Sample records for proximal interphalangeal joints

  1. Finger Proximal Interphalangeal Joint Dislocation. (United States)

    Ramponi, Denise; Cerepani, Mary Jo


    Finger dislocations are common injuries that are often managed by emergency nurse practitioners. A systematic physical examination following these injuries is imperative to avoid complications. Radiographic views, including the anteroposterior, lateral, and oblique views, are imperative to evaluate these finger dislocations. A dorsal dislocation of the proximal interphalangeal (PIP) joint is the most common finger dislocation type often easily reduced. A volar PIP dislocation can often be difficult to reduce and may result in finger deformity. Finger dislocations should be reduced promptly. Referral to an orthopedic hand specialist is required if the dislocation is unable to be reduced or if the finger joint is unstable following reduction attempts.

  2. Irreducible Proximal Interphalangeal Joint Dislocation of the Fourth ...

    African Journals Online (AJOL)

    Dislocation of the interphalangeal joint of the toe is a very rare injury and there are only few published reports. Most of the cases reported are those of the hallucal interphalangeal joint. There are only very few reports of complex dislocations of the proximal interphalangeal joint of the fourth toe in the world literature. Nigerian ...

  3. Management of posttraumatic proximal interphalangeal joint contracture. (United States)

    Houshian, Shirzad; Jing, Shan Shan; Chikkamuniyappa, Chandrasekar; Kazemian, Gholam Hussein; Emami-Moghaddam-Tehrani, Mohammad


    Chronic flexion contracture of the proximal interphalangeal (PIP) joint presents a common yet challenging problem to hand surgeons. Over the years, multiple treatment modalities have been described for this problem, producing limited results. Nonoperative treatment using serial casting and splints should be tried before attempting open surgical release, which should be done in selected patients. The use of external fixation for treating PIP contracture has been encouraging and can be a useful alterative. This review provides an update on the current management of PIP joint contractures and presents a flowchart of treatment to aid decision making. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  4. Management of proximal interphalangeal joint dislocations in athletes. (United States)

    Bindra, Randy R; Foster, Brian J


    Proximal interphalangeal joint dislocations are common athletic injuries. In dislocations and fracture dislocations, the most important treatment principle is congruent joint reduction and maintenance of stability. This article reviews the relevant anatomy, injury characteristics, and treatment options for proximal interphalangeal joint dislocations and fracture dislocations. Treatment methods discussed include closed reduction, percutaneous fixation, and open reduction.

  5. Silicone arthroplasty for chronic proximal interphalangeal joint dislocations. (United States)

    Criner, Katherine T; Ilyas, Asif M


    Chronic dislocations of the proximal interphalangeal (PIP) joint pose a significant treatment challenge. Chronically dislocated PIP joints can experience several changes to the articular cartilage including pressure necrosis, degeneration, and the development of secondary incongruence. Moreover, chronic dislocation allows the edema and hemorrhage from soft tissue trauma to develop into collateral ligament fibrosis and inelastic scar formation. Similarly, chronic dislocations associated with a fracture at the base of the middle phalanx can also experience changes in the form of joint incongruency, bony resorption, or malunion formation. Subsequently, these cumulative joint changes prohibit standard open reduction of the PIP joint and can cause significant loss of motion thereby demanding a different approach to restore motion and minimize pain. We propose the use of silicone arthroplasty in the management of chronic dislocations of the PIP joint.

  6. Complications following dislocations of the proximal interphalangeal joint. (United States)

    Mangelson, John J; Stern, Peter J; Abzug, Joshua M; Chang, James; Osterman, A Lee


    Dorsal fracture-dislocations of the proximal interphalangeal joint are challenging injuries to treat and are associated with many complications. The determination of stability is crucial to appropriate management. Stable injuries can usually be treated nonsurgically, whereas unstable injuries typically require surgical stabilization. Many surgical techniques have been used, including extension block pinning, volar plate arthroplasty, open reduction and internal fixation, external fixation, and hemihamate autografting. Because stiffness and flexion contracture are frequent complications, every effort should be made to initiate early motion while maintaining concentric reduction. Other complications include redislocation, chronic swelling, swan neck and coronal plane deformities, and pin tract infections. Assessing injury characteristics, including chronicity, the percentage of articular surface fractured, and the degree of comminution, and understanding complications will help in determining the most appropriate treatment. Chronic dislocations and those injuries in which painful arthritis develops can be successfully treated with salvage procedures, including arthroplasty and arthrodesis.

  7. Proximal interphalangeal joint dislocations and treatment: an evolutionary process. (United States)

    Joyce, Kenneth Michael; Joyce, Cormac Weekes; Conroy, Frank; Chan, Jeff; Buckley, Emily; Carroll, Sean Michael


    Proximal interphalangeal joint (PIPJ) dislocations represent a significant proportion of hand clinic visits and typically require frequent follow-ups for clinical assessment, orthotic adjustments, and physiotherapy. There are a large number of treatment options available for PIPJ dislocations, yet no prospective or controlled studies have been carried out, largely due to the diversity of the various types of injuries. We retrospectively reviewed all the PIPJ dislocations in our institution over a five-year period and directly compared the different splinting techniques that we have used over this time frame. There were a total of 77 dislocations of the PIPJ (57 men and 20 women) that were included in our study. We found that our management has shifted gradually from complete immobilisation to controlled early mobilisation with figure-of-eight splints. Following treatment, the range of motion of the PIPJ in the figure-of-eight group was significantly greater than that in the other three methods (Ptreatment groups. The treatment of PIPJ dislocations has undergone a significant evolution in our experience. Early controlled mobilisation has become increasingly important, and therefore, splints have had to be adapted to allow for this. The figure-of-eight splint has yielded excellent results in our experience. It should be considered for all PIPJ dislocations, but careful patient selection is required to achieve optimum results.

  8. Proximal Interphalangeal Joint Dislocations and Treatment: An Evolutionary Process

    Directory of Open Access Journals (Sweden)

    Kenneth Michael Joyce


    Full Text Available Background Proximal interphalangeal joint (PIPJ dislocations represent a significant proportion of hand clinic visits and typically require frequent follow-ups for clinical assessment, orthotic adjustments, and physiotherapy. There are a large number of treatment options available for PIPJ dislocations, yet no prospective or controlled studies have been carried out, largely due to the diversity of the various types of injuries. Methods We retrospectively reviewed all the PIPJ dislocations in our institution over a five-year period and directly compared the different splinting techniques that we have used over this time frame. Results There were a total of 77 dislocations of the PIPJ (57 men and 20 women that were included in our study. We found that our management has shifted gradually from complete immobilisation to controlled early mobilisation with figure-of-eight splints. Following treatment, the range of motion of the PIPJ in the figure-of-eight group was significantly greater than that in the other three methods (P<0.05 used. There were significantly fewer hospital visits in the figure-of-eight splint group than in the other treatment groups. Conclusions The treatment of PIPJ dislocations has undergone a significant evolution in our experience. Early controlled mobilisation has become increasingly important, and therefore, splints have had to be adapted to allow for this. The figure-of-eight splint has yielded excellent results in our experience. It should be considered for all PIPJ dislocations, but careful patient selection is required to achieve optimum results.

  9. Severe contracture of the proximal interphalangeal joint in Dupuytren's disease: does capsuloligamentous release improve outcome? (United States)

    Beyermann, K; Prommersberger, K J; Jacobs, C; Lanz, U B


    This prospective study assessed whether patients with severe proximal interphalangeal joint contracture (#10878;60 degrees ) due to Dupuytren's disease which persisted after fasciectomy alone benefited from an additional capsuloligamentous release. Forty-three patients with 43 severely contracted proximal interphalangeal joints underwent operative correction followed by a standardized postoperative rehabilitation programme. All were followed for 6 months. In 11 patients correction of the proximal interphalangeal joint to 20 degrees could not be achieved by fasciectomy alone, and an additional capsuloligamentous release was performed which effectively corrected all their residual flexion contractures. There were no statistically significant differences between the capsulotomy and the non-capsulotomy group with respect to the residual proximal interphalangeal joint contracture at the end of surgery, or at their last follow-up examination.

  10. The quantitative role of flexor sheath incision in correcting Dupuytren proximal interphalangeal joint contractures. (United States)

    Blazar, P E; Floyd, E W; Earp, B E


    Controversy exists regarding intra-operative treatment of residual proximal interphalangeal joint contractures after Dupuytren's fasciectomy. We test the hypothesis that a simple release of the digital flexor sheath can correct residual fixed flexion contracture after subtotal fasciectomy. We prospectively enrolled 19 patients (22 digits) with Dupuytren's contracture of the proximal interphalangeal joint. The average pre-operative extension deficit of the proximal interphalangeal joints was 58° (range 30-90). The flexion contracture of the joint was corrected to an average of 28° after fasciectomy. In most digits (20 of 21), subsequent incision of the flexor sheath further corrected the contracture by an average of 23°, resulting in correction to an average flexion contracture of 4.7° (range 0-40). Our results support that contracture of the tendon sheath is a contributor to Dupuytren's contracture of the joint and that sheath release is a simple, low morbidity addition to correct Dupuytren's contractures of the proximal interphalangeal joint. Additional release of the proximal interphalangeal joint after fasciectomy, after release of the flexor sheath, is not necessary in many patients. IV (Case Series, Therapeutic). © The Author(s) 2015.

  11. Stability of acute dorsal fracture dislocations of the proximal interphalangeal joint: a biomechanical study. (United States)

    Tyser, Andrew R; Tsai, Michael A; Parks, Brent G; Means, Kenneth R


    We performed a cadaveric biomechanical study to characterize proximal interphalangeal joint stability after an injury to different amounts of the volar articular base of the middle phalanx (intact, 20%, 40%, 60%, and 80% volar defects). Eighteen digits on 6 hands were tested through full proximal interphalangeal joint range of motion using computer-controlled flexion and extension via the digital tendons. We collected proximal interphalangeal joint kinematic cine data in a true lateral projection with mini-fluoroscopy. We measured the amount of dorsal middle phalanx translation in full proximal interphalangeal joint extension. As we cycled the joint from full flexion into extension, we recorded the angle at which subluxation occurred. No specimens with 20% volar bony defect subluxated. All specimens in the 60% and 80% groups subluxated at an average flexion angle of 67° (range, 10° to 90°) in the 60% group and at all degrees of flexion in the 80% group. In the 40% group, 28% of specimens demonstrated subluxation at an average flexion angle of 14° (range, 4° to 40°). Mean dorsal translation of the middle phalanx in relation to the proximal phalanx at full digital extension was 0.2 mm in the 20% group, 0.8 mm in the 40% group, 3.2 mm in the 60% group, and 3.1 mm in the 80% group. Simulated volar articular bony defects of 20% were stable, whereas those with 60% and 80% defects were unstable during digital motion. Stability in the 40% group was variable and appeared to be the threshold for stability. Knowledge of the typical amount of middle phalanx defect and degree of proximal interphalangeal joint extension that can lead to joint instability may improve management of mechanically important proximal interphalangeal joint fracture dislocations. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  12. A prospective randomized study of conservative versus surgical treatment of unstable palmar plate disruption in the proximal interphalangeal finger joint

    DEFF Research Database (Denmark)

    Werlinrud, Jens Christian; Petersen, Kirstin; Lauritsen, Jens


    The aim of this study was to assess the effect of conservative versus operative treatment for unstable palmar plate disruption in the proximal interphalangeal (PIP) joint of the fingers with respect to preservation of joint stability, mobility, and pain. The study was conducted as a prospective...... do not recommend primary surgical repair of unstable isolated palmar plate lesions in the proximal interphalangeal joints of the 4 ulnar fingers. Type of study/level of evidence Therapeutic, Level II....

  13. Management of difficult intra-articular fractures or fracture dislocations of the proximal interphalangeal joint. (United States)

    Liodaki, E; Xing, S G; Mailaender, P; Stang, F


    Intra-articular fractures or fracture dislocations of the proximal interphalangeal joint are difficult clinically because the bone and soft tissue structures are small and intricate. Suboptimal treatment of intra-articular fractures typically leads to functional impairment of the hand. This article reviews the current methods of treatment, together with the senior author's experience in treating difficult proximal interphalangeal joint fractures and dislocations. Besides conservative treatments, surgical treatments include open or closed reduction with traditional Osteosynthesis, such as K-wires, screws or plates. Among recent developments are the percutaneous application of thin cannulated compression screws and novel dynamic external fixators. After a preferred minimally invasive treatment with stable reconstruction of the articular surface, sufficient aftercare is necessary to improve surgical outcomes. © The Author(s) 2014.

  14. Neurovascular Advancement Flap to Release Flexion Contracture of the Proximal Interphalangeal Joint. (United States)

    Tseng, James; Lin, Yu-Te


    Various methods have been described to surgically release posttraumatic flexion contracture of the proximal interphalangeal joint. Extension of the distal digit often creates a soft tissue defect on the volar aspect of the finger. Although various flaps and skin grafting have been utilized for coverage of this defect, they can be associated with morbidity. We present our experience with a volar neurovascular advancement flap to achieve soft tissue release in proximal interphalangeal joint flexion contracture. This advancement flap is designed to include both digital neurovascular bundles and eliminates the need for a secondary procedure as it allows primary closure of the subsequent defect. It is indicated for contracture lengthening of 10 to 14 mm. Surgical considerations of flap design are discussed. Copyright © 2017 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  15. Radial collateral ligament injury of the little finger proximal interphalangeal joint in young pianists. (United States)

    Gong, Hyun Sik; Cho, Hoyune Esther; Rhee, Seung Hwan; Kim, Jihyeong; Lee, Young Ho; Baek, Goo Hyun


    To report the features of radial collateral ligament injury of the little finger proximal interphalangeal joint in young piano players. Between 2005 and 2012, we treated 6 cases of radial collateral ligament injury of the little finger proximal interphalangeal joint in young piano players at a single referral center. We conducted a retrospective review of charts and radiographs and telephone-interviewed all patients at a mean follow-up of 33 months (range, 12-66 mo) to evaluate features of this injury. All patients were girls with a mean age of 10 years (range, 8-12 y), and all had injuries in their right hands. Patients had been playing piano for a mean 3.8 years (range, 3-5 y) and practicing for a mean 1.8 hours per day (range, 1-3 h). Pain was commonly aggravated when they played octaves or advanced pieces requiring extensive finger movements. All patients were playing on standard-size piano keyboards and had generalized hypermobility with a mean Beighton and Horan score of 6.3 (range, 5-9). Two patients had an ulnar deviation deformity of 10° and 15° each at the proximal interphalangeal joint whereas the others had no fixed joint deformity. Five patients showed improvement with conservative treatment, but 1 patient underwent surgery. In our practice, all piano-related radial collateral ligament injuries were in female preadolescents with evidence of generalized hypermobility; patients had been playing piano extensively, suggesting that the injury could have resulted from stress on the joint during piano playing. Future studies should further evaluate the efficacy of modifying keyboard size, techniques, and repertoires for piano lessons and of patient education for this type of injury. Therapeutic IV. Copyright © 2014 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  16. Volar plating for unstable proximal interphalangeal joint dorsal fracture-dislocations. (United States)

    Cheah, Andre E J; Tan, David M K; Chong, Alphonsus K S; Chew, Winston Y C


    To report our results of open reduction internal fixation with volar mini plate and screw fixation for unstable dorsal fracture dislocations (DFDs) of the proximal interphalangeal (PIP) joint. We performed a retrospective review of 13 consecutive DFDs of the PIP joint treated with volar mini plate and screw fixation, measuring both clinical and radiological outcomes. The age range of our patients was 15 to 56 years (average, 33 y). Six injuries were related to work, 5 to sports, and 2 to motor vehicle accidents. Of the 13 DFDs, 6 were comminuted. Articular involvement ranged from 30% to 70% (average, 44%). The average time to surgery was 7 days (range, 0-23 d). Patients had follow-up of 12 to 60 months (average, 25 mo). Four patients had a postoperative course complicated by plate and screw removal at an average of 4 months later, either as part of a secondary procedure to improve range of motion or owing to patient request. All patients returned to their original occupation. Of the 13 patients, 11 were satisfied with the result, and 12 of 13 had either no or mild pain. All 13 DFDs united in good alignment but 3 showed degenerative changes. Average grip strength was 85% of the unaffected side, and average active PIP joint and distal interphalangeal joint motion arcs were 75° and 65°, respectively. Average Quick Disabilities of Arm, Shoulder, and Hand score was 4 (range, 0-9). All patients had non-tender swelling of the proximal interphalangeal joints but no signs of flexor tenosynovitis or infection. Fixation of unstable PIP joint DFDs via a volar approach is technically feasible with mini plates and screws. This treatment allows early active range of motion and provides good objective and subjective outcomes; however, noteworthy complications occurred in 39% of patients. Therapeutic IV. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  17. [Fractures of the proximal interphalangeal joint: Diagnostic and operative therapy options]. (United States)

    Unglaub, F; Langer, M F; Hahn, P; Müller, L P; Ahrens, C; Spies, C K


    Joint fractures of the fingers often entail operative interventions in contrast to extra-articular fractures. These types of fracture are inclined to dislocate in addition to the actual fracture. The proximal interphalangeal (PIP) joint in particular often shows comminuted fractures due to the long leverage of the finger and a relatively small diameter of the joint. The clinical examination, X-ray diagnostics and if necessary computed tomography allow the classification into stable and unstable fractures. Unstable fractures must be treated by surgical reduction and fixation. A multitude of operative techniques are available for these mostly complicated fractures. The foremost goal is a stable osteosynthesis of the fracture with repositioning of the dislocation, which enables early physiotherapy in order to prevent tendon adhesion and contracture. This article presents the different types of PIP joint fractures, their specific surgical treatment and postoperative treatment regimens.

  18. Modified hemihamate arthroplasty technique for treatment of acute proximal interphalangeal joint fracture-dislocations. (United States)

    Yang, Dae Suk; Lee, Sang Ki; Kim, Kap Jung; Choy, Won Sik


    We retrospectively reviewed 11 patients who underwent modified hemihamate arthroplasty for the treatment of comminuted dorsal fracture-dislocation of the proximal interphalangeal (PIP) joint. This technique was used to minimize the potential risk of complications at the recipient site by volarly oblique osteotomy in the coronal plane at graft harvesting and anatomical repair of the detached flexor sheath. The average joint involvement of the fracture was 58.4%, and the mean duration of follow-up was 38 months. The active range of motion of the distal interphalangeal, PIP, and metacarpophalangeal joint was 80.4, 85.4, and 91.8 degrees, respectively. The mean disabilities of the arm, shoulder, and hand score was 4.8, and all patients achieved bony union at final follow-up. One patient showed radiographic signs of graft absorption, but this did not limit their daily activities. The modified hemihamate arthroplasty technique is safe and reliable and reduces the risk of iatrogenic damage when used to treat comminuted dorsal fracture-dislocations of the PIP joint.

  19. [Supplementary arthrolysis of the proximal interphalangeal joint of fingers in surgical treatment of Dupuytren's contracture]. (United States)

    Hohendorff, B; Biber, F; Sauer, H; Ries, C; Spies, C; Franke, J


    Correction of residual flexion deformity of the proximal interphalangeal (PIP) joint after excision of diseased connective tissue in Dupuytren's contracture by stepwise arthrolysis. Flexion deformity of the PIP joint of 20° or more after excision of the diseased connective tissue in Dupuytren's contracture. Joint deformities, osteoarthrosis, intrinsic muscle contracture, instability of the PIP joint. Arthrolysis of the PIP joint is performed by six consecutive steps: dissection of the remaining skin ligaments, opening the flexor tendon sheath by transverse incision at the distal end of the A2 pulley, dissection of the checkrein ligaments, dissection of the accessory collateral ligaments, releasing the palmar plate proximally, releasing the palmar plate up to its insertion at the middle phalanx base. Dorsal plaster of Paris with extended fingers and compressive dressing in the palm for 2 days, occupational/physical therapy, static and possible dynamic extension splint several weeks/months. A total of 31 fingers in 28 patients with Dupuytren's contracture were evaluated an average of 22 months after arthrolysis of the PIP joint. In all, 26 joints with an average recurrent flexion contracture of 29° were improved compared to the preoperative flexion contracture of 81°; 4 PIP joints with a recurrent flexion contracture averaging 60° were worse. In one patient, PIP flexion contracture of 90° was unchanged at follow-up although the joint could be extended intraoperatively to 10° of flexion.

  20. Invited Hand Article: Current Concepts in Treatment of Fracture-Dislocations of the Proximal Interphalangeal Joint (United States)

    Haase, Steven C.; Chung, Kevin C.


    Background Proximal interphalangeal joint fracture-dislocations are common injuries that require expedient and attentive treatment for the best outcomes. Management can range from protective splinting and early mobilization to complex operations. In this review, the current concepts surrounding the managment of these injuries are reviewed. Methods A literature review was performed of all recent articles pertaining to proximal interphalangeal joint fracture-dislocation, with specific focus on middle phalangeal base fractures. Where appropriate, older articles, or articles on closely related injury types were included for completeness. The methodology and outcomes of each study were analyzed. Results When small avulsion fractures are present, good results are routinely obtained with reduction and early mobilization of stable injuries. Strategies for management of the unstable dorsal fracture-dislocation have evolved over time. To provide early stability, a variety of techniques have evolved, including closed, percutaneous, external, and internal fixation methods. Although each of these techniques can be successful in skilled hands, none have been subjected to rigorous, prospective, comparative trials. Volar dislocations fare less well, with significant loss of motion in many studies. Pilon fractures represent the most complicated injuries, and return of normal motion is not expected. Conclusion The best outcomes can be achieved by (1) establishing enough stability to allow early motion, (2) restoring gliding joint motion rather than non-congruent motion, and (3) restoring the articular surface congruity when possible. Although the majority of literature on this topic consists of expert opinion and retrospective case series, the consensus appears to favor less invasive techniques whenever possible. PMID:25415092

  1. Comparative study on the effectiveness of corticosteroid injections between trigger fingers with and without proximal interphalangeal joint flexion contracture. (United States)

    Shinomiya, R; Sunagawa, T; Nakashima, Y; Kawanishi, Y; Masuda, T; Ochi, M


    Trigger fingers with proximal interphalangeal joint flexion contracture are suggested to have a poorer response to corticosteroid injection than those without contracture, though this has not been proven scientifically. We compared the clinical response to corticosteroid injection between trigger fingers with and without proximal interphalangeal joint contracture, and investigated the influence of the injection on the A1 pulley and flexor digitorum tendons using ultrasonography. One month after injection, pain was significantly reduced in the no contracture group, and 56% of trigger fingers with proximal interphalangeal joint contracture resolved. Before injection, relative thickening of the A1 pulley and flexor digitorum tendons, and a partial hypoechoic lesion of the flexor digitorum superficialis tendon were observed in the contracture group. One month after injection, the thickening of the tendons and the A1 pulley was reduced, but the partial hypoechoic lesion was still observed in significant numbers. We have demonstrated that the presence of a proximal interphalangeal joint contracture was associated with a reduced clinical response to corticosteroid injection, and we suggest that the pathologic change in the flexor digitorum superficialis tendon, represented by the partial hypoechoic lesion, contributed to corticosteroid injection resistance. IV. © The Author(s) 2015.

  2. Predictors of Proximal Interphalangeal Joint Flexion Contracture After Homodigital Island Flap. (United States)

    Nakanishi, Akito; Omokawa, Shohei; Iida, Akio; Kaji, Daisuke; Tanaka, Yasuhito


    To identify independent predictors of postoperative proximal interphalangeal (PIP) joint contracture after direct-flow homodigital island flap transfer. Forty-four fingertip amputations in 39 patients treated with oblique triangular flaps were evaluated at a minimum of 1 year after surgery. Five variables were examined: patient age, injured finger, mechanism of injury, flap advancement distance, and time required for wound healing. Univariate and multivariate linear regression analyses were performed to identify the extent to which these variables affected the flexion contracture of the PIP joint. The average reduction in the passive extension angle of the PIP joint was 16° at final follow-up. Univariate analysis indicated significant correlations of PIP joint flexion contracture with age, injured finger, and time for wound healing, but no significant correlation with the distance the flap was advanced. Multivariate analysis indicated that the age and duration of wound healing were independent predictors of the flexion contracture of the PIP joint. Elderly people and cases with delayed wound healing are at risk for postoperative PIP joint contracture after homodigital flap transfer. Intervention with early hand therapy and orthotics may be useful in elderly patients with delayed wound healing. Prognostic II. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  3. [Complex fracture-dislocation of the proximal interphalangeal joint. A case report and focus on palmar proximal interphalangeal fractures-dislocations]. (United States)

    Lawson, E; Thomsen, L; Hans-Moevi Akué, A; Falcone, M-O


    The palmar fracture-dislocation of the proximal interphalangeal (PIP) joint of fingers is an uncommon injury. We report a complex form in a 16-year old teenager, associating a palmar fracture-dislocation and a fracture of the base of the middle phalanx with the dorsal fragment dislocated between the neck of the proximal phalange and the palmar plate. The management was surgical with open reduction and fixation of the fragments by K-wires and temporary PIP arthrorisis. The result at 6months of follow- up after removal of the wires and physiotherapy was satisfactory. The patient was painless with a range of motion of 115°. Clinically, the sagittal and frontal stability of the joint both in flexion and extension was maintained. Osseous healing was obtained on X-ray control. The patient went back to his usual activities. A focus on palmar fracture-dislocations of PIP joint is presented through incidence, mechanism and treatment. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  4. Unstable dorsal proximal interphalangeal joint fracture-dislocations treated with extension-block pinning. (United States)

    Bear, David M; Weichbrodt, Matthew T; Huang, Chris; Hagberg, William C; Balk, Marshall L


    Unstable proximal interphalangeal (PIP) joint fracture-dislocations, which can cause significant disability, can be treated with multiple techniques. Extension-block pinning (EBP) allows for early motion and is less technically demanding than alternative surgical treatments. In the study reported here, 12 patients with unstable dorsal PIP fracture-dislocations were treated with closed reduction of the PIP joint followed by percutaneous insertion of a Kirschner wire (K-wire) into the distal aspect of the proximal phalanx. For these patients, extent of articular surface involvement averaged 43% (range, 25%-75%). Active motion was initiated early after surgery, and the K-wire was removed a mean of 25 days after pinning. Radiographic reduction of joint dislocation was achieved and maintained for 11 of the 12 patients at a mean follow-up of 35.5 months. At follow-up, mean visual analog scale (VAS) score was 0.64 (scale, 0-10). Mean score on the Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) questionnaire was 5.7, suggesting minimal functional impairment. Mean PIP active motion was 84° (range, 50°-110°). Grip strength was equal between operative and contralateral hands. Patient satisfaction most closely correlated with low VAS and QuickDASH scores. One patient developed a malunion, which was treated with corrective osteotomy. EBP is a simple, safe, and reproducible technique for unstable PIP fracture-dislocations. This technique yields outcomes similar to those reported for more complex surgical procedures.

  5. Optical clearing of human skin for the enhancement of optical imaging of proximal interphalangeal joints (United States)

    Kolesnikova, Ekaterina A.; Kolesnikov, Aleksandr S.; Zabarylo, Urszula; Minet, Olaf; Genina, Elina A.; Bashkatov, Alexey N.; Tuchin, Valery V.


    We are proposing a new method for enhancement of optical imaging of proximal interphalangeal (PIP) joints in humans at skin using optical clearing technique. A set of illuminating laser diodes with the wavelengths 670, 820, and 904 nm were used as a light source. The laser diodes, monochromatic digital CCD camera and specific software allowed for detection of the finger joint image in a transillumination mode. The experiments were carried out in vivo with human fingers. Dehydrated glycerol and hand cream with urea (5%) were used as optical clearing agents (OCAs). The contrast of the obtained images was analyzed to determine the effect of the OCA. It was found that glycerol application to the human skin during 60 min caused the decrease of contrast in 1.4 folds for 670 nm and the increase of contrast in 1.5 and 1.7 folds for 820 nm and 904 nm, respectively. At the same time, the hand cream application to the human skin during 60 min caused the decrease of contrast in 1.1 folds for 670 nm and the increase of contrast in 1.3 and 1.1 folds for 820 nm and 904 nm, respectively. The results have shown that glycerol and the hand cream with 5% urea allow for obtaining of more distinct image of finger joint in the NIR. Obtained data can be used for development of optical diagnostic methods of rheumatoid arthritis.

  6. Resection of the flexor digitorum superficialis for trigger finger with proximal interphalangeal joint positional contracture. (United States)

    Favre, Yann; Kinnen, Louis


    Open release of the A1 pulley is a widely known procedure for the treatment of trigger finger. A subset of patients presents with both trigger finger and a positional contracture of the proximal interphalangeal (PIP) joint. These patients usually have a long history of trigger finger or have already undergone a surgical release of the annular pulley. This study is a retrospective review of the outcomes of resection of the flexor digitorum superficialis (FDS) for patients whose trigger finger was associated with a positional contracture of the PIP joint. Thirty-six patients (39 fingers) were treated by resection of the FDS after section of the A1 pulley. The mean age of the patients was 63 years (range, 45-90 y). Seven patients (19 %) had previously undergone an open release of the A1 pulley and had developed a positional contracture of the PIP joint 2 to 5 months afterward. We performed a retrospective review with a mean follow-up of 30 months (range, 12-60 mo). No patient was lost to follow-up. The active range of motion was recorded at the PIP joint before and after surgery. The mean preoperative positional contracture of the PIP joint was 24° (range, 15°-30°). The mean postoperative positional contracture of the PIP joint was 4° (range, 0°-10°). The most commonly affected digit was the middle finger (26 fingers, 67%). In 28 fingers (72%), full extension was achieved following only the surgical procedure. The remaining 11 fingers (28%) had a postoperative residual positional contracture (range, 5°-10°). However, all fingers achieved a full range of motion after physical therapy and an injection of betamethasone. All of the resected tendons had histological damage. This technique is a useful treatment for selected patients whose trigger finger is associated with a positional contracture. Copyright © 2012 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  7. Goniometry of the proximal and distal interphalangeal joints, Part II: placement prefereces, interrater reliability, and concurrent validity. (United States)

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


    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.

  8. Delayed treatment of unstable proximal interphalangeal joint fracture-dislocations with a dynamic external fixator. (United States)

    Shen, Xiao Fang; Mi, Jing Yi; Rui, Yong Jun; Xue, Ming Yu; Chou, Jiandong; Tian, Jian; Chim, Harvey


    Fracture-dislocations of the proximal interphalangeal joint (PIPJ) remain a challenging problem to treat. Although there are a number of papers describing the use of dynamic external fixators and force couples for treatment of unstable PIPJ fracture-dislocations acutely, the literature is scarce on delayed treatment of PIPJ fracture-dislocations, where malunion of the articular surface may theoretically compromise postoperative range of motion (ROM) at the PIPJ. The purpose of this study was to evaluate the effectiveness of dynamic distraction external fixation (DDEF) for the delayed treatment of PIPJ fracture-dislocations at least 3 weeks after the inciting injury. Ten consecutive patients were treated with delayed DDEF between 2010 and 2013. Postoperative ROM at the PIPJ was measured. Disabilities of the Arm, Shoulder and Hand (DASH) score and Michigan Hand Outcomes Questionnaire were administered to all patients postoperatively. Mean time from injury to surgery was 27.5 days. The mean follow-up period was 23.7 months (range 10-36). The mean active ROM at the PIPJ on final postoperative follow-up was 83.9° (range 52-100). None of the patients experienced pin-tract infections. Mean DASH score was 3.7+3.4 and mean Michigan Hand Outcomes Questionnaire score was 97.3+3.0. All patients returned to work and resumed normal activities. Delayed treatment of unstable PIPJ fracture-dislocations with a DDEF is effective in restoring function to the PIPJ. Nascent malunion of the PIPJ articular surface does not compromise postoperative outcomes and the joint surface undergoes remodelling over time to restore a smooth and functional articular surface. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Minimally invasive proximal interphalangeal joint arthrodesis using a locking compression plate and tissue engineering in horses: A pilot study (United States)

    Seo, Jong-pil; Yamaga, Takashi; Tsuzuki, Nao; Yamada, Kazutaka; Haneda, Shingo; Furuoka, Hidefumi; Tabata, Yasuhiko; Sasaki, Naoki


    This pilot study assessed the efficacy of 2 minimally invasive techniques for proximal interphalangeal (PIP) joint arthrodesis in horses. The PIP joints of both forelimbs (n = 6) were stabilized with locking compression plates (LCP) using a minimally invasive technique (LCP technique). Subsequently, for 1 randomly selected PIP joint of each horse, surgical drilling (SurD) was performed and tissue engineering (TE) was applied (LCP/SurD/TE technique). Minimally invasive PIP joint arthrodesis with LCP demonstrated low postoperative infection rates. Gross and histological evaluations revealed considerable destruction of the articular cartilage in the LCP/SurD/TE-treated joints. In contrast, almost no destruction of the cartilage was observed in the LCP-treated joints. Our results suggest that the LCP technique alone is not sufficient for PIP joint arthrodesis and that the LCP/SurD/TE technique may be useful for PIP joint arthrodesis in horses. PMID:25392547

  10. Computer-aided joint space analysis of the metacarpal-phalangeal and proximal-interphalangeal finger joint: normative age-related and gender-specific data

    Energy Technology Data Exchange (ETDEWEB)

    Pfeil, Alexander; Boettcher, Joachim; Seidl, Bettina E.; Heyne, Jens-Peter; Petrovitch, Alexander; Mentzel, Hans-Joachim; Kaiser, Werner A. [Friedrich-Schiller-University Jena, Institute of Diagnostic and Interventional Radiology, Jena (Germany); Eidner, Torsten; Wolf, Gunter; Hein, Gert [Friedrich-Schiller-University Jena, Department of Rheumatology and Osteology, Clinic of Internal Medicine III, Jena (Germany)


    The purpose of the study was to provide reference data for computer-aided joint space analysis based on a semi-automated and computer-aided diagnostic system for the measurement of metacarpal-phalangeal and proximal-interphalangeal finger joint widths; additionally, the determination of sex differences and the investigation of changes in joint width with age were evaluated. Eighty hundred and sixty-nine patients (351 female and 518 male) received radiographs of the hand for trauma and were screened for a host of conditions known to affect the joint spaces. All participants underwent measurements of joint space distances at the metacarpal-phalangeal articulation (JSD-MCP) from the thumb to the small finger and at the proximal-interphalangeal articulation (JSD-PIP) from the index finger to the small finger using computer-aided diagnosis technology with semi-automated edge detection. The study revealed an annual narrowing of the JSD of 0.6% for the JSD-MCP and for the JSD-PIP. Furthermore, the data demonstrated a notable age-related decrease in JSD, including an accentuated age-related joint space narrowing in women for both articulations. Additionally, males showed a significantly wider JSD-MCP (+11.1%) and JSD-PIP (+15.4%) compared with the female cohort in all age groups. Our data presented gender-specific and age-related normative reference values for computer-aided joint space analysis of the JSD-MCP and JSD-PIP that could be used to identify disease-related joint space narrowing, particularly in patients with osteoarthritis and rheumatoid arthritis commonly involving the peripheral small hand joints. (orig.)

  11. Effect of a collateral ligament sparing surgical approach on mechanical properties of equine proximal interphalangeal joint arthrodesis constructs. (United States)

    Bras, Jose J; Lillich, James D; Beard, Warren L; Anderson, David E; Armbrust, Laura J; Frink, Elizabeth; Lease, Kevin


    To (1) compare the effect of a collateral ligament sparing surgical approach with an open surgical approach on mechanical properties of proximal interphalangeal joint (PIPJ) arthrodesis, and (2) to determine the percentage of articular cartilage surface removed by transarticular (TA) drilling with different diameter drill bits. Randomized paired limb design. Cadaveric equine limbs (n=76). Cadaveric PIPJ were drilled using a 3.5, 4.5, or 5.5 mm drill bit at 80-84° to the dorsal plane to remove articular cartilage and subchondral bone from the distal articular surface of the proximal phalanx (P1) and the proximal articular surface of the middle phalanx (P2). Bone ends were photographed and the percentage of the projected surface area that was denuded of cartilage was measured. PIPJ arthrodesis constructs (3-hole dynamic compression plate [DCP], two 5.5 mm TA screws inserted in lag fashion, medial and lateral to the DCP; DCP-TA) were created using 2 surgical approaches in paired limbs. A conventional open approach was used in 1 limb and a collateral ligament sparing approach used in the other limb. Constructs were tested to failure in single-cycle 3-point dorsopalmar/plantar or lateromedial bending. Maximum load, yield load, and composite stiffness were compared between techniques. The 3.5, 4.5, and 5.5 mm drill bits removed 24±4%, 35±5%, and 45±7% of total PIPJ articular cartilage surface, respectively. Constructs with the collateral ligament sparing approach had significantly greater mean yield load (11.3±2.8 versus 7.68±1.1 kN, P=.008) and mean maximum load (13.5±3.1 versus 10.1±1.94 kN, P=.02) under lateromedial bending. Under dorsopalmar/plantar bending there was no significant difference between surgical approaches. The collateral ligament sparing arthrodesis technique had a shorter surgical time (19±3 minutes) compared with the open technique (31±3 minutes). A collateral ligament sparing surgical approach to the PIPJ with removal of articular

  12. The effect of a therapy protocol for increasing correction of severely contracted proximal interphalangeal joints caused by dupuytren disease and treated with collagenase injection. (United States)

    Skirven, Terri M; Bachoura, Abdo; Jacoby, Sidney M; Culp, Randall W; Osterman, A Lee


    To determine the effect of a specific orthotic intervention and therapy protocol on proximal interphalangeal (PIP) joint contractures of greater than 40° caused by Dupuytren disease and treated with collagenase injections. All patients with PIP joints contracted at least 40° by Dupuytren disease were prospectively invited to participate in the study. Following standard collagenase injection and cord rupture by a hand surgeon, a certified hand therapist evaluated and treated each patient based on a defined treatment protocol that consisted of orthotic intervention to address residual PIP joint contracture. In addition, exercises were initiated emphasizing reverse blocking for PIP joint extension and distal interphalangeal joint flexion exercises with the PIP joint held in extension to lengthen a frequently shortened oblique retinacular ligament. Patients were assessed before injection, immediately after injection, and 1 and 4 weeks later. There were 22 fingers in 21 patients. The mean age at treatment was 63 years (range, 37-80 y). The mean baseline passive PIP joint contracture was 56° (range, 40° to 80°). At cord rupture, the mean PIP joint contracture became 22° (range, 0° to 55°). One week after cord rupture and therapy, the contracture decreased further to a mean of 12° (range, 0° to 36°). By 4 weeks, the mean contracture was 7° (range, 0° to 35°). The differences in PIP joint contracture were statistically significant at all time points except when comparing the means at 1 week and 4 weeks. The results represent an 88% improvement of the PIP joint contracture. In the short term, it appears that severe PIP joint contractures benefit from specific, postinjection orthotic intervention and targeted exercises. Therapeutic IV. Copyright © 2013 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  13. Ultrasonography of the metacarpophalangeal and proximal interphalangeal joints in rheumatoid arthritis: a comparison with magnetic resonance imaging, conventional radiography and clinical examination

    DEFF Research Database (Denmark)

    Szkudlarek, Marcin; Klarlund, Mette; Narvestad, E.


    ultrasonography can provide information on signs of inflammation and destruction in RA finger joints that are not available with conventional radiography and clinical examination, and comparable to the information provided by magnetic resonance imaging (MRI). The second to fifth metacarpophalangeal and proximal...... interphalangeal joints of 40 RA patients and 20 control persons were assessed with ultrasonography, clinical examination, radiography and MRI. With MRI as the reference method, the sensitivity, specificity and accuracy of ultrasonography in detecting bone erosions in the finger joints were 0.59, 0.98 and 0.......96, respectively; they were 0.42, 0.99 and 0.95 for radiography. The sensitivity, specificity and accuracy of ultrasonography, with signs of inflammation on T1-weighted MRI sequences as the reference method, were 0.70, 0.78 and 0.76, respectively; they were 0.40, 0.85 and 0.72 for the clinical examination...

  14. Biomechanical characteristics of hemi-hamate reconstruction versus volar plate arthroplasty in the treatment of dorsal fracture dislocations of the proximal interphalangeal joint. (United States)

    Tyser, Andrew R; Tsai, Michael A; Parks, Brent G; Means, Kenneth R


    To compare stability and range of motion after hemi-hamate reconstruction versus volar plate arthroplasty in a biomechanical proximal interphalangeal (PIP) joint fracture-dislocation model. Eighteen digits from 6 cadaver hands were tested. We created defects of 40%, 60%, and 80% in the palmar base of each digit's middle phalanx, simulating an acute PIP joint fracture-dislocation. Each defect scenario was reconstructed with a hemi-hamate arthroplasty followed by a volar plate arthroplasty. A computer-controlled mechanism was used to bring each digit's PIP joint from full extension to full flexion via the digital tendons in each testing state, and in the intact state. During each testing scenario we collected PIP joint cinedata in a true lateral projection using mini-fluoroscopy. A digital radiography program was used to measure the amount of middle phalanx dorsal translation (subluxation) in full PIP joint extension. We recorded the angle at which subluxation, if present, occurred during each testing scenario. Average dorsal displacement of the middle phalanx in relation to the proximal phalanx was 0.01 mm for the hemi-hamate reconstructed joints and -0.03 mm for the volar plate arthroplasty, compared with the intact state. Flexion contractures were noted in each of the specimens reconstructed with volar plate arthroplasty. Degree of contracture was directly correlated with defect size, averaging 20° for 40% defects, 35° for 60% defects, and 60° for 80% defects. We observed no flexion contractures in the hemi-hamate reconstructions. Surgeons can use both hemi-hamate and volar plate arthroplasty to restore PIP joint stability following a fracture dislocation with a large middle phalanx palmar base defect. Use of volar plate arthroplasty led to an increasing flexion contracture as the middle phalanx palmar base defect increased. Clinicians can use the information from this study to help with surgical decision-making and patient education. Copyright © 2015

  15. Efficacy and safety of collagenase clostridium histolyticum in the treatment of proximal interphalangeal joints in dupuytren contracture: combined analysis of 4 phase 3 clinical trials. (United States)

    Badalamente, Marie A; Hurst, Lawrence C; Benhaim, Prosper; Cohen, Brian M


    To examine the results of proximal interphalangeal (PIP) joint contractures from 4 phase 3 clinical trials of collagenase clostridium histolyticum (CCH) injection for Dupuytren contracture. Patients enrolled in Collagenase Option for Reduction of Dupuytren I/II and JOINT I/II with one or more PIP joint contractures (20° to 80°) received CCH 0.58 mg/0.20 mL or placebo (Collagenase Option for Reduction of Dupuytren I/II only) injected directly into a palpable cord. The percentage of PIP joints achieving clinical success (0° to 5° of full extension), clinical improvement (50% or more reduction in baseline contracture), and range of motion improvement at 30 days after the first and last CCH injections was assessed. The PIP joint contractures were classified into low (40° or less) and high (more than 40°) baseline severity. Adverse events were recorded. A total of 506 adults (mean age, 63 ± 10 y; 80% male) received 1,165 CCH injections in 644 PIP joint cords (mean, 1.6 injections/cord). Most patients (60%) received 1 injection, with 24%, 16%, and 1% receiving 2, 3, and 4 injections, respectively. Clinical success and clinical improvement occurred in 27% and 49% of PIP joints after one injection and in 34% and 58% after the last injection. Patients with lower baseline severity showed greater improvement and response was comparable between fingers, as were improvements in range of motion. Adverse events occurring in more than 10% of patients were peripheral edema (58%), contusion (38%), injection site hemorrhage (23%), injection site pain (21%), injection site swelling (16%), and tenderness (13%). This incidence was consistent with data reported in phase 3 trials. Two tendon ruptures occurred. No further ruptures occurred after a modified injection technique was adopted. Collagenase clostridium histolyticum was effective and well tolerated in the short term in patients with Dupuytren PIP joint contractures. Therapeutic II. Copyright © 2015 American Society for


    Directory of Open Access Journals (Sweden)

    Masahiro Kurosaka


    Full Text Available During bowling, a twenty year old man could not pull out his middle finger from the ball in release and injured his finger. X-ray revealed a palmar fracture- dislocation of the PIP joint. We manipulated the PIP joint, but a gap remained at the fracture site on the X-ray after reduction. Surgical treatment was performed with a screw. Postoperatively, the middle finger was fixed with a splint for two weeks, and then active range of motion exercises were started. One year after the operation, the fracture had healed with a congruous joint surface, and the patient had full range of motion in the middle finger with no difficulties in activities of daily living. The etiology of a palmar fracture-dislocation of the PIP joint is still controversial, but we suggested the mechanism of the fracture-dislocation was caused by a shearing force to the middle phalangeal base from a dorsal direction. The main cause of the current injury was the poor fit between the middle finger and the hole of the bowling ball. Bowling is a popular and safe sport, but we should be aware of unexpected hand injuries related to bowling which may occur, especially in players at a recreational level

  17. Radiosynovectomy of Proximal Interphalangeal Joint Synovitis in Rheumatoid Arthritis Treated with Rhenium-188 Labeled Tin-colloid and Imaging with Single-photon Emission Computerized Tomography/Computed Tomography: A First Case Report. (United States)

    Kamaleshwaran, Koramadai Karuppusamy; Rajamani, Venkataraman; Krishnan, Boopathi; Mallia, Madhav; Kalarikal, Radhakrishnan; Mohanan, Vyshakh; Shinto, Ajit Sugunan


    Rheumatoid arthritis (RA) is a chronic disease that is mainly characterized by the asymmetric erosive synovitis, particularly affecting peripheral joints. Radiation synovectomy or radiosynovectomy (RSV), also known as radiosynoviorthesis was first described in 1950's as an adjuvant treatment for RA. RSV is based on the irradiation of the joint synovium by the intra-articular administration of various β-emitting radiopharmaceuticals. As a generator-produced β-emitting radionuclide, the importance of rhenium-188 (Re-188) for radionuclide therapy is increasing rapidly. There are previous reports which used Re-188 tin colloid in knee joint synovitis, but use of Re-188 tin colloid in small joint is not yet reported. We describe the use of Re-188 tin colloid in a 45-year-old female who presented with right 4(th) proximal interphalangeal joint synovitis due to rheumatoid arthritis.

  18. Hallux interphalangeal joint range of motion in feet with and without limited first metatarsophalangeal joint dorsiflexion. (United States)

    Munuera, Pedro V; Trujillo, Piedad; Güiza, Israel


    This work was designed to assess the degree of correlation between hallux interphalangeal joint and first metatarsophalangeal joint dorsiflexion and to compare the mobility of the hallux interphalangeal joint between participants with and without limited first metatarsophalangeal joint dorsiflexion (hallux limitus). Dorsiflexion of the hallux interphalangeal joint was measured in 60 normal feet and in 60 feet with hallux limitus to find correlations with first metatarsophalangeal joint dorsiflexion with the Spearman correlation coefficient and a simple linear regression equation. In addition, movement of the hallux interphalangeal joint was compared between normal and hallux limitus feet with the Mann-Whitney U test. Significant differences were found between the groups in mean ± SD interphalangeal joint dorsiflexion (control group: 1.17° ± 2.50° ; hallux limitus group: 10.65° ± 8.24° ; P dorsiflexion and hallux interphalangeal joint dorsiflexion (ρ = -0.766, P dorsiflexion = 27.17 - 0.381 × first metatarsophalangeal joint dorsiflexion. Hallux interphalangeal joint dorsiflexion was greater in feet with hallux limitus than in normal feet. There was a strong inverse correlation between first metatarsophalangeal joint dorsiflexion and hallux interphalangeal joint dorsiflexion.

  19. An in vitro biomechanical comparison of equine proximal interphalangeal joint arthrodesis techniques: an axial positioned dynamic compression plate and two abaxial transarticular cortical screws inserted in lag fashion versus three parallel transarticular cortical screws inserted in lag fashion. (United States)

    Sod, Gary A; Riggs, Laura M; Mitchell, Colin F; Hubert, Jeremy D; Martin, George S


    To compare in vitro monotonic biomechanical properties of an axial 3-hole, 4.5 mm narrow dynamic compression plate (DCP) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion (DCP-TLS) with 3 parallel transarticular 5.5 mm cortical screws inserted in lag fashion (3-TLS) for the equine proximal interphalangeal (PIP) joint arthrodesis. Paired in vitro biomechanical testing of 2 methods of stabilizing cadaveric adult equine forelimb PIP joints. Cadaveric adult equine forelimbs (n=15 pairs). For each forelimb pair, 1 PIP joint was stabilized with an axial 3-hole narrow DCP (4.5 mm) using 5.5 mm cortical screws in conjunction with 2 abaxial transarticular 5.5 mm cortical screws inserted in lag fashion and 1 with 3 parallel transarticular 5.5 mm cortical screws inserted in lag fashion. Five matching pairs of constructs were tested in single cycle to failure under axial compression, 5 construct pairs were tested for cyclic fatigue under axial compression, and 5 construct pairs were tested in single cycle to failure under torsional loading. Mean values for each fixation method were compared using a paired t-test within each group with statistical significance set at P<.05. Mean yield load, yield stiffness, and failure load under axial compression and torsion, single cycle to failure, of the DCP-TLS fixation were significantly greater than those of the 3-TLS fixation. Mean cycles to failure in axial compression of the DCP-TLS fixation was significantly greater than that of the 3-TLS fixation. The DCP-TLS was superior to the 3-TLS in resisting the static overload forces and in resisting cyclic fatigue. The results of this in vitro study may provide information to aid in the selection of a treatment modality for arthrodesis of the equine PIP joint.

  20. Double Dislocation of Interphalangeal Joints Accompanied with Contralateral Shoulder Dislocation: A Case Report. (United States)

    Raval, Pradyumna Ramchandra; Jariwala, Arpit


    Dislocation of any joint is an orthopaedic emergency and needs immediate attention by the attending physician. A delay in reducing a dislocated joint can lead to disastrous complications both immediately as well as in the long run. Although anterior dislocation of a shoulder joint is by far the commonest dislocation encountered by any emergency care physician, other joints may also get dislocated. In certain cases two joints may get dislocated simultaneously. Such dislocation is known as a double dislocation. Double dislocation of the proximal interphalangeal joint and the distal interphalangeal joint in the same finger is a rare injury. High impact loading at the fingertip is the primary cause in most cases and it is often associated with younger individuals playing contact sports. The right little finger is the digit commonly involved and this injury is evident in football players more often than not. Although closed reduction is a preferred treatment, it may not be always successful. Time of presentation, tendon interposition, associated swelling and co-existent phalangeal fractures are certain key impediments to a successful closed reduction manoeuvre. In patients with an open injury, a thorough wash out and appropriate antibiotic cover is mandatory. We report a rare case of double dislocation of the interphalangeal joints accompanied with contralateral shoulder dislocation in an elderly man sustained after a fall which was treated successfully with closed reduction and early mobilization. © 2016 Chinese Orthopaedic Association and John Wiley & Sons Australia, Ltd.

  1. Dynamic pinch tolerance of the phalanges and interphalangeal joints. (United States)

    Kent, Richard; Stacey, Stephen; Parenteau, Chantal


    This article presents force and displacement tolerances for pinch loading of the bones and joints of the digits. Dynamic (54 mm/s) pinch loading was applied in a dorsal-palmar direction to all digits (fingers and thumb) on matched pairs of hands from 8 adult human cadavers. Opposed 3.1-mm thick, 1.0-mm radius of curvature aluminum pinching surfaces were used to represent the geometry of moving surfaces in an automobile, such as doors, lift gates, or window edges. Injury timing was determined using acoustic sensors. The applied force and the distance between the pinching surfaces at the time of an acoustic burst were recorded. The force tolerance ranged from 245 N for the distal phalanx of the fifth digit (little finger) to 1,155 N for the middle phalanx of the second digit (index finger), with a general trend toward increasing force tolerance for more proximal anatomical structures. The distance between pinching surfaces (gap) at the time of injury ranged from 4.5 mm for the distal interphalangeal joint of the fifth digit to 9.1 mm for the proximal phalanx of the third digit (middle finger). Orthopedic trauma found during necropsy of the test specimens included tuft fractures, transverse fractures, cortical crush injuries, a longitudinal fracture, and tendon injuries. A value of approximately 35% of the initial dorsal-palmar dimension of the phalanx is reasonably representative of the gap tolerance for all digits and loading sites considered here. Although additional testing is required to quantify variability in tolerance, the tests here indicate that moving surfaces having geometry similar to that considered here would not be expected to injure a digit if the opposing surfaces come no closer together than 35% of the digit's dorsal-palmar dimension.

  2. Distal interphalangeal joint implant arthroplasty in a musician. (United States)

    Schwartz, D A; Peimer, C A


    Degenerative joint disease commonly affects the distal interphalangeal (DIP) joints, causing articular destruction and marginal bone formation. Treatment for pain relief and function is most often done through arthrodesis. The case of a 70-year-old concert violinist with left index finger DIP joint osteoarthritis is presented. Arthritis in the involved joint caused pain and deformity and interfered with the patient's ability to play music. Trial arthrodesis with K-wires proved impossible because of the patient's need for continued mobility. Swanson hinge implant arthroplasty was performed on the affected DIP joint. The patient eventually achieved an excellent result and was able to return to playing the violin professionally. Treatment and therapy guidelines are presented.

  3. Open Reduction of Proximal Interphalangeal Fracture-Dislocation through a Midlateral Incision Using Absorbable Suture Materials

    Directory of Open Access Journals (Sweden)

    Jae Jun Lee


    Full Text Available BackgroundFracture-dislocation of the proximal interphalangeal (PIP joint is a relatively common injury. Various treatments for fracture-dislocation of the PIP joint have been reported. In the present study, we performed open reduction through a midlateral incision using absorbable sutures to reduce the small bone fragments and performed volar plate repair.MethodsWe treated nine patients with fracture-dislocation of the PIP joint with small fractured bone fragments too small for pinning or screw fixation. Patients with volar plate injury were treated with open reduction and volar plate repair at the periosteum of the middle phalangeal bone base by the modified Kessler method using absorbable sutures. All patients were placed in a dorsal aluminum extension block splint, which maintained the PIP joint in approximately 30 degrees of flexion to avoid excessive tension on the sutured volar plate.ResultsAt a mean final follow-up of postoperative 9 months, all patients were evaluated radiographically and had adequate alignment of the PIP joint and reduction of the displaced bone fragments. Range of motion was improved and there were no complications.ConclusionsThis technique is an excellent alternative to the current method of treating patients with fracture-dislocations that include small fragments that are too small for pinning or screw fixation. It is a less invasive surgical method and enables stable reduction and early exercise without noticeable complications.

  4. Sonographic analyses of pulley and flexor tendon in idiopathic trigger finger with interphalangeal joint contracture. (United States)

    Sato, Junko; Ishii, Yoshinori; Noguchi, Hideo; Takeda, Mitsuhiro


    This study investigated the sonographic appearance of the pulley and flexor tendon in idiopathic trigger finger in correlation with the contracture of the interphalangeal (IP) joint in the thumb or proximal IP (PIP) joint in the other digits. Sonographic measurements using axial images were performed in 177 affected digits including 17 thumbs and 34 other digits judged to have IP or PIP joint contracture and 77 contralateral control digits. The A1 pulley of the contracture group was significantly thicker than that of the non-contracture group in all digits, whereas the flexor tendon was thicker only in digits other than the thumb. In the analysis using calculated cut-off values, A1 pulley thickening in the thumb and A1 pulley and flexor tendon thickening in the other digits showed statistically significant correlations with IP or PIP joint contracture. This study sonographically confirmed previous reports showing that enlargement of the flexor tendons contribute to the pathogenesis of PIP joint contracture. Copyright © 2014 World Federation for Ultrasound in Medicine & Biology. Published by Elsevier Inc. All rights reserved.

  5. Irreducible plantar dislocation of the interphalangeal joint of the great toe due to an accessory sesamoid bone: a case report. (United States)

    Ohmori, Takaaki; Katsuo, Shinichi; Sunayama, Chiaki; Mizuno, Katsunori; Ojima, Tomohiro; Yamakado, Kotaro; Ando, Tomonari; Watanabe, Shin; Hayashi, Seigaku; Tsuchiya, Hiroyuki


    Great toe dislocation frequently occurs at the metatarsophalangeal joint. However, an irreducible dislocation of the great toe interphalangeal (IP) joint due to an accessory sesamoid bone is relatively unusual. A 23-year-old woman suffered a dislocated IP joint of the left great toe. The distal phalanx was plantar subluxated, and the articular surface was misaligned. Ultrasound, magnetic resonance imaging, and computed tomography images did not indicate any factors inhibiting reduction. In addition, the sesamoid bone at the IP joint was found to be rotated in the long-axis direction. The sesamoid bone of the IP joint was hooked from the distal direction and occupied the intercondylar area. IP joint of the left great toe was flexed and the distal phalanx was pushed toward the proximal phalanx during reduction locking with fluoroscopic guidance under local anesthesia, and the dislocation was successfully reduced. The sesamoid bone at the IP joint is anatomically located dorsal to the flexor hallucis longus tendon and volar plate. The sesamoid bone fitted exactly in the distal intercondylar area. The sesamoid bone in our patient could be rotated by forcible plantar flexion of the IP joint displaced proximally and hooked into the intercondylar area from the proximal aspect. Then, the distal phalanx was pulled proximally through the volar plate. This is the first report on a plantar dislocation of the IP joint.

  6. Distal border synovial invaginations of the equine distal sesamoid bone communicate with the distal interphalangeal joint. (United States)

    Olive, Julien; Videau, Marine


    Macroscopic studies have suggested a link between distal border synovial invaginations of the navicular bone and the distal interphalangeal joint. However, many practitioners consider that these invaginations are directly and solely related to navicular disease. The objective was to investigate the communication pattern of these synovial invaginations with the synovial compartments of the distal interphalangeal joint and the navicular bursa, using minimally invasive imaging techniques. In a prospective observational study, 10 cadaveric limbs with radiographically evident distal border synovial invaginations were randomly assigned to computed tomography arthrography or bursography groups, using iopamidol. In 5/5 limbs, contrast medium filled the invaginations following distal interphalangeal arthrography. In the other five limbs, no contrast medium filled the invaginations following bursography. Contrary to existing beliefs, these invaginations are more likely associated with distal interphalangeal joint synovitis and may not be directly linked to primary navicular bone pathology, but might reflect distal interphalangeal arthropathy. Therefore, the rationale for assessment of these invaginations in stallion selection or pre-purchase examinations as a predictive sign for navicular disease is questionable. Nonetheless, comorbidities are frequent in the equine distal limb. Enlarged synovial invaginations may also be seen in limbs with concomitant primary navicular disease. Further studies are needed to elucidate possible inter-related pathological processes.

  7. [Repair of collateral ligament rupture in the interphalangeal joint using superficial flexor tendon of finger]. (United States)

    Ka, S; Guan, Z M; Liu, C


    To introduce the surgical procedure and clinical result of microsurgical repair on collateral ligament rupture in the interphalangeal joint using superficial flexor tendon of finger. From 1987, 23 cases with collateral ligament rupture in the interphalangeal joint were repaired by part of superficial flexor tendon of finger. The initial point of collateral ligament was drilled two holes, 2 to 3 mm in distance, and crossed by steel wire. Then the superficial flexor tendon of finger was crossed under the steel wire and sutured to the terminal point of superficial flexor tendon of finger by 5/0 to 7/0 nontraumatic suture thread to maintain suitable tension, and sutured to collateral ligament by 8/0 nontraumatic suture thread. Extension splint fixation was performed 4 to 6 weeks postoperatively. Followed up 3 to 6 months, 15 cases were excellent, 6 cases were better, 2 cases were moderate, and the excellent rate was 91.34% according to Saetta standard. Microsurgical repair on collateral ligament rupture in the interphalangeal joint using superficial flexor tendon of finger is a convenient and effective surgical method.

  8. Irreducible dislocation of the thumb interphalangeal joint due to displaced flexor pollicis longus tendon: case report and new reduction technique. (United States)

    Naito, Kiyohito; Sugiyama, Yoichi; Igeta, Yuka; Kaneko, Kazuo; Obayashi, Osamu


    Dislocation of the thumb interphalangeal (IP) joint is uncommon because of the inherent stability of the joint. Cases in which reduction was blocked by the volar plate, the flexor pollicis longus (FPL) tendon, the sesamoid bone, and an osteochondral fragment have been described in the literature. This article reports a case of closed thumb IP joint dislocation caused by the displacement of the FPL tendon. A new percutaneous reduction technique for this injury will also be presented. A 63-year-old woman presented to the emergency room with an obvious thumb deformity. Radiographs confirmed dorsal dislocation of the thumb IP joint without associated fracture. Closed reduction was not successful. Percutaneous reduction was performed under locoregional anesthesia, because the dislocation was due to an FPL tendon that had displaced dorsally and radially to the proximal phalanx. After reduction, Kirschner wire fixation was not needed, but IP joint immobilization with a splint was required for 3 weeks. Postoperatively, there were no complications in soft tissues and the operative scar was almost unrecognizable. This technique enables a mini-invasive reduction by operating percutaneously on the FPL. In addition, unlike with a volar zigzag approach, it is possible to suppress the occurrence of postoperative adhesion of the flexor tendon. This new minimally invasive reduction technique is useful for irreducible dislocation of the thumb IP joint due to a displaced FPL tendon.

  9. [Control observation between mild moxibustion and TDP for obsolete collateral ligament injury of interphalangeal joints]. (United States)

    Liang, Yulei; Li, Weihua; Xu, Xiaokang; Ding, Chenguang; Tian, Ling; Duan, Jiaqiang; Zhang, Zhifang; Sun, Lihong


    To compare the effects between mild moxibustion and specific electromagnetic spectrum therapy apparatus (TDP) for obsolete collateral ligament injury of interphalangeal joints. Sixty patients were randomly divided into a mild moxibustion group and a TDP group, 30 cases in each one. In the mild moxibustion group, pure moxa sticks were used at the affected digital joints locally for 20-30 min a time. In the TDP group, TDP was applied at the affected digital joints locally for 20-30 min a time. The treatment was given once a day for two courses, and 10-day treatment was made into a course. Visual analogue scale (VAS) for pain, swelling degree of the affected digital joints before and after treatment were observed and the clinical efficacy and safety were evaluated in the two groups. The excellent rate was 56.7% (17/30) and the excellent and, good rate was 83.4% (25/30) in the mild moxibustion group,which were better than 36.7% (11/30) and 76.7% (23/30) in the TDP group respectively (both P ligament injury of interphalangeal joints, which is superior to TDP.

  10. Causes of prolapse and collapse of the proximal interphalangeal joint

    NARCIS (Netherlands)

    J.C.H.M. van der Meulen (Jacques)


    textabstractAn understanding of abnormal finger motion depends on a basic knowledge of normal functional anatomy, which can be found in the contributions made by Eyler and Markee (1954), Kaplan (1953), Milford (1968), Stack (1962), Tubiana and Valeillin (1963). It is then possible to appreciate that

  11. Rare open hallux interphalangeal joint dislocations sustained in combatives training: a case series. (United States)

    Jones, Marc D; May, Ian C; Sweet, Kerry J


    Hallux interphalangeal joint dislocations are a very rare occurrence, and open medial dislocations of the hallux interphalangeal joint, to our knowledge, have not been previously reported in the literature. We report two open medial dislocations, one with fracture, that were sustained within a year of each other at the same military installation. Both patients presented were active duty soldiers that were involved in barefoot combatives and caught their hallux in the fold of the mats while simultaneously experiencing a "twisting force" applied to their foot by their combatives partner. Each soldier required surgical intervention and healed uneventfully, able to return to full activities in an average of 10 weeks with no residual pain. Two injuries of this rarity occurring with the same mechanism of injury within a year at the same military base raise concerns about the surface and shoegear being used for combatives training. The initial analysis of these two separate but similar cases points to the fact that injuries to the foot and toes may be reduced by using seamless mats and/or wearing closed-toed shoes (wrestling style) during combatives training. Reprint & Copyright © 2014 Association of Military Surgeons of the U.S.


    Liu, Jinwei; He, Zaopeng; Li, Wei; Zhou, Congzhen; Zheng Yudong; Zeng, Difan; Liu, Dongbo


    To explore a new improved technique and its effectiveness to repair dorsal thumb composite tissue defects including interphalangeal joint by transplantation of modified hallux toe-nail composite tissue flap. The hallux toe-nail composite tissue flap carrying distal half hallux proximal phalanx, extensor hallucis longus, and interphalangeal joint capsule were designed and applied to repair the dorsal skin, nails, and interphalangeal joint defect of thumb in 14 cases between January 2007 and June 2013. They were all males, aged from 19 to 52 years (mean, 30 years). The time from injury to hospital was 0.5-2.0 hours (mean, 1.2 hours). The area of the thumb nail and dorsal skin defects ranged from 2.5 cm x 1.5 cm to 5.0 cm x 2.5 cm. The dorsal interphalangeal joint had different degrees of bone defect, with residual bone and joint capsule at the palm side. The length of bone defect ranged from 2.5 to 4.0 cm (mean, 3.4 cm). The hallux nail flap size ranged from 3.0 cm x 2.0 cm to 6.0 cm x 3.0 cm. The donor sites were repaired by skin grafting in 5 cases, and retrograde second dorsal metatarsal artery island flap in 9 cases. After operation, arterial crisis occurred in 1 case and the flap survived after relieving pressure; the other flaps survived, and wounds healed by first intention. Liquefaction necrosis of the skin grafting at donor site occurred in 3 cases, and the other skin grafting and all retrograde second dorsal metatarsal artery island flaps survived. The follow-up ranged from 9 months to 3 years and 6 months (mean, 23 months). The secondary plastic operation was performed in 4 cases at 6 months after operation because of slightly bulky composite tissue flaps. The other composite tissue flaps had good appearance, color, and texture. The growth of the nail was good in 12 cases, and slightly thickened in 2 cases. At last follow-up, X-ray examination showed that bone graft and proximal phalanx of the thumb had good bone healing in 12 cases. Good bone healing was

  13. Magnetic resonance imaging guided treatment of equine distal interphalangeal joint collateral ligaments: 2009-2014

    Directory of Open Access Journals (Sweden)

    Nathaniel A. White


    Full Text Available Objectives: To determine the success of treating distal interphalangeal joint collateral ligament (DIJCL desmopathy using magnetic resonance imaging (MRI guided ligament injection. Methods: Medical records of 13 adult horses diagnosed with DIJCL desmopathy using low field MRI and treated by MRI guided ligament injection of mesenchymal stem cells and/or platelet rich plasma were reviewed. Information collected included signalment, MRI diagnosis, treatment type, time to resolution of lameness and level of exercise after treatment. Results: Collateral ligament inflammation was diagnosed as a cause of lameness in 13 horses. MRI was used to guide the injection of the injured DIJCL. All lameness attributed to DIJCL desmopathy resolved with the resulting level of performance at expected (10 or less than expected (3. Conclusions and Clinical Relevance: Injection of the DIJCL can be completed in horses standing in a low field magnet guided by MRI as previously demonstrated in cadaver specimens. Administration of stem cells or PRP appears useful as a treatment for DIJCL desmopathy.

  14. Evaluation of the diffusion of corticosteroids between the distal interphalangeal joint and navicular bursa in horses. (United States)

    Pauwels, Frederik E; Schumacher, James; Castro, Fernando A; Holder, Troy E; Carroll, Roger C; Sega, Gary A; Rogers, Chris W


    To determine whether clinically effective concentrations of methylprednisolone or triamcinolone can be achieved in the navicular bursa after injection of methylprednisolone acetate (MPA) or triamcinolone acetonide (TA) into the distal interphalangeal joint (DIPJ) and whether clinically effective concentrations of these drugs can be achieved in the DIPJ after injecting the navicular bursa with the same doses of MPA or TA. 32 healthy horses. Horses in groups 1 through 4 received 40 mg of MPA in the DIPJ, 10 mg of TA in the DIPJ, 40 mg of MPA in the navicular bursa, and 10 mg of TA in the navicular bursa, respectively. Concentrations of corticosteroids that diffused into the adjacent synovial structure were determined. For group 1, injection of MPA into the DIPJ yielded a mean +/- SD concentration of 0.24 +/- 0.072 microg of methylprednisolone/mL in the navicular bursa. For group 2, injection of TA into the DIPJ yielded 0.124 +/- 0.075 microg of triamcinolone/mL in the navicular bursa. For group 3, injection of MPA into the navicular bursa yielded 0.05 +/- 0.012 microg of methylprednisolone/mL in the DIPJ. For group 4, injection of TA into the navicular bursa yielded 0.091 +/- 0.026 microg of triamcinolone/mL in the DIPJ. A clinically effective concentration of methylprednisolone or triamcinolone diffused between the DIPJ and navicular bursa after intra-articular or intrabursal injection, which would justify injection of the DIPJ with MPA or TA to ameliorate inflammation of the navicular bursa.

  15. Comparison of Extension Orthosis Versus Percutaneous Pinning of the Distal Interphalangeal Joint for Closed Mallet Injuries. (United States)

    Renfree, Kevin J; Odgers, Ryan A; Ivy, Cynthia C


    We compared a static extension orthosis with percutaneous pinning of the distal interphalangeal joint (DIPJ) for treatment of closed mallet injuries. After receiving counsel about treatment options, 44 patients (25 women and 19 men; mean age, 57 years) freely chose orthosis and 18 patients (5 women and 13 men; mean age, 51 years) chose pinning. Both the extension orthosis and the pin remained in place for 6 weeks; the pin then was removed, and the care in both groups was transitioned to nighttime orthosis use for an additional 6 weeks. The patients in the pin group were allowed to immediately resume unrestricted activity postoperatively. The mean follow-up was 32 months in the orthosis group and 19 months in the pin group. Final residual extensor lag was better in the pin group (5 vs 10 degrees, P = 0.048). Improvement between the groups was in favor of percutaneous pinning (36 vs 17 degrees, P = 0.001). No correlation was seen between time to treatment (≤14 vs >14 days from injury) and final extensor lag in either group (P = 0.85). The final mean DIPJ flexion was 53 degrees for orthosis and 46 degrees for pinning. Among the patients, 93% of the orthosis group and 100% of the pin group said that they would choose the same treatment again. Both groups had a mean of 5 hand therapy visits during treatment. Two complications occurred in the orthosis group (5%) and 3 (17%) occurred in the pin group. Extension orthotics and pinning are both well-tolerated, effective treatments of mallet injury. The techniques produce satisfactory correction of extensor lag and have high patient satisfaction. Pinning allows better correction of DIPJ extensor lag and results in a smaller degree of final extensor lag. Pinning is more expensive and may result in more DIPJ stiffness (ie, loss of active flexion), but it may be justified in certain patients (eg, medical professionals, food service workers) who would have difficulty working with an orthosis.

  16. Soft tissue distraction using pentagonal frame for long-standing traumatic flexion deformity of interphalangeal

    Directory of Open Access Journals (Sweden)

    Nazerani Shahram


    Full Text Available 【Abstract】Objective: Interphalangeal joint con-tracture is a challenging complication of hand trauma, which reduces the functional capacity of the entire hand. In this study we evaluated the results of soft tissue distraction with no collateral ligament transection or volar plate removal in comparison with traditional operation of contracture re-lease and partial ligament transection and volar plate removal. Methods: In this prospective study, a total of 40 pa-tients in two equal groups (A and B were studied. Patients suffering from chronic flexion contracture of abrasive trau-matic nature were included. Group A were treated by soft tissue distraction using pentagonal frame technique and in Group B the contracture release was followed by finger splinting. Results: Analyzed data revealed a significant differ-ence between the two groups for range of motion in the proximal interphalangeal joints (P<0.05, while it was not meaningful in the distal interphalangeal joints (P>0.05. There was not a significant difference in the degrees of flexion contracture between groups (P>0.05. Regression analysis showed that using pentagonal frame technique significantly increased the mean improvement in range of motion of proxi-mal interphalangeal joints (P<0.001, while the higher the preoperative flexion contracture was observed in proximal interphalangeal joints, the lower improvement was achieved in range of motion of proximal interphalangeal joints after intervention (P<0.001. Conclusion: Soft tissue distraction using pentagonal frame technique with gradual and continuous collateral liga-ment and surrounding joint tissues distraction combined with skin Z-plasty significantly improves the range of mo-tion in patients with chronic traumatic flexion deformity of proximal and/or distal interphalangeal joints. Key words: Osteogenesis, distraction; Finger joint; Hand deformities

  17. Clinical and radiographic changes of carpi, tarsi and interphalangeal joints of beef zebu bulls on semen collection regimen

    Directory of Open Access Journals (Sweden)

    G.A. Motta

    Full Text Available ABSTRACT Osteoarthritis and osteochondrosis are highly correlated to reproductive failure in bulls. This study aimed to evaluate the carpal, tarsal and interphalangeal lesions in beef zebu bulls on semen collection regimen. Twenty-one beef cattle bulls, in a total of forty-one animals, were split into three age-based groups: animals from two to four years old (GI, from more than four to eight years old (GII and above eight years old (GIII. The clinical findings were conformational changes of limbs, synovial effusion, peripheral venous engorgement of joints and prolonged decubitus. The total population showed moderate clinical manifestation and radiographic score. The GIII presented more severe joint lesions. Carpi and tarsi regions had discrete to difuse osteophytosis, subchondral cysts, cartilaginous flaps, bone incongruence and fragmentation, osteitis, and ankylosis. Interphalangeal joints presented osteophytosis, distal phalanx osteitis and enthesophytosis. The digital radiographic examination allowed full identification of articular lesions and their clinical correspondences, besides the positive correlation between age, body weight and radiographic score.

  18. Stenosing Tenosynovitis of the Flexor Hallucis Longus Tendon Associated with the Plantar Capsular Accessory Ossicle at the Interphalangeal Joint of the Great Toe

    Directory of Open Access Journals (Sweden)

    Song Ho Chang


    Full Text Available This report presents a case of stenosing tenosynovitis of the flexor hallucis longus tendon associated with the plantar capsular accessory ossicle at the interphalangeal joint of the great toe, which was confirmed by intraoperative observation and was successfully treated with surgical resection of the ossicle. As the plantar capsular accessory ossicle was not visible radiographically due to the lack of ossification, ultrasonography was helpful for diagnosing this disorder.

  19. Personnel Exposure to Scattered Radiation During Radiography of the Distal Interphalangeal Joint in the Horse Using a Portable X-Ray Machine

    Directory of Open Access Journals (Sweden)

    J. Šterc


    Full Text Available Radiography of the distal interphalangeal joints of two limbs of a cadaver of a horse weighing 550 kg was conducted in the present study. The examination was performed on lateromedial, palmaroproximal-palmarodistal views and on dorsoproximal-palmarodistal, dorsolateral-palmaromedial, dorsomedial-palmarolateral views of a raised limb placed on a navicular block, and of weight-bearing limbs. During the examination, doses of scattered radiation were measured at the sites of radiographer, assistant holding a film cassette and assistant positioning the examined limb or the opposite one. The lowest radiation dose was received by the assistant holding the cassette behind the examined region; a total equivalent dose of 183.6 - 201.7 nSv was received by his hands and genitals, and 110.8 - 113.3 nSv by his eye lens and neck during the examination of the distal interphalangeal joint. The radiographer was exposed to higher radiation; an equivalent dose of 846.6 - 854.1 nSv was received by his hands and genitals, and 271.8 - 328.2 nSv by the eye lens and the neck. The highest scattered radiation dose was received by the assistant positioning the examined limbs; equivalent doses were 7751 - 9354 nSv (hands, 1117.3 - 1119.5 nSv (genitals, and 880.6 - 1096.2 nSv (eye lens and neck. The equivalent dose values measured, received by the radiographer and the assistants during the examination of the distal interphalangeal joint seem to be very low relative to radiation exposure limits. However, it must be taken into account that the personnel involved in radiography is also exposed to scattered radiation during other examinations where radiation doses are often much higher. These results indicate the necessity to use protective lead aprons, gloves and collars during radiography of the distal interphalangeal joint.

  20. Bilateral, atraumatic, proximal tibiofibular joint instability. (United States)

    Morrison, Troy D; Shaer, James A; Little, Jill E


    Dislocation of the tibiofibular joint is rare and usually results from a traumatic event. Only 1 case of atraumatic proximal tibiofibular joint instability in a 14-year-old girl has been reported in the literature, however this condition might occur more frequently than once thought. A wide range of treatment options exist for tibiofibular dislocations. Currently, the first choice is a conservative approach, and when this fails, surgical means such as resection of the fibula head, arthrodesis, and reconstruction are considered. However, no consensus exists on the most effective treatment. This article reports a unique case of bilateral, atraumatic, proximal tibia and fibular joint instability involving a 30-year-old man with a 20-year history of pain and laxity in the right knee. The patient had no trauma to his knees; he reported 2 immediate family members with similar complaints, which suggests that this case is likely congenital. After conservative approaches proved to be ineffective, the patient underwent capsular reconstruction using free autologous gracilis tendon. At 6-month postoperative follow-up, the patient was pain free with no locking and instability. He then underwent surgery on the left knee. At 1-year follow-up after the second surgery, the patient had no symptoms or restrictions in mobility. We provide an alternative surgical approach to arthrodesis and resection for the treatment of chronic proximal tibiofibular instability. In the treatment of chronic tibiofibular instability, we believe that reconstruction of the tibiofibular joint is a safe and effective choice. Copyright 2011, SLACK Incorporated.

  1. Involvement of different risk factors in clinically severe large joint osteoarthritis according to the presence of hand interphalangeal nodes. (United States)

    Valdes, Ana M; McWilliams, Daniel; Arden, Nigel K; Doherty, Sally A; Wheeler, Margaret; Muir, Kenneth R; Zhang, Weiya; Cooper, Cyrus; Maciewicz, Rose A; Doherty, Michael


    To quantify the differences in risk factors influencing total hip replacement (THR) and total knee replacement (TKR) based on the presence versus absence of multiple interphalangeal nodes in 2 or more rays of the fingers of each hand in patients with large joint osteoarthritis (OA). A group of 3,800 patients with large joint OA who underwent total joint replacement (1,201 of whom had the nodal phenotype) and 1,906 control subjects from 2 case-control studies and a population-based cohort in the UK were studied. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated for the risk of total joint replacement in association with age, sex, body mass index (BMI), height, and prevalence of the T allele in the GDF5 rs143383 polymorphism. ORs for total joint replacement were compared between cases of nodal OA and cases of non-nodal OA and between patients who underwent TKR and those who underwent THR. Age, sex, and BMI had significantly higher ORs for an association with total joint replacement in nodal OA cases than in non-nodal OA cases. The GDF5 polymorphism was significantly associated with THR in cases of nodal OA, but not in cases of non-nodal OA, and increased height was a risk factor for THR in non-nodal OA cases only. Female sex was a protective risk factor for TKR in non-nodal OA cases (OR 0.60, 95% CI 0.52-0.70) but was predisposing for TKR in the nodal form of OA (OR 1.83, 95% CI 1.49-2.26). The nodal phenotype was associated with a significantly higher risk of undergoing both THR and TKR (OR 1.46, 95% CI 1.09-1.94) and also a significantly higher risk of bilateral TKR (OR 1.70, 95% CI 1.37-2.11), but, paradoxically, was associated with a lower risk of bilateral THR (OR 0.72, 95% CI 0.56-0.91). Nodal and non-nodal forms of large joint OA have significantly different risk factors and outcomes, indicating a different etiology for the 2 forms of OA. With regard to the likelihood of undergoing THR, this appears to be, at least in part, genetically

  2. Evaluation of diffusion of triamcinolone acetonide from the distal interphalangeal joint into the navicular bursa in horses. (United States)

    Boyce, Mary; Malone, Erin D; Anderson, Lorraine B; Park, Seijin; Godden, Sandra M; Jenner, Florien; Trumble, Troy N


    To determine whether triamcinolone acetonide diffuses from the distal interphalangeal joint (DIPJ) to the navicular bursa, diffusion is direct or systemic, and addition of sodium hyaluronan has an effect on diffusion in horses. 11 adult horses without forelimb lameness. 1 randomly chosen forelimb DIPJ of each horse received an injection of 10 mg of triamcinolone acetonide plus 20 mg of sodium hyaluronan (group 1), and the contralateral forelimb DIPJ received an injection of 10 mg of triamcinolone acetonide plus 2 mL of lactated Ringer's solution (group 2). Synovial fluid samples were taken from both forelimb navicular bursae and 1 hind limb navicular bursa (systemic control group) at 6 hours. Triamcinolone acetonide concentrations in synovial fluid were quantified by use of high-performance liquid chromatography plus tandem mass spectrometry. Data were logarithmically transformed, and contrast analysis was performed on the 3 groups. Triamcinolone acetonide was detected in navicular bursal samples in all groups. Groups 1 and 2 had significantly greater concentrations of triamcinolone acetonide than the systemic control group. There was no significant difference between groups 1 and 2. Triamcinolone acetonide diffused directly from the DIPJ into the navicular bursa in clinically normal horses, and diffusion was not affected by addition of hyaluronan. Injection into the DIPJ with triamcinolone acetonide or a triamcinolone acetonide-hyaluronan combination can potentially be used for treatment of navicular syndrome, but further studies are needed to determine whether triamcinolone acetonide diffuses similarly in horses with navicular syndrome.

  3. A closed dorsolateral dislocation of PIP joint of the fourth toe-a case ...

    African Journals Online (AJOL)

    Interphalangeal (IP) joint dislocations of the toes are uncommon lesions. We present here a case of closed dorsolateral dislocation of proximal interphalangeal (PIP) joint of the fourth toe. Closed reduction and buddy strapping have been done with middle toe for two weeks under digital block. There was painless full range ...

  4. The treatment of prolapse and collapse of the proximal interphalangeal joint

    NARCIS (Netherlands)

    J.C.H.M. van der Meulen (Jacques)


    textabstractIt is intended here to discuss the correction of these deformities rather than the treatment of the conditions leading to prolapse and collapse. Most hand surgeons will agree that in this kind of surgery success and failure go hand in hand and that it is difficult to separate the two.

  5. Difference in Success Treating Proximal Interphalangeal and Metacarpophalangeal Joints with Collagenase

    DEFF Research Database (Denmark)

    Liv Hansen, Karina; Werlinrud, Jens Christian; Larsen, Søren


    BACKGROUND: Dupuytren disease (DD) is a fibroproliferative disorder of the palmar fasciae causing extension deficit and impaired hand function. Treatment with injection of collagenase clostridium histolyticum (CCH) is a nonsurgical treatment method. The aim of this study was to evaluate the diffe......BACKGROUND: Dupuytren disease (DD) is a fibroproliferative disorder of the palmar fasciae causing extension deficit and impaired hand function. Treatment with injection of collagenase clostridium histolyticum (CCH) is a nonsurgical treatment method. The aim of this study was to evaluate...

  6. Treatment of unstable proximal interphalangeal joint fractures with hemi-hamate osteochondral autografts. (United States)

    Burnier, M; Awada, T; Marin Braun, F; Rostoucher, P; Ninou, M; Erhard, L


    The primary aim of this study was to assess the clinical and radiological results after hemi-hamate resurfacing arthroplasty in patients with acute or chronic unstable fractures of the base of the middle phalanx and to describe technical features that can facilitate the surgical procedure. Hemi-hamate arthroplasties were done in 19 patients (mean age 39 years) with an isolated fracture at the base of the middle phalanx that involved more than 40% of the articular surface. We assessed ten chronic cases (treated >6 weeks after fracture) and nine acute ones (partial graft lysis. IV.

  7. Tumour necrosis factor blockade for the treatment of erosive osteoarthritis of the interphalangeal finger joints: a double blind, randomised trial on structure modification. (United States)

    Verbruggen, Gust; Wittoek, Ruth; Vander Cruyssen, Bert; Elewaut, Dirk


    Adalimumab blocks the action of tumor necrosis factor-α and reduces disease progression in rheumatoid arthritis and psoriatic arthritis. The effects of adalimumab in controlling progression of structural damage in erosive hand osteoarthritis (HOA) were assessed. Sixty patients with erosive HOA on radiology received 40 mg adalimumab or placebo subcutaneously every two weeks during a 12-month randomized double-blind trial. Response was defined as the reduction in progression of structural damage according to the categorical anatomic phase scoring system. Furthermore, subchondral bone, bone plate erosion, and joint-space narrowing were scored according to the continuous Ghent University Score System (GUSSTM). The disease appeared to be active since 40.0% and 26,7% of patients out of the placebo and adalimumab group, respectively, showed at least one new interphalangeal (IP) joint that became erosive during the 12 months follow-up. These differences were not significant and the overall results showed no effect of adalimumab. Risk factors for progression were then identified and the presence of palpable soft tissue swelling at baseline was recognized as the strongest predictor for erosive progression. In this subpopulation at risk, statistically significant less erosive evolution on the radiological image (3.7%) was seen in the adalimumab treated group compared to the placebo group (14.5%) (P = 0.009). GUSSTM scoring confirmed a less rapid rate of mean increase in the erosion scores during the first 6 months of treatment in patients in adalimumab-treated patients. Palpable soft tissue swelling in IP joints in patients with erosive HOA is a strong predictor for erosive progression. In these joints adalimumab significantly halted the progression of joint damage compared to placebo.

  8. Tumour necrosis factor blockade for the treatment of erosive osteoarthritis of the interphalangeal finger joints: a double blind, randomised trial on structure modification (United States)

    Verbruggen, Gust; Wittoek, Ruth; Cruyssen, Bert Vander; Elewaut, Dirk


    Background Adalimumab blocks the action of tumor necrosis factor-α and reduces disease progression in rheumatoid arthritis and psoriatic arthritis. The effects of adalimumab in controlling progression of structural damage in erosive hand osteoarthritis (HOA) were assessed. Methods Sixty patients with erosive HOA on radiology received 40 mg adalimumab or placebo subcutaneously every two weeks during a 12-month randomized double-blind trial. Response was defined as the reduction in progression of structural damage according to the categorical anatomic phase scoring system. Furthermore, subchondral bone, bone plate erosion, and joint-space narrowing were scored according to the continuous Ghent University Score System (GUSSTM). Results The disease appeared to be active since 40.0% and 26,7% of patients out of the placebo and adalimumab group, respectively, showed at least one new interphalangeal (IP) joint that became erosive during the 12 months follow-up. These differences were not significant and the overall results showed no effect of adalimumab. Risk factors for progression were then identified and the presence of palpable soft tissue swelling at baseline was recognized as the strongest predictor for erosive progression. In this subpopulation at risk, statistically significant less erosive evolution on the radiological image (3.7%) was seen in the adalimumab treated group compared to the placebo group (14.5%) (P = 0.009). GUSSTM scoring confirmed a less rapid rate of mean increase in the erosion scores during the first 6 months of treatment in patients in adalimumab-treated patients. Conclusion Palpable soft tissue swelling in IP joints in patients with erosive HOA is a strong predictor for erosive progression. In these joints adalimumab significantly halted the progression of joint damage compared to placebo. PMID:22128078


    McGill, Shannon L; Gutierrez-Nibeyro, Santiago D; Schaeffer, David J; Hartman, Susan K; O'Brien, Robert T; Joslyn, Stephen K


    Abnormalities of the deep digital flexor tendon, navicular bone, and collateral sesamoidean ligament can be difficult to visualize using magnetic resonance imaging (MRI) if bursal fluid is absent. The use of saline podotrochlear bursography improves podotrochlear apparatus evaluation, however, the technique has disadvantages. The objective of this prospective feasibility study was to describe saline arthrography of the distal interphalangeal joint as an alternative technique for improving MRI visualization of the deep digital flexor tendon, navicular bone, collateral sesamoidean ligament, and podotrochlear bursa, and to compare this technique with saline podotrochlear bursography. Eight paired cadaver forelimbs were sampled. Saline podotrochlear bursography or saline arthrography techniques were randomly assigned to one limb, with the alternate technique performed on the contralateral limb. For precontrast and postcontrast studies using each technique, independent observers scored visualization of the dorsal aspect of the deep digital flexor tendon, palmar aspect of the navicular bone, collateral sesamoidean ligament, and podotrochlear bursa. Both contrast techniques improved visualization of structures over precontrast MR images and visualization scores for both techniques were similar. Findings from this study demonstrated that saline arthrography is feasible and comparable to saline podotrochlear bursography for producing podotrochlear bursa distension and separation of the structures of the podotrochlear apparatus on nonweight bearing limbs evaluated with low-field MRI. Clinical evaluation of saline arthrography on live animals is needed to determine if this technique is safe and effective as an alternative to saline podotrochlear bursography in horses with suspected pathology of the podotrochlear apparatus. © 2015 American College of Veterinary Radiology.

  10. Frequency of Penetration of the Digital Flexor Tendon Sheath and Distal Interphalangeal Joint Using a Direct Endoscopic Approach to the Navicular Bursa in Horses. (United States)

    Kane-Smyth, Justine; Taylor, Sarah Elizabeth; García, Eugenio Cillán; Reardon, Richard J M


    To evaluate the frequency of inadvertent penetration of the digital flexor tendon sheath (DFTS) and/or distal interphalangeal joint (DIPJ) when using a direct endoscopic approach to the navicular bursa, and to evaluate an alternate direct approach to the navicular bursa. Cadaveric study. Equine cadaver limbs (n = 40 for direct; n = 12 for alternate approach). Four surgeons performed the direct endoscopic approach to the navicular bursa on 10 limbs each. Frequencies of inadvertent synovial penetration and iatrogenic damage were compared between surgeons. Use of an alternate direct approach, adopting a straight parasagittal trajectory, was evaluated by 2 surgeons. Inadvertent synovial penetration occurred in 45% of limbs (DFTS 37.5%; DIPJ 17.5%; and both structures 10%). Successful bursa entry was achieved on the first attempt in 45% of limbs. Significant variation in frequency of inadvertent synovial penetration was observed between surgeons (range 10-80%). Inadvertent synovial penetration did not occur when using the alternate direct technique. Iatrogenic damage to navicular bone fibrocartilage and/or deep digital flexor tendon occurred in 55% of limbs using the direct endoscopic approach and in 0% of limbs using the alternate direct approach. Because of the considerable risk of inadvertent penetration of the DFTS and/or the DIPJ when making a direct endoscopic approach to the navicular bursa, it is advisable to investigate for inadvertent penetration when treating navicular bursa sepsis using a direct approach. The alternate direct technique may reduce the risk of inadvertent penetration; however, the view within the bursa may be restricted. © 2016 The Authors. Veterinary Surgery published by Wiley Periodicals Inc. on behalf of The American College of Veterinary Surgeons.

  11. A closed dorsolateral dislocation of PIP joint of the fourth toe-a case report and review of literature

    Directory of Open Access Journals (Sweden)

    Prof. Giris Kumar Singh


    Full Text Available Interphalangeal (IP joint dislocations of the toes are uncommon lesions. We present here a case of closed dorsolateral dislocation of proximal interphalangeal (PIP joint of the fourth toe. Closed reduction and buddy strapping have been done with middle toe for two weeks under digital block. There was painless full range of movement after 2 weeks. We propose that attempt of closed reduction must be given adequately under anesthesia before proceeding for open reduction.

  12. Proximal tibiofibular joint: Rendezvous with a forgotten articulation

    Directory of Open Access Journals (Sweden)

    Amitav Sarma


    Full Text Available The proximal tibiofibular joint (PTFJ is a plane type synovial joint. The primary function of the PTFJ is dissipation of torsional stresses applied at the ankle and the lateral tibial bending moments besides a very significant tensile, rather than compressive weight bearing. Though rare, early diagnosis and treatment of the PTFJ dislocation are essential to prevent chronic joint instability and extensive surgical intervention to restore normal PTFJ biomechanics, ankle and knee function, especially in athletes prone to such injuries. PTFJ dislocations often remain undiagnosed in polytrauma scenario with ipsilateral tibial fracture due to the absence of specific signs and symptoms of PTFJ injury. Standard orthopedic textbooks generally describe no specific tests or radiological signs for assessment of the integrity of this joint. The aim of this paper was to review the relevant clinical anatomy, biomechanics and traumatic pathology of PTFJ with its effect on the knee emphasizing the importance of early diagnosis through a high index of suspicion. Dislocation of the joint may have serious implications for the knee joint stability since fibular collateral ligament and posterolateral ligament complex is attached to the upper end of the fibula. Any high energy knee injury with peroneal nerve palsy should immediately raise the suspicion of PTFJ dislocation especially if the mechanism of injury involved knee twisting in flexion beyond 80° and in such cases a comparative radiograph of the contralateral side should be performed. Wider clinical awareness can avoid both embarrassingly extensive surgeries due to diagnostic delays or unnecessary overtreatment due to misinformation on the part of the treating surgeon.

  13. Sex Differences in Proximal Control of the Knee Joint (United States)

    Mendiguchia, Jurdan; Ford, Kevin R.; Quatman, Carmen E.; Alentorn-Geli, Eduard; Hewett, Timothy E.


    Following the onset of maturation, female athletes have a significantly higher risk for anterior cruciate ligament (ACL) injury compared with male athletes. While multiple sex differences in lower-extremity neuromuscular control and biomechanics have been identified as potential risk factors for ACL injury in females, the majority of these studies have focused specifically on the knee joint. However, increasing evidence in the literature indicates that lumbopelvic (core) control may have a large effect on knee-joint control and injury risk. This review examines the published evidence on the contributions of the trunk and hip to knee-joint control. Specifically, the sex differences in potential proximal controllers of the knee as risk factors for ACL injury are identified and discussed. Sex differences in trunk and hip biomechanics have been identified in all planes of motion (sagittal, coronal and transverse). Essentially, female athletes show greater lateral trunk displacement, altered trunk and hip flexion angles, greater ranges of trunk motion, and increased hip adduction and internal rotation during sport manoeuvres, compared with their male counterparts. These differences may increase the risk of ACL injury among female athletes. Prevention programmes targeted towards trunk and hip neuromuscular control may decrease the risk for ACL injuries. PMID:21688868

  14. Disruption of the proximal tibiofibular joint in the setting of multi-ligament knee injury

    Energy Technology Data Exchange (ETDEWEB)

    Porrino, Jack A. [University of Washington, Department of Radiology, 4245 Roosevelt Way NE, Box 354755, Seattle, WA (United States)


    Instability of the proximal tibiofibular joint is a relatively uncommon condition when in isolation; however, instability of the proximal tibiofibular joint is far more frequent in those presenting with a severe multi-ligament injury of the knee. If this joint is left unstable, repair of a co-existent injury of the posterolateral corner may fail, regardless of the proficiency of the technique. We present two patients with disruption of the proximal tibiofibular joint, including the MRI appearance, who initially presented to our hospital for management of significant polytrauma, as well as multi-ligament injury of the ipsilateral knee. (orig.)

  15. Magnetic resonance imaging, radiography, and scintigraphy of the finger joints

    DEFF Research Database (Denmark)

    Klarlund, M; Ostergaard, M; Jensen, K E


    To evaluate synovial membrane hypertrophy, tenosynovitis, and erosion development of the 2nd to 5th metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints by magnetic resonance imaging in a group of patients with rheumatoid arthritis (RA) or suspected RA followed up for one year...

  16. Dislocation of the proximal tibiofibular joint, do not miss it

    NARCIS (Netherlands)

    van Wulfften Palthe, A.F.Y.; Musters, L.; Sonnega, R.J.A.; van der Sluijs, J.A.


    We present a case of a 45-year-old woman with a right proximal tibiofibular dislocation she sustained after a fall during roller skating. Anteroposterior and lateral radiographs confirmed the diagnosis; there were no other injuries. The dislocation was reduced by direct manipulation after

  17. Assessment of finger joint inflammation by diffuse optical tomography (United States)

    Hielscher, Andreas H.; Klose, Alexander D.; Scheel, Alexander K.; Backhaus, Marina; Netz, Uwe J.; Beuthan, Juergen


    Inflammatory processes as they occur during rheumatoid arthritis (RA) lead to changes in the optical properties of joint tissues and fluids. These changes occur early on in the disease process and can potentially be used as diagnostic parameter. In this work we report on in vivo studies involving 12 human subjects, which show the potential of diffuse optical tomographic techniques for the diagnosis of inflammatory processes in proximal interphalangeal (PIP) joints.

  18. Dislocation of the proximal tibiofibular joint, do not miss it (United States)

    van Wulfften Palthe, Alexander FY; Musters, Linda; Sonnega, Remko JA; van der Sluijs, Hans A


    We present a case of a 45-year-old woman with a right proximal tibiofibular dislocation she sustained after a fall during roller skating. Anteroposterior and lateral radiographs confirmed the diagnosis; there were no other injuries. The dislocation was reduced by direct manipulation after intra-articular infiltration, in our emergency department. The patient was treated with a long, non-weight bearing leg cast for 1 week. After 4 weeks, she had no pain and a full range of motion of the knee. PMID:26628303

  19. Importance of proximal A2 and A4 pulleys to maintaining kinematics in the hand: a biomechanical study. (United States)

    Chow, James C; Sensinger, Jon; McNeal, David; Chow, Bettina; Amirouche, Farid; Gonzalez, Mark


    The A2 and A4 pulleys have been shown to be important in finger flexor tendon function. Other authors have suggested either reconstruction or venting of portions of these pulleys in an attempt to preserve finger function in certain clinical situations. This study examines the effects of partial incision of these pulleys on finger flexion kinematics and biomechanics. The index and ring fingers of 16 cadaveric hands were studied. The flexor digitorum profundus tendon was isolated and attached to a computer driven servo-motor. Micro-potentiometers measured flexion angles of the metacarpophalangeal, proximal inter-phalangeal and distal inter-phalangeal joints. Joint inertial torques were calculated making use of this experimental kinematic data. Proximal 50 % incisions of either the A2 or the A4 pulleys resulted in a statistically significant decrease in overall finger motion. This effect was greatest in the proximal inter-phalangeal joint, with a decrease in joint motion, as well as an earlier time to initiation of motion. These changes in finger motion were more pronounced with A2 pulley incision than they were with A4 pulley incision, but the changes were statistically significant in either case. No significant changes in joint inertial torques were shown. Our data provides evidence to the importance of the proximal portions of the A2 and A4 pulleys, and may support partial distal incision of these pulleys in certain clinical situations.

  20. Jam Injuries of the Finger: Diagnosis and Management of Injuries to the Interphalangeal Joints Across Multiple Sports and Levels of Experience. (United States)

    Carruthers, Katherine H; Skie, Martin; Jain, Margaret


    Jam injuries of the finger are frequently encountered in general orthopaedic and sports medicine practice. The finger joints in particular are very susceptible to traumatic injury, but in the absence of severe deformity, digital trauma is often downplayed in the hopes of a more rapid return to game play. Articles published from 1966 to 2015 were reviewed to capture historical and current views on the presentation, diagnosis, and treatment of jam injuries in athletes. Clinical review. Level 5. Although jam injuries are frequently grouped together, they represent a host of injuries that can be challenging to differentiate. A thorough knowledge of finger joint anatomy and injury mechanism is critical to perform an appropriate examination, establish an accurate diagnosis, and identify a treatment plan for each patient. Every member of the athletic care team must be aware of the spectrum of digital injuries, including the basic signs present on examination, which may indicate the need for more formal workup. Additionally, preventing injury through athlete education is paramount to athletic care. © 2016 The Author(s).

  1. Instability of the proximal tibiofibular joint associated with total knee arthroplasty

    Directory of Open Access Journals (Sweden)

    Martin Bédard, MD, FRCSC


    Full Text Available To our knowledge, proximal tibiofibular joint instability has never been reported in a patient with a total knee arthroplasty (TKA. We present the case of a patient with anterolateral proximal tibiofibular joint instability associated with a complex primary TKA. In 2010, a male patient of 47 years was referred for TKA after posttraumatic osteoarthritis. The patient's history includes a fracture of the left lateral tibial plateau in 2008 and removal of osteosynthesis material in 2009. TKA with a lateral metal augment and intramedullary stem was performed in 2010. After TKA, instability of the left proximal tibiofibular joint (PTFJ was diagnosed. The patient underwent PTFJ arthrodesis and, at 5 years' follow-up, had no residual pain, with full range of motion. In this case, arthrodesis was the only possible surgical option because reconstruction surgeries require the establishment of bone tunnels in the tibia and fibula for the passage of a graft. Low bone quality and the use of an intramedullary stem with a metal augment in the tibia made any reconstruction technique unfeasible because the proximal tibia was obliterated. Although several PTFJ reconstruction techniques are available, they are difficult to apply to patients with a complex TKA.

  2. Are flexible flat feet associated with proximal joint problems in children? (United States)

    Kothari, A; Dixon, P C; Stebbins, J; Zavatsky, A B; Theologis, T


    The role of flexible flat feet (FF) in the development of musculoskeletal symptoms at joints proximal to the ankle is unclear. We undertook an observational study to investigate the relationship between foot posture and the proximal joints in children. It was hypothesised that reduced arch height would be associated with proximal joint symptoms and altered gait kinematics and kinetics particularly in the transverse plane at the hip and knee. Ninety-five children between the ages of 8-15 were recruited into this ethically approved study. Foot posture was classified using the arch height index (AHI). The frequency of knee and hip/back pain was documented, and each child underwent three dimensional gait analysis. Reduced arch height was associated with increased odds of knee symptoms (p<0.01) and hip/back symptoms (p=0.01). A flat foot posture was also significantly associated with a reduction in the second peak of the vertical ground reaction force (p=0.03), which concomitantly affected late stance hip and knee moments. A reduced AHI was also associated with increased pelvic retraction and increased knee valgus in midstance. No kinematic and kinetic parameter associated with a flat foot posture related to increased proximal joint symptoms in the FF group. Children with a flatter foot posture are more likely to have pain or discomfort at the knee, hip and back; however, the mechanisms by which this occurs remain unclear. Treating FF without explicit understanding of how it relates to symptoms is difficult, and further work in this area is required. Copyright © 2016 Elsevier B.V. All rights reserved.

  3. How many joints does the 5th toe have? A review of 606 patients of 655 foot radiographs.

    LENUS (Irish Health Repository)

    Moulton, Lawrence Stephen


    It is a common understanding that the fifth toe has three bones with two interphalangeal joints. However, our experience shows that a significant number have only two phalanges with one interphalangeal joint.

  4. The Determinants of National Funding in Trans-national Joint Research: Exploring the Proximity Dimensions

    Energy Technology Data Exchange (ETDEWEB)

    Reale, E.; Spinello, A.; Zinilli, A.


    This paper investigates -using an explorative approach, why policy makers at national level engage in transnational joint research activities and mobilize dedicated financial resources. The research question is: why policy makers (either Governments or Research Funding Organisations-RFOs) in EU28 countries invest in transnational joint research activities beyond the European Framework Programmes, and what are the determinants of different levels of funding engagement? The question is relevant to understand the reasons that generate the existing imbalances within European countries as to the participation in transnational research, which are likely to create peripheries within the ERA, thus undermining the process of European integration. We assume that proximity linked to cognitive, institutional and organizational dimensions can affect the policy decisions about the level of funding (real engagement) joint European research programmes, because the closeness or distance in these dimensions generate similarities that are likely to influence the possibility of decision makers to collaborate in the implementation of research programmes. The paper also explores the existence of any effect of geographical proximity, although it is not supposed to play a role in policy decisions about investment in transnational research programmes. (Author)

  5. Magnetic Resonance Imaging of the Dorsal Proximal Synovial Plica of the Equine Metacarpo-/Metatarsophalangeal Joint. (United States)

    Hauspie, S; Vanderperren, K; Gielen, I; Pardon, B; Kromhout, K; Martens, A; Saunders, J H


    A synovial plica is present at the dorsoproximal aspect of the fetlock joint. The objective of this study was to describe the location of the synovial plica during induced hyperextension using Magnetic Resonance Imaging. For this study 20 cadaver limbs from five Warmblood horses were used. Measurements were made of the dorsal; palmar/plantar length and the thickness of the plica with the joint in a normal position. During induced hyperextension of the joint, the position of the plica was described; the dorsal angle of extension and angle of contact between the proximal phalanx (P1) and the condyle were measured. The dorsal length differed between front/hind limbs and between the medial/lateral aspect of the joint. The angle of contact between P1 and condyle differed between front/hind limbs; between the lateral and medial aspect of the joint and between different positions of the plica. Four different positions of the plica were observed: shortened with the tip curved towards palmar/plantar; projecting distally; projecting towards dorsal and projecting distally with the tip interposed between P1 and the condyle. During induced hyperextension, a close relation is present between the synovial plica, P1 and the condyle with a variable position of the plica; which is suggestive for a contact interface between P1 and the metacarpal/metatarsal bone. However the plica does not seem to act consistently as a cushioning surface. © 2014 Blackwell Verlag GmbH.

  6. Joint effects of genetic variants and residential proximity to pesticide applications on hypospadias risk. (United States)

    Carmichael, Suzan L; Yang, Wei; Ma, Chen; Roberts, Eric; Kegley, Susan; English, Paul; Lammer, Edward J; Witte, John S; Shaw, Gary M


    We examined risks associated with joint exposure of gene variants and pesticides. Analyses included 189 cases and 390 male controls born from 1991 to 2003 in California's San Joaquin Valley. We used logistic regression to examine risks associated with joint exposures of gene variants and pesticides that our previous work identified as associated with hypospadias. Genetic variables were based on variants in DGKK, genes involved in sex steroid synthesis/metabolism, and genes involved in genital tubercle development. Pesticide exposure was based on residential proximity to commercial agricultural pesticide applications. Odds ratios (ORs) were highest among babies with joint exposures, who had two- to fourfold increased risks; for example, the OR was 3.7 (95% confidence interval [CI], 0.8-16.5) among subjects with the risk-associated DGKK haplotype and pesticide exposure; OR, 1.5 (95% CI, 0.7-3.1) among subjects with the haplotype and no pesticide exposure; and OR, 0.9 (95% CI, 0.5-1.6) among subjects without the haplotype but with pesticide exposure, relative to subjects with neither. However, results did not provide statistical evidence that these risks were significantly greater than expected on an additive scale, relative to risks associated with one exposure at a time. We observed elevated risks associated with joint exposures to selected pesticides and genetic variants but no statistical evidence for interaction. Birth Defects Research (Part A) 106:653-658, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  7. Coxins interfalangeanos sobre paquidermodactilia Interphalangeal pads on pachydermodactyly

    Directory of Open Access Journals (Sweden)

    José Marcos Pereira


    Full Text Available Coxins interfalangeanos são nodulações ceratósicas, de limites precisos, com aproximadamente um centímetro de diâmetro, geralmente sobre as articulações interfalangenas das mãos. A paquidermodactilia é uma tumefação uniforme da pele que ocorre nas falanges proximais das mãos. É relatado o caso de um jovem com associação de paquidermodactilia e coxins interfalangeanos, fato não encontrado na literatura médica. Embora haja descrição que considera serem essas manifestações diversas da mesma doença, acredita-se que sejam entidades distintas. O ato compulsivo de atritar a pele parece ser o denominador comum mais aceito para justificar as duas doenças. Os autores postulam que o coxim interfalangeano seria uma resposta epidérmica, enquanto a paquidermodactilia, uma resposta dérmica a um mesmo fator traumático sobre a pele. O paciente foi tratado com infiltração intralesional de triancinolona, com melhora clínica expressiva das duas manifestações.Knuckle pads are keratotic nodulations within precise limits and approximately one centimeter in diameter, usually on the interphalangeal joints of the hands. Pachydermodactyly is a uniform swelling of the skin occurring in the proximal phalanges of the hands. A case involving a young man suffering from several knuckle pad lesions concomitant with pachydermodactyly was studied. This association has not been previously described in the literature. Although it has been reported that both conditions are different manifestations of the same disease, they are believed to be distinct disorders. The compulsive act of rubbing the skin seems to be a common denominator mostly accepted as the cause of both diseases. The authors affirm that knuckle pads may be acquired as an epidermal response, while pachydermodactyly, is a dermal response to the same traumatic factor to the skin. The patient was treated with intralesional infiltration of triamcinolone resulting in a remarkable clinical

  8. Arthroscopic surgery for osteochondral fractures of the proximal phalanx of the metacarpophalangeal and metatarsophalangeal (fetlock) joints in horses. (United States)

    Yovich, J V; McIlwraith, C W


    Arthroscopic surgery for osteochondral fractures of the proximal phalanx was performed on 74 fetlock joints of 63 horses for a total of 87 fractures during a 2-year period. The medial dorsal proximal aspect of the proximal phalanx of the forelimbs was most commonly involved (59 fractures), followed by the lateral aspect (26 fractures), and 2 fractures occurred in the fetlock joint of the right hindlimb. At surgery, 82 fragments were removed and 5 fragments that had healed or were embedded in the joint capsule were not removed. Of the fragments removed, 15 were fixed firmly to the proximal phalanx, 63 were easily movable by arthroscopic instruments (but had soft tissue attachments to the proximal phalanx), and 4 were floating free within the joint. Arthroscopic surgery allowed excellent visualization and appreciation of the attachments of fragments and their stage of healing. Horses returned to full race training at an average of 11 1/2 weeks (range, 6 to 24 weeks). Thirty eight of 46 horses (82.6%) with adequate postoperative follow-up returned to athletic performance at least equal to that before fetlock injury.

  9. Employee customer orientation in manufacturing organizations: joint influences of customer proximity and the senior leadership team. (United States)

    Liao, Hui; Subramony, Mahesh


    Pursuing a customer-focused strategy in manufacturing organizations requires employees across functions to embrace the importance of understanding customer needs and to align their everyday efforts with the goal of satisfying and retaining customers. Little prior research has examined what factors influence employee customer orientation in manufacturing settings. Drawing on the attraction-selection-attrition model, upper-echelons theory, and contingency theories of leadership, this study investigated the joint influences of functional roles' proximity to external customers and the senior leadership team's customer orientation on employee customer orientation. Hierarchical linear modeling results based on data obtained from 4,299 employees and 403 senior leaders from 42 facilities of a global manufacturer operating in 16 countries revealed that employees occupying customer-contact roles had the highest level of customer orientation, followed by employees occupying production roles, and then by those in support roles. In addition, there was a positive relationship between the senior leadership team's customer orientation and employee customer orientation for all 3 functional roles. The positive relationship between the senior leadership team and employee customer orientation was the strongest for employees in support roles, suggesting that lower levels of proximity to external customers may create a greater need for leadership in developing employees' customer-oriented attitudes. Copyright 2008 APA

  10. Successful treatment of a guitarist with a finger joint injury using instrument-assisted soft tissue mobilization: a case report


    Terry Loghmani, M.; Bayliss, Amy J.; Clayton, Greg; Gundeck, Evelina


    Finger injuries are common and can greatly affect a musician’s quality of life. A 55-year-old man, who had injured the proximal interphalangeal joint of the left index finger 6 months prior to any intervention, was treated with a manual therapy approach incorporating instrument-assisted soft tissue mobilization (IASTM). Initial examination findings included self-reported pain and functional limitations and physical impairments that significantly impeded his ability to play the acoustic guitar...

  11. No difference between two types of exercise after proximal phalangeal fracture fixation: a randomised trial. (United States)

    Miller, Lauren; Crosbie, Jack; Wajon, Anne; Ada, Louise


    Are 6 weeks of synergistic wrist and finger exercises with the metacarpophalangeal joint constrained in an orthosis (constrained exercises) more effective than traditional finger exercises with the metacarpophalangeal joint unconstrained (unconstrained exercises) after open reduction and internal fixation of a proximal phalangeal fracture in terms of impairment, activity limitation and participation restriction at 6 and 12 weeks? Randomised, parallel-group trial with concealed allocation, intention-to-treat analysis and blinded outcome assessors. Sixty-six participants within 1 week of open reduction and internal fixation of proximal phalangeal fractures. The experimental group carried out 6 weeks of synergistic wrist and finger exercises with the metacarpophalangeal joint constrained, whilst the control group carried out finger exercises with the metacarpophalangeal joint unconstrained, as part of a comprehensive rehabilitation program. The primary outcomes were: active proximal interphalangeal joint extension of the injured finger, total active range of motion, and strength. Secondary outcomes were: pain, difficulty with specific hand activity and difficulty with usual hand activity. A blinded assessor measured outcomes at Weeks 1, 6 and 12. By Week 6, there were no significant between-group differences in improvement for: active proximal interphalangeal joint extension (MD 2 deg, 95% CI -3 to 7); total active finger range of motion (MD 0 deg, 95% CI -21 to 22); strength (MD -2kg, 95% CI -8 to 4); pain (MD 1/50, 95% CI -3 to 5); difficulty with specific hand activity (MD 2/60, 95% CI -3 to 8); or difficulty with usual hand activity (MD 0/40, 95% CI -4 to 3). By Week 12, there were also no significant between-group differences in any outcome. Constrained and unconstrained exercises has similar effects after open reduction and internal fixation of proximal phalangeal fracture. Australian New Zealand Clinical Trials Registry (ACTRN12610000294055). Copyright © 2016

  12. Yubitsume: ritualistic self-amputation of proximal digits among the Yakuza. (United States)

    Bosmia, Anand N; Griessenauer, Christoph J; Tubbs, R Shane


    Yubitsume is the ritualistic self-amputation of the proximal digits at the distal interphalangeal joint (DIP) among members of the Japanese Mafia, or Yakuza. This practice of self-mutilation is done as a sign of apology for making a mistake deemed punishable by higher-ranking members or violating the code of the Yakuza. Members of the Yakuza may present to emergency departments seeking medical assistance to stop hemorrhage or treat infection at the site of injury following self-amputation or to have the severed portion of the injured finger reattached. .© 2014 KUMS, All rights reserved.

  13. Heterotopic Vascularized Joint Transfer in Mutilating Hand Injuries. (United States)

    Chang, Nai-Jen; Chang, Johnny T; Hsu, Chung-Chen; Lin, Cheng-Hung; Lin, Chih-Hung; Lin, Yu-Te


    In cases of mutilating hand injuries, the primary goal is recovery of prehensile function. This is particularly true in the case of joints, which are extremely difficult to replace or reconstruct adequately when damaged. Heterotopic vascularized joint transfer is indicated when salvageable joints are available for transfer to a more functionally optimal position on the hand. Seven cases of mutilating hand injuries treated with heterotopic vascularized joint transfers from 2003 to 2012 were retrospectively identified. All patients sustained severe metacarpophalangeal joint (MPJ) or proximal interphalangeal joint (PIPJ) damage that threatened recovery of optimal hand function. All patients were men, with an average age of 34.7 years. Operative, perioperative, and postoperative details including final active range of motion were collected and analyzed. Seven joints were taken from nonsalvageable amputated digits: 4 from the amputated parts, and 3 from the proximal stumps. Five joints were transferred as free flaps requiring microvascular anastomosis, and 2 were transferred on neurovascular pedicles. One joint was lost due to vasospasm. Average active range of motion was 68.3° for homojoint transfers (MPJ to MPJ, PIPJ to PIPJ), and 35° for heterojoint transfers. All but 1 patient were able to achieve tripod pinch; the remaining patient achieved only side-to-side pinch. Heterotopic vascularized joint transfer is a useful technique to consider in cases of mutilating hand injuries. Improved recovery of prehensile function can be achieved with thoughtful design and execution, followed by proper patient education and rehabilitation.

  14. Measurement of finger joint angles and maximum finger forces during cylinder grip activity. (United States)

    Lee, J W; Rim, K


    Finger joint angles and finger forces during maximal cylindrical grasping were measured using multi-camera photogrammetry and pressure-sensitive sheets, respectively. The experimental data were collected from four healthy subjects gripping cylinders of five different sizes. For joint angles, an image analysis system was used to digitize slides showing markers. During the calibration of the camera system, both the nonlinear least square and the direct linear transform methods were applied and compared, the former providing the fewer errors; it was used to determine joint angles. Data were collected from the pressure-sensitive grip films by using the same image analysis system as used in the collection of the joint angle data. The method of using pressure-sensitive sheets provided an estimation of the weighted centre of the phalangeal forces. Results indicate that finger flexion angles at the metacarpophalangeal and proximal interphalangeal joints gradually increase as cylinder diameter decreases, but that at the distal interphalangeal joint the angle remains constant throughout all cylinder sizes. It was also found that most of the radio-ulnar deviation and the axial rotation angles at the finger joints deviate from zero, but the deviations are small. For the force measurement, it was found that total finger force increases as cylinder size decreases, and the phalangeal force centres are not located at the mid-points of the phalanges. The data obtained in this experiment would be useful for muscle force predictions and for the design of handles.

  15. Chondrocalcinosis of femoro-tibial and proximal tibio-fibular joints in cadaveric specimens: a high-resolution CT imaging study of the calcification distribution.

    Directory of Open Access Journals (Sweden)

    Sébastien Touraine

    Full Text Available OBJECTIVES: To analyze calcium deposits by computed tomography (CT in femoro-tibial compartments and proximal tibio-fibular joints; to assess the relationship with CT-assessed osteoarthritis (OA. METHODS: 68 (34 pairs cadaveric knees (mean age of 84 were scanned at high resolution CT. Menisci and hyaline cartilage calcifications in the femoro-tibial and proximal tibio-fibular joints were analyzed. OA was CT-assessed by the Kellgren and Lawrence score. Gross appearance of OA was evaluated on 29 left knees after dissection and India ink staining of tibial plateaus. RESULTS: In femoro-tibial joints, meniscal calcifications (MC and hyaline cartilage calcifications (HCC were detected in 23(34% and 14(21% knees respectively. Calcifications mainly involved the three meniscal segments and were mainly observed in all thirds of the femoro-tibial compartments. In proximal tibio-fibular joints, HCC were detected in 19(28% knees. The association HCC-MC in femoro-tibial joints and between calcifications in femoro-tibial and proximal tibio-fibular joints was strong (p<0.0001. Femoro-tibial and proximal tibio-fibular CT-assessed OA were respectively found in 23(34% and 19(28% knees. HCC were significantly associated with femoro-tibial OA (p = 0.04 while MC were not (p = 0.34. OA macroscopic evaluation showed a mean surface of cartilage lesions of 35% (range 0.13-0.55. No significant difference was demonstrated regarding the CT-detection of MC, HCC or CT-assessed OA. CONCLUSIONS: This is the first study to report a strong association of chondrocalcinosis between femoro-tibial and tibio-fibular joints in addition to a strong association between MC and HCC in femoro-tibial compartments. No significant relationship between chondrocalcinosis and OA was demonstrated.

  16. Chondrocalcinosis of femoro-tibial and proximal tibio-fibular joints in cadaveric specimens: a high-resolution CT imaging study of the calcification distribution. (United States)

    Touraine, Sébastien; Ea, Hang Korng; Bousson, Valérie; Cohen-Solal, Martine; Laouisset, Liess; Chappard, Christine; Lioté, Frédéric; Laredo, Jean-Denis


    To analyze calcium deposits by computed tomography (CT) in femoro-tibial compartments and proximal tibio-fibular joints; to assess the relationship with CT-assessed osteoarthritis (OA). 68 (34 pairs) cadaveric knees (mean age of 84) were scanned at high resolution CT. Menisci and hyaline cartilage calcifications in the femoro-tibial and proximal tibio-fibular joints were analyzed. OA was CT-assessed by the Kellgren and Lawrence score. Gross appearance of OA was evaluated on 29 left knees after dissection and India ink staining of tibial plateaus. In femoro-tibial joints, meniscal calcifications (MC) and hyaline cartilage calcifications (HCC) were detected in 23(34%) and 14(21%) knees respectively. Calcifications mainly involved the three meniscal segments and were mainly observed in all thirds of the femoro-tibial compartments. In proximal tibio-fibular joints, HCC were detected in 19(28%) knees. The association HCC-MC in femoro-tibial joints and between calcifications in femoro-tibial and proximal tibio-fibular joints was strong (p<0.0001). Femoro-tibial and proximal tibio-fibular CT-assessed OA were respectively found in 23(34%) and 19(28%) knees. HCC were significantly associated with femoro-tibial OA (p = 0.04) while MC were not (p = 0.34). OA macroscopic evaluation showed a mean surface of cartilage lesions of 35% (range 0.13-0.55). No significant difference was demonstrated regarding the CT-detection of MC, HCC or CT-assessed OA. This is the first study to report a strong association of chondrocalcinosis between femoro-tibial and tibio-fibular joints in addition to a strong association between MC and HCC in femoro-tibial compartments. No significant relationship between chondrocalcinosis and OA was demonstrated.

  17. Distraction lengthening of the proximal phalanx in distal thumb amputations. (United States)

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


    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.


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    Carlos Alberto Hussni


    Full Text Available The purpose of this study was to investigate the effects of the superficial digital tenotomy and the superior check ligament desmotomy on the radio-metacarpal, metacarpophalangeal, proximal and distal interphalangeal angles in horses. Under general anesthesia the superficial digital flexor tenotomy and superior check ligament desmotomy were performed, respectively, on the right and left forelimbs in nine horses. Before surgery and on 15th, 30th, and 60th postoperative days the radio-metacarpal, metacarpophalangeal, and proximal and distal interphalangeal angles were measured by radiographic examination. Tenotomy decreased significantly the metacarpophalangeal angle (mean ± standard deviation: preoperative – 140.7º ± 6.85; 60th day – 128.2º ± 5.93 and increased the distal interphalangeal angle (mean ± standard deviation: preoperative – 172.6 ± 1.87; 60th day – 167.6 ± 1.36. Desmotomy decreased the proximal interphalangeal angle (mean ± standard deviation: preoperative – 180.2º ± 5.43; 60th day- 197.3º ± 8.29. These surgical procedures did not change the radio-metacarpal angle. The superficial digital flexor tenotomy and the superior check ligament desmotomy cause different and significant changes in joint angles distal to the carpus.

    KEY WORDS: Desmotomy, horses, joint angles, tenotomy.
    A proposta deste estudo foi avaliar os efeitos da tenotomia do músculo flexor digital superficial e a desmotomia do seu ligamento acessório sobre os ângulos formados pelas faces dorsais radiometacarpiano, metacarpofalângico e interfalângicos proximal e distal em equinos. Realizaram-se em nove equinos a tenotomia do músculo flexor digital superficial no membro torácico direito (MTD e a desmotomia de seu ligamento acessório no membro torácico esquerdo (MTE. A goniometria radiológica foi procedida no pré-operatório e aos quinze, trinta e sessenta dias após as cirurgias. A tenotomia praticada no MTD diminuiu

  19. Validity of joint space width measurements in hand osteoarthritis. (United States)

    Kwok, W Y; Bijsterbosch, J; Malm, S H; Biermasz, N R; Huetink, K; Nelissen, R G; Meulenbelt, I; Huizinga, T W J; van 't Klooster, R; Stoel, B C; Kloppenburg, M


    To investigate the validity of joint space width (JSW) measurements in millimeters (mm) in hand osteoarthritis (OA) patients by comparison to controls, grading of joint space narrowing (JSN), and clinical features. Hand radiographs of 235 hand OA patients (mean age 65 years, 83% women) and 471 controls were used. JSW was measured with semi-automated image analysis software in the distal, proximal interphalangeal and metacarpal joints (DIPJs, PIPJs and MCPJs). JSN (grade 0-3) was assessed using the osteoarthritis research society international (OARSI) atlas. Associations between the two methods and clinical determinants (presence of pain, nodes and/or erosions, decreased mobility) were assessed using Generalized Estimating Equations with adjustments for age, sex, body mass index (BMI) and mean width of proximal phalanx. JSW was measured in 5631 joints with a mean JSW of 0.98 mm (standard deviation (SD) 0.21), being the smallest for DIPJs (0.70 (SD 0.25)) and largest for MCPJs (1.40 (SD 0.25)). The JSN=0 group had a mean JSW of 1.28 mm (SD 0.34), the JSN=3 group 0.17 mm (SD 0.23). Controls had larger JSW than hand OA patients (P-valuemeasurement is a valid method to measure joint space and shows a good relation with clinical features. Copyright © 2011 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  20. Comparative study of the detection of joint injury in early-stage rheumatoid arthritis by magnetic resonance imaging of the wrist and finger joints and physical examination. (United States)

    Tamai, Mami; Kawakami, Atsushi; Iwamoto, Naoki; Kawashiri, Shin-Ya; Fujikawa, Keita; Aramaki, Toshiyuki; Kita, Junko; Okada, Akitomo; Koga, Tomohiro; Arima, Kazuhiko; Kamachi, Makoto; Yamasaki, Satoshi; Nakamura, Hideki; Ida, Hiroaki; Origuchi, Tomoki; Takao, Shoichiro; Aoyagi, Kiyoshi; Uetani, Masataka; Eguchi, Katsumi


    To verify whether magnetic resonance imaging (MRI)-proven joint injury is sensitive as compared with joint injury determined by physical examination. MRI of the wrist and finger joints of both hands was examined in 51 early-stage rheumatoid arthritis (RA) patients by both plain and gadolinium diethylenetriaminepentaacetic acid-enhanced MRI. Synovitis, bone edema, and bone erosion (the latter two included as bone lesions at the wrist joints); metacarpophalangeal joints; and proximal interphalangeal joints were considered as MRI-proven joint injury. Japan College of Rheumatology-certified rheumatologists had given a physical examination just before the MRI study. The presence of tender and/or swollen joints in the same fields as MRI was considered as joint injury on physical examination. The association of MRI-proven joint injury with physical examination-proven joint injury was examined. A total of 1,110 sites were available to be examined. MRI-proven joint injury was found in 521 sites, whereas the other 589 sites were normal. Physical examination-proven joint injury was found in 305 sites, which was significantly low as compared with MRI-proven joint injury (P = 1.1 × 10(-12) versus MRI). Joint injury on physical examination was not found in 81.5% of the sites where MRI findings were normal. Furthermore, an association of the severity of MRI-proven joint injury with that of joint injury on physical examination was clearly demonstrated (P = 1.6 × 10(-15), r(s) = 0.469). Our present data suggest that MRI is not only sensitive but accurately reflects the joint injury in patients with early-stage RA. Copyright © 2011 by the American College of Rheumatology.

  1. Joint angle measurement: a comparative study of the reliability of goniometry and wire tracing for the hand. (United States)

    Ellis, B; Bruton, A; Goddard, J R


    To compare the inter- and intra-rater reliability of goniometry and wire tracing in the assessment of finger joint angles: metacarpo-phalangeal (MCPJ), proximal (PIPJ) and distal interphalangeal joints (DIPJ). Twenty occupational therapists and 20 physiotherapists with a range of clinical experience were recruited from nine different centres. Using a masked goniometer and wire tracing they carried out repeated assessments of the MCPJ, PIPJ and DIPJ of a normal subject fixed in two different positions. The two assessment methods did not produce comparable angle measurements. Goniometry showed greater inter- and intra-rater reliability than wire tracing. Regardless of the assessment tool, the repeatability coefficient indicated that DIPJ measurement was less reliable than the other joints. Clinical and specialist experience did not affect reliability. Although both goniometry and wire tracing show limitations as reliable assessment tools, it is recommended that where possible goniometry should be used.

  2. Modeling the finger joint moments in a hand at the maximal isometric grip: the effects of friction. (United States)

    Wu, John Z; Dong, Ren G; McDowell, Thomas W; Welcome, Daniel E


    The interaction between the handle and operator's hand affects the comfort and safety of tool and machine operations. In most of the previous studies, the investigators considered only the normal contact forces. The effect of friction on the joint moments in fingers has not been analyzed. Furthermore, the observed contact forces have not been linked to the internal musculoskeletal loading in the previous experimental studies. In the current study, we proposed a universal model of a hand to evaluate the joint moments in the fingers during grasping tasks. The hand model was developed on the platform of the commercial software package AnyBody. Only four fingers (index, long, ring, and little finger) were included in the model. The anatomical structure of each finger is comprised of four phalanges (distal, middle, proximal, and metacarpal phalange). The simulations were performed using an inverse dynamics technique. The joint angles and the normal contact forces on each finger section reported by previous researchers were used as inputs, while the joint moments of each finger were predicted. The predicted trends of the dependence of the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joint moments on the cylinder diameter agree with those of the contact forces on the fingers observed in the previous experimental study. Our results show that the DIP and PIP joint moments reach their maximums at a cylinder diameter of about 31mm, which is consistent with the trend of the finger contact forces measured in the experiments. The proposed approach will be useful for simulating musculoskeletal loading in the hand for occupational activities, thereby optimizing tool-handle design.

  3. [Dislocation of the PIP-Joint - Treatment of a common (ball)sports injury]. (United States)

    Müller-Seubert, Wibke; Bührer, Gregor; Horch, Raymund E


    Background  Fractures or fracture dislocations of the proximal interphalangeal joint often occur during sports or accidents. Dislocations of the PIP-joint are the most common ligamentary injuries of the hand. As this kind of injury is so frequent, hand surgeons and other physicians should be aware of the correct treatment. Objectives  This paper summarises the most common injury patterns and the correct treatment of PIP-joint dislocations. Materials and Methods  This paper reviews the current literature and describes the standardised treatment of PIP-joint dislocations. Results  What is most important is that reposition is anatomically correct, and this should be controlled by X-ray examination. Depending on the instability and possible combination with other injuries (e. g. injury to the palmar plate), early functional physiotherapy of the joint or a short immobilisation period is indicated. Conclusions  Early functional treatment of the injured PIP-joint, initially using buddy taping, is important to restore PIP-joint movement and function. Depending on the injury, joint immobilisation using a K-wire may be indicated. Detailed informed consent is necessary to explain to the patient the severity of the injury and possible complications, such as chronic functional disorders or development of arthrosis. © Georg Thieme Verlag KG Stuttgart · New York.

  4. Inflammation and damage in an individual joint predict further damage in that joint in patients with early rheumatoid arthritis. (United States)

    Boers, M; Kostense, P J; Verhoeven, A C; van der Linden, S


    OBJECTIVE; Several factors predict joint damage in early rheumatoid arthritis (RA). In the context of a trial in early RA, we studied the relationship between clinical signs in individual joints and their propensity to develop progressive damage. The COBRA (Combinatietherapie Bij Reumatoide Artritis) multicenter trial compared the efficacy of prednisolone, methotrexate, and sulfasalazine against sulfasalazine alone in 155 patients with early RA. Two blinded observers interpreted radiographs in sequence (using the Sharp/Van der Heijde scoring system); in each center, one blinded observer performed clinical assessments every 3 months. The current analysis is based on clinical and radiologic data of the individual metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of 135 patients. Conditional stepwise logistic regression analyzed the relationship between damage (progression) and clinical signs at baseline and followup for each of these joints individually in each patient. Combination therapy strongly retarded the progression of damage. Progression was stronger in patients with rheumatoid factor, HLA-DR4, and high levels of disease activity at baseline. At baseline, 6% of the MCP and PIP joints showed damage; after 1 year, disease had progressed in 10% of these joints. Baseline damage, swelling, or pain in a joint independently and strongly predicted the progression of damage in that joint (P < 0.001). Each additional point in the swelling score (range 0-2) tripled the risk for subsequent progression. Each additional point on the Sharp scale (range 0-8 per joint) and each additional point on the pain scale (range 0-3) doubled the risk. The mean pain and swelling scores over the year were even stronger predictors of damage. Local expression of early RA disease activity, both at baseline and at 1-year followup, is strongly related to progression of damage in the individual joint.

  5. Potential of optical spectral transmission measurements for joint inflammation measurements in rheumatoid arthritis patients (United States)

    Meier, A. J. Louise; Rensen, Wouter H. J.; de Bokx, Pieter K.; de Nijs, Ron N. J.


    Frequent monitoring of rheumatoid arthritis (RA) patients enables timely treatment adjustments and improved outcomes. Currently this is not feasible due to a shortage of rheumatologists. An optical spectral transmission device is presented for objective assessment of joint inflammation in RA patients, while improving diagnostic accuracy and clinical workflow. A cross-sectional, nonrandomized observational study was performed with this device. In the study, 77 proximal interphalangeal (PIP) joints in 67 patients have been analyzed. Inflammation of these PIP joints was also assessed by a rheumatologist with a score varying from 1 (not inflamed) to 5 (severely inflamed). Out of 77 measurements, 27 were performed in moderate to strongly inflamed PIP joints. Comparison between the clinical assessment and an optical measurement showed a correlation coefficient r=0.63, p<0.001, 95% CI [0.47, 0.75], and a ROC curve (AUC=0.88) that shows a relative good specificity and sensitivity. Optical spectral transmission measurements in a single joint correlate with clinical assessment of joint inflammation, and therefore might be useful in monitoring joint inflammation in RA patients.

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

    Vander Griend, Robert


    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.

  7. Exploiting kinematic constraints to compensate magnetic disturbances when calculating joint angles of approximate hinge joints from orientation estimates of inertial sensors. (United States)

    Laidig, Daniel; Schauer, Thomas; Seel, Thomas


    Inertial Measurement Units (IMUs) have become a widely used tool for rehabilitation and other application domains in which human motion is analyzed using an ambulatory or wearable setup. Since the magnetic field is inhomogeneous in indoor environments and in the proximity of ferromagnetic material, standard orientation estimation and joint angle calculation algorithms often lead to inaccurate or even completely wrong results. One approach to circumvent this is to exploit the kinematic constraint that is induced by mechanical hinge joints and also by approximate hinge joints such as the knee joint and the finger (interphalangeal) joints of the human body. We propose a quaternion-based method for joint angle measurement for approximate hinge joints moving through inhomogeneous magnetic fields. The method exploits the kinematic constraint to compensate the error that the magnetic disturbances induce in the IMU orientation estimates. This is achieved by realtime estimation and correction of the relative heading (azimuth) error that is caused by the disturbance. Since the kinematic constraint does not allow heading correction when the joint axis is vertical, we extend the proposed method such that it improves accuracy and robustness when the joint is close to that singularity. We evaluate the method by simulations of a quick hand motion and study the effect of inaccurate sensor-to-segment (anatomical) calibration and joint constraint relaxations. As a main result, the proposed method is found to reduce the root-mean-square error of the joint angle from 25.8° to 2.6° in the presence of large magnetic disturbances.

  8. Proximal First Metatarsal Osteotomy and Mc Bride Procedure in Hallux Valgus: 5-years results of 25 cases

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    Ali Yeganeh


    Full Text Available More than 130 operations have been described for the treatment of hallux valgus, However, no evidence that any of these methods of treatment are superior to the others has been described, excepting studies in the long term. The aim of this study was to analyse a series of patients who had undergone Proximal osteotomy of first metatarsal and Mc Bride procedure and had been followed up for 5 years. In This prospective study During a 6 years period, (2005-2010, 25 feet in 24 cases with hallux valgus underwent Proximal first metatarsal osteotomy and MCbride procedure, With a mean follow-up of 3/5±1/5 years. The cases were evaluated by American Orthopaedics Foot & Ankle Society HalluxMetatarsophalangeal-interphalangeal scale (AOFAS/HMI. Pre and post hallux valgus angle (HVA, intermetatarsal angle (1-2IMA, and the correlation between the angles and patient satisfaction were statistically evaluated. The mean angular corrections for hallux valgus (HVA, and intermetatarsal angle (IMA were 28 and 10/6 degrees respectively. 13 Patients reported good to excellent results, while in 11 cases dissatisfaction were reported. Proximal first metatarsal osteotomy and Mc Bride procedure for hallux valgus is an acceptable procedure in Patients with hallux valgus deformity correction.Pain and first MTP joint contractures are two main side effects.

  9. Joint Involvement in Primary Sjögren’s Syndrome: An Ultrasound “Target Area Approach to Arthritis”

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    Luis M. Amezcua-Guerra


    Full Text Available Objective. To characterize the ultrasound (US pattern of joint involvement in primary Sjögren’s syndrome (pSS. Methods. Seventeen patients with pSS, 18 with secondary Sjögren’s syndrome (sSS, and 17 healthy controls underwent US examinations of various articular regions. Synovitis (synovial hypertrophy/joint effusion, power Doppler (PD signals, and erosions were assessed. Results. In patients with pSS, synovitis was found in the metacarpophalangeal joints (MCP, 76%, wrists (76%, and knees (76%, while the proximal interphalangeal joints, elbows, and ankles were mostly unscathed. Intra-articular PD signals were occasionally detected in wrists (12%, elbows (6%, and knees (6%. Erosions were evident in the wrists of three (18% patients with pSS, one of these also having anti-cyclic citrullinated peptide (anti-CCP antibodies. While US synovitis does not discriminate between sSS and pSS, demonstration of bone erosions in the 2nd MCP joints showed 28.8% sensitivity and 100% specificity for diagnosing sSS; in comparison, these figures were 72.2 and 94.1% for circulating anti-CCP antibodies. Conclusions. In pSS, the pattern of joint involvement by US is polyarticular, bilateral, and symmetrical. Synovitis is the US sign most commonly found in patients with pSS, especially in MCP joints, wrists, and knees, and bone erosions also may occur.

  10. Predictive value of tender joints compared to synovitis for structural damage in rheumatoid arthritis (United States)

    Cheung, Peter P; Mari, Karine; Devauchelle-Pensec, Valérie; Jousse-Joulin, Sandrine; D'Agostino, Maria Antonietta; Chalès, Gérard; Gaudin, Philippe; Mariette, Xavier; Saraux, Alain; Dougados, Maxime


    Objective To evaluate the predictive value of tender joints compared to synovitis for structural damage in rheumatoid arthritis (RA). Methods A post hoc analysis was performed on a prospective 2-year study of 59 patients with active RA starting on antitumour necrosis factor (TNF). Tenderness and synovitis was assessed clinically at baseline, followed by blinded ultrasound assessment (B-mode and power Doppler ultrasound (PDUS)) on the hands and feet (2 wrists, 10 metacarpophalangeal, 10 proximal interphalangeal and 10 metatarsophalangeal (MTP) joints). Radiographs of these joints were performed at baseline and at 2 years. The risk of radiographic progression with respect to the presence of baseline tenderness or synovitis, as well as its persistence (after 4 months of anti-TNF), was estimated by OR (95% CI). Results Baseline tender joints were the least predictive for radiographic progression (OR=1.53 (95% CI 1.02 to 2.29) pjoints with the presence of synovitis were predictive of radiographic progression (OR=1.89 (95% CI 1.25 to 2.85) p=0.002), especially seen in the MTP joints. Non-tender joints with no synovitis were negatively predictive (OR=0.57 (95% CI 0.39 to 0.82) p=0.003). Persistence of tender joints was negatively predictive (OR=0.38 (95% CI 0.18 to 0.78) p=0.009) while persistence of synovitis was predictive (OR=2.41 (95% CI 1.24 to 4.67) p=0.01) of radiographic progression. Conclusions Synovitis is better than tenderness to predict for subsequent structural progression. However, coexistence of tenderness and synovitis at the level of an individual joint is predictive of structural damage, particularly in the MTP joints. Trial registration number NCT00444691. PMID:27042336

  11. Clinical miscount of involved joints denotes the need for ultrasound complementation in usual practice for patients with rheumatoid arthritis. (United States)

    Murayama, Go; Ogasawara, Michihiro; Nemoto, Takuya; Yamada, Yusuke; Ando, Seiichiro; Minowa, Kentaro; Kon, Takayuki; Tada, Kurisu; Matsushita, Masakazu; Yamaji, Ken; Tamura, Naoto; Takasaki, Yoshinari


    Ultrasound (US) examination can visualise and clarify involved joints anatomically in patients with rheumatoid arthritis (RA), and it enables physicians to verify the accuracy of clinical assessments of involved joints. Here, we studied the practical 'miscount'- calculated by subtracting US-determined involved joint count from clinically determined involved joint count - and analysed possible contributing factors for increased miscount. The study population consisted of 137 patients with RA. Physical joint examination was performed by 3 assessors with different levels of experience in rheumatology, followed by US joint examination. Clinical and US examinations were performed on 28 joints (proximal interphalangeal, metacarpophalangeal, wrist, elbow, shoulder, and knee on both sides). Miscount was calculated for all patients, and multivariate analysis was conducted on possible contributing factors for miscount, including age, sex, body mass index, disease duration, Steinbrocker stage, erythrocyte sedimentation rate (ESR), C-reactive protein level, patient global assessment (GA), evaluator GA, matrix metalloproteinase-3 level, and power Doppler (PD) score. A high variability in concordance rate among the joint sites was observed among the 3 assessors. The average miscount was 1.07 (SD, 5.19; range, 18 to -11). ESR and patient GA were determined as significant contributing factors for false-positive miscount, whereas PD score and age were significant factors for false-negative miscount. In addition to the condition of the involved joint distribution and the assessor's clinical examination skills, the patients' background can also lead to increased miscount. Assessors should be blinded to patients' background information, and US complementation should be included in usual clinical joint examinations.

  12. Plate fixation of extra-articular fractures of the proximal phalanx: do new implants cause less problems? (United States)

    Brei-Thoma, Pascale; Vögelin, Esther; Franz, Torsten


    Limited range of finger motion is a frequent complication after plate fixation of phalangeal fractures. The purpose of this study was to evaluate the results of plate fixation of extra-articular fractures of the proximal phalanx using current low-profile mini-fragment-systems. From 2006 to 2012, 32 patients with 36 extra-articular fractures of the proximal phalanx of the triphalangeal fingers were treated with open reduction and plate fixation (ORPF) using 1.2 and 1.5 mm mini-fragment systems. Patients presenting with open fractures grade 2 and 3 or relevant laceration of adjacent structures were excluded from the study. We retrospectively evaluated the rate of mal-union or non-union after ORPF, the need for revision surgery, for plate removal, and for tenolysis. Data were analyzed for further complications with regard to infections or complex regional pain syndrome (CRPS). No infections were noted. Five patients developed transient symptoms of CRPS. Six weeks postoperatively, total active finger motion (TAM) averaged 183°, and all 32 patients underwent formal hand therapy. At the latest follow-up or at the time of plate removal, respectively, the mean TAM improved to 213°. Extension lag of proximal interphalangeal joints was found in 67 % of all fractured fingers. Secondary surgery was necessary in 14 of 32 patients (2 corrective osteotomies, 12 plate removals including 7 procedures explicitly because of reduced mobility). Despite of new implant designs significant problems persist. Adhesions of extensor tendons leading to limited range of finger motion are still the most frequent complications after ORPF of proximal phalangeal fractures, even in absence of significant soft-tissue damage. Therapeutic, Retrospective, Level IV.

  13. The intercarpal ligaments of the equine midcarpal joint, Part 2: The role of the palmar intercarpal ligaments in the restraint of dorsal displacement of the proximal row of carpal bones. (United States)

    Whitton, R C; Rose, R J


    To determine the relative contributions of the palmar intercarpal ligaments in the midcarpal joint to the restraint of dorsal displacement of the proximal row of carpal bones. A biomechanical study of cadaver equine carpi. Eight equine forelimbs from six thoroughbred horses. With joints in full extension, the radius was dorsally displaced while midcarpal joint displacement was measured. The restraining force at a joint displacement of 1.5 mm was determined from the load-displacement curve. A ligament or pair of ligaments was then cut and the testing procedure repeated. Their contribution to restraining force was calculated as the percentage change in restraining force after the ligament was sectioned. Relative cross-sectional areas of the ligaments tested were measured at the level of the midcarpal joint. The collateral ligaments were the major contributors to the restraint of dorsal displacement (P ligaments contributed a greater proportion than the palmar carpal ligament (PCL) (P ligaments, 14.5 +/- 1.4 for the PCL, and 22.7 +/- 2.2 for the palmar intercarpal ligaments. Mean cross-sectional area expressed as a percentage (+/-SEM) of the total ligamentous area were 9.0 +/- 0.3 for the palmar intercarpal ligaments, 27.1 +/- 3.0 for the PCL, and 63.8 +/- 2.8 for the collateral ligaments. Despite the small size of the palmar intercarpal ligaments, they play an important role in the restraint of dorsal displacement of the proximal row of carpal bones. Interpretation, as well as prevention and treatment of intercarpal ligament tearing requires an understanding of their function.

  14. Ultrasound measurement of joint cartilage thickness in large and small joints in healthy children: a clinical pilot study assessing observer variability

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    Pfeiffer-Jensen Mogens


    Full Text Available Abstract Background Loss of joint cartilage is a feature of destructive disease in JIA. The cartilage of most joints can be visualized with ultrasonography (US. Our present study focuses on discriminant validity of US in children. We studied reproducibility between and within a skilled and a non-skilled investigator of US assessment of cartilage thickness in small and large joints in healthy children. Methods and results In 11 healthy children (5 girls/6 boys, aged 9.6 years (9.3–10 years, 110 joints were examined. Cartilage thickness of the right and left hip, knee, ankle, 2nd metacarpophalangeal (MCP, and 2nd proximal interphalangeal (PIP joint independently. The joints were examined twice, two days apart by a skilled and a non-skilled investigator. Mean cartilage thickness in the five joints was: hip 2.59 ± 0.41, knee 3.67 ± 0.64, ankle 1.08 ± 0.31, MCP 1.52 ± 0.27 and PIP 0.73 ± 0.15 mm. We found the same mean differences in CTh of 0.6 mm in the inter-observer part with regard of the PIP joint. Within investigators (intra-observer, the smallest mean difference of CTh was found in the MCP joint with -0.004 (skilled and 0.013 mm (non-skilled. Conclusion We found the level of agreement between observers within a 95% Confidence Interval in assessment of cartilage thickness in hip-, knee-, ankle-, MCP-, and PIP joints in healthy children. Observer variability seems not to relate to joint size but to the positioning of the joints and the transducer. These factors seem to be of major importance for reproducible US measurements. The smallest difference in measurement of cartilage thickness between observers was found in the PIP joint, and within observers in the MCP joint and it seems that using EULAR standard US guidelines is feasible for a pediatric setting. The use of US in children is promising. Studies on larger groups of children are needed to confirm the validation and variability of US in children as well as determining the smallest

  15. [The lateral-dorsal transposition flap for closure of a palmar soft tissue defect of the proximal phalanx on the little finger after limited fasciectomy in recurrent Dupuytren's contracture]. (United States)

    Walle, L; Hohendorff, B; Pillukat, T; van Schoonhoven, J


    Closure of a palmar soft tissue defect of the proximal phalanx after limited fasciectomy in recurrent Dupuytren's contracture. A palmar soft tissue defect between the distal flexion crease of the palm and the flexion crease of the proximal interphalangeal joint (PIP) after limited fasciectomy in Dupuytren's contracture. Scars at the lateral-dorsal portion of the proximal phalanx (e.g., after burns). Modified incision after Bruner ("mini-Bruner"). Removal of the involved fascial cord. If necessary, arthrolysis of the PIP. Raising the lateral-dorsal transposition flap from distal to proximal and rotating it into the palmar soft tissue defect of the proximal phalanx. Closure of the donor site with a skin transplant. Dorsal plaster of Paris with extended fingers and compressive dressing in the palm for 2 days. Afterwards static dorsal splint and daily physiotherapy. Between 2002 and 2007, a total of 32 lateral-dorsal transposition flaps in 30 patients with recurrent Dupuytren's disease of the little finger underwent surgery. In a retrospective study, 19 patients with 20 flaps were available for follow-up evaluation after a mean of 6 years. All flaps had healed. The median flexion contracture of the metacarpophalangeal joint was 0° (preoperatively, 20°), and of the PIP 20° (preoperatively, 85°) according to Tubiana stage 1 (preoperatively, Tubiana stage 3). The median grip strength of both the operated and the contralateral hand was 39 kg. The DASH score averaged 11 points. Overall, 11 patients were very satisfied, 6 patients were satisfied, 1 patient was less satisfied, and 1 patient was unsatisfied.

  16. A new musculoskeletal ultrasound scoring system (US10) of the hands and wrist joints for evaluation of early rheumatoid arthritis patients. (United States)

    Luz, Karine R; Pinheiro, Marcelo M; Petterle, Giovanna S; Dos Santos, Marla F; Fernandes, Artur R C; Natour, Jamil; Furtado, Rita N V


    To propose a novel ultrasound scoring system for hand and wrist joints (US10) for evaluation of patients with early rheumatoid arthritis (RA) and to correlate the US10 with clinical, laboratory and functional variables. Forty-eight early RA patients underwent clinical and laboratory evaluations as well as blinded ultrasound (US) examinations at baseline, three, six and 12 months. The proposed US10 system involved the assessment of the wrist, second and third metacarpophalangeal and proximal interphalangeal joints. The score consisted of inflammation parameters (synovial proliferation [SP], power Doppler [PD] and tenosynovitis [TN]) and joint damage parameters (bone erosion [BE] and cartilage damage [CD]). SP, PD, BE and CD were scored qualitatively (0-1) and semi-quantitatively (grades 0-3). Tenosynovitis was scored as presence/absence. The evaluation also involved the 28-Joint Disease Activity Score (DAS28), Health Assessment Questionnaire (HAQ) and C-reactive protein level (CRP). Mean duration of symptoms was 7.58±3.59 months. Significant correlations (psystem proved to be a useful tool for monitoring inflammation and joint damage in early RA patients, demonstrating significant correlations with longitudinal changes in disease activity and functional status. Copyright © 2016. Published by Elsevier Editora Ltda.

  17. Ultrasonography of the Collateral Ligaments of the Distal Interphalangeal Joint in Horses: Technique and Reference Images

    National Research Council Canada - National Science Library

    Evrard, Laurence; Bolen, GeRaldine; Maquet, Nathalie; Busoni, Valeria


    ...), and evaluates the portion of the CLs assessable by US in a series of normal forelimbs. Transverse and longitudinal US images were obtained on five healthy horses and on 25 equine cadaver forelimbs...

  18. Proximal Hypospadias (United States)

    Kraft, Kate H.; Shukla, Aseem R.; Canning, Douglas A.


    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

  19. PIP joint volar rotatory dislocation: An anatomical study to explore extensor system lesions and the Stener effect. (United States)

    Journé, A; Dana, C; Kilinc, A S; Nourissat, G; Doursounian, L


    Volar rotatory dislocation of the proximal interphalangeal joint results from volar rotation of the condyle around an intact opposite collateral ligament. A cadaveric study was preformed to better understand the mechanisms of this injury. Thirty-two long fingers (II to V) were studied. After partial section of the triangular ligament, the radial collateral ligament was cut (partly or completely, at proximal or distal insertion) and volar rotatory dislocation was induced. We studied the incidence of a fixed dislocation, the distal extension of the triangular ligament lesion, and the Stener lesion of the radial collateral ligament. A buttonhole lesion was produced by a dislocated lateral band in all cases with complete section of the collateral ligament. When the lesion of the triangular ligament extended distally, dislocation became irreducible. A Stener effect (interposition of the lateral band between the condyle and the collateral ligament) was observed after reduction in 21% of cases with proximal lesions of the radial collateral ligament. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  20. Disease: H00484 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available e proximal interphalangeal joints. Multiple synostosis syndrome is a more severe form of proximal symphalang...ism with additional bone fusions involving carpal, tarsal, and other joints. Skel

  1. Disease: H00484 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available proximal interphalangeal joints. Multiple synostosis syndrome is a more severe form of proximal with additional bone fusions involving carpal, tarsal, and other joints. Skele

  2. Colour Doppler ultrasonography evaluation of vascularization in the wrist and finger joints in rheumatoid arthritis patients and healthy subjects

    Energy Technology Data Exchange (ETDEWEB)

    Carotti, M. [Department of Radiology, Poliytechnic University of Marche, Ancona (Italy); Salaffi, F., E-mail: [Department of Rheumatology, Poliytechnic University of Marche, Ospedale A. Murri - Via dei Colli 52, 60035 Jesi, Ancona (Italy); Morbiducci, J. [Department of Radiology, Poliytechnic University of Marche, Ancona (Italy); Ciapetti, A., E-mail: [Department of Rheumatology, Poliytechnic University of Marche, Ospedale A. Murri - Via dei Colli 52, 60035 Jesi, Ancona (Italy); Bartolucci, L. [Department of Radiology, Poliytechnic University of Marche, Ancona (Italy); Gasparini, S. [Department of Rheumatology, Poliytechnic University of Marche, Ospedale A. Murri - Via dei Colli 52, 60035 Jesi, Ancona (Italy); Ferraccioli, G. [Division of Rheumatology, Catholic University of the Sacred Heart, Rome (Italy); Giuseppetti, G.M. [Department of Radiology, Poliytechnic University of Marche, Ancona (Italy); Grassi, W. [Department of Rheumatology, Poliytechnic University of Marche, Ospedale A. Murri - Via dei Colli 52, 60035 Jesi, Ancona (Italy)


    Objectives: To evaluate the presence of blood flow by colour Doppler ultrasonography (CDUS) in the wrist and finger joints of rheumatoid arthritis (RA) patients and healthy subjects and to define a cut-off value of CDUS resistive index (RI). Methods: Forty-three patients with RA and 43 healthy controls were examined by CDUS. The wrists, second and third metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints were evaluated in each patient and healthy subject. Spectral Doppler analysis was performed in order to characterize the type of flow and a mean RI was measured to define a cut-off level. The area under receiver operating characteristic curve was used to evaluate the screening method's performance. Results: Flow was detected in 219 of the 430 total joints (50.9%) of RA patients (111 in the wrists, 49 in the MCP and 30 in the PIP joints). Healthy subjects had a quantifiable flow in 45 of the 430 joints (10.5%) and, in particular, 39 (86.4%) in the wrist, 5 (11.14%) in the MCP and 1 (2.2%) in the PIP joints. The intra- and inter-reader agreements for the detection of Doppler signal were very good (kappa 0.82 and 0.89, respectively). Mean RI values were 0.72 {+-} 0.06 in RA patients and 0.86 {+-} 0.06 in healthy subjects (p < 0.01). At cut-off point of RI < 0.79 the sensitivity was 89.6% and the specificity was 78.8% (positive likelihood ratio 4.22). Conclusion: DUS is a useful tool for the detection of abnormal blood flow in inflammatory joints of RA patients.

  3. Assessing Finger Joint Biomechanics by Applying Equal Force to Flexor Tendons In Vitro Using a Novel Simultaneous Approach.

    Directory of Open Access Journals (Sweden)

    Tai-Hua Yang

    Full Text Available The flexor digitorum superficialis (FDS and flexor digitorum profundus (FDP are critical for finger flexion. Although research has recently focused on these tendons' coactivity, their contributions in different tasks remain unclear. This study created a novel simultaneous approach to investigate the coactivity between the tendons and to clarify their contributions in different tasks.Ten human cadaveric hands were mounted on our custom frame with the FDS and FDP of the third finger looped through a mechanical pulley connected to a force transducer. Joint range of motion, tendon excursion and loading force were recorded during individual joint motion and free joint movement from rest to maximal flexion. Each flexor tendon's moment arm was then calculated.In individual motions, we found that the FDP contributed more than the FDS in proximal interphalangeal (PIP joint motion, with an overall slope of 1.34 and all FDP-to-FDS excursion (P/S ratios greater than 1.0 with force increase. However, the FDP contributed less than the FDS in metacarpophalangeal (MCP joint motion, with an overall slope of 0.95 and P/S ratios smaller than 1.0 throughout the whole motion except between 1.9% and 13.1% force. In free joint movement, the FDP played a greater role than the FDS, with an overall ratio of 1.37 and all P/S ratios greater than 1.0.The new findings include differences in finger performance and excursion amounts between the FDS and FDP throughout flexion. Such findings may provide the basis for new hand models and treatments.

  4. Sensitivity of standardised musculoskeletal examination of the hand and wrist joints in detecting arthritis in comparison to ultrasound findings in patients attending rheumatology clinics. (United States)

    Almoallim, Hani; Attar, Suzan; Jannoudi, Nahid; Al-Nakshabandi, Nizar; Eldeek, Basem; Fathaddien, Omar; Halabi, Hussien


    The aim of this study is to standardise the muscuoloskeletal (MSK) examination of the hand and wrist joints and to determine the sensitivity of this standard exam to diagnose arthritis in comparison to ultrasound (US) findings. A standardised approach to MSK examination of the hand and wrist joints was formulated. It consists of inspection, followed by screening exam based on active range of motion testing, and then using specific techniques to detect clinical swelling and tenderness. The scissor and squeeze techniques for metacarpophalangeal (MCP) joints, 4-finger technique for the proximal interphalangeal (PIP) joints and 2-thumb technique for the wrist joints. Patients aged 18-75 years with symptoms suggestive of inflammatory arthritis for more than 3 months were included in the study from two centres. Two rheumatologists conducted MSK examination, while a grayscale with power Doppler US was performed by two ultrasonographers recording signs of arthritis (effusion, proliferation and hyperaemia) on the same day of visit. Statistical analysis was carried out to compare MSK examination findings in detecting swelling and tenderness to US examination findings. A total of 2,112 joints were assessed both clinically and with US. Using a standard MSK examination by a rheumatologist to detect clinical swelling showed the following sensitivities as compared to US findings: 4-finger technique of 69 % in third PIP, the scissor technique of 74 % in second MCP and 70 % in third MCP, and the 2-thumb technique of 80 % at the wrist joint. The MCP squeeze technique showed sensitivity of 66 % for tenderness. A standard MSK examination with its described techniques is a sensitive tool if used appropriately to diagnose clinical arthritis as compared to US.

  5. Sensitivity-to-change and validity of semi-automatic joint space width measurements in hand osteoarthritis: a follow-up study. (United States)

    Damman, W; Kortekaas, M C; Stoel, B C; van 't Klooster, R; Wolterbeek, R; Rosendaal, F R; Kloppenburg, M


    To assess sensitivity-to-change and validity of longitudinal quantitative semi-automatic joint space width (JSW) measurements and to compare this method with semi-quantitative joint space narrowing (JSN) scoring in hand osteoarthritis (OA) patients. Baseline and 2-year follow-up radiographs of 56 hand OA patients (mean age 62 years, 86% women) were used. JSN was scored 0-3 using the Osteoarthritis Research Society International atlas and JSW was quantified in millimetres (mm) in the second to fifth distal, proximal interphalangeal and metacarpal joints (DIPJs, PIPJs, MCPJs). Sensitivity-to-change was evaluated by calculating Standardized Response Means (SRMs). Change in JSW or JSN above the Smallest Detectable Difference (SDD) defined progression on joint level. To assess construct validity, progressed joints were compared by cross-tabulation and by associating baseline ultrasound variables with progression (using generalized estimating equations, adjusting for age and sex). The JSW method detected statistically significant mean changes over 2.6 years (-0.027 mm (95%CI -0.01; -0.04), -0.024 mm (-0.01; -0.03), -0.021 mm (-0.01; -0.03) for DIPJs, PIPJs, MCPJs, respectively). Sensitivity-to-change was low (SRMs: 0.174, 0.168, 0.211, respectively). 9.1% (121/1336) of joints progressed in JSW, but 3.6% (48/1336) widened. 83 (6.2%) joints progressed in JSW only, 36 (2.7%) in JSN only and 37 (2.8%) in both methods. Progression in JSW showed weaker associations with baseline inflammatory ultrasound features than progression in JSN. Assessment of progression in hand OA defined by JSW measurements is possible, but performs less well than progression defined by JSN scoring. Therefore, the value of JSW measurements in hand OA clinical trials remains questionable. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  6. Validation of automatic joint space width measurements in hand radiographs in rheumatoid arthritis. (United States)

    Schenk, Olga; Huo, Yinghe; Vincken, Koen L; van de Laar, Mart A; Kuper, Ina H H; Slump, Kees C H; Lafeber, Floris P J G; Bernelot Moens, Hein J


    Computerized methods promise quick, objective, and sensitive tools to quantify progression of radiological damage in rheumatoid arthritis (RA). Measurement of joint space width (JSW) in finger and wrist joints with these systems performed comparable to the Sharp-van der Heijde score (SHS). A next step toward clinical use, validation of precision and accuracy in hand joints with minimal damage, is described with a close scrutiny of sources of error. A recently developed system to measure metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints was validated in consecutive hand images of RA patients. To assess the impact of image acquisition, measurements on radiographs from a multicenter trial and from a recent prospective cohort in a single hospital were compared. Precision of the system was tested by comparing the joint space in mm in pairs of subsequent images with a short interval without progression of SHS. In case of incorrect measurements, the source of error was analyzed with a review by human experts. Accuracy was assessed by comparison with reported measurements with other systems. In the two series of radiographs, the system could automatically locate and measure 1003/1088 (92.2%) and 1143/1200 (95.3%) individual joints, respectively. In joints with a normal SHS, the average (SD) size of MCP joints was [Formula: see text] and [Formula: see text] in the two series of radiographs, and of PIP joints [Formula: see text] and [Formula: see text]. The difference in JSW between two serial radiographs with an interval of 6 to 12 months and unchanged SHS was [Formula: see text], indicating very good precision. Errors occurred more often in radiographs from the multicenter cohort than in a more recent series from a single hospital. Detailed analysis of the 55/1125 (4.9%) measurements that had a discrepant paired measurement revealed that variation in the process of image acquisition (exposure in 15% and repositioning in 57%) was a more frequent source of

  7. Successful treatment of a guitarist with a finger joint injury using instrument-assisted soft tissue mobilization: a case report. (United States)

    Terry Loghmani, M; Bayliss, Amy J; Clayton, Greg; Gundeck, Evelina


    Finger injuries are common and can greatly affect a musician's quality of life. A 55-year-old man, who had injured the proximal interphalangeal joint of the left index finger 6 months prior to any intervention, was treated with a manual therapy approach incorporating instrument-assisted soft tissue mobilization (IASTM). Initial examination findings included self-reported pain and functional limitations and physical impairments that significantly impeded his ability to play the acoustic guitar. He was treated once a week for 6 weeks with IASTM, joint mobilization, therapeutic exercise, and ice massage. Additionally, a home exercise program and self-care instructions were provided. The patient gained positive outcomes with improvements in pain (Numerical Pain Rating Scale while playing the guitar: initial 5/10, discharge 1/10) and function (Disability Arm Shoulder Hand Sports-Performing Arts Optional Module: initial 75; discharge 6·25), each reaching a minimum clinically important difference. Importantly, he was able to play the guitar with minimal to no pain as desired. Physical measures also improved, including an immediate gain in finger range of motion with IASTM alone. Manual therapy approaches integrating IASTM may provide an effective conservative treatment strategy for patients with finger/hand conditions in the performing arts and other patient populations.

  8. Accuracy and Validity of Goniometer and Visual Assessments of Angular Joint Positions of the Hand and Wrist. (United States)

    McVeigh, Kimberly H; Murray, Peter M; Heckman, Michael G; Rawal, Bhupendra; Peterson, Jeffrey J


    To compare goniometric and visual assessments of angular hand joint and wrist joint positions measured by board-certified hand surgeons and certified hand therapists. We hypothesized that visual estimation would be similar to the goniometric measurement accuracy of digital and wrist joint positions. The wrist, index finger metacarpophalangeal (MCP) joint, and index finger proximal interphalangeal (PIP) joint were evaluated in different positions by 40 observers: 20 board-certified hand surgeons and 20 certified hand therapists. Each observer estimated the position of the wrist, index MCP joint, and index PIP joint of the same volunteer, who was positioned in low-profile orthoses to reproduce predetermined positions. Following visual estimation, the participants measured the same joint positions using a goniometer. The control measurement was digitally determined by a radiologist who obtained radiographs of the hand and wrist positions in each orthosis. Observers were blinded to the results of control measurements. When considering all joints at all positions, neither visual assessments nor goniometer assessments were consistently within ± 5° of the measurements obtained on control radiographs. When considering individual joints, goniometer measurements were significantly closer to control radiograph measurements than the visual assessments for all 3 PIP joint positions. There was no difference for the measurements at the wrist or for 2 of the 3 MCP joint positions. Significant differences between surgeon and therapist joint angle measurements were not observed when comparing visual and goniometer assessments to radiograph controls. Compared with radiograph measurements, neither visual nor goniometer assessment displayed high levels of accuracy. On average, visual assessment of the angular positions of the index MCP and wrist joint were as accurate as the goniometer assessment, whereas goniometer assessment of the angular position of the PIP joint was more

  9. 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. (United States)

    Lee, K B; Cho, N Y; Park, H W; Seon, J K; Lee, S H


    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.

  10. Distal radioulnar joint injuries


    Thomas, Binu P.; Raveendran Sreekanth


    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...

  11. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 2: reliability and application to multiple joints of a standardised consensus-based scoring system (United States)

    Terslev, Lene; Naredo, Esperanza; Aegerter, Philippe; Wakefield, Richard J; Backhaus, Marina; Balint, Peter; Bruyn, George A W; Iagnocco, Annamaria; Jousse-Joulin, Sandrine; Schmidt, Wolfgang A; Szkudlarek, Marcin; Conaghan, Philip G; Filippucci, Emilio


    Objectives To test the reliability of new ultrasound (US) definitions and quantification of synovial hypertrophy (SH) and power Doppler (PD) signal, separately and in combination, in a range of joints in patients with rheumatoid arthritis (RA) using the European League Against Rheumatisms–Outcomes Measures in Rheumatology (EULAR-OMERACT) combined score for PD and SH. Methods A stepwise approach was used: (1) scoring static images of metacarpophalangeal (MCP) joints in a web-based exercise and subsequently when scanning patients; (2) scoring static images of wrist, proximal interphalangeal joints, knee and metatarsophalangeal joints in a web-based exercise and subsequently when scanning patients using different acquisitions (standardised vs usual practice). For reliability, kappa coefficients (κ) were used. Results Scoring MCP joints in static images showed substantial intraobserver variability but good to excellent interobserver reliability. In patients, intraobserver reliability was the same for the two acquisition methods. Interobserver reliability for SH (κ=0.87) and PD (κ=0.79) and the EULAR-OMERACT combined score (κ=0.86) were better when using a ‘standardised’ scan. For the other joints, the intraobserver reliability was excellent in static images for all scores (κ=0.8–0.97) and the interobserver reliability marginally lower. When using standardised scanning in patients, the intraobserver was good (κ=0.64 for SH and the EULAR-OMERACT combined score, 0.66 for PD) and the interobserver reliability was also good especially for PD (κ range=0.41–0.92). Conclusion The EULAR-OMERACT score demonstrated moderate-good reliability in MCP joints using a standardised scan and is equally applicable in non-MCP joints. This scoring system should underpin improved reliability and consequently the responsiveness of US in RA clinical trials. PMID:28948984

  12. Gray-scale and color duplex Doppler ultrasound of hand joints in the evaluation of disease activity and treatment in rheumatoid arthritis. (United States)

    Ivanac, Gordana; Morović-Vergles, Jadranka; Brkljačić, Boris


    To evaluate the role of gray-scale and color duplex-Doppler ultrasound (CDUS) in diagnosis of changes of hand joints and assessment of treatment efficacy in patients with rheumatoid arthritis (RA) by comparing qualitative and quantitative US parameters with clinical and laboratory indicators of disease activity. Ulnocarpal (UC), metacarpophalangeal (MCP), and proximal interphalangeal (PIP) joints in 30 patients with RA were examined by gray-scale and CDUS before and after six months of treatment. Morphologic and quantitative Doppler findings (synovial thickness, effusion quantity, vascularization degree, resistance index, velocities) were compared with clinical indicators of disease progression: disease activity score (DAS 28), Health Assessment Questionnaire (HAQ), rheumatoid factor (RF), erythrocyte sedimentation rate (ESR), and C reactive protein (CRP). Clinical indicators changed significantly after treatment: ESR from 38.1±22.4 mm/h to 27.8±20.9 mm/h (P=0.013), DAS 28 from 5.47±1.56 to 3.87±1.65 (Pjoints we observed a significant change in at least one US parameter, in 6 out of 12 joints we observed a significant change in ≥2 parameters, and in 2 UC joints we observed significant changes in ≥3 parameters. The new finding was that the cut-off values of resistance index of 0.40 at baseline and of 0.55 after the treatment indicated the presence of active disease and the efficacy of treatment, respectively; also it was noticed that PIP joints can be omitted from examination protocol. Gray scale and CDUS are useful in diagnosis of changes in UC and MCP joints of patients with RA and in monitoring the treatment efficacy.

  13. [Association between limited joint mobility syndrome and risk of accidental falls in diabetic patients]. (United States)

    López-Martín, I; Benito Ortiz, L; Rodríguez-Borlado, B; Cano Langreo, M; García-Martínez, F J; Martín Rodríguez, M F


    Limited joint mobility syndrome (LJMS) appears exclusively in both type 1 and type 2 diabetic patients. It is characterized by a limited range of digital motion, with involvement of small joints of the hands. It initially affects the proximal interphalangeal joints, followed by wrists, elbows, shoulders, knees, and axial skeleton. The diagnosis can be made by the simple "prayer sign" test. The objective was to study the prevalence of diabetic patients with LJMS, and to evaluate the association between LJMS and metabolic control, and the risk of accidental falls. A cross-sectional study was conducted in the San Fernando II Health Centre, Madrid (suburbs). The sample consisted of 184 patients with a diagnosis of diabetes of over 5 years from November to March, 2013. The prayer sign was used to define which patients had LJMS. Fall risk was determined using the Timed Up & Go test. A total of 99 patients (53.8%) (95% CI 46.6 to 61) had a positive prayer sign. No statistically significant relationship was found with HbA1c, but there was an association with the Timed Up & Go test (P<.001) (95% CI 1.173 to 1.611). The patients with LJMS had a moderate risk of falls compared with those without LJMS, which was of low risk. The prevalence of LJMS is high. This is the first study that shows a relationship between LJMS and the risk of falls in diabetic patients. Copyright © 2013 Sociedad Española de Médicos de Atención Primaria (SEMERGEN). Publicado por Elsevier España. All rights reserved.

  14. Proximal renal tubular acidosis (United States)

    Renal tubular acidosis - proximal; Type II RTA; RTA - proximal; Renal tubular acidosis type II ... by alkaline substances, mainly bicarbonate. Proximal renal tubular acidosis (Type II RTA) occurs when bicarbonate is not ...

  15. 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. (United States)

    Akiyama, Toru; Saita, Kazuo; Ogura, Koichi; Kawai, Akira; Imanishi, Jungo; Yazawa, Yasuo; Kawashima, Noritaka; Ogata, Toru


    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.

  16. Interrater reliability in finger joint goniometer measurement in Dupuytren's disease. (United States)

    Engstrand, Christina; Krevers, Barbro; Kvist, Joanna


    We investigated interrater reliability of motion (ROM) measurement in the finger joints of people with Dupuytren's disease. Eight raters measured flexion and extension of the three finger joints in one affected finger of each of 13 people with different levels of severity of Dupuytren's disease, giving 104 measures of joints and motions. Reliability measures, represented by intraclass correlation coefficient (ICC), standard error of the mean (SEM), and differences between raters with the highest and lowest mean scores, were calculated. ICCs ranged from .832 to .973 depending on joint and motion. The SEM was ≤3° for all joints and motions. Differences in mean between highest and lowest raters were larger for flexion than for extension; the largest difference was in the distal interphalangeal joint. The results indicate that following these standardized guidelines, the interrater reliability of goniometer measurements is high for digital ROM in people with Dupuytren's disease.

  17. Modelling of the mechanical behavior of a polyurethane finger interphalangeal joint endoprosthesis after surface modification by ion implantation (United States)

    Beliaev, A.; Svistkov, A.; Iziumov, R.; Osorgina, I.; Kondyurin, A.; Bilek, M.; McKenzie, D.


    Production of biocompatible implants made of polyurethane treated with plasma is very perspective. During plasma treatment the surface of polyurethane acquires unique physic-chemical properties. However such treatment may change the mechanical properties of polyurethane which may adversely affect the deformation behaviour of the real implant. Therefore careful study of the mechanical properties of the plasma-modified polyurethane is needed. In this paper, experimental observations of the elastic characteristics of plasma treated polyurethane and modelling of the deformation behaviour of polyurethane bio-implants are reported.

  18. 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.

  19. Proximal and distal muscle fatigue differentially affect movement coordination. (United States)

    Cowley, Jeffrey C; Gates, Deanna H


    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.

  20. Proximal and distal muscle fatigue differentially affect movement coordination (United States)

    Cowley, Jeffrey C.


    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

  1. Multiset proximity spaces

    Directory of Open Access Journals (Sweden)

    A. Kandil


    Full Text Available A multiset is a collection of objects in which repetition of elements is essential. This paper is an attempt to explore the theoretical aspects of multiset by extending the notions of compact, proximity relation and proximal neighborhood to the multiset context. Examples of new multiset topologies, open multiset cover, compact multiset and many identities involving the concept of multiset have been introduced. Further, an integral examples of multiset proximity relations are obtained. A multiset topology induced by a multiset proximity relation on a multiset M has been presented. Also the concept of multiset δ- neighborhood in the multiset proximity space which furnishes an alternative approach to the study of multiset proximity spaces has been mentioned. Finally, some results on this new approach have been obtained and one of the most important results is: every T4- multiset space is semi-compatible with multiset proximity relation δ on M (Theorem 5.10.

  2. Treatment of three- and four-part proximal humeral fractures with locking proximal humerus plate. (United States)

    Sun, Jing-Cheng; Li, Yu-Lin; Ning, Guang-Zhi; Wu, Qiang; Feng, Shi-Qing


    The purpose of this study was to evaluate the effectiveness and complications of the locking proximal humerus plate to treat proximal humerus fractures. A retrospective clinical trial. Department of Orthopaedics, Tianjin Medical University General Hospital. Sixty-eight consecutive patients with three- or four-part fractures of the proximal humerus were treated with locking proximal humerus plates. The deltopectoral anterolateral acromial approach was used to the proximal humerus; open reduction and locking proximal humerus plate were applied. Constant Score was used to measure the shoulder functional recovery, and Visual Analog Scale (VAS) was used to measure subjective evaluation of pain. The radiology was observed. After average 26.7 months, the average Constant Score was 72.6 ± 13.2 points and the average VAS was 1.2 ± 0.8 points. All the complications such as screw perforation into the glenohumeral joint, screws loosening, soft tissue infections, avascular necrosis and delayed union occurred in eight cases (11.8 %). The effectiveness of the locking proximal humerus plate was similar to other published literatures on treating fractures of the proximal humerus; however, a lower complications rate in short follow-up time was observed in this study. It may potentially provide a favorable option for treating three- or four-part fractures of the proximal humerus. Dealing with each particular fracture pattern, surgeons should have a decision of appropriate way to internal fixation.

  3. Proximal Probes Facility (United States)

    Federal Laboratory Consortium — The Proximal Probes Facility consists of laboratories for microscopy, spectroscopy, and probing of nanostructured materials and their functional properties. At the...

  4. Proximal tibiofibular dislocation: a case report and review of literature

    NARCIS (Netherlands)

    Nieuwe Weme, R. A.; Somford, M. P.; Schepers, T.


    An isolated dislocation of the proximal tibiofibular joint is uncommon. The mechanism of this injury is usually sports related. We present a case where initial X-rays did not show the tibiofibular joint dislocation conclusively. It was diagnosed after comparative bilateral AP X-rays of the knees

  5. Isolated Proximal Tibiofibular Dislocation during Soccer

    Directory of Open Access Journals (Sweden)

    Casey Chiu


    Full Text Available Proximal tibiofibular dislocations are rarely encountered in the Emergency Department (ED. We present a case involving a man presenting to the ED with left knee pain after making a sharp left turn on the soccer field. His physical exam was only remarkable for tenderness over the lateral fibular head. His X-rays showed subtle abnormalities of the tibiofibular joint. The dislocation was reduced and the patient was discharged from the ED with orthopedic follow-up.

  6. A digital-signal-processor-based optical tomographic system for dynamic imaging of joint diseases (United States)

    Lasker, Joseph M.

    joint diseases, especially effects of rheumatoid arthritis (RA) in the proximal interphalangeal finger joints. Using a dual-wavelength tomographic imaging system and previously implemented reconstruction scheme, I have performed initial dynamic imaging case studies on healthy volunteers and patients diagnosed with RA. These studies support our hypothesis that differences in the vascular and metabolic reactivity exist between affected and unaffected joints and can be used for diagnostic purposes.

  7. Pathological fractures of the proximal humerus treated with a proximal humeral locking plate and bone cement. (United States)

    Siegel, H J; Lopez-Ben, R; Mann, J P; Ponce, B A


    Bone loss secondary to primary or metastatic lesions of the proximal humerus remains a challenging surgical problem. Options include preservation of the joint with stabilisation using internal fixation or resection of the tumour with prosthetic replacement. Resection of the proximal humerus often includes the greater tuberosity and adjacent diaphysis, which may result in poor function secondary to loss of the rotator cuff and/or deltoid function. Preservation of the joint with internal fixation may reduce the time in hospital and peri-operative morbidity compared with joint replacement, and result in a better functional outcome. We included 32 patients with pathological fractures of the proximal humerus in this study. Functional and radiological assessments were performed. At a mean follow-up of 17.6 months (8 to 61) there was no radiological evidence of failure of fixation. The mean revised musculoskeletal Tumour Society functional score was 94.6% (86% to 99%). There was recurrent tumour requiring further surgery in four patients (12.5%). Of the 22 patients who were employed prior to presentation all returned to work without restrictions. The use of a locking plate combined with augmentation with cement extends the indications for salvage of the proximal humerus with good function in patients with pathological and impending pathological fractures.

  8. Capacitive proximity sensor (United States)

    Kronberg, James W.


    A proximity sensor based on a closed field circuit. The circuit comprises a ring oscillator using a symmetrical array of plates that creates an oscillating displacement current. The displacement current varies as a function of the proximity of objects to the plate array. Preferably the plates are in the form of a group of three pair of symmetric plates having a common center, arranged in a hexagonal pattern with opposing plates linked as a pair. The sensor produces logic level pulses suitable for interfacing with a computer or process controller. The proximity sensor can be incorporated into a load cell, a differential pressure gauge, or a device for measuring the consistency of a characteristic of a material where a variation in the consistency causes the dielectric constant of the material to change.

  9. Neighborhoods and manageable proximity

    Directory of Open Access Journals (Sweden)

    Stavros Stavrides


    Full Text Available The theatricality of urban encounters is above all a theatricality of distances which allow for the encounter. The absolute “strangeness” of the crowd (Simmel 1997: 74 expressed, in its purest form, in the absolute proximity of a crowded subway train, does not generally allow for any movements of approach, but only for nervous hostile reactions and submissive hypnotic gestures. Neither forced intersections in the course of pedestrians or vehicles, nor the instantaneous crossing of distances by the technology of live broadcasting and remote control give birth to places of encounter. In the forced proximity of the metropolitan crowd which haunted the city of the 19th and 20th century, as well as in the forced proximity of the tele-presence which haunts the dystopic prospect of the future “omnipolis” (Virilio 1997: 74, the necessary distance, which is the stage of an encounter between different instances of otherness, is dissipated.

  10. Atrofia muscular proximal familiar

    Directory of Open Access Journals (Sweden)

    José Antonio Levy


    Full Text Available Os autores relatam dois casos de atrofia muscular proximal familiar, moléstia caracterizada por déficit motor e atrofias musculares de distribuição proximal, secundárias a lesão de neurônios periféricos. Assim, como em outros casos descritos na literatura, foi feito inicialmente o diagnóstico de distrofia muscular progressiva. O diagnóstico correto foi conseguido com auxílio da eletromiografia e da biopsia muscular.

  11. Complications following surgical treatment for Dupuytren's contracture. (United States)

    Prosser, R; Conolly, W B


    Dupuytren's disease is a proliferative fibroplasia that can lead to a significant contracture of the metacarpophalangeal (MCP) and interphalangeal (IP) joints, causing a functional disability. Surgical excision of the Dupuytren's tissue and release of the contracted joints may be necessary to restore function. Most patients require hand therapy postoperatively. Postoperative complications have been reported at 17%. These include excessive inflammation, hematoma, ischemic skin necrosis, infection, granuloma formation, transient paresthesia, scar contracture, persistent proximal interphalangeal (PIP) flexion contracture, distal interphalangeal (DIP) hyperextension deformity, joint stiffness, poor flexion and grip strength, pain, and reflex sympathetic dystrophy (RSD). The hand therapist plays a vital role in the early detection and treatment of many of these complications.

  12. [Experimental proximal carpectomy. Biodynamics]. (United States)

    Kuhlmann, J N


    Proximal carpectomy was performed in 10 fresh cadavre wrists. Dynamic x-rays were taken and the forces necessary to obtain different movements before and after the operation were measured. Comparison of these parameters clearly defines the advantages and limitations of carpectomy and indicates the reasons.

  13. Proximate Analysis of Coal (United States)

    Donahue, Craig J.; Rais, Elizabeth A.


    This lab experiment illustrates the use of thermogravimetric analysis (TGA) to perform proximate analysis on a series of coal samples of different rank. Peat and coke are also examined. A total of four exercises are described. These are dry exercises as students interpret previously recorded scans. The weight percent moisture, volatile matter,…

  14. Proximal Tibial Bone Graft (United States)

    ... the Big Toe Ailments of the Smaller Toes Diabetic Foot Treatments Currently selected Injections and other Procedures Treatments ... from which the bone was taken if the foot/ankle surgeries done at the same time allow for it. ... problems after a PTBG include infection, fracture of the proximal tibia and pain related ...

  15. Acute neuropathic joint in diabetic foot: Plain radiographic findings

    Energy Technology Data Exchange (ETDEWEB)

    Yoon, Dae Young; Kang, Heung Sik; Sim, Jung Suk; Yoon, Yong Kyu; Kim, Chu Wan [Seoul National University College of Medicine, Seoul (Korea, Republic of)


    To determine the plain film findings of acute neuropathic joint in diabetic foot. Acute neuropathic joint in diabetic foot was considered when fragmentation of the articular ends of bone and subluxation of the affected joint developed within eight weeks after clinical onset of diabetic gangrene. Eight toes of six diabetics were satisfactory to our criteria. We analyzed plain radiographic findings of the affected joint and soft tissue, interval changes in followed-up radiographs, and deformities after healing. The time interval between clinical onset of gangrene and bone destruction ranges from 2 weeks to 4 weeks(mean 2.6 weeks). Plane radiographs showed fragmentation of the articular ends, subluxation, and soft tissue swelling of the metatarsophalangeal joint or interphalangeal joint. The significant feature of these patients was rapid progression of the lesions. Clinically, all patients had diabetic gangrene in affected toes, however, there was no evidence of osteomyelitis in our series. Amputation was done in 2 cases, and lesions in 3 of the remaining 4 cases were repaired spontaneously with regression of gangrene, leaving radiological residua such as pointed-end, tapered-end, and ball and socket deformity. Rapid disorganisation of the joint with associated evidence of soft tissue gangrene in plain radiograph is believed to be valuable for the diagnosis of diabetic osteoarthropathy.

  16. Clinical efficacy of radiation synovectomy in digital joint osteoarthritis

    Energy Technology Data Exchange (ETDEWEB)

    Kampen, Willm Uwe; Hellweg, Leif; Massoudi-Nickel, Schirin; Czech, Norbert; Henze, Eberhard [University Hospital Schleswig-Holstein, Clinic of Nuclear Medicine, Kiel (Germany); Brenner, Winfried [University Hospital Hamburg-Eppendorf, Department of Nuclear Medicine (Germany)


    Radiation synovectomy was developed for local treatment of rheumatoid arthritis. In this study, the long-term efficacy of radiation synovectomy was retrospectively evaluated in patients with osteoarthritis (activated arthrosis) of the digital joints using an algofunctional score. Fifty-three digital joints in 29 patients (mean age 64.8 years) were treated by intra-articular injection of{sup 169}Er citrate. All joints were painful despite pharmacotherapy and showed an elevated blood pool pattern in a pretherapeutic three-phase bone scan, indicative for local synovitis. The patients were asked to classify their complaints with respect to different daily manual activities on a ten-step pain scale from 1 (total disability) to 10 (lack of any impairment) prior to and after treatment, with a mean follow-up of 41 months. Local signs of osteoarthritis such as joint swelling or pain were additionally evaluated and were scored from progression of complaints to excellent improvement based on patient self-evaluation. All patients reported a pronounced improvement in their manual activities. The mean total score of 4.73{+-}0.58 for all activities prior to treatment increased significantly to 6.79{+-}0.47 after radiation synovectomy (p<0.05). The best results were obtained in the thumb base joints, whereas distal interphalangeal joints were frequently resistant to therapy. Radiation synovectomy is highly effective in digital joint osteoarthritis with concomitant local synovitis. (orig.)

  17. Pseudoarthrosis following proximal humeral fractures: A possible mechanism

    Energy Technology Data Exchange (ETDEWEB)

    Rooney, P.J.; Cockshott, W.P.


    A small series of four patients with pseudarthrosis of the proximal humeral shaft is reported. These patients all had restricted movement of the shoulder joint prior to the trauma, three as a result of rheumatoid arthritis and one due a surgical fusion of the glenohumeral joint. It is suggested that pseudarthrosis is more likely under these circumstances and that pursuit of union of the fracture in such patients may not always be necessary.


    Directory of Open Access Journals (Sweden)

    O. G. Alekseeva


    Full Text Available Rheumatoid arthritis (RA is a chronic inflammatory disease causing joint destructive changes and disability.Objective: to investigate the association between the ultrasound signs of active inflammation and destruction of the joints, as evidenced by radiography, in RA patients treated with a treat-to-target strategy and to study whether ultrasound study (USS of the joints can be used to predict the occurrence of their destructive changes.Subjects and methods. The investigation included 81 patients (medium age 56 [46; 62] years with RA, who had been followed up at the V.A. Nasonova Research Institute of Rheumatology within the first Russian strategic study of pharmacotherapy for RA – REMARCA (Russian invEstigation of MethotrexAte and biologicals for eaRly aCtive Arthritis. In all the patients, methotrexate (Metoject, MEDAS, Germany as the first disease-modifying anti-rheumatic drug was subcutaneously injected at an initial dose of 10 mg/week with its rapid escalation up to 20–25 mg/week. Then the therapy was added by biologicals as the need arose. Clinical and laboratory parameters were analyzed immediately before and then after 12, 24, 36, and 48 weeks. Efficacy was assessed using the European League Against Rheumatism (EULAR criteria, CDAI, and SDAI. USS of eight articular areas (the wrist, second and third metacarpophalangeal, second and third proximal interphalangeal, second and fifth metatarsophalangeal joints in the hand and foot of the clinically dominant side was carried out in all the patients before treatment and then after 12, 24, 36, and 48 weeks. Semiquantitative gray-scale (GS assessment and power Doppler (PD were performed. Radiographic examination was done before and after 48 weeks of therapy. The Sharp method modified by van der Heijde was employed to estimate X-ray changes.Results and discussion. In the group of patients with radiographic progression, the activity of inflammation, as evidenced by PD USS, was significantly

  19. Evaluation of the structural changes of the hand joints and the rates of rheumatoid arthritis progression according to ultrasound data

    Directory of Open Access Journals (Sweden)

    Rita Aleksandrovna Osipyants


    Full Text Available Objective: to define the significance of ultrasonography (USG in the diagnosis of early destructive changes in the hand joints and the rates of rheumatoid arthritis (RA progression in patients at different ages of disease onset. Subjects and methods. 100 patients with a valid RA diagnosis (American College of Rheumatology (ACR 1987 criteria were examined. They were divided into 2 groups: 1 11 patients with an early RA history of less than 2 years (ERA; 2 35 patients with a RA history of over 2 years (LRA. Hand USG (Voluson-i GE; a 4-13-MHz linear probe; gray scale mode was carried out at baseline and after 6-month follow-up. A sonographic index (US-Er-10 based on the bilateral evaluation of 5 articular areas, such as wrinkles, second-to-third metacarpophalangeal (MCP and second-to-third proximal interphalangeal (PIP joints, was proposed to evaluate the progression of destruction. According to US-Er-10 changes, the rates of development of the destructive process were arbitrarily separated into three categories: 1 slow progression rate; 2 moderate progression rate; 3 a rapidly progressive course. The X-ray parameters of structural progression were estimated at 12-month follow-up, by employing the Sharp method modified by van der Heide (SHS. Results. The USG versus X-ray detection rate of erosions was significantly higher in both ERA and LRA (p < 0.05. The ERA patients who had fallen ill after 55 years of age were found to have more significant baseline and final destructive changes according to a total SHS score (p < 0.05 and US-Er-10 index (p < 0.005 than those with RA onset at a younger age. In the ERA patients in whom US-Er-10 increased by three points or more at 6-month follow-up, the rates of X-ray progression at 12 months were significantly higher than those with less pronounced negative changes in this index (Δ total SHS score of 13.5 [3-23] and 0 [0-0], respectively; p < 0.05. The LRA group displayed no statistically relationships between

  20. Proximal femoral fractures

    DEFF Research Database (Denmark)

    Palm, Henrik; Teixidor, Jordi


    -displaced femoral neck fractures and prosthesis for displaced among the elderly; and sliding hip screw for stabile- and intramedullary nails for unstable- and sub-trochanteric fractures) but they are based on a variety of criteria and definitions - and often leave wide space for the individual surgeons' subjective...... guidelines for hip fracture surgery and discuss a method for future pathway/guideline implementation and evaluation. METHODS: By a PubMed search in March 2015 six studies of surgical treatment pathways covering all types of proximal femoral fractures with publication after 1995 were identified. Also we...... searched the homepages of the national heath authorities and national orthopedic societies in West Europe and found 11 national or regional (in case of no national) guidelines including any type of proximal femoral fracture surgery. RESULTS: Pathway consensus is outspread (internal fixation for un...

  1. Proximal humeral fractures


    Mauro, Craig S.


    Proximal humeral fractures may present with many different configurations in patients with varying co-morbities and expectations. As a result, the treating physician must understand the fracture pattern, the quality of the bone, other patient-related factors, and the expanding range of reconstructive options to achieve the best functional outcome and to minimize complications. Current treatment options range from non-operative treatment with physical therapy to fracture fixation using percuta...

  2. Finger Stiffness Measured by Goniometry Method—A Simple Useful Tool for Early Diagnosis of Reflex Sympathetic Dystrophy After Colles' Fracture

    Directory of Open Access Journals (Sweden)

    Garg Rajesh


    Full Text Available We assess the finger joint stiffness by measuring the active range of motion of all metacarpophalangeal, proximal interphalangeal, and distal interphalangeal joints of the involved hand with a hand goniometer. It is then compared with the normal hand for the effective range of total motion and thereby using it as a quantitative, qualitative, and reproducible method for early diagnosis of reflex sympathetic dystrophy after Colles' fracture. It is sensitive and specific.

  3. Proximal iliotibial band syndrome: case report

    Directory of Open Access Journals (Sweden)

    Guilherme Guadagnini Falotico


    Full Text Available OBJECTIVE: The overuse injuries in the hip joint occur commonly in sports practitioners and currently due to technical advances in diagnostic imaging, especially magnetic resonance imaging (MRI, are often misdiagnosed. Recently, a group of people were reported, all female, with pain and swelling in the pelvic region.T2-weighted MRI showed increased signal in the enthesis of the iliotibial band (ITB along the lower border of the iliac tubercle. We report a case of a 34 year old woman, non-professional runner, with pain at the iliac crest with no history of trauma and whose MRI was compatible with the proximal iliotibial band syndrome.

  4. The use of a passive motion machine in the postoperative rehabilitation of Dupuytren's disease. (United States)

    Sampson, S P; Badalamente, M A; Hurst, L C; Dowd, A; Sewell, C S; Lehmann-Torres, J; Ferraro, M; Semon, B


    The purpose of this study was to prospectively compare the postoperative use of passive motion (PM) and standard hand therapy after surgical treatment of Dupuytren's disease for extent and rate of recovery of joint motion. Our data indicate that metacarpophalangeal joint contractures improved completely to a mean of 0 degrees, regardless of the postoperative protocol. Contractures at the proximal interphalangeal joint showed incomplete recovery in both study groups, with a mean residual contracture of 28 degrees for PM patients and 38 degrees for control patients. Contractures of the metacarpophalangeal-proximal interphalangeal joints in the same finger showed complete metacarpophalangeal joint recovery to a mean of 0 degrees but incomplete proximal interphalangeal joint recovery with a mean residual contracture of 30 degrees in PM patients and 22 degrees in control patients. We conclude that the use of a PM machine in the rehabilitation of Dupuytren's disease does not offer an advantage in the postoperative management of this condition.

  5. Proximal focal femoral deficiency in Ibadan a developing country's ...

    African Journals Online (AJOL)

    Prof Ezechukwu


    Jun 9, 2011 ... The major problems are limb length inequality and variable inadequacy of the proximal femoral musculature and hip joint. Treatment is indicated and ranges from amputation and prosthetic rehabilitation to limb salvage, lengthening, and hip re- construction. Until the early 1960s, treatment for PFFD at the St.

  6. Outcome of plate osteosynthesis in the management of proximal ...

    African Journals Online (AJOL)

    Background: This paper reports the aetiology, presentation and management of proximal humeral fractures (PHF) in our setup. Objective: To ... Five of thirty two operated cases (15%) developed significant shoulder joint stiffness. ... There is need for arthroplasty in those with severe injury, particularly those with osteoporosis.

  7. Some Properties of Fuzzy Soft Proximity Spaces (United States)

    Demir, İzzettin; Özbakır, Oya Bedre


    We study the fuzzy soft proximity spaces in Katsaras's sense. First, we show how a fuzzy soft topology is derived from a fuzzy soft proximity. Also, we define the notion of fuzzy soft δ-neighborhood in the fuzzy soft proximity space which offers an alternative approach to the study of fuzzy soft proximity spaces. Later, we obtain the initial fuzzy soft proximity determined by a family of fuzzy soft proximities. Finally, we investigate relationship between fuzzy soft proximities and proximities. PMID:25793224

  8. Joint ventures

    DEFF Research Database (Denmark)

    Sørensen, Karsten Engsig

    Afhandlingen analysere de konkurrenceretlige og selskabsretlige regler som er bestemmende for hvordan et joint venture samarbejde er struktureret......Afhandlingen analysere de konkurrenceretlige og selskabsretlige regler som er bestemmende for hvordan et joint venture samarbejde er struktureret...

  9. Radiographic Shape of Foot With Second Metatarsophalangeal Joint Dislocation Associated With Hallux Valgus. (United States)

    Kokubo, Tetsuro; Hashimoto, Takeshi; Suda, Yasunori; Waseda, Akeo; Ikezawa, Hiroko


    Second metatarsophalangeal (MTP) joint dislocation is associated with hallux valgus, and the treatment of complete dislocation can be difficult. The purpose of this study was to radiographically clarify the characteristic foot shape in the presence of second MTP joint dislocation. Weight-bearing foot radiographs of the 268 patients (358 feet) with hallux valgus were examined. They were divided into 2 groups: those with second MTP joint dislocation (study group = 179 feet) and those without dislocation (control group = 179 feet). Parameters measured included the hallux valgus angle (HVA), first-second intermetatarsal angle (IMA), second MTP joint angle, hallux interphalangeal angle (IPA), second metatarsal protrusion distance (MPD), metatarsus adductus angle (MAA), and the second metatarsal declination angle (2MDA). Furthermore, the dislocation group was divided into 3 subgroups according to second toe deviation direction: group M (medial type), group N (neutral type), and group L (lateral type). The IPA and the 2MDA were significantly greater in the study group than in the control group. By multiple comparison analysis, the IMA was greatest in group M and smallest in group L. The IPA was smaller and 2MDA greater in group N than in group L. The HVA and MAA in group L were greatest, and MPD in group L was smallest. The patients with second MTP joint dislocation associated with hallux valgus had greater hallux interphalangeal joint varus and a second metatarsal more inclined than with hallux valgus alone. The second toe deviated in a different direction according to the foot shape. Level III, retrospective comparative study.


    Directory of Open Access Journals (Sweden)

    Ion Dorin BUMBENECI


    Full Text Available The purpose of this study is to evaluate the level of assimilation for the terms "Proximity Management" and "Proximity Manager", both in the specialized literature and in practice. The study has two parts: the theoretical research of the two terms, and an evaluation of the use of Proximity management in 32 companies in Gorj, Romania. The object of the evaluation resides in 27 companies with less than 50 employees and 5 companies with more than 50 employees.

  11. Joint Disorders (United States)

    A joint is where two or more bones come together, like the knee, hip, elbow, or shoulder. Joints can be damaged by many types of injuries or diseases, including Arthritis - inflammation of a joint. It causes pain, stiffness, and swelling. Over time, ...

  12. Evolution of treatment of of the proximal humerus fractures (review

    Directory of Open Access Journals (Sweden)

    P. G. Kogan


    Full Text Available The article in generalized form acquaints with the publications devoted to the bases of proximal humeral fractures treatment. A brief digression on anatomy and biomechanics of the humeral joint allows to consider the main morphological features of it. The most commonly used classification of proximal humeral fractures concisely classify many types of damage. According to the clinical and anatomical characteristics of fractures tracked the historical aspect, the development and the current state of the most common methods of treatment. In his review collected works authors share their experience in the application of methods. It allows to further the perspective directions.

  13. Joint Injection/Aspiration (United States)

    ... A Patient / Caregiver Treatments Joint Injection / Aspiration Joint Injections (Joint Aspirations) Fast Facts Joint aspiration is used ... is derived from a joint aspiration or joint injection? Joint aspiration usually is done for help with ...

  14. Design and Clinical Application of Proximal Humerus Memory Connector (United States)

    Xu, Shuo-Gui; Zhang, Chun-Cai


    Treatment for comminuted proximal humerus fractures and nonunions are a substantial challenge for orthopedic surgeons. Plate and screw fixation does not provide enough stability to allow patients to begin functional exercises early after surgery. Using shape memory material nickel titanium alloy, we designed a new device for treating severe comminuted proximal humerus fractures that accommodates for the anatomical features of the proximal humerus. Twenty-two cases of comminuted fracture, malunion, and nonunion of the proximal humerus were treated with the proximal humeral memory connector (PHMC). No external fixation was needed after the operation and patients began active shoulder exercises an average of 8 days after the operation. Follow-up evaluation (mean 18.5 months) revealed that bone healing with lamellar bone formation occurred an average of 3.6 months after surgery for the fracture cases and 4.5 months after surgery for the nonunion cases. Average shoulder function was 88.5 according to the criteria of Michael Reese. PHMC is an effective new device to treat comminuted proximal humerus fractures and nonunions. The use of this device may reduce the need for shoulder joint arthroplasty.

  15. [Clinical analysis of prosthesis replacement for proximal humerus tumors]. (United States)

    Weng, Xiaojun; Liao, Qiande; Li, Xiaosheng; Wang, Jing


    To explore surgical strategies, functions and prognosis of artificial prosthesis replacement and soft tissue reconstruction for patients with invasive benign or primary malignant proximal humerus tumor.
 A total of 17 patients with invasive benign or primary malignant proximal humerus tumor underwent prosthetic replacement after segment bone tumor resection and soft tissues reconstruction from April 2007 to April 2014 were enrolled. Based on histological types, tumor stages and surgical procedures, the effects of artificial prosthesis replacement and soft tissue reconstruction on prognosis and shoulder joint function were evaluated.
 All patients were followed up for 8 to 96 months (average time: 58.9 months). Among 11 patients with primary malignant tumor, 5 died of tumor recurrence or metastasis, and 6 showed tumor-free survival for 24 to 91 months (average time: 54.83 months). The 6 patients with aggressive benign tumors survived for 39 to 96 months, with an average of 72.33 months. The shoulder joint function of 17 patients recovered to 64.88% of normal. There were significant differences in the shoulder joint function between the patients who underwent half shoulder replacement and those who underwent total shoulder replacement (56.25% vs 72.56%, Pshoulder joint function between the patients who underwent Type I A excision (retention of abductor muscles and rotator cuff) and those who underwent Type I B excision (68.75% vs 61.44%, Pshoulder joint function is associated with the methods of prosthesis replacement and soft tissue resection.

  16. The Applications of Finite Element Analysis in Proximal Humeral Fractures


    Yongyu Ye; Wei You; Weimin Zhu; Jiaming Cui; Kang Chen; Daping Wang


    Proximal humeral fractures are common and most challenging, due to the complexity of the glenohumeral joint, especially in the geriatric population with impacted fractures, that the development of implants continues because currently the problems with their fixation are not solved. Pre-, intra-, and postoperative assessments are crucial in management of those patients. Finite element analysis, as one of the valuable tools, has been implemented as an effective and noninvasive method to analyze...

  17. Korrekturosteotomie bei lateraler Tibiakopfimpression und Valgusfehlstellung == Correction of lateral tibial plateau depression and valgus malunion of the proximal tibia

    NARCIS (Netherlands)

    Marti, René K.; Kerkhoffs, Gino M. M. J.; Rademakers, Maarten V.


    OBJECTIVE: Improvement of joint congruency in malunited lateral tibial plateau fractures, reduction of pain, prevention of osteoarthritis. INDICATIONS: Valgus malalignment of the proximal tibia combined with intraarticular depression of the tibial plateau. CONTRAINDICATIONS: Patients in poor general

  18. Measuring implementation of a school-based violence prevention program : Fidelity and teachers' responsiveness as predictors of proximal outcomes

    NARCIS (Netherlands)

    Schultes, Marie Therese; Stefanek, Elisabeth; van de Schoot, Rens|info:eu-repo/dai/nl/304833207; Strohmeier, Dagmar; Spiel, Christiane


    When school-based prevention programs are put into practice, evaluation studies commonly only consider one indicator of program implementation. The present study investigates how two different aspects of program implementation - fidelity and participant responsiveness - jointly influence proximal

  19. Fractures of the proximal humerus

    DEFF Research Database (Denmark)

    Brorson, Stig


    . The bandages were further supported by splints made of wood or coarse grass. Healing was expected in forty days. Different fracture patterns have been discussed and classified since Ancient Greece. Current classification of proximal humeral fractures mainly relies on the classifications proposed by Charles......, classification of proximal humeral fractures remains a challenge for the conduct, reporting, and interpretation of clinical trials. The evidence for the benefits of surgery in complex fractures of the proximal humerus is weak. In three systematic reviews I studied the outcome after locking plate osteosynthesis......Fractures of the proximal humerus have been diagnosed and managed since the earliest known surgical texts. For more than four millennia the preferred treatment was forceful traction, closed reduction, and immobilization with linen soaked in combinations of oil, honey, alum, wine, or cerate...

  20. Ceramic joints (United States)

    Miller, Bradley J.; Patten, Jr., Donald O.


    Butt joints between materials having different coefficients of thermal expansion are prepared having a reduced probability of failure of stress facture. This is accomplished by narrowing/tapering the material having the lower coefficient of thermal expansion in a direction away from the joint interface and not joining the narrow-tapered surface to the material having the higher coefficient of thermal expansion.

  1. The infrastructure of psychological proximity

    DEFF Research Database (Denmark)

    Nickelsen, Niels Christian Mossfeldt


    ). The experience of psychological proximity between patient and nurse is provided through confidence, continuity and the practical set-up. This constitutes an important enactment of skillfulness, which may render telemedicine a convincing health service in the future. Methodology: The study draws on a pilot...... (Langstrup & Winthereik 2008). This study contributes by showing the infrastructure of psychological proximity, which is provided by way of device, confidence, continuity and accountability....

  2. Nonoperative treatment of PIPJ flexion contractures associated with Dupuytren's disease. (United States)

    Larocerie-Salgado, J; Davidson, J


    Post-surgical outcomes in patients with Dupuytren's disease causing flexion contractures of the proximal interphalangeal joint can be inconsistent and are often associated with protracted rehabilitation, reduced flexion, recurrence of the contracture, and patient dissatisfaction. An alternative treatment option, comprised of splinting and soft tissue mobilization techniques, was introduced to stabilize early contractures of the proximal interphalangeal joint in the hopes of delaying or obviating surgery. Over the course of approximately 12.6 months (± 7.8), thirteen patients were followed at the hand clinic at Hotel Dieu Hospital in Kingston. One patient was unable to complete the course of therapy. Of the remaining patients, analysis showed significant improvement in active proximal interphalangeal joint extension of approximately 14.6° (SD: ± 5.1°; range: 5-25°) over the course of the treatment (p Dupuytren's disease.

  3. The Applications of Finite Element Analysis in Proximal Humeral Fractures (United States)

    Ye, Yongyu; You, Wei; Zhu, Weimin; Cui, Jiaming; Chen, Kang


    Proximal humeral fractures are common and most challenging, due to the complexity of the glenohumeral joint, especially in the geriatric population with impacted fractures, that the development of implants continues because currently the problems with their fixation are not solved. Pre-, intra-, and postoperative assessments are crucial in management of those patients. Finite element analysis, as one of the valuable tools, has been implemented as an effective and noninvasive method to analyze proximal humeral fractures, providing solid evidence for management of troublesome patients. However, no review article about the applications and effects of finite element analysis in assessing proximal humeral fractures has been reported yet. This review article summarized the applications, contribution, and clinical significance of finite element analysis in assessing proximal humeral fractures. Furthermore, the limitations of finite element analysis, the difficulties of more realistic simulation, and the validation and also the creation of validated FE models were discussed. We concluded that although some advancements in proximal humeral fractures researches have been made by using finite element analysis, utility of this powerful tool for routine clinical management and adequate simulation requires more state-of-the-art studies to provide evidence and bases. PMID:29081829

  4. The Applications of Finite Element Analysis in Proximal Humeral Fractures

    Directory of Open Access Journals (Sweden)

    Yongyu Ye


    Full Text Available Proximal humeral fractures are common and most challenging, due to the complexity of the glenohumeral joint, especially in the geriatric population with impacted fractures, that the development of implants continues because currently the problems with their fixation are not solved. Pre-, intra-, and postoperative assessments are crucial in management of those patients. Finite element analysis, as one of the valuable tools, has been implemented as an effective and noninvasive method to analyze proximal humeral fractures, providing solid evidence for management of troublesome patients. However, no review article about the applications and effects of finite element analysis in assessing proximal humeral fractures has been reported yet. This review article summarized the applications, contribution, and clinical significance of finite element analysis in assessing proximal humeral fractures. Furthermore, the limitations of finite element analysis, the difficulties of more realistic simulation, and the validation and also the creation of validated FE models were discussed. We concluded that although some advancements in proximal humeral fractures researches have been made by using finite element analysis, utility of this powerful tool for routine clinical management and adequate simulation requires more state-of-the-art studies to provide evidence and bases.

  5. [Arthrodesis of the first metatarsophalangeal joint]. (United States)

    Fuhrmann, R A; Pillukat, T


    Fusion of the first metatarsophalangeal joint and realignment of the great toe in patients with painful arthritis to achieve pain-free walking. Hallux rigidus grade 3/4, hallux valgus et rigidus, claw toe deformity of the great toe, salvage after endoprosthesis or cheilectomy, avascular necrosis of the first metatarsal head arthritis of the first metatarsophalangeal joint. Infection, painful arthritis of the interphanageal joint (relative contraindication), and severe osteoporosis (relative contraindication). Dorsal approach to the first metatarsophalangeal joint. Removal of all osteophytes and circumferential capsular release. Debridement of the sesamoids. Cartilage resection (flat cuts or "cup and cone" reaming) and multiple drilling of the subchondral layer. In case of osseous defects, interposition of a corticocancellous bone graft. Trial reduction and assessment of the toe alignment. Fixation with two screws, one lag screw and dorsal plating, or dorsal plating only. Wound closure in layers. Full weight bearing in a postoperative shoe or partial weight bearing in a short cast for 4-6 weeks. If the X-ray reveals sufficient bone healing, patients are allowed to wear sneakers with a stiff sole for 3-6 months. Sport activities with impact loading are limited for at least 3 months. Final X-ray control after 6 months. A total of 70 feet with a fusion of the first metatarsophalangeal joint were followed up after 28 months. Postoperative complications (7.3%): 5 wound slough, 1 infection, and 6 painful delayed union. Modified AOFAS forefoot score (max. 85 points) was 43 (32-58) points preoperatively and 82 (71-85) points postoperatively. Great toe alignment was perfect in 57 feet. Nine toes showed a valgus (> 20°) and 4 toes a varus malalignment. Fifty-four attained full ground contact. Eight patients reached the ground by flexion of the interphalangeal joint and 8 patients presented with dorsiflexion of the great toe. X-ray showed consolidation of the

  6. [Gait analysis after rotationplasty hip surgery for malignant tumor of the proximal femur]. (United States)

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


    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.

  7. Joint Commission (United States)

    ... Commission Websites Quick Links The Center for Transforming Healthcare Blogs DataMart Event ... Table of Contents and Abstracts for The Joint Commission Journal on Quality and Patient Safety Monday October 2, ...

  8. Joint pain (United States)

    ... or conditions. It may be linked to arthritis , bursitis , and muscle pain . No matter what causes it, ... Autoimmune diseases such as rheumatoid arthritis and lupus Bursitis Chondromalacia patellae Crystals in the joint: Gout (especially ...

  9. Cubesat Proximity Operations Demonstration (CPOD) (United States)

    Villa, Marco; Martinez, Andres; Petro, Andrew


    The CubeSat Proximity Operations Demonstration (CPOD) project will demonstrate rendezvous, proximity operations and docking (RPOD) using two 3-unit (3U) CubeSats. Each CubeSat is a satellite with the dimensions 4 inches x 4 inches x 13 inches (10 centimeters x 10 centimeters x 33 centimeters) and weighing approximately 11 pounds (5 kilograms). This flight demonstration will validate and characterize many new miniature low-power proximity operations technologies applicable to future missions. This mission will advance the state of the art in nanosatellite attitude determination,navigation and control systems, in addition to demonstrating relative navigation capabilities.The two CPOD satellites are scheduled to be launched together to low-Earth orbit no earlier than Dec. 1, 2015.

  10. Joint dynamics and intra-subject variability during countermovement jumps in children and adults

    DEFF Research Database (Denmark)

    Raffalt, Peter C; Alkjær, Tine; Simonsen, Erik B


    The present study investigated lower limb joint work, lower limb joint energy transport and intra-subject variation of the joint dynamics during countermovement jumps in children and adults. Twelve healthy men and eleven healthy boys performed ten maximal countermovement jumps. Three dimensional...... countermovement jumps were less efficient in producing proximal joint work, transferring energy through joint centres and characterized by a higher intra-subject variation....

  11. Multiple intramedullary nailing of proximal phalangeal fractures of hand

    Directory of Open Access Journals (Sweden)

    Patankar Hemant


    Full Text Available Background: Proximal phalangeal fractures are commonly encountered fractures in the hand. Majority of them are stable and can be treated by non-operative means. However, unstable fractures i.e. those with shortening, displacement, angulation, rotational deformity or segmental fractures need surgical intervention. This prospective study was undertaken to evaluate the functional outcome after surgical stabilization of these fractures with joint-sparing multiple intramedullary nailing technique. Materials and Methods: Thirty-five patients with 35 isolated unstable proximal phalangeal shaft fractures of hand were managed by surgical stabilization with multiple intramedullary nailing technique. Fractures of the thumb were excluded. All the patients were followed up for a minimum of six months. They were assessed radiologically and clinically. The clinical evaluation was based on two criteria. 1. total active range of motion for digital functional assessment as suggested by the American Society for Surgery of Hand and 2. grip strength. Results: All the patients showed radiological union at six weeks. The overall results were excellent in all the patients. Adventitious bursitis was observed at the point of insertion of nails in one patient. Conclusion: Joint-sparing multiple intramedullary nailing of unstable proximal phalangeal fractures of hand provides satisfactory results with good functional outcome and fewer complications.


    African Journals Online (AJOL)

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    SHORT COMMUNICATION. PROXIMATE COMPOSITION, MINERAL CONTENT AND ANTINUTRITIONAL. FACTORS OF SOME CAPSICUM (Capsicum annum) VARIETIES GROWN IN. ETHIOPIA. Esayas K.1, Shimelis A.2, Ashebir F.3, Negussie R.3, Tilahun B.4 and Gulelat D.4*. 1Hawassa University, Department of Food ...

  13. Anatomy and Physiology of the Lesser Metatarsophalangeal Joints. (United States)

    Finney, Fred T; Cata, Ezequiel; Holmes, James R; Talusan, Paul G


    Knowledge and command of anatomy is paramount to effectively treating disorders of the lesser metatarsophalangeal (MTP) joints. The osseous structures consist of the proximal phalanx of the toe and the metatarsal head. The soft tissues on the dorsum of the MTP joint include the joint capsule and the tendons of extensor digitorum longus and extensor digitorum brevis. The proper and accessory collateral ligaments form the medial and lateral walls and contribute to stability in the coronal and sagittal planes. The plantar plate forms the plantar border of the MTP joint and stabilizes the MTP joint against hyperextension and dorsal translation. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. [Anatomy of the fetlock joint in horses by means of joint casts]. (United States)

    Stiglhuber, A; Breit, S; König, H E


    The equine fetlock joint cavity shows ten pouches. The dorsal recess, which is oriented to the proximal side, is separated from those three pouches, which show to the distal direction, by several capsular folds. These folds are documented by means of sagittal sections through the fetlock joint. A medial/lateral recess is covered by the deep part of the collateral ligament of the fetlock joint. The collateral ligaments as well as the sesamoidean collateral ligaments are closely connected with the joint capsule, from which two capsular folds are separated. Between the part of the sesamoidean collateral ligament, that inserts to the metacarpus/metatarsus and the part that inserts to the proximal phalanx, the fetlock joint cavity pouches as Recessus palmaris/plantaris distalis medialis/lateralis. The palmar/plantar distal pouch, which lies in the median line, is covered by the Ligamentum sesamoideum rectum. This recess is narrowed down by the cruciated sesamoidean ligaments. The dominant palmar/plantar proximal recess is subdivided into several small pouches by strings or bands of the joint capsule, which can already be seen with an unaided eye.

  15. Indications for computed tomography (CT-) diagnostics in proximal humeral fractures

    DEFF Research Database (Denmark)

    Bahrs, Christian; Rolauffs, Bernd; Südkamp, Norbert P


    diagnostics depending on the fractured parts. METHODS: In a prospective diagnostic study in two level 1 trauma centers, 44 patients with proximal humeral fractures were diagnosed with conventional X-rays (22 AP + axillary views, 22 AP + scapular Y-views) and CT (multi-planar reconstruction (MPR) and maximum...... a significantly better assessment of the relevant structures than conventional diagnostics (p X-rays with AP view and a high-quality axillary view are useful for primary diagnostics of the fracture......--independently of the number of fractured parts--when the proximal humerus and the shoulder joint are not presented with sufficient X-ray-quality to establish a treatment plan....

  16. Joint purpose?

    DEFF Research Database (Denmark)

    Pristed Nielsen, Helene


    of anti-discrimination in Europe today? And what empirical evidence may be found for such a joint approach? The paper discusses how the contemporary EU context differs from the American context which prompted Crenshaw to raise the point about intersectionality, and it analyses documents and interviews...

  17. Retrospective analysis of the rate and interval to union for joint arthrodesis of the foot and ankle. (United States)

    Mirmiran, Roya; Wilde, Brandon; Nielsen, Michael


    Arthrodesis is a common procedure indicated for surgical treatment of end-stage degenerative joint disease of the foot and ankle. Many published studies have reviewed the union rate, focusing on specific technique or fixation. However, studies reporting on the average period required to achieve fusion, irrespective of the type of fixation or surgical method used, have been lacking. We report on the union rate and interval to fusion in patients who had undergone primary arthrodesis of various joints of the foot and ankle. A retrospective review of the medical records of 135 patients was performed. The specific joints studied were ankle, and the subtalar, triple, first tarsometatarsal, first metatarsophalangeal, and hallux interphalangeal joints. Our results showed that the average interval for complete fusion was significantly less for the joints in the forefoot, with the subtalar joint, ankle, and triple arthrodesis requiring a longer period to achieve complete fusion. The nonunion rate was also greater when the fusion involved the joints of the rearfoot. Our results have refuted the idea that 6 weeks is the minimum period required to achieve fusion in the foot and ankle. The results of our study support the need for additional education of the patients and surgeons that the interval required for recovery after foot and ankle fusion depends on the location and surface area that has been fused. Copyright © 2014 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  18. Photoactivated In Vivo Proximity Labeling. (United States)

    Beck, David B; Bonasio, Roberto


    Identification of molecular interactions is paramount to understanding how cells function. Most available technologies rely on co-purification of a protein of interest and its binding partners. Therefore, they are limited in their ability to detect low-affinity interactions and cannot be applied to proteins that localize to difficult-to-solubilize cellular compartments. In vivo proximity labeling (IPL) overcomes these obstacles by covalently tagging proteins and RNAs based on their proximity in vivo to a protein of interest. In IPL, a heterobifunctional probe comprising a photoactivatable moiety and biotin is recruited by a monomeric streptavidin tag fused to a protein of interest. Following UV irradiation, candidate interacting proteins and RNAs are covalently biotinylated with tight spatial and temporal control and subsequently recovered using biotin as an affinity handle. Here, we describe experimental protocols to discover novel protein-protein and protein-RNA interactions using IPL. © 2017 by John Wiley & Sons, Inc. Copyright © 2017 John Wiley & Sons, Inc.

  19. Prox-1 Automated Proximity Operations (United States)


    on demonstrating the functionality required to meet minimum mission success criteria. The minimum mission includes on- orbit spacecraft checkout of...also includes deployment of LightSail-B from the P-POD, and imaging of LightSail-B for 20 minutes as it recedes from Prox-1. small satellite ; proximity...criteria. The minimum mission includes on- orbit spacecraft checkout of all spacecraft subsystems, including flight qualification of the following new

  20. Proximal spinal muscular atrophy: current orthopedic perspective

    Directory of Open Access Journals (Sweden)

    Haaker G


    Full Text Available Gerrit Haaker, Albert Fujak Department of Orthopaedic Surgery, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany Abstract: Spinal muscular atrophy (SMA is a hereditary neuromuscular disease of lower motor neurons that is caused by a defective "survival motor neuron" (SMN protein that is mainly associated with proximal progressive muscle weakness and atrophy. Although SMA involves a wide range of disease severity and a high mortality and morbidity rate, recent advances in multidisciplinary supportive care have enhanced quality of life and life expectancy. Active research for possible treatment options has become possible since the disease-causing gene defect was identified in 1995. Nevertheless, a causal therapy is not available at present, and therapeutic management of SMA remains challenging; the prolonged survival is increasing, especially orthopedic, respiratory and nutritive problems. This review focuses on orthopedic management of the disease, with discussion of key aspects that include scoliosis, muscular contractures, hip joint disorders, fractures, technical devices, and a comparative approach of conservative and surgical treatment. Also emphasized are associated complications including respiratory involvement, perioperative care and anesthesia, nutrition problems, and rehabilitation. The SMA disease course can be greatly improved with adequate therapy with established orthopedic procedures in a multidisciplinary therapeutic approach. Keywords: spinal muscular atrophy, scoliosis, contractures, fractures, lung function, treatment, rehabilitation, surgery, ventilation, nutrition, perioperative management

  1. Joint Hypermobility: What Causes Loose Joints? (United States)

    ... result in a higher incidence of dislocations and sprains. Your doctor might suggest physical therapy to help strengthen the muscles surrounding these joints. See your doctor if your loose joints also cause you pain. Rarely, joint hypermobility is a sign ...

  2. Effect of triple pelvic osteotomy on the proximal femoral geometry in dysplastic dogs. (United States)

    Sarierler, Murat; Yildirim, Ismail Gokce; Ocal, Mehmet Kamil


    Triple pelvic osteotomy (TPO) is one of the surgical procedures for use to try to reduce subsequent degenerative joint disease or modify the progress of hip dysplasia in young dogs. Joint force and pressure distribution were changed by this procedure. Therefore, the aim of this study was to find out whether the remodeling of proximal femur exists or not after TPO in dysplastic dogs. Ten femora from five young dysplastic mongrel dogs, treated unilaterally with TPO using 20° canine pelvic osteotomy plates, were used. One year after TPO, neck-proximal shaft angle, femoral head, neck, diaphyseal and mid-shaft diameters, total femoral, femoral neck axis, and intertrochanteric, femoral head offset lengths as well as the lengths from head center to lateral margin of greater trochanter and to proximal femoral axis were measured from the bone. The significant differences between treatment and control side were determined in Norberg angle, neck-proximal shaft angle, neck diameter, diaphyseal diameter, mid-shaft diameter, length from head center to proximal femoral axis and femoral head offset length. In conclusion, although small number of cases was used, it was determined that the aforementioned variables are affected by TPO. So, these variables may be supply additional information about the changes to the joint following TPO in dysplastic dogs. Copyright © 2010 Elsevier Ltd. All rights reserved.

  3. Determination of muscle effort at the proximal femur rotation osteotomy (United States)

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


    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.

  4. Cushing proximal symphalangism and the NOG and GDF5 genes

    Energy Technology Data Exchange (ETDEWEB)

    Plett, Sara K. [Columbia University, College of Physicians and Surgeons, New York, NY (United States); Berdon, Walter E.; Oklu, Rahmi [Columbia Presbyterian Medical Center, Department of Radiology, New York, NY (United States); Cowles, Robert A. [Morgan Stanley Children' s Hospital of New York-Presbyterian, Division of Pediatric Surgery, Department of Surgery, New York, NY (United States); Campbell, John B. [Arnold Palmer Hospital for Children, Department of Radiology, Orlando, FL (United States)


    Proximal symphalangism (SYM1) is an autosomal-dominant developmental disorder of joint fusion. This disorder is best known from famous historical descriptions of two large kindred: Cushing's description in 1916 of the ''straight-fingered'' Brown family of Virginia and Drinkwater's description in 1917 of the British Talbot family of noble blood, descended from the English war hero John Talbot, the first Earl of Shrewsbury (1388-1453). Recent genetic studies link this phenotype to expression of abnormal genes at future joint sites: too little expression of NOG, a growth antagonist, or overexpression of GDF5, a growth agonist, results in cartilage overgrowth and bony fusion. This review unites in depth the first historical accounts of SYM1 with a clinical description and reviews the current understanding of the molecular mechanism underlying what is likely the oldest dominant trait ever studied. (orig.)


    African Journals Online (AJOL)


    PROXIMATE AND ELEMENTAL COMPOSITION OF WHITE GRUBS. 1 Alhassan, A. J. 1M .S. Sule, 1J. ... ABSTRACT. This study determined the proximate and mineral element composition of whole white grubs using standard methods of analysis. Proximate ... days, before pulverized to powder and kept in plastic container.

  6. Intraoperative Fracture of a Pyrocarbon PIP Total Joint—A Case Report


    Skie, Martin; Gove, Nicholas; Ciocanel, Despina


    Pain or dysfunction of the finger joints due to arthritis or traumatic injuries that fail medical management may necessitate arthroplasty or joint replacement. The goals of the finger joint implant arthroplasty are to relieve pain, to correct deformity, and to improve the function and appearance of the hand. Several prosthetic implants have been used for the replacement of the proximal interphalangeal (PIP) joint. Pyrocarbon materials, a form of pyrolytic carbon, a ceramic-like material, have...

  7. Equilibrium properties of proximity effect

    Energy Technology Data Exchange (ETDEWEB)

    Esteve, D.; Pothier, H.; Gueron, S.; Birge, N.O.; Devoret, M.


    The proximity effect in diffusive normal-superconducting (NS) nano-structures is described by the Usadel equations for the electron pair correlations. We show that these equations obey a variational principle with a potential which generalizes the Ginzburg-Landau energy functional. We discuss simple examples of NS circuits using this formalism. In order to test the theoretical predictions of the Usadel equations, we have measured the density of states as a function of energy on a long N wire in contact with a S wire at one end, at different distances from the NS interface. (authors). 12 refs.

  8. Force-Sensing Actuator with a Compliant Flexure-Type Joint for a Robotic Manipulator

    Directory of Open Access Journals (Sweden)

    Mathieu Grossard


    Full Text Available This paper deals with the mechatronic design of a novel self-sensing motor-to-joint transmission to be used for the actuation of robotic dexterous manipulators. Backdrivability, mechanical simplicity and efficient flexure joint structures are key concepts that have guided the mechanical design rationale to provide the actuator with force sensing capabilities. Indeed, a self-sensing characteristic is achieved by the specific design of high-resolution cable-driven actuators based on a DC motor, a ball-screw and a monolithic compliant anti-rotation system together with a novel flexure pivot providing a frictionless mechanical structure. That novel compliant pivot with a large angular range and a small center shift has been conceived of to provide the inter-phalangeal rotational degree of freedom of the fingers’ joints to be used for integration in a multi-fingered robotic gripper. Simultaneously, it helps to remove friction at the joint level of the mechanism. Experimental tests carried out on a prototype show an accurate matching between the model and the real behavior. Overall, this mechatronic design contributes to the improvement of the manipulation skills of robotic grippers, thanks to the combination of high performance mechanics, high sensitivity to external forces and compliance control capability.

  9. Pachydermodactyly: An Unknown Entity. (United States)

    Tolis, Konstantinos; Stavropoulos, Nikolaos; Mavrogenis, Andreas; Spyridonos, Sarantis


    Pachydermodactyly is a rare benign disease that usually affects the dorsal skin and subcutaneous tissue of the proximal interphalangeal joints of the index, middle, ring, and little fingers; the thumb is usually spared. Hyperkeratosis on the dorsal side of the affected areas is common. We present a case of a 19-year-old man who was diagnosed with pachydermodactyly after evaluation of a painless, progressive swelling and hyperkeratosis at the proximal interphalangeal and distal interphalangeal joints of all fingers, bilaterally, for 6 years before presentation. Conservative treatment was prescribed and the patient remains asymptomatic. Given the benign and nonprogressive course of the disease, symptomatic treatment alone is all that is usually required. Copyright © 2016 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

  10. Concomitant ipsilateral proximal tibia and femoral Hoffa fractures. (United States)

    Jain, Anuj; Aggarwal, Prakash; Pankaj, Amite


    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.


    Guo, Jinhai; Huang, Fuguo


    To review the research progress of the biomechanics of proximal row carpal instability (IPRC). The related literature concerning IPRC was extensively reviewed. The biomechanical mechanism of the surrounding soft tissue in maintaining the stability of the proximal row carpal (PRC) was analyzed, and the methods to repair or reconstruct the stability and function of the PRC were summarized from two aspects including basic biomechanics and clinical biomechanics. The muscles and ligaments of the PRC are critical to its stability. Most scholars have reached a consensus about biomechanical mechanism of the PRC, but there are still controversial conclusions on the biomechanics mechanism of the surrounding soft tissue to stability of distal radioulnar joint when the triangular fibrocartilage complex are damaged and the biomechanics mechanism of the scapholunate ligament. At present, there is no unified standard about the methods to repair or reconstruct the stability and function of the PRC. So, it is difficult for clinical practice. Some strides have been made in the basic biomechanical study on muscle and ligament and clinical biomechanical study on the methods to repair or reconstruct the stability and function of PRC, but it will be needed to further study the morphology of carpal articular surface and the adjacent articular surface, the pressure of distal carpals to proximal carpal and so on.


    African Journals Online (AJOL)


    that her maternal twin had psoriasis. There was not any rheumatic disease in family her background. No psoriasis was detected in the patient. In physical examination, there was redness in the cornea of left eye and the 3cm alopecic region in hairy skin. There were pressure-induced pains in proximal interphalangeal joints ...

  13. Camptodactyly: A Phenotype of Dupuytren′s Contracture

    Directory of Open Access Journals (Sweden)

    Kamleader Singh


    Full Text Available A 15 year old boy had permanent flexion contractures at proximal interphalangeal joints of the little and ring fingers of both hands, along with slight hemiatrophy of face and bilateral mild ptosis. The hand deformity superficially resembled. Dupuytren′s contacture. This combination of features does not fit with the syndromes described so far, whose one of, the components is camptodactyly.

  14. The Power of a Soccer Ball: A Traumatic Open Finger Dislocation—A Rare Case Presentation

    Directory of Open Access Journals (Sweden)

    Turan Cihan Dülgeroğlu


    Full Text Available Proximal interphalangeal joint dislocations are injuries observed frequently and caused by axial loading on the finger in the extension. In this paper we present a traumatic open finger dislocation due to a ball hitting a wrestler. It was successfully treated with reduction and the volar plate and collateral bond fixation were applied with absorbable sutures.

  15. Alloplasty of the humeral joint. (United States)

    Górecki, Andrzej; Struzik, Sławomir


    Background. Since 1980's, shoulder arthroplasty has become more oftenly performed procedure, and for severe comminuted fractures of proximal humerus (fou r- fragmented fractures, according to Neer's classification) has become first - line therapeutic option. At the beginnig of 90's, contemporary prinicples of shoulder arthroplasty were introduced. It is assumed that 4 mechanical parameters, i.e. range of motion, joint stability, strengh and smoothness of prosthesis components contribute to shoulder function, and we sholud reach toward their reconstruction during surgical procedure. Material and Methods. In our Department from 1995 to1999 we performed 14 shoulder hemiarthroplasties using Bio-Modular prosthesis (12 women and 2 men). Patients' age ranged from 41 to 75 years (average 61.8 years). Indications included: acute comminuted proximal humerus fractures, proximal humerus malunions, and either degenerative arthritis or rheumatoid arthrits of the shoulder. Aftertreatment consisted of passive motions introduced on the first day after an operation, followed by assisted active excercises 4- 6 weeks later, and motions against resistance, allowed 2 months postoperatively. Results. The outcomes were evaluated three years after surgery, and were measured as the score in the Constant scale and as subjective patients' assesments. Improvement was seen as an increase from average 28.3 preoperative Constant score, to 60.3 postoperatively. Subjectively, excellent outcome was reported by 4 patients, good - by 7, and fair by 2 patients. Conclusions. Our experience shows that whereas indications to shoulder artrhroplasty are not frequent in cases of fractures or orthopedic conditions of the affected region, in properly selected group of patients this procedure is effective treatment option, alleviating pain and allowing for regaining well - functioning joint, but long-lasting, at leats one-year long rehabilitation programm after surgery is mandatory.

  16. Complications in proximal humeral fractures. (United States)

    Calori, Giorgio Maria; Colombo, Massimiliano; Bucci, Miguel Simon; Fadigati, Piero; Colombo, Alessandra Ines Maria; Mazzola, Simone; Cefalo, Vittorio; Mazza, Emilio


    Necrosis of the humeral head, infections and non-unions are among the most dangerous and difficult-to-treat complications of proximal humeral fractures. The aim of this work was to analyse in detail non-unions and post-traumatic bone defects and to suggest an algorithm of care. Treatment options are based not only on the radiological frame, but also according to a detailed analysis of the patient, who is classified using a risk factor analysis. This method enables the surgeon to choose the most suitable treatment for the patient, thereby facilitating return of function in the shortest possible time. The treatment of such serious complications requires the surgeon to be knowledgeable about the following possible solutions: increased mechanical stability; biological stimulation; and reconstructive techniques in two steps, with application of biotechnologies and prosthetic substitution. Copyright © 2016 Elsevier Ltd. All rights reserved.

  17. Joint mobilization. (United States)

    Saunders, Deborah Gross; Walker, J Randy; Levine, David


    Therapeutic touch has been used in human beings to soothe aches and pains. Most dogs also seem to enjoy being touched. Manual therapy techniques are skilled hand movements intended to improve tissue extensibility; increase range of motion; induce relaxation; mobilize or manipulate soft tissue and joints; modulate pain; and reduce soft tissue swelling, inflammation, or restriction. The intent of this article is to provide an overview of the principles of manual therapy, followed by selected treatment techniques for the hip, stifle, elbow, shoulder, carpus.and thoracic and lumbar spine. The techniques of G.D. Maitland, an Australian physical therapist who developed a clinically based approach in the 1960s and 1970s, are emphasized.

  18. Bilateral sternoclavicular joint dislocation due to sternal fracture: Is it a dislocation or a separation? (United States)

    Yi, Jin Woong; Kim, Doo Hyun; Heo, Youn Moo; Jun, June Bum


    Traumatic bilateral sternoclavicular joint dislocation is very rare injury. In shoulder girdle injuries, anterior dislocation of the sternoclavicular joint accounts for 3 % and posterior sternoclavicular joint dislocation is lesser. Previous reported cases about bilateral sternoclavicular joint dislocation were result from proximal clavicle fracture with intact connection between sternum and ribs. But, the sternoclavicular joint dislocation secondary to fracture and angulation of the sternum with intact relationship between ribs and clavicle has not been reported. Authors experienced patient who has a bilateral anterior sternoclavicular joint dislocation caused by sternum fracture and anterior angulation, but intact relationship between ribs and clavicle. We report this case with satisfactory result.

  19. Proximity sensor technology for manipulator end effectors (United States)

    Johnston, A. R.


    Optical proximity sensing techniques which could be used to help control the critical grasping phase of a remote manipulation are described. The proximity sensors described use a triangulation geometry to detect a surface located in a pre-determined region. The design of the proximity sensors themselves is discussed, as well as their application to manipulator control with a local control loop, and possibilities for future development are discussed.

  20. Reliability of Tubular Joints

    DEFF Research Database (Denmark)

    Sørensen, John Dalsgaard; Thoft-Christensen, Palle

    In this paper the preliminary results obtained by tests on tubular joints are presented. The joints are T-joints and the loading is static. It is the intention in continuation of these tests to perform tests on other types of joints (e.g. Y-joints) and also with dynamic loading. The purpose of th...

  1. Paraplegic flexion contracture of hip joints: An unsolvable problem. (United States)

    Bhattacharyya, Sailendra


    Paraplegic flexion contracture of hip joints beyond 90° is a difficult condition to treat for any orthopedic surgeon. There is no fixed protocol of treatment described, by and large it is individualized. A 20 year old female presented with paraplegia for last 15 years due to irrecoverable spinal cord disease with complete sensory and motor loss of both lower extremities and was admitted with acute flexion contracture of both hip joints with trunk resting on thighs. She underwent bilateral proximal femoral resection. Both hip joints were straight immediately after surgery and patient could lie on her back. In a course of time, she started sitting on her buttocks, led a comfortable wheelchair life with a sitting balance. Proximal femoral resection is an effective method to treat long standing irrecoverable paraplegic acute flexion deformity of the hip joint.

  2. Proximate composition and antinutrient content of pumpkin ...

    African Journals Online (AJOL)

    Proximate composition and antinutrient content of pumpkin ( Cucurbita pepo ) and sorghum ( Sorghum bicolor ) flour blends fermented with Lactobacillus plantarum , Aspergillus niger and Bacillus subtilis.

  3. Joint Replacement (Finger and Wrist Joints) (United States)

    ... artificial joint Damage to vessels, nerves or other structures in the region of the surgery Alternatives Some alternate procedures for treating arthritis include: Joint injections Oral medications such as aspirin or anti-inflammatory medicines Hand therapy exercises and ...

  4. Joint x-ray (United States)

    X-ray - joint; Arthrography; Arthrogram ... x-ray technologist will help you position the joint to be x-rayed on the table. Once in place, pictures are taken. The joint may be moved into other positions for more ...

  5. Vascularized transfer of two coherent toe joints in simultaneously reconstructing MCP and PIP of a mutilated finger. (United States)

    Bachleitner, K; Blank, B; Klein, S; Geis, S; Aung, T; Prantl, L; Dolderer, J H


    The reconstruction of metacarpal- and interphalangeal joints after severe hand injuries has been proven to be challenging. Commonly used procedures like arthrodesis, amputation or ray resection of the finger compromise the functionality of the injured finger. Especially for young patients, the restoration of all functions of the fingers is a priority. Local tissue transfers for finger joint reconstructions is not an option due to inacceptable donor site morbidity; microsurgical tissue transfers in terms of free toe joint transfers have proven to be a valuable method. We present the case of a patient who suffered an excessive injury from a circular saw to his dominant hand. The MCP Joints of D2-D4 were fully destroyed, along with the PIP joint of a subtotally amputated D4. Arteries, nerves and tendons could be coapted directly, while primarily reconstructing of the finger joints was impossible. To ensure a possible regain of full functionality, two coherent joints, the MTP and the PIP of one toe, were transferred to the ring finger as a single transplant, reconstructing the MCP and the PIP joints of the injured finger in a one step procedure. Additionally the MCP joint of the D2 was reconstructed by the use of a free PIP-joint transfer, further the MCP joint of the D3 was replaced by an MCP endoprosthesis. After a follow up of 3 years the patient displayed full function of his dominant hand including sensitivity, and has gone back to manual work without limitations. The result was cosmetically acceptable and the donor site defect was easily being tolerated by the patient who is playing soccer in the regional soccer league. Free double toe joint transfer has been proven feasible in this patient. While transferring a single toe joint to reconstruct a finger joint is a well-established method, our review of the latest literature showed no case of a free transfer of two coherent joints and three transplanted joints in one hand. The applied microsurgical technique should

  6. Giant cell tumor of the tendon sheath restricting joint movement in the thumb: A case study and review of literature

    Directory of Open Access Journals (Sweden)

    Muzaffer Durmus


    Full Text Available Giant cell tumors of the tendon sheath are the second most common type of subcutaneous benign tumors found in the hand. These tumors are slow growing soft tissue mases that develop over a long period of time and can occur at any age. Although such lesions are usually painless, there is a possibility of recurrence of the tumor. Patients should seek postoperative management in order to prevent any possibility of recurrence. In view of the current literature, we present a case involving a patient suffering from a multifocal giant cell tumor of the tendon sheath that restricted movement of the interphalangeal joints of the thumb. [Hand Microsurg 2015; 4(1.000: 16-19

  7. Functional outcome following proximal humeral interlocking system plating for displaced proximal humeral fractures


    Thyagarajan David; Haridas Samarth; Jones Denise; Dent Colin; Evans Richard; Williams Rhys


    Aim: To assess the functional outcome following internal fixation with the PHILOS (proximal humeral interlocking system) for displaced proximal humeral fractures. Patients and Methods: We reviewed 30 consecutive patients treated surgically with the proximal humeral locking plate for a displaced proximal humeral fracture. Functional outcome was determined using the American Shoulder and Elbow Society (ASES) score and Constant Murley score. Results: Average age of the patients was 58 years...

  8. Best Proximity Points for a New Class of Generalized Proximal Mappings

    Directory of Open Access Journals (Sweden)

    Tayyab Kamran


    Full Text Available The best proximity points are usually used to find the optimal approximate solution of the operator equation Tx = x, when T has no fixed point. In this paper, we prove some best proximity point theorems for nonself multivalued operators, following the foot steps of Basha and Shahzad [Best proximity point theorems for generalized proximal contractions, Fixed Point Theory Appl., 2012, 2012:42].

  9. Preliminary phytochemical screening, proximate and elemental ...

    African Journals Online (AJOL)

    The seed powder of Moringa oleifera was analysed for its phytochemical, proximate and elemental composition using Folin-Denis spectrophotometric method, gravimetric method and energy dispersing X-ray fluorescence (EDXRF) transmission emission technique respectively. The seed powder had the following proximate ...

  10. Bimalleolar ankle fracture with proximal fibular fracture

    NARCIS (Netherlands)

    Colenbrander, R. J.; Struijs, P. A. A.; Ultee, J. M.


    A 56-year-old female patient suffered a bimalleolar ankle fracture with an additional proximal fibular fracture. This is an unusual fracture type, seldom reported in literature. It was operatively treated by open reduction and internal fixation of the lateral malleolar fracture. The proximal fibular

  11. Grouping by Proximity in Haptic Contour Detection (United States)

    Overvliet, Krista E.; Krampe, Ralf Th.; Wagemans, Johan


    We investigated the applicability of the Gestalt principle of perceptual grouping by proximity in the haptic modality. To do so, we investigated the influence of element proximity on haptic contour detection. In the course of four sessions ten participants performed a haptic contour detection task in which they freely explored a haptic random dot display that contained a contour in 50% of the trials. A contour was defined by a higher density of elements (raised dots), relative to the background surface. Proximity of the contour elements as well as the average proximity of background elements was systematically varied. We hypothesized that if proximity of contour elements influences haptic contour detection, detection will be more likely when contour elements are in closer proximity. This should be irrespective of the ratio with the proximity of the background elements. Results showed indeed that the closer the contour elements were, the higher the detection rates. Moreover, this was the case independent of the contour/background ratio. We conclude that the Gestalt law of proximity applies to haptic contour detection. PMID:23762364

  12. Proximate analysis on four edible mushrooms ADEDAYO ...

    African Journals Online (AJOL)

    Michael Horsfall

    Vol. 15 (1) 9 - 11. Full-text Available Online at Proximate analysis on four edible mushrooms. ADEDAYO, MAJEKODUNMI RACHEL. Nigerian Stored Product Research Institute, P.M.B.3032, Kano. ABSTRACT: Proximate study was conducted on four edible mushrooms commonly found in farmlands in.

  13. Proximate Sources of Collective Teacher Efficacy (United States)

    Adams, Curt M.; Forsyth, Patrick B.


    Purpose: Recent scholarship has augmented Bandura's theory underlying efficacy formation by pointing to more proximate sources of efficacy information involved in forming collective teacher efficacy. These proximate sources of efficacy information theoretically shape a teacher's perception of the teaching context, operationalizing the difficulty…

  14. Phytochemical screening, proximate analysis and anticonvulsant ...

    African Journals Online (AJOL)

    Spigelia anthelmia is used traditionally in Southern Nigeria for the treatment of infant convulsion and epilepsy. This study investigated the phytochemical constituents, proximate analysis and anticonvulsant effect of the methanolic extract of Spigelia anthelmia. Phytochemical evaluation and proximate analysis was carried ...

  15. Intramedullary compression device for proximal ulna fracture. (United States)

    Hong, Choon Chiet; Han, Fucai; Decruz, Joshua; Pannirselvam, Vinodhkumar; Murphy, Diarmuid


    Proximal ulna fractures account for 20% of all proximal forearm fractures. Many treatment options are available for such fractures, such as cast immobilisation, plate and screw fixation, tension band wiring and intramedullary screw fixation, depending on the fracture pattern. Due to the subcutaneous nature of the proximal forearm, it is vulnerable to open injuries over the dorsal aspect of the proximal ulna. This may in turn prove challenging, as it is critical to obtain adequate soft tissue coverage to reduce the risk of implant exposure and bony infections. We herein describe a patient with a Gustillo III-B open fracture of the proximal ulna, treated with minimally invasive intramedullary screw fixation using a 6.0-mm cannulated headless titanium compression screw (FusiFIX, Péronnas, France).

  16. The shape of the hominoid proximal femur: a geometric morphometric analysis (United States)

    Harmon, Elizabeth H


    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

  17. Arthroscopy of the fetlock joint of the dromedary camel. (United States)

    Ali, M M; Abd-Elnaeim, M


    To describe a technique for arthroscopy of the fetlock joint of the dromedary camel, and the problems that could occur during and after arthroscopy. Seven animals (4 cadaveric limbs and 3 living camels) were used in this study. Two dorsal arthroscopic portals (lateral and medial) and one palmaro-lateral portal were used. Distension of the joint capsule was effected by injecting Ringer´s lactate solution into the joint cavity. Landmarks for the dorsal arthroscopic portals were located at the centre of the groove bounded by the lateral branch of the suspensory ligament and the large metacarpus at a point 1 cm proximal to the joint. The palmaro-lateral portal was located in a triangular area between the branch of the suspensory ligament, the large metacarpus, and the sesamoid bone, with insertion of the arthroscope in a 45° joint flexion angle. Arthroscopy of the fetlock joint via the dorso-lateral portal allowed examination of the distal end of the large metacarpus and the proximal end of the first phalanx of the fourth digit. Arthroscopy via a dorso-medial approach allowed examination of the distal end of the large metacarpus and the proximal end of the first phalanx and the distal end of the third digit. The palmaro-lateral portal allowed examination of the sesamoid bones, the synovial membrane, and the synovial villi. The main complications recorded during arthroscopy were iatrogenic articular surface injury as well as obstruction of vision with the synovial villi. This is the first work to describe the normal arthroscopy of the fetlock joint in the dromedary camel, the arthroscopic portals, and the complications that could occur during and after arthroscopy. Further studies are required for diagnosis of pathological changes in the fetlock joint of the dromedary camel and for arthroscopy of other joints in the dromedary camel.

  18. Proximal Alternating Direction Method with Relaxed Proximal Parameters for the Least Squares Covariance Adjustment Problem

    Directory of Open Access Journals (Sweden)

    Minghua Xu


    Full Text Available We consider the problem of seeking a symmetric positive semidefinite matrix in a closed convex set to approximate a given matrix. This problem may arise in several areas of numerical linear algebra or come from finance industry or statistics and thus has many applications. For solving this class of matrix optimization problems, many methods have been proposed in the literature. The proximal alternating direction method is one of those methods which can be easily applied to solve these matrix optimization problems. Generally, the proximal parameters of the proximal alternating direction method are greater than zero. In this paper, we conclude that the restriction on the proximal parameters can be relaxed for solving this kind of matrix optimization problems. Numerical experiments also show that the proximal alternating direction method with the relaxed proximal parameters is convergent and generally has a better performance than the classical proximal alternating direction method.

  19. Evaluation of percutaneous pinning in unstable proximal humeral fractures: A novel technique

    Directory of Open Access Journals (Sweden)

    Nishikant Kumar


    Full Text Available Management of unstable proximal humeral fractures has remained controversial since ages. Open reduction and internal fixation have resulted in devastating complications like stiffness of shoulder joint, avascular necrosis, infection, etc., We are presenting a novel method of percutaneous pinning of unstable proximal humeral fractures. All cases (32 were done closely without soft tissue stripping. All cases were followed-up for a period of 3 years; and results were assessed according to 100 point constant score. A total of 75% cases showed excellent to good results. To minimize the complications like pin site infection, loosening, neurovascular damage we used fixed pin site insertion technique, and threaded pins in osteoporotic patients. So percutaneous pinning is a safe and novel method of management of unstable proximal humeral fractures if certain principles are borne in mind before using it.

  20. 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)


    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.)

  1. Composite pipe to metal joint

    Energy Technology Data Exchange (ETDEWEB)

    Leslie, James C.; Leslie, II, James C.; Heard, James; Truong, Liem V.; Josephson, Marvin


    A method for making a metal to composite tube joint including selecting an elongated interior fitting constructed with an exterior barrel, reduced in exterior diameter to form a distally facing annular shoulder and then projecting still further distally to form an interior sleeve having a radially outwardly facing bonding surface. Selecting an elongated metal outer sleeve formed proximally with a collar constructed for receipt over the barrel and increased in interior diameter and projecting distally to form an exterior sleeve having a radially inwardly facing bonding surface cooperating with the first bonding surface to form an annulus receiving an extremity of a composite tube and a bond bonding the extremity of the tube to the bonding surfaces.

  2. Detailed examination of the lower cervical spine facet joints in a road traffic crash fatality - a case study

    DEFF Research Database (Denmark)

    Uhrenholt, Lars; Nielsen, Edith; Vesterby, Annie


    The lower cervical spine facet joints of a road traffic crash fatality were examined using diagnostic imaging and histological techniques. No injuries to the cervical spine facet joints could be identified with diagnostic imaging including conventional radiology, CT and MRI. Examination of stained...... histological sections visualised the morphology and integrity of the facet joints in detail. Occult injuries to and in close proximity of the cervical spine facet joints were identified only on histological examination....

  3. Detailed examination of the lower cervical spine facet joints in a road traffic crash fatality - a case study

    DEFF Research Database (Denmark)

    Uhrenholt, Lars; Nielsen, Edith; Vesterby, Annie


    The lower cervical spine facet joints of a road traffic crash fatality were examined using diagnostic imaging and histological techniques. No injuries to the cervical spine facet joints could be identified with diagnostic imaging including conventional radiology, CT and MRI. Examination of staine...... histological sections visualised the morphology and integrity of the facet joints in detail. Occult injuries to and in close proximity of the cervical spine facet joints were identified only on histological examination....

  4. The Life Saving Effects of Hospital Proximity

    DEFF Research Database (Denmark)

    Bertoli, Paola; Grembi, Veronica

    We assess the lifesaving effect of hospital proximity using data on fatality rates of road-traffic accidents. While most of the literature on this topic is based on changes in distance to the nearest hospital triggered by hospital closures and use OLS estimates, our identification comes from......) increases the fatality rate by 13.84% on the sample average. This is equal to a 0.92 additional death per every 100 accidents. We show that OLS estimates provide a downward biased measure of the real effect of hospital proximity because they do not fully solve spatial sorting problems. Proximity matters...

  5. Proximal row carpectomy in total arthrodesis of the rheumatoid wrist. (United States)

    Pham, T T; Lenoir, H; Coulet, B; Wargny, M; Lazerges, C; Chammas, M


    Advanced proximal carpal row damage is common in rheumatoid arthritis (RA). Proximal row carpectomy (PRC) simplifies total wrist arthrodesis, obviating the need for an iliac bone graft. In theory, PRC also improves the chances of healing, as fusion of a single joint space is needed for the procedure to be successful. Potential effects of the loss of carpal height related to PRC are unknown. We hypothesised that PRC performed concomitantly with total wrist arthrodesis in patients with RA produces good clinical and radiological outcomes, without inducing loss of strength or digital deformities. In 38 total arthrodeses of rheumatoid wrists, a clinical evaluation was performed, including a visual analogue scale (VAS) pain score, the Patient-Rated Wrist Evaluation (PRWE), grip strength, digital deformities, and patient satisfaction. A standard radiographic workup was obtained to assess healing and carpal height indices. After a mean follow-up of 50 months, the mean VAS pain score was 0.4 (range: 0-7), the mean PRWE score was 21 (range: 0-80.5), and grip strength as a percentage of the contralateral limb was 76%. The healing rate was 92% (35/38 wrists), and 34 (90%) patients reported being satisfied or very satisfied. No effects of carpal height loss on clinical or radiographic parameters was detected. Total wrist arthrodesis combined with PRC provides reliable and reproducible benefits. This study found no evidence of adverse effects related to the loss of carpal height. IV, retrospective study. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  6. Proximity and Collaboration in European Nanotechnology

    NARCIS (Netherlands)

    Cunningham, S.W.; Werker, C.


    Collaborations are particularly important for the development and deployment of technology. We analyze the influence of organizational, technological and geographical proximity on European nanotechnology collaborations with the help of a publication dataset and additional geographical information.

  7. Promoting proximal formative assessment with relational discourse (United States)

    Scherr, Rachel E.; Close, Hunter G.; McKagan, Sarah B.


    The practice of proximal formative assessment - the continual, responsive attention to students' developing understanding as it is expressed in real time - depends on students' sharing their ideas with instructors and on teachers' attending to them. Rogerian psychology presents an account of the conditions under which proximal formative assessment may be promoted or inhibited: (1) Normal classroom conditions, characterized by evaluation and attention to learning targets, may present threats to students' sense of their own competence and value, causing them to conceal their ideas and reducing the potential for proximal formative assessment. (2) In contrast, discourse patterns characterized by positive anticipation and attention to learner ideas increase the potential for proximal formative assessment and promote self-directed learning. We present an analysis methodology based on these principles and demonstrate its utility for understanding episodes of university physics instruction.

  8. Ammonia transport in the proximal tubule. (United States)

    Hamm, L L; Simon, E E


    The transport of ammonia in the proximal tubule is a complex interaction of a number of processes. Ammonia transport in the proximal tubule is clearly bidirectional; ammonia is secreted into the early proximal tubule lumen, but later in the proximal tubule, efflux out of the lumen may result in net ammonia reabsorption. Two mechanisms of ammonia transport have clearly been established: NH3 diffusion and NH4+ transport on the Na(+)-H+ exchanger. The relative contribution of these pathways to ammonia transport is still unsettled. Other pathways for ammonia transport, particularly NH4+ efflux out of the lumen, may be important as well. A variety of factors may modulate ammonia transport: plasma, cell and luminal pH, luminal flow rate, luminal potassium, and angiotensin II. Each of these factors also alters ammonia production rates and in most circumstances, ammonia transport appears to follow ammonia production rates.

  9. Proximate composition and cholesterol concentrations of ...

    African Journals Online (AJOL)



    DWB) for raw and fried samples, respectively, but decreased to 295.20 ... Key words: Rhynchophorus phoenicis, Oryctes monoceros, proximate composition, cholesterol, heat treatment. INTRODUCTION. Insects have played ...


    African Journals Online (AJOL)

    Babatunde Emmanuel


    Oct 6, 2011 ... Fish allows for protein improved nutrition in that it has a high biological value in terms of high ... marine algae upon which the fish feed [11]. ... Proximate composition of catfish Clarias gariepinus and Tarpon atlanticus were.

  11. [Bone development trend in the knee joint of Tibetan teenagers in Aba Prefecture of Sichuan Province]. (United States)

    Ding, Shi-Rong; Ying, Chong-Liang; Wan, Lei; Wei, Hua; Wang, Ya-Hui; Zhu, Guang-You


    To discuss bone development trend in the knee joint of Tibetan teenagers in Sichuan province and to effectively update the database for estimating the living age of Tibetan teenagers in terms of bone age of the knee joint. Radiographs including epiphysis of distal femur, proximal tibia and proximal fibula were taken from 483 Tibetan male and female teenagers aged from 14 to 19 years old in Aba prefecture of Sichuan province in order to observe epiphyseal growth situation. The descriptive data of the epiphyseal closure ages of these teenagers' knee joints were statistically analyzed by SPSS 16.0 software. The distal femur epiphyseal closure occurred earliest, while the proximal fibula epiphyseal closure occurred latest. The epiphyseal growth of knee joints of females occurred about one year earlier than that of males. The forensic information and data related to Tibetan teenagers' bone age identification should be updated regularly. These results provide potential value for the practice of forensic medicine, anthropology and clinical medicine.

  12. Phytochemical screening, proximate analysis and acute toxicity ...

    African Journals Online (AJOL)

    Phytochemical screening, proximate analysis and acute toxicity studies were carried out on the leaf extract of Cola lepidota, in accordance with established standard procedures. The proximate analysis reveals a moisture content of 27.43 ± 3.11 % w/w, total ash value 9.32 ± 0.27 % w/w, acid insoluble ash 3.12 ± 1.05 % w/w ...

  13. Proximate, Mineral and Phytochemical Composition of Dioscorea ...

    African Journals Online (AJOL)


    ABSTRACT: Proximate, mineral and phytochemical composition of Dioscorea dumetorum tubers was investigated using standard procedures. Proximate analysis included in g% dry weight: crude protein (6.44 ± 0.32), crude fat (0.75 ± 0.04), crude fibre (15.00 ± 0.56), total ash. (3.45 ± 0.20) and a moisture content of 70.04 ...

  14. Painful Spastic Hip Dislocation: Proximal Femoral Resection


    Albiñana, Javier; Gonzalez-Moran, Gaspar


    The dislocated hip in a non-ambulatory child with spastic paresis tends to be a painful interference to sleep, sitting upright, and perineal care. Proximal femoral resection-interposition arthroplasty is one method of treatment for this condition. We reviewed eight hips, two bilateral cases, with a mean follow-up of 30 months. Clinical improvement was observed in all except one case, with respect to pain relief and sitting tolerance. Some proximal migration was observed in three cases, despit...

  15. Design and Development of a Bilateral Therapeutic Hand Device for Stroke Rehabilitation

    Directory of Open Access Journals (Sweden)

    Akhlaquor Rahman


    Full Text Available The major cause of disability is stroke. It is the second highest cause of death after coronary heart disease in Australia. In this paper, a post stroke therapeutic device has been designed and developed for hand motor function rehabilitation that a stroke survivor can use for bilateral movement practice. A prototype of the device was fabricated that can fully flex and extend metacarpophalangeal (MCP, proximal interphalangeal (PIP and distal interphalangeal (DIP joints of the fingers, and interphalangeal (IP, metacarpophalangeal (MCP and trapeziometacarpal (IM joints of the thumb of the left hand (impaired hand, based on movements of the right hand's (healthy hand fingers. Out of 21 degrees of freedom (DOFs of hand fingers, the prototype of the hand exoskeleton allowed fifteen degrees of freedom (DOFs, with three degrees of freedom (DOFs for each finger and three degrees of freedom (DOFs for the thumb. In addition, testing of the device on a healthy subject was conducted to validate the design requirements.

  16. Proximity sensor system development. CRADA final report

    Energy Technology Data Exchange (ETDEWEB)

    Haley, D.C. [Oak Ridge National Lab., TN (United States); Pigoski, T.M. [Merrit Systems, Inc. (United States)


    Lockheed Martin Energy Research Corporation (LMERC) and Merritt Systems, Inc. (MSI) entered into a Cooperative Research and Development Agreement (CRADA) for the development and demonstration of a compact, modular proximity sensing system suitable for application to a wide class of manipulator systems operated in support of environmental restoration and waste management activities. In teleoperated modes, proximity sensing provides the manipulator operator continuous information regarding the proximity of the manipulator to objects in the workspace. In teleoperated and robotic modes, proximity sensing provides added safety through the implementation of active whole arm collision avoidance capabilities. Oak Ridge National Laboratory (ORNL), managed by LMERC for the United States Department of Energy (DOE), has developed an application specific integrated circuit (ASIC) design for the electronics required to support a modular whole arm proximity sensing system based on the use of capacitive sensors developed at Sandia National Laboratories. The use of ASIC technology greatly reduces the size of the electronics required to support the selected sensor types allowing deployment of many small sensor nodes over a large area of the manipulator surface to provide maximum sensor coverage. The ASIC design also provides a communication interface to support sensor commands from and sensor data transmission to a distributed processing system which allows modular implementation and operation of the sensor system. MSI is a commercial small business specializing in proximity sensing systems based upon infrared and acoustic sensors.

  17. Transformations through Proximity Flying: A Phenomenological Investigation (United States)

    Holmbom, Maria; Brymer, Eric; Schweitzer, Robert D.


    Participation in extreme sports has been linked to personal transformations in everyday life. Descriptions of lived experience resulting from transformative experiences are limited. Proximity flying, a relatively new discipline involving BASE jumping with a wingsuit where participants fly close to solid structures, is arguably one of the most extreme of extreme sports. The aim of this paper, part of a larger phenomenological study on the lived experience of proximity flying, is to explicate the ways in which participating in proximity flying influences the everyday lives of participants. Interpretative phenomenological analysis was used to explicate the lived experience of six proximity pilots. An analysis of interview transcripts revealed three significant themes describing the lived experience of participants. First, experiences of change were described as positive and skills developed through proximity flying were transferable into everyday life. Second, transformative experiences were considered fundamental to participants’ perspectives on life. Third, experience of transformation influenced their sense of personal identity and facilitated flourishing in other aspects of everyday life. Participants were clear that their experiences in proximity flying facilitated a profound process of transformation which manifest as changes in everyday capabilities and behaviors, values and sense of identity. PMID:29104552

  18. Butt Joint Tool Commissioning

    Energy Technology Data Exchange (ETDEWEB)

    Martovetsky, N N


    ITER Central Solenoid uses butt joints for connecting the pancakes in the CS module. The principles of the butt joining of the CICC were developed by the JAPT during CSMC project. The difference between the CSMC butt joint and the CS butt joint is that the CS butt joint is an in-line joint, while the CSMC is a double joint through a hairpin jumper. The CS butt joint has to carry the hoop load. The straight length of the joint is only 320 mm, and the vacuum chamber around the joint has to have a split in the clamp shell. These requirements are challenging. Fig.1 presents a CSMC joint, and Fig.2 shows a CS butt joint. The butt joint procedure was verified and demonstrated. The tool is capable of achieving all specified parameters. The vacuum in the end was a little higher than the target, which is not critical and readily correctable. We consider, tentatively that the procedure is established. Unexpectedly, we discover significant temperature nonuniformity in the joint cross section, which is not formally a violation of the specs, but is a point of concern. All testing parameters are recorded for QA purposes. We plan to modify the butt joining tool to improve its convenience of operation and provide all features necessary for production of butt joints by qualified personnel.

  19. Limb-sparing surgery in a dog with osteosarcoma of the proximal femur. (United States)

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


    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. Joint Replacement (Finger and Wrist Joints) (United States)

    ... alternate procedures for treating arthritis include: Joint injections Oral medications such as aspirin or anti-inflammatory medicines Hand therapy exercises and protective splints Arthrodesis surgery to fuse bones together, which relieves pain by eliminating motion be-tween damaged joint surfaces ...

  1. Hand osteoarthritis: Differential diagnosis with inflammatory joint diseases and treatment policy

    Directory of Open Access Journals (Sweden)

    Yu. A. Olyunin


    Full Text Available Osteoarthritis (OA usually affects certain joint groups selectively and the hand joints (HJ are one of its classical locations. Hand OA is widespread in the population. In their practice rheumatologists encounter HJ injury in OA in 38% of cases. It is conventional to identify three main types of hand OA. These are 1 interphalangeal OA that may or may not be accompanied by nodulation; 2 first carpometacarpal OA; and 3 erosive OA. At the same time, the rate of clinical forms ranges from 2.0 to 6.2%; it is 4.7 to 20.4% in the elderly. Nonsteroidal antiinflammatory drugs (NSAIDs are most commonly used to relieve pain that is the main manifestation of the disease. The risk for NSAID-related adverse gastrointestinal (GI events is substantially reduced by the drugs that exert their effects mainly on cyclooxygenase 2. These include nimesulide in particular. Undesirable GI effects may be also considerably minimized by using NSAIDs that have both their gastroprotective and antiinflammatory activities. By suppressing pain and inflammatory changes, the recently designed NSAID amtolmetin guacil simultaneously exerts a protective effect on the GI mucosa, by elevating its nitric oxide levels.

  2. Arthroscopic visualisation of the distal radioulnar joint. (United States)

    Yamamoto, Michiro; Koh, Shukuki; Tatebe, Masahiro; Shinohara, Takaaki; Shionoya, Kaori; Nakamura, Ryogo; Hirata, Hitoshi


    The diagnosis of chronic wrist pain is challenging and wrist arthroscopy has been recognised as the "gold standard". The present study investigated the efficacy of adding distal radioulnar joint (DRUJ) arthroscopy to routine wrist arthroscopy. The records of 67 patients who underwent DRUJ arthroscopy were reviewed, and the success rates for visualisation of intra-articular structures were determined. Pathological findings were correlated with ulnar-side wrist pain. In seven patients, pre-operative diagnoses were altered after DRUJ arthroscopy. The ulnar head and proximal surface of the triangular fibrocartilage complex (TFCC) were visualised in 100% and 99% of patients, respectively, while the foveal insertion of TFCC and sigmoid notch were visualised in 57% and 69%, respectively. Pathological findings of the proximal surface of TFCC tended to relate to ulnar wrist pain (p = 0.06). DRUJ arthroscopy should be included in routine wrist arthroscopy to enhance the accuracy of diagnosis.

  3. Generalised joint hypermobility and knee joint hypermobility

    DEFF Research Database (Denmark)

    Junge, Tina; Henriksen, Peter; Hansen, Sebrina


    AIM: Several biomechanical factors, such as knee joint hypermobility (KJH), are suggested to play a role in the etiology of knee joint symptoms and knee osteoarthritis. Nevertheless, the prevalence or consequences of KJH solely or included in the classification of generalized joint hypermobility...... (GJHk) is unknown for a general population. Therefore, the objectives were to report the prevalence of self-reported GJHk and KJH, as well as the association of these conditions to knee joint symptoms, severity and duration of symptoms, and health-related quality of life (HRQoL) in a Danish adult...... population. METHOD: This study is a cross-sectional population-based survey of 2056 Danish adults. Respondents received online questionnaires of GJHk and KJH, knee joint symptoms, the severity and duration of these, as well as HRQoL. RESULTS: Total response rate was 49% (n = 1006). The prevalence of self...

  4. MP Joint Arthritis (United States)

    ... crack extends into the joint Certain medical conditions ( rheumatoid arthritis , gout and pseudogout , psoriasis, etc.) Infections, often after a cut, puncture or animal bites where bacteria are introduced into the joint and cause rapid ...

  5. Knee joint replacement - slideshow (United States)

    ... this page: // Knee joint replacement - series—Normal anatomy To use the ... to slide 4 out of 4 Overview The knee is a complex joint. It contains the distal ...

  6. Image based weighted center of proximity versus directly measured knee contact location during simulated gait. (United States)

    Wang, Hongsheng; Chen, Tony; Koff, Matthew F; Hutchinson, Ian D; Gilbert, Susannah; Choi, Dan; Warren, Russell F; Rodeo, Scott A; Maher, Suzanne A


    To understand the mechanical consequences of knee injury requires a detailed analysis of the effect of that injury on joint contact mechanics during activities of daily living. Three-dimensional (3D) knee joint geometric models have been combined with knee joint kinematics to dynamically estimate the location of joint contact during physiological activities-using a weighted center of proximity (WCoP) method. However, the relationship between the estimated WCoP and the actual location of contact has not been defined. The objective of this study was to assess the relationship between knee joint contact location as estimated using the image-based WCoP method, and a directly measured weighted center of contact (WCoC) method during simulated walking. To achieve this goal, we created knee specific models of six human cadaveric knees from magnetic resonance imaging. All knees were then subjected to physiological loads on a knee simulator intended to mimic gait. Knee joint motion was captured using a motion capture system. Knee joint contact stresses were synchronously recorded using a thin electronic sensor throughout gait, and used to compute WCoC for the medial and lateral plateaus of each knee. WCoP was calculated by combining knee kinematics with the MRI-based knee specific model. Both metrics were compared throughout gait using linear regression. The anteroposterior (AP) location of WCoP was significantly correlated with that of WCoC on both tibial plateaus in all specimens (p0), but the correlation was not significant in the mediolateral (ML) direction for 4/6 knees (p>0.05). Our study demonstrates that while the location of joint contact obtained from 3D knee joint contact model, using the WCoP method, is significantly correlated with the location of actual contact stresses in the AP direction, that relationship is less certain in the ML direction. Copyright © 2014 Elsevier Ltd. All rights reserved.

  7. Managing Joint Production Motivation

    DEFF Research Database (Denmark)

    Lindenberg, Siegwart; Foss, Nicolai Juul


    We contribute to the microfoundations of organizational performance by proffering the construct of joint production motivation. Under such motivational conditions individuals see themselves as part of a joint endeavor, each with his or her own roles and responsibilities; generate shared...... representations of actions and tasks; cognitively coordinate cooperation; and choose their own behaviors in terms of joint goals. Using goal-framing theory, we explain how motivation for joint production can be managed by cognitive/symbolic management and organizational design....

  8. Locking plate fixation for proximal humerus fractures.

    LENUS (Irish Health Repository)

    Burke, Neil G


    Locking plates are increasingly used to surgically treat proximal humerus fractures. Knowledge of the bone quality of the proximal humerus is important. Studies have shown the medial and dorsal aspects of the proximal humeral head to have the highest bone strength, and this should be exploited by fixation techniques, particularly in elderly patients with osteoporosis. The goals of surgery for proximal humeral fractures should involve minimal soft tissue dissection and achieve anatomic reduction of the head complex with sufficient stability to allow for early shoulder mobilization. This article reviews various treatment options, in particular locking plate fixation. Locking plate fixation is associated with a high complication rate, such as avascular necrosis (7.9%), screw cutout (11.6%), and revision surgery (13.7%). These complications are frequently due to the varus deformation of the humeral head. Strategic screw placement in the humeral head would minimize the possibility of loss of fracture reduction and potential hardware complications. Locking plate fixation is a good surgical option for the management of proximal humerus fractures. Complications can be avoided by using better bone stock and by careful screw placement in the humeral head.

  9. A double blind randomised trial of low power laser treatment in rheumatoid arthritis.


    Heussler, J K; Hinchey, G; Margiotta, E; Quinn, R.; Butler, P.; Martin, J; Sturgess, A D


    OBJECTIVES--To define the value of low power laser treatment in small joint rheumatoid arthritis. METHODS--Twenty five women with active disease were recruited. The metacarpophalangeal and proximal interphalangeal joints of one hand were treated with 12 J/cm2 for 30 s with a gallium-aluminium-arsenate laser. The other hand received a sham laser treatment designed so that neither therapist nor patient could distinguish the active laser from the sham laser. Each patient received 12 treatments o...

  10. International joint ventures

    DEFF Research Database (Denmark)

    Sørensen, Karsten Engsig


    The article analysis problems connected with corporate joint ventures. Among others the possible conflicts between the joint venture agreement and the statutes of the companies is examined, as well as certain problems connected to the fact that the joint venture partners have created commen contr...

  11. Bridges Expansion Joints


    Sergey W. Kozlachkow


    The survey is concerned with the expansion joints, used in bridge constructions to compensate medium and significant operational linear and spatial displacements between adjacent spans or between bridge span and pier. The analysis of design features of these types of expansion joints, their advantages and disadvantages, based on operational experience justified the necessity to design constructions, meeting the modern demands imposed to expansion joints.

  12. Displaced 3- and 4-part proximal humeral fractures: Evaluation and management with an intramedullary nail within 48 h, in the emergency department

    Directory of Open Access Journals (Sweden)

    Francesco Nobile


    Conclusions: The nail utilized is provided with locking and multiplanar proximal screws and could be applied through a mini-invasive anterolateral approach. This enables the reduction of the fracture fragments, while preserving vascularization of the scapulo-humeral joint. Our results confirm that the indication of endomedullary nail could be extended to the treatment of complex proximal humeral fractures with 3 and 4 fragments (level of evidence IV, according to the Oxford Centre for Evidence Based Medicine Levels of Evidence Working Group.

  13. Industrial Computed Tomography using Proximal Algorithm

    KAUST Repository

    Zang, Guangming


    In this thesis, we present ProxiSART, a flexible proximal framework for robust 3D cone beam tomographic reconstruction based on the Simultaneous Algebraic Reconstruction Technique (SART). We derive the proximal operator for the SART algorithm and use it for minimizing the data term in a proximal algorithm. We show the flexibility of the framework by plugging in different powerful regularizers, and show its robustness in achieving better reconstruction results in the presence of noise and using fewer projections. We compare our framework to state-of-the-art methods and existing popular software tomography reconstruction packages, on both synthetic and real datasets, and show superior reconstruction quality, especially from noisy data and a small number of projections.

  14. Correlation between social proximity and mobility similarity. (United States)

    Fan, Chao; Liu, Yiding; Huang, Junming; Rong, Zhihai; Zhou, Tao


    Human behaviors exhibit ubiquitous correlations in many aspects, such as individual and collective levels, temporal and spatial dimensions, content, social and geographical layers. With rich Internet data of online behaviors becoming available, it attracts academic interests to explore human mobility similarity from the perspective of social network proximity. Existent analysis shows a strong correlation between online social proximity and offline mobility similarity, namely, mobile records between friends are significantly more similar than between strangers, and those between friends with common neighbors are even more similar. We argue the importance of the number and diversity of common friends, with a counter intuitive finding that the number of common friends has no positive impact on mobility similarity while the diversity plays a key role, disagreeing with previous studies. Our analysis provides a novel view for better understanding the coupling between human online and offline behaviors, and will help model and predict human behaviors based on social proximity.

  15. [Disorders of sex development and proximal hypospadias]. (United States)

    Oswald, J


    Children with ambiguous genitalia due to different chromosome or gonadal sex are a particular challenge concerning the diagnostic and therapeutic implications. Proximal hypospadias patients with normal gonadal development should be distinguished from children with DSD (disorders of sex development) to guarantee normal gender identity and the best possible surgical therapy. This paper focuses on the terminology, embryology, and pathophysiology of the different manifestations of DSD. The state of knowledge about this disease pattern with particular emphasis on proximal hypospadias based on national and international scientific discussions is presented. The different clinical pictures as well as therapeutic options of DSD with a special focus on recent literature and giving particular attention to patients with proximal hypospadias are presented. Because of the complexity of patients suffering from disorders of sex development an interdisciplinary DSD healthcare team including a paediatric endocrinologist as well as paediatric urologist should be provided. These specialists enable an accurate diagnosis in severe hypospadias patients without reference to DSD diseases patterns.

  16. Infiltrating/sealing proximal caries lesions

    DEFF Research Database (Denmark)

    Martignon, S; Ekstrand, K R; Gomez, J


    This randomized split-mouth controlled clinical trial aimed at assessing the therapeutic effects of infiltration vs. sealing for controlling caries progression on proximal surfaces. Out of 90 adult students/patients assessed at university clinics and agreeing to participate, 39, each with 3...... differences in lesion progression between infiltration and placebo (P = 0.0012) and between sealing and placebo (P = 0.0269). The study showed that infiltration and sealing are significantly better than placebo treatment for controlling caries progression on proximal lesions. No significant difference...... proximal lesions identified radiographically around the enamel-dentin junction to the outer third of the dentin, were included. Lesions were randomly allocated for treatment to test-A (Infiltration: ICON-pre-product; DMG), test-B (Sealing: Prime-Bond-NT; Dentsply), or control-C (Placebo). Primary outcome...

  17. Knowledge networks in the Dutch aviation industry: The proximity paradox

    NARCIS (Netherlands)

    Broekel, T.; Boschma, R.A.


    The importance of geographical proximity for interaction and knowledge sharing has been discussed extensively in recent years. There is increasing consensus that geographical proximity is just one out of many types of proximities that might be relevant. We argue that proximity may be a crucial

  18. The effect of smartphone addiction on hand joints in psoriatic patients: an ultrasound-based study. (United States)

    Megna, M; Gisonni, P; Napolitano, M; Orabona, G Dell'Aversano; Patruno, C; Ayala, F; Balato, N


    Distal interphalangeal (DIP) arthritis is a frequent form of psoriatic arthritis being often linked to nail psoriasis. Modern society is characterized by overuse of smartphones. Indeed, literature has recently focalized on research into smartphone addiction and health-related problems. As smartphone addiction is able to determine overuse and repeated movements of DIP joints and nails, the aim of this study was to evaluate the impact of smartphone use on hand joints of young psoriatic patients. An observational study involving four different groups such as non-smartphone-addicted (SA) psoriatic patients, SA psoriatic patients, non-SA controls and SA controls was performed. Each subject underwent an ultrasound examination of both hands by three independent and blinded to group assignment radiologists. A specific score was used to evaluate the inflammatory state of the analysed joints. The total ultrasound score was statistically significantly higher in SA controls respect to non-SA controls (3.4 vs. 1.4; P < 0.05) as well as in SA psoriasis patients compared to non-SA psoriatic subjects (15.2 vs. 6.7; P < 0.01). Higher mean of ultrasound score was found for left hand in controls (both SA or not) and for right hand in psoriatic subjects (both SA or not), however without reaching statistical significance. Smartphone overuse was found to be linked with higher signs of inflammation of musculoskeletal structures of hands joints in both psoriasis and controls through ultrasound examination. Therefore, smartphone overuse may be a factor which facilitate or speed up the possible development of psoriatic arthritis. © 2017 European Academy of Dermatology and Venereology.

  19. The developmental spectrum of proximal radioulnar synostosis

    Energy Technology Data Exchange (ETDEWEB)

    Elliott, Alison M. [University of Manitoba, Winnipeg Regional Health Association Program of Genetics and Metabolism, Winnipeg, MB (Canada); University of Manitoba, Department of Paediatrics and Child Health, Winnipeg, MB (Canada); University of Manitoba, Department of Biochemistry and Medical Genetics, Winnipeg, MB (Canada); University of Manitoba, WRHA Program of Genetics and Metabolism, Departments of Paediatrics and Child Health, Biochemistry and Medical Genetics, Winnipeg, MB (Canada); Kibria, Lisa [University of Manitoba, Department of School of Medical Rehabilitation, Winnipeg, MB (Canada); Reed, Martin H. [University of Manitoba, Department of Paediatrics and Child Health, Winnipeg, MB (Canada); University of Manitoba, Department of Biochemistry and Medical Genetics, Winnipeg, MB (Canada); University of Manitoba, Department of Diagnostic Imaging, Winnipeg, MB (Canada)


    Proximal radioulnar synostosis is a rare upper limb malformation. The elbow is first identifiable at 35 days (after conception), at which stage the cartilaginous anlagen of the humerus, radius and ulna are continuous. Subsequently, longitudinal segmentation produces separation of the distal radius and ulna. However, temporarily, the proximal ends are united and continue to share a common perichondrium. We investigated the hypothesis that posterior congenital dislocation of the radial head and proximal radioulnar fusion are different clinical manifestations of the same primary developmental abnormality. Records were searched for ''proximal radioulnar fusion/posterior radial head dislocation'' in patients followed at the local Children's Hospital and Rehabilitation Centre for Children. Relevant radiographic, demographic and clinical data were recorded. Ethics approval was obtained through the University Research Ethics Board. In total, 28 patients met the inclusion criteria. The majority of patients (16) had bilateral involvement; eight with posterior dislocation of the radial head only; five had posterior radial head dislocation with radioulnar fusion and two had radioulnar fusion without dislocation. One patient had bilateral proximal radioulnar fusion and posterior dislocation of the left radial head. Nine patients had only left-sided involvement, and three had only right-sided involvement.The degree of proximal fusion varied, with some patients showing 'complete' proximal fusion and others showing fusion that occurred slightly distal to the radial head: 'partially separated.' Associated disorders in our cohort included Poland syndrome (two patients), Cornelia de Lange syndrome, chromosome anomalies (including tetrasomy X) and Cenani Lenz syndactyly. The suggestion of a developmental relationship between posterior dislocation of the radial head and proximal radioulnar fusion is supported by the fact that both anomalies

  20. Early arthrosis of the digital joints

    Energy Technology Data Exchange (ETDEWEB)

    Fischer, E.


    Arthrosis of the digital joints begins predominantly on the volar joint surface and the volar-proximal margin of the head. Because of this localisation, and in order to obtain adequate contrast and definition, these early changes are best shown by means of low R.V. radiographs in three views. The early changes consist of the following local processes: intrachondral sclerosis, exomarginal and endomarginal subchondral sclerosis, discreet increase in the spongiosa; this leads to disrounding and hooklike form of the head; thickening or disappearance of the sub-marginal spongiosa and marginal defects. Artifacts produced by the projections or local bone variants must be recognised, as well as diffuse idiopathic skeletal hyperostosis. 21 figs.

  1. Coxofemoral joint radiography in standing cattle. (United States)

    Wenzinger, Beatrice; Hagen, Regine; Schmid, Tanja; Nuss, Karl


    The objective of this study was to establish a technique for radiographic examination of the coxofemoral joint and adjacent bony structures in standing cattle. Left (or right) 30° dorsal-right (or left) ventral radiographic views of the coxofemoral joint region of standing cattle (n = 10) with hind limb lameness were evaluated retrospectively. In addition, an experimental study of oblique laterolateral views of the coxofemoral joint region of a bovine skeleton at angles of 15-45° was carried out to determine the optimal position for visualization of the hip region. In the 10 clinical patients, the bodies of the ilium and ischium, the acetabulum and proximal third of the femur could be assessed. Six of these cattle had fractures of the body of the ilium and body of the ischium, five with and one without involvement of the acetabulum, two had craniodorsal and one caudoventral luxation of the femur and one had a femoral neck fracture. The described laterodorsal-lateroventral radiographs of the hip region in standing cattle were suitable for assessing the coxofemoral joint, the proximal aspect of the femur and parts of the ischium, ilium and pubis. After testing the optimal angle on the skeleton, it was seen that distortion and superimposition were minimized by positioning the X-ray beam at an angle of 25° to the horizontal plane. It can be concluded that the described technique improves the evaluation of injuries of the coxofemoral region in cattle. With the appropriate angle, the technique can also be applied in recumbent cattle. © 2012 Veterinary Radiology & Ultrasound.

  2. Pattern of joints involvement in Kashin-Beck disease: a local osteochondropathy in China. (United States)

    Farooq, Umer; Xiong, Guo; Irshad, Romana; Yaqoob, Shehzad


    Kashin-Beck Disease (KBD) is an endemic osteochondropathy. The disease starts in childhood and attacks the growth of joint cartilage, the joints become deformed and painful, and the worst forms result in dwarfism. The most fiequent joints involved are the finger, wrist, ankles, knees and elbows. In this study the pattern of joints involved in KBD was studied. A total of 368 patients aged above 13 from 6 villages in endemic areas of the Shaanxi province, located in the northwest of China, were selected through multistage stratified sampling. The patients were diagnosed based on the clinical criteria for diagnosis of KBD. The patients were administered with a battery of questionnaires along with clinical examination for joint involvement. The patients presented both as oligoarticular as well as polyarticular pattern. Smaller joints were more frequently involved with a proximal-distal pattern. The number of joints involved increased with the severity of the disease. Proximal smaller joints are more frequently involved in the disease. The involvement of bigger joints takes place in later stages of disease, i.e., in the second and third degree. The pattern of joint involvement shows some correlation with Rheumatoid Arthritis which needs further investigation and comparative studies.

  3. Complication rates in diabetics with first metatarsophalangeal joint arthrodesis

    Directory of Open Access Journals (Sweden)

    John J. Anderson


    Full Text Available Background: First metatarsophalangeal joint (MTPJ arthrodesis has been an effective surgical entity when indicated, but a range of severe to mild complications can occur from this procedure. Patients with diabetes mellitus have an increased risk in surgical complications, most commonly associated with soft tissue and bone healing, when compared to non-diabetic patients. The purpose of this study was to evaluate the complication rates of first MTPJ arthrodesis in diabetic patients and compare them to the existing complication rates for the procedure. Methods: A retrospective chart review was done on 76 diabetic patients, from June 2002 to August 2012. Thirty-two males and 44 females were included in the study. The authors evaluated many variables that could impact postoperative complications, including age, gender, bone graft incorporation, hemoglobin A1c, tobacco use, body mass index, peripheral neuropathy, hallux extensus, hallux interphalangeal arthritis, and rheumatoid arthritis, and compared them with the complication findings. Patient follow-up was no less than 24 months. Results: Overall, approximately two-thirds of the patients had no complications and 35.5% of patients had at least one mild or moderate complication. Of the non-union and mal-union complications, 80 and 70% had peripheral neuropathy, respectively. One hundred percent of the patients that had mal-positions or hardware failure also had peripheral neuropathy. No severe complications were seen during follow-up. Only two of the moderate complications needed revisions, and the rest of those with moderate complications were asymptomatic. Conclusion: In conclusion, first MTPJ arthrodesis is overall an effective and beneficial procedure in patients with diabetes mellitus. Diabetic patients with peripheral neuropathy have an increased risk for mild and moderate complications.

  4. Is central skeleton bone quality a predictor of the severity of proximal humeral fractures? (United States)

    Lee, Seung Yeol; Kwon, Soon-Sun; Kim, Tae Hoon; Shin, Sang-Jin


    The objectives of this study were to evaluate the correlation between bone attenuation around the shoulder joint assessed on conventional computed tomography (CT) and bone mineral density (BMD) based on dual-energy X-ray absorptiometry (DEXA) of the central skeleton and the correlation between the bone quality around the shoulder joint and the severity of the fracture pattern of the proximal humerus. A total of 200 patients with proximal humeral fracture who underwent preoperative 3-dimensional shoulder CT as well as DEXA within 3 months of the CT examination were included. Fracture types were divided into simple and comminuted fracture based on the Neer classification. After reliability testing, bone attenuation of the glenoid, three portions of the humeral head, and metaphysis was measured by placing a circular region of interest on the center of each bony region on CT images. Partial correlation analysis was used to assess the correlation between the bone quality around the shoulder joint on CT and the BMD on the central skeleton after adjusting for age and body mass index. Partial correlations between fracture classification and CT/DEXA results were also evaluated. Bone attenuation measurements of the glenoid and humeral head showed good to excellent reliability (intraclass correlation coefficient, 0.623-0.998). Bone attenuation of the central portion of the humeral head on CT showed a significant correlation with the BMD of L1, L4, the femoral neck, and femoral trochanter (correlation coefficient, 0.269-0.431). Bone attenuation of other areas showed a lower correlation with BMD by DEXA. As the level of the Neer classification increased from a 2 to 4-part fracture, bone attenuation of the central humeral head decreased significantly (r=-0.150, p=0.034). However, the BMD on DEXA was not a predictive factor for comminuted fracture of the proximal humerus. DEXA examination of the central skeleton may not reflect the bone quality of the proximal humerus and

  5. An Overall Look for Temporomandibular Joint Pathologies and Imaging

    Directory of Open Access Journals (Sweden)

    Hakan Eren


    Full Text Available Temporomandibular joint (TMJ complex is one of the most complex joint which connects the mandible to the skull. This kind of joint system has ability to perform complex and bilateral movements. Because, TMJ has a complicated anatomy, there is a need for a thorough investigation to find the correct cause of TMJ disorders, as well as knowing the TMJ anatomy. Anatomical structures of TMJ contain hard tissues and soft tissues. Soft tissues consist of joint capsule, ligaments, articular disc, muscles and tendons. A healthy joint is connected to proper and compatible function of all these anatomical structures. Temporomandibular disorder (TMD is a term used for any problems that affecting the temporomandibular joint. Possible causes for TMD are injury to the TMJ or related anatomical structures, clenching the teeth or bruxism, dislocation of the disc, presence of osteoarthritis or rheumatoid arthritis in the TMJ, emotional stress, aging, etc. The most common TMJ disorders are pain dysfunction syndrome, internal derangement, arthritis, and traumas. Radiographic imaging is an important element in the correct diagnosis. Because of the anatomic complexity of the temporomandibular joint and its proximity to the temporal bone, mastoid air cells, and auditory structures, imaging of the joint structures should also be investigated. Therefore, careful clinical and radiological examinations are essential in the evaluation of TMJ. In this review, TMJ anatomy, Imaging methods, the classification of various pathologies and radiological techniques, are discussed.

  6. preliminary phytochemical screening, proximate and elemental

    African Journals Online (AJOL)


    ABSTRACT. The seed powder of Moringa oleifera was analysed for its phytochemical, proximate and elemental composition using Folin-Denis spectrophotometric method, gravimetric method and energy dispersing X-ray fluorescence (EDXRF) transmission emission technique respectively. The seed powder had the ...

  7. Proximate, mineral composition, antioxidant activity, and total ...

    African Journals Online (AJOL)

    Four varieties of the red pepper fruits (Capsicum species) were evaluated for chemical composition, antioxidant activity and total phenolic contents using standard analytical technique, ferric-ion reducing antioxidant potential (FRAP) assay and Folin-Colcalteau method respectively. The proximate composition values ...

  8. 9__43 - 50__Tijjani_Proximate

    African Journals Online (AJOL)


    Sena et al., 1998). In Nigeria, the plant is commonly consumed by the Hausa speaking communities as a spice and a sauce (Ibrahim et al., 2012). However, during preparation the leaves and stem are not carefully separated before processing of food. Thus, the present study was aimed at evaluating the proximate, minerals ...

  9. Phytochemistry and proximate composition of ginger ( Zingiber ...

    African Journals Online (AJOL)

    ... a little crude fibre content of 0.92 %. The results indicated that ginger rhizome is an excellent natural remedy for a wide range of ailments. Keywords: Zingiber officinale, spice, rhizome, phytochemistry, proximate analysis, Zingiberaceae, zingerone, methanolic extraction. Journal of Pharmaceutical and Allied Sciences, Vol.


    African Journals Online (AJOL)



    Oct 24, 2012 ... opinions are analyzed and it revealed that the site has major impacts on the residents perceived quality of life, security and ... Key words: Landfill, Property value, Health and safety, Residential property, Solous. Introduction. The location ... Proximity to landfills and hazardous waste sites can severely affect ...

  11. Renal fibrosis: Primacy of the proximal tubule. (United States)

    Gewin, Leslie S


    Tubulointerstitial fibrosis (TIF) is the hallmark of chronic kidney disease and best predictor of renal survival. Many different cell types contribute to TIF progression including tubular epithelial cells, myofibroblasts, endothelia, and inflammatory cells. Previously, most of the attention has centered on myofibroblasts given their central importance in extracellular matrix production. However, emerging data focuses on how the response of the proximal tubule, a specialized epithelial segment vulnerable to injury, plays a central role in TIF progression. Several proximal tubular responses such as de-differentiation, cell cycle changes, autophagy, and metabolic changes may be adaptive initially, but can lead to maladaptive responses that promote TIF both through autocrine and paracrine effects. This review discusses the current paradigm of TIF progression and the increasingly important role of the proximal tubule in promoting TIF both in tubulointerstitial and glomerular injuries. A better understanding and appreciation of the role of the proximal tubule in TIF has important implications for therapeutic strategies to halt chronic kidney disease progression. Copyright © 2017 International Society of Matrix Biology. Published by Elsevier B.V. All rights reserved.

  12. 182 179 Comparative Study on the Proximate

    African Journals Online (AJOL)


    Dec 2, 2008 ... Key words: Annona squamosa, Fruits, Proximate, Minerals, nutrient density. INTRODUCTION. Sugar apple (Annona squamosa) also called. “Gwanda masar” in Hausa belong to the family. Annonacae. The most widely grown of all the species are A. muricata, A. cherimola, A reticulata, A. senegalensis and ...

  13. Phytochemical Screening, Proximate and Mineral Composition of ...

    African Journals Online (AJOL)

    Leaves of sweet potato (Ipomoea batatas) grown in Tepi area was studied for their class of phytochemicals, mineral and proximate composition using standard analytical methods. The phytochemical screening revealed the presence of alkaloids, flavonoid, terpenoids, saponins, quinones, phenol, tannins, amino acid and ...

  14. Phytochemical screening, proximate and elemental analysis of ...

    African Journals Online (AJOL)

    Citrus sinensis was screened for its phytochemical composition and was evaluated for the proximate and elemental analysis. The phytochemical analysis indicated the presence of reducing sugar, saponins, cardiac glycosides, tannins and flavonoids. The elemental analysis indicated the presence of the following mineral ...

  15. Phytochemical Screening and Proximate Analysis of Newbouldia ...

    African Journals Online (AJOL)

    The study was conducted to assess the phytochemical and proximate composition of Newboudia laevis leaves and Allium sativum bulb extracts. The leaves and bulbs extracts were analyzed for their chemical composition and antinutritional factors (ANFs) which include moisture, crude protein, crude fat, crude fiber, total ash ...

  16. Disability occurrence and proximity to death

    NARCIS (Netherlands)

    Klijs, Bart; Mackenbach, Johan P.; Kunst, Anton E.


    Purpose. This paper aims to assess whether disability occurrence is related more strongly to proximity to death than to age. Method. Self reported disability and vital status were available from six annual waves and a subsequent 12-year mortality follow-up of the Dutch GLOBE longitudinal study.

  17. [Four family members with proximal myotonic myopathy

    NARCIS (Netherlands)

    Tieleman, A.A.; Velden, M.P. van der; Visser, M.C.; Wokke, J.H.J.; Scheffer, H.; Engelen, B.G.M. van


    A 41-year-old woman had a 15-year history of pain in her thighs and arms, which also became weaker, and a decrease in visual acuity. Her 35-year-old brother, their 38-year-old sister and their 64-year-old mother also had myalgia, myotonia and proximal muscle weakness, and the women also had

  18. Phytochemical screening, proximate and elemental analysis of ...

    African Journals Online (AJOL)

    ... was about 0.01 in concentration. Proximate analysis also shows that it has a high nutritional value such as carbohydrate, fibre, Ash, fat and protein. These results recommended the consumption of these peels of desired physiochemical properties as sources of food fibres or low-calorie bulk ingredients in food applications ...

  19. Proximate composition and consumer acceptability of African ...

    African Journals Online (AJOL)

    The aim of the study was to assess the organoleptic differences of Clarias gariepinus smoked with two different energy sources, Anogeissus leiocarpus and Tamarindus indica with the help of a hedonic scale and to determine possible proximate composition difference between the smoked products. Smoking of the fishes ...

  20. Controllable proximity effect in superconducting hybrid devices

    NARCIS (Netherlands)

    Bakurskiy, S.V.


    This thesis is devoted to the study of controllable proximity effects in superconductors, both in terms of fundamental aspects and applications. As a part of this thesis theoretical description was suggested for a number of structures with superconducting electrodes and multiple interlayers. These

  1. Proximate, chemical compositions and sulphur concentrations on ...

    African Journals Online (AJOL)

    0, 10, 20, 50, 100, 150, 200, 250 and 300 ppm) on the nutritional value and the proximate composition of six selected mango cultivars (Tommy Atkins, Peach, Saber, Sunshine, Keitt and Vhavenda) grown in South Africa. The study shows that ...

  2. Proximate composition, bread characteristics and sensory ...

    African Journals Online (AJOL)

    This study was carried out to investigate proximate composition, bread characteristics and sensory evaluation of cocoyam-wheat composite breads at different levels of cocoyam flour substitution for human consumption.A whole wheat bread (WWB) and cocoyam-composite breads (CCB1,CCB 2 and CCB 3) were prepared ...

  3. Evaluation of the Proximate, Chemical and Phytochemical ...

    African Journals Online (AJOL)

    The increased interest in the utilization of the leaves of Moringa oleifera necessitated this study which evaluated the proximate, chemical and phytochemical composition, especially the presence of anti- physiological and toxic factors in the leaves. The results of the phytochemical analyses were: alkaloid 1.24 ± 0.141%; ...

  4. comparative proximate composition and antioxidant vitamins

    African Journals Online (AJOL)


    ABSTRACT. The proximate composition and antioxidant vitamins analysis of two varieties of honey (dark amber and light amber) were carried out using standard methods. The values for moisture, ash, crude lipid, crude protein and crude carbohydrate contents of the two honeys, (light amber and dark amber) are 9.39 ...

  5. Proximate composition and cholesterol concentrations of ...

    African Journals Online (AJOL)

    Proximate composition and cholesterol concentrations of Rhynchophorus phoenicis and Oryctes monoceros larvae subjected to different heat treatments. ... 514.63 mg/100g dry weight basis (DWB) for raw and fried samples, respectively, but decreased to 295.20 mg/100 g DWB in the smoke-dried samples. Similarly, the ...

  6. Preliminary Phytochemical Screening, Elemental and Proximate ...

    African Journals Online (AJOL)

    The study aimed at phytochemical screening, elemental and proximate composition of two varieties of Cyperus esculentus (tiger nut) big yellow and small brown nuts using standard methods. The phytochemicals tested for were alkaloid, saponin, tannin, glycoside, flavonoid, steroid and resin. All the aforementioned ...

  7. Protein biomarker validation via proximity ligation assays. (United States)

    Blokzijl, A; Nong, R; Darmanis, S; Hertz, E; Landegren, U; Kamali-Moghaddam, M


    The ability to detect minute amounts of specific proteins or protein modifications in blood as biomarkers for a plethora of human pathological conditions holds great promise for future medicine. Despite a large number of plausible candidate protein biomarkers published annually, the translation to clinical use is impeded by factors such as the required size of the initial studies, and limitations of the technologies used. The proximity ligation assay (PLA) is a versatile molecular tool that has the potential to address some obstacles, both in validation of biomarkers previously discovered using other techniques, and for future routine clinical diagnostic needs. The enhanced specificity of PLA extends the opportunities for large-scale, high-performance analyses of proteins. Besides advantages in the form of minimal sample consumption and an extended dynamic range, the PLA technique allows flexible assay reconfiguration. The technology can be adapted for detecting protein complexes, proximity between proteins in extracellular vesicles or in circulating tumor cells, and to address multiple post-translational modifications in the same protein molecule. We discuss herein requirements for biomarker validation, and how PLA may play an increasing role in this regard. We describe some recent developments of the technology, including proximity extension assays, the use of recombinant affinity reagents suitable for use in proximity assays, and the potential for single cell proteomics. This article is part of a Special Issue entitled: Biomarkers: A Proteomic Challenge. © 2013.

  8. Phytochemical screening, proximate and elemental analysis of ...

    African Journals Online (AJOL)

    Michael Horsfall

    2009). The aim of this study was to analyses the extract of. Citrus sinensis peels for the phytochemical, proximate and elemental composition. MATERIALS AND METHODS. Plant materials Fresh peels of Citrus sinensis were collected from Uselu market in Benin City, Edo. State, Nigeria. It was identified and authenticated by.

  9. Keldysh proximity action for disordered superconductors

    Indian Academy of Sciences (India)

    Abstract. We review a novel approach to the superconductive proximity effect in dis- ordered normal–superconducting (N–S) structures. The method is based on the multi- charge Keldysh action and is suitable for the treatment of interaction and fluctuation effects. As an application of the formalism, we study the subgap ...

  10. Goal-Proximity Decision-Making (United States)

    Veksler, Vladislav D.; Gray, Wayne D.; Schoelles, Michael J.


    Reinforcement learning (RL) models of decision-making cannot account for human decisions in the absence of prior reward or punishment. We propose a mechanism for choosing among available options based on goal-option association strengths, where association strengths between objects represent previously experienced object proximity. The proposed…

  11. Case report: Chronic arthritis of fetlock joint in the horse

    Directory of Open Access Journals (Sweden)

    Toholj Bojan


    Full Text Available Diseases of extremities in horses are the most significant part of the pathology in this species. This paper shows neurectomy as the ultimo ratio in the treatment of chronic arthritis of the fetlock joint in the horse. This disease is characterized by the appearance of exostoses in the area of the fetlock joint which reduces the mobility of the joint and causes pain during movement. The disease was diagnosed in a clinical examination, with a probe of the flexion of the suspected joint, and using diagnostic anesthesia. After data were collected in this way, we opted for neurectomy of the n.palmaris medialis. The operation was performed in general anesthesia. Local anesthesia was also applied as proximal palmar anesthesia. The postoperative course was smooth. Following the withdrawal of the edema and the healing of the wound, the lameness ceased and the usability value of the stallion was restored.

  12. Vascularized proximal fibular epiphyseal transfer for distal radial reconstruction. (United States)

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


    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

  13. A scale-space curvature matching algorithm for the reconstruction of complex proximal humeral fractures. (United States)

    Vlachopoulos, Lazaros; Székely, Gábor; Gerber, Christian; Fürnstahl, Philipp


    The optimal surgical treatment of complex fractures of the proximal humerus is controversial. It is proven that best results are obtained if an anatomical reduction of the fragments is achieved and, therefore, computer-assisted methods have been proposed for the reconstruction of the fractures. However, complex fractures of the proximal humerus are commonly accompanied with a relevant displacement of the fragments and, therefore, algorithms relying on the initial position of the fragments might fail. The state-of-the-art algorithm for complex fractures of the proximal humerus requires the acquisition of a CT scan of the (healthy) contralateral anatomy as a reconstruction template to address the displacement of the fragments. Pose-invariant fracture line based reconstruction algorithms have been applied successful for reassembling broken vessels in archaeology. Nevertheless, the extraction of the fracture lines and the necessary computation of their curvature are susceptible to noise and make the application of previous approaches difficult or even impossible for bone fractures close to the joints, where the cortical layer is thin. We present a novel scale-space representation of the curvature, permitting to calculate the correct alignment between bone fragments solely based on corresponding regions of the fracture lines. The fractures of the proximal humerus are automatically reconstructed based on iterative pairwise reduction of the fragments. The validation of the presented method was performed on twelve clinical cases, surgically treated after complex proximal humeral fracture, and by cadaver experiments. The accuracy of our approach was compared to the state-of-the-art algorithm for complex fractures of the proximal humerus. All reconstructions of the clinical cases resulted in an accurate approximation of the pre-traumatic anatomy. The accuracy of the reconstructed cadaver cases outperformed the current state-of-the-art algorithm. Copyright © 2017 Elsevier B

  14. Hip abductor moment arm - a mathematical analysis for proximal femoral replacement

    Directory of Open Access Journals (Sweden)

    Temple H Thomas


    Full Text Available Abstract Background Patients undergoing proximal femoral replacement for tumor resection often have compromised hip abductor muscles resulting in a Trendelenberg limp and hip instability. Commercially available proximal femoral prostheses offer several designs with varying sites of attachment for the abductor muscles, however, no analyses of these configurations have been performed to determine which design provides the longest moment arm for the hip abductor muscles during normal function. Methods This study analyzed hip abductor moment arm through hip adduction and abduction with a trigonometric mathematical model to evaluate the effects of alterations in anatomy and proximal femoral prosthesis design. Prosthesis dimensions were taken from technical schematics that were obtained from the prosthesis manufacturers. Manufacturers who contributed schematics for this investigation were Stryker Orthopaedics and Biomet. Results Superior and lateral displacement of the greater trochanter increased the hip abductor mechanical advantage for single-leg stance and adduction and preserved moment arm in the setting of Trendelenberg gait. Hip joint medialization resulted in less variance of the abductor moment arm through coronal motion. The Stryker GMRS endoprosthesis provided the longest moment arm in single-leg stance. Conclusions Hip abductor moment arm varies substantially throughout the hip's range of motion in the coronal plane. Selection of a proximal femur endoprosthesis with an abductor muscle insertion that is located superiorly and laterally will optimize hip abductor moment arm in single-leg stance compared to one located inferiorly or medially.


    Miki, Roberto Augusto; Kam, Check C; Gennis, Elisabeth R; Barkin, Jodie A; Riel, Ryan U; Robinson, Philip G; Owens, Patrick W


    Purpose Thumb carpometacarpal (CMC) joint arthritis is one of the most common problems addressed by hand surgeons. The gold standard of treatment for thumb CMC joint arthritis is trapeziectomy, ligament reconstruction and tendon interposition. Denervation of the thumb CMC joint is not currently used to treat arthritis in this joint due to the failure of the procedure to yield significant symptomatic relief. The failure of denervation is puzzling, given that past anatomic studies show the radial nerve is the major innervation of the thumb CMC joint with the lateral antebrachial nerve and the median nerve also innervating this joint. Although no anatomic study has ever shown that the ulnar nerve innervates the CMC joint, due to both the failure of denervation and the success of arthroscopic thermal ablation, we suspect that previous anatomic studies may have overlooked innervation of the thumb CMC joint via the ulnar nerve. Methods We dissected 19 formalin-preserved cadaveric hand-to-mid-forearm specimens. The radial, median and ulnar nerves were identified in the proximal forearm and then followed distally. Any branch heading toward the radial side of the hand were followed to see if they innervated the thumb CMC joint. Results Eleven specimens (58%) had superficial radial nerve innervation to the thumb CMC joint. Nine specimens (47%) had median nerve innervation from the motor branch. Nine specimens (47%) had ulnar nerve innervation from the motor branch. Conclusions We believe this is the first study to demonstrate that the ulnar nerve innervates the thumb CMC joint This finding may explain the poor results seen in earlier attempts at denervation of the thumb CMC, but the more favorable results with techniques such as arthroscopy with thermal ablation. PMID:22096446

  16. Bridges Expansion Joints

    Directory of Open Access Journals (Sweden)

    Sergey W. Kozlachkow


    Full Text Available The survey is concerned with the expansion joints, used in bridge constructions to compensate medium and significant operational linear and spatial displacements between adjacent spans or between bridge span and pier. The analysis of design features of these types of expansion joints, their advantages and disadvantages, based on operational experience justified the necessity to design constructions, meeting the modern demands imposed to expansion joints.

  17. Elbow joint instability

    DEFF Research Database (Denmark)

    Olsen, Bo Sanderhoff; Henriksen, M G; Søjbjerg, Jens Ole


    The effect of simultaneous ulnar and radial collateral ligament division on the kinematics of the elbow joint is studied in a cadaveric model. Severance of the anterior part of the ulnar collateral ligament and the annular ligament led to significant elbow joint instability in valgus and varus...... of the specimens was recorded. The reproducibility of the instability pattern suggests that this model is suitable for evaluating stabilizing procedures aimed at correction of elbow joint instability before these procedures are introduced into patient care....

  18. Jointly Poisson processes


    Johnson, D. H.; Goodman, I. N.


    What constitutes jointly Poisson processes remains an unresolved issue. This report reviews the current state of the theory and indicates how the accepted but unproven model equals that resulting from the small time-interval limit of jointly Bernoulli processes. One intriguing consequence of these models is that jointly Poisson processes can only be positively correlated as measured by the correlation coefficient defined by cumulants of the probability generating functional.

  19. Dorsal approach for open reduction of complex metacarpophalangeal joint dislocations. (United States)

    Patterson, Ryan W; Maschke, Steven D; Evans, Peter J; Lawton, Jeffrey N


    The metacarpophalangeal (MP) joint is resistant to injury due to its strong capsuloligamentous structures, which include the volar plate and deep transverse metacarpal and collateral ligaments. Complex MP joint dislocations are, by definition, irreducible by closed means and require open reduction, as the volar plate becomes entrapped between the metacarpal head and proximal phalanx. The dorsal approach may offer the following advantages: 1) reduced risk to palmarly displaced neurovascular structures, 2) facilitated management of osteochondral fractures, and 3) full exposure of the volar plate. However, the dorsal approach requires splitting of the volar plate for adequate reduction, which may delay recovery.

  20. Shape of growth plate of proximal femur in children and its significance in the aetiology of slipped capital femoral epiphysis. (United States)

    Kandzierski, Grzegorz; Matuszewski, Lukasz; Wójcik, Anna


    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.

  1. Bridges Expansion Joints

    National Research Council Canada - National Science Library

    Sergey W. Kozlachkow


    .... The analysis of design features of these types of expansion joints, their advantages and disadvantages, based on operational experience justified the necessity to design constructions, meeting...

  2. Internal fixation of proximal humerus fractures using the T2-proximal humeral nail. (United States)

    Popescu, Dragos; Fernandez-Valencia, Jenaro A; Rios, Moisés; Cuñé, Jordi; Domingo, Anna; Prat, Salvi


    Surgical management of proximal humerus fractures remains controversial and there is an increasing interest in intramedullary nailing. Created to improve previous designs, the T2-proximal humeral nail (PHN) (Stryker) has been recently released, and the English literature lacks a series evaluating its results. We present a clinical prospective study evaluating this implant for proximal humeral fractures. We evaluated the functional and radiological results and possible complications. Twenty-nine patients with displaced fractures of the proximal humerus were treated with this nail. One patient was lost right after surgery and excluded from the assessment. Eighteen patients were older than 70 years. There were 21 fractures of the proximal part of the humerus and 7 fractures that also involved the shaft; 15 of the fractures were two-part fractures (surgical neck), 5 were three-part fractures, and 1 was a four-part fracture. All fractures healed in a mean period of 2.7 months. There was one delayed union that healed in 4 months. One case of avascular necrosis of the humeral head was observed (a four-part fracture), but remained asymptomatic and did not require further treatment. In one case a back-out of one proximal screw was observed. A final evaluation with a minimum 1 year follow-up was performed by an independent observer; in 18 patients, the mean Constant score was 65.7 or 76.1% with the adjustment of age and gender; in 19 patients, the mean Oxford Shoulder Score was 21.7. The results obtained with the T2-PHN nail indicate that it represents a safe and reliable method in the treatment of two- and three-part fractures of the proximal humerus. The proximal fixation mechanism diminishes the rate of back-out of the screws, a frequent complication described in the literature. Better functional results were obtained from the patients younger than 70 years, but these were not statistically significant.

  3. Proximal tubular hypertrophy and enlarged glomerular and proximal tubular urinary space in obese subjects with proteinuria.

    Directory of Open Access Journals (Sweden)

    Ana Tobar

    Full Text Available BACKGROUND: Obesity is associated with glomerular hyperfiltration, increased proximal tubular sodium reabsorption, glomerular enlargement and renal hypertrophy. A single experimental study reported an increased glomerular urinary space in obese dogs. Whether proximal tubular volume is increased in obese subjects and whether their glomerular and tubular urinary spaces are enlarged is unknown. OBJECTIVE: To determine whether proximal tubules and glomerular and tubular urinary space are enlarged in obese subjects with proteinuria and glomerular hyperfiltration. METHODS: Kidney biopsies from 11 non-diabetic obese with proteinuria and 14 non-diabetic lean patients with a creatinine clearance above 50 ml/min and with mild or no interstitial fibrosis were retrospectively analyzed using morphometric methods. The cross-sectional area of the proximal tubular epithelium and lumen, the volume of the glomerular tuft and of Bowman's space and the nuclei number per tubular profile were estimated. RESULTS: Creatinine clearance was higher in the obese than in the lean group (P=0.03. Proteinuria was similarly increased in both groups. Compared to the lean group, the obese group displayed a 104% higher glomerular tuft volume (P=0.001, a 94% higher Bowman's space volume (P=0.003, a 33% higher cross-sectional area of the proximal tubular epithelium (P=0.02 and a 54% higher cross-sectional area of the proximal tubular lumen (P=0.01. The nuclei number per proximal tubular profile was similar in both groups, suggesting that the increase in tubular volume is due to hypertrophy and not to hyperplasia. CONCLUSIONS: Obesity-related glomerular hyperfiltration is associated with proximal tubular epithelial hypertrophy and increased glomerular and tubular urinary space volume in subjects with proteinuria. The expanded glomerular and urinary space is probably a direct consequence of glomerular hyperfiltration. These effects may be involved in the pathogenesis of obesity

  4. New endoprosthesis suspension method with polypropylene monofilament knitted mesh after resection of bone tumors in proximal humerus. (United States)

    Fujibuchi, Taketsugu; Matsumoto, Seiichi; Shimoji, Takashi; Ae, Keisuke; Tanizawa, Taisuke; Gokita, Tabu; Hayakawa, Keiko


    Endoprosthetic reconstruction of the proximal humerus is one of the standard procedures after resection of tumors of the proximal humerus and has been considered a reliable method to reconstruct the proximal humerus in recent reports. However, instability of the shoulder joint caused by loss of the rotator cuff and deltoid muscle function is often observed after such an endoprosthetic reconstruction. We performed the endoprosthesis suspension method with polypropylene monofilament knitted mesh. This suspension method, by which the endoprosthesis is suspended from the bone structure, was used after resection of tumors in 9 patients. We assessed postoperative stability of the shoulder joint by comparing these patients with 12 patients who underwent the conventional surgical technique, by which the mesh-wrapped endoprosthesis is attached only to soft tissue. In radiographic and physical evaluation, 4 of the 12 patients in the soft tissue reconstruction group showed shoulder joint instability. No patient in the suspension method group showed subluxation of the humeral prosthesis. The mean shoulder flexion was 35° and 65° and the mean shoulder abduction was 40° and 40° for the soft tissue reconstruction group and the suspension method group, respectively. Shoulder joint subluxation sometimes occurs because of elongation of the attached soft tissue in the conventional reconstruction with mesh, whereas no shoulder joint subluxation occurs after endoprosthetic reconstruction in the suspension method because the bone structure has no leeway for elongation. Excellent stability of our new method enables exercise of the surgical shoulder at an early stage, leading to improved range of shoulder joint motion. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier Inc. All rights reserved.

  5. Pachydermodactyly: a Case Report and Literature Review

    Directory of Open Access Journals (Sweden)

    Paravina Mirjana


    Full Text Available Pachydermodactyly is a rare, benign form of digital fibromatosis, characterized by asymptomatic and progressive, periarticular and usually symmetrical soft tissue finger swelling, specifically on the lateral aspects of the proximal interphalangeal joints mainly of the second, third, and fourth fingers; it mostly affects young adolescents and is probably due to repeated mechanical injury of the skin (such as repeated clasping or rubbing of crossed fingers, sometimes as a result of obsessive-compulsive disorder, which must be distinguished from obsessive “chewing pads”. This paper presents a male patient aged 19, who presented with first symptoms at the age of 12, and was diagnosed with periarticular hypertrophy: localized soft tissue thickening around the proximal interphalangeal joints of all fingers except the thumbs; slight hypertrophy of the skin; absence of subjective complaints; normal joint function. Dermatological status on admission revealed: symmetrical soft tissue swelling of all fingers of both hands except the thumbs at the level of the proximal interphalangeal joints; normal appearance of the distal parts of all fingers; thickening at the level of the proximal interphalangeal joints, bilateral, almost symmetrical hypertrophy (ulnar and radial of phalanges of the affected fingers except both index fingers, affecting only the ulnar side. The skin lesions were pain-free on palpation, with homogeneous texture and elastic consistency, freely movable over underlying structures. The affected joints showed no functional deficit. The test results, sonography, radiography and histopathology confirmed our clinical diagnosis-pachydermodactyly. The review of the currently available literature, published between 1973 and 2014, including 99 papers and 160 patients, provided important insight into the characteristics and variations of the disease.

  6. [Arthroscopic fracture management in proximal humeral fractures]. (United States)

    Lill, H; Katthagen, C; Jensen, G; Voigt, C


    Arthroscopy has become increasingly more established in the treatment of proximal humeral fractures. In addition to the known advantages of minimally invasive surgery fracture and implant positioning can be optimized and controlled arthroscopically and relevant intra-articular concomitant pathologies (e.g. biceps tendon complex and rotator cuff) can be diagnosed and treated. Arthroscopic techniques have proven to be advantageous in the treatment of various entities of greater tuberosity fractures, lesser tuberosity fractures (suture bridging technique) and subcapital humeral fractures (arthroscopic nailing). This article presents an overview on innovative arthroscopic modalities for treating proximal humeral fractures, describes the surgical techniques and the advantages compared to open procedures as well as initial clinical results.

  7. SINA: A test system for proximity fuses (United States)

    Ruizenaar, M. G. A.


    SINA, a signal generator that can be used for testing proximity fuses, is described. The circuitry of proximity fuses is presented; the output signal of the RF circuit results from a mixing of the emitted signal and received signal that is Doppler shifted in frequency by the relative motion of the fuse with respect to the reflecting target of surface. With SINA, digitized and stored target and clutter signals (previously measured) can be transformed to Doppler signals, for example during a real flight. SINA can be used for testing fuse circuitry, for example in the verification of results of computer simulations of the low frequency Doppler signal processing. The software of SINA and its use are explained.

  8. Tunable Magnetic Proximity Effects in Graphene Junctions (United States)

    Lazic, Predrag; Belashchenko, Kirill; Zutic, Igor


    The characteristic length of the magnetic proximity effects exceed the thickness of a graphene layer leading to an important, but typically overlooked, modifications of equilibrium and transport properties, as well as the implications for graphene spintronics. Using the first-principles studies that integrate a real space density functional theory (GPAW) with the state-of-the art boundary elements electrostatic code based on the Robin Hood method, we explore tunable electronic structure and magnetic proximity effects in the ferromagnet/insulator/graphene junctions. We show that the inclusion of a finite-size gate electrodes and van der Walls interaction lead to nontrivial effects that could also be important in other two-dimensional materials beyond graphene. Work supported by US ONR, NSF-DMR and Nebraska NSF MRSEC.

  9. Management of Proximal Third Arm Replantation

    Directory of Open Access Journals (Sweden)

    Süleyman Taş


    Full Text Available Notwithstanding the recent success in major limb replantation achieved through the advancements in microsurgical techniques, the viability of the extremity is still relatively low at the transhumeral level following a replantation. There are no exact guidelines for deciding whether to undertake a stump repair or a replantation in such amputations at the proximal level. However, a highly motivated patient with realistic expectations and protected shoulder function can be a candidate to undergo replantation. The replanted arm may help the uninjured arm in daily activities. In this report we present the case of a 47-year-old man whose arm was amputated at proximal third level by an asphalt machine and successfully replanted together with the encountered problems and their solutions. The roadmap followed in this rare case may be a guide for hand surgeons.

  10. Dedifferentiated chondrosarcoma of right proximal femur

    Directory of Open Access Journals (Sweden)

    Sachin A Badge


    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.

  11. Treatment of subchondral lucencies in the medial proximal radius with a bone screw in 8 horses. (United States)

    Roquet, Imma; Lane Easter, J; Coomer, Richard P C; Ezquerra, Luis J; Marsh, Chad A; Trostle, Steve S; Santschi, Elizabeth M


    To describe the results of screw placement through subchondral lucencies (SCL) of the proximal radius in 8 horses. Retrospective clinical study. Horses with cubital SCL causing lameness (n=8). Medical record review and clinical follow-up. Eight horses with SCL in the proximal radius causing lameness were treated with a screw placed across the lucency. The horses range in age from 1 to 20 years. In 4 of 8 horses, the lameness had been intermittently severe (apparent at the walk). Lameness was isolated to the cubital joint by intra-articular anesthesia in 5 horses and diagnosed radiographically in all 8. All horses had a 4.5 mm cortical bone screw placed from medial to lateral (6 lag, 2 neutral) across the SCL using fluoroscopic or radiographic control. Postoperative care included stall confinement with hand walking for 30-60 days, followed by an additional 30-60 days of pasture turnout. Radiographic SCL healing (reduction in SCL size) was demonstrated at 3-4 months after surgery in all horses, and 7/8 horses (87.5%) were used as intended (4 performance, 3 pasture turn-out) within 6 months. Lameness in the remaining horse improved initially (dressage) but returned. A screw placed through the SCL of the proximal-medial radius was effective in reducing or resolving lameness associated with the elbow joint in 7/8 horses (88%). Screw placement in the proximal radius should be considered for horses with lameness caused by an SCL when a quick return to exercise is desired or conservative therapy is ineffective. © 2017 The American College of Veterinary Surgeons.

  12. Management of Acute Proximal Humeral Fractures. (United States)

    Kancherla, Vamsi Krishna; Singh, Anshuman; Anakwenze, Oke A


    Proximal humeral fractures, which typically occur in elderly persons, are among the most common fractures. A myriad of nonsurgical and surgical treatment options exist for these injuries, including short-term immobilization and early physical therapy, percutaneous fixation, plate osteosynthesis, intramedullary nailing, hemiarthroplasty, and reverse shoulder arthroplasty. The choice of treatment depends on the fracture type and severity, surgeon expertise, patient age, and patient health status.

  13. Superconducting proximity effect in clean ferromagnetic layers


    Zareyan, M.; Belzig, W.; Nazarov, Yu. V.


    We investigate the superconducting proximity effect in clean ferromagnetic layers with rough boundaries. The subgap density of states is formed by Andreev bound states at energies which depend on trajectory length and the ferromagnetic exchange field. At energies above the gap, the spectrum is governed by resonant scattering states. The resulting density of states, measurable by tunneling spectroscopy, exhibits a rich structure, which allows us to connect the theoretical parameters from exper...

  14. Alternating proximal algorithm for blind image recovery


    Bolte, Jérôme; Combettes, Patrick Louis; Pesquet, Jean-Christophe


    International audience; We consider a variational formulation of blind image recovery problems. A novel iterative proximal algorithm is proposed to solve the associated nonconvex minimization problem. Under suitable assumptions, this algorithm is shown to have better convergence properties than standard alternating minimization techniques. The objective function includes a smooth convex data fidelity term and nonsmooth convex regularization terms modeling prior information on the data and on ...

  15. Transverse Stress Fracture of the Proximal Patella (United States)

    Atsumi, Satoru; Arai, Yuji; Kato, Ko; Nishimura, Akinobu; Nakazora, Shigeto; Nakagawa, Shuji; Ikoma, Kazuya; Fujiwara, Hiroyoshi; Sudo, Akihiro; Kubo, Toshikazu


    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

  16. Capacitive Proximity Sensor Has Longer Range (United States)

    Vranish, John M.


    Capacitive proximity sensor on robot arm detects nearby object via capacitive effect of object on frequency of oscillator. Sensing element part of oscillator circuit operating at about 20 kHz. Total capacitance between sensing element and ground constitutes tuning capacitance of oscillator. Sensor circuit includes shield driven by replica of alternating voltage applied to sensing element. Driven shield concentrates sensing electrostatic field in exterior region to enhance sensitivity to object. Sensitivity and dynamic range has corresponding 12-to-1 improvement.


    African Journals Online (AJOL)


    The proximate analysis (moisture, crude protein, crude fat, mineral ash and total carbohydrates) in the kernels and flour of African Bush Mango (. ) were investigated. The results revealed that the kernels contained moisture (2.5 g/100 g), crude protein (8.9 g/100 g), crude fat (68.4 g/100 g), mineral ash (2.3 g/100 g) and total ...

  18. [Proximity and breastfeeding at the maternity hospital]. (United States)

    Fradin-Charrier, Anne-Claire


    The establishment of breastfeeding, as well as its duration, are facilitated through the proximity of the mother with her new baby. However, in maternity hospitals, breastfeeding mothers very often leave their baby in the nursery at night time. A study carried out in 2014 in several maternity hospitals put forward suggestions and highlighted areas to improve in everyday practice. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  19. Influence of muscle groups' activation on proximal femoral growth tendency. (United States)

    Yadav, Priti; Shefelbine, Sandra J; Pontén, Eva; Gutierrez-Farewik, Elena M


    Muscle and joint contact force influence stresses at the proximal growth plate of the femur and thus bone growth, affecting the neck shaft angle (NSA) and femoral anteversion (FA). This study aims to illustrate how different muscle groups' activation during gait affects NSA and FA development in able-bodied children. Subject-specific femur models were developed for three able-bodied children (ages 6, 7, and 11 years) using magnetic resonance images. Contributions of different muscle groups-hip flexors, hip extensors, hip adductors, hip abductors, and knee extensors-to overall hip contact force were computed. Specific growth rate for the growth plate was computed, and the growth was simulated in the principal stress direction at each element in the growth front. The predicted growth indicated decreased NSA and FA (of about [Formula: see text] over a four-month period) for able-bodied children. Hip abductors contributed the most, and hip adductors, the least, to growth rate. All muscles groups contributed to a decrease in predicted NSA ([Formula: see text]0.01[Formula: see text]-0.04[Formula: see text] and FA ([Formula: see text]0.004[Formula: see text]-[Formula: see text]), except hip extensors and hip adductors, which showed a tendency to increase the FA ([Formula: see text]0.004[Formula: see text]-[Formula: see text]). Understanding influences of different muscle groups on long bone growth tendency can help in treatment planning for growing children with affected gait.

  20. Proximal Gastrojejunal Reconstruction after Pancreaticoduodenal Resection

    Directory of Open Access Journals (Sweden)

    M. Wayne


    Full Text Available Introduction. Reconstruction by proximal gastrojejunostomy, and distal biliary and pancreatic anastomoses is infrequently used after resection of the head of the pancreas because of fear of fistulas and cholangitis. Pancreaticoduodenectomy is being performed more frequently for cystic malignant and premalignant lesions. Because of this there is a need for endoscopic visualization and biopsy of the residual pancreatic duct, since multi-centricity is characteristic of some of these malignancies. Since endoscopic access of the bile duct and pancreatic duct is difficult and unsuccessful in 50–70% after B II or Roux Y reconstruction, we prospectively studied the merit and complications (early and late of proximal gastrojejunal (PGJ reconstruction after pancreaticoduodenal resection. Material and Methods. Thirty nine consecutive, non-radomized patients underwent pancreaticoduodenectomy and PGJ reconstruction over 14 mos. There were 21 males and 18 females. Results. 7 patients with IPMN have undergone repeat CT scanning for surveillance, with 3 requiring repeat EUS and ERCP. There were no technical difficulties accessing the pancreas or the pancreatic duct, supporting the PGJ reconstruction. Conclusion. Proximal gastrojejunal reconstruction following pancreaticoduodenal resection may be safely done with similar morbidity to traditional pancreaticojejunal reconstructions. PGJ reconstruction may be of greater value when direct visual access to the bile duct or pancreatic duct is necessary, and should be considered when doing resection for mucinous cysts or IPMN of the head of the pancreas.

  1. MR diagnosis of temporomandibular joint. A study of joint effusion

    Energy Technology Data Exchange (ETDEWEB)

    Kaneda, Takashi; Yamashiro, Mitsuaki; Ozawa, Kaoru; Suzuki, Hiromi; Okada, Hiroyuki; Yamamoto, Hirotsugu [Nihon Univ., Matsudo, Chiba (Japan). School of Dentistry


    The purposes of this study were to evaluate the relationship between correlation of MR joint effusion of the temporomandibular joint and disk position, to evaluate the relationship between joint effusion and aging, and to assess the frequency of MR joint effusion of bilateral temporomandibular joints. The temporomandibular joints of 192 patients with clinical symptoms of temporomandibular joint disorders were imaged bilaterally using high field, surface-coil MR imaging. Oblique sagittal and coronal proton density-weighted and T2-weighted images were obtained. Imaging findings of joint effusion were correlated with disk position, aging, and bilateral temporomandibular joints. MR showed effusion in 4% of the joints with normal superior disk position, 36% of the joints with disk displacement with reduction, and 45% of the joints with disk displacement without reduction. There were significant differences in the incidence of joint effusion between normal disk position and anterior disk displacement with or without reduction. Younger patients less than 40 years were significant higher the incidence of joint effusion than those of older patients. A significant association was seen between joint effusion and aging. MR showed effusion in 17% of the unilateral temporomandibular joint, 24% of the bilateral temporomandibular joints. There was no significant difference between unilateral and bilateral case. These results indicated that joint effusion using MR imaging was associated with varied temporomandibular joint pathologic states. (author)

  2. Creep of timber joints

    NARCIS (Netherlands)

    Van de Kuilen, J.W.G.


    A creep analysis has been performed on nailed, toothed-plates and split-ring joints in a varying uncontrolled climate. The load levels varied between 30% and 50% of the average ultimate short term strength of these joints, tested in accordance with ISO 6891. The climate in which the tests were

  3. 13. Sacroiliac joint pain

    NARCIS (Netherlands)

    Vanelderen, P.; Szadek, K.M.; Cohen, S.P.; Witte, J.; Lataster, A.; Patijn, J.; Mekhail, N.; van Kleef, M.; van Zundert, J.


    The sacroiliac joint accounts for approximately 16% to 30% of cases of chronic mechanical low back pain. Pain originating in the sacroiliac joint is predominantly perceived in the gluteal region, although pain is often referred into the lower and upper lumbar region, groin, abdomen, and/ or lower

  4. [Long-term consequences of resection of 1/3 proximal epiphysis of child's right tibia--a case study]. (United States)

    Duda, Sławomir; Jasiewicz, Barbara; Potaczek, Tomasz; Tęsiorowski, Maciej


    Authors report a case of a patient with varus deformity of right knee, caused by wide resection of proximal metaphysis and epiphysis of right tibia. Afore mentioned procedure led to loss of right knee joint integrity, with its lateral instability, shortening, and axis deviation of right tibia. Surgical treatment of this complications was performed in several stages and took about 5 years, starting from temporal, lateral hemiepiphysiodesis of proximal tibial epiphysis, subacute epiphysiolysis of proximal tibial epiphysis and high valgus tibia osteotomy, at the end finished with medial tibia condyle reconstruction with autogenic graft and osteoconductive substances. The proper mechanical and anatomical axis of the right limb, with full stability and movement of right knee was achieved after those surgeries. The process of treatment of lower extremity axis deviation takes long time, frequently involves several surgeries and needs firm cooperation between doctor and patient.

  5. Calibrating animal-borne proximity loggers. (United States)

    Rutz, Christian; Morrissey, Michael B; Burns, Zackory T; Burt, John; Otis, Brian; St Clair, James J H; James, Richard


    Growing interest in the structure and dynamics of animal social networks has stimulated efforts to develop automated tracking technologies that can reliably record encounters in free-ranging subjects. A particularly promising approach is the use of animal-attached 'proximity loggers', which collect data on the incidence, duration and proximity of spatial associations through inter-logger radio communication. While proximity logging is based on a straightforward physical principle - the attenuation of propagating radio waves with distance - calibrating systems for field deployment is challenging, since most study species roam across complex, heterogeneous environments.In this study, we calibrated a recently developed digital proximity-logging system ('Encounternet') for deployment on a wild population of New Caledonian crows Corvus moneduloides. Our principal objective was to establish a quantitative model that enables robust post hoc estimation of logger-to-logger (and, hence, crow-to-crow) distances from logger-recorded signal-strength values. To achieve an accurate description of the radio communication between crow-borne loggers, we conducted a calibration exercise that combines theoretical analyses, field experiments, statistical modelling, behavioural observations, and computer simulations.We show that, using signal-strength information only, it is possible to assign crow encounters reliably to predefined distance classes, enabling powerful analyses of social dynamics. For example, raw data sets from field-deployed loggers can be filtered at the analysis stage to include predominantly encounters where crows would have come to within a few metres of each other, and could therefore have socially learned new behaviours through direct observation. One of the main challenges for improving data classification further is the fact that crows - like most other study species - associate across a wide variety of habitats and behavioural contexts, with different signal

  6. Proximate chemical composition and fatty acid profiles of ...

    African Journals Online (AJOL)

    Proximate chemical composition and fatty acid profiles of Longissimus Proximate chemical composition and fatty acid profiles of Longissimus thoracis from pasture fed LHRH immunocastrated, castrated and intact Bos indicus bulls.

  7. Proximate Analysis and Total Lycopene Content of Some Tomato ...

    African Journals Online (AJOL)



    Jun 5, 2017 ... Standard analytical techniques were employed to determine the proximate composition and lycopene content of three tomato cultivars namely: ... Keywords: Antioxidant, lycopene content, proximate composition, tomato cultivars. INTRODUCTION ..... from oranges, tomatoes and carrots. African. Journal of ...

  8. A Regularized Algorithm for the Proximal Split Feasibility Problem

    Directory of Open Access Journals (Sweden)

    Zhangsong Yao


    Full Text Available The proximal split feasibility problem has been studied. A regularized method has been presented for solving the proximal split feasibility problem. Strong convergence theorem is given.

  9. Comparison of Findings from Oblique Radiographs of the Raised Limb with Those of the Weight-bearing Limb for Selected Diseases of the Equine Digit

    Directory of Open Access Journals (Sweden)

    J. Šterc


    Full Text Available In the present study, the radiographic examination of the distal and proximal interphalangeal joints was performed in 43 randomly selected horses. A total of 86 forelimbs were examined. On the forelimbs, dorsolateral-palmaromedial, and dorsomedial-palmarolateral oblique views were performed. The oblique views were performed on raised limbs placed in a navicular block and on weight-bearing limbs placed on a pedestal made at the equine clinic. In total, 688 dorsolateral-palmaromedial and dorsomedial-palmarolateral views were taken. During the evaluation of the radiographs we focused on the detection of signs of degenerative joint disease of the distal and proximal iterphalangeal joints, and the detection of new bone formation in the phalanx regions, not associated with a disease of the distal or proximal interphalangeal joints. Based on the radiographic signs visible on these views, we diagnosed 9 cases of degenerative joint disease of the distal intraphalangeal joint, 13 cases of the degenerative joint disease of the proximal intraphalangeal joint and 21 cases of new bone formation in the phalanx regions. These signs were observed in 253 of 688 oblique views. Positive radiographic findings of the above-mentioned disorders were shown on 127 oblique views of the raised limb placed in the navicular block and 126 oblique views of the weight-bearing limb placed on the pedestal we made. When 128 oblique views of the weight-bearing limb (placed on the pedestal were compared with those of the raised limb (in the navicular block, there were different radiographic findings in three cases only. The differences in detection rates of radiographic signs between different type views showed no statistical significance (p ≥ 0.05. Therefore we assume that the pedestal we made can be routinely used for the radiographic examination of the distal and proximal interphalangeal joints on DL-PM and DM-PL oblique views, as part of pre-purchase examination or diagnosis

  10. Frequency distribution of osteochondral fragmentation of the dorsoproximal articular surface of the proximal phalanx in racing Thoroughbreds in the UK. (United States)

    Walsh, R; Smith, M R W; Wright, I M


    Osteochondral fragmentation of the dorsoproximal margin of the proximal phalanx is commonly recognised in racing Thoroughbreds. Frequency distribution has been documented in racing Thoroughbreds and Quarter Horses in the USA and in European Warmbloods but no data have been published from the UK. Concurrent intra-articular soft tissue lesions and radiographic accuracy of fragment distribution in racing Thoroughbreds have not previously been reported. To document frequency distribution of dorsoproximal fragmentation of the proximal phalanx in a UK population of racing Thoroughbreds and to compare this with published data. To document concurrent intra-articular lesions identified arthroscopically and radiographic accuracy of fragment distribution. A retrospective single centre-based, observational study. Surgical reports and radiographs of all racing Thoroughbreds that underwent arthroscopic surgery for removal of fragmentation from the dorsoproximal margin of the proximal phalanx at Newmarket Equine Hospital between 2011 and 2015 were reviewed. Two hundred and forty-two (85.8%) horses were in or being prepared for flat racing. Osteochondral fragmentation of the dorsoproximal aspect of the proximal phalanx was present in 428 fetlock joints of 282 horses, consisting of 194 (45.3%) left and 188 (43.9%) right metacarpophalangeal joints, and 20 (4.7%) left and 26 (6.1%) right metatarsophalangeal joints. Fragmentation was located dorsomedially in 316 (73.8%), dorsolaterally in 32 (7.5%) and biaxially in 80 (18.7%) joints. Concurrent soft tissue lesions were identified in 168 (39.3%) joints. Radiographic evidence of fragmentation was visible in 320 joints (74.8%). Limited numbers preclude conclusions with respect to yearlings and horses in jump race training. Dorsoproximal fragmentation of the proximal phalanx occurred most frequently medially and in the forelimbs. Sidedness was not demonstrated. Although similar to previously reported data, variance in limb distribution is

  11. Surgically Relevant Bony and Soft Tissue Anatomy of the Proximal Femur (United States)

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


    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

  12. The leading joint hypothesis for spatial reaching arm motions. (United States)

    Ambike, Satyajit; Schmiedeler, James P


    The leading joint hypothesis (LJH), developed for planar arm reaching, proposes that the interaction torques experienced by the proximal joint are low compared to the corresponding muscle torques. The human central nervous system could potentially ignore these interaction torques at the proximal (leading) joint with little effect on the wrist trajectory, simplifying joint-level control. This paper investigates the extension of the LJH to spatial reaching. In spatial motion, a number of terms in the governing equation (Euler's angular momentum balance) that vanish for planar movements are non-trivial, so their contributions to the joint torque must be classified as net, interaction or muscle torque. This paper applies definitions from the literature to these torque components to establish a general classification for all terms in Euler's equation. This classification is equally applicable to planar and spatial motion. Additionally, a rationale for excluding gravity torques from the torque analysis is provided. Subjects performed point-to-point reaching movements between targets whose locations ensured that the wrist paths lay in various portions of the arm's spatial workspace. Movement kinematics were recorded using electromagnetic sensors located on the subject's arm segments and thorax. The arm was modeled as a three-link kinematic chain with idealized spherical and revolute joints at the shoulder and elbow. Joint torque components were computed using inverse dynamics. Most movements were 'shoulder-led' in that the interaction torque impulse was significantly lower than the muscle torque impulse for the shoulder, but not the elbow. For the few elbow-led movements, the interaction impulse at the elbow was low, while that at the shoulder was high, and these typically involved large elbow and small shoulder displacements. These results support the LJH and extend it to spatial reaching motion.

  13. The regional dimension of intergenerational proximity in the Netherlands

    NARCIS (Netherlands)

    van der Pers, Marieke; Mulder, Clara H.

    Previous research has shown the impact of individual characteristics on intergenerational proximity but has largely ignored the regional dimension of such proximity. In this paper, we examine the regional variation in intergenerational proximity in the Netherlands. We address this issue by

  14. Quality Assessment and Proximate Analysis of Amaranthus hybridus ...

    African Journals Online (AJOL)

    The aim of this research is to determine the quality and proximate composition of Amaranthus hybridus, Celosia argentea, and Talinum triangulare obtained from open markets in Benin City, Nigeria. Microbiological and proximate analysis were carried out using standard methods. Results of the proximate analysis revealed ...

  15. 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 ...

  16. Minimally Invasive Fixation for Proximal Humeral Fracture: A Review on the use of T2 Proximal Humeral Nail

    Directory of Open Access Journals (Sweden)

    Sze-Ling Iris Ngai


    Discussion and conclusion: With the proper surgical technique high union rate, good functional recovery, and low complication rate can be achieved by using T2 Proximal Humeral Nail in managing traumatic proximal humeral fracture.

  17. Appendicular joint dislocations. (United States)

    Hindle, Paul; Davidson, Eleanor K; Biant, Leela C; Court-Brown, Charles M


    This study defines the incidence and epidemiology of joint dislocations and subluxations of the appendicular skeleton. All patients presenting acutely to hospital with a dislocation or subluxation of the appendicular skeleton from a defined population were included in the study. There were 974 dislocations or subluxations over one year between the 1st November 2008 and the 31st October 2009. There was an overall joint dislocation incidence of 157/10(5)/year (188/10(5)/year in males and 128/10(5)/year in females). Males demonstrated a bimodal distribution with a peak incidence of 446/10(5)/year at 15-24 years old and another of 349/10(5)/year in those over 90 years. Females demonstrate an increasing incidence from the seventh decade with a maximum incidence of 520/10(5)/year in those over 90 years. The most commonly affected joints are the glenohumeral (51.2/10(5)/year), the small joints of the hand (29.9/10(5)/year), the patellofemoral joint (21.6/10(5)/year), the prosthetic hip (19.0/10(5)/year), the ankle (11.5/10(5)/year), the acromioclavicular joint (8.9/10(5)/year) and the elbow (5.5/10(5)/year). Unlike fractures, dislocations are more common in the both the most affluent and the most socially deprived sections of the population. Joint disruptions are more common than previously estimated. Copyright © 2013 Elsevier Ltd. All rights reserved.

  18. Partial fasciectomy for Dupuytren's contractures. (United States)

    Mavrogenis, Andreas F; Spyridonos, Sarantis G; Ignatiadis, Ioannis A; Antonopoulos, Dimitrios; Papagelopoulos, Panayiotis J


    One hundred ninety-six patients with Dupuytren's contractures were treated by partial fasciectomy and adequate postoperative rehabilitation. All patients had flexion contracture of the proximal interphalangeal joint of >20 degrees ; 93 patients had flexion contracture of the associated metacarpophalangeal joint of >30 degrees ; 143 patients had risk factors for Dupuytren's disease. Primary skin closure and splinting were done in all patients. Range of motion was begun by the 1st week. Splinting was discontinued by the 2nd week, followed by night-time splinting until the 8th week. The mean follow-up was 6.6 years (range, 2-9 years). At the latest examination, 72.5% of the patients had complete range of motion of the metacarpophalangeal and proximal interphalangeal joints; 20.2% had 5 degrees -10 degrees of extension deficit and 7.3% had recurrent contractures of >20 degrees at the proximal interphalangeal joint and were subjected to reoperation. Complications included digital neurovascular injury in 5%, complex regional pain syndrome in 10.1%, and wound-healing problems and superficial infections in 15.1%.

  19. Delayed homicides and the proximate cause. (United States)

    Lin, Peter; Gill, James R


    Delayed homicides result from complications of remote injuries inflicted by "the hands of another." The investigation of delayed homicides may be a challenge due to a number of factors including: failure to report the death to the proper authorities, lack of ready and adequate documentation of the original injury and circumstances, and jurisdictional differences between the places of injury and death. The certification of these deaths also requires the demonstration of a pathophysiologic link between the remote injury and death. In sorting through these issues, it is helpful to rely upon the definition of the proximate cause of death. Over a 2-year period in New York City, there were 1211 deaths certified as homicide of which 42 were due to injuries sustained greater than 1 year before death. The survival interval ranged from 1.3 to 43.2 years. The most common immediate causes of death were: infections (22), seizures (7), and intestinal obstructions/hernias (6). Common patterns of complications included infection following a gunshot wound of the spinal cord, seizure disorder due to blunt head trauma, and intestinal obstruction/hernia due to adhesions from an abdominal stab wound. Spinal cord injuries resulted in paraplegia in 14 instances and quadriplegia in 8. The mean survival interval for paraplegics was 20.3 years and 14.8 years for quadriplegics; infections were a frequent immediate cause of death in both groups, particularly infections due to chronic bladder catheterization. The definition of proximate cause originated with civil law cases and was later applied to death certification as the proximate cause of death. The gradual extinction of the "year and a day rule" for the limitation of bringing homicide charges in delayed deaths may result in more of these deaths going to trial. Medical examiners/coroners must be able to explain the reasoning behind these death certifications and maintain consistent standards for the certification of all delayed deaths due

  20. Laparoscopic proximal gastrectomy with oblique jejunogastrostomy. (United States)

    Tanaka, Kimitaka; Ebihara, Yuma; Kurashima, Yo; Nakanishi, Yoshitsugu; Asano, Toshimichi; Noji, Takehiro; Murakami, Soichi; Nakamura, Toru; Tsuchikawa, Takahiro; Okamura, Keisuke; Shichinohe, Toshiaki; Hirano, Satoshi


    Proximal early gastric cancer is a good indication for totally laparoscopic proximal gastrectomy (TLPG) with double-tract reconstruction (DTR). However, when most of the dietary intake passes through the escape route of the jejunum, the functional benefits of proximal gastrectomy might be similar to those after total gastrectomy. Our DTR procedure was improved for easy passage through the remnant stomach. The purposes of this study were to present a novel technique for intracorporeal DTR using linear staplers after TLPG and to investigate surgical outcomes. DTR was performed using linear staplers only. A side-to-side jejunogastrostomy with twisting of both the remnant stomach and the anal jejunum was performed for the purpose of passing meals through the remnant stomach (an oblique jejunogastrostomy technique). The ten patients who underwent TLPG with DTR from January 2011 to August 2016 in Hokkaido University Hospital were retrospectively reviewed. Their clinicopathological characteristics and surgical and postoperative outcomes were collected and analyzed. The median duration of operation was 285 (range 146-440) min. No patients required blood transfusions. The number of dissected lymph nodes was 32 (range 22-56). There were no intraoperative complications, and no cases were converted to open surgery. All the patients were pT1N0M0 stage IA. No anastomotic leakage or complications were detected. Postoperative gastrography after reconstruction showed that contrast medium flowed mainly to the remnant stomach. The average percentage body weight loss was 14.0 ± 7.1% at 10 months. The average percentage decrease in serum hemoglobin was 5.4 ± 10.4% at 12 months. This novel technique for intracorporeal DTR provided a considerable advantage by the passage of dietary intake to the remnant stomach after LPG.

  1. Bicarbonate secretion by rabbit proximal colon. (United States)

    Sullivan, S K; Smith, P L


    Stripped segments of proximal colon (1-6 cm distal to the ampulla caecalis coli) were studied in vitro in Ussing chambers under short-circuit conditions using the pH-stat technique. With glucose and HCO3-CO2 present in the serosal bathing solution only, proximal colon alkalinizes the luminal bathing solution at a rate of 2.1 +/- 0.2 mu eq X h-1 X cm-2 (n = 36). With HCO3-CO2 present in the luminal bathing solution alone, proximal colon does not significantly acidify or alkalinize the serosal bathing solution. Addition of glucose (10 mM) to the luminal bathing solution abolished luminal alkalinization. Removal of HCO3 and CO2 from the serosal bathing solution or replacement of O2 with N2 also abolished luminal alkalinization. Acetazolamide (0.1 mM) added to both bathing solutions did not alter the rate of luminal alkalinization. Ion-replacement studies revealed that the alkalinization process was highly dependent on the presence of Na in the bathing solutions and much less dependent on the presence of Cl. Furthermore, ouabain (0.1 mM) significantly reduced luminal alkalinization. As in rabbit ileum, serosal epinephrine (0.1 mM) did not alter luminal alkalinization but increased serosal alkalinization by a Na-dependent mechanism. These results suggest that luminal alkalinization results from a Na-dependent, active transcellular HCO3 transport process and that a Na-dependent HCO3 absorptive process is activated by adrenergic stimuli.

  2. Temporal Proximity Promotes Integration of Overlapping Events. (United States)

    Zeithamova, Dagmar; Preston, Alison R


    Events with overlapping elements can be encoded as two separate representations or linked into an integrated representation, yet we know little about the conditions that promote one form of representation over the other. Here, we tested the hypothesis that the proximity of overlapping events would increase the probability of integration. Participants first established memories for house-object and face-object pairs; half of the pairs were learned 24 hr before an fMRI session, and the other half 30 min before the session. During scanning, participants encoded object-object pairs that overlapped with the initial pairs acquired on the same or prior day. Participants were also scanned as they made inference judgments about the relationships among overlapping pairs learned on the same or different day. Participants were more accurate and faster when inferring relationships among memories learned on the same day relative to those acquired across days, suggesting that temporal proximity promotes integration. Evidence for reactivation of existing memories-as measured by a visual content classifier-was equivalent during encoding of overlapping pairs from the two temporal conditions. In contrast, evidence for integration-as measured by a mnemonic strategy classifier from an independent study [Richter, F. R., Chanales, A. J. H., & Kuhl, B. A. Predicting the integration of overlapping memories by decoding mnemonic processing states during learning. Neuroimage, 124, 323-335, 2016]-was greater for same-day overlapping events, paralleling the behavioral results. During inference itself, activation patterns further differentiated when participants were making inferences about events acquired on the same day versus across days. These findings indicate that temporal proximity of events promotes integration and further influences the neural mechanisms engaged during inference.

  3. Acromioclavicular joint dislocations. (United States)

    Babhulkar, Ashish; Pawaskar, Aditya


    Acromioclavicular (AC) dislocation is a common injury especially among sportsmen. There is still a lack of consensus on whether to conserve or operate type III AC joint dislocations. Even among surgeons inclined to operate AC joint dislocations there is no unanimity on which surgical technique. There are a plethora of choices between mechanical fixation or synthetic materials or biologic anatomic reconstructions. Even among surgeons, there is a choice between open repairs and the latest-arthroscopic reconstructions. This review of AC joint dislocations intends to analyze the available surgical options, a critical analysis of existing literature, actual technique of anatomic repair, and also accompanying complications.

  4. Anterior glenohumeral joint dislocations. (United States)

    Dodson, Christopher C; Cordasco, Frank A


    The glenohumeral joint is the most mobile articulation in the body and the most commonly dislocated diarthroidal joint. Anterior dislocation is by far the most common direction and can lead to instability of the glenohumeral joint, which ranges from subtle increased laxity to recurrent dislocation. Overtime, understanding of anterior shoulder dislocations and the resulting instability has improved. Likewise, significant advances in arthroscopic equipment have allowed use of the arthroscope to address anatomically the various lesions that cause instability. This article reviews the anatomy, pathophysiology, clinical evaluation, and treatment of anterior shoulder instability.

  5. [Angle-stable intramedullary nailing of proximal humerus fractures with the PHN (proximal humeral nail)]. (United States)

    Blum, Jochen; Hansen, Matthias; Rommens, Pol Maria


    Stable fixation of two- and three-part fractures of the proximal humerus through minimally invasive operative technique and rapid bone healing as well as restoration of original anatomy. Early functional training with the goal of restoration of former mobility and daily activities. Unstabile two- and three-part fractures of the proximal humerus (AO classification: 11-A2, 11-A3, 11-B1, 11-B2, 11-B3). Subcapital nonunion of the humerus. Pathologic fractures. Pediatric fractures of the proximal humerus. Fractures of the proximal humerus types 11-C2 und 11-C3 according to the AO classification. Active local infection, e.g., after former operation. Closed reduction. Anterior acromial incision, splitting of the deltoid muscle and the rotator cuff. Opening of the medullary canal with the awl. Nail introduction. Spiral blade introduction in cannulated technique through stab incision. Distal interlocking through aiming device, angle-stable blocking of nail and blade through end cap. Postoperative fixation in Gilchrist sling until 2nd postoperative day; then physiotherapy respecting fracture type and stability, local swelling, patient's age and compliance, and concomitant injuries. 151 proximal humeral fractures were treated with a proximal humeral nail (PHN). 108 patients could be followed up 1 year postoperatively. Significant complications were perforation of the articular surface through bolts or blades (n = 8), implant-related pain (n = 10), fragment dislocation (n = 2), nonunion (n = 2), humeral head necrosis (n = 3), and superficial infection (n = 1). 1 year after the operation, the Constant-Murley Score showed a median value of 75.3 in the injured shoulder and of 89.9 in the uninjured shoulder. The DASH (Disability of the Arm, Shoulder and Hand) Score was 5.9 preoperatively and 9.3 at 1 year postoperatively. The worst results regarding the Constant-Murley Score as well as the DASH Score were found in C-type fractures.

  6. Impacted valgus fractures of the proximal humerus

    Directory of Open Access Journals (Sweden)

    Fabiano Rebouças Ribeiro


    Full Text Available Impacted valgus fractures of the proximal humerus are considered to be a special type fracture, since impaction of the humeral head on the metaphysis with maintenance of the posteromedial periosteum improves the prognosis regarding occurrences of avascular necrosis. This characteristic can also facilitate the reduction maneuver and increase the consolidation rate of these fractures, even in more complex cases. The studies included were obtained by searching the Bireme, Medline, PubMed, Cochrane Library and Google Scholar databases for those published between 1991 and 2013. The objective of this study was to identify the most common definitions, classifications and treatment methods used for these fractures in the orthopedic medical literature.

  7. Ontogeny of rabbit proximal tubule urea permeability (United States)



    Urea transport in the proximal tubule is passive and is dependent on the epithelial permeability. The present study examined the maturation of urea permeability (Purea) in in vitro perfused proximal convoluted tubules (PCT) and basolateral membrane vesicles (BLMV) from rabbit renal cortex. Urea transport was lower in neonatal than adult PCT at both 37 and 25°C. The PCT Purea was also lower in the neonates than the adults (37°C: 45.4 ± 10.8 vs. 88.5 ± 15.2 × 10−6 cm/s, P 0.05). The activation energy for PCT Purea was not different between the neonatal and adult groups. BLMV Purea was determined by measuring vesicle shrinkage, due to efflux of urea, using a stop-flow instrument. Neonatal BLMV Purea was not different from adult BLMV Purea at 37°C [1.14 ± 0.05 × 10−6 vs. 1.25 ± 0.05 × 10−6 cm/s; P = not significant (NS)] or 25°C (0.94 ± 0.06 vs. 1.05 ± 0.10 × 10−6 cm/s; P = NS). There was no effect of 250 μM phloretin, an inhibitor of the urea transporter, on Purea in either adult or neonatal BLMV. The activation energy for urea diffusion was also identical in the neonatal and adult BLMV. These findings in the BLMV are in contrast to the brush-border membrane vesicles (BBMV) where we have previously demonstrated that urea transport is lower in the neonate than the adult. Urea transport is lower in the neonatal proximal tubule than the adult. This is due to a lower rate of apical membrane urea transport, whereas basolateral urea transport is the same in neonates and adults. The lower Purea in neonatal proximal tubules may play a role in overall urea excretion and in developing and maintaining a high medullary urea concentration and thus in the ability to concentrate the urine during renal maturation. PMID:11353675

  8. Comparison of equine articular cartilage thickness in various joints. (United States)

    Lee, Hyeon; Kirkland, W Grant; Whitmore, Ryan N; Theis, Kelcie M; Young, Hannah E; Richardson, Ashton J; Jackson, Robert L; Hanson, R Reid


    Thicknesses of fresh equine articular cartilage surfaces from the fetlock, carpal and stifle joints were measured employing a needle probe test. Eighty-seven samples used in measurement were cultivated from fetlock, carpal and stifle joints of 12 deceased within 4 h of death. After approximately three minutes of exposure to air during dissection, all cartilage samples were preserved in a saline solution to keep the articular cartilage hydrated for testing. The thickness was measured on five different spots on the same sample. The thicknesses of the fetlock, carpus and stifle were compared. The articular cartilage of the stifle was thicker than the fetlock and carpus, while the fetlock and the carpus had similar thickness values. The average thickness of the fetlock, carpal and stifle joint are 0.86, 0.87 and 2.1 mm, respectively. They were statistically compared using the Student t-test. The differences on the articular cartilage thicknesses between the fetlock and stifle, and carpus and stifle were "very highly significant" (p fetlock and carpus. Four different surfaces in the fetlock and four in the carpal joint were also compared. Significant differences between each set of the four surfaces were not observed. In the carpus, the difference in thickness between the distal radius and proximal third carpal bone articular cartilage surfaces as well as the proximal radial carpal bone and distal radial carpal bone articular cartilage surfaces were statistically significant.

  9. Baron Guillaume Dupuytren: Dupuytren's contracture. (United States)

    Ellis, Harold


    Dupuytren's contracture of the hand is an extremely common deformity in middle aged and elderly men but it is rarely encountered in women. It usually involves the fifth and fourth fingers, less commonly the other two fingers, and never the thumb. There is a flexion deformity between the head of the metacarpal and the adjacent proximal phalanx and at the proximal interphalangeal joint. However, the distal interphalangeal joint is not affected. Indeed, in a severe case, the distal phalanx may actually be extended as it becomes progressively pressed into the palm of the hand. It is often bilateral and may affect the sole of the foot--although I have only had one old gentleman where his foot lesion troubled him enough for him to request surgical cure.

  10. Immediate effects of different treatments for the wrist joints of subdominant hands, using electromechanical reaction time. (United States)

    Hu, Chunying; Huang, Qiuchen; Yu, Lili; Zhou, Yue; Gu, Rui; Cui, Yao; Ge, Meng; Xu, Yanfeng; Liu, Jianfeng


    [Purpose] The aim of this study was to examine the immediate effects of muscle strength training and neuromuscular joint facilitation distal resistance training on wrist joints by using electromechanical reaction time. [Subjects and Methods] The subjects were 12 healthy young people (24.2 ± 3.1 years, 169.7 ± 6.5 cm, 65.3 ± 12.6 kg). Two kinds of isotonic contraction techniques were applied on the wrist joint: the wrist joint extension muscle strength training and the wrist joint extension pattern of neuromuscular joint facilitation. The electromechanical reaction time, premotor time, and motor time of the left upper limb were measured before and after each intervention session of muscle strength training and neuromuscular joint facilitation. [Results] The neuromuscular joint facilitation group showed significant shortening of the electromechanical reaction time and motor time after the intervention. [Conclusion] These results suggest that the electromechanical reaction time and motor time of the wrist joint can be improved by neuromuscular joint facilitation together with proximal resistance training, which can be used as a new form of exercise for improving the functions of subdominant hand wrist joints.

  11. Management of the proximal tibia fractures by mini external fixation: A case series of 30 cases

    Directory of Open Access Journals (Sweden)

    Samar K Biswas


    Full Text Available Background: Management of high velocity trauma is a challenging problem because of morbidity of trauma and sometime residual problems of failure of proper healing of fractures with the restriction of movements of knee, shortening, and added risk of compartment syndrome in the proximal tibia fracture. There is always risk of post-operative infection and infected non-union in extensive open surgical procedure and internal fixation. Hence, there is always look out for the middle path procedure for a solution to the above said problems with the added advantage of less hospital stay and early return to work by minimal invasive procedure and stabilization of fracture reduction by multiple K-wire fixation with a frame applied externally. Stabilization of fracture with reduced pain allows early movements of neighbouring joint knee and ankle; hence, reduces the chances of fracture diseases. With this we have been stimulated to take-up the study of managing the proximal tibia fracture by mini external fixator. Aim: The aim of this study was to manage proximal tibia fractures by mini external fixator and evaluate the results and efficacy of this method. Material and Method: A total of 30 patients having proximal tibial fractures admitted at our center between 2008 and 2010 were taken and the procedure carried out was closed manipulative reduction and stabilization with mini external fixator. All acute proximal tibia fractures including tibial plateau fractures above 17 years of age of either sex were included in the study. Fracture more than 3 weeks old were excluded from the study. Result: Out of 30 cases 13 were excellent, 14 cases good, and 3 showed fair. It was found that type 5 and 6 of Schatzker′s classification have lesser outcome type of fractures Conclusion: We have found that management of the proximal tibia fractures by mini external fixation method has a better outcome. Early mobilization of knee in the proximal tibia fractures after

  12. Composite measures of multi-joint symptoms, but not of radiographic osteoarthritis, are associated with functional outcomes: the Johnston County Osteoarthritis Project. (United States)

    Nelson, Amanda E; Elstad, Emily; DeVellis, Robert F; Schwartz, Todd A; Golightly, Yvonne M; Renner, Jordan B; Conaghan, Philip G; Kraus, Virginia B; Jordan, Joanne M


    To determine associations between multiple joint symptoms and radiographic osteoarthritis (rOA) and functional outcomes. Complete cross-sectional data for multi-joint symptoms and radiographs, Health Assessment Questionnaire (HAQ) scores, and gait speed were available for 1307 Johnston County Osteoarthritis Project participants (34% men, 32% African American, mean age 66 years). Factor analysis of symptom scores and radiographic grades for the lumbosacral spine, bilateral hands, knees, and hips provided composite scores. Regression models were used to determine associations between composite scores, HAQ, and gait speed, adjusting for age, body mass index, gender, and race. Five rOA factors were identified: (1) IP/CMC factor (carpometacarpal [CMC] and all interphalangeal [IP] joints); (2) MCP factor (metacarpophalangeal joints 2-5); (3) Knee factor (tibiofemoral and patellofemoral joints); (4) Spine factor (L1/2 to L5/S1); and (5) Symptom factor. After adjustment, only the Symptom composite was significantly associated with HAQ and gait speed; a 1-standard deviation increase in Symptom score was associated with 9 times higher odds of having poorer function on the HAQ (odds ratio 9.32, 95% confidence interval [CI] 6.80, 12.77), and a clinically significant decline in gait speed (0.06 m/s, 95% CI -0.07, -0.05). A novel Symptom composite score was associated with poorer functional outcomes. Osteoarthritis (OA) commonly affects multiple joints and is the most common form of arthritis. Symptomatic assessments, which can be easily executed by rehabilitation practitioners, are more closely related to self-reported and performance-based functional status than are less accessible and more costly radiographs. Symptomatic assessments are likely to be more informative for understanding, treating, and potentially preventing functional limitations than radiographic assessments.

  13. Joint Quantum Institute (United States)

    Federal Laboratory Consortium — The Joint Quantum Institute (JQI) is pursuing that goal through the work of leading quantum scientists from the Department of Physics of the University of Maryland...

  14. Wrist joint assembly (United States)

    Kersten, L.; Johnson, J. D. (Inventor)


    A wrist joint assembly is provided for use with a mechanical manipulator arm for finely positioning an end-effector carried by the wrist joint on the terminal end of the manipulator arm. The wrist joint assembly is pivotable about a first axis to produce a yaw motion, a second axis is to produce a pitch motion, and a third axis to produce a roll motion. The wrist joint assembly includes a disk segment affixed to the terminal end of the manipulator arm and a first housing member, a second housing member, and a third housing member. The third housing member and the mechanical end-effector are moved in the yaw, pitch, and roll motion. Drive means are provided for rotating each of the housings about their respective axis which includes a cluster of miniature motors having spur gears carried on the output drive shaft which mesh with a center drive gear affixed on the housing to be rotated.

  15. Distal radioulnar joint injuries

    National Research Council Canada - National Science Library

    Thomas, Binu P; Sreekanth, Raveendran


    .... 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...

  16. Joint Aspiration (Arthrocentesis) (United States)

    ... include juvenile idiopathic arthritis (or JIA, formerly called rheumatoid arthritis, or JRA), systemic lupus erythematosus (SLE), and Lyme disease. Joint aspiration is diagnostic but it also can be therapeutic, helping to ...

  17. Improved orthopedic arm joint (United States)

    Dane, D. H.


    Joint permits smooth and easy movement of disabled arm and is smaller, lighter and less expensive than previous models. Device is interchangeable and may be used on either arm at the shoulder or at the elbow.

  18. Resealing concrete pavement joints (United States)


    The primary objective of this study was to evaluate the relative performance of the selected joint sealant materials. Other objectives were to determine the effect of selected sealant configurations and installation methods, and to identify sealant m...

  19. Concrete pavement joint deterioration. (United States)


    Concrete pavements are an important part of our national infrastructure. In recent years the relatively small number of reported joints deteriorating prematurely in concrete pavements around Indiana has increased. Changes over the past 45 years in IN...

  20. Joint Services Electronics Program. (United States)


    Compound Semiconductors." 4 ......... I-*. Univesity of California. Berkeley Electronics Research Laboratory Joint Services Electronics Program August 15...reduction techniques [SCH-66,MCG- 73,HAM-75], for essentially i educing the proportionality constant. A significant portion of the probabilistic literature

  1. Hip joint replacement (United States)

    ... a part of the pelvic bone called the acetabulum) The upper end of the thighbone (called the ... Other reasons for replacing the hip joint are: Fractures in the thigh bone. Older adults often have ...

  2. Congenital anomalies and proximity to landfill sites.

    LENUS (Irish Health Repository)

    Boyle, E


    The occurrence of congenital anomalies in proximity to municipal landfill sites in the Eastern Region (counties Dublin, Kildare, Wicklow) was examined by small area (district electoral division), distance and clustering tendancies in relation to 83 landfills, five of which were major sites. The study included 2136 cases of congenital anomaly, 37,487 births and 1423 controls between 1986 and 1990. For the more populous areas of the region 50% of the population lived within 2-3 km of a landfill and within 4-5 km for more rural areas. In the area-level analysis, the standardised prevalence ratios, empirical and full Bayesian modelling, and Kulldorff\\'s spatial scan statistic found no association between the residential area of cases and location of landfills. In the case control analysis, the mean distance of cases and controls from the nearest landfill was similar. The odds ratios of cases compared to controls for increasing distances from all landfills and major landfills showed no significant difference from the baseline value of 1. The kernel and K methods showed no tendency of cases to cluster in relationship to landfills. In conclusion, congenital anomalies were not found to occur more commonly in proximity to municipal landfills.

  3. Scattering Effects in Proximity Effect Tunneling Spectroscopy. (United States)

    Gai, Wei

    PETS (Proximity Effect Tunneling Spectroscopy) technique has been applied to Niobium/Yttrium and Niobium/Lutetium bilayers. We have determined electron - phonon interaction parameter lambda_{rm e -ph} is 0.55 for Yttrium and 0.67 for Lutetium. Spin fluctuations parameter lambda_{ rm S} is 0.20 for Yttrium and 0.33 for Lutetium. We found that the large spin fluctuations in Yttrium and Lutetium has responsibility to the absence of superconductivity in them. Our results have given a reasonable explanation of high superconducting transition temperature in them under high pressure. The large reflection coefficient and strong diffuse scattering at Nb/Y and Nb/Lu interface has been discovered and it should have strong influence on the transport properties of metallic superlattices. From the modeling study of elastic scattering in proximity effect tunnel junctions, we have explained why some conventional made high {rm T_{C}} superconducting tunnel junctions give ideal like characteristics in the gap region but variable strength phonon structures in the phonon region.

  4. Proteomics of Primary Cilia by Proximity Labeling. (United States)

    Mick, David U; Rodrigues, Rachel B; Leib, Ryan D; Adams, Christopher M; Chien, Allis S; Gygi, Steven P; Nachury, Maxence V


    While cilia are recognized as important signaling organelles, the extent of ciliary functions remains unknown because of difficulties in cataloguing proteins from mammalian primary cilia. We present a method that readily captures rapid snapshots of the ciliary proteome by selectively biotinylating ciliary proteins using a cilia-targeted proximity labeling enzyme (cilia-APEX). Besides identifying known ciliary proteins, cilia-APEX uncovered several ciliary signaling molecules. The kinases PKA, AMPK, and LKB1 were validated as bona fide ciliary proteins and PKA was found to regulate Hedgehog signaling in primary cilia. Furthermore, proteomics profiling of Ift27/Bbs19 mutant cilia correctly detected BBSome accumulation inside Ift27(-/-) cilia and revealed that β-arrestin 2 and the viral receptor CAR are candidate cargoes of the BBSome. This work demonstrates that proximity labeling can be applied to proteomics of non-membrane-enclosed organelles and suggests that proteomics profiling of cilia will enable a rapid and powerful characterization of ciliopathies. Copyright © 2015 Elsevier Inc. All rights reserved.

  5. Empathy: Its ultimate and proximate bases. (United States)

    Preston, Stephanie D; de Waal, Frans B M


    There is disagreement in the literature about the exact nature of the phenomenon of empathy. There are emotional, cognitive, and conditioning views, applying in varying degrees across species. An adequate description of the ultimate and proximate mechanism can integrate these views. Proximately, the perception of an object's state activates the subject's corresponding representations, which in turn activate somatic and autonomic responses. This mechanism supports basic behaviors (e.g., alarm, social facilitation, vicariousness of emotions, mother-infant responsiveness, and the modeling of competitors and predators) that are crucial for the reproductive success of animals living in groups. The Perception-Action Model (PAM), together with an understanding of how representations change with experience, can explain the major empirical effects in the literature (similarity, familiarity, past experience, explicit teaching, and salience). It can also predict a variety of empathy disorders. The interaction between the PAM and prefrontal functioning can also explain different levels of empathy across species and age groups. This view can advance our evolutionary understanding of empathy beyond inclusive fitness and reciprocal altruism and can explain different levels of empathy across individuals, species, stages of development, and situations.

  6. Proximal femoral osteotomy in cerebral palsy. (United States)

    Tylkowski, C M; Rosenthal, R K; Simon, S R


    The purpose of this study was to examine the results of the proximal femoral osteotomy for the management of hip deformity in 32 children, aged 4 to 15 years. Twenty-two bilateral and ten unilateral procedures were performed. The indications for surgery were subluxation in 16, dislocation in two, and intoeing and femoral anteversion in 14. The average follow-up was two years and 11 months. CE angle of Wiberg, acetabular index and neck shaft angle were evaluated. The average time to regain preoperative ambulatory status was six months with intensive physical therapy. In osteotomies performed for subluxation, dislocation did not occur; roentgenographic indices showed variability in the degree of subluxation. Osteotomy performed in children older than 8 years of age produced no evidence of acetabular remodeling. THere was no recurrence with osteotomies for dislocation. In those patients with internal rotation gait, improvement resulted. Complications were few and minor. Hip dislocation in children with progressive subluxation, in spite of previous soft-tissue releases, is preventable by proximal femoral osteotomy. The inability of the roentgenographic indices to quantitate the increased stability indicates the procedure's major effect is to realign muscle forces about the hip. Treatment of the intoeing gait produced improvement of rotational deformity.

  7. Obesity and supermarket access: proximity or price? (United States)

    Drewnowski, Adam; Aggarwal, Anju; Hurvitz, Philip M; Monsivais, Pablo; Moudon, Anne V


    We examined whether physical proximity to supermarkets or supermarket price was more strongly associated with obesity risk. The Seattle Obesity Study (SOS) collected and geocoded data on home addresses and food shopping destinations for a representative sample of adult residents of King County, Washington. Supermarkets were stratified into 3 price levels based on average cost of the market basket. Sociodemographic and health data were obtained from a telephone survey. Modified Poisson regression was used to test the associations between obesity and supermarket variables. Only 1 in 7 respondents reported shopping at the nearest supermarket. The risk of obesity was not associated with street network distances between home and the nearest supermarket or the supermarket that SOS participants reported as their primary food source. The type of supermarket, by price, was found to be inversely and significantly associated with obesity rates, even after adjusting for individual-level sociodemographic and lifestyle variables, and proximity measures (adjusted relative risk=0.34; 95% confidence interval=0.19, 0.63) Improving physical access to supermarkets may be one strategy to deal with the obesity epidemic; improving economic access to healthy foods is another.

  8. Demonstration of automated proximity and docking technology (United States)

    Anderson, Robert L.; Tsugawa, Roy K.; Bryan, Thomas C.


    Automated spacecraft docking operations are being performed using a full scale motion based simulator and an optical sensor. This presentation will discuss the work in progress at TRW and MSFC facilities to study the problem of automated proximity and docking operations. The docking sensor used in the MSFC Optical Sensor and simulation runs are performed using the MSFC Flat Floor Facility. The control algorithms and six degrees of freedom (6DOF) simulation software were developed at TRW and integrated into the MSFC facility. Key issues being studied are the quantification of docking sensor requirements and operational constraints necessary to perform automated docking maneuvers, control algorithms capable of performing automated docking in the presence of sensitive and noisy sensor data, and sensor technologies for automated proximity and docking operations. As part of this study the MSFC sensor characteristics were analyzed and modeled so that off line simulation runs can be performed for control algorithm testing. Our goal is to develop and demonstrate full 6DOF docking capabilities with actual sensors on the MSFC motion based simulator. We present findings from actual docking simulation runs which show sensor and control loop performance as well as problem areas which require close attention. The evolution of various control algorithms using both phase plane and Clohessy-Wiltshire techniques are discussed. In addition, 6DOF target acquisition and control strategies are described.

  9. Successfully Developing Joint Leaders (United States)


    units” (HQ/USA, 1998, 4). For example, Infantrymen proceed to Fort Benning, Georgia, an Aviation officer to Fort Rucker , Alabama, an Armor officer...Supreme Command. New York, NY: Anchor Books, 2002. Colaizzi, Jennifer . “Pinnacle course offers two and three-star commanders joint education...Personal Interview. January 2005. Snider, Don M. “Jointess, Defense Transformation, and the Need for a New Joint Warfare Profession.” Parameters

  10. [Surgical treatment of sternoclavicular joint instability with tenodesis]. (United States)

    Goost, H; Kabir, K; Burger, C; Pennekamp, P; Röhrig, H; Wirtz, D C; Deborre, C; Rabanus, A


    Instability of the sternoclavicular joint is a very uncommon disorder of the shoulder girdle. Acute traumatic dislocations are commonly treated nonoperatively. But severe displacement or chronic instability with recurrent symptomatic subluxation may require surgical intervention. We present our results with open reduction and internal fixation through an autologous gracilis tendon transplant or fiber tape in 8 patients treated surgically. The operative stabilisation of the sternoclavicular joint reduces pain level and improves function of the shoulder. This technique provides an effective surgical procedure for treatment of symptomatic sternoclavicular joint instability. Restoration of the function and aspect of the sternoclavicular joint. Chronic and painful instabilities. Local infection, tumor. The gracilis tendon graft is harvested as previously described by Petersen. Direct incision over the sternoclavicular joint. Sharp dissection of the periostal sleeve and partial release of sternocleidomastoideus and pextoralis muscle. Resection of osteophytes. Careful placement of a raspatorium under the proximal clavicle and sternum to protect the mediastinal structures. Application of 2.5 or 3.2 mm drill holes to the sternum and the proximal clavicle. The gracilis tendon or the fiber tape is pulled through the drill holes in a figure of eight and then sutured. Recontruction of the joint capsule, closure of the wound. Gilchrist brace for 3-5 days, functional physiotherapy with a maximum abduction of 90° for 6 weeks. No carrying or lifting of weights greater than 5 kg for 3 months. During the period from January 2006 to December 2010, 8 patients with sternoclavicular instability were treated. Four patients were treated with fiber tape and four were treated with a gracilis tendon autograft. Postoperative all patients described a reduction of pain and improved shoulder function. The Constant score was 72 points, the DASH 58 points.

  11. Microanatomic studies to define predictive factors for the topography of periarticular erosion formation in inflammatory arthritis

    DEFF Research Database (Denmark)

    McGonagle, Dennis; Tan, Ai Lyn; Møller Døhn, Uffe


    OBJECTIVE: The microanatomic basis for formation of erosions in inflammatory arthritis is incompletely understood but is thought to be related to bare areas and the associated cartilage-synovium junction. The purpose of this study was to test the hypothesis that erosion-prone sites are associated...... with microdamage in macroscopically normal joints. METHODS: Histologic evaluation of erosion-prone sites was performed on 20 collateral ligaments (CLs) from the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of 5 normal cadavers. In addition, the MCP joints (n = 17) and PIP joints (n = 3...

  12. GOUT – induced by Infliximab?- case report

    Directory of Open Access Journals (Sweden)

    Anca Chiriac


    Full Text Available Gout is a metabolic disease caused by a disturbance in purine metabolism; crystals of monosodium urate are deposited in tissues, such as joints, kidneys, and soft tissues, producing an inflammatory response. A 52-year-old woman presented in our department with 1 month history of firm, white papules, nodules and plaques over digits. She has been suffered from Rheumatoid Arthritis for many years, she has been under Infliximab therapy for more than 2 years, with good evolution of the disease. She had marked joint deformities of the proximal interphalangeal joints and slight ulnar deviation at the metacarpophalangeal joints bilaterally.

  13. Proximal-to-distal sequencing in vertical jumping with and without arm swing. (United States)

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


    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.

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

    Directory of Open Access Journals (Sweden)

    Mukesh Kumar


    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.

  15. Closed traumatic rupture of finger flexor pulleys. (United States)

    Bowers, W H; Kuzma, G R; Bynum, D K


    Nine patients are described with closed traumatic rupture of the digital flexor pulley system. All presented with significant flexion contractures of the proximal interphalangeal joint and bow-stringing of the flexor tendons. In seven patients, the pathology was verified at surgery and pulley reconstruction provided a good result. The diagnoses in the other patients, treated conservatively, were verified by tenogram and magnetic resonance imaging.

  16. Use of bovine carpal joints as a training model for cruciate ligament repair. (United States)

    Calvert, Nicholas; Grainger, Nicholas; Hurworth, Mark


    Currently, there is a lack of cheap and effective training models to allow orthopaedic surgery trainees to learn the basics of anterior cruciate ligament reconstruction. The aim of this paper was to investigate the viability of using various animal joints as models for the training of anterior cruciate ligament reconstruction. Equine stifles, bovine stifles and carpal joints, sheep stifles and porcine stifles, were sourced from a local abattoir. Each joint was assessed for the following criteria: suitable tendons for harvesting, ease of arthroscopy access, adequacy of arthroscopy view and suitable joint surfaces. Tendon harvesting, preparation, joint arthroscopy and tendon tunnelling were performed on the most suitable joint. Equine, bovine, sheep and porcine stifles were found to be unsuitable. The bovine carpal joint was similar to a human wrist joint with two rows of carpal bones and fused metacarpal bones, but with deeper flexion - similar to a human knee joint. The distal joint space was found to provide a greater range of flexion and space than the narrower proximal joint space. The joint capsule provided sufficient integrity during saline irrigation to allow adequate visualization of joint structures. Tendons surrounding the joint were found to be of similar diameter to human hamstring tendons and easily accessible. Tendon tunnelling was successfully performed in a manner similar to human anterior cruciate ligament repair. The use of bovine carpal joints is a cost-effective, safe and easily reproducible model for education on basic anterior cruciate ligament repair skills and technique prior to patient contact. © 2013 Royal Australasian College of Surgeons.

  17. Digital camera resolution and proximal caries detection. (United States)

    Prapayasatok, S; Janhom, A; Verochana, K; Pramojanee, S


    To evaluate the diagnostic accuracy of proximal caries detection from digitized film images captured by a digital camera at different resolution settings. Twenty-five periapical radiographs of 50 premolar and 25 molar teeth were photographed using a digital camera, Sony Cyber-shot, DSC-S75 at three different resolution settings: 640 x 480, 1280 x 960 and 1600 x 1200. Seventy-five digital images were transferred to a computer, saved and opened using ACDSee software. In addition, a PowerPoint slide was made from each digital image. Five observers scored three groups of images (the films, the displayed 1:1 digital images on the ACDSee software, and the PowerPoint slides) for the existence of proximal caries using a 5-point confidence scale, and the depth of caries on a 4-point scale. Ground sections of the teeth were used as the gold standard. Az values under the receiver operating characteristic (ROC) curve of each group of images and at different resolutions were compared using the Friedman and Wilcoxon signed rank tests. Mean different values between the lesions' depth interpreted by the observers and that of the gold standard were analysed. Films showed the highest Az values. Only the 1280 x 960 images on the ACDSee software showed no significant difference of the Az value from the films (P=0.28). The digital images from three resolution settings on the PowerPoint slides showed no significant differences, either among each other or between them and the films. For caries depth, the 1280 x 960 images showed lower values of mean difference in enamel lesions compared with the other two resolution groups. This study showed that in order to digitize conventional films, it was not necessary to use the highest camera resolution setting to achieve high diagnostic accuracy for proximal caries detection. The 1280 x 960 resolution setting of the digital camera demonstrated comparable diagnostic accuracy with film and was adequate for digitizing radiographs for caries

  18. The non-operative resin treatment of proximal caries lesions. (United States)

    Ekstrand, Kim; Martignon, Stefania; Bakhshandeh, Azam; Ricketts, David N J


    Epidemiological data show that the prevalence of caries on proximal surfaces in need of operative treatment is very high around the world, both in the primary and the permanent dentition. This article presents two new treatment methods: proximal sealing and proximal infiltration. The indications are progressing proximal caries lesions, radiographically with a depth around the enamel-dentine junction. A small number of studies regarding the effect of sealing and infiltration on proximal caries versus the use of fluoride varnish, placebo treatment and flossing instructions have been carried out. About half of the studies disclose a not significant difference between test and control treatment. In the other half, the therapeutic effect is significant and corresponds to about 30% reduction in lesion progression. However, longitudinal studies of longer duration are lacking. Proximal sealing and proximal infiltration may have a place in the treatment of non-cavitated proximal lesions. Proximal caries is a problem in both primary and permanent dentitions. Proximal sealants or lesion infiltration are possible treatments.

  19. Prediction of the pre-morbid 3D anatomy of the proximal humerus based on statistical shape modelling. (United States)

    Poltaretskyi, S; Chaoui, J; Mayya, M; Hamitouche, C; Bercik, M J; Boileau, P; Walch, G


    situations. This information can be used in the surgical planning and operative reconstruction of patients with severe degenerative osteoarthritis or with a fracture of the proximal humerus. Cite this article: Bone Joint J 2017;99-B:927-33. ©2017 The British Editorial Society of Bone & Joint Surgery.

  20. The Standard Joint Unit. (United States)

    Casajuana Kögel, Cristina; Balcells-Olivero, María Mercedes; López-Pelayo, Hugo; Miquel, Laia; Teixidó, Lídia; Colom, Joan; Nutt, David John; Rehm, Jürgen; Gual, Antoni


    Reliable data on cannabis quantities is required to improve assessment of cannabis consumption for epidemiological analysis and clinical assessment, consequently a Standard Joint Unit (SJU) based on quantity of 9-Tetrahydrocannabinol (9-THC) has been established. Naturalistic study of a convenience sample recruited from February 2015-June 2016 in universities, leisure spaces, mental health services and cannabis clubs in Barcelona. Adults, reporting cannabis use in the last 60 days, without cognitive impairment or language barriers, answered a questionnaire on cannabis use and were asked to donate a joint to further determine their 9-THC and Cannabidiol (CBD) content. 492 participants donated 315 valid joints. Donators were on average 29 years old, mostly men (77%), single (75%), with at least secondary studies (73%) and in active employment (63%). Marijuana joints (N=232) contained a median of 6.56mg of 9-THC (Interquartile range-IQR=10,22) and 0.02mg of CBD (IQR=0.02); hashish joints (N=83) a median of 7.94mg of 9-THC (IQR=10,61) and 3.24mg of CBD (IQR=3.21). Participants rolled 4 joints per gram of cannabis and paid 5€ per gram (median values). Consistent 9-THC-content in joints lead to a SJU of 7mg of 9-THC, the integer number closest to the median values shared by both cannabis types. Independently if marijuana or hashish, 1 SJU = 1 joint = 0.25 g of cannabis = 7 mg of 9-THC. For CBD, only hashish SJU contained relevant levels. Similarly to the Standard Drink Unit for alcohol, the SJU is useful for clinical, epidemiological and research purposes. Copyright © 2017 Elsevier B.V. All rights reserved.

  1. First Metatarsophalangeal Contact Properties Following Proximal Opening Wedge and Scarf Osteotomies for Hallux Valgus Correction: A Biomechanical Study. (United States)

    Kia, Cameron; Yoshida, Ryu; Cote, Mark; DiVenere, Jessica; Geaney, Lauren E


    Proximal opening wedge osteotomy (POWO) is an established procedure for moderate to severe hallux valgus. A common concern of this procedure is that it results in lengthening of the first metatarsal, which could cause increased intra-articular pressure of the first metatarsophalangeal joint (MTP) and may ultimately lead to arthritis because of these altered mechanics. The purpose of this study was to use a cadaveric model to compare intra-articular pressures and articulating contact properties of the MTP joint following either scarf osteotomy or POWO. Fresh-frozen cadaveric below-knee specimens with pre-existing hallux valgus (n = 12) and specimens without hallux valgus (n = 6, control group) were used. The hallux valgus specimens were stratified into 2 groups (n = 6 each): POWO or scarf osteotomy. The groups were matched based on the degree of deformity. Peak intra-articular pressure, force, and area were measured in all normal, preoperative, and postoperative specimens with a simulated weightbearing model. These measurements were made with a pressure transducer placed within the first MTP joint. Postoperatively POWO group had slightly higher contact forces and pressures compared to the scarf group and lower contact forces and pressures than those of the normal group but were not statistically significant ( P > .05). Normal specimens had higher intra-articular force, pressure, and area than postoperative specimens but the difference was not found to be significant. First metatarsal lengthening was found in both the scarf and POWO specimens; however, neither increase was found to be significant ( P > .05). The results from this study show that after operative correction, contact properties of the fist MTP joint among normal, POWO, and scarf osteotomy groups revealed no significant differences. First MTP joints in those with hallux valgus had significantly lower contact force and pressure compared to those without hallux valgus. With little long-term outcomes of

  2. Rehabilitation and Prevention of Proximal Hamstring Tendinopathy. (United States)

    Beatty, Nicholas R; Félix, Ioonna; Hettler, Jessica; Moley, Peter J; Wyss, James F

    Proximal hamstring tendinopathy (PHT) comprises a small but significant portion of hamstring injuries in athletes, especially runners. PHT is a chronic condition that is clinically diagnosed but can be supported with imaging. The main presenting complaint is pain in the lower gluteal or ischial region that may or may not radiate along the hamstrings in the posterior thigh. There is little scientific evidence on which to base the rehabilitation management of PHT. Treatment is almost always conservative, with a focus on activity modification, addressing contributing biomechanical deficiencies, effective tendon loading including eccentric training, and ultrasound-guided interventional procedures which may facilitate rehabilitation. Surgery is limited to recalcitrant cases or those involving concomitant high-grade musculotendinous pathology. The keys to PHT management include early and accurate diagnosis, optimal rehabilitation to allow for a safe return to preinjury activity level, and preventative strategies to reduce risk of reinjury.

  3. DC Proximal Newton for Nonconvex Optimization Problems. (United States)

    Rakotomamonjy, Alain; Flamary, Rémi; Gasso, Gilles


    We introduce a novel algorithm for solving learning problems where both the loss function and the regularizer are nonconvex but belong to the class of difference of convex (DC) functions. Our contribution is a new general purpose proximal Newton algorithm that is able to deal with such a situation. The algorithm consists in obtaining a descent direction from an approximation of the loss function and then in performing a line search to ensure a sufficient descent. A theoretical analysis is provided showing that the iterates of the proposed algorithm admit as limit points stationary points of the DC objective function. Numerical experiments show that our approach is more efficient than the current state of the art for a problem with a convex loss function and a nonconvex regularizer. We have also illustrated the benefit of our algorithm in high-dimensional transductive learning problem where both the loss function and regularizers are nonconvex.

  4. Proximity Effects in Superconductor-Graphene Junctions (United States)

    Cuellar, Fabian A.; Perconte, David; Martin, Marie-Blandine; Dlubak, Bruno; Piquemail, Maelis; Bernard, Rozenn; Trastoy, Juan; Moreau-Luchaire, Constance; Seneor, Pierre; Villegas, Javier E.; Kidambi, Piran; Hofmann, Stephan; Robertson, John


    Superconducting proximity effects are of particular interest in graphene: because of its band structure, an unconventional (specular) Andreev reflection is expected. In this context, high-Tc superconductor-graphene junctions are especially attractive. In these, the size of the superconducting energy-gap may exceed the graphene doping inhomogeneities around the Dirac point, which should favor the observation of the specular Andreev reflection. Yet, the fabrication of high-Tc superconductor-graphene junctions is challenging: the usual growth and lithography processes in both materials are incompatible. We report here on a fabrication method that allow us to fabricate planar cuprate superconductor-graphene junctions, which we characterize via conductance spectroscopy. We analyze the features in the conductance spectra as a function of graphene doping, and discuss them in the framework of the Andreev reflection. Work supported by Labex Nanosaclay.

  5. Phonon engineering in proximity enhanced superconductor heterostructures. (United States)

    Tang, Yong-Chao; Kwon, Sangil; Mohebbi, Hamid R; Cory, David G; Miao, Guo-Xing


    In this research, we tailor the phonon density of states (DOS) in thin superconducting films to suppress quasiparticle losses. We examine a model system of a proximity-enhanced three-layered Al/Nb/Al heterostructure and show that the local quantized phonon spectrum of the ultrathin Al cladding layers in the heterostructure has a pronounced effect on the superconducting resonator's quality factors. Instead of a monotonic increase of quality factors with decreasing temperatures, we observe the quality factor reaches a maximum at 1.2 K in 5/50/5 nm Al/Nb/Al microstrip resonators, because of a quantized phonon ladder. The phonon DOS may be engineered to enhance the performance of quantum devices.

  6. Traumatic thumb carpometacarpal joint dislocations. (United States)

    Bosmans, B; Verhofstad, M H J; Gosens, T


    Isolated traumatic dislocation of the thumb carpometacarpal joint, also called the trapeziometacarpal joint, is a rare injury. Controversy still exists concerning which ligaments are the true key stabilizers for the joint and therefore need to be damaged to result in dislocation, and optimal treatment strategies for thumb carpometacarpal joint dislocations are the subject of continuing debate. We give a review of the literature concerning traumatic dislocations of the carpometacarpal joint of the thumb and propose a treatment algorithm.

  7. Mouse model of proximal tubule endocytic dysfunction. (United States)

    Weyer, Kathrin; Storm, Tina; Shan, Jingdong; Vainio, Seppo; Kozyraki, Renata; Verroust, Pierre J; Christensen, Erik I; Nielsen, Rikke


    Several studies have indicated the central role of the megalin/cubilin multiligand endocytic receptor complex in protein reabsorption in the kidney proximal tubule. However, the poor viability of the existing megalin-deficient mice precludes further studies and comparison of homogeneous groups of mice. Megalin- and/or cubilin-deficient mice were generated using a conditional Cre-loxP system, where the Cre gene is driven by the Wnt4 promoter. Kidney tissues from the mice were analysed for megalin and cubilin expression by quantitative reverse transcription-polymerase chain reaction, western blotting and immunohistochemistry. Renal albumin uptake was visualized by immunohistochemistry. Twenty-four-hour urine samples were collected in metabolic cages and analysed by sodium dodecyl sulphate-polyacrylamide gel electrophoresis and western blotting. Urinary albumin/creatinine ratios were measured by ELISA and the alkaline picrate method. The Meg(lox/lox);Cre(+), Cubn(lox/lox);Cre(+) and Meg(lox/lox), Cubn(lox/lox);Cre(+) mice were all viable, fertile and developed normal kidneys. Megalin and/or cubilin expression, assessed by immunohistology and western blotting, was reduced by >89%. Consistent with this observation, the mice excreted megalin and cubilin ligands such as transferrin and albumin in addition to low-molecular weight proteins. We further show that megalin/cubilin double-deficient mice excrete albumin with an average of 1.45 ± 0.54 mg/day, suggesting a very low albumin concentration in the glomerular ultrafiltrate. We report here the efficient genetic ablation of megalin, cubilin or both, using a Cre transgene driven by the Wnt4 promoter. The viable megalin/cubilin double-deficient mice now allow for detailed large-scale group analysis, and we anticipate that the mice will be of great value as an animal model for proximal tubulopathies with disrupted endocytosis.


    Directory of Open Access Journals (Sweden)

    Brian J. Cole


    Full Text Available A comprehensive source of information in the management of cartilage lesions of major joints using nonoperative or surgical techniques other than total joint replacement. The text also includes chapters in basic sciences, imaging and rehabilitation.The editors are aiming to provide a reference about the latest concepts and techniques in the treatment of cartilage lesions including future aspects by a comprehensive approach to the alternative joint restoration procedures such as biological, pharmacological and surgical techniques of cartilage repairing and partial resurfacing etc.Orthopedic surgeons in sports medicine, orthopedic surgeons performing joint replacements, orthopedic resident and fellows will be the main audiences.The text is 349 pages, divided into 34 chapters in 7 sections. Section I is "Background-articular cartilage and allograft processing" including chapters about pathology, patient evaluation, imaging and allograft processing. Section II is "Nonoperative treatment" including chapters about neutraceuticals, pharmacological treatment and rehabilitation. Section III is "Operative treatment-knee" including chapters about arthroscopic debridment, microfracture, osteochondral autograft transplantation, mosaicplasty, osteochondral autograft transfer, osteochondral allografts, autologous chondrocyte implantation, existing cell-based technologies, minimally invasive second-generation autologous chondrocyte implantation, future development in cartilage repair, meniscus transplantation, management of OCD, patellafemoral chondral disease, proximal tibial and distal femoral osteotomies, unicompartmental arthritis current techniques, unicompartmental knee replacement. Section IV is "Operative treatment-Hip" including chapters about hip arthroscopy and arthroscopic partial resurfacing, related osteotomies. Section V is "operative treatment-shoulder" including chapters about arthroscopic debridment and release, biologic resurfacing and

  9. Temporomandibular joint examination reviewed

    Directory of Open Access Journals (Sweden)

    L. Guarda Nardini


    Full Text Available The temporo-mandibular joint (TMJ it’s a joint closely related to the skull base, the spine, and the jaws; all these anatomical structures must be taken in consideration when evaluating pain involving the tmj. In order to detect patients affected by pathology or dysfunctions of the tmj, physical examination is of great value in orienting the diagnosis. Inspection must consider the symmetry of the body, the dental status and the type of occlusion. Palpation is a way to assess contractiont involving the muscles of the masticatory system and of the neck. Auscultation, based on articular noise provides means to determine whether we are dealing with degeneration of the joint or a dislocation of the intrarticular disc. In order to confirm the diagnosis obtained with the clinical evaluation, it’s useful to perform imaging techniques as opt, tomography and TC of the tmj and electromyokineosiography – index of the mandibular functionality and of the muscles status. MRI and dynamic MRI are among the non invasive exams which give the greatest amount of information, regarding the disc position and the joint degeneration. Arthroscopy is an invasive technique that allows early diagnosis of degeneration and is helpful to reveal early inflammatory processes of the joint.

  10. Dissimilar metals joint evaluation (United States)

    Wakefield, M. E.; Apodaca, L. E.


    Dissimilar metals tubular joints between 2219-T851 aluminum alloy and 304L stainless steel were fabricated and tested to evaluate bonding processes. Joints were fabricated by four processes: (1) inertia (friction) weldings, where the metals are spun and forced together to create the weld; (2) explosive welding, where the metals are impacted together at high velocity; (3) co-extrusion, where the metals are extruded in contact at high temperature to promote diffusion; and (4) swaging, where residual stresses in the metals after a stretching operation maintain forced contact in mutual shear areas. Fifteen joints of each type were prepared and evaluated in a 6.35 cm (2.50 in.) O.D. size, with 0.32 cm (0.13 in.) wall thickness, and 7.6 cm (3.0 in) total length. The joints were tested to evaluate their ability to withstand pressure cycle, thermal cycle, galvanic corrosion and burst tests. Leakage tests and other non-destructive test techniques were used to evaluate the behavior of the joints, and the microstructure of the bond areas was analyzed.

  11. Radiation synovectomy with holmium-166 ferric hydroxide macroaggregate in equine metacarpophalangeal and metatarsophalangeal joints. (United States)

    Mäkelä, Olli; Sukura, Antti; Penttilä, Pirkko; Hiltunen, Jukka; Tulamo, Riitta-Mari


    To evaluate the effects of radiation synovectomy (RSYN) with holmium-166 ferric hydroxide macroaggregate (Ho-166 FHMA) on synovium and synovial fluid in normal metacarpo- and metatarsophalangeal joints of horses and to determine intraarticular distribution of radioactivity after Ho-166 FHMA treatment. Either Ho-166 FHMA or nonradioactive Ho-165 FHMA was injected into metacarpo- or metatarsophalangeal joints. Six adult mixed-breed horses without any clinical evidence of metacarpo- or metatarsophalangeal joint disease. Joints were injected with a single high dose of Ho-166 FHMA (mean, 1,000 MBq/joint) or a nonradioactive Ho-165 FHMA preparation (controls). Clinical examination, arthroscopy, synovial fluid analyses, and histologic studies were performed to detect effects of RSYN. Scintigraphy was used to localize intraarticular distribution of Ho-166 FHMA. Ho-166 FHMA treatment induced joint inflammation leading to regional edema, effusion, and scar tissue formation. Scintigraphy revealed the highest intensity of radioactivity in the proximal plantar joint pouch, at which the Ho-166 FHMA treatment caused multifocal necrosis. In the dorsal joint pouch, however, arthroscopic study and histologic analysis showed very little effect of RSYN. There was no regeneration of synovium evident within 2 months. Synovial fluid protein concentration was significantly (P equine fetlock joints. Inflamed equine joints with synovial lining hyperplasia could benefit from Ho-166 FHMA-induced radiation synovectomy if excessive scar tissue formation can be avoided. Copyright 2003 by The American College of Veterinary Surgeons

  12. Functional joint regeneration is achieved using reintegration mechanism in Xenopus laevis. (United States)

    Tsutsumi, Rio; Yamada, Shigehito; Agata, Kiyokazu


    A functional joint requires integration of multiple tissues: the apposing skeletal elements should form an interlocking structure, and muscles should insert into skeletal tissues via tendons across the joint. Whereas newts can regenerate functional joints after amputation, Xenopus laevis regenerates a cartilaginous rod without joints, a "spike." Previously we reported that the reintegration mechanism between the remaining and regenerated tissues has a significant effect on regenerating joint morphogenesis during elbow joint regeneration in newt. Based on this insight into the importance of reintegration, we amputated frogs' limbs at the elbow joint and found that frogs could regenerate a functional elbow joint between the remaining tissues and regenerated spike. During regeneration, the regenerating cartilage was partially connected to the remaining articular cartilage to reform the interlocking structure of the elbow joint at the proximal end of the spike. Furthermore, the muscles of the remaining part inserted into the regenerated spike cartilage via tendons. This study might open up an avenue for analyzing molecular and cellular mechanisms of joint regeneration using Xenopus.

  13. [Arthroscopic refixation of acute proximal anterior cruciate ligament rupture using suture anchors]. (United States)

    Achtnich, A; Rosslenbroich, S; Beitzel, K; Imhoff, A B; Petersen, W


    Arthroscopic assisted suture anchor refixation combined with microfracturing of the femoral ACL insertion zone in cases of acute proximal anterior cruciate ligament (ACL) rupture to restore anatomical and biomechanical properties of the native ACL. Acute proximal ACL rupture/avulsion, multiligament injury of the knee CONTRAINDICATIONS: Chronic (>6 weeks) proximal ACL rupture, intraligamentary rupture, as well as previous ACL surgery. Arthroscopic examination of the knee joint, debridement of the femoral insertion zone, examination of the ligament quality by a probe, insertion of a curved lasso through the ACL to place the sutures and use of a drill guide to place the anchor in the middle of the femoral ACL insertion. Microfracturing holes around the femoral footprint were made by an awl to enhance healing properties of the ACL. Partial weight bearing was permitted and crutches were used for 6 weeks, knee brace limited for the first 2 weeks 0‑0-0°, then 0‑0-90° for the following 4 weeks. A total of 20 patients who underwent acute proximal ACL suture anchor refixation were evaluated after a mean follow-up of 28 months. Regarding stability, mean values of the KT-1000 arthrometer indicated stable results (Knee Documentation Committee) score indicated that 17 cases were very good to good (12A, 4B) and in 3 cases the results were satisfactory (3C). Magnetic resonance imaging showed that the ALC was found to be intact in 17 cases. The total rate of revision was 15 % (3/20) because of recurrent instability.

  14. Spatial Proximity and Intercompany Communication: Myths and Realities


    Aguilera, Anne; Lethiais, Virginie; Alain RALLET


    Spatial proximity is credited with numerous virtues in the economic literature. In particular, for a company to be located near other companies is seen as conducive to the development of business relations. Spatial proximity is also considered to contribute to the quality and efficiency of these relations by facilitating face-to-face meetings that foster the exchange of complex knowledge and, in particular, the emergence of innovation. This article explores the notion of spatial proximity in ...

  15. Diagnosis of Proximal Caries in Primary Molars with DIAGNOdent pen


    Ermler, Romy


    Proximal surfaces, together with fissures, are the areas where most primary caries occur. Due to the anatomy of the deciduous molars, proximal caries cannot be detected at an early stage in crowded teeth by simply using a mirror and probe. Therefore, additional methods to find early proximal caries have to be used. KaVo uses laser fluorescence to detect caries. Originally, the DIAGNOdent devices were able to detect only occlusal caries (56, 61, 62, 65, 66). New results are now also available ...

  16. Studies of welded joints

    Directory of Open Access Journals (Sweden)

    J. M. Krupa


    Full Text Available Studies of a welded joint were described. The joint was made as a result of the reconstruction of a truss and one of the possible means to make a repair. The studies were of a simulation character and were targeted at the detection of welding defects and imperfections thatshould be eliminated in a real structure. A model was designed and on this model the tests and examinations were carried out. The modelwas made under the same conditions as the conditions adopted for repair. It corresponded to the real object in shape and dimensions, and in the proposed technique of welding and welding parameters. The model was composed of five plates joined together with twelve beads.The destructive and non-destructive tests were carried out; the whole structure and the respective welds were also examined visually. Thedefects and imperfections in welds were detected by surface methods of inspection, penetration tests and magnetic particle flaw detection.The model of the welded joint was prepared by destructive methods, a technique that would never be permitted in the case of a realstructure. For the investigations it was necessary to cut out the specimens from the welded joint in direction transverse to the weld run. The specimens were subjected to metallographic examinations and hardness measurements. Additionally, the joint cross-section was examined by destructive testing methods to enable precise determination of the internal defects and imperfections. The surface methods were applied again, this time to determine the severity of welding defects. The analysis has proved that, fabricated under proper conditions and with parameters of the welding process duly observed, the welded joint has good properties and repairs of this type are possible in practice.

  17. Inexact proximal Newton methods for self-concordant functions

    DEFF Research Database (Denmark)

    Li, Jinchao; Andersen, Martin Skovgaard; Vandenberghe, Lieven


    with an application to L1-regularized covariance selection, in which prior constraints on the sparsity pattern of the inverse covariance matrix are imposed. In the numerical experiments the proximal Newton steps are computed by an accelerated proximal gradient method, and multifrontal algorithms for positive definite......We analyze the proximal Newton method for minimizing a sum of a self-concordant function and a convex function with an inexpensive proximal operator. We present new results on the global and local convergence of the method when inexact search directions are used. The method is illustrated...

  18. Transversely Compressed Bonded Joints

    DEFF Research Database (Denmark)

    Hansen, Christian Skodborg; Schmidt, Jacob Wittrup; Stang, Henrik


    The load capacity of bonded joints can be increased if transverse pressure is applied at the interface. The transverse pressure is assumed to introduce a Coulomb-friction contribution to the cohesive law for the interface. Response and load capacity for a bonded single-lap joint was derived using...... non-linear fracture mechanics. The results indicated a good correlation between theory and tests. Furthermore, the model is suggested as theoretical base for determining load capacity of bonded anchorages with transverse pressure, in externally reinforced concrete structures....

  19. Temporomandibular joint examination reviewed


    L. Guarda Nardini


    The temporo-mandibular joint (TMJ) it’s a joint closely related to the skull base, the spine, and the jaws; all these anatomical structures must be taken in consideration when evaluating pain involving the tmj. In order to detect patients affected by pathology or dysfunctions of the tmj, physical examination is of great value in orienting the diagnosis. Inspection must consider the symmetry of the body, the dental status and the type of occlusion. Palpation is a way to assess contractiont inv...


    Directory of Open Access Journals (Sweden)

    T. I. Zlobina


    Full Text Available Joint involvement in syphilis has been considered as casuistry in recent years. At the same time, the high incidence of primary syphilis and the notified cases of late neurosyphilis may suggest that joint involvement in this disease is by no means always verified. Traditionally there are two forms of syphilitic arthritis: primary synovial (involving the articular membranes and sac and primary bone (involving the articular bones and cartilages ones. The paper describes the authors' clinical case of the primary bone form of articular syphilis in a 34-year-old man. 

  1. Consequences of Avulsion Fracture of the Proximal Phalanx Caused by a Technical Failure of Hallux Valgus Surgery. (United States)

    Park, Young Uk; Lee, Kyung Tai; Jegal, Hyuk; Kim, Ki Chun; Choo, Ho Sik; Kweon, Heon Ju


    Several cases of avulsion fracture of the proximal phalanx of the big toe during the lateral capsular release procedure were observed. However, these fractures have not been reported as a complication of hallux valgus surgery. The purpose of the present study was to report the proximal phalanx base fracture as an unrecognized complication and to evaluate the clinical and radiographic consequences of this complication. We retrospectively reviewed 225 feet that had undergone hallux valgus surgery involving proximal chevron osteotomy and distal soft tissue release from May 2009 to December 2012. Of these 225 feet (198 patients), 12 (5.3%) developed proximal phalanx base fracture postoperatively. These patients were assigned to the fracture group. The remaining patients were assigned to the nonfracture group. Patients were followed to observe whether the fractures united and whether degenerative changes developed at the first metatarsophalangeal joint because of this fracture. The mean follow-up period was 36 (range 12 to 72) months. All the subjects in the fracture and nonfracture groups underwent weightbearing anteroposterior and lateral radiographs of the foot at the initial presentation and final follow-up point. The 2 groups were compared with respect to the hallux valgus angle, intermetatarsal angle, range of motion, American Orthopaedic Foot and Ankle Society score, satisfaction, and degenerative changes. No significant differences were found in age, follow-up period, hallux valgus angle, intermetatarsal angle, range of motion of the first metatarsophalangeal joint, American Orthopaedic Foot and Ankle Society score, satisfaction, and degenerative changes between the 2 groups. Ten (83.3%) of the 12 fractures healed, 2 (16.7% of the fractures, 0.89% of the operated feet) progressed to asymptomatic nonunion, and 3 (1.33%) developed first metatarsophalangeal joint degeneration. Avulsion fracture of the proximal phalanx of the big toe is an uncommon complication of

  2. Magnetic resonance study on the anatomical relationship between the posterior proximal region of the tibia and the popliteal artery ☆

    Directory of Open Access Journals (Sweden)

    Rogério Franco de Araujo Goes


    Full Text Available ABSTRACTOBJECTIVE: To analyze and describe the distance from the popliteal artery to three specific areas of the proximal region of the tibia, with the knee extended, by means of magnetic resonance. METHODS: Images of 100 knees of patients who underwent magnetic resonance examinations were analyzed. The location of the popliteal artery was measured in three different areas of the posterior proximal region of the tibia. The first measurement was made at the level of the knee joint (tibial plateau. The second was 9 mm distally to the tibial plateau. The third was at the level of the anterior tuberosity of the tibia (ATT. RESULTS: The distances between the popliteal artery and the tibial plateau and ATT region were significantly greater in males than in females. The distances between the popliteal artery and the regions 9 mm distally to the tibial plateau and the ATT were significantly greater in the age group over 36 years than in the group ≤36 years. CONCLUSION: Knowledge of the anatomical position of the popliteal artery, as demonstrated through magnetic resonance studies, is of great relevance in planning surgical procedures that involve the knee joint. In this manner, devastating iatrogenic injuries can be avoided, particularly in regions that are proximal to the tibial plateau and in young patients.

  3. Charcot arthropathy of the first metatarsophalangeal joint. (United States)

    Wünschel, Markus; Wülker, Nikolaus; Gesicki, Marco


    Charcot arthropathy is an acute or subacute, often indolent, non-infectious or tumorous osteoarticular destruction of weightbearing skeletal structures in patients with reduced pain perception due to peripheral neuropathy. The authors present a rare case of progressive Charcot arthropathy of the first metatarsophalangeal joint with accompanying ulcer and foot deformity due to peripheral neuropathy. An arthrodesis of the first metatarsophalangeal joint with resection of the hypertrophic bone and osteophytes using a locking plate was performed. Also a condylectomy of the base of the proximal phalanx digitus II and III as well as a shortening osteotomy of the third metatarsal were conducted. The ulcer was debrided and primarily closed by suture. Mobilization was performed without weightbearing in a postoperative shoe for 6 weeks, the ulcer was completely healed and the arthrodesis had fused. Owing to the complexity of Charcot arthropathy careful preoperative evaluation, timing and dimension of surgery as well as treatment of associated comorbidities and sufficient postoperative care is important to reduce the complication rate and improve long-term results.

  4. Thickness Distribution of Glenohumeral Joint Cartilage. (United States)

    Schleich, Christoph; Bittersohl, Bernd; Antoch, Gerald; Krauspe, Rüdiger; Zilkens, Christoph; Kircher, Jörn


    High-resolution 3-dimensional cartilage-specific magnetic resonance imaging (MRI) was performed at 3 T to test the following hypotheses: (1) there is a nonuniform cartilage thickness distribution both on the proximal humerus and on the glenoid surface and (2) the glenohumeral joint as a combined system is congruent with the level of the joint cartilage surface without substantial radial mismatch. Inclusion of 38 volunteers (19 females, mean age 24.34 ± 2.22 years; range 21-29 years) in a prospective study. Measurements of: cartilage thickness in 3 regions and 3 zones; radius of both circles (glenoid and humeral cartilage) for congruency calculation using 3-T MRI with 3-dimensional dual-echo steady-state sequence with water excitation. A homogenous mean cartilage thickness (1.2-1.5 mm) and slightly higher values for the glenoidal articulating surface radii both in the mid-paracoronar section (2.4 vs. 2.1 cm, P cartilage changes at the shoulder for future studies.

  5. New Joint Sealants. Criteria, Design and Materials. (United States)

    Building Research Inst., Inc., Washington, DC.

    Contents include--(1) sealing concrete joints, (2) sealing glass and metal joints, (3) metal and glass joint sealants from a fabricator's viewpoint, (4) a theory of adhesion for joint sealants, (5) geometry of simple joint seals under strain, (6) joint sealant specifications from a manufacturer's viewpoint, (7) joint sealant requirements from an…

  6. Effects of femoral neck length, stem size, and body weight on strains in the proximal cement mantle. (United States)

    Harrington, Melvyn A; O'Connor, Daniel O; Lozynsky, Andrew J; Kovach, Ian; Harris, William H


    Several studies have shown that certain cemented total hip replacement femoral stems have been associated with the complications of early debonding, loosening, and osteolysis. Some authors have suggested that these failures may be related to the surface finish of the stems. We developed an in vitro biomechanical experiment characterized by simulated stair-climbing to investigate the multiple factors involved in loosening of cemented femoral stems. In this study, we measured the effects of stem neck length, body weight, stem size, and calcar-collar contact on the torsional stability, as reflected by the strains in the proximal cement mantle, of one design of cemented femoral stem. Eight Centralign femoral stems (Zimmer, Warsaw, Indiana) were cemented into eight cadaver femora with use of contemporary cementing techniques. Prior to insertion, fifteen strain-gauge rosettes were mounted around the proximal portion of the stem. The stems were loaded on a jig that simulated static peak loading during stair-climbing. Loading was repeated for each stem with three different joint reaction forces and for three different neck lengths. Calcar loading by the collar was then eliminated by removing a 0.5-mm slice of bone beneath the collar, and all loadings were then repeated. The peak principal tensile strains in the proximal cement increased linearly with both body weight (r (2) > 0.95) and neck length (r (2) > 0.75). Increasing body weight affected the peak cement strains far more than did increasing neck length. During simulated stair-climbing, calcar-collar contact reduced peak strains in the proximal cement by a factor of 1.5 to two. Peak principal tensile strains in the proximal cement often exceeded 1000 me when the smaller stems were used. In this stair-climbing test model, the peak proximal cement strains were increased more by changes in body weight than they were by changes in neck length. Even during stair-climbing, calcar-collar contact reduced peak cement strains.

  7. Keyed shear joints

    DEFF Research Database (Denmark)

    Hansen, Klaus

    This report gives a summary of the present information on the behaviour of vertical keyed shear joints in large panel structures. An attemp is made to outline the implications which this information might have on the analysis and design of a complete wall. The publications also gives a short...

  8. Imaging the temporomandibular joint

    Energy Technology Data Exchange (ETDEWEB)

    Katzberg, R.W.; Manzione, J.V.; Westesson, P.L.


    This book encompasses all imaging modalities as they apply to the Temporomandibular Joint and its disorders. The volume employs correlative line drawings to elaborate on diagnostic images. It helps teach methods of TMJ imaging and describes findings identified by different imaging modalities to both radiologists and dental clinicians.

  9. Phenomenology of Joint Attention

    African Journals Online (AJOL)


    of phenomenology by offering a phenomenology of joint attention. The first section reviews elementary. Husserlian phenomenology and introduces a system for symbolically representing the structure of intentional mental states. The second section summarizes Edith Stein's phenomenological description of empathy, the ...

  10. Acromioclavicular Joint Separations (United States)


    injuries. The sports most likely to cause AC joint dislocations are football, soccer, hockey, rugby , and skiing, among others [9, 28, 29]. The major cause...resected end of the distal clavicle was first described by Weaver and Dunn in 1972 [10]. However, the value of this technique has been ques- tioned since

  11. Joint Robotics Program (United States)


    Kotler , P.M. (1997). Marketing management : Analysis, planning, implementation, and control. Upper Saddle River, NJ: Prentice Hall...collaborations which can identify better solutions and practices in acquisition, contract, financial, logistics and program management . For further...Project Manager , Robotics Joint Project Introduction Sun Tzu wrote first about the importance of logistics over two thousand years ago (Griffith

  12. Temporomandibular Joint Septic Arthritis

    Directory of Open Access Journals (Sweden)

    Gianfranco Frojo, MD


    Full Text Available Summary:. Infection of the temporomandibular joint (TMJ is a rare pediatric condition resulting from the introduction of pathogens into the joint by hematogenous seeding, local extension, or trauma. Early recognition of the typical signs and symptoms including fever, trismus, preauricular swelling, and TMJ region tenderness are critical in order to initiate further evaluation and prevent feared complications of fibrosis, ankylosis, abnormal facial structure, or persistence of symptoms. Contrast-enhanced computed tomography with ancillary laboratory analysis including erythrocyte sedimentation rate, C-reactive protein, and white blood cell count are beneficial in confirming the suspected diagnosis and monitoring response to therapy. Initial intervention should include empiric parenteral antibiotics, early mandibular mobilization, and joint decompression to provide synovial fluid for analysis including cultures. This report describes a case of TMJ bacterial arthritis in a healthy 6-year-old male who was promptly treated nonsurgically with intravenous antibiotics and localized needle joint decompression with return to normal function after completion of oral antibiotics and physical therapy.

  13. Jointness: A Selected Bibliography (United States)


    Durell Young, and S. Rebecca Zimmerman . What It Takes: Air Force Command of Joint Operations. Santa Monica: RAND, 2009. 110pp. (U260 .S63 2009...2009. 64pp. McCaffrey, Rachel A. Reciprocally Embedding ISR [Intelligence, Surveillance, and Reconnaissance

  14. Joint Custody and Coparenting. (United States)

    Sell, Kenneth D.

    Results are presented of an intensive search of U.S. newspapers and periodicals on the joint custody of children after divorce, where both parents have continued responsibility for parenting and where the children spend part of each week, month, or year with both of the parents. Areas of concern addressed by these materials include the following:…

  15. Joint-Use Libraries (United States)

    Casstevens, Susan


    The joint-use library is a place where people of all ages, interests, and income levels can find items of interest at no personal cost. The mission of A. H. Meadows Public and High School Library in Midlothian, Texas, is to offer what other public libraries provide: educational and entertainment resources to a community. Yet, the staff also wants…

  16. Posterolateral elbow joint instability

    DEFF Research Database (Denmark)

    Olsen, Bo Sanderhoff; Søjbjerg, Jens Ole; Nielsen, K K


    Thirty-five osteoligamentous elbows were included in a study on the kinematics of posterolateral elbow joint instability during the pivot shift test (PST) before and after separate ligament cuttings in the lateral collateral ligament complex (LCLC). Division of the annular ligament or the lateral...

  17. Automated Acquisition of Proximal Femur Morphological Characteristics (United States)

    Tabakovic, Slobodan; Zeljkovic, Milan; Milojevic, Zoran


    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

  18. Imaging of rectus femoris proximal tendinopathies

    Energy Technology Data Exchange (ETDEWEB)

    Pesquer, Lionel; Poussange, Nicolas; Meyer, Philippe; Dallaudiere, Benjamin; Feldis, Matthieu [Clinique du Sport de Bordeaux, Centre d' Imagerie Osteo-articulaire, Merignac (France); Sonnery-Cottet, Bertrand [Groupe Ramsay Generale de Sante - Hopital Prive Jean Mermoz, Centre Orthopedique Santy, Lyon (France); Graveleau, Nicolas [Clinique du Sport de Bordeaux, Centre de Chirurgie Orthopedique et Sportive, Merignac (France)


    The rectus femoris is the most commonly injured muscle of the anterior thigh among athletes, especially soccer players. Although the injury pattern of the muscle belly is well documented, less is known about the anatomy and specific lesions of the proximal tendons. For each head, three distinctive patterns may be encountered according to the location of the injury, which can be at the enthesis, within the tendon, or at the musculotendinous junction. In children, injuries correspond most commonly to avulsion of the anteroinferior iliac spine from the direct head and can lead to subspine impingement. Calcific tendinitis and traumatic tears may be encountered in adults. Recent studies have shown that traumatic injuries of the indirect head may be underdiagnosed and that injuries of both heads may have a surgical issue. Finally, in the case of tears, functional outcome and treatment may vary if the rupture involves one or both tendons and if the tear is partial or complete. Thus, it is mandatory for the radiologist to know the different ultrasound and magnetic resonance imaging (MRI) patterns of these lesions in order to provide accurate diagnosis and treatment. The purpose of this article is to recall the anatomy of the two heads of rectus femoris, describe a reliable method of assessment with ultrasound and MRI and know the main injury patterns, through our own experience and literature review. (orig.)

  19. Proximate industrial activity and psychological distress (United States)

    Downey, Liam; Jackson, James S.; Merrill, J. Bryce; Saint Onge, Jarron M.; Williams, David R.


    This paper examines the role that gender, occupational status, and family status play in moderating the effect of industrial activity on the psychological well-being of nearby residents. Using a unique spatial assessment of industrial activity and an environmental risk/social stressor framework in conjunction with individual-level data from the Detroit Area Study (DAS) and demographic data from the U.S. census, we find that residents of neighborhoods in close proximity to industrial activity report elevated levels of psychological distress compared to residents of neighborhoods removed from this type of activity. These influences are more pronounced among women but gender differences are also contingent upon occupational and family statuses. We show that specific combinations of work and family statuses make persons particularly vulnerable to the influence of this environmental stressor and women are two and a half times more likely than men to have these vulnerable statuses. This study makes an important contribution to the environmental health literature because it reminds researchers of the fundamental influence of social roles when examining the link between environmental risks and mental health. PMID:19444334

  20. [Ophthalmologists in the proximity of Adolf Hitler]. (United States)

    Rohrbach, J M


    Adolf Hitler met or at least knew about 5 ophthalmologists. The chair of ophthalmology in Berlin, Walther Löhlein, personally examined Hitler's eyes at least two times. The chair of ophthalmology in Breslau, Walter Dieter, developed "air raid protection spectacles" with the aid of high representatives of the NS-system and probably Adolf Hitler himself. Heinrich Wilhelm Kranz became rector of the universities of Giessen and Frankfurt/Main. He was known as a very strict advocate of the NS-race hygiene. Werner Zabel made plans for Hitler's diet and tried to interfere with Hitler's medical treatment. Finally, Hellmuth Unger was an influential representative of the medical press and a famous writer. Three of his novels with medical topics were made into a film which Hitler probably saw. Hitler had, so to say, a small "ophthalmological proximity" which, however, did not play a significant role for himself or the NS-state. © Georg Thieme Verlag KG Stuttgart · New York.

  1. Proximity coupling in superconductor-graphene heterostructures. (United States)

    Lee, Gil-Ho; Lee, Hu-Jong


    This review discusses the electronic properties and the prospective research directions of superconductor-graphene heterostructures. The basic electronic properties of graphene are introduced to highlight the unique possibility of combining two seemingly unrelated physics, superconductivity and relativity. We then focus on graphene-based Josephson junctions, one of the most versatile superconducting quantum devices. The various theoretical methods that have been developed to describe graphene Josephson junctions are examined, together with their advantages and limitations, followed by a discussion on the advances in device fabrication and the relevant length scales. The phase-sensitive properties and phase-particle dynamics of graphene Josephson junctions are examined to provide an understanding of the underlying mechanisms of Josephson coupling via graphene. Thereafter, microscopic transport of correlated quasiparticles produced by Andreev reflections at superconducting interfaces and their phase-coherent behaviors are discussed. Quantum phase transitions studied with graphene as an electrostatically tunable two-dimensional platform are reviewed. The interplay between proximity-induced superconductivity and the quantum-Hall phase is discussed as a possible route to study topological superconductivity and non-Abelian physics. Finally, a brief summary on the prospective future research directions is given. © 2018 IOP Publishing Ltd.

  2. Semiconductor detectors with proximity signal readout

    Energy Technology Data Exchange (ETDEWEB)

    Asztalos, Stephen J. [XIA, LLC, Hayward, CA (United States)


    Semiconductor-based radiation detectors are routinely used for the detection, imaging, and spectroscopy of x-rays, gamma rays, and charged particles for applications in the areas of nuclear and medical physics, astrophysics, environmental remediation, nuclear nonproliferation, and homeland security. Detectors used for imaging and particle tracking are more complex in that they typically must also measure the location of the radiation interaction in addition to the deposited energy. In such detectors, the position measurement is often achieved by dividing or segmenting the electrodes into many strips or pixels and then reading out the signals from all of the electrode segments. Fine electrode segmentation is problematic for many of the standard semiconductor detector technologies. Clearly there is a need for a semiconductor-based radiation detector technology that can achieve fine position resolution while maintaining the excellent energy resolution intrinsic to semiconductor detectors, can be fabricated through simple processes, does not require complex electrical interconnections to the detector, and can reduce the number of required channels of readout electronics. Proximity electrode signal readout (PESR), in which the electrodes are not in physical contact with the detector surface, satisfies this need.

  3. Altruism by age and social proximity. (United States)

    Long, Mark C; Krause, Eleanor


    This study evaluates the extent to which an individual's stated altruistic sentiments can be influenced by context-most importantly, by the age and social proximity of the other person and by the nature of what is being sacrificed. We measure willingness to sacrifice own health for another person's health and willingness to sacrifice own wealth for another person's wealth. To evaluate these sentiments, two surveys were administered to representative samples of Americans which contained hypothetical scenarios with context randomly assigned; the first survey posed a dictator game question and the second survey was designed to elicit marginal rates of substitution between own and other's health/wealth. As expected, we find less altruism towards those who are more socially distant (e.g., strangers relative to family). We find individuals are more health altruistic towards young children and more wealth altruistic towards adults, and health altruism tends to be lowest for survey respondents near retirement age. We find no relationship between levels of altruism and the distance between the respondent's state of birth and state of current residence. These findings improve society's understanding of situational altruism and kinship and reciprocity as motivations for altruism, and they have practical implications concerning the economic valuation of human lives used to guide public policy-making.

  4. Optical proximity correction with principal component regression (United States)

    Gao, Peiran; Gu, Allan; Zakhor, Avideh


    An important step in today's Integrated Circuit (IC) manufacturing is optical proximity correction (OPC). In model based OPC, masks are systematically modified to compensate for the non-ideal optical and process effects of optical lithography system. The polygons in the layout are fragmented, and simulations are performed to determine the image intensity pattern on the wafer. Then the mask is perturbed by moving the fragments to match the desired wafer pattern. This iterative process continues until the pattern on the wafer matches the desired one. Although OPC increases the fidelity of pattern transfer to the wafer, it is quite CPU intensive; OPC for modern IC designs can take days to complete on computer clusters with thousands of CPU. In this paper, techniques from statistical machine learning are used to predict the fragment movements. The goal is to reduce the number of iterations required in model based OPC by using a fast and efficient solution as the initial guess to model based OPC. To determine the best model, we train and evaluate several principal component regression models based on prediction error. Experimental results show that fragment movement predictions via regression model significantly decrease the number of iterations required in model based OPC.

  5. Altruism by age and social proximity.

    Directory of Open Access Journals (Sweden)

    Mark C Long

    Full Text Available This study evaluates the extent to which an individual's stated altruistic sentiments can be influenced by context-most importantly, by the age and social proximity of the other person and by the nature of what is being sacrificed. We measure willingness to sacrifice own health for another person's health and willingness to sacrifice own wealth for another person's wealth. To evaluate these sentiments, two surveys were administered to representative samples of Americans which contained hypothetical scenarios with context randomly assigned; the first survey posed a dictator game question and the second survey was designed to elicit marginal rates of substitution between own and other's health/wealth. As expected, we find less altruism towards those who are more socially distant (e.g., strangers relative to family. We find individuals are more health altruistic towards young children and more wealth altruistic towards adults, and health altruism tends to be lowest for survey respondents near retirement age. We find no relationship between levels of altruism and the distance between the respondent's state of birth and state of current residence. These findings improve society's understanding of situational altruism and kinship and reciprocity as motivations for altruism, and they have practical implications concerning the economic valuation of human lives used to guide public policy-making.

  6. Altruism by age and social proximity (United States)


    This study evaluates the extent to which an individual’s stated altruistic sentiments can be influenced by context–most importantly, by the age and social proximity of the other person and by the nature of what is being sacrificed. We measure willingness to sacrifice own health for another person’s health and willingness to sacrifice own wealth for another person’s wealth. To evaluate these sentiments, two surveys were administered to representative samples of Americans which contained hypothetical scenarios with context randomly assigned; the first survey posed a dictator game question and the second survey was designed to elicit marginal rates of substitution between own and other’s health/wealth. As expected, we find less altruism towards those who are more socially distant (e.g., strangers relative to family). We find individuals are more health altruistic towards young children and more wealth altruistic towards adults, and health altruism tends to be lowest for survey respondents near retirement age. We find no relationship between levels of altruism and the distance between the respondent’s state of birth and state of current residence. These findings improve society’s understanding of situational altruism and kinship and reciprocity as motivations for altruism, and they have practical implications concerning the economic valuation of human lives used to guide public policy-making. PMID:28837557

  7. On the existence of best proximity points for generalized contractions

    Directory of Open Access Journals (Sweden)

    V. Vetrivel


    Full Text Available In this article we establish the existence of a unique best proximity point for some generalized non self contractions on a metric space in a simpler way using a geometric result. Our results generalize some recent best proximity point theorems and several fixed point theorems proved by various authors.

  8. Phytochemical, Proximate and Toxicity Studies of Aqueous Extract of ...

    African Journals Online (AJOL)

    Phytochemical, Proximate and Toxicity Studies of Aqueous Extract of Crinum ornatum (Toad's Onion) ... The results indicate that, the bulbs can be considered as a spice that could serve as potential sources of flavouring agent with medicinal benefits. Keywords: Crinum ornatum, Phytochemical, Proximate, Toxicity ...

  9. Proximity and inter-organizational collaboration: a literature review

    NARCIS (Netherlands)

    Knoben, J.; Oerlemans, L.A.G.


    The proximity concept is used in many different ways in the literature. These dimensions of proximity are, however, defined and measured in many different (sometimes even contradictory) ways, show large amounts of overlap, and often are under- or over-specified. The goal of this paper is to specify

  10. Proximate composition and levels of some toxicants in four ...

    African Journals Online (AJOL)

    Proximate composition and levels of some toxicants (anti-nutrients) in four commonly consumed spices were investigated. The spices were garlic (Allium sativum), ginger (Zingiber officinale), onion (Allium cepa var. cepa), and Piper guineense seeds (Ashanti pepper). Proximate analyses showed the spices to contain (on ...

  11. Properties of Sn-Ag proximity effect bridges

    Energy Technology Data Exchange (ETDEWEB)

    Fan Hongchang; Yu Zheng


    We have measured the I-V characteristics, I/sub c/(t) and T/sub c/ of Sn-Ag proximity effect bridges, obtaining some interesting results. We have also analyzed and tried to explain the results in terms of phenomenological theories, believing that microbridge theories of Skocpol, Beasley and Tinkham (SBT) also apply to our proximity effect bridges.

  12. Determination of Proximate Composition and Amino Acid Profile of ...

    African Journals Online (AJOL)

    The proximate composition and amino acid profile of the seed of 30 Nigerian sesame genotypes were determined based on the standard methods of the Association of Official Analytical Chemists (AOAC) and the Sequential Multi- sample amino acid Analyzer (TSM). Proximate analysis showed that sesame seed contained ...

  13. Water Balance and Proximate Composition in Cowpea ( vigna ...

    African Journals Online (AJOL)

    Studying the water balance and proximate composition in plants subjected to these stresses compared the influence of drought and flooding on cowpea seedlings. In drought plants the leaf water potential, its components and the proximate composition were markedly reduced by the end of the experimental period.

  14. Cast index in predicting outcome of proximal pediatric forearm fractures

    Directory of Open Access Journals (Sweden)

    Hassaan Qaiser Sheikh


    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. Proximate composition and mineral contents of Pebbly fish, Alestes ...

    African Journals Online (AJOL)


    The objective of this study was to determine the proximate composition and mineral contents of A. ... and also develop suitable processing method. This study determined the proximate composition and mineral contents of A. baremoze fillets based on fish size. Materials and .... moisture contents can vary with sex of the fish ...

  16. 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 ...

  17. In vivo analysis of trapeziometacarpal joint arthrokinematics during multi-directional thumb motions. (United States)

    Su, Fong-Chin; Lin, Chien-Ju; Wang, Chien-Kuo; Chen, Guan-Po; Sun, Yung-Nien; Chuang, Alan K; Kuo, Li-Chieh


    The investigation of the joint arthrokinematics of the trapeziometacarpal joint is critical to comprehend the causative mechanism underlying this common form of osteoarthritis. Therefore, the purpose of this study is to evaluate the arthrokinematics of the trapeziometacarpal joint during thumb postures in vivo. Fifteen healthy participants were enrolled in this study. Static computed tomography images of the 1st metacarpal bone and trapezium were taken at specific thumb postures during thumb flexion-extension, abduction-adduction, and circumduction motions. Images were analyzed to examine the joint gliding, expressed as displacement of the centroid of the articular surface of the 1st metacarpal bone, relative to the trapezium. The gliding ratio, defined as joint gliding in each direction normalized to the dimension of the trapezium joint surface in the given direction, was computed and compared between different thumb motions. The results indicate that thumb motions influenced joint gliding. The centroids of the articular surface of the 1st metacarpal bone were primarily located at the central and dorsal-radial regions while executing these motions. The maximum joint gliding of the 1st metacarpal bone occurred in the radial-ulnar direction when performing abduction-adduction, and in the dorsal-volar direction while performing flexion-extension and circumduction, with the gliding ratio values of 42.35%, 51.65%, and 51.85%, respectively. Activities that involved abduction-adduction in the trapeziometacarpal joint caused greater joint gliding in the ulnar-radial direction, while flexion-extension resulted in greater joint gliding in the dorsal-volar and distal-proximal directions. Understanding normal joint kinematics in vivo may provide insights into the possible mechanism leading to osteoarthritis of the trapeziometacarpal joint, and help to improve the design of implants. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Rehabilitation of proximal hamstring tendinopathy utilizing eccentric training, lumbopelvic stabilization, and trigger point dry needling: 2 case reports. (United States)

    Jayaseelan, Dhinu J; Moats, Nick; Ricardo, Christopher R


    Case report. Proximal hamstring tendinopathy is a relatively uncommon overuse injury seen in runners. In contrast to the significant amount of literature guiding the evaluation and treatment of hamstring strains, there is little literature about the physical therapy management of proximal hamstring tendinopathy, other than the general recommendations to increase strength and flexibility. Two runners were treated in physical therapy for proximal hamstring tendinopathy. Each presented with buttock pain with running and sitting, as well as tenderness to palpation at the ischial tuberosity. Each patient was prescribed a specific exercise program focusing on eccentric loading of the hamstrings and lumbopelvic stabilization exercises. Trigger point dry needling was also used with both runners to facilitate improved joint motion and to decrease pain. Both patients were treated in 8 to 9 visits over 8 to 10 weeks. Clinically significant improvements were seen in pain, tenderness, and function in each case. Each patient returned to running and sitting without symptoms. Proximal hamstring tendinopathy can be difficult to treat. In these 2 runners, eccentric loading of the hamstrings, lumbopelvic stabilization exercises, and trigger point dry needling provided short- and long-term pain reduction and functional benefits. Further research is needed to determine the effectiveness of this cluster of interventions for this condition. Therapy, level 4.

  19. Acupuncture for peripheral joint osteoarthritis.

    NARCIS (Netherlands)

    Manheimer, Eric; Cheng, K.; Linde, Klaus; Lao, Lixing; Yoo, Junghee; Wieland, Susan; van der Windt, Daniëlle Awm; Berman, Brian M.; Bouter, Lex M.


    BACKGROUND: Peripheral joint osteoarthritis is a major cause of pain and functional limitation. Few treatments are safe and effective. OBJECTIVES: To assess the effects of acupuncture for treating peripheral joint osteoarthritis. SEARCH STRATEGY: We searched the Cochrane Central Register of

  20. Steroid injections - tendon, bursa, joint (United States)

    ... gov/ency/article/007678.htm Steroid injections - tendon, bursa, joint To use the sharing features on this ... can be injected into a joint, tendon, or bursa. Description Your health care provider inserts a small ...

  1. Proximal femoral periprosthetic fracture fixation with a hooked ...

    African Journals Online (AJOL)

    The advent and increasing use of joint replacement for various pathologies has led to a new group of fractures- the periprosthetic fractures. The hip joint is no exception to this group, a fair share of these fractures do occur around the hip joint. The management of these fractures is complex and usually needs application of ...

  2. Spontaneous Healing of a Pediatric Scaphoid Proximal Pole Fracture Nonunion. (United States)

    Rupani, Neal; Riley, Nicholas; McNab, Ian


    Background  Scaphoid fractures in the pediatric population are rare. The majority of nondisplaced fractures tend to unite; however, there is an increased risk of nonunion in proximal pole fractures. Limited evidence exists in their outcomes, owing to the scarcity of the fracture pattern. Case Description  A 13-year-old boy who presented late after developing a traumatic proximal pole scaphoid fracture developed nonunion. He was treated conservatively owing to it being asymptomatic and developed union at 18 months. Literature Review  No previous case of proximal pole pediatric scaphoid fractures with established nonunion that has developed union with conservative management has been described. Clinical Relevance  The authors highlight a unique case of an established proximal pole scaphoid nonunion in a child progressing to union with nonoperative intervention. Owing to its rarity and difficulty in obtaining research, we recommend consideration of nonoperative management of asymptomatic nondisplaced proximal pole fractures in children.

  3. Comparison of three drilling techniques for carpometacarpal joint arthrodesis in horses. (United States)

    Lang, Hayley M; Panizzi, Luca; Allen, Andrew L; Woodbury, Murray R; Barber, Spencer M


    To evaluate 3 drilling techniques for arthrodesis of the equine carpometacarpal (CMC) joint. Experimental study. Cadaveric equine forelimbs (n=15). Limbs were divided into 3 groups (5 limbs each) to evaluate 3 drilling techniques: (1) use of a 4.5 mm drill bit inserted into the joint through 4 entry points and moved in a fanning motion; (2) a 5.5 mm drill bit inserted through 2 entry points to create 3 nonfanned drill tracts (3 drill technique); and (3) a 4.5 mm drill bit used in a 3 drill technique. The CMC joint was disarticulated after drilling, and cartilage and subchondral bone damage evaluated visually and by gross and microradiographic examination using planimetry. Technique 1 produced significantly more damage of the proximal surface, but significantly less to the subchondral bone of the distal surface. Technique 1 produced the most damage to both the articular cartilage and subchondral bone of the total CMC joint than either of the 3 drill tract techniques; however, the difference between techniques 1 and 2 was not significant. Damage from technique 3 was significantly less than that with techniques 1 or 2. Techniques 1 and 2 produced the most cartilage and subchondral bone damage with technique 2 changes more equally distributed between proximal and distal joint surfaces. Technique 1 (fanning) and 2 (5.5 mm 3 drill tracts) may be preferable to achieve arthrodesis of the CMC joint. Morbidity and efficacy of these arthrodesis techniques need to be evaluated in vivo.

  4. Strength Variation of Parachute Joints (United States)

    Mollmann, Catherine


    A parachute joint is defined as a location where a component is sewn or connected to another component. During the design and developmental phase of a parachute system, the joints for each structural component are isolated and tested through a process called seam and joint testing. The objective of seam and joint testing is to determine the degradation on a single component due to interaction with other components; this data is then used when calculating the margin of safety for that component. During the engineering developmental phase of CPAS (Capsule Parachute Assembly System), the parachute system for the NASA Orion Crew Module, testing was completed for every joint of the six subsystems: the four parachutes (main, drogue, pilot, and FBCP [forward bay cover parachute]), the retention release bridle, and the retention panels. The number of joint tests for these subsystems totaled 92, which provides a plethora of data and results for further analysis. In this paper, the data and results of these seam and joint tests are examined to determine the effects, if any, of different operators and sewing machines on the strength of parachute joints. Other variables are also studied to determine their effect on joint strength, such as joint complexity, joint strength magnitude, material type, and material construction. Findings reveal that an optimally-run seam and joint test program could result in an increased understanding of the structure of the parachute; this should lead to a parachute built with optimal components, potentially saving system weight and volume.

  5. Nanocrystal Bioassembly: Asymmetry, Proximity, and Enzymatic Manipulation

    Energy Technology Data Exchange (ETDEWEB)

    Claridge, Shelley A. [Univ. of California, Berkeley, CA (United States)


    Research at the interface between biomolecules and inorganic nanocrystals has resulted in a great number of new discoveries. In part this arises from the synergistic duality of the system: biomolecules may act as self-assembly agents for organizing inorganic nanocrystals into functional materials; alternatively, nanocrystals may act as microscopic or spectroscopic labels for elucidating the behavior of complex biomolecular systems. However, success in either of these functions relies heavily uponthe ability to control the conjugation and assembly processes.In the work presented here, we first design a branched DNA scaffold which allows hybridization of DNA-nanocrystal monoconjugates to form discrete assemblies. Importantly, the asymmetry of the branched scaffold allows the formation of asymmetric2assemblies of nanocrystals. In the context of a self-assembled device, this can be considered a step toward the ability to engineer functionally distinct inputs and outputs.Next we develop an anion-exchange high performance liquid chromatography purification method which allows large gold nanocrystals attached to single strands of very short DNA to be purified. When two such complementary conjugates are hybridized, the large nanocrystals are brought into close proximity, allowing their plasmon resonances to couple. Such plasmon-coupled constructs are of interest both as optical interconnects for nanoscale devices and as `plasmon ruler? biomolecular probes.We then present an enzymatic ligation strategy for creating multi-nanoparticle building blocks for self-assembly. In constructing a nanoscale device, such a strategy would allow pre-assembly and purification of components; these constructs can also act as multi-label probes of single-stranded DNA conformational dynamics. Finally we demonstrate a simple proof-of-concept of a nanoparticle analog of the polymerase chain reaction.

  6. Translational Imaging Spectroscopy for Proximal Sensing. (United States)

    Rogass, Christian; Koerting, Friederike M; Mielke, Christian; Brell, Maximilian; Boesche, Nina K; Bade, Maria; Hohmann, Christian


    Proximal sensing as the near field counterpart of remote sensing offers a broad variety of applications. Imaging spectroscopy in general and translational laboratory imaging spectroscopy in particular can be utilized for a variety of different research topics. Geoscientific applications require a precise pre-processing of hyperspectral data cubes to retrieve at-surface reflectance in order to conduct spectral feature-based comparison of unknown sample spectra to known library spectra. A new pre-processing chain called GeoMAP-Trans for at-surface reflectance retrieval is proposed here as an analogue to other algorithms published by the team of authors. It consists of a radiometric, a geometric and a spectral module. Each module consists of several processing steps that are described in detail. The processing chain was adapted to the broadly used HySPEX VNIR/SWIR imaging spectrometer system and tested using geological mineral samples. The performance was subjectively and objectively evaluated using standard artificial image quality metrics and comparative measurements of mineral and Lambertian diffuser standards with standard field and laboratory spectrometers. The proposed algorithm provides highly qualitative results, offers broad applicability through its generic design and might be the first one of its kind to be published. A high radiometric accuracy is achieved by the incorporation of the Reduction of Miscalibration Effects (ROME) framework. The geometric accuracy is higher than 1 μpixel. The critical spectral accuracy was relatively estimated by comparing spectra of standard field spectrometers to those from HySPEX for a Lambertian diffuser. The achieved spectral accuracy is better than 0.02% for the full spectrum and better than 98% for the absorption features. It was empirically shown that point and imaging spectrometers provide different results for non-Lambertian samples due to their different sensing principles, adjacency scattering impacts on the signal

  7. Observer differentiation of proximal enamel mechanical defects versus natural proximal dental caries with computed dental radiography. (United States)

    Kang, B C; Farman, A G; Scarfe, W C; Goldsmith, L J


    Various models have been used to study the accuracy of imaging systems for detection of dental caries. This study compares the ability of dentists to detect mechanically created defects versus natural dental caries cavitations on the proximal surfaces of extracted teeth with Computed Dental Radiography (Schick Industries, Long Island City, N.Y.). Detection rates are investigated according to lesion depth to permit comparisons to be made between studies in the literature with other mechanical defects or natural caries models. Discrimination of natural caries versus artificial defects with Computed Dental Radiography is also compared with a previous report that used standard dental film. Fifty-two extracted molar and premolar teeth were mounted into representative sets of maxillary and mandibular posterior arches for bite-wing radiography. There were 16 proximal surfaces with natural caries and 28 proximal surfaces with mechanical defects. An optical bench was used to ensure constant beam geometry. A 1.8 cm acrylic soft tissue equivalent attenuator was placed in front of the receptor. Thirty dentists acted independently as observers to differentiate between sound proximal tooth surfaces, natural dental caries, and mechanical defects. Evaluation of intra- and interobserver variability was made with use of the kappa statistic. The Zelen test of odds ratios was used to test for homogeneity, and the Mantel-Haenszel analysis plus stratified logistic regression were used for inference about the common odds ratio. Significance was set at p detection was 74% for mechanical defects and 67% for natural caries. The odds of detecting a mechanical defect were 1.40 times the odds of finding natural dental caries cavitation of the same depth. Lesion depth did influence the probability of correctly identifying the presence of a lesion; the odds of identifying cavitation increased 1.41 times with every 0.1 mm increase in lesion depth. Correct designation of lesion type was 1.42 times

  8. Peripheral degenerative joint diseases

    Directory of Open Access Journals (Sweden)

    Nilzio Antonio da Silva


    Full Text Available Osteoarthritis, a degenerative joint disease, is the most commonrheumatic disorder mainly in a geriatric population. Manifestationsare pain, stiffness and functional loss in the affected joint.According to etiology it is classifi ed as primary (or idiopathicand secondary. Some risk factors for disease development aregenetics, race, age, sex, obesity, occupational activities andarticular biomechanics. Pathogenesis is the same for any cause orlocalization, being catabolic alterations, with synthesis, inhibitionand reparing intent of the cartilage matrix. Metalloproteinases andcytokines (IL-1,IL-6,TNF-α actions promote infl ammatory reactionand cartilage degradation. Pain, the most important symptom,does not correlate with radiologic fi ndings. Peripheral osteoarthritisoccurs predominantly in the knee, hip and hand. Diagnosis is basedon clinical features, laboratorial tests and radiological changes.Rheumatological associations’ guidelines for treatment includenon-pharmacologic (education, physiotherapy, assistive devices,and pharmacologic (analgesics, anti-infl ammatory drugs therapyand surgery. Arthroplasty seems to work better than medicines, butshould be used if other treatments have failed.

  9. Temporomandibular joint disorder (review). (United States)

    Dugashvili, G; Menabde, G; Janelidze, M; Chichua, Z; Amiranashvili, I


    Etiopathogenesis and clinical management of TMJD integrates a number of medical disciplines. In particular, dentistry, oral - facial surgery, neurology, rheumatology and so on. Nowadays there is no unified strategy for the management of this disease. Most cases of temporomandibular disorder (TMD) respond to simple treatment and the prognosis is good. Symptoms usually remit with simple care. In cases of secondary involvement of temporomandibular joint (TMJ), the prognosis depends on the primary disease. A comprehensive, chronological history and physical and examination of the patient, including dental history and examination, is essential to diagnose the specific condition to decide further investigations, if any, and to provide specific treatment. in severe cases, a joint consultation of a dentist, neurologist and rheumatologist is needed.

  10. Joint International Accelerator School

    CERN Multimedia

    CERN Accelerator School


    The CERN and US Particle Accelerator Schools recently organised a Joint International Accelerator School on Beam Loss and Accelerator Protection, held at the Hyatt Regency Hotel, Newport Beach, California, USA from 5-14 November 2014. This Joint School was the 13th in a series of such schools, which started in 1985 and also involves the accelerator communities in Japan and Russia.   Photo courtesy of Alfonse Pham, Michigan State University.   The school attracted 58 participants representing 22 different nationalities, with around half from Europe and the other half from Asia and the Americas. The programme comprised 26 lectures, each of 90 minutes, and 13 hours of case study. The students were given homework each day and had an opportunity to sit a final exam, which counted towards university credit. Feedback from the participants was extremely positive, praising the expertise and enthusiasm of the lecturers, as well as the high standard and quality of their lectures. Initial dis...

  11. Outpatient Total Joint Arthroplasty. (United States)

    Bert, Jack M; Hooper, Jessica; Moen, Sam


    Outpatient total joint arthroplasty (OTJA) allows for a safe, cost effective pathway for appropriately selected patients. With current pressures on arthroplasty surgeons and their associated institutions to reduce costs per episode of care, it is important to define the steps and challenges associated with establishing an outpatient arthroplasty program. Several studies have outlined techniques of selecting patients suitable for this type of postoperative pathway. With emerging concerns about patients who undergo outpatient arthroplasty being at increased risk of medical complications, which may lessen projected cost savings, it is important to identify value-based strategies to optimize patient recovery after OTJA. This article reviews digital techniques for patient selection and data collection, operating room efficiency systems, and provides a summary of methods to build and maintain value in outpatient total joint replacement within the framework of bundled payment reimbursement.

  12. Numerical Optimization of the Position in Femoral Head of Proximal Locking Screws of Proximal Femoral Nail System; Biomechanical Study. (United States)

    Konya, Mehmet Nuri; Verim, Özgür


    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.

  13. Proximal Intermetatarsal Divergence in Distal Chevron Osteotomy for Hallux Valgus: An Overlooked Finding. (United States)

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


    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

  14. The Joint Cities

    Directory of Open Access Journals (Sweden)

    Romano Fistola


    Full Text Available The new connections, which high speed train allows to activate among the metropolitan systems, seem to be able to give life to new urban macro-structures for which the transfer time, among the main poles of the railway segment, becomes comparable to an inside moving into the city and therefore considered as an inter-functional mobility. The tunnel effect generated by the high speed connection seems to be able to allow a new temporal and functional joint among the metropolitan systems consequently supporting the possibility, for the users, to move themselves among the different urban functions belonging to the different cities. The birth of these urban aggregations seems to drive towards new megalopolis, which we can define for the first time with the term: joint-city. For this new metropolitan settlement it seems to be very interesting to investigate the constitutive peculiarities, the systemic articulation, its relational structures, the evolutionary scenarios, and so on. The urban functions (activities can be considered as structures of relationships between people that allows to define "organizational links" inside the community; the urban functions are located in specific places inside urban container or in open spaces. The urban functions represent the urban engines and the functional system can be thought as the “soul of the city", abstract but essential to its survival. In the definition set out here the analysis is carried out for many interconnected urban functional system points (specifically those in Rome and Naples. The new high speed railway has to be considered not only as a new channel of mobility between cities, but as a real possibility of joint between the functional systems of the two centres. A final consideration can be carried out in relation to the possibility of implementing new measures of governance of urban transformations considering the new macro-city: the "Joint City".

  15. Australias Joint Approach (United States)


    Chapter 2. The most significant change is that the section on tools for the Needs Phase, mentioned earlier in this paper, has been deleted . In late...considering how they can be linked into common joint functions, runs the risk of becoming stuck in a replacement syndrome for capability development. 2...culture will be aided by the FPR’s implementation proposal to that Defence creates a culture where corporate behaviour is valued and rewarded. 313

  16. Joint Mission Command Implementation (United States)


    1 AIR WAR COLLEGE AIR UNIVERSITY JOINT MISSION COMMAND IMPLEMENTATION by Michael Dane Acord, COL, US Army A Research Report Submitted to...assigned to the Air War College, Air University, Maxwell Air Force Base (AFB), AL. Following the Army Command and General Staff College and School...holds a Bachelor’s Degree in Biology and two Masters Degrees, a Masters in Management from Troy University and a Master of Military Arts and Sciences

  17. Redefining Murder: Joint Enterprise


    Mitchell-Rodd, Nicola


    This article explores the evolution of secondary liability and the unforgiving doctrine of joint enterprise in homicide cases. Exploration of the current law ensues to determine if the distinct decisions of their Lordships in both Powell and Rahman have failed to sufficiently clarify the law; followed by in depth analysis of the Law Commission and Ministry of Justice proposals to reform this infamously disputed area of law.

  18. Prosthetic elbow joint (United States)

    Weddendorf, Bruce C. (Inventor)


    An artificial, manually positionable elbow joint for use in an upper extremity, above-elbow, prosthetic is described. The prosthesis provides a locking feature that is easily controlled by the wearer. The instant elbow joint is very strong and durable enough to withstand the repeated heavy loadings encountered by a wearer who works in an industrial, construction, farming, or similar environment. The elbow joint of the present invention comprises a turntable, a frame, a forearm, and a locking assembly. The frame generally includes a housing for the locking assembly and two protruding ears. The forearm includes an elongated beam having a cup-shaped cylindrical member at one end and a locking wheel having a plurality of holes along a circular arc on its other end with a central bore for pivotal attachment to the protruding ears of the frame. The locking assembly includes a collar having a central opening with a plurality of internal grooves, a plurality of internal cam members each having a chamfered surface at one end and a V-shaped slot at its other end; an elongated locking pin having a crown wheel with cam surfaces and locking lugs secured thereto; two coiled compression springs; and a flexible filament attached to one end of the elongated locking pin and extending from the locking assembly for extending and retracting the locking pin into the holes in the locking wheel to permit selective adjustment of the forearm relative to the frame. In use, the turntable is affixed to the upper arm part of the prosthetic in the conventional manner, and the cup-shaped cylindrical member on one end of the forearm is affixed to the forearm piece of the prosthetic in the conventional manner. The elbow joint is easily adjusted and locked between maximum flex and extended positions.

  19. The international joint commission


    Clamens, Murray


    For over 92 years the International Joint Commission (IJC), United States and Canada, has effectively served the two nations in approving and providing continuous oversight of water resource projects along the 5000-mile common border, in assisting the governments in preventing and resolving issues and disagreements regarding the use of these waters, and in addressing other environmental issues affecting or potentially affecting one or both of the countries. During the first years of the 20th...

  20. 2009 Joint CBRN Conference (United States)


    Angeles, CA USC Rand Arroyo Center Tampa, FL University of South Florida Tempe, AZ ASU Research Park Austin, TX University of Texas Houghton, MI...Engagement 16 Maneuver Enhancement Brigade X A unique multi-functional unit to support Maneuver & Joint Forces commanders One of the five modular ...forward deployed CBRN detection capabilities • Key capabilities will focus on a modular approach – Analytical equipment – Analytical processes

  1. Demographic and clinical factors associated with radiographic severity of first metatarsophalangeal joint osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot. (United States)

    Menz, H B; Roddy, E; Marshall, M; Thomas, M J; Rathod, T; Myers, H; Thomas, E; Peat, G M


    To explore demographic and clinical factors associated with radiographic severity of first metatarsophalangeal joint osteoarthritis (OA) (First MTPJ OA). Adults aged ≥50 years registered with four general practices were mailed a Health Survey. Responders reporting foot pain within the last 12 months were invited to undergo a clinical assessment and weight-bearing dorso-plantar and lateral radiographs of both feet. Radiographic first MTPJ OA in the most severely affected foot was graded into four categories using a validated atlas. Differences in selected demographic and clinical factors were explored across the four radiographic severity subgroups using analysis of variance (ANOVA) and ordinal regression. Clinical and radiographic data were available from 517 participants, categorised as having no (n = 105), mild (n = 228), moderate (n = 122) or severe (n = 62) first MTPJ OA. Increased radiographic severity was associated with older age and lower educational attainment. After adjusting for age, increased radiographic first MTPJ OA severity was significantly associated with an increased prevalence of dorsal hallux and first MTPJ pain, hallux valgus, first interphalangeal joint (IPJ) hyperextension, keratotic lesions on the dorsal aspect of the hallux and first MTPJ, decreased first MTPJ dorsiflexion, ankle/subtalar joint eversion and ankle joint dorsiflexion range of motion, and a trend towards a more pronated foot posture. This cross-sectional study has identified several dose-response associations between radiographic severity of first MTPJ OA and a range of demographic and clinical factors. These findings highlight the progressive nature of first MTPJ OA and provide insights into the spectrum of presentation of the condition in clinical practice. Crown Copyright © 2014. Published by Elsevier Ltd. All rights reserved.

  2. Passive Muscle-Tendon Unit Gearing is Joint Dependent in Human Medial Gastrocnemius

    Directory of Open Access Journals (Sweden)

    Emma F Hodson-Tole


    Full Text Available Skeletal muscles change length and develop force both passively and actively. Gearing allows muscle fibre length changes to be uncoupled from those of the whole muscle-tendon unit. During active contractions this process allows muscles to operate at mechanically favorable conditions for power or economical force production. Here we ask whether gearing is constant in passive muscle; determining the relationship between fascicle and muscle-tendon unit length change in the bi-articular medial gastrocnemius and investigating the influence of whether motion occurs at the knee or ankle joint. Specifically, the same muscle-tendon unit length changes were elicited by rotating either the ankle or knee joint whilst simultaneously measuring fascicle lengths in proximal and distal muscle regions using B-mode ultrasound. In both the proximal and distal muscle region, passive gearing values differed depending on whether ankle or knee motion occurred. Fascicle length changes were greater with ankle motion, likely reflecting anatomical differences in proximal and distal passive tendinous tissues, as well as shape changes of the adjacent mono-articular soleus. This suggests that there is joint-dependent dissociation between the mechanical behaviour of muscle fibres and the muscle-tendon unit during passive joint motions that may be important to consider when developing accurate models of bi-articular muscles.

  3. Interventions for treating proximal humeral fractures in adults. (United States)

    Handoll, Helen H G; Brorson, Stig


    Fracture of the proximal humerus, often termed shoulder fracture, is a common injury in older people. The management of these fractures varies widely. This is an update of a Cochrane Review first published in 2001 and last updated in 2012. To assess the effects (benefits and harms) of treatment and rehabilitation interventions for proximal humeral fractures in adults. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register, the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE, and other databases, conference proceedings and bibliographies of trial reports. The full search ended in November 2014. We considered all randomised controlled trials (RCTs) and quasi-randomised controlled trials pertinent to the management of proximal humeral fractures in adults. Both review authors performed independent study selection, risk of bias assessment and data extraction. Only limited meta-analysis was performed. We included 31 heterogeneous RCTs (1941 participants). Most of the 18 separate treatment comparisons were tested by small single-centre trials. The main exception was the surgical versus non-surgical treatment comparison tested by eight trials. Except for a large multicentre trial, bias in these trials could not be ruled out. The quality of the evidence was either low or very low for all comparisons except the largest comparison.Nine trials evaluated non-surgical treatment in mainly minimally displaced fractures. Four trials compared early (usually one week) versus delayed (three or four weeks) mobilisation after fracture but only limited pooling was possible and most of the data were from one trial (86 participants). This found some evidence that early mobilisation resulted in better recovery and less pain in people with mainly minimally displaced fractures. There was evidence of little difference between the two groups in shoulder complications (2/127 early mobilisation versus 3/132 delayed mobilisation; 4 trials) and

  4. 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


    Bonadio, Frank; Vaugh, Trevor; McManus, Ronan; MacNally, Shane


    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...

  5. Preliminary bolted-joint data (United States)

    Wichorek, G. R.


    Bolted-joint strength and failure modes for advanced graphite/polyimide composite laminates at 116K (-250 F), room temperature, and 589K (600 F) were determined to provide preliminary design data. The bolted-joint test setup for the low and elevated temperature tests is described. Test results are reported on a quasi-isotropic laminate of Celion 6000/PMR-15. Single bolt, double lap shear specimens were tested to obtain maximum joint strength and failure mode. The effect of joint geometry and temperature on joint strength and failure mode is presented.

  6. Catastrophic cement reaction following cementation for megaprosthesis for proximal femoral fracture. (United States)

    Baig, Muhammad Nouman; Curtin, William; Callaghan, Michael Andrew; Murphy, Colin G


    Bone cement implantation syndrome (BCIS) is a well-described and potentially fatal complication of orthopaedic surgery involving pressurised bone cement. Although also described for certain spinal procedures, it is most commonly associated with cemented hip and knee arthroplasty and with cemented hemiarthroplasty following neck of femur fracture in particular.Donaldson et alproposed the definition of BCIS as a syndrome "characterized by hypoxia, hypotension or both and/or unexpected loss of consciousness occurring around the time of cementation, prosthesis insertion, reduction of the joint or, occasionally, limb tourniquet deflation in a patient undergoing cemented bone surgery". Other features include increased vascular resistance, cardiac arrhythmias and cardiac arrest post cement use.We describe a case of a patient who suffered a catastrophic reaction to cement during surgery for a comminuted proximal femoral fracture. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

  7. 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


    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...

  8. Effect of age on proximal esophageal response to swallowing

    Directory of Open Access Journals (Sweden)

    Roberto Oliveira Dantas


    Full Text Available CONTEXT: It has been demonstrated that the ageing process affects esophageal motility. OBJECTIVES: To evaluate the effect of the age on the proximal esophageal response to wet swallows. METHOD: We measured the proximal esophageal response to swallows of a 5 mL bolus of water in 69 healthy volunteers, 20 of them aged 18-30 years (group I, 27 aged 31-50 years (group II, and 22 aged 51-74 years (group III. We used the manometric method with continuous perfusion. The proximal esophageal contractions were recorded 5 cm from a pharyngeal recording site located 1 cm above the upper esophageal sphincter. The time between the onset of the pharyngeal and of the proximal esophageal recording (pharyngeal-esophageal time and the amplitude, duration and area under the curve of the proximal esophageal contraction were measured. RESULTS: The pharyngeal-esophageal time was shorter in group I subjects than in group II and III subjects (P<0.05. The duration of proximal esophageal contractions was longer in group I than in groups II and III (P<0.001. There was no differences between groups in the amplitude or area under the curve of contractions. There were no differences between groups II and III for any of the measurements. CONCLUSION: We conclude that the age may affects the response of the proximal esophagus to wet swallows.

  9. Dual pathology proximal median nerve compression of the forearm.

    LENUS (Irish Health Repository)

    Murphy, Siun M


    We report an unusual case of synchronous pathology in the forearm- the coexistence of a large lipoma of the median nerve together with an osteochondroma of the proximal ulna, giving rise to a dual proximal median nerve compression. Proximal median nerve compression neuropathies in the forearm are uncommon compared to the prevalence of distal compression neuropathies (eg Carpal Tunnel Syndrome). Both neural fibrolipomas (Refs. 1,2) and osteochondromas of the proximal ulna (Ref. 3) in isolation are rare but well documented. Unlike that of a distal compression, a proximal compression of the median nerve will often have a definite cause. Neural fibrolipoma, also called fibrolipomatous hamartoma are rare, slow-growing, benign tumours of peripheral nerves, most often occurring in the median nerve of younger patients. To our knowledge, this is the first report of such dual pathology in the same forearm, giving rise to a severe proximal compression of the median nerve. In this case, the nerve was being pushed anteriorly by the osteochondroma, and was being compressed from within by the intraneural lipoma. This unusual case highlights the advantage of preoperative imaging as part of the workup of proximal median nerve compression.

  10. Digital contrast subtraction radiography for proximal caries diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Kang, Byung Cheol; Yoon, Suk Ja [Department of Dental Radiology, Chonnam National University Hospital, Gwangju (Korea, Republic of)


    To determine whether subtraction images utilizing contrast media can improve the diagnostic performance of proximal caries diagnosis compared to conventional periapical radiographic images. Thirty-six teeth with 57 proximal surfaces were radiographied using a size no.2 RVG-ui sensor (Trophy Radiology, Marne-la-Vallee, France). The teeth immersed in water-soluble contrast media and subtraction images were taken. Each tooth was then sectioned for histologic examination. The digital radiographic images and subtraction images were examined and interpreted by three dentists for proximal caries. The results of the proximal caries diagnosis were then verified with the results of the histologic examination. The proximal caries sensitivity using digital subtraction radiography was significantly higher than simply examining a single digital radiograph. The sensitivity of the proximal dentinal carious lesion when analyzed with the subtraction radiograph and the radiograph together was higher than with the subtraction radiograph or the radiograph alone. The use of subtraction radiography with contrast media may be useful for detecting proximal dentinal carious lesions.

  11. Laboratory characterization of rock joints

    Energy Technology Data Exchange (ETDEWEB)

    Hsiung, S.M.; Kana, D.D.; Ahola, M.P.; Chowdhury, A.H.; Ghosh, A. [Southwest Research Inst., San Antonio, TX (United States). Center for Nuclear Waste Regulatory Analyses


    A laboratory characterization of the Apache Leap tuff joints under cyclic pseudostatic and dynamic loads has been undertaken to obtain a better understanding of dynamic joint shear behavior and to generate a complete data set that can be used for validation of existing rock-joint models. Study has indicated that available methods for determining joint roughness coefficient (JRC) significantly underestimate the roughness coefficient of the Apache Leap tuff joints, that will lead to an underestimation of the joint shear strength. The results of the direct shear tests have indicated that both under cyclic pseudostatic and dynamic loadings the joint resistance upon reverse shearing is smaller than that of forward shearing and the joint dilation resulting from forward shearing recovers during reverse shearing. Within the range of variation of shearing velocity used in these tests, the shearing velocity effect on rock-joint behavior seems to be minor, and no noticeable effect on the peak joint shear strength and the joint shear strength for the reverse shearing is observed.

  12. Proximity to urban parks and mental health. (United States)

    Sturm, Roland; Cohen, Deborah


    Urban parks have received attention in recent years as a possible environmental factor that could encourage physical activity, prevent obesity, and reduce the incidence of chronic conditions. Despite long hypothesized benefits of parks for mental health, few park studies incorporate mental health measures. To test the association between proximity to urban parks and psychological distress. Cross-sectional analysis of individual health survey responses. Data were collected for a study of capital improvements of neighborhood parks in Los Angeles. A survey was fielded on a sample of residential addresses, stratified by distance from the park (within 400m, 800m, 1.6 km, and 3.2km; N=1070). We used multiple regression to estimate the relationship between the psychological distress as measured by the MHI-5 (outcome variable) and distance to parks (main explanatory variable), controlling for observed individual characteristics. Mental health is significantly related to residential distance from parks, with the highest MHI-5 scores among residents within short walking distance from the park (400m) and decreasing significantly over the next distances. The number of visits and physical activity minutes are significantly and independently related to distance, although controlling for them does not reduce the association between distance and mental health. This paper provides a new data point for an arguably very old question, but for which empirical data are sparse for the US. A nearby urban park is associated with the same mental health benefits as decreasing local unemployment rates by 2 percentage points, suggesting at least the potential of environmental interventions to improve mental health. The analysis is cross-sectional, making it impossible to control for important confounders, including residential selection. Mental health policy has traditionally focused on individual-centered interventions. Just as health policy for preventable chronic illnesses has shifted

  13. Proximal caries detection: Sirona Sidexis versus Kodak Ektaspeed Plus. (United States)

    Khan, Emad A; Tyndall, Donald A; Ludlow, John B; Caplan, Daniel


    This study compared the accuracy of intraoral film and a charge-coupled device (CCD) receptor for proximal caries detection. Four observers evaluated images of the proximal surfaces of 40 extracted posterior teeth. The presence or absence of caries was scored using a five-point confidence scale. The actual status of each surface was determined from ground section histology. Responses were evaluated by means of receiver operating characteristic (ROC) analysis. Areas under ROC curves (Az) were assessed through a paired t-test. The performance of the CCD-based intraoral sensor was not different statistically from Ektaspeed Plus film in detecting proximal caries.

  14. Friction between human finger flexor tendons and pulleys at high loads. (United States)

    Schweizer, A; Frank, O; Ochsner, P E; Jacob, H A C


    A method was developed to indirectly measure friction between the flexor tendons and pulleys of the middle and ring finger in vivo. An isokinetic movement device to determine maximum force of wrist flexion, interphalangeal joint flexion (rolling in and out) and isolated proximal interphalangeal (PIP) joint flexion was built. Eccentric and concentric maximum force of these three different movements where gliding of the flexor tendon sheath was involved differently (least in wrist flexion) was measured and compared. Fifty-one hands in 26 male subjects were evaluated. The greatest difference between eccentric and concentric maximum force (29.9%) was found in flexion of the PIP joint. Differences in the rolling in and out movement (26.8%) and in wrist flexion (14.5%) were significantly smaller. The force of friction between flexor tendons and pulleys can be determined by the greater difference between eccentric and concentric maximum force provided by the same muscles in overcoming an external force during flexion of the interphalangeal joints and suggests the presence of a non-muscular force, such as friction. It constitutes of 9% of the eccentric flexion force in the PIP joint and therefore questions the low friction hypothesis at high loads. Copyright 2002 Elsevier Science Ltd.

  15. 49 CFR 213.351 - Rail joints. (United States)


    ... 49 Transportation 4 2010-10-01 2010-10-01 false Rail joints. 213.351 Section 213.351... Rail joints. (a) Each rail joint, insulated joint, and compromise joint shall be of a structurally sound design and dimensions for the rail on which it is applied. (b) If a joint bar is cracked, broken...

  16. Size and shape variation in the proximal femur of Australopithecus africanus. (United States)

    Harmon, Elizabeth


    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.

  17. The association of distal femur and proximal tibia shape with sex: The Osteoarthritis Initiative. (United States)

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


    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.

  18. Tibia-based referencing for standard proximal tibial radiographs during intramedullary nailing. (United States)

    Bible, Jesse E; Choxi, Ankeet A; Dhulipala, Sravan C; Evans, Jason M; Mir, Hassan R


    Limited information exists to define standard tibial radiographs. The purpose of this study was to define new landmarks on the proximal tibia for standard anteroposterior and lateral radiographs. In 10 cadaveric knees, fibular head bisection was considered the anteroposterior image, and femoral condyle overlap the lateral image. In another 10 knees, a "twin peaks" anteroposterior view, showing the sharpest profile of the tibial spines, was used. The "flat plateau" lateral image was obtained by aligning the femoral condyles then applying a varus adjustment with overlap of the tibial plateaus. Medial peritendinous approaches were performed, and an entry reamer used to open the medullary canal. A priori analysis showed good to excellent intra-/inter-observer reliability with the new technique (intra-class correlation coefficient ICC 0.61-0.90). The "twin peaks" anteroposterior radiograph was externally rotated 2.7±2.1° compared to the standard radiograph with fibular head bisection. Portal position and incidence of damage to intra-articular structures did not significantly differ between groups (P>.05). The "twin peaks" anteroposterior view and "flat plateau" lateral view can safely be used for nail entry portal creation in the anatomic safe zone. Tibia-based radiographic referencing is useful for intramedullary nailing cases in which knee or proximal tibiofibular joint anatomy is altered.

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

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


    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).

  20. Stabilization of the Proximal Ulnar Stump after the Darrach or Sauvé-Kapandji Procedure by Using the Extensor Carpi Ulnaris Tendon (United States)

    Chu, Po-Jung; Lee, Hung-Maan; Hung, Sheng-Tsai


    The Darrach and Sauvé-Kapandji procedures are considered to be useful treatment options for distal radioulnar joint disorders. Postoperative instability of the proximal ulnar stump and radioulnar convergence, however, may cause further symptoms. From October 1999 to May 2002, a total of 19 wrists in 15 men and four women, with an average age of 48.3 years, were treated by stabilizing the proximal ulnar stump with a half-slip of the extensor carpi ulnaris tendon using modified Darrach and Sauvé-Kapandji procedures. The average follow-up period was 77 months (range, 62 to 91 months). No patient complained of symptoms due to instability of the proximal ulnar stump. Grip strength improved in all wrists after surgery. Postoperative X-rays, including loading X-rays, showed improved alignment in both coronal and lateral planes. We concluded that stabilization of the proximal ulnar stump with ECU tenodesis is an effective procedure for treating distal radioulnar joint disorder after the Darrach and Sauvé-Kapandji procedures. PMID:18780014