Schinke, Thorsten; Jahnen-Dechent, Willi

    2017-01-01

    Fetuin-A / α2-Heremans-Schmid-glycoprotein (gene name Ahsg) is a systemic inhibitor of ectopic calcification. Due to its high affinity for calcium phosphate, fetuin-A is highly abundant in mineralized bone matrix. Foreshortened femora in fetuin-A-deficient Ahsg-/- mice indicated a role for fetuin-A in bone formation. We studied early postnatal bone development in fetuin-A-deficient mice and discovered that femora from Ahsg-/- mice exhibited severely displaced distal epiphyses and deformed growth plates, similar to the human disease slipped capital femoral epiphysis (SCFE). The growth plate slippage occurred in 70% of Ahsg-/- mice of both sexes around three weeks postnatal. At this time point, mice weaned and rapidly gained weight and mobility. Epiphysis slippage never occurred in wildtype and heterozygous Ahsg+/- mice. Homozygous fetuin-A-deficient Ahsg-/- mice and, to a lesser degree, heterozygous Ahsg+/- mice showed lesions separating the proliferative zone from the hypertrophic zone of the growth plate. The hypertrophic growth plate cartilage in long bones from Ahsg-/- mice was significantly elongated and V-shaped until three weeks of age and thus prior to the slippage. Genome-wide transcriptome analysis of laser-dissected distal femoral growth plates from 13-day-old Ahsg-/- mice revealed a JAK-STAT-mediated inflammatory response including a 550-fold induction of the chemokine Cxcl9. At this stage, vascularization of the elongated growth plates was impaired, which was visualized by immunofluorescence staining. Thus, fetuin-A-deficient mice may serve as a rodent model of growth plate pathologies including SCFE and inflammatory cartilage degradation.

  6. Short-term observations of the regenerative potential of injured proximal sensory nerves crossed with distal motor nerves

    Directory of Open Access Journals (Sweden)

    Xiu-xiu Zhang

    2017-01-01

    Full Text Available Motor nerves and sensory nerves conduct signals in different directions and function in different ways. In the surgical treatment of peripheral nerve injuries, the best prognosis is obtained by keeping the motor and sensory nerves separated and repairing the nerves using the suture method. However, the clinical consequences of connections between sensory and motor nerves currently remain unknown. In this study, we analyzed the anatomical structure of the rat femoral nerve, and observed the motor and sensory branches of the femoral nerve in the quadriceps femoris. After ligation of the nerves, the proximal end of the sensory nerve was connected with the distal end of the motor nerve, followed by observation of the changes in the newly-formed regenerated nerve fibers. Acetylcholinesterase staining was used to distinguish between the myelinated and unmyelinated motor and sensory nerves. Denervated muscle and newly formed nerves were compared in terms of morphology, electrophysiology and histochemistry. At 8 weeks after connection, no motor nerve fibers were observed on either side of the nerve conduit and the number of nerve fibers increased at the proximal end. The proportion of newly-formed motor and sensory fibers was different on both sides of the conduit. The area occupied by autonomic nerves in the proximal regenerative nerve was limited, but no distinct myelin sheath was visible in the distal nerve. These results confirm that sensory and motor nerves cannot be effectively connected. Moreover, the change of target organ at the distal end affects the type of nerves at the proximal end.

  7. Biomechanical comparison of polyaxial-type locking plates and a fixed-angle locking plate for internal fixation of distal femur fractures.

    Science.gov (United States)

    Otto, Randall J; Moed, Berton R; Bledsoe, J Gary

    2009-10-01

    To test the stability to axial loading of 2 new polyaxial locking screw-plate designs and analyze different angles of screw insertion. The noncontact bridging (NCB) polyaxial locking plate (Zimmer) and the POLYAX plate (DePuy) were compared with a fixed-angle less invasive stabilization system (LISS; Synthes). Twenty-five synthetic femurs were divided into 5 groups and assigned fixation with the LISS plate (group I), POLYAX plate (groups IIA and IIB), or NCB plate (groups IIIA and IIIB). The polyaxial constructs were divided into parallel and crossed distal condylar screw configurations. Each construct was tested under axial loading and stressed to failure at a displacement rate of 5 mm/min with a preload of 100 N. Outcome measurements included stiffness, load to failure, peak force, and mode of failure. All LISS and POLYAX constructs failed by plastic deformation of the plate, whereas 9 of 10 NCB constructs failed by an intra-articular lateral condyle fracture. No failures occurred at the screw-plate interface in either polyaxial constructs. Load to failure of the LISS was 33% greater than the parallel POLYAX (P NCB (parallel and crossed) were 24% greater than the parallel POLYAX (P NCB. There was no difference between the LISS and NCB with regard to stiffness, load to failure, and peak force. Parallel and crossed polyaxial constructs showed no difference in stiffness or failure loads. There were no failures of either polyaxial screw-plate interface despite large forces and screw angle did not affect the overall strength of these constructs, supporting the biomechanical soundness of both polyaxial device designs under axial loading. However, the POLYAX supported smaller loads compared with the LISS and NCB while under axial loading. In addition, the mode of failure of the NCB plate, creating an intra-articular fracture propagating from the distal posterior screw hole, may be of some concern. Additional testing is needed to determine the clinical importance of the

  8. Distal and proximal factors associated with aggression towards partners and non-partners among patients in substance abuse treatment.

    Science.gov (United States)

    Epstein-Ngo, Quyen M; Walton, Maureen A; Sanborn, Michelle; Kraus, Shane; Blow, Fred; Cunningham, Rebecca; Chermack, Stephen T

    2014-10-01

    Studies of violence in substance use disorder (SUD) treatment settings typically focus on partner aggression (PA) although non-partner aggression (NPA) is also a common problem. This study examines potentially distinct paths of distal and proximal risk factors related to aggression towards non-partners (NPA) and partners (PA) among a SUD treatment sample. The sample included 176 adults reporting past-year violence. Bivariate analyses indicated several distal and proximal factors were associated with NPA and PA. According to multivariate, multiple mediation analyses youth aggression history was a factor for both NPA and PA. Alcohol and cocaine use and psychological distress were associated with NPA; marijuana use was associated with PA. There also was evidence of indirect effects of distal factors on NPA and PA. The results suggest that there may be substantially different dynamics associated with NPA and PA, and have implications for developing screening, assessment and treatment protocols targeting violence among individuals in SUD treatment. Copyright © 2014 Elsevier Inc. All rights reserved.

  9. Changes in bone mineral density of the distal femur after total knee arthroplasty: a 7-year DEXA follow-up comparing results between obese and nonobese patients.

    Science.gov (United States)

    Järvenpää, Jaakko; Soininvaara, Tarja; Kettunen, Jukka; Miettinen, Hannu; Kröger, Heikki

    2014-01-01

    Periprosthetic femoral bone mineral density (BMD, g/cm2) decreases after total knee arthroplasty (TKA) as a result of the stress-shielding phenomenon. It is not known whether obesity has an effect on this phenomenon or not. The aim of this study was to assess long-term periprosthetic BMD changes after TKA and compare whether there is a difference between obese and nonobese patients. A total of 69 TKAs in 61 patients were performed, and BMD measurements of the distal femur were followed up to 7 years postoperatively. The patients were divided into two study groups according to their body mass index, and the groups were compared in relation to BMD and functional outcome. The mean of periprosthetic bone loss during the 7-year follow-up varied from 10.3% to 30.6% depending on the region of interest (pobese with a body mass index value of ≥30 kg/m2. The obese patients' total periprosthetic BMD was higher at both baseline (8.6%) and 7 years after operation (p=0.05) (15.2%). Periprosthetic bone loss around the femoral component continued for up to 7 years postoperatively. The loss of bone density was not associated with any negative clinical outcome in this study, but periprosthetic bone loss was of a smaller quantity in the obese which is probably due to higher weight induced stresses on bone. Copyright © 2013 Elsevier B.V. All rights reserved.

  10. O esôfago curto e o refluxo distal são fatores de risco para o refluxo proximal? Short length of the esophagus and distal reflux are risk factors for proximal esophageal reflux?

    Directory of Open Access Journals (Sweden)

    Humberto Oliveira Serra

    2010-12-01

    Full Text Available RACIONAL: Não está claro se pacientes que apresentam refluxo gastroesofágico distal têm maior risco de apresentar também refluxo proximal. O senso comum sugere que um episódio de refluxo poderia chegar mais facilmente à faringe em pacientes que tivessem menor distância a percorrer entre o esfíncter inferior do esôfago e o superior. OBJETIVO: Investigar se o esôfago curto e a presença de refluxo esofágico distal são fatores de risco para refluxo proximal nos pacientes com sintomas respiratórios. MÉTODO: Cento e sete pacientes foram avaliados prospectivamente por meio de entrevista, esofagoscopia, manometria e pHmetria. Utilizaram-se o teste t de Student, o de correlação de Spearman, o do Qui-quadrado e odds-ratio. O nível de significância foi 0,05. RESULTADOS: Os sintomas que motivaram a investigação da doença do refluxo gastroesofágico foram: tosse 43 (40,2%; pigarro 25 (23,4%, globo faríngeo 23 (21,5% e rouquidão 16 (14,9%. No estudo endoscópico 22 apresentaram esofagite e 14 hérnia de hiato. Na avaliação manométrica 11 (10,8% apresentaram hipotonia do esfíncter inferior. A média do comprimento do esôfago foi 24,3 (± 1,9 cm, variando de 20 a 30 cm. Na avaliação pHmétrica 23 (21,5% apresentaram refluxo distal patológico e 12 (11,2% refluxo proximal. CONCLUSÕES: O comprimento do esôfago não esteve associado com a presença de refluxo proximal. Pacientes que apresentaram refluxo gatroesofágico distal, independente do comprimento do esôfago, tiveram risco aumentado de 4,6 vezes para apresentarem refluxo proximal.BACKGROUND: It is not clear whether patients suffering from distal esophageal reflux also present high risk to proximal esophageal reflux. Common sense suggests that reflux would more easily reach the pharynx in patients who have a smaller distance between the lower esophageal sphincter and the upper one and, thus, short esophagus. AIM: To Investigate if short esophageal length and presence of

  11. Canine total knee replacement performed due to osteoarthritis subsequent to distal femur fracture osteosynthesis: two-year objective outcome.

    Science.gov (United States)

    Eskelinen, E V; Liska, W D; Hyytiäinen, H K; Hielm-Björkman, A

    2012-01-01

    A 27-kg German Shorthaired Pointer was referred for evaluation due to the complaint of left pelvic limb lameness and signs of pain in the left stifle joint. Radiographs revealed signs of a healed supracondylar femoral fracture that had been previously repaired at another hospital with an intramedullary pin and two cross pins. In addition, there were signs of severe osteoarthritis (OA). The OA had been managed medically with administration of carprofen and nutraceuticals for nine months without any improvement. Left total knee replacement (TKR) surgery was performed to alleviate signs of pain. The patient was assessed preoperatively and at six months, one year, and two years after surgery using radiology, force platform analysis of gait, thigh circumference measures, goniometry, and lameness evaluation. Following surgery, the dog resumed normal activity without any signs of pain and a good quality of life at 3.5 months. Force plate analysis found that peak vertical force on the TKR limb was 85.7% of the normal contralateral limb after two years. Total knee replacement was a successful treatment to manage knee OA associated with a healed distal femoral fracture and internal fixation in this dog.

  12. Anatomia radiográfica da região proximal do fêmur: correlação com a ocorrência de fraturas Radiographic anatomy of the proximal femur: correlation with the occurrence of fractures

    Directory of Open Access Journals (Sweden)

    Robinson Esteves Santos Pires

    2012-01-01

    Full Text Available OBJETIVO: Avaliar se existe correlação entre parâmetros radiográficos da anatomia da região proximal do fêmur e a ocorrência de fraturas. MÉTODOS: Trezentas e cinco radiografias digitais da bacia foram analisadas na incidência ântero-posterior. Destas radiografias, vinte e sete apresentavam fratura do colo femoral ou transtrocantérica. Os parâmetros anatômicos analisados foram: Largura do colo femoral (LCF, comprimento do colo femoral (CCF, comprimento do eixo femoral (CEF, ângulo cérvico-diafisário (ACD, distância entre as lágrimas acetabulares (DLA e a distância grande trocânter- sínfise púbica (DGTSP.Foram analisadas, comparativamente, as radiografias com e sem fratura da região proximal do fêmur, para verificar se existem parâmetros radiográficos que estão associados com maior probabilidade de ocorrência de fratura do colo femoral ou transtrocantérica. RESULTADOS: Não foi encontrada diferença entre os parâmetros anatômicos dos grupos com e sem fratura na região proximal do fêmur. CONCLUSÃO: Não foi encontrada nenhuma associação entre alterações anatômicas na região proximal do fêmur e maior susceptibilidade à ocorrência de fraturas. Nível de evidência IV, Estudo Transversal.OBJECTIVE: To evaluate the correlation between radiographic parameters of the proximal femur anatomy and fractures. METHODS: Three hundred and five digital x-rays of the pelvis were analyzed in the anteroposterior view. Of these x-rays, twenty-seven showed femoral neck or transtrochanteric fractures. The anatomical parameters analyzed were: femoral neck width (FNW, femoral neck length (FNL, femoral axis length (FAL, cervicodiaphyseal angle (CDA, acetabular tear-drop distance (ATD and great trochanter-pubic symphysis distance (GTPSD. The analysis was performed by comparing the results of the x-rays with and without proximal femoral fracture, to establish a correlation between them. RESULTS: No differences were found between

  13. The different pathogeneses of sporadic adenoma and adenocarcinoma in non-ampullary lesions of the proximal and distal duodenum.

    Science.gov (United States)

    Niwa, Ayumi; Kuwano, Seiya; Tomita, Hiroyuki; Kimura, Keita; Orihara, Yukiya; Kanayama, Tomohiro; Noguchi, Kei; Hisamatsu, Kenji; Nakashima, Takayuki; Hatano, Yuichiro; Hirata, Akihiro; Miyazaki, Tatsuhiko; Kaneko, Kazuhiro; Tanaka, Takuji; Hara, Akira

    2017-06-20

    Non-ampullary duodenal adenoma with activation of Wnt/β-catenin signalling is common in familial adenomatous polyposis (FAP) patients, whereas sporadic non-ampullary adenoma is uncommon. The adenoma-carcinoma sequence similar to colon cancer is associated with duodenal tumors in FAP, but not always in sporadic tumors. We obtained 37 non-ampullary duodenal tumors, including 25 adenomas and 12 adenocarcinomas, were obtained from biopsies and endoscopic resections. We performed immunohistochemistry for β-catenin, the hallmark of Wnt activation, and aldehyde dehydrogenase 1 (ALDH1), a putative cancer stem cell marker. In non-ampullary lesions, abnormal nuclear localization of β-catenin was observed in 21 (84.0%) of 25 adenomas and 4 (33.3%) of 12 adenocarcinomas. In the proximal duodenum, nuclear β-catenin was less frequent in both adenomas and adenocarcinomas. Gastric duodenal metaplasia (GDM) was observed only in the proximal duodenum. All adenomas with GDM were the gastric foveolar and pyloric gland types, and showed only membranous β-catenin. The intestinal-type adenomas had nuclear β-catenin in the proximal and distal duodenum. ALDH1-positive cells were more frequent in adenocarcinomas than adenomas. Nuclear β-catenin accumulation frequently occurred in ALDH1-positive cells in adenoma, but not in adenocarcinoma. In the non-ampullary proximal duodenum, Wnt/β-catenin pathway activation was more closely associated with adenomas than adenocarcinomas, and while it might cooperate with ALDH1 in adenoma, it does not in adenocarcinoma. The pathogenesis thus may differ between sporadic adenoma and adenocarcinoma of non-ampullary duodenal lesions, especially in the proximal and distal duodenum.

  14. Biomechanical Study on Distal Filling Effects in Cementless Total Hip Replacement

    Science.gov (United States)

    Chae, Soo-Won; Lee, Jun-Hyoung; Choi, Hyung-Yun

    In cementless total hip replacement, initial stability of the femoral component is important in the long term fixation of the femoral stem. Initial stability is closely related to the relative displacement between the prosthesis and the cancellous bone of the proximal femur. After implantation of the prosthesis, the surrounding bone is partially shielded from load carrying and starts to resorb. Stress shielding causes the loss of the proximal bone. The stress distribution of femur must be assessed to predict stress shielding. The initial stability and the stress shielding were investigated for two loading conditions approximating a single leg stance and stair climbing. Two types of stems involving a distal filling and a distal short stem were studied by the finite element method to investigate the biomechanical distal filling effects. The distal short stem produced less stress shielding at the proximal bone than the distal filling stem, while both types of stems seemed to satisfy the initial stability requirement.

  15. A retrospective analysis of the InterTan nail and proximal femoral nail anti-rotation-Asia in the treatment of unstable intertrochanteric femur fractures in the elderly.

    Science.gov (United States)

    Yu, Weiguang; Zhang, Xinchao; Zhu, Xingfei; Hu, Jun; Liu, Yunjiang

    2016-01-15

    The purpose of this study was to compare the clinical outcomes of elderly patients undergoing surgery for treatment of unstable trochanteric fractures receiving either proximal femoral nails anti-rotation-Asia (PFNA-IIs) or InterTan nails (ITs). Between January 1, 2012, and June 31, 2015, 168 elderly patients with unstable intertrochanteric femur fractures enrolled in this study. The only intervention was ITs or PFNA-IIs of the unstable trochanteric femur fractures. Follow-up was at 1, 3, 6, and 12 months postoperatively and yearly thereafter. Intraoperative variables and postoperative complications were compared between the two groups. Eight patients died, six were too infirmed for follow-up, and seven were lost during follow-up, leaving 147 patients meeting the criteria were evaluated at a mean follow-up of 20 months (range 16-26 months). Significant differences were observed between the two groups regarding local complications (IT, n = 10 vs. PFNA-II, n = 20), varus collapse of the head/neck or femoral shaft fractures at the tip of the nail (IT, n = 1 vs. PFNA-II, n = 8), femoral neck shortening (IT, 4.4 ± 1.1 mm vs. PFNA-II, 7.4 ± 2.4 mm), fracture healing time (IT, 14.7 ± 2.1 weeks vs. PFNA-II, 15.7 ± 2.4 weeks), femoral shaft fractures (IT, n = 0 vs. PFNA-II, n = 4), rotational loss of reduction (IT, n = 0 vs. PFNA-II, n = 9), lateral cortex fractures of the proximal femur or lateral greater trochanter fractures (IT, n = 8 vs. PFNA-II, n = 1), operative time (IT, 71.9 ± 6.8 min vs. PFNA-II, 52.3 ± 4.0 min), intraoperative blood loss (IT, 190.6 ± 6.0 mL vs. PFNA-II, 180.9 ± 10.8 mL), fluoroscopy time (IT, 5.0 ± 0.48 min vs. PFNA-II, 2.8 ± 0.33 min), hospital stay (IT, 9.65 ± 0.95 days vs. PFNA-II, 8.58 ± 0.93 days), cut-out (IT, n = 0 vs. PFNA-II, n = 6), and tip-apex distance (IT, 26.7 ± 0.91 mm vs. PFNA-II, 23.2 ± 1.22 mm). No significant differences existed for the other observation indexes (p > 0.05). The IT nail may have more advantage for

  16. Immature mice are more susceptible to the detrimental effects of high fat diet on cancellous bone in the distal femur.

    Science.gov (United States)

    Inzana, Jason A; Kung, Ming; Shu, Lei; Hamada, Daisuke; Xing, Lian Ping; Zuscik, Michael J; Awad, Hani A; Mooney, Robert A

    2013-11-01

    With the increasing prevalence of obesity among children and adolescents, it is imperative to understand the implications of early diet-induced obesity on bone health. We hypothesized that cancellous bone of skeletally immature mice is more susceptible to the detrimental effects of a high fat diet (HFD) than mature mice, and that removing excess dietary fat will reverse these adverse effects. Skeletally immature (5weeks old) and mature (20weeks old) male C57BL/6J mice were fed either a HFD (60% kcal fat) or low fat diet (LFD; 10% kcal fat) for 12weeks, at which point, the trabecular bone structure in the distal femoral metaphysis and third lumbar vertebrae were evaluated by micro-computed tomography. The compressive strength of the vertebrae was also measured. In general, the HFD led to deteriorations in cancellous bone structure and compressive biomechanical properties in both age groups. The HFD-fed immature mice had a greater decrease in trabecular bone volume fraction (BVF) in the femoral metaphysis, compared to mature mice (p=0.017 by 2-way ANOVA). In the vertebrae, however, the HFD led to similar reductions in BVF and compressive strength in the two age groups. When mice on the HFD were switched to a LFD (HFD:LFD) for an additional 12weeks, the femoral metaphyseal BVF in immature mice showed no improvements, whereas the mature mice recovered their femoral metaphyseal BVF to that of age-matched lean controls. The vertebral BVF and compressive strength of HFD:LFD mouse bones, following diet correction, were equivalent to those of LFD:LFD mice in both age groups. These data suggest that femoral cancellous metaphyseal bone is more susceptible to the detrimental effects of HFD before skeletal maturity and is less able to recover after correcting the diet. Negative effects of HFD on vertebrae are less severe and can renormalize with LFD:LFD mice after diet correction, in both skeletally immature and mature animals. © 2013. Published by Elsevier Inc. All rights

  17. Vascularised and modified lower-leg rotationplasty for the treatment of severe infection and bone loss of the proximal femur: a case report.

    Science.gov (United States)

    Fischer, Sebastian; Hirche, Christoph; Heppert, Volkmar G; Grützner, Paul A; Kneser, Ulrich; Kremer, Thomas

    2017-09-19

    We report a reconstructive case in a paraplegic patient, who suffers from a severe proximal femur infection. Aiming at the preservation of the capacity to remain in a seated position to operate a wheelchair, lower leg rotationplasty was considered suitable for reconstruction. Due to severe infection and subclinical femoral artery stenosis, rotationplasty was supercharged by the inferior epigastric artery. Furthermore, extensor tendons of the foot were attached to the acetabulum to facilitate stability of the neo-hip joint. Follow-up examination 1 year after surgery revealed no complications and a satisfied patient. Especially in paraplegic patients, lower leg rotationplasty is a possible treatment option for severe femoral infection. Supercharging provides well-vascularised tissue to the former infection site and improves wound healing.

  18. 3D bone mineral density distribution and shape reconstruction of the proximal femur from a single simulated DXA image: an in vitro study

    Science.gov (United States)

    Whitmarsh, Tristan; Humbert, Ludovic; De Craene, Mathieu; del Río Barquero, Luis M.; Fritscher, Karl; Schubert, Rainer; Eckstein, Felix; Link, Thomas; Frangi, Alejandro F.

    2010-03-01

    Area Bone Mineral Density (aBMD) measured by Dual-energy X-ray Absorptiometry (DXA) is an established criterion in the evaluation of hip fracture risk. The evaluation from these planar images, however, is limited to 2D while it has been shown that proper 3D assessment of both the shape and the Bone Mineral Density (BMD) distribution improves the fracture risk estimation. In this work we present a method to reconstruct both the 3D bone shape and 3D BMD distribution of the proximal femur from a single DXA image. A statistical model of shape and a separate statistical model of the BMD distribution were automatically constructed from a set of Quantitative Computed Tomography (QCT) scans. The reconstruction method incorporates a fully automatic intensity based 3D-2D registration process, maximizing the similarity between the DXA and a digitally reconstructed radiograph of the combined model. For the construction of the models, an in vitro dataset of QCT scans of 60 anatomical specimens was used. To evaluate the reconstruction accuracy, experiments were performed on simulated DXA images from the QCT scans of 30 anatomical specimens. Comparisons between the reconstructions and the same subject QCT scans showed a mean shape accuracy of 1.2mm, and a mean density error of 81mg/cm3. The results show that this method is capable of accurately reconstructing both the 3D shape and 3D BMD distribution of the proximal femur from DXA images used in clinical routine, potentially improving the diagnosis of osteoporosis and fracture risk assessments at a low radiation dose and low cost.

  19. Goniometry of the proximal and distal interphalangeal joints, Part II: placement prefereces, interrater reliability, and concurrent validity.

    Science.gov (United States)

    Groth, G N; VanDeven, K M; Phillips, E C; Ehretsman, R L

    2001-01-01

    The purposes of this repeated-measures single-case-design study were to describe goniometric placement preferences and their effect on the measurement of the proximal and distal interphalangeal joints, to determine interrater reliability, and to determine concurrent validity. Thirty-nine therapists measured one patient dorsally and laterally with the DeVore and the 6" clear goniometers. No significant differences were found between the two goniometers used in the study. Comparison of the means of lateral and dorsal measurements revealed that the only joint associated with a significant difference was the contracted index proximal interphalangeal joint (p=0.0347). Preferences did affect the standard deviations and ranges but not the means of the measurements. Interrater reliability was high (ICC 2,1: 0.99 and 0.86). Clinical and radiographic measurements were markedly different from each other (paired-difference t-tests), leading to inconclusive concurrent validity.

  20. Correction of moderate to severe hallux valgus with combined proximal opening wedge and distal chevron osteotomies: a reliable technique.

    Science.gov (United States)

    Jeyaseelan, L; Chandrashekar, S; Mulligan, A; Bosman, H A; Watson, A J S

    2016-09-01

    The mainstay of surgical correction of hallux valgus is first metatarsal osteotomy, either proximally or distally. We present a technique of combining a distal chevron osteotomy with a proximal opening wedge osteotomy, for the correction of moderate to severe hallux valgus. We reviewed 45 patients (49 feet) who had undergone double osteotomy. Outcome was assessed using the American Orthopaedic Foot and Ankle Society (AOFAS) and the Short Form (SF) -36 Health Survey scores. Radiological measurements were undertaken to assess the correction. The mean age of the patients was 60.8 years (44.2 to 75.3). The mean follow-up was 35.4 months (24 to 51). The mean AOFAS score improved from 54.7 to 92.3 (p technique which, when compared with other metatarsal osteotomies, provides strong angular correction and excellent outcomes with a low rate of complications. Cite this article: Bone Joint J 2016;98-B:1202-7. ©2016 The British Editorial Society of Bone & Joint Surgery.

  1. High Dental Caries among Adults Aged 35 to 44 Years: Case-Control Study of Distal and Proximal Factors

    Directory of Open Access Journals (Sweden)

    Mauro H. N. G. Abreu

    2013-06-01

    Full Text Available The aim of this study was to determine whether a high degree of dental caries severity is associated with the distal and proximal determinants of caries in a group of Brazilian adults aged 35 to 44 years. A population-based case-control study was conducted using two groups—a case group with high caries severity (DMFT ≥ 14 and a control group without high caries severity (DMFT < 14. The sample comprised adults from metropolitan Belo Horizonte, Brazil (180 cases and 180 controls matched for gender and age. The exam was performed by calibrated dentists using the DMFT index. The statistical analysis used the Mann-Whitney test and bivariate and multivariate logistic regression (the conditional backward stepwise method. The mean DMFT was 8.4 ± 3.9 in the control group and 20.1 ± 4.5 in the case group. High caries severity was associated with regular visits to the dentist, low income, use of private/supplementary dental service and not petitioning the authorities for community benefits. The results of the study underscore the importance of considering distal and proximal factors in the assessment of the severity of dental caries. Greater caries severity persists among low-income families and among groups with a low degree of social cohesion.

  2. Estudo anatômico do terço proximal do fêmur: impacto femoroacetabular e o efeito cam Anatomic study of the proximal third of the femur: femoroacetabular impact and the cam effect

    Directory of Open Access Journals (Sweden)

    Pedro José Labronici

    2009-04-01

    Full Text Available OBJETIVO: Analisar as varia��ões anatômicas da extremidade proximal do fêmur que pudessem desenvolver o impacto femoroacetabular. MÉTODOS: Foram utilizados 199 espécimes anatômicos de fêmures esqueleticamente maduros. Os fêmures foram medidos para determinar o ângulo da anteversão do colo femoral, ângulo cervicodiafisário, esfericidade da cabeça femoral em ântero-posterior e súpero-inferior, ângulo entre a epífise e o colo femoral anterior, ângulo entre a epífise e o colo em perfil, distância em ântero-posterior a 5mm da junção cabeça e colo e distância em ântero-posterior da base do colo. RESULTADOS: Observou-se que o subgrupo com impacto apresentou diâmetro da junção a 5mm (p = 0,0001 e cam-cabeça (% (p = 0,0001 significativamente maiores e base-cam (% (p = 0,0001 significativamente menor que o subgrupo sem impacto. Identificou-se que cam-cabeça (% > 80 e base-cam (% OBJECTIVE: to analyze anatomical variations of the proximal end of femur that could cause a femoroacetabular impact. METHODS: 199 skeletically mature anatomical specimens of femurs were used. The femurs were measured in order to determine the anteversion angle of the femoral neck, neckshaft angle, sphericity of the femoral head at anteroposterior and superoinferior, angle between epiphysis and the anterior femoral neck, angle between epiphysis and the neck at lateral plane, anteroposterior distance at 5mm of the head and neck junction and anteroposterior distance of the neck base. RESULTS: we found that the impact subgroup presented a significantly larger junction diameter of 5mm (p = 0.0001 and cam-head (% (p= 0.0001, while base-cam (% (p = 0.0001 showed a significantly smaller diameter than the subgroup without impact. It was identified that cam-head (% > 80 e base-cam (% < 73 were identified as the optimal impact points. CONCLUSION: our study showed that the effect cam, caused by anatomical variations of the proximal femoral end focused the

  3. Preliminary radiographic outcomes of surgical correction in juvenile hallux valgus: single proximal, single distal versus double osteotomies.

    Science.gov (United States)

    Edmonds, Eric W; Ek, Dorsey; Bomar, James D; Joffe, Avrum; Mubarak, Scott J

    2015-01-01

    Surgical correction of juvenile hallux valgus has a high risk of recurrence and complications. This short-term follow-up study evaluates the radiographic differences between 3 osteotomy types: distal first metatarsal osteotomy, proximal first metatarsal osteotomy, and double first metatarsal osteotomy with regard to ability to achieve correction and the risk of hallux varus. A total of 106 feet were evaluated. Percent correction of hallux valgus angle (HVA), intermetatarsal angle (IMA), and distal metatarsal articular angle (DMAA) was recorded, as well as complication and reoperation rates. Radiographs were evaluated at the initial visit, intraoperatively, and at final follow-up. The single distal osteotomy achieved: IMA within normal limits 21% of the time with no cases of overcorrection; HVA within normal limits 42% of the time with 13% overcorrected; and DMAA within normal limits 46% of the time with 4% overcorrected.The single proximal osteotomy achieved: IMA within normal limits 36% of the time with no cases of overcorrection; HVA within normal limits 36% of the time with no cases of overcorrection; and DMAA within normal limits 36% of the time with 7% overcorrected.The double osteotomy achieved: IMA within normal limits 54% of the time with no cases of overcorrection; HVA within normal limits 40% of the time with 7% overcorrected; and DMAA within normal limits 56% of the time with 22% overcorrected.The rate of HVA overcorrection was not found to be correlated with osteotomy type (P=0.37). The double osteotomy was found to have a higher DMAA overcorrection rate than either single osteotomy (PDMAA. Level III-retrospective case control study.

  4. Effects of intravenous bumetanide administration on renal haemodynamics and proximal and distal tubular sodium reabsorption in conscious rats

    Energy Technology Data Exchange (ETDEWEB)

    Shalmi, M.; Petersen, J.S.; Christensen, S. (Department of pharmacology, University of Copenhagen (Denmark))

    1989-01-01

    The renal effects of 0.02-62.5 mg/kg bumetanide given as intravenous bolus injections were studied in water diuretic conscious rats. Clearances of {sup 14}C-tetraethylammonium, {sup 3}H-inulin and lithium were used as markers for renal plasma flow (RPF), glomerular filtion rate (GFR) and proximal tubular output, respectively. Bumetanide caused biphasic, transient and dose-independent changes in the renal haemodynamics without significant alterations of the filtration fraction. At dose-levels above 0.02 mg/kg bumetanide increased urine flow, absolute and fractional Na excretion as well as the indices for fractional output of Na from the proximal tubules (C{sub Li}/C{sub I}n) and the distal nephron segments (C{sub Na}/C{sub Li}). The changes in C{sub Li}/C{sub In} became maximal at doses above 0.5 mg/kg, whereas C{sub Na}/C{sub Li} was increased with the dose up to 12.5 mg/kg. Paradoxically, doses above 12.5 mg/kg were less natriuretic due to a decrease of C{sub Na}/C{sub Li}. It is concluded that in rats bumetanide is an effective although short-acting diuretic when administered intravenously. When comparing peak responses bumetanide is equipotent to furosemide but has a lower maximal efficacy. Judged from the changes in fractional lithium excretion, the natriuretic effect of bumetanide is effected by inhibition of Na reabsorption in the proximal tubule in addition to the well-known effect on the distal nephron segment. (author).

  5. The Influence of High-Impact Exercise on Cortical and Trabecular Bone Mineral Content and 3D Distribution Across the Proximal Femur in Older Men: A Randomized Controlled Unilateral Intervention.

    Science.gov (United States)

    Allison, Sarah J; Poole, Kenneth E S; Treece, Graham M; Gee, Andrew H; Tonkin, Carol; Rennie, Winston J; Folland, Jonathan P; Summers, Gregory D; Brooke-Wavell, Katherine

    2015-09-01

    Regular exercisers have lower fracture risk, despite modest effects of exercise on bone mineral content (BMC). Exercise may produce localized cortical and trabecular bone changes that affect bone strength independently of BMC. We previously demonstrated that brief, daily unilateral hopping exercises increased femoral neck BMC in the exercise leg versus the control leg of older men. This study evaluated the effects of these exercises on cortical and trabecular bone and its 3D distribution across the proximal femur, using clinical CT. Fifty healthy men had pelvic CT scans before and after the exercise intervention. We used hip QCT analysis to quantify BMC in traditional regions of interest and estimate biomechanical variables. Cortical bone mapping localized cortical mass surface density and endocortical trabecular density changes across each proximal femur, which involved registration to a canonical proximal femur model. Following statistical parametric mapping, we visualized and quantified statistically significant changes of variables over time in both legs, and significant differences between legs. Thirty-four men aged mean (SD) 70 (4) years exercised for 12-months, attending 92% of prescribed sessions. In traditional regions of interest, cortical and trabecular BMC increased over time in both legs. Cortical BMC at the trochanter increased more in the exercise than control leg, whereas femoral neck buckling ratio declined more in the exercise than control leg. Across the entire proximal femur, cortical mass surface density increased significantly with exercise (2.7%; p 6%) at anterior and posterior aspects of the femoral neck and anterior shaft. Endocortical trabecular density also increased (6.4%; p 12% at the anterior femoral neck, trochanter, and inferior femoral head. Odd impact exercise increased cortical mass surface density and endocortical trabecular density, at regions that may be important to structural integrity. These exercise-induced changes were

  6. New Endovascular Technique to Prevent Distal Embolism for Iliofemoral Occlusive Disease: Reverse Flow Aspiration With Proximal Sheath Blockage.

    Science.gov (United States)

    Soga, Yoshimitsu; Tomoi, Yusuke; Hiramori, Seiichi; Murata, Naotaka; Kobayashi, Yohei; Ichihashi, Kei; Aodo, Kenji

    2017-08-01

    To report the safety and efficacy of a new technique to prevent distal embolism during treatment of iliofemoral occlusions: reverse flow aspiration with proximal sheath blockage (ReFLAP). Between October 2013 and December 2014, 90 patients (mean age 74 years; 66 men) were prospectively enrolled in a study to evaluate the ReFLAP technique during treatment of 110 occlusions in the iliac artery (72, 65%) or superficial femoral artery (SFA; 38, 35%). The mean occlusion lengths of iliac and SFA lesions were 79 and 179 mm, respectively. The concept of ReFLAP is to aspirate debris after balloon dilation using reverse flow through collaterals without antegrade flow. The main endpoints were the incidence of distal embolization, amputation, complications, and the ReFLAP capture rate, which was visually estimated during aspiration using 4 prespecified grades (0, none; 1, foamy debris; 2, small particles; 3, massive particles). ReFLAP was successful in 105 (95.4%) of the 110 lesions attempted; the 5 failures were due to severe vessel tortuosity or calcification. The incidences of distal embolization and amputation were both 0. Minor complications unrelated to ReFLAP were observed in 8 patients. The ReFLAP procedure aspirated debris in 57 (54%) of the 105 lesions. Aspirated material, including marked clots (grades 2 and 3), was confirmed in 40 (38%) of the lesions. The distribution of aspiration grades was significantly different between iliac and SFA lesions (p=0.02). Our results suggest that the ReFLAP endovascular technique to prevent distal embolization during iliofemoral occlusive disease treatment is simple, safe, and effective.

  7. Treatment of an open distal tibia fracture with segmental bone loss in combination with a closed proximal tibia fracture: a case report.

    Science.gov (United States)

    Park, Jin; Yang, Kyu Hyun

    2012-08-01

    The treatment of open distal tibia fractures remains challenging, particularly when the fracture is infected and involves segmental bone loss. We report the case of a 38-year-old man who sustained an open distal tibiofibular fracture with segmental bone loss and a closed proximal tibial fracture. The fractures were initially fixed with a temporary external fixator. The open distal tibial fracture was infected, and the skin was covered after the wound became culture negative. The tibia was then internally transported with a ring external fixator; the closed fracture of the proximal tibia served as the corticotomy for internal transport without conventional corticotomy. After 5 cm internal transport, the docking site of the distal tibia was fixed with a locking plate and autogenous cancellous bone graft. Bone graft was also used to the distal tibiofibular space to achieve distal tibiofibular synostosis. We describe one treatment option for an infected open fracture of the distal tibia with segmental bone loss that is accompanied by a closed fracture of the proximal tibia. This method can treat two fractures simultaneously.

  8. Proximal Femur Bone Density Decreases up to 5 Years After Total Hip Arthroplasty in Young, Active Patients.

    Science.gov (United States)

    Nam, Denis; Barrack, Robert L; Clohisy, John C; Nunley, Ryan M

    2016-12-01

    The number of young, active patients undergoing hip arthroplasty continues to increase. The purpose of this study was to evaluate femoral bone density over a 5-year period after hip arthroplasty in young, active patients. A total of 96 patients (103 hips) with a presymptomatic University of California at Los Angeles (UCLA) score ≥6 who had a total hip arthroplasty (THA; 45 hips) or surface replacement arthroplasty (SRA; 58 hips) were prospectively enrolled. UCLA and Harris Hip Scores were collected preoperatively and postoperatively, and dual energy X-ray absorptiometry scans were performed at 6 weeks, 6 months, 1 year, 2 years, and 5 years postoperatively. Bone density was analyzed for 7 traditional Gruen zones in both groups and 6 femoral neck zones in the SRA group. Bone density ratios were calculated for change in bone density compared with baseline. No differences were present in the preoperative or postoperative UCLA or Harris Hip Scores between the SRA and THA cohorts (P = .07-.7). In the THA group, bone density never returned to baseline during the 5-year period in Gruen zones 1 (91.2% of baseline), 2 (94.8%), 6 (97.3%), and 7 (89.2%). There were no decreases in bone mineral density ratio for the femoral Gruen zones in the SRA group at any interval. Femoral neck bone density after SRA increased on the lateral, tension side up to 5 years postoperatively (P femur in Gruen zones 1, 2, and 7 over time. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Finite element model of the proximal femur under consideration of the hip centralizing forces of the iliotibial tract.

    Science.gov (United States)

    Birnbaum, K; Pandorf, T

    2011-01-01

    the aim of our investigations was the development of a finite element model of the hip joint under consideration of the hip centralizing forces of the iliotibial tract within different femoral neck angles and its influence to the centralizing of the femoral head to the acetabulum. for the development of the finite element model of the femur and the iliotibial tract we utilized the program IDEAS 3D as well as the material/lengthening characteristics of the iliotibial tract. In the following step we developed a hip joint model with different centrum-collum-diaphysis-angles of 115°, 128° and 155° for determination of the IT force and the consequential force on the femoral head. with a coxa vara the force on the femoral head in relation to the physiological centrum-collum-diaphysis-angle and the coxa valga decreased (115°=1601N, 128°=2360N, and 155°=2422N). On the other side the hip centralizing forces of the iliotibial tract within a coxa vara increased in comparison to 128° (physiological) and 155° (valga) (115°=997N, 128°=655,5N, and 155°=438N). Within a coxa valga a higher compressive force on the femoral head and with a coxa vara a decreasing compressive force on the femoral head occurred. the clinical relevance consists in the predictability of an increasing or decreasing band wiring effect of the iliotibial tract in reliance to the centrum-collum-diaphysis-angle of the femoral neck and its importance for the displacement osteotomy of the growing hip. 2010 Elsevier Ltd. All rights reserved.

  10. INTERTAN nail versus proximal femoral nail antirotation-Asia for intertrochanteric femur fractures in elderly patients with primary osteoporosis

    OpenAIRE

    Zhang, Hui; Zeng, Xianshang; Zhang, Nan; Zeng, Dan; Xu, Ping; Zhang, Lili; Chen, Deng; Yu, Weiguang; Zhang, Xinchao

    2017-01-01

    Objectives To compare the long-term functional and radiographic outcomes of the proximal femoral nail antirotation-Asia (PFNA-II) and INTERTAN nail (IT) in the management of intertrochanteric femoral fractures (IFFs) (AO/OTA Type 31A1.1-A2.3) in elderly patients with primary osteoporosis. Methods A retrospective comparative study was performed in our institution. From January 2009 to March 2012, 243 patients with osteoporosis (243 hips) with IFFs (AO/OTA Type 3.1A1.1-A2.3) underwent repair wi...

  11. Fraturas proximais do fêmur em idosos: qual o melhor tratamento? Proximal fracture of the femur on the elderly: what's the best treatment?

    Directory of Open Access Journals (Sweden)

    Lygia Paccini Lustosa

    2009-01-01

    Full Text Available As fraturas proximais do fêmur em idosos representam um sério problema dentro do contexto da saúde pública, devido aos elevados custos econômicos para o tratamento e as suas consequências, assim como pela alta taxa de morbidade e mortalidade. O objetivo desse estudo foi discutir quais os tratamentos mais indicados para esse tipo de fratura, em idosos, por meio de uma revisão da literatura. As bases de dados pesquisadas foram MEDLINE, COCHRANE e PEDro. Os critérios de inclusão foram estudos publicados nos últimos sete anos; nos idiomas português, inglês e espanhol; realizados em seres humanos, sem distinção de gênero e com idade maior que 60 anos; estudos com desenho metodológico de ensaios clínicos, ensaios clínicos aleatorizados e revisões sistemáticas com e sem meta-análise. Foram encontrados sete artigos e após a análise pode se afirmar que não existe um tratamento específico para as fraturas proximais do fêmur em idosos. O tratamento normalmente indicado na maioria dessas fraturas é cirúrgico e requer envolvimento fisioterápico para uma reabilitação adequada. Apesar da dificuldade de comparação entre os estudos, foi observado que uma equipe de profissionais da saúde parece promover uma reabilitação mais efetiva, além de prevenir complicações.The proximal fractures of the femur on the elderly represent a serious problem inside the public health context, because of the high economic costs needed for the treatment and it's consequence, as the high taxes of morbidity and mortality. The goal of this study was to discuss, through a literature revision, which is the most indicated treatment for the proximal fractures of the femur, on the elderly. The researched data bases were MEDLINE, COCHRANE and PEDro. The inclusion criterions were published studies on the last seven years, only on the Portuguese, English and Spanish languages, accomplished on human beings, with no genre distinction and with ages above 60

  12. Intermittent internal fixation with a locking plate to preserve epiphyseal growth function during limb-salvage surgery in a child with osteosarcoma of the distal femur: a case report.

    Science.gov (United States)

    Mei, Jiong; Ni, Ming; Jia, Guang-Yao; Chen, Yan-Xi; Zhu, Xiao-Zhong

    2015-05-01

    Limb shortening is a problem associated with surgery for osteosarcoma of the lower extremity in adolescents, as the tumors frequently occur near the epiphysis. Herein we report the use of a less invasive stabilization system (LISS) and an intermittent fixation method to preserve the growth function of epiphysis in an 11-year-old patient with an osteosarcoma of the distal femur.The 11-year-old male presented with left knee enlargement and pain for 2 weeks, and magnetic resonance imaging (MRI) and biopsy were consistent with osteosarcoma of the left distal femur. After preoperative chemotherapy, en bloc tumor resection was performed with margins based on MRI findings preserving the epiphyseal growth plate, the tumor cavity was filled with inactivated bone and bone cement, and a LISS was used to stabilize the femur. Aggressive postoperative chemotherapy was given. Approximately 105 weeks after surgery radiography showed that the distal end of the plate had moved superior to the epiphysis along with bone growth. Locking screws were placed in the distal part of the LISS plate to stabilize the re-implanted bone, and external fixation was not needed.The patient was able to walk with the crutches 1 week postoperatively, and bear weight on the extremity 6 weeks postoperatively. At 6 years after surgery, the patient's height had increased 52 cm, shortening of the affected limb was only 1 cm, and the circumference of the affected limb was 2 cm smaller than that of the contralateral limb. There was no significant discomfort in the affected limb, and there was no gait abnormality. The patient could jump and run, and could participate in sports including basketball and badminton to the same degree as his peers.In summary, the novel method of bone reconstruction and fixation provided good results in a child with an osteosarcoma of the distal femur. This fixation method preserves the osteogenic function of the epiphysis and restored bone integrity simultaneously, and

  13. Sealing distal proximal caries lesions in first primary molars: efficacy after 2.5 years.

    Science.gov (United States)

    Martignon, S; Tellez, M; Santamaría, R M; Gomez, J; Ekstrand, K R

    2010-01-01

    The prevalence of proximal caries in primary molar teeth is high in many countries. (1) To study by means of a split-mouth design the 1- and 2.5-year efficacy of sealing proximal lesions vs. flossing instructions (control) on primary molar teeth. (2) To assess children's behaviour and pain perception during the procedure. Ninety-one 4- to 6-year-old children from Bogotá, Colombia participated. Participants had to have at least two proximal lesions scored according to the following radiographic classification system: radiolucency (1) in enamel outer half, (2) restricted to enamel-dentine junction, or (3) restricted to dentine outer third. Baseline, 1- and 2.5-year follow-up bitewing radiographs were taken. Test and control lesions were randomly selected. After temporary separation test lesions were sealed (adhesive). Parents/caregivers received a flossing leaflet for their children. Progression of the lesions was assessed by means of independent reading of conventional bitewing radiographs. One-year (n = 73) test vs. control lesion progression was 27.4 vs. 50.7%, respectively (p caries baseline data. More than 88% of the participants presented positive to definitively positive behaviour and very low or low pain intensity at both first and second appointments. The sealing technique was superior to flossing instructions both after 1 and 2.5 years of follow-up and the majority of the participants had no anxiety or pain during the treatment. Copyright © 2010 S. Karger AG, Basel.

  14. Incidencia y factores de riesgo de la fractura de fémur proximal por osteoporosis Incidence of and risk factors associated with fractures of the proximal femur due to osteoporosis

    Directory of Open Access Journals (Sweden)

    María Teresa Mosquera

    1998-04-01

    Full Text Available Todos los años se producen en el mundo más de un millón de fracturas de fémur proximal, sobre todo en personas de edad avanzada. Dado el continuo envejecimiento de las poblaciones, las fracturas aumentarán año tras año y constituirán un problema cada vez más grave de salud pública. Se espera que el mayor aumento de dichas fracturas ocurra en América Latina alrededor del 2050. Teniendo en cuenta que cerca de 70% de las fracturas atraumáticas en personas mayores de 45 años de edad se deben a osteoporosis, se diseñó un estudio de casos y controles en la ciudad de Mar del Plata, Argentina, para conocer la incidencia de fracturas de fémur proximal por osteoporosis y los factores de riesgo asociados. Entre el 1 de agosto de 1992 y el 31 de julio de 1993 se registraron todos los casos de fracturas de fémur proximal por osteoporosis en personas mayores de 50 años de edad que acudieron a cualquiera de los 30 centros de salud públicos y privados de la ciudad. Se registró un total de 246 casos. La tasa de incidencia por 100 000 habitantes en la población mayor de 50 años fue de 259 en mujeres y de 92 en varones, con una relación de 2,8:1. La incidencia fue siempre mayor a mayor edad y sobre todo a partir de los 75 años. Los factores asociados con aumento del riesgo de fractura de fémur proximal con significación estadística fueron: antecedentes de enfermedades neurológicas, consumo de psicofármacos, consumo de alcohol, fracturas previas, enfermedades cardiovasculares y menor consumo de lácteos. No se observaron diferencias entre los casos y los controles con respecto a edad de inicio de la menopausia, peso, talla, actividad previa, hábito de fumar o exposición al sol, como así tampoco en el porcentaje de mujeres que habían tenido ooforectomías.Every year more than one million fractures of the proximal femur occur in the world, especially in older persons. Given the continuous aging experienced by populations, such

  15. The Absolute Dating Potential of Proximal-Distal Tephra Correlations in an Aegean Marine Stratigraphy (Core LC21).

    Science.gov (United States)

    Satow, Christopher; Lowe, John; Rohling, Eelco; Blockley, Simon; Menzies, Martin; Grant, Katharine; Smith, Vicki; Tomlinson, Emma

    2010-05-01

    Quaternary marine stratigraphies frequently suffer from poor absolute age control. Radiocarbon dating is intuitively the most appropriate technique for most marine stratigraphies, but its application is limited to the last 50ka or so by the decay rate of carbon. There are also uncertainties related to reservoir effects and the calibration of radiocarbon time to real time. However, precise dating and correlation of marine cores is essential to understand the timing and spatial relationships of the valuable environmental records they preserve. Here we demonstrate the potential of both visible and "invisible" micro-tephra layers to precisely date an important marine environmental record (Core LC21 from the Southern Aegean Sea). This is done by geochemically correlating the distal marine tephra layers to proximal volcanic deposits from Italy, Greece and Turkey. We use both Major Element (EPMA- Oxford Archaeology) and Trace Element (LA-ICP-MS, Royal Holloway Earth Sciences) analyses on individual tephra shards to determine the source of the tephra, and to make the correlations to explosive eruptive events. The most precise date (14C, 39Ar:40Ar or U-Th) from the event's proximal deposit is then imported into the equivalent distal tephra found in the marine core. Many of these distal "micro-tephras" were previously undetected by standard core logging techniques such as visual stratigraphy or scanning XRF. The extent and potential application of these tephras is now being realised. This study will provide the first direct (same core) and independent, absolute chronological markers for sapropels S3, S4 and S5, three major anoxic events found in the Eastern Mediterranean. In addition, the major and trace element geochemistry will be used to robustly correlate three marine cores spanning the Mediterranean. This work forms the Marine Tephrostratigraphy component (Work Package 5) of the UK Natural Environment Research Council (NERC) consortium project "RESET" (Response of

  16. The impact of care pathways for patients with proximal femur fracture: rationale and design of a cluster-randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Vanhaecht Kris

    2012-05-01

    Full Text Available Abstract Background Proximal femur fracture (PFF is associated with considerable morbidity and mortality. The European Quality of Care Pathway (EQCP study on PFF (NCT00962910 was designed to determine how care pathways (CP for hospital treatment of PFF affect consistency of care, adherence to evidence-based key interventions, and clinical outcome. Methods/Design An international cluster-randomized controlled trial (cRCT will be performed in Belgium, Ireland, Italy and Portugal. Based on power analyses, a sample of 44 hospital teams and 437 patients per arm will be included in the study. In the control arm, usual care will be provided. Experimental teams will implement a care pathway which will include three active components: a formative evaluation of quality and organization of the care setting, a set of evidence-based key interventions, and support of the development and implementation of the CP. Main outcome will be the six-month mortality rate. Discussion The EQCP study constitutes the first international cRCT on care pathways. The EQCP project was designed as both a research and a quality improvement project and will provide a real-world framework for process evaluation to improve our understanding of why and when CP can really work. Trial registration number NCT00962910

  17. COMPARATIVE STUDY BETWEEN PROXIMAL FEMORAL NAILING AND DYNAMIC HIP SCREW IN THE MANAGEMENT OF INTERTROCHANTERIC FRACTURES OF FEMUR

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    Penugonda Ravi Shankar

    2015-01-01

    Full Text Available AIMS AND OBJECTIVES : To determine the rate of union, complications, operative risks and functional outcomes in intertrochanteric fractures treated with DHS and PFN , To compare the results obtained and To compare the effectiveness of DHS and PFN in treatment of intertrochanteric fractures. RESULTS : In the present series of 24 cases of Intertrochanteric fractures were treated by proximal femoral nailing and dynamic hip screw, 12 cases in each. Out of 24 there were 13 male and 11 female. Minimum age was 36 years, maximum age 76 years with mean age of 59.25 years. Slip and fall accounted for 75% of cases. BOYD and GRIFFIN type II fracture accounted for 58.3% of cases. Mean duration of hospital stay was 26 days in both PFN and DHS groups. Length of incision was small 5 - 6cm in PFN group compared to 10 - 12cm in DHS group. Mean external blood loss 150ml in PFN group and 315 ml in DHS group. Mean time for full weight bearing was 11.5 weeks for PFN group and 14.3 weeks for DHS group. Radiological union was 12.3 weeks in PFN group and 15.5 weeks in DHS group. Good to excellent results were seen in 91.7% of cases in PFN group and 75% in DHS group. CONCLUSION : From the study, we consider PFN as better alternative to DHS in the treatment of intertrochanteric fractures but is technically difficult procedure and requires more expertise compared to DHS.As learning curve of PFN procedure is steep, with experience gained from each case operative time, radiation exposure and intraoperative complications can be reduced in each case of PFN

  18. INTERTAN nail versus proximal femoral nail antirotation-Asia for intertrochanteric femur fractures in elderly patients with primary osteoporosis.

    Science.gov (United States)

    Zhang, Hui; Zeng, Xianshang; Zhang, Nan; Zeng, Dan; Xu, Ping; Zhang, Lili; Chen, Deng; Yu, Weiguang; Zhang, Xinchao

    2017-08-01

    Objectives To compare the long-term functional and radiographic outcomes of the proximal femoral nail antirotation-Asia (PFNA-II) and INTERTAN nail (IT) in the management of intertrochanteric femoral fractures (IFFs) (AO/OTA Type 31A1.1-A2.3) in elderly patients with primary osteoporosis. Methods A retrospective comparative study was performed in our institution. From January 2009 to March 2012, 243 patients with osteoporosis (243 hips) with IFFs (AO/OTA Type 3.1A1.1-A2.3) underwent repair with either a PFNA-II or IT. Follow-up assessments were performed 1, 3, 6, 9, and 12 months postoperatively and every year thereafter. All implant position changes were noted. Patient-related functional outcomes were evaluated based on the Harris hip score. Results In total, 174 patients with osteoporosis (IT, n = 86; PFNA-II, n = 88) were evaluated during a mean follow-up period of 40 months (range, 38-60 months). An increased risk of femoral shaft fracture after implant removal was observed at month 9 of follow-up in 0.0% and 4.4% of the IT and PFNA-II groups, respectively. This difference remained over time with rates of 1.1% and 6.8%, respectively, at the last follow-up. Conclusion The IT nail appears to be a reliable implant in the management of IFFs (AO/OTA Type 3.1A1.1-A2.3) in elderly patients with primary osteoporosis.

  19. When there Seem to be No Predetermining Factors: Early Child and Proximal Family Risk Predicting Externalizing Behavior in Young Children Incurring No Distal Family Risk

    Science.gov (United States)

    Roskam, I.; Meunier, J.-C.; Stievenart, M.; Noel, M.-P.

    2013-01-01

    The main objective of the current study was to examine the impact of two child risk factors, i.e. personality and inhibition, and two proximal family risk factors, i.e. parenting and attachment, and the impact of their cumulative effect on later externalizing behavior among young children incurring no distal family risk. Data were collected in a…

  20. Proximal and distal social influence on alcohol consumption and marijuana use among middle school adolescents.

    Science.gov (United States)

    Salvy, Sarah-Jeanne; Pedersen, Eric R; Miles, Jeremy N V; Tucker, Joan S; D'Amico, Elizabeth J

    2014-11-01

    This study assesses the independent and combined effects of (1) perceived peer norms, (2) best friend use, and (3) being in the presence of others who use on middle school adolescents' consumption of marijuana and alcohol, and how the effects of these sources of social influence evolve over time as youth progress through middle school. The analytic sample consisted of 11,667 adolescents (50% female; >65% Hispanic) in 6th, 7th or 8th grade from 16 middle schools across three school districts in Southern California. Participants were assessed at 5 time points from 2008 to 2011. All sources of social influence were predictive of alcohol and marijuana consumption. As youth grew older, spending time with other adolescents who drink increased adolescents' likelihood of drinking alcohol, whereas perceived norms became less influential. Furthermore, as adolescents spent more time around other youths who drink, the predictive value of perceived norms on alcohol consumption decreased. Similarly, as youth grew older, the influence of best friend's use and spending time with other adolescents who use marijuana remain stable, whereas perceived norms became less influential. Findings suggest that perceived peer norms may be more influential in early adolescence; whereas proximal social determinants (e.g., being in the presence of other peers who consume) become more influential as youth enter middle adolescence. Prevention programs should continue to address misperception of norms with younger adolescents to decrease the chances of initiation, but also utilize strategies such as refusal skills and alternate coping mechanisms for older adolescents. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  1. Achilles Tendon Vascularization of Proximal, Medial, and Distal Portion Before and After Partial Lesion in Rats Treated with Phototherapy.

    Science.gov (United States)

    Ferreira, Rafaela; Silva, Rosangela; Folha, Roberta A C; Polacow, Maria Luiza O; Teodori, Rosana Macher; Pinfildi, Carlos Eduardo

    2015-12-01

    The Achilles tendon is one of the tendons most commonly injured by microtraumas and overuse during sports practice. This tendon is especially fragile because of the low blood supply in its central part. Nevertheless, the literature does not offer enough scientific support to explain the composition and vascular dynamic of animal tendons, despite the relevance of being able to observe if the animal tendon undergoes the same processes of vascularization in different regions, as occurs in humans. We used 28 rats weighing 280 ± 20 g, which were divided into four groups with seven animals each (control, sham, 830 nm, 660 nm). The laser parameters were: power output 60 mW for both lasers, 40 J/cm(2) of energy density, total energy 1.1 J, power density 2.14 W/cm(2), and application time 18.6 sec. This study evaluated the vascular constitution of healthy and injured calcaneous tendons. The tendons of each animal were processed to be embedded in Paraplast and, after that, they were divided into three parts: proximal, medial, and distal. Afterwards, they were cut in slices of 6 μm were made, then they were stained with hematoxylin and eosin. Using an ocular lens reticulated with magnification × 400, we analyzed the number and the area density of the blood vessels using morphometric methods. Data were analyzed with the Shapiro-Wilk test, followed by Tukey, considering p as <0.05. The area density and the number of blood vessels in the proximal part were 36% and 42%, respectively, of the values found in the medial part. The distal part had 64% more vessels and 52.8% more area density (p < 0.05) than the medial part. Low-level laser therapy (LLLT) had no effect on the studied parameters. The vascularization of rat tendon is similar to that of humans, which contributes to the studies of therapies that have been applied in humans.

  2. Distal and proximal actions of peptide pheromone M-factor control different conjugation steps in fission yeast.

    Directory of Open Access Journals (Sweden)

    Taisuke Seike

    Full Text Available Mating pheromone signaling is essential for conjugation between haploid cells of P-type (P-cells and haploid cells of M-type (M-cells in Schizosaccharomyces pombe. A peptide pheromone, M-factor, produced by M-cells is recognized by the receptor of P-cells. An M-factor-less mutant, in which the M-factor-encoding genes are deleted, is completely sterile. In liquid culture, sexual agglutination was not observed in the mutant, but it could be recovered by adding exogenous synthetic M-factor, which stimulated expression of the P-type-specific cell adhesion protein, Map4. Exogenous M-factor, however, failed to recover the cell fusion defect in the M-factor-less mutant. When M-factor-less cells were added to a mixture of wild-type P- and M-cells, marked cell aggregates were formed. Notably, M-factor-less mutant cells were also incorporated in these aggregates. In this mixed culture, P-cells conjugated preferentially with M-cells secreting M-factor, and rarely with M-factor-less M-cells. The kinetics of mating parameters in liquid culture revealed that polarized growth commenced from the contact region of opposite mating-type cells. Taken together, these findings indicate that M-factor at a low concentration induces adhesin expression, leading to initial cell-cell adhesion in a type of "distal pheromone action", but M-factor that is secreted directly in the proximity of the adhered P-cells may be necessary for cell fusion in a type of "proximal pheromone action".

  3. Frequency of Osteoporosis and Osteopenia According To Bone Mineral Density of Proximal Femur Subregions in Normal and Osteopenic Postmenopausal Women With Respect to Total Hip Bone

    Directory of Open Access Journals (Sweden)

    Murat Ersöz

    2002-09-01

    Full Text Available In this study 29 normal (mean age: 65.6 ± 5.1 years and 33 osteopenic (mean age: 67.6 ± 4.9 years postmenopausal women according to total bone mineral density (BMD of the hip were evaluated for BMD values of subregions of proximal femur. The percentages for osteoporosis and osteopenia with respect to subregions were 13.8% and 58.6% for femoral neck and 20.7% and 41.4% for Ward’s triangle in normal group. In trochanteric and intertrochanteric measurements there were no T scores below –2.5 but 17.2% of the subjects were osteopenic with regard to trochanteric and 6.9% were osteopenic due to intertrochanteric BMD values. The percentages for osteoporosis and osteopenia with respect to subregion measurements were 57.6% and 42.4% for femoral neck, 60.6% and 36.4% for Ward’s triangle, 3% and 78.8% for trochanteric, 9.1% and 87.9% for intertrochanteric regions in osteopenic group according to total hip values. Knowing that hip fracture risk is increasing 2-3 fold for 1 standart deviation decrease from the young adult mean value for all subregions and knowing the relation between cervical hip fractures and BMD values of Ward’s triangle and femoral neck and the relation between intertrochanteric fractures and trochanteric BMD values, it is recommended to evaluate the BMD values of subregions of the hip besides the total hip values in daily practice.

  4. Distribution of bone density in the proximal femur and its association with hip fracture risk in older men: the osteoporotic fractures in men (MrOS) study.

    Science.gov (United States)

    Yang, Lang; Burton, Annabel C; Bradburn, Mike; Nielson, Carrie M; Orwoll, Eric S; Eastell, Richard

    2012-11-01

    This prospective case-cohort study aimed to map the distribution of bone density in the proximal femur and examine its association with hip fracture. We analyzed baseline quantitative computed tomography (QCT) scans in 250 men aged 65 years or older, which comprised a randomly-selected subcohort of 210 men and 40 cases of first hip fracture during a mean follow-up period of 5.5 years. We quantified cortical, trabecular, and integral volumetric bone mineral density (vBMD), and cortical thickness (CtTh) in four quadrants of cross-sections along the length of the femoral neck (FN), intertrochanter (IT), and trochanter (TR). In most quadrants, vBMDs and CtTh were significantly (p fracture, we merged the two quadrants in the medial and lateral aspects of the FN, IT, and TR. At most sites, QCT measurements were associated significantly (p fracture, the hazard ratio (HR) adjusted for age, body mass index (BMI), and clinical site for a 1-SD decrease ranged between 2.28 (95% confidence interval [CI], 1.44-3.63) to 6.91 (95% CI, 3.11-15.53). After additional adjustment for total hip (TH) areal BMD (aBMD), trabecular vBMDs at the FN, TR, and TH were still associated with hip fracture significantly (p fracture significantly (p > 0.05) better than TH aBMD. With an area under the receiver operating characteristic curve (AUC) of 0.901 (95% CI, 0.852-0.950), the regression model combining TH aBMD, age, and trabecular vBMD predicted hip fracture significantly (p fracture risk and highlight trabecular vBMD at the FN and TR as an independent risk factor. Copyright © 2012 American Society for Bone and Mineral Research.

  5. Distal and proximal factors related to aggression severity among patients in substance abuse treatment: family history, alcohol use and expectancies.

    Science.gov (United States)

    Chermack, Stephen T; Wryobeck, John M; Walton, Maureen A; Blow, Frederic C

    2006-05-01

    This study examined the relationships among distal (paternal and maternal family history of alcohol problems and violence) and proximal (general alcohol use, acute use associated with conflict incidents, alcohol-aggression expectancies) factors and physical aggression severity among 125 men and 125 women recruited from substance abuse treatment. Paternal alcohol problem history (PA) was related to alcohol-aggression expectancies, but no family history factors were related to general or acute alcohol use. Separate analyses examining predictors of aggression were conducted, one with general alcohol use and one with acute alcohol use. In both analyses, alcohol use and the maternal violence (MV) by PA interaction were significant. Specifically, MV was associated with aggression severity for those with a history of PA. The general alcohol use model also revealed significant alcohol by expectancy and MV by gender interactions. The findings suggest that expectancies are not the primary mediator of the alcohol-aggression relationship, alcohol use measurement issues may impact whether expectancies are observed to moderate the alcohol-aggression relationship, and that both maternal and paternal family history factors appear to impact aggression severity.

  6. Interaction between the DRD4 VNTR Polymorphism and Proximal and Distal Environments in Alcohol Dependence during Emerging and Young Adulthood

    Science.gov (United States)

    Park, Aesoon; Sher, Kenneth J.; Todorov, Alexandre A.; Heath, Andrew C.

    2011-01-01

    The manifestation of alcohol dependence at different developmental stages may be associated with different genetic and environmental factors. Taking a developmental approach, the current study characterized interaction between the dopamine receptor 4 variable number tandem repeat (DRD4 VNTR) polymorphism and developmentally specific environmental factors (childhood adversity, college/Greek involvement, and delayed adult role transition) on alcohol dependence during emerging and young adulthood. Prospective data were obtained from a cohort of 234 Caucasian individuals (56% female) followed up at ages 18 through 34. A longitudinal hierarchical factor model was estimated to model a trait-like persistent alcohol dependence factor throughout emerging and young adulthood and two residual state-like alcohol dependence factors limited to emerging adulthood and young adulthood, respectively. To account for those alcohol dependence factors, three two-way interaction effects between the DRD4 VNTR polymorphism and the three developmentally specific environment factors were modeled. Carriers of the DRD4 long allele showed greater susceptibility to environmental effects; they showed more persistent alcohol dependence symptoms as childhood adversity increased and more alcohol dependence symptoms limited to emerging adulthood as college/Greek involvement increased. Alcohol dependence among non-carriers of the long allele, however, did not differ as a function of those environments. Although replication is necessary, these findings highlight the importance of repeated phenotypic assessments across development and modeling both distal and proximal environments and their interaction with genetic susceptibility at specific developmental stages. PMID:21381802

  7. Differences in the stress distribution in the distal femur between patellofemoral joint replacement and total knee replacement: a finite element study

    NARCIS (Netherlands)

    Jonbergen, H.P. van; Innocenti, B.; Gervasi, G.L.; Labey, L.; Verdonschot, N.J.

    2012-01-01

    BACKGROUND: Patellofemoral joint replacement is a successful treatment option for isolated patellofemoral osteoarthritis. However, results of later conversion to total knee replacement may be compromised by periprosthetic bone loss. Previous clinical studies have demonstrated a decrease in distal

  8. Probiotics intake from proximal or distal gastrointestinal tract: The investigation on intestinal morphology and performance of Japanese quail.

    Science.gov (United States)

    Seifi, K; Karimi-Torshizi, M A; Deldar, H

    2018-02-01

    The aim of the present study was to investigate the efficacy of early single-dose probiotics administered from proximal or distal gastrointestinal tract on quails' performance and small intestinal morphology. A total of 120 Japanese quail (Coturnix coturnix japonica) 1-d-old chicks were divided into the following experimental groups before being transferred to the raising room: (i) control (no probiotic administered); (ii) oral group (received probiotics via oesophageal gavage); and (iii) vent lip group (received probiotics directly into vent). Four replicates of 10 chicks per cage were considered for each treatment and birds were raised up to 35 days in the same conditions with ad libitum access to feed and water. A commercial probiotics (Protexin, Somerset, UK) used in this study contained 2 × 109  cfu/g of nine different micro-organisms. On day 35, all birds were weighed and then three birds in every pen were killed via cervical dislocation. Two cm of mid-point of duodenum and ileum were cut for histomorphology assays. Both probiotics-treated groups had higher body weight and body weight gain than control (p < .01). Ileum was longer in probiotics-treated groups than in the control (p < .01). Orally treated birds had the highest duodenum villus height and crypt depth (p < .01). In the cloacally treated quails, ileum villus length was higher than the both other groups, and crypts' depth was deeper than the control (p < .01). The numbers of both types of goblet cells (acidic mucin producer and neutral mucin producer) were higher in the birds receiving probiotics than control birds (p < .01). Although there were no statistical differences in performance values between the different ways of probiotics entrance into gut, some intestinal histomorphometric parameters were improved in ileum of the birds receiving probiotics through distal gut that is cloaca (p < .01). © 2017 Blackwell Verlag GmbH.

  9. Chromosome breakage in Prader-Willi and Angelman syndrome deletions may involve recombination between a repeat at the proximal and distal breakpoints

    Energy Technology Data Exchange (ETDEWEB)

    Amos-Landgraf J.; Nicholls, R.D. [Case Western Reserve Univ., Cleveland, OH (United States); Gottlieb, W. [Univ. of Florida, Gainesville, FL (United States)] [and others

    1994-09-01

    Prader-Willi (PWS) and Angelman (AS) syndromes most commonly arise from large deletions of 15q11-q13. Deletions in PWS are paternal in origin, while those in AS are maternal in origin, clearly demonstrating genomic imprinting in these clinically distinct neurobehavioural disorders. In at least 90% of PWS and AS deletion patients, the same 4 Mb region within 15q11-q13 is deleted with breakpoints clustering in single YAC clones at the proximal and distal ends. To study the mechanism of chromosome breakage in PWS and AS, we have previously isolated 25 independent clones from these three YACs using Alu-vector PCR. Four clones were selected that appear to detect a low copy repeat that is located in the proximal and distal breakpoint regions of chromosome 15q11-q13. Three clones detect the same 4 HindIII bands in genomic DNA, all from 15q11-q13, with differing intensities for the probes located at the proximal or distal breakpoints region, respectively. This suggests that these probes detect related members of a low-copy repeat at either location. Moreover, the 254RL2 probe detects a novel HindIII band in two unrelated PWS deletion patients, suggesting that this may represent a breakpoint fragment, with recombination occurring within a similar interval in both patients. A fourth clone, 318RL3 detects 5 bands in HindIII-digested genomic DNA, all from 15q11-q13. This YAC endclone itself is not deleted in PWS and AS deletion patients, as seen by an invariant strong band. Two other strong bands are variably intact or deleted in different PWS or AS deletion patients, suggesting a relationship of this sequence to the breakpoints. Moreover, PCR using 318RL3 primers from the distal 93C9 YAC led to the isolation of a related clone with 96% identity, demonstrating the existence of a low-copy repeat with members close to the proximal and distal breakpoints. Taken together, our data suggest a complex, low-copy repeat with members at both the proximal and distal boundaries.

  10. Proximal balloon occlusion versus distal filter protection in carotid artery stenting: A meta-analysis and review of the literature.

    Science.gov (United States)

    Omran, Jad; Mahmud, Ehtisham; White, Christopher J; Aronow, Herbert D; Drachman, Douglas E; Gray, William; Abdullah, Obai; Abu-Fadel, Mazen; Firwana, Belal; Mishkel, Gergory; Al-Dadah, Ashraf S

    2017-04-01

    Carotid artery stenting (CAS) is typically performed using embolic protection devices (EPDs) as a means to reduce the risk of procedure-related stroke. In this study, we compared procedural morbidity and mortality associated with distal (D-EPD) vs. proximal (P-EPD) protection. MEDLINE, EMBASE, and the Cochrane Central Register of Controlled Trials were queried from January 1998 through May 2015. Only studies comparing (D-EPD) and (P-EPD) were included. Two independent reviewers selected and appraised studies and extracted data in duplicate. Random-effects meta-analysis was used to pool outcomes across studies. Heterogeneity of treatment effect among studies was assessed using the I2 statistics. Publication bias was assessed using inspection of funnel plots. The primary endpoints included 30-day mortality and stroke. Secondary endpoints included new cerebral lesions on diffusion-weighted magnetic resonance imaging (DW-MRI) and contralateral lesions on DW-MRI. A total of 12,281 patients were included from 18 studies (13 prospective and 5 retrospective) comparing (D-EPD) and (P-EPD) in the setting of CAS. The mean patient age was 69 years and 64% of patients were male. No evidence of publication bias was detected. There was no significant difference between the two modalities in terms of the risk of stroke (risk difference [RD] 0.0, 95% confidence interval [CI] -0.01 to 0.01) or mortality (RD 0.0, 95% CI -0.01 to 0.01) nor was there any difference in the incidence of new cerebral lesions on DW-MRI or contralateral DW-MRI lesions. In patients undergoing CAS, both D-EPD and P-EPD provide similar levels of protection from peri-procedural stroke and 30 days mortality. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  11. Low Osteoporosis Treatment Initiation Rate in Women after Distal Forearm or Proximal Humerus Fracture: A Healthcare Database Nested Cohort Study.

    Directory of Open Access Journals (Sweden)

    Marie Viprey

    Full Text Available Treatment initiation rates following fragility fractures have often been reported to be low and in recent years numerous programs have been implemented worldwide to increase them. This study aimed at describing osteoporosis (OP treatment initiation in a representative sample of women who were hospitalized for a distal forearm fracture (DFF or proximal humerus fracture (PHF in 2009-2011 in France. The data source was a nationwide sample of 600,000 individuals, extracted from the French National Insurance Healthcare System database. All women aged 50 years and older who were hospitalized for a DFF or PHF between 2009 and 2011 and who had not received any OP treatment in the preceding 12 months were included in a retrospective cohort study. OP treatments initiated during the year following the fracture were analyzed. From 2009 to 2011, 729 women were hospitalized for a DFF or a PHF and 284 were on OP treatment at the time of the fracture occurrence. Among the 445 women who had no prevalent OP treatment, 131 (29.4% received supplementation treatment only (vitamin D and/or calcium and 42 (9.4% received a pharmacologic OP treatment in the year following their fracture. Pharmacological OP treatments included bisphosphonates (n = 21, strontium ranelate (n = 14, hormone replacement therapy (n = 4, or raloxifene (n = 3. General practitioners prescribed 75% of initial OP treatments. Despite the guidelines published in 2006 and the numerous initiatives to promote post-fracture OP treatment, OP treatment initiation rate in women who were hospitalized for a fragility fracture remained low in 2009-2011 in France.

  12. Effect of proximal versus distal 50% enterectomy on nutritional parameters in rats preconditioned with a high-fat diet or regular chow

    OpenAIRE

    Ujwal R. Yanala; Roger D. Reidelberger; Jon S. Thompson; Valerie K. Shostrom; Mark A. Carlson

    2015-01-01

    Obesity may protect against the nutritional consequences of short bowel syndrome. We hypothesized that rats preconditioned with an obesogenic diet would have better outcomes after surgical induction of short bowel syndrome compared to rats on regular chow. Rats were fed a high-fat diet or regular rat chow for six months, and then underwent 50% proximal, 50% distal, or sham enterectomy. Food intake, weight, and body composition were monitored before and for 4 weeks after surgery. The high-fat ...

  13. Results of uncemented distal locked prosthesis in revision hip arthroplasty with proximal femoral bone loss: A retrospective study

    Directory of Open Access Journals (Sweden)

    Sanjay Agarwala

    2013-01-01

    Conclusion: Uncemented distal locked prosthesis provide adequate stability in revision THA, aiding the reconstruction of bony deficiencies while avoiding the disadvantages of fully porous or cemented implants.

  14. Long Noncoding RNA RP11-380D23.2 Drives Distal-Proximal Patterning of the Lung by Regulating PITX2 Expression.

    Science.gov (United States)

    Banerjee, Poulomi; Surendran, Harshini; Bharti, Kapil; Morishita, Kaoru; Varshney, Anurag; Pal, Rajarshi

    2018-02-01

    Early lung development is a tightly orchestrated process encompassing (a) formation of definitive endoderm, (b) anteriorization of definitive endoderm, followed by (c) specification and maturation of both proximal and distal lung precursors. Several reports detailing the interaction of genes and proteins during lung development are available; however, studies reporting the role(s) of long noncoding RNAs (lncRNA) in lung morphogenesis are limited. To investigate this, we tailored a protocol for differentiation of human-induced pluripotent stem cells into distal and proximal lung progenitors to mimic in vivo lung development. The authenticity of differentiated cells was confirmed by expression of key lung markers such as FoxA2, Sox-17, Nkx2.1, Pitx2, FoxJ1, CC10, SPC, and via scanning as well as transmission electron microscopy. We employed next generation sequencing to identify lncRNAs and categorized them based on their proximity to genes essential for lung morphogenesis. In-depth bioinformatical analysis of the sequencing data enabled identification of a novel lncRNA, RP11-380D23.2, which is located upstream of PITX2 and includes a binding site for PARP1. Chromatin immunoprecipitation and other relevant studies revealed that PARP1 is a repressor for PITX2. Whole genome microarray analysis of RP11-380D23.2/PITX2 knockdown populations of progenitors demonstrated enrichment in proximal progenitors and indicated altered distal-proximal patterning. Dysregulation of WNT effectors in both knockdowns highlighted direct modulation of PITX2 by RP11-380D23.2. Most of these results were validated in four independent hiPSC lines (including a patient-specific CFTR mutant line). Taken together, these findings offer a mechanistic explanation underpinning the role of RP11-380D23.2 during lung morphogenesis via WNT signaling. Stem Cells 2018;36:218-229. © 2017 AlphaMed Press.

  15. Effect of intertrochanteric osteotomy on the proximal femur of rabbits: assessment with power Doppler sonography and scintigraphy Efeito da osteotomia intertrocantérica no femur proximal de coelhos: avaliação com utra-sonografia power Doppler e cintilografia

    Directory of Open Access Journals (Sweden)

    Andrea S. Doria

    2007-01-01

    Full Text Available OBJECTIVE: In bone injury, repair results in local increased vascularity and bone marrow remodeling. Characterizing the vascular and metabolic imaging patterns of the proximal femur following an intertrochanteric osteotomy may help clinicians decide proper management of the patient. Our objective was to measure Doppler sonography and scintigraphy interval changes in the proximal femur following intertrochanteric osteotomy and compare imaging and histomorphometric measurements in the late post-operative stage (6 weeks after surgery in a rabbit model of bone injury. MATERIALS AND METHODS: Both hips of 12 adult rabbits were imaged with power Doppler sonography and scintigraphy prior to and after (7 days and 6 weeks unilateral osteotomy. Accuracy of the imaging methods was evaluated using hip operative status and histomorphometric results (vascular fractional area and number of vessels per area unit as reference standard measures. RESULTS: A significant difference in the mean number of pixels was noted between operated and non-operated femura in late post-operative power Doppler examinations (P=0.049. Although without reaching statistical significance, the AUC of Doppler measurements (AUC=0.99 was numerically greater than the AUC of scintigraphy measurements (AUC=0.857±0.099 (P=0.15 in differentiating proximal femura with regard to their fractional vascular areas in the late post-operative stage. In contrast, scintigraphy tended to perform better (AUC=0.984±0.022 than Doppler ultrasound (AUC=0.746±0.131 to demonstrate the vascularity intensity per area unit (P=0.07 in the late stage. CONCLUSION: Our results warrant further investigation to determine the value of different imaging modalities for assessment of pathologic changes following hip surgery. Power Doppler sonography demonstrated larger AUCs (representing higher accuracy for the discrimination of vascular fractional areas and scintigraphy, for discrimination of the number of vessels per

  16. Pulsed electromagnetic fields for postmenopausal osteoporosis and concomitant lumbar osteoarthritis in southwest China using proximal femur bone mineral density as the primary endpoint: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Liu, Hui-Fang; He, Hong-Chen; Yang, Lin; Yang, Zhou-Yuan; Yao, Ke; Wu, Yuan-Chao; Yang, Xi-Biao; He, Cheng-Qi

    2015-06-10

    Osteoporosis (OP) and osteoarthritis (OA) are prevalent skeletal disorders among postmenopausal women. Coexistence is common especially that of postmenopausal osteoporosis (PMO) and lumbar OA. An hypothesis has been raised that OP and OA might share the same pathogenic mechanism, and pulsed electromagnetic fields (PEMFs) were reported to have anti-osteoporosis and anti-osteoarthritis properties, but this suggestion was based primarily on biomarker data. Therefore, whether these two effects could take place simultaneously has not yet been investigated. This randomized controlled trial (RCT) is designed to explore the effect of PEMFs for PMO and concomitant lumbar OA. The study will include PMO patients (postmenopausal women; aged between 50 and 70 years; have been postmenopausal for at least 5 years and diagnosed with OP using proximal femur T-score) with concomitant lumbar OA (patients with confounding disorders like diabetes, hypertension, hyperlipidemia, and previous fracture history, etcetera, will be excluded) will be randomly assigned to two arms: PEMFs group and sham PEMFs group. There will be 25 participants in each arm (50 in total) and the outcome assessment, including the primary endpoint (proximal femur bone mineral density), will be performed at 5 weeks, 3 months and 6 months after enrollment. PMO and lumbar OA are prominent public health problem, especially for postmenopausal women. We hope this RCT will provide scientific evidence to primary care of the postmenopausal women regarding the use of these nonpharmaceutical, noninvasive modalities, PEMFs, in managing PMO and lumbar OA. Chinese Clinical Trial Registry: ChiCTR-TRC-14005156 (28 August 2014).

  17. [Stenting of subtotal conclusion of internal carotid artery and comparing the cerebral embolic load of proximal balloon protection device with distal filter protection device].

    Science.gov (United States)

    Yang, Qing-wei; Ji, Xun-ming; Li, Shen-mao; Zhu, Feng-shui; Chen, Yan-fei; Ye, Ming; Jiao, Li-qun

    2013-07-16

    To study the safety, efficacy and perioperative complications of endovascular therapy in the treatment of subtotal conclusion of internal carotid artery(ICA) in patients. To compare the cerebral embolic load of proximal balloon protection device versus distal filter protection device during the operation. Review all the operations of stenting for subtotal conclusion of ICA in Xuanwu hospital. New cerebral infarction after stenting was assessed by diffusion-weighted magnetic resonance imaging. Count the number of new ischemic lesions of every patient. 35 patients with subtotal conclusion of ICA received endovascular stenting. Proximal protective device was used for 21 patients. Distal protective device was used for 14 patients. All procedures succeeded. 32 patients received the cerebral MRI 1 week before and within 48 hours after the operation. Compared with filter protection(n = 14), proximal balloon device(n = 18) resulted in a significant reduction in the incidence of new cerebral infarction (6/18 vs 10/14, P = 0.03). The number of new cerebral ischemic lesions were significant reduced by proximal balloon device (1/18 vs 4/14, P = 0.0006) . There were no serious cardiovascular events in 35 patients during the operation and the following up 3 months. 3 patients had restenosis which was demonstrated by ultrasound of ICA at 3 months after stenting. Endovascular stenting may be a safe and valid method for the treatment of subtotal occlusion of ICA. For the stenting of subtotal occlusion of ICA, proximal balloon protection device as compared with filter protection may reduce the embolic load to the brain more effectively. The stenting of subtotal occlusion of ICA still needs the randomized trails to confirm the safety and validity.

  18. Long-Term Effects of Prematurity, Cumulative Medical Risk, and Proximal and Distal Social Forces on Individual Differences in Diurnal Cortisol at Young Adulthood.

    Science.gov (United States)

    Winchester, Suzy B; Sullivan, Mary C; Roberts, Mary B; Bryce, Crystal I; Granger, Douglas A

    2018-01-01

    This study examined the effects of prematurity, cumulative medical risk, and proximal and distal social forces on individual differences in the activity of the hypothalamic-pituitary-adrenal (HPA) axis in young adulthood. A prospective sample of 149 infants born healthy preterm (PT; n = 22), sick PT ( n = 93, medical illness, neurological illness, small for gestational age), and full term ( n = 34) was recruited from a Level III neonatal intensive care unit in southern New England between 1985 and 1989 and followed to age 23 years. Cumulative medical risk was indexed across seven assessment waves (spanning 17 years) using medical and neurological health status at birth, toddlerhood (ages 18 and 30 months), childhood (ages 4 and 8 years), and adolescence (ages 12 and 17 years). Distal risk included socioeconomic status (SES) at birth. Proximal social factors were indexed from assessments of the home environment and measures of child vulnerability and maternal self-esteem, involvement, and control style from birth, 4 years, 8 years, and 12 years. At age 23 years, five saliva samples were collected upon awakening, 45 min after waking, 4 hr after waking, 8 hr after waking, and bedtime (later assayed for cortisol). Results reveal effects of cumulative medical risk on the diurnal pattern of HPA axis activity, with moderating effects of SES and proximal social factors. Findings are discussed in terms of implications for contemporary theories related to developmental sensitivity and susceptibility to context and the developmental origins of health and disease theory.

  19. Motility patterns and distribution of interstitial cells of Cajal and nitrergic neurons in the proximal, mid- and distal-colon of the rat

    DEFF Research Database (Denmark)

    Albertí, E; Mikkelsen, Hanne Birte; Larsen, Jytte Overgaard

    2005-01-01

    The aim of this work was to study the patterns of spontaneous motility in the circular and longitudinal muscle strips and to characterize the distribution of c-kit positive interstitial cells of Cajal (ICCs) and nitrergic neurons (nNOS) in the proximal, mid- and distal-colon of Sprague-Dawley rats...... of the AP and the major density was found in the mid-colon. Electrical field stimulation abolished LF but did not affect HF contractions. Our results indicate that HF contractions are due to the ICC network found associated with the submuscular plexus (ICC-SMP). The origin of LF contractions is still...

  20. Axonal regeneration and development of de novo axons from distal dendrites of adult feline commissural interneurons after a proximal axotomy

    DEFF Research Database (Denmark)

    Fenrich, Keith K; Skelton, Nicole; MacDermid, Victoria E

    2007-01-01

    , develop de novo axons. Our goal was to determine whether spinal commissural interneurons (CINs), axotomized by 3-4-mm midsagittal transection at C3, form de novo axons from distal dendrites. All experiments were performed on adult cats. CINs in C3 were stained with extracellular injections of Neurobiotin...

  1. Reliability and Validity of an Observational Measure of Client Decision-Making: The Client Language Assessment - Proximal/Distal (CLA-PD).

    Science.gov (United States)

    Magill, Molly; R Apodaca, Timothy; Karno, Mitchell; Gaume, Jacques; Durst, Ayla; Walthers, Justin; L Stout, Robert; DiClemente, Carlo

    2016-04-01

    The Client Language Assessment - Proximal/Distal (CLA-PD) is a language rating system for measuring client decision-making in interventions that target a specified behavior change (e.g., alcohol or other drug use). In the CLA-PD, there are five dimensions of change language (Reason, Ability, Commitment, Taking Steps, Other) adapted from the client portion of the Motivational Interviewing Skill Code (MISC). For the CLA-PD, language codes are sub-divided to discriminate statements regarding the primary, or target behavior change (distal change) from the intermediate coping activities (proximal change) that are prescribed to facilitate that target behavior change. The goal of the CLA-PD is to allow for higher specificity than existing client language measures, when process studies consider interventions that are multi-session and skill-based (e.g., cognitive behavioral therapy). Three raters received 40 hours of training on the use of the CLA-PD. The data were a sample of therapy session audio-files from a completed clinical trial (N=126), which enabled examination of client language across four sessions (i.e., first three and final attended) of three evidence-based alcohol interventions (cognitive behavioral therapy, twelve-step facilitation therapy, motivational enhancement therapy). Inter-rater reliability results for summary scores showed "excellent" reliability for the measure. Specifically, two-way mixed intraclass coefficients ranged from .83 to .95. Internal consistency reliability showed alphas across sessions that ranged from "fair" to "good" (α=.74-.84). In convergent and discriminant validity analyses using data independently measured with MISC-based ratings, the pattern of results was as would be expected. Specifically, convergent correlations, by valence (i.e., change and sustain talk), between CLA-PD Distal and MISC-based language scores were moderate (r=.46-.55, planguage scores were small (r=.22-.24, p<.05). Finally, proportion Change Talk Proximal

  2. Association between insulin resistance, lean mass and muscle torque/force in proximal versus distal body parts in healthy young men.

    Science.gov (United States)

    Gysel, T; Calders, P; Cambier, D; Roman de Mettelinge, T; Kaufman, J-M; Taes, Y; Zmierczak, H-G; Goemaere, S

    2014-03-01

    The purpose of this study was to investigate whether there is already an association of insulin resistance (IR) with muscle mass and -force/torque in an adult population and whether this relationship is the same in distal and proximal body parts. 358 Healthy young men were divided into a more insulin sensitive (MIS) (n=89) and a less insulin sensitive (LIS) group (n=89), respectively using lower and upper quartiles of HOMA-IR index (Homeostasis Model Assessment of IR). Muscle force/torque and lean mass, were compared between the two groups. LIS subjects had higher absolute thigh lean mass, but not higher thigh muscle torque, resulting in a lower torque per kg muscle. In upper arm, lean mass was higher in LIS subjects, but also absolute muscle torque resulted higher. For handgrip force, the LIS and MIS group had similar results, despite a trend towards higher forearm lean mass in LIS subjects. Lean mass % of total lean mass is lower in LIS subjects in more distal body parts. Already in a young healthy population, IR seems to be associated with lower force/torque per muscle mass and lower lean mass % of total lean mass predominantly in more distal body parts.

  3. Dissociation between distal and proximal left limb agraphia and agraphesthesia in a patient with a callosal disconnection syndrome.

    Science.gov (United States)

    Bachoud-Lévi, A C; Ergis, A M; Cesaro, P; Degos, J D

    2000-06-01

    A few neuropsychological studies have suggested the existence of bilateral hemispheric representations for the proximal parts of the limbs in humans. We report the case of a patient who presented with a callosal disconnection syndrome, which at a later stage of disease became restricted to left agraphia, left agraphesthesia and left auditory extinction. The anomic character of the agraphesthesia was demonstrated. Tactile naming was normal, which allows us to conclude that separate callosal pathways related to the left language areas transmit information for graphesthesia and tactile naming. Agraphia and agraphesthesia were not observed when the proximal part of the left upper limb was utilized. These observations support the conclusion that writing and graphesthesia with the proximal part of the limb can be mediated by the ipsilateral cortex.

  4. "Death by a thread"--peritonitis due to visceral perforation by a guide wire, during proximal femur osteosynthesis with DHS: a fatal case and legal implications.

    Science.gov (United States)

    Durão, Carlos; Barros, André; Guerreiro, Rui; Pedrosa, Frederico

    2015-04-01

    Iatrogenic intestinal perforations in orthopaedic surgery are very rare. Reports of iatrogenic lesions caused by a guide wire during femur fracture osteosynthesis are even scarcer. There are no similar reports in recent literature. As opposed to what is normally described the lesion documented in this case report was not identified on time resulting in death by peritonitis. The forensic autopsy allowed the identification of an intestinal perforation with faecal leakage to peritoneal space in association with a vesical perforation enabling the reproduction of the guide wire path. In view of the increasing number of osteosynthesis it is essential for the surgeon to be aware of possible complications due to guide wire perforations. Cases like this go unnoticed if the forensic pathologist is not familiarized with the surgical technique which may explain the rarity of such descriptions in literature. Copyright © 2015. Published by Elsevier Ireland Ltd.

  5. The effects of necrotic lesion size and orientation of the femoral component on stress alterations in the proximal femur in hip resurfacing - a finite element simulation.

    Science.gov (United States)

    Tai, Ching-Lung; Chen, Yung-Chou; Hsieh, Pang-Hsin

    2014-08-05

    Due to the advantages of its bone-conserving nature, hip resurface arthroplasty (HRA) has recently gained the interest of orthopedic surgeons for the treatment of young and active patients who have osteonerosis of the femoral head. However, in long-term follow-up studies after HRA, narrowing of the femoral neck has often been found, which may lead to fracture. This phenomenon has been attributed to the stress alteration (stress shielding). Studies addressing the effects of necrotic size and the orientation of the implant on stress alterations are lacking. Computed tomography images of a standard composite femur were used to create a three-dimensional finite-element (FE) intact femur model. Based on the intact model, FE models simulating four different levels of necrotic regions (0°, 60°, 100°, 115°) and three different implant insertion angles (varus 10°, neutral, valgus 10°) were created. The von Mises stress distributions and the displacement of the stem tip of each model were analyzed and compared for loading conditions that simulated a single-legged stance. Stress shielding occurred at the femoral neck after HRA. More severe stress shielding and an increased displacement of the stem tip were found for femoral heads that had a wider necrotic lesion. From a biomechanics perspective, the results were consistent with clinical evidence of femoral neck narrowing after HRA. In addition, a varus orientation of the implant resulted in a larger displacement of the stem tip, which could lead to an increased risk of implant loosening. A femoral head with a wide necrotic lesion combined with a varus orientation of the prosthesis increases the risk of femoral neck narrowing and implant loosening following HRA.

  6. Distal femoral flexion deformity from growth disturbance treated with a two-level osteotomy and internal lengthening nail.

    Science.gov (United States)

    Fragomen, Austin T; Fragomen, Fiona R

    2017-11-01

    Salter Harris fractures of the distal femur can lead to growth disturbance with resulting leg length inequality and knee deformity. We have looked at a case series (3) of patients who presented with a distal femur flexion malunion and shortening treated with a distal femoral osteotomy and plating and a proximal femoral osteotomy with a magnetic internal lengthening nail. Does a two-level osteotomy and internal fixation approach provide a reliable result both radiographically and functionally? The average knee extension loss was 12°, LLD 47 mm, PDFA 65°, MAD 2 mm. The patients were treated with an acute, posterior, opening wedge osteotomy of the distal femur stabilized with a lateral plate and screws and grafted with cancellous chips and putty. A second osteotomy was made proximally in the femur percutaneously, and the internal lengthening nail was inserted. Lengthening was done at approximately 1 mm/day. The average extension gain was 12°; amount of lengthening at the proximal site was 40 mm, LLD was 3 mm. The average PDFA was 81°, and MAD 3 mm. There were no complications. Functional results were excellent. Bone healing index was 24 days/cm. The average distance from the distal osteotomy to the joint line was 57 mm. The technique of two-level femur osteotomy stabilized with a plate and lengthening nail yielded excellent results with acceptable correction of deformity, full knee extension, and improved function. There were no complications including implant failure, infection, need for blood transfusion, knee stiffness, nonunion, compartment syndrome, or malunion.

  7. Distal femoral flexion deformity from growth disturbance treated with a two-level osteotomy and internal lengthening nail

    Directory of Open Access Journals (Sweden)

    Austin T. Fragomen

    2017-10-01

    Full Text Available Abstract Salter Harris fractures of the distal femur can lead to growth disturbance with resulting leg length inequality and knee deformity. We have looked at a case series (3 of patients who presented with a distal femur flexion malunion and shortening treated with a distal femoral osteotomy and plating and a proximal femoral osteotomy with a magnetic internal lengthening nail. Does a two-level osteotomy and internal fixation approach provide a reliable result both radiographically and functionally? The average knee extension loss was 12°, LLD 47 mm, PDFA 65°, MAD 2 mm. The patients were treated with an acute, posterior, opening wedge osteotomy of the distal femur stabilized with a lateral plate and screws and grafted with cancellous chips and putty. A second osteotomy was made proximally in the femur percutaneously, and the internal lengthening nail was inserted. Lengthening was done at approximately 1 mm/day. The average extension gain was 12°; amount of lengthening at the proximal site was 40 mm, LLD was 3 mm. The average PDFA was 81°, and MAD 3 mm. There were no complications. Functional results were excellent. Bone healing index was 24 days/cm. The average distance from the distal osteotomy to the joint line was 57 mm. The technique of two-level femur osteotomy stabilized with a plate and lengthening nail yielded excellent results with acceptable correction of deformity, full knee extension, and improved function. There were no complications including implant failure, infection, need for blood transfusion, knee stiffness, nonunion, compartment syndrome, or malunion.

  8. Weakness in the mechanical properties of the femurs of growing female rats exposed to cadmium

    Energy Technology Data Exchange (ETDEWEB)

    Brzoska, Malgorzata M.; Moniuszko-Jakoniuk, Janina [Medical University of Bialystok, Department of Toxicology, Bialystok (Poland); Majewska, Katarzyna [University of Warmia and Mazury (Poland). Faculty of Food Science

    2005-09-01

    The study assessed the effect of cadmium (Cd) intoxication on the risk of deformities and fractures of the growing bones of female rats, in order to model human exposure to this metal. For this purpose, bone mineral density and mechanical properties of the proximal and distal ends and diaphysis of the femur were investigated in female Wistar rats exposed to 1, 5 and 50 mg Cd/l in drinking water for 3, 6, 9 and 12 months after the onset of weaning. Daily Cd doses received from drinking water during the treatment period were in the following ranges: 0.059-0.219, 0.236-1.005 and 2.247-9.649 mg/kg body weight at 1, 5 and 50 mg Cd/l, respectively. Biomechanical properties of the femoral proximal and distal ends were evaluated in a compression test, and those of the femoral diaphysis in a cutting test, with loading perpendicular to the longitudinal axis of the bone in all tests. The mineralization and mechanical properties of the bone tissue at various locations on the femur were affected by exposure to Cd in a dose- and duration-dependent manner. Exposure to 1 mg Cd/l (corresponding to low human exposure) during skeletal development weakened the fracture strength of the femoral neck and the trabecular bone at the level of the distal end of the femur and affected the elastic properties of the cortical bone at the femoral diaphysis. At higher levels of Cd exposure, adverse effects were generally observed after a shorter exposure period than for 1 mg Cd/l, and were more advanced. The cadmium-induced weakening of the biomechanical properties of bone at particular sites on the femur correlated with the decreased bone mineralization. The results indicate that even a low exposure to Cd may affect the mineralization and biomechanical properties of growing bone, thus enhancing the risk of fracture. (orig.)

  9. Weakness in the mechanical properties of the femur of growing female rats exposed to cadmium

    Energy Technology Data Exchange (ETDEWEB)

    Brzoska, Malgorzata M.; Moniuszko-Jakoniuk, Janina [Medical University of Bialystok, Department of Toxicology, Bialystok (Poland); Majewska, Katarzyna [University of Warmia and Mazury, Olsztyn (Poland). Faculty of Food Science

    2005-05-01

    This study was aimed at assessing the effect of cadmium (Cd) intoxication on the risk of deformities and fractures of the growing bone on a female rat model of human exposure to this metal. For this purpose, bone mineral density (BMD) and mechanical properties of the proximal and distal ends and diaphysis of the femur were investigated in female Wistar rats exposed to 1, 5, and 50 mg Cd L{sup -1} in drinking water for 3, 6, 9, and 12 months since weaning. Daily Cd doses received from the drinking water during the treatment period were in the ranges 0.059-0.219, 0.236-1.005, and 2.247-9.649 mg kg{sup -1} body weight at 1, 5, and 50 mg Cd L{sup -1}, respectively. Biomechanical properties of the femoral proximal and distal ends were evaluated in a compression test and those of the femoral diaphysis in a cutting test with loading perpendicular to the bone longitudinal axis in all tests. Cd dose- and exposure duration-dependently affected the mineralization and mechanical properties of the bone tissue at various locations of the femur. Exposure to 1 mg Cd L{sup -1} (corresponding to low human exposure) during skeletal development weakened the fracture strength of the femoral neck and of the trabecular bone at the level of the distal end of the femur and affected the elastic properties of the cortical bone at the femoral diaphysis. At the higher levels of Cd treatment, the adverse action generally occurred after shorter exposure than at 1 mg Cd L{sup -1} and was more seriously advanced. The Cd-induced weakening in the bone biomechanical properties at particular sites of the femur correlated with the decreased bone mineralization. The results indicate that even low exposure to Cd may affect the mineralization and biomechanical properties of growing bone, thus increasing the risk of fractures. (orig.)

  10. Association between femur size and a focal defect of the superior femoral neck.

    Science.gov (United States)

    Gee, A H; Treece, G M; Tonkin, C J; Black, D M; Poole, K E S

    2015-12-01

    Within each sex, there is an association between hip fracture risk and the size of the proximal femur, with larger femurs apparently more susceptible to fracture. Here, we investigate whether the thickness and density of the femoral cortex play a role in this association: might larger femurs harbour focal, cortical defects? To answer this question, we used cortical bone mapping to measure the distribution of cortical mass surface density (CMSD, mg/cm(2)) in cohorts of 308 males and 125 females. Principal component analysis of the various femoral surfaces led to a measure of size that is linearly independent from shape. After mapping the data onto a canonical femur surface, we used statistical parametric mapping to identify any regions where CMSD depends on size, allowing for other confounding covariates including shape. Our principal finding was a focal patch on the superior femoral neck, where CMSD is reduced by around 1% for each 1% increase in proximal-distal size (pfracture risk. Copyright © 2015. Published by Elsevier Inc.

  11. [THE HUMORAL, NEUROHORMONAL VEGETATIVE AND HYDRAULIC REGULATION OF METABOLISM. THE DISTAL AND PROXIMAL SECTIONS OF ARTERIAL BLOODSTREAM. THE FATTY ACIDS AND METABOLIC ARTERIAL HYPERTENSION (A LECTURE)].

    Science.gov (United States)

    Titov, V N; Dmitriev V A

    2015-04-01

    The regulation of metabolism formed sequentially in phylogenesis at three levels separately: autocrine level--in cell; in paracrin cell cenosis--structural and functional units of organs; at organism level. The interrelated variants of regulation: humoral; neurohumoral; neurohormonal; vegetative-sympathetic; parasympathetic--conduction of nervous impulse is to be evaluated in consequence of becoming of stages of phylogenesis. The becoming of hydrodynamic regulation is early even. The impact by pressure (blood flow) in paracrin cell cenosis is implemented by local peristaltic pumps in open-ended system of lymph and blood circulation. In closed system of circulation occurred separation of arterial flow on two functional sections. Phylogenetically early distal with regulation of hydrodynamic pressure by arterioles of muscular type in paracrin cell cenosis and compensation of disorders of biological reaction metabolism-micro-circulation (MM). In later proximal section, arteries of elastic type arterial pressure forms heart as a central pump under sympathetic innervation at level of organism from vasomotor center. The physical factor--pressure--became regulator of reaction M M. Increasing of arterial pressure in proximal systemically increases blood pressure in distal and all paracrin cell cenosises compensating alteration of reaction M M. The systemic non-optimal increasing of hydrodynamic pressure invoke negative reaction of organs controlling hydrodynamics in local pools of intercellular medium: kidneys with pool of primary urine; brain with spinal fluid; lungs with pulmonary circulation; placenta with pool of amniotic medium. All of them tend to decrease blood flow in organs. The activation of synthesis of angiotensin-II forms pathologic compensation and their secondary damage as organs-targets. The sympathetic stimulation of heart forces it to work at full capacity. No humoral mediator or internal organ can regulate arterial pressure.

  12. Quantitative CT assessment of proximal femoral bone density. An experimental study concerning its correlation to breaking load for femoral neck fractures; Quantitative CT des proximalen Femurs. Experimentelle Untersuchungen zur Korrelation mit der Bruchlast bei Schenkelhalsfrakturen

    Energy Technology Data Exchange (ETDEWEB)

    Buitrago-Tellez, C.H.; Schulze, C.; Gufler, H.; Langer, M. [Abt. Roentgendiagnostik, Radiologische Universitaetsklinik, Albert-Ludwigs-Univ. Freiburg (Germany); Bonnaire, F.; Hoenninger, A.; Kuner, E. [Abt. Unfallchirurgie, Chirurgische Universitaetsklinik, Albert-Ludwigs-Univ. Freiburg (Germany)

    1997-12-01

    Purpose: In an experimental study, the correlation between the trabecular bone density of the different regions of the proximal femur and the fracture load in the setting of femoral neck fractures was examined. Methods: The bone mineral density 41 random proximal human femora was estimated by single-energy quanitative CT (SE-QCT). The trabecular bone density was measured at the greatest possible extracortical volume at midcapital, midneck and intertrochanteric level and in the 1 cm{sup 3} volumes of the centres of these regions in a standardised 10 mm thick slice in the middle of the femoral neck axis (in mg/ml Ca-hydroxyl apatite). The proximal femora were then isolated and mounted on a compression/bending device under two-legged stand conditions and loaded up to the point when a femoral neck fracture occurred. Results: Statistical analysis revealed a linear correlation between the trabecular bone density and the fracture load for the greater regions, with the highest value in the maximal area of the head (coefficient factor r=0.76). Conclusion: According to our data, the measurement of the trabecular bone by SE-QCT at the femoral head is a more confident adjunct than the neck or trochanteric area to predict a femoral neck fracture. (orig.) [Deutsch] Ziel: In einer experimentellen Versuchsserie wurde der Zusammenhang zwischen der Knochendichte an verschiedenen Lokalisationen des proximalen Femurs und der maximalen Last bei der Entstehung von Schenkelhalsfrakturen (Bruchlast) untersucht. Methode: An 41 frisch entnommenen proximalen Leichenfemora wurde die trabekulaere Knochendichte mit Hilfe der Ein-Energie Quantitativen Computertomographie (SE-QCT) bei einer Schichtdicke von 10 mm in der Mitte der Schenkelhalsachse bestimmt. Erfasst wurden die maximale extrakortikale, zylinderfoermige Messregion im Hueftkopf, Schenkelhals und der Intertrochantaerregion sowie das 1 cm{sup 3} umfassende Zentrum dieser Regionen. Die Praeparate wurden unter Zweibeinstandbedingungen

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

    Science.gov (United States)

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

    2015-12-01

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

  14. Perioperative and mid-term results of endovascular management of complicated type B aortic dissection using a proximal thoracic endoprosthesis and selective distal bare stenting.

    Science.gov (United States)

    Kische, Stephan; D'Ancona, Giuseppe; Belu, Ioan Christian; Stoeckicht, Yannik; Agma, Umut; Ortak, Jasmin; Ince, Hüseyin

    2015-10-01

    To present results of endovascular treatment of complicated type B aortic dissection. Patients with acutely complicated type B aortic dissection extending from the left sub-clavian artery to the abdominal aorta were treated. The strategy involved the placement of a covered endoprosthesis to seal the primary entry tear and, in cases where malperfusion persisted, distal extension with uncovered stents, to enhance true lumen (TL) expansion and reperfusion of the ischaemic arterial branches originating from the TL. Thirty-five patients were included. Mean age was 63.1 (37-79) years and malperfusion syndrome occurred in 71.4%. Average aortic coverage with endoprostheses was 220.6 mm (136-355 mm). In 17 cases (48.5%), distal extension with uncovered stents was necessary. Thirty-day major morbidity was 28.5%, and mortality 2.8%. At follow-up (25.6 ± 19.5 months; 4-73 months), overall mortality was 15.2%, and aortic mortality 12.1%. Additional aortic intervention was necessary in 18.2%. Although patients undergoing distal extension with bare metal stents suffered most often from preoperative malperfusion, no significant differences were noted in the 30-day and follow-up clinical results. Follow-up angio-computed tomography showed complete thrombosis of the false lumen in the proximal half of the thoracic aorta in 76.4%. Patients treated with bare stents had significantly larger aortic TL sizes, at the different abdominal aorta levels. In patients with complicated type B aortic dissection, tailored elongation with uncovered stents is a safe treatment of persistent malperfusion. Although the results presented are encouraging, randomized data and a longer follow-up are required to confirm benefits and complications of this strategy. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  15. Importance of a distal proximal contact on load transfer by implant-supported single adjacent crowns in posterior region of the mandible: a photoelastic study

    Science.gov (United States)

    de AGUIAR JÚNIOR, Fábio Afrânio; TIOSSI, Rodrigo; MACEDO, Ana Paula; de MATTOS, Maria da Gloria Chiarello; RIBEIRO, Ricardo Faria; RODRIGUES, Renata Cristina Silveira

    2013-01-01

    Objective This study aimed to evaluate the importance of a distal proximal contact on the load transfer to the posterior region of the mandible by non-splinted adjacent implant-supported crowns using photoelastic stress analysis. Material and Methods A rectangular model (68x30x15 mm) was made of polymethylmethacrylate resin to simulate half of the mandibular arch. One model was completed with resin replicas representing the first premolar and second molar and with two 3.75 mm dia.x11 mm internal hexagon threaded implants replacing the second premolar and first molar. The other model was manufactured in the same way but without the second molar. Both models were duplicated using photoelastic resin. The roots of the teeth replicas were covered with a layer of polyether impression material to simulate the periodontal ligament. Two different vertical loads were applied to the crowns as follows: 1 - single static point load alternately applied to the crowns replacing the second premolar and first molar (50 N); 2 - simultaneous static point loads applied to both of the crowns replacing the second premolar and first molar (100 N). The resulting isochromatic fringe pattern in the photoelastic model was monitored and photographed. Results All loading conditions studied showed that the presence of the second molar has changed the load transmission and the pattern of stresses. Conclusion Results showed that the presence of a second molar proximal contact can help minimize the stresses around the implants. PMID:24212984

  16. Importance of a distal proximal contact on load transfer by implant-supported single adjacent crowns in posterior region of the mandible: a photoelastic study

    Directory of Open Access Journals (Sweden)

    Fabio Afranio de Aguiar Junior

    2013-09-01

    Full Text Available OBJECTIVE: This study aimed to evaluate the importance of a distal proximal contact on the load transfer to the posterior region of the mandible by non-splinted adjacent implant-supported crowns using photoelastic stress analysis. MATERIAL AND METHODS: A rectangular model (68x30x15 mm was made of polymethylmethacrylate resin to simulate half of the mandibular arch. One model was completed with resin replicas representing the first premolar and second molar and with two 3.75 mm dia.x11 mm internal hexagon threaded implants replacing the second premolar and first molar. The other model was manufactured in the same way but without the second molar. Both models were duplicated using photoelastic resin. The roots of the teeth replicas were covered with a layer of polyether impression material to simulate the periodontal ligament. Two different vertical loads were applied to the crowns as follows: 1 - single static point load alternately applied to the crowns replacing the second premolar and first molar (50 N; 2 - simultaneous static point loads applied to both of the crowns replacing the second premolar and first molar (100 N. The resulting isochromatic fringe pattern in the photoelastic model was monitored and photographed. RESULTS: All loading conditions studied showed that the presence of the second molar has changed the load transmission and the pattern of stresses. CONCLUSION: Results showed that the presence of a second molar proximal contact can help minimize the stresses around the implants.

  17. Correlação entre tempo para o tratamento cirúrgico e mortalidade em pacientes idosos com fratura da extremidade proximal do fêmur Correlation between time until surgical treatment and mortality among elderly patients with fractures at the proximal end of the femur

    Directory of Open Access Journals (Sweden)

    Gustavo Gonçalves Arliani

    2011-04-01

    Full Text Available OBJETIVO: O objetivo primário do estudo é analisar a possível associação entre o atraso para a realização do tratamento cirúrgico e mortalidade em pacientes idosos com fratura da extremidade proximal do fêmur. MÉTODOS: Foram estudados 269 pacientes com fraturas da extremidade proximal do fêmur (fraturas do colo do fêmur e fraturas intertrocanterianas, tratadas cirurgicamente no Hospital São Paulo - Unifesp-SP, no período de janeiro de 2003 a dezembro de 2007. Foram analisados e comparados com a literatura referente ao assunto os seguintes atributos: sexo, idade, tipo de fratura, classificação da mesma, lado acometido, síntese utilizada, mecanismo de trauma, tempo de internação, tempo para cirurgia, comorbidades associadas, hemograma de entrada, tipo de anestesia, necessidade de transfusão sanguínea, dia da semana e estação do ano da fratura. RESULTADOS: O estudo apresentou correlação entre maior número de comorbidades clínicas, maior tempo de internação e utilização de anestesia geral na cirurgia com maior mortalidade dos pacientes. CONCLUSÃO: Não houve associação entre tempo para realização da cirurgia e mortalidade.OBJECTIVE: The primary aim of this study was to analyze the possible association between delay in receiving surgical treatment and mortality among elderly patients with fractures at the proximal end of the femur. METHODS: 269 patients with fractures at the proximal end of the femur (femur neck and intertrochanteric fractures who were treated surgically at Hospital São Paulo, UNIFESP, São Paulo, between January 2003 and December 2007, were studied. Sex, age, type of fracture, classification of the fracture, affected side, synthesis used, trauma mechanism, length of hospitalization, length of surgery, associated comorbidities, hemogram at admission, type of anesthesia, need for blood transfusion, day of the week and season of the year of the fracture were analyzed and compared with the literature

  18. A comparison of proximal and distal Chevron osteotomy, both with lateral soft-tissue release, for moderate to severe hallux valgus in patients undergoing simultaneous bilateral correction: a prospective randomised controlled trial.

    Science.gov (United States)

    Lee, K B; Cho, N Y; Park, H W; Seon, J K; Lee, S H

    2015-02-01

    Moderate to severe hallux valgus is conventionally treated by proximal metatarsal osteotomy. Several recent studies have shown that the indications for distal metatarsal osteotomy with a distal soft-tissue procedure could be extended to include moderate to severe hallux valgus. The purpose of this prospective randomised controlled trial was to compare the outcome of proximal and distal Chevron osteotomy in patients undergoing simultaneous bilateral correction of moderate to severe hallux valgus. The original study cohort consisted of 50 female patients (100 feet). Of these, four (8 feet) were excluded for lack of adequate follow-up, leaving 46 female patients (92 feet) in the study. The mean age of the patients was 53.8 years (30.1 to 62.1) and the mean duration of follow-up 40.2 months (24.1 to 80.5). After randomisation, patients underwent a proximal Chevron osteotomy on one foot and a distal Chevron osteotomy on the other. At follow-up, the American Orthopedic Foot and Ankle Society (AOFAS) hallux metatarsophalangeal interphalangeal (MTP-IP) score, patient satisfaction, post-operative complications, hallux valgus angle, first-second intermetatarsal angle, and tibial sesamoid position were similar in each group. Both procedures gave similar good clinical and radiological outcomes. This study suggests that distal Chevron osteotomy with a distal soft-tissue procedure is as effective and reliable a means of correcting moderate to severe hallux valgus as proximal Chevron osteotomy with a distal soft-tissue procedure. ©2015 The British Editorial Society of Bone & Joint Surgery.

  19. Luciferase reporter gene assay on human, murine and rat histamine H4 receptor orthologs: correlations and discrepancies between distal and proximal readouts.

    Directory of Open Access Journals (Sweden)

    Uwe Nordemann

    Full Text Available The investigation of the (pathophysiological role of the histamine H4 receptor (H4R and its validation as a possible drug target in translational animal models are compromised by distinct species-dependent discrepancies regarding potencies and receptor subtype selectivities of the pharmacological tools. Such differences were extremely pronounced in case of proximal readouts, e. g. [(32P]GTPase or [(35S]GTPγS binding assays. To improve the predictability of in vitro investigations, the aim of this study was to establish a reporter gene assay for human, murine and rat H4Rs, using bioluminescence as a more distal readout. For this purpose a cAMP responsive element (CRE controlled luciferase reporter gene assay was established in HEK293T cells, stably expressing the human (h, the mouse (m or the rat (r H4R. The potencies and efficacies of 23 selected ligands (agonists, inverse agonists and antagonists were determined and compared with the results obtained from proximal readouts. The potencies of the examined ligands at the human H4R were consistent with reported data from [(32P]GTPase or [(35S]GTPγS binding assays, despite a tendency toward increased intrinsic efficacies of partial agonists. The differences in potencies of individual agonists at the three H4R orthologs were generally less pronounced compared to more proximal readouts. In conclusion, the established reporter gene assay is highly sensitive and reliable. Regarding discrepancies compared to data from functional assays such as [(32P]GTPase and [(35S]GTPγS binding, the readout may reflect multifactorial causes downstream from G-protein activation, e.g. activation/amplification of or cross-talk between different signaling pathways.

  20. Fatigue-related firing of distal muscle nociceptors reduces voluntary activation of proximal muscles of the same limb.

    Science.gov (United States)

    Kennedy, David S; McNeil, Chris J; Gandevia, Simon C; Taylor, Janet L

    2014-02-15

    With fatiguing exercise, firing of group III/IV muscle afferents reduces voluntary activation and force of the exercised muscles. These afferents can also act across agonist/antagonist pairs, reducing voluntary activation and force in nonfatigued muscles. We hypothesized that maintained firing of group III/IV muscle afferents after a fatiguing adductor pollicis (AP) contraction would decrease voluntary activation and force of AP and ipsilateral elbow flexors. In two experiments (n = 10) we examined voluntary activation of AP and elbow flexors by measuring changes in superimposed twitches evoked by ulnar nerve stimulation and transcranial magnetic stimulation of the motor cortex, respectively. Inflation of a sphygmomanometer cuff after a 2-min AP maximal voluntary contraction (MVC) blocked circulation of the hand for 2 min and maintained firing of group III/IV muscle afferents. After a 2-min AP MVC, maximal AP voluntary activation was lower with than without ischemia (56.2 ± 17.7% vs. 76.3 ± 14.6%; mean ± SD; P muscle afferents from the hand decreased voluntary drive and force of AP. Moreover, this effect decreased voluntary drive and torque of proximal unfatigued muscles, the elbow flexors. Fatigue-sensitive group III/IV muscle nociceptors act to limit voluntary drive not only to fatigued muscles but also to unfatigued muscles within the same limb.

  1. Relationships of trabecular bone structure with quantitative ultrasound parameters: in vitro study on human proximal femur using transmission and backscatter measurements.

    Science.gov (United States)

    Padilla, F; Jenson, F; Bousson, V; Peyrin, F; Laugier, P

    2008-06-01

    The present study was designed to assess the relationships between QUS parameters and bone density or microarchitecture on samples of human femoral trabecular bone. The normalized slope of the frequency-dependent attenuation (nBUA), the speed of sound (SOS) and the broadband ultrasound backscatter coefficient (BUB) were measured on 37 specimens of pure trabecular bones removed from upper parts of fresh human femurs. Bone mineral density (BMD) was assessed using a clinical scanner. Finally, 8 mm diameter cylindrical cores were extracted from the specimens and their microarchitecture was reconstructed after synchrotron radiation microtomography experiments (isotropic resolution of 10 microm). A large number of microarchitectural parameters were computed, describing morphology, connectivity and geometry of the specimens. BMD correlated with all the microarchitectural parameters and the number of significant correlations was found among the architectural parameters themselves. All QUS parameters were significantly correlated to BMD (R=0.83 for nBUA, R=0.81 for SOS and R=0.69 for BUB) and to microarchitectural parameters (R=-0.79 between nBUA and Tb.Sp, R=-0.81 between SOS and Tb.Sp, R=-0.65 between BUB and BS/BV). Using multivariate model, it was found that microstructural parameters adds 10%, 19%, and 4% to the respective BMD alone contribution for the three variables BUA, SOS and BUB. Moreover, the RMSE was reduced by up to 50% for SOS, by up to 21% for nBUA and up to 11% when adding structural variables to BMD in explaining QUS results. Given the sample, which is not osteoporosis-enriched, the added contribution is quite substantial. The variability of SOS was indeed completely explained by a multivariate model including BMD and independent structural parameters (R(2)=0.94). The inverse problem on the data presented here has been addressed using simple and multiple linear regressions. It was shown that the predictions (in terms of R(2) or RMSE) of microarchitectural

  2. Age and whole rock glass compositions of proximal pyroclastics from the major explosive eruptions of Somma-Vesuvius: A review as a tool for distal tephrostratigraphy

    Science.gov (United States)

    Santacroce, Roberto; Cioni, Raffaello; Marianelli, Paola; Sbrana, Alessandro; Sulpizio, Roberto; Zanchetta, Giovanni; Donahue, Douglas J.; Joron, Jean Louis

    2008-10-01

    A review of compositional data of the major explosive eruptions of Vesuvius is presented, comparing compositions (major elements) of whole rock with glass shards from the proximal deposits, hopefully useful for long-distance correlation. A critical review of published and new geochronological data is also provided. All available 14C ages are calibrated to give calendar ages useful for the reconstruction of the volcanological evolution of the volcanic complex. The pyroclastic deposits of the four major Plinian eruptions (22,000 yr cal BP "Pomici di Base", 8900 yr cal BP "Mercato Pumice", 4300 yr cal BP "Avellino Pumice", and A.D. 79 "Pompeii Pumice") are widely dispersed and allow a four-folded, Plinian to Plinian, stratigraphic division: 1. B-M (between Pomici di Base and Mercato); 2. M-A (between Mercato and Avellino); 3. A-P (between Avellino and Pompeii); 4. P-XX (from the Pompeii Pumice to the last erupted products of the XXth century). Within each interval, the age, lithologic and compositional features of pyroclastic deposits of major eruptions, potentially useful for tephrostratigraphic purposes on distal areas, are briefly discussed. The Vesuvius rocks are mostly high Potassic products, widely variable in terms of their silica saturation. They form three groups, different for both composition and age: 1. slightly undersaturated, older than Mercato eruption; 2. mildly undersaturated, from Mercato to Pompeii eruptions; 3. highly undersaturated, younger than Pompeii eruption. For whole rock analyses, the peculiar variations in contents of some major and trace elements as well as different trends in element/element ratios, allow a clear, unequivocal, easy diagnosis of the group they belong. Glass analyses show large compositional overlap between different groups, but selected element vs. element plots are distinctive for the three groups. The comparative analysis of glass and whole rock major element compositions provides reliable geochemical criteria helping

  3. Proximal femur geometry in the adult Kenyan femur and its ...

    African Journals Online (AJOL)

    The PDF file you selected should load here if your Web browser has a PDF reader plug-in installed (for example, a recent version of Adobe Acrobat Reader). If you would like more information about how to print, save, and work with PDFs, Highwire Press provides a helpful Frequently Asked Questions about PDFs.

  4. Inhibition of Notch signalling has ability to alter the proximal and distal TCR signalling events in human CD3+ αβ T-cells.

    Science.gov (United States)

    Dar, Asif A; Bhat, Sajad A; Gogoi, Dimpu; Gokhale, Abhiram; Chiplunkar, Shubhada V

    2017-12-01

    The Notch signalling pathway is an important regulator of T cell function and is known to regulate the effector functions of T cells driven by T cell receptor (TCR). However, the mechanism integrating these pathways in human CD3+ αβ T cells is not well understood. The present study was carried out to investigate how Notch and TCR driven signalling are synchronized in human αβ T cells. Differential expression of Notch receptors, ligands, and target genes is observed on human αβ T cells which are upregulated on stimulation with α-CD3/CD28 mAb. Inhibition of Notch signalling by GSI-X inhibited the activation of T cells and affected proximal T cell signalling by regulating CD3-ζ chain expression. Inhibition of Notch signalling decreased the protein expression of CD3-ζ chain and induced expression of E3 ubiquitin ligase (GRAIL) in human αβ T cells. Apart from affecting proximal TCR signalling, Notch signalling also regulated the distal TCR signalling events. In the absence of Notch signalling, α-CD3/CD28 mAb induced activation and IFN-γ production by αβ T cells was down-modulated. The absence of Notch signalling in human αβ T cells inhibited proliferative responses despite strong signalling through TCR and IL-2 receptor. This study shows how Notch signalling cooperates with TCR signalling by regulating CD3-ζ chain expression to support proliferation and activation of human αβ T cells. Copyright © 2017 Elsevier Ltd. All rights reserved.

  5. Extensile decompression of the proximal and distal tarsal tunnel combined with partial plantar fascia release in the treatment of chronic plantar heel pain.

    Science.gov (United States)

    Mook, William R; Gay, Tenaja; Parekh, Selene G

    2013-02-01

    Chronic heel pain that is recalcitrant to nonoperative measures is a rare but disabling condition. There are no reports in the literature of extensile proximal and distal tarsal tunnel release combined with partial plantar fasciotomy in the treatment of chronic heel pain. We present our results. A retrospective chart review was conducted, and charts were assessed for details of their presenting complaints, physical exam, diagnostic studies, medical history, Visual Analog Scale (VAS) scores for pain, American Orthopaedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores, and complications. The mean AOFAS ankle-hindfoot score was 86 ± 12.9 (range = 69-100). Of 15 heels, 10 (67%) had an excellent or good rating at the time of the last follow-up visit. One of 15 (7%) reported a poor outcome. The mean VAS pain score changed from 6.3 ± 3.1 to 1.4 ± 1.8 (P = .001). There were no wound complications or infections. This technique offers another operative option for chronic heel pain that is associated with satisfactory outcomes and rest pain relief. Despite reducing pain at rest in all patients, the majority of patients may be left with mild to moderate residual symptoms with activity that is similar to the outcomes of previously reported procedures.

  6. Effect of proximal versus distal 50% enterectomy on nutritional parameters in rats preconditioned with a high-fat diet or regular chow.

    Science.gov (United States)

    Yanala, Ujwal R; Reidelberger, Roger D; Thompson, Jon S; Shostrom, Valerie K; Carlson, Mark A

    2015-11-27

    Obesity may protect against the nutritional consequences of short bowel syndrome. We hypothesized that rats preconditioned with an obesogenic diet would have better outcomes after surgical induction of short bowel syndrome compared to rats on regular chow. Rats were fed a high-fat diet or regular rat chow for six months, and then underwent 50% proximal, 50% distal, or sham enterectomy. Food intake, weight, and body composition were monitored before and for 4 weeks after surgery. The high-fat diet consistently produced obesity (>25% body fat). All procedures induced weight loss, but there was no discernable difference between resection vs. sham resection. Rats on the high-fat diet had a greater post-resection loss of body fat compared to rats on chow (36 vs. 26 g, respectively). There was a nonsignificant trend of less lean mass loss in the former compared to the latter rats (16 vs. 33 g, respectively). Enterectomy moderated serum ghrelin, GIP, PPY, insulin, and leptin. Intestinal adaptation was not different between obese vs. non-obese rats. Rats preconditioned with the high-fat diet may have had better retention of lean body mass after a surgical procedure compared to rats on chow. The effect of 50% enterectomy was less than expected.

  7. Efeitos do treinamento físico sobre a resistência mecânica do terço proximal do fêmur de ratos Effects of physical training on the mechanical resistance of rat femur proximal thirds

    Directory of Open Access Journals (Sweden)

    Andreo Fernando Aguiar

    2010-01-01

    Full Text Available OBJETIVO: Analisar o comportamento mecânico do terço proximal do fêmur de ratos submetidos ao treinamento aeróbio e resistido crônicos. MÉTODOS: Ratos Wistar machos (80 dias, 300 a 350 g foram divididos em 3 grupos (n=8 por grupo: Treinamento aeróbio/8 semanas (TA, Treinamento resistido/8 semanas (TR e controle/8 semanas (CO. Ao término do período de treinamento os animais foram sacrificados e o fêmur direito coletado. Para análise do comportamento mecânico do fêmur foram realizados ensaios de flexo-compressão. RESULTADOS: O treinamento resistido ocasionou redução significante da força máxima (Fmáx do fêmur. Por outro lado, promoveu um aumento (23,7% relevante, porém não significante, da deformação da força máxima (DFmáx. O treinamento aeróbio não afetou a Fmáx, porém promoveu uma redução (26,6% considerável, também não significante, da DFmáx. CONCLUSÕES: Os resultados demonstram que o treinamento resistido e aeróbio, promoveram redução da Fmáx e da DFmáx óssea, respectivamente. Os dados evidenciam uma ação diferencial de ambos os modelos de treinamento físico sobre as propriedades mecânicas do fêmur de ratos.OBJECTIVE: To analyze the mechanical behavior of rat femur proximal thirds submitted to chronic aerobic and resistance training. METHODS: Male Wistar rats (80 days of age, weighing 300 to 350 g were divided into 3 groups (n=8 per group: control (CO, aerobic training (TA and resistance training (TR. At the end of the training, the animals were euthanized and the right femur was collected. Flexion-compression tests were carried out to analyze the mechanical behavior of the femurs. RESULTS: The resistance training promoted a significant reduction in maximum force (Fmáx of the femur. However, it also promoted a relevant increase (23.7%, though without statistical significance, in maximum force deformation (DFmáx. The aerobic training did not affect maximum force, however, it caused a

  8. Femur fracture repair - discharge

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/patientinstructions/000166.htm Femur fracture repair - discharge To use the sharing features on this page, please enable JavaScript. You had a fracture (break) in the femur in your leg. It ...

  9. Evaluation of bone deformities of the femur, tibia, and patella in Toy Poodles with medial patellar luxation using computed tomography.

    Science.gov (United States)

    Yasukawa, Shinji; Edamura, Kazuya; Tanegashima, Koji; Seki, Mamiko; Teshima, Kenji; Asano, Kazushi; Nakayama, Tomohiro; Hayashi, Kei

    2016-01-01

    To evaluate morphological parameters of the femur, tibia, and patella in Toy Poodles with medial patellar luxation (MPL) using three-dimensional (3D) computed tomography (CT) and to compare these parameters between radiography and CT. Thirty-five hindlimbs of Toy Poodles were divided into normal and grade 2 and 4 MPL groups. The anatomical and mechanical lateral proximal femoral angle, anatomical and mechanical lateral distal femoral angle (aLDFA, mLDFA), femoral varus angle (FVA), inclination of the femoral head angle, procurvation angle, anteversion angle (AA), frontal angle of the femoral neck, mechanical medial proximal or distal tibial angle, mechanical cranial proximal or distal tibial angle, tibial plateau angle, tibial torsion angle (TTA), Z angle, relative tibial tuberosity width, ratio of the medial distance of tibial tuberosity to the proximal tibial width (MDTT/PTW), patella size, and the patellar ligament length: patellar length (L:P) ratio were evaluated on radiography and 3D CT. The aLDFA, mLDFA, FVA, and TTA were significantly larger and the AA, MDTT/PTW, and patella were significantly smaller in the grade 4 MPL group. There were significant differences in many parameters between imaging tools, and CT was considered less susceptible to potential artefacts and rotational deformities. Toy Poodles with grade 4 MPL had significant femoral varus deformity, medial displacement of the tibial tuberosity, internal torsion of the proximal tibia, and hypoplasia of the patella.

  10. The effect of an external hip joint stabiliser on gait function after surgery for tumours located around the circumference of the pelvis: analysis of seven cases of internal hemipelvectomy or proximal femur resection.

    Science.gov (United States)

    Akiyama, Toru; Saita, Kazuo; Ogura, Koichi; Kawai, Akira; Imanishi, Jungo; Yazawa, Yasuo; Kawashima, Noritaka; Ogata, Toru

    2016-03-01

    Limb-sparing resection of malignant pelvic tumours provides the opportunity for patients to obtain better post-operative mobility. However, because few studies have examined in detail the gait function of patients following pelvic tumour resection, the factors affecting gait performance remain to be clarified. Here, with the laboratory-based computer-assisted gait analysis, we evaluated these patients' gait objectively and the impact of a hip-stabilising supporter on gait improvement was simultaneously examined. Three-dimensional gait analysis was performed to obtain cross-sectional data for seven post-operative patients (mean age, 42.7 years; range, 20-61 years) who underwent various types of resection, including P1/4 internal hemipelvectomy (IH), P1/2/3 IH, and proximal femur resection with prosthetic reconstruction. To assess the immediate effects of a hip joint stabiliser, we instructed subjects to walk at their self-selected preferred speed and compared gait parameters with and without use of the hip stabiliser. At baseline, the average walking speed was 0.75 m/s (95% CI 0.53-0.97). As shown by the intra-subject comparison, the hip stabiliser increased walking speed in all but one subject, increasing both temporal and spatial parameters. Ground reaction force of operated limbs increased for some subjects, while step length increased on at least one side in all subjects. Improvement in the gait parameters is indicative of better control provided by the external hip stabiliser over the affected limb. Moreover, our findings show the potential of a biomechanical approach to improve gait function following pelvic tumour resection.

  11. Biased, non-equivalent gene-proximal and -distal binding motifs of orphan nuclear receptor TR4 in primary human erythroid cells.

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    Lihong Shi

    2014-05-01

    Full Text Available We previously reported that TR2 and TR4 orphan nuclear receptors bind to direct repeat (DR elements in the ε- and γ-globin promoters, and act as molecular anchors for the recruitment of epigenetic corepressors of the multifaceted DRED complex, thereby leading to ε- and γ-globin transcriptional repression during definitive erythropoiesis. Other than the ε- and γ-globin and the GATA1 genes, TR4-regulated target genes in human erythroid cells remain unknown. Here, we identified TR4 binding sites genome-wide using chromatin immunoprecipitation followed by massively parallel sequencing (ChIP-seq as human primary CD34(+ hematopoietic progenitors differentiated progressively to late erythroid precursors. We also performed whole transcriptome analyses by RNA-seq to identify TR4 downstream targets after lentiviral-mediated TR4 shRNA knockdown in erythroid cells. Analyses from combined ChIP-seq and RNA-seq datasets indicate that DR1 motifs are more prevalent in the proximal promoters of TR4 direct target genes, which are involved in basic biological functions (e.g., mRNA processing, ribosomal assembly, RNA splicing and primary metabolic processes. In contrast, other non-DR1 repeat motifs (DR4, ER6 and IR1 are more prevalent at gene-distal TR4 binding sites. Of these, approximately 50% are also marked with epigenetic chromatin signatures (such as P300, H3K27ac, H3K4me1 and H3K27me3 associated with enhancer function. Thus, we hypothesize that TR4 regulates gene transcription via gene-proximal DR1 sites as TR4/TR2 heterodimers, while it can associate with novel nuclear receptor partners (such as RXR to bind to distant non-DR1 consensus sites. In summary, this study reveals that the TR4 regulatory network is far more complex than previously appreciated and that TR4 regulates basic, essential biological processes during the terminal differentiation of human erythroid cells.

  12. Avaliação do emprego da haste femoral curta na fratura trocantérica instável do fêmur Evaluating the use of a proximal femoral nail in unstable trochanteric fracture of the femur

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    João Antonio Matheus Guimarães

    2008-09-01

    , devido a uma redução inadequada em varo, ocorreu um cutout que necessitou de revisão cirúrgica. Outro caso de fratura do tipo 31A2, evoluiu para necrose avascular da cabeça femoral, após consolidação da fratura. Por fim, um caso de fratura do tipo 31A3, devido a redução inadequada no plano sagital, evoluiu para retarde de consolidação, com quebra da haste após 13 meses da cirurgia. CONCLUSÃO: A osteossíntese com haste proximal, como tratamento da fratura trocantérica instável do fêmur realizada em pacientes com idade superior a 60 anos, resultou na consolidação da maioria dos casos. As complicações foram distintas nos dois subgrupos estudados. A redução adequada da fratura antes da introdução da haste intramedular é fundamental para o sucesso do procedimento.OBJECTIVE: Identifying the rate of healing of unstable trochanteric fractures submitted to osteosynthesis with a proximal femoral nail (PFN® - AO/ASIF, in patients operated on between November 1999 and March 2004. METHODS: 45 patients were analyzed, ages ranging from 60 to 93, with unstable trochanteric fractures of the femur submitted to osteosynthesis with short PFN®, with indirect reduction in a traction device guided by radioscopy. The fractures were classified according to the AO/OTA classification. Bone quality was evaluated by the Singh index in the post-operative radiographic routine. The quality of the reduction achieved and the positioning of the implant were evaluated by post-operative anteroposterior and profile X-ray of the proximal femur, with analysis of the cervicodiaphyseal angle and the distance between the tip of the sliding nail and the center of the femoral head, the so-called "tip apex distance" (TAD. RESULTS: The mean age of patients studied was 80.8 years (60-93. Females prevailed, with 37 cases (82.2%. The right side was involved in 22 cases (48.89% and the left side, in 23 (51.1%. All fractures were unstable, 22 of them of the type 31A2 (48.8%, and 23, of the

  13. Distal radioulnar joint injuries

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    Thomas, Binu P.; Raveendran Sreekanth

    2012-01-01

    Distal radioulnar joint is a trochoid joint relatively new in evolution. Along with proximal radioulnar joint , forearm bones and interosseous membrane, it allows pronosupination and load transmission across the wrist. Injuries around distal radioulnar joint are not uncommon, and are usually associated with distal radius fractures,fractures of the ulnar styloid and with the eponymous Galeazzi or Essex_Lopresti fractures. The injury can be purely involving the soft tissue especially the triang...

  14. Characteristics of Differently Located Colorectal Cancers Support Proximal and Distal Classification: A Population-Based Study of 57,847 Patients.

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    Jiao Yang

    Full Text Available It has been suggested that colorectal cancer be regarded as several subgroups defined according to tumor location rather than as a single entity. The current study aimed to identify the most useful method for grouping colorectal cancer by tumor location according to both baseline and survival characteristics.Cases of pathologically confirmed colorectal adenocarcinoma diagnosed from 2000 to 2012 were identified from the Surveillance, Epidemiology, and End Results database and categorized into three groups: right colon cancer (RCC, left colon cancer (LCC, and rectal cancer (ReC. Adjusted hazard ratios for known predictors of disease-specific survival (DSS in colorectal cancer were obtained using a Cox proportional hazards regression model.The study included 57847 patients: 43.5% with RCC, 37.7% with LCC, and 18.8% with ReC. Compared with LCC and ReC, RCC was more likely to affect old patients and women, and to be at advanced stage, poorly differentiated or un-differentiated, and mucinous. Patients with LCC or ReC had better DSS than those with RCC in subgroups including stage III or IV disease, age ≤70 years and non-mucinous adenocarcinoma. Conversely, patients with LCC or ReC had worse DSS than those with RCC in subgroups including age ˃70 years and mucinous adenocarcinoma.RCC differed from both LCC and ReC in several clinicopathologic characteristics and in DSS. It seems reasonable to group colorectal cancer into right-sided (i.e., proximal and left-sided (i.e., distal ones.

  15. Expected accuracy of proximal and distal temperature estimated by wireless sensors, in relation to their number and position on the skin.

    Science.gov (United States)

    Longato, Enrico; Garrido, Maria; Saccardo, Desy; Montesinos Guevara, Camila; Mani, Ali R; Bolognesi, Massimo; Amodio, Piero; Facchinetti, Andrea; Sparacino, Giovanni; Montagnese, Sara

    2017-01-01

    A popular method to estimate proximal/distal temperature (TPROX and TDIST) consists in calculating a weighted average of nine wireless sensors placed on pre-defined skin locations. Specifically, TPROX is derived from five sensors placed on the infra-clavicular and mid-thigh area (left and right) and abdomen, and TDIST from four sensors located on the hands and feet. In clinical practice, the loss/removal of one or more sensors is a common occurrence, but limited information is available on how this affects the accuracy of temperature estimates. The aim of this study was to determine the accuracy of temperature estimates in relation to number/position of sensors removed. Thirteen healthy subjects wore all nine sensors for 24 hours and reference TPROX and TDIST time-courses were calculated using all sensors. Then, all possible combinations of reduced subsets of sensors were simulated and suitable weights for each sensor calculated. The accuracy of TPROX and TDIST estimates resulting from the reduced subsets of sensors, compared to reference values, was assessed by the mean squared error, the mean absolute error (MAE), the cross-validation error and the 25th and 75th percentiles of the reconstruction error. Tables of the accuracy and sensor weights for all possible combinations of sensors are provided. For instance, in relation to TPROX, a subset of three sensors placed in any combination of three non-homologous areas (abdominal, right or left infra-clavicular, right or left mid-thigh) produced an error of 0.13°C MAE, while the loss/removal of the abdominal sensor resulted in an error of 0.25°C MAE, with the greater impact on the quality of the reconstruction. This information may help researchers/clinicians: i) evaluate the expected goodness of their TPROX and TDIST estimates based on the number of available sensors; ii) select the most appropriate subset of sensors, depending on goals and operational constraints.

  16. Distal femoral complications following antegrade intramedullary nail placement

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    Amanda J. Fantry

    2015-03-01

    Full Text Available While antegrade nailing for proximal and diaphyseal femur fractures is a commonly utilized fixation method with benefits including early mobilization and high rates of fracture union, both intraoperative and postoperative complications may occur. Intraoperative errors include leg length discrepancy, anterior cortical perforation, malreduction of the fracture, and neurovascular injury, and postoperative complications include nonunion, malunion, infection, and hardware failure. This case series reviews complications affecting the distal femur after intramedullary nailing including fracture surrounding a distal femoral interlocking screw (Case #1, nonunion after dynamization with nail penetration into the knee joint (Case #2, and anterior cortical perforation (Case #3. Prevention of intraoperative and postoperative complications surrounding intramedullary nailing requires careful study of the femoral anatomy and nail design specifications (radius of curvature, consideration of the necessity of distal interlocking screws, the need for close radiographic follow-up after nail placement with X-rays of the entire length of the nail, and awareness of possible nail penetration into the knee joint after dynamization.

  17. Correlação da espessura médio-intimal das carótidas primitivas proximal e distal

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    Leonard Hermann Roelke

    2013-09-01

    Full Text Available FUNDAMENTO: O aumento da espessura do IMT (do inglês intima-media thickness das carótidas é utlizado como marcador precoce de aterosclerose e para avaliação do risco de eventos cardiovasculares. O ultrassom é utilizado na sua avaliação pela acessibilidade e baixo custo. São descritas medidas realizadas em diferentes regiões das carótidas. OBJETIVOS: Correlacionar o IMT nas regiões proximal e distal da carótida primitiva bilateral no intuito de orientar a sua utilização na prática clínica. MÉTODOS: O IMT foi medido nas porções proximais e distais da artéria carótida primitiva de 798 indivíduos (35-74 anos de ambos os sexos usando ultrassom de alta resolução. O coeficiente de correlação de Pearson foi usado para se estabelecer as associações. As análises foram feitas inicialmente para toda a amostra e nos subgrupos com IMT 0,90 mm em pelo menos um sítio de medida. A significância estatística foi considerada para p 0,90 mm, houve expressiva queda de correlações, que se situaram entre 0,20 e 0,40. CONCLUSÃO: Os dados sugerem que o espessamento médio-intimal é mais uniforme ao longo das carótidas em fases mais precoces do desenvolvimento e tende a adquirir desenvolvimento focal à medida que progride. Portanto, na avaliação clínica de pacientes, toda a extensão das carótidas comuns deve ser investigada bilateralmente para melhor utilizar os softwares disponíveis e concluir sobre a presença ou não de espessamento do complexo médio-intimal.

  18. The effectiveness of the implementation of new technologies in the prevention of purulent complications of repeated surgеries for complications of fractures of the proximal femur of patients

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    An. V. Kalashnikov

    2016-06-01

    Full Text Available Despite the latest achievements of modern traumatology, remains quite high percentage of unsatisfactory results of treatment of fractures of the proximal femur (fPf. According to the literature repeated surgery increases the risk of postoperative purulent complications in several times. The authors of the article developed the innovations introduced in practice based on the use of thrombocytopoiesis fibrin gel, which has a high antibacterial activity due to preservation of leukocytes (local antibiotic effect, together with bone shavings during the performing of the operations when performing reactioneze and TEP after performing osteosynthesis, and also at persons of senile and elderly, for prevention of postoperative purulent complications in fPf. A comprehensive clinical study of 120 patients with fPf complications (false joints, aseptic necrosis of the femoral head, axial deformation after osteomyelitis who underwent re-operative intervention was provided. Patients were divided into two groups, first (control group consisted of 60 patients with consequences fPf who underwent total endoprosthesis (TEP of the hip joint (30 patients and locked intramedullary nailing (LIN (30 patients by conventional methods. The second (experimental group consisted of 60 patients with consequences fPf who underwent TEP of the hip joint (30 patients and LIN (30 patients with use developed by authors of innovations. Effectiveness of prevention of septic complications in both groups of observation was evaluated. The observation period was 1 year. There was statistically significant (p≤0.01 decrease in the number of early (4 times and late (3 times postoperative complications in patients of the experimental group in comparison with patients of control group. The new technologies use allows to increase in 8.4% the efficiency of preventive maintenance of purulent complications of surgical treatment of patients with complications after performing osteosynthesis in the

  19. Análisis numérico comparativo de fijadores para el tratamiento de fracturas proximales del fémur // Comparative numerical analysis of fixers for the treatment of proximal fractures of the femur

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    Jorge Bosch-Cabrera

    2011-08-01

    Full Text Available ResumenMúltiples son los dispositivos utilizados para lograr la consolidación de las fracturas proximales delfémur, algunos sufren roturas antes de ser retirados del paciente, ocasionando nuevascomplicaciones al mismo. En esta investigación se presentan los resultados del análisis numéricorealizado a un fijador interno del tipo placa DHS (Dinámic Hip Screw y a un fijador externomonolateral con tornillo cefálico RALCA (Rodrigo Álvarez Cambras, con el propósito de determinarel comportamiento del estado tensional-deformacional de ambos dispositivos durante laconsolidación ósea de fracturas proximales de cadera, bajo la marcha monopodal del paciente. Parala modelación geométrica de los dispositivos en cuestión se empleó el paquete de diseño en 3DSolidWorks y la simulación numérica se realizó con el empleo del paquete de análisis por elementosfinitos Cosmos/Works. Los resultados muestran valores inferiores de las tensiones máximas en elfijador externo en comparación con las tensiones que surgen en la placa dinámica bajo la acción delas cargas actuantes en los modelos, por lo que se concluye que el primero posee mejorescaracterísticas resistivas, siendo recomendable su uso en pacientes de mayor peso corporal o quepodrían realizar actividades físicas más activas durante su recuperación postoperatoria.Palabras claves: elementos finitos, biomecánica, osteosíntesis, fractura de cadera.____________________________________________________________________________AbstractMultiple are devices used to achieve the consolidation of proximal femur fractures, some sufferingbreakage before being removed from the patient, causing new complications to them. This researchpresents the results of the numerical analysis made to an internal fixer type plate DHS (Dinámic HipScrew, and to a monolateral external fixer with RALCA (Rodrigo Alvarez Cambras head screw, withthe purpose of determining the behavior of the tensional

  20. Avaliação da espessura do esmalte proximal em segundos pré-molares superiores humanos e sua correlação com o diâmetro mésio-distal = Thickness valuation of adjacent enamel in second superior human pre molar teeth an their relationship with mesio distal diameter

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    Fischer, Luís Henrique

    2006-01-01

    Full Text Available A determinação da espessura do esmalte proximal à altura do ponto de contato é de grande importância, visto que o desgaste desta região dental é freqüentemente utilizado na clínica ortodôntica com a finalidade de correção de discrepâncias dentais e estabilidade do tratamento. Com o intuito de determinar os valores do diâmetro mésio-distal e aferir os valores médios da espessura do esmalte nas faces proximais à altura do ponto de contato, foram avaliados 42 segundos pré-molares superiores. Os diâmetros mésio-distais foram mensurados com auxílio de um paquímetro digital, em seguida foram incluídos em resina e seccionados obtendo-se uma lâmina central de 0,7 mm de espessura, possibilitando a medição da espessura do esmalte em um perfilômetro de precisão milesimal. Com base nos dados obtidos, também foram analisadas as possíveis correlações entre a espessura do esmalte nas faces proximais e o diâmetro mésio-distal. Os resultados indicaram que o valor médio do diâmetro mésio-distal é de 6,85 mm para o segundo pré-molar superior e com espessura media do esmalte de 1,101 mm na mesial e 1,157 mm na distal. De acordo com os testes de Spearman e Pearson foram encontradas correlações estatisticamente significantes no lado direito entre a espessura do esmalte na face mesial e o diâmetro mésio-distal, entre a espessura na face distal e o diâmetro mésiodistal. No lado esquerdo foram encontradas correlações positivas entre a espessura do esmalte distal e o diâmetro mésio-distal. Em ambos os lados houve correlações estatisticamente significantes entre a espessura do esmalte mesial e a espessura do esmalte distal. Independente do lado, a espessura média do esmalte é maior na face distal que na mesial

  1. Distal Extension of the Anterior Approach to the Hip Using the Femoral Interbundle Technique: Surgical Technique and Case Series.

    Science.gov (United States)

    Ghijselings, Stijn G M; Driesen, Ronald; Simon, Jean-Pierre; Corten, Kristoff

    2017-07-01

    The direct anterior approach (DAA) is becoming more popular as the standard surgical approach for primary total hip arthroplasty. However, it has been associated with an increased incidence of intraoperative femoral fractures in particular during the learning curve. Distal extension of the approach may be needed in case of intraoperative complications. The aim of the present study is to describe the distal extension of the DAA using the femoral interbundle technique. A stepwise approach based on a cadaveric study to extend the DAA distally is presented. The interval between the neurovascular bundles running to the vastus lateralis is used to gain access to the femur. Clinical and electromyography results of 5 patients undergoing a revision of the femoral component through an extended anterior approach are reported. In 2 cases, the proximal bundle was exposed whereas in 3 cases the interval between the proximal and distal bundle was developed and cerclage wires were applied around the isthmus of the femur. All fractures had healed at 6 months of follow-up. Four cases had a normal electromyography, and 1 case demonstrated a neuropraxia of a branch to the vastus lateralis. All cases had a 5/5 extension power of the quadriceps muscle clinically. The interbundle technique is an alternative way to gain additional exposure of the femur during the DAA and is based on precise knowledge of the periarticular neurovascular structures. This approach can be helpful to safely deal with intraoperative complications such as fractures requiring proximal femoral cerclage wiring during the anterior approach. Copyright © 2017 Elsevier Inc. All rights reserved.

  2. Transverse Stress Fracture of the Proximal Patella

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    Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

    2016-01-01

    Abstract Among stress fractures associated with sports activities, patellar stress fracture is rare. Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella. We describe an extremely rare case of transverse stress fracture of proximal patella in a 9-year-old athlete. A 9-year old boy, who participated in sports (sprints and Kendo) presented with left knee pain without any external injury. In plain radiographs, a fracture line was observed in the proximal 1/3 of the left patella, and a patella stress fracture was diagnosed. For treatment, because 7 months of conservative therapy showed no improvement, internal fixation was carried out using Acutrak screws, and bone union was thus achieved. Three months after the operation, he was able to return to his previous level of athletic sports activity. Regarding the mechanism of onset, it is believed that the causes are longitudinal traction force and patellofemoral contact pressure. On the other hand, the contact region of the patella with the femur changes with the flexion angle of the knee. In the current case, the fracture occurred at a site where the patella was in contact with the femur at a flexion angle of >90°, so it is believed that it occurred as a clinical condition from being subjected to repeated longitudinal traction force and patellofemoral contact pressure at a flexion angle of >90°, during the sports activities of sprints and Kendo. The nonunion of the transverse stress fracture of his proximal patella was successfully treated with internal fixation using Acutrak screws. PMID:26871789

  3. Safe zones and a technical guide for cerclage wiring of the femur: a computed topographic angiogram (CTA) study.

    Science.gov (United States)

    Apivatthakakul, Theerachai; Siripipattanamongkol, P; Oh, Chang-Wug; Sananpanich, K; Phornphutkul, C

    2017-09-27

    Cerclage wiring for reduction of complex femoral shaft fractures can create iatrogenic vascular injury. To describe the anatomical relation of blood vessels to the femur and develop a technical guide for safe passage of cerclage wire. CT lower-limb angiographs (CTA) of 80 patients were reviewed and analysed to identify the superficial femoral artery (SFA) and the deep femoral artery (DFA) as well as the relation of those arteries to the femoral cortex. The total length of the femur was measured and divided into eight equal segments (seven levels). At each level, the medial half of the femur was divided into eight sectors labelled A through H and the position of the SFA and DFA was recorded. The shortest distance between the femoral cortex and the SFA and DFA at each level was measured. The data was analysed using STATA version 10.0. The average total femoral length from the tip of greater trochanter to lateral joint line was 402.98 ± 26.16 cm. The average distances from the SFA to the femur (d1) for levels 1 through 7 were 37.20 ± 5.0, 32.09 ± 4.74, 27.13 ± 4.19, 27.71 ± 5.46, 23.71 ± 4.40, 13.63 ± 3.59 and 10.08 ± 3.09 mm, respectively. The average distances between the DFA and the femur (d2) for levels 1 through 3 were 26.70 ± 4.13, 14.76 ± 3.27 and 9.58 ± 3.79 mm, respectively. The position of the SFA is located in sectors B through E at levels 1-3 and in sectors E through H at levels 4-7 and the position of the DFA located in sectors B through F at levels 1-3. Cerclage wiring should be started from the posterior intermuscular septum at the linea aspera. The safe area is the proximal half (midshaft) of the femur where the SFA and DFA lie at a safe distance from the femur. Between the midshaft and the distal 1/4, insertion of the passer must be done meticulously with the tip kept close to posteromedial cortex. Below the distal 1/4, the tip of the passer should be kept close to the posterior cortex to avoid injury to the SFA and

  4. Ipsilateral vascularised ulnar transposition autograft for limb-sparing surgery of the distal radius in 2 dogs with osteosarcoma : clinical communication

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    G.S. Irvine-Smith

    2006-06-01

    Full Text Available Canine osteosarcoma is the most commonly diagnosed primary bone tumour in the dog, affecting mainly large and giant breed dogs with the predilection site being the metaphysis of long bones, specifically the distal radius, proximal humerus, distal femur and proximal tibia and fibula. Treatment options are either palliative or curative intent therapy, the latter limb amputation or limb-sparing surgery together with chemotherapy. This article describes the use of an ipsilateral vascularised ulnar transposition autograft as well as chemotherapy in 2 dogs with osteosarcoma of the distal radius. Both dogs showed minimal complications with the technique and both survived over 381 days following the surgery. Complications seen were loosening of the screws and osteomyelitis. The procedure was well tolerated with excellent limb use. This technique is indicated for use in cases with small tumour size that have not broken through the bone cortex.

  5. The potential application of functionally graded material for proximal femoral nail antirotation device.

    Science.gov (United States)

    Gong, He; Wang, Lizhen; Zheng, Dong; Fan, Yubo

    2012-09-01

    Proximal femoral nail antirotation (PFNA) device is an intramedullary nail system designing for the treatment of trochanteric fractures. It is composed of a helical neck blade, a nail and a distal locking bolt. There were some reports of femoral shaft fractures even after the fractures were healed. The stress shielding effects of the PFNA device made of stiff titanium alloy on the bone-remodeling behavior of the host femur and the uneven distribution of interface shear stress may contribute to this complication. Recently, a new class of composite called functionally graded material (FGM) was developed, that consisted a gradual pattern of material composition and/or microstructures, and was introduced in dental implant and cementless hip stem. Accordingly, in this paper, we hypothesized that FGM might be used as the material of the nail in PFNA device with the material composition of the nail gradually shifting from more stiff at the proximal side of the femur to more flexible 'iso-elastic' towards the distal side. This hypothesis can be evaluated from the long-term remodeling behavior of host femur and the stress distributions in the PFNA device and bone. Copyright © 2012 Elsevier Ltd. All rights reserved.

  6. Evolução das varizes esofagogástricas após anastomose esplenorrenal proximal versus esplenorrenal distal

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    Raquel Aparecida Antunes

    Full Text Available Avaliou-se, retrospectivamente, a evolução pós-operatória das varizes esofagogástricas em 40 pacientes submetidos a um dos seguintes procedimentos cirúrgicos: a (n=27 derivação esplenorrenal distal (ERD e B (n=13 derivação esplenorrenal proximal (ERP. Todos os pacientes tinham hipertensão porta esquistossomótica com diagnóstico prévio de varizes do esôfago, presentes ou não no estômago, com um ou mais episódios de sangramento. Os pacientes foram submetidos a um dos procedimentos cirúrgicos de acordo com a preferência do cirurgião assistente. Foram realizadas, nesses pacientes, endoscopias no período pré-operatório e aos seis, 12 e 18 meses no pós-operatório. Os dados de cada endoscopia foram coletados e comparados entre os grupos, verificando-se a presença de varizes do esôfago e estômago nos diferentes períodos, comparando esses achados através do teste do qui-quadrado, com significância para p<0,05. Os resultados obtidos não mostraram casos de ressangramento até o 18º mês pós-operatório, nem casos de encefalopatia. Foram diagnosticadas varizes esofágicas, no pré-operatório, em 100% dos pacientes nos dois grupos. No período pós-operatório, houve redução significativa das varizes do esôfago, quando estudados os dois grupos conjuntamente, para 40% no sexto mês (p = 0,0002, 30% no 12º mês (p = 0,003 e 27,5% no 18º mês (p = 0,003. No sexto mês pós-operatório, a incidência de varizes do esôfago foi maior nos pacientes com ERD quando comparados àqueles com ERP (51,9% vs. 15,4%, p = 0,03. Quando estudadas as varizes aos 12 e 18 meses não foi observada diferença significativa entre pacientes submetidos a ERD ou ERP (12º mês, 37% vs. 15,4%; 18º mês, 25,9% vs. 30,8%. Foram vistas varizes gástricas em 37,5% dos pacientes, com redução significativa no sexto mês (2,5%, p = 0,005. Entretanto, quando comparada com a freqüência do sexto mês, houve aumento significativo no 12º mês (5%, p

  7. Tumor de células gigantes da extremidade distal do fêmur: um desafio de tratamento Giant cell tumor of femoral distal end: a challenge in treatment

    Directory of Open Access Journals (Sweden)

    Suraj Bajracharya

    2009-01-01

    Full Text Available Apresentamos aqui um caso de tumor de células gigantes na extremidade distal do fêmur direito tratado com ressecção da massa tumoral em bloco com remoção aguda da extremidade proximal e distal e fixado com hastes longas em K atravessando o joelho, do fêmur à tíbia. Após a consolidação / união completa das extremidades, foi feita a remoção da haste em K, seguida pela corticotomia juntamente com a osteogênese da distração com o auxílio do anel fixador de Ilizarov. O comprimento foi alcançado com este processo. O resultado final foi muito bom neste caso. Revisamos as opções de tratamento para tumor maligno de células gigantes na extremidade distal do fêmur e as dificuldades de tratá-lo.We present a case of malignant giant cell tumor of distal end of right femur treated with resection of the tumor mass en block with acute docking of proximal and distal end and fixed with long K-nail across knee from femur to tibia. After complete consolidation/ union of the ends, removal of K nail was done followed by corticotomy along with distraction osteogenesis with the help of Ilizarov ring fixator. The length was achieved with this process. The end result was very good in this case. We reviewed the treatment options for malignant giant cell tumor of femoral distal end and the challenges in its treatment.

  8. Risk of Proximal Colonic Neoplasms in Asymptomatic Adults Older Than 50 Years Found to Have Distal Hyperplastic Polyps on Routine Colorectal Cancer Screening

    OpenAIRE

    Collins, Bradley D

    2010-01-01

    Purpose: A retrospective case-control study was conducted to evaluate whether hyperplastic polyps (HPs) found in the lower 50 cm of colon could be used as indicators for synchronous proximal neoplasms (SPNs) in the large intestine. Additionally, other characteristics considered included age; sex; ethnicity; history of cancer, cholecystectomy, or appendectomy; current use of aspirin or nonsteroidal anti-inflammatory drugs (NSAIDs); current use of estrogen or hormone replacement therapy (HRT) i...

  9. Evaluation of the isometry of different points of the patella and femur for medial patellofemoral ligament reconstruction.

    Science.gov (United States)

    Gobbi, Riccardo Gomes; Pereira, César Augusto Martins; Sadigursky, David; Demange, Marco Kawamura; Tírico, Luis Eduardo Passarelli; Pécora, José Ricardo; Camanho, Gilberto Luis

    2016-10-01

    The location of patellar and femoral fixation of the graft in medial patellofemoral ligament reconstructions has been widely discussed. This study aimed to assess the distances between different patellar and femoral fixation points to identify the least anisometric pairs of points. Ten cadaver knees were attached to an apparatus that simulated an active range of motion of 120°, with three metallic markers fixed onto the medial side of the patella, and seven markings onto the medial epicondyle. The examined points included the proximal patella pole (1), the patellar center (3), the midpoint between points 1 and 3 (2), a point directly on the epicondyle (6), points 5mm anterior (5) and posterior (7) to the epicondyle, points 5mm anterior to point 5 (4) and 5mm posterior to point 7 (8), and points 5mm proximal (9) and distal (10) to the epicondyle. The distances between patella and femur points were measured by a photogrammetry system at 15° intervals. The pair of points that exhibited the lowest average variability in distance, and hence was the most isometric, was the patella center combined with the anterior to the medial femoral epicondyle. The pairs of points that exhibited the highest average variability in distance, and hence were the least isometric, were the ones located distal or posterior to the medial femoral epicondyle, with less influence by the patellar location. Surgeons should avoid positioning the graft distally or posterior to the epicondyle due to the increase in anisometry. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. Design and Development of Potential Tissue Engineering Scaffolds from Structurally Different Longitudinal Parts of a Bovine-Femur

    Science.gov (United States)

    Pramanik, Sumit; Pingguan-Murphy, Belinda; Cho, Jongman; Osman, Noor Azuan Abu

    2014-07-01

    The complex architecture of the cortical part of the bovine-femur was examined to develop potential tissue engineering (TE) scaffolds. Weight-change and X-ray diffraction (XRD) results show that significant phase transformation and morphology conversion of the bone occur at 500-750°C and 750-900°C, respectively. Another breakthrough finding was achieved by determining a sintering condition for the nucleation of hydroxyapatite crystal from bovine bone via XRD technique. Scanning electron microscopy results of morphological growth suggests that the concentration of polymer fibrils increases (or decreases, in case of apatite crystals) from the distal to proximal end of the femur. Energy-dispersive analysis of X-ray, Fourier transform infrared, micro-computer tomography, and mechanical studies of the actual composition also strongly support our microscopic results and firmly indicate the functionally graded material properties of bovine-femur. Bones sintered at 900 and 1000°C show potential properties for soft and hard TE applications, respectively.

  11. Distal femoral bone mineral density after total knee arthroplasty: a comparison with general bone mineral density.

    NARCIS (Netherlands)

    Loon, C. van; Oyen, W.J.G.; Waal Malefijt, M.C. de; Verdonschot, N.J.J.

    2001-01-01

    The bone mineral density (BMD) of the distal femur may decrease after cemented total knee arthroplasty (TKA) as a result of the stress shielding effect of the femoral component. The purpose of the study was to determine the changes in BMD of the distal femur compared with those of the femoral necks

  12. Avaliação da apresentação de sinais e sintomas de impacto femoroacetabular após epifisiólise do fêmur proximal Evaluation of presentation of signs and symptoms of femoroacetabular impingement after epiphysiolysis of the proximal femur

    Directory of Open Access Journals (Sweden)

    Fábio Peng Krüger

    2011-04-01

    Full Text Available OBJETIVO: Neste trabalho, procuramos avaliar se existe relação entre o grau de deslizamento da epifisiólise femoral proximal (EFP e a presença de impacto femoroacetabular (IFA. Ainda, analisou-se o arco de movimento do quadril (ADM em relação ao IFA, além de revisar a literatura sobre o assunto. MÉTODO: Foram analisados 19 casos de EFP em 15 pacientes tratados cirurgicamente com epifisiodese in situ com um parafuso canulado, com seguimento médio de 27 meses. Realizou-se a análise do grau de deslizamento da EFP pelos ângulos epimetafisário (âEM e coloepifisário (âCE da radiografia em perfil, dos sinais de impacto radiográficos na incidência anteroposterior, dos sintomas clínicos e do ADM do quadril. RESULTADOS: Evidenciou-se que o grau de deslizamento da EFP (através do âEM apresenta relação inversa estatisticamente significante com a presença de IFA no período médio de seguimento deste estudo. Ou seja, os pacientes que demonstraram um quadro sintomático de IFA apresentaram graus menores de deslizamento. Isso pode ser explicado pelo fato que o tipo de impacto que ocorre na EFP (came de inclusão ou de impacção depende do grau de deslizamento, e estes se apresentam de forma e cronologia diferentes. O ADM do quadril não apresentou relação com o IFA. CONCLUSÃO: Há relação entre o grau de deslizamento e a presença de IFA clínicoradiológica após EFP.OBJECTIVES: In this study, we sought to evaluate whether there is any relationship between the degree of epiphysiolysis of the proximal femur (EPF and the presence of femoroacetabular impingement (FAI. Hip range of motion (ROM was also analyzed in relation to FAI, and the literature on this topic was reviewed. METHODS: Nineteen cases of EPF in fifteen patients who had been treated surgically by means of in situ epiphysiodesis with a cannulated screw were evaluated. The mean follow-up was 27 months. The degree of EPF was analyzed using the epimetaphyseal and neck

  13. Modified Van Nes rotationplasty for osteosarcoma of the proximal tibia in children.

    Science.gov (United States)

    de Bari, A; Krajbich, J I; Langer, F; Hamilton, E L; Hubbard, S

    1990-11-01

    Above-knee amputation has been the traditional treatment for osteosarcoma of the proximal tibia. Recent advances in chemotherapy have encouraged the development of limb-salvage techniques. Van Nes rotationplasty for malignant lesions of the distal femur has increased in popularity as a reconstructive technique, but no similar procedure has been described for lesions of the proximal tibia. We have developed a modified rotationplasty for this lesion and have performed it in four children. The surgical technique, postoperative management and results of the procedure are described. Two patients had delayed wound healing. No other complications have developed and our patients were disease-free at follow-up, while the appearance of the leg was well accepted by the patients and their parents. This procedure is a useful addition to the armamentarium of the tumour surgeon for the treatment of malignant lesions of the proximal tibia.

  14. Evaluation of reach and grasp robot-assisted therapy suggests similar functional recovery patterns on proximal and distal arm segments in sub-acute hemiplegia.

    Science.gov (United States)

    Loureiro, Rui C V; Harwin, William S; Lamperd, Robert; Collin, Christine

    2014-05-01

    This paper provides some additional evidence in support of the hypothesis that robot therapies are clinically beneficial in neurorehabilitation. Although only four subjects were included in the study, the design of the intervention and the measures were done so as to minimize bias. The results are presented as single case studies, and can only be interpreted as such due to the study size. The intensity of intervention was 16 h and the therapy philosophy (based on Carr and Shepherd) was that coordinated movements are preferable to joint based therapies, and that coordinating distal movements (in this case grasps) helps not only to recover function in these areas, but has greater value since the results are immediately transferable to daily skills such as reach and grasp movements.

  15. Influence of Distal Resistance and Proximal Stiffness on Hemodynamics and RV Afterload in Progression and Treatments of Pulmonary Hypertension: A Computational Study with Validation Using Animal Models

    Directory of Open Access Journals (Sweden)

    Zhenbi Su

    2013-01-01

    Full Text Available We develop a simple computational model based on measurements from a hypoxic neonatal calf model of pulmonary hypertension (PH to investigate the interplay between vascular and ventricular measures in the setting of progressive PH. Model parameters were obtained directly from in vivo and ex vivo measurements of neonatal calves. Seventeen sets of model-predicted impedance and mean pulmonary arterial pressure (mPAP show good agreement with the animal measurements, thereby validating the model. Next, we considered a predictive model in which three parameters, PVR, elastic modulus (EM, and arterial thickness, were varied singly from one simulation to the next to study their individual roles in PH progression. Finally, we used the model to predict the individual impacts of clinical (vasodilatory and theoretical (compliance increasing PH treatments on improving pulmonary hemodynamics. Our model (1 displayed excellent patient-specific agreement with measured global pulmonary parameters; (2 quantified relationships between PVR and mean pressure and PVS and pulse pressure, as well as studiying the right ventricular (RV afterload, which could be measured as a hydraulic load calculated from spectral analysis of pulmonary artery pressure and flow waves; (3 qualitatively confirmed the derangement of vascular wall shear stress in progressive PH; and (4 established that decreasing proximal vascular stiffness through a theoretical treatment of reversing proximal vascular remodeling could decrease RV afterload.

  16. The use of a 3-dimensional computed tomography bone database to evaluate the risk of distal contact between the rasp tip and the endosteal cortical bone.

    Science.gov (United States)

    Connor, Emmalynn; Cowie, Jonathan G; Wuestemann, Thies; Howell, Jonathan R; Whitehouse, Sarah L; Crawford, Ross W

    2016-12-01

    To use a 3-dimensional computed tomography (CT) bone database to evaluate the risk of distal contact between the rasp tip and the endosteal cortical bone. Using a 3-dimensional CT bone database, the rasps for Exeter stems of 125 mm in length and body size 1, with a femoral offset of 37.5, 44, or 50 mm were compared with those for Exeter stems of 150 mm in length and same body size with the corresponding femoral offset. Rasp geometry was determined using an engineering drawing software. Of the 631 femurs in the database, 238 (187 Caucasian and 51 Asian) were of appropriate femoral offset and proximal body size to receive a stem with an offset of 37.5, 44, or 50 mm. Of these, 145 (115 Caucasian and 30 Asian) femurs were of champagne-flute type; the prevalence was comparable between the 2 populations (61% vs. 59%, p=0.729). When using the 150-mm rasp, 70 (55 Caucasian and 15 Asian) of the 238 femurs had distal contact between the rasp and femoral cortex; the prevalence was comparable between the 2 populations (29% vs. 29%, relative risk=1.0, p=1.0). Distal contact between the rasp and femoral cortex occurred more commonly in champagne-flute-type femurs than other femurs in the anteroposterior plane (28% [41/145] vs. 2% [2/93], relative risk=13.1, p<0.001) and in the mediolateral plane (27% [39/145] vs. 14% [13/93], relative risk=1.92, p=0.019). When using the 125-mm rasp, only one femur (with a canal flare index of 4.52) had distal contact in the mediolateral plane with an offset of 37.5 mm. Distal contact between the rasp and femoral cortex occurred more often with the 150-mm rasp than the 125-mm rasp in both planes (p<0.001). The use of a shorter stem may enhance anatomic fit in patients with a narrow femoral canal and prevent distal contact between the rasp and femoral cortex.

  17. Biomechanical comparison of dynamic condylar screw and locking compression plate fixation in unstable distal femoral fractures: An in vitro study

    Directory of Open Access Journals (Sweden)

    Ashutosh Kumar Singh

    2013-01-01

    Full Text Available Background: Distal femur fractures are difficult to manage and the selection of implant for internal fixation remains controversial. The objective of this study is to establish the relative strength of fixation of a distal femoral locking plate (DFLP compared with the dynamic condylar screw (DCS in the distal femur fractures. Materials and Methods: Study was conducted on 16 freshly harvested cadaveric distal femoral specimens, eight implanted with DCS and other eight with DFLP. The construct was made unstable by removing a standard sized medial wedge of 1 cm base (gap-osteotomy beginning 6 cm proximal to the lateral joint line in distal metaphyseal region with the loss of medial buttress. Fatigue test was conducted under load control mode at the frequency of I Hz. Specimens were subjected to cyclic loading of 2 kN, under observation for 50,000 cycles or until failure/cutout, which ever occurred earlier. Results: In DFLP group, there was no implant failure and the average number of cycles sustained was 50,000. Six out of eight specimens completed 50,000 cycles and two failed in DCS group. The average number of cycles sustained by DCS was 46150. Though the bone quality as assessed by dual energy X-ray absorptiometry DEXA was comparable in both DFLP and DCS group ( P = 0.06, none failed in DFLP group and subsidence was 1.02 ± 0.34 mm (range: 0.60-1.32 mm, which was significantly 43% lower ( P = 0.006 than subsidence in DCS group (1.82 ± 0.58; range: 1.20-3.08 mm. The average stiffness of DCS group was 52.8 ± 4.2 N/mm, which was significantly lower than average stiffness of locked condylar plate group (71.2 ± 5.1 N/mm ( P = 0.02. Conclusions: DFLP fixation of the distal femur fractures resulted in stronger construct than the DCS fixation in both cyclic loading and ultimate strength in biomechanical testing of a simulated A3 distal femur fracture.

  18. Numerical Optimization of the Position in Femoral Head of Proximal Locking Screws of Proximal Femoral Nail System; Biomechanical Study.

    Science.gov (United States)

    Konya, Mehmet Nuri; Verim, Özgür

    2017-09-29

    Proximal femoral fracture rates are increasing due to osteoporosis and traffic accidents. Proximal femoral nails are routinely used in the treatment of these fractures in the proximal femur. To compare various combinations and to determine the ideal proximal lag screw position in pertrochanteric fractures (Arbeitsgemeinschaft für Osteosynthesefragen classification 31-A1) of the femur by using optimized finite element analysis. Biomechanical study. Computed tomography images of patients' right femurs were processed with Mimics. Afterwards a solid femur model was created with SolidWorks 2015 and transferred to ANSYS Workbench 16.0 for response surface optimization analysis which was carried out according to anterior-posterior (-10°0) and posterior-anterior directions of the femur neck significantly increased these stresses. The most suitable position of the proximal lag screw was confirmed as the middle of the femoral neck by using optimized finite element analysis.

  19. Chronic skeletal unloading of the rat femur: mechanisms and functional consequences of vascular remodeling.

    Science.gov (United States)

    Stabley, John N; Prisby, Rhonda D; Behnke, Bradley J; Delp, Michael D

    2013-12-01

    Chronic skeletal unloading diminishes hindlimb bone blood flow. The purpose of the present investigation was to determine 1) whether 7 and 14days of skeletal unloading alter femoral bone and marrow blood flow and vascular resistance during reloading, and 2) whether putative changes in bone perfusion are associated with a gross structural remodeling of the principal nutrient artery (PNA) of the femur. Six-month old male Sprague-Dawley rats were assigned to 7-d or 14-d hindlimb unloading (HU) or weight-bearing control groups. Bone perfusion was measured following 10min of standing (reloading) following the unloading treatment. Histomorphometry was used to determine PNA media wall thickness and maximal diameter. Bone blood flow, arterial pressure and PNA structural characteristics were used to calculate arterial shear stress and circumferential wall stress. During reloading, femoral perfusion was lower in the distal metaphyseal region of 7-d HU rats, and in the proximal and distal metaphyses, diaphysis and diaphyseal marrow of 14-d HU animals relative to that in control rats. Vascular resistance was also higher in all regions of the femur in 14-d HU rats during reloading relative to control animals. Intraluminal diameter of PNAs from 14-d HU rats (138±5μm) was smaller than that of control PNAs (162±6μm), and medial wall thickness was thinner in PNAs from 14-d HU (14.3±0.6μm) versus that of control (18.0±0.8μm) rats. Decreases in both shear stress and circumferential stress occurred in the PNA with HU that later returned to control levels with the reductions in PNA maximal diameter and wall thickness, respectively. The results demonstrate that chronic skeletal unloading attenuates the ability to increase blood flow and nutrient delivery to bone and marrow with immediate acute reloading due, in part, to a remodeling of the bone resistance vasculature. © 2013.

  20. Proximal nailfold microhemorrhage events are manifested as distal cuticular (eponychial) hemosiderin-containing deposits (CEHD) (syn. Maricq sign) and can aid in the diagnosis of dermatomyositis and systemic sclerosis.

    Science.gov (United States)

    McBride, Jeffrey D; Sontheimer, Richard D

    2016-02-17

    Many patients present with cutaneous signs and symptoms that suggest a diagnosis on the autoimmune disease spectrum. During the "acute phase" of disease activity, patients with systemic sclerosis (SSc) and dermatomyositis (DM) have characteristic nailfold findings, including dilated capillaries, microhemorrhages, and hemosiderin deposits. To review the literature on the presentation of microhemorrhages and to highlight the differences (in terms of terminology, characterization, and clinical relevance) between proximal microhemorrhage events and the distal products, often thought of as "hemosiderin deposits" located in the cuticle (eponychium). Because we found no studies directly showing these cuticular products are in fact "hemosiderin-containing," we conducted a direct staining experiment in vivo using Prussian blue in order to increase our confidence that these products are indeed hemosiderin-containing and that the terminology is accurate for further use. In July-December 2014, the MeSH function in PubMed was used to identify approximately 165 articles relating to capillaroscopy. We reviewed these articles for mention of microhemorrhages and hemosiderin deposits. In addition, we used PubMed and Google Scholar searches for "hemosiderin + nail", "Prussian Blue + nail", and "hemosiderin deposit." We found no papers reporting the use of Prussian Blue directly on nailfolds of patients with SSc and DM in vivo. In our literature review, "microhemorrhages" and "hemosiderin deposits" were often used synonymously, yet they are clearly distinct entities. We present a case in which the presence of these deposits supported a diagnosis of amyopathic DM. We used Prussian blue staining solution to visualize the cuticular (eponychial) hemosoderin-containing deposits (CEHD) - distal cuticular products that reflect previous proximal nailfold microhemorrhage events. CEHD can serve as an indicator of active autoimmune disease, particularly in SSc and DM. CEHD are in fact

  1. Transverse Stress Fracture of the Proximal Patella: A Case Report.

    Science.gov (United States)

    Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

    2016-02-01

    Among stress fractures associated with sports activities, patellar stress fracture is rare. Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella. We describe an extremely rare case of transverse stress fracture of proximal patella in a 9-year-old athlete.A 9-year old boy, who participated in sports (sprints and Kendo) presented with left knee pain without any external injury. In plain radiographs, a fracture line was observed in the proximal 1/3 of the left patella, and a patella stress fracture was diagnosed. For treatment, because 7 months of conservative therapy showed no improvement, internal fixation was carried out using Acutrak screws, and bone union was thus achieved. Three months after the operation, he was able to return to his previous level of athletic sports activity.Regarding the mechanism of onset, it is believed that the causes are longitudinal traction force and patellofemoral contact pressure. On the other hand, the contact region of the patella with the femur changes with the flexion angle of the knee. In the current case, the fracture occurred at a site where the patella was in contact with the femur at a flexion angle of >90°, so it is believed that it occurred as a clinical condition from being subjected to repeated longitudinal traction force and patellofemoral contact pressure at a flexion angle of >90°, during the sports activities of sprints and Kendo. The nonunion of the transverse stress fracture of his proximal patella was successfully treated with internal fixation using Acutrak screws.

  2. Biomechanical comparison of 2 different locking plate fixation methods in vancouver b1 periprosthetic femur fractures.

    Science.gov (United States)

    Pletka, Joshua D; Marsland, Daniel; Belkoff, Stephen M; Mears, Simon C; Kates, Stephen L

    2011-03-01

    Locking plates are commonly used to treat fractures around a well-fixed femoral component. The optimal construct should provide sufficient fixation while minimizing soft-tissue dissection. The purpose of the current study was to determine whether plate length, working length, or bone mineral density affects survival of locking plate fixation for Vancouver type B1 periprosthetic hip fractures. A transverse osteotomy was created just distal to cemented femoral prostheses in 9 pairs of cadaveric femurs. Fractures were stabilized with long (20-hole) or short (12-hole) locking plates that were secured proximally with cables and screws and distally with screws only. Specimens were then cycled 10 000 times at 2500 N of axial force and 15 Nm of torque to simulate full weightbearing. A motion capture system was used to record fracture displacement during cycling. Failure occurred in 5 long and 3 short plates, with no significant differences found in the number of cycles to failure. For the specimens that survived, there were no significant differences found between long and short plates for displacement or rotation observed at the fracture site. A shorter working length was not associated with increased failure rate. Lower bone mineral density was significantly associated with failure (P = .02). We concluded that long locked plates do not appear to offer a biomechanical advantage over short locking plates in terms of fixation survival, and that bone mineral density was a better predictor of failure than was the fixation construct type.

  3. Acute Primary Hematogenous Osteomyelitis in the Epiphysis of the Distal Tibia: A Case Report With Review of the Literature.

    Science.gov (United States)

    Hwang, Hyun-Jung; Jeong, Woong-Kyo; Lee, Dae-Hee; Lee, Soon-Hyuck

    2016-01-01

    Osteomyelitis originating in the epiphysis of the long bones is quite rare and is usually found at either the distal femur or the proximal tibia. We report the case of a 12-year-old male with epiphyseal osteomyelitis that had developed in the distal tibia. To the best of our knowledge, this is the first published case report. The patient's history of a trauma that resembled an ankle sprain had delayed the diagnosis and subsequently led him to develop septic arthritis. The ankle is a common site of simple trauma; however, epiphyseal osteomyelitis is rare at this site. Therefore, if the symptoms continue or worsen after trauma, the clinician should check the affected site and take a more aggressive approach to make an early diagnosis. Copyright © 2016 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  4. Prediction of Pathologic Fracture Risk in Activities of Daily Living and Rehabilitation of Patients With Metastatic Breast Carcinoma of the Pelvis and Femur

    National Research Council Canada - National Science Library

    Inoue, Nozomu

    2002-01-01

    The purpose of the project was to develop a computer model of the pelvis and proximal femur which could be used to predict pathologic fracture risk and study the effects of pelvic and proximal femoral...

  5. Subtrochanteric and Distal Femur Fractures in a Patient with ...

    African Journals Online (AJOL)

    Case Report. Pires RE1,2, Santana EO Jr.2, Labronici PJ3, Almeida Filho IA2. 1Department of the Locomotive Apparatus, Federal University of Minas Gerais, 2Department of Orthopedics and. Traumatology, Felicio Rocho Hospital, Belo Horizonte, MG, 3Department of Orthopedics and Traumatology, Santa Teresa. Hospital ...

  6. Case report 468: Epiphyseal osteoid osteoma distal end of femur

    Energy Technology Data Exchange (ETDEWEB)

    Destian, S.; Hernanz-Schulman, M.; Genieser, N.; Becker, M.; Raskin, K.; Crider, R.; Greco, M.A.

    1988-03-01

    A case of intraepiphyseal osteoid osteoma evaluated by computed tomography in a 5 year old black girl was presented with a review of the literature. The differential diagnosis and optimal imaging studies were discussed. The authors stressed that osteoid osteoma is rare in an epiphysis and in black people. They also indicated that osteoid osteoma is exceptional in the presence of an open physis. Osteoporosis, synovial effusion and synovial inflammation histologically are often but not necessarily the associated findings of an epiphyseal osteoid osteoma. In this case, no osteoporosis, synovial effusion or synovitis was identified.

  7. Morphometric differences between the distal femora of men and women

    Directory of Open Access Journals (Sweden)

    Krstonošić Bojana

    2012-01-01

    Full Text Available Introduction: Distal part of the femur is the component of the knee joint. Its fractures are common orthopedic injuries, that occur to younger people as a result of high energy trauma and in the elderly, often after lower energy falls, along with osteoporosis or other medical comorbidities. Distal femur has been the subject of many researches. Goal: The purpose of this study was to evaluate the mesurements of the distal part of the femur and their relation to gender.Material and methods: We examined 32 adult human femora from the Osteological collection at the Department of Anatomy of Medical Faculty in Novi Sad. For sex determination of femora, we used the protocol from Alunni-Perret at al. (2008. We measured ten diameters: anteroposterior diameter of the lateral condyle, anteroposterior diameter of the medial condyle, mediolateral width of both condyles, mediolateral diameter of the lateral condyle, mediolateral diameter of the medial condyle, lateral anterior height, medial anterior height, width of the intercondylar fossa, height of the intercondylar fossa, epicondylar width. We also calculated three intercondylar notch idices: notch width, shape and area index. Dimensions were measured by means of the software program'Image J'. Results: Our findings showed that the dimensions of the distal part of the femur were greater in males than in females. Measures of intercondylar notch geometry showed no gender differences. Conclusion: The knowledge of gender differences in the dimensions of the distal part of the femur may be useful for diagnosis and treatment of this region.

  8. Chemokine (C-C Motif Receptor 2 Mediates Dendritic Cell Recruitment to the Human Colon but Is Not Responsible for Differences Observed in Dendritic Cell Subsets, Phenotype, and Function Between the Proximal and Distal ColonSummary

    Directory of Open Access Journals (Sweden)

    David Bernardo

    2016-01-01

    Full Text Available Background & Aims: Most knowledge about gastrointestinal (GI-tract dendritic cells (DC relies on murine studies where CD103+ DC specialize in generating immune tolerance with the functionality of CD11b+/− subsets being unclear. Information about human GI-DC is scarce, especially regarding regional specifications. Here, we characterized human DC properties throughout the human colon. Methods: Paired proximal (right/ascending and distal (left/descending human colonic biopsies from 95 healthy subjects were taken; DC were assessed by flow cytometry and microbiota composition assessed by 16S rRNA gene sequencing. Results: Colonic DC identified were myeloid (mDC, CD11c+CD123− and further divided based on CD103 and SIRPα (human analog of murine CD11b expression. CD103-SIRPα+ DC were the major population and with CD103+SIRPα+ DC were CD1c+ILT3+CCR2+ (although CCR2 was not expressed on all CD103+SIRPα+ DC. CD103+SIRPα- DC constituted a minor subset that were CD141+ILT3−CCR2−. Proximal colon samples had higher total DC counts and fewer CD103+SIRPα+ cells. Proximal colon DC were more mature than distal DC with higher stimulatory capacity for CD4+CD45RA+ T-cells. However, DC and DC-invoked T-cell expression of mucosal homing markers (β7, CCR9 was lower for proximal DC. CCR2 was expressed on circulating CD1c+, but not CD141+ mDC, and mediated DC recruitment by colonic culture supernatants in transwell assays. Proximal colon DC produced higher levels of cytokines. Mucosal microbiota profiling showed a lower microbiota load in the proximal colon, but with no differences in microbiota composition between compartments. Conclusions: Proximal colonic DC subsets differ from those in distal colon and are more mature. Targeted immunotherapy using DC in T-cell mediated GI tract inflammation may therefore need to reflect this immune compartmentalization. Keywords: CCR2, Dendritic Cells, Distal Colon, Human Gastrointestinal Tract

  9. {sup 99m}Tc-MDP bone uptake in secondary hyperparathyroidism: comparison among mandible, cranium, radius and femur

    Energy Technology Data Exchange (ETDEWEB)

    Boasquevisque, Edson; Silva, Jorge Wagner Esteves da; Bernardo, Vanessa V. de Albuquerque; Macedo, Sara Mello Santana de; Boasquevisque, Camila S.

    2008-07-01

    Full text: Objective: Evaluating bone involvement in secondary hyperparathyroidism (SHPT) by {sup 99m}Tc-MDP uptake in the mandible, cranium, radius and femur and with data correlation with PTHi serum (Intact Parathyroid Hormone). Materials and Methods: In a prospective study of 54 patients with SHPT due to chronic renal disease and 15 normal individuals (control group), all patients had elevated serum PTHi, concentration and positive {sup 99m}Tc-MDP bone scintigraphy. Bone uptake measurements were carried out drawing regions-of-interest (ROI) on the mandible, posterior cranium, distal radius and proximal femur. Additionally, soft tissue uptake was measured with one region-of-interest on the internal tight soft tissue (BG). The ROI-BG ratio used as the index of normalized bone uptake. Results: The uptake differences from SHPT and control groups mainly for mandible (p = 0,001) and cranium (p = 0,002) were statistically significant, even when the SHPT groups were separated according to serum PTHi levels. There was increased bone uptake with the increased levels of PTHi serum. All of the mandibles of the SHPT patients were abnormal with 33% having focal lesions. Conclusions: The bone uptake in SHPT group was abnormal in all areas evaluated, with high uptake of {sup 99m}Tc-MDP correlated to the increase of PTHi serum concentration. (author)

  10. Influência do tamanho e da rigidez dos objetos nos ajustes proximais e distais do alcance de lactentes Influence of object size and rigidity on proximal and distal adjustments to infant reaching

    Directory of Open Access Journals (Sweden)

    NACF Rocha

    2006-09-01

    Full Text Available CONTEXTUALIZAÇÃO: Estudos têm identificado que as propriedades dos objetos induzem os ajustes no alcance; no entanto, poucos investigaram a influência específica do tamanho e rigidez dos objetos em lactentes jovens. OBJETIVO: Verificar se lactentes de 4 a 6 meses realizam ajustes proximais e distais ao alcançarem objetos de diferentes tamanhos e rigidez. MÉTODOS: Nove lactentes saudáveis foram posicionados em uma cadeira inclinada a 50º. Quatro objetos foram apresentados, um rígido grande (RG, um rígido pequeno (RP, um maleável grande (MG e um maleável pequeno (MP, por um período de 1 minuto cada. Em um total de 384 alcances, foram analisados os ajustes proximais (alcance uni e bimanual e distais (orientação da mão horizontal, vertical e oblíqua; mão aberta, fechada e semi-aberta e o sucesso do alcance dos objetos. RESULTADOS: Constatou-se ajuste bimanual para o objeto RG e unimanual para os demais. A orientação da mão oblíqua foi predominante no toque dos objetos, enquanto para a preensão dos mesmos, a predominância foi a vertical, principalmente para o objeto RG. A orientação horizontal não foi observada na preensão do objeto RG. A mão semi-aberta foi mais freqüente no início do alcance para todos os objetos, enquanto no toque do objeto RG a mão aberta foi predominante. O sucesso do alcance foi maior para os objetos maleáveis (MG, MP do que para os rígidos (RG e RP. CONCLUSÃO: Lactentes jovens estudados são capazes de planejar e ajustar seus movimentos baseados na percepção das propriedades físicas dos objetos, o que sugere interação percepção-ação.BACKGROUND: Studies have identified that object properties lead to adjustments to reaching. However, few have investigated the specific influence of object size and rigidity among young infants. OBJECTIVE: To verify whether four to six-month-old infants make proximal and distal adjustments when reaching for objects of different sizes and rigidity. METHOD

  11. Energy flow analysis of amputee walking shows a proximally-directed transfer of energy in intact limbs, compared to a distally-directed transfer in prosthetic limbs at push-off.

    Science.gov (United States)

    Weinert-Aplin, R A; Howard, D; Twiste, M; Jarvis, H L; Bennett, A N; Baker, R J

    2017-01-01

    Reduced capacity and increased metabolic cost of walking occurs in amputees, despite advances in prosthetic componentry. Joint powers can quantify deficiencies in prosthetic gait, but do not reveal how energy is exchanged between limb segments. This study aimed to quantify these energy exchanges during amputee walking. Optical motion and forceplate data collected during walking at a self-selected speed for cohorts of 10 controls, 10 unilateral trans-tibial, 10 unilateral trans-femoral and 10 bilateral trans-femoral amputees were used to determine the energy exchanges between lower limb segments. At push-off, consistent thigh and shank segment powers were observed between amputee groups (1.12W/kg vs. 1.05W/kg for intact limbs and 0.97W/kg vs. 0.99W/kg for prosthetic limbs), and reduced prosthetic ankle power, particularly in trans-femoral amputees (3.12W/kg vs. 0.87W/kg). Proximally-directed energy exchange was observed in the intact limbs of amputees and controls, while prosthetic limbs displayed distally-directed energy exchanges at the knee and hip. This study used energy flow analysis to show a reversal in the direction in which energy is exchanged between prosthetic limb segments at push-off. This reversal was required to provide sufficient energy to propel the limb segments and is likely a direct result of the lack of push-off power at the prosthetic ankle, particularly in trans-femoral amputees, and leads to their increased metabolic cost of walking. Copyright © 2016 IPEM. Published by Elsevier Ltd. All rights reserved.

  12. Biomechanical effects of harvesting bone graft with the Reamer/Irrigator/Aspirator on the adult femur: a cadaver study.

    Science.gov (United States)

    Silva, Jason A; McCormick, Jeremy J; Reed, Mark A; Morse, Andrew S; Heffernan, Michael J; Lavado, Robert D; Billiar, Kristen; Wixted, John J

    2010-11-01

    Test the biomechanical properties of femurs that have undergone reaming with the Reamer Irrigator Aspirator (RIA) device with an aim to prove no difference in torsional strength between matched pairs. Intact femurs were harvested from embalmed cadavers, representing 19 matched pairs. One femur from each pair was randomly selected to undergo reaming using the RIA to 15 mm. The bones were then cut and potted using a uniform jig for testing. Each specimen was tested in torsion and torsional stiffness was calculated for each pair. Samples were loaded until fracture or 11 3 N·m of torque. Nine of the reamed specimens and 13 of the unreamed samples remained intact until the machine limit of 113 N·m was reached, representing approximately four times the peak torque of 30N·m seen with stair climbing [Garino J, Beredjiklian P. Core Knowledge in Orthopaedics: Adult Reconstruction and Arthroplasty. Chapter 1, page 33. Mosby, 2007]. Mean torsional stiffness for the reamed group was 532.1 N·m/rad (SD = 208.2), and the unreamed was 546.2 N·m/rad (SD=206). Torsional load capacity was calculated for all specimens and compared in groups in which both reamed and unreamed specimens failed. In these five groups, mean load capacity was 80.6 Nm (SD = 9.5) for the reamed group, and 85 Nm (SD = 16.1) for the unreamed group. 17 of our reamed specimens and all of our unreamed specimens withstood normal physiologic load seen with stair climbing. In addition, 16 of 19 reamed specimens remained intact at twice this load. The specimen in the reamed group with the lowest torsional load capacity was eccentrically reamed in the distal anterior cortex highlighting potential complications. Given these findings, reaming the cortex of the femur with the RIA device for the purpose of harvesting bone graft does not appear to dramatically diminish the mechanical properties of the cortex or require postoperative weight bearing restrictions. However, careful attention must be paid to technique as

  13. Tamanho e rigidez dos objetos influenciam os ajustes proximais e distais do alcance de crianças? Can size and rigidity of objects influence infant's proximal and distal adjustments of reaching?

    Directory of Open Access Journals (Sweden)

    Fernanda P. S. Silva

    2011-02-01

    whether these adjustments change in older infants. OBJECTIVES: The aim of this study was to determine whether the size and rigidity of objects influence the proximal and distal adjustments to reaching of infants of 6, 7, 8 and 36 months of age. METHODS: Nine healthy infants were presented with: one large rigid, one small rigid, one large malleable and one small malleable object. The movements were videotaped and later analyzed qualitatively with regard to proximal (unimanual and bimanual reaching and distal adjustments (horizontal, vertical and oblique hand orientation, opened, half-open and closed hand and with regard to grasping of these objects (with and without. Friedman test and Dunn multiple comparisons were applied and 0.05 was considered as a significant difference. RESULTS: Infants of 36 months of age performed more unimanual reaching than younger infants. Additionally, at all ages, unimanual reaching was particularly performed for small objects. At 36 months of age infants guided the hand horizontally to touch and grasp the objects, while at 6 and 7 months the hand orientation was oblique to touch and vertical to grasp the objects, regardless of the object's properties. Over the months, both at the beginning and at the end of reaching, the hands became more open, especially to touch the large rigid object, and infants increasingly performed reaching with successful grasping, especially for malleable or small objects. CONCLUSIONS: From 6 to 36 months of age, the reaching became more refined and the infants adjusted to the different properties of the objects which were observed through changes in the proximal and distal adjustments.

  14. Extreme femoral valgus and patella dislocation following lateral plate fixation of a pediatric femur fracture.

    Science.gov (United States)

    Ezzat, Ahmed; Iobst, Christopher

    2016-07-01

    A 15-year-old boy presented with a 35° femoral valgus deformity, leg-length discrepancy, painful retained hardware, and a lateral dislocation of the patella 4 years after undergoing lateral plate fixation of a distal femur fracture. Femoral valgus is a possible complication of lateral plate fixation in up to 30% of pediatric distal femur fractures. With this patient's unusual combination of deformities as an example, we suggest early hardware removal after fracture union to prevent the development of deformity. If plate removal is not chosen, then continued close monitoring of the patient is necessary until skeletal maturity.

  15. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures.

    Science.gov (United States)

    Jain, Anuj; Aggarwal, Prakash; Pankaj, Amite

    2014-01-01

    The aim of this study was to report our experience on concomitant ipsilateral proximal tibia and femoral Hoffa fractures. Nine patients (8 male, 1 female; mean age: 30.9; range: 19-49 years) presented to our emergency room with an ipsilateral proximal tibia and femoral Hoffa fracture, following road traffic accident. Six patients had open fracture. Two patients had ipsilateral femoral shaft fracture, two patients had fracture of intercondylar part of distal femur, one had fracture of patella and one had fracture of both bones of the leg. Out of nine Hoffa's fracture eight involved lateral and one involved medial femoral condyle. There were five type II, two type VI, one type I and one type IV proximal tibial fracture according to Schatzker classification. Mean duration of follow-up was 13 months (range: 9-21 months). At final follow-up, all fractures united. Mean knee society score was 163 (range: 127-182). Mean ROM at knee joint was 97.4 degrees (75°-115°). Our results suggest that in this combination of intraarticular fractures anatomic reduction and rigid fixation followed by early mobilization reveal satisfactory results.

  16. Osteoporosis and low bone mass at the femur neck or lumbar spine in older adults: United States, 2005-2008

    Science.gov (United States)

    Many current clinical guidelines recommend that assessment of osteoporosis or low bone mass, as defined by the World Health Organization (WHO) (1), be based on bone mineral density at either the femur neck region of the proximal femur (hip) or the lumbar spine (2,3). This data brief presents the mos...

  17. [Infusion of ileal juice by distal stoma].

    Science.gov (United States)

    Kunzle, J E; Ziliotto, A; De Araujo Filho, A A

    1976-01-01

    The authors present a simple and practical method to avoid the ileal juice expoliation in patients with ileostomy after intestinal resection. In the cases presented, after the resection, stomies were performed of the proximal and distal portions of the intestine, in relation to the extirpated segment. The juice collected in the proximal stomy was infused in the distal stomy, simulating that way the physiologic intestinal transit.

  18. Proximal placement of lateral thigh skin markers reduces soft tissue artefact during normal gait using the Conventional Gait Model.

    Science.gov (United States)

    Cockcroft, John; Louw, Quinette; Baker, Richard

    2016-11-01

    A primary source of measurement error in gait analysis is soft-tissue artefact. Hip and knee angle measurements, regularly used in clinical decision-making, are particularly prone to pervasive soft tissue on the femur. However, despite several studies of thigh marker artefact it remains unclear how lateral thigh marker height affects results using variants of the Conventional Gait Model. We compared Vicon Plug-in Gait hip and knee angle estimates during gait using a proximal and distal thigh marker placement for ten healthy subjects. Knee axes were estimated by optimizing thigh rotation offsets to minimize knee varus-valgus range during gait. Relative to the distal marker, the proximal marker produced 37% less varus-valgus range and 50% less hip rotation range (p < 0.001), suggesting that it produced less soft-tissue artefact in knee axis estimates. The thigh markers also produced different secondary effects on the knee centre estimate. Using whole gait cycle optimization, the distal marker showed greater minimum and maximum knee flexion (by 6° and 2° respectively) resulting in a 4° reduction in range. Mid-stance optimization reduced distal marker knee flexion by 5° throughout, but proximal marker results were negligibly affected. Based on an analysis of the Plug-in Gait knee axis definition, we show that the proximal marker reduced sensitivity to soft-tissue artefact by decreasing collinearity between the points defining the femoral frontal plane and reducing anteroposterior movement between the knee and thigh markers. This study suggests that a proximal thigh marker may be preferable when performing gait analysis using the Plug-in Gait model.

  19. [Atypical fractures of the femur: apropos of 3 clinical cases].

    Science.gov (United States)

    Sanduloviciu, Maria; Stoll, Delphine; Lamy, Olivier; Krieg, Marc-Antoine; Aubry-Rozier, Bérengère

    2014-08-06

    Osteoporosis is an increasing public health problem. The bisphophonates are the most useful treatment used through the world to prevent osteoporotic fractures. Their large prescription revealed an unpredictable side effect: the atypical fracture. These fractures appear in the subtrochanteric or diaphysal femoral proximal site, spontaneously or after a low trauma, and could be bilateral. X-rays shows a transversal or oblique fracture with a spur in the cortex and with a diffuse thickening of the cortical of the proximal femur. Expert's recommendations are current in progress to well understand and managed this problem. Here we report three cases of atypical femur fractures occurred in our Centre of bone diseases with some management and treatment propositions.

  20. Cesarean Section and Femur Fracture: A Rare Complication

    Directory of Open Access Journals (Sweden)

    Eyup Zengin

    2013-08-01

    Full Text Available Femoral fracture due to birth trauma which is rare, can ocur during cesarean section. This case represents a new born delivered by cesarean section for breech presentation who sustained proximal fracture of the femur. Then newborn was treated with immobilization in bryant traction. Bryant%u2019s traction for 3 weeks in hospital is a safe method for the treatment of femoral fractures in neonates,and the outcome is good.

  1. Management von Kombinationsfrakturen des Femurschafts und des proximalen Femurs

    DEFF Research Database (Denmark)

    Schmal, H; Strohm, P C; Mehlhorn, A T

    2008-01-01

    . Also considering the combination of femoral shaft fractures with fractures of the acetabulum and the distal femur (knee), the proportion of chain injuries of the femur was 3.1%. The rate of multiply injured patients in the group of patients with ipsilateral femoral neck and shaft fractures was 64......PURPOSE: The combination of ipsilateral femoral neck and shaft fractures remains a treatment challenge in orthopedic surgery because both fracture types constitute separate entities and require specific treatment concepts. MATERIAL AND METHODS: In a case control study, incidence, treatment...... strategies, and outcomes of this injury were analyzed. All patients with femoral fractures treated between 1 January 2001 and 31 July 2007 at a level I trauma center were included in the study. RESULTS: Twenty-one out of 1,935 patients (1.1%) sustained 22 combined fractures of the femoral neck and shaft...

  2. Acute postoperative osteomyelitis in femur fracture: contribution of bone scintilography (case report)

    Energy Technology Data Exchange (ETDEWEB)

    Borges, Natalie Ferreira; Rezende, Cleuza Maria de Faria; Sanchez-Ucros, Natalia; Laguardia, Priscilla [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Escola de Veterinaria; Diniz, Simone Odilia Fernandes; Cardoso, Valbert Nascimento [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Farmacia; Rodrigues, Carlos Jorge Simal [Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG (Brazil). Faculdade de Medicina; Santos, Raquel Gouvea dos [Centro de Desenvolcimento da Tecnologia Nuclear (CDTN/CNEN-MG), Belo Horizonte, MG (Brazil). Lab. de Radiobiologia

    2009-07-01

    The treatment of bone fractures is aimed at consolidating and returns of function as soon as possible and can be performed by different methods. Treatment with the plate in fractures of the femur in bridge aims not to address the location of fracture and stabilize it, maintaining the anatomical axis by the fixation of proximal and distal segments. Postoperative follow-up of the fracture is necessary to evaluate the irrigation of the bone structure and the effect of the method. The scintigraphy is a method capable of assessing the degree of bone remodeling and the presence or absence of local bone homeostasis. The objective of this report is to present the case of a rabbit, male, which was subjected to osteotomy and fixation of the femoral diaphysis by means of the plate in the bridge. After 10 days the animal was subjected to scintigraphic and radiographic evaluations. The animal came to death and an autopsy was performed on the same when it was observed macroscopy consistent with acute osteomyelitis due to contamination postoperative time. Radiographic evaluation in acute osteomyelitis is unclear. The methods assist in the scintigraphic diagnosis of osteomyelitis by allowing the detection of functional changes in this infectious process. The bone scintigraphy with diphosphonates labeled with technetium-99m shows increased bone turnover in the infected area and its high sensitivity, even in an early stage makes it the method of choice in the diagnosis of acute osteomyelitis in patients without prior bone disease and bone radiologically normal. (author)

  3. Emergency treatment of proximal femural fracture within 48h: The

    Directory of Open Access Journals (Sweden)

    Pellegrino Ferrara

    2017-09-01

    Full Text Available Objective: To study the main aspects of osteoporotic emergency fracture of the hip in the Umbria Region in the years 2006-2011. Methods: The study was conducted from January 1 of 2006 to December 31 of 2011, and included only patients over 49 years of age. Patients who did not habitually reside in the region were excluded. They were collected in each based on the following data: age, sex, place of residence (urban or rural, time of the year, fractured side, type of trauma, history of fracture contralateral and perioperative mortality. Results: From 2006 to 2011, a progressive increase in the number of femoral fracture admissions in regional hospitals was observed, equal to 4.73% per annum. The incidence went from 6.8 to 8.1 for 1.000 ultra-65th residents. The most affected age groups are those between 75-84 years and 85- 94 years. Conclusions: The epidemiology of osteoporotic hip fracture in the Umbria Region follows a pattern similar to that of other Italian regions. The in-hospital mortality of these patients is partly determined by age and number of complications they suffer during admission. The impact of economic resources on patients who break the osteoporotic hip justifies the implementation of programs for the prevention of osteoporosis and fractures.

  4. Pre-operative traction for fractures of the proximal femur.

    Science.gov (United States)

    Parker, M J; Handoll, H H G

    2003-01-01

    Pre-operative traction following an acute hip fracture remains standard practice in some hospitals. To evaluate the effects of traction applied to the injured limb prior to surgery for a fractured hip. Different methods of applying traction (skin or skeletal) were considered. We searched the Cochrane Musculoskeletal Injuries Group's specialised register (February 2003), the Cochrane Controlled Trials Register (The Cochrane Library Issue 1, 2003), MEDLINE (1966 to February 2003), EMBASE (1988 to 2003 Week 8), CINAHL (1982 to February 2003), the National Research Register Issue 1, 2003, conference proceedings and reference lists of articles. Date of most recent search: February 2003. All randomised or quasi-randomised trials comparing either skin or skeletal traction with no traction, or skin with skeletal traction for patients with an acute hip fracture prior to surgery. Both reviewers independently assessed trial quality, using a nine item scale, and extracted data. Additional information was sought from all trialists. Wherever appropriate and possible, the data are presented graphically. Eight randomised trials, mainly of moderate quality, involving a total of 1349 predominantly elderly patients, were identified and included in the review. The inclusion in this review update of a newly available trial resulted in no important change in the results or conclusions. Seven trials compared traction with no traction. Although no data pooling was possible, overall these provided no evidence of benefit from traction, either in the relief of pain, ease of fracture reduction or quality of fracture reduction at time of surgery. One of these trials included both skin and skeletal traction groups. This trial and one other compared skeletal traction with skin traction and found no important differences between these two methods, although the initial application of skeletal traction was noted as being more painful and more costly. From the evidence available, the routine use of traction (either skin or skeletal) prior to surgery for a hip fracture does not appear to have any benefit. However, the evidence is also insufficient to rule out the potential advantages for traction, in particular for specific fracture types, or to confirm additional complications due to traction use. Further, high quality trials would be required to confirm or refute the absence of benefits of traction.

  5. Revisiones de cadera en defectos óseos femorales Paprosky II y IIIA Utilización de prótesis no cementada, modular, de fijación proximal y anclaje distal. [Revision total hip arthroplasty in Paprosky II and IIIA femoral bone defects. Use of modular uncemented stems with proximal fixation ].

    Directory of Open Access Journals (Sweden)

    German Garabano

    2016-05-01

    Full Text Available Introducción: El objetivo de este estudio retrospectivo fue observar el comportamiento de un tallo modular de fijación proximal y anclaje distal en revisiones de cadera con defectos femorales II y IIIA (Praposky, evaluando la estabilidad protésica y articular, la restauración del off-set y la discrepancia de longitud. Materiales: Analizamos 22 RRTC de los cuales 12 (56,5% fueron mujeres y 10 varones con un promedio de edad de 62,38 años. El seguimiento promedio fue de 62 meses. El tallo femoral utilizado fue el S-ROM ® (Depuy – J&J. Los defectos óseos femorales fueron 15 tipo II y 7 IIIA de Praposky. Para la evaluación clínica se utilizó el Score de cadera de Harris (HHS. Radiológicamente se analizó el comportamiento del tallo, su integración, la discrepancia de longitud y el off-set femoral, considerándose como correcto una diferencia menor a 5mm. Resultados: el offset fue restaurado en 16 (72,3% casos y la longitud de miembros se restauró en 15 (68,2%. Hubo un solo hundimiento del tallo, y de acuerdo con Engh se observaron 17 (77,27% uniones óseas. Hubieron 7 (31,8% complicaciones, 2 luxaciones que requirieron revisión, 4 fracturas intra-operatorias y una paresia de CPE.   Conclusión este tallo impresiona ser una alternativa valida para resolver un problema complejo. Por su versatilidad, permite resolver mecánicamente el defecto óseo, devuelve la longitud al miembro y el off set a la articulación, presentando un índice de complicaciones aceptables.

  6. Aloenxerto circunferencial de femur proximal em cirurgia de revisäo de artroplastia total de quadril: relato de casos com seguimento mínimo de 20 anos Circumferential proximal femoral allografts in revision surgery on total hip arthroplasty: case reports with a minimum follow-up of 20 years

    Directory of Open Access Journals (Sweden)

    Bruno Dutra Roos

    2012-01-01

    Full Text Available Dentre as opções para reconstrução femoral em cirurgias de revisão de artroplastia total do quadril (RATQ em defeitos circunferenciais extensos está a utilização de aloenxerto de fêmur proximal. O seu uso permite a correção do mecanismo abdutor do quadril e da discrepância de comprimento dos membros inferiores, além de apresentar potencial osteocondutivo. Os autores relatam os achados clínicos e radiográficos de dois casos de RATQ com uso desta técnica, em seguimento mínimo de 20 anos.Among the options for femoral reconstruction in total hip arthroplasty (THA revision procedures, in cases of extensive circumferential defects, is the use of proximal femoral allografts. This technique makes it possible to correct the hip abductor mechanism and the leg length discrepancy, as well as presenting osteoconductive potential. The authors report the clinical and radiographic results from two cases of THA revision using this technique, with a minimum follow-up of 20 years.

  7. The Odocoileus virginianus Femur: Mechanical Behavior and Morphology.

    Directory of Open Access Journals (Sweden)

    Mark J Hedgeland

    Full Text Available Biomechanical research relies heavily on laboratory evaluation and testing with osseous animal structures. While many femora models are currently in use, including those of the European red deer (Cervus elaphus, the Odocoileus virginianus femur remains undocumented, despite its regional abundance in North America. The objective of this study was to compare biomechanical and morphological properties of the Odocoileus virginianus femur with those of the human and commonly used animal models. Sixteen pairs of fresh-frozen cervine femora (10 male, 6 female, aged 2.1 ± 0.9 years were used for this study. Axial and torsional stiffnesses (whole bone were calculated following compression and torsion to failure tests (at rates of 0.1 mm/sec and 0.2°/sec. Lengths, angles, femoral head diameter and position, periosteal and endosteal diaphyseal dimensions, and condylar dimensions were measured. The results show that the cervine femur is closer in length, axial and torsional stiffness, torsional strength, and overall morphology to the human femur than many other commonly used animal femora models; additional morphological measurements are comparable to many other species' femora. The distal bicondylar width of 59.3mm suggests that cervine femora may be excellent models for use in total knee replacement simulations. Furthermore, the cervine femoral head is more ovoid than other commonly-used models for hip research, making it a more suitable model for studies of hip implants. Thus, with further, more application-specific investigations, the cervine femur could be a suitable model for biomechanical research, including the study of ballistic injuries and orthopaedic device development.

  8. Treatment outcomes of intertrochanteric femur fractures treated with DLT™ nail

    Directory of Open Access Journals (Sweden)

    Mehmet Arıcan

    2015-12-01

    Full Text Available Objective: Intramedullary nails frequently use in proximal femur fractures. In this study, 49 patients with intertrochanteric fractures were evaluated clinical and radiological results treated with dyna locking trochanteric (DLT™ nail retrospectively. Methods: Twenty-two (44.9% patients were male and 27 (55.1% patients were female. Mean age was 74.29±1.98 (28-99 years and Followed up for a mean of 14.35±3.43 (9-24 months. Thirty-seven (75.6% of the fractures resulted from simple falls while 6 (12.2% caused from traffic accidents and 6 (12.2% fall down from height. There were 24 (49.0% left and 25 (51.0% right lower extremities fractured. According to Orthopaedic Trauma Association classification system; 21 (42.9%, 21 (42.9% and 7 (14.2% fractures were classified as 31A1, 31A2, and 31A3 respectively. One (2.0% patient had claviculae fracture, 3 (6.1% patients had radius distal fracture and 1 (2.0% patient had total knee arthroplasty. After surgery, X-ray was used for radiological results and functional outcomes were evaluated according to the Harris hip scoring system. Results: The average waiting time for the surgery was 2.02±0.18 (1-7 days and hospitalization time was 6.23±0.29 (4-15 days. Mean fracture healing time was 11.74±1.82 (8-15 weeks. Three patients had screw cut-out in the follow-up time and performed hemiarthroplasty. The average Harris hip score was 88.02±1.21 (42-97 points and included 29 (59.2% excellent cases, 17 (34.7% good and 3 (6.1% poor. Conclusion: DLT ™ nail is a safe and successful method because of low complication rates, and capability of detection.

  9. Femur length and biparietal diameter

    African Journals Online (AJOL)

    2014-12-02

    Dec 2, 2014 ... Conclusion: The fetal parameters used in this study were consistently smaller than reported values from European studies up to the 34th week of ... parameters include crown‑rump length, abdominal circumference, femur ... the continuous mid‑line echo is broken by the cavum septi pellucidi, and taken from ...

  10. femur in foetal age determination

    African Journals Online (AJOL)

    Summary. Our objective was to verify ultrasonic measurement of biparietal diameter and femur in foetal age determination in the second and third trimester of pregnancy. The prospec- tive cross sectional study was carried out at the ultrasound department of Aberdeen Maternity Hospital Scotland. The study population ...

  11. A process evaluation of the WHiTE Two trial comparing total hip artroplasty with and without dual mobility component in the treatment of displaced intracapsular fractures of the proximal femur: Can a trial investigating total hip arthroplasty for hip fracture be delivered in the NHS?

    Science.gov (United States)

    Huxley, C; Achten, J; Costa, M L; Griffiths, F; Griffin, X L

    2016-10-01

    The annual incidence of hip fracture is 620 000 in the European Union. The cost of this clinical problem has been estimated at 1.75 million disability-adjusted life years lost, equating to 1.4% of the total healthcare burden in established market economies. Recent guidance from The National Institute for Health and Clinical Excellence (NICE) states that research into the clinical and cost effectiveness of total hip arthroplasty (THA) as a treatment for hip fracture is a priority. We asked the question: can a trial investigating THA for hip fracture currently be delivered in the NHS? We performed a contemporaneous process evaluation that provides a context for the interpretation of the findings of WHiTE Two - a randomised study of THA for hip fracture. We developed a mixed methods approach to situate the trial centre within the context of wider United Kingdom clinical practice. We focused on fidelity, implementation, acceptability and feasibility of both the trial processes and interventions to stakeholder groups, such as healthcare providers and patients. We have shown that patients are willing to participate in this type of research and that surgeons value being part of a team that has a strong research ethos. However, surgical practice does not currently reflect NICE guidance. Current models of service delivery for hip fractures are unlikely to be able to provide timely total hip arthroplasty for suitable patients. Further observational research should be conducted to define the population of interest before future interventional studies are performed.Cite this article: C. Huxley, J. Achten, M. L. Costa, F. Griffiths, X. L. Griffin. A process evaluation of the WHiTE Two trial comparing total hip artroplasty with and without dual mobility component in the treatment of displaced intracapsular fractures of the proximal femur: Can a trial investigating total hip arthroplasty for hip fracture be delivered in the NHS? Bone Joint Res 2016;5:444-452. DOI: 10

  12. A FUNCTIONAL EVALUATION STUDY OF DISTAL FEMORAL FRACTURES FIXED WITH DISTAL FEMORAL LOCKING PLATE

    Directory of Open Access Journals (Sweden)

    Manikumar C. J

    2017-04-01

    Full Text Available BACKGROUND Fractures of the distal femur present considerable challenges in management. Older patients especially women sustain fractures due to osteoporosis. Supracondylar fractures of femur have a bimodal distribution. They account for 6% of all femur fractures and 31% if hip fractures were excluded. Nearly, 50% of distal femur intra-articular fractures are open fractures. Before 1970, most supracondylar fractures were treated nonoperatively; however, difficulties were often encountered including persistent angulatory deformity, knee joint incongruity, loss of knee motion and delayed mobilisation. The trend of open reduction and internal fixation has become evident in recent years with good results being obtained with AO blade plate, dynamic condylar screw, intramedullary supracondylar nail and locking compression plate. Elderly patients and osteoporosis pose difficulty in treating intra-articular fractures of the lower end of femur. Loss of stable fixation is of great concern in these cases. Hence, locking compression plate use has an advantage in these patients. MATERIALS AND METHODS In this study, 20 patients with closed fracture of distal femur were studied. All the cases were treated at the Department of Orthopaedics, Rangaraya Medical College/Government General Hospital, Kakinada, Andhra Pradesh, between November 2013 and November 2015. The method used for fracture fixation was open reduction and internal fixation with distal femoral locking plate. The duration of follow up ranged from 3 months to 24 months. All the fractures in this series were posttraumatic. The patients were functionally evaluated with Neer’s scoring system. 1 RESULTS Twenty distal femoral fractures were treated with distal femoral locking plates. 15 patients were males and 5 patients were females. The median age was 47 years ranging from 28-70 years. 16 of the fractures were caused by road traffic accidents and 2 were due to fall, 2 were due to assault. 12 patients

  13. New quantitative ultrasound techniques for bone analysis at the distal radius in hip fracture cases: differences between femoral neck and trochanteric fractures.

    Science.gov (United States)

    Horii, Motoyuki; Fujiwara, Hiroyoshi; Sakai, Ryo; Sawada, Koshiro; Mikami, Yasuo; Toyama, Syogo; Ozaki, Etsuko; Kuriyama, Nagato; Kurokawa, Masao; Kubo, Toshikazu

    2017-01-01

    Ample evidence on etiological and pathological differences between femoral neck and trochanteric fracture cases suggests the possibility of individualized treatment. There are many issues related to areal bone mineral density and other quantitative computed tomography parameters of the proximal femur. Although osteoporosis is a systemic problem, little has been reported regarding differences in bone structural parameters, including bone mineral density, between them in regions other than the proximal femur. Participants were consecutive female patients >50 years of age admitted to the Saiseikai Suita Hospital (Osaka prefecture, Japan) for their first hip fracture between January 2012 and September 2014. Cortical thickness (CoTh, mm), volumetric trabecular bone mineral density (TBD, mg/cm 3 ), and elastic modulus of trabecular bone (EMTb, GPa) were obtained as the new QUS parameters using the LD-100 system (Oyo Electric, Kyoto, Japan). The mean values of these parameters were compared between femoral neck and trochanteric fracture cases. In addition, correlations between age and each QUS parameter were investigated for each fracture type. A receiver operating characteristic (ROC) curve analysis was performed to examine the degree of effect each parameter on the fracture types. The area under the curve (AUC) for each parameter was compared to the AUC for age. There were 63 cases of femoral neck fracture (mean age, 78.2 years) and 37 cases of trochanteric fracture (mean age, 85.9 years). Mean TBD and EMTb were significantly higher for femoral neck fractures. There were significant negative correlations between QUS parameters and age for femoral neck fractures (P femoral neck fractures were above those for trochanteric fractures for TBD and EMTb. AUCs were 0.72 for age, and 0.61, 0.65, and 0.65 for CoTh, TBD, and EMTb, respectively. The new QUS parameters indicated that TR fracture cases were more osteoporotic than were FN fracture cases, even at the distal radius

  14. Instrument access device for instrument access system, has connector member connecting proximal member with instrument seals, where proximal member and connector member are configured to retain proximal end of retractor member

    OpenAIRE

    Bonadio, Frank; Vaugh, Trevor; McManus, Ronan; MacNally, Shane

    2010-01-01

    The device (203) has instrument seals sealingly arranged in a body of a patient, and a distal anchoring member located in a wound interior. A retractor member is proximally extended from a distal anchoring member to retract sides of a wound opening. A proximal member is adopted for locating an external part of the wound opening. A connector member connects the proximal member with the instrument seals. The proximal member and the connector member are configured to retain a proximal end of the...

  15. Der umgedrehte Plattenfixateur zur osteosynthetischen Stabilisierung bei erschwerter Frakturheilung am proximalen Femur

    DEFF Research Database (Denmark)

    Mehlhorn, A T; Strohm, P C; Müller, C A

    2009-01-01

    AIM: The aim of the study was to evaluate the application of a locked internal fixator in complex fractures of the proximal femur, in which the internal fixation with standard implants was not possible due to poor quality of bone or already failed internal fixation in the past. METHOD: Ten patien...

  16. [Effect of intramedullary reaming and nailing on the production of growth factors in the femur fracture callus in rats].

    Science.gov (United States)

    Mingo-Robinet, J; Valle-Cruz, J A; Ortega-Medina, L; Fuentes-Ferrer, M; López-Durán Stern, L

    2013-01-01

    Many studies have been conducted to determine the different effects that reaming or intramedullary nailing have on fracture healing, but there is no evidence in the literature of the effect of intramedullary reaming on osteogenesis. We performed a prospective study to analyse the effect of intramedullary reaming and nailing on the production of growth factors during the process of fracture healing in the femur of rats. A transverse mid-shaft non-comminuted femur fracture was produced in 64 rats; 34 rats did not receive any treatment, and a standardized surgical procedure was performed on 30 rats, by exposing the left knee, reaming the medullary canal from distal to proximal, and then fixing the fracture with a steel pin. The rats were sacrificed at the 24th hour, 4th, 7th and 15th days after the fracture. The amount of growth factors that appeared in the callus fracture was measured using histopathology studies. The primary categorical variables analysed were PDGFA, TGF2 and TGFβ-R2. These variables were analysed in each group at the different sacrifice times. The results of the primary variables of the study, stratified by the time until sacrifice, showed no statistically significant differences. Even if the presence of an intramedullary wire facilitates the fracture repair and the stabilising the bridge of bone between both edges of the fracture site, no evidence was found that reaming changes the expression of the growth factors studied (PDGFA, TGFβ-R2 and TGFβ2) during the callus formation in rats. © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  17. Subtrochanteric and diaphyseal femur fractures in patients treated with alendronate: a register-based national cohort study

    DEFF Research Database (Denmark)

    Abrahamsen, Bo; Eiken, Pia; Eastell, Richard

    2009-01-01

    of bone turnover. Two national observational register-based studies were performed: (1) cross-sectional study (N = 11,944) comparing age distribution, exposure, and trauma mechanisms between different types of proximal femur fractures and (2) matched cohort study in patients with prior nonhip fractures (N......Alendronate (aln) is a potent bisphosphonate with a prolonged duration of action. Recent reports have found long-term aln use to be common in patients with subtrochanteric or proximal diaphyseal femur fracture, raising concerns that these fractures could be a consequence of excessive suppression...... = 5187 + 10,374), testing the hypothesis that the increase in the risk of subsequent atypical femur fractures exceeded the increase in typical hip fractures. We also sought evidence of a dose-response relationship, where high adherence to or long-term use of aln led to more atypical femur fractures. We...

  18. A case of acute bilateral femur fracture with vascular injury

    Directory of Open Access Journals (Sweden)

    Slavisa Zagorac

    2016-01-01

    Full Text Available The femoral fractures remain the great challenge for orthopedic surgeons regarding time of fixation and appropriate fixation techniques. There is a bimodal distribution of fractures occurring most frequently in young males after high-energy trauma (motor vehicle accidents and in elderly females after falls from standing. Young patients with femoral fracture are under the great risk of multiple injuries. Hence, the great significance is optimal time of fixation. We present a case of unusual pattern of injury and fixation technique of bilateral proximal femur fracture associated with vascular injury, with very satisfied outcome.

  19. Distal Femoral Complications Following Antegrade Intramedullary Nail Placement

    OpenAIRE

    Fantry, Amanda J.; Gregory Elia; Brian G. Vopat; Daniels, Alan H.

    2015-01-01

    While antegrade nailing for proximal and diaphyseal femur fractures is a commonly utilized fixation method with benefits including early mobilization and high rates of fracture union, both intraoperative and postoperative complications may occur. Intraoperative errors include leg length discrepancy, anterior cortical perforation, malreduction of the fracture, and neurovascular injury, and postoperative complications include nonunion, malunion, infection, and hardware failure. This case series...

  20. In vitro ultrasound measurement at the human femur.

    Science.gov (United States)

    Padilla, F; Akrout, L; Kolta, S; Latremouille, C; Roux, C; Laugier, P

    2004-11-01

    Measurements of broadband ultrasonic attenuation (BUA) represent an established means of skeletal status assessment in osteoporosis. Today, the skeletal site that is the most widely used clinically is the calcaneus (heel bone). However, we hypothesized that fracture risk predictions could be improved if ultrasound measurements were performed directly at the main site of fracture, e.g., the proximal femur. The goal of this paper is to demonstrate in vitro the feasibility of quantitative ultra sound (QUS) imaging at the upper part of fee femur, and to investigate the relationships of BUA to bone mineral density (BMD). Forty-four excise human femurs were measured in transmission with a pair of focused 0.5-MHz central frequency transducers. Two-dimensional scans were performed, and the radio frequency (rf) signals were recorded at each measurement point. A data acceptance criterion for region of interest (ROI) selection was established based on the linearity of the frequency-dependent attenuation. Five measurements with repositioning were performed on each sample to determine the reproducibility. Dual energy x-ray absorptiometry (DXA) scans have been performed on the samples for BMD measurements: Three ROIs were selected in the specimens: greater, trochanter intertrochanteric, and femoral neck regions. Coefficient of variations were in the range 1.6% to 2.5%. The determination coefficients (r(2)) between BUA and BMD in site-matched ROIs were 0.81, 0.78, and 0.73, respectively, for the greater trochanteric, intertrochanteric, and femoral neck regions. Our results are consistent with data previously shown at the calcaneus and demonstrate the feasibility of QUS measurements at the femur in vitro, with reasonable reproducibility.

  1. Distal Communication by Chimpanzees (Pan troglodytes): Evidence for Common Ground?

    Science.gov (United States)

    Leavens, David A; Reamer, Lisa A; Mareno, Mary Catherine; Russell, Jamie L; Wilson, Daniel; Schapiro, Steven J; Hopkins, William D

    2015-01-01

    van der Goot et al. (2014) proposed that distal, deictic communication indexed the appreciation of the psychological state of a common ground between a signaler and a receiver. In their study, great apes did not signal distally, which they construed as evidence for the human uniqueness of a sense of common ground. This study exposed 166 chimpanzees to food and an experimenter, at an angular displacement, to ask, "Do chimpanzees display distal communication?" Apes were categorized as (a) proximal or (b) distal signalers on each of four trials. The number of chimpanzees who communicated proximally did not statistically differ from the number who signaled distally. Therefore, contrary to the claim by van der Goot et al., apes do communicate distally. © 2015 The Authors. Child Development © 2015 Society for Research in Child Development, Inc.

  2. Semi-automated landmark-based 3D analysis reveals new morphometric characteristics in the trochlear dysplastic femur.

    Science.gov (United States)

    Van Haver, Annemieke; De Roo, Karel; De Beule, Matthieu; Van Cauter, Sofie; Audenaert, Emmanuel; Claessens, Tom; Verdonk, Peter

    2014-11-01

    The authors hypothesise that the trochlear dysplastic distal femur is not only characterised by morphological changes to the trochlea. The purpose of this study is to describe the morphological characteristics of the trochlear dysplastic femur in and outside the trochlear region with a landmark-based 3D analysis. Arthro-CT scans of 20 trochlear dysplastic and 20 normal knees were used to generate 3D models including the cartilage. To rule out size differences, a set of landmarks were defined on the distal femur to isotropically scale the 3D models to a standard size. A predefined series of landmark-based reference planes were applied on the distal femur. With these landmarks and reference planes, a series of previously described characteristics associated with trochlear dysplasia as well as a series of morphometric characteristics were measured. For the previously described characteristics, the analysis replicated highly significant differences between trochlear dysplastic and normal knees. Furthermore, the analysis showed that, when knee size is taken into account, the cut-off values of the trochlear bump and depth would be 1 mm larger in the largest knees compared to the smallest knees. For the morphometric characteristics, the analysis revealed that the trochlear dysplastic femur is also characterised by a 10% smaller intercondylar notch, 6-8% larger posterior condyles (lateral-medial) in the anteroposterior direction and a 6% larger medial condyle in the proximodistal direction compared to a normal femur. This study shows that knee size is important in the application of absolute metric cut-off values and that the posterior femur also shows a significantly different morphology.

  3. Effect of electroacupuncture at distal–proximal acupoint combinations on spinal interleukin-1 beta in a rat model of neuropathic pain

    Directory of Open Access Journals (Sweden)

    Huili Jiang

    2015-01-01

    Conclusion: EA at distal + proximal acupoints, distal points, as well as proximal points attenuated upregulation of spinal IL-1β, alleviated the extent of neuropathic pain hypersensitivity, and promoted mechanical withdrawal threshold, resulting in EA analgesia.

  4. Immediate weight bearing of comminuted supracondylar femur fractures using locked plate fixation.

    Science.gov (United States)

    Granata, Jaymes D; Litsky, Alan S; Lustenberger, David P; Probe, Robert A; Ellis, Thomas J

    2012-08-01

    Comminuted supracondylar femur fractures (AO-OTA 33A3) are commonly treated with locked plates. Weight bearing is generally restricted for 6 to 12 weeks until radiologic evidence exists of sufficient callous to support weight bearing. Recent clinical studies have reported high nonunion rates with distal femur locked plates. In an attempt to induce beneficial motion across the fracture site, some studies have recommended earlier weight bearing. The purpose of the current study was to determine the biomechanical feasibility of an immediate weight-bearing rehabilitation protocol to encourage healing of distal femur fractures treated with lateral locked plate fixation.Sixteen fresh-frozen cadaveric femora were used for this study. A 2.5-cm supracondylar gap osteotomy was made. Ten-hole, 4.5-mm distal femur locking plates were used with a standardized screw configuration that maximized the working length. The specimens were placed in a servohydraulic testing machine and axially loaded (unidirectional) at 1 Hz for up to 200,000 cycles. Failure was defined as 1 cm of deformation of the construct. The staircase method was used to determine the fatigue limit of the construct. The fatigue limit was calculated to be 1329±106 N. No specimen failed through the non-locking diaphyseal screws. Plastic deformation, when present, occurred at the metaphyseal flare of the plate. The fatigue limit of the locked plate constructs equaled 1.9 times body weight for an average 70-kg patient over a simulated 10-week postoperative course. Given that distal femoral loads during gait have been estimated to be more than 2 times body weight, the data from this study do not support immediate full weight bearing. Copyright 2012, SLACK Incorporated.

  5. Proximal Hypospadias

    Science.gov (United States)

    Kraft, Kate H.; Shukla, Aseem R.; Canning, Douglas A.

    2011-01-01

    Hypospadias results from abnormal development of the penis that leaves the urethral meatus proximal to its normal glanular position. Meatal position may be located anywhere along the penile shaft, but more severe forms of hypospadias may have a urethral meatus located at the scrotum or perineum. The spectrum of abnormalities may also include ventral curvature of the penis, a dorsally redundant prepuce, and atrophic corpus spongiosum. Due to the severity of these abnormalities, proximal hypospadias often requires more extensive reconstruction in order to achieve an anatomically and functionally successful result. We review the spectrum of proximal hypospadias etiology, presentation, correction, and possible associated complications. PMID:21516286

  6. Distal renal tubular acidosis

    Science.gov (United States)

    ... this disorder. Alternative Names Renal tubular acidosis - distal; Renal tubular acidosis type I; Type I RTA; RTA - distal; Classical RTA Images Kidney anatomy Kidney - blood and urine flow References Krapf R, ...

  7. Distal radioulnar joint injuries

    National Research Council Canada - National Science Library

    Thomas, Binu P; Sreekanth, Raveendran

    2012-01-01

    .... Injuries around distal radioulnar joint are not uncommon, and are usually associated with distal radius fractures,fractures of the ulnar styloid and with the eponymous Galeazzi or Essex_Lopresti fractures...

  8. Use of a long distally fixed intramedullary stem to treat a periprosthetic femoral fracture following total hip arthroplasty using a thrust plate hip prosthesis: A case report.

    Science.gov (United States)

    Hatanaka, Hiroyuki; Motomura, Goro; Ikemura, Satoshi; Sonoda, Kazuhiko; Kubo, Yusuke; Utsunomiya, Takeshi; Yamamoto, Takuaki; Nakashima, Yasuharu

    2017-01-01

    The thrust plate hip prosthesis (TPP; Zimmer, Winterthur, Switzerland) is a hip prosthesis that is no longer in production. Few reports have focused on periprosthetic fractures following total hip arthroplasty (THA) with the use of a TPP. We report a 57-year-old woman with a periprosthetic femoral fracture 13 years after THA with the use of a TPP. A plain radiograph showed a displaced subtrochanteric fracture of the right femur just below the distal tip of the lateral plate without implant loosening. She underwent revision surgery with a long distally fixed intramedullary stem in conjunction with a plate and cable system. Three months after surgery, bone union was confirmed using radiography and the patient was clinically asymptomatic. We encountered three major problems while planning surgical treatment, these being, discontinuation of the TPP system, loss of proximal femoral cancellous bone, and difficulties with the type of subtrochanteric fracture. After considering these problems, we planned revision surgery using a long distally fixed intramedullary stem in conjunction with a plate and cable system. This case shows that sufficient implant preparation based on precise preoperative planning is necessary to obtain good clinical results for the surgical treatment of periprosthetic femoral fractures following THA with the use of a TPP. Copyright © 2017 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  9. Glucagon-like peptide 1 (7-36) amide stimulates exocytosis in human pancreatic beta-cells by both proximal and distal regulatory steps in stimulus-secretion coupling

    DEFF Research Database (Denmark)

    Gromada, J; Bokvist, K; Ding, W G

    1998-01-01

    The effect of glucagon-like peptide 1(7-36) amide [GLP-1(7-36) amide] on membrane potential, whole-cell ATP-sensitive potassium channel (K[ATP]) and Ca2+ currents, cytoplasmic Ca2+ concentration, and exocytosis was explored in single human beta-cells. GLP-1(7-36) amide induced membrane depolariza......The effect of glucagon-like peptide 1(7-36) amide [GLP-1(7-36) amide] on membrane potential, whole-cell ATP-sensitive potassium channel (K[ATP]) and Ca2+ currents, cytoplasmic Ca2+ concentration, and exocytosis was explored in single human beta-cells. GLP-1(7-36) amide induced membrane...... depolarization that was associated with inhibition of whole-cell K(ATP) current. In addition, GLP-1(7-36) amide (and forskolin) produced greater than fourfold potentiation of Ca2+-dependent exocytosis. The latter effect resulted in part (40%) from acceleration of Ca2+ influx through voltage-dependent (L-type) Ca......2+ channels. More importantly, GLP-1(7-36) amide (via generation of cyclic AMP and activation of protein kinase A) potentiated exocytosis at a site distal to a rise in the cytoplasmic Ca2+ concentration. Photorelease of caged cAMP produced a two- to threefold potentiation of exocytosis when...

  10. Modified distal revascularization with interval ligation procedure for steal syndrome after arteriovenous fistula creation for hemodialysis access

    NARCIS (Netherlands)

    van der Meer, Saskia; Zeebregts, Clark; Tielliu, Ignacc; Verhoeven, Eric; van den Dungen, Jan

    2007-01-01

    Patients diagnosed with steal syndrome after hemodialysis access surgery have a few options for symptom relief while maintaining vascular access. These include fistula lengthening, banding, distal revascularization with interval ligation (DRIL), revision using distal inflow (RUDI) or proximalization

  11. The effect of implant overlap on the mechanical properties of the femur.

    Science.gov (United States)

    Harris, Timothy; Ruth, John T; Szivek, John; Haywood, Brett

    2003-05-01

    The most biomechanically stable relationship between the side plate of a compression hip screw (CHS) and retrograde intramedullary (IM) femoral nail has not been described in the literature. This becomes a clinical issue when treating supracondylar femur fractures with a retrograde nail in patients with a history of compression hip screw fixation of intertrochanteric fractures. The proximal end of the nail and the interlocking screws may act as a stress riser in the femoral diaphysis. The purpose of this study is to determine the biomechanical consequences of the amount of implant overlap between a CHS plate and retrograde IM femoral nail. Nine paired fresh-frozen cadaver femora from elderly donors were cleaned of soft tissue and fixed with uniaxial strain gauges. Each femur was loaded three times in a fall-loading configuration to 50 kg at a rate of 1 Hz. The study consisted of two phases. In phase 1, six pair were randomly divided into a control and test femur from each pair. Three states were compared on each test femur: uninstrumented, instrumented with CHS, and instrumented with CHS and retrograde nail. The control femur consisted of the matched femur tested in two states: uninstrumented and instrumented with a CHS. The femora were then loaded to failure. The tests were performed with the retrograde nail and CHS gapped 3 cm, kissing, and overlapping by two screw holes (two pair for each state). In phase 2, each of the remaining three pair were instrumented with a CHS and retrograde nail overlapping in one femur and gapped in the matched femur and tested in the same manner. Data analysis was performed using Pearson's correlation coefficients between groups. Paired samples t tests were used to compare differences within test states and independent samples t tests were used to compare differences between femora. Mean strain at 50-kg load, load-versus-strain patterns, failure patterns, and load and strain at failure were recorded. RESULTS; Correlation coefficients

  12. Radiation‑free Insertion of Distal Interlocking Screw in Tibial and ...

    African Journals Online (AJOL)

    Intramedullary nailing is the standard treatment method for closed and most of the open fractures of the long-bone diaphysis.[1,2] Targeting the distal holes of the intrameduallry (IM) nail for insertion of distal interlocking screws remain a challenge for the orthopedic surgeons. Proximally based distal targeting devices have ...

  13. Unilateral proximal focal femoral deficiency, fibular aplasia, tibial campomelia and oligosyndactyly in an Egyptian child – Probable FFU syndrome

    Directory of Open Access Journals (Sweden)

    Rabah M. Shawky

    2014-07-01

    Full Text Available We report a fifteen month old Egyptian male child, the third in order of birth of healthy non consanguineous parents, who has normal mentality, normal upper limbs and left lower limb. The right lower limb has short femur, and tibia with anterior bowing, and an overlying skin dimple. The right foot has also oligosyndactyly (three toes, and the foot is in vulgus position. There is limited abduction at the hip joint, full flexion and extension at the knee, limited dorsiflexion and plantar flexion at the ankle joint. The X-ray of the lower limb and pelvis shows proximal focal femoral deficiency, absent right fibula with shortening of the right tibia and anterior bowing of its distal third. The acetabulum is shallow. He has a family history of congenital cyanotic heart disease. Our patient represents most probably the first case of femur fibula ulna syndrome (FFU in Egypt with unilateral right leg affection. We suggest that the condition in our patient may be due to a rare autosomal dominant mutation with possible gonadal mosaicism and with variable expression in the family, as limb anomaly in one child and cyanotic congenital heart disease in another child.

  14. Load along the femur shaft during activities of daily living.

    Science.gov (United States)

    D'Angeli, V; Belvedere, C; Ortolani, M; Giannini, S; Leardini, A

    2013-08-09

    A comprehensive knowledge of the loads applied during activities of daily living to the femur shaft is necessary to the design of direct attachments of relevant prostheses. A motion analysis system was used together with an established protocol with skin markers to estimate the three components of the forces and moments acting on ten equidistant points along the full femur shaft. Twenty healthy young volunteers were analyzed while performing three repetitions of the following tasks: level walking at three different speeds, straight-line and with sudden changes of direction to the right and to the left, stairs ascending and descending, squat, rising from a chair and sitting down. Average load patterns, after normalisation for body weight and height, were calculated over subjects for each point, about the three anatomical axes, and for each motor task. These patterns were found consistent over subjects, but different among the anatomical axes and tasks. In general, the moments were observed limitedly influenced by the progression speed, and higher for more proximal points. The moments were also higher in abd/adduction (8.1% body weight*height on average), nearly three times larger than those in flex/extension (2.6) during stair descending. The largest value over all moments was 164.8 N m, abd/adduction in level walking at high speed. The present results should be of value also for a most suitable level for amputation in transfemoral amputation, for in-vitro mechanical tests and for finite element models of the femur. Copyright © 2013 Elsevier Ltd. All rights reserved.

  15. Current concepts in pediatric femur fracture treatment.

    Science.gov (United States)

    Kanlic, Enes; Cruz, Miguel

    2007-12-01

    Femoral neck fractures require urgent evacuation of intracapsular hematoma, anatomic reduction, and secure fixation with screws and cast immobilization. Extracapsular trochanteric and subtrochanteric fractures are best treated by fixed angle devices (locked plates or dynamic screw and side plate). "Length stable" low energy shaft fractures with minimal displacement or nails. Bridge plating will provide better stability in complex fractures. Children > 12 years have less risk of vascular disturbance to the proximal physis, and should have lateral transtrochanateric entry locked rigid nails. Fractures with severe soft tissue injuries could be temporized with external fixation. Distal physis and epiphyseal injuries require anatomical reduction and smooth wires and/or screw fixation (placed in such a way as to minimize further damage to the physis) and need to be augmented with a brace. Leg-length discrepancy is not a significant clinical problem in operatively treated patients. We recommend hardware removal after complete fracture healing, usually in 6 to 12 months. Implants left in the growing child could become buried deep inside of the bone, or cause "periprosthetic" fractures and/or eventually impede adult reconstruction. Minimal risks are reported for hardware removal in healthy patients with healed fractures (4 cortices bridged).

  16. Metachronous bilateral subtrochanteric fracture of femur in an osteopetrotic bone: A case report with technical note☆

    Science.gov (United States)

    Kumar, Dharmendra; Jain, Vijay Kumar; lal, Hitesh; Arya, Rajinder Kumar; Sinha, Skand

    2012-01-01

    Osteopetrosis is a rare inherited skeletal disorder characterized by increased density. The increased fragility of such dense bone results in a greater incidence of fractures, especially around hip and proximal femur. The surgical treatment of such fractures is difficult due to hard but brittle structure of bone. Herein we report a case of bilateral subtrochanteric fracture in an osteopetrotic patient. It was fixed using a dynamic hip screw with plate. PMID:26403447

  17. Small differences between anatomical and mechanical sagittal femur axes: a radiological and navigated study of 50 patients.

    Science.gov (United States)

    Jenny, Jean-Yves; Barbe, Bruno

    2012-07-01

    The purposes of the study were to define the orientation of the anatomical and mechanical axes of the femur on the lateral plane on long leg X-rays including the femoral head, and to compare these results to the intra-operative measurement of the mechanical axis by a nonimage-based navigation system. Fifty cases of patients operated on for total knee replacement were included. All patients had digital pre- and post-operative long leg lateral X-rays including the femoral head. All prostheses were implanted with a nonimage-based navigation system. Five sagittal femur axes were measured on pre- and post-operative X-rays. The sagittal orientation of the distal femoral resection was measured by the navigation system and on the post-operative X-rays. Significant, but small differences were observed in the orientation of the different axes on the pre- and post-operative X-rays. The correlation and the agreement between all axes were good. There was no significant modification on the post-operative X-rays. There were significant, but small differences between the navigated and radiological orientation of the distal femur resection, but the correlation and the agreement were good. The differences observed are small and have probably little clinical relevance. The distal cortical axis may be the best compromise. The navigation system allows measuring accurately the orientation of the distal femoral resection in the sagittal plane.

  18. Unilateral proximal focal femoral deficiency, fibular aplasia, tibial ...

    African Journals Online (AJOL)

    ... dominant mutation with possible gonadal mosaicism and with variable expression in the family, as limb anomaly in one child and cyanotic congenital heart disease in another child. Keywords: Short femur; Limb anomaly; FFU syndrome; Proximal focal femoral deficiency; Fibular aplasia; Tibial campomelia; Oligosyndactyly ...

  19. Transverse Stress Fracture of the Proximal Patella: A Case Report

    National Research Council Canada - National Science Library

    Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu

    2016-01-01

    .... Regarding patella stress fractures, so far only distal transverse or lateral longitudinal fractures have been reported, but there are no reports of transverse fractures occurring in the proximal patella...

  20. Morphometric Evaluation of Korean Femurs by Geometric Computation: Comparisons of the Sex and the Population

    Directory of Open Access Journals (Sweden)

    Ho-Jung Cho

    2015-01-01

    Full Text Available We measured 28 parameters of 202 femurs from Koreans by an automated geometric computation program using 3D models generated from computed tomography images. The measurement parameters were selected with reference to physical and forensic anthropology studies as well as orthopedic implant design studies. All measurements were calculated using 3D reconstructions on a computer using scientific computation language. We also analyzed sex and population differences by comparison with data from previous studies. Most parameters were larger in males than in females. The height, head diameter, head center offset, and chord length of the diaphysis, most parameters in the distal femur, and the isthmic width of the medullary canal were smaller in Koreans than in other populations. However, the neck-shaft angle, subtense, and width of the intercondylar notch in the distal femur were larger than those in other populations. The results of this study will be useful as a reference for physical and forensic anthropology as well as the design of medical devices suitable for Koreans.

  1. Pictorial essay: Distal colostography

    Directory of Open Access Journals (Sweden)

    Rahalkar Mukund

    2010-01-01

    Full Text Available Distal colostography (DC, also called distal colography or loopography, is an important step in the reparative management of anorectal malformations (ARMs with imperforate anus, Hirschsprung′s disease (occasionally and colonic atresia (rarely in children and obstructive disorders of the distal colon (colitis with stricture, carcinoma or complicated diverticulosis in adults. It serves to identify/confirm the type of ARM, presence/absence of fistulae, leakage from anastomoses, or patency of the distal colon. We present a pictorial essay of DC in a variety of cases.

  2. Pediatric Distal Radius Fractures.

    Science.gov (United States)

    Dua, Karan; Abzug, Joshua M; Sesko Bauer, Andrea; Cornwall, Roger; Wyrick, Theresa O

    2017-02-15

    Distal radius fractures are the most common orthopaedic injury that occur in the pediatric population. The annual incidence of distal radius fractures has increased as a result of earlier participation in sporting activities, increased body mass index, and decreased bone mineral density. Most distal radius fractures are sustained after a fall onto an outstretched arm that results in axial compression on the extremity or from direct trauma to the extremity. Physeal fractures of the distal radius are described based on the Salter-Harris classification system. Extraphyseal fractures of the distal radius are described as incomplete or complete based on the amount of cortical involvement. A thorough physical examination of the upper extremity is necessary to rule out any associated injuries. PA and lateral radiographs of the wrist usually are sufficient to diagnose a distal radius fracture. The management of distal radius fractures is based on several factors, including patient age, fracture pattern, and the amount of growth remaining. Nonsurgical management is the most common treatment option for patients who have distal radius fractures because marked potential for remodeling exists. If substantial angulation or displacement is present, closed reduction maneuvers with or without percutaneous pinning should be performed. Patients with physeal fractures of the distal radius that may result in malunion who present more than 10 days postinjury should not undergo manipulation of any kind because of the increased risk for physeal arrest.

  3. Femur ultrasound (FemUS)--first clinical results on hip fracture discrimination and estimation of femoral BMD.

    Science.gov (United States)

    Barkmann, R; Dencks, S; Laugier, P; Padilla, F; Brixen, K; Ryg, J; Seekamp, A; Mahlke, L; Bremer, A; Heller, M; Glüer, C C

    2010-06-01

    A quantitative ultrasound (QUS) device for measurements at the proximal femur was developed and tested in vivo (Femur Ultrasound Scanner, FemUS). Hip fracture discrimination was as good as for DXA, and a high correlation with hip BMD was achieved. Our results show promise for enhanced QUS-based assessment of osteoporosis. Dual X-ray absorptiometry (DXA) at the femur is the best predictor of hip fractures, better than DXA measurements at other sites. Calcaneal quantitative ultrasound (QUS) can be used to estimate the general osteoporotic fracture risk, but no femoral QUS measurement has been introduced yet. We developed a QUS scanner for measurements at the femur (Femur Ultrasound Scanner, FemUS) and tested its in vivo performance. Using the FemUS device, we obtained femoral QUS and DXA on 32 women with recent hip fractures and 30 controls. Fracture discrimination and the correlation with femur bone mineral density (BMD) were assessed. Hip fracture discrimination using the FemUS device was at least as good as with hip DXA and calcaneal QUS. Significant correlations with total hip bone mineral density were found with a correlation coefficient R (2) up to 0.72 and a residual error of about one half of a T-score in BMD. QUS measurements at the proximal femur are feasible and show a good performance for hip fracture discrimination. Given the promising results, this laboratory prototype should be reengineered to a clinical applicable instrument. Our results show promise for further enhancement of QUS-based assessment of osteoporosis.

  4. Distal radius triplane fracture.

    Science.gov (United States)

    Parkar, A A H; Marya, S; Auplish, S

    2014-11-01

    A triplane fracture is so named because of the three planes traversed by the fracture line. These are physeal fractures that result from injury during the final phase of maturation and cessation of growth. This fracture pattern typically involves the distal tibia. We present a rare case of a triplane fracture involving the distal radius.

  5. Bone morphology of the femur and tibia captured by statistical shape modelling predicts rapid bone loss in acute spinal cord injury patients.

    Science.gov (United States)

    Varzi, Delaram; Coupaud, Sylvie A F; Purcell, Mariel; Allan, David B; Gregory, Jennifer S; Barr, Rebecca J

    2015-12-01

    After spinal cord injury (SCI), bone loss in the paralysed limbs progresses at variable rates. Decreases in bone mineral density (BMD) in the first year range from 1% (slow) to 40% (rapid). In chronic SCI, fragility fractures commonly occur around the knee, with significant associated morbidity. Osteoporosis treatments await full evaluation in SCI, but should be initiated early and targeted towards patients exhibiting rapid bone loss. The potential to predict rapid bone loss from a single bone scan within weeks of a SCI was investigated using statistical shape modelling (SSM) of bone morphology, hypothesis: baseline bone shape predicts bone loss at 12-months post-injury at fracture-prone sites. In this retrospective cohort study 25 SCI patients (median age, 33 years) were scanned at the distal femur and proximal tibia using peripheral Quantitative Computed Tomography at tibia mode 3, +1 SD) was associated with 9.4% additional 12-month tibial trabecular BMD loss. Baseline bone shape determined from a single bone scan is a valid imaging biomarker for the prediction of 12-month bone loss in SCI patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  6. Malunion of the distal radius.

    Science.gov (United States)

    Prommersberger, Karl-Josef; Pillukat, Thomas; Mühldorfer, Marion; van Schoonhoven, Jörg

    2012-05-01

    Fractures of the distal radius are extremely common injuries, which are steadily becoming a public health issue. One of the most common complications following distal radius fractures is still malunion of the distal radius. This review of the literature surrounding distal radius malunion covers the biomechanics of distal radial malunion, treatment options, indications for surgery, surgical techniques, and results.

  7. Ekspresi Tartrate-Resistant Acid Phosphatase-5b pada Epifisis Tulang Femur Tikus Ovariektomi yang Mengkonsumsi Calcitriol dan Raloxifene (TARTRATE-RESISTANT ACID PHOSPHATASE-5b EXPRESSION OF EPIPHYSYS DISTALIS FEMUR OVARIECTOMIZED RATS CONSUMING CALCITRIO

    Directory of Open Access Journals (Sweden)

    Hartiningsih .

    2016-03-01

    Full Text Available Tartrate resistant alkaline phosphatase 5b (TRACP5b is secreted by osteoclasts during bonedifferentiation and resorption. The objective of the research was to study TRAP5b expression inovariectomized Wistar rat consuming the combinations of calcitriol and raloxifene supplementation foreight weeks. Twenty five female Wistar rats aged eight weeks were randomly divided into five groups:normal control (NK, ovariectomy control (OVK, ovariectomy+calcitriol supplementation (OVD,ovariectomy+ raloxifene supplementation (OVR, and ovariectomy+calcitriol+ raloxifene supplementation(OVDR. At the end of the treatment, blood samples were taken from plexus orbitalis medialis forestrogen analysis. All rats were euthanized, the uteri were taken and weighed. Left femur was taken forhistopatological examination and immunohistochemistry TRAP5b using monoclonal antibody anti TRAP5bwhich was detected with streptavidin-biotin. The results showed that estrogen levels of the rats in OVKgroup were significantly decreased compared to the rats in NK group, meanwhile estrogen levels in the OVDR rat group were significantly decreased compared to the NK and OVK rat group. Histopathologicalobservation of distal femur epiphysis in group NK showed normal structure, meanwhile, distal femurepiphysis in OVK group was found osteoporosis, with some abnormalities, such as: increased of bonemarrow space, domination of adipocytes in the bone marrow, and decrease of trabecular bone speculum inepiphysis. Histopathological findings of distal femur epiphysis in OVDR group were increased of trabecularbone speculum in epiphysis and the domination of adipocytes in the bone marrow of epiphysis.Immunohistochemistry of distal femur epiphysis in OVDR group revealed increasing tartrate resistantalkaline phosphatase 5b (TRAP5b expression in trabecular bone, which was located in bone marrow spaceand trabecular speculum surface as well. It can be concluded that the combination of calcitriol and

  8. Sextant of Sapphires for Molar Distalization.

    Science.gov (United States)

    Ponnada, Swaroopa Rani; Palla, Yudistar Venkata; Ganugapanta, Vivek Reddy

    2016-08-01

    Space analysis quantifies the amount of crowding within the arches estimating the severity of space discrepancy. The space gaining procedures include extraction and non-extraction procedures like expansion, proximal stripping and molar distalization. To identify features seen in molar distalization cases. The sample size comprised 20 patients in whom molar distalization was decided as the treatment plan. The study models and lateral cephalograms of all the patients were taken. Occlusograms were obtained. Model analysis and cephalometric analysis were performed. Descriptive statistical analysis like mean, standard deviation, standard error and mode were done. The parameters in Question gave following results. The Bolton analysis showed anterior mandibular excess with mean value of 1.56mm±1.07. The first order discrepancy between maxillary central and lateral incisors was 5±1.95. The premolar rotation showed mean value of 16.58±5.12. The molar rotation showed the value of 7.66±2.26. The nasolabial angle showed the mean of 101.25±8.7 IMPA of 101.4±5.74. The six features studied in molar distalization cases [First order discrepancy between upper central and lateral incisors; Rotation of premolars and molars; Bolton's discrepancy in anterior dentition; Average to horizontal growth pattern; Proclined lower incisors and Obtuse nasolabial angle] can be taken as patterns seen in molar distalization cases and considered as a valid treatment plan.

  9. Distal vertebral artery reconstruction when managing vertebrobasilar insufficiency

    OpenAIRE

    D. M. Galaktionov; A. V. Dubovoy; K. S. Ovsyannikov

    2017-01-01

    This article presents a literature review devoted to the reconstruction of the distal vertebral artery and a clinical case of successful surgical treatment of a patient suffering from vertebrobasilar insufficiency caused by occlusion of the vertebral artery in a proximal segment. The external carotid artery-distal vertebral artery bypass was performed by using the radial artery.Received 27 February 2017. Revised 25 July 2017. Accepted 3 August 2017.Funding: The study did not have sponsorship....

  10. Plate fixation in periprosthetic femur fractures Vancouver type B1-Trochanteric hook plate or subtrochanterical bicortical locking?

    Science.gov (United States)

    Lenz, Mark; Stoffel, Karl; Kielstein, Heike; Mayo, Keith; Hofmann, Gunther O; Gueorguiev, Boyko

    2016-12-01

    Proximal plate fixation in periprosthetic femur fractures can be improved by plate anchorage in the greater trochanter (lateral tension band principle) or bicortical locking screw placement beside the prosthesis stem in an embracement configuration. Both concepts were compared in a biomechanical test using a femoral hook plate (hook) or a locking attachment plate (LAP). After bone mineral density (BMD) measurement in the greater trochanter, six pairs of fresh frozen human femora were assigned to two groups and instrumented with cemented hip endoprostheses. A transverse osteotomy was set distal to the tip of the prosthesis, simulating a Vancouver B1 fracture. Each pair was instrumented using a plate tensioner with either hook or LAP construct. Cyclic testing (2Hz) with physiologic profile and monotonically increasing load was performed until catastrophic failure. Plate stiffness was compared in a four-point-bending-test. Paired student's-t-test was used for statistical evaluation (p<0.05). Mean BMD was 250mgHA/ccm±47. The hook construct exhibited a significantly (p=0.015) lower number of cycles and load to failure (26'177cycles±2777; 3'118N±778) correlating significantly with BMD (R2=0.83; p=0.04) compared to the LAP construct (37'423cycles±5'299; 4'242N±1'030) (R2=0.71;p=0.11). BMD was a significant covariate (p=0.01). Plate stiffness was in a comparable range (hook Plate 468N/mm±7; LCP 445N/mm±6). Subtrochanterically placed LAP provides an increased fixation strength under repetitive loading compared to hook plate fixation in the greater trochanter. Trochanteric fixation is highly BMD dependent and may be restricted to major greater trochanteric involvement requiring stabilization. Copyright © 2016 Elsevier Ltd. All rights reserved.

  11. Management of distal humeral coronal shear fractures

    Science.gov (United States)

    Yari, Shahram S; Bowers, Nathan L; Craig, Miguel A; Reichel, Lee M

    2015-01-01

    Coronal shear fractures of the distal humerus are rare, complex fractures that can be technically challenging to manage. They usually result from a low-energy fall and direct compression of the distal humerus by the radial head in a hyper-extended or semi-flexed elbow or from spontaneous reduction of a posterolateral subluxation or dislocation. Due to the small number of soft tissue attachments at this site, almost all of these fractures are displaced. The incidence of distal humeral coronal shear fractures is higher among women because of the higher rate of osteoporosis in women and the difference in carrying angle between men and women. Distal humeral coronal shear fractures may occur in isolation, may be part of a complex elbow injury, or may be associated with injuries proximal or distal to the elbow. An associated lateral collateral ligament injury is seen in up to 40% and an associated radial head fracture is seen in up to 30% of these fractures. Given the complex nature of distal humeral coronal shear fractures, there is preference for operative management. Operative fixation leads to stable anatomic reduction, restores articular congruity, and allows initiation of early range-of-motion movements in the majority of cases. Several surgical exposure and fixation techniques are available to reconstruct the articular surface following distal humeral coronal shear fractures. The lateral extensile approach and fixation with countersunk headless compression screws placed in an anterior-to-posterior fashion are commonly used. We have found a two-incision approach (direct anterior and lateral) that results in less soft tissue dissection and better outcomes than the lateral extensile approach in our experience. Stiffness, pain, articular incongruity, arthritis, and ulnohumeral instability may result if reduction is non-anatomic or if fixation fails. PMID:25984515

  12. The microvasculature in the equine distal phalanx: implications for fracture healing.

    Science.gov (United States)

    Schade, S M; Arnoczky, S P; Bowker, R M

    2014-01-01

    To describe the intra-osseous microvasculature of the distal phalanx of the equine forelimb with regard to its potential clinical relevance. Eleven clinically normal equine forelimbs were used from six adult horses (range: 4 to 18 years old) euthanatized for reasons unrelated to lameness. In each limb the median artery was catheterized at the level of the carpus and India ink was injected under constant manual pressure. The limbs were frozen and 5 mm thick sections of the foot were cut in the sagittal, coronal, or transverse planes on a band saw. The sections were fixed in 10% formalin and cleared using a modified Spalteholz technique. Once cleared, the sections were photographed and the microvascular anatomy identified. The vascular injections revealed a rich intra-osseous microvascular supply of the distal phalanx originating from the medial and lateral palmar digital arteries. In addition, numerous smaller vessels from the terminal arch, formed by anastomosis of the medial and lateral palmar digital arteries, could be seen branching into the distal aspects of the distal phalanx. This distal portion of the distal phalanx appeared more densely vascularized than the proximal part in all specimens examined. The increased vascularity demonstrated in the distal portion of the distal phalanx appears to correlate with improved fracture healing reported in this area. This may also explain why healing fractures which involve both the distal and proximal portions of the distal phalanx have been described as progressing from distal-to-proximal.

  13. Femur-mounted navigation system for the arthroscopic treatment of femoroacetabular impingement

    Science.gov (United States)

    Park, S. H.; Hwang, D. S.; Yoon, Y. S.

    2013-07-01

    Femoroacetabular impingement stems from an abnormal shape of the acetabulum and proximal femur. It is treated by resection of damaged soft tissue and by the shaping of bone to resemble normal features. The arthroscopic treatment of femoroacetabular impingement has many advantages, including minimal incisions, rapid recovery, and less pain. However, in some cases, revision is needed owing to the insufficient resection of damaged bone from a misreading of the surgical site. The limited view of arthroscopy is the major reason for the complications. In this research, a navigation method for the arthroscopic treatment of femoroacetabular impingement is developed. The proposed navigation system consists of femur attachable measurement device and user interface. The bone mounted measurement devices measure points on head-neck junction for registration and position of surgical instrument. User interface shows the three-dimensional model of patient's femur and surgical instrument position that is tracked by measurement device. Surgeon can know the three-dimensional anatomical structure of hip joint and surgical instrument position on surgical site using navigation system. Surface registration was used to obtain relation between patient's coordinate at the surgical site and coordinate of three-dimensional model of femur. In this research, we evaluated the proposed navigation system using plastic model bone. It is expected that the surgical tool tracking position accuracy will be less than 1 mm.

  14. Cast index in predicting outcome of proximal pediatric forearm fractures

    Directory of Open Access Journals (Sweden)

    Hassaan Qaiser Sheikh

    2015-01-01

    Conclusion: Cast index is useful in predicting redisplacement of manipulated distal forearm fractures. We found that in proximal half forearm fractures it is difficult to achieve a CI of <0.8, but increased CI does not predict loss of position in these fractures. We therefore discourage the use of CI in proximal half forearm fractures.

  15. Distal rupture of the adductor longus in a skier.

    Science.gov (United States)

    Greditzer, Harry G; Nawabi, Danyal; Li, Angela Eh; Jawetz, Shari T

    Acute adductor longus ruptures occur infrequently and have been rarely described in the literature. Schlegel et al. re