WorldWideScience

Sample records for sagittal split osteotomy

  1. Bilateral sagittal split osteotomy versus distraction osteogenesis for mandibular advancements

    NARCIS (Netherlands)

    Baas, E.M.

    2015-01-01

    The aim of this thesis was to compare the treatment modality of distraction osteogenesis (DO) with the gold standard for mandibular advancement surgery. In fact we compare distraction osteogenesis with the standard of care, which is a conventional bilateral sagittal split osteotomy as described by

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

    Science.gov (United States)

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

    2013-11-01

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

  3. Comparative Study of Skeletal Stability between Postoperative Skeletal Intermaxillary Fixation and No Skeletal Fixation after Bilateral Sagittal Split Ramus Osteotomy

    DEFF Research Database (Denmark)

    Hartlev, Jens; Godtfredsen, Erik; Andersen, Niels Trolle

    2014-01-01

    OBJECTIVES: The purpose of the present study was to evaluate skeletal stability after mandibular advancement with bilateral sagittal split osteotomy. MATERIAL AND METHODS: Twenty-six patients underwent single-jaw bilateral sagittal split osteotomy (BSSO) to correct skeletal Class II malocclusion....

  4. Cost, operation and hospitalization times in distraction osteogenesis versus sagittal split osteotomy

    NARCIS (Netherlands)

    van Strijen, P. J.; Breuning, K. H.; Becking, A. G.; Perdijk, F. B. T.; Tuinzing, D. B.

    2003-01-01

    Distraction osteogenesis in 'common' surgical orthodontics is mentioned as an alternative for conventional sagittal split osteotomy. After a 'learning curve' in the surgical skills of distraction, the two techniques can be compared concerning time and cost aspects. Forty-seven patients (male n=28,

  5. Soft tissue profile changes after bilateral sagittal split osteotomy for mandibular setback: a systematic review.

    NARCIS (Netherlands)

    Joss, C.U.; Joss-Vassalli, I.M.; Berge, S.J.; Kuijpers-Jagtman, A.M.

    2010-01-01

    PURPOSE: To evaluate the ratio of soft tissue to hard tissue in bilateral sagittal split setback osteotomy with rigid internal fixation or wire fixation. MATERIALS AND METHODS: A literature search was performed using PubMed, Medline, CINAHL, Web of Science, the Cochrane Library, and Google Scholar

  6. Long term stability of mandibular advancement procedures : bilateral sagittal split osteotomy versus distraction osteogenesis

    NARCIS (Netherlands)

    Baas, E. M.; Pijpe, J.; de Lange, J.

    The aim of this study was to compare the postoperative stability of the mandible after a bilateral lengthening procedure, either by bilateral sagittal split osteotomy (BSSO) or distraction osteogenesis (DO). All patients who underwent mandibular advancement surgery between March 2001 and June 2004

  7. Stability of mandibular advancement procedures: bilateral sagittal split osteotomy versus distraction osteogenesis

    NARCIS (Netherlands)

    Vos, M.D.; Baas, E.M.; de Lange, J.; Bierenbroodspot, F.

    2009-01-01

    The aim of this study was to compare the postoperative stability of the mandible after a bilateral lengthening procedure, either by bilateral sagittal split osteotomy (BSSO) or distraction osteogenesis (DOG). All patients who underwent mandibular advancement surgery between March 2001 and June 2004

  8. Stability of unilateral sagittal split ramus osteotomy for correction of facial asymmetry: long-term case series and literature review

    OpenAIRE

    Lee, Seong-Geun; Kang, Young-Hoon; Byun, June-Ho; Kim, Uk-Kyu; Kim, Jong-Ryoul; Park, Bong-Wook

    2015-01-01

    Bilateral sagittal split ramus osteotomy is considered a standard technique in mandibular orthognathic surgeries to reduce unexpected bilateral stress in the temporomandibular joints. Unilateral sagittal split ramus osteotomy (USSO) was recently introduced to correct facial asymmetry caused by asymmetric mandibular prognathism and has shown favorable outcomes. If unilateral surgery could guarantee long-term postoperative stability as well as favorable results, operation time and the incidence...

  9. [A biomechanic study on the relapse after sagittal split and oblique osteotomy of Ramus].

    Science.gov (United States)

    Li, Wei; Song, Yufeng; Wang, Dazhang

    2004-02-01

    The relapse after orthognathic surgery was frequently reported in recent years. But up to now researches concerning bio-mechanic mechanism of relapse are rare. The purpose of this study, by imitating the operation on monkeys, was to examine the biomechanical properties and histological characteristics after operation in order to investigate the mechanism of the relapse after orthognathic surgery. 20 rhesus monkeys divided into two groups were subjected to bilateral sagittal split and oblique osteotomy, respectively. The broken strength, stress and strain of the operated sites were examined with the use of biomechanical methods, and the healing scab was observed using histological method and SEM at 3, 6, 12, 24 weeks after operation. The results obtained demonstrated that bone healing and biomechanical properties reached certain level after 6 to 12 weeks' recovery in both operation groups; the biomechanical properties and histological characteristics recovered faster in sagittal split group than in oblique osteotomy group. Histological examination also demonstrated similar results. From the data above it is suggested that the higher relapse rate in sagittal split may more closely related to the mechanical effect different from the scab healing, although 8 weeks' fixation may meet the requirement of clinical treatment, accessory fixation method should be adopted after the removal of inter-maxilla fixation.

  10. Infections after sagittal split osteotomy: a retrospective analysis of 336 patients.

    Science.gov (United States)

    Bouchard, Carl; Lalancette, Michelle

    2015-01-01

    The purpose of this study was to determine the rate of infection after bilateral sagittal split osteotomy. The investigators implemented a retrospective case series study. To be included in this study, patients needed to have a complete medical chart and a postoperative follow-up of at least 3 months. The outcome variable was postoperative infections. The predicator variables were type of surgery, medical comorbidities, third molar extraction, smoking, type of fixation, and antibiotic prophylaxis. Descriptive and bivariate statistics were computed, and significance was set at P 336 patients with ages ranging from 13 to 65 years (27.2 ± 10.6). The rate of infection was 11.3%, and plates, screws, or both were removed in 10 patients (3%). There was a statistically significant association between age and infections (odds ratio, 1.04; 95% CI, 1.01-1.07; P = .02). The results of this study suggest that infection after bilateral sagittal split osteotomy is within normal range for a clean-contaminated procedure. Rigid fixation of the osteotomy may decrease the need for hardware removal. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. All rights reserved.

  11. Sagittal split ramus osteotomy for aneurysmal bone cyst of the mandibular condyle.

    Science.gov (United States)

    Bhandari, Amit; Sharma, Rohit; Muralidharan, Chiyyarath Gopalan

    2015-01-01

    Aneurysmal bone cyst is a benign pseudocystic osseous lesion characterized by a fibrous connective tissue stroma with cellular fibrous tissue, multinucleated giant cells, and large blood-filled spaces with no endothelial lining. The entity is uncommon in facial bones, and it rarely involves the mandibular condyle. Resection of the lesion is the most accepted treatment. The present case is the 11th reported case of aneurysmal bone cyst of the mandibular condyle in the existing literature and the first where, rather than using conventional extra oral approach, sagittal split ramus osteotomy was used to excise the lesion successfully with no recurrence after 3 years of follow-up.

  12. Endoscopically assisted sagittal split osteotomy for mandibular lengthening: technical note and initial experience.

    Science.gov (United States)

    Mommaerts, Maurice Y

    2010-03-01

    To demonstrate the feasibility of carrying out a sagittal split osteotomy with rigid osteosynthesis via a small oral incision, working in two distinct tunnels and one corridor, using a standard 30 degrees 4-mm Ø endoscope. The procedure can be classified as minimally invasive, allowing for ambulatory treatment and return to daily activities within a week. Thirty-one bilateral procedures were performed on selected patients, all of whom needed mandibular lengthening to obtain a functional occlusion and enhanced facial profile. Transoral osteosynthesis was performed in all but one patient, in whom a transbuccal approach was required to fix the beginning of a "bad" split. Three screws were placed in each of 50 mandibular sides; two screws were placed in each of 10 sides (six screws along the upper border, and four above and below the mandibular canal). Two sides required additional plate osteosynthesis. In four patients, there was fixation instability, either bilaterally with opening of the bite, or unilaterally with protrusion of the mandible; these instabilities were managed conservatively with intermaxillary elastics. In the cases of mandibular lengthening only, oedema was minimal after one week, allowing patients to return to normal daily activities. Endoscopically assisted mandibular lengthening with bilateral sagittal split osteotomies and transoral osteosynthesis reduces periosteal degloving and consequent oedema. The minimal surface available for screw osteosynthesis contributes to the difficulty of the procedure.

  13. Position of mandibular canal and ramus morphology before and after sagittal split ramus osteotomy.

    Science.gov (United States)

    Ueki, Koichiro; Okabe, Katsuhiko; Miyazaki, Mao; Mukozawa, Aya; Marukawa, Kohei; Nakagawa, Kiyomasa; Yamamoto, Etsuhide

    2010-08-01

    The purpose of this study was to evaluate changes in the mandibular canal and ramus morphology before and after a sagittal split ramus osteotomy. The subjects were 30 patients (60 sides) with mandibular prognathism who had undergone bilateral sagittal split ramus osteotomy setback surgery. The mandibular canal position and ramus morphology were measured at the 3 horizontal planes under the mandibular foramen level (level A), 1 cm lower than level A (level B), and 2 cm lower than level A (level C) preoperatively and 1 year postoperatively by computed tomography. Postoperative ramus width, lateral distance, lateral marrow distance, and canal length were significantly larger than the preoperative values at the foramen, 1 cm lower, and 2 cm lower. The mandibular canal completely contacted the lateral cortex without lateral bone marrow in 6 sides (10%) in levels A and B and 4 sides (6.7%) in level C preoperatively and 6 sides (10%) in level C postoperatively. This study suggested that postoperative mandibular canal position was located more posteriorly and the postoperative lateral bone marrow became thicker compared with the preoperative state. Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2014-01-01

    The aim of this study was to determine the influence of the design of the sagittal split ramus osteotomy (SSRO) on the mechanical resistance to vertical forces. An in vitro study was designed for 30 test specimens. Two osteotomy models were made on two polyurethane hemimandibles, where group I presented a SSRO with an angle at vestibular level between both molars and group II presented a linear SSRO towards the basilar border. In both groups a standard osteosynthesis was performed with a 2.0 system plate and four monocortical screws, establishing sub-groups according to the degree of mandibular advancement: group A without advancement, group B with an advancement of 3 mm, and group C with advancement of 7 mm. Hemimandibles were subjected to a vertical load in the Instron machine until reaching peak load with failure, recording the value of the load and displacement. The data were analyzed with a t-test to establish statistical significance, considering p<0.05. The results showed that group II presented the best response to the compressive load, tolerating the highest load values. These results were observed in almost all the groups with statistically significant differences (p<0.05). By contrast, group I presented torsional forces prior to reaching system failure. It can be concluded that the osteotomy design influences mechanical resistance and that the linear SSRO offers the best mechanical resistance.

  15. 3D evaluation of the lingual fracture line after a bilateral sagittal split osteotomy of the mandible.

    NARCIS (Netherlands)

    Plooij, J.M.; Naphausen, M.T.P.; Maal, T.J.J.; Xi, T.; Rangel, F.A.; Swennnen, G.; Koning, M.J.J. de; Borstlap, W.A.; Berge, S.J.

    2009-01-01

    The purpose of this prospective observational study was to evaluate whether cone beam CT (CBCT) is a useful tool for analyzing the fracture line in a bilateral sagittal split osteotomy (BSSO). The patient group consisted of 40 consecutive patients (9 males and 31 females) with a mandibular

  16. Skeletal Stability after Large Mandibular Advancement (> 10 mm) with Bilateral Sagittal Split Osteotomy and Skeletal Elastic Intermaxillary Fixation

    DEFF Research Database (Denmark)

    Schwartz, Kristoffer; Rodrigo, Maria; Jensen, Thomas

    2016-01-01

    OBJECTIVES: The aim of the present study was to assess the skeletal stability after large mandibular advancement (> 10 mm) with bilateral sagittal split osteotomy and skeletal elastic intermaxillary fixation and to correlate the skeletal stability with the vertical facial type. MATERIAL AND METHO...... to distraction osteogenesis in large mandibular advancements....

  17. Long-lasting neurosensory disturbance following advancement of the retrognathic mandible : distraction osteogenesis versus bilateral sagittal split osteotomy

    NARCIS (Netherlands)

    Wijbenga, J. G.; Verlinden, C. R. A.; Jansma, J.; Becking, A. G.; Stegenga, B.

    Neurosensory disturbance (NSD) of the inferior alveolar nerve (IAN) is the most common complication after bilateral sagittal split osteotomy (BSSO) and distraction osteogenesis (DO) of the retrognathic mandible. It is suggested that the risk is lower after DO than after BSSO. This retrospective

  18. Distraction osteogenesis versus bilateral sagittal split osteotomy for advancement of the retrognathic mandible : a review of the literature

    NARCIS (Netherlands)

    Schreuder, W. H.; Jansma, J.; Bierman, M. W. J.; Vissink, A.

    Bilateral sagittal split osteotomy (BSSO) and distraction osteogenesis (DO) are the most common techniques currently applied to surgically correct mandibular retrognathia. It is the responsibility of the maxillofacial surgeon to determine the optimal treatment option in each individual case. The aim

  19. Osseous healing after sagittal splitting ramus osteotomy in mandibular prognathism. Three-dimensional CT measurement

    Energy Technology Data Exchange (ETDEWEB)

    Nemoto, Toshiyuki; Akizuki, Hiromichi; Michi, Ken-ichi [Showa Univ., Tokyo (Japan). School of Dentistry

    2001-07-01

    The purpose of the present study was to clarify the relationship between the cleavage and fixation of bone fragments and the osseous healing after sagittal splitting ramus osteotomy. Subjects consisted of 12 patients with mandibular prognathism, on which we performed sagittal splitting ramus osteotomy on both sides. Thus, we performed this osteotomy on 24 rami. These rami were studied immediately after, and 1 year after, surgery by Three-dimensional CT. With regard to the morphology of the anterior and posterior borders of the mandibular ramus, the majority (70.8%) showed the smooth type (smooth type: proximal and distal bone fragments are not discernible, and there is a smooth transition between them) in the lower plane. In the upper plane, the smooth type was less frequent (39.6%), and the stairway type (stairway type: either the proximal bone fragment or the distal bone fragment is protruded, thus showing a stairway form) was more frequent (43.8%). The concave type (concave type: there is a gap, i.e. an opened bone fragment, between two bone fragments, thus showing a concave form) was more frequently observed at the anterior border than at the posterior border, in both planes. With regard to the relationship between the morphology of the posterior border of the mandibular ramus and the cleavage of proximal and distal fragments, the stairway type was more frequent if both fragments were completely split through the posterior border, but the smooth type was more frequent if the cleavage spared the posterior border. With regard to the relationship between the morphology of the anterior and posterior borders of the mandibular ramus and the distance between proximal and distal bone fragments, the distance was greatest in the concave type, followed by the stairway type and the smooth type, in this order. The concave type was observed in cases in which the mean distance was more than 6.1 mm. As for the relationship between the posterior protrusion of the distal bone

  20. Assessment and comparison of proximal segment changes following mandibular set-back through bilateral sagittal split ramus osteotomy and intraoral verticosagittal ramus osteotomy

    Directory of Open Access Journals (Sweden)

    Mahmood Hashemi H.

    2008-04-01

    Full Text Available Background and Aim: Proximal segment movements following different methods of ramus osteotomy is one of the undesired consequences of orthognathic surgery. Theoretically, it seems that intraoral verticosagittal ramus osteotomy can minimize the movement of proximal segment. In this study, changes in intergonial distance and ramus flaring angles were evaluated and compared in transverse plane after mandibular set back by two osteotomy techniques.Materials and Methods: In this randomized clinical trial 20 patients with mandibular prognathism without any asymmetry were selected and divided into two groups of 10 each.One group was treated by bilateral sagittal split ramus osteotomy and the other by intraoral verticosagittal ramus osteotomy technique. Intergonial width and inner ramal angle in transverse plane were measured on radiographs before and 1 and 12 weeks post surgery . Data were analyzed using covariance test with P<0.05 as the level of significance.Results: Changes of intergonial distance and interramal angle in each group were significant after 1 and 12 weeks after surgery. No statistically significant difference was observed between the two studied groups.Conclusion: According to the results of this study, there is no difference between bilateral sagittal split and intraoral verticosagittal ramus osteotomy techniques regarding mandibular width and ramus flaring changes.

  1. Biomechanical Loading Evaluation of Unsintered Hydroxyapatite/poly-l-lactide Plate System in Bilateral Sagittal Split Ramus Osteotomy

    Directory of Open Access Journals (Sweden)

    Shintaro Sukegawa

    2017-07-01

    Full Text Available OSTEOTRANS MX® (Takiron Co., Ltd., Osaka, Japan is a bioactive resorbable maxillofacial osteosynthetic material composed of an unsintered hydroxyapatite/poly-l-lactide composite, and its effective osteoconductive capacity has been previously documented. However, the mechanical strength of this plate system is unclear. Thus, the aim of this in vitro study was to assess its tensile and shear strength and evaluate the biomechanical intensity of different osteosynthesis plate designs after sagittal split ramus osteotomy by simulating masticatory forces in a clinical setting. For tensile and shear strength analyses, three mechanical strength measurement samples were prepared by fixing unsintered hydroxyapatite/poly-l-lactide composed plates to polycarbonate skeletal models. Regarding biomechanical loading evaluation, 12 mandibular replicas were used and divided into four groups for sagittal split ramus osteotomy fixation. Each sample was secured in a jig and subjected to vertical load on the first molar teeth. Regarding shear strength, the novel-shaped unsintered hydroxyapatite/poly-l-lactide plate had significantly high intensity. Upon biomechanical loading evaluation, this plate system also displayed significantly high stability in addition to bioactivity, with no observed plate fracture. Thus, we have clearly demonstrated the efficacy of this plate system using an in vitro model of bilateral sagittal split ramus osteotomy of the mandible.

  2. Complications of Bilateral Sagittal Split Osteotomy in Patients with Mandibular Prognathism

    Directory of Open Access Journals (Sweden)

    Majid Eshghpour

    2013-12-01

    Full Text Available Introduction: Bilateral sagittal split osteotomy (BSSO of mandible is vastly used in treatment of mandibular deficiencies and discrepancies. Since this method could affect esthetic as well as function, evaluating these effects from various aspects is crucial. This study assessed the effects of this technique on the function of masseter muscle, jaw movements, and sensory changes along with failures in screws used for fixation. Methods: 48 patients with mandibular prognathism participated. Electromyography (EMG of the masseter muscle; limits of jaw movements including maximum opening (MIO, protrusive (PM, lateral movements (LLE and LRE; presences of sensory changes and two point discrimination test; and number of removed screws were recorded at the baseline, 3 months, and 6 months after surgery. Results: EMG activity of masseter decreased significantly 3 months after the surgery. However, after 6 months the masseter activity revealed no statistically significant difference with baseline activity. There was a significant decrease in MIO and PM after 3 months. The 6 month measurement of MIO and PM was also lower than baseline. However, no difference was observed between LRE and LLE in both follow up sessions. Among 46 patients, 27 patients developed lip paresthesia 3 months after surgery. After 6 month, lip paresthesia remained in 11 patients. Among 276 screws used for fixation 3 screws removed due to exposure to oral cavity and 2 due to patient discomfort. Conclusion: As BSSO in patients with mandibular prognathism revealed temporary functional and sensory changes, it is a safe and appropriate method in orthognathic surgery.

  3. Hybrid fixation in the bilateral sagittal split osteotomy for lower jaw advancement

    Directory of Open Access Journals (Sweden)

    Felipe Ladeira Pereira

    2010-02-01

    Full Text Available Miniplate and screw fixation has been widely used in bilateral sagittal split osteotomy, but some issues remain unclear concerning its lack of rigidity when compared to Spiessl's bicortical technique. This paper demonstrates the hybrid fixation technique in a case report. A 34-year-old female patient underwent a double jaw surgery with counter-clockwise rotation of the mandible fixed using the hybrid fixation technique. The patient evolved well in the postoperative period and is still under follow up after 14 months, reporting satisfaction with the results and no significant deviation from the treatment plan up to now. No damage to tooth roots was done, maxillomandibular range of motion was within normality and regression of the inferior alveolar nerve paresthesia was observed bilaterally. The hybrid mandibular fixation is clearly visible in the panoramic and cephalometric control radiographs. It seems that the hybrid fixation can sum the advantages of both monocortical and bicortical techniques in lower jaw advancement, increasing fixation stability without significant damage to the mandibular articulation and the inferior alveolar nerve. A statistical investigation seems necessary to prove its efficacy.

  4. Neuropathic pain following sagittal split ramus osteotomy of the mandible: prevalence, risk factors, and clinical course.

    Science.gov (United States)

    Marchiori, Érica C; Barber, Jacob S; Williams, W Bradford; Bui, Peter Q; O'Ryan, Felice S

    2013-12-01

    To estimate the prevalence of, risk factors for, and clinical course of neuropathic pain (NPP) after sagittal split ramus osteotomy (SSRO) of the mandible in a large cohort of patients. A retrospective cohort of all patients who underwent SSRO at 2 medical centers within Kaiser Permanente Northern California from January 2007 through September 2012 was assembled. Demographic, clinical, and surgical factors were abstracted from medical records and relevant comorbidities were identified. The prevalence of NPP in the cohort was calculated and the clinical signs, symptoms, temporal characteristics, and treatment response in affected patients were noted. The authors identified 1,778 patients who underwent SSRO and excluded 107 patients according to predefined criteria. The remaining 1,671 patients had a median age of 24 years (interquartile range, 19 to 35 yr) and 62.4% were women. Seven patients developed NPP after SSRO, which was an overall prevalence of 0.42%. All patients with NPP in this cohort were women and had a median age of 49 years. The risk factors for developing NPP after this surgery were older age (P = .0098), depression (P = .0100), and female gender. NPP developed an average of 30 days postoperatively (range, 18 to 56 days) and persisted for a median duration of 52 days (range, 30 to 69.5 days). All patients responded favorably to anticonvulsant (n = 6) or tricyclic (n = 1) medications, and no patients developed chronic postsurgical pain. NPP was an infrequent complication after SSRO, occurring in 1 of 238 patients in this cohort. The short duration and positive response to medication are reassuring findings. The results of this investigation highlight the need for prospective studies to further understand the spectrum of postoperative NPP. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Skeletal Stability after Large Mandibular Advancement (> 10 mm with Bilateral Sagittal Split Osteotomy and Skeletal Elastic Intermaxillary Fixation

    Directory of Open Access Journals (Sweden)

    Kristoffer Schwartz

    2016-06-01

    Full Text Available Objectives: The aim of the present study was to assess the skeletal stability after large mandibular advancement (> 10 mm with bilateral sagittal split osteotomy and skeletal elastic intermaxillary fixation and to correlate the skeletal stability with the vertical facial type. Material and Methods: A total of 33 consecutive patients underwent bimaxillary surgery to correct skeletal Class II malocclusion with a mandibular advancement (> 10 mm measured at B-point and postoperative skeletal elastic intermaxillary fixation for 16 weeks. Skeletal stability was evaluated using lateral cephalometric radiographs obtained preoperative (T1, 8 weeks postoperatively (T2, and 18 month postoperatively (T3. B-point and pogonion (Pog was used to measure the skeletal relapse and the mandibular plane angle (MP-angle was used to determine the vertical facial type. Results: The mean advancement from T1 to T2 were 11.6 mm and 13.5 mm at B-point and Pog, respectively. The mean skeletal relapse from T2 to T3 was -1.3 mm at B-point and -1.6 mm at Pog. The nineteen patients characterized as long facial types, showed the highest amount of skeletal relapse (-1.5 mm at B-point and -1.9 mm at Pog. Conclusions: The present study showed a limited amount of skeletal relapse in large mandibular advancement (> 10 mm with bilateral sagittal split osteotomy and skeletal elastic intermaxillary fixation. Bilateral sagittal split osteotomy in combination with skeletal intermaxillary fixation can therefore be an alternative to distraction osteogenesis in large mandibular advancements.

  6. Is the Lingual Fracture Line Influenced by the Mandibular Canal or the Mylohyoid Groove During a Bilateral Sagittal Split Osteotomy? A Human Cadaveric Study

    NARCIS (Netherlands)

    Mensink, Gertjan; Gooris, Peter J. J.; Bergsma, Eelco J.; Frank, Michael H.; van Gemert, Jan T. M.; van Merkesteyn, J. P. Richard

    2014-01-01

    Purpose: Although the bilateral sagittal split osteotomy (BSSO) is a routinely performed procedure, exact control of the lingual fracture line remains problematic. The purpose of this study was to determine the various lingual splitting patterns in cadaveric human mandibles after a BSSO and the

  7. Morphological changes in the temporomandibular joint before and after sagittal splitting ramus osteotomy of the mandible for skeletal mandibular protrusion.

    Science.gov (United States)

    Enami, Koji; Yamada, Kazuhiro; Kageyama, Toru; Taguchi, Akira

    2013-04-01

    Changes of temporomandibular joint (TMJ) morphology were analyzed in 21 patients with mandibular protrusion corrected using bilateral sagittal split ramus osteotomy (SSRO) and mini-plate fixation with TMJ cephalometric laminographs. The condylar pass angle, eminence to the FH plane angle, and total height of fossa and lower height of fossa in both left and right sides, significantly decreased after surgery. The width of the condyle, in both left and right sides, significantly increased after treatment. However, in the joint spaces, there were no significant differences before and after treatment. The amount of change in the eminence to the FH plane angle, total height of fossa and lower height of fossa, before and after surgery, showed significant positive correlations with that of SNB, before and after surgery. These results suggest that adaptive bone remodeling of the TMJ might occur due to the correction of occlusion and craniofacial morphology by SSRO in patients with mandibular protrusion.

  8. Computed tomographic analysis of the position and course of the mandibular canal: relevance to the sagittal split ramus osteotomy.

    Science.gov (United States)

    Tsuji, Y; Muto, T; Kawakami, J; Takeda, S

    2005-05-01

    The aim of this study was to investigate the position and course of the mandibular canal through the mandibular ramus using computed tomographic (CT) imaging and to relate the findings to performing sagittal split ramus osteotomies. The mandibles of 35 patients with skeletal Class III prognathism with symmetry (12 males and 23 females) were observed on transaxial computed tomograms acquired with a slice thickness of 2 mm. The position and course of the mandibular canal from the mandibular foramen to the mandibular body at the level of the second molar were measured at four specific locations in the same plane. Among the 70 rami examined, lack of a bone marrow space on the buccal side, including a fusion type anatomy with no buccal side cortical bone of the mandibular canal, were observed at the CT location between the mandibular foramen and mandibular angle. Our results suggest that special care must be taken when sagittal splitting is performed, and the safest location for the buccal corticotomy is anterior to the mandibular angle.

  9. Evaluation of mandibular anatomy related to sagittal split ramus osteotomy using 3-dimensional computed tomography scan images.

    Science.gov (United States)

    Yu, I H; Wong, Y K

    2008-06-01

    Sagittal split ramus osteotomy (SSRO) of the mandible is one of the most common surgical techniques to correct mandibular deformities. Measurement of nerve position using conventional methods has been reported in the literature, but surgeons have found that further investigation of the anatomical relationship is needed. The aim of this study was to attempt to increase the accuracy of treatment by using 3-dimensional computed tomography scan measurements. From the normal population, 20 females and 20 males were enrolled during planning of denture implants in Taiwan. The mean age was 28+/-6, ranging from 20 to 39 years old. Using 3D tomography data, nerve position at osteotomy sites was measured and the geometric relationship examined between the antilingula and mandibular foramen. The results gave the mean distance from buccal plate to mandibular canal at the second molar, from mandibular canal to inferior border of the mandibular body, from the mandibular foramen to the highest tip of the lingula, and from the mandibular foramen to the anterior margin of the oblique ridge. When applied to SSRO operations, the anatomic data provided by this study may help surgeons gain more understanding of nerve position during surgery.

  10. Failure mode and effects analysis in designing a virtual reality-based training simulator for bilateral sagittal split osteotomy.

    Science.gov (United States)

    Sofronia, R E; Knott, T; Davidescu, A; Savii, G G; Kuhlen, T; Gerressen, M

    2013-03-01

    Virtual reality-based simulators offer a cost-effective and efficient alternative to traditional medical training and planning. Developing a simulator that enables the training of medical skills and also supports recognition of errors made by the trainee is a challenge. The first step in developing such a system consists of error identification in the real procedure, in order to ensure that the training environment covers the most significant errors that can occur. This paper focuses on identifying the main system requirements for an interactive simulator for training bilateral sagittal split osteotomy (BSSO). An approach is proposed based on failure mode and effects analysis (FMEA), a risk analysis method that is well structured and already an approved technique in other domains. Based on the FMEA results, a BSSO training simulator is currently being developed, which centres upon the main critical steps of the procedure (sawing and splitting) and their main errors. FMEA seems to be a suitable tool in the design phase of developing medical simulators. Herein, it serves as a communication medium for knowledge transfer between the medical experts and the system developers. The method encourages a reflective process and allows identification of the most important elements and scenarios that need to be trained. Copyright © 2013 John Wiley & Sons, Ltd.

  11. A prospective electromyographic and computer-aided thermal sensitivity assessment of nerve lesions after sagittal split osteotomy and Le Fort I osteotomy.

    Science.gov (United States)

    Schultze-Mosgau, S; Krems, H; Ott, R; Neukam, F W

    2001-02-01

    The purpose of this study was to determine the incidence of temporary and permanent sensory disturbance of the inferior alveolar nerve (IAN) after bilateral sagittal split osteotomy (BSSO) of the mandible and of the infraorbital nerve (ION) after Le Fort I osteotomy, as well as the rate of recovery of sensory function using subjective and objective measures. Preoperatively and after 1 week, and 1, 3, 6, and 12 months postoperatively, sensibility in the distribution of 36 IONs after Le Fort I osteotomy and 24 IANs after BSSO in 19 patients were investigated by using sharp-blunt testing, 2-point discrimination, electromyographic recording, and thermal sensitivity (Pain and Thermal Sensitivity Test Device [PATH]) tests of the Adelta and C nerve fibers. With conventional clinical sharp-blunt and 2-point discrimination tests, the incidence of temporary impairment was 81% for the ION (29 of 36) and 83% for the IAN (20 of 24). The rate of permanent sensibility disturbance with conventional clinical testing was 6% for the ION and 15% for the IAN. Obvious recovery was found after 1 to 3 months for the ION, but it took 6 to 12 months for the IAN. In contrast, electromyography (EMG) testing showed lower rates of temporary sensory disturbance, namely, 54% (13 of 24) for the ION and 68% (15 of 22) for the IAN. Permanent sensory losses were not found. The results of the EMG test was confirmed by the PATH test. Objective tests for sensory disturbances show lower rates than the conventional tests. For quality control, preoperative and postoperative measurement and documentation of postoperative recovery of sensation is recommended.

  12. Tongue-palatal contact changes in patients with skeletal mandibular prognathism after sagittal split ramus osteotomy: an electropalatography study.

    Science.gov (United States)

    Kojima, S; Kaku, M; Yamamoto, I; Yasuhara, Y; Sumi, H; Yamamoto, T; Yashima, Y; Izumino, J; Nakajima, K; Nagano, Y; Kono, M; Yoshimura, A; Ueasa, M; Tanimoto, K

    2017-09-01

    The purpose of this study was to investigate the changes in tongue-palatal contact patterns using electropalatography (EPG) before and after sagittal split ramus osteotomy (SSRO) in patients with mandibular prognathism. Nine clients who underwent SSRO for mandibular setback and seven control subjects were participated in this study. Tongue-palatal contact patterns for /t/, /s/ and /k/ production were investigated using EPG before surgery and 3 months after surgery. The mean value of whole total of palate contact (WT) in the maximum contact frame was examined before and after SSRO. The correlation quantity between the change of center of gravity (COG) value and the amount of mandibular setback was also evaluated. The mean value of WT for /t/ and /s/ significantly increased after SSRO, and the EPG pattern became normal. However, a remarkable change in WT for /k/ was not observed, and the mean value was significantly larger in the SSRO group before and after surgery than in the control group. A negative correlation between COG variation and the amount of mandibular setback for /t/ and positive correlation for /s/ was observed. This study demonstrated that tongue-palatal contact patterns for /t/ and /s/ articulation improved clearly after SSRO. There was a significant correlation between COG variation and the amount of mandibular setback. However, no significant change was detected through perceptual assessment before and after SSRO. Further investigation is needed to determine whether these results will change over time. © 2017 John Wiley & Sons Ltd.

  13. Comparison of five different fixation techniques of sagittal split ramus osteotomy using three-dimensional finite elements analysis.

    Science.gov (United States)

    Sato, F R L; Asprino, L; Noritomi, P Y; da Silva, J V L; de Moraes, M

    2012-08-01

    The aim of this study was to compare the mechanical stress over hemimandible substrate and hardware after sagittal split ramus osteotomy (SSRO) fixed with five different techniques using three-dimensional (3D) finite element analysis. A 3D finite element model of a hemimandible was created and a 5mm advancement SSRO was simulated on a computer model. The model was fixed with five different techniques: 3 linear 60° screw arrangement; 3 linear 90° screw arrangement; 3 inverted L screw arrangement; 1 conventional miniplate; and 1 locking miniplate with four monocortical screws. Load was applied until 3mm displacement was reached and the results were compared with previous mechanical and photoelastic tests, thus analysing the mechanical stresses developed in the proximity of miniplates and screws and within the fixation system itself. The maximum principal stress values demonstrate a lower mechanical stress rate in bone and in the fixation system with the inverted L arrangement, followed by the linear 90° and linear 60° arrangements. The locking miniplate/screw system presented lower maximum principal stress and better stress distribution compared with the conventional system. Under the conditions tested, the reversed L arrangement provided the most favourable stress dissipation behaviour. Crown Copyright © 2012. Published by Elsevier Ltd. All rights reserved.

  14. Evaluation of different screw fixation techniques and screw diameters in sagittal split ramus osteotomy: finite element analysis method.

    Science.gov (United States)

    Sindel, A; Demiralp, S; Colok, G

    2014-09-01

    Sagittal split ramus osteotomy (SSRO) is used for correction of numerous congenital or acquired deformities in facial region. Several techniques have been developed and used to maintain fixation and stabilisation following SSRO application. In this study, the effects of the insertion formations of the bicortical different sized screws to the stresses generated by forces were studied. Three-dimensional finite elements analysis (FEA) and static linear analysis methods were used to investigate difference which would occur in terms of forces effecting onto the screws and transmitted to bone between different application areas. No significant difference was found between 1·5- and 2-mm screws used in SSRO fixation. Besides, it was found that 'inverted L' application was more successful compared to the others and that was followed by 'L' and 'linear' formations which showed close rates to each other. Few studies have investigated the effect of thickness and application areas of bicortical screws. This study was performed on both advanced and regressed jaws positions. © 2014 John Wiley & Sons Ltd.

  15. Changes of mandibular movement tracings after the correction of mandibular protrusion by bilateral sagittal split ramus osteotomy.

    Science.gov (United States)

    Wang, Dahui; Fu, Hongjun; Zeng, Rongsheng; Yang, Xiaoping

    2009-10-01

    We investigated the effects on mandibular movement tracings after the correction of mandibular protrusion by bilateral sagittal split ramus osteotomy (BSSRO). This study was comprised of 30 control subjects and 14 mandibular protrusion patients. Mandibular movements were recorded during opening, protrusion, and laterotrusion of the jaw with the ARCUSdigma 3-dimensional mandibular kinesiograph (KaVo Dental, Biberach, Germany). The kinematic center and incisor point were used as reference points. The mandibular movement tracings of patients before the correction of mandibular protrusion by BSSRO were significantly different from those in subjects in the control group, whereas there were no significant differences between the mandibular movement tracings after the correction of mandibular protrusion by BSSRO and those in the control group. Furthermore, the mean biases of the condylar kinematic center in the 3-dimensional directions during the opening, protrusive, and laterotrusive movements of the jaws in the preoperative group were smaller than those in the postoperative group (P .05). After correction by BSSRO, the mandibular movement tracings in mandibular protrusion patients will be altered to be similar to those in subjects in the control group, which we believe might support the return of mandibular functional movements in treated patients.

  16. Morphologic features of the mandibular ramus associated with increased surgical time and blood loss in sagittal split-ramus osteotomy.

    Science.gov (United States)

    Kuroyanagi, Norio; Miyachi, Hitoshi; Kanazawa, Teruyuki; Kamiya, Noboru; Nagao, Toru; Shimozato, Kazuo

    2013-01-01

    To determine whether specific morphologic features of the mandibular ramus can predict increased surgical time and blood loss in sagittal split-ramus osteotomy (SSRO). The clinical and morphologic features of the mandibular ramus, obtained from computed tomographic images (n=50), were analyzed to predict the surgical time, the time required for ablation of the medial mandibular ramus, and the time required for sectioning of the mandible in performing a modified Obwegeser SSRO. Significant factors associated with surgical time were an anterior border of the ramus at least 10.5 mm wide, a maximal length of the thickened ramus of at least 8.5 mm, and a distance from the mandibular incisor to the posterior border of the mandible of at least 97.5 mm. There were significant differences in blood loss between the 2 axial aspects of the medial ramus. The greater protrusion of the medial oblique ridge, thickened ramus, and longer distance from the mandibular incisors to the posterior border of the mandible may increase the surgical time and blood loss in patients undergoing classic SSRO. When planning or performing an SSRO, the morphologic features obtained from computed tomographic images may help surgeons gain a better understanding of the potential difficulties when the surgical site involves the medial aspect of the ascending ramus of the mandible. Copyright © 2013 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  17. Assessment of Soft Tissue Changes by Cephalometry and Two-Dimensional Photogrammetry in Bilateral Sagittal Split Ramus Osteotomy Cases

    Science.gov (United States)

    Martin, Alice

    2011-01-01

    ABSTRACT Objectives We aimed to compare the standard methods of cephalometry and two-dimensional photogrammetry, to evaluate the reliability and accuracy of both methods. Material and Methods Twenty-six patients (mean age 25.5, standard deviation (SD) 5.2 years) with Class II relationship and 23 patients with Class III relationship (mean age 26.4, SD 4.7 years) who had undergone bilateral sagittal split ramus osteotomy were selected, with a median follow-up of 8 months between pre- and postsurgical evaluation. Pre- and postsurgical cephalograms and lateral photograms were traced and changes were recorded. Results Pre- and postsurgical measurements of hard tissue angles and distances revealed higher correlations with cephalometrically performed soft tissue measurements of facial convexity (Class II: N-PG, r = - 0.50, P = 0.047; Class III: ANB, r = 0.73, P = 0.005; NaPg , r = 0.71, P = 0.007;) and labiomental angle (Class II: SNB, r = 0.72, P = 0.002; ANB, r = - 0.72, P = 0.002; N-B, r = - 0.68, P = 0.004; ANS-Gn, r = 0.71, P = 0.002; Class III: ANS-Gn, r = 0.65, P = 0.043) compared with two-dimensional photogrammetry. However, two-dimensional photogrammetry revealed higher correlation between lower lip length and cephalometrically assessed angular hard tissue changes (Class II: SNB, r = 0.98, P = 0.007; N-B, r = 0.89, P = 0.037; N-Pg, r = 0.90, P = 0.033; Class III: SNB, r = - 0.54, P = 0.060; NAPg, r = - 0.65, P = 0.041; N-Pg, r = 0.58, P = 0.039). Conclusions Our findings suggest that cephalometry and two-dimensional photogrammetry offer the possibility to complement one another. PMID:24421994

  18. Assessment of Soft Tissue Changes by Cephalometry and Two-Dimensional Photogrammetry in Bilateral Sagittal Split Ramus Osteotomy Cases

    Directory of Open Access Journals (Sweden)

    Jan Rustemeyer

    2011-07-01

    Full Text Available Objectives: We aimed to compare the standard methods of cephalometry and two-dimensional photogrammetry, to evaluate the reliability and accuracy of both methods.Material and Methods: Twenty-six patients (mean age 25.5, standard deviation (SD 5.2 years with Class II relationship and 23 patients with Class III relationship (mean age 26.4, SD 4.7 years who had undergone bilateral sagittal split ramus osteotomy were selected, with a median follow-up of 8 months between pre- and postsurgical evaluation. Pre- and postsurgical cephalograms and lateral photograms were traced and changes were recorded.Results: Pre- and postsurgical measurements of hard tissue angles and distances revealed higher correlations with cephalometrically performed soft tissue measurements of facial convexity (Class II: N-PG, r = - 0.50, P = 0.047; Class III: ANB, r = 0.73, P = 0.005; NaPg , r = 0.71, P = 0.007; and labiomental angle (Class II: SNB, r = 0.72, P = 0.002; ANB, r = - 0.72, P = 0.002; N-B, r = - 0.68, P = 0.004; ANS-Gn, r = 0.71, P = 0.002; Class III: ANS-Gn, r = 0.65, P = 0.043 compared with two-dimensional photogrammetry. However, two-dimensional photogrammetry revealed higher correlation between lower lip length and cephalometrically assessed angular hard tissue changes (Class II: SNB, r = 0.98, P = 0.007; N-B, r = 0.89, P = 0.037; N-Pg, r = 0.90, P = 0.033; Class III: SNB, r = - 0.54, P = 0.060; NAPg, r = - 0.65, P = 0.041; N-Pg, r = 0.58, P = 0.039.Conclusions: Our findings suggest that cephalometry and two-dimensional photogrammetry offer the possibility to complement one another.

  19. [Effect of segmental Le Fort I osteotomy and bilateral sagittal split ramus osteotomy on the condyle position in skeletal class III malocclusion patients].

    Science.gov (United States)

    He, Wei; Xie, Xiao-yan; Wang, Xing; Wang, Xiao-xia; Fu, Kai-yuan; Li, Zi-li

    2015-10-18

    To investigate the effect of segmental Le Fort I osteotomy and bilateral sagittal split ramus osteotomy (BSSRO) on the condyle position in skeletal class III malocclusion patients. In this retrospective study, 19 patients with skeletal class III malocclusion who met the inclusion criteria were enrolled. All the patients underwent the segmental Le Fort I osteotomy and BSSRO. Cone beam computed tomography (CBCT) scans were performed in the following phases: T1: within one week before the surgeries; T2: within one week post-surgery;T3:three months post-surgery; T4: 6 to 14 months post-surgery. The posterior spaces, anterior spaces and the superior spaces of the bilateral temporomandibular joints were measured according to the Kamelchuk method respectively. The fossa ratios of the condyle and the distribution of the condyle positions related to the glenoid fossa (anterior, concentric and posterior position)were calculated. The results were analyzed statistically. The posterior space, the anterior space and the superior space of bilateral temporomandibular joints in T2 phase[right: (2.78±1.23) mm, (2.47±0.89) mm, (3.07±0.85) mm; left: (2.93±0.83) mm, (2.69±1.14) mm, (3.44±1.16) mm] showed significantly larger spaces than those in T1 phase [right: (1.81±0.95) mm, (1.65±0.55) mm, (2.13±0.52) mm; left: (2.12± 1.05) mm, (1.79±0.59) mm, (2.15±0.93) mm],in T3 phase [right: (2.08±1.25) mm, (1.79±0.68) mm, (1.80±0.76) mm; left: (2.05±0.75) mm, (1.99±0.94) mm, (2.14±0.71) mm] and in T4 phase [right: (1.94±0.77) mm, (1.81±0.69) mm, (2.05±0.69) mm; left: (1.89±0.69) mm, (1.80±0.61) mm, (2.19±0.75) mm], P0.05).The fossa ratio and the condyle position related to the glenoid fossa had no significant difference in all the four phases (P>0.05).The results suggested that the condyle moved downward in T2 phase and changed to the original pre-surgery position in T3 phase, then keot stable in T4 phase. Segmental Le Fort I osteotomy and BSSRO caused significant and

  20. Systematic Analysis of Clinical Outcomes of Bilateral Sagittal Split Ramus Osteotomy With Preoperative Modeling and Postoperative Orthodontic in the Treatment of Mandibular Protrusion.

    Science.gov (United States)

    Li, Yawei; Sun, Xiaomei; Teng, Li; Xu, Jiajie; Lu, Jianjian; Ding, Bo; Zhang, Chao; Xie, Fang; Sun, Xuejian

    2017-11-01

    The purpose of this study was to determine the changes in hard tissues, soft tissues, and teeth after bilateral sagittal split ramus osteotomy and orthodontic treatment for the treatment of mandibular protrusion. Cephalometric analysis was used to evaluate the aesthetic effects and occlusal relationships obtained. The subjects included 11 women and 9 men (aged 18-27 years; average, 20 years) with mandibular protrusion who underwent bilateral sagittal split ramus osteotomy. Based on a preoperative computer-aided manufacturing/design-assisted, model surgical design and an occlusal guide plate, new occlusal relationships were established for the patients. In addition, the preoperative and the end of postoperative orthodontic treatment cephalometric radiographs were systematically analyzed. In all patients, the surgical incisions underwent primary healing, with no infection or osteonecrosis. Significant differences were observed in the preoperative and the end of postoperative orthodontic treatment values of all hard tissue and teeth parameters, except for SNA°, ANB°, GoGn-SN°, SE (mm), NP-FH°, SGn-FH°, OP-FH°, 1-MP°, Li-E (mm). The most obvious significant differences were seen in SNB°, SND°, 1_-NA°, 1_-NA (mm), 1-NB (mm), 1-NB°, Po-NB (mm), NA-PA°, AB-NP°, 1-OP°, Ui-E (mm), and S-N'-B'° (P mandibular protrusion with satisfactory occlusal relationship, facial appearance, and minimal postoperative complications.

  1. Three-dimensional computed tomographic evaluation of bilateral sagittal split osteotomy lingual fracture line and le fort I pterygomaxillary separation in orthognathic surgery using cadaver heads: ultrasonic osteotome versus conventional saw.

    Science.gov (United States)

    Dammous, Sophie; Dupont, Quentin; Gilles, Roland

    2015-06-01

    The purpose of this study was to observe the quality of the fracture line on the lingual side of the mandible after sagittal split osteotomy and the quality of pterygomaxillary separation after Le Fort I osteotomy using the BoneScalpel ultrasonic osteotome. Bimaxillary procedures, according to the standard protocol, were performed using 10 fresh cadaver heads. The ultrasonic osteotome was used in the study group, and a reciprocating saw was used in the control group. Three-dimensional reconstructions of postoperative computed tomographic scans were obtained. The lingual ramus fracture pattern and the pterygomaxillary separation pattern were observed, classified, and compared. Postoperative dissections of the skulls were performed to assess the integrity of the infra-alveolar nerve and the descending palatine artery. No significant differences were found in the cutting time of bone between the BoneScalpel and the sagittal saw. Of the sagittal split osteotomies in the study group, 90% showed a good pattern (vertical pattern of fracture line extending to the inferior border of the mandible running behind the mandibular canal) compared with 50% of the sagittal split osteotomies in the control group. Ideal separation of the pterygoid plates without fractures was observed in 80% of the Le Fort I osteotomies in the study group compared with 50% of the osteotomies in the control group. High-level fractures occurred in 30% of cases in the control group compared with none in the study group. The integrities of the infra-alveolar nerve and the descending palatine artery were preserved in all cases. Use of the ultrasonic BoneScalpel did not require more time than the conventional method. An improved pattern of lingual fracture lines in mandibular sagittal split osteotomy procedures and the pattern of pterygomaxillary separation in Le Fort I osteotomy procedures were observed. Copyright © 2015 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc

  2. Do the changes in muscle mass, muscle direction, and rotations of the condyles that occur after sagittal split advancement osteotomies play a role in the aetiology of progressive condylar resorption?

    NARCIS (Netherlands)

    Dicker, G.J.; Castelijns, J.A.; Tuinzing, D.B.; Stoelinga, P.J.W.

    2015-01-01

    Changes in cross-sectional area (CSA), volume (indicating muscle strength), and direction of the masseter and medial pterygoid muscles after surgical mandibular advancement were measured, along with the rotation of the condyles after bilateral sagittal split osteotomies (BSSOs) to advance the

  3. Comparative study of postoperative stability between conventional orthognathic surgery and a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy for skeletal class III correction.

    Science.gov (United States)

    Mah, Deuk-Hyun; Kim, Su-Gwan; Oh, Ji-Su; You, Jae-Seek; Jung, Seo-Yun; Kim, Won-Gi; Yu, Kyung-Hwan

    2017-02-01

    The purpose of this study is to compare the postoperative stability of conventional orthognathic surgery to a surgery-first orthognathic approach after bilateral sagittal split ramus osteotomy (BSSRO). The study included 20 patients who underwent BSSRO for skeletal class III conventional orthognathic surgery and 20 patients who underwent a surgery-first orthognathic approach. Serial lateral cephalograms were analyzed to identify skeletal changes before surgery (T0), immediately after surgery (T1), and after surgery (T2, after 1 year or at debonding). The amount of relapse of the mandible in the conventional orthognathic surgery group from T1 to T2 was 2.23±0.92 mm (Psurgery-first orthognathic approach group from T1 to T2 was 3.49±1.71 mm (Psurgery-first orthognathic approach. Therefore, careful planning and skeletal stability should be considered in orthognathic surgery.

  4. Biomechanical evaluation of magnesium-based resorbable metallic screw system in a bilateral sagittal split ramus osteotomy model using three-dimensional finite element analysis.

    Science.gov (United States)

    Lee, Jin-Yong; Lee, Jung-Woo; Pang, Kang-Mi; Kim, Hyoun-Ee; Kim, Soung-Min; Lee, Jong-Ho

    2014-02-01

    The aim of this study was to evaluate the stress distribution of a magnesium (Mg)-based resorbable screw system in a bilateral sagittal split ramus osteotomy (BSSO) and to compare its biomechanical stability with those of titanium (Ti)-based and polymer (IN)-based systems. A 3-dimensional BSSO model (10-mm advancement and setback) was constructed with Mimics. Bicortical screw fixation using Ti, IN, and Mg screws was performed with 4 different geometries of fixation. With an occlusal load of 132 N on the lower first molar, the von Mises stress (VMS) distribution was calculated using ANSYS. The VMS distribution of Mg was more similar to that of Ti than to that of IN. In all cases, the highest VMS was concentrated on the screw at the most posterior and superior area. Stress was distributed mainly around the screw holes (cancellous bone) and the retromolar area (cortical bone). In the advancement surgery, fixation with 5 Mg screws (5A-Mg, 99.810 MPa at cortical bone) showed biomechanical stability, whereas fixation with the same number of IN screws did not (5A-IN, 109.021 MPa at cortical bone). In the setback surgery, although the maximum VMSs at cortical bone for Mg, IN, and Ti were lower than 108 MPa (yield strength of cortical bone), Mg screws showed more favorable results than IN screws because the maximum VMSs of Mg at cancellous bone were lower than those of IN. The Mg-based resorbable screw system is a promising alternative to the IN-based system. Copyright © 2014 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  5. Short- and long-term changes of condylar position after bilateral sagittal split ramus osteotomy for mandibular advancement in combination with Le Fort I osteotomy evaluated by cone-beam computed tomography.

    Science.gov (United States)

    Chen, Shuo; Lei, Jie; Wang, Xing; Fu, Kai-Yuan; Farzad, Payam; Yi, Biao

    2013-11-01

    Bilateral sagittal split ramus osteotomy (BSSO) may change condylar position, which can be one of the factors contributing to skeletal relapse. This study evaluated short- and long-term changes in condylar position using cone-beam computed tomography (CBCT) and investigated changes in temporomandibular joint (TMJ) signs after BSSO for mandibular advancement in combination with Le Fort I osteotomy. Thirty-one patients were included, and CBCT data of 62 TMJs were collected before surgery (T0), immediately after surgery (T1), 3 months after surgery (T2), and at the last follow-up at 12.1 ± 3.0 months after surgery (T3). The relation of the condyle to the fossa was evaluated by the method of Pullinger and Hollender (Oral Surg Oral Med Oral Pathol 62:719, 1986). Clinical examination, with a special focus on signs of temporomandibular disorder (TMD), was documented at T0, T2, and T3. Repeated-measures analysis of variance (P = .05) and χ2 test (P = .05) were performed. Data of 27 patients were used for statistical analysis. Values from the formula of Pullinger and Hollender changed significantly with time, but there was no significant difference between the right and left condyles. Condyles moved inferoposteriorly immediately after surgery (T0 to T1) followed by anterosuperior movement 3 months after surgery (T1 to T2). The superimposed effect showed posterosuperior movement compared with the initial position before surgery (T0 to T2) and this position remained stable at 1-year follow-up (T2 to T3). A decrease of TMD signs over time, from 22.6% (T0) to 12.9% (T2) and 9.7% (T3), was observed, which showed no statistical significance. There were obvious changes in condylar position after BSSO in combination with Le Fort I osteotomy. Condyles tended to be located in a concentric position in relation to the glenoid fossa 3 months after surgery and remained stable during the 1-year follow-up. These changes did not cause an increase of TMD signs. Copyright © 2013 American

  6. Laser Biophotomodulation in Patients with Neurosensory Disturbance of the Inferior Alveolar Nerve After Sagittal Split Ramus Osteotomy: A 2-Year Follow-Up Study.

    Science.gov (United States)

    Guarini, Daniela; Gracia, Benjamín; Ramírez-Lobos, Valeria; Noguera-Pantoja, Alfredo; Solé-Ventura, Pedro

    2017-10-12

    To evaluate the effect of the application of photobiomodulation in a 2-year follow-up period in patients who have been intervened with a sagittal ramus split osteotomy and present neurosensory disturbance of the inferior alveolar nerve. Photobiomodulation is a common clinical tool in dentistry, for its beneficial effects have been shown in surgical and periodontal wound healing, reducing of swelling and pain, neurosensory recovery, and treatment of temporomandibular joint disorders. This study is a 2-year follow-up study with an experimental (Laser) group (n = 33) that received photobiomodulation, and a control (Sham) group (n = 9), placebo. All patients from the Laser group received laser applications (continuous wave of 0.353 W/cm(2), 27 J in 270 sec per session) on days 1, 2, 3, 5, 10, 14, 21, and 28 after surgery. Neurosensory disturbance was evaluated with five tests: Visual Analog Scale (VAS) for pain and sensitivity, sensitivity threshold test, two-point discrimination, and thermal discrimination. All tests were performed before (24 h before surgery) and after surgery (24 h, 28 days, 60 days, 6 months, 1 year, 2 years, more than 2 years). Participants and evaluator were blinded to intervention. Variables were described with absolute frequencies, percentages, and medians. Ordinal and dichotomous variables were compared with Mann-Whitney's and Fisher's tests, respectively. Clinical improvement was observed during the follow-up period for the Laser group; general VAS for sensitivity was normal in 11 participants from the Laser group at 2 years postsurgery (40.74%), while no participants from the Sham group achieved this (p = 0.0341). Twenty-three participants recovered initial values for two-point discrimination (69.7%) after 2 years of follow-up (p = 0.0025) as well as sensitivity threshold test. General VAS for pain was normal in 31 patients from the Laser group after 2 years of follow-up (93.94%, p = 0.0254). Photobiomodulation

  7. Relationship between inferior alveolar nerve canal position at mandibular second molar in patients with prognathism and possible occurrence of neurosensory disturbance after sagittal split ramus osteotomy.

    Science.gov (United States)

    Yoshioka, Izumi; Tanaka, Tatsurou; Khanal, Amit; Habu, Manabu; Kito, Shinji; Kodama, Masaaki; Oda, Masafumi; Wakasugi-Sato, Nao; Matsumoto-Takeda, Shinobu; Fukai, Yasuhiro; Tokitsu, Takatoshi; Tomikawa, Megumi; Seta, Yuji; Tominaga, Kazuhiro; Morimoto, Yasuhiro

    2010-12-01

    To elucidate the relationship between the anatomic position of the inferior alveolar nerve (IAN) at the mandibular second molar and the occurrence of neurosensory disturbances of the IAN after sagittal split ramus osteotomy (SSRO) in patients with mandibular prognathism. Also, the present study evaluated the difference in anatomic position of the IAN between patients with and without mandibular prognathism. Computed tomography images were taken of 28 patients with mandibular prognathism and 30 without prognathism. On these scans, the IANs from the mandibular second molar region to the mandibular foramen in the mandibular ramus were identified. The present study was designed as a cross-sectional study. The distance from the buccal aspect of the IAN canal to the outer buccal cortical margin of the mandible in the mandibular second molar regions was measured on the computed tomography images. Also, the linear distance between the superior aspect of the IAN canal and the alveolar crest in these regions was calculated. In addition, we investigated the presence or absence of contact between the IAN canal and the inner buccal cortical margin of the mandible from the mandibular second molar to the mandibular foramen in the mandibular ramus. Next, we examined whether neurosensory disturbances occurring after SSRO were related to the position of the IAN at the mandibular second molar. A significant difference was found in the occurrence of neurosensory disturbances of the IAN after SSRO between men and women (χ(2) test, P mandibular second molar region, a significant difference was found between groups with and without neurosensory disturbances (Student's t test, P position of the IAN canal at the mandibular second molar are significantly related to the occurrence of neurosensory disturbances of the IAN after SSRO. Therefore, surgeons should clearly inform patients of the increased possibility of neurosensory disturbances after SSRO when the patients are female and are

  8. A long-term comparative study of two rigid internal fixation techniques in terms of masticatory function and neurosensory disturbance after mandibular correction by bilateral sagittal split ramus osteotomy.

    Science.gov (United States)

    Yamashita, Y; Otsuka, T; Shigematsu, M; Goto, M

    2011-04-01

    Bilateral sagittal split ramus osteotomy (BSSO) is widely used to treat mandibular prognathism. Several methods have been described for fixation of the bony segments. This study compared two methods of rigid fixation (bicortical screws and monocortical miniplates) to identify differences in postoperative masticatory function and neurosensory disturbance after 5 years of mandibular set-back correction. 77 women who had undergone BSSO for Class III malocclusion were reviewed, and masticatory functions and neurosensory recovery were examined with the appropriate indicators pre- and postoperatively (at approximately 1 month, and 1, 2, 3, 4, and 5 years). Masticatory function exhibited similar recovery patterns in both groups. Orthognathic surgery improved occlusal force and occlusal contact area, but longer than 4 years after surgery may be required for postoperative occlusal functions in prognathic patients to reach the level of healthy subjects. The groups showed no significant differences in the recovery of parameters of masticatory functions and neurosensory disturbance even 5 years after surgery. In the evaluation of temporomandibular joint function using the Helkimo index, the score was significantly higher for the screw group than for the miniplate group. This suggests that BSSO fixed with miniplates may offer a relatively safe and reliable procedure yielding adequate results and high patient satisfaction. Copyright © 2010 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  9. Intra-oral mandibular sagittal osteotomy technique to correct mandibular distocclusion and mesio-occlusion. Study in canine cadavers.

    Science.gov (United States)

    Carvalho, V G G; Gioso, M A; Carvalho, P E G; Cunha, F P; Martinez, L A V; Lemos, L S

    2014-01-01

    Skeletal malocclusions may be due to disturbances in the growth of the mandible or maxilla. In most cases, discomfort is the result of tooth-to-tooth malocclusion or tooth-to-soft-tissue contact. Currently, in veterinary medicine, these problems are treated palliatively. In humans, orthognathic surgery is indicated to correct severe skeletal malocclusions, offering aesthetic and functional benefits to the patients. This research evaluated the effects of an intra-oral mandibular sagittal split osteotomy in 20 dog cadavers with skeletal malocclusion. After sagittal osteotomy and mandibular repositioning, the osteotomies were fixed with titanium mini-plates and 1.5 mm diameter screws or 1.5 mm bicortical screws. The statistical analysis revealed a significant occlusion difference in the treated cadavers (Wilcoxon test, pmalocclusion in cadavers. However, it would be important to prepare a preoperative orthodontic-surgical treatment plan to obtain a satisfactory occlusion during the surgery in clinical patients.

  10. Sagittal balance analysis after pedicle subtraction osteotomy in ankylosing spondylitis.

    Science.gov (United States)

    Debarge, Romain; Demey, Guillaume; Roussouly, Pierre

    2011-09-01

    This is a radiographic study of ankylosing spondylitis patients with severe fixed kyphotic deformity who underwent pedicle subtraction osteotomy. Our goal was to measure and validate new angle to assess global kyphosis and to evaluate the sagittal balance after surgery. This is the first report which describes new angle to assess global kyphosis (T1-S1). Pre and postoperative controls were compared according to the Pelvic Incidence. The sagittal parameters ankylosing spondylitis patients were compared with 154 asymptomatic patients. In addition to the pelvic parameters and the C7 tilt, we used the spino-sacral angle. Pelvic incidence in ankylosing spondylitis patients was higher than asymptomatic population (61° vs. 51°). For a same tilt of C7 for both groups, the low pelvic incidence group had a lower sacral slope and pelvic tilt and a higher global kyphosis (spino-sacral angle = 90°) than the high pelvic incidence group (spino-sacral angle = 98°). In the adult volunteers, the C7 tilt and spino-sacral angle measured, respectively, 95° and 135°. The preoperative C7 tilt measured 73° and increased to 83° (p = 0.0025). The preoperative spino-sacral angle measured 96° and increased to 113.3° (p = 0.003). A low pelvic incidence pelvis has a lower sacral slope than in high pelvic incidence and can support a bigger kyphosis. All the parameters were improved by the pedicle subtraction osteotomy, but the average spinosacral angle remained lower than the control group. When C7 tilt was useful to assess the improvement of the sagittal balance, SSA allowed a better evaluation of the correction of kyphosis itself.

  11. Alphabet Soup: Sagittal Balance Correction Osteotomies of the Spine-What Radiologists Should Know.

    Science.gov (United States)

    Takahashi, T; Kainth, D; Marette, S; Polly, D

    2017-11-30

    Global sagittal malalignment has been demonstrated to have correlation with clinical symptoms and is a key component to be restored in adult spinal deformity. In this article, various types of sagittal balance-correction osteotomies are reviewed primarily on the basis of the 3 most commonly used procedures: Smith-Petersen osteotomy, pedicle subtraction osteotomy, and vertebral column resection. Familiarity with the expected imaging appearance and commonly encountered complications seen on postoperative imaging studies following correction osteotomies is crucial for accurate image interpretation. © 2018 by American Journal of Neuroradiology.

  12. Walking sagittal balance correction by pedicle subtraction osteotomy in adults with fixed sagittal imbalance.

    Science.gov (United States)

    Yagi, Mitsuru; Kaneko, Shinjiro; Yato, Yoshiyuki; Asazuma, Takashi; Machida, Masafumi

    2016-08-01

    Pedicle subtraction osteotomy (PSO) is widely used to treat severe fixed sagittal imbalance. However, the effect of PSO on balance has not been fully documented. The aim of this study was to assess dynamic walking balance after PSO to treat fixed sagittal imbalance. Gait and balance were assessed in 15 consecutive adult female patients who had been treated by PSO for a fixed sagittal imbalance and compare patients' preop and postop dynamic walking balance with that of 15 age- and gender-matched healthy volunteers (HV). Each patient's chart, X-rays, pre and postop SRS22 outcome scores, and ODI were reviewed. Means were compared by Mann-Whitney U test and Chi-square test. The mean age was 66.3 years (51-74 years). The mean follow-up was 2.7 years (2-3.5 years). The C7PL and GL, measured on the force platform, were both improved from 24.2 ± 7.3 cm and 27.6 ± 9.4 to 5.4 ± 2.6 cm and 7.2 ± 3.4 cm, respectively. The baseline hip ROM was significantly smaller in patients compared to HV, whereas no significant difference was observed in the knee or ankle ROM. The pelvic tilt (preop -0.4° ± 1.4°, postop 8.9° ± 1.0°), and maximum hip-extension angle (preop -1.2° ± 14.2°, postop -11.2° ± 7.2°) were also improved after surgery. Cadence (116 s/min), stance-swing ratio (stance 63.2 % vs. swing 36.8 %), and stride (98.0 cm) were all increased after surgery. On the other hand, gait velocity was significantly slower in the PSO group at both pre and postop than in HV (PSO 53.3 m/min at preop and 58.8 m/min at postop vs. HV 71.1 m/min, p = 0.04). Despite a mild residual spinal-pelvic malalignment, PSO restored sagittal alignment and balance satisfactorily and has improved the gait pattern.

  13. Technique of Reverse Smith Petersen Osteotomy (RSPO) in a patient with fixed lumbar hyperlordosis and negative sagittal imbalance.

    Science.gov (United States)

    Lewis, Stephen J; Gray, Randolph; David, Kenny; Kopka, Michaela; Magana, Sofia

    2010-07-01

    Case report. To determine the viability and safety of Reverse Smith Petersen Osteotomy (RSPO) to re-established sagittal balance in patients with fixed lumbar hyperlordosis. Lumbar hyperlordosis is seen as a compensatory mechanism in thoracic Scheuermann disease and in sagittal decompensation in severe neuromuscular scoliosis. Hyperlordosis may also be seen after overcorrection with spinal osteotomies, but rarely causes clinically significant negative sagittal imbalance because of the thoracic compensation. We describe a case using a kyphosing osteotomy to treat hyperlordosis in a patient that was treated with a pedicle subtraction osteotomy for post-Harrington kyphosis. The radiographs and clinical chart were reviewed of a patient treated with a RSPO at L2-L3 to correct the negative sagittal imbalance created by a previous extension of her fusion to the sacrum with a pedicle subtraction osteotomy. A reduction in the lumbar lordosis by 20 degrees at L2-L3 and restoration of the global sagittal balance was achieved with the RSPO. RSPO is a viable surgical technique that can be used to re-establish sagittal balance in patients with fixed lumbar hyperlordosis. Appreciation of a patient's balanced sagittal alignment and available compensatory mechanisms can help ensure appropriate osteotomies are performed.

  14. Intra-operative complications in sagittal and vertical ramus osteotomies

    NARCIS (Netherlands)

    van Merkesteyn, J. P.; Groot, R. H.; van Leeuwaarden, R.; Kroon, F. H.

    1987-01-01

    In orthognatic surgery of the mandibular ramus, intra-operative complications as a lesion of the inferior alveolar nerve, fractures of the osteotomised segments, incomplete sectioning, malpositioning of segments and haemorrhage may occur. In this report, intra-operative complications in 124 sagittal

  15. Multilevel Schwab grade II osteotomies for sagittal plane correction in the management of adult spinal deformity.

    Science.gov (United States)

    Ghobrial, George M; Lebwohl, Nathan H; Green, Barth A; Gjolaj, Joseph P

    2017-11-01

    Prior reports have compared posterior column osteotomies with pedicle subtraction osteotomies in terms of utility for correcting fixed sagittal imbalance in adolescent patients with deformity. No prior reports have described the use of multilevel Smith-Petersen Osteotomies (SPOs) alone for surgical correction in the adult spinal deformity (ASD) population. The study aimed to determine the utility of multilevel SPOs in the management of global sagittal imbalance in ASD patients. This is a retrospective observational study at a single academic center. The sample included 85 ASD patients. This is a radiographic outcomes cohort study. The radiographs of 85 ASD patients were retrospectively evaluated before and after long-segment (>5 spinal levels) fusion and multilevel SPO (≥3 levels) for sagittal imbalance correction. The number of osteotomies, correction in regional lumbar lordosis (LL), and correction per osteotomy was evaluated. Independent predictors of correction per SPO were evaluated with a hierarchical linear regression analysis. Eighty-five patients (mean age: 67.5±11 years) were identified with ASD (372 SPOs). The mean preoperative sagittal vertical axis (SVA) and T1 pelvic angle (TPA) were 8.16±6.75 cm and 25°±13.23°, respectively. The mean postoperative central sacral vertical line (CSVL) and SVA were 0.67±0.70 cm and 1.29±5.41 cm, respectively. The mean improvement in SVA was 6.29 cm achieved with a correction of approximately 5.05° per SPO. The mean LL restoration was 20.3°±13.9°, and 33(39%) patients achieved a final pelvic incidence minus lumbar lordosis (PI-LL) ≤10°. Fifty-four (64%) achieved a postoperative PI-LL ≤15°, 75 (88%) with a PI-LL ≤20°, and 85 (100%) achieved a PI-LL ≤25°. Correction per SPO was similar regardless of prior fusion (4.87° vs. 5.72° for revisions, p=.192). In a subgroup analysis of SVA greater than 10 cm, there was no significant difference in the final LL, thoracic kyphosis, PI-LL, SVA

  16. Spontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy.

    Science.gov (United States)

    Smith, Justin S; Shaffrey, Christopher I; Lafage, Virginie; Blondel, Benjamin; Schwab, Frank; Hostin, Richard; Hart, Robert; O'Shaughnessy, Brian; Bess, Shay; Hu, Serena S; Deviren, Vedat; Ames, Christopher P

    2012-10-01

    Sagittal spinopelvic malalignment is a significant cause of pain and disability in patients with adult spinal deformity. Surgical correction of spinopelvic malalignment can result in compensatory changes in spinal alignment outside of the fused spinal segments. These compensatory changes, termed reciprocal changes, have been defined for thoracic and lumbar regions but not for the cervical spine. The object of this study was to evaluate postoperative reciprocal changes within the cervical spine following lumbar pedicle subtraction osteotomy (PSO). This was a multicenter retrospective radiographic analysis of patients from International Spine Study Group centers. Inclusion criteria were as follows: adults (>18 years old) with spinal deformity treated using lumbar PSO, a preoperative C7-S1 plumb line greater than 5 cm, and availability of pre- and postoperative full-length standing radiographs. Seventy-five patients (60 women, mean age 59 years) were included. The lumbar PSO significantly improved sagittal alignment, including the C7-S1 plumb line, C7-T12 inclination, and pelvic tilt (p sagittal malalignment (postoperative sagittal vertical alignment sagittal spinopelvic malalignment compensate with abnormally increased cervical lordosis in an effort to maintain horizontal gaze. Surgical correction of sagittal malalignment results in improvement of the abnormal cervical hyperlordosis through reciprocal changes.

  17. Analysis of risk factors for sagittal translation after pedicle subtraction osteotomy in ankylosing spondylitis patients.

    Science.gov (United States)

    Park, Jin-Sung; Kim, Jaedong; Joo, Il-Han; Sim, Kyu-Dong; Park, Ye-Soo

    2018-01-02

    Sagittal translation, a potential complication of pedicle subtraction osteotomy (PSO), can results in neurologic damage. However, few studies have been conducted on sagittal translation and its risk factors after PSO in patients with ankylosing spondylitis (AS). To report cases of sagittal translation that developed after PSO in patients with AS with kyphotic deformity and to analyze risk factors for sagittal translation. A retrospective case-control study PATIENT SAMPLE: This study included 53 patients (58 cases) with AS who underwent PSO to correct their kyphotic deformity. The modified Stoke Ankylosing Spondylitis Spine Score (mSASSS) was measured before the surgery. Radiologic pelvic and sagittal parameters were also measured before and after surgery. Developments of sagittal translation were confirmed with intraoperative radiograph. The subjects were grouped according to the presence (ST group) and absence (non-ST group) of sagittal translation. The demographic and radiologic parameters were compared between two groups. Through multivariate logistic regression analysis, the correlations between sagittal translation and relevant parameters were analyzed for risk factor evaluation. Sagittal translation developed in 16 patients (30.2%) [16 cases (27.6%)]. The mean lumbar lordosis angle and sagittal vertical axis of both ST group and non-ST group were successfully corrected. In a comparison of two groups, the ST group (58.2 ± 13.3) showed a significantly higher mSASSS than the non-ST group (33.9 ± 11.9) (p<0.001). The ST group (50.4°± 7.8°, 16.9° ± 6.8°) also showed a significantly higher preoperative pelvic incidence and sacral slope than the non-ST group (45.3° ± 7.2°, 11.0°± 7.7°) (p=0.026, p=0.011). No significant differences were observed between the two groups for the rest of radiologic parameters. In multivariate analysis, only mSASSS was positively correlated with sagittal translation (odds ratio 1.16, p=0.001). The incidence of sagittal

  18. Risk factors affecting somatosensory function after sagittal split osteotomy

    DEFF Research Database (Denmark)

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

    2008-01-01

    age, 31 ± 10 years) scheduled for BSSO participated in 1 session before BSSO and 5 sessions after BSSO (at 2 and 14 days and 3, 6, and 12 months). At each session, subjective oral sensation was scored and quantitative sensory tests were performed. Results The results showed that complete exposure...

  19. A Preliminary Algorithm Using Spine Measurement Software to Predict Sagittal Alignment Following Pedicle Subtraction Osteotomy

    Science.gov (United States)

    Merrill, Robert K.; Kim, Jun S.; Leven, Dante M.; Meaike, Joshua J.; Kim, Joung Heon

    2017-01-01

    Study Design: Retrospective case series. Objective: To evaluate if spine measurement software can simulate sagittal alignment following pedicle subtraction osteotomy (PSO). Methods: We retrospectively reviewed consecutive adult spinal deformity patients who underwent lumbar PSO. Sagittal measurements were performed on preoperative lateral, standing radiographs. Sagittal measurements after simulated PSO were compared to actual postoperative measurements. A regression equation was developed using cases 1-7 to determine the amount of manual rotation required of each film to match the simulated sagittal vertical axis (SVA) to the actual postoperative SVA. The equation was then applied to cases 8-13. Results: For all 13 cases, the spine software accurately simulated lumbar lordosis, pelvic incidence lumbar lordosis mismatch, and T1 pelvic angle, with no significant differences between actual and simulated measurements. The pelvic tilt (PT), sacral slope (SS), thoracolumbar alignment (TL), thoracic kyphosis (TK), T9 spino-pelvic inclination (T9SPi), T1 spino-pelvic inclination (T1SPi), and SVA were inaccurately simulated. The PT, SS, T9SPi, T1SPi, and SVA all change with manual rotation of the film, and by using the regression equation developed with cases 1-7, we were able to improve the accuracy and decrease the variability of the simulated PT, SS, T9SPi, T1SPi, and SVA for cases 8-13. Conclusions: Dedicated spine measurement software can accurately simulate certain sagittal measurements, such as LL, PI-LL, and TPA, following PSO. A number of measurements, including PT, SS, TL, TK, T9SPi, T1SPi, and SVA were inaccurately simulated. Our preliminary algorithm improved the accuracy and decreased the variability of certain measurements, but requires future prospective studies for further validation. PMID:28894684

  20. Unilateral intraoral vertical ramus osteotomy and sagittal split ramus osteotomy for the treatment of asymmetric mandibles

    National Research Council Canada - National Science Library

    Lee, Jee-Ho; Park, Tae-Jun; Jeon, Ju-Hong

    2015-01-01

    ...) may cause a large bone gap between the proximal and distal segments as well as condylar displacement, resulting in a relapse of the temporomandibular joint disorder, especially in severe cases...

  1. Olecranon fractures with sagittal splits treated with dual fixation.

    Science.gov (United States)

    Morwood, Michael P; Ruch, David S; Leversedge, Fraser J; Mithani, Suhail K; Kamal, Robin N; Richard, Marc J

    2015-04-01

    To assess the results of olecranon fractures with an intra-articular sagittal plane fracture managed by orthogonal fixation constructs. A retrospective chart review was performed and 14 proximal ulna fractures with intra-articular comminution resulting in separate medial and lateral fragments were identified. All fractures were classified according to the Schatzker, Mayo, and AO classification systems. Postoperative functional assessment, Disabilities of the Arm, Shoulder, and Hand (DASH) score, time to union, and complications were recorded. Eleven patients were treated with both dorsal and lateral plates. Three patients were managed with a single dorsal plate and cerclage wires. All fractures healed. Mean length of follow-up was 15 months (range, 4-72 mo). Mean range of motion at final follow-up was a flexion-extension arc of 24° to 129° with 89° and 79° of pronation and supination, respectively. The most common complication was symptomatic hardware, leading to removal of hardware in 5 of 14 (36%) patients. Average postoperative Disabilities of the Arm, Shoulder, and Hand score was 7. Two patients developed heterotopic ossification and 1 patient required a local pedicled flap for soft-tissue coverage. Identification of this subset of fractures is critical to successful management. A supplemental lateral plate or cerclage wires can successfully manage these difficult fractures and achieve good outcomes. Therapeutic IV. Copyright © 2015 American Society for Surgery of the Hand. Published by Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Elio Hitoshi Shinohara

    2013-01-01

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

  3. Correction of sagittal relationship using mandibular anterior segmental osteotomy for middle-aged adults

    Directory of Open Access Journals (Sweden)

    You-Sun Lee

    2017-01-01

    Full Text Available Surgically assisted orthodontics can be an effective treatment option to overcome advanced periodontal diseases, especially if retraction of the anterior teeth is required. A 46-year-old woman was treated with mandibular anterior segmental osteotomy (ASO and prosthodontic restorations. Periodontally, hopeless teeth and an impacted canine were extracted in consideration of her age and treatment strategy. Mandibular ASO was performed for correction of anterior crossbite and lip protrusion. Treatment results were achieved in 22 months with combination of periodontal treatment and ASO-assisted orthodontic treatment. This report presents an effective surgically assisted orthodontic treatment option for correction of protrusion through mandibular ASO and premolar extraction in periodontally involved middle-aged adults.

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

    Science.gov (United States)

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

    2014-10-15

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

  5. Registration strategy using occlusal splint based on augmented reality for mandibular angle oblique split osteotomy.

    Science.gov (United States)

    Zhu, Ming; Chai, Gang; Zhang, Yan; Ma, Xiaofei; Gan, Jiliang

    2011-09-01

    An augmented reality tool allows for visual tracking of real anatomic structures in superposition with volume-rendered computed tomographic or magnetic resonance imaging scans and thus can be used for navigated translocation of important structures during operation. In this feasibility study, ARToolKit was used in mandibular angle oblique split osteotomy to define the cutting planes according to an operative plan. We overlay the operative plan on the model of a mandible made by rapid prototyping technology, and the technology was successfully used in 15 patients. Before the operation, all patients underwent computed tomographic scan, and dental casts were prepared by surgeons. Then, surgeons make the occlusal splint according to a dental cast to fix the marker, which can be recognized by the ARToolKit. The occlusal splint and marker were transformed to three-dimensional data using a laser scanner, and a programmer that runs on a personal computer named Rapidform matches the marker and the mandible image to generate the virtual image. By this step, the virtual image describing the marker, occlusal splint, and the mandible image of the patient are integrated. During the operation, the operative plan was overlaid on the rapid prototyping model of the mandible as soon as the ARToolKit recognized the marker. The technology was successfully used in 15 patients; the virtual image of the mandible and the cutting-plane both overlaid the real model of the mandible. This study has reported a new and effective way for mandibular angle oblique split osteotomy, and using occlusal splint might be a powerful option for the registration of augmented reality. Augmented reality tools like ARToolKit may be helpful for control of maxillary translocation in orthognathic surgery.

  6. The Average Change in Facial Height Following Bilateral Sagittal Split Osteotomy Advancement in Class II Patients

    Science.gov (United States)

    2017-04-21

    DEPARTMENT OF THE AIR FORCE 59TH MEDICAL WING (AETC) JOINT BASE SAN ANTONIO - LACKLAND TEXAS MEMORANDUMFORSGDTR ATTN: MAJ PAUL SMITH FROM: 59...3. GME/GHSE STUDENT: 4. PROTOCOL NUMBER: Paul Smith, Maj , 0-4, SGDTR 0 YES IZI NO FWH20160053H 5. PROTOCOL TITLE: (NOTE: For each new release of...NAME, FIRST NAME ANO M.I. GRADE/RANK SQUADRON/GROUP/OFFICE SYMBOL INSTITUTION (If not 59 MOW) a. Primary/Corresponding Author Smith, Paul 0-4/ Maj SGDTR

  7. An investigation on the incidence of neurosensory disturbances of inferior alveolar nerve and condylardisplacement with Choung (IVSRO osteotomy

    Directory of Open Access Journals (Sweden)

    Shirani Gh

    2004-02-01

    Full Text Available The choung osteotomy (Intraoral Vertico- Sagittal Ramus Osteotomy has developed"nsince 1992 in the treatment of mandibular prognathism. In IVSRO, osteotomy plane is theoretically parallel to"nthe original sagittal plane and thereby attempting to decrease the incidence of condylar dispacement. This"nosteotomy designed additionally to decrease neurosensory disturbances."nPurpose: The aim of this study was to evaluate the incidence of neurosensory deficit and condylar"ndisplacement with IVSRO and Sagittal Split Ramus Osteotomy (SSRO."nMaterials and Methods: In this study, mandibular set back surgery was accomplished upon 7 patients by"nchoung osteotomy. In addition to choung osteotomy, in 2 patients Lefort 1 osteomy was performed for"nmaxillary protrusion and for 2 other patients, chain surgery was performed. Variables such as the"nneurosensory disturbances of inferior alveolar nerve and condylar displacement following choung osteotomy"nwere investigated. All the patients were followed up one year after osteotomy. OPG, Lateral Cephalogram and"nSubmentovertex radiographies were take pre and postoperatively for all patients."nResults: No statistically significant differences were found in condylar displacement (P>0.5. However, Mc"nNemar analysis showed significant difference of neurosensory deficit between IVSRO and SSRO (P=0.001."nConclusion: It is suggested that choung osteotomy is a safe procedure for mandibular surgery.

  8. Biomechanical in vitro evaluation of three stable internal fixation techniques used in sagittal osteotomy of the mandibular ramus: a study in sheep mandibles

    Directory of Open Access Journals (Sweden)

    Leandro Benetti de Olivera

    2012-08-01

    Full Text Available Among the osteotomies performed in orthognathic surgery, the sagittal osteotomy of the mandibular ramus (SOMR is the most common, allowing a great range of movements and stable internal fixation (SIF, therefore eliminating the need of maxillomandibular block in the postoperative period. OBJECTIVES: The purpose of this study was to evaluate the biomechanical resistance of three national systems used for SIF in SOMR in sheep mandibles. MATERIAL AND METHODS: The study was performed in 30 sheep hemi-mandibles randomly divided into 3 experimental groups, each containing 10 hemi-mandibles. The samples were measured to avoid discrepancies and then subjected to SOMR with 5-mm advancement. In group I, 2.0x12 mm screws were used for fixation, inserted in an inverted "L" pattern (inverted "L" group. In group II, fixation was performed with two 2.0x12 mm screws, positioned in a linear pattern and a 4-hole straight miniplate and four 2.0x6.0 mm monocortical screws (hybrid group. In group III, fixation was performed with two 4-hole straight miniplates and eight 2.0x6.0 mm monocortical screws (mini plate group. All materials used for SIF were supplied by Osteosin - SIN. The hemimandibles were subjected to vertical linear load test by Kratos K2000MP mechanical testing unit for loading registration and displacement. RESULTS: All groups showed similar resistance during mechanical test for loading and displacement, with no statistically significant differences between groups according to analysis of variance. CONCLUSION: These results indicate that the three techniques of fixation are equally effective for clinical fixation of SOMR.

  9. A surgical option for multilevel anterior lumbar interbody fusion with ponte osteotomy to achieve optimal lumbar lordosis and sagittal balance.

    Science.gov (United States)

    Suh, Loo-Ree; Jo, Dae-Jean; Kim, Sung-Min; Lim, Young-Jin

    2012-10-01

    To document lumbar lordosis (LL) of the spine and its change during surgeries with the different height but the same angle setting of the anterior cage. Additionally, we attempted to determine if sufficient LL is achieved at different cage heights and to quantify the change in LL during multi-level anterior lumbar interbody fusion (ALIF). The medical records and radiographs of 42 patients who underwent more than 2 level ALIFs between 2008 and 2009 were retrospectively reviewed. We evaluated 3 parameters seen on lateral whole spine radiographs : LL, pelvic incidence (PI), and sagittal vertical axis (SVA). The mean follow-up time was 28.1 months and the final follow-up radiographs of all patients were reviewed at least 2 years after surgery. Statistical analysis was performed using the paired t-tests. Lumbar lordosis had changed up to 30 degrees immediately and 2 years after surgery (preoperative mean LL, SVA : 22.45 degrees, 112.31 mm; immediate postoperative mean LL, SVA : 54.45 degrees, 37.36 mm; final follow-up mean LL, SVA : 49.56 degrees, 26.95 mm). Our goal of LL is to obtain as much PI as possible, preoperative mean PI value was 55.38±3.35. The pre-operative and two year post-surgery follow-up mean of the Japanese Orthopedic Association score were 9.2±0.6 and 13.2±0.6 (favorable outcome rate : 95%), respectively. In addition, we were able to obtain good clinical outcomes and sagittal balance with a subsidence rate of 22.7%. We were able to achieve sufficient LL, such that it was similar to the PI, utilizing multi-level ALIF with the use of a tall cage with the same angle setting of the cage. We have found out that achieving sufficient lumbar lordosis and sagittal balance require an anterior lumbar cage with high angle and height.

  10. Robot-Assisted Surgery for Mandibular Angle Split Osteotomy Using Augmented Reality: Preliminary Results on Clinical Animal Experiment.

    Science.gov (United States)

    Zhou, Chaozheng; Zhu, Ming; Shi, Yunyong; Lin, Li; Chai, Gang; Zhang, Yan; Xie, Le

    2017-10-01

    Mandibular angle split osteotomy (MASO) is a procedure widely used for prominent mandibular angles. However, conventional mandibular plastic surgery is invasive and high risk. It may induce postoperative neurosensory disturbance of the inferior alveolar nerve, fractures and infection due to the complexity of the anatomical structure and the narrow surgical field of view. The success rate of MASO surgery usually depends on the clinical experience and skills of the surgeon. To evaluate the performance of inexperienced plastic surgeons conducting this surgery, a self-developed and constructed robot system based on augmented reality is used. This robot system provides for sufficient accuracy and safety within the clinical environment. To evaluate the accuracy and safety of MASO surgery, an animal study using this robot was performed in the clinical room, and the results were then evaluated. Four osteotomy planes were successfully performed on two dogs; that is, twenty tunnels (each dog drilled on bilaterally) were drilled in the dogs' mandible bones. Errors at entrance and target points were 1.04 ± 0.19 and 1.22 ± 0.24 mm, respectively. The angular error between the planned and drilled tunnels was 6.69° ± 1.05°. None of the dogs experienced severe complications. Therefore, this technique can be regarded as a useful approach for training inexperienced plastic surgeons on the various aspects of plastic surgery. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  11. Safety and Efficacy of One-stage Spinal Osteotomy for Severe and Rigid Congenital Scoliosis Associated with Split Spinal Cord Malformation.

    Science.gov (United States)

    Chen, Bo; Yuan, Zhi; Chang, Michael S; Huang, Jing-Hui; Li, Huan; Yang, Wei-Zhou; Luo, Zhuo-Jing; Tao, Hui-Ren

    2015-09-15

    Retrospective clinical study. To retrospectively evaluate the safety and efficacy of one-stage spinal osteotomy in the treatment of severe and progressive congenital scoliosis (CS) associated with split spinal cord malformation (SSCM). For severe and rigid spinal deformity, spinal osteotomies are often advocated for correcting the deformity. However, the safety and efficacy of one-stage spinal osteotomy in the treatment of severe and rigid CS with SSCM have been unclear thus far. Patients were treated by one-stage spinal osteotomy between September 2007 and June 2011 in our hospital. The clinical records were reviewed for demographic and radiographical data, operative time, intraoperative blood loss, blood transfusion, perioperative complications, and functional outcomes. There were 18 females and 11 males with an average age of 15.5 ± 3.6 years (range, 12-28 yr). Spinal cord was longitudinally split by a bony spur in 11 patients (type I SSCM) and by a fibrous band in 18 patients (type II SSCM). Patients were observed for a minimum of 24 months after initial surgical treatment with an average follow-up of 43.0 ± 17.1 months (range 24-68 mo) from September 2007 to June 2013. The mean operative time and average blood loss of type ISSCM was significantly greater than those of type II SSCM (P spinal osteotomy is effective for the correction of severe CS and SSCM without increasing the rate of surgical complications. However, surgical treatment of type I SSCM does require more operating time and blood loss. 4.

  12. The Impact of Le Fort I Advancement and Bilateral Sagittal Split Osteotomy Setback on Ventilation during Sleep

    Czech Academy of Sciences Publication Activity Database

    Foltán, R.; Hoffmannová, J.; Doněv, F.; Vlk, M.; Šedý, Jiří; Kufa, R.; Bulík, O.

    2009-01-01

    Roč. 38, č. 10 (2009), s. 1036-1040 ISSN 0901-5027 Grant - others:GA MZd(CZ) NR8038 Institutional research plan: CEZ:AV0Z50390512 Keywords : orthognathic surgery * sleep apnoea * ventilation Subject RIV: FH - Neurology Impact factor: 1.444, year: 2009

  13. Static and dynamic loading of mandibular condyles and their positional changes after bilateral sagittal split advancement osteotomies

    NARCIS (Netherlands)

    Dicker, G.J.; Tuijt, M.; Koolstra, J.H.; van Schijndel, R.A.; Castelijns, J.A.; Tuinzing, D.B.

    2012-01-01

    This study analysed the effects of change of direction of masseter (MAS) and medial pterygoid muscles (MPM) and changes of moment arms of MAS, MPM and bite force on static and dynamic loading of the condyles after surgical mandibular advancement. Rotations of the condyles were assessed on axial

  14. Sacral and pelvic osteotomies for correction of spinal deformities.

    Science.gov (United States)

    Bodin, Arnaud; Roussouly, Pierre

    2015-01-01

    Restoring a physiological sagittal spine balance is one of the main goals in spine surgery. Several technics have been described previously, as pedicle subtraction osteotomy. In more complicated cases involving spino-pelvic disorders, three authors proposed sacral osteotomy to restore sagittal balance of the spine. The authors describe the use of pelvic osteotomies for the correction of lumbo-sacral kyphosis, for decreasing pelvic incidence and for achieving sagittal balance correction in cases of lumbo-sacral sagittal deformity as an alternative of pedicle subtraction osteotomies (PSO). We simulate four types of pelvic osteotomies previously described for hip pathology (Salter, modified Salter, Chiari and posterior sacral osteotomy) on drawing software, and calculate during these osteotomies the variation of pelvic incidence (PI). Then, we compare the behaviour in this simulation to a cadaveric model where we perform the same four pelvic osteotomies. Via X-rays made the study, we calculate also the PI. Then, we analyse 11 patients who underwent pelvic osteotomies for sagittal unbalance, analysing operative and clinical data. We find a mathematical law governing the PI during anterior opening and posterior closing osteotomies (respectively Salter and sacral osteotomy):[Formula: see text]These laws are confirmed in the cadaveric model which retrieves the same behaviour. In the clinical series, Salter osteotomy is easy and efficient on sagittal rebalancing; sacral osteotomy is more powerful. The Salter osteotomy is efficient for restoring sagittal balance of the spine. The posterior sacral osteotomy is more powerful but technically demanding. The indications of such special osteotomies are fixed lumbo-sacral kyphosis, especially high-grade spondylolisthesis, previously operated or not. A study of a more substantial series would be considered.

  15. The Relationship between T1 Sagittal Angle and Sagittal Balance: A Retrospective Study of 119 Healthy Volunteers

    OpenAIRE

    Yang, Mingyuan; Yang, Changwei; Ni, Haijian; Zhao, Yuechao; Li, Ming

    2016-01-01

    T1 sagittal angle has been reported to be used as a parameter for assessing sagittal balance and cervical lordosis. However, no study has been performed to explore the relationship between T1 sagittal angle and sagittal balance, and whether T1 sagittal angle could be used for osteotomy guidelines remains unknown. The aim of our study is to explore the relationship between T1 sagittal angle and sagittal balance, determine the predictors for T1 sagittal angle, and determine whether T1 sagittal ...

  16. Mandibular angle split osteotomy based on a novel augmented reality navigation using specialized robot-assisted arms--A feasibility study.

    Science.gov (United States)

    Lin, Li; Shi, Yunyong; Tan, Andy; Bogari, Melia; Zhu, Ming; Xin, Yu; Xu, Haisong; Zhang, Yan; Xie, Le; Chai, Gang

    2016-02-01

    Augmented reality (AR) navigation, is a visible 3-dimensional display technology, that, when combined with robot-assisted surgery (RAS), allows precision and automation in operational procedures. In this study, we used an innovative, minimally invasive, simplified operative method to position the landmarks and specialized robot-assisted arms to apply in a rapid protyping (RP) model. This is the first report of the use of AR and RAS technology in craniomaxillofacial surgery. Five patients with prominent mandibular angle were randomly chosen for this feasibility study. We reconstructed the mandibular modules and created preoperational plans as semi-embedded and nail-fixation modules for an easy registration procedure. The left side of the mandibular modules comprised the experimental groups with use of a robot, and the right sides comprised the control groups without a robot. With AR Toolkits program tracking and display system applied, we carried out the operative plans and measured the error. Both groups were successfully treated in this study, but the RAS was more accurate and stable. The average position and angle were significant (p augmented reality navigation with specialized robot-assisted arms for mandibular angle split osteotomy. AR and RAS can be helpful for patients undergoing craniomaxillofacial surgery. Copyright © 2015 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  17. The Relationship between T1 Sagittal Angle and Sagittal Balance: A Retrospective Study of 119 Healthy Volunteers.

    Science.gov (United States)

    Yang, Mingyuan; Yang, Changwei; Ni, Haijian; Zhao, Yuechao; Li, Ming

    2016-01-01

    T1 sagittal angle has been reported to be used as a parameter for assessing sagittal balance and cervical lordosis. However, no study has been performed to explore the relationship between T1 sagittal angle and sagittal balance, and whether T1 sagittal angle could be used for osteotomy guidelines remains unknown. The aim of our study is to explore the relationship between T1 sagittal angle and sagittal balance, determine the predictors for T1 sagittal angle, and determine whether T1 sagittal angle could be used for osteotomy guidelines to restore sagittal balance. Medical records of healthy volunteers in our outpatient clinic from January 2014 to August 2015 were reviewed, and their standing full-spine lateral radiographs were evaluated. Demographic and radiological parameters were collected and analyzed, including age, gender, T1 sagittal angle, maxTK, maxLL, SS, PT, and PI. Correlation coefficients between T1 sagittal angle and other spinopelvic parameters were determined. In addition, multiple regression analysis was performed to establish predictive radiographic parameters for T1 sagittal angle as the primary contributors. A total of 119 healthy volunteers were recruited in our study with a mean age of 34.7 years. It was found that T1 sagittal angle was correlated with maxTK with very good significance (r = 0.697, Psagittal angle could be predicted by using the following regression equation: T1 sagittal angle = 0.6 * maxTK-0.2 * maxLL + 8. In the healthy population, T1 sagittal angle could be considered as a useful parameter for sagittal balance; however, it could not be thoroughly replaced for SVA. maxTK was the primary contributor to T1 sagittal angle. According to this equation, we could restore sagittal balance by surgically changing thoracic kyphosis and lumbar lordosis, which could serve as a guideline for osteotomy.

  18. Spinal osteotomies: indications, limits and pitfalls

    Science.gov (United States)

    Kose, Kamil Cagri; Bozduman, Omer; Yenigul, Ali Erkan; Igrek, Servet

    2017-01-01

    The aims of spinal deformity surgery are to achieve balance, relieve pain and prevent recurrence or worsening of the deformity. The main types of osteotomies are the Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO), bone-disc-bone osteotomy (BDBO) and vertebral column resection (VCR), in order of increasing complexity. SPO is a posterior column osteotomy in which the posterior ligaments and the facet joints are removed and correction is performed through the disc space. A mobile anterior disc is essential. SPO is best in patients with +6-8 cm C7 plumbline. The amount of correction is 9.3° to 10.7°/level (1°/mm bone). PSO is a technique where the posterior elements and pedicles are removed. Then a triangular wedge through the pedicles is removed and the posterior spine is shortened using the anterior cortex as a hinge. The ideal candidates are patients with a severe sagittal imbalance. A single level osteotomy can produce 30° 40° of correction. A single level osteotomy may restore global sagittal balance by an average of 9 cm with an upper limit of 19 cm. BDBO is an osteotomy done above and below a disc level. A BDBO provides correction rates in the range of 35° to 60°. The main indications are deformities with the disc space as the apex and severe sagittal plane deformities. VCR is indicated for rigid multi-planar deformities, sharp angulated deformities, hemivertebra resections, resectable spinal tumours, post-traumatic deformities and spondyloptosis. The main indication for a VCR is fixed coronal plane deformity. The type of osteotomy must be chosen mainly according to the aetiology, type and apex of the deformity. One may start with SPOs and may gradually advance to complex osteotomies. Cite this article: EFORT Open Rev 2017;2:73-82. DOI: 10.1302/2058-5241.2.160069 PMID:28507779

  19. Osteotomies in the Cervical Spine

    Science.gov (United States)

    Nemani, Venu M.; Derman, Peter B.

    2016-01-01

    Rigid cervical deformities are difficult problems to treat. The goals of surgical treatment include deformity correction, achieving a rigid fusion, and performing a thorough neural decompression. In stiff and ankylosed cervical spines, osteotomies are required to restore sagittal and coronal balance. In this chapter, we describe the clinical and radiographic workup for patients with cervical deformities, and delineate the various factors that must be considered when planning surgical treatment. We also describe in detail the various types of cervical osteotomies, along with their surgical technique, advantages, and potential complications. PMID:26949476

  20. Duration of orthodontic treatment and mandibular lengthening by means of distraction or bilateral sagittal split osteotomy in patients with Angle Class II malocclusions

    NARCIS (Netherlands)

    Breuning, K.H.; van Strijen, P.J.; Prahl-Andersen, B.; Tuinzing, D.B.

    2005-01-01

    The purpose of this study was to investigate the duration of treatment of patients with skeletal Angle Class II malocclusions treated with orthodontic appliances and surgical lengthening of the mandible to close residual overjets. Methods: In this retrospective study, the patients were divided into

  1. Risk Factors for Post-operative Infection Following Single Piece Osteotomy.

    Science.gov (United States)

    Abdul Wahab, P U; Senthil Nathan, P; Madhulaxmi, M; Muthusekhar, M R; Loong, Soh Chen; Abhinav, Rajendra Prabhu

    2017-09-01

    The aim of this retrospective study was to identify the significant risk factors that contribute towards postoperative infection in patients recovering from orthognathic surgery. Retrospective records of 522 patients who underwent orthognathic surgery over 9 year period were evaluated for postoperative infection within 3 months of surgery and after 3 months of surgery. The variables of interest included age, gender, habits like smoking and alcohol consumption and incidence of postoperative infection. The overall infection rate was 4.60%. Patients who underwent bilateral sagittal split osteotomy to advance the mandible had an infection rate of 10.4%. Statistically significant predictor variables (P < 0.05) included patients who had the smoking habit, and those that received bone grafts in both the time periods. In conclusion, the occurrence of infection after orthognathic surgery is influenced by multiple factors, among which are the type of osteotomy, smoking habit and bone grafting procedures.

  2. Delayed progressive haematoma after Le Fort I osteotomy: A possible severe complication in orthognatic surgery

    Directory of Open Access Journals (Sweden)

    Dario Bertossi

    2012-01-01

    Full Text Available Although the Le Fort I osteotomy is a safe surgical technique, many complications have been reported. We present a case of an extended cervico-facial haematoma due to delayed bleeding from the terminal branches of the maxillary artery after orthognatic surgery. A 23-year-old man was referred to our observation for the surgical correction of a class III asymmetric malocclusion. The patient underwent a Le Fort I osteotomy, with impaction of the maxilla, associated with an Epker mandibular bilateral sagittal split osteotomy, with maxillary advancement and rigid internal fixation of the mandible with four miniplates and another four for the upper maxilla as well. The first post-surgery day, the patient developed a gradual dispnea together with neck swelling. By second postoperative day, the patient′s general condition improved with a progressive normalization of laboratory tests values. The Computerised Axial Tomography (CAT scan confirmed a decrease in the parapharyngeal thickening. Total recovery was achieved within two months, the final clinical check showed a healthy appearance with good occlusion. An increased knowledge of the basic biology of the Le Fort I osteotomy, the development of instruments specially designed for the Le Fort I procedure and the use of hypotensive anaesthesia could reduce the morbidity and duration of this procedure.

  3. Supramalleolar Osteotomies.

    Science.gov (United States)

    Chopra, Varun; Stone, Paul; Ng, Alan

    2017-10-01

    Distal tibial malalignment can result from posttraumatic malunion, physeal disturbances, congenital or metabolic diseases, and degenerative arthritis. Malalignment leads to an altered load distribution across the joint leading to early ankle joint arthritis. If a substantial part of the joint is salvageable, ankle fusion or joint replacement is not always the best option. Realignment of the distal tibia with a joint-sparing supramalleolar osteotomy is a valuable procedure in correcting deformity at the distal tibia. The goal of a supramalleolar osteotomy is to restore axial alignment. Several studies have demonstrated the successes of the osteotomy in improving function and relieving pain. Copyright © 2017 Elsevier Inc. All rights reserved.

  4. Osteotomies mandibulaires virtuelles : acquisition, planification, modelisation et production d’un guide occlusal et condylien imprime en 3 dimensions. Mise en place d’une chaîne méthodologique de la faisabilité à la clinique

    OpenAIRE

    Laurentjoye, Mathieu

    2015-01-01

    The purpose of this work was the implementation of a methodological chain for bilateral sagittal split osteotomy (BSSO) virtual planning and its transfer in the operating room. In the first part of the work, usual methods for planning BSSO are exposed. Usually realized from plaster models on articulator, the planning and the occlusal surgical guides production are at risk of temporo-­‐mandibular functional disorders. The quality of the functional result depends on the correct positioning of t...

  5. Quality control of reconstructed sagittal balance for sagittal imbalance.

    Science.gov (United States)

    Chang, Kao-Wha; Leng, Xiangyang; Zhao, Wenhai; Ching-Wei, Cheng; Chen, Tsung-Chein; Chang, Ku-I; Chen, Yin-Yu

    2011-02-01

    Prospective radiographic study. To investigate the feasibility of controlling quality of reconstructed sagittal balance for sagittal imbalance. Patients with sagittal imbalance cannot walk or stand erect without overwork of musculature because of compromised biomechanical advantage. The result is muscle fatigue and activity-related pain. During reconstructive surgery, restoration of optimal sagittal balance is crucial for obtaining satisfactory clinical results. However, there is no way to control quality of reconstructed sagittal balance before or during surgery. A method was developed to determine the lumbosacral curve in a way that theoretically would bring sagittal balance to an ideal state by calculation and simulation for each patient before surgery and then template rods of the curve and a blueprint were made accordingly for operative procedures. Ninety-four consecutive patients with sagittal imbalance due to lumbar kyphosis were treated for intractable pain and then followed up for a mean of 4.3 years. Radiographs were analyzed before surgery, 2 months after surgery, and at most recent follow-up. The mean estimated values of L1-S1 lordosis, sacral inclination angle, sacrofemoral distance, and distribution of L1-S1 lordosis at the closing-opening wedge osteotomy site and L4-S1 segments were 30.8°, 24.6°, 0 mm, 16.1% (-5°), and 62% (-19°), respectively. The mean reconstructed values were 41.1°, 23.3°, 3.9 mm, 41% (-17°), and 46% (-19°), respectively. There were significant differences between estimated and reconstructed values of L1-S1 lordosis and the percentage of distributions; however, there was no significant difference between the estimated and reconstructed magnitude of L4-S1 lordosis, sacral inclination angle, and sacrofemoral distance. A properly oriented pelvis can be brought nearly directly above the hip axis. The mean sagittal global balance, represented by the distance between the vertical line through the hip axis and sacral promontory

  6. The Relationship between T1 Sagittal Angle and Sagittal Balance: A Retrospective Study of 119 Healthy Volunteers.

    Directory of Open Access Journals (Sweden)

    Mingyuan Yang

    Full Text Available T1 sagittal angle has been reported to be used as a parameter for assessing sagittal balance and cervical lordosis. However, no study has been performed to explore the relationship between T1 sagittal angle and sagittal balance, and whether T1 sagittal angle could be used for osteotomy guidelines remains unknown. The aim of our study is to explore the relationship between T1 sagittal angle and sagittal balance, determine the predictors for T1 sagittal angle, and determine whether T1 sagittal angle could be used for osteotomy guidelines to restore sagittal balance. Medical records of healthy volunteers in our outpatient clinic from January 2014 to August 2015 were reviewed, and their standing full-spine lateral radiographs were evaluated. Demographic and radiological parameters were collected and analyzed, including age, gender, T1 sagittal angle, maxTK, maxLL, SS, PT, and PI. Correlation coefficients between T1 sagittal angle and other spinopelvic parameters were determined. In addition, multiple regression analysis was performed to establish predictive radiographic parameters for T1 sagittal angle as the primary contributors. A total of 119 healthy volunteers were recruited in our study with a mean age of 34.7 years. It was found that T1 sagittal angle was correlated with maxTK with very good significance (r = 0.697, P<0.001, maxLL with weak significance (r = 0.206, P = 0.024, SS with weak significance (r = 0.237, P = 0.009, PI with very weak significance (r = 0.189, P = 0.039, SVA with moderate significance (r = 0.445, P<0.001, TPA with weak significance (r = 0.207, P = 0.023, and T1SPI with weak significance (r = 0.309, P = 0.001. The result of multiple regression analysis showed that T1 sagittal angle could be predicted by using the following regression equation: T1 sagittal angle = 0.6 * maxTK-0.2 * maxLL + 8. In the healthy population, T1 sagittal angle could be considered as a useful parameter for sagittal balance; however, it could not

  7. Tibial osteotomies for cranial cruciate ligament insufficiency in dogs.

    Science.gov (United States)

    Kim, Stanley E; Pozzi, Antonio; Kowaleski, Michael P; Lewis, Daniel D

    2008-02-01

    To review the biomechanical considerations, experimental investigations, and clinical data pertaining to tibial osteotomy procedures for treatment of cranial cruciate ligament (CrCL) insufficiency in dogs. Literature review. Literature search through Pub Med, Veterinary Information Network, Commonwealth Agricultural Bureau Abstracts, and conference proceedings abstracts (November 1977 to March 2007). Reported tibial osteotomy procedures attempt to eliminate sagittal instability (cranial tibial thrust) in CrCL-deficient stifles by altering the conformation of the proximal tibia. Functional stability can be achieved by decreasing the tibial plateau slope (cranial tibial closing wedge osteotomy [CTWO], tibial plateau leveling osteotomy [TPLO], combined TPLO and CTWO, proximal intraarticular osteotomy, chevron wedge osteotomy), altering the alignment of the patellar tendon (tibial tuberosity advancement), or both (triple tibial osteotomy). Clinical reports assessing the efficacy of these procedures frequently use subjective outcome measures, and the periods of follow-up evaluation are highly variable. Satisfactory results have been reported in most (>75%) dogs irrespective of the type of tibial osteotomy procedure. Currently available data does not allow accurate comparisons between different tibial osteotomy procedures, or with traditional methods of stabilizing the CrCL-deficient stifle. Carefully designed long-term clinical studies and further biomechanical analyses are required to determine the optimal osteotomy technique, and whether these procedures are superior to other stabilization methods. Limb function in dogs with CrCL insufficiency can be improved using the currently described tibial osteotomy techniques.

  8. Comparison of autologous and heterologous bone graft stability effects for filling maxillary bone gap after Le Fort I osteotomy.

    Science.gov (United States)

    Eser, Cengiz; Gencel, Eyüphan; Gökdoğan, Mahmut; Kesiktaş, Erol; Yavuz, Metin

    2015-01-01

    The amount of postoperative maxillary relapse of two different bone graft materials after Le Fort I osteotomy were compared in this study. The aim of this study is to compare postoperative maxillary relapse rates using heterologous and autologous graft materials after Le Fort I osteotomy. A total of 80 patients who had developmental malocclusion were analyzed retrospectively in this study. Twenty nine (36.2%) and 51 (63.8%) patients underwent Le Fort I osteotomy, and Le Fort I and bilateral sagittal split ramus osteotomy (two-jaw surgery), respectively. Forty two (52.5%) maxillary bone gaps were filled with heterologous bone grafts (group A) and 38 (47.5%) were filled with autologous bone grafts (group B) after Le Fort I osteotomy. The cephalometric graphics and measurements were taken before (T1), 1 week after (T2), and 1 year after (T3) the surgery. The results were documented and determined by the Dolphin imaging 10.5 (Dolphin Imaging, Chatsworth, Calif.) computer program for skeletal relapse. Whether or not the relationship between group A's and B's maxillary relapse rates was evaluated in the postoperative period. It was observed that both graft materials have positive effects on maxillary relapse rate in the postoperative period. When the groups are compared to each other, the relapse rates were similar between group A (8.3%) and group B (10.8%) (p>0.05). Heterologous bone graft material (Osteoplant®-Flex) is thought to be a good alternative to autologous grafts in decreasing the relapse rates and reducing the morbidity of the donor area of the patients who underwent Le Fort I osteotomy.

  9. Rod strain after pedicle subtraction osteotomy

    DEFF Research Database (Denmark)

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

    2016-01-01

    Pedicle subtraction osteotomy (PSO) can provide major sagittal correction for adult spinal deformity, sometimes achieving correction greater than 308. Surgeons have reported failure rates up to 30% within 2 years, increasing to 46% after 4 to 5 years (SDC Figure 1, http://links.lww.com/BRS/B87......). Revision following failure is difficult on the patient. PSO has achieved positive outcomes, but when used to correct posture in older patients with spinal deformity and fixed sagittal imbalance, rod breakage often leads to multiple surgical revisions. These complications must be avoided....

  10. Velopharyngeal Configuration Changes Following Le Fort I Osteotomy With Maxillary Advancement in Patients With Cleft Lip and Palate: A Cephalometric Study.

    Science.gov (United States)

    Wu, Yu; Wang, Xing; Ma, Lian; Li, Zili

    2015-11-01

    To describe the morphological changes of velopharyngeal components in patients with cleft lip and palate after Le Fort I osteotomy with maxillary advancement and to clarify whether the velopharyngeal morphological changes are related to the distance of maxillary advancement. Retrospective case series. Hospital and Stomatology Unit of Peking University, Beijing, China. A total of 47 patients with maxillary hypoplasia secondary to cleft lip and palate. Le Fort I osteotomy combined with bilateral sagittal split ramus osteotomy and/or genioplasty for treatment of maxillofacial deformity. The lateral cephalometric radiographs with velum at rest (n = 47) and during phonation of /i/ (n = 17) were undertaken preoperatively (T1), 1 week postoperatively (T2), and at least 6 months postoperatively (T3). Some measure indices of velopharyngeal configuration were collected and analyzed. The average maxillary advancement distance was 4.08 ± 1.58 mm. The velar length, velar angle, and nasopharyngeal depth increased, but velar thickness decreased. The motion of the soft palate had no significant change, but the motion of the posterior pharyngeal wall and the Passavant's ridge increased significantly. No significant linear correlation was found between maxillary advancement distance and velopharyngeal configuration changes. Correction of maxillary hypoplasia by Le Fort I osteotomy with maxillary advancement increases the velopharyngeal cavity depth, which may impair velopharyngeal competence. The compensatory effects of the velopharyngeal soft tissue and posterior pharyngeal wall may alleviate this impairment to a certain extent.

  11. Correção das deformidades sagitais fixas pela técnica de osteotomia de subtração pedicular (PSO Corrección de las deformidades sagitales fijas por la técnica de osteotomía de sustracción pedicular (PSO Pedicle subtraction osteotomy (PSO for the treatment of sagittal deformities

    Directory of Open Access Journals (Sweden)

    Rodrigo José Fernandes da Costa

    2011-01-01

    with fixed sagittal deformities. METHODS: The medical records and radiographs performed during the pre- and post-operative period of nine patients with fixed sagittal deformities caused by ankylosing spondylitis (4 patients, flat back post-arthrodesis (3 patients, adult kyphoscoliosis (1 patient and pseudohypoparathyroidism (1 patient, were retrospectively reviewed. All patients were submitted to lumbar osteotomy (three at level L3 and two at level L2. Clinical data such as durotomy, neurologic injury, infection of the surgical wound, implant failure and pseudarthrosis were also assessed. Pre- and post-operative radiographic assessment was performed by measuring angles of thoracic kyphosis, lumbar lordosis and sagittal axis. RESULTS: In patients with lumbar osteotomy, final follow up radiographs showed an increase in lumbar lordosis from 14.6° to 44.7° (increase of 30°, whereas thoracic kyphosis remained stable from 46° to 48°. Sagittal imbalance reduced from 13.7 to 5.4mm, and thoracic kyphosis remained stable (48°. The mean time of surgery was 8 hours 10 minutes and mean bleeding was 2,460mL. No neurologic complications were found, but one patient showed durotomy and two patients showed wound infection requiring posterior surgical approach. CONCLUSIONS: Although the pedicle subtraction osteotomy requires great surgical skills and experience, due to the blood loss, long operative time and severe implications, this procedure reaches a significant improvement in sagittal imbalance as observed in ankylosing spondylitis and implications of previous surgeries.

  12. [Is calcaneal osteotomy justified in Haglund's disease?].

    Science.gov (United States)

    Maynou, C; Mestdagh, H; Dubois, H H; Petroff, E; Elise, S

    1998-11-01

    The authors report their experience of Zadek's wedge osteotomy in the treatment of posterior talalgia in adults and evaluate the various radiographical measurements for calcaneus deformity measurement.... This procedure was performed in 27 patients with a total of 36 calcanea treated between 1985 and 1996. The sex ratio was 20 women for 7 men with an average age of 27 years. Prior to this osteotomy nine feet were operated by resection of the postero-superior tuberosity with recurrence of pain and disability, and two patients presented an inflammatory arthritis. For the surgical procedure, the patient was placed in lateral position. Skin incision was five to six centimeters long, curvilinear along the lateral side of the tendo achillis. Two dorsal pins were inserted, creating a triangle so that the apex pointed plantarly and the base dorsally. The sagittal saw was then used to create a wedge osteotomy with a dorsal base of seven to ten millimeters. A screw was then driven across the osteotomy site for ultimate fixation. Eighty per cent (29 osteotomies) of patients had been examined clinically and radiologically with a mean follow-up of 29 months. Considering pain, daily activity and discomfort with footwear, results were excellent in 12 cases, good in 10, fair in 5 and poor in two cases. No radiological criteria used for the diagnosis of Haglund's disease were absolutely reliable. The "total angle" of Ruch, the "c.l angle" of Chauveaux and the "parallel pitch lines" of Heneghan reflect the amount of deformation most accurately, but especially, the calcaneal inclination angle was always increased (16 cases between 18 degrees and 30 degrees, 6 cases > 30 degrees). All patients had a weight-bearing calcaneal talus, either alone or in the context of posterior pes cavus. This study confirms the responsibility of rearfoot morphostatic disorders in posterior talalgia and the goods results obtained by Zadek osteotomy.

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

    Science.gov (United States)

    Rahpeyma, Amin; Khajehahmadi, Saeedeh; Ghasemi, Ali

    2016-04-01

    In bilateral cleft lip/palate patients, sometimes the premaxilla is severely protruded and twisted. In such situations premaxillary osteotomy is beneficial. In this article a new technique for fixation of premaxilla after osteotomy is presented. The lip-split approach and premaxillary osteotomy and ostectomy from bony nasal septum were carried out. Fixation of osteotomized premaxilla was achieved with low profile miniplate or microplate. Bone grafting of that side was performed during the same session. This procedure was performed in three patients, with good labial repair after the lip split. The bone graft was successful in all the three cases and there were no complication for premaxillary osteotomy in this series. In protruding premaxilla, osteotomy and fixation of premaxilla with miniplate to the vomer bone during alveolar bone grafting through a lip-split approach yielded satisfactory results in patients requiring secondary functional cheilorhinoplasty. Copyright © 2015. Published by Elsevier Taiwan.

  14. Triple Pelvic Osteotomy and Double Pelvic Osteotomy.

    Science.gov (United States)

    Guevara, Francisco; Franklin, Samuel P

    2017-07-01

    Triple and double pelvic osteotomy (TPO, DPO) are performed with the goal of increasing acetabular ventro-version, increasing femoral head coverage, and decreasing femoral head subluxation. Since the first descriptions of TPO, there have been modifications in technique, most notably omission of the ischial osteotomy for DPO, and improvements in the implants, including availability of locking TPO/DPO bone plates. Associated complication rates seem to have declined accordingly. The most salient questions regarding these procedures remain what selection criteria should be used to identify candidates and whether halting or preventing osteoarthritis is necessary to consider these surgeries clinically beneficial. Copyright © 2017 Elsevier Inc. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Amin Rahpeyma

    2016-04-01

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

  16. Variability in Minimally Invasive Surgery for Sagittal Craniosynostosis.

    Science.gov (United States)

    Garland, Catharine B; Camison, Liliana; Dong, Shirley M; Mai, Rick S; Losee, Joseph E; Goldstein, Jesse A

    2018-01-01

    Minimally invasive approaches to the surgical correction of sagittal craniosynostosis are gaining favor as an alternative to open cranial vault remodeling. In this systematic review, the reviewers evaluate the variability in described surgical techniques for minimally invasive correction of sagittal craniosynostosis. Articles were selected based on predetermined inclusion and exclusion criteria from an online literature search through PubMed, EMBASE, and the Cochrane library. Extracted data included the incisions, method of dissection, osteotomies performed, and type of force therapy utilized.A total of 28 articles from 15 author groups were included in the final analysis. Of the 28 articles, 17 distinct techniques were identified. Significant variation existed in both the technique and the terminology used to describe it. Access to the cranium varied between a standard bicoronal incision (n = 2), a "lazy S" incision (n = 2), and multiple short incisions along the fused sagittal suture (n = 13). Additional variations were found in the size and design of the osteotomy, the usage (and duration, if applicable) of force therapy, and the age of the patient at the time of surgical intervention.This systematic review demonstrates that minimally invasive approaches to sagittal craniosynostosis vary widely in technique with respect to the incisions, osteotomies, and force therapy used. Additionally, the terminology employed in describing minimally invasive approaches is inconsistent across centers. This discrepancy between technique and terminology presents challenges for reporting and interpreting the increasing body of literature on this subject. We recommend standard terminology be used for future publications on minimally invasive techniques.

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

    Science.gov (United States)

    Radcliff, Kristen E; Jakoi, Andre M

    2015-04-01

    To the authors' knowledge, this is the first article to present a pedicle subtraction osteotomy in the lumbar spine to correct and stabilize a high-grade isthmic spondylolisthesis, which poses many challenges with regard to treatment options and outcomes. The optimal surgical treatment for high-grade spondylolisthesis is controversial, but the goals of treatment are to stabilize the affected spinal levels and to decompress the neural elements. A pedicle subtraction osteotomy is a reconstructive procedure that addresses fixed sagittal imbalance by increasing lumbar lordosis through posterior spinal column shortening. The authors report a 46-year-old patient with chronic, progressively worsening back and leg radiculopathy accompanied by sagittal plane malalignment and for which a pedicle subtraction osteotomy was performed. The procedure yielded stabilization of the patient's lumbar spondylolisthesis and sagittal plane alignment was restoration. At 3 months postoperatively, the patient's pain had fully resolved and her motor and neurologic examination exhibited no deficits. At 24 months postoperatively, she was still symptom-free and ambulating without assistance. This report is the first documented successful pedicle subtraction osteotomy in the treatment of high-grade spondylolisthesis. This report indicates that certain patient populations may be amenable to pedicle subtraction osteotomy as a treatment option for pathology involving high-grade isthmic spondylolisthesis. Copyright 2015, SLACK Incorporated.

  18. Utilization trends of pedicle subtraction osteotomies compared to posterior spinal fusion for deformity: a national database analysis between 2008?2011

    OpenAIRE

    Gum, Jeffrey L.; Carreon, Leah Y.; Buchowski, Jacob M.; Lenke, Lawrence G.; Glassman, Steven D.

    2016-01-01

    Background Increased awareness regarding the importance of the sagittal spinal profile has led to more aggressive correction of sagittal malalignment. The utilization trends of pedicle subtraction osteotomy (PSO) for sagittal plane correction in spinal deformity surgery have not been well characterized. Methods A commercially available database (PearlDiver, Inc) was queried for both Private Payor and 5?% Medicare claims from 2008 to 2011. Revision and clarification of the coding guidelines fo...

  19. Osteotomy for treating knee osteoarthritis

    NARCIS (Netherlands)

    R.W. Brouwer (Reinoud); T.M. van Raaij (Tom); S.M. Bierma-Zeinstra (Sita); A.P. Verhagen (Arianne); T.S. Jakma (Tijs); J.A.N. Verhaar (Jan)

    2007-01-01

    textabstractBackground: Patients with unicompartmental osteoarthritis of the knee can be treated with a correction osteotomy. The goal of the correction osteotomy is to transfer the load bearing from the pathologic to the normal compartment of the knee. A successful outcome of the osteotomy relies

  20. Principles of first metatarsal osteotomies.

    Science.gov (United States)

    Nyska, M

    2001-09-01

    Summarizing all the data while choosing the suitable procedure for hallux valgus deformity leads to classification of 3 main categories, which are based on the intermetatarsal angle (Table 1). Mild deformity has less than 15 degrees intermetatarsal angle, intermediate deformity has 15 degrees to 20 degrees intermetatarsal angle, and severe deformity has more than 20 degrees [table: see text] intermetatarsal angle. Every category may be divided further into low degree of DMAA (8 degrees) or high degree of DMAA (> 15 degrees). When choosing the correct procedure, the length of the first metatarsal has to be considered. In short first metatarsals, base angular osteotomies lead to further shortening of the metatarsal. Displacement osteotomies are preferred. In mild deformity, a distal osteotomy can be performed. If a mild deformity has a high DMAA, it can be corrected by a distal rotated chevron osteotomy. Intermediate deformity with a normal DMAA can be corrected by displacement osteotomies, and high DMAA can be corrected by rotated scarf of double osteotomy, which includes a base osteotomy to correct the intermetatarsal angle and a distal osteotomy, such as Riverdin, to correct the DMAA. Severe deformity can be corrected only by angular osteotomies. Inherently, these osteotomies increase the DMAA; they can be performed only in normal DMAA. Only a base angular osteotomy and distal rotation osteotomy can correct high levels of DMAA in severe intermetatarsal angles.

  1. Split Cord Malformations

    Directory of Open Access Journals (Sweden)

    Yurdal Gezercan

    2015-06-01

    Full Text Available Split cord malformations are rare form of occult spinal dysraphism in children. Split cord malformations are characterized by septum that cleaves the spinal canal in sagittal plane within the single or duplicated thecal sac. Although their precise incidence is unknown, split cord malformations are exceedingly rare and represent %3.8-5 of all congenital spinal anomalies. Characteristic neurological, urological, orthopedic clinical manifestations are variable and asymptomatic course is possible. Earlier diagnosis and surgical intervention for split cord malformations is associated with better long-term fuctional outcome. For this reason, diagnostic imaging is indicated for children with associated cutaneous and orthopedic signs. Additional congenital anomalies usually to accompany the split cord malformations. Earlier diagnosis, meticuolus surgical therapy and interdisciplinary careful evaluation and follow-up should be made for good prognosis. [Cukurova Med J 2015; 40(2.000: 199-207

  2. Tibial osteotomy - slideshow

    Science.gov (United States)

    ... GO GO About MedlinePlus Site Map FAQs Customer Support Health Topics Drugs & Supplements Videos & Tools Español You Are Here: Home → Medical Encyclopedia → Tibial osteotomy - series—Normal anatomy URL of this page: //medlineplus.gov/ency/presentations/ ...

  3. [Distal osteotomy for the treatment of hallux valgus (Chevron osteotomy)].

    Science.gov (United States)

    Stukenborg-Colsman, C; Claaßen, L; Ettinger, S; Yao, D; Lerch, M; Plaaß, C

    2017-05-01

    Distal osteotomies, like the Chevron osteotomy, is indicated for mild to moderate hallux valgus deformities. Splayfoot, painful pseudoexostosis, and transfer metatasalgia are observed in the clinical examination. Radiographic examination should be done with weight bearing in two planes. Preoperatively the intermetatarsal (IM), hallux valgus, and distal metatarsal articular (DMAA) angles should be measured. The operative technique is based on soft tissue and bony correction. Modifications of the osteotomy allow a shortening, lengthening, or neutral correction of the first metatarsal. With a modified Chevron osteotomy, an increased DMAA can be also corrected.

  4. Case Presentation of Sagittal Balance.

    Science.gov (United States)

    Kim, Paul K

    2016-04-01

    Sagittal balance is an important concept in spinal coronal and kyphotic deformity correction. Sagittal alignment/lumbar lordosis is increasingly recognized and discussed in terms of surgical outcomes. Positive sagittal balance can lead to development of iatrogenic kyphosis, flatback syndrome, adjacent level degeneration, and junctional kyphosis. This concept is no longer associated only with deformity. Spine surgeons have learned that sagittal alignment/lumbar lordosis is very important even in 1-level or 2-level interbody fusion procedures, and that it can be attained, maintained, or lost during any procedure, resulting in complications.

  5. Pediatric sagittal alignment.

    Science.gov (United States)

    Mac-Thiong, Jean-Marc; Labelle, Hubert; Roussouly, Pierre

    2011-09-01

    There is a wide variation in the regional parameters used to describe the spine and sacro-pelvis in children and adolescents. There is a slight tendency for thoracic kyphosis and lumbar lordosis to increase with age. Pelvic incidence and pelvic tilt also tend to increase during growth, while sacral slope remains relatively stable. Strong knowledge of the close relationships between adjacent anatomical regions of the spine and sacro-pelvis is the key when evaluating and interpreting sagittal spino-pelvic alignment. The scheme of correlations between adjacent regional parameters needs to be preserved in order to maintain a balanced posture. The net resultant from these relationships between adjacent anatomical regions is best represented by parameters of sagittal global balance. C7 plumbline tends to move backwards from childhood to adulthood, where it stabilizes or slightly moves forward secondary to degenerative changes. C7 plumbline in front of both hip axis and center of the upper sacral endplate occurs in 29% of subjects aged 3-10 years, 12% of subjects aged between 10 and 18 years, and 14% of subjects aged 18 years or older. Therefore, although most normal subjects stand with a C7 plumbline behind the hip axis, a C7 plumbline in front of both hip axis and sacrum can be seen in normal individuals. However, progressive forward displacement of C7 plumbline should raise a suspicion for the risk of developing spinal pathology.

  6. A technique of anterior screw removal through a posterior costotransversectomy approach for posterior-based osteotomies.

    Science.gov (United States)

    Lewis, Stephen J; David, Kenny; Singer, Syndie; Bacon, Sarah A; Kopka, Michaela; Gray, Randolph; Magana, Sofia

    2010-05-15

    Case report. To describe a novel technique to remove anterior instrumentation from a posterior approach while performing posterior-based osteotomies for spinal deformities. Posterior-based osteotomies such as pedicle subtraction osteotomies (PSOs) and vertebral column resections are performed to restore sagittal alignment. The removal of previously placed anterior implants at the desired osteotomy level can often be challenging. We propose a technique for the removal of anterior instrumentation through a posterior approach to facilitate osteotomy closure and deformity correction, while avoiding the need for an anterior incision. A 34-year-old woman presented with a residual deformity after several anterior and posterior procedures. The residual coronal Cobb angle measured 60 degrees between T7 and L2, with a 46 degrees thoracolumbar kyphosis between T10 and L2. The screw head at the desired osteotomy level was in close proximity to the liver after the previous right-sided thoracoabdominal approach. Therefore, the T11 anterior screw was accessed through a posterior costotransversectomy approach and disconnected from the rod proximally and distally with a high-speed side-cutting burr. A portion of the right lateral vertebral body of T11 was removed to expose the neck of the screw, which was separated from the shaft with the same burr. A PSO was performed at T11 and the remaining screw shank was removed with the posterior-based osteotomy. No major complications were encountered during the procedure. The anterior screw at T11 was removed from posteriorly, and the PSO was completed successfully. Postoperative recovery was without incident, and the patient was very satisfied with her results. This technique describes a novel, safe, and effective method to deal with anterior instrumentation from the posterior approach while performing posterior-based osteotomies for rigid spinal deformities.

  7. The "clamshell" craniotomy technique in treating sagittal craniosynostosis in older children.

    Science.gov (United States)

    Smyth, Matthew D; Tenenbaum, Marissa J; Kaufman, Christian B; Kane, Alex A

    2006-10-01

    Although most patients with sagittal craniosynostosis are recognized and treated in infancy, some children are not referred to craniofacial centers until later in childhood. In this paper the authors describe a novel operative technique for calvarial reconstruction in older children with previously untreated sagittal craniosynostosis. The authors report a clinical series of eight patients who were treated using novel single-stage calvarial reconstruction, and they assess the complications and outcomes. The patient is placed supine for the procedure, which consists of a coronal incision, bifrontal craniotomy without orbital osteotomy, and multiple interlocking midline parietooccipital osteotomies and recontouring. Fixation is achieved using a bioabsorbable plate system. Cranial indices were calculated from measurements obtained before and after the reconstructive procedures. Preoperative, intraoperative, and postoperative photographs and three-dimensional computed tomography scans are presented for review. Between November 2003 and April 2005, the authors treated seven boys (age range approximately 1-10 years, mean age 4.2 years) with uncorrected sagittal craniosynostosis and one with bicoronal and sagittal synostosis. The mean operating time was 5.13 hours (range 4.3-8 hours), with a mean blood loss of 425 ml (range 200-800 ml). As a percentage of the estimated circulating blood volume, the mean operative blood loss was 33.5% (range 17-57%). The mean hospital stay was 4.9 days. The cranial index significantly improved from a mean of 65.6 to 71.3% (p = 0.001). No acute or delayed complications have been noted. Follow-up examinations performed at an average of 12 months (range 1-17 months) have confirmed early patient and family satisfaction. An approach of aggressive calvarial reconstruction with multiple interleaving osteotomies crossing the midline achieves improvements in biparietal narrowing. Combined with a bifrontal reconstruction, early outcomes are excellent

  8. Adult Spinal Deformity: Sagittal Imbalance

    Directory of Open Access Journals (Sweden)

    Cavanilles-Walker JM

    2014-10-01

    Full Text Available Spinal sagittal imbalance, deformity of the spine in the sagittal plane, is nowadays a major cause of pain and disability among patients presenting to the spine clinic in daily practice. Normal sagittal spinal balance is a result of mutual articulation of the pelvis and the spine in the sagittal plane. Sagittal imbalance of the spine could be related to many spinal pathologies interesting primarily the spine or could appear after an instrumentation spinal surgery. Variations in the spine sagittal alignment can be compensated by compensatory mechanisms occurring in the spine, pelvis and lower limb areas. The main objective of these mechanisms is to allow the patient to keep an erect position within the cone of economy in an energy-efficient way. Once a spinal deformity surpasses these compensatory mechanisms surgical intervention is often requested. In this paper the Authors performed comprehensive a critical analysis of the rigidity of the deformity, including the spinal and pelvic parameters. The compensatory mechanisms are paramount in order to be able to offer a tailored solution to these patients. Since conservative measures fail in most patients, successful management of these patients requires achieving fusion of a balanced spine. Appropriate preoperative optimization as well as appropriate surgical preoperative planning are critical in order to avoid potential complications. Selecting the appropriate surgical technique to achieve spinal balance is crucial to success.

  9. T1 pelvic angle: a new predictor for postoperative sagittal balance and clinical outcomes in adult scoliosis.

    Science.gov (United States)

    Qiao, Jun; Zhu, Feng; Xu, Leilei; Liu, Zhen; Zhu, Zezhang; Qian, Bangping; Sun, Xu; Qiu, Yong

    2014-12-01

    A retrospective radiographical study. To compare the prediction abilities of T1 pelvic angle (TPA) and other parameters for postoperative sagittal balance, and investigate the relationships between these parameters and health-related quality of life. Using sagittal vertical axis (SVA) to assess sagittal alignment fails to take account of the pelvic compensation. A new parameter, TPA, has been recommended to represent the global sagittal balance of adult scoliosis. A retrospective review was performed on patients with adult scoliosis undergoing correction surgery from May 2009 to March 2013. The Spearman ρ was used to determine the correlations between the radiographical parameters (preoperative, postoperative, and changes) and the overall Oswestry Disability Index (ODI), visual analogue scale (VAS), and Scoliosis Research Society-22 (SRS-22) questionnaire scores. Significant correlations were found between the changes of TPA and the changes of lumbar lordosis, pelvic tilt, sacral slope, pelvic incidence, SVA, spinosacral angle, ODI, VAS, SRS-22, and pedicle subtraction osteotomy (PSO) degrees (P 0.05). Significant correlations were found between the changes of spinosacral angle and the changes of thoracolumbar kyphosis, TPA, ODI, VAS, SRS-22, and PSO degrees (P 0.05). TPA could better reflect the postoperative changes of sagittal alignment and health-related quality of life for patients with adult scoliosis. Moreover, the changes of TPA are strongly correlated to the osteotomy degrees for PSO and, TPA could be used as a reference parameter in surgical planning. 4.

  10. Embryo splitting

    Directory of Open Access Journals (Sweden)

    Karl Illmensee

    2010-04-01

    Full Text Available Mammalian embryo splitting has successfully been established in farm animals. Embryo splitting is safely and efficiently used for assisted reproduction in several livestock species. In the mouse, efficient embryo splitting as well as single blastomere cloning have been developed in this animal system. In nonhuman primates embryo splitting has resulted in several pregnancies. Human embryo splitting has been reported recently. Microsurgical embryo splitting under Institutional Review Board approval has been carried out to determine its efficiency for blastocyst development. Embryo splitting at the 6–8 cell stage provided a much higher developmental efficiency compared to splitting at the 2–5 cell stage. Embryo splitting may be advantageous for providing additional embryos to be cryopreserved and for patients with low response to hormonal stimulation in assisted reproduction programs. Social and ethical issues concerning embryo splitting are included regarding ethics committee guidelines. Prognostic perspectives are presented for human embryo splitting in reproductive medicine.

  11. Modified biplanar chevron osteotomy.

    Science.gov (United States)

    Corte-Real, Nuno M; Moreira, Rodrigo M

    2009-12-01

    The surgical treatment of hallux valgus with an increased distal metatarsal articular angle (DMAA) should include the correction of this angle to maintain a congruent joint. The purpose of this study was to report our results with this procedure. From January 2000 until December 2006, 23 feet (13 patients) with an increased DMAA were operated upon by the same surgeon using a biplanar chevron osteotomy. The technique was modified making the plantar cut more horizontal and only removing a wedge from the dorsal cut. Clinical and radiographic evaluation was made after a mean followup of 56 months. The AOFAS score for the hallux was used and angular deformities were measured. The patients had a mean age of 51 years and were all female. A good functional result was achieved with a mean AOFAS score of 87. An improvement of the angular deformities was noted in all patients. The mean hallux valgus angle improved from 28 degrees pre-op to 14 degrees post-op, the intermetatarsal angle from 12 degrees to 7 degrees and the DMAA from 20 degrees to 7 degrees. All patients except one were satisfied with the outcome of the procedure. Minimally symptomatic AVN of the metatarsal head was observed in one foot. We conclude that this procedure is a good choice for the treatment of symptomatic hallux valgus with an increased DMAA, producing a good clinical and radiographic result.

  12. Biplanar chevron osteotomy.

    Science.gov (United States)

    Nery, Caio; Barroco, Rui; Réssio, Cibele

    2002-09-01

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

  13. [The profile surgery. Mandibular osteotomies].

    Science.gov (United States)

    Sancho, M A; Grande, C; Parri, F J; Rivera, A; Sarget, R; Morales, L

    1996-04-01

    During the years 1987-1994, 31 mandibular osteotomies have been performed in 25 patients, 15 had mandibular alteration alone, 10 of them with prognatism, 2 with microretrognatia and 3 with chin hipoplasia. The other 10 had a combined maxillary-mandibular alteration with hipoplasia and maxillary retrussion. The preoperative work-up included cephalometric and dental study, and a cast model was done to asses the theoretical benefic of the osteotomy. All these patients underwent orthodontic treatment before and after surgery. The results have been good or very good in 96% of the cases. The ortognatic surgery offers significant aesthetic and functional improvement to these patients.

  14. Safety and efficacy of osteotomies in adult spinal deformity: what happens in the first year?

    Science.gov (United States)

    Ayhan, Selim; Aykac, Bilal; Yuksel, Selcen; Guler, Umit Ozgur; Pellise, Ferran; Alanay, Ahmet; Perez-Grueso, Francisco Javier Sanchez; Acaroglu, Emre

    2016-08-01

    Spinal surgery for adult spinal deformity (ASD) may require the use of osteotomies, which may have high complication rates (up to 80 %). These may be expected to affect health-related quality of life (HRQOL) in the early postoperative phase but little is known about the clinical course of these patients in the first year following surgery. The aim of the study is to evaluate the radiological results and HRQOL in patients undergoing a spinal osteotomy for ASD within the first year following surgery with special reference to the effect of complications. From a prospective multicenter ASD database, patients who had undergone a Smith-Petersen osteotomy (SPO), pedicle substraction osteotomy (PSO), vertebral column resection (VCR) or any combination of these were reviewed for radiological sagittal alignment parameters [sagittal vertical axis (SVA), global tilt, lumbar lordosis, T2-sagittal tilt (ST)] as well as HRQOL [Oswestry Disability Index (ODI), short form-36 items (SF-36) Physical Component Score (PCS), SF-36 mental CS (MCS), Scoliosis Research Society (SRS)-22 questionnaire (SRS-22) subtotal] preoperatively and at the 6th- and 12th-month follow-ups with special reference to complications classified as major (life threatening or requiring additional surgery) and minor and their effects on HRQOL. 121 patients (85 F, 36 M) with a total of 71 SPOs, 45 PSOs and 13 VCRs were evaluated. Osteotomy resulted in correction of the major coronal Cobb angle from 43.0 ± 3.7° to 24.8 ± 2.8° (p death were observed. Osteotomies were moderately effective in radiological improvement but resulted in a significant increase in HRQOL. They were associated with a high rate of complications but these had no/minimal effect on the clinical outcome. Contrary to the general perception, the greatest improvements in HRQOL were seen to take place during the first 6 months after surgery, even in the presence of complications.

  15. Spinal Realignment for Adult Deformity: Three-column Osteotomies Alter Total Hip Acetabular Component Positioning.

    Science.gov (United States)

    Barry, Jeffrey J; Yucekul, Altug; Theologis, Alexander A; Hansen, Erik N; Ames, Christopher; Deviren, Vedat

    2017-02-01

    A goal of adult spinal deformity surgery is correction of sagittal imbalance by increasing lumbar lordosis (LL), allowing a previously retroverted pelvis to normalize as evidenced by decreases in pelvic tilt (PT). Realignment of pelvic orientation may alter the position of preexisting total hip arthroplasties (THAs). Twenty-seven patients with unilateral THA who underwent thoracolumbar fusions for adult spinal deformity from the pelvis to L1 or above were retrospectively reviewed (levels fused, 10.3 [range, 6 to 17]; age, 70 ± 9 years). Comparisons of preoperative and postoperative spinal deformity parameters, acetabular tilt (AT), and acetabular cup abduction angle (CAA) were performed, with subgroup analysis for those who had undergone three-column osteotomy and those who had not. Preoperative deformity was severe, with findings of a sagittal vertical axis >9 cm, PT >25°, and pelvic incidence-LL >20°. Postoperatively, AT decreased significantly (-7° ± 10°; P Spinal deformity correction, with techniques such as three-column osteotomy, result in significant THA acetabular component repositioning in the sagittal plane. Resultant decreased AT (ie, retroversion) theoretically may affect tribology, wear, and joint stability and warrants further investigation.

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

    Directory of Open Access Journals (Sweden)

    Eric Klineberg

    2011-01-01

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

  17. Analysis of instrumentation failures after three column osteotomies of the spine.

    Science.gov (United States)

    Kavadi, Niranjan; Tallarico, Richard A; Lavelle, William F

    2017-01-01

    Correction of fixed spinal imbalance in a sagittal and/or coronal plane frequently needs a tricolumnar wedge resection when the deformity is rigid. Complications associated with deformity correction surgery are pseudoarthrosis and implant failure located along the construct. The purposes of this study were to assess comparative rates of pseudoarthrosis (implant failure) at weaker points along lumbosacral junction and level of osteotomy, estimate overall incidence of implant failure, and comparatively analyze failures at different points along the construct. This was an IRB approved, single center study retrospective analysis. Twenty-six patients who underwent three column osteotomies were grouped according to procedure: pedicle subtraction osteotomy (PSO, (n = 18)); vertebral column resection (VCR, (n = 4)); hemivertebra excision (HE, (n = 2)); and extracavitary corpectomy (EC, (n = 2)). Follow-up data is presented on all of the study patients. Number of levels of fusion, anchors, percent saturation of fixation levels, type of bone graft and graft substitutes, and rod material and diameter were recorded. Radiographical data was reviewed preoperatively and postoperatively at 2 weeks and 3, 6, and 12 months and annually to determine sagittal and coronal balance, lumbopelvic parameters, presence or absence of interbody structural support, laterality or rod failure, and time to implant failure. Twenty-seven percent (7/26) patients demonstrated rod breakage either unilaterally (N = 2) or bilaterally (N = 5) during follow-up. Seventy-one percent had increasing back pain or worsening sagittal balance, while remaining failures found incidentally. No failures in children were seen. Tricolumnar osteotomy by posterior approach is a valuable tool. Rod failures found approximately 1 year from surgery, with 86% located at level of osteotomy and 14% at lumbosacral junction. Possible reasons are increased stress in the rod at this point and relatively

  18. Is McMurray′s osteotomy obsolete?

    Directory of Open Access Journals (Sweden)

    Phaltankar P

    1995-10-01

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

  19. Surgical Treatment of Congenital Scoliosis Associated With Tethered Cord by Thoracic Spine-shortening Osteotomy Without Cord Detethering.

    Science.gov (United States)

    Huang, Jing-Hui; Yang, Wei-Zhou; Shen, Chao; Chang, Michael S; Li, Huan; Luo, Zhuo-Jing; Tao, Hui-Ren

    2015-10-15

    Retrospective case series. To investigate the safety and efficacy of spine-shortening osteotomy for congenital scoliosis with tethered cord. Conventional surgery for congenital scoliosis associated with tethered cord risks the complications of detethering. Spine-shortening osteotomy holds the potential to correct scoliosis and decrease spinal cord tension simultaneously without an extra detethering procedure, but no data on this issue is available. 21 patients (14 females and 7 males, average age 15.4 yr) underwent spine-shortening osteotomy without detethering. All of the patients had tethered cord. Patients with main curve more than 90° underwent vertebral column resection (VCR), whereas the others had pedicle subtraction osteotomy (PSO) performed. The average postoperative follow-up period was 45.2 months. The mean operation time was 544.5 min with average blood loss of 2769.1 ml. The deformity correction was 61.3% in the coronal plane and 43.9° in the sagittal plane. 10 patients had neurological deficits preoperatively. At the final follow-up, the deficits in 8 (80%) patients were significantly improved, whereas 2 (20%) remained unchanged. At final follow-up, 71.4% (5/7) patients reported improvement in motor function, 100% (3/3) had improved pain scores, and 75% (3/4) reported better sensory function after the spine-shortening osteotomy. Urinary dysfunction and bowel incontinence present preoperatively in 3 patients all recovered by final follow-up. 5 (23.8%) patients incurred complications including temporary neurological deterioration in 1 patient, urinary tract infection in 2 patients, cerebrospinal fluid leakage in 1 patient, and blood loss more than 5000 ml in 1 patient. Spine-shortening osteotomy is a safe and effective procedure for congenital scoliosis associated with tethered cord. Spine-shortening osteotomy at the thoracic apical vertebrae level not only corrects the spine deformity but also simultaneously releases the tension of the tethered cord

  20. Computer assisted SCFE osteotomy planning

    Energy Technology Data Exchange (ETDEWEB)

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

    2008-11-15

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

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

    Science.gov (United States)

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

    2011-09-01

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

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

    Science.gov (United States)

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

    2016-07-01

    The purpose of the present study was to evaluate the indications, safety, and treating orthodontists' assessment of outcomes after bimaxillary orthognathic surgery that included segmental osteotomies. We performed a retrospective cohort study of patients treated by a single surgeon from 2004 to 2013. The index group consisted of a consecutive series of subjects with a bimaxillary dentofacial deformity (DFD) involving the chin and symptomatic chronic obstructive nasal breathing. All the subjects underwent Le Fort I osteotomy, bilateral sagittal ramus osteotomy, septoplasty, inferior turbinate reduction, and osseous genioplasty. The predictor variables included age, gender, pattern of presenting DFD, type of maxillary osteotomy, and maxillary premolar extractions. The outcome variables included orthodontist assessment of the results achieved and the occurrence of maxillary complications. The orthodontist assessment was documented through a survey questionnaire completed 1 to 11 years after surgery. The maxillary complications studied included gingival recession, pulpal injury, oronasal fistula, and the need for hardware removal. During the study period, 262 subjects met the inclusion criteria. Their age at surgery averaged 25 years (range 13 to 63), and 134 were female (51%). The major patterns of the presenting DFD included long face (30%) and maxillary deficiency (25%). Of the 262 subjects, 66 (25%) underwent maxillary premolar extractions to relieve dental compensations. Also, 30% of the subjects presented for preoperative reassessment with a posterior arch form of skeletal anomaly. They underwent 2-segment Le Fort I osteotomy, and 34% presented with both posterior arch form and curve of Spee skeletal anomalies. They underwent 3-segment Le Fort I osteotomy. The subjects who had not undergone preoperative maxillary premolar extractions were more likely to have undergone 3-segment Le Fort I osteotomy (P = .008). No direct surgical injury occurred to a dental root

  3. A pedicle subtraction osteotomy as an adjunctive tool in the surgical treatment of a rigid thoracolumbar hyperkyphosis; a preliminary report.

    Science.gov (United States)

    van Loon, Piet J M; van Stralen, Gijs; van Loon, Corne J M; van Susante, Job L C

    2006-01-01

    A pedicle subtraction osteotomy can be considered as part of the surgical treatment of a symptomatic sagittal imbalance. The literature on the use of this technique is limited and thus far not applied to a rigid thoracolumbar hyperkyphosis. To evaluate our preliminary results of a pedicle subtraction osteotomy as an adjunctive tool in the surgical treatment of thoracolumbar kyphotic deformities. Case series Eleven patients with a symptomatic kyphotic deformity were treated with a thoracolumbar pedicle subtraction osteotomy in combination with a multilevel correction. The mean follow-up was 42.8 months (range 26-105). The clinical outcome, radiographic correction, and perioperative complications were analyzed. The results in six more traditional indications (ankylosing spondylitis, kyphoscoliosis, congenital and posttraumatic deformity), were compared with the results in a subgroup of five cases with a rigid thoracolumbar hyperkyphosis. All patients had a kyphotic thoracolumbar junction. An average of 5.8 levels was involved in the corrective fusion. A pedicle subtraction was always performed between the level Th10 and L2 to correct the sagittal balance. A lordotic correction of 38.8 (range 25-49) degrees was established with this fusion. The osteotomy contributed 66% (26.9 degrees) of the correction, whereas the remaining correction came from multilevel facetectomies. The visual analogue scale for both pain and impairment improved significantly (p<.005) for the entire group. Statistical analysis on the results for both subgroups separately was inappropriate because of the small number of patients available; however, overall both subgroups appeared to do equally well. All patients were very satisfied with the result and would choose surgical treatment again. No major complications were encountered. A pedicle subtraction osteotomy is a technically demanding but well tolerated operative procedure for the correction of a kyphotic deformity. This technique can also be

  4. A novel step osteotomy for correction of hemifacial microsomia – A case report

    OpenAIRE

    Howlader, Debraj; Bhutia, Dichen P.; Vignesh, U.; Mehrotra, Divya

    2016-01-01

    Facial asymmetry is one of the commonest facial anomalies, with reported incidence as high as 34%. Hemifacial microsomia (HFM) has an incidence of 1 in every 4000–5600 children and is one of the commonest causes of facial asymmetry. The standard treatment of HFM is orthognathic surgery by bilateral saggital split osteotomy (BSSO) or distraction osteogenesis (DO) of the mandible, both of which involve prolonged periods of occlusal adjustments by an orthodontist. Here, we present distraction of...

  5. Computerized preoperative planning for correction of sagittal deformity of the spine.

    Science.gov (United States)

    Aurouer, Nicolas; Obeid, Ibrahim; Gille, Olivier; Pointillart, Vincent; Vital, Jean-Marc

    2009-12-01

    Various methods of preoperative planning have been described for the correction of spinal sagittal deformities. They are reliable on condition that the thoracolumbar spine is totally fused and enable only the simulation of pedicle subtraction osteotomy (PSO). In this study, a new theoretical planning that can be used regardless of the etiology of the deformity and the type of osteotomy is described and assessed. The spino-pelvic sagittal balance can be expressed by two parameters: pelvic tilt (PT) and center of both acoustic meati (CAM) overhang. These two parameters vary according to the type, number, level, and angulation of osteotomies. The general principle of the planning is to define the surgical program in order to obtain PT and CAM overhang as close as possible to the normal values. The theoretical planning is based on a trigonometric construction which depends on numerous factors and is challenging to use in daily practice without the aid of a software tool. Modifications are proposed if the spine cannot be modeled as a solid beam due to unfused disks allowing relative motion. The SpineView software, which enables analysis and quick visualization of different correction possibilities, is presented. The planning method is assessed in a prospective cohort of 11 patients by comparing planned values of spino-pelvic parameters to postoperative values. In all, 8 preoperative plans out of 11 were concordant with the postoperative results. The preoperative planning enables the surgeon to estimate the clinical effects of the different surgical techniques in order to choose the best procedure for a given patient.

  6. Distal Metatarsal Osteotomy in Hallux Valgus Surgery: Chevron Osteotomy

    Directory of Open Access Journals (Sweden)

    Fatih Dogar

    2016-04-01

    Full Text Available Aim: Hallux valgus is a complex foot deformity resulting from medial deviation of first metatarsal and lateral deviation of toe. Radiographic and functional outcomes of chevron type distal metatarsal osteotomy applied to symptomatic hallux valgus patients with moderate deformity were assessed in the present study. Chevron osteotomy was applied to 27 feet (13 left, 14 right of 22 patients (12 women and 10 men; mean age: 45±16.7 years. Mean follow-up was 15.4± 4.71 months (range, 10%u201324. Material and Method: The average preoperative AOFAS score of 39.1 ± 8.55 (range, 32%u201357 improved (p < 0.0001 to 87.8 ± 4.7 (range, 82%u201397. The average preoperative hallux valgus angle (HVA of 37.4 ± 5.8 (range, 29%u201350 improved (p < 0.0001 to 14.8 ± 3.1 (range, 10%u201320 , and the average preoperative intermetatarsal 1-2 angle (IMA of 13.1 ± 1.5 (range, 11%u201317 improved (p < 0.0001 to 7.1 ± 1.4 (range, 5%u20139 . The average sesamoid position improved from 2.9 ± 0.2 (range, 2-3 preoperatively to 1.2 ± 0.4 (range, 1-2 (p < 0.0001. Toe hypoesthesia was developed in one patient as a complication. At the end of follow-up, patient satisfaction was found to be excellent in 16 feet (59.2% and good in 11 feet (40.8%. Results: The results of the study that chevron osteotomy yields good radiological result, high degree of postoperative patient satisfaction with minimal complications. Chevron ostoetomy is most effective method in the treatment of moderate hallux valgus.

  7. [Sagittal balance of the spine].

    Science.gov (United States)

    Mangione, P; Sénégas, J

    1997-01-01

    The authors examined the modifications of sagittal shape and muscular functions in different vertebral diseases in order to investigate their correlations and to specify the role of hip extension in standing posture. We included 57 patients presenting various diseases, among which lumbar kyphosis, spondylosis and spondylolisthesis, backache and lumbar stenosis. We measured joint mobility (hip extension, lumbar flexion), muscular retractions (ilio-psoas, hamstrings, rectus femoris), and muscular strength (spine flexors and extensors, hamstrings, quadriceps femoris). On standing lateral x-rays, measurements were made of various spinal and pelvic parameters, among which the "pelvi-femoral angle", proposed by the authors for hip extension evaluation. There was a significant correlation between pelvi-femoral angle and pelvic backward tilting (r = 0.8037 p tilt-up arise compensating the anterior displacement of the center of gravity, while in spondylolisthesis, anterior displacement is secondary to sacral obliquity. It is very important to evaluate the pelvis position in sagittal spinal diseases, in order to understand postural deterioration mechanisms. Lumbar kyphosis and spondylolisthesis are two examples of failure of upright posture.

  8. Hemivertebra resection and osteotomies in congenital spine deformity.

    Science.gov (United States)

    Ruf, Michael; Jensen, Rubens; Letko, Lynn; Harms, Jürgen

    2009-08-01

    Retrospective study of posterior hemivertebra resection and osteotomies with transpedicular instrumentation in very young children. Assessment of early intervention in congenital scoliosis with almost complete correction of the main deformity. There is a trend to early correction of congenital deformities, however, there is a lack of long-term follow-up. Forty-one children aged 1 to 6 years with congenital scoliosis were operated on by hemivertebra resection by a posterior only approach with transpedicular instrumentation. Mean age at time of surgery was 3 years 5 months. They were retrospectively studied with a mean follow-up of 6 years 2 months. In group 1 (patients without bar formation), the average Cobb angle of the main curve was 36 degrees before surgery and 7 degrees after surgery. Compensatory cranial curve improved spontaneously from 15 degrees to 3 degrees, compensatory caudal curve from 17 degrees to 4 degrees. The angle of kyphosis was 22 degrees before surgery and 8 degrees after surgery. In group 2 (patients with bar formation) the main curve improved from 69 degrees to 23 degrees, cranial curve from 27 degrees to 11 degrees, caudal curve from 34 degrees to 14 degrees, and kyphosis from 24 degrees to 9 degrees. Posterior hemivertebra resection, in case of bar formation with osteotomy of the bar, allows for excellent correction in both the frontal and sagittal planes, with a short segment of fusion. Early surgery in young children prevents the development of severe local deformities and secondary structural curves, thus allowing for normal growth in the unaffected parts of the spine.

  9. Puerperal Superior Sagittal Sinus Thrombosis and Pulmonary ...

    African Journals Online (AJOL)

    Superior sagittal sinus thrombosis is a rare and often misdiagnosed disorder. Its occurrence with pulmonary embolism (PE) is much rarer, more so when it occurs in the setting of puerperium. Although cerebral sagittal sinus thrombosis can occur at any time during life, women are particularly vulnerable before delivery and ...

  10. Three-dimensional translations following posterior three-column spinal osteotomies for the correction of severe and stiff kyphoscoliosis.

    Science.gov (United States)

    Li, Xueshi; Huang, Zifang; Deng, Yaolong; Fan, Hengwei; Sui, Wenyuan; Wang, Chongwen; Yang, Junlin

    2017-06-07

    Posterior three-column spinal osteotomies were shown to be effective to treat severe and stiff kyphoscoliosis. Translations at the site of osteotomy after deformity correction were commonly seen intraoperatively, which might cause potential neurologic deficits. However, this phenomenon was not thoroughly discussed in the current literature. This study aimed to evaluate the three-dimensional (3D) translations at the three-column osteotomy site and their effects on neurologic outcome in the surgical correction of severe and stiff kyphoscoliosis. A retrospective study was carried out. Sixty-nine patients treated by posterior three-column spinal osteotomy for severe kyphoscoliosis of idiopathic, congenital, neuromuscular, neurofibromatosis, and tuberculosis origin were included. General, coronal, and sagittal translations were graded three-dimensionally according to the theory of Meyerding. The charts of 69 clinical patients with severe and stiff kyphoscoliosis treated by posterior three-column osteotomy from January 2013 to June 2015 were reviewed. There were 35 male patients with an average age of 21.5 years and 34 female patients with an average age of 22.5 years. The etiologies of these spinal deformities were idiopathic, congenital, neuromuscular, neurofibromatosis, and tuberculosis. According to our classification system of spinal cord neurologic function, there were 41 type A, 13 type B, and 15 type C cases. The 3D spine models were reconstructed from thin-sliced computed tomography (CT) scan, and the 3D translations at the three-column osteotomy site were graded and analyzed. The incidences of general translation (GT), frontal translation (FT), and sagittal translation (ST) were 62.3%, 52.2%, and 26.1%. The incidence of evoked potential (EP) change in cases with GT/FT being or more than grade II (GT, 42.9%; FT, 50.0%) was significantly higher than that with GT/FT being less than grade II (GT, 16.7%; FT, 18.2%), whereas the incidence of EP change in cases with

  11. Accuracy assessment of surgical planning and three-dimensional-printed patient-specific guides for orthopaedic osteotomies.

    Science.gov (United States)

    Sys, Gwen; Eykens, Hannelore; Lenaerts, Gerlinde; Shumelinsky, Felix; Robbrecht, Cedric; Poffyn, Bart

    2017-06-01

    This study analyses the accuracy of three-dimensional pre-operative planning and patient-specific guides for orthopaedic osteotomies. To this end, patient-specific guides were compared to the classical freehand method in an experimental setup with saw bones in two phases. In the first phase, the effect of guide design and oscillating versus reciprocating saws was analysed. The difference between target and performed cuts was quantified by the average distance deviation and average angular deviations in the sagittal and coronal planes for the different osteotomies. The results indicated that for one model osteotomy, the use of guides resulted in a more accurate cut when compared to the freehand technique. Reciprocating saws and slot guides improved accuracy in all planes, while oscillating saws and open guides lead to larger deviations from the planned cut. In the second phase, the accuracy of transfer of the planning to the surgical field with slot guides and a reciprocating saw was assessed and compared to the classical planning and freehand cutting method. The pre-operative plan was transferred with high accuracy. Three-dimensional-printed patient-specific guides improve the accuracy of osteotomies and bony resections in an experimental setup compared to conventional freehand methods. The improved accuracy is related to (1) a detailed and qualitative pre-operative plan and (2) an accurate transfer of the planning to the operation room with patient-specific guides by an accurate guidance of the surgical tools to perform the desired cuts.

  12. Management of sagittal balance in adult spinal deformity with minimally invasive anterolateral lumbar interbody fusion: a preliminary radiographic study.

    Science.gov (United States)

    Manwaring, Jotham C; Bach, Konrad; Ahmadian, Amir A; Deukmedjian, Armen R; Smith, Donald A; Uribe, Juan S

    2014-05-01

    Minimally invasive (MI) fusion and instrumentation techniques are playing a new role in the treatment of adult spinal deformity. The open pedicle subtraction osteotomy (PSO) and Smith-Petersen osteotomy (SPO) are proven segmental methods for improving regional lordosis and global sagittal parameters. Recently the MI anterior column release (ACR) was introduced as a segmental method for treating sagittal imbalance. There is a paucity of data in the literature evaluating the alternatives to PSO and SPO for sagittal balance correction. Thus, the authors conducted a preliminary retrospective radiographic review of prospectively collected data from 2009 to 2012 at a single institution. The objectives of this study were to: 1) investigate the radiographic effect of MI-ACR on spinopelvic parameters, 2) compare the radiographic effect of MI-ACR with PSO and SPO for treatment of adult spinal deformity, and 3) investigate the radiographic effect of percutaneous posterior spinal instrumentation on spinopelvic parameters when combined with MI transpsoas lateral interbody fusion (LIF) for adult spinal deformity. Patient demographics and radiographic data were collected for 36 patients (9 patients who underwent MI-ACR and 27 patients who did not undergo MI-ACR). Patients included in the study were those who had undergone at least a 2-level MI-LIF procedure; adequate preoperative and postoperative 36-inch radiographs of the scoliotic curvature; a separate second-stage procedure for the placement of posterior spinal instrumentation; and a diagnosis of degenerative scoliosis (coronal Cobb angle > 10° and/or sagittal vertebral axis > 5 cm). Statistical analysis was performed for normality and significance testing. Percutaneous transpedicular spinal instrumentation did not significantly alter any of the spinopelvic parameters in either the ACR group or the non-ACR group. Lateral MI-LIF alone significantly improved coronal Cobb angle by 16°, and the fractional curve significantly

  13. Changes in Cervical Alignment after Multilevel Schwab Grade II Thoracolumbar Osteotomies for Adult Spinal Deformity.

    Science.gov (United States)

    Ghobrial, George M; Lebwohl, Nathan H; Green, Barth A; Gjolaj, Joseph P

    2017-05-19

    Retrospective Cohort OBJECTIVE.: To describe changes in cervical alignment(CA) and deformity (CD) after multilevel Schwab Grade II Osteotomies for adult spinal deformity (ASD). Reciprocal cervical and global changes after ASD surgery have not been previous described in the setting of multilevel osteotomy. Patients with long-segment (> 5 levels) fusion and osteotomy for ASD were radiographically evaluated. Pre- and post-operative cervical parameters evaluated included cervical lordosis (CL), C2-C7 sagittal vertical axis (C2-C7 SVA), and the T1 slope (T1S) minus the CL (T1S-CL). CD was defined as C2-C7 SVA >4 cm, CL SVA) was 7.54 ± 6.7 cm, pelvic tilt (PT) was 30.0° ± 8.96°, lumbopelvic mismatch was 32° ± 17.1°, and the T1 pelvic angle (TPA) was 26.8° ± 12.9°. The C7 SVA and TPA corrected to 3.90 cm (p SVA from 10.1 cm to 6.37 cm (p SVA (ρ=.624, p SVA and CLIn this study, the presence of any single preoperative CD criterion was noted to be a risk for persistent global deformity on postoperative radiograph (OR = 2.5) and the development of PJK (OR = 2.1). The T1-CL < 15° may indicate an even greater risk for persistent 3global deformity (OR = 3.5). Thoracolumbar fusion with multilevel Schwab Grade II Osteotomies was associated with a decreased CL and reciprocal increases in TK and T1S-CL. 3.

  14. Brain structure in sagittal craniosynostosis

    Science.gov (United States)

    Paniagua, Beatriz; Kim, Sunghyung; Moustapha, Mahmoud; Styner, Martin; Cody-Hazlett, Heather; Gimple-Smith, Rachel; Rumple, Ashley; Piven, Joseph; Gilmore, John; Skolnick, Gary; Patel, Kamlesh

    2017-03-01

    Craniosynostosis, the premature fusion of one or more cranial sutures, leads to grossly abnormal head shapes and pressure elevations within the brain caused by these deformities. To date, accepted treatments for craniosynostosis involve improving surgical skull shape aesthetics. However, the relationship between improved head shape and brain structure after surgery has not been yet established. Typically, clinical standard care involves the collection of diagnostic medical computed tomography (CT) imaging to evaluate the fused sutures and plan the surgical treatment. CT is known to provide very good reconstructions of the hard tissues in the skull but it fails to acquire good soft brain tissue contrast. This study intends to use magnetic resonance imaging to evaluate brain structure in a small dataset of sagittal craniosynostosis patients and thus quantify the effects of surgical intervention in overall brain structure. Very importantly, these effects are to be contrasted with normative shape, volume and brain structure databases. The work presented here wants to address gaps in clinical knowledge in craniosynostosis focusing on understanding the changes in brain volume and shape secondary to surgery, and compare those with normally developing children. This initial pilot study has the potential to add significant quality to the surgical care of a vulnerable patient population in whom we currently have limited understanding of brain developmental outcomes.

  15. Radiographic diagnosis of sagittal plane rotational displacement in pelvic fractures: a cadaveric model and clinical case study.

    Science.gov (United States)

    Shui, Xiaolong; Ying, Xiaozhou; Kong, Jianzhong; Feng, Yongzeng; Hu, Wei; Guo, Xiaoshan; Wang, Gang

    2015-08-01

    Our objective was to measure the sagittal plane rotational (flexion and extension) displacement of hemipelvis radiologically and analyze the ratio of flexion and extension displacement of unstable pelvic fractures. We used 8 cadaveric models to study the radiographic evidence of pelvic fractures in the sagittal plane. We performed pelvic osteotomy on 8 cadavers to simulate anterior and posterior pelvic ring injury. Radiological data were measured in the flexion and extension group under different angles (5°, 10°, 15°, 20°, and 25°). We retrospectively reviewed 164 patients who were diagnosed with a unilateral fracture of the pelvis. Pelvic ring displacement was identified and recorded radiographically in cadaveric models. The flexion and extension displacement of pelvic fractures was measured in terms of the vertical distance of fracture from the top of iliac crest to the pubic tubercle (CD) or from the top of iliac crest to the lowest point of ischial tuberosity (AB). Fifty-seven pelves showed flexion displacement and 15 showed extension displacement. Closed reduction including internal fixation and external fixation was successfully used in 141 cases (86.0 %). The success rates of closed reduction in flexion and extension displacement groups were 77 and 73 %, respectively, which were lower than in unstable pelvic ring fractures. The sagittal plane rotation (flexion and extension) displacement of pelvic fractures could be measured by special points and lines on the radiographs. Minimally invasive reduction should be based on clearly identified differences between the sagittal plane rotation and the vertical displacement of pelvic fractures.

  16. C7-T1 anterior closing wedge bone-disc-bone osteotomy for the treatment of cervical hyperlordosis in muscular dystrophy: a new technique for correction of a rare deformity.

    Science.gov (United States)

    Kose, Kamil Cagri; Caliskan, Islam; Bal, Emre; Inanmaz, Mustafa Erkan; Isik, Cengiz

    2014-08-15

    A new surgical technique of cervical closing wedge osteotomy to correct an extension deformity of the cervical spine in patients with muscular dystrophy presenting clinically with debilitating hyperlordosis is described, and 3 cases are reported. To describe a new surgical technique with emphasis on the clinical results and the effect of osteotomy on sagittal balance, gaze angle, and spinopelvic parameters. Previous reports of cervical osteotomy essentially have described opening wedge (extension osteotomy) for correction of severe flexion deformities. To the authors' knowledge, C7-T1 closing wedge osteotomy to correct hyperextension deformity due to muscular dystrophy in the cervical spine has not been described previously. Three male patients aged 16, 16, and 21 years presented with cervical hyperlordosis due to Becker muscular dystrophy. There was upward deviation of forward gaze in all patients. Anterior closing wedge (bone-disc-bone) osteotomy of C7-T1 was performed followed with a posterior release correction and instrumented stabilization. The chin-brow angle was visualized with the aid of fluoroscopy during the operation. After closure and posterior fixation, patient was turned supine again and the osteotomy site was grafted and fixed with a plate to further strengthen the construct and to prevent any translation. The gaze angles and both sitting and standing postures of the patients markedly improved. There was documented fusion at the osteotomy sites. The patients were free of complaints at the last follow-up. Bone-disc-bone closing wedge osteotomy done at C7-T1 level is a technically demanding procedure but results in significant acute clinical and radiological improvement in patients with hyperextension deformity of the cervical spine. 4.

  17. A novel step osteotomy for correction of hemifacial microsomia - A case report.

    Science.gov (United States)

    Howlader, Debraj; Bhutia, Dichen P; Vignesh, U; Mehrotra, Divya

    2016-01-01

    Facial asymmetry is one of the commonest facial anomalies, with reported incidence as high as 34%. Hemifacial microsomia (HFM) has an incidence of 1 in every 4000-5600 children and is one of the commonest causes of facial asymmetry. The standard treatment of HFM is orthognathic surgery by bilateral saggital split osteotomy (BSSO) or distraction osteogenesis (DO) of the mandible, both of which involve prolonged periods of occlusal adjustments by an orthodontist. Here, we present distraction of the mandible by means of a novel modified step osteotomy to correct the facial asymmetry in a case of hemifacial microsomia without disturbing the occlusion. This novel technique can prove to be a new tool in the maxillofacial surgeons armamentarium to treat facial asymmetry.

  18. Analysis of sagittal spinopelvic parameters in achondroplasia.

    Science.gov (United States)

    Hong, Jae-Young; Suh, Seung-Woo; Modi, Hitesh N; Park, Jong-Woong; Park, Jung-Ho

    2011-08-15

    Prospective radiological analysis of patients with achondroplasia. To analyze sagittal spinal alignment and pelvic orientation in achondroplasia patients. Knowledge of sagittal spinopelvic parameters is important for the treatment of achondroplasia, because they differ from those of the normal population and can induce pain. The study and control groups were composed of 32 achondroplasia patients and 24 healthy volunteers, respectively. All underwent lateral radiography of the whole spine including hip joints. The radiographic parameters examined were sacral slope (SS), pelvic tilt, pelvic incidence (PI), S1 overhang, thoracic kyphosis, T10-L2 kyphosis, lumbar lordosis (LL1, LL2), and sagittal balance. Statistical analysis was performed to identify significant differences between the two groups. In addition, correlations between parameters and symptoms were sought. Sagittal spinopelvic parameters, namely, pelvic tilt, pelvic incidence, S1 overhang, thoracic kyphosis, T10-L2 kyphosis, lumbar lordosis 1 and sagittal balance were found to be significantly different in the patient and control groups (P achondroplasia patients and normal healthy controls. The present study shows that sagittal spinal and pelvic parameters can assist the treatment of spinal disorders in achondroplasia patients.

  19. Splitting Descartes

    DEFF Research Database (Denmark)

    Schilhab, Theresa

    2007-01-01

    Kognition og Pædagogik vol. 48:10-18. 2003 Short description : The cognitivistic paradigm and Descartes' view of embodied knowledge. Abstract: That the philosopher Descartes separated the mind from the body is hardly news: He did it so effectively that his name is forever tied to that division....... But what exactly is Descartes' point? How does the Kartesian split hold up to recent biologically based learning theories?...

  20. Ischiofemoral impingement secondary to valgus intertrochanteric osteotomy: a case report

    Directory of Open Access Journals (Sweden)

    Alice Duarte de Carvalho

    Full Text Available Abstract We report an unusual case of ischiofemoral impingement secondary to valgus intertrochanteric osteotomy. The osteotomy was performed for treatment of epiphysiolysis of the left femoral head.

  1. Nasal osteotomies: a cadaveric study of fracture lines.

    Science.gov (United States)

    Gabra, Nathalie; Rahal, Akram; Ahmarani, Christian

    2014-01-01

    The different nasal osteotomy patterns used to perform rhinoplasty are poorly described in the literature, and there is a continuous debate between surgeons on the ideal sequence and technique to obtain desired results. (1) To evaluate the necessity of a paramedian osteotomy when performing a high-low-high (HLH) osteotomy, (2) to study the fracture pattern of a high-low-low (HLL) osteotomy when combined with a paramedian osteotomy in the presence and in the absence of a transverse osteotomy, and (3) to evaluate the mobility of the central segment (located between the paramedian osteotomies) after digital pressure and the ideal osteotomy to mobilize it if needed. This was a prospective cadaveric study performed in the dissection laboratory in our tertiary referral center. Twenty cadavers were divided in 2 groups of 10. Group A had a paramedian osteotomy combined with an HLH osteotomy on 1 side and an HLH osteotomy alone on the other side. Group B had a paramedian combined with a transverse osteotomy followed by HLL osteotomy on 1 side. On the other side, we performed a paramedian combined with an HLL osteotomy. Finally, we evaluated the mobility of the central segment in group B, first with digital manipulation and then with a transverse osteotomy. The 3 authors evaluated individually the different fracture patterns. A result was considered successful when (1) the fracture followed the desired pattern, (2) a continuous line was obtained, and (3) a complete mobilization of the nasal segment was visualized. In group A, the side without a paramedian osteotomy had more unstable and greenstick fractures than the other side (P Digital manipulation alone was not enough to mobilize the central segment in 8 of the 10 cadavers studied. Following this study we make the following suggestions: (1) to perform a paramedian osteotomy when an HLH osteotomy is needed, (2) to perform a transverse osteotomy before an HLL osteotomy when combined with paramedian osteotomy, and (3) to

  2. Osteotomy of the Spine to Correct the Spinal Deformity

    OpenAIRE

    Kim, Ki-Tack; Park, Kyoung-Jun; Lee, Jung-Hee

    2009-01-01

    There are a number of reports on Smith-Petersen osteotomy (SPO), pedicle subtraction osteotomy (PSO) and vertebral column resection (VCR). However, there are few systematic reviews of all three kinds of osteotomies. Literature review and author's experience of SPO, PSO and VCR osteotomy will be described. Various surgical techniques can be applied according to the disease entity and magnitude of the deformity. The most appropriate methods for deformity correction should be chosen and the pote...

  3. Computer simulation of two-level pedicle subtraction osteotomy for severe thoracolumbar kyphosis in ankylosing spondylitis

    Directory of Open Access Journals (Sweden)

    Ning Zhang

    2017-01-01

    Full Text Available Background: Advanced ankylosing spondylitis is often associated with thoracolumbar kyphosis, resulting in an abnormal spinopelvic balance and pelvic morphology. Different osteotomy techniques have been used to correct AS deformities, unfortunnaly, not all AS patients can gain spinal sagittal balance and good horizontal vision after osteotomy. Materials and Methods: Fourteen consecutive AS patients with severe thoracolumbar kyphosis who were treated with two-level PSO were studied retrospectively. All were male with a mean age of 34.9 ± 9.6 years. The followup ranged from 1–5 years. Preoperative computer simulations using the Surgimap Spinal software were performed for all patients, and the osteotomy level and angle determined from the computer simulation were used surgically. Spinal sagittal parameters were measured preoperatively, after the computer simulation, and postoperatively and included thoracic kyphosis (TK, lumbar lordosis (LL, sagittal vertical axis (SVA, pelvic incidence, pelvic tilt (PT, and sacral slope (SS. The level of correlation between the computer simulation and postoperative parameters was evaluated, and the differences between preoperative and postoperative parameters were compared. The visual analog scale (VAS for back pain and clinical outcome was also assessed. Results: Six cases underwent PSO at L1 and L3, five cases at L2 and T12, and three cases at L3 and T12. TK was corrected from 57.8 ± 15.2° preoperatively to 45.3 ± 7.7° postoperatively (P < 0.05, LL from 9.3 ± 17.5° to −52.3 ± 3.9° (P < 0.001, SVA from 154.5 ± 36.7 to 37.8 ± 8.4 mm (P < 0.001, PT from 43.3 ± 6.1° to 18.0 ± 0.9° (P < 0.001, and SS from 0.8 ± 7.0° to 26.5 ± 10.6° (P < 0.001. The LL, VAS, and PT of the simulated two-level PSO were highly consistent with, or almost the same as, the postoperative parameters. The correlations between the computer simulations and postoperative parameters were significant. The VAS decreased

  4. The Level of Fibula Osteotomy and Incidence of Peroneal Nerve ...

    African Journals Online (AJOL)

    2010-06-29

    Jun 29, 2010 ... Osteotomy of the fibula is an inseparable component of tibial osteotomy and may be performed at different levels. Studies have shown that the site of osteotomy of the fibula contributes to the incidence of peroneal nerve palsy (PNP).[1-4] Significant complications were observed in adults who had fibular.

  5. Intertrochanteric osteotomy for posttraumatic arthritis after acetabular fractures

    NARCIS (Netherlands)

    Marti, R. K.; Chaldecott, L. R.; Kloen, P.

    2001-01-01

    To evaluate the long-term results of intertrochanteric osteotomies for posttraumatic arthritis after acetabular fractures. Retrospective study of eight patients who underwent a total of ten intertrochanteric osteotomies. Two patients underwent two osteotomies of the same hip. Academic Level I trauma

  6. Proximal femoral osteotomy in cerebral palsy.

    Science.gov (United States)

    Tylkowski, C M; Rosenthal, R K; Simon, S R

    1980-09-01

    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. Secondary fractures of Le Fort I osteotomy.

    Science.gov (United States)

    Wilson, M W; Maheshwari, P; Stokes, K; Wheatley, M J; McLoughlin, S; Talbot, M; Shults, W T; Dailey, R A; Wobig, J L

    2000-07-01

    To report the ophthalmic complications of Le Fort I osteotomy for the correction of dentofacial deformities and to determine the maximal compressive loads applied during pterygomaxillary separation in a cadaver model. Two cases of ophthalmic complications arising after Le Fort I osteotomy are reported. Le Fort I osteotomy was performed on five cadavers. The maximal compressive load applied during pterygomaxillary separation was recorded with a 10 kN (3,000 lbf) load cell of a MTS Mini-Bionix servo-hydraulic machine (MTS, Eden Prairie, MN, U.S.A.). A paired t test was used to compare forces applied to the right and left sides. Computed tomography scans of each specimen were obtained after Le Fort I osteotomy to document secondary fractures. The skulls were subsequently stained with 1% fuschin red to highlight secondary fractures. Maximum compressive loads during pterygomaxillary separation ranged from 22 N (5.0 lbf) to 162 N (36.5 lbf), with an average of 106 N (23.8 lbf) (SD 47.6 N [10.7 lbf]). Forces applied on the first operative side were significantly greater than forces applied on the second operative side (p = 0.0034). Secondary fractures were found in three specimens by computed tomography and in two specimens by 1% fuschin red. All secondary fractures occurred on the second operative side. Secondary fractures in the Le Fort I osteotomy procedures occurred on the side opposite the greater maximal compressive load and on the second operative side.

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

    Science.gov (United States)

    Krengel, W F; Staheli, L T

    1992-10-01

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

  9. Complex ankle arthrodesis with step-cut osteotomy in Charcot arthropathy with bone loss.

    Science.gov (United States)

    Booth, Sean; Ballal, Moez; Pillai, Anand

    2017-03-01

    We report a case of a complex limb salvage ankle arthrodesis in a patient with Charcot arthropathy. A step-cut osteotomy was performed in order to tackle the issues of anterior tibial bone loss; worsening leg length discrepancy; soft tissue contraction; joint instability and high risk of non-union. The construct formed by the step-cut allowed for the preservation of good bone stock; avoidance of further limb shortening; increased torsional stability and increased surface area for bony union. This resulted in a patient with a stable, plantigrade foot appropriate for footwear. We use this case to highlight this technique as an option in the operative management of complex ankle fusions with sagittal or coronal plane deformity with bone loss and subluxation of the ankle joint. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  10. Rotational Osteotomy for Hallux Valgus. A New Technique for Primary and Revision Cases

    Science.gov (United States)

    Ortiz, Cristian; Wagner, Emilio

    2017-01-01

    More than 200 different surgical techniques exist for hallux valgus (HV). Some of them are designed for mild, moderate, or severe deformities depending on their correction power. Nevertheless, they all correct only the coronal and/or sagittal plane deformity. Just a handful of them correct the known axial malrotation that exists in most HV cases. This malrotation is one possible factor that could be the source of recurrence of an operated HV as it has been described. We describe a new technique which simultaneously corrects the metatarsal internal rotation and varus deformity by rotating the metatarsal through an oblique plane osteotomy. This is performed with no bone wedge resection. Also, there is a broader bone surface contact than on a transverse proximal osteotomy. This technique is easy to remember and relatively simple to perform in primary and revision cases. The authors results show that it is as safe and effective as other procedures, with some advantages to be discussed. Levels of Evidence: Diagnostic Level 5. See Instructions for Authors for a complete description of levels of evidence. PMID:28286430

  11. Clinical and radiological outcome after periacetabular osteotomy

    DEFF Research Database (Denmark)

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

    2014-01-01

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

  12. Periacetabulaer osteotomi og hoftedysplasi hos yngre voksne

    DEFF Research Database (Denmark)

    Troelsen, Anders; Søballe, Kjeld

    2009-01-01

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

  13. Puerperal Superior Sagittal Sinus Thrombosis and Pulmonary ...

    African Journals Online (AJOL)

    Superior sagittal sinus thrombosis is a rare and often misdiagnosed disorder. Its occurrence with pulmonary embolism (PE) .... and prolonged immobilization, hence, the possibility that her PE could have resulted from superior ... been forgotten and was alluded to by Diaz etal., as “a syndrome rediscovered in their report.”[20].

  14. Evolution of Sagittal Imbalance Following Corrective Surgery for Sagittal Plane Deformity.

    Science.gov (United States)

    McDowell, Michael M; Tempel, Zachary J; Gandhoke, Gurpreet S; Khattar, Nicholas K; Hamilton, D Kojo; Kanter, Adam S; Okonkwo, David O

    2017-07-01

    Sagittal balance in adult spinal deformity is a major predictor of quality of life. A temporary loss of paraspinal muscle force and somatic pain following spine surgery may limit a patient's ability to maintain posture. To assess the evolution of sagittal balance and clinical outcomes during recovery from adult spinal deformity surgery. Retrospective review of a prospective observational database identified a consecutive series of patients with sagittal vertical axis (SVA) > 40 mm undergoing adult deformity surgery. Radiographic parameters and clinical outcomes were measured out to 2 yr after surgery. A total of 113 consecutive patients met inclusion criteria. Mean preoperative SVA was 90.3 mm, increased to 104.6 mm in the first week, then gradually reduced at each follow-up interval to 59.2 mm at 6 wk, 45.0 mm at 3 mo, 38.6 mm at 6 mo, and 34.1 mm at 1 yr (all P sagittal alignment did not fully reflect surgical correction of sagittal balance until 6 mo after adult deformity surgery. Sagittal balance initially worsened then steadily improved at each interval over the first year postoperatively. At 1 yr, all clinical and radiographic measures outcomes were significantly improved.

  15. Altering the angulation of a curved osteotome--does it have effects on the type of pterygomaxillary disjunction in Le Fort I osteotomy? An experimental study.

    Science.gov (United States)

    Stajcić, Z

    1991-10-01

    A standard Le Fort I osteotomy was performed on 12 cadavers to determine whether the incidence of pterygoid plate fractures could be reduced by increasing the angle of the curved osteotome relative to the sagittal plane. In the group where an osteotome with the usual angulation was employed, fractures occurred on 9 of 12 sides. In the increased angulation group, 5 of 12 pterygoid plates were fractured. All fractures were restricted to the level of the horizontal osteotomy cut. It is concluded that increased angulation of a curved osteotome can decrease the incidence of fractures of the pterygoid plates. This procedure, however, is not recommended because it can cause fracture of the palatine bone or displacement of the fractured pterygoid plate fragment posteriorly.

  16. Radiological morphology variances of osteotomized vertebra-disc complex following pedicle subtraction osteotomy for ankylosing spondylitis with thoracolumbar kyphosis: the incidence, mechanisms and prognosis.

    Science.gov (United States)

    Mao, Sai-Hu; Feng, Zong-Xian; Qian, Bang-Ping; Qiu, Yong

    2017-12-15

    Inaccurate osteotomy cut along with incomplete or even subluxated bone-on-bone closure of osteotomy gap following pedicle subtraction osteotomy (PSO) may be disastrous, hampering the lordosing effect and increasing the likelihood of complications. The inelastic yet osteoporotic spine in ankylosing spondylitis (AS) is specially predisposed to such suboptimal osteotomy, while the relevant data concerning this issue is scarce. To analyze the incidence of radiological morphology variances (RMV) of osteotomized vertebra-disc complex (OVDC) following PSO in kyphotic AS patients, conceptualize the mechanisms of the deviated morphology and investigate the prognosis. Retrospective radiological data analysis. The sample being screened comprises 71 thoracolumbar kyphotic AS patients who underwent single level PSO at our hospital between March 2006 to February 2014. They were stratified by the presence of bridging syndesmophytes (BS) locating within OVDC. Any irregular radiological configuration of OVDC other than the wedge morphology would be considered as RMV and were studied with care to fully describe and classify the spectrum of deviated morphological features. Multiple spino-pelvic sagittal parameters were measured to assess both the regional lordosing effect and the global realignment of sagittal spinal profile. For each selected patient with confirmed RMV, the radiological morphology was assessed, defined and categorized. The prognosis involving surgical corrections and maintenance of spino-pelvic sagittal parameters, as well as the remodeling in disordered osteotomized vertebral shape over time, were also investigated. The incidence of RMV was 21.9% in positive BS Group (PG) and 30.8% in negative BS Group (NG). Inappropriate angle and range of osteotomy accounted for the largest share (1 no. for PG and 10 no. for NG, 57.9%) of mechanisms responsible for RMV, followed by vertebral subluxation (VS) (5 no. for PG and 2 no. for NG, 36.8%) and failed osteotomy gap closure

  17. Sagittal Balance in Adolescent Idiopathic Scoliosis

    Science.gov (United States)

    Xu, Xi-Ming; Wang, Fei; Zhou, Xiao-Yi; Liu, Zi-Xuan; Wei, Xian-Zhao; Bai, Yu-Shu; Li, Ming

    2015-01-01

    Abstract The relationship between spinal sagittal alignment and pelvic parameters is well known in adolescent idiopathic scoliosis. However, few studies have reported the sagittal spinopelvic relationship after selective posterior fusion of thoracolumbar/lumbar (TL/L) curves. We evaluated the relationship between spinal sagittal alignment and the pelvis, and analyzed how the pelvic sagittal state is adjusted in Lenke type 5C patients. We conducted a retrospective study of 36 patients with Lenke type 5C curves who received selective posterior TL/L curve fusion. Coronal and spinopelvic sagittal parameters were pre and postoperatively compared. Pearson coefficients were used to analyze the correlation between all spinopelvic sagittal parameters before and after surgery. We also evaluated 3 pelvic morphologies (anteverted, normal, and retroverted) before and after surgery. Preoperatively, the mean pelvic incidence was 46.0°, with a pelvic tilt and sacral slope (SS) of 8.2° and 37.8°, respectively, and 25% (9/36) of patients had an anteverted pelvis, whereas the other 75% had a normal pelvis. Postoperatively, 42% (15/36) of patients had a retroverted pelvis, 53% (19/36) had a normal pelvis, and 2 patients had an anteverted pelvis. Logistic regression analyses yielded 2 factors that were significantly associated with the risk for a postoperative unrecovered anteverted pelvis, including increased lumbar lordosis (LL) (odds ratio [OR] 4.8, P = 0.029) and increased SS (OR 5.6, P = 0.018). Four factors were significantly associated with the risk of a postoperative newly anteverted pelvis, including LL at the final follow-up (OR 6.9, P = 0.009), increased LL (OR 8.9, P = 0.003), LL below fusion (OR 9.4, P = 0.002), and increased SS (OR 11.5, P = 0.001). The pelvic state may be adjusted after selective posterior TL/L curve fusion in Lenke 5C adolescent idiopathic scoliosis patients. It is difficult to improve an anteverted pelvis in patients who have

  18. Effect and Strategy of 1-stage Interrupted 2-level Transpedicular Wedge Osteotomy for Correcting Severe Kyphotic Deformities in Ankylosing Spondylitis.

    Science.gov (United States)

    Zhao, Yongfei; Wang, Yan; Wang, Zheng; Zhang, Xuesong; Mao, Keya; Zhang, Yonggang

    2017-05-01

    Prospective study. To investigate the safety, outcome, and strategy of the 1-stage interrupted 2-level transpedicular wedge osteotomy for correcting the severe kyphotic deformity in ankylosing spondylitis (AS). There has been a large series in the literature reporting on results of osteotomy for the correction of kyphotic deformity secondary to AS. However, few articles have reported, in detail, the plan, design, strategy, and effect of 1-stage interrupted 2-level transpedicular wedge osteotomy for the correction of severe kyphotic deformity in AS. From May 2003 to February 2010, 24 consecutive patients, 17 males and 7 females, suffering from AS with severe spinal kyphosis, underwent 1-stage interrupted 2-level transpedicular wedge osteotomy in our hospital by the corresponding author. Improvements in relevant parameters were recorded and clinical results were evaluated. The average operating time was 282±43 minutes, and the average blood loss was 2202±737 mL. All the global and regional spinal alignments improved to relatively normal status: the global thoracolumbar kyphosis angle improved from 101.5±10.8 to 24.8±5.8 degrees (P<0.001), the thoracolumbar kyphosis improved from 37.9±5.1 to 0.7±12.8 degrees (P<0.001), and the lumbar lordosis improved from 35.0±9.2 to -25.7±10.9 degrees (P<0.001). Meanwhile, the chin-brow vertical angle improved from 79.5±5.1 to 8.5±2.7 degrees (P<0.001), and the sagittal imbalance distance improved from 49.6±6.5 to 11.5±3.5 cm (P<0.001). All the patients could walk with horizontal vision and lie on their backs postoperatively, and scoliosis research society-22 scores improved from 1.6±0.2 preoperatively to 4.3±0.2 at the 2-year follow-up. The mean time of follow-up was 52±28 months. Fusion of the osteotomy was achieved in each patient and no instances of loss of correction or implant failure were noted. For correcting severe kyphosis in patients with AS, the 1-stage interrupted 2-level transpedicular wedge osteotomy is

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

    DEFF Research Database (Denmark)

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

    2016-01-01

    BACKGROUND: Different techniques of proximal osteotomies have been introduced to correct severe hallux valgus. The open wedge osteotomy is a newly introduced method for proximal osteotomy. The aim of this prospective randomized study was to compare the radiological and clinical results after...... operation for severe hallux valgus, comparing the open wedge osteotomy to the crescentic osteotomy which is our traditional treatment. METHODS: Forty-five patients with severe hallux valgus (hallux valgus angle >35̊, and intermetatarsal angle >15̊) were included in this study. The treatment was proximal...... and 12 months after the operation. RESULTS: In group 1 the hallux valgus angle decreased from 39.0̊ to 24.1̊ after 4 months and 27.9̊ after 12 months. In group 2 the angle decreased from 38.3̊ to 21.4̊ after 4 months and 27.0̊ after 12 months. The intermetatarsal angle in group 1 was 19.0̊ preoperatively...

  20. Ellis-van Creveld Syndrome with Sagittal Craniosynostosis.

    Science.gov (United States)

    Fischer, Andrew S; Weathers, William M; Wolfswinkel, Erik M; Bollo, Robert J; Hollier, Larry H; Buchanan, Edward P

    2015-06-01

    Ellis-van Creveld syndrome (EVC) is a rare disorder (the incidence is estimated at around 7/1,000,000) characterized by the clinical tetrad of chondrodystrophy, polydactyly, ectodermal dysplasia, and cardiac anomalies. Sagittal synostosis is characterized by a dolichocephalic head shape resulting from premature fusion of the sagittal suture. Both are rare disorders, which have never been reported together. We present a case of EVC and sagittal synostosis. We report the clinical features of a Hispanic boy with EVC and sagittal craniosynostosis who underwent cranial vault remodeling. The presentation of this patient is gone over in detail. A never before reported case of EVC and sagittal synostosis is presented in detail.

  1. Ulnar shortening osteotomy with a new sliding-hole plate.

    Science.gov (United States)

    Kitzinger, Hugo B; Löw, Steffen; Krimmer, Hermann

    2003-09-01

    Ulnar shortening osteotomy represents a common procedure for surgical treatment of the ulnar impaction syndrome but is still associated with complications like malrotation, angulation, or malunion because of incomplete closure of the osteotomy gap. Therefore, the authors developed a special 7-hole compression plate that allows fixation of the ulna before the osteotomy is carried out to prevent rotation. With this plate, a shortening of up to 10 mm is possible and the compression holes allow closure of the osteotomy gap. The plate has been used in 23 ulnar shortening cases at their center with good results. The authors describe the technique and report their results of ulnar shortening with this device.

  2. Morphological segmentation for sagittal plane image analysis.

    Science.gov (United States)

    Bezerra, F N; Paula, I C; Medeiros, F S; Ushizima, D M; Cintra, L S

    2010-01-01

    This paper introduces a morphological image segmentation method by applying watershed transform with markers to scale-space smoothed images and furthermore provides images for clinical monitoring and analysis of patients. The database comprises sagittal plane images taken from a digital camera of patients submitted to Global Postural Reeducation (GPR) physiotherapy treatment. Orthopaedic specialists can use these segmented images to diagnose posture problems, assess physiotherapy treatment evolution and thus reduce diagnostic errors due to subjective analysis.

  3. Combination tibial plateau leveling osteotomy and cranial closing wedge osteotomy of the tibia for the treatment of cranial cruciate ligament-deficient stifles with excessive tibial plateau angle.

    Science.gov (United States)

    Talaat, Miriam B; Kowaleski, Michael P; Boudrieau, Randy J

    2006-12-01

    To describe a surgical technique, and outcome, for treatment of cranial cruciate ligament (CrCL) deficient stifle joints with excessive tibial plateau angle (TPA) by combined tibial plateau leveling osteotomy and cranial closing wedge osteotomy (TPLO/CCWO). Retrospective clinical study. Fifteen client-owned dogs (18 stifle joints). Medical records of dogs that had TPLO/CCWO were reviewed. Pre- and postoperative TPA, CCWO technique, method of fixation and complications were recorded. In-hospital re-evaluation of limb function and length of time to radiographic healing was reviewed. Long-term outcome was assessed by owner telephone interview. Mean pre- and postoperative TPA was 42 degrees and 8 degrees, respectively. The Slocum biradial saw was used to create the CCWO in 4 stifle joints (mean postoperative TPA, 16 degrees) and a sagittal saw was used in 14 stifle joints (mean postoperative TPA, 5 degrees). Postoperative surgical complications were documented in 77.8% of cases; including patellar tendon thickening (61.1%), and implant loosening or breakage (27.8%), seroma formation (11.1%), and local irritation (11.1%). A second surgical procedure was performed in one-third of cases primarily to retrieve implants. Mean time to documented radiographic healing was 18 weeks. Final in-hospital re-evaluation of limb function (mean, 23 weeks postoperatively) was recorded as no lameness in 73.3% and mild lameness in 26.7%. All interviewed owners were satisfied with outcome and 90.9% reported marked improvement or a return to preinjury status. Long-term clinical outcome of TPLO/CCWO was very good in dogs with excessive TPA, with high owner satisfaction. Longer healing times and a higher complication rate were observed compared with TPLO alone. TPLO/CCWO of the tibia in stifle joints with excessive TPA allows for full correction of the TPA to 5 degrees without eliminating buttress support of the tibial tuberosity.

  4. [Anatomy in relation to posterior maxillary osteotomy].

    Science.gov (United States)

    Hua, Z; Chen, Z; Hu, X

    2000-09-01

    The most common site of haemorrhage in maxillary osteotomies is the posterior maxilla. Better understanding of the anatomy of this region would minimize possible vascular complications. The aim of this study is to investigate the anatomy of posterior maxilla and establish safety guidelines for Le Fort I osteotomy. Thirty dry human skulls were selected for direct measurement and computerized image analysis. Synosteosis of the pterygomaxillary junction was noted in 10% of the samples. The height of the pterygomaxillary junction was 13.15 mm. The height from the inferior point of the pterygomaxillary junction to the inferior point of the maxillary tuberosity was 5.25 mm. The height from the superior point of the pterygomaxillary junction to the inferior point of the maxillary tuberrosity was 18.05 mm. The average distance from the piriform rim to the descending palatine canal was 35.25 mm. The width of the pterygoid process was 12.34 mm. The average length from the zygo-alveolar ridge to the pterygomaxillary junction was 25.47 mm. The average length from anterior nasal spine to the posterior nasal spine was 46.27 mm, and the angle between the descending palatine canal and the palate plane was 58 degrees 47'. The study is to provide further understanding of the posterior maxillary anatomy in relation to the bone-cut design of Le fort I osteotomy and to create clinical safety guidelines in order to avoid damaging the descending palatine vessels.

  5. Analysis of sagittal balance of ankylosing spondylitis using spinopelvic parameters.

    Science.gov (United States)

    Lee, Jung Sub; Suh, Kuen Tak; Kim, Jeung Il; Goh, Tae Sik

    2014-05-01

    Prospective study. To analyze sagittal spinopelvic parameters in ankylosing spondylitis (AS) patients. There are little data on the relationship between the sagittal spinopelvic parameters and AS. The study and control groups comprised 90 AS patients and 40 controls. Participants were classified into 3 groups: normal (n=40), sagittal balance (n=58), and sagittal imbalance (n=32) groups. All underwent lateral radiograph of the whole spine including hip joints. The radiographic parameters were sacral slope, pelvic tilting, pelvic incidence, overhang of S1, thoracic kyphosis, lumbar lordosis, and C7 plumbline. Statistical analysis was performed to identify significant differences between the 2 groups. Correlations between radiological parameters and symptoms were sought. AS patients and controls were found to be significantly different in terms of sagittal balance, sacral slope, pelvic tilt, pelvic incidence, S1 overhang, and lumbar lordosis. However, no significant difference was observed between these 2 groups for thoracic kyphosis (P>0.05). Of the 90 AS patients, 32 patients (5 women and 27 men) were assigned to the sagittal imbalance group and 58 (12 women and 46 men) to the sagittal balance group. There was a significant difference in all sagittal parameters and visual analogue scale (VAS) score between these 2 groups. Correlation analysis revealed significant relationships between sagittal parameters in AS. However, there was no association between sacral slope and S1 overhang, and between pelvic incidence and VAS score. Stepwise logistic regression analysis revealed that pelvic tilt contributed significantly to sagittal balance. AS patients and normal controls were found to be significantly different in terms of sagittal spinopelvic parameters. Significant relationships were found between sagittal spinopelvic parameters in AS patients. Pelvic tilt was a significant parameter in determination of sagittal balance in AS patient. Furthermore, VAS scores were

  6. The Sagittal Pelvic Thickness: A Determining Parameter for the Regulation of the Sagittal Spinopelvic Balance

    OpenAIRE

    Jean, Legaye

    2013-01-01

    Objective. To propose and validate a dimensional parameter, the sagittal pelvic thickness (SPT) (distance between the middle point of the upper sacral plate and the femoral heads axis, expressed as a ratio with the length of the upper plate of S1: (SPT/S1) for the analysis of the sagittal balance of the pelvispinal unit. Methods. The parameters were analysed on standing radiographic imaging and compared for normal, low back pain, children, and spondylolysis cases. Results. Values of SPT/S1 we...

  7. The use of the T1 sagittal angle in predicting overall sagittal balance of the spine.

    Science.gov (United States)

    Knott, Patrick T; Mardjetko, Steven M; Techy, Fernando

    2010-11-01

    A balanced sagittal alignment of the spine has been shown to strongly correlate with less pain, less disability, and greater health status scores. To restore proper sagittal balance, one must assess the position of the occiput relative to the sacrum. The assessment of spinal balance preoperatively can be challenging, whereas predicting postoperative balance is even more difficult. This study was designed to evaluate and quantify multiple factors that influence sagittal balance. Retrospective analysis of existing spinal radiographs. A retrospective review of 52 adult spine patient records was performed. All patients had full-column digital radiographs that showed all the important skeletal landmarks necessary for accurate measurement. The average age of the patient was 53 years. Both genders were equally represented. The radiographs were measured using standard techniques to obtain the following parameters: scoliosis in the coronal plane; lordosis or kyphosis of the cervical, thoracic, and lumbar spine; the T1 sagittal angle (angle between a horizontal line and the superior end plate of T1); the angle of the dens in the sagittal plane; the angle of the dens in relation to the occiput; the sacral slope; the pelvic incidence; the femoral-sacral angle; and finally, the sagittal vertical axis (SVA) measured from both the dens of C2 and from C7. It was found that the SVA when measured from the dens was on average 16 mm farther forward than the SVA measured from C7 (psagittal angle was found to have a moderate positive correlation (r=0.65) with SVA(dens), psagittal T1 tilt can be used as a good predictor of overall sagittal balance. When examining the other variables, it was found that cervical lordosis had a weak correlation (r=0.37) with SVA(dens) that was unexpected, given that cervical lordosis determines head position. Thoracic kyphosis also had a weak correlation (r=0.26) with SVA(C1), which was equally surprising. Lumbar lordosis had a slightly higher correlation

  8. Triple pelvic osteotomy in the treatment of hip dysplasia

    Directory of Open Access Journals (Sweden)

    Vukašinović Zoran

    2009-01-01

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

  9. Z-osteotomy in hallux valgus: clinical and radiological outcome after Scarf osteotomy

    Directory of Open Access Journals (Sweden)

    Marcus Jaeger

    2009-05-01

    Full Text Available Correction osteotomies of the first metatarsal are common surgical approaches in treating hallux valgus deformities whereas the Scarf osteotomy has gained popularity. The purpose of this study was to analyze short- and mid-term results in hallux valgus patients who underwent a Scarf osteotomy. The subjective and radiological outcome of 131 Scarf osteotomies (106 hallux valgus patients, mean age: 57.5 years, range: 22-90 years were retrospectively analyzed. Mean follow-up was 22.4 months (range: 6 months-5 years. Surgical indications were: intermetatarsal angle (IMA of 12-23°; increased proximal articular angle (PAA>8°, and range of motion of the metatarsophalangeal joint in flexion and extension >40°. Exclusion criteria were severe osteoporosis and/or osteoarthritis. The mean subjective range of motion (ROM of the great toe post-surgery was 0.8±1.73 points (0: full ROM, 10: total stiffness. The mean subjective cosmetic result was 2.7±2.7 points (0: excellent, 10: poor. The overall post-operative patient satisfaction with the result was high (2.1±2.5 points (0: excellent, 10: poor. The mean hallux valgus angle improvement was 16.6° (pre-operative mean value: 37.5° which was statistically significant (p<0.01. The IMA improved by an average of 5.96° from a pre-operative mean value of 15.4° (p<0.01. Neither osteonecrosis of the distal fragment nor peri-operative fractures were noted during the follow-up. In keeping with our follow-up results, the Scarf osteotomy approach shows potential in the therapy of hallux valgus. 筻

  10. Patella height changes post high tibial osteotomy

    Directory of Open Access Journals (Sweden)

    Siew Ghim Gooi

    2017-01-01

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

  11. Coded Splitting Tree Protocols

    DEFF Research Database (Denmark)

    Sørensen, Jesper Hemming; Stefanovic, Cedomir; Popovski, Petar

    2013-01-01

    This paper presents a novel approach to multiple access control called coded splitting tree protocol. The approach builds on the known tree splitting protocols, code structure and successive interference cancellation (SIC). Several instances of the tree splitting protocol are initiated, each...... as possible. Evaluations show that the proposed protocol provides considerable gains over the standard tree splitting protocol applying SIC. The improvement comes at the expense of an increased feedback and receiver complexity....

  12. Radiological analysis of ankylosing spondylitis patients with severe kyphosis before and after pedicle subtraction osteotomy.

    Science.gov (United States)

    Debarge, Romain; Demey, Guillaume; Roussouly, Pierre

    2010-01-01

    This is a radiographic study of ankylosing spondylitis patients with severe fixed kyphotic deformity who underwent pedicle subtraction osteotomy. Our goal was to measure and validate new angle to assess global kyphosis and to evaluate the radiological outcomes after surgery. This is the first report which describes new angle to assess global kyphosis (T1-S1). Pre and postoperative controls were compared according to the Pelvic Incidence. The sagittal parameters ankylosing spondylitis patients were compared with 154 asymptomatic patients. In addition to the pelvic parameters and the C7 tilt, we used the spino-sacral angle. Pelvic incidence in ankylosing spondylitis patients was higher than asymptomatic population (61 vs. 51 degrees). For a same tilt of C7 for both groups, the low pelvic incidence group had a lower sacral slope and pelvic tilt and a higher global kyphosis (spino-sacral angle = 90 degrees) than the high pelvic incidence group (spino-sacral angle = 98 degrees ). In the adult volunteers, the C7 tilt and spino-sacral angle measured, respectively, 95 and 135 degrees. The preoperative C7 tilt measured 73 degrees and increased to 83 degrees (p = 0.0025). The preoperative spino-sacral angle measured 96 degrees and increased to 113.3 degrees (p = 0.003). A low pelvic incidence pelvis has a lower sacral slope than in high pelvic incidence and can support a bigger kyphosis. All the parameters were improved by the pedicle subtraction osteotomy, but the average spino-sacral angle remained lower than the control group. When C7 tilt was useful to assess the improvement of the balance, SSA allowed a better evaluation of the correction of kyphosis itself.

  13. Single Level Proximal Thoracic Pedicle Subtraction Osteotomy for Fixed Hyperkyphotic Deformity: Surgical Technique and Patient Series.

    Science.gov (United States)

    Obeid, Ibrahim; Diebo, Bassel G; Boissiere, Louis; Bourghli, Anouar; Cawley, Derek T; Larrieu, Daniel; Pointillart, Vincent; Challier, Vincent; Vital, Jean Marc; Lafage, Virginie

    2017-07-22

    Thoracic hyperkyphosis can display pathological deterioration, resulting in either hyperlordotic cervical compensation or sagittal malalignment. Various techniques have been described to treat fixed malalignment. Pedicle subtraction osteotomy (PSO) is commonly used in the lumbar spine and frequently limited to the distal thoracic spine. This series focuses on the surgical specificities of proximal thoracic PSO, with clinical and radiological outcomes. To report the surgical specificities and assess the clinical and radiological outcomes of proximal thoracic osteotomies for correction of rigid kyphotic deformities. This is a retrospective review of 10 consecutive patients who underwent single level proximal thoracic PSO (T2-T5). Preoperative and postoperative full-body EOS TM radiographs, perioperative data, and complications were recorded. The surgical technique and its nuances were described in detail. Patients had mean age of 41.8 yr and 50% were female. The technique provided correction of segmental and global kyphosis, 26.6° and 29.5°, respectively. Patients reported reciprocal reduction in C2-C7 cervical lordosis (37.6°-18.6°, P  hyperkyphosis (R = 0.840, P  = .002). Mean operative time was 291 min, blood loss 1650 mL, and mean hospital stay was 13.8 d. Three patients reported complications that were resolved, including 1 patient who was revised because of a painful cross link. There were no neurological complications, pseudarthroses, instrumentation breakage, or wound infections at a minimum of 2-yr follow-up. Proximal thoracic PSO can be a safe and effective technique to treat fixed proximal thoracic hyperkyphosis leading to kyphosis reduction and craniocervical relaxation.

  14. Navigation-Assisted Nasal Bone Osteotomy for Malunited Fracture.

    Science.gov (United States)

    Ogino, Akihiro; Onishi, Kiyoshi; Nakamichi, Miho; Okaneya, Tetsuya

    2018-01-01

    Nasal bone osteotomy subjectively judges the position for osteotomy by visual inspection and by manual feel using the fingertip. Therefore, the outcome depends on the surgeon's experience and mastery of the procedure is technically challenging. The authors applied a navigation system for the intraoperative evaluation of the osteotomy line and reduction position in 5 patients with malunited nasal bone fracture. The authors performed the operation with a temporal bone post developed for otologic surgery using Stealth Station S7 System (Medtronic, Minneapolis, MN). The suretrack is attached to the bone chisel. The authors performed the osteotomies while visualizing the tip of the chisel on the monitor.In addition, evaluation of the reduction position was performed by insertion of a 23G needle syringe with the suretrack to the nasal bone surface. The tip of the bone chisel was visible on the monitor, and the authors could perform osteotomies while confirming the position and direction of osteotomy. In addition, the reduction position could be visualized clearly on the monitor. Navigation systems can confirm the 3-dimensional spatial relationship around the fracture site in real time, requiring only comparatively simple preoperative preparation and intraoperative operation without radiation exposure. Therefore, the advantage is that even an inexperienced surgeon can perform an accurate evaluation. This would be useful as a guide for young doctors and medical students as it would be possible to perform safe and accurate osteotomy for old nasal bone fractures.

  15. Ulnar shortening osteotomy with a premounted sliding-hole plate.

    Science.gov (United States)

    Kitzinger, Hugo B; Karle, Birgit; Löw, Steffen; Krimmer, Hermann

    2007-06-01

    Ulnar shortening osteotomy represents a common procedure for various ulnar-sided wrist disorders but is still associated with complications like malrotation, angulation, or nonunion because of incomplete closure of the osteotomy gap. We describe the use of a newly developed palmarly placed sliding-hole dynamic compression plate that allows fixation of the ulna before the oblique osteotomy is carried out. We performed ulnar shortening osteotomy on 27 consecutive patients. The indication was ulnar impaction syndrome in 25 patients and symptomatic ulnar plus variance secondary to malunited distal radial fracture in 2 patients. The mean preoperative ulnar variance was +2.1 mm (range, +1 mm to +8 mm). All patients were evaluated before and after surgery and graded with the Disability of Arm-Shoulder-Hand (DASH) scoring system. All 27 osteotomies healed uneventfully over an average of 9.2 +/- 2.1 weeks. The mean postoperative ulnar variance was -2.1 mm (range, -3.1 mm to 0 mm). There were significant improvements in DASH score, pain, and grip strength at an average follow-up of 8.1 months. Six patients complained of plate irritation. Favorable results suggest that ulnar shortening osteotomy using an oblique osteotomy and a premounted sliding-hole compression plate avoids malrotation and angulation and is associated with satisfactory outcomes. This device does not require an assisting device, which minimizes the surgical exposure of the ulna. Palmar placement of the plate seems to reduce hardware irritation.

  16. Chin Wing Osteotomy for Bilateral Goldenhar Syndrome Treated by "Chin Wing Mentoplasty": Aesthetic, Functional, and Histological Considerations.

    Science.gov (United States)

    Cortese, Antonio; Pantaleo, Giuseppe; Amato, Massimo; Claudio, Pier Paolo

    2015-07-01

    Various treatment strategies have been proposed to perform the aesthetic surgical correction of asymmetric deformities of the mandible. These techniques range from relatively simple to complex procedures including bimaxillary surgery associated with complex mandibular osteotomies. The authors describe a patient with grade III Goldenhar syndrome, treated by a "chin wing" mentoplasty as described by Triaca. These situations are classically treated with a bilateral sagittal splint osteotomy (BSSO) in combination with mentoplasty. However, because of a good occlusion with Angle's class I relation, slight imbalance of the occlusal plane with good function of the mouth opening, the patient refused to be treated with a BSSO, hence, a chin wing mentoplasty was performed. Size and stability of bone regeneration were evaluated by histological examination and dynamic-volume computed tomography (CT). Mature bone in the grafted areas was detected by histology and CT scan with stable results and a significant increase of facial aesthetics 1 year after surgery. The authors also demonstrated that the chin wing technique provided a little but significant breathing improvement as detected on CT scans and lateral X-ray cephalograms by measuring the breathing area. Chin wing mentoplasty is a moderately invasive technique that is able to improve the aesthetics of the face and patient breathing.

  17. Complications in bilateral mandibular distraction osteogenesis using internal devices

    NARCIS (Netherlands)

    van Strijen, P. J.; Breuning, K. H.; Becking, A. G.; Perdijk, F. B. T.; Tuinzing, D. B.

    2003-01-01

    We sought to evaluate the possibility of distraction osteogenesis as an alternative to conventional bilateral sagittal split osteotomy. Complications (intraoperative, intradistraction, and postdistraction) were evaluated retrospectively. Seventy consecutive patients (40 males and 30 females,

  18. Ellis–van Creveld Syndrome with Sagittal Craniosynostosis

    Science.gov (United States)

    Fischer, Andrew S.; Weathers, William M.; Wolfswinkel, Erik M.; Bollo, Robert J.; Hollier, Larry H.; Buchanan, Edward P.

    2014-01-01

    Ellis–van Creveld syndrome (EVC) is a rare disorder (the incidence is estimated at around 7/1,000,000) characterized by the clinical tetrad of chondrodystrophy, polydactyly, ectodermal dysplasia, and cardiac anomalies. Sagittal synostosis is characterized by a dolichocephalic head shape resulting from premature fusion of the sagittal suture. Both are rare disorders, which have never been reported together. We present a case of EVC and sagittal synostosis. We report the clinical features of a Hispanic boy with EVC and sagittal craniosynostosis who underwent cranial vault remodeling. The presentation of this patient is gone over in detail. A never before reported case of EVC and sagittal synostosis is presented in detail. PMID:26000085

  19. Craniotomy of the Fused Sagittal Suture Over the Superior Sagittal Sinus Is a Safe Procedure.

    Science.gov (United States)

    Kölby, David; Fischer, Sara; Arab, Khalid; Maltese, Giovanni; Olsson, Robert; Paganini, Anna; Tarnow, Peter; Kölby, Lars

    2017-05-01

    Spring-assisted cranioplasty to correct sagittal synostosis is based on midline craniotomy through the closed sagittal suture, over the superior sagittal sinus (SSS). The aim of the present study was to evaluate the perioperative safety of this technique. This is a retrospective study of all patients operated with median craniotomy and springs from 1998 to the end of 2015. For comparison, all Pi-plasties performed during the same time interval were also evaluated. The safety measures were evaluated based on incidence of damage to SSS, incidence of dural tears, perioperative blood loss, operative time, and hospital stay. In the group that had undergone midline craniotomy combined with springs (n = 225), 4 perioperative damages to SSS and 1 dural tear were seen. The perioperative blood loss was 62.8 ± 65.3 mL (mean ± standard deviation). The operative time was 67.9 ± 21.5 minutes and the hospital stay was 4.8 ± 1.1 days. In the group that had undergone pi-plasty (n = 105), no damages to SSS but 3 dural tears were seen. The perioperative blood loss was 352.8 ± 174.4 mL. The operative time was 126.0 ± 31.7 minutes and the hospital stay was 7.1 ± 1.4 days. Craniotomy SSS in sagittal synostosis is a safe procedure with low morbidity in terms of damage to the SSS. Midline craniotomy combined with springs has significantly lower preoperative blood loss, operative time, and hospital stay (P < 0.001 for all) compared to pi-plasty.

  20. Alveolar Ridge Split Technique Using Piezosurgery with Specially Designed Tips

    Directory of Open Access Journals (Sweden)

    Alessandro Moro

    2017-01-01

    Full Text Available The treatment of patients with atrophic ridge who need prosthetic rehabilitation is a common problem in oral and maxillofacial surgery. Among the various techniques introduced for the expansion of alveolar ridges with a horizontal bone deficit is the alveolar ridge split technique. The aim of this article is to give a description of some new tips that have been specifically designed for the treatment of atrophic ridges with transversal bone deficit. A two-step piezosurgical split technique is also described, based on specific osteotomies of the vestibular cortex and the use of a mandibular ramus graft as interpositional graft. A total of 15 patients were treated with the proposed new tips by our department. All the expanded areas were successful in providing an adequate width and height to insert implants according to the prosthetic plan and the proposed tips allowed obtaining the most from the alveolar ridge split technique and piezosurgery. These tips have made alveolar ridge split technique simple, safe, and effective for the treatment of horizontal and vertical bone defects. Furthermore the proposed piezosurgical split technique allows obtaining horizontal and vertical bone augmentation.

  1. Comparison of Ponte Osteotomies and 3-Column Osteotomies in the Treatment of Congenital Spinal Deformity.

    Science.gov (United States)

    Chan, Priscella; Andras, Lindsay M; Nielsen, Ena; Sousa, Ted; Joiner, Elizabeth; Choi, Paul D; Tolo, Vernon T; Skaggs, David L

    2017-08-02

    Congenital spinal deformity (CSD) has traditionally been treated with 3-column osteotomies [hemivertebrectomy (HV) or vertebral column resection (VCR)] to address rigid deformities. Alternatively, multiple Ponte osteotomies (PO) may provide correction while minimizing risk. The purpose of this study was to compare safety and outcomes of patients undergoing surgical treatment for CSD with these 3 procedures. Retrospective review of CSD patients treated with posterior spinal fusion between 1996 to 2013. Patients treated with multiple Ponte osteotomies (PO group) were compared with those managed with 3-column osteotomies (HV/VCR group). Patients with previous instrumentation, isolated cervical deformity, growing spine instrumentation, or Deformity angular ratio (DAR) was calculated as curve magnitude divided by number of levels of the deformity. There were 49 patients [17 PO, 32 HV/VCR (26 HV, 6 VCR)]. For the PO group, mean age was 14 years, and they had an average of 4 ponte osteotomies and 11 levels fused. Mean total DAR was 25 and mean number of congenital anomalies was 1.8 in the PO group. The HV/VCR group had a mean age of 7 years and 5 levels fused. Mean total DAR was 28 and mean number of congenital anomalies was 2.1 in the HV/VCR group. Patients had a mean of 54.1% correction of coronal deformity in the PO group and 54.4% in the HV/VCR group (P=0.78). Signal changes were observed less frequently with PO (1/17) and HV (1/26) than with VCR (4/6), P=0.001. Revision rates were 17.6% (3/17) in the PO group and 37.5% (12/32) in the HV/VCR group (P=0.35). Patients with CSD and a mean total DAR of 25 treated with multiple PO and long fusions had correction comparable with the HV/VCR group. Patients treated with VCR had the highest incidence of signal changes and postoperative neurologic deficits. Level III.

  2. The True Ponte Osteotomy: By the One Who Developed It.

    Science.gov (United States)

    Ponte, Alberto; Orlando, Giuseppe; Siccardi, Gian Luigi

    2018-01-01

    Technique and applications. To define the anatomy, biomechanics, indications, and surgical technique of the true Ponte osteotomy. The Ponte osteotomy, originally developed for thoracic kyphosis, was the first one to obtain posterior shortening of the thoracic spine, maintaining the anterior column load-sharing capacity. It has become a widely applied technique in various types of spine deformities and a frequent topic of presentations at meetings and in scientific articles. Several of them offer unquestionable evidence of an incorrect execution, with consequently distorted outcomes and erroneous conclusions. A clearing up became essential. Our original experience is based on a series of 240 patients with thoracic hyperkyphosis operated in the years 1969-2015, at first with a standard posterior Harrington technique and then by using the Ponte osteotomy with different instrumentations. A series of 78 of them, operated in the years 1987-1997, who had Ponte osteotomies at every level, is presented. The average preoperative kyphosis has been corrected from 80° (range 61°-102°) to 31° (range 15°-50°) by a substantial posterior shortening. A number of publications use the term Ponte osteotomy loosely for by far incomplete resections and mixing it up with Smith-Petersen's osteotomy. The true Ponte osteotomy is capable of producing marked flexibility in extension, flexion and rotation, justifying its wide use in thoracic deformities, mainly in scoliosis. An exact performance of the osteotomy with adequate bony resections, including the laminae, is an absolute condition to take full advantage of its properties. Level IV, therapeutic study. Copyright © 2017 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved.

  3. Ulnar shortening osteotomy for malunited distal radius fractures: results of a 7-year follow-up with special regard to the grade of radial displacement and post-operative ulnar variance.

    Science.gov (United States)

    Löw, Steffen; Mühldorfer-Fodor, Marion; Pillukat, Thomas; Prommersberger, Karl-Josef; van Schoonhoven, Jörg

    2014-01-01

    The treatment of ulnar-sided wrist pain after malunited distal radius fractures remains controversial. Radial corrective osteotomy can restore congruity in the distal radioulnar joint (DRUJ) as well as adequate length of the radius. Ulnar shortening osteotomies leave the radius' angular deformities unchanged, risking secondary DRUJ osteoarthritis. We supposed that, even within the widely accepted limit of 20°, a greater angulation of the radius in the sagittal plane correlates with a higher rate of DRUJ osteoarthritis. Furthermore, we suspected worse results from an ulna shortened to a negative rather than a neutral or positive ulnar variance. For this retrospective study, we reviewed 23 patients a mean 7.2 (range 5.6-8.5) years after ulnar shortening osteotomy for malunion of distal radius fractures. We compared 14 patients with up to 10° dorsal or palmar displacement from the normal palmar tilt of 10° to 9 patients with more than 10° displacement, and 15 patients whose post-operative ulnar variance was neutral or positive to 8 who had a negative one. Ulnar-sided wrist pain decreased enough to satisfy 21 of the 23 patients. Clinical results tended to be better when radial displacement was minor and when post-operative ulnar variance was positive or neutral. A shorter ulna significantly increased the rate of DRUJ osteoarthritis, whereas a greater degree of radial displacement only increased the rate slightly. Radial corrective osteotomy should be discussed as alternative when displacement of the radius in the sagittal plane exceeds 10°. The ulna should be shortened moderately to reduce the risk of osteoarthritis in the distal radioulnar joint.

  4. FUNCTIONAL DISABILITY, SAGITTAL ALIGNMENT AND PELVIC BALANCE IN LUMBAR SPONDYLOLISTHESIS

    Directory of Open Access Journals (Sweden)

    Luis Muñiz Luna

    2016-03-01

    Full Text Available ABSTRACT Objectives: To demonstrate the recovery of lumbar sagittal pelvic alignment and sagittal pelvic balance after surgical reduction of lumbar spondylolisthesis and establish the benefits of the surgery for reduction and fixation of the lumbar spondylolisthesis with 360o circumferential arthrodesis for 2 surgical approaches by clinical and functional evaluation. Method: Eight patients with lumbar spondylolisthesis treated with surgical reduction and fixation of listhesis and segmental circumferential fusion with two surgical approaches were reviewed. They were evaluated before and after treatment with Oswestry, Visual Analogue for pain and Odom scales, performing radiographic measurement of lumbar sagittal alignment and pelvic sagittal balance with the technique of pelvic radius. Results: Oswestry scales and EVA reported improvement of symptoms after treatment in 8 cases; the Odom scale had six outstanding cases reported. The lumbar sagittal alignment presented a lumbosacral lordosis angle and a lumbopelvic lordosis angle reduced in 4 cases and increased in 4 other cases; pelvic sagittal balance increased the pelvic angle in 4 cases and decreased in 3 cases and the sacral translation of the hip axis to the promontory increased in 6 cases. Conclusion: The surgical procedure evaluated proved to be useful by modifying the lumbar sagittal alignment and the pelvic balance, besides reducing the symptoms, enabling the patient to have mobility and movement and the consequent satisfaction with the surgery.

  5. The usefulness of sagittal reformation for diagnosis of sternal fracture

    Energy Technology Data Exchange (ETDEWEB)

    Im, Dong Jin; Hahn, Seok; Kim, Young Ju [Dept. of Radiology, Wonju Severance Christian Hospital, Yonsei University Wonju College of Medicine, Wonju (Korea, Republic of)

    2014-01-15

    The purpose of our study was to evaluate the usefulness of sagittal reformation of chest computed tomography for the diagnosis of sternal fracture after trauma. We retrospectively reviewed medical records and chest computer tomography (CT) of 716 patients in the emergency department after trauma between January and December 2010. Two radiologists investigated chest CT images. We investigated numbers and locations of sternal fractures on axial images only and on both axial and sagittal images for each radiologist. First, radiologist found sternal fractures in 58 patients (70.7%) on only axial images, and 80 (97.5%) on both axial and sagittal images. Second, radiologist found fractures in 67 patients (81.7%) on axial image only and 81 (98.7%) on both axial and sagittal images. The sensitivity increased after adding sagittal reformation images for each radiologist (p < 0.05, respectively). On the axial images, the interobserver agreement was low (k 0.596) between the two radiologists. However, on both axial and sagittal images, the interobserver agreement increased (k = 0.872). Sagittal reformation of chest CT increases the chance of diagnosis for sternal fracture and leads to early diagnosis resulting in appropriate treatment.

  6. Sagittal Balance Correction in Lateral Interbody Fusion for Degenerative Scoliosis.

    Science.gov (United States)

    Blizzard, Daniel J; Gallizzi, Michael A; Sheets, Charles; Smith, Benjamin T; Isaacs, Robert E; Eure, Megan; Brown, Christopher R

    2016-01-01

    Sagittal balance restoration has been shown to be an important determinant of outcomes in corrective surgery for degenerative scoliosis. Lateral interbody fusion (LIF) is a less-invasive technique which permits the placement of a high lordosis interbody cage without risks associated with traditional anterior or transforaminal interbody techniques. Studies have shown improvement in lumbar lordosis following LIF, but only one other study has assessed sagittal balance in this population. The objective of this study is to evaluate the ability of LIF to restore sagittal balance in degenerative lumbar scoliosis. Thirty-five patients who underwent LIF for degenerative thoracolumbar scoliosis from July 2013 to March 2014 by a single surgeon were included. Outcome measures included sagittal balance, lumbar lordosis, Cobb Angle, and segmental lordosis. Measures were evaluated pre-operative, immediately post-operatively, and at their last clinical follow-up. Repeated measures ANOVAs were used to assess the differences between pre-operative, first postoperative, and a follow-up visit. The average sagittal balance correction was not significantly different: 1.06cm from 5.79cm to 4.74cm forward. The average Cobb angle correction was 14.1 degrees from 21.6 to 5.5 degrees. The average change in global lumbar lordosis was found to be significantly different: 6.3 degrees from 28.9 to 35.2 degrees. This study demonstrates that LIF reliably restores lordosis, but does not significantly improve sagittal balance. Despite this, patients had reliable improvement in pain and functionality suggesting that sagittal balance correction may not be as critical in scoliosis correction as previous studies have indicated. LIF does not significantly change sagittal balance; however, clinical improvement does not seem to be contingent upon sagittal balance correction in the degenerative scoliosis population. The DUHS IRB has determined this study meets criteria for an IRB waiver.

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

    Science.gov (United States)

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

    2016-03-01

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

  8. Scarf osteotomy or Mau osteotomy for correction of moderate to severe hallux valgus deformity: a prospective, randomized study

    OpenAIRE

    Avcu, Bülent; Akalın, Yavuz; Çevik, Nazan; Öztürk, Alpaslan; Şahin, Namık; Öztaş, Savaş; Özkan, Yüksel

    2017-01-01

    Objective. The aim of this studywas to compare the clinical and radiological results of Mau osteotomy and Scarfosteotomy with a modified McBride procedure to patients with moderate to severehallux valgus deformity. Methods. The study included 40 feetwhich patients were separated into 2 groups followed up for 5 months. Scarfosteotomy was applied to 20 patients including 16 females and 4 males (Scarfgroup)) and a Mau osteotomy to 20 patients including 17 females and 3 males(Mau group). Radiolog...

  9. The pterygomaxillary junction: An imaging study for surgical information of LeFort I osteotomy.

    Science.gov (United States)

    Chin, Yen-Po; Leno, Maria Belen; Dumrongwongsiri, Sarayuth; Chung, Kyung Hoon; Lin, Hsiu-Hsia; Lo, Lun-Jou

    2017-08-30

    Maxillary osteotomy is a common surgical procedure and often involves separation of the pterygomaxillary junction (PMJ), which is a "blinded" procedure with inherent risks. Knowledge of the PMJ structure is essential. It remains unclear whether patients with different facial types have different PMJ structures, or different surgical outcome. This study evaluated the computed tomographic images of 283 consecutive patients who received orthognathic surgery. Patients were classified into Angle class I, II, III and cleft lip/palate groups. The results showed that the PMJ was 5.1 ± 1.4 mm in thickness, 9.7 ± 1.7 mm in width, and 102.0 ± 4.0 degrees relative to the sagittal plane in the level of posterior nasal spine. There were no statistically significant differences in these measurements among the groups. The class III group demonstrated significantly smaller angle relative to the maxillary occlusal plane. The cleft group showed significantly longer vertical distance between the posterior nasal spine and the lower border of PMJ, shorter distance between the second molar and PMJ, and longer distance between the descending palatine artery and PMJ. With regard to postoperative outcome, the cleft group showed higher incidence of pterygoid plate fracture. The results in this study provide additional surgical anatomic information.

  10. Sagittal Abdominal Diameter: Application in Clinical Practice

    Directory of Open Access Journals (Sweden)

    Thaís Da Silva-Ferreira

    2014-05-01

    Full Text Available Excess visceral fat is associated with cardiovascular risk factors. Sagittal abdominal diameter (SAD has recently been highlighted as an indicator of abdominal obesity, and also may be useful in predicting cardiovascular risk. The purpose of the present study was to review the scientific literature on the use of SAD in adult nutritional assessment. A search was conducted for scientific articles in the following electronic databases: SciELO , MEDLINE (PubMed and Virtual Health Library. SAD is more associated with abdominal fat (especially visceral, and with different cardiovascular risk factors, such as, insulin resistance, blood pressure, and serum lipoproteins than the traditional methods of estimating adiposity, such as body mass index and waist-to-hip ratio. SAD can also be used in association with other anthropometric measures. There are still no cut-off limits established to classify SAD as yet. SAD can be an alternative measure to estimate visceral adiposity. However, the few studies on this diameter, and the lack of consensus on the anatomical site to measure SAD, are obstacles to establish cut-off limits to classify it.

  11. Outcome of primary posterior sagittal anorectoplasty of high ...

    African Journals Online (AJOL)

    2013-01-29

    Jan 29, 2013 ... Background: Conventional posterior sagittal anorectoplasty (PSARP) for high anorectal malformation (ARM) involves initial colostomy creation with ... associated multiple congenital anomalies and high risk of overwhelming sepsis .... muscle complex, and mark the position for the neoanus. Inclusion criteria.

  12. Posterior sagittal rectopexy in the treatment of recurrent rectal ...

    African Journals Online (AJOL)

    Pediatric Surgery. Annals of Pediatric Surgery 2011, 7:101–104. Keywords: children, complications, posterior sagittal rectopexy, rectal prolapse, recurrent. Department of ... Correspondence to Amel Abd Eltwab Hashish, Department of Pediatric Surgery,. Faculty of ... without constipation, prolonged diarrhea, malnutrition,.

  13. Tibial Plateau Leveling Osteotomy Plate Contouring and Proximal Load Screw Angulation Affect Osteotomy Compression.

    Science.gov (United States)

    Mathis, Karl R; Roe, Simon C; Johnson, Kenneth A

    2015-11-01

    To evaluate the effect of contouring a tibial plateau leveling osteotomy (TPLO) plate, the associated angulation of the dynamic compression plate (DCP) hole relative to the long axis of the tibia, and angulation of the screw relative to the DCP hole on the osteotomy compression generated by load screws in a TPLO model. In vitro biomechanical study. Polyoxymethylene (POM) rod and synthetic cortical bone substitute model (n = 9). The distal portion of a Slocum TPLO plate was attached to a horizontally positioned POM rod that was connected to a load cell. A segment of synthetic cortical bone substitute was attached to the end mount of the testing frame and adjusted to conform to the angle of the proximal portion of the TPLO plate. A 3.5 mm cortical bone screw was inserted in the proximal DCP hole and tightened to 1.5 Nm. The peak longitudinal load (N) was recorded. Screw insertion and data collection were repeated for proximal plate angles of 0-40° at 5° increments. A significant increase in the compression generated was observed as the plate angle was increased from 0° to 10°. The compression ceased to significantly increase until the plate was bent more than 20°, after which a significant decrease in compression was noted. A marked reduction in the compression generated occurred at plate angles greater than 30°. Angulation of the DCP hole and screw insertion angle can have deleterious effects on the magnitude of osteotomy compression. © Copyright 2015 by The American College of Veterinary Surgeons.

  14. Evaluation of Global Sagittal Balance in Koreans Adults.

    Science.gov (United States)

    Cho, Yongjae

    2017-09-01

    The global sagittal postural patterns as characterized by Roussouly classification have been previously described in various ethnicities, there were no studies investigated in Koreans. To analyze the distribution of the global sagittal postural patterns in Korean adults using Roussouly classification, the author prospectively studied. 252 asymptomatic Korean adults was recruited. Data was obtained by reviewing the films for each subject. Spinopelvic parameters were measured and sagittal postural patterns were then determined according to Roussouly classification. We compared the data across different ethnicities from our study and a previous study to further characterize Korean sagittal postures. The subject included 151 males and 101 females, with mean age of 33.2±8.2 years. The average descriptive results were as below: thoracic kyphosis 28.6±7.7°, lumbar lordosis 48.3±10.2°, sacral slope 37.8±5.8°, pelvic incidence 45.1±7.5°, pelvic tilt 9.4±6.7°, spinosacral angle 130.1±5.4°, and sagittal vertical axis 16.25±22.5 mm. 125 subjects among 252 (49.6%) belonged to Roussouly type 3 (namely neutral). There were also 58 (23%), 33 (13.1%), and 36 (14.3) subjects in type 1, 2, and 4 (namely non-neutral), respectively. Enrolling 252 asymptomatic Korean adults, this prospective study found that 49.6% of asymptomatic Korean adults possessed a sagittal posture of Roussouly type 3. All radiologic parameters follows general concept of spinal sagittal balance pattern. Overall, this study might be a basis for further investigation of spinal sagittal balance.

  15. Noninvasive diagnosis of superior sagittal sinus thrombosis in a neonate.

    Science.gov (United States)

    Govaert, P; Voet, D; Achten, E; Vanhaesebrouck, P; van Rostenberghe, H; van Gysel, D; Afschrift, M

    1992-05-01

    A newborn boy presented within the first day of life with moaning, anemia, and thrombocytopenia. The clinical syndrome resulted from thrombosis of the posterior part of the superior sagittal sinus due to impression at birth of the tip of the occipital squama. Both computed tomography and ultrasound scans were valuable noninvasive tools for documentation of the thrombus itself and the cerebral sequelae. Color Doppler ultrasound scan confirmed the absence and reappearance of flow in the superior sagittal sinus.

  16. Mid-sagittal plane and mid-sagittal surface optimization in brain MRI using a local symmetry measure

    DEFF Research Database (Denmark)

    Stegmann, Mikkel Bille; Skoglund, Karl; Ryberg, Charlotte

    2005-01-01

    This paper describes methods for automatic localization of the mid-sagittal plane (MSP) and mid-sagittal surface (MSS). The data used is a subset of the Leukoaraiosis And DISability (LADIS) study consisting of three-dimensional magnetic resonance brain data from 62 elderly subjects (age 66 to 84...... years). Traditionally, the mid-sagittal plane is localized by global measures. However, this approach fails when the partitioning plane between the brain hemispheres does not coincide with the symmetry plane of the head. We instead propose to use a sparse set of profiles in the plane normal direction......, the mid-sagittal plane is not always planar, but a curved surface resulting in poor partitioning of the brain hemispheres. To account for this, this paper also investigates an optimization strategy which fits a thin-plate spline surface to the brain data using a robust least median of squares estimator...

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

    Directory of Open Access Journals (Sweden)

    Shu-Jung Chen

    2015-04-01

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

  18. First Metatarsal Proximal Opening Wedge Osteotomy for Correction of Hallux Valgus Deformity: Comparison of Straight versus Oblique Osteotomy

    Science.gov (United States)

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

    2015-01-01

    Purpose The aim of this study was to compare clinical and radiographic outcomes of proximal opening wedge osteotomy using a straight versus oblique osteotomy. Materials and Methods We retrospectively reviewed 104 consecutive first metatarsal proximal opening wedge osteotomies performed in 95 patients with hallux valgus deformity. Twenty-six feet were treated using straight metatarsal osteotomy (group A), whereas 78 feet were treated using oblique metatarsal osteotomy (group B). The hallux valgus angle (HVA), intermetatarsal angle (IMA), distal metatarsal articular angle, and distance from the first to the second metatarsal (distance) were measured for radiographic evaluation, whereas the American Orthopaedic Foot and Ankle Society (AOFAS) forefoot score was used for clinical evaluation. Results Significant corrections in the HVA, IMA, and distance from the first to the second metatarsal were obtained in both groups at the last follow-up (p<0.001). There was no difference in the mean IMA correction between the 2 groups (6.1±2.7° in group A and 6.0±2.1° in group B). However, a greater correction in the HVA and distance from the first to the second metatarsal were found in group B (HVA, 13.2±8.2°; distance, 25.1±0.2 mm) compared to group A (HVA, 20.9±7.7°; distance, 28.1±0.3 mm; p<0.001). AOFAS scores were improved in both groups. However, group B demonstrated a greater improvement relative to group A (p=0.005). Conclusion Compared with a straight first metatarsal osteotomy, an oblique first metatarsal osteotomy yielded better clinical and radiological outcomes. PMID:25837181

  19. Correction of midface hypoplasia using a novel trapezoidal osteotomy.

    Science.gov (United States)

    Li, Wenyang; Khadka, Ashish; Hu, Jing; Wang, Dazhang; Wang, Qiushi; Li, Jihua

    2012-05-01

    Currently, investigating an optimal method to deal with midface hypoplasia has become a significant issue in the field of facial aesthetic surgery. Traditional ways to address this problem primarily include segmental osteotomies and using autogenous bone or cartilage grafts or synthetic implants. For the patients with paranasal hypoplasia but without malocclusion, autogenous bone grafts or implants are recommended. However, some of these patients have a flattened nose and protrusive malar, especially in the Eastern Asian; the nose will seem more flattened after augmentation the paranasal area. Hence, osteotomy is necessary in these patients to bring the flattened nose forward to get a more satisfying contour of the midface. We propose a novel osteotomy through the application of model surgery to solve the problem of midface hypoplasia combined with flattened nose but without malocclusion. When compared with other techniques, this novel method not only allows the augmentation to be performed on a broader scale composed of different segments of the midface skeleton, but also results in a lower surgical risk and maintenance of the stability of occlusion. This novel osteotomy can bring the premaxilla in combination with the nasal bone forward to solve the problem of midface hypoplasia combined with flattened nose in patients with normal occlusion. Through simultaneous augmentation of the different segments of the midface through this novel osteotomy, a more pleasing contour of the midface in all 3 dimensions can be achieved.

  20. Biomechanical superiority of plate fixation for proximal tibial osteotomy.

    Science.gov (United States)

    Hartford, James M; Hester, Peter; Watt, Phil M; Hamilton, Doris; Rohmiller, Michael; Pienkowski, David

    2003-07-01

    Proximal tibial osteotomies require secure and durable fixation to allow early range of motion; however, biomechanical data comparing commonly used fixation methods are lacking. The current study was done to quantify the dynamic biomechanical performance of blade staple fixation and plate fixation of simulated proximal tibial osteotomies. A 15 degrees proximal tibial osteotomy was done on each of 18 synthetic adult composite tibias. Blade staples were used as the means of fixation in nine tibias; plate fixation was used in the remaining nine tibias. The specimens were stressed cyclically in sinusoidal loading whose peak compression and tension loads imitate those measured during normal gait. Device performance was quantified by measuring displacement at the osteotomy site and the number of cycles to failure. Plate fixation had a greater fatigue life than staples (eight plates surviving past 200,000 cycles versus one blade staple) and showed a trend toward less displacement (0.69 mm versus 0.97 mm). Plate fixation of proximal tibial osteotomies offers better fixation and dynamic mechanical performance than blade staples.

  1. Bilateral varus osteotomies in hip deformities: are early interventions superior?

    Science.gov (United States)

    Marti, R. K.

    2006-01-01

    Coxa valga (with or withour excessive femoral anteversion) combined with acetabular dysplasia is a well-known cause of early osteoarthritis. Many authors have stated that the best result of an osteotomy can be achieved at an early stage of these osteoarthritic changes. In this study, we present 26 patients with a symmetrical hip deformity for which we performed a therapeutic osteotomy on the symptomatic hip. The contralateral hip had the same anatomical predisposition to develop an OA, but there were only minor to no complaints. We advised and performed an early osteotomy on these hips. On radiological evaluation, an average Sharp angle of 42.2 degrees and an average CCD of 142 degrees was present. During an average follow-up period of 19.9 years (range 15.0–25.9), 14 hips were converted to THR after the primary osteotomy, whereas there were only 6 after the early osteotomy (chi-square coxa valga with excessive femoral anteversion and acetabular dysplasia can be superior to the results achieved when surgery is postponed until the complaints and arthrosis have become more severe. PMID:16783551

  2. Concomitant Hip Arthroscopy and Periacetabular Osteotomy.

    Science.gov (United States)

    Domb, Benjamin G; LaReau, Justin M; Hammarstedt, Jon E; Gupta, Asheesh; Stake, Christine E; Redmond, John M

    2015-11-01

    To detail our early experience using concomitant hip arthroscopy and periacetabular osteotomy (PAO) for the treatment of acetabular dysplasia. We prospectively collected and retrospectively reviewed the surgical and outcome data of 17 patients who underwent concomitant hip arthroscopy and PAO between October 2010 and July 2013. Preoperative and postoperative range of motion, outcome and pain scores, and radiographic data were collected. Intraoperative arthroscopic findings and postoperative complications were recorded. The group consisted of 3 male and 14 female patients with a mean follow-up period of 2.4 years. Three patients had undergone previous surgery on the affected hip. Chondrolabral pathology was identified in all 17 patients. Twelve patients underwent labral repair, and five patients underwent partial labral debridement. No patient was converted to total hip arthroplasty or required revision surgery at short-term follow-up. All 4 patient-reported outcome scores showed statistically significant changes from baseline to latest follow-up (P hip arthroscopy and PAO has been favorable. We noted that all our patients have evidence of chondrolabral damage at the time of PAO when the joint is distracted and evaluated. All patients in this series had intra-articular pathology treated arthroscopically and showed satisfactory mean clinical improvement. Hip arthroscopy with PAO did not appear to introduce complications beyond the PAO alone. Level IV, therapeutic case series. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  3. [Biomechanics of the Chiari pelvic osteotomy].

    Science.gov (United States)

    Shiba, N

    1991-05-01

    We have reviewed our findings on 476 hip joints that underwent a Chiari pelvic osteotomy (Chiari) between June 1983 and March 1990, employing computer simulation using non-linear analysis based on the rigid-body spring model (RBSM) proposed by Kawai. We further made estimates of the changes in the hip abduction force resulting from the Chiari. The abduction force was measured by a Cybex II machine, before and after Chiari, and they were compared with those from simulation modeling (using the abduction muscle model: ABMM) for the power change expected by Chiari. According to the results in the RBSM, the resultant force, the abduction force, deviation of the pelvis, and the joint stress improved outcome after Chiari. Chiari had a positive effect on the peak torque of the hip abduction, though the abduction force was not fully restored clinically. The simulation by ABMM, showed similar results with the abduction force decreasing with increasing degree of hip abduction. From these results, we have developed and established a new technique for the reattachment of the greater trochanter in Chiari.

  4. Cervical spine alignment, sagittal deformity, and clinical implications: a review.

    Science.gov (United States)

    Scheer, Justin K; Tang, Jessica A; Smith, Justin S; Acosta, Frank L; Protopsaltis, Themistocles S; Blondel, Benjamin; Bess, Shay; Shaffrey, Christopher I; Deviren, Vedat; Lafage, Virginie; Schwab, Frank; Ames, Christopher P

    2013-08-01

    This paper is a narrative review of normal cervical alignment, methods for quantifying alignment, and how alignment is associated with cervical deformity, myelopathy, and adjacent-segment disease (ASD), with discussions of health-related quality of life (HRQOL). Popular methods currently used to quantify cervical alignment are discussed including cervical lordosis, sagittal vertical axis, and horizontal gaze with the chin-brow to vertical angle. Cervical deformity is examined in detail as deformities localized to the cervical spine affect, and are affected by, other parameters of the spine in preserving global sagittal alignment. An evolving trend is defining cervical sagittal alignment. Evidence from a few recent studies suggests correlations between radiographic parameters in the cervical spine and HRQOL. Analysis of the cervical regional alignment with respect to overall spinal pelvic alignment is critical. The article details mechanisms by which cervical kyphotic deformity potentially leads to ASD and discusses previous studies that suggest how postoperative sagittal malalignment may promote ASD. Further clinical studies are needed to explore the relationship of cervical malalignment and the development of ASD. Sagittal alignment of the cervical spine may play a substantial role in the development of cervical myelopathy as cervical deformity can lead to spinal cord compression and cord tension. Surgical correction of cervical myelopathy should always take into consideration cervical sagittal alignment, as decompression alone may not decrease cord tension induced by kyphosis. Awareness of the development of postlaminectomy kyphosis is critical as it relates to cervical myelopathy. The future direction of cervical deformity correction should include a comprehensive approach in assessing global cervicalpelvic relationships. Just as understanding pelvic incidence as it relates to lumbar lordosis was crucial in building our knowledge of thoracolumbar deformities, T

  5. Sagittal spino-pelvic alignment in chronic low back pain.

    Science.gov (United States)

    Chaléat-Valayer, Emmanuelle; Mac-Thiong, Jean-Marc; Paquet, Jérôme; Berthonnaud, Eric; Siani, Fabienne; Roussouly, Pierre

    2011-09-01

    The differences in sagittal spino-pelvic alignment between adults with chronic low back pain (LBP) and the normal population are still poorly understood. In particular, it is still unknown if particular patterns of sagittal spino-pelvic alignment are more prevalent in chronic LBP. The current study helps to better understand the relationship between sagittal alignment and low back pain. To compare the sagittal spino-pelvic alignment of patients with chronic LBP with a cohort of asymptomatic adults. Sagittal spino-pelvic alignment was evaluated in prospective cohorts of 198 patients with chronic LBP and 709 normal subjects. The two cohorts were compared with respect to the sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), lumbar tilt (LT), lordotic levels, thoracic kyphosis (TK), thoracic tilt (TT), kyphotic levels, and lumbosacral joint angle (LSA). Correlations between parameters were also assessed. Sagittal spino-pelvic alignment is significantly different in chronic LBP with respect to SS, PI, LT, lordotic levels, TK, TT and LSA, but not PT, LL, and kyphotic levels. Correlations between parameters were similar for the two cohorts. As compared to normal adults, a greater proportion of patients with LBP presented low SS and LL associated with a small PI, while a greater proportion of normal subjects presented normal or high SS associated with normal or high PI. Sagittal spino-pelvic alignment was different between patients with chronic LBP and controls. In particular, there was a greater proportion of chronic LBP patients with low SS, low LL and small PI, suggesting the relationship between this specific pattern and the presence of chronic LBP.

  6. Split Malcev algebras

    Indian Academy of Sciences (India)

    project of the Spanish Ministerio de Educación y Ciencia MTM2007-60333. References. [1] Calderón A J, On split Lie algebras with symmetric root systems, Proc. Indian. Acad. Sci (Math. Sci.) 118(2008) 351–356. [2] Calderón A J, On split Lie triple systems, Proc. Indian. Acad. Sci (Math. Sci.) 119(2009). 165–177.

  7. The history, evolution and basic science of osteotomy techniques

    Directory of Open Access Journals (Sweden)

    John Dabis

    2017-10-01

    Full Text Available Abstract Osteotomy techniques date back to Hippocrates circa 415 BC (Jones Hippocrates collected works I, Harvard University Press, Cambridge, 2006; Brorson in Clin Orthop Relat Res 467(7:1907–1914, 2009. There is debate about the best way to divide the bone surgically and which technique yields the best bone regenerate in lengthening; ensuring predictable new bone formation and healing of the osteotomy are the primary goals. We review the history and techniques of the osteotomy and consider the evidence for optimum bone formation. Methods discussed include variants of the ‘drill and osteotome’ technique, use of the Gigli saw and use of a power saw. Differences in bone formation through the different techniques are covered.

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

    Science.gov (United States)

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

    2015-10-01

    The technique of double first metatarsal osteotomies was first developed in response to the high frequency of recurrence noted in the treatment of severe adolescent congruent hallux valgus deformities. The concept behind the use of this technique is that it allows the individual correction of each component of the deformity. We have modified the technique for use in adult hallux valgus where the majority of deformities are incongruent deformities and the distal chevron osteotomy is used primarily for its additional translational properties rather than purely to correct the distal metatarsal articular angle (DMAA). We report on a series of double first metatarsal osteotomies (basal opening wedge and distal chevron osteotomy) with Akin osteotomy in the treatment of moderate to severe adult hallux valgus deformity. All patients presenting to our institution with a hallux valgus deformity and treated with this procedure between 2008 and 2013 with a minimum of 1 year of follow-up were identified. Data were obtained through review of case notes, electronic charts, and digital imaging. A total of 50 feet in 48 patients underwent double first metatarsal osteotomy with Akin osteotomy. Three patients were excluded due to loss to follow-up, leaving 47 feet in 45 patients with a mean follow-up of 45 months (range, 14-60 months). Of these 43 (96%) were female and the mean age was 56 years (range, 35-70 years). The mean preoperative hallux valgus angle (HVA), intermetatarsal angle (IMA), DMAA, sesamoid position, and lateral first metatarsotalar angle were 42 degrees (range, 32-52 degrees), 18 degrees (range, 6-26 degrees), 12 degrees (range, 4-26 degrees), stage 6 (range, 4-7), and 2 degrees of dorsiflexion (range, 20 degrees of dorsiflexion to 4 degrees of plantar flexion), respectively. The mean postoperative HVA, IMA, DMAA, sesamoid position, and lateral first metatarsotalar angle were 7 degrees (range, 2 to 24 degrees), 4 degrees (range, 4-14 degrees), 6 degrees (range, 10

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

    NARCIS (Netherlands)

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

    2008-01-01

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

  10. Biomechanical comparison of two alternative tibial plateau leveling osteotomy plates with the original standard in an axially loaded gap model: an in vitro study.

    Science.gov (United States)

    Kloc, Paul A; Kowaleski, Michael P; Litsky, Alan S; Brown, Nancy O; Johnson, Kenneth A

    2009-01-01

    fractured in the sagittal plane through the tibial plateau depression at the point of load application. The Slocum and Securos plate/tibia construct have similar stiffness, whereas the Synthes/tibia constructs are significantly stiffer than the Slocum/tibia constructs. Modes of fixation failure observed in this model were consistent with TPLO fixation failures observed clinically. Construct stiffness in axial load varies with implant type. Implants that confer higher stiffness to the construct may result in greater fixation stability in tibial metaphyseal osteotomies.

  11. Analysis of Global Sagittal Postural Patterns in Asymptomatic Chinese Adults.

    Science.gov (United States)

    Hu, Panpan; Yu, Miao; Sun, Zhuoran; Li, Weishi; Jiang, Liang; Wei, Feng; Liu, Xiaoguang; Chen, Zhongqiang; Liu, Zhongjun

    2016-04-01

    A prospective imaging study. To characterize the distribution of the global sagittal postural patterns in asymptomatic Chinese adults using Roussouly classification. The norms of sagittal parameters in asymptomatic Chinese population have been previously described, but no report described their global sagittal postural patterns as characterized by Roussouly classification. A cohort of 272 asymptomatic Chinese adults was recruited. Data was assimilated by reviewing the films for each subject. Sagittal parameters were measured and sagittal postural patterns were then determined according to Roussouly classification. The pattern distributions were compared across genders within the study cohort. We also compared the data across different ethnicities from our study and a previous study to further characterize Chinese sagittal postures. The cohort included 161 males and 111 females, with mean age of 23.2±4.4 years. The average descriptive results were as below: pelvic incidence (PI) 46.4°±9.6°, thoracic kyphosis (TK) 24.2°±9.0°, lumbar lordosis (LL) 50.6°±10.6°, sacral slope (SS) 37.2°±7.6°, pelvic tilt (PT) 9.4°±6.8°, spinosacral angle (SSA) 131.1°±7.5° and sagittal vertical axis (SVA) 17.24±32.36 mm. Despite a significant difference between two genders in LL, PI, SSA, and SVA, no difference was found in the distribution of Roussouly types among them. 47.8% of our cohort belonged to Roussouly type 3, while type 1, 2 and 4 comprised 23.2%, 14.0% and 15.1% of the subjects, respectively. Roussouly classification was capable of categorizing sagittal parameters except for the PT. This study also found that 4.4% of the recruited subjects belonged to the C7-anterior subgroup. From a characterization of the sagittal postural patterns of asymptomatic Chinese adults using Roussouly classification, the distribution was similar between Chinese males and females; however, from a cross-study comparison, it was different between asymptomatic Chinese and Caucasian

  12. [Metal/alumine metallosis on tibial osteotomy. A case report].

    Science.gov (United States)

    Mathieu, G; Roue, J; Poignard, A; Hernigou, P

    2008-05-01

    Metallosis is mainly described in the hip joint at the time of wear or inappropriate use. Cases have also been reported in patients with a knee prosthesis, but never after tibial osteotomy. We report a rare case of metallosis resulting from metal-alumina contact after open wedge tibial osteotomy. The patient complained of pain, which was relieved after removal of the plate nine months after the first operation. Intraoperative inspection revealed metallosis at the synthesis site and local plate wear at zone of contact with the ceramic filler. Removal of the plate and cleaning of the metallosis zone led to full relief of the pain at one and a half months.

  13. Change in sagittal balance with placement of an interspinous spacer.

    Science.gov (United States)

    Schulte, Leah M; O'Brien, Joseph R; Matteini, Lauren E; Yu, Warren D

    2011-09-15

    A prospective case series. To determine the effect of X-STOP implantation on sagittal spinal balance using 36-inch films. Interspinous process spacers have been shown as an effective treatment of neurogenic claudication. The devices block the last few degrees of extension at the stenotic level, thus preventing compression of the nerve roots. These devices have been criticized because they may push the patient's spine into a kyphotic position. However, opening the stenotic level may allow a patient to stand more upright, thereby improving sagittal balance. Institutional review board's approval was obtained. A prospective study of 20 patients who were undergoing an X-STOP insertion was utilized. Their spines were x-rayed preoperatively and postoperatively with 36-inch films. Preoperative and postoperative sagittal balance was measured with a C7 body plum line on both films and the difference was measured. Lumbar lordosis was also compared using Cobb angles. Measurements taken from lateral full-length spine radio-graphs showed an average improvement in sagittal balance of 2.0 cm (range -3.7 to 6.1 cm). The average change in lordosis was -1.1°. Although previous studies of interspinous process distraction have examined segmental lordosis, disc angles, and other parameters, this study is the first to examine overall spinal balance on full-length films. Interspinous distraction does not seem to be detrimental to sagittal balance, and may improve it.

  14. Dentoalveolar Heights in Vertical and Sagittal Facial Patterns.

    Science.gov (United States)

    Islam, Zafar Ul; Shaikh, Attiya Jawaid; Fida, Mubassar

    2016-09-01

    To determine and compare the mean dentoalveolar heights (mm) in different vertical and sagittal facial patterns. Cross-sectional study. Orthodontics Clinic, The Aga Khan University Hospital, Karachi, from September to November 2013. Subjects, aged 15 - 20 years, having fully erupted first permanent molars and central incisors were included in the study from orthodontic records. The pretreatment cephalographs of subjects were traced manually over an illuminator. The various parameters like angles and dentoalveolar heights were measured and recorded on data collection form. Mean value ± SD for the variables were generated. ANOVAwas used to compare the means of dentoalveolar heights among the vertical and sagittal facial patterns. Post Hoc Bonferroni test was applied to show difference among the three vertical and three sagittal facial patterns. P-value equal to or less than 0.05 was taken as statistically significant. The mean age of subjects was 15.8 ±3.2 years in vertical group and 16.3 ±2.9 years in sagittal group. There was statistically significant difference (p=0.008) for the upper anterior dentoalveolar height (UADH) among vertical groups, with statistically significant difference for UADH between hyperdivergent and normodivergent (p=0.04) and hyperdivergent and hypodivergent (p=0.01) facial patterns. The UADH were significantly greater in the hyperdivergent group as compared to both the normodivergent and hypodivergent groups. The sagittal groups showed no statistically significant difference for dentoalveolar heights.

  15. Early Outcomes of Minimally Invasive Anterior Longitudinal Ligament Release for Correction of Sagittal Imbalance in Patients with Adult Spinal Deformity

    Directory of Open Access Journals (Sweden)

    Armen R. Deukmedjian

    2012-01-01

    Full Text Available The object of this study was to evaluate a novel surgical technique in the treatment of adult degenerative scoliosis and present our early experience with the minimally invasive lateral approach for anterior longitudinal ligament release to provide lumbar lordosis and examine its impact on sagittal balance. Methods. All patients with adult spinal deformity (ASD treated with the minimally invasive lateral retroperitoneal transpsoas interbody fusion (MIS LIF for release of the anterior longitudinal ligament were examined. Patient demographics, clinical data, spinopelvic parameters, and outcome measures were recorded. Results. Seven patients underwent release of the anterior longitudinal ligament (ALR to improve sagittal imbalance. All cases were split into anterior and posterior stages, with mean estimated blood loss of 125 cc and 530 cc, respectively. Average hospital stay was 8.3 days, and mean follow-up time was 9.1 months. Comparing pre- and postoperative 36′′ standing X-rays, the authors discovered a mean increase in global lumbar lordosis of 24 degrees, increase in segmental lumbar lordosis of 17 degrees per level of ALL released, decrease in pelvic tilt of 7 degrees, and decrease in sagittal vertical axis of 4.9 cm. At the last followup, there was a mean improvement in VAS and ODI scores of 26.2% and 18.3%. Conclusions. In the authors’ early experience, release of the anterior longitudinal ligament using the minimally invasive lateral retroperitoneal transpsoas approach may be a feasible alternative in correcting sagittal deformity.

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

    Science.gov (United States)

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

    2014-04-30

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

  17. Revisional Surgery for Hallux Valgus with Serial Osteotomies at Two Levels

    Directory of Open Access Journals (Sweden)

    Jason B. T. Lim

    2011-01-01

    Full Text Available The aetiology and form of hallux valgus (HV is varied with many corrective procedures described. We report a 39-year-old woman, previously treated with a Chevron osteotomy, who presented with recurrent right HV, metatarsus primus varus, and associated bunion. Osteotomies were performed at two levels as a revisional procedure. This report highlights (1 limitations of the Chevron osteotomy and (2 the revisional procedure of the two level osteotomies: (i proximal opening-wedge basal osteotomy and (ii distal short Scarf with medial closing wedges. If a Chevron osteotomy is used inappropriately, for example, in an attempt to correct too large a deformity, it may angulate laterally causing a malunion with an increased distal metatarsal articular angle. Secondly, it is feasible to correct this combined deformity using a combination of proximal opening-wedge and distal short Scarf osteotomies.

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

    Science.gov (United States)

    Vander Griend, Robert

    2017-02-01

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

  19. Corrective osteotomy for procurvatum deformity caused by distal femoral physeal fracture malunion stabilised with String-of-Pearls locking plates: results in two dogs and a review of the literature.

    Science.gov (United States)

    Kim, S E; Lewis, D D

    2014-03-01

    This report describes the treatment of severe procurvatum because of distal femoral physeal fracture malunion in two skeletally immature dogs. Both dogs presented with severe right hindlimb lameness and markedly reduced stifle extension at less than 5 months of age. Severe distal femoral procurvatum and mild-to-moderate femoral shortening secondary to distal femoral physeal fracture malunion were evident on radiographs. The sagittal plane deformities were addressed with a caudal opening-wedge osteotomy in one dog and cranial closing wedge ostectomy in the other dog. String-of-Pearls locking plates were used to stabilise the osteotomies. Functional stifle extension range of motion and femoral length were improved post surgery in both dogs. Explantation of the plates was required in both dogs because of local soft tissue irritation. Both dogs had excellent outcomes based on subjective and objective measures (pressure sensitive walkway, force platform analysis) when assessed at skeletal maturity. Corrective osteotomy stabilised with String-of-Pearls locking plates is a viable treatment option for improving limb function in dogs with severe procurvatum deformities caused by distal femoral physeal fracture malunion. © 2014 Australian Veterinary Association.

  20. Objective classification system for sagittal craniosynostosis based on suture segmentation

    Science.gov (United States)

    Qian, Xiaohua; Tan, Hua; Zhang, Jian; Zhuang, Xiahai; Branch, Leslie; Sanger, Chaire; Thompson, Allison; Zhao, Weiling; Li, King Chuen; David, Lisa; Zhou, Xiaobo

    2015-01-01

    Purpose: Spring-assisted surgery is an effective and minimally invasive treatment for sagittal craniosynostosis (CSO). The principal barrier to the advancement of spring-assisted surgery is the patient-specific spring selection. The selection of spring force depends on the suture involved, subtypes of sagittal CSO, and age of the infant, among other factors. Clinically, physicians manually judge the subtype of sagittal CSO patients based on their CT image data, which may cause bias from different clinicians. An objective system would be helpful to stratify the sagittal CSO patients and make spring choice less subjective. Methods: The authors developed a novel informatics system to automatically segment and characterize sutures and classify sagittal CSO. The proposed system is composed of three phases: preprocessing, sutures segmentation, and classification. First, the three-dimensional (3D) skull was extracted from the CT images and aligned with the symmetry of the cranial vault. Second, a “hemispherical projection” algorithm was developed to transform 3D surface of the skull to a polar two-dimensional plane. Through the transformation, an “effective” projected region can be obtained to enable easy segmentation of sutures. Then, the different types of sutures, such as coronal sutures, lambdoid sutures, sagittal suture, and metopic suture, obtained from the segmented sutures were further identified by a dual-projection technique of the midline of the sutures. Finally, 108 quantified features of sutures were extracted and selected by a proposed multiclass feature scoring system. The sagittal CSO patients were classified into four subtypes: anterior, central, posterior, and complex with the support vector machine approach. Fivefold cross validation (CV) was employed to evaluate the capability of selected features in discriminating the four subtypes in 33 sagittal CSO patients. Receiver operating characteristics (ROC) curves were used to assess the robustness

  1. Sagittal alignment of cervical spine in adult idiopathic scoliosis.

    Science.gov (United States)

    Aykac, Bilal; Ayhan, Selim; Yuksel, Selcen; Guler, Umit Ozgur; Pellise, Ferran; Alanay, Ahmet; Perez-Grueso, Francisco Javier Sanchez; Acaroglu, Emre

    2015-06-01

    Alignment of the cervical spine (CS) in adolescent idiopathic scoliosis (IS) as well as in asymptomatic adult populations has recently been studied and described as being less lordotic in the adolescent IS population. However, few studies have examined the sagittal alignment of the CS in adult IS or its association with other radiological variables and clinical relevance. The aim of this study is to analyse the sagittal alignment of CS in adult IS and its association with age, alignment of the thoracic, lumbar and global spinal column as well as health-related quality of life (HRQOL) parameters. A retrospective review of prospectively collected data from a multicenter database was performed. Of 468 consecutive adult IS patients, 213 were included in the study; the remainder were excluded due to poor quality X-rays where the CS was not properly visible, or previous surgery. X-rays were measured for the following CS parameters: [Cranial base-C2 (C0-C2) lordosis, C2-C7 lordosis, thoracic (T1) slope, thoracic inlet angle (TIA) and odontoid (Od)-T1 offset using a measurement software]. These measurements were then evaluated for possible associations with patient age and with pre-existing alignment parameters and HRQOL scores using Pearson correlation tests. The average and standard deviations for CS alignment parameters were 32.3° ± 10.2° for C0-C2; 5.7° ± 14.1° for C2-C7; 23.9° ± 11.3° for T1 slope, 70.5° ± 14.7° for TIA and 20.8° ± 16.5° for Od-T1 offset. CS alignment showed a significant (p < 0.05) correlation with age, T kyphosis and several other sagittal alignment parameters such as sagittal vertical axis (SVA), global tilt and T1 sagittal tilt, but not with the HRQOL parameters. The sagittal alignment of the CS in adult IS is less lordotic than the normal average while less kyphotic than that of IS of a younger age. It correlates with age, thoracic kyphosis and some global sagittal alignment parameters. These findings suggest that CS alignment is

  2. Sagittal synostosis: I. Preoperative morphology of the skull

    DEFF Research Database (Denmark)

    Guimaraes-Ferreira, J.; Gewalli, F.; David, L.

    2006-01-01

    The aim of this study was to characterise the preoperative morphology of the skull in sagittal synostosis in an objective and quantified way. The shapes of the skulls of 105 patients with isolated premature synostosis of the sagittal suture ( SS group) were studied and compared with those...... of a control group of 72 children with unilateral incomplete cleft lip (UICL). A standardised radiocephalometric technique was used to obtain the images. A modification of a method developed by Kreiborg was used to analyse the radiocephalograms, which included the digitisation of 88 landmarks in the calvaria...

  3. Trochanteric reduction osteotomy as a treatment for refractory trochanteric bursitis

    NARCIS (Netherlands)

    Govaert, L. H. M.; van der Vis, H. M.; Marti, R. K.; Albers, G. H. R.

    2003-01-01

    We describe a new operative procedure for patients with chronic trochanteric bursitis. Between March 1994 and May 2000, a trochanteric reduction osteotomy was performed on ten patients (12 hips). All had received conservative treatment for at least one year. Previous surgical treatment with a

  4. Horizontal osteotomy for reconstruction of the narrow edentulous mandible

    NARCIS (Netherlands)

    Raghoebar, GM; Batenburg, RHK; Meijer, HJA; Vissink, A

    The aim of this retrospective study was to evaluate the applicability of a horizontal osteotomy procedure for reconstruction of a narrow edentulous mandible in order to enable insertion of implants. In 7 edentulous patients a narrow inferior alveolar ridge was reconstructed with autogenous bone

  5. Splitting Ward identity

    Energy Technology Data Exchange (ETDEWEB)

    Safari, Mahmoud [Institute for Research in Fundamental Sciences (IPM), School of Particles and Accelerators, P.O. Box 19395-5531, Tehran (Iran, Islamic Republic of)

    2016-04-15

    Within the background-field framework we present a path integral derivation of the splitting Ward identity for the one-particle irreducible effective action in the presence of an infrared regulator, and make connection with earlier works on the subject. The approach is general in the sense that it does not rely on how the splitting is performed. This identity is then used to address the problem of background dependence of the effective action at an arbitrary energy scale. We next introduce the modified master equation and emphasize its role in constraining the effective action. Finally, application to general gauge theories within the geometric approach is discussed. (orig.)

  6. Splitting Ward identity

    Science.gov (United States)

    Safari, Mahmoud

    2016-04-01

    Within the background-field framework we present a path integral derivation of the splitting Ward identity for the one-particle irreducible effective action in the presence of an infrared regulator, and make connection with earlier works on the subject. The approach is general in the sense that it does not rely on how the splitting is performed. This identity is then used to address the problem of background dependence of the effective action at an arbitrary energy scale. We next introduce the modified master equation and emphasize its role in constraining the effective action. Finally, application to general gauge theories within the geometric approach is discussed.

  7. Surgical Treatment of Class III Malocclusion: Monozygotic Twin.

    Science.gov (United States)

    Ertaş, Ümit; Saruhan, Nesrin; Yalçin, Ertan

    2016-07-01

    Mandibular deformities present with infinite variation with different aesthetic and functional problems. Orthognathic surgery is required to achieve satisfactory results for functional and aesthetically in mandibular prognathism patient. Setback of the mandible to correct mandibular prognathism is a well-known procedure. The 2 most frequently used techniques are the intraoral vertical ramus osteotomy and the bilateral sagittal split ramus osteotomy (BSSRO). Bilateral sagittal split ramus osteotomy is an effective and commonly used method to correct mandibular prognathism. In this patient report, mandibular prognathism in female monozygotic twin patients was treated with BSSRO is presented.

  8. Triangle tilt and steel osteotomy: similar approaches to common problems.

    Science.gov (United States)

    Nath, Rahul K; Somasundaram, Chandra; Mahmooduddin, Faiz

    2011-03-24

    Each year, thousands of children worldwide suffer obstetric brachial plexus nerve injuries resulting not only in primary nerve injury, but also in development of secondary muscle and bone deformities of the shoulder. The triangle tilt surgery has been developed and shown to effectively address these deformities. The triangle tilt procedure was initially designed by the lead author (RKN) to follow the concepts of joint normalization featured in the Steel pelvic osteotomy used to correct developmental dysplasia of the hip joint, and indeed ultimately bears a striking resemblance to the Steel osteotomy. Prior to performing these bony surgical procedures, soft tissue procedures are performed to release the muscle contractures of the shoulder and hip. The purpose of this article is to compare and analyze the similarities between the indications, surgical techniques, involved anatomy, and outcomes of these operative procedures. A literature review was conducted using PubMed to identify articles pertaining to triangle tilt surgery and the Steel pelvic osteotomy. Functional parameters and surgical strategies were compared. Pre- and post-operative CTs were analyzed to compare anatomical results of the procedures. Similarities were found between both procedures in terms of indications, involved anatomy, surgical techniques, and outcomes. The triangle tilt surgery is indicated to correct the developmental dysplasia of the glenohumeral joint in obstetric brachial plexus injury patients. Steel pelvic osteotomy is performed to correct the subluxation and dislocation of the hip innominate bone in patients with congenital dysplasia, cerebral palsy myelodysplasia, and poliomyelitis. The involved anatomy of both procedures is similar in that both involve limb girdles and ball-and-socket joints, namely the shoulder and hip. Both procedures are also triple osteotomies, the triangle tilt involving the acromion, clavicle and scapula while the Steel osteotomy involves the iliac spine

  9. Subtubercle Osteotomy for Medial Compartment Osteoarthritis of the Knee Using Ilizarov Technique: Survival Analysis and Clinical Outcomes.

    Science.gov (United States)

    Warner, Stephen J; O'Connor, Daniel P; Brinker, Mark R

    2018-01-03

    in clinical status. The STO technique provides several advantages over acute correction with internal fixation through a conventional high tibial osteotomy, including maintenance of the patellofemoral relationship, no retained implants, and accurate coronal and sagittal plane corrections. Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  10. Global sagittal axis: a step toward full-body assessment of sagittal plane deformity in the human body.

    Science.gov (United States)

    Diebo, Bassel G; Oren, Jonathan H; Challier, Vincent; Lafage, Renaud; Ferrero, Emmanuelle; Liu, Shian; Vira, Shaleen; Spiegel, Matthew Adam; Harris, Bradley Yates; Liabaud, Barthelemy; Henry, Jensen K; Errico, Thomas J; Schwab, Frank J; Lafage, Virginie

    2016-10-01

    OBJECTIVE Sagittal malalignment requires higher energy expenditure to maintain an erect posture. Because the clinical impact of sagittal alignment is affected by both the severity of the deformity and recruitment of compensatory mechanisms, it is important to investigate new parameters that reflect both disability level and compensatory mechanisms for all patients. This study investigated the clinical relevance of the global sagittal axis (GSA), a novel measure to evaluate the standing axis of the human body. METHODS This is a retrospective review of patients who underwent full-body radiographs and completed health-related quality of life (HRQOL) questionnaires: Oswestry Disability Index (ODI), Scoliosis Research Society-22, EuroQol-5D (EQ-5D), and the visual analog scale for back and leg pain. The GSA was defined as the angle formed by a line from the midpoint of the femoral condyles to the center of C-7, and a line from the midpoint between the femoral condyles to the posterior superior corner of the S-1 sacral endplate. After evaluating the correlation of GSA/HRQOL with sagittal parameters, linear regression models were generated to investigate how ODI and GSA related to radiographic parameters (T-1 pelvic angle, pelvic retroversion, knee flexion, and pelvic posterior translation). RESULTS One hundred forty-three patients (mean age 44 years) were included. The GSA correlated significantly with all HRQOL (up to r = 0.6 with EQ-5D) and radiographic parameters (up to r = 0.962 with sagittal vertical axis). Regression between ODI and sagittal radiographic parameters identified the GSA as an independent predictor (r = 0.517, r2 = 0.267; p Analysis of standardized coefficients revealed that when controlling for deformity, the GSA increased with a concurrent decrease in pelvic retroversion (-0.837) and increases in knee flexion (+0.287) and pelvic posterior translation (+0.193). CONCLUSIONS The GSA is a simple, novel measure to assess the standing axis of the human

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

    Science.gov (United States)

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

    2016-01-01

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

  12. Splitting of Comets

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 7; Issue 1. Splitting of Comets. Utpal Mukhopadhyay. General Article Volume 7 Issue 1 January 2002 pp 11-22. Fulltext. Click here to view fulltext PDF. Permanent link: http://www.ias.ac.in/article/fulltext/reso/007/01/0011-0022. Keywords. Cometary ...

  13. The split hand sign

    Directory of Open Access Journals (Sweden)

    Rajesh Benny

    2012-01-01

    Full Text Available Amyotrophic Lateral sclerosis (ALS is a disease characterized by pure motor asymmetric wasting of various muscles with associated upper motor neuron signs. The split hand sign, which is because of dissociated muscle weakness in the hands (thenar muscles disproportionately wasted as compared to the hypothenar muscles is a useful clinical sign for bed side diagnosis of ALS.

  14. Influence of tonsil size on sagittal cephalometric measurements.

    Science.gov (United States)

    Diouf, Joseph Samba; Ngom, Papa Ibrahima; Fadiga, Mohamed Siddick; Badiane, Alpha; Diop-Ba, Khady; Sonko, Ousmane; Diagne, Falou

    2015-06-01

    The role of tonsils in the origin of sagittal skeletodental abnormalities has been widely discussed in the literature but remains controversial. Data on the probable relationship between enlarged tonsils and the presence of these abnormalities were subjective. The aim of this study was to quantify the relationship between the space occupied by the palatine tonsils and sagittal cephalometric measurements. A cross-sectional study was performed on a group of children divided into 5 subgroups according to the standardized tonsillar hypertrophy grading scale. Cephalometric measurements were recorded for each child. Data were analyzed using SPSS 20.0 for Windows. The strength of the association between tonsil grades and quantitative variables was assessed using Spearman's rank correlation coefficient (Rho). The level of significance was fixed at P=0.05. Lengths SN, t2-p3, h-Gn and Xi-pm, and angles I/F, I/SN, i/M, SNB, SNPog and SNGn were significantly and negatively correlated with grades. The ANB angle, the sagittal position of the pogonion and the angle of facial convexity were significantly and positively correlated with grades. Early evaluation of tonsil size can prevent certain skeletodental abnormalities in the sagittal plane caused by upper airway obstruction. Thus, more aggressive late treatments, which are not always as effective as when they are performed during childhood, can be avoided. Copyright © 2015 CEO. Published by Elsevier Masson SAS. All rights reserved.

  15. CHANGES IN THE SAGITTAL BALANCE IN CONGENITAL SCOLIOSIS CORRECTION SURGERY

    Directory of Open Access Journals (Sweden)

    José Antonio Mancuso Filho

    Full Text Available ABSTRACT Objective: This study aimed to determine whether surgery leads to changes in sagittal balance in patients with congenital scoliosis. Methods: We retrospectively reviewed all cases of scoliosis operated in a tertiary hospital between January 2009 and January 2013. In all cases the deformity in the coronal and sagittal planes, kyphosis, and lordosis were measured, using the Cobb method, and spinopelvic parameters: pelvic incidence (PI, sacral slope (SS, and pelvic tilt (PT. Results A hundred and eleven medical records were analyzed, but the sample resulted in 10 patients, six of whom were females (60%. The average age was 13.4 years. In the comparative analysis between pre and postoperative, only the coronal deformity (12.37; CI 95% [7.88-16.86]; p<0.001, the sagittal deformity (12.71; CI 95% [4.21-21.22]; p=0.011, and the lumbar lordosis (9.9; CI 95% [0.38-19.42]; p=0.043 showed significant change. Conclusion: There was no change in the spinopelvic parameters of patients with congenital scoliosis undergoing surgery at IOF-FMUSP between 2009 and 2013; however, it was observed decrease in lumbar lordosis, and deformity angle in the sagittal and coronal planes.

  16. Lenke 1 and 5: changes in sagittal balance

    Directory of Open Access Journals (Sweden)

    Delson Valdemir Pessin

    2014-09-01

    Full Text Available OBJECTIVE: To assess in a cross-sectional study whether there are changes in sagittal balance in patients with adolescent idiopathic scoliosis Lenke types 1 and 5 compared with patients without pathology of the spine and compare the values of the parameters of normal subjects with the parameters found in the literature. METHODS: We measured the values of the parameters of sagittal balance of 21 patients with scoliosis and 14 patients without scoliosis in panoramic radiographs or simply collected data previously measured from the medical records. We compared the mean values of normal subjects, the mean values found in the literature, and the means between normal subjects and patients with scoliosis. For this, we used the Student t test. RESULTS: Using a confidence interval of 5% (p < 0.05 and the Student t test we obtained statistical significance in the comparison of two parameters of sagittal balance between normal subjects and patients with scoliosis. We observed similarities in the measurements of the average parameters of normal subjects with regard to the work already published. CONCLUSIONS: The adolescent idiopathic scoliosis causes changes in two parameters of sagittal balance with statistical significance but suggests changes in all other parameters. As for comparison with previously published work, the results were similar.

  17. Laser therapy for neurosensory recovery after saggital split ramus oseotomy

    Directory of Open Access Journals (Sweden)

    Astrid Virginia Buysse Temprano

    2017-10-01

    A group of twelve patients with the need of surgical correction of their dental-skeletal anomaly underwent orthognathic surgery with bilateral mandibular sagittal osteotomy. Patients were treated unilaterally and blinded with a low intensity infrared GaAlAs laser of 808 nm, and compared with the contralateral site as a control group, following the course of the inferior dental nerve. The parameters used were of 100 mW of power, irradiation of 3.6 W/cm2, 2.8 J of energy per point, an energy density of 100 J/cm2, to 28 s in each point with a distance of 1 cm between points. The treatment included two sessions per week with a minimum of 10 sessions, starting 48 h after surgery. Mechanical and thermal evaluations were performed in the first, fourth, seventh and tenth sessions. A significant improvement was observed in the subjective response of the patients on the treated side. The treatment of neurosensory disorders with low-intensity infrared laser has been shown to be effective in accelerating recovery, providing greater patient comfort, and presenting advantages over other existing methods.

  18. Osteotomy for lower third molar germectomy: randomized prospective crossover clinical study comparing piezosurgery and conventional rotatory osteotomy.

    Science.gov (United States)

    Sivolella, Stefano; Berengo, Mario; Bressan, Eriberto; Di Fiore, Adolfo; Stellini, Edoardo

    2011-06-01

    The aim of the present study was to compare piezoelectric surgery and conventional rotatory osteotomy for mandibular third molar germ extraction to determine the 2 methods' suitability and the postoperative outcomes. Mandibular third molar germectomy was performed bilaterally, randomly choosing 1 side for rotatory osteotomy (rotatory group) and the other for piezoelectric surgery (piezo group). The predictor variable was the duration of the surgical procedure. The outcome variables were the suitability of the method used, bleeding, and the postoperative parameters (ie, mouth opening range, clinical appearance of soft tissues, exudate, abscess, wound dehiscence, locoregional lymphadenopathy, pain on palpation at the extraction site, persistent edema) at 7 and 30 days postoperatively. The patients recorded their subjective postoperative pain daily for 7 days using a visual analog scale. The Wilcoxon rank-sum test and stepwise logistic regression model with binary variables were used for statistical analysis. A total of 26 patients (mean age 15.4 ± 1.29 years) were enrolled in the present study. The time needed to complete the osteotomy and extraction was significantly greater for the piezo group (15.77 ± 6.56 minutes) than for the rotatory group (11.77 ± 6.24 minutes; P = .028). No statistically significant differences emerged between the 2 methods for the other outcome variables considered. Piezoelectric osteotomy proved comparable to the rotatory method in terms of the surgeon's perception of the suitability of the 2 methods and the related postoperative sequelae. However, piezoelectric osteotomy took longer to complete than the rotatory method. Copyright © 2011 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.

  19. Compensatory mechanisms contributing to keep the sagittal balance of the spine

    National Research Council Canada - National Science Library

    Barrey, Cédric; Roussouly, Pierre; Le Huec, Jean-Charles; D’Acunzi, Gennaro; Perrin, Gilles

    2013-01-01

    .... For the two last stages, the compensatory mechanisms permit to limit the consequences of loss of lumbar lordosis on global sagittal alignment and therefore contribute to keep the sagittal balance...

  20. Sagittal plane biomechanics cannot injure the ACL during sidestep cutting.

    Science.gov (United States)

    McLean, Scott G; Huang, Xuemei; Su, Anne; Van Den Bogert, Antonie J

    2004-10-01

    Knee joint sagittal plane forces are a proposed mechanism of anterior cruciate ligament injury during sport movements such as sidestep cutting. Ligament force magnitudes for these movements however, remain unknown. The need to examine injury-causing events suggests elucidation via model-based investigations is possible. Using this approach, the current study determined whether sagittal plane knee loading during sidestep cutting could in isolation injure the anterior cruciate ligament. Experiments were performed on subject-specific forward dynamic musculoskeletal models, generated from data obtained from 10 male and 10 female athletes. Models were optimized to simulate subject-specific cutting movements. Random perturbations (n=5000) were applied to initial contact conditions and quadriceps/hamstrings activation levels to simulate their effect on peak 3D knee loads. Injury via the sagittal plane mechanism was based on the criterion of an anterior drawer force greater than 2000 N. Realistic neuromuscular perturbations produced significant increases in external knee anterior force and valgus and internal rotation moments. Peak anterior drawer force never exceeded 2000 N in any model, and thus failed to cause anterior cruciate ligament injuries. Valgus loads reached values that were high enough to rupture the ligament, occurring more frequently in females than in males. Sagittal plane knee joint forces cannot rupture the anterior cruciate ligament during sidestep cutting. The interaction between muscle and joint mechanics and external ground reaction forces in this plane, places a ceiling on ligament loads. Valgus loading is a more likely injury mechanism, especially in females. Modifying sagittal plane biomechanics will thus unlikely contribute to the prevention of anterior cruciate ligament injuries.

  1. Developing a System for Efficient Analysis of Lumbosacral Sagittal Balance

    Directory of Open Access Journals (Sweden)

    D. M. Zhuk

    2015-01-01

    Full Text Available Lumbosacral sagittal balance is the neutral vertical alignment in the sagittal plane to provide decreasing stress loading on muscular-ligamentous structures. The achieving sagittal balance is a basis to provide successful surgical treatment and minimize further complications. As of today, there is no standard quantitative evaluation method of sagittal lumbo-sacral balance, which allows conducting its effective analysis and planning surgical treatment taking into consideration the preservation of normal biomechanics of lumbosacral spine. The goal of the study is to develop a diagnostic system for individual correction of lumbo-sacral sagittal balance by the author’s method with automatic counting and optimized matching of data values based on a specified number of terms using medical visualization data. This study has been conducted with RMAPE’s Department of Traumatology and Orthopedic Surgery. To solve the problem, a random searching algorithm has been exploited. The stop condition of the algorithm was to achieve the objective function value in adjusted interval, initial points of which are the calculated (angular values. The interaction of the angular values, used in the proposed method has been investigated, and their proportional change has been proved. Moreover, the mathematical dependence among geometrical and anatomical parameters of lumbosacral spine has been determined. Based on conducted study, a number of algorithms enabling the automation of the individual determination of optimal lumbosacral balance’s parameters at preoperative planning stage for patients with vertebral column diseases have been created. This allows us to raise physician’s efficiency, minimize mid- and long-term risk of postoperative complications, and avoid reoperations, and prognosticate long-term complications already performed surgery.

  2. Reliability of cervical lordosis and global sagittal spinal balance measurements in adolescent idiopathic scoliosis.

    Science.gov (United States)

    Vidal, Christophe; Ilharreborde, Brice; Azoulay, Robin; Sebag, Guy; Mazda, Keyvan

    2013-06-01

    Radiological reproducibility study. To assess intra and interobserver reliability of radiographic measurements for global sagittal balance parameters and sagittal spine curves, including cervical spine. Sagittal spine balance in adolescent idiopathic scoliosis (AIS) is a main issue and many studies have been reported, showing that coronal and sagittal deformities often involve sagittal cervical unbalance. Global sagittal balance aims to obtain a horizontal gaze and gravity line at top of hips when subject is in a static position, involving adjustment of each spine curvature in the sagittal plane. To our knowledge, no study did use a methodologically validated imaging analysis tool able to appreciate sagittal spine contours and distances in AIS and especially in the cervical region. Lateral full-spine low-dose EOS radiographs were performed in 75 patients divided in three groups (control subjects, AIS, operated AIS). Three observers digitally analyzed twice each radiograph and 11 sagittal measures were collected for each image. Reliability was assessed calculating intraobserver Pearson's r correlation coefficient, interobserver intra-class correlation coefficient (ICC) completed with a two-by-two Bland-Altman plot analysis. This measurement method has shown excellent intra and interobserver reliability in all parameters, sagittal curvatures, pelvic parameters and global sagittal balance. This study validated a simple and efficient tool in AIS sagittal contour analysis. It defined new relevant landmarks allowing to characterize cervical segmental curvatures and cervical involvement in global balance.

  3. Splitting water with cobalt.

    Science.gov (United States)

    Artero, Vincent; Chavarot-Kerlidou, Murielle; Fontecave, Marc

    2011-08-01

    The future of energy supply depends on innovative breakthroughs regarding the design of cheap, sustainable, and efficient systems for the conversion and storage of renewable energy sources, such as solar energy. The production of hydrogen, a fuel with remarkable properties, through sunlight-driven water splitting appears to be a promising and appealing solution. While the active sites of enzymes involved in the overall water-splitting process in natural systems, namely hydrogenases and photosystem II, use iron, nickel, and manganese ions, cobalt has emerged in the past five years as the most versatile non-noble metal for the development of synthetic H(2)- and O(2)-evolving catalysts. Such catalysts can be further coupled with photosensitizers to generate photocatalytic systems for light-induced hydrogen evolution from water. Copyright © 2011 WILEY-VCH Verlag GmbH & Co. KGaA, Weinheim.

  4. Split warhead simultaneous impact

    Directory of Open Access Journals (Sweden)

    Rahul Singh Dhari

    2017-12-01

    Full Text Available A projectile system is proposed to improve efficiency and effectiveness of damage done by anti-tank weapon system on its target by designing a ballistic projectile that can split into multiple warheads and engage a target at the same time. This idea has been developed in interest of saving time consumed from the process of reloading and additional number of rounds wasted on target during an attack. The proposed system is achieved in three steps: Firstly, a mathematical model is prepared using the basic equations of motion. Second, An Ejection Mechanism of proposed warhead is explained with the help of schematics. Third, a part of numerical simulation which is done using the MATLAB software. The final result shows various ranges and times when split can be effectively achieved. With the new system, impact points are increased and hence it has a better probability of hitting a target.

  5. Proximal femoral derotation osteotomy for idiopathic excessive femoral anteversion and intoeing gait

    OpenAIRE

    Naqvi, Gohar; Stohr, Kuldeep; Rehm, Andreas

    2017-01-01

    Aim: The purpose of this study is to assess the symptoms caused by excessive femoral anteversion and the outcomes of femoral derotation osteotomy. Methods: We reviewed data on patients who underwent proximal femoral derotation osteotomy for symptomatic intoeing gait caused by femoral anteversion. Only symptomatic patients were considered for corrective derotation osteotomy. Degree of femoral anteversion was confirmed on computed tomography (CT) scan. Results: T...

  6. Insufficient restoration of lumbar lordosis and FBI index following pedicle subtraction osteotomy is an indicator of likely mechanical complication.

    Science.gov (United States)

    Le Huec, J C; Cogniet, A; Demezon, H; Rigal, J; Saddiki, R; Aunoble, S

    2015-01-01

    Pedicle subtraction osteotomies (PSO) enable correction of spinal deformities but remain difficult and are associated with high complication rates. This study aimed to prospectively review different post-operative complications and mechanical problems in patients who underwent PSO as treatment for sagittal imbalance as sequelae of degenerative disc disease or previous spinal fusion. This was a descriptive prospective single center study of 63 patients who underwent sagittal imbalance correction by PSO. Radiographic analysis of pre- and post-operative pelvic and spinal parameters was completed based on EOS images following 3D modeling. Global and sub-group analyses were completed based on the Roussouly classification. A systematic analysis of post-operative complications was conducted during hospital stay and at follow-up visits. Complications included 15 cases (20.2%) of bilateral leg pain, with transient neurological deficit in 6 cases (9.5%), and 9 cases (12.5%) of early surgical site infections. Intra-operative complications included five tears of the dura mater and two cases of excessive blood loss (>5,000 mL). Two mortalities occurred from major intracerebral bleeds in the early post-operative period. Mechanical complications were principally non-union (9 cases) and junctional kyphosis (3 cases). All 19 post-operative complications (28.1%) were revised at an average of 2 years following surgery. All mechanical complications were found in the patients who had insufficient imbalance correction and this was mainly associated with high PI (>60°) or a moderate PI (45-60º) combined with excess FBI pre-operatively that remained >10° post-operatively. Infection and neurologic complications following PSO are relatively common, and frequently reported in the literature. The principal cause of mechanical complications, such as non-union or junctional kyphosis, was insufficient sagittal correction, characterized by post-operative FBI >10°. The risks of insufficient

  7. Utilization trends of pedicle subtraction osteotomies compared to posterior spinal fusion for deformity: a national database analysis between 2008-2011.

    Science.gov (United States)

    Gum, Jeffrey L; Carreon, Leah Y; Buchowski, Jacob M; Lenke, Lawrence G; Glassman, Steven D

    2016-01-01

    Increased awareness regarding the importance of the sagittal spinal profile has led to more aggressive correction of sagittal malalignment. The utilization trends of pedicle subtraction osteotomy (PSO) for sagittal plane correction in spinal deformity surgery have not been well characterized. A commercially available database (PearlDiver, Inc) was queried for both Private Payor and 5 % Medicare claims from 2008 to 2011. Revision and clarification of the coding guidelines for PSO were introduced in 2008. Patients who had a thoracic and/or lumbar PSO were identified using CPT codes (22206-22208). In order to appropriately interpret trends in PSO use, three comparison groups were identified. Patients who had a diagnosis of adult spine deformity were identified using ICD-9 codes. Patients who had fusion for spine deformity or posterior spine fusion were identified using CPT codes. Differences in annual utilization and demographics between these four groups were then compared. From the Private Payor database, 199 PSOs were identified with the number of PSOs increasing from 33 in 2008, to 61 in 2011, representing a 185 % increase. From the Medicare data, 102 PSOs were identified, increasing from 13 in 2008 to 32 in 2011, a 246 % increase. In contrast, from both databases, there was minimal to no increase in the incidence of adult spine deformity, fusion for spine deformity or posterior spine fusion over the study time interval. Over the study time interval, there was up to a 3.2-fold increase in the utilization of PSOs while the diagnosis of adult spine deformity, fusion for spine deformity and posterior spine fusions had minimal to no increase.

  8. Posterior maxillary anatomy: implications for Le Fort I osteotomy.

    Science.gov (United States)

    Cheung, L K; Fung, S C; Li, T; Samman, N

    1998-10-01

    The most common site of haemorrhage in maxillary osteotomies is the posterior maxilla. Better understanding of the anatomy in this region may minimize possible vascular complications. The aim of the study was to study the osteology of the posterior maxillary region and establish clinical safety guidelines for the Le Fort I osteotomy Thirty human dry skulls were selected and assessed by a combination of direct inspection, computerized imaging and computed tomography (CT) scan analysis. Results showed that the presence of maxillary third molars influenced the transverse angulation of the posterior vertical cut. Synostosis of the pterygomaxillary junction was noted in 12% of samples. The mean length of the medial sinus wall from the piriform rim to the descending palatine canal at the Le Fort I level was 34 mm. The three-dimensional CT-reconstructed descending palatine canal ran at 60 degrees anteroinferiorly to the palatine plane and slightly medially to the exit through the greater palatine foramen.

  9. Triphalangeal Thumb Reduction Osteotomy Through a Versatile Spiral Approach.

    Science.gov (United States)

    Alrabai, Hamza M; Farr, Sebastian; Girsch, Werner

    2016-06-01

    Triphalangeal thumb (TPT) is a congenital condition characterized by the presence of an additional phalanx. Variable degrees of thumb deformity, malalignment, and excessive length are common features. Impairment of hand function has been reported with TPT probably secondary to anomalistic long thumb incompatible with fine hand skills. Abnormal thumb appearance moreover represents a major psychological concern from patient's perspective. Both removal of the extra phalanx and phalangeal reduction osteotomy with resection of the unhealthy extra interphalangeal joint are established methods for correction of the associated excessive thumb length. In our experience, however, previous surgical approaches have not been able to sufficiently reduce the skin and soft tissue surplus, which exists after reduction osteotomy through classic circular incisions. We thus feel that conduction of TPT reconstruction through a spiral incision provides a safe and generous anatomic exposure required for simultaneous reduction of skeletal and soft tissue components.

  10. Roentgen stereogrammetry in high tibial osteotomy for gonarthrosis

    Energy Technology Data Exchange (ETDEWEB)

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

    1981-01-01

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

  11. Influence of third molars in Le Fort 1 osteotomy.

    Science.gov (United States)

    Balaji, S M

    2011-07-01

    The influence of maxillary third molar (M3) on the outcomes of Le Fort 1 osteotomy is not deeply investigated. To investigate the influence of M3 on Le Fort 1 osteotomies. Tertiary Referral Center, operated by a single surgeon, prospective study. January 2005 to December 2010. Consecutive Le Fort 1 osteotomy patients with both M3. Gender, position, M3 root morphology, and degree of impaction. Time taken after all osteotomy cuts to point of time when maxilla is placed in predetermined plane. A total of 658 M3 in line of cut were studied. Of all M3, 312 were impacted, 28.9% were partially impacted and 23.7% were erupted. Of all the M3, 2.9% had their cuspal tips above the horizontal cut, 13.8% along the line of cut, and in 20.7% below the line but not erupted. Buccoverted tooth took shortest time (7.74 minutes), while palatoversion required more time (8.44 minutes) (P = 0.000). When the cuspal tip of M3 was located above the horizontal line of cut, the mean time required to achieve the planned position was 7 minutes, while the completely erupted teeth took a mean of 8.24 minutes (P = 0.000). When the M3 is placed higher, it takes lesser time to prepare basal bone to receive the maxilla at its predetermined level. Angulation of M3 influences the outcome. Deeply placed M3 reduces the manipulation of the greater pterygoid palatine vessels in the area thereby minimizing the bleeding in the surgical field.

  12. Sarcoidosis Nodules on the Lateral Nasal Osteotomy Lines.

    Science.gov (United States)

    Basat, Salih Onur; Ceran, Fatih; Aksan, Tolga; Ozturk, Muhammed Besir

    2016-09-01

    Sarcoidosis is a multisystem inflammatory disease that manifests as noncaseating granulomas, commonly in the lungs and intrathoracic lymph nodes. Subcutaneous manifestations of sarcoidosis that are caused by granulomas are referred to as specific for sarcoidosis, whereas other lesions are considered nonspecific. The authors present "sarcoidosis nodule formation on the lateral nasal osteotomy lines" in a sarcoidosis patient undergoing rhinoplasty surgery as a rare patient. V.

  13. The effects of Mandibular Osteotomy on articulation and resonance

    Directory of Open Access Journals (Sweden)

    Delsa Geffen

    1978-08-01

    Full Text Available Pre- and post-operative speech samples were studied in nine adult cases who received Mandibular Osteotomy. Lateral cephalograms were taken during sustained production of selected sounds and trained listeners judged recordings. In most cases there was an improvement in the general quality of the speech. Considering that the functional  relationships between the speech organs had altered, it would appear that some form of adaptation by the speaker had in fact taken place.

  14. Lateral window and transalveolar osteotomy sinus lifting technique

    OpenAIRE

    Ruslin, Muhammad

    2011-01-01

    The insertion of dental implants in atrophy maxilla is a complicated issue because no bone support due to expansion of maxillary sinus and atrophy of maxillary ridge alveolar. Surgery by sinus lifting with autogenous bone transplantation has been proven to be an acceptable treatment to get bone support. The lateral window technique and transalveolar osteotomy sinus lifting are the methods to correct the height of inadequate bone in the posterior area of maxilla for preparation of implan denta...

  15. Proximal supination osteotomy of the first metatarsal for hallux valgus.

    Science.gov (United States)

    Yasuda, Toshito; Okuda, Ryuzo; Jotoku, Tsuyoshi; Shima, Hiroaki; Hida, Takashi; Neo, Masashi

    2015-06-01

    Risk factors for hallux valgus recurrence include postoperative round-shaped lateral edge of the first metatarsal head and postoperative incomplete reduction of the sesamoids. To prevent the occurrence of such conditions, we developed a proximal supination osteotomy of the first metatarsal. Our aim was to describe this novel technique and report the outcomes in this report. Sixty-six patients (83 feet) underwent a distal soft tissue procedure combined with a proximal supination osteotomy. After the proximal crescentic osteotomy, the proximal fragment was pushed medially, and the distal fragment was abducted, and then the distal fragment of the first metatarsal was manually supinated. Outcomes were assessed using the American Orthopaedic Foot & Ankle Society (AOFAS) score and radiographic examinations. The average follow-up duration was 34 (range, 25 to 52) months. The mean AOFAS score improved significantly from 58.0 points preoperatively to 93.8 points postoperatively (P hallux valgus and intermetatarsal angle decreased significantly from 38.6 and 18.0 degrees preoperatively to 11.0 and 7.9 degrees postoperatively, respectively (both, P hallux valgus, defined as a hallux valgus angle ≥ 25 degrees. The rates of occurrence of a positive round sign and incomplete reduction of the sesamoids significantly decreased postoperatively, which may have contributed to the low hallux valgus recurrence rates. We conclude that a proximal supination osteotomy was an effective procedure for correction of hallux valgus and can achieve a low rate of hallux valgus recurrence. Level IV, retrospective case series. © The Author(s) 2015.

  16. Osteotomies in ankylosing spondylitis: where, how many, and how much?

    Science.gov (United States)

    Koller, H; Mayer, M; Hempfing, A; Koller, J

    2017-12-30

    This article presents the current concepts of correction of spinal deformity in ankylosing spondylitis (AS) patients. Untreated AS can be a debilitating disease. In a few patients, disease progression results in severe spinal deformity affecting not only the thoracolumbar, but also the cervical spine. Surgery for correction in AS patients has a long history. With the advent of modern instrumentation, standardization of surgical and anesthesiologic techniques, surgical safety and corrective results could be improved and experiences from lumbar osteotomies could be transferred to the cervical spine. This article presents the current concepts of correction of spinal deformity in AS patients. In particular, questions regarding the localization and number of osteotomies, the optimal surgical target angle as well as planning and prediction of postoperative alignment are discussed. Insight into recent technical developments, current challenges with correction and geometric analysis of center of rotation (COR) in cervical 3-column osteotomies (3CO) will be presented. The article should encourage readers to improve surgical correction efficacy and provide a better understanding of correction geometry in 3CO for thoracolumbar and cervical spinal deformities.

  17. Use of locking plate and screws for triple pelvic osteotomy.

    Science.gov (United States)

    Rose, Scott A; Bruecker, Ken A; Petersen, Steve W; Uddin, Nizam

    2012-01-01

    To evaluate the efficacy and complication rate associated with use of a purpose-specific locking triple pelvic osteotomy (LTPO) plate. Prospective study. Dogs (n = 9; 15 hips). Physical examination, plain film radiography, computed tomography (CT) of the pelvis, and coxofemoral arthroscopy were performed before unilateral triple pelvic osteotomy (TPO) or staged bilateral TPO. Radiographs were taken after each procedure and 3-5, 6-8, and ≥12 weeks postoperatively. Pelvic width was measured at 3 locations to evaluate pelvic canal narrowing. No screw loosening occurred. Complications occurred in only 1 hip (7%) where pullout of the locking plate-screw construct from the caudal iliac segment occurred because of a fracture of the cis-cortex; the dog made a full recovery after a salvage procedure. There was no significant reduction in the cranial pelvic width but a small reduction at the level of the acetabuli and ischiatic tuberosities was noted 3-5 weeks after the 2nd TPO. The LTPO plate was associated with a lower complication rate than previously reported for TPOs using Slocum canine pelvic osteotomy plates (CPOP) and warrants further investigation. Pullout of the caudal plate-screw construct is a complication specific to LTPO implants. Bicortical screw purchase is recommended to prevent fracture of the cis-cortex and implant pullout. © Copyright 2011 by The American College of Veterinary Surgeons.

  18. Hardware Location and Clinical Outcome in Ulna Shortening Osteotomy.

    Science.gov (United States)

    Megerle, Kai; Hellmich, Susanne; Germann, Günter; Sauerbier, Michael

    2015-10-01

    The purpose of this study was to investigate the influence of plate location during ulna shortening osteotomy on the incidence of hardware irritation and clinical outcome. Forty patients (17 women, 23 men; mean age, 47 years) who underwent a shortening osteotomy of the ulna due to idiopathic ulna impaction syndrome were examined after a mean of 36 months. All complications and secondary procedures were extracted from the patients' records. The rate of hardware removal was higher in patients who had a dorsal placement of the plate in comparison with ulnar or palmar placements, although this difference was not statistically significant. Apart from hardware irritation, there were 4 nonunions, 1 secondary osteoarthritis of the distal radioulnar joint, and 1 case of chronic irritation of the dorsal branch of the ulnar nerve, which required secondary surgery. The incidence of secondary surgery other than hardware removal was not significantly related to the original location of the plate. Secondary surgery after ulnar shortening osteotomy is common. However, we found no difference in clinical outcomes based on plate location.

  19. Temporomandibular joint computed tomography: development of a direct sagittal technique

    Energy Technology Data Exchange (ETDEWEB)

    van der Kuijl, B.; Vencken, L.M.; de Bont, L.G.; Boering, G. (Univ. of Groningen, (Netherlands))

    1990-12-01

    Radiology plays an important role in the diagnosis of temporomandibular disorders. Different techniques are used with computed tomography offering simultaneous imaging of bone and soft tissues. It is therefore suited for visualization of the articular disk and may be used in patients with suspected internal derangements and other disorders of the temporomandibular joint. Previous research suggests advantages to direct sagittal scanning, which requires special positioning of the patient and a sophisticated scanning technique. This study describes the development of a new technique of direct sagittal computed tomographic imaging of the temporomandibular joint using a specially designed patient table and internal light visor positioning. No structures other than the patient's head are involved in the imaging process, and misleading artifacts from the arm or the shoulder are eliminated. The use of the scanogram allows precise correction of the condylar axis and selection of exact slice level.

  20. Sagittal plane deformity: an overview of interpretation and management.

    Science.gov (United States)

    Roussouly, Pierre; Nnadi, Colin

    2010-11-01

    The impact of sagittal plane alignment on the treatment of spinal disorders is of critical importance. A failure to recognise malalignment in this plane can have significant consequences for the patient not only in terms of pain and deformity, but also social interaction due to deficient forward gaze. A good understanding of the principles of sagittal balance is vital to achieve optimum outcomes when treating spinal disorders. Even when addressing problems in the coronal plane, an awareness of sagittal balance is necessary to avoid future complications. The normal spine has lordotic curves in the cephalad and caudal regions with a kyphotic curve in between. Overall, there is a positive correlation between thoracic kyphosis and lumbar lordosis. There are variations on the degree of normal curvature but nevertheless this shape allows equal distribution of forces across the spinal column. It is the disruption of this equilibrium by pathological processes or, as in most cases, ageing that results in deformity. This leads to adaptive changes in the pelvis and lower limbs. The effects of limb alignment on spinal posture are well documented. We now also know that changes in pelvic posture also affect spinal alignment. Sagittal malalignment presents as an exaggeration or deficiency of normal lordosis or kyphosis. Most cases seen in clinical practise are due to kyphotic deformity secondary to inflammatory, degenerative or post-traumatic disorders. They may also be secondary to infection or tumours. There is usually pain and functional disability along with concerns about self-image and social interaction due to inability to maintain a horizontal gaze. The resultant pelvic and lower limb posture is an attempt to restore normal alignment. Addressing this complex problem requires detailed expertise and awareness of the potential pitfalls surrounding its treatment.

  1. Sagittal spinopelvic balance in normal children and adolescents.

    Science.gov (United States)

    Mac-Thiong, Jean-Marc; Labelle, Hubert; Berthonnaud, Eric; Betz, Randal R; Roussouly, Pierre

    2007-02-01

    The sagittal spinopelvic balance is poorly documented in normal pediatric subjects. The purpose of this study is to characterize the sagittal spinopelvic balance in the pediatric population and to evaluate the correlations between spinopelvic parameters. Seven parameters were evaluated from the lateral standing radiographs of 341 normal subjects aged 3-18 years old: thoracic kyphosis (TK), thoracic tilt (TT), lumbar lordosis (LL), lumbar tilt (LT), sacral slope (SS), pelvic tilt (PT) and pelvic incidence (PI). The mean values for the pelvic parameters were 49.1+/-11.0, 7.7+/-8.0 and 41.4+/-8.2 degrees for PI, PT and SS, respectively. The mean values for the spinal parameters were 48.0+/-11.7, 44.0+/-10.9, -7.3+/-5.2 and -3.1+/-5.2 degrees for LL, TK, LT and TT, respectively. The spinopelvic parameters were different from those reported in normal adults, but the correlations between the parameters were similar. PI was significantly related to SS and PT. Significant correlations were found between the parameters of adjacent anatomical regions. Pelvic morphology (PI) regulates sagittal sacro-pelvic orientation (SS and PT). Sacral orientation (SS) is correlated with the shape (LL) and orientation (LT) of the lumbar spine. Adjacent anatomical regions of the spine and pelvis are interdependent, and their relationships result in a stable and compensated posture, presumably to minimize energy expenditure. Results from this study could be used as an aid for the planning of surgery in pediatric patients with spinal deformity in order to restore a relatively normal sagittal spinopelvic balance.

  2. Classification of normal sagittal spine alignment: refounding the Roussouly classification.

    Science.gov (United States)

    Laouissat, Féthi; Sebaaly, Amer; Gehrchen, Martin; Roussouly, Pierre

    2017-04-28

    Although the Roussouly classification of common variants in spinal sagittal alignment is well accepted, no studies have implemented it in an asymptomatic adult population. In addition, no study investigated the radiographic features of asymptomatic patients with an anteverted pelvis. The aim of this prospective radiographic study of 296 asymptomatic adults without spinal pathology was to investigate how the Roussouly classification could include the anteverted pelvis concept. Pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), and the lumbar parameters lumbar lordosis (Global LL), lordosis tilt angle (LTA), total number of lordotic vertebra (LL verteb), and C7 plumbline/sacrofemoral distance ratio (C7PL ratio) were evaluated in 296 healthy volunteers (126 males, 170 females; mean age, 27 years; range 18-48 years). Comparison between the five types of the Roussouly classification used Student, ANOVA, and Tukey tests for quantitative variables and χ (2), Fischer, and Holm tests for qualitative variables. Mean PI and PT were, respectively, (39°, 10°) for type 1, (41°, 10°) for type 2, (53°, 13°) for type 3, and (62°, 12°) for type 4 (p  35°. PT was low or negative (mean 4° ± 3°). C7PL ratio was >1 (in front of the hip axis) in 13% of all cases, and between 0 and 1 (between sacrum and hip axis) in 49%. Although asymptomatic adults stood with stable global balance, the sagittal spinal alignment of healthy subjects, newly divided in 5 sagittal types, varied significantly. Type 3 AP appears as a new and unusual sagittal shape with low-grade PI, very low or negative PT, and hyperlordosis. Whereas most asymptomatic adults stood with C7PL behind the hip axis, a sizeable portion had C7 in front of the hip axis. This could be a new controversial aspect of ideal spinal balance.

  3. Sagittal plane deformity: an overview of interpretation and management

    Science.gov (United States)

    Roussouly, Pierre

    2010-01-01

    The impact of sagittal plane alignment on the treatment of spinal disorders is of critical importance. A failure to recognise malalignment in this plane can have significant consequences for the patient not only in terms of pain and deformity, but also social interaction due to deficient forward gaze. A good understanding of the principles of sagittal balance is vital to achieve optimum outcomes when treating spinal disorders. Even when addressing problems in the coronal plane, an awareness of sagittal balance is necessary to avoid future complications. The normal spine has lordotic curves in the cephalad and caudal regions with a kyphotic curve in between. Overall, there is a positive correlation between thoracic kyphosis and lumbar lordosis. There are variations on the degree of normal curvature but nevertheless this shape allows equal distribution of forces across the spinal column. It is the disruption of this equilibrium by pathological processes or, as in most cases, ageing that results in deformity. This leads to adaptive changes in the pelvis and lower limbs. The effects of limb alignment on spinal posture are well documented. We now also know that changes in pelvic posture also affect spinal alignment. Sagittal malalignment presents as an exaggeration or deficiency of normal lordosis or kyphosis. Most cases seen in clinical practise are due to kyphotic deformity secondary to inflammatory, degenerative or post-traumatic disorders. They may also be secondary to infection or tumours. There is usually pain and functional disability along with concerns about self-image and social interaction due to inability to maintain a horizontal gaze. The resultant pelvic and lower limb posture is an attempt to restore normal alignment. Addressing this complex problem requires detailed expertise and awareness of the potential pitfalls surrounding its treatment. PMID:20567858

  4. Isolated sagittal craniosynostosis: definition, classification, and surgical indications.

    Science.gov (United States)

    Massimi, Luca; Caldarelli, Massimo; Tamburrini, Gianpiero; Paternoster, Giovanna; Di Rocco, Concezio

    2012-09-01

    Sagittal craniosynostosis (SC) remains the most common type of synostosis, accounting for about a half of all forms. It would result from a mesenchymal disorder involving the intramembranous ossification of the sagittal suture and leading to its early fusion. No specific data on the etiologic factors are currently available. The premature ossification of the sagittal suture can result in three main types of SC, according to the different segment prevalently involved: anterior, posterior, and complete SC. The diagnosis is easily obtained by clinical examination. However, a radiological work up (3D CT scan) may be necessary to rule out hidden venous or cranial anomalies possibly associated with most severe cases, or for the surgical planning. The most common indication for surgery is the improvement of the cosmetic appearance of the skull, since a cranial deformation may have a significant psychological impact on affected subjects. To relieve from raised intracranial pressure is a further indication to surgery. Although an increased intracranial pressure can be demonstrated in a minority of affected children at diagnosis, indeed, it can present later (usually after the second/third year of life) with chronic symptoms. The role of surgery in the preservation of cognitive functions in scaphocephalic patients does not seem to be relevant, since minor anomalies of the cerebral development associated with SC would occur independently from the cranial shape. On the other hand, the surgical correction may show a protective effect on some visual skills, like the ability to fix and follow, and the fixation shift.

  5. Short-Term Clinical Outcomes of Radial Shortening Osteotomy and Capitates Shortening Osteotomy in Kienböck Disease

    Directory of Open Access Journals (Sweden)

    Ahmadreza Afshar

    2015-07-01

    Full Text Available Background:  There is no consensus on the best surgical treatment in Kienböck disease. We compared the shortterm outcomes of radial shortening osteotomy and capitate shortening osteotomy in patients affected with this disease.  Methods:  In a retrospective study of 21 patients with Lichtman stage IIIA of Kienböck disease, 12 patients with an average follow up of 3.2 ± 0.6 years had radial shortening osteotomy (group I and 9 patients with an average follow up of 3.1 ± 0.7 years had capitate shortening osteotomy (group II. The two groups were comparable in age, sex, operated side, initial Lichtman stage, and follow-up duration. At the last follow-up the patients were evaluated for pain, wrist range of motion, grip strength, wrist functional status and change in their Lichtman stage. The overall results were evaluated by the Cooney wrist function score and DASH score.  Results:  All the patients in the two groups had improvement of their wrist pains. According to the Cooney wrist function score group I had 1 excellent, 9 good, and 2 fair scores and group II had 1 excellent, 6 good, and 2 fair scores. Comparisons between the means of pain VAS scores, wrist range of movement, grip strength, DASH score, and Cooney wrist function score in the two groups were not significant. Also, the changes of the Lichtman stage in the two groups were not significant. Conclusions:  Both groups had reasonable short-term outcomes. We were unable to recognize a substantial clinical difference between the two surgical treatments in short-term outcomes.

  6. Sinus lifting dengan teknik lateral window dan transalveolar osteotomy Lateral window and transalveolar osteotomy sinus lifting technique

    OpenAIRE

    Muhammad Ruslin

    2011-01-01

    The insertion of dental implants in atrophy maxilla is a complicated issue because no bone support due to expansion of maxillary sinus and atrophy of maxillary ridge alveolar. Surgery by sinus lifting with autogenous bone transplantation has been proven to be an acceptable treatment to get bone support. The lateral window technique and transalveolar osteotomy sinus lifting are the methods to correct the height of inadequate bone in the posterior area of maxilla for preparation of ...

  7. Effect of Preoperative Sagittal Balance on Cervical Laminoplasty Outcomes.

    Science.gov (United States)

    Oshima, Yasushi; Takeshita, Katsushi; Taniguchi, Yuki; Matsubayashi, Yoshitaka; Doi, Toru; Ohya, Junichi; Soma, Kazuhito; Kato, So; Oka, Hiroyuki; Chikuda, Hirotaka; Tanaka, Sakae

    2016-11-01

    Retrospective case series. To clarify how preoperative global sagittal imbalance influences outcomes in patients with cervical compression myelopathy undergoing cervical laminoplasty. The influence of sagittal balance on outcomes of cervical laminoplasty remains uncertain. The authors retrospectively reviewed data of 106 patients who underwent double-door cervical laminoplasty between 2004 and 2011 and investigated the influence of the C7 sagittal vertical axis (SVA) on outcome scores. Primary outcomes used were Japanese Orthopedic Association (JOA) scores, Numerical Rating Scale for neck or arm pain, the Short Form 36 Health Survey (physical and mental component summary scores ), and the Neck Disability Index (NDI). Ninety-two patients with complete data were eligible for inclusion. The preoperative C7 SVA was ≤5 cm in 64 patients (69.6%) and > 5 cm in 28 (30.4%). We compared each parameter by the magnitude of spinal sagittal balance (preoperative C7 SVA > 5 cm vs. C7 SVA ≤ 5 cm) after adjusting for age via the least square mean analysis because the average age was significantly higher in patients with C7 SVA > 5 cm. As for the radiographic parameters, both C2-7 SVA and C7 SVA were larger in patients when the C7 SVA was > 5 cm. Numerical Rating Scale for postoperative arm pain, postoperative JOA scores, and both pre- and postoperative physical component summary and NDI were worse in patients with C7 SVA > 5 cm; however, the JOA score recovery rate and changes in physical component summary and NDI were not significantly different. Postoperative functional outcome scores were significantly lower in patients with C7 SVA > 5 cm, although the improvement after cervical laminoplasty was not greatly affected. The involvement of global sagittal balance and cervical regional alignment should be considered in evaluating surgical outcomes for patients undergoing cervical laminoplasty. 4.

  8. Evaluation of a CT-based technique to measure the transfer accuracy of a virtually planned osteotomy

    NARCIS (Netherlands)

    Dobbe, J. G. G.; Kievit, A. J.; Schafroth, M. U.; Blankevoort, L.; Streekstra, G. J.

    2014-01-01

    Accurate transfer of a preoperatively planned osteotomy plane to the bone is of significance for corrective surgery, tumor resection, implant positioning and evaluation of new osteotomy techniques. Methods for comparing a preoperatively planned osteotomy plane with a surgical cut exist but the

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

    DEFF Research Database (Denmark)

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

    2006-01-01

    BaCKGROUND: Periacetabular osteotomy improves radiographic predictors of osteoarthrosis and diminishes pain and functional impairment. No changes in function quantified by gait analysis have yet been documented. We evaluated the functional outcome of periacetabular osteotomy in relation to gait. ...... upright walking pattern but continued to relieve the hip joint by maintaining a reduced flexor moment....

  10. Multi directional intertrochanteric osteotomy for primary and secondary osteoarthritis--results after 15 to 29 years

    NARCIS (Netherlands)

    Haverkamp, D.; Eijer, H.; Patt, T. W.; Marti, R. K.

    2006-01-01

    Between 1974 and 1987, 276 intertrochanteric osteotomies were performed in 217 patients. In 48 hips the osteotomy was done for idiopathic osteoarthritis. In 166 hips the osteoarthritis was secondary to acetabular dysplasia, in 23 to trauma, in 14 to slipped capital femoral epiphysis, in five to

  11. Intraoperative blood loss in bimaxillary orthognathic surgery with multisegmental Le Fort I osteotomies and additional procedures.

    Science.gov (United States)

    Kretschmer, W B; Baciut, G; Bacuit, Mihaela; Zoder, W; Wangerin, K

    2010-06-01

    Autologous blood donation is not currently recommended by most authors for routine bimaxillary osteotomies. There are few data about bimaxillary procedures with multisegmental maxillary osteotomies. Our aim was to investigate the effect of additional osteotomies and iliac crest grafts on operative blood loss. A total of 225 consecutive patients having bimaxillary multisegmental osteotomies during a three-year period (January 2006-January 2009) were examined to see if their haemoglobin concentration and packed cell volume were reduced. The influence of iliac crest grafts, additional osteotomies (genioplasty, malar osteotomy, iliac crest graft, anterior mandibular segmental osteotomy), operating time, age, and sex were assessed. Neither age nor sex influenced blood loss, whereas operating time correlated significantly with reductions in haemoglobin concentration and packed cell volume. Blood loss was significantly higher in the group who had additional procedures (p 0.001 for haemoglobin concentration and packed cell volume) than in the group who had no additional procedures, whereas there were no significant differences among the three subgroups who had additional procedures (additional osteotomies, iliac crest grafts, or both procedures). Four patients who had additional procedures required transfusion, whereas no blood was given in the group who had no additional procedures. Because the transfusion rate was so low, we could make no general recommendation for preoperative blood donation in such cases. Copyright 2009 The British Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Дмитрий Борисович Барсуков

    2014-06-01

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

  13. Split calvarium cranioplasty.

    Science.gov (United States)

    Weber, R S; Kearns, D B; Smith, R J

    1987-01-01

    Fronto-orbital deformities secondary to trauma, infection, or surgery create a difficult problem for the reconstructive surgeon. The location of the deformity is particularly critical because it involves the most visible part of the face. Since the skull is rarely able to produce bony regeneration over large areas, numerous alloplastic materials have been used to repair these defects. Complications with these materials are commonplace. Autogenous bone has been used with good results and avoids many of the problems inherent to the use of foreign materials. Rib, scapula, and iliac crest may be used, but they require a separate incision and often provide less than satisfactory cosmetic results. We describe a technique of cranioplasty utilizing split calvarium for repair of frontal bone defects. Cosmesis is excellent, morbidity is minimal, and only one incision is necessary.

  14. A novel osteotomy in shoulder joint replacement based on analysis of the cartilage/metaphyseal interface.

    Science.gov (United States)

    Harrold, Fraser; Malhas, Amar; Wigderowitz, Carlos

    2014-11-01

    The accuracy of reconstruction is thought to impact on functional outcome following glenohumeral joint arthroplasty. The objective of this study was to define an area of minimal anatomic variation at the cartilage/metaphyseal interface of the proximal humerus to optimize the osteotomy of the humeral head, enabling accurate reconstruction with a prosthetic component. Hand held digitization and 3D surface laser scanning techniques were used to digitize 24 cadaveric arms and determine the normal geometry. Each humeral head was then examined to identify the most consistent anatomical landmarks for the ideal osteotomy plane to optimize humeral component positioning. The novel, posterior referencing, osteotomy resulted in a mean increase in retroversion of only 0.4° when compared to the original geometry. A traditional anterior referencing osteotomy, by comparison, produced a mean increase in retroversion of 11°. In addition, the novel osteotomy only increased axial diameter by 0.71mm and head height by 0.02mm compared to an anterior referencing osteotomy (3.0mm and 2.7mm respectively). The traditional osteotomy, referencing the anterior border of the cartilage/metaphyseal interface potentially resulted in an increase in prosthetic head size and retroversion. The novel osteotomy, referencing from the posterior cartilage/metaphyseal interface enabled a more accurate recovery of head geometry. Importantly, the increase in retroversion created by the traditional osteotomy was not replicated with the novel technique. Referencing from the posterior cartilage/metaphyseal interface produced a more reliable osteotomy, more closely matching the original humeral geometry. Basic Science, Anatomic study, Computer model. Copyright © 2014 Elsevier Ltd. All rights reserved.

  15. Comparative assessment of sagittal skeletal discrepancy: a cephalometric study.

    Science.gov (United States)

    Aparna, P; Kumar, Dilip N; Prasad, Mandav; Shamnur, Naveen; G, Arun Kumar; K R, Sridhar; B R, Gopal Krishna; Gupta, Neeraj

    2015-04-01

    Evaluating the sagittal apical base relationship during orthodontic diagnosis and treatment planning is an important step. This study was aimed at comparison of Beta angle, ANB angle and Wit's appraisal for assessment of sagittal skeletal discrepancy. Eighty six young adults (43 female and 43 male) were selected from the patient's reporting to Department of Orthodontics, College of Dental Sciences, Davangere, India. Family lineage was studied to know the nativity of Davangere. The standardized pre-treatment lateral cephalogram of the chosen sample was traced. The sample was divided into three skeletal pattern groups: Class I, Class II and Class III, based on the ANB angle and profile, Beta angle was assessed in each group. The data was subjected to statistical analysis student's t-test, ANOVA test and correlation and regression analysis, using the software namely SPSS Software version 13. Microsoft word and Excel were used to generate graphs and tables. In the local Davangere population, Class I skeletal pattern group exhibited Beta angle between 26°-34°, Beta angle less than 27° was found in Class II skeletal pattern, and Beta angle greater than 32° was seen Class III skeletal pattern. The coefficient of variation of Beta angle in all the three groups was significantly homogenous compared to ANB angle and Wits appraisal. The correlation and regression analysis of the total sample indicated a highly significant correlation between Beta angle and ANB angle (pskeletal patterns. The Correlation and regression analysis for the total sample suggests a highly significant relation between Beta angle and ANB angle and, between Beta angle and Wits appraisal. It can be more reliably used to assess sagittal jaw discrepancies than ANB angle and Wits appraisal.

  16. Sagittal morphology and equilibrium of pelvis and spine.

    Science.gov (United States)

    Vaz, G; Roussouly, P; Berthonnaud, E; Dimnet, J

    2002-02-01

    A prospective analysis of the sagittal profile of 100 healthy young adult volunteers was carried out in order to evaluate the relationship between the shape of the pelvis and lumbar lordosis and to create a databank of the morphologic and positional parameters of the pelvis and spine in a normal healthy population. Inclusion criteria were as follows: no previous spinal surgery, no low back pain, no lower limb length inequality, no scoliotic deviation. For each subject, a 30 x 90-cm sagittal radiograph including spine, pelvis and proximal femurs in standing position on a force plate was performed. The global axis of gravity was determined with the force plate. Each radiograph was digitized using dedicated software. The spinal parameters registered were values for thoracic kyphosis and lumbar lordosis. The pelvic angles measured were: pelvic incidence, sacral slope and pelvic tilt. The global axis of gravity was on average 9 mm anterior of the center of the femoral heads. The anatomic parameter of pelvic incidence angle varied from 33 degrees to 85 degrees (mean: 51.7 degrees, SD: 11 degrees). The average lumbar lordosis was 46.5 degrees. The average thoracic kyphosis was 47 degrees. We found a statistical correlation between incidence angle and lumbar lordosis (r=0.69, P<0.001) and between sacral slope angle and lumbar lordosis (r=0.75, P<0.001). Spine and pelvis balance around the hip axis in order to position the gravity line over the femoral heads. We propose a scheme of sagittal balance of the standing human body.

  17. SAGITTAL SPINAL MORPHOLOGY IN HIGHLY TRAINED ADOLESCENT TENNIS PLAYERS

    Directory of Open Access Journals (Sweden)

    José M. Muyor

    2013-09-01

    Full Text Available Sports with a predominance of forward-bending and extension postures have been associated with alterations in the sagittal spinal curvatures and greater risk of spinal injury. Because, the tennis players adopt these postures, the aims of this study were: 1 to describe spinal curvatures and pelvic tilt in male and female highly trained adolescent tennis players during relaxed standing posture and with thoracic spine corrected (in prone lying on the floor; and 2 to determine the frequency of thoracic hyperkyphosis and lumbar hypo/hyper lordosis in these postures. Forty adolescent tennis players (24 male and 16 female aged 13-18 years, participated voluntarily in this study. The Spinal Mouse system was used to measure sagittal spinal curvatures and pelvic tilt. The mean values in the relaxed standing posture were 43.83° ± 7.87° (thoracic kyphosis, - 27.58° ± 7.01° (lumbar lordosis, and 13.38° ± 5.57° (pelvic tilt for male tennis players, respectively; and 36.13° ± 6.69° (thoracic kyphosis, - 32.69° ± 5.06° (lumbar lordosis, 20.94° ± 5.36° (pelvic tilt for female tennis players (p < 0.05 between genders in all spinal parameters. The male and female tennis players showed a frequency of 62.5% and 93.8% (p = 0.032 for neutral thoracic kyphosis, and 83.3% and 93.8% (p = 0.062 in neutral lumbar lordosis, respectively. In conclusion, due to the high percentage of neutral spinal curvatures in both male and female tennis players, to practice tennis in these levels does not alter sagittal spinal morphology in the relaxed standing posture in adolescent highly trained tennis players

  18. [Sagittal balance of the spine: a therapeutic revolution].

    Science.gov (United States)

    Faundez, A; Roussouly, P; Le Huec, J C

    2011-12-21

    In humans, the erect position and bipedal walk is possible because of a balance between pelvic and spinal parameters. The most important pelvic parameter is the pelvic incidence which represents the base on which the spine lies. With aging, thoracic kyphosis increases, lumbar lordosis decreases, compromising the spino-pelvic balance. Compensatory phenomenons are possible, but rely mostly on the amplitude of pelvic incidence. Analysis of spino-pelvic parameters and detection of a compensated or uncompensated sagittal imbalance are mandatory before any therapeutic action is undertaken for a degenerative pathology of the spine.

  19. ANALYSIS AND PLANNING OF HINDFOOT DEFORMITY CORRECTION IN SAGITTAL PLANE

    Directory of Open Access Journals (Sweden)

    L. N. Solomin

    2017-01-01

    Full Text Available Background. The disadvantage of the known methods of analysis and planning of hindfoot deformities in the sagittal plaBackground. Long bone deformity planning is well established. However, there are not well described methods of analysis and planning of hindfoot deformities in the sagittal plane. Such planning is made even more difficult with concomitant deformation of the midfoot and/or ankle contracture or malpositioned arthrodesis. The aim of our study was to develop a universal method of analysis and planning of the calcaneus correction, based on the normally derived reference lines and angles.Methods. We analyzed 65 standing lateral foot films in normal adults, 23-54 years old were analyzed. We drew the talus joint line (points “a” and “b” – Line 1. We drew a second line, (Line 2 the calcaneal line, which starts at the back of the calcaneal tuberosity (point “d”, drawn perpendicular to a line from top to bottom of the calcaneal tuberosity. The intersection of the calcaneal line and the talar joint line form point (c anteriorly. We measured lines ab, ac and cd, and their ratios: ac/ab, and cd/ab.Results. Talar joint line (Line 1 and calcaneal line (Line 2 intersect at a point (c, forming an angle 15.2° (±3.4°. The ratio ac/ab = 2.56 (± 1.1. The ratio cd/ab = 4.59 (±1.0. These ratios are constants for calculating the idealized joint lines for deformity planning. For deformity cases, draw Line 1, the talar joint line ab. Extend that line anteriorly to (c, which is a distance ab×2.56 from point (a. From (c, draw an idealized calcaneal line, Line-2, at an angle 15° to Line 1. Place (d on this line, at a distance ab×4.59 from point (c. Next, draw the deformed calcaneal line (Line 3 and point (d1 where it exits the calcaneal tuberosity. Use the same technique and landmarks as for drawing the normal calcaneal line. The intersection of Lines 2 and 3 is the apex of the deformity. Rotate the piece containing Line 3 around this

  20. The role of minimally invasive lateral lumbar interbody fusion in sagittal balance correction and spinal deformity.

    Science.gov (United States)

    Costanzo, Giuseppe; Zoccali, Carmine; Maykowski, Philip; Walter, Christina M; Skoch, Jesse; Baaj, Ali A

    2014-10-01

    The recent proliferation of minimally invasive lateral lumbar interbody fusion (LLIF) techniques has drawn attention to potential for these techniques to control or correct sagittal misalignment in adult spinal deformity. We systemically reviewed published studies related to LLIF use in adult spinal deformity treatment with emphasis on radiographic assessment of sagittal balance. A literature review was conducted to examine studies focusing on sagittal balance restoration in adult degenerative scoliosis with the LLIF approach. Fourteen publications, 12 retrospective and 2 prospective, reported data regarding lumbar lordosis correction (1,266 levels in 476 patients) but only two measured global sagittal alignment. LLIF appears to be especially effective when the lumbar lordosis and sagittal balance correction goals are less than 10° and 5 cm, respectively. However, the review demonstrated a lack of consistent reporting on sagittal balance restoration with the MIS LLIF techniques.

  1. [Sagittal Balance of the Spine--Clinical Importance and Radiographic Assessment].

    Science.gov (United States)

    Decker, S; Müller, C W; Omar, M; Krettek, C; Schwab, F; Trobisch, P D

    2016-04-01

    Sagittal deformities of the spine frequently result in back pain, as patients have to expend much energy in compensation. The sagittal alignment of the spine is defined by its curvatures (lordosis and kyphosis) relative to the position of the pelvis. Diagnostic assessment is based on full spine a. p. and lateral X-rays. The sagittal balance is primarily described by different angles that can be measured, e.g. lumbar lordosis, pelvic incidence, pelvic tilt and thoracic kyphosis. The quality of life can best be estimated by subtracting lumbar lordosis from the pelvic incidence. However, initial evaluation of the sagittal balance can also be based on the sagittal vertical axis. The severity of imbalance can be described by the sagittal vertical axis and the pelvic tilt, but surgical therapy necessitates a more profound analysis, which can be based on the SRS-Schwab classification. Georg Thieme Verlag KG Stuttgart · New York.

  2. The value of three-dimensional photogrammetry in isolated sagittal synostosis: Impact of age and surgical technique on intracranial volume and cephalic index─a retrospective cohort study.

    Science.gov (United States)

    Mertens, Christian; Wessel, Eline; Berger, Moritz; Ristow, Oliver; Hoffmann, Jürgen; Kansy, Katinka; Freudlsperger, Christian; Bächli, Heidrun; Engel, Michael

    2017-09-22

    The aim of this study was to compare the outcome of intracranial volume (ICV) and cephalic index (CI) between two different techniques for surgical therapy of sagittal synostosis. Between 2011 and 2015, all patients scheduled for surgical therapy of sagittal synostosis were consecutively enrolled. All patients younger than 6 months underwent early extended strip craniectomy (ESC group), and patients older than 6 months underwent late modified pi-procedure (MPP group). To measure ICV and CI, data acquisition was performed via three-dimensional photogrammetry, 1 day before (T0) and between 10 and 12 weeks after surgery (T1). Results were compared with an age-matched reference group of healthy children. Perioperative parameters, as duration of surgery and the amount of blood loss of both surgical procedures were analyzed. A total of 85 patients were enrolled. Of the patients, 48 underwent an extended strip craniotomy with parietal osteotomies and biparietal widening and 37 patients underwent a late modified pi-procedure. There was no significant difference between the ESC group and the MPP group regarding the efficacy of improving CI (p > 0.05). Both techniques were able to normalize CI and to improve head shape. ICV was normal compared to age-matched norm-groups with both techniques, pre- and postoperatively. However, duration of the surgical procedure and calculated blood loss were significantly lower in the ESC group (p photogrammetry is a valid method to objectively evaluate patients before and after surgery without exposing pediatric patients to ionizing radiation. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  3. Analysis of the relationship between coronal and sagittal deformities in adolescent idiopathic scoliosis.

    Science.gov (United States)

    Hu, Panpan; Yu, Miao; Liu, Xiao; Zhu, Bin; Liu, Xiaoguang; Liu, Zhongjun

    2016-02-01

    To characterize the sagittal alignment of each Lenke type and investigate the relationship between coronal and sagittal deformities in adolescent idiopathic scoliotic (AIS) patients. A cohort of 184 subjects with AIS was retrospectively recruited. Radiographic data were measured and collected, including the Lenke types, Cobb angles of structural curves, and sagittal spino-pelvic parameters. Subjects were grouped according to their genders, Lenke curve types, lumbar modifiers and the amount of coronal structural curves. The sagittal alignment was then compared between the different groups, and correlation analysis was also taken between coronal and sagittal parameters. Besides, each subject's Roussouly type was decided and its distribution was compared among different Lenke types. The cohort included 59 males and 125 females, averagely aged at 15.5 ± 3.3 years old. Most sagittal parameters except thoracic kyphosis (TK) and pelvic tilt (PT) were similar among different Lenke types, while all the sagittal parameters were similar between males and females. The groups with different lumbar modifiers had similar sagittal parameters except TK, which was also true for the groups with different amounts of coronal curves. 42.4 % of the cohort belonged to Roussouly type 3, and the distribution of Roussouly types was comparable among all Lenke types. All sagittal parameters except C7 translation ratio were significantly different among Roussouly types (P < 0.05). Correlation analysis showed that main thoracic (MT) was negatively correlated with lumbar lordosis (LL, r = -0.324), sacral slope (r = -0.321) and spino-sacral angle (r = -0.363). Partial correlation analysis found that thoracolumbar/lumbar was negatively correlated with TK (r = -0.464) and LL (r = -0.422) when MT was controlled. The influence of coronal deformity on sagittal parameters was limited and mainly reflected in the deviation of TK. Most coronal and sagittal parameters were not significantly correlated, and

  4. Prediction of sagittal balance in patients with osteoporosis using spinopelvic parameters.

    Science.gov (United States)

    Lee, Jung Sub; Lee, Hong Seok; Shin, Jong Ki; Goh, Tae Sik; Son, Seung Min

    2013-05-01

    Little data is available on the relationships between sagittal balance and spinopelvic parameters in osteoporosis. We analyzed sagittal spinopelvic parameters in osteoporotic patients. In this prospective study, the patient and control groups comprised 124 osteoporotic patients and 40 controls. Average age was 72.4 ± 6.8 in the osteoporosis group and 42.7 ± 12.5 in the control group, which was significantly different (P sagittal vertical axis, namely, a sagittal balance group (n = 56) and a sagittal imbalance group (n = 68). All 164 study subjects underwent whole spine lateral radiography, which included hip joints. The radiographic parameters investigated were sacral slope, pelvic tilt, pelvic incidence, thoracic kyphosis, lumbar lordosis, and sagittal vertical axis. Statistical analysis was performed to identify significant differences between the two groups. Osteoporotic patients and controls were found to be significantly different in terms of sagittal vertical axis, sacral slope, pelvic tilt, lumbar lordosis, and thoracic kyphosis. However, no significant difference was observed between patients and controls in terms of pelvic incidence (P > 0.05). Significant differences were found between the balance and imbalance groups in terms of age, lumbar spine bone mineral density (LSBMD), femoral neck BMD (FNBMD), visual analogue scale (VAS) score, sacral slope, and pelvic incidence. Correlation analysis revealed significant relationships between sagittal parameters and osteoporosis. Stepwise logistic regression analysis revealed that FNBMD and pelvic incidence contributed significantly to sagittal balance. Sagittal spinopelvic parameters were found to be significantly different in patients and normal controls. Significant relationships were found between sagittal spinopelvic parameters in osteoporotic patients. In particular, low FNBMD and high pelvic incidence were significant parameters in determination of sagittal balance in osteoporotic patients.

  5. Global sagittal alignment and health-related quality of life in lumbosacral spondylolisthesis

    National Research Council Canada - National Science Library

    Harroud, Adil; Labelle, Hubert; Joncas, Julie; Mac-Thiong, Jean-Marc

    2013-01-01

    Global sagittal alignment is considered as an important aspect in the management of spinal disorders, but the evidence establishing its clinical impact in lumbosacral spondylolisthesis is still poor...

  6. Distribution of sagittal occlusal relationships in different stages of dentition

    Directory of Open Access Journals (Sweden)

    Emine KAYGISIZ

    2015-01-01

    Full Text Available The aim of this study was to assess the distribution of sagittal occlusal relationships in different dentition periods in a Turkish sample group. In total, 1,110 patients (561 females, 549 males aged 4.6-23 years were randomly chosen after intraoral clinical examination. The subjects were classified according to their sagittal occlusal relationships and four dentition stages –deciduous, early mixed, late mixed, and permanent dentition. The statistical significance of the occurrence of malocclusion types in dentition stages was evaluated by Chi-square and Fischer’s exact tests. Class I malocclusion was observed at the highest rate in all dentition stages. Class III malocclusion was observed at the highest rate in the permanent dentition, whereas Class II malocclusion was observed at the highest rate in the late mixed dentition. The rates of Class I, II, and III malocclusions were similar in males and females. Our study reveals that the prevalence of malocclusion and need for orthodontic treatment has increased in the population towards the permanent dentition.

  7. Analysis of sagittal condyl inclination in subjects with temporomandibular disorders

    Directory of Open Access Journals (Sweden)

    Dodić Slobodan

    2010-01-01

    Full Text Available Bacground/Aim. Disturbances of mandibular border movements is considered to be one of the major signs of temporomandibular disorders (TMD. The purpose of this study was to evaluate the possible association between disturbances of mandibular border movements and the presence of symptoms of TMD in the young. Methods. This study included two groups of volunteers between 18 and 26 years of age. The study group included 30 examineers with signs (symptoms of TMD, and the control group also included 30 persons without any signs (symptoms of TMD. The presence of TMD was confirmed according to the craniomandibular index (Helkimo. The functional analysis of mandibular movements was performed in each subject using the computer pantograph. Results. The results of this study did not confirm any significant differences between the values of the condylar variables/sagittal condylar inclination, length of the sagital condylar guidance, in the control and in the study group. Conclusion. The study did not confirm significant differences in the length and inclination of the protrusive condylar guidance, as well as in the values of the sagittal condylar inclination between the subjects with the signs and symptoms of TMD and the normal asymptomatic subjects.

  8. Osteotomia proximal da tíbia: estabilização da abertura medial com enxerto tricortical de ilíaco Proximal tibial osteotomy: stabilization of the medial opening with atricortical iliac bone graft

    Directory of Open Access Journals (Sweden)

    Roberto da Cunha Luciano

    2010-01-01

    Full Text Available OBJETIVO: Avaliação radiográfica do alinhamento do membro inferior, nos planos frontal e sagital, após osteotomia alta da tíbia. Para estabilização da osteotomia foi utilizado enxerto tricortical de ilíaco e parafuso de posicionamento. MÉTODOS: Estudo prospectivo envolvendo 46 pacientes com idade entre 17 e 61 anos, sendo 42 portadores de geno varo secundário à osteoartrose e quatro por outras causas. A telerradiografia foi realizada para planejamento cirúrgico, utilizando o método de Frank Noyes modificado por Fugizawa. Foi realizado acesso cirúrgico convencional de 3cm para retirada do enxerto tricortical de ilíaco. A osteotomia foi realizada sob controle de radioscopia, por incisão anteromedial de 3cm com liberação da porção superficial do ligamento colateral medial. O enxerto foi colocado na porção posterior da osteotomia, para manter inalterado o slope tibial. O parafuso cruzou a osteotomia ortogonalmente para proteger a cortical lateral. Foram estabelecidos critérios radiográficos pré e pós-operatórios para avaliação dos resultados. RESULTADOS: Houve consolidação em 100% dos casos e manutenção do eixo mecânico, obtido no intraoperatório, em 94%. A inclinação posterior do platô tibial, no plano sagital, variou entre 7º e 12º. A mobilidade articular foi restabelecida em todos os pacientes operados. Onze pacientes apresentaram dor temporária no local da retirada do enxerto; no entanto, nenhum apresentou parestesia. A incidência de complicações foi de 8% (infecção, perda da correção, fratura articular. CONCLUSÃO: A técnica mostrou-se reprodutível, simples, biológica, precisa e com baixos custos, podendo ser uma alternativa às técnicas já existentes.OBJECTIVE: Roentgenographic assessment of lower limb alignment, in the frontal and sagittal planes, after a high tibial osteotomy. To stabilize the osteotomy, a tricortical iliac graft was used along with a positioning screw. METHODS

  9. Effects of Osteotomy Lengths on the Temperature Rise of the Crestal Bone During Implant Site Preparation.

    Science.gov (United States)

    Katic, Zvonimir; Jukic, Tomislav; Stubljar, David

    2018-02-13

    To compare temperatures of the crestal bone during implant site preparation for different osteotomy lengths and implant systems. Bovine ribs were used to simulate the cortical bone of the human mandible. Three different implant systems were tested: Astra Tech, Ankylos, and XiVE. Six drills per system were performed, meaning each drilling set was used for 2 drills per 3 osteotomy lengths (8, 12, and 16 mm). Drilling force, drilling speed, drilling length, and temperature were recorded. Differences in the maximum temperature of the crestal bone during the first drilling for various osteotomy lengths (P = 0.021) and all implant systems (P = 0.013) were observed. A similar result was showed during the second drilling; osteotomy lengths (P = 0.014) and drilling systems (P = 0.003). Second drillings showed lower temperatures of the crestal bone with statistical differences on all measurements (P Ankylos implant systems showed similar performance; XiVE had lower temperature and higher temperature differences between osteotomy lengths. Different drilling lengths contributed to the variation in temperature regardless of the implant system. Longer drills and osteotomies induced higher temperatures on the crestal bone. The maximum temperature difference between the shortest and the longest osteotomy was under 1°C. Temperature above 47°C that could cause bone necrosis was not recorded at any time. The XiVE system showed the best performance.

  10. Miniplate 1.5 fixation for the repair of mandibular osteotomies in cats.

    Science.gov (United States)

    Silva, Adelina Maria da; Souza, Wilson Machado de; Barnabé, Patrícia de Athayde; Koivisto, Marion Burkhardt de; Souza, Nair Trevizan Machado de

    2011-02-01

    To evaluate the application of the maxillofacial miniplate 1.5 in the repair of unilateral mandibular osteotomies in cats. Twelve adult cats were divided into two groups. In group 1 (n=6), the osteotomy was performed in the body of the mandible, behind the 1(st) molar. In group 2 (n=6), the osteotomy was performed between the 4(th) premolar and 1(st) molar. The osteotomy was fixed with a titanium miniplate 1.5. Oral alimentation was reinitiated 24 hours after surgery. Cats were euthanized at 12 weeks postoperative. Radiographs taken 1 week after surgery showed a radiolucent line. The osteotomy line was not more visible on the radiographs taken at 12 weeks postoperative. Macroscopic examination confirmed alignment and bone union of operated hemimandibles. Histological examination showed formation of woven bone within the osteotomy line. The percentage of bone tissue at these areas was measured by the histometry. There was no statistically significant difference between the values of group 1(75.07 ± 5.99) and group 2 (74.76 ± 8.54) (Mann-Whitney's test p= 0.469). We concluded that the use of miniplate 1.5 for the fixation of mandibular osteotomy in cats provided the main goals in the treatment of mandibular fractures: bone union, normal dental occlusion and immediate return to oral alimentation.

  11. Mechanical evaluation of pin and tension-band wire factors in an olecranon osteotomy model.

    Science.gov (United States)

    Neat, Benjamin C; Kowaleski, Michael P; Litsky, Alan S; Boudrieau, Randy J

    2006-06-01

    To evaluate the effect of altering pin and wire diameter, wire position and configuration, and osteotomy angle on applied load and absorbed strain energy in a pin and tension-band wire (PTBW) fixation model. In vitro mechanical study. Delrin models (n=96). PTBW was applied to Delrin olecranon osteotomy models. A control configuration was defined and then altered, 1 variable (wire diameter, pin diameter, wire-hole position, wire configuration, osteotomy angle) at a time, to create 11 test configurations. Tensile force was applied and displacement at the caudal aspect of the osteotomy was measured. Fixation strength, in terms of tensile load and strain energy, was compared between control and each test configuration at 4 osteotomy displacements. Models with larger wire, pins, or combined figure-of-eight/lateral wires were stronger than control, whereas those with smaller wire, pins, or a solitary lateral wire were weaker. The superior strength of the larger wire was apparent for all assessed osteotomy displacement. PTBW fixation strength increases as implant diameter is increased, with wire diameter having greatest effect. Lateral wire configuration is weaker than figure-of-eight, but can be added to figure-of-eight configuration to increase strength. Wire-hole position and osteotomy angle have little effect on PTBW strength. Wire diameter is the key determinant of PTBW strength, whereas pin diameter is somewhat less critical. Wire passage through an additional hole proximally provides equivalent strength and may avoid soft-tissue entrapment and subsequent loosening.

  12. Split SUSY Radiates Flavor

    CERN Document Server

    Baumgart, Matthew; Zorawski, Thomas

    2014-01-01

    Radiative flavor models where the hierarchies of Standard Model (SM) fermion masses and mixings are explained via loop corrections are elegant ways to solve the SM flavor puzzle. Here we build such a model in the context of Mini-Split Supersymmetry (SUSY) where both flavor and SUSY breaking occur at a scale of 1000 TeV. This model is consistent with the observed Higgs mass, unification, and WIMP dark matter. The high scale allows large flavor mixing among the sfermions, which provides part of the mechanism for radiative flavor generation. In the deep UV, all flavors are treated democratically, but at the SUSY breaking scale, the third, second, and first generation Yukawa couplings are generated at tree level, one loop, and two loops, respectively. Save for one, all the dimensionless parameters in the theory are O(1), with the exception being a modest and technically natural tuning that explains both the smallness of the bottom Yukawa coupling and the largeness of the Cabibbo angle.

  13. [Effects of Le-Fort-I-Osteotomy on nasalance scores].

    Science.gov (United States)

    Zemann, Wolfgang; Feichtinger, Matthias; Santler, Gert; Kärcher, Hans

    2006-07-01

    Nasalance represents a measure of the relative amount of oral and nasal acoustic energy produced by a speaker. Literature shows changes in nasalance after surgery of the oropharynx. The aim of this prospective study was to evaluate the outcome of speech and nasalance scores after Le-Fort-I-Osteotomy. A total of 20 individuals with normal speech development were examined preoperatively and 6 weeks postoperatively with the Nasometer 6200 (Kay-Elemetrics, USA) after bimaxillary surgery. The tone materials used comprised the standardized text passage: "Ein Kindergeburtstag", the vowels: /a/, /e/, /i/, /o/, /u/ and a syllable repetition subtest. All patients showed changes in nasalance scores 6 weeks postoperatively. There were no significant changes reading the standard text. The syllable repetition test showed significant changes for repetition of "ma ma ma" and "na na na" (p=0,003, respectively p=0,033). Intonation of the vowel /a/1 also revealed significant changes regarding the pre- and postoperative values (p=0,006). However, the obtained values had no significant impact on the nasality characteristics of speech. This study confirms that maxillary osteotomies can result in significant changes of nasalance scores. However these changes do not have any impact on normal speech and voice.

  14. Complete Cranial Iliac Osteotomy to Approach the Lumbosacral Foramen

    Directory of Open Access Journals (Sweden)

    Barbara Dyall

    2017-05-01

    Full Text Available An approach using a complete cranial iliac osteotomy (CCIO to access the lumbosacral (LS foramen in dogs from lateral was developed using cadavers and applied in a clinical patient with degenerative lumbosacral stenosis (DLSS. The foraminal enlargement in the cadavers and the patient was documented on postoperative CT scans. The preoperative CT scan of the patient showed moderate cranial telescoping of the sacral roof and a moderate central disk protrusion, leading to moderate to severe compression of the cauda equina. In addition, there was lateral spondylosis with consequential stenosis of the right LS foramen. The right L7 nerve had lost its fat attenuation and appeared thickened. After a routine L7S1 dorsal laminectomy with a partial discectomy, a CCIO was performed, providing good access to the LS foramen and the adhesions around the proximal L7 nerve caudoventral to the foramen. The osteotomy was stabilized with a locking plate and a cerclage wire. The dog recovered well from the procedures and after 36 h, the dog walked normally and was discharged from the hospital. Eight and 16 weeks later, the signs of the DLSS had markedly improved. From these data, it can be concluded that the CCIO is a useful approach to the LS foramen and intervertebral disk in selected patients with DLSS, giving good access to the structures around the LS foramen.

  15. Partial ear canal ablation and lateral bulla osteotomy in rabbits.

    Science.gov (United States)

    Eatwell, K; Mancinelli, E; Hedley, J; Keeble, E; Kovalik, M; Yool, D A

    2013-06-01

    Six lop rabbits were presented with clinical signs of otitis media or externa. The presence of disease was confirmed by computerized tomography examination, with two rabbits suffering from bilateral disease. The rabbits were anaesthetized and underwent surgery of the affected bulla. Rabbits with bilateral disease had a minimum of 2 weeks between procedures. A single vertical incision was made over the base of the vertical canal, which was bluntly dissected free from surrounding tissue. The ventral portion of the vertical canal was removed and a lateral bulla osteotomy was performed. The mucosa at the base of the dorsal vertical canal was apposed and the aural cartilage sutured to form a blind-ending pouch open at the pretragic incisure. Histopathological samples taken from the dorsal margin of the vertical canal yielded subtle and non-specific changes in the six samples submitted. All rabbits were discharged within 48 hours of surgery. The cosmetic outcome was excellent with animals retaining visually normal aural anatomy. The partial ear canal ablation/lateral bulla osteotomy procedure is quick and has a good cosmetic result when performed in rabbits. © 2013 British Small Animal Veterinary Association.

  16. Predicting translational deformity following opening-wedge osteotomy for lower limb realignment.

    Science.gov (United States)

    Barksfield, Richard C; Monsell, Fergal P

    2015-11-01

    An opening-wedge osteotomy is well recognised for the management of limb deformity and requires an understanding of the principles of geometry. Translation at the osteotomy is needed when the osteotomy is performed away from the centre of rotation of angulation (CORA), but the amount of translation varies with the distance from the CORA. This translation enables proximal and distal axes on either side of the proposed osteotomy to realign. We have developed two experimental models to establish whether the amount of translation required (based on the translation deformity created) can be predicted based upon simple trigonometry. A predictive algorithm was derived where translational deformity was predicted as 2(tan α × d), where α represents 50 % of the desired angular correction, and d is the distance of the desired osteotomy site from the CORA. A simulated model was developed using TraumaCad online digital software suite (Brainlab AG, Germany). Osteotomies were simulated in the distal femur, proximal tibia and distal tibia for nine sets of lower limb scanograms at incremental distances from the CORA and the resulting translational deformity recorded. There was strong correlation between the distance of the osteotomy from the CORA and simulated translation deformity for distal femoral deformities (correlation coefficient 0.99, p < 0.0001), proximal tibial deformities (correlation coefficient 0.93-0.99, p < 0.0001) and distal tibial deformities (correlation coefficient 0.99, p < 0.0001). There was excellent agreement between the predictive algorithm and simulated translational deformity for all nine simulations (correlation coefficient 0.93-0.99, p < 0.0001). Translational deformity following corrective osteotomy for lower limb deformity can be anticipated and predicted based upon the angular correction and the distance between the planned osteotomy site and the CORA.

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

    Directory of Open Access Journals (Sweden)

    Hassan Rahimi

    2013-09-01

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

  18. Global Locator, Local Locator, and Identifier Split (GLI-Split

    Directory of Open Access Journals (Sweden)

    Michael Menth

    2013-03-01

    Full Text Available The locator/identifier split is an approach for a new addressing and routing architecture to make routing in the core of the Internet more scalable. Based on this principle, we developed the GLI-Split framework, which separates the functionality of current IP addresses into a stable identifier and two independent locators, one for routing in the Internet core and one for edge networks. This makes routing in the Internet more stable and provides more flexibility for edge networks. GLI-Split can be incrementally deployed and it is backward-compatible with the IPv6 Internet. We describe its architecture, compare it to other approaches, present its benefits, and finally present a proof-of-concept implementation of GLI-Split.

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

    Science.gov (United States)

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

    2011-02-01

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

  20. The patterns of loss of correction after posterior wedge osteotomy in ankylosing spondylitis-related thoracolumbar kyphosis: a minimum of five-year follow-up.

    Science.gov (United States)

    Qiao, Mu; Qian, Bang-Ping; Mao, Sai-Hu; Qiu, Yong; Wang, Bin

    2017-11-17

    Short-term studies have demonstrated good surgical outcomes after pedicle subtraction osteotomy (PSO) in ankylosing spondylitis (AS) patients, but there is a paucity of literature focused on middle-term results, especially regarding patterns of loss of correction. The objective of this study is to assess the durability of surgical outcomes and the patterns of loss of correction in thoracolumbar kyphosis secondary to AS following lumbar PSO with over 5-year follow-up. We performed a retrospective review of 155 consecutive AS patients undergoing lumbar PSO from January 2001 to December 2011. Twenty-four patients were included with an average follow-up of 6.9 years (range, 5-15 years). Radiographical evaluations included global kyphosis (GK), lumbar lordosis (LL), sagittal vertical axis, spinal-sacral angle, kyphosis of proximal non-fused segments (KPNS), angle of fused segments (AFS), osteotomized vertebra angle (OVA), distal intervertebral disc wedging (DIDW) and proximal junctional angle. Meanwhile, clinical outcomes were assessed by the Oswestry disability index (ODI) and Numerical rating scale (NRS). The average correction per PSO segment was 34.9°. Significant improvement in sagittal parameters were found postoperatively, and no obvious deterioration was noticed during the follow-up. Mild loss of correction in GK (2.82°) and LL (3.77°) were observed at the final follow-up (P  0.05). The ODI and NRS improved significantly from 20.6 and 6.6 preoperatively to 5.9 and 2.3 at the final follow-up (P < 0.05). PSO is an effective procedure for treating AS-related thoracolumbar kyphosis and can maintain sustained surgical outcomes during the middle-term follow-up. The loss of correction was mainly attributable to non-instrumented segments without fully ossified bridging syndesmophyte in the thoracolumbar region instead of instrumented levels.

  1. Subtotal cranial vault remodelling in anterior sagittal suture closure: impact of age on surgical outcome

    NARCIS (Netherlands)

    Engel, M.; Hoffmann, J.; Muhling, J.; Castrillon-Oberndorfer, G.; Seeberger, R.; Freudlsperger, C.

    2012-01-01

    Isolated fusion of the sagittal suture is usually treated before 1 year of age, but some patients present at a later age. The aim of this study was to evaluate the impact of children's age on the surgical outcome. The authors investigated 46 patients with isolated nonsyndromic sagittal

  2. Extensor Tendon Instability Due to Sagittal Band Injury in a Martial Arts Athlete: A Case Report.

    Science.gov (United States)

    Kochevar, Andrew; Rayan, Ghazi

    2017-03-01

    A Taekwondo participant sustained a hand injury from punching an opponent that resulted in painful instability of the ring finger extensor digitorum communis tendon due to sagittal band damage. His symptoms resolved after reconstructive surgery on the sagittal band (SB) with stabilization of the extensor tendon over the metacarpophalangeal joint.

  3. Superior Sagittal Sinus Thrombosis Complicating Typhoid Fever in a Teenager

    Directory of Open Access Journals (Sweden)

    P. O. Okunola

    2012-01-01

    Full Text Available Cerebral venous sinus (sinovenous thrombosis (CSVT is a rare life-threatening disorder in childhood that is often misdiagnosed. CSVT encompasses cavernous sinus thrombosis, lateral sinus thrombosis, and superior sagittal sinus thrombosis (SSST. We present an adolescent girl who was well until two weeks earlier when she had a throbbing frontal headache and fever with chills; she later had dyspnoea, jaundice, melena stool, multiple seizures, nuchal rigidity, and monoparesis of the right lower limb a day before admission. Urine test for Salmonella typhi Vi antigen was positive, and Widal reaction was significant. Serial cranial computerized tomography scans revealed an expanding hypodense lesion in the parafalcine region consistent with SSST or a parasagittal abscess. Inadvertent left parietal limited craniectomy confirmed SSST. She recovered completely with subsequent conservative management. Beyond neuropsychiatric complications of Typhoid fever, CSVT should be highly considered when focal neurologic deficits are present.

  4. Degenerative retrolisthesis: is it a compensatory mechanism for sagittal imbalance?

    Science.gov (United States)

    Jeon, C-H; Park, J-U; Chung, N-S; Son, K-H; Lee, Y-S; Kim, J-J

    2013-09-01

    We investigated the spinopelvic morphology and global sagittal balance of patients with a degenerative retrolisthesis or anterolisthesis. A total of 269 consecutive patients with a degenerative spondylolisthesis were included in this study. There were 95 men and 174 women with a mean age of 64.3 years (sd 10.5; 40 to 88). A total of 106 patients had a pure retrolisthesis (R group), 130 had a pure anterolisthesis (A group), and 33 had both (R+A group). A backward slip was found in the upper lumbar levels (mostly L2 or L3) with an almost equal gender distribution in both the R and R+A groups. The pelvic incidence and sacral slope of the R group were significantly lower than those of the A (both p anterolisthesis and high pelvic incidence.

  5. Sagittal spinopelvic parameters in 2-level lumbar degenerative spondylolisthesis

    Science.gov (United States)

    Wang, Tao; Wang, Hui; Liu, Huan; Ma, Lei; Liu, Feng-Yu; Ding, Wen-Yuan

    2016-01-01

    Abstract The purpose of our study is to evaluate sagittal parameters in 2-level lumbar degenerative spondylolisthesis (DS) (TLDS). A total of 15 patients with TLDS, 40 patients with single-level DS (SLDS), and 30 normal volunteers as control were included in our study. All subjects performed on full spine X-ray. Two categorized data were analyzed: patient characteristics—age, sex, body mass index, radiographic parameters-pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL), sacral slope (SS), PI–LL, Cobb between the fifth thoracic vertebral and 12th thoracic vertebral (T5–T12), sagittal vertical axis (SVA) Cobb angle of spondylolisthesis level (CSL), ratio of PT to SS (PT/SS), CSL/LL, variation trend of SS over PI, and LL over PI. The PI (73.1° vs 52.9°), SS (50.8° vs 32.2°), LL (53.1° vs 46.9°), SVA (66.1 vs 22.0 mm), PI–LL (20.0° vs 6.0°), and CSL (23.6° vs 20.0°) in TLDS were significantly larger than these in SLDS. The PI (73.1° vs 40.6°), PT (22.3° vs 17.1°), SS (50.8° vs 23.5°), LL (53.1° vs 32.5°), PI–LL (20.0° vs 8.1°), and SVA (66.1 vs 17.0 mm) in TLDS were significantly larger than those in the normal group (NG). The PI (52.9° vs 40.6°), PT (21.0° vs 17.1°), SS (32.2° vs 23.5°), LL (46.9° vs 32.5°), and SVA (22.0 vs 17.0 mm) in SLDS were significantly higher than those in NG. However, PT/SS (44.0%), LL over PI (y = 0.39x + 24.25), SS over PI (y = 10.79 + 0.55x) were lower in TLDS than these in SLDS (63.8%, y = 0.41x + 25, y = 0.65x − 2.09, respectively), and the similar tend between SLDS and NG (74.0%, y = 0.49x + 13.09, y = 0.67x − 3.9, respectively). Our results showed that 2-level lumbar DS, which was caused by multiple-factors, has a severe sagittal imbalance, but single-level has not any. When we plan for surgical selection for 2-level lumbar DS, global sagittal balance must be considered. PMID:27977581

  6. ISR split-field magnet

    CERN Multimedia

    CERN PhotoLab

    1975-01-01

    The experimental apparatus used at intersection 4 around the Split-Field Magnet by the CERN-Bologna Collaboration (experiment R406). The plastic scintillator telescopes are used for precise pulse-height and time-of-flight measurements.

  7. [Becker V-shaped lateral rotation osteotomy in total hip arthroplasty for Crowe type IV development dislocation of hip].

    Science.gov (United States)

    Li, Yongwang; Ma, Wenhai; Sun, Junying; Song, Xingjian; An, Ming; Zhang, Qian

    2013-09-01

    To summarize the surgical technique and the effectiveness of Becker V-shaped lateral rotation osteotomy in total hip arthroplasty (THA) for Crowe type IV development dislocation of the hip (DDH). Between January 2000 and December 2009, 18 patients (22 hips) with Crowe type IV DDH underwent THA. There were 3 males and 15 females with an average age of 54 years (range, 41-75 years). The unilateral hip was involved in 14 cases and bilateral hips in 4 cases. All patients had over anteversion of the femoral neck, with the acetabular anteversion angle of (21.28 +/- 4.87) degrees, the femoral neck anteversion angle of (59.06 +/- 1.44) degrees, and combined anteversion angle of (80.33 +/- 1.55) degrees. All the patients had limb-length discrepancy, ranged from 1.0 to 3.5 cm (mean, 2.5 cm). Before operation, gluteus medius muscle strength was grade 2 in 17 hips and grade 3 in 5 hips; severe or moderate claudication was observed in 13 and 5 patients, respectively. Trendelenburg sign was positive in all patients. Preoperative Harris score was 30.00 +/- 6.32. Cementless prosthesis was used. Becker V-shaped lateral rotation osteotomy and subtrochanteric shortening with overlapping femoral resection were performed, and proximal femoral shaft splitting was performed on 21 hips having narrow bone marrow cavity. All the cases achieved primary healing of incision. No complication of anterior dislocation, deep infection, nerve traction injury, or femoral uncontrolled fracture occurred. All the cases were followed up 3-12 years (mean, 8 years). Postoperative X-ray films showed that the initial fixation result of femoral prosthesis was excellent in 18 hips and good in 4 hips. Bone healing of osteotomy stump was obtained at 3-6 months (mean, 5 months) after operation. Affected limb prolonged for 2.5-3.5 cm (mean, 3.0 cm) at 1 year after operation; limb-length discrepancy was 0.5-1.5 cm (mean, 1.0 cm). The gluteus medius muscle strength was restored to grade 4 in 5 hips and grade 5 in 17

  8. Assessment of spring cranioplasty biomechanics in sagittal craniosynostosis patients.

    Science.gov (United States)

    Borghi, Alessandro; Schievano, Silvia; Rodriguez Florez, Naiara; McNicholas, Roisin; Rodgers, Will; Ponniah, Allan; James, Greg; Hayward, Richard; Dunaway, David; Jeelani, N U Owase

    2017-11-01

    OBJECTIVE Scaphocephaly secondary to sagittal craniosynostosis has been treated in recent years with spring-assisted cranioplasty, an innovative approach that leverages the use of metallic spring distractors to reshape the patient skull. In this study, a population of patients who had undergone spring cranioplasty for the correction of scaphocephaly at the Great Ormond Street Hospital for Children was retrospectively analyzed to systematically assess spring biomechanical performance and kinematics in relation to spring model, patient age, and outcomes over time. METHODS Data from 60 patients (49 males, mean age at surgery 5.2 ± 0.9 months) who had received 2 springs for the treatment of isolated sagittal craniosynostosis were analyzed. The opening distance of the springs at the time of insertion and removal was retrieved from the surgical notes and, during the implantation period, from planar radiographs obtained at 1 day postoperatively and at the 3-week follow-up. The force exerted by the spring to the patient skull at each time point was derived after mechanical testing of each spring model-3 devices with the same geometry but different wire thicknesses. Changes in the cephalic index between preoperatively and the 3-week follow-up were recorded. RESULTS Stiffer springs were implanted in older patients (p springs were used (p spring models, however, the devices all plateaued. Indeed, regardless of patient age or spring model, after 10 days from insertion, all the devices were open. CONCLUSIONS Results in this study provide biomechanical insights into spring-assisted cranioplasty and could help to improve spring design and follow-up strategy in the future.

  9. Photocatalytic water splitting

    Science.gov (United States)

    Kuo, Yenting

    New photocatalystic materials Ti-In oxy(nitride) and nanosized Ru-loaded strontium titanate doped with Rh (Ru/SrTiO3:Rh) have been synthesized. The textural and surface characteristic properties were studied by nitrogen BET analysis, diffuse reflectance UV-vis spectroscopy, X-ray photoelectron spectroscopy, transmission electron microscopy, scanning electron microscopy and powder XRD. The photocatalytic properties were enhanced by the binary metal oxides of titanium dioxide and indium oxide. The XRD patterns confirmed the oxygen exchange between two metal oxides during the synthesis. Moreover, the presence of titanium dioxide can help the stabilization of InN during hot NH3(g) treatment. On the other hand, the particle sizes of aerogel prepared Ru/SrTiO3:Rh varied from 12 to 25 nm depended on different Rh doping. A mixture of ethanol and toluene was found to be the best binary solvent for supercritical drying, which yielded a SrTiO3 sample with a surface area of 130 m2/g and an average crystallite size of 6 nm. Enhanced photocatalytic hydrogen production under UV-vis light irradiation was achieved by ammonolysis of intimately mixed titanium dioxide and indium oxide at high temperatures. Gas chromatography monitored steadily the formation of hydrogen when sacrificial (methanol or ethanol) were present. XRD patterns confirmed that the photocatalysts maintain crystalline integrity before and after water splitting experiments. Moreover, the presence of InN may be crucial for the increase of hydrogen production activities. These Ru/SrTiO3:Rh photocatalysts have been studied for photocatalytic hydrogen production under visible light. The band gap of the bulk SrTiO 3 (3.2 eV) does not allow response to visible light. However, after doping with rhodium and loaded with ruthenium, the modified strontium titanates can utilize light above 400 nm due to the formation of valence band or electron donor levels inside of the band gap. Moreover, the surface areas of these

  10. C7 sagittal vertical axis is the determinant of the C5-C7 angle in cervical sagittal alignment.

    Science.gov (United States)

    Matsubayashi, Yoshitaka; Chikuda, Hirotaka; Oshima, Yasushi; Taniguchi, Yuki; Fujimoto, Yoh; Shimizu, Takachika; Tanaka, Sakae

    2017-05-01

    Previous studies have indicated that the T1 slope correlates with cervical lordosis. In contrast, the specific impact of the C7 sagittal vertical axis (C7SVA) on cervical lordosis remains unknown. This study aimed to investigate the specific role of C7SVA in cervical lordosis. This was a retrospective radiographic study. Forty-eight consecutive patients who underwent lateral standing radiography of the entire spine were retrospectively reviewed. Radiographic parameters included occipito (Oc)-C7, Oc-C2, C2-C7, C2-C4, and C5-C7 angles; T1 slope; C7SVA; T1 pelvic angle (TPA); pelvic incidence; pelvic tilt; and sacral slope. The radiographs of 96 consecutive patients who underwent lateral standing radiography of the entire spine in June 2015 in our hospital were retrospectively reviewed. Patients having cervical deformities, having undergone cervical fusion, and under 18 years of age were excluded. A total of 48 Asian patients (14 men and 34 women; mean age, 54.6 years) were eligible. Pathologies included scoliosis, myelopathy, thoracolumbar deformity, and spondylosis. Spearman rank correlation coefficients were used to examine correlations between the parameters. The relationship between C5-C7 lordosis and the radiographic parameters was calculated using the forward stepwise multivariate regression analysis. The authors do not have financial associations relevant to this article. C7SVA correlated with the Oc-C7 (r=0.42) and C2-C7 (r=0.50) angles. However, the correlation coefficient was smaller than that between the T1 slope and Oc-C7 (r=0.83) or C2-C7 (r=0.76) angles. When the C2-C7 angle was divided into C2-C4 and C5-C7 angles, C7SVA correlated with the C5-C7 (r=0.63) angle but not with the C2-C4 angle. The correlation coefficient between the C5-C7 angle and C7SVA was higher than that between the C5-C7 angle and T1 slope (r=0.53) or the C5-C7 angle and TPA (r=0.60). Using radiographic parameters and age, multiple regression analysis revealed that only C7SVA affected

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

    Science.gov (United States)

    Sakamoto, Tetsuya; Naito, Masatoshi; Nakamura, Yoshinari

    2015-11-01

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

  12. The role of trochanteric flip osteotomy in fixation of certain acetabular fractures

    Directory of Open Access Journals (Sweden)

    Sandeep Gupta

    2017-06-01

    Conclusion: Trochanteric flip osteotomy is a very effective technique to fix certain acetabular fractures especially those with dome involvement. It is more accurate and associated with no significant complications compared with conventional way.

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

    Directory of Open Access Journals (Sweden)

    Orion Luiz Haas Junior

    2016-01-01

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

  14. Dentoalveolar Segmental Osteotomy Combined with Orthodontic Treatment for an Impacted and Ankylosed Upper Canine

    DEFF Research Database (Denmark)

    Aludden, Hanna Cecilia; Jensen, Thomas

    2016-01-01

    for the management of ankylosed teeth involving extraction, surgical luxation, and osteotomy followed by dentoalveolar distraction or conventional orthodontic treatment. This case report describes a 55-year-old female who was referred by her orthodontist due to an impacted and ankylosed maxillary upper left canine....... A dentoalveolar segmental osteotomy with immediate repositioning of an upper canine was performed. One year after final orthodontic treatment a satisfying occlusal and esthetic treatment outcome was obtained....

  15. Unicompartmental Knee Osteoarthritis (UKOA: Unicompartmental Knee Arthroplasty (UKA or High Tibial Osteotomy (HTO?

    Directory of Open Access Journals (Sweden)

    E. Carlos RODRIGUEZ-MERCHAN

    2016-10-01

    Full Text Available Background: The aim of this review article is to analyze the results of high tibial osteotomy compared to unicompartmental knee arthroplasty in patients with unicompartmental knee osteoarthritis.   Methods: The search engine used was PubMed. The keywords were: "high tibial osteotomy versus unicompartmental knee arthroplasty". Twenty-one articles were found on 28 February 2015, but only eighteen were selected and reviewed because they strictly focused on the topic. Results: In a meta-analysis the ratio for an excellent outcome was higher in unicompartmental knee arthroplasty than high tibial osteotomy and the risks of revision and complications were lower in the former. A prospective comparative study showed that unicompartmental knee arthroplasty offers better long-term success (77% for unicompartmental knee arthroplasty and 60% for high tibial osteotomy at 7-10 years. However, a review of the literature showed no evidence of superior results of one treatment over the other. A multicenter study stated that unicompartmental knee osteoarthritis without constitutional deformity should be treated with unicompartmental knee arthroplasty while in cases with constitutional deformity high tibial osteotomy should be indicated. A case control study stated that unicompartmental knee arthroplasty offers a viable alternative to high tibial osteotomy if proper patient selection is done. Conclusion: The literature is still controversial regarding the best surgical treatment for unicompartmental knee osteoarthritis (high tibial osteotomy or unicompartmental knee arthroplasty. However, unicompartmental knee arthroplasty utilization is increasing, while high tibial osteotomy utilization is decreasing, and a meta-analysis has shown better outcomes and less risk of revision and complications in the former. A systematic review has found that with correct patient selection, both procedures show effective and reliable results. However, prospective randomized studies

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

    Science.gov (United States)

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

    2015-01-01

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

  17. Midterm outcome after correction of hallux valgus deformity using scarf osteotomy in adult population

    OpenAIRE

    Laura Ibrahim Alolayan; Mohammed H Alshehri; Amjaad Hamad Almohawis; Thuriya Saud Alsumai; Alkenani, Nader S.

    2017-01-01

    Context: Determining the efficacy of any surgical treatment is the key to achieve better practice and best outcomes for patients. Aims: This study is designed to address midterm outcome in adult patients with moderate-to-severe hallux valgus (HV), who underwent scarf osteotomy from 2012 to 2014. Settings and Design: This is a retrospective cohort study in which charts of all adult patients with moderate-to-severe HV who underwent scarf osteotomy from 2011 to 2014 were reviewed. Subjects and M...

  18. The tilt-up osteotomy for correction of intractable plantar keratoses.

    Science.gov (United States)

    Berkun, R N; DeVincentis, A; Goller, W L

    1984-01-01

    The purpose of this paper is to describe and follow-up a new surgical technique used for the correction of intractable plantar keratoses. Twenty-five osteotomies were studied from 8 to 20 months postoperatively. The results showed a 60% success rate, but a patient satisfaction rate of 92%. The tilt-up osteotomy is a promising new procedure for the correction of intractable plantar keratoses.

  19. [Orthognathic mandibular osteotomy and condyle positioning: update and innovation].

    Science.gov (United States)

    Laurentjoye, Mathieu; Charton, Jérôme; Boileau, Marie-José

    2015-03-01

    The temporomandibular joints function in synergy with the dental occlusion within the manducatory system. Orthodontists and surgeons must take into account the condylar position since any problem related to positioning of the condyle could result in occlusal disorders including relapse and the risk of occurrence, decompensation or worsening of temporomandibular dysfunction. We wanted to answer three questions: What is the position of the condyle following orthognathic surgery? What benefit is there in repositioning the condyle? What means are available to check condylar position? Finally, in the light of the answers, we describe an innovative occlusal and condylar positioning device for mandibular osteotomies based on computer-assisted surgical planning techniques. It consists of a three-dimensional, printed guide enabling surgeons to position the condyles as desired. It is accurate, simple, reproducible, independent of operator experience as well as rapid and economical. © EDP Sciences, SFODF, 2015.

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

    Science.gov (United States)

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

    2016-11-01

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

  1. Midface distraction advancement in the canine without osteotomies.

    Science.gov (United States)

    Staffenberg, D A; Wood, R J; McCarthy, J G; Grayson, B H; Glasberg, S B

    1995-05-01

    Midface hypoplasia, often associated with exorbitism and malocclusion, has been traditionally corrected by using Le Fort advancement osteotomies through wide surgical exposure. These procedures suffer the disadvantages of hemorrhage, unpredictable bone graft resorption, the need for retained hardware, and bone graft donor-site morbidity. We present an investigation of midface distraction in the canine without osteotomies. Five canines were the subjects of this study and were divided into two groups. At the time of placement of the lengthening devices, Group 1 animals were 10 weeks of age and Group 2 animals were 5 years of age. Under general anesthesia, four modified Hoffman bone distractors were mounted on 2-mm half pins placed individually across the nasofrontal and the zygomaticotemporal sutures on each side of the craniofacial skeleton. Distraction of all devices was begun on postoperative day 1 at the rate of 0.5 mm/day for 4 days and then 1.0 mm/day for 28 days, after which interval the devices were removed. The dogs were serially monitored and examined for 3 months. One dog in the first group served as a sham control. The results were assessed by standardized cephalograms, and craniofacial computed tomographic scans with three-dimensional reconstruction performed before device placement as well as after removal of the device. In one Group 1 animal, computed tomographic scanning was performed every 2 to 4 weeks for 3 months. Gross examination of the Group 1 animals demonstrated the development of enophthalmos, dolichocephaly, and a class II malocclusion-overbite.(ABSTRACT TRUNCATED AT 250 WORDS)

  2. Subcapital Correction Osteotomy for Malunited Slipped Capital Femoral Epiphysis

    Science.gov (United States)

    Anderson, Lucas A.; Gililland, Jeremy; Pelt, Christoper; Peters, Christopher L.

    2013-01-01

    Background Slipped capital femoral epiphysis (SCFE), causing posterior and inferior displacement and retroversion of the femoral head, is a well-recognized etiology for femoroacetabular impingement (FAI) and can lead to premature arthritis in the young adult. The treatment of malunited SCFE remains controversial. Surgical dislocation and subcapital correction osteotomy (SCO) has been described as a powerful method to correct the proximal femoral deformity. Methods Between January 2003 and January 2010, 11 patients (12 hips) with closed femoral physes and symptomatic FAI from malunited SCFE were treated with surgical dislocation and SCO. We performed a retrospective review of patient histories, physical exams, operative findings, and pre and postoperative anteroposterior (AP) and groin lateral (GLat) radiographs. Mean follow-up was 61 months. Results There were 4 female and 7 male patients with an average age of 15 years at the time of SCO. On the AP radiograph the mean inferior femoral head displacement (AP epiphyseal-neck angle) was significantly improved (-26° to -6°, pfemoral head displacement (Lateral epiphyseal-neck angle) was significantly improved (-45° to -3°, pfemoral osteochondral defect, 8 Outerbridge grade 3-4 acetabular cartilage lesions, and 10 labral lesions. Significant improvement of the mean Harris hip score (HHS) was seen at latest follow-up (54 to 77, p=0.016). Complications occurred in 4 of the 12 cases with AVN in two patients, a worse postoperative HHS in one patient, and failure of fixation treated successfully with revision open reduction internal fixation in one patient. Conclusions Subcapital correction osteotomy as an adjunct to surgical dislocation and osteochondroplasty can be used to correct the deformity of the proximal femur associated with malunited SCFE. Normalization of proximal femoral anatomy may postpone progression to severe osteoarthritis and thus delay the need for arthroplasty in this young patient population. However

  3. Inverted 'V' osteotomy excision arthroplasty for bony ankylosed elbows

    Directory of Open Access Journals (Sweden)

    Rex Chadrabose

    2011-12-01

    Full Text Available Abstract Background Bony ankylosis of elbow is challenging and difficult problem to treat. The options are excision arthroplasty and total elbow replacement. We report our midterm results on nine patients, who underwent inverted 'V' osteotomy excision arthroplasty in our hospital with good functional results. Materials Our case series includes 9 patients (seven males and two females with the mean age of 34 years (13-56 years. Five patients had trauma, two had pyogenic arthritis, one had tuberculous arthritis, and one had pyogenic arthritis following surgical fixation. Results The average duration of follow up is 65 months (45 months-80 months. The mean Mayo's elbow performance score (MEPS preoperatively was 48 (35-70. The MEPS at final follow up was 80 (60-95. With no movement at elbow and fixed in various degrees of either flexion or extension preoperatively, the mean preoperative position of elbow was 64°(30°to 100°. The mean post operative range of motion at final follow up was 27°of extension (20-500, 116°of flexion (1100-1300, and the arc of motion was 88°(800-1000. One patient had ulnar nerve neuropraxia and another patient developed median nerve neuropraxia, and both recovered completely in six weeks. No patient had symptomatic instability of the elbow. All patients were asymptomatic except one patient, who had pain mainly on heavy activities. Conclusion We conclude that inverted 'V' osteotomy excision arthroplasty is a viable option in the treatment of bony ankylosis of the elbow in young patients.

  4. Inverted 'V' osteotomy excision arthroplasty for bony ankylosed elbows.

    Science.gov (United States)

    Rex, Chadrabose; Periyasamy, Rameshkumar; Balaji, Subbachandra; Premanand, C; Alva, Shreyas; Reddy, Shiva

    2011-12-05

    Bony ankylosis of elbow is challenging and difficult problem to treat. The options are excision arthroplasty and total elbow replacement. We report our midterm results on nine patients, who underwent inverted 'V' osteotomy excision arthroplasty in our hospital with good functional results. Our case series includes 9 patients (seven males and two females) with the mean age of 34 years (13-56 years). Five patients had trauma, two had pyogenic arthritis, one had tuberculous arthritis, and one had pyogenic arthritis following surgical fixation. The average duration of follow up is 65 months (45 months-80 months). The mean Mayo's elbow performance score (MEPS) preoperatively was 48 (35-70). The MEPS at final follow up was 80 (60-95). With no movement at elbow and fixed in various degrees of either flexion or extension preoperatively, the mean preoperative position of elbow was 64°(30°to 100°). The mean post operative range of motion at final follow up was 27°of extension (20-500), 116°of flexion (1100-1300), and the arc of motion was 88°(800-1000). One patient had ulnar nerve neuropraxia and another patient developed median nerve neuropraxia, and both recovered completely in six weeks. No patient had symptomatic instability of the elbow. All patients were asymptomatic except one patient, who had pain mainly on heavy activities. We conclude that inverted 'V' osteotomy excision arthroplasty is a viable option in the treatment of bony ankylosis of the elbow in young patients.

  5. Long-term results of intertrochanteric varus osteotomy for the dysplastic hip.

    Science.gov (United States)

    Nishiyama, Takayuki; Saegusa, Yasuhiro; Fujishiro, Takaaki; Hayashi, Shinya; Kanzaki, Noriyuki; Hashimoto, Shingo; Kurosaka, Masahiro

    2012-01-01

    Total hip arthroplasty (THA) is a well established treatment for arthrosis of the hip, however many problems remain which have not yet been resolved, including component loosening and infection. Therefore, surgeons hesitate to perform THA in younger patients showing early signs of the disease. Intertrochanteric varus osteotomy was developed for osteoarthrosis with coxa valga. This procedure has been commonly used in patients with dysplastic hips. However, femoral head coverage is not sufficiently improved by this procedure. In order to overcome the disadvantages of this procedure, since 1972 we performed intertrochanteric varus osteotomy simultaneously combined with acetabuloplasty for the treatment of osteoarthrosis secondary to dysplasia. Between 1969 and 1994, we performed 104 intertrochanteric varus osteotomies for prearthrosis and early stage arthrosis of the hip due to acetabular dysplasia in 84 patients. In this study, we reviewed these patients clinically and radiographically, over 15 years. The intertrochanteric varus osteotomy alone was employed in 38 hips (varus group). Combined intertrochanteric varus osteotomy and acetabuloplasty was employed in 63 hips (combined group). The average Harris hip score at the latest follow-up in the combined group significantly higher than that in the 'varus' group. Postoperative centre-edge angle and age at operation were correlated with the Harris hip score at the most recent follow-up. The results of the present study indicate that this combined intertrochanteric varus osteotomy and acetabuloplasty for dysplastic hip should be considered in young patients when the disease is at an early stage.

  6. Olecranon osteotomy for exposure of fractures and nonunions of the distal humerus.

    Science.gov (United States)

    Ring, David; Gulotta, Lawrence; Chin, Kingsley; Jupiter, Jesse B

    2004-08-01

    Although olecranon osteotomy provides excellent exposure of the distal humerus, enthusiasm for this approach has been limited by reports suggesting numerous complications. It has been suggested that specific techniques for creating and repairing an olecranon osteotomy may help limit complications. This paper describes a technique for olecranon osteotomy using an apex, distal, chevron-shaped osteotomy, Kirschner wires directed out the anterior ulnar cortex distal to the coronoid process and bent 180degrees and impacted into the olecranon proximally, and two 22- gauge, figure-of-eight, stainless steel tension wires. A single surgeon used this technique for exposure of a fracture (16 patients) or nonunion (29 patients) of the distal humerus in 45 consecutive patients. One patient returned to activity too soon, had loosening of the wire fixation, and required a second operation for plate fixation of the ulna. The remaining 44 osteotomies (98%) healed with good alignment within 6 months. There were no broken or migrated wires prior to healing. Twelve patients (27%) had removal of the wires used to repair the olecranon: in 6 patients, this was for symptoms related to the wires (13%); 1 for septic olecranon bursitis, and 5 at the time of another procedure (elbow capsular release in 4 patients and submuscular ulnar nerve transposition in 1). Olecranon osteotomy can be used for exposure of the distal humerus with a low rate of complications when specific techniques are used.

  7. Vertigine parossistica posizionale benigna conseguente alla procedure di mini-rialzo del pavimento del seno mascellare: osteotomi a percussione vs. osteotomi a vite. RCT a triplo cieco.

    OpenAIRE

    Mariniello, Mauro

    2013-01-01

    Obiettivo: Comparare l’insorgenza della vertigine parossistica posizionale benigna (VPPB) nelle metodiche di mini-rialzo del seno mascellare a seconda che impieghino osteotomi a vite o osteotomi a percussione. Materiali e Metodi: Questo RCT a triplo cieco ha coinvolto 196 pazienti (107 uomini e 89 donne; età media 62.05 anni ± 7.10, range 49-79 anni) con un’edentulia mascellare di un singolo elemento, che richiedesse una metodica di mini-rialzo del seno mascellare. I pazienti mediante una...

  8. Multilevel Posterior Column Osteotomies Are Not Inferior For the Correction of Rigid Adult Spinal Deformity Compared with Pedicle Subtraction Osteotomy.

    Science.gov (United States)

    Han, Sanghyun; Hyun, Seung-Jae; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib; Lee, Byoung Hun; Choi, Ho Yong

    2017-11-01

    Posterior column osteotomy (PCO) has been used for the correction of various spinal deformities. However, little evidence is available regarding the effects of multilevel PCO in adult spinal deformity (ASD) surgery. This study aimed to show the usefulness of PCO in rigid ASD surgery by assessing radiographic and clinical outcomes. We also aimed to assess the corrective potential of multilevel PCOs compared with a single-level pedicle subtraction osteotomy (PSO). Between 2012 and 2016, the medical records of 70 consecutive patients who underwent a multilevel PCO (35 patients) or a single-level PSO (35 patients) for ASD in a single institute were reviewed. Baseline data, radiographic measurements, and clinical outcomes using the Scoliosis Research Society-22 (SRS-22) questionnaire were compared between groups. The following variables were no different between the groups: age at surgery, sex, level fused, preoperative and postoperative radiologic parameters, and bone mineral density T score. However, operation time (380.0 vs. 483.6 minutes), estimated blood loss (1175.7 vs. 1362.6 mL), and the number of complications (8 vs. 20) were significantly reduced in the PCO group compared with the PSO group. A significant improvement in the SRS-22 score was seen in both groups after surgery, although no difference was observed between the groups postoperatively. Multilevel PCOs for the correction of rigid ASD were slightly superior to PSO, regarding clinical outcomes. Radiographic outcomes were similar between groups. Thus, multilevel PCOs may be a viable option for the treatment of rigid ASD with a mobile segment. Copyright © 2017 Elsevier Inc. All rights reserved.

  9. Importance of sagittal MR imaging in nontraumatic femoral head osteonecrosis in children

    Energy Technology Data Exchange (ETDEWEB)

    Ha, Alice S. [Hospital of the University of Pennsylvania, Department of Radiology, Philadelphia, PA (United States); Wells, Lawrence [Children' s Hospital of Philadelphia, Department of Orthopedic Surgery, Philadelphia, PA (United States); Jaramillo, Diego [Children' s Hospital of Philadelphia, Department of Radiology, Philadelphia, PA (United States)

    2008-11-15

    In nontraumatic femoral head osteonecrosis, characterization of femoral head collapse is important in staging disease progression and planning treatment. Few prior studies have quantitatively compared the ability of sagittal and coronal MR images to detect femoral head collapse. We hypothesized that sagittal MR images show a greater degree and angular span of femoral head collapse than coronal images. We reviewed 38 hip MRI scans of nontraumatic femoral head osteonecrosis from 34 pediatric patients. In both sagittal and coronal images, the maximal extent and angular location along with the angular span of the femoral head collapse were measured. Differences were evaluated using a paired t-test. The extent of bone and cartilage loss from the femoral head was evaluated. Sagittal MR images showed 29% maximal femoral head radius collapse, whereas coronal images showed 16% collapse (P<0.001). Sagittal images showed a larger angular span of collapse (115 ) than coronal images (55 , P<0.001). Sagittal images showed greater epiphyseal bone loss in the anterior than in the posterior portion (P<0.001), whereas coronal images did not show a significant difference in bone loss between the medial and lateral portion (P=0.32). Sagittal images show greater femoral head collapse than coronal images in nontraumatic femoral head osteonecrosis. (orig.)

  10. Cementless Total Hip Arthroplasty Involving Trochanteric Osteotomy without Subtrochanteric Shortening for High Hip Dislocation.

    Science.gov (United States)

    Lee, Soong Joon; Yoo, Jeong Joon; Kim, Hee Joong

    2017-03-01

    Total hip arthroplasty with subtrochanteric shortening osteotomy is widely performed for high hip dislocation. However, suboptimal leg length discrepancy correction and nonunion of the osteotomy site remain concerns. Although total hip arthroplasty using trochanteric osteotomy without subtrochanteric osteotomy was introduced, cemented implants have been more commonly used than contemporary cementless implants in this procedure. We evaluated the long-term results of cementless total hip arthroplasty with trochanteric osteotomy without subtrochanteric osteotomy for high hip dislocation. From 1990 to 2002, 27 cementless total hip arthroplasties using trochanteric osteotomy without subtrochanteric osteotomy were performed in 26 patients with Crowe III or IV high hip dislocation and a mean age of 36.4 ± 12.9 years. Seven ceramic-on-ceramic, 8 ceramic-on-polyethylene, 10 metal-on-polyethylene, and 2 metal-on-metal bearings were inserted. Mean follow-up was 15.1 ± 3.7 years. We retrospectively reviewed medical records and radiographic data and evaluated the clinical and radiological results including the Harris hip score, implant survival, correction of leg length discrepancy, and occurrence of complications. The mean Harris hip score and leg length discrepancy improved significantly from 73.3 to 94.9 points and from 4.3 cm to 1.0 cm, respectively. With revision for loosening set as the end point, implant survival rates at 10 and 15 years postoperatively were 96.0% and 90.9% for stems and 74.1% and 52.3% for cups. In 8 of 10 hips with the metal-on-polyethylene bearing and 4 of 8 hips with the ceramic-on-polyethylene bearing, revision surgery was performed for aseptic loosening. However, no revision was performed in hips with the ceramic-on-ceramic bearing or the metal-on-metal bearing. Implant survival was significantly different by the type of bearing surface. Two permanent neurologic complications occurred in patients with a limb lengthening over 3.5 cm. With proper

  11. Lumbar Lordosis Minus Thoracic Kyphosis: A Novel Regional Predictor for Sagittal Balance in Elderly Populations.

    Science.gov (United States)

    Yang, Changwei; Yang, Mingyuan; Wei, Xianzhao; Shao, Jie; Chen, Yuanyuan; Zhao, Jian; Zhu, Xiaodong; He, Dawei; Li, Ming

    2016-03-01

    A retrospective study. The aim of this study is to introduce a novel regional predictor for sagittal balance in elderly populations and explore its effectiveness of evaluating sagittal balance. Sagittal balance is getting increasing recognition of importance due to its significant association of health-related quality of life. However, no regional parameters could well reflect and predict the whole sagittal balance. Medical records of elderly patients in our outpatient clinic from January 2012 to January 2014 were reviewed with standing full-spine lateral radiograph. Radiological parameters were evaluated, including max thoracic kyphosis (maxTK), max lumbar lordosis (maxLL), LL minus TK(LL-TK), PI minus LL (PI-LL), sacrum slope (SS), pelvic tilt (PT), pelvic incidence (PI), and SVA (sagittal vertical axis). Correlation analysis between SVA, LL-TK, and other radiological spinopelvic parameters and was pursued. Patients were divided into two groups according to whether patients were well-aligned in sagittal plane: Group A (well-aligned, SVA ≤50  mm) and Group B (poorly aligned, SVA >50  mm), and demographic and sagittal parameters were compared. LL-TK ≥0° and PI-LL ≤13° were used as a threshold value to evaluate their effectiveness of prediction for sagittal balance. A total of 129 patients (M: 25 and F: 104) were included in this study. SVA was significantly correlated with NRS (numeric rating scales), age, maxLL, PT, LL-TK, and PI-LL (all, P 13°, 34 patients were poorly aligned (34/39, 87%). LL-TK was a good regional predictor for sagittal balance in elderly population, especially combined with PI-LL. 4.

  12. Age-related variations in global spinal alignment and sagittal balance in asymptomatic Japanese adults.

    Science.gov (United States)

    Yokoyama, Kunio; Kawanishi, Masahiro; Yamada, Makoto; Tanaka, Hidekazu; Ito, Yutaka; Kawabata, Shinji; Kuroiwa, Toshihiko

    2017-05-01

    The global spinal sagittal alignment varies widely among healthy individuals as it is affected by not only race, but also aging. We investigated age-related changes in the spinal alignment in asymptomatic Japanese individuals. The subjects comprised 220 individuals without any spine-related neurological symptoms or treatment history thereof who visited our outpatient clinic. Lateral radiographs of the whole spine were taken for all subjects in the standing position. Based on the images obtained, spino-pelvic parameters were calculated using Jackson's method so as to analyze any correlations with age. TIA, TK, and C2-C7A were found to markedly increase with age from late middle age (P sagittal balance (P > 0.05). However, there were 22 subjects (10%) with C7SVA > 50 mm, with those aged 70 years or older accounting for half of this subpopulation. Sagittal balance tended to be retained even in elderly subjects if lumbosacral lordosis was large enough to compensate for thoracic kyphosis. A very strong correlation was found between the L1 slope and whole-spine sagittal balance (P sagittal balance. The whole-spine sagittal balance can deteriorate if the compensatory changes in the lumbosacral spine are insufficient. The L1 slope is a central parameter that defines the whole-spine sagittal balance. PI; pelvic incidence; SS; sacral slope; PT; pelvic tilt; LL; lumbar lordosis; C7SVA; C7 sagittal vertical axis; SSA; spinosacral angle; TK; thoracic kyphosis; C2-C7SVA; C2-C7 sagittal vertical axis; C2-C7A; C2-C7 Angle; TIA; thoracic inlet angle; NT; neck tilt.

  13. Solar water splitting: efficiency discussion

    CERN Document Server

    Juodkazyte, Jurga; Sebeka, Benjaminas; Savickaja, Irena; Malinauskas, Tadas; Badokas, Kazimieras; Juodkazis, Kestutis; Juodkazis, Saulius

    2016-01-01

    The current state of the art in direct water splitting in photo-electrochemical cells (PECs) is presented together with: (i) a case study of water splitting using a simple solar cell with the most efficient water splitting electrodes and (ii) a detailed mechanism analysis. Detailed analysis of the energy balance and efficiency of solar hydrogen production are presented. The role of hydrogen peroxide formation as an intermediate in oxygen evolution reaction is newly revealed and explains why an oxygen evolution is not taking place at the thermodynamically expected 1.23 V potential. Solar hydrogen production with electrical-to-hydrogen conversion efficiency of 52% is demonstrated using a simple ~0.7%-efficient n-Si/Ni Schottky solar cell connected to a water electrolysis cell. This case study shows that separation of the processes of solar harvesting and electrolysis avoids photo-electrode corrosion and utilizes optimal electrodes for hydrogen and oxygen evolution reactions and achieves ~10% efficiency in light...

  14. A lamellar model for the X-ray rocking curves of sagittally bent Laue crystals.

    Science.gov (United States)

    Zhong, Z; Kao, C C; Siddons, D P; Zhong, H; Hastings, J B

    2003-01-01

    The use of sagittally bent asymmetric Laue crystals in horizontally focusing monochromators for high-energy synchrotron X-rays necessitates simulation of the X-ray reflectivity by such crystals. Based on the theory of the lattice distortion in the diffraction plane of sagittally bent Laue crystals, a lamellar model was developed to predict their rocking curves. The model was experimentally verified by rocking-curve measurements from various reflections on silicon crystals of four representative orientations, sagittally bent to various radii, using X-rays of 67 keV energy.

  15. [Proximal femoral varus osteotomy in adults after developmental dysplasia of the hip: long-term results].

    Science.gov (United States)

    Rozkydal, Z; Janíček, P; Otiepka, P

    2010-01-01

    The aim of this retrospective study was to assess the results of varus osteotomy of the proximal femur in adults with coxa valga after developmental dysplasia of the hip (DDH) and to evaluate the efficacy of this method. Thirty hips in 28 patients treated by proximal femoral varus osteotomy in the period from 1983 to 1990 were evaluated. The indication for surgery involved coxa valga (145°-168°) with grade I- III of osteoarthritis and mild acetabular dysplasia. The patient group comprised twenty six women and two men with an average age of 28 years (18 to 42) at the time of surgery. The mean follow-up was 22 years (19 to 26). The preoperative radiographic examination included an AP view of the pelvis, AP views of the hip in neutral and in frog-leg position and AP views of the hip in 30° of abduction and neutral rotation. Varus osteotomy was indicated when the best position of the hip joint was achieved in abduction. The procedure was performed according to M. Müller. Hip assessment was based on the grade of osteoarthritis, CCD angle, Wiberg angle and AHI index. The results were statistically evaluated using the life table analysis of clinical survivorship of osteotomy and the Kaplan- Meier curve. Clinical failure was defined as conversion of osteotomy to total hip replacement (THR). At the latest follow-up of 22 years on the average, 18 patients (19 hips) still had osteotomy and 10 patients (11 hips) had undergone conversion to THR. The life table analysis showed the cumulative proportion of osteotomy with a clinical survivorship of 0.97 at 5 years, 0.75 at 10 and 15 years, and 0.68 at 20 and 25 years after surgery. The cumulative rate of clinical survivorship of osteotomy, as shown by the Kaplan-Meier curve, was 0.89 at 10 years, 0.75 at 20 years and 0.67 at 25 years after surgery. Nineteen patients were satisfied with the osteotomy outcome. The median of Harris hip scores in the patients with osteotomy was 48 points before surgery and 78 points at the latest

  16. Importance of sagittal kick symmetry for underwater dolphin kick performance.

    Science.gov (United States)

    Atkison, Ryan R; Dickey, James P; Dragunas, Andrew; Nolte, Volker

    2014-02-01

    The purpose of this study was to determine how sagittal kick symmetry in the underwater dolphin kick (UDK) between the downkick and upkick phases is related to UDK performance. Fifteen adult male competitive swimmers ranging from provincial to international level were filmed performing three trials each of maximum effort UDK over 15m using an underwater video camera. Video frames were manually digitized and each subjects' single fastest trial was evaluated for between-subject comparisons. Kinematic variables were calculated for each individual and Pearson product-moment correlations between the average horizontal centre of mass velocity (Vx) and all kinematic variables were calculated. Horizontal velocity during the downkick, horizontal velocity during the upkick, relative time spent in each phase, maximum chest flexion angle, maximum knee and ankle extension angles, the ratio of flexion/extension for chest, knee and ankle angles, and maximum vertical toe velocity during the upkick phase correlated significantly with Vx (pimportance of kick symmetry for UDK performance, and indicate that performing the upkick phase well appears to be most important for UDK performance. Copyright © 2013 Elsevier B.V. All rights reserved.

  17. Sagittal venous sinus thrombosis after cesarean section: a case report

    Directory of Open Access Journals (Sweden)

    Farideh Keypour

    2013-07-01

    Full Text Available Background: Cerebral venous thrombosis (CVT is uncommon after cesarean section. Although it can be a leading cause of maternal mortality. CVT may occur during pregnancy because of hypercoagulable states such as preeclampsia, thrombophilias, antiphospholipid antibody syndrome and sepsis.Case presentation: A 31 years old woman G2 Ab1 at 37 weeks gestational age with  premature rupture of membrane underwent cesarean section because breech presentation and preeclampsia. Spinal anesthesia was done for emergent cesarean section. On the second day after cesarean section, she developed headache, vomiting, focal neurologic deficits, paresthesia, blurred vision. Brain magnetic resonance imaging (MRI showed thrombosis in anterior half of superior sagittal sinus. Treatment consisted of anticoagulation.  Conclusion: Thrombophilias, pregnancy-related hypertension and cesarean section are the predisposing factors for thromboembolism. Unfractionated heparin and low molecular weight heparin (LMWs are effective drugs for thromboprophylaxis. It is vital to prevent venous thrombosis to reduce mortality during both intrapartum and postpartum periods. Consideration of cerebral venous thrombosis in similar cases is recommended.

  18. The effects of medial and lateral displacement calcaneal osteotomies on ankle and subtalar joint pressure distribution.

    Science.gov (United States)

    Davitt, J S; Beals, T C; Bachus, K N

    2001-11-01

    We compared the pressure distribution in the ankle and posterior facet of the subtalar joint following 1 cm medial and lateral displacement calcaneal osteotomies to the pressure distribution in the intact foot. Six cadaver specimens were loaded in neutral alignment while pressure measurements were recorded. A 1-cm medial displacement osteotomy shifted the average center of force in the ankle 1.0 mm medially (p = 0.36) while a lateral displacement osteotomy shifted the center of force 1.1 mm laterally (p = 0.42). There was also a slight shift in the percentage of pressure toward the side of the talus to which the calcaneus was shifted. For the lateral displacement osteotomy, the pressure increased 4.0% in the lateral-most quadrant (p = 0.05), while the medial osteotomy increased the pressure 1.3% in the medial quadrant (p = 0.30). In the subtalar joint, a medial displacement osteotomy shifted the pressure distribution slightly medially (5.9%, p = 0.06) and more anteriorly (9.6%, p = 0.02) while the distribution was shifted laterally (5.9%, p = 0.17) and anteriorly (5.6%, p = 0.03) with a lateral displacement osteotomy. These shifts of percentage of pressure between quadrants of the joints were slight-less than 5% in the ankle and less than 10% in the subtalar joint. Significant translation of the calcaneal tuberosity appears to have only a small effect on pressure distribution in the ankle and posterior facet of the subtalar joint in a weighted cadaver model.

  19. Biomechanical consequences of adding plantar fascia release to metatarsal osteotomies: Changes in forefoot plantar pressures.

    Science.gov (United States)

    Aydogan, Umur; Roush, Evan P; Moore, Blake E; Andrews, Seth H; Lewis, Gregory S

    2017-04-01

    Destruction of the normal metatarsal arch by a long metatarsal is often a cause for metatarsalgia. When surgery is warranted, distal oblique, or proximal dorsiflexion osteotomies of the long metatarsal bones are commonly used. The plantar fascia has anatomical connection to all metatarsal heads. There is controversial scientific evidence on the effect of plantar fascia release on forefoot biomechanics. In this cadaveric biomechanical study, we hypothesized that plantar fascia release would augment the plantar metatarsal pressure decreasing effects of two common second metatarsal osteotomy techniques. Six matched pairs of foot and ankle specimens were mounted on a pressure mat loading platform. Two randomly assigned surgery groups, which had received either distal oblique, or proximal dorsiflexion osteotomy of the second metatarsal, were evaluated before and after plantar fasciectomy. Specimens were loaded up to a ground reaction force of 400 N at varying Achilles tendon forces. Average pressures, peak pressures, and contact areas were analyzed. Supporting our hypothesis, average pressures under the second metatarsal during 600 N Achilles load were decreased by plantar fascia release following proximal osteotomy (p fascia release following modified distal osteotomy, under multiple Achilles loading conditions (p < 0.05). Plantar fasciotomy should not be added to distal metatarsal osteotomy in the treatment of metatarsalgia. If proximal dorsiflexion osteotomy would be preferred, plantar fasciotomy should be approached cautiously not to disturb the forefoot biomechanics. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:800-804, 2017. © 2016 Orthopaedic Research Society. Published by Wiley Periodicals, Inc.

  20. The likelihood of reaching minimum clinically important difference and substantial clinical benefit at 2 years following a 3-column osteotomy: analysis of 140 patients.

    Science.gov (United States)

    Fakurnejad, Shayan; Scheer, Justin K; Lafage, Virginie; Smith, Justin S; Deviren, Vedat; Hostin, Richard; Mundis, Gregory M; Burton, Douglas C; Klineberg, Eric; Gupta, Munish; Kebaish, Khaled; Shaffrey, Christopher I; Bess, Shay; Schwab, Frank; Ames, Christopher P

    2015-09-01

    Three-column osteotomies (3COs) are technically challenging techniques for correcting severe rigid spinal deformities. The impact of these interventions on outcomes reaching minimum clinically important difference (MCID) or substantial clinical benefit (SCB) is unclear. The objective of this study was to determine the rates of MCID and SCB in standard health-related quality of life (HRQOL) measures after 3COs in patients with adult spinal deformity (ASD). The impacts of location of the uppermost instrumented vertebra (UIV) on clinical outcomes and of maintenance on sagittal correction at 2 years postoperatively were also examined. The authors conducted a retrospective multicenter analysis of the records from adult patients who underwent 3CO with complete 2-year radiographic and clinical follow-ups. Cases were categorized according to established radiographic thresholds for pelvic tilt (> 22°), sagittal vertical axis (> 4.7 cm), and the mismatch between pelvic incidence and lumbar lordosis (> 11°). The cases were also analyzed on the basis of a UIV in the upper thoracic (T1-6) or thoracolumbar (T9-L1) region. Patient-reported outcome measures evaluated preoperatively and 2 years postoperatively included Oswestry Disability Index (ODI) scores, the Physical Component Summary and Mental Component Summary (MCS) scores of the 36-Item Short Form Health Survey, and Scoliosis Research Society-22 questionnaire (SRS-22) scores. The percentages of patients whose outcomes for these measures met MCID and SCB were compared among the groups. Data from 140 patients (101 women and 39 men) were included in the analysis; the average patient age was 57.3 ± 12.4 years (range 20-82 years). Of these patients, 94 had undergone only pedicle subtraction osteotomy (PSO) and 42 only vertebral column resection (VCR); 113 patients had a UIV in the upper thoracic (n = 63) orthoracolumbar region (n = 50). On average, 2 years postoperatively the patients had significantly improved in all HRQOL

  1. Trans trochanteric approach with coronal osteotomy of the great trochanter

    Directory of Open Access Journals (Sweden)

    Steffann Francois

    2015-01-01

    Full Text Available Several surgical approaches could be used in hip arthroplasty or trauma surgery: anterior, anterolateral, lateral, posterior (with or without trochanterotomy, using or not an orthopedic reduction table. Subtrochanteric and extra-capsular trochanteric fractures (ECTF are usually treated by internal fixation with mandatory restrictions on weight bearing. Specific complications have been widely described. Mechanical failures are particularly high in unstable fractures. Hip fractures are a major public health issue with a mortality rate of 12%–23% at 1 year. An alternative option is to treat ECTF by total hip arthroplasty (THA to prevent decubitus complications, to help rapid recovery, and to permit immediate weight bearing as well as quick rehabilitation. However, specific risks of THA have to be considered such as dislocation or cardiovascular failure. The classical approach (anterior or posterior requires the opening of the joint and capsule, weakening hip stability and the repair of the great trochanter is sometimes hazardous. For 15 years, we have been treating unstable ECTF by THA with cementless stem, dual mobility cup (DMC, greater trochanter (GT reattachment, and a new surgical approach preserving capsule, going through the fracture and avoiding joint dislocation. Bombaci first described a similar approach in 2008; our trans fractural digastric approach (medial gluteus and lateral vastus is different. A coronal GT osteotomy is performed when there is no coronal fracture line. It allows easy access to the femoral neck and acetabulum. The THA is implanted without femoral internal rotation to avoid extra bone fragment displacement. With pre-operative planning, cup implantation is easy and stem positioning is adjusted referring to the top of the GT after trial reduction and preoperative planning. The longitudinal osteotomy and trochanteric fracture are repaired with wires and the digastric incision is closed. This variant of Bombaci

  2. On split Lie triple systems

    Indian Academy of Sciences (India)

    The key tool in this job is the notion of connection of roots in the framework of split Lie triple systems. Author Affiliations. Antonio J Calderón Martín1. Departamento de Matemáticas, Universidad de Cádiz, 11510 Puerto Real, Cádiz, Spain. Dates. Manuscript received: 25 January 2008. Proceedings – Mathematical Sciences.

  3. Beam splitting on weak illumination.

    Science.gov (United States)

    Snyder, A W; Buryak, A V; Mitchell, D J

    1998-01-01

    We demonstrate, in both two and three dimensions, how a self-guided beam in a non-Kerr medium is split into two beams on weak illumination. We also provide an elegant physical explanation that predicts the universal character of the observed phenomenon. Possible applications of our findings to guiding light with light are also discussed.

  4. Dual focus polarisation splitting lens.

    Science.gov (United States)

    Moseley, Paul; Savini, Giorgio; Zhang, Jin; Ade, Peter

    2017-10-16

    We have successfully designed and measured a unique polarisation splitting lens which focuses the orthogonal linear polarisations side-by-side in the lens focal plane. This concept can find application in situations where there is limited space for the beam splitters and focusing optics that are required for incoherent detectors.

  5. VBSCan Split 2017 Workshop Summary

    Energy Technology Data Exchange (ETDEWEB)

    Anders, Christoph Falk; et al.

    2018-01-12

    This document summarises the talks and discussions happened during the VBSCan Split17 workshop, the first general meeting of the VBSCan COST Action network. This collaboration is aiming at a consistent and coordinated study of vector-boson scattering from the phenomenological and experimental point of view, for the best exploitation of the data that will be delivered by existing and future particle colliders.

  6. Water splitting by cooperative catalysis

    NARCIS (Netherlands)

    Hetterscheid, D.G.H.; van der Vlugt, J.I.; de Bruin, B.; Reek, J.N.H.

    2009-01-01

    A mononuclear Ru complex is shown to efficiently split water into H2 and O2 in consecutive steps through a heat- and light-driven process (see picture). Thermally driven H2 formation involves the aid of a non-innocent ligand scaffold, while dioxygen is generated by initial photochemically induced

  7. Split supersymmetry in brane models

    Indian Academy of Sciences (India)

    Type-I string theory in the presence of internal magnetic fields provides a concrete realization of split supersymmetry. To lowest order, gauginos are massless while squarks and sleptons are superheavy. For weak magnetic fields, the correct Standard Model spectrum guarantees gauge coupling unification with sin2 W ...

  8. Criteria to restore the sagittal balance in deformity and degenerative spondylolisthesis.

    Science.gov (United States)

    Lamartina, Claudio; Berjano, Pedro; Petruzzi, Mary; Sinigaglia, Aldo; Casero, Giovanni; Cecchinato, Riccardo; Damilano, Marco; Bassani, Roberto

    2012-05-01

    To present in a single source the relevant information needed to assess spinopelvic balance and alignment, and to estimate the amount of correction needed in a patient during surgical treatment. Narrative literature review Sagittal balance can be evaluated by global balance estimates (sagittal vertical axis and T1 tilt). Other important parameters are the relationship between pelvic incidence and lumbar lordosis (spinopelvic harmony), between pelvic incidence and difference of thoracic kyphosis and lumbar lordosis (spinopelvic balance), excess of pelvic tilt, knee flexion and thoracic compensatory hypokyphosis. Different methods to calculate the amount of surgical correction needed in patients with sagittal imbalance have been based on combinations of these parameters. Relevant parameters of sagittal imbalance have been identified and correlated with clinical outcomes. Methods for calculation of surgical correction of imbalance have been proposed, but not validated in patients with mid-term follow-up.

  9. Multidirectional Cranial Distraction Osteogenesis with Simplified Modifications for Treating Sagittal Synostosis

    Directory of Open Access Journals (Sweden)

    Ataru Sunaga, MD

    2017-10-01

    Conclusions:. Simplified MCDO has a number of advantages over conventional distraction procedures such as discretionary reshaping/expansion of cranium and predictable osteogenesis and is a valid treatment option for patients with sagittal synostosis.

  10. Estimated force and moment of shoulder external rotation muscles: differences between transverse and sagittal planes.

    Science.gov (United States)

    de Castro, Marcelo Peduzzi; Ribeiro, Daniel Cury; de Camargo Forte, Felipe; de Toledo, Joelly Mahnic; Costa Krug, Roberto; Fagundes Loss, Jefferson

    2012-12-01

    The aim of this study was to compare shoulder muscle force and moment production during external rotation performed in the transverse and sagittal planes. An optimization model was used for estimating shoulder muscle force production of infraspinatus, teres minor, supraspinatus, anterior deltoid, middle deltoid and posterior deltoid muscles. The model uses as input data the external rotation moment, muscle moment arm magnitude, muscle physiologic cross-sectional area and muscle specific tension. The external rotation moment data were gathered from eight subjects in transverse and six subjects in sagittal plane using an isokinetic dynamometer. In the sagittal plane, all studied muscles presented larger estimated force in comparison with the transverse plane. The infraspinatus, teres minor, supraspinatus and posterior deltoid muscles presented larger moment in sagittal when compared with transverse plane. When prescribing shoulder rehabilitation exercises, therapists should bear in mind the described changes in muscle force production.

  11. A previously unreported variant of the synostotic sagittal suture: Case report and review of salient literature

    Directory of Open Access Journals (Sweden)

    Madison Budinich

    2016-12-01

    Conclusion: To our knowledge, a synostotic sagittal suture has not been reported that extended posteriorly it involve the occipital bone. Those who interpret imaging or operate on this part of the skull should consider such a variation.

  12. Radiological lumbar stenosis severity predicts worsening sagittal malalignment on full-body standing stereoradiographs.

    Science.gov (United States)

    Buckland, Aaron J; Ramchandran, Subaraman; Day, Louis; Bess, Shay; Protopsaltis, Themistocles; Passias, Peter G; Diebo, Bassel G; Lafage, Renaud; Lafage, Virginie; Sure, Akhila; Errico, Thomas J

    2017-05-17

    Patients with degenerative lumbar stenosis (DLS) adopt a forward flexed posture in an attempt to decompress neural elements. The relationship between sagittal alignment and severity of lumbar stenosis has not previously been studied. We hypothesized that patients with increasing radiological severity of lumbar stenosis will exhibit worsening sagittal alignment. This is a cross-sectional study. Our sample consists of patients who have DLS. Standing pelvic, regional, lower extremity and global sagittal alignment, and health-related quality of life (HRQoL) were the outcome measures. Patients with DLS were identified from a retrospective clinical database with corresponding full-body stereoradiographs. Exclusion criteria included coronal malalignment, prior spine surgery, spondylolisthesis>Grade 1, non-degenerative spinal pathology, or skeletal immaturity. Central stenosis severity was graded on axial T2-weighted magnetic resonance imaging (MRI) from L1-S1. Foraminal stenosis and supine lordosis was graded on sagittal T1-weighted images. Standing pelvic, regional, lower extremity, and global sagittal alignment were measured using validated software. The HRQoL measures were also analyzed in relation to severity of stenosis. A total of 125 patients were identified with DLS on appropriate imaging. As central stenosis grade increased, patients displayed significantly increasing standing T1 pelvic angle, pelvic tilt, sagittal vertical axis, and pelvic incidence-lumbar lordosis (pHRQoLs in central or foraminal stenosis. Severity of central lumbar stenosis as graded on MRI correlates with severity of sagittal malalignment. These findings support theories of sagittal malalignment as a compensatory mechanism for central lumbar stenosis. Copyright © 2017 Elsevier Inc. All rights reserved.

  13. Global sagittal alignment and health-related quality of life in lumbosacral spondylolisthesis.

    Science.gov (United States)

    Harroud, Adil; Labelle, Hubert; Joncas, Julie; Mac-Thiong, Jean-Marc

    2013-04-01

    Global sagittal alignment is considered as an important aspect in the management of spinal disorders, but the evidence establishing its clinical impact in lumbosacral spondylolisthesis is still poor. This study evaluated the impact of global sagittal alignment on the health-related quality of life (HRQOL) of patients with spondylolisthesis. A retrospective study of 149 consecutive unoperated children and adolescents presenting with lumbosacral spondylolisthesis (117 low-grade and 32 high-grade) was performed. Two global sagittal alignment parameters were measured on standing lateral radiographs: spinal tilt (ST) and C7 plumbline deviation (C7P deviation). All patients completed the SRS-22 questionnaire to assess HRQOL. Pearson's correlations were calculated between parameters of global sagittal alignment and HRQOL. Multiple regression analyses were also undertaken to account for slip percentage and lumbosacral kyphosis (LSK). Both global sagittal alignment parameters were correlated with the SRS-22 total score. When analyzed separately, the correlation was absent in patients with a low-grade slip but remained significant for patients with a high-grade slip (r = 0.35 for ST; r = -0.35 for C7P deviation). The relation was strengthened in high-grade spondylolisthesis when considering only patients with a C7P in front of the posterior corner of upper sacral endplate (r = 0.48 for ST; r = -0.48 for C7P deviation) and was also positive for the SRS-22 pain and appearance domains. For these last patients, the relationship with global sagittal alignment remained significant in the multiple regression analysis. HRQOL was particularly worse for high-grade patients with a C7P in front of the hip axis. In high-grade spondylolisthesis, an increasing positive sagittal alignment was related to a poorer SRS-22 total score, especially when the C7P is in front of the hip axis. Global sagittal alignment should particularly be assessed in patients with high-grade spondylolisthesis.

  14. Superior sagittal sinus thrombosis: a rare complication in a child with nephrotic syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Pirogovsky, A.; Adi, M.; Barzilai, N. [Dept. of Radiology, Kaplan Medical Center, Rehovot (Israel); Dagan, A.; Sinai, L.; Sthoeger, D. [Div. of Paediatrics, Kaplan Medical Center, Rehovot (Israel); Tabachnik, E. [Div. of Paediatrics, Kaplan Medical Center, Rehovot (Israel); Paediatric ICU, Kaplan Hospital, Rehovot (Israel)

    2001-10-01

    A 2-year-old boy with new-onset nephrotic syndrome developed recurrent vomiting, apathy and papilloedema. Superior sagittal sinus thrombosis was diagnosed on cranial CT and MRI. He gradually recovered after treatment with heparin, fresh frozen plasma and warfarin with complete resolution of the thrombosis after 1 month. Superior sagittal sinus thrombosis is an extremely rare complication of nephrotic syndrome in children. Early diagnosis is essential for institution of anticoagulation therapy and a successful outcome. (orig.)

  15. Comparison of Sagittal Spinopelvic Alignment in Patients With Ankylosing Spondylitis and Thoracolumbar Fracture

    Science.gov (United States)

    Pan, Tao; Qian, Bang-Ping; Qiu, Yong

    2016-01-01

    Abstract This article is a comparative study. The aim of the study is to investigate the difference of sagittal alignment of the pelvis and spine between patients with thoracolumbar kyphosis secondary to ankylosing spondylitis (AS) and thoracolumbar fracture, and to evaluate the role of sacropelvic component in AS patients’ adaption to the changes in sagittal alignment. Advanced stages of AS are often associated with thoracolumbar kyphosis, resulting in an abnormal spinopelvic balance and pelvic morphology, whereas thoracolumbar fractures may lead to major kyphosis with a potential compromise of the spinal canal, which can cause an abnormal spinopelvic balance. Until now, the comparison of that sagittal alignment between AS and thoracolumbar fracture is not found in the literature. This study included 30 cases of AS and 30 cases of thoracolumbar fracture. Sagittal spinal and pelvic parameters were measured from the standing lateral radiograph, and the following 11 radiological parameters were measured, including global kyphosis (GK), thoracic kyphosis (TK), C7 tilt (C7T), sagittal vertical axis (SVA), spino-pelvic angle (SSA), lumbar lordosis (LL), upper arc of lumbar lordosis (ULL), lower arc of lumbar lordosis (LLL), pelvic incidence (PI), sacrum slope (SS), pelvic tilt (PT), and T9 tilt (T9T). Analysis of variance was used in the comparison of each dependent variable between the 2 cohorts. The relationship between sagittal spinal alignment and pelvic morphology of AS patients was determined via Pearson correlation coefficient (r). Compared with the thoracolumbar fracture group, AS patients had significantly lower C7T, SSA, LL, LLL and SS (78.3° ± 9.3° vs 88.0° ± 2.7°, P sagittal alignment of the pelvis and spine between patients with AS and thoracolumbar fracture, and changes in pelvic morphology compensated more in AS patients for a thoracolumbar kyphosis. These findings may be helpful for better understanding of sagittal alignment in patients

  16. Postoperative changes in pelvic parameters and sagittal balance in adult isthmic spondylolisthesis.

    Science.gov (United States)

    Park, Se Jun; Lee, Chong Suh; Chung, Sung Soo; Kang, Kyung Chung; Shin, Seong Kee

    2011-06-01

    Correction of deformity in adult isthmic spondylolisthesis can affect the pelvic parameters and sagittal balance. To evaluate the correlation with the amount of deformity correction and the subsequent change in pelvic parameters after surgical correction of adult isthmic spondylolisthesis and to determine which deformity parameter most affects the postoperative restoration of spinopelvic sagittal alignment. Fifty-eight patients with 1-level isthmic spondylolisthesis were included. Their average age was 55 years (range, 24-76 years). All patients underwent operation by posterior lumbar interbody fusion and posterior instrumentation. The pre- and postoperative sacral slope, pelvic tilt, lumbar lordosis (LL), and sagittal balance were measured, and then the correlation between these parameters and deformity parameters such as slip degree, slip angle, and height of the intervertebral disc (HOD) was evaluated. The slip degree, slip angle, and HOD were significantly recovered after surgery. Pelvic parameters and sagittal balance changed subsequently. Sacral slope was increased by 4.4 degrees, and pelvic tilt was decreased by 4.4 degrees. LL was increased by 5.2 degrees and sagittal balance was displaced 5.6 mm posteriorly. Only the restoration of the HOD showed a significant correlation with the change in LL (r = 0.305, P = .02) and sagittal balance (r = 0.377, P = .004). Surgical correction of adult isthmic spondylolisthesis with posterior lumbar interbody fusion and posterior instrumentation resulted in improvement of sacral slope, pelvic tilt, LL, and sagittal balance. Only restoration of the HOD was significantly correlated with improvement of LL and sagittal balance. Therefore we presume it is important to restore the HOD in surgical correction of adult isthmic spondylolisthesis.

  17. Biomechanical Comparison of Single- and Double-Leg Jump Landings in the Sagittal and Frontal Plane

    OpenAIRE

    Taylor, Jeffrey B.; Ford, Kevin R.; Nguyen, Anh-Dung; Shultz, Sandra J.

    2016-01-01

    Background: Double-leg forward or drop-jump landing activities are typically used to screen for high-risk movement strategies and to determine the success of neuromuscular injury prevention programs. However, research suggests that these tasks that occur primarily in the sagittal plane may not adequately represent the lower extremity biomechanics that occur during unilateral foot contact or non?sagittal plane movements that are characteristic of many multidirectional sports. Purpose: To exami...

  18. The effect of Core Stability Exercises (CSE) on trunk sagittal acceleration

    OpenAIRE

    Aluko, Augustine

    2012-01-01

    This thesis was submitted for the degree of Doctor of Philosophy and awarded by Brunel University. Aims: The aim of this study was to investigate Core Stability Exercise (CSE) induced changes in trunk sagittal acceleration as a measure of performance in participants following an acute onset of non-specific low back pain (LBP). Methodology: A Lumbar Motion Monitor (LMM) was used to measure trunk sagittal acceleration. The LMM was demonstrated to be reliable [Intra-Class Correlation (ICC)...

  19. The Role of Proprioception in the Sagittal Setting of Anticipatory Postural Adjustments During Gait Initiation

    OpenAIRE

    Pereira Marcelo P.; Pelicioni Paulo H. Silva; Gobbi Lilian T.B.

    2015-01-01

    Purpose. Previous studies have studied the role of proprioception on the setting of anticipatory postural adjustments (APA) during gait initiation. However, these studies did not investigate the role of proprioception in the sagittal APA setting. We aimed to investigate the role of proprioception manipulation to induce APA sagittal adaptations on gait initiation. Methods. Fourteen healthy adults performed gait initiation without, and with, vibration applied before movement onset, and during m...

  20. Piezoelectric osteotomies in craniofacial procedures: a series of 15 pediatric patients. Technical note.

    Science.gov (United States)

    Kramer, Franz-Josef; Ludwig, Hans Christoph; Materna, Thomas; Gruber, Rudolf; Merten, Hans Albert; Schliephake, Henning

    2006-01-01

    Frontoorbital advancement has become a standard method both to increase intracranial volume and to improve facial appearance in patients with syndromal or nonsyndromal craniosynostosis. Relevant complications of this procedure include severe hemorrhage and trauma to intracranial, orbital, or facial soft tissues, which mostly arise during the process of bone exposure or osteotomy. To minimize the risk of soft tissue injury and to increase the precision of the osteotomy, the authors applied a piezoelectric osteotome for frontoorbital advancement in 15 patients with craniosynostosis seen consecutively (mean age 11.3 months). They demonstrated that this new device can cut cranial bones using ultrasonic microvibrations created by piezoelectric effects. In all patients, this instrument allowed an easy and precise handling during osteotomy with a reduced amount of trauma to adjacent soft tissues and with no complications. Although the time required for piezoelectric osteotomy was longer compared with conventional techniques, the total operation time remained approximately the same because the preparation requirements are less extensive. Postoperatively, bone regeneration was uneventful. The authors conclude that this new technique of piezoelectric osteotomy is a valuable tool for craniofacial reconstructive surgery in pediatric patients.

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

    Directory of Open Access Journals (Sweden)

    Albuquerque Roberto Freire da Mota e

    2003-01-01

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

  2. Dynamic analysis of maxillary perfusion during Le Fort I osteotomy using indocyanine green.

    Science.gov (United States)

    Salman, S; Fattahi, T; Fernandes, R; Steinberg, B

    2018-02-02

    The aim of this study was to evaluate the dynamic perfusion of the maxilla during various stages of a Le Fort I osteotomy using indocyanine green (ICG) dye angiography. This was a retrospective evaluation of patients who underwent a Le Fort I osteotomy. ICG was used to assess perfusion at specific time points during the procedure. Twenty-four patients underwent a Le Fort I osteotomy with dynamic perfusion ICG angiography. Statistically significant differences in perfusion were noted at all three locations assessed between preoperative (T0), post down-fracture (T1), and postoperative (T2) time points. When controlling for mean arterial pressure, statistically significant differences were noted at all three locations assessed between T0 and T1, and between T0 and T2. There were no statistically significant differences in patient age, heart rate, preservation or sacrifice of the descending palatine arteries, or conventional vs. segmental Le Fort I osteotomies across T0, T1, and T2. In conclusion, there was a statistically significant decrease in perfusion, as assessed by intraoperative dynamic angiography, to the anterior maxilla following maxillary down-fracture. Patient age, conventional vs. segmental Le Fort I osteotomy, changes in mean arterial pressure and/or heart rate, and preservation of the descending palatine vessels had no statistically significant effect on perfusion. Copyright © 2018 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  3. Indices affecting outcome of neglected femoral neck fractures after valgus intertrochanteric osteotomy.

    Science.gov (United States)

    Varghese, Viju D; Boopalan, Palapattu R; Titus, Vijay T K; Oommen, Anil T; Jepegnanam, Thilak S

    2014-07-01

    To evaluate preoperative neck resorption and postoperative valgus orientation as predictors of union and functional outcome after valgus intertrochanteric osteotomy for treatment of neglected femoral neck fractures and nonunions. Retrospective cohort study. Tertiary care center. Forty consecutive patients with neglected femoral neck fracture and nonunions were treated with valgus intertrochanteric osteotomy, and follow-up was available in 32 patients (average age, 43 years; range, 14-60 years; average nonunion duration, 6 ± 7 months; range, 1-36 months). Valgus intertrochanteric osteotomy. Clinical outcome was assessed with Harris hip score. Plain radiographs were evaluated for union, avascular necrosis, preoperative bone deficiency (neck resorption ratio), and postoperative femoral head fragment alignment (head-shaft angle). Follow-up at 5 ± 3 years (range, 2-12 years) after surgery showed union in 29 patients (91%), and Harris hip score was 82 ± 13 points (range, 63-100 points). The 3 patients with persistent nonunion at the neck of femur had neck resorption ratio 15 degrees compared with the contralateral side was associated with poor functional outcome. The presence of avascular necrosis did not affect the outcome. Valgus intertrochanteric osteotomy resulted in union and satisfactory functional outcome in most patients who had neglected femoral neck fractures and nonunions. Preoperative neck resorption ratio <0.5 was a risk factor for nonunion, and excessive valgus alignment was a risk factor for poor functional outcome after osteotomy. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

  4. [How to make your own custom cutting guides for both mandibular and fibular stair step osteotomies?

    Science.gov (United States)

    Rem, K; Bosc, R; De Kermadec, H; Hersant, B; Meningaud, J-P

    2017-12-01

    Using tailored cutting guides for osteocutaneous free fibula flap in complex mandibular reconstruction after cancer resection surgery constitutes a substantial improvement. Autonomously conceiving and manufacturing the cutting guides within a plastic surgery department with computer-aided design (CAD) and three-dimensional (3D) printing allows planning more complex osteotomies, such as stair-step osteotomies, in order to achieve more stable internal fixations. For the past three years, we have been producing by ourselves patient-tailored cutting guides using CAD and 3D printing. Osteotomies were virtually planned, making the cutting lines more complex in order to optimize the internal fixation stability. We also printed reconstructed mandible templates and shaped the reconstruction plates on them. We recorded data including manufacturing techniques and surgical outcomes. Eleven consecutive patients were operated on for an oral cavity cancer. For each patient, we planned the fibular and mandibular stair-step osteotomies and we produced tailored cutting guides. In all patients, we achieved to get immediately stable internal fixations and in 10 patients, a complete bone consolidation after 6 months. Autonomously manufacturing surgical cutting guides for mandibular reconstruction by free fibula flap is a significant improvement, regarding ergonomics and precision. Planning stair-step osteotomies to perform complementary internal fixation increases contact surface and congruence between the bone segments, thus improving the reconstructed mandible stability. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  5. The poor quality and reliability of information on periacetabular osteotomy on the internet in Japan.

    Science.gov (United States)

    Takegami, Yasuhiko; Seki, Taisuke; Amano, Takafumi; Higuchi, Yoshitoshi; Komatsu, Daigo; Nishida, Yoshihiro; Ishiguro, Naoki

    2017-08-01

    Although many patients use the internet to access health-related information, the quality and the reliability of the information is highly inconsistent. Periacetabular osteotomy (PAO) is one of the surgical procedures for hip dysplasia. However, medical information on PAO is limited on the internet. This study aims to evaluate the quality and reliability of information available on PAO on the internet in Japan. A web search was conducted on two search engines for the following terms: "hip osteotomy," "pelvic osteotomy," and "osteotomy for hip preservation" in Japanese. In total, we found 120 websites. To determine the quality and reliability of information on each website, we used the Health on the Net Foundation (HON) score, the Brief DISCERN score, and an osteotomy-specific content (OSC) score. After eliminating duplicate websites, we reviewed 49 unique websites. Only three websites (6.1%) had good reliability, as indicated by their HON scores. Twelve websites (24.4%) had good-quality information, as measured by their Brief DISCERN scores. As evaluated by their OSC scores, physician websites were found to be biased toward etiology and surgical indication and did not provide information on the complications of procedures. Non-physician websites were generally insufficient. The information about PAO on the internet is, therefore, unreliable and of poor-quality for Japanese patients.

  6. Unilateral zygomatic hypoplasia correction by L-shaped zygomatic osteotomy with natural coral.

    Science.gov (United States)

    Su, Ruowei; Gui, Lai; Liu, Jianfeng; Niu, Feng; Chen, Ying; Wang, Meng

    2015-05-01

    Zygomatic osteotomy is a common method of zygomatic hypoplasia correction. Natural coral is considered to be a good bone substitute. Few studies on unilateral zygomatic hypoplasia correction by zygomatic osteotomy with natural coral have been reported. This study was performed to evaluate the clinical morphological results and surgical outcomes of unilateral zygomatic hypoplasia correction by L-shaped zygomatic osteotomy with natural coral. From 1996 to 2012, a total of 42 patients with hypoplastic zygomas treated by L-shaped zygomatic osteotomy with natural coral were included in this study. Based on facial analysis results and x-ray and CT measurements, the degradation of natural coral, new bone formation, and clinical outcomes were observed and recorded. All surgical procedures achieved satisfactory results without complications. During the stabilization period of about 12 to 15 months, all natural coral blocks were completely degraded and replaced by new bone. Good mechanical strength and continuity of the new bone and good zygomatic asymmetry were achieved in each patient. No recurrence was observed during the follow-up period. L-shaped zygomatic osteotomy with natural coral is an effective method of unilateral zygomatic hypoplasia correction.

  7. The biplanar open wedge high tibial osteotomy preserving the tibial tubercle.

    Science.gov (United States)

    Hopwood, Sam; Khan, Wasim; Agarwal, Sanjeev

    2016-11-01

    High tibial osteotomy (HTO) is a treatment option for relatively young patients with isolated medial compartment arthritis of the knee. Medial open wedge osteotomies allow easier control of correction, but can lead to patella infera as a result of distalization of the tibial tubercle. This retrospective study reports results of a biplanar tibial tubercle preserving HTO, designed to preserve patellar height. The study is a retrospective analysis of 12 consecutive patients (11 men, 1 woman) average age 39.6 years who underwent the procedure between 2009 and 2012. A biplanar open wedge tibial osteotomy was performed and stabilised with a medial locking plate. Patients were allowed full weight bearing at 6 weeks. Preoperative and postoperative function was recorded on the Oxford knee score, Lysholm score and Tegner activity scale. Minimum follow up was 26 months. All patients had healing of the osteotomy with no delayed union. Eleven patients reported improvement in symptoms with an average preoperative Oxford score of 26 and postoperative score of 39 out of 48. The Lysholm score improved from 58 to 72 out of 100. There was one point improvement in Tegner activity scale. There was no statistical difference in patellar height before and one year after surgery. The correction in varus averaged 8.3°. The biplanar High tibial Osteotomy allows preservation of patellar height, while achieving desired varus correction. Crown Copyright © 2016. Published by Elsevier B.V. All rights reserved.

  8. Evaluation of Hallux Valgus Correction With Versus Without Akin Proximal Phalanx Osteotomy.

    Science.gov (United States)

    Shibuya, Naohiro; Thorud, Jakob C; Martin, Lanster R; Plemmons, Britton S; Jupiter, Daniel C

    2016-01-01

    Although the efficacy of Akin proximal phalanx closing wedge osteotomy as a sole procedure for correction of hallux valgus deformity is questionable, when used in combination with other osseous corrective procedures, the procedure has been believed to be efficacious. However, a limited number of comparative studies have confirmed the value of this additional procedure. We identified patients who had undergone osseous hallux valgus correction with first metatarsal osteotomy or first tarsometatarsal joint arthrodesis with (n = 73) and without (n = 81) Akin osteotomy and evaluated their radiographic measurements at 3 points (preoperatively, within 3 months after surgery, and ≥6 months after surgery). We found that those people who had undergone the Akin procedure tended to have a larger hallux abduction angle and a more laterally deviated tibial sesamoid position preoperatively. Although the radiographic correction of the deformity was promising immediately after corrective surgery with the Akin osteotomy, maintenance of the correction was questionable in our cohort. The value of additional Akin osteotomy for correction of hallux valgus deformity is uncertain. Published by Elsevier Inc.

  9. Role of high tibial osteotomy in cartilage regeneration – Is correction of malalignment mandatory for success?

    Directory of Open Access Journals (Sweden)

    Matthew Dhanaraj Thambiah

    2017-01-01

    Full Text Available Malalignment of the knee can cause debilitating symptoms such as pain, resulting in a decline in function and mobility. Surgical options that exist to address this problem include realignment osteotomies and joint replacements. Realignment osteotomies are the more appropriate options in certain patient populations, especially with regard to age and level of activity. Since a high tibial osteotomy (HTO was first used to manage malalignment of the knee and osteoarthritis, different techniques involving the use of specialized implants have been developed and further refined to good effect. There has also since been much research into the field of cartilage restoration techniques, both as a standalone treatment option and as an adjunct to a realignment osteotomy. This review attempts to detail the origin and the evolution of HTO, particularly in regard to combining this tried and tested procedure with adjunct cartilage restoration techniques, and the overall patient outcomes. A literature search on PubMed was performed, and articles pertaining to the outcomes of the use of an HTO and cartilage restoration techniques were reviewed. The literature in this field indicates good outcomes in terms of objective measurements of cartilage regeneration (such as arthroscopic visualization and magnetic resonance imaging evaluation and subjective patient outcome scoring systems (such as the International Knee Documentation Committee and Lysholm scores with a realignment osteotomy alone, and studies have shown that patient outcomes can be further improved with the use of a cartilage restoration procedure as an adjunct.

  10. A comparison of standard definitions and sagittal abdominal ...

    Science.gov (United States)

    Introduction: Metabolic syndrome (MeTS) is the cluster of several clinical symptoms that together represent the strongest risk factor for cardiovascular disease. The prevalence of MeTS in adolescents is difficult to estimate given that there are several, but no agreed upon definition of MeTS for this age group. It is important to estimate MeTS and identify at-risk adolescents early in order to provide effective interventions prior to the development of diabetes and coronary heart disease. Objective: Study objectives are to: (1) estimate the prevalence of MeTS in U.S. adolescents using three widely adopted definitions and (2) compare changes in prevalence of MeTS when utilizing sagittal abdominal diameter (SAD) as a component of MeTS. Methods: Data from U.S. adolescents ages 12–19 years (N=970) in the NHANES (2011–2014) were analyzed. MeTS standard definitions developed by Cook et al. (2003), deFerranti et al. (2007), and the International Disease Federation (IDF, 2007) were applied to estimate the sex-stratified, weighted prevalence of MeTS and its individual components (i.e., high waist circumference (WC), hypertension, blood lipid abnormalities, and high fasting blood glucose (FBG)). The definitions were modified by substituting SAD for WC, and weighted MeTS prevalence was re-estimated. Results: Regardless of gender and definition, abnormal blood lipids and high WC were the most prevalent MeTS components. For both sexes, estimated prevalence of componen

  11. Influence of age and sagittal balance of the spine on the value of the pelvic incidence.

    Science.gov (United States)

    Jean, Legaye

    2014-07-01

    The pelvic incidence (PI) was recognized as the key factor of the sagittal balance of the spine. Its value was described own for each individual and unchanged during adulthood. To bring out the effect of the age and of a sagittal imbalance in the variability of the value of PI. 200 subjects with chronic low back pain due to sagittal imbalance were compared to 89 normal subjects. For each groups, the cases were divided according to the age (19-40, 6-40 years, over 60 years). The PI and the sagittal positional parameters were measured on large radiographs in standardized standing position. The correlation between age and PI was observed significant only for the >60 years cases. The mean values of PI were significantly greater for these cases. An increase of the value of PI was attributable to a twisting mobilization within the sacroiliac joint. It results from a forward projection of the gravity due to a sagittal disturbance and a pelvic compensatory backward rotation. This twisting into the sacroiliac joint was incriminated in the origin of chronic low back pain. The sagittal pelvi-spinal imbalance may be incriminated in the increasing of the value of PI by a painful destabilization sacro-iliac, with leads to an increasing of the value of PI.

  12. Virtual Planning of a Complex Three-Part Bimaxillary Osteotomy

    Directory of Open Access Journals (Sweden)

    Chiara Di Blasio

    2017-01-01

    Full Text Available In maxillofacial surgery, every patient presents special problems requiring careful evaluation. Conventional methods to study the deformities are still reliable, but the advent of tridimensional (3D imaging, especially computed tomography (CT scan and laser scanning of casts, created the opportunity to better understanding the skeletal support and the soft tissue structures. Nowadays, virtual technologies are increasingly employed in maxillofacial surgery and demonstrated precision and reliability. However, in complex surgical procedures, these new technologies are still controversial. Especially in the less frequent cases of three-part maxillary surgery, the experience is limited, and scientific literature cannot give a clear support. This paper presents the case of a young patient affected by a complex long face dentofacial deformity treated by a bimaxillary surgery with three-part segmentation of the maxilla. The operator performed the surgical study completely with a virtual workflow. Pre- and postoperative CT scan and optical scanning of plaster models were collected and compared. Every postoperatory maxillary piece was superimposed with the presurgical one, and the differences were examined in a color-coded map. Only mild differences were found near the osteotomy lines, when the bony surface and the teeth demonstrated an excellent coincidence.

  13. Cool covered sky-splitting spectrum-splitting FK

    Energy Technology Data Exchange (ETDEWEB)

    Mohedano, Rubén; Chaves, Julio; Falicoff, Waqidi; Hernandez, Maikel; Sorgato, Simone [LPI, Altadena, CA, USA and Madrid (Spain); Miñano, Juan C.; Benitez, Pablo [LPI, Altadena, CA, USA and Madrid, Spain and Universidad Politécnica de Madrid (UPM), Madrid (Spain); Buljan, Marina [Universidad Politécnica de Madrid (UPM), Madrid (Spain)

    2014-09-26

    Placing a plane mirror between the primary lens and the receiver in a Fresnel Köhler (FK) concentrator gives birth to a quite different CPV system where all the high-tech components sit on a common plane, that of the primary lens panels. The idea enables not only a thinner device (a half of the original) but also a low cost 1-step manufacturing process for the optics, automatic alignment of primary and secondary lenses, and cell/wiring protection. The concept is also compatible with two different techniques to increase the module efficiency: spectrum splitting between a 3J and a BPC Silicon cell for better usage of Direct Normal Irradiance DNI, and sky splitting to harvest the energy of the diffuse radiation and higher energy production throughout the year. Simple calculations forecast the module would convert 45% of the DNI into electricity.

  14. Mechanism of bone incorporation of beta-TCP bone substitute in open wedge tibial osteotomy in patients.

    NARCIS (Netherlands)

    Gaasbeek, R.D.A.; Toonen, H.G.; Heerwaarden, R.J. van; Buma, P.

    2005-01-01

    A histological study was performed of bone biopsies from 16 patients (17 biopsies) treated with open wedge high tibial osteotomies for medial knee osteoarthritis. The open wedge osteotomies were filled with a wedge of osteoconductive beta tricalcium phosphate (beta-TCP) ceramic bone replacement. At

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

    Science.gov (United States)

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

    2017-01-01

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

  16. Constructing and drawing regular planar split networks.

    Science.gov (United States)

    Spillner, Andreas; Nguyen, Binh T; Moulton, Vincent

    2012-01-01

    Split networks are commonly used to visualize collections of bipartitions, also called splits, of a finite set. Such collections arise, for example, in evolutionary studies. Split networks can be viewed as a generalization of phylogenetic trees and may be generated using the SplitsTree package. Recently, the NeighborNet method for generating split networks has become rather popular, in part because it is guaranteed to always generate a circular split system, which can always be displayed by a planar split network. Even so, labels must be placed on the “outside” of the network, which might be problematic in some applications. To help circumvent this problem, it can be helpful to consider so-called flat split systems, which can be displayed by planar split networks where labels are allowed on the inside of the network too. Here, we present a new algorithm that is guaranteed to compute a minimal planar split network displaying a flat split system in polynomial time, provided the split system is given in a certain format. We will also briefly discuss two heuristics that could be useful for analyzing phylogeographic data and that allow the computation of flat split systems in this format in polynomial time.

  17. Sagittal spinal profile and spinopelvic balance in parents of scoliotic children.

    Science.gov (United States)

    Janssen, Michiel M A; Vincken, Koen L; van Raak, Sjoerd M; Vrtovec, Tomaž; Kemp, Bastiaan; Viergever, Max A; Bartels, Lambertus W; Castelein, René M

    2013-12-01

    It is well known that spinal biomechanics and familial predisposition play an important role in the onset and evolution of idiopathic scoliosis. The relationship between the sagittal profile of the spine and spinal biomechanics has also been established in a number of studies. It has been suggested previously that a certain sagittal spinal configuration with implications for spinal rotational stiffness is inherited, thus providing a possible explanation for the well-known hereditary component in adolescent idiopathic scoliosis (AIS). To test the hypothesis that the familial trend in AIS may be partially explained by the inheritance of a sagittal spinal profile, which has been shown to make the spine less resistant to rotatory decompensation. A prospective case controlled radiographic analysis of the sagittal profile of the spine and spinopelvic alignment. One hundred two parents of scoliotic children, compared with 102 age-matched controls (parents of nonscoliotic children). Physiologic measures: sagittal profile of the spine and spinopelvic alignment. Freestanding lateral radiographs of 51 parent couples of girls with severe (Cobb angle >30°) progressive AIS (AIS group) and 102 age-matched controls (control group) were taken. Parents with manifest spinal deformities or spinal pathology of any kind were excluded based on history or spinal X-ray to avoid distorted sagittal images with unreliable measurements. Values were calculated for thoracic kyphosis (T4-T12), lumbar lordosis (L1-L5), spinal balance (sagittal plumb line of C7 and T4, T1-L5 sagittal spinal inclination, T9 sagittal offset), curvature parameters (expressed in the area under the curve [AUC]), and pelvic parameters (pelvic tilt, pelvic incidence, and sacral slope). In addition, the height, offset, and length of the posteriorly inclined spinal segment, inclination of each vertebra, and normalized sagittal spinal profile were calculated. Differences in spinopelvic alignment between fathers and mothers

  18. New Technique: A Novel Femoral Derotation Osteotomy for Malrotation following Intramedullary Nailing

    Directory of Open Access Journals (Sweden)

    S. Jagernauth

    2012-01-01

    Full Text Available A 19-year-old female patient sustained a closed spiral midshaft femoral fracture and subsequently underwent femoral intramedullary nail insertion. At followup she complained of difficulty in walking and was found to have a unilateral in-toeing gait. CT imaging revealed 30 degrees of internal rotation at the fracture site, which had healed. A circumferential osteotomy was performed distal to the united fracture site using a Gigli saw with the intramedullary femoral nail in situ. The static distal interlocking screws were removed and the malrotation was corrected. Two further static distal interlocking screws were inserted to secure the intramedullary nail in position. The osteotomy went on to union and her symptoms of pain, walking difficulty, and in-toeing resolved. Our paper is the first to describe a technique for derotation osteotomy following intramedullary malreduction that leaves the intramedullary nail in situ.

  19. Simultaneous femoral and tibial osteotomies during total knee arthroplasty for severe extra-articular deformity.

    Science.gov (United States)

    Moyad, Thomas F; Estok, Daniel

    2009-01-01

    Total knee arthroplasty (TKA) performed in knees with mild or moderate intraarticular deformity often can be resolved with careful ligament balancing and bone resection. However, extra-articular deformity may require an osteotomy to safely create rectangular flexion and extension gap balance. In these challenging situations, restoring the mechanical axis through intra-articular bone resection and soft tissue releases alone can lead to excessive bone loss and ligament instability. We report a case of TKA with combined femoral and tibial osteotomies in a post-polio patient with extra-articular deformities. Although a few small case studies have been previously published in the literature, specific details regarding this procedure are lacking. Our objective is to provide a detailed surgical technique and to review the indications for extra-articular osteotomies performed during TKA.

  20. Osteotomy for femoral anteversion. A prospective 9-year study of 52 children.

    Science.gov (United States)

    Svenningsen, S; Terjesen, T; Apalset, K; Anda, S

    1990-08-01

    Fifty-two children with increased femoral anteversion had bilateral derotational subtrochanteric osteotomies at a mean age of 7 years. They were followed prospectively until at least 15 years of age; the mean observation time was 9 years. They were a subset of 95 children whose 2-year results were reported in 1989. The mean increase of femoral anteversion after the osteotomy was 6 degrees (0.7 degrees per year) and of the neck-shaft angle 5 degrees. The CE angle did not increase. Although we at present practice a more restrictive attitude towards operation of increased femoral anteversion, our study showed that a derotational osteotomy is effective in eliminating the intoeing gait and associated complaints, and the hip angles change only moderately during the remaining period of growth.

  1. Limb shortening osteotomy in a patient with achondroplasia and leg length difference after total hip arthroplasty

    Directory of Open Access Journals (Sweden)

    Christian L. Galata

    2013-07-01

    Full Text Available Introduction: Achondroplasia is the most common reason for disproportionate short stature. Normally, orthopedic limb lengthening procedures must be discussed in the course of this genetic disorder and have been successful in numerous achondroplastic patients in the past. In some cases, the disease may lead to leg length differences with need for surgical correction. Case Report: We report a case of achondroplastic dysplastic coxarthrosis with symptomatic leg length difference after bilateral total hip arthroplasty in a 52-year-old female patient, in which a distal femoral shortening osteotomy was successfully performed. Conclusion: Femoral shortening osteotomy is very uncommon in patients with achondroplasia. We conclude, however, that in rare cases it can be indicated and provide the advantage of shorter operation time, less perioperative complications and faster recovery compared to leg lengthening procedures. Keywords: Achondroplasia, dysplastic coxarthrosis, limb shortening, distal femur osteotomy.

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

    Science.gov (United States)

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

    2016-12-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  4. Low frequency split cycle cryocooler

    Science.gov (United States)

    Bian, S. X.; Zhang, Y. D.; Wan, W. W.; Wang, L.; Hu, Q. C.

    1985-01-01

    A split cycle Stirling cryocooler with two different drive motors and operating at a low drive frequency can have high thermodynamic efficiency. The temperature of the cold end of the cryocooler varies with drive frequency, voltage of the input electrical power and initial charge pressure values. The cryocooler operating at 8 Hz can provide 7 watts of refrigeration at 77 K for 230 watts of electrical input power.

  5. High tibial closing wedge osteotomy for medial compartment osteoarthrosis of knee

    Directory of Open Access Journals (Sweden)

    Tuli S

    2008-01-01

    Full Text Available Background: Most patients of symptomatic osteoarthrosis of knee are associated with varus malalignment that is causative or contributory to painful arthrosis. It is rational to correct the malalignment to transfer the functional load to the unaffected or less affected compartment of the knee to relieve symptoms. We report the outcome of a simple technique of high tibial osteotomy in the medial compartment of osteoarthrosis of the knee. Materials and Methods: Between 1996 and 2004 we performed closing wedge osteotomy in 78 knees in 65 patients. The patients selected for osteotomy were symptomatic essentially due to medial compartment osteoarthrosis associated with moderate genu varum. Of the 19 patients who had bilateral symptomatic disease 11 opted for high tibial osteotomy of their second knee 1-3 years after the first operation. Preoperative grading of osteoarthrosis and postoperative function was assessed using Japanese Orthopaedic Association (JOA rating scale. Results: At a minimum follow-up of 2 years (range 2-9 years 6-10° of valgus correction at the site of osteotomy was maintained, there was significant relief of pain while walking, negotiating stairs, squatting and sitting cross-legged. Walking distance in all patients improved by two to four times their preoperative distance of 200-400 m. No patient lost any preoperative knee function. The mean JOA scoring improved from preoperative 54 (40-65 to 77 (55-85 at final follow-up. Conclusion: Closing wedge high tibial osteotomy performed by our technique can be undertaken in any setup with moderate facilities. Operation related complications are minimal and avoidable. Kirschner wire fixation is least likely to interfere with replacement surgery if it becomes necessary.

  6. Drilling- and withdrawing-related thermal changes during implant site osteotomies.

    Science.gov (United States)

    Strbac, Georg D; Giannis, Katharina; Unger, Ewald; Mittlböck, Martina; Vasak, Christoph; Watzek, Georg; Zechner, Werner

    2015-02-01

    Intrabony temperature increase is not only dependent on shearing energy and mechanical friction between bone and surgical drill but is also related to heat capacity and thermal conductivity of the surrounding bone and the applied surgical instrument. Thus time of occurrence of the highest temperature rise can be expected after the shearing process of the osteotomy, potentially affecting the process of osseointegration. The aim of this study was to evaluate temperature changes during the shearing and withdrawing processes during osteotomies. An overall 160 automated intermittent osteotomies (10/16 mm drilling depth) with 2 mm diameter twist drills and 3.5 mm diameter conical drills and different irrigation methods (without/external/internal/combined) were performed on standardized bone specimens. The drilling cycles were operated by a computer-controlled surgical system, while a linear motion potentiometer and multichannel temperature sensors in various intrabony levels ensured the real-time documentation of temperature changes during the shearing and withdrawing processes. The highest temperature changes were invariably recorded during the process of withdrawal. Significantly lower temperature changes (p irrigation method. During coolant supply, 2 mm diameter twist drills showed higher temperatures (10 mm, p irrigation (16 mm, p irrigation by the use of conical implant drills. Considering that heat generation during osteotomies is a multifactorial scenario, this study could demonstrate that the highest temperature rise during implant osteotomies occurs during the withdrawing process and that the time of occurrence is influenced by predominant factors such as osteotomy depth and mode of irrigation. © 2013 Wiley Periodicals, Inc.

  7. A minimally invasive technique using a modified stoppa approach for periacetabular osteotomy: A preliminary cadaveric study

    Directory of Open Access Journals (Sweden)

    Turgut Akgul

    2017-01-01

    Full Text Available Background: Developmental hip dysplasia is diagnosed when the femoral head is not sufficiently covered by the acetabulum. Anterior and lateral cover deficiency is seen, as a result a dysplastic hip joint. Various incision modifications have been developed because of the muscle dissection and wide wound scar in Smith-Peterson incision, which was originally used in Bernese osteotomy. This study evaluates applicability of the modified Stoppa approach in the performance of Bernese periacetabular osteotomy (PAO. Materials and Methods: Ten hemipelvises of five donor cadavers were used. The transverse Stoppa incision was made 2 cm over the symphysis pubis for quadrilateral surface exposure and pubic and ischial bone osteotomies. The second skin incision, a few centimeters lateral to the original incision, was made along the tensor fascia lata. Iliac bone osteotomy was performed starting just above the rectus femoris insertion. The displacement of the osteotomy was measured clinically and radiographically. Results: The mean anterior coverage calculated with center-edge angle was improved from 22.8° ±2.8 (range 20° min–28° max preoperatively to 44.1° ± 3.7 (range 36° min–48° max. The displacement of the osteotomy at the iliopectineal line calculated on the iliac inlet view radiographs was 22.1 ± 3.4 mm (range 15 mm min–26 mm max. The clinical amount of the anterior displacement on the cadavers was 17.8 ± 3.35 mm (range 11 mm–21 mm and lateral displacement was 20.3 ± 3.23 mm (range 15 mm–24 mm. The amount of the posterior intact bone enlargement at the quadrilateral surface was 5.3 ± 0.48 mm. Conclusion: This less traumatic two-incision exposure is an adequate technique for Bernese PAO, allowing the bone to be cut under direct visual observation and reducing the need to use fluoroscopy.

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

    Science.gov (United States)

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

    2016-09-01

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

  9. Geometrical Applications of Split Octonions

    Directory of Open Access Journals (Sweden)

    Merab Gogberashvili

    2015-01-01

    Full Text Available It is shown that physical signals and space-time intervals modeled on split-octonion geometry naturally exhibit properties from conventional (3 + 1-theory (e.g., number of dimensions, existence of maximal velocities, Heisenberg uncertainty, and particle generations. This paper demonstrates these properties using an explicit representation of the automorphisms on split-octonions, the noncompact form of the exceptional Lie group G2. This group generates specific rotations of (3 + 4-vector parts of split octonions with three extra time-like coordinates and in infinitesimal limit imitates standard Poincare transformations. In this picture translations are represented by noncompact Lorentz-type rotations towards the extra time-like coordinates. It is shown how the G2 algebra’s chirality yields an intrinsic left-right asymmetry of a certain 3-vector (spin, as well as a parity violating effect on light emitted by a moving quantum system. Elementary particles are connected with the special elements of the algebra which nullify octonionic intervals. Then the zero-norm conditions lead to free particle Lagrangians, which allow virtual trajectories also and exhibit the appearance of spatial horizons governing by mass parameters.

  10. Pedicle Subtraction Osteotomy in a 5-Year-Old Child with Congenital Kyphosis

    Directory of Open Access Journals (Sweden)

    Farzad Omidi-Kashani

    2015-07-01

    Full Text Available Vertebral anomalies may also distort the normal regional or global spinal alignment and necessitate some therapeutic interventions. Hemiepiphysiodesis is a traditional procedure usually described for these young patients but in more severe cases some type of osteotomy seems to be necessary. In this technical note, we describe a 5-year-old boy with failed previous hemiepiphysiodesis surgery, who was successfully treated with one level pedicle subtraction osteotomy. This procedure not only corrects the kyphotic deformity at the time of the procedure (not relying on future spinal growth, but also avoids more hazardous anterior approach.

  11. Reanalysis of Agelietti Procedure (A Method of Corrective Supracondylar Femoral Osteotomy

    Directory of Open Access Journals (Sweden)

    Sharat Agarwal

    2012-04-01

    Full Text Available Objective: Supracondylar femoral osteotomy is the time tested method, used for correcting the angular (varus & valgus deformities at the knee. Traditionally, Coventry type of osteotomy where a medial or lateral based wedge of bone is removed or an open wedge osteotomy is made & the space filled with bone graft, is done to achieve the desired correction. This osteotomy is subsequently stabilized with Kirschner wires or plates & screws. Later the limb is externally supported in brace or plaster cast. Here we present a case series of 10 cases, where we have analyzed the efficacy of Aglietti procedure, as a method of femoral supracondylar osteotomy for correcting the valgus deformity at the knee. Methods: Ten valgus adolescent knees were operated in 7 patients by following the Aglietti procedure for correcting the angular deformity at the knee. The results were analyzed taking into consideration the operating time, blood loss during surgery estimated by the number of surgical mops used, stability of the osteotomy in the post-operative period & ultimate range of motion (ROM obtained at the end of 6 months after the surgery. Results: The average age of patients dealt with was 12.6 years (n=7 with females predominating (n=5 against 2 males. The average time was 47.5 minutes. The average size of the surgical mops used was 15x20 cms. Surgical mops used per patient were 1.6. The average range of flexion achieved at the end of 6 months after surgery was 131.45 degrees ( Rounded average to a measurable value being 131 degrees. Conclusion: In our case series we found Aglietti procedure as an effective method to correct the valgus deformity in adolescent knees. Supracondylar femoral osteotomies are not only for varus an valgus corrections; this osteotomy is used as well for rotation correction and flexion and extension correction, mainly in CP patients. But we used the Agelietti procedure for the correction of angular deformities(varus/valgus in patients of

  12. Brachymetatarsia of the fourth metatarsal, lengthening scarf osteotomy with bone graft

    Directory of Open Access Journals (Sweden)

    Ankit Desai

    2013-09-01

    Full Text Available A 16-year-old girl presented with left fourth metatarsal shortening causing significant psychological distress. She underwent lengthening scarf osteotomy held with an Omnitech® screw (Biotech International, France with the addition of two 1 cm cancellous cubes (RTI Biologics, United States. A lengthening z-plasty of the extensor tendons and skin were also performed. At 6 weeks the patient was fully weight bearing and at one-year follow up, the patient was satisfied and discharged. A modified technique of lengthening scarf osteotomy is described for congenital brachymatatarsia. This technique allows one stage lengthening through a single incision with graft incorporation by 6 weeks.

  13. Case report - curved femoral osteotomy for management of medial patellar luxation

    DEFF Research Database (Denmark)

    Allpass, Maja; Miles, James Edward

    2015-01-01

    Medial patellaluxation kan forårsages af femoral varus hos hund. Førhen har patienter med excessiv femoralvarus været korrigeret ved en lateralt placeret femoral kile-ostektomi. Her præsenteres en case, hvor en buet osteotomi blev anvendt til behandling af medial patellaluxation.......Medial patellaluxation kan forårsages af femoral varus hos hund. Førhen har patienter med excessiv femoralvarus været korrigeret ved en lateralt placeret femoral kile-ostektomi. Her præsenteres en case, hvor en buet osteotomi blev anvendt til behandling af medial patellaluxation....

  14. Early outcomes of one-stage combined osteotomy in Legg-Calve´-Perthes disease.

    Science.gov (United States)

    Bhuyan, Basant Kumar

    2016-01-01

    Legg-Calve´-Perthes disease (LCPD) is an idiopathic avascular necrosis of the femoral head. There are multiple approaches to the treatment of LCPD ranging from conservative management to a wide variety of surgical methods. Conservative management necessitates extreme degrees of abduction in an orthosis for a longer period of time which further jeopardize capital femoral head vascularity. Surgical containment methods are used in cases where it is desirable. Initial surgical containment methods are varus or varus-derotational osteotomy of the proximal femur or an innominate osteotomy as described by Salter and other pelvic osteotomies. The purpose of this study was to describe the early results of containment methods by one-stage combined osteotomy (femoral varus osteotomy and Salter innominate osteotomy) in patients with severe LCPD. 23 children were operated in the age group of 4-9 years for LCPD by one-stage combined osteotomy procedure between January 2005 and June 2012. There were 19 boys and 4 girls, left hip involved in 10 cases and right in 13 cases. Preoperatively, they were classified according to Catterall, Joseph's stage and lateral pillar (LP) classification. Postoperatively, clinical results were evaluated in accordance with Ratliff classification and radiological assessment was made by Mose's index, modified Stulberg classification and Epiphyseal extrusion index. Seventeen hips were Catterall group III, 6 in group IV and all had two or more "head-at-risk" signs. There were 2 patients with stage IIA, 15 were in stage IIB and 6 were in stage IIIA as classified by Joseph's stage of disease. According to LP classification, 11 patients were group B, 3 were group B/C and 9 were in group C. At an average followup of 5.4 years (range 2-9.5 years), the clinical results were good in 12, fair in 9 and poor in 2. According to Mose scale, 8 patients had good results, 13 fair results and 2 had poor results. Based on modified Stulberg classification, there were 10

  15. [Case-control study on two osteotomy techniques for the treatment of distal radial malunion].

    Science.gov (United States)

    Zhang, Bing-bing; Yuan, Zhi-guo; Shao, Jian-jun; Yang, Shi-ning; Chai, Xi-ping

    2015-07-01

    Radial corrective osteotomy is an established but challenging treatment for distal radial malunion. There is an ongoing discussion about whether an opening or closing-wedge osteotomy between should employed. The purpose of the present study was to retrospectively compare the clinical and radio graphic results between conventional opening-wedge osteotomy and closing-wedge technique. From January 2004 and December 2012,42 patients with extra-articular distal radial malunion were managed with corrective osteotomy and were followed for a minimum of one year. Twenty-two patients (5 males and 17 females, ranging in age from 25 to 75 years old) were managed with radial opening-wedge osteotomy and implanting of interpositional bone graft or bone-graft substitute, and twenty patients (4 males and 16 females, ranging in age from 19 to 79 years) were managed with simultaneous radial closing-wedge and ulnar shortening osteotomy without bone graft. The selection of the surgical procedure was determined by the surgeon. Each patient was evaluated on the basis of objective radio graphic measurements, and functional outcomes were determined on the basis of clinical examinations, including range of wrist motion, grip strength, pain-rating score, Mayo wrist score, and Disabilities of the Arm, Shoulder and Hand (DASH) score. The mean duration of follow-up was 36 months (ranged, 12 to 101 months) for the opening-wedge cohort and 28 months (ranged, 12 to 87 months) for the closing-wedge cohort. The two techniques were comparable in terms of complications. Post-operative volar tilt and ulnar variance were improved significantly in each cohort. The ulnar variance was more frequently restored to within defined criteria (22.5 to 0.5 mm) in the closing-wedge cohort than that in the opening-wedge cohort. The post-operative mean extension-flexion are of the wrist and Mayo wrist score were significantly better in the closing-wedge cohort. Differences in the pronation-supination arc, grip

  16. Biomechanical comparison of sagittal-parallel versus non-parallel pedicle screw placement.

    Science.gov (United States)

    Farshad, Mazda; Farshad-Amacker, Nadja A; Bachmann, Elias; Snedeker, Jess G; Schmid, Samuel L

    2014-11-01

    While convergent placement of pedicle screws in the axial plane is known to be more advantageous biomechanically, surgeons intuitively aim toward a parallel placement of screws in the sagittal plane. It is however not clear whether parallel placement of screws in the sagittal plane is biomechanically superior to a non-parallel construct. The hypothesis of this study is that sagittal non-parallel pedicle screws do not have an inferior initial pull-out strength compared to parallel placed screws. The established lumbar calf spine model was used for determination of pull-out strength in parallel and non-parallel intersegmental pedicle screw constructs. Each of six lumbar calf spines (L1-L6) was divided into three levels: L1/L2, L3/L4 and L5/L6. Each segment was randomly instrumented with pedicle screws (6/45 mm) with either the standard technique of sagittal parallel or non-parallel screw placement, respectively, under fluoroscopic control. CT was used to verify the intrapedicular positioning of all screws. The maximum pull-out forces and type of failure were registered and compared between the groups. The pull-out forces were 5,394 N (range 4,221 N to 8,342 N) for the sagittal non-parallel screws and 5,263 N (range 3,589 N to 7,554 N) for the sagittal-parallel screws (p = 0.838). Interlevel comparisons also showed no statistically significant differences between the groups with no relevant difference in failure mode. Non-parallel pedicle screws in the sagittal plane have at least equal initial fixation strength compared to parallel pedicle screws in the setting of the here performed cadaveric calf spine experiments.

  17. Reproduction of superior sagittal sinus animal model by bypass transplantation of biomaterial graft

    Directory of Open Access Journals (Sweden)

    Qing-yong LUO

    2011-03-01

    Full Text Available Objective To establish the beagles model of superior sagittal sinus bypass graft,and explore the feasibility of reconstruction of superior sagittal sinus with biomaterials using this model.Methods Eight adult male beagles(weight: 12.5-22.0kg were involved in the present study.The superior sagittal sinus was exposed and blocked via bone window,and then anastomosed side-to-end to the biomaterial graft under the dedicated microscope of neurosurgery surgery,expectant treatment such as anti-inflammatory was given for the animals.The digital subtraction venography(DSV and color Doppler flow imaging(CDFI of superior sagittal sinus were performed in 1,2,4 and 8 weeks after the operation.Eight weeks after the operation,all the animals were sacrificed and the material graft was examined histologically.Results The DSV and CDFI of superior sagittal sinus showed that the stomas of 2 beagles were with slight stenosis and high flow velocity,of 1 beagle with small leakage and low flow velocity,while of other 5 beagles were normal.The histological examination showed endothelial cells were growing on the graft and superior sagittal sinus,and crawling toward the lumen of graft 8 weeks after the operation.Conclusion The beagles model of superior sagittal sinus bypass graft was established successfully.The short-term effect of the model was satisfactory,while further work should be performed to determine the long-term effects.

  18. Sagittal alignment of the spine-pelvis-lower extremity axis in patients with severe knee osteoarthritis

    Science.gov (United States)

    Wang, W. J.; Liu, F.; Zhu, Y.W.; Sun, M.H.; Qiu, Y.

    2016-01-01

    Objectives Normal sagittal spine-pelvis-lower extremity alignment is crucial in humans for maintaining an ergonomic upright standing posture, and pathogenesis in any segment leads to poor balance. The present study aimed to investigate how this sagittal alignment can be affected by severe knee osteoarthritis (KOA), and whether associated changes corresponded with symptoms of lower back pain (LBP) in this patient population. Methods Lateral radiograph films in an upright standing position were obtained from 59 patients with severe KOA and 58 asymptomatic controls free from KOA. Sagittal alignment of the spine, pelvis, hip and proximal femur was quantified by measuring several radiographic parameters. Global balance was accessed according to the relative position of the C7 plumb line to the sacrum and femoral heads. The presence of chronic LBP was documented. Comparisons between the two groups were carried by independent samples t-tests or chi-squared test. Results Patients with severe KOA showed significant backward femoral inclination (FI), hip flexion, forward spinal inclination, and higher prevalence of global imbalance (27.1% versus 3.4%, p 10° (n = 36) presented with significant pelvic anteversion and hip flexion. A total of 39 patients with KOA (66.1%) suffered from LBP. There was no significant difference in sagittal alignment between KOA patients with and without LBP. Conclusions The sagittal alignment of spine-pelvis-lower extremity axis was significantly influenced by severe KOA. The lumbar spine served as the primary source of compensation, while hip flexion and pelvic anteversion increased for further compensation. Changes in sagittal alignment may not be involved in the pathogenesis of LBP in this patient population. Cite this article: W. J. Wang, F. Liu, Y.W. Zhu, M.H. Sun, Y. Qiu, W. J. Weng. Sagittal alignment of the spine-pelvis-lower extremity axis in patients with severe knee osteoarthritis: A radiographic study. Bone Joint Res 2016;5:198–205

  19. Sagittal balance of the spine in patients with osteoporotic vertebral fractures.

    Science.gov (United States)

    Fechtenbaum, J; Etcheto, A; Kolta, S; Feydy, A; Roux, C; Briot, K

    2016-02-01

    This study aims to compare the sagittal global spinal balance of patients consulting for osteoporosis, aged above 50 years with and without osteoporotic vertebral fractures (VFs). Global spinal balance is abnormal even in subjects without VFs. VFs and age are determinants of sagittal global balance; however, pelvic parameters play a role in compensatory mechanisms. This study aims to compare the spine curvatures, pelvic parameters, and the sagittal global spinal balance of patients aged above 50 years with and without osteoporotic vertebral fractures. Two hundred patients (95 % women) aged 68.3 ± 9.5 years underwent full skeleton radiographs in the standing position, by EOS®, a low dose biplane X-ray imaging system. VFs were evaluated according to Genant's classification. Spinal (thoracic and lumbar Cobb's indices, thoracic and lumbar tilts) and pelvic (pelvic tilt, sacral slope, and pelvic incidence) parameters were measured. Sagittal spinal balance was measured using the C7 plumb line and the spinosacral angle (SSA). We compared these parameters in patients with and without vertebral fracture and assessed the determinants of abnormal sagittal spinal balance. Sixty-nine patients had at least one VF. The sagittal spinal balance was significantly altered in patients with at least one VF, and there was an effect of the number and severity of VFs on parameters. Discriminative value for identification of patients with at least one VF, assessed by Area Under the Curves (AUCs) was 0.652 and 0.706 for C7 plumbline and SSA, respectively. Using multivariate analysis, parameters significantly associated with abnormal spinal balance (SSA) were the presence of at least one VF (OR = 4.96, P balance is abnormal in subjects consulting for osteoporosis, even in subjects without VFs. VFs and age are determinants of abnormal sagittal global balance; however, pelvic parameters play a role in compensatory mechanisms.

  20. Sagittal plane analysis of the spine and pelvis in adult idiopathic scoliosis.

    Science.gov (United States)

    Li, Wei-Shi; Li, Gang; Chen, Zhong-Qiang; Wood, Kirkham B

    2010-11-01

    There has been an increasing recognition of the importance of sagittal spinopelvic alignment in patients with scoliosis as it relates to clinical outcomes. However, the changes seen in sagittal spinopelvic alignment in adult idiopathic scoliosis patients is poorly defined. This study was conducted to evaluate the sagittal alignment of pelvis and spine in adult idiopathic scoliosis patients. The sagittal parameters of the spine and pelvis were analyzed in lateral standing radiographs of 124 patients (mean age 47.4 years) with adult idiopathic scoliosis, including thoracic kyphosis (TK), thoracolumbar junction kyphosis (TLJ), lumbar lordosis (LL), pelvic incidence (PI), sacrum slope (SS), pelvic tilt (PT) and C7 plumb line (C7PL). The patients were divided into three groups according to the age: 20 - 40 years, 41 - 64 years, and ≥ 65 years. The parameters were compared with those in normal adults and adolescent idiopathic scoliosis (AIS) patients. The relationship between all parameters as well as age and sagittal parameters were analyzed. The PI in patients with adult idiopathic scoliosis was 58.1° ± 13.0°, which was significantly higher than that in normal adults. The PT (19.9° ± 10.6°) was also higher than that in both normal adults and AIS patients, while the SS (38.1° ± 12.0°) was similar or smaller. As age increased, C7PL, PT and TJL increased while LL decreased. There was no relationship between age and both PI and TK. PT had the strongest statistical association with the C7PL. PI is higher in adult idiopathic scoliosis than normal subjects. The PT is the most relevant pelvic parameter to the global sagittal alignment of the spine. Age significantly influences sagittal parameters of the spine and pelvis except the PI and TK.

  1. Return to work and sporting activities after high tibial osteotomy.

    Science.gov (United States)

    Faschingbauer, Martin; Nelitz, Manfred; Urlaub, Stefanie; Reichel, Heiko; Dornacher, Daniel

    2015-08-01

    High tibial osteotomy (HTO) is a commonly used treatment to correct varus malalignment of the knee. The purpose of this study was, first, to determine, whether HTO allows return to pre-operative work, depending on the amount of work load. Second, the restoration of sports ability and a difference in sports activities pre- to postoperative should be analyzed. Fifty-one patients were included in this study. Patients were divided into three groups dependent on work intensity. Sporting activity was evaluated by an activity score (Naal). Clinical examination includes Tegner-score, Lysholm-score and visual analog pain scale. General health was assessed using the 36-Item Short Form Survey questionnaire. On an average of 16.7 ± 15.6 weeks after surgery patients returned to work, and 93.8 % of the patients returned to pre-operative work load. The Tegner activity score did not show significant changes pre- and postoperatively. At the time of survey Lysholm score reached a value of 68.7 ± 23.9 points on average. Postoperatively, patients remarked on decreased pain by VAS by an average of 2.6 ± 2.3 points. In total, 92.3 % returned to pre-operative sports activities after surgery. A shift away from high impact activities to lower impact activities, a significant decrease of the duration of sports activities and number of sports disciplines was detected. In summary, HTO allows the young, active patient with medial osteoarthritis of the knee to return to work with the same work intensity and to return to sports.

  2. Biomechanical analysis of titanium fixation plates and screws in ...

    African Journals Online (AJOL)

    Biomechanical analysis of titanium fixation plates and screws in sagittal split ramus osteotomies. F Atik, MS Ataç1, A Özkan2, Y Kılınç1, M Arslan1. Department of Biomedical Engineering, Faculty of Engineering, Institute of Science, Düzce University,. 2Department of Biomedical Engineering, Faculty of Engineering, Düzce ...

  3. Clinical Investigation Program.

    Science.gov (United States)

    1984-10-01

    Nespeca JA, Hammer HS: Intraoral Sagittal Split Osteotomy and Two-Step Genioplasty: Case Report. Milit Med 149(8):468-470, Aug 1984 DEPARTMENT OF...expected to indicate an optimization of deconvolution radiography with respect to image signal to noise ratio. 122 Detail Summary Sheet Date: 21 Dec 84

  4. Biomechanical analysis of titanium fixation plates and screws in ...

    African Journals Online (AJOL)

    Objective: The aim of the study was to evaluate the mechanical behavior of three different fixation methods used in the bilateral sagittal split ramus osteotomy. Materials and Methods: Three different three-dimensional finite element models were created, each corresponding to three different fixation methods. The mandibles ...

  5. Use of iowa spaces for the orthodontic management of mandibular postsurgical skeletal relapse

    Directory of Open Access Journals (Sweden)

    Roberto Justus

    2016-01-01

    Full Text Available It has been documented that there is a tendency for skeletal relapse after orthognathic surgery. This relapse occurs more often following mandibular bilateral sagittal split osteotomy setbacks. The possible causes for lack of postsurgical stability as well as the clinical recommendations to manage the relapse are presented. Among these recommendations is the creation of Iowa Spaces.

  6. Pre- and postoperative spinopelvic sagittal balance in adolescent patients with lenke type 5 idiopathic scoliosis.

    Science.gov (United States)

    Yang, Xi; Liu, Limin; Song, Yueming; Zhou, Chunguang; Zhou, Zhongjie; Wang, Lei; Wang, Liang

    2015-01-15

    A retrospective study. To investigate the preoperative spinopelvic sagittal alignment in Lenke 5 patients with adolescent idiopathic scoliosis (AIS), and analyze how it alters after posterior correction. The structural thoracolumbar or lumbar curve may change the local sagittal alignment thereby altering the sagittal balance in Lenke 5 patients with AIS. However, few studies have evaluated the spinopelvic sagittal alignment before and after the surgery in these patients. Forty-eight Lenke 5 patients with AIS who underwent posterior correction and fusion were included in this study. Preoperative and postoperative radiographs were reviewed measuring both the coronal and sagittal parameters. Three pelvic sagittal states (anteverted, normal, or retroverted) were evaluated according to the magnitude relationship of individual pelvic tilt with pelvic incidence (PI). Both the coronal and sagittal parameters between different pelvic sagittal states were compared. The alterations of these parameters by surgery would also be analyzed. The mean follow-up was 1.8 years. Preoperatively, the mean PI was 44.3° with a pelvic tilt of 4.1°. There was 48% patients showing the anteverted pelvis, whereas the remaining 52% showing normal. The patients with anteverted pelvis showed a smaller PI and more distal lower end vertebra than normal pelvis ones. Logistic regression analysis revealed PI (odds ratio [OR] = 0.62, P = 0.024) and lower end vertebra (OR = 2.1, P = 0.037) were significantly associated with the risk of developing anteverted pelvis. The pelvic tilt was significantly increased and 61% of patients with preoperative anteverted pelvis had recovered. Logistic regression analysis revealed PI (OR = 0.7, P = 0.034) and lower instrumented vertebra (OR = 6.5, P = 0.002) were significantly associated with the risk of postoperative uncovered of anteverted pelvis. Anteverted pelvis appears in almost half of Lenke 5 patients with AIS, especially in who have smaller PI or distal lower

  7. Effect of one- or two-level posterior lumbar interbody fusion on global sagittal balance.

    Science.gov (United States)

    Cho, Jae Hwan; Joo, Youn-Suk; Lim, Cheongsu; Hwang, Chang Ju; Lee, Dong-Ho; Lee, Choon Sung

    2017-06-02

    Sagittal imbalance is associated with poor clinical outcomes in patients with degenerative lumbar disease. However, there is no consensus on the impact of posterior lumbar interbody fusion (PLIF) on local and global sagittal balance. To reveal the effect of one- or two-level PLIF on global sagittal balance. A retrospective case-control study. This study included 88 patients who underwent a one- or two-level PLIF for spinal stenosis with spondylolisthesis. Clinical and radiological parameters were measured pre- and postoperatively. All patients were followed up for >2 years. Clinical outcomes included a visual analog scale, Oswestry Disability Index, and EuroQol 5-dimension questionnaire (EQ-5D). Radiological parameters were measured using whole-spine standing lateral radiographs. Fusion, loosening, subsidence rates, and adverse events were also evaluated. Patients were divided into two groups according to their preoperative C7-S1 sagittal vertical axis (SVA): Group N: SVA≤5 cm vs Group I: SVA>5 cm; they were also divided according to postoperative changes in C7-S1 SVA. Clinical and radiological outcomes were compared between the groups. All clinical outcomes and radiological parameters improved postoperatively. C7-S1 SVA improved (-1.6 cm) after L3-L5 fusion, but it was compromised (+3.6 cm) after L4-S1 fusion (p=.001). Preoperative demographic and clinical data showed no difference except in the anxiety or depression domain of EQ-5D. No differences were found in postoperative clinical outcomes. Lumbar lordosis, pelvic tilt, and thoracic kyphosis slightly improved in Group N, whereas C7-S1 SVA decreased from 9.5 cm to 3.8 cm (pSVA, we found that the decreasing trend in the postoperative C7-S1 SVA was related to a larger preoperative C7-S1 SVA (p=.030) and a more proximal level fusion (L3-L5 vs L4-S1, p=.033). Global sagittal balance improved after short-level lumbar fusion surgery in patients having spinal stenosis with spondylolisthesis who showed

  8. Sagittal plane tilting deformity of the patellofemoral joint: a new concept in patients with chondromalacia patella.

    Science.gov (United States)

    Aksahin, Ertugrul; Aktekin, Cem Nuri; Kocadal, Onur; Duran, Semra; Gunay, Cüneyd; Kaya, Defne; Hapa, Onur; Pepe, Murad

    2017-10-01

    The aims of this study were to evaluate sagittal plane alignment in patients with chondromalacia patella via magnetic resonance imaging (MRI), analyse the relationships between the location of the patellar cartilaginous lesions and sagittal alignment and finally investigate the relationships between the sagittal plane malalignment and patellofemoral loadings using by finite element analysis. Fifty-one patients who were diagnosed with isolated modified Outerbridge grade 3-4 patellar chondromalacia based on MRI evaluation and 51 control subjects were evaluated. Chondromalacia patella patients were divided into three subgroups according to the chondral lesion location as superior, middle and inferior. The patella-patellar tendon angle (P-PT) was used for evaluation of sagittal alignment of patellofemoral joint. Each subgroup was compared with control group by using P-PT angle. To investigate the biomechanical effects of sagittal plane malpositioning on patellofemoral joint, bone models were created at 30°, 60° and 90° knee flexion by using mean P-PT angles, which obtained from patients with chondromalacia patellae and control subjects. The total loading and contact area values of the patellofemoral joints were investigated by finite element analysis. The mean age of all participants was 52.9 ± 8.2 years. The mean P-PT angle was significantly lower in chondromalacia group (142.1° ± 3.6°) compared to control group (144.5° ± 5.3°) (p = 0.008). Chondral lesions were located in superior, middle and inferior zones in 16, 20 and 15 patients, respectively. The mean P-PT angles in patients with superior (141.8 ± 2.7) and inferior subgroups (139.2 ± 2.3) were significantly lower than the values in the control group (p chondromalacia than in the control models at the same flexion degrees. There were increased loadings at 30° and 90° flexions in the sagittal patellar tilt models. This study revealed that sagittal plain malpositioning of the

  9. Correlates of bone mineral density and sagittal spinal balance in the aged.

    Science.gov (United States)

    Cho, Yung; Lee, Gangpyo; Aguinaldo, Jhoan; Lee, Kun-Jai; Kim, Keewon

    2015-02-01

    To investigate the relationship between bone mineral density (BMD) and sagittal spinal balance in the Korean elderly population. The retrospective study included subjects aged 60 years and above, who had whole-spine lateral radiography and dual-energy X-ray absorptiometry (DEXA) within a year's gap between each other. Sagittal vertical axis (SVA) for evaluation of sagittal spinal balance and five spinopelvic parameters were measured through radiography. The presence of compression fracture was identified. Correlations of BMD T-scores with SVA and with the spinopelvic parameters were assessed using Pearson correlation coefficient (PCC). Linear regression analyses were performed between SVA and the clinical and radiologic variables. One hundred twenty-two subjects (42 males and 80 females; mean age, 69.93±5.5 years) were included in the study. BMD, femur or spine, was not correlated with SVA or any spinopelvic parameters in both genders (PCCsagittal spinal balance in the aged. Sagittal spinal balance was explained partly by lumbar lordosis and compression fracture. Further study is warranted to understand progression of sagittal imbalance with age.

  10. Influence of transforaminal lumbar interbody fusion procedures on spinal and pelvic parameters of sagittal balance.

    Science.gov (United States)

    Ould-Slimane, Mourad; Lenoir, Thibaut; Dauzac, Cyril; Rillardon, Ludovic; Hoffmann, Etienne; Guigui, Pierre; Ilharreborde, Brice

    2012-06-01

    Restitution of sagittal balance is important after lumbar fusion, because it improves fusion rate and may reduce the rate of adjacent segment disease. The purpose of the present study was to describe the impact of transforaminal lumbar interbody fusion (TLIF) procedures on pelvic and spinal parameters and sagittal balance. Forty-five patients who had single-level TLIF were included in this study. Pelvic and spinal radiological parameters of sagittal balance were measured preoperatively, postoperatively and at latest follow-up. Age at surgery averaged 58.4 (±9.6) years. Mean follow-up was 35.1 months (±4.1). Twenty-nine percent of the patients exhibited anterior imbalance preoperatively, with high pelvic tilt (17.6° ± 7.9°). Of the 32 (71%) patients well balanced before the procedure, 22 (70%) had a large pelvic tilt (>20°), due to retroversion of the pelvis as an adaptive response to the loss of lordosis. Three dural tears (7%) were reported intraoperatively. Interbody cages were more posterior than intended in 27% of the cases. Disc height and lumbar lordosis at fusion level significantly increased postoperatively (p sagittal balance was not significantly modified (p = 0.07). Single-level circumferential fusion helps patients reducing their pelvic compensation, but the amount of correction does not allow for complete correction of sagittal imbalance.

  11. Sagittal balance and pelvic parameters--a paradigm shift in spinal surgery.

    Science.gov (United States)

    Johnson, R D; Valore, A; Villaminar, A; Comisso, M; Balsano, M

    2013-02-01

    It has become evident in recent years that global assessment of spinal sagittal balance is necessary for optimal management of the degenerate spine. Pelvic parameters have been developed which appear to correlate well with the natural history of degenerative spine disorders and outcomes from surgery. Although these parameters have a limited evidence base, they are now in widespread use by spinal surgeons and, in particular, spinal deformity surgeons. It is necessary for all surgeons treating spinal pathology to have a working knowledge of the principles of spinal sagittal balance, to be able to recognise sagittal imbalance and its compensatory mechanisms. In this article we outline the main concepts of spinal sagittal balance and pelvic parameters and how these concepts are leading to a paradigm shift in the surgical management of spinal disorders. We propose that analysis of pelvic parameters of sagittal balance will form an essential part of the evaluation of new surgical techniques for spinal conditions. Copyright © 2012 Elsevier Ltd. All rights reserved.

  12. Treatment of Sagittal Fracture of the Zygomatic Arch Root Assisted by Surgical Navigation Technology.

    Science.gov (United States)

    Dai, Jin-Hong; Xu, Dong-Dong; Yang, Chang-Yuan; Li, Zu-Bing; Li, Zhi

    2018-01-29

    Sagittal fracture at the temporal root of the zygomatic arch often occurs as a part of zygomaticomaxillary fractures. The authors described the application of computer-assisted navigation in the lag screw insertion for the fixation of sagittal fracture at the temporal root of zygomatic arch. Using the presurgical planning of the computer-assisted navigation system, the trajectory of lag screw insertion was designed, and the insertion depth was calculated. In the presurgical planning, the trajectory of screw insertion was placed with an anterior inclination of 10° to 15° (mean: 12.24°), and the screw insertion depth was 9.0 to 12.0 mm (mean: 10.65 mm). In the operation, the screw insertion in the fixation of the sagittal fracture was performed under the guidance of navigation system according to the presurgical planning. The postoperative CT scan showed exact reduction and fixation of the sagittal fracture in all cases. Computer-assisted navigation is a useful tool for the lag screw insertion in the precise fixation of sagittal fracture at the temporal root of the zygomatic arch in complex zygomaticomaxillary fractures.

  13. Effects of mandibular setback with or without maxillary advancement osteotomies on pharyngeal airways: An overview of systematic reviews.

    Directory of Open Access Journals (Sweden)

    Su Keng Tan

    Full Text Available Mandibular setback osteotomies potentially lead to narrowing of the pharyngeal airways, subsequently resulting in post-surgical obstructive sleep apnea (OSA.To summarize current evidence from systematic reviews that has evaluated pharyngeal airway changes after mandibular setback with or without concomitant upper jaw osteotomies.PubMed, EMBASE, Web of Science, and Cochrane Library databases were searched with no restriction of language or date. Systematic reviews studying changes in pharyngeal airway dimensions and respiratory parameters after mandibular setback with or without concomitant upper jaw osteotomies have been identified, screened for eligibility, included and analyzed in this study.Six systematic reviews have been included. While isolated mandibular setback osteotomies result in reduced oropharyngeal airway dimensions, the reduction is lesser in cases with concomitant upper jaw osteotomies. Only scarce evidence exists currently to what happens to naso- and hypo-pharyngeal airways. There is no evidence for post-surgical OSA, even though some studies reported reduced respiratory parameters after single-jaw mandibular setback with or without concomitant upper jaw osteotomies.Although mandibular setback osteotomies reduce pharyngeal airway dimensions, evidence confirming post-surgical OSA was not found. Nevertheless, potential post-surgical OSA should be taken into serious consideration during the treatment planning of particular orthognathic cases. As moderate evidence exists that double-jaw surgeries lead to less compromised post-surgical pharyngeal airways, they should be considered as the method of choice especially in cases with severe dentoskeletal Class III deformity.PROSPERO (registration number: CRD42016046484.

  14. Anterior open bite correction by Le Fort I osteotomy with or without anterior segmentation: which is more stable?

    Science.gov (United States)

    Ismail, I N; Leung, Y Y

    2017-06-01

    A retrospective cohort study was conducted to analyze the relapse rate of anterior open bite (AOB) correction comparing Le Fort I osteotomy with and without anterior segmentation. The risk factors that might contribute to relapse were also assessed. Lateral cephalograms obtained at six different times were analyzed. A total of 81 patients with AOB were recruited. Thirty-five patients underwent Le Fort I osteotomy without anterior segmentation and 46 patients underwent anterior segmentation. Le Fort I osteotomy with anterior segmentation resulted in significantly more AOB relapse when compared to that without anterior segmentation at 7 weeks postoperative (15.2% vs. 0%, P=0.016). During the early postoperative period, factors that contributed to AOB relapse in Le Fort I osteotomy with anterior segmentation were AOB closure ≥4mm and inferior positioning of the anterior segment >2mm. Over the long term, AOB closure ≥4mm and intraoral vertical ramus osteotomy as the only mandibular procedure were factors identified as causing more AOB relapse in those treated by Le Fort I osteotomy with anterior segmentation. In conclusion, Le Fort I osteotomy without anterior segmentation was found to be more stable in the surgical correction of AOB in the early and late postoperative periods. Copyright © 2017 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  15. Single-Tooth Osteotomy Combined Wide Linear Corticotomy Under Local Anesthesia for Correcting Anterior Protrusion With Ectopically Erupted Canine.

    Science.gov (United States)

    Iskenderoglu, Nur Serife; Choi, Byung-Joon; Seo, Kyung Won; Lee, Yeon-Ji; Lee, Baek-Soo; Kim, Seong-Hun

    2017-01-01

    This article presents the alternative surgical treatments of both anterior protrusion by carrying out retraction on mandibular anterior fragment, meanwhile applying retraction force on maxilla anterior teeth and ectopically erupted canine with using platelet-rich fibrin (PRF). Anterior segmental osteotomy was combined with linear corticotomy under local anesthesia. The correction of right ectopic canine was achieved through 2 stages. First, dento-osseous osteotomy on palatal side was performed. Then second osteotomy with immediate manual repositioning of the canine with concomitant first premolar extraction was enhanced with PRF, which was prepared by centrifuging patient's blood, applied into buccal side of high canine during osteotomy. Mandibular retraction was accomplished by anterior segmental osteotomy. Single-tooth osteotomy is a more effective surgical method for ankylosed or ectopically erupted tooth in orthodontic treatment. It can reduce the total orthodontic treatment time and root resorption, 1 common complication. Significant improved bone formation was seen with the addition of PRF on noncritical size defects in the animal model. It is reasonable to think that PRF can promote bone regeneration. So early bone formation also can reduce the complication such as postoperative infection. As an alternative to anterior protrusion and ectopically erupted canine treatment, segmental osteotomy and corticotomy combined platelet-rich plasma can enhance orthodontic treatment outcome.

  16. Evidence showing the relationship between sagittal balance and clinical outcomes in surgical treatment of degenerative spinal diseases: a literature review

    National Research Council Canada - National Science Library

    Le Huec, Jean-Charles; Faundez, Antonio; Dominguez, Dennis; Hoffmeyer, Pierre; Aunoble, Stéphane

    2015-01-01

    The measure of radiographic pelvic and spinal parameters for sagittal balance analysis has gained importance in reconstructive surgery of the spine and particularly in degenerative spinal diseases (DSD...

  17. Evaluation of the dorsal acetabular coverage obtained by a modified triple pelvic osteotomy (2.5 pelvic osteotomy): an ex vivo study on a cadaveric canine codel.

    Science.gov (United States)

    Petazzoni, M; Tamburro, R; Nicetto, T; Kowaleski, M P

    2012-01-01

    To evaluate the acetabular ventroversion obtained with a modified triple pelvic osteotomy (2.5 PO) compared with that resulting from standard double pelvic osteo-tomy (DPO). Ex vivo study. Seven pelves obtained from skeletally mature dogs with a total body weight ranging from 26-41 kg were used. Unilateral DPO technique and dorsal ischial mono-cortical osteotomy were performed on every right hemipelvis. Angular ventral rotation was measured by determining the relative orientation of two Kirschner wires placed in the ilial wing and in the dorsal acetabular rim. The mean angle of ventroversion was 9.5 ± 5.2 degrees for the DPO group (range 2.1-18.1) and 10.9 ± 4.8 degrees for the 2.5 PO group (range 4.1-19.5). The mean difference between the 2.5 PO and DPO was 1.5 ± 0.6 degrees (range 0.5-2.1). The 2.5 PO technique increased acetabular ventroversion versus DPO.

  18. Method for carbon dioxide splitting

    Science.gov (United States)

    Miller, James E.; Diver, Jr., Richard B.; Siegel, Nathan P.

    2017-02-28

    A method for splitting carbon dioxide via a two-step metal oxide thermochemical cycle by heating a metal oxide compound selected from an iron oxide material of the general formula A.sub.xFe.sub.3-xO.sub.4, where 0.ltoreq.x.ltoreq.1 and A is a metal selected from Mg, Cu, Zn, Ni, Co, and Mn, or a ceria oxide compound of the general formula M.sub.aCe.sub.bO.sub.c, where 0gas mixture, adding carbon dioxide, and heating to a temperature less than approximately 1400 C, thereby producing carbon monoxide gas and the original metal oxide compound.

  19. Split quaternion nonlinear adaptive filtering.

    Science.gov (United States)

    Ujang, Bukhari Che; Took, Clive Cheong; Mandic, Danilo P

    2010-04-01

    A split quaternion learning algorithm for the training of nonlinear finite impulse response adaptive filters for the processing of three- and four-dimensional signals is proposed. The derivation takes into account the non-commutativity of the quaternion product, an aspect neglected in the derivation of the existing learning algorithms. It is shown that the additional information taken into account by a rigorous treatment of quaternion algebra provides improved performance on hypercomplex processes. A rigorous analysis of the convergence of the proposed algorithms is also provided. Simulations on both benchmark and real-world signals support the approach. Copyright 2009 Elsevier Ltd. All rights reserved.

  20. Review Outcome of Combined Open Reduction and Femoral Shortening Osteotomy for Developmental Dysplasia of the Hip in Children

    Directory of Open Access Journals (Sweden)

    Nguyen Ngoc Hung

    2017-02-01

    Full Text Available BACKGROUND: Reports of the efficacy of Open reduction combined femoral shortening osteotomy on children for developmental dislocation of the hip. Surgical outcomes were evaluated clinically and roentgenographically. METHODS: We performed a retrospective match-controlled study in which 58 patients, they were surgical femoral shortening osteotomy following Open reduction, Zigzag Osteotomy, Fibular Allograft (ZOFA and femoral shortening osteotomy. Deformity of femoral head or neck or acetabulum according to the Severin, Avascular Necrosis (AVN according to Kalamchi, Clinical evaluation according to Barrett modified McKay criteria. RESULTS: Between 2009 and 2014, Femoral shortening Osteotomy For 58 Hips (all patients operated unilateral side. There were 42 (72.4% were girls and 16 (27.6% were boys. None had preoperative skin or skeletal traction, nor derotational varus or valgus osteotomies. The Femoral Neck Anteversion angle: Average 27.726º (SD = 12.153, The Shaft - Neck angle: Average 149.649º (SD = 5.815, The Femoral Neck - Shaft angle: Average 162° (SD = 8.642. Average age at femoral shortening osteotomy was 29.9 months (range, 14-36 months. Average distance shortening osteotomy was 1.52 cm. Duration of the Follow-up was 28. 6 months (range, 24-62 months; Average age at latest Follow- up 66.3 months (range, 38-85 months.There were 1 (1.7% Trendelenberg gait. AVN in 9 (15.5%. Subluxation in 2 (3.4%. At lastest result: Excellent in 44 (75.9%, Good in 8 (13.8%, Fair 4 (6.9%, and Poor 2 (3.4%; Satisfy Results (Excellent and Good of Open reduction and Femoral Shortening in 52 (97.5%. The femoral head or neck or acetabulum were normal in 44 (75.9% hips. CONCLUSIONS: On the basis of this study, the femoral shortening Osteotomy reduce incidence AVN, Re-Dislocation, and improved Postoperative result.

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

    Directory of Open Access Journals (Sweden)

    Vladimir E Baskov

    2016-06-01

    Conclusion. Transposition of the acetabulum after iliac and ischial pelvic osteotomy is an effective treatment for dysplastic instability of the acetabulum in children aged 9–16 years. The procedure is indicated when it is necessary to rotate the acetabular fragment by more than 25°, and there is no need for hip medialization.

  2. Fixation stability and new surgical concepts of osteotomies around the knee

    NARCIS (Netherlands)

    Brinkman, J.M.

    2013-01-01

    Osteotomy around the knee, in order to re-align its mechanical axis, thereby unloading certain degenerated and painful regions of the joint, was once a well-established technique in the treatment of uni-compartmental osteoarthritis of the knee. To a large extent this was because of a lack of other

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

    NARCIS (Netherlands)

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

    2016-01-01

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

  4. Effect of Maxillary Osteotomy on Speech in Cleft Lip and Palate: Perceptual Outcomes of Velopharyngeal Function

    Science.gov (United States)

    Pereira, Valerie J.; Sell, Debbie; Tuomainen, Jyrki

    2013-01-01

    Background: Abnormal facial growth is a well-known sequelae of cleft lip and palate (CLP) resulting in maxillary retrusion and a class III malocclusion. In 10-50% of cases, surgical correction involving advancement of the maxilla typically by osteotomy methods is required and normally undertaken in adolescence when facial growth is complete.…

  5. W/M serrated osteotomy for infantile Blount's disease in Ghana ...

    African Journals Online (AJOL)

    2015-10-30

    Oct 30, 2015 ... Purpose: The W/M serrated high tibial osteotomy is a not frequently described surgical technique for simultaneously correcting the varus and torsional deformity in patients with Blount's disease. Without the need for internal fixation, this surgical treatment is well suited for developing countries. This study ...

  6. Proximal femoral derotation osteotomy for idiopathic excessive femoral anteversion and intoeing gait.

    Science.gov (United States)

    Naqvi, Gohar; Stohr, Kuldeep; Rehm, Andreas

    2017-01-01

    The purpose of this study is to assess the symptoms caused by excessive femoral anteversion and the outcomes of femoral derotation osteotomy. We reviewed data on patients who underwent proximal femoral derotation osteotomy for symptomatic intoeing gait caused by femoral anteversion. Only symptomatic patients were considered for corrective derotation osteotomy. Degree of femoral anteversion was confirmed on computed tomography (CT) scan. Thirty-five extremities were operated in 21 patients with an average age of 13.3 (8-18) years. Mean follow-up was 16 months (6-36 months). Mean femoral anteversion angle was 40.8° (28°-53°). External rotation of extended hips improved significantly, from 30° to 51.8° (p Intoeing completely resolved in all except two patients. Thirteen out of 21 children complained about tripping and frequent falling while running and playing sports, eight patients had hip pain while 13 children had knee pain preoperatively. Tripping, falling and hip pain resolved in all patients postoperatively, while three patients whose primary complaint was knee pain failed to improve postsurgery. Eighteen of the 21 parents were satisfied with the decision to perform surgical correction. Excessive femoral anteversion can present with unexplained hip or knee pain refractory to conservative treatments. Careful assessment of lower limb malalignment is a valuable tool in such circumstances and derotation proximal femoral osteotomy can certainly be a procedure of choice in carefully selected cases. © The Authors, published by EDP Sciences, 2017.

  7. Endovaskulaer embolisering af svaer blødning i forbindelse med periacetabulaer osteotomi

    DEFF Research Database (Denmark)

    Brenøe, Anne-Sofie; Andersen, Poul Erik; Overgaard, Søren

    2006-01-01

    Embolisation is a well-known procedure for trauma patients with pelvic injuries and bleeding complications. We report a case in which haemostasis was successfully achieved by angiographic embolisation in a patient with bleeding complications due to periacetabular osteotomy. This case illustrates...

  8. Effect of Le Fort III osteotomy on mandibular growth in patients with Crouzon and Apert syndromes.

    Science.gov (United States)

    Bu, B H; Kaban, L B; Vargervik, K

    1989-07-01

    Midface advancement by Le Fort III osteotomy is a common procedure in craniofacial surgery. However, little data exist concerning the effect of midface advancement on mandibular growth. This is a retrospective study of 38 patients from two craniofacial centers who had Le Fort III osteotomy. The aims of this investigation were to document the size and shape of the mandible in Crouzon and Apert syndromes and to determine the effect on these parameters of downward and forward movement of the midface. The syndrome patients had increased gonial angle, increased MP-SN, increased ramus height, and increased ratio of ramus height to body length when compared with normal standards. Patients operated during growth and those operated when growth was completed had similar mandibular size and shape indicating that Le Fort III osteotomy had no measurable effect on these parameters. Inclination of the mandible to the anterior cranial base was increased by the operation and remained unchanged during the follow-up period. The results of this study indicate that the size and morphology of the mandible are similar in Crouzon and Apert syndromes. The pattern of growth is more vertical in the syndrome patients than in normals. Le Fort III osteotomy in growing children does not result in altered mandibular size and shape despite backward rotation of the mandible as a result of midface advancement.

  9. Application of Orthopedic Dual Sliding Compression Plate (ODSCP) in High Medial Tibial Open Wedge Osteotomies.

    Science.gov (United States)

    Samani, Seyed Salman; Kachooei, Amir Reza; Ebrahimzadeh, Mohammad Hosein; Omidi Kashani, Farzad; Mahdavian Naghashzargar, Reza; Razi, Shiva

    2013-04-01

    Angular deformities about the knee are one of the common disorders. High Tibial osteotomy is a way of correcting the deformity. Although the general agreement is focused toward the open wedge technique, discussion about the type of device is a subject to debate. This current study has attempted to evaluate the results of Orthopedic Dual Sliding Compression Plate (ODSCP) in high medial open wedge osteotomies of the tibia. In this cross-sectional study, 16 patients with genuvarum undergone high medial tibial open wedge osteotomy and fixed by Orthopedic Dual Sliding Compression Plate. At the time of the last follow up visit, Lysholm score was gathered. The mean follow-up time was 9.33 ± 1.87 month. The average age was 45.13 ± 7.25 years. Three patients were male and 13 patients were female. The lysholm score showed a significant difference before and after surgery. The ODSCP has many advantages over the other type of plates. It can help the surgeon to operate with a relaxed mind and it is advisable for high tibial medial open wedge osteotomies.

  10. In vitro investigation of biomechanical changes of the hip after Salter pelvic osteotomy.

    Science.gov (United States)

    Pfeifer, R; Hurschler, C; Ostermeier, S; Windhagen, H; Pressel, T

    2008-03-01

    Salter innominate osteotomy of the pelvis is widely used to improve the coverage of the femoral head in developmental dysplasia of the hip, but the biomechanical and geometric changes after this osteotomy are not well understood. A CT dataset of an 8-year-old child with severe dysplasia of both hips was used to create a polyamide model of the left hemipelvis and proximal femur. The hemipelvis was mounted to a holding device and the proximal femur attached to a sensor guided industrial robot. The robot was programmed to apply joint forces and torques based on single-leg stance. Two major muscles were represented by wires connected to hydraulic cylinders; muscle forces were adjusted to balance the joint moments. Resulting joint forces were measured using a pressure measuring sensor before and after Salter osteotomy of the hip. Geometric changes were recorded using a three-dimensional ultrasound measurement system. The preoperative hip joint resultant force was 583N (270% body weight), while after the operation a mean force of 266N (120% body weight) was measured. Postoperative muscle forces were roughly half the preoperative values. The hip joint was translated medially and caudally. Postoperatively, the length of gluteus medius and maximus muscles increased. The preoperative value of the resultant hip joint force is comparable to values reported in the literature. The results suggest that Salter innominate osteotomy leads to a reduction of hip joint and muscle forces in addition to increasing joint contact area.

  11. What factors predict failure 4 to 12 years after periacetabular osteotomy?

    DEFF Research Database (Denmark)

    Hartig-Andreasen, Charlotte; Troelsen, Anders; Thillemann, Theis Muncholm

    2012-01-01

    The goal of periacetabular osteotomy (PAO) is to delay or prevent osteoarthritic development in dysplastic hips. However, it is unclear whether the surgical goals are achieved and if so in which patients. This information is essential to select appropriate patients for a durable PAO that achieves...

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

    Science.gov (United States)

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

    2017-05-01

    Posterolateral tibial plateau fractures are not uncommon and the diagnosis can be easily missed. The treatment is technically demanding, which can easily lead to malunion of the posterolateral tibial plateau fracture. Here, we describe an innovative intra-articular osteotomy for the treatment of posterolateral tibial plateau fracture malunion. From 2010 through 2012, 13 patients with a posterolateral tibial plateau fracture malunion were treated in our trauma center. The patients were referred because of instability or knee pain. The instability was confirmed by physical examinations preoperatively. The depression malunion and lower limb alignment were evaluated on X-rays and computed tomography scans. All posterolateral tibial plateau fracture malunions were treated with an innovative intra-articular osteotomy via an extended anterolateral approach. The mean follow-up was 19.6 months (range, 14-28 months). The posterolateral osteotomy healed at an average of 15.1 weeks. The depression malunion was corrected in all patients, which was from 15.4 mm preoperatively to 3.3 mm at 12 months postoperatively. The average Lysholm, Knee Society Score, and visual analog scale scores were 91.7, 92.5, and 0.5, respectively. No loss of reduction, nonunion, or wound infection was observed. An innovative intra-articular osteotomy via an extended anterolateral approach is an effective treatment for posterolateral tibial plateau fracture malunion. The treatment achieved satisfactory functional results and knee stability restoration. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  13. Low dose of propranolol does not affect rat osteotomy healing and callus strength

    Science.gov (United States)

    Smitham, Peter; Crossfield, Lawrence; Hughes, Gillian; Goodship, Allen; Blunn, Gordon; Chenu, Chantal

    2014-01-01

    Experimental studies suggest that the β-blocker propranolol stimulates bone formation but little work has investigated its effect on fracture healing. In this study, we examined if a low dose of propranolol, previously shown to be preventive against bone loss in rats, improves bone repair. Female Wistar rats were injected with saline or propranolol (0.1 mg/kg/day) (n = 20/group), 5 days a week for 8 weeks. Three weeks after the beginning of treatment, all rats underwent a mid-diaphyseal transverse osteotomy in the left femur. Radiographic analysis of ostetomy healing was performed 2 and 5 weeks after osteotomy. Rats were sacrificed at 5 weeks and femora collected for measurements of fracture strength by torsional testing, callus volume, and mineral content by micro-CT analysis and histology of fracture callus. Eighty nine percent of osteotomies achieved apparent radiological union by 5 weeks in both groups. Propranolol treatment did not significantly alter the torsional strength of the fractured femur compared with controls. The volume and mineralization of fracture callus at 5 weeks were not significantly different in both groups. Histology showed that endochondral ossification was not affected by propranolol. Altogether, our results demonstrate that propranolol using the regimen described does not significantly improve or inhibit rat osteotomy healing and mechanical strength. PMID:24710688

  14. Early outcomes of one-stage combined osteotomy in Legg-Calve´-Perthes disease

    Directory of Open Access Journals (Sweden)

    Basant Kumar Bhuyan

    2016-01-01

    Conclusions: The surgical treatment of LCPD with the best expected outcome is still a challenge. Advanced containment methods by one-stage combined osteotomy can be considered as an alternative treatment where femoral head subluxation or deformity which makes containment difficult or impossible by more conventional methods.

  15. Acellular Dermal Matrix as an Adjunct Material in Cleft Le Fort I Osteotomies.

    Science.gov (United States)

    Susarla, Srinivas M; MacIsaac, Zoe M; Swanson, Edward; Davidson, Edward; Kumar, Anand

    2017-01-01

    To evaluate the use of acellular dermal matrix in the management of nasal lining deficiency at the time of Le Fort I osteotomy. This was a retrospective cohort study of patients with residual/recurrent oronasal fistulae who underwent Le Fort I osteotomy. In instances where there was an inadequate volume of nasal mucosa for tension-free closure or for defects >1 cm in width, the acellular dermal matrix was used for augmentation. Demographic and cleft-related factors were recorded. Complications (recurrent fistula, infection, seroma, and wound dehiscence) were recorded. Over the 3-year period, the authors used acellular dermal matrix to augment nasal lining in 8 subjects. The sample's mean age was 18.7 ± 3.1 years; 5 subjects were male. Six patients had bilateral cleft defects. The mean follow-up time was 20.2 ± 3.2 years. There were no episodes of infection, seroma, wound dehiscence, or recurrent fistula. Acellular dermal matrix is a useful adjunct for managing nasal liningdeficiency at the time of Le Fort I osteotomy. There were no episodes of bone graft extrusion, infection, tooth loss, or bone graft loss. The Enemark scores improved significantly across both subsets (P managed at the time of Le Fort I osteotomy using allograft bone and acellular dermal matrix.

  16. Combined osteotomy in patients with severe Legg-Calve-Perthes disease.

    Science.gov (United States)

    Eamsobhana, Perajit; Kaewpornsawan, Kamolporn

    2012-10-01

    The purpose of the present study was to describe the clinical and radiographic results obtained with the combined osteotomy in patients with severe Legg-Calve-Perthes disease. During 2000 to 2010 patients with Legg-Calve-Perthes disease who intervened with combined osteotomy at Siriraj Hospital were evaluated. Clinical evaluation was categorized by Ratliff classification and radiographic evaluation was performed by Moss index, Lloyd Roberts classification and Stulberg classification. Twenty patients intervened with combined osteotomy. There were nineteen males and one female with a mean age of 7.7 years. The average follow-up was 49 months. Nine had a Catterall III and eleven had a Catterall IV. According to Herring classification, fourteen patients were Herring B and six were Herring C. In accordance with the Ratliff classification, the postoperative clinical results: fifteen good, three fair and two poor. According to Mose scale, eight patients had good results, nine had fair results and three had poor results. According to the Lloyd-Roberts classification eight patients had good results, nine had fair results and three had poor results. Based on the Stulberg classification, there were ten patients in class II, nine in class III and one in class V. The surgical treatment for severe Perthes disease with the best expected outcome is still a challenge. According to the results reported here, the combined osteotomy is safe and effective procedure for patients with severe Perthes disease in whom the femoral head cannot be contained by conventional forms of treatment.

  17. Arthroscopic subcapital realignment osteotomy in chronic and stable slipped capital femoral epiphysis: early results

    Directory of Open Access Journals (Sweden)

    Bruno Dutra Roos

    Full Text Available ABSTRACT OBJECTIVE: This study aimed to evaluate the clinical and radiographic outcomes, as well as the complications of arthroscopic subcapital realignment osteotomy in chronic and stable slipped capital femoral epiphysis (SCFE. As indicated by the literature review, this is the first time this type of arthroscopic osteotomy was described. METHODS: Between June 2012 and December 2014, seven patients were submitted to arthroscopic subcapital realignment osteotomy in chronic and stable SCFE. The mean age was 11 years and 4 months, and the mean follow-up period was 16.5 months (6-36. Clinical results were evaluated using the Modified Harris Hip Score (MHHS, which was measured pre- and postoperatively. Radiographs were evaluated using the Southwick quantitative classification and the epiphysis-diaphysis angle (pre- and postoperatively. Complications were assessed. RESULTS: The mean preoperative MHHS was 35.8 points, and 97.5 points post-operatively (p < 0.05. Radiographically, five patients were classified as Southwick classification grade II and two as grade III. The mean correction of the epiphysis-diaphysis angle was 40°. No immediate postoperatively complications were observed. One patient presented femoral head avascular necrosis, without collapse or chondrolysis at the most recent follow-up (22 months. CONCLUSION: The arthroscopic technique presented for subcapital realignment osteotomy in chronic and stable SCFE showed satisfactory clinical and radiographic outcomes in a 16.5 months follow-up period.

  18. Arthroscopic subcapital realignment osteotomy in chronic and stable slipped capital femoral epiphysis: early results.

    Science.gov (United States)

    Roos, Bruno Dutra; Assis, Marcelo Camargo de; Roos, Milton Valdomiro; Camisa Júnior, Antero; Lima, Ezequiel Moreno Ungaretti; Pagani, Rodolfo Cavanus

    2017-01-01

    This study aimed to evaluate the clinical and radiographic outcomes, as well as the complications of arthroscopic subcapital realignment osteotomy in chronic and stable slipped capital femoral epiphysis (SCFE). As indicated by the literature review, this is the first time this type of arthroscopic osteotomy was described. Between June 2012 and December 2014, seven patients were submitted to arthroscopic subcapital realignment osteotomy in chronic and stable SCFE. The mean age was 11 years and 4 months, and the mean follow-up period was 16.5 months (6-36). Clinical results were evaluated using the Modified Harris Hip Score (MHHS), which was measured pre- and postoperatively. Radiographs were evaluated using the Southwick quantitative classification and the epiphysis-diaphysis angle (pre- and postoperatively). Complications were assessed. The mean preoperative MHHS was 35.8 points, and 97.5 points post-operatively (p epiphysis-diaphysis angle was 40°. No immediate postoperatively complications were observed. One patient presented femoral head avascular necrosis, without collapse or chondrolysis at the most recent follow-up (22 months). The arthroscopic technique presented for subcapital realignment osteotomy in chronic and stable SCFE showed satisfactory clinical and radiographic outcomes in a 16.5 months follow-up period.

  19. Staple fixation for akin proximal phalangeal osteotomy in the treatment of hallux valgus interphalangeus.

    Science.gov (United States)

    Neumann, Julie A; Reay, Kathleen D; Bradley, Kendall E; Parekh, Selene G

    2015-04-01

    The Akin proximal phalangeal osteotomy is commonly used in conjunction with metatarsal osteotomies to treat hallux valgus. Multiple fixation methods including suture, wire, screw, and staple fixation have been described. The aims of this study were to assess the intraoperative and postoperative complications and to evaluate short-term postoperative outcomes in patients who underwent Akin osteotomy with staple fixation. Forty-four patients (51 feet) with painful hallux valgus were retrospectively reviewed at an average of 40.4 ± 15.8 (range, 25.9 to 79.9) weeks following an Akin osteotomy with staple fixation. Patient reported preoperative and postoperative Visual Analog Score (VAS) (0 to 10, 0 = no pain) was recorded. Level of activity was reported postoperatively. Hallux valgus angles (HVAs), intermetatarsal angles (IMAs), and hallux valgus interphalangeus angles (IPAs) were evaluated on preoperative as well as final postoperative radiographs. Postoperative clinical and radiographic examinations were used to evaluate for complications. Mean VAS improved from 4.4 ± 2.6 to 1.0 ± 1.2 (P hallux valgus correction with improvement in pain and hallux valgus deformity with a low risk for complications. Level IV, case series. © The Author(s) 2014.

  20. Triple osteotomy for the correction of severe hallux valgus deformity: Patient reported outcomes and radiological evaluation.

    Science.gov (United States)

    Booth, Sean; Bhosale, Abhijit; Mustafa, Abubakar; Shenoy, Ravi; Pillai, Anand

    2016-08-01

    Symptomatic Hallux valgus can be treated with metatarsal osteotomy combined with proximal phalangeal osteotomy, however this might not be sufficient to treat severe HV deformities. Fifteen feet in eleven female patients treated with double first metatarsal and proximal phalanx osteotomies without lateral release were prospectively studied and outcome measures including radiological angles and validated patient reported outcome scores collected. Mean radiological follow up was 15 months and PROMs data 17 months. Mean hallux valgus and intermetatarsal angles were corrected from 45 to 24.7° and 18.7 to 7.4° respectively. There was an eight degree recurrence of hallux valgus angle. There was no wound problems, non-unions or evidence of avascular necrosis. The EQ-5D descriptive index showed a non-statistically significant improvement. All three elements of the MOxFQ score showed a statistically significant improvement: Forefoot pain (59-26.8), Walking and Stability (49.9-29.6) and Social Interaction (56.4-33.1) CONCLUSION: Triple osteotomy, without a lateral soft tissue release, leads to good radiological and functional outcomes in those with severe hallux valgus deformity. Patients need to be warned of the recovery time and potential for future metalwork removal. The risk of early recurrence suggests that a lateral release should be included in order to maintain a long lasting correction. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Preoperative radiological factors correlated to long-term recurrence of hallux valgus following distal chevron osteotomy.

    Science.gov (United States)

    Pentikainen, Ilkka; Ojala, Risto; Ohtonen, Pasi; Piippo, Jouni; Leppilahti, Juhana

    2014-12-01

    The purpose of this article was to analyze the long-term radiologic results after distal chevron osteotomy for hallux valgus treatment and to determine the preoperative radiographic factors correlating with radiological recurrence of the deformity. The study included 100 consecutive patients who received distal chevron osteotomy for hallux valgus. The osteotomy included fixation with an absorbable pin in 50 cases, and no fixation in the other 50. For 6 weeks postoperatively, half of each group used a soft cast and half had a traditional elastic bandage. Weight-bearing radiographs were evaluated at 6 weeks, 6 months, 1 year, and a mean of 7.9 (range, 5.8-9.4) years postoperatively. At the final follow-up, radiological recurrence of hallux valgus deformity (HVA > 15 degrees) was observed in 56 feet (73%). Eleven feet (14%) had mild recurrence (HVA hallux valgus recurrence was significantly affected by preoperative congruence, DMAA, sesamoid position, HVA, and I/II IMA. Radiological recurrence of hallux valgus deformity of 15 degrees or more was very common at long-term follow-up after distal chevron osteotomy. Preoperative congruence, DMAA, sesamoid position (LaPorta), HVA, and I/II IMA significantly affected recurrence. Level III, comparative case series. © The Author(s) 2014.

  2. Outcomes in chevron osteotomy for Hallux Valgus in a large cohort

    NARCIS (Netherlands)

    van Groningen, B. (Bart); M.C.M. (Marieke) van der Steen,; M. Reijman (Max); Bos, J. (Janneke); Hendriks, J.G.E. (Johannes G.E.)

    2016-01-01

    textabstractClinical and radiological related outcomes have been reported for Chevron osteotomy as correction for mild to moderate hallux valgus, but only for relatively small patient series. Moreover, evaluation of the patient's point of view has mostly been conducted by means of more

  3. Compensatory mechanisms contributing to keep the sagittal balance of the spine.

    Science.gov (United States)

    Barrey, Cédric; Roussouly, Pierre; Le Huec, Jean-Charles; D'Acunzi, Gennaro; Perrin, Gilles

    2013-11-01

    Aging spine is characterized by facet joints arthritis, degenerative disc disease, bone remodeling and atrophy of extensor muscles resulting in a progressive kyphosis of the lumbar spine. The aim of this paper is to describe the different compensatory mechanisms for patients with severe degenerative lumbar spine. According to the severity of the imbalance, three stages are observed: balanced, balanced with compensatory mechanisms and imbalanced. For the two last stages, the compensatory mechanisms permit to limit the consequences of loss of lumbar lordosis on global sagittal alignment and therefore contribute to keep the sagittal balance of the spine. The basic concept is to extend adjacent segments of the kyphotic spine allowing for compensation of the sagittal unbalance but potentially inducing adverse effects. Finally, we propose a three-step algorithm to analyze the global balance status and take into consideration the presence of the compensatory mechanisms in the spinal, pelvic and lower limb areas.

  4. Influence of implant rod curvature on sagittal correction of scoliosis deformity

    DEFF Research Database (Denmark)

    Salmingo, Remel A.; Tadano, Shigeru; Abe, Yuichiro

    2014-01-01

    BACKGROUND CONTEXT: Deformation of in vivo–implanted rods could alter the scoliosis sagittal correction. To our knowledge, no previous authors have investigated the influence of implanted-rod deformation on the sagittal deformity correction during scoliosis surgery. PURPOSE: To analyze the changes...... of the implant rod’s angle of curvature during surgery and establish its influence on sagittal correction of scoliosis deformity. STUDY DESIGN: A retrospective analysis of the preoperative and postoperative implant rod geometry and angle of curvature was conducted. PATIENT SAMPLE: Twenty adolescent idiopathic...... scoliosis patients underwent surgery. Average age at the time of operation was 14 years. OUTCOME MEASURES: The preoperative and postoperative implant rod angle of curvature expressed in degrees was obtained for each patient. METHODS: Two implant rods were attached to the concave and convex side...

  5. The effect of platelet-rich plasma on osseous healing in dogs undergoing high tibial osteotomy.

    Directory of Open Access Journals (Sweden)

    Samuel P Franklin

    Full Text Available The purpose of this study was to investigate whether platelet-rich plasma (PRP enhances osseous healing in conjunction with a high tibial osteotomy in dogs.Randomized controlled trial.Sixty-four client-owned pet dogs with naturally occurring rupture of the anterior cruciate ligament and that were to be treated with a high tibial osteotomy (tibial plateau leveling osteotomy were randomized into the treatment or control group. Dogs in the treatment group received autologous platelet-rich plasma activated with calcium chloride and bovine thrombin to produce a well-formed PRP gel that was placed into the osteotomy at the time of surgery. Dogs in the control group received saline lavage of the osteotomy. All dogs had the osteotomy stabilized with identical titanium alloy implants and all aspects of the surgical procedure and post-operative care were identical among dogs of the two groups. Bone healing was assessed at exactly 28, 49, and 70 days after surgery with radiography and ultrasonography and with MRI at day 28. The effect of PRP on bone healing was assessed using a repeated measures analysis of covariance with radiographic and ultrasonographic data and using a t-test with the MRI data.Sixty dogs completed the study. There were no significant differences in age, weight, or gender distribution between the treatment and control groups. Twenty-seven dogs were treated with PRP and 33 were in the control group. The average platelet concentration of the PRP was 1.37x106 platelets/μL (±489x103 with a leukocyte concentration of 5.45x103/μL (±3.5x103. All dogs demonstrated progressive healing over time and achieved clinically successful outcomes. Time since surgery and patient age were significant predictors of radiographic healing and time since surgery was a significant predictor of ultrasonographic assessment of healing. There was no significant effect of PRP treatment as assessed radiographically, ultrasonographically, or with MRI.The PRP used

  6. Double pelvic osteotomy for the treatment of hip dysplasia in young dogs.

    Science.gov (United States)

    Vezzoni, A; Boiocchi, S; Vezzoni, L; Vanelli, A B; Bronzo, V

    2010-01-01

    The aim of this study was to evaluate the feasibility of the double pelvic osteotomy (DPO) (osteotomy of the ilium and pubis) to treat clinical cases of hip dyplasia in young dogs instead of performing a triple pelvic osteotomy (TPO) (osteotomy of the ilium, pubis, and ischium). Candidates for DPO were 4.5- to nine-month-old dogs with coxofemoral joint subluxation and laxity, indicative of susceptibility to future development of severe hip dysplasia. The angle of reduction (AR) and angle of subluxation (AS) with Ortolani's sign, Norberg angle (NA), percentage of femoral head (PC) covered by the acetabulum, and the pelvic diameters and their relationships were measured clinically and radiographically before and after surgery. The surgical technique was similar to the TPO technique, but excluded ischiatic osteotomy. A DPO was carried out in 53 joints of 34 dogs; AR and AS values immediately postoperatively and at the one- and two-month follow-up examinations were significantly lower than the preoperative values (p <0.01). The complications encountered were mainly represented by implant failure (3.5%), partial plate pull-out (9.4%), and incomplete fracture of the ischial table (7.5%). Changes in PC and NA values obtained immediately after surgery and at the first and second follow-up examinations were significantly greater (p <0.01 both) than values obtained before surgery. Sufficient acetabular ventroversion was achieved to counteract joint subluxation and the modifications of AR and AS. The NA and PC direct postoperative values reflected a significant improvement in the dorsal acetabular coverage. Restoration of normal joint congruity (PC from 50 to 72%) and maintenance of the pelvic geometry without pelvic narrowing were the most intriguing features of DPO. The complications observed were greatly reduced when using dedicated DPO plates. Based on our experience, the morbidity after unilateral and bilateral DPO was lower than after TPO because elimination of the

  7. The effect of platelet-rich plasma on osseous healing in dogs undergoing high tibial osteotomy

    Science.gov (United States)

    Burke, Emily E.; Holmes, Shannon P.

    2017-01-01

    Objectives The purpose of this study was to investigate whether platelet-rich plasma (PRP) enhances osseous healing in conjunction with a high tibial osteotomy in dogs. Study design Randomized controlled trial. Methods Sixty-four client-owned pet dogs with naturally occurring rupture of the anterior cruciate ligament and that were to be treated with a high tibial osteotomy (tibial plateau leveling osteotomy) were randomized into the treatment or control group. Dogs in the treatment group received autologous platelet-rich plasma activated with calcium chloride and bovine thrombin to produce a well-formed PRP gel that was placed into the osteotomy at the time of surgery. Dogs in the control group received saline lavage of the osteotomy. All dogs had the osteotomy stabilized with identical titanium alloy implants and all aspects of the surgical procedure and post-operative care were identical among dogs of the two groups. Bone healing was assessed at exactly 28, 49, and 70 days after surgery with radiography and ultrasonography and with MRI at day 28. The effect of PRP on bone healing was assessed using a repeated measures analysis of covariance with radiographic and ultrasonographic data and using a t-test with the MRI data. Results Sixty dogs completed the study. There were no significant differences in age, weight, or gender distribution between the treatment and control groups. Twenty-seven dogs were treated with PRP and 33 were in the control group. The average platelet concentration of the PRP was 1.37x106 platelets/μL (±489x103) with a leukocyte concentration of 5.45x103/μL (±3.5x103). All dogs demonstrated progressive healing over time and achieved clinically successful outcomes. Time since surgery and patient age were significant predictors of radiographic healing and time since surgery was a significant predictor of ultrasonographic assessment of healing. There was no significant effect of PRP treatment as assessed radiographically, ultrasonographically

  8. Roussouly's sagittal spino-pelvic morphotypes as determinants of gait in asymptomatic adult subjects.

    Science.gov (United States)

    Bakouny, Ziad; Assi, Ayman; Massaad, Abir; Saghbini, Elie; Lafage, Virginie; Skalli, Wafa; Ghanem, Ismat; Kreichati, Gaby

    2017-05-01

    Sagittal alignment is known to greatly vary between asymptomatic adult subjects; however, there are no studies on the possible effect of these differences on gait. The aim of this study is to investigate whether asymptomatic adults with different Roussouly sagittal alignment morphotypes walk differently. Ninety-one asymptomatic young adults (46M & 45W), aged 21.6±2.2years underwent 3D gait analysis and full body biplanar X-rays with three-dimensional (3D) reconstructions of their spines and pelvises and generation of sagittal alignment parameters. Subjects were divided according to Roussouly's sagittal alignment classification. Sagittal alignment and kinematic parameters were compared between Roussouly types. 17 subjects were classified as type 2, 47 as type 3, 26 as type 4 but only 1 as type 1. Type 2 subjects had significantly more mean pelvic retroversion (less mean pelvic tilt) during gait compared to type 3 and 4 subjects (type 2: 8.2°; type 3:11.2°, type 4: 11.3°) and significantly larger ROM pelvic obliquity compared to type 4 subjects (type 2: 11.0°; type 4: 9.1°). Type 2 subjects also had significantly larger maximal hip extension during stance compared to subjects of types 3 and 4 (type 2: -11.9°; type 3: -8.8°; type 4: -7.9°) and a larger ROM of ankle plantar/dorsiflexion compared to type 4 subjects (type 2: 31.1°; type 4: 27.9°). Subjects with type 2 sagittal alignment were shown to have a gait pattern involving both increased hip extension and pelvic retroversion which could predispose to posterior femoroacetabular impingement and consequently osteoarthritis. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. [SPINO-PELVIC SAGITTAL ALIGNMENT IN PATIENTS WITH HIGH-GRADE L5 ISTHMIC SPONDYLOLISTHESIS].

    Science.gov (United States)

    Yang, Xi; Kong, Qingquan; Song, Yueming; Liu, Limin; Li, Tao; Gong, Quan; Zeng, Jiancheng; Liu, Hao

    2016-01-01

    To observe the character of spino-pelvic sagittal alignment in patients with high-grade L5 isthmic spondylolisthesis, and to analyze the sagittal alignment alteration after operation. Between January 2009 and June 2014, 25 patients with high-grade L5 isthmic spondylolisthesis underwent posterior surgery, and the clinical data were retrospectively analyzed as study group. There were 14 males and 11 females with a mean age of 42.5 years (range, 20-65 years). The mean disease duration was 6 months (range, 3-12 months). According to the Meyerding evaluating system, 15 cases were rated as degree III, and 10 cases as degree IV. Eighty healthy adult volunteers were recruited simultaneously as control group. The lumbar sacral angle (LSA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis (LL), thoracic kyphosis (TK), and sagittal vertical axis (SVA) were measured on preoperative and last follow-up standing full length lateral X-ray films. And these parameters were compared between study group (preoperative parameters) and control group. Then the patients in study group were divided into 2 subgroups according to Hresko's method: the balanced pelvis subgroup (n = 14) and unbalanced pelvis subgroup (n = 11). The sagittal parameters were compared between 2 subgroups, and the alteration of sagittal parameters before surgery and at last follow-up was analyzed in each subgroup respectively. All patients in study group were followed up 18 months on average (range, 6-48 months). After surgery, spondylolisthesis was reduced from degree III to degree 0 in 12 cases and to degree I in 3 cases, and from degree IV to degree 0 in 6 cases and to degree I in 4 cases. Bone fusion was obtained in all patients at last follow-up. The preoperative PI, SS, PT, and SVA of study group were significantly greater than those of control group (P spondylolisthesis have greater PI, abnormal lumbosacral kyphosis, and sagittal imbalance.

  10. Is there a sagittal imbalance of the spine in isthmic spondylolisthesis? A correlation study

    Science.gov (United States)

    Ilharreborde, Brice; Dauzac, Cyril; Lenoir, Thibault; Rillardon, Ludovic; Guigui, Pierre

    2007-01-01

    Recent studies suggested a predominant role of spinopelvic parameters to explain lumbosacral spondylolisthesis pathogeny. We compare the pelvic incidence and other parameters of sagittal spinopelvic balance in adolescents and young adults with developmental spondylolisthesis to those parameters in a control group of healthy volunteers. We compared the angular parameters of the sagittal balance of the spine in a cohort of 244 patients with a developmental L5–S1 spondylolisthesis with those of a control cohort of 300 healthy volunteers. A descriptive and correlation study was performed. The L5 anterior slipping and lumbosacral kyphosis in spondylolisthesis patients was described using multiple regression analysis study. Our study demonstrates that the related measures of sagittal spinopelvic alignment are disturbed in adolescents and young adults with developmental spondylolisthesis. These subjects stand with an increased sacral slope, pelvic tilt and lumbar lordosis but with a decreased thoracic kyphosis. Pelvic incidence was significantly higher in spondylolisthesis patients as compared with controls but was not clearly correlated with the grade of slipping. We showed the same “sagittal balance strategy” in spondylolisthesis patients as in the control group regarding correlations between pelvic incidence, sacral slope, pelvic tilt and lumbar lordosis. We believe that the lumbosacral kyphosis is a stronger factor than pelvic incidence which need to be taken into account as a predominant factor in theories of pathogenesis of lumbosacral spondylolithesis. We thus believe that increased lumbar lordosis associated with L5–S1 spondylolisthesis is secondary to the high pelvic incidence and is an important factor causing high shear stresses at the L5–S1 pars interarticularis. However, the “local” sagittal imbalance of the lumbosacral junction is compensated by adjacent mobile segments in the upper lumbar spine, the pelvis orientation and the thoracic spine

  11. Postural model of sagittal spino-pelvic alignment and its relevance for lumbosacral developmental spondylolisthesis.

    Science.gov (United States)

    Mac-Thiong, Jean-Marc; Wang, Zhi; de Guise, Jacques A; Labelle, Hubert

    2008-10-01

    Comparative study of sagittal spino-pelvic alignment in children and adolescents with developmental lumbosacral spondylolisthesis compared with asymptomatic subjects. To develop a global postural model of sagittal spino-pelvic alignment. The relationships between parameters of sagittal spino-pelvic alignment in developmental spondylolisthesis are still unclear. Radiographs of 120 control subjects and 131 subjects with developmental spondylolisthesis (91 low-grade, 40 high-grade) were reviewed. Subjects with high-grade spondylolisthesis were divided according to their sacro-pelvic alignment: balanced versus retroverted sacro-pelvis. Parameters of the sacro-pelvis (pelvic incidence, pelvic tilt, sacral slope), lumbosacral region (lumbosacral angle, slip percentage), lumbar spine (lumbar lordosis, lumbar tilt), thoracic spine (thoracic kyphosis, thoracic tilt), and global balance (spinal tilt, sagittal offset between C7 and femoral heads) were assessed. Parameters were compared between all groups and a correlation study was performed between all parameters. A postural model that includes the measured parameters was used to analyze the obtained correlations. Significant differences in all parameters are found between all groups, except for sagittal offset. The pattern and strength of correlations is similar between normal and low-grade subjects, showing interdependence between sacro-pelvic, lumbosacral, lumbar, and thoracic regions. The pattern of relationships was altered in high-grade spondylolisthesis, especially for subjects with a retroverted sacro-pelvis for which correlations between pelvic incidence and pelvic tilt, and between the sacro-pelvic unit and lumbar spine geometry are lost. Children and adolescents stand with a relatively constant global sagittal spino-pelvic alignment, regardless of the local lumbosacral deformity. A normal posture is maintained in low-grade spondylolisthesis and in high-grade spondylolisthesis with a balanced sacro-pelvis. Posture

  12. Does Participation in Sports Affect Osteoarthritic Progression After Periacetabular Osteotomy?

    Science.gov (United States)

    Hara, Daisuke; Hamai, Satoshi; Fukushi, Jun-Ichi; Kawaguchi, Ken-Ichi; Motomura, Goro; Ikemura, Satoshi; Komiyama, Keisuke; Nakashima, Yasuharu

    2017-09-01

    Periacetabular osteotomy (PAO) is an effective treatment for symptomatic acetabular dysplasia. However, whether postoperative participation in sports leads to progression of the Kellgren-Lawrence (KL) grade of osteoarthritis (OA) in these patients is unclear. To investigate (1) participation in sports before and after PAO and (2) whether postoperative participation in sports leads to progression of the KL grade. Case-control study; Level of evidence, 3. The authors retrospectively reviewed data on 161 patients (183 hips) who underwent PAO for symptomatic acetabular dysplasia with preoperative KL grade 1 or 2 between 1998 and 2011. The mean age at the time of surgery was 42.0 ± 10.9 years (range, 12-64 years), and the mean follow-up duration was 100 months (range, 13-180 months). Data included participation in sports, the University of California, Los Angeles (UCLA) activity scale score, age at the time of surgery, body mass index, follow-up duration, history of treatment for developmental hip dislocations, Merle d'Aubigné-Postel score, Oxford Hip Score, center-edge angle, and KL grade. Univariate and multivariate analyses were applied to determine which factors were associated with progression to KL grade 3 or 4 after PAO. The number of patients who participated in sports significantly increased from 50 (31.1%) preoperatively to 89 (55.3%) postoperatively. The mean UCLA score significantly increased from 4.7 ± 2.1 preoperatively to 5.5 ± 2.0 postoperatively. The KL grade progressed to grade 3 or 4 in 16 hips, including 4 hips that underwent conversion to total hip arthroplasty. No significant differences were found in postoperative participation in sports (89 hips [53.3%] vs 11 hips [68.8%], respectively; P = .24) and the UCLA score (5.6 ± 2.0 vs 5.1 ± 2.0, respectively; P = .30) between hips with KL grade 1 or 2 and KL grade 3 or 4. A multivariate analysis revealed that no factors, including postoperative participation in sports, were significantly

  13. Combination tibial plateau leveling osteotomy and transverse corrective osteotomy of the proximal tibia for the treatment of complex tibial deformities in 12 dogs.

    Science.gov (United States)

    Weh, Jennifer L; Kowaleski, Michael P; Boudrieau, Randy J

    2011-08-01

    To describe a surgical technique, and outcome, for treatment of proximal tibial deformity (varus, valgus, excessive tibial plateau angle [eTPA], tibial torsion and patellar luxation) by combined tibial plateau leveling osteotomy (TPLO) and transverse corrective osteotomy. Cases series. Dogs (n=12; 19 stifle joints). Medical records of dogs that had combination TPLO and transverse corrective osteotomy, were reviewed. Pre- and postoperative tibial angulation, tibial torsion, tibial plateau angle (TPA), corrective osteotomy technique, method of fixation, and complications were recorded. In hospital re-evaluation of limb function and alignment and length of time to radiographic healing were reviewed. Long-term outcome was assessed by visual analog scale (VAS) questionnaire and owner telephone interview. Proximal tibial varus or valgus was present in 68.4%; 73.7% had eTPA; and 47.4% had both. Medial patellar luxation (MPL) was present in 57.9%, of which 47.4% had tibial tuberosity displacement. Severe tibial torsion was present in 68.4%. Mean pre- and postoperative TPA was 37.5° and 5.7°, respectively. The mean postoperative mechanical medial proximal tibial angle (mMPTA) and mechanical medial distal tibial angle (mMDTA) were 92.2° (range, 88-96°) and 96.1° (range, 94-101°), respectively. Postoperative surgical complications were documented in 21.0%, which included implant loosening or breakage (5.3%), seroma (5.3%), septic arthritis (5.3%), and infection of the proximal tibia (5.3%). All complications were considered major because they required additional surgery. Mean time to document radiographic healing was 10.4 weeks. In-hospital re-evaluation of lameness was obtained at the same time; 82.4% were not lame or had a mild lameness, 17.6% had severe lameness (2/3 with infection). The VAS evaluation revealed excellent results and owner satisfaction in all ten dogs in which long-term follow-up was obtained. Long-term clinical outcome of combination TPLO and

  14. Sagittal synostosis: II. Cranial morphology and growth after the modified pi-plasty

    DEFF Research Database (Denmark)

    Guimaraes-Ferreira, J.; Gewalli, F.; David, L.

    2006-01-01

    The aim of this study was to characterise the postoperative cranial growth and morphology after a modified pi-plasty for sagittal synostosis. The shape of the skull of 82 patients with isolated premature synostosis of the sagittal suture ( SS group) operated on with a modified pi-plasty was studied...... selected landmarks, and angles defined by groups of three landmarks). Paired and unpaired t tests were used to assess the differences between the variables studied. These were accepted as significant for values of p...

  15. Importance of Sagittal Alignment of the Cervical Spine in the Management of Degenerative Cervical Myelopathy.

    Science.gov (United States)

    Buell, Thomas J; Buchholz, Avery L; Quinn, John C; Shaffrey, Christopher I; Smith, Justin S

    2018-01-01

    Cervical spine sagittal malalignment correlates with worse symptoms and outcomes in patients with degenerative cervical myelopathy (DCM), and should influence surgical management. An anterior versus posterior surgical approach may not significantly change outcomes in patients with preoperative lordosis; however, most studies suggest improved neurologic recovery among kyphotic patients after adequate correction of local sagittal alignment through an anterior or combined anterior-posterior approach. There are no comprehensive guidelines for DCM management in the setting of cervical malalignment; therefore, surgical management should be tailored to individual patients and decisions made at the discretion of treating surgeons with attention to basic principles. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Responsiveness of the SF-36 and WOMAC following periacetabular osteotomy for acetabular dysplasia.

    Science.gov (United States)

    Davidson, Darin; Yen, Yi-Meng; Jette, Alan M; Olarsch, Sippy; Kim, Young-Jo

    2011-12-07

    Periacetabular osteotomy is a relatively common reconstructive procedure for the adolescent or young adult with acetabular dysplasia. Although several measures have been used to characterize the outcome, the responsiveness of these measures in this population has not been determined. The purpose of this study was to estimate the responsiveness of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the Short Form-36 (SF-36) in patients with acetabular dysplasia treated with periacetabular osteotomy. Eighty-three patients with acetabular dysplasia treated with periacetabular osteotomy between 2000 and 2005 completed the WOMAC and SF-36 both preoperatively and postoperatively. The scores on each domain of these outcome measures were calculated and analyzed to determine the parameters of responsiveness, including the minimal detectable change at the 90% confidence level. The mean duration of follow-up was 1.9 years. Comparison of the effect size, standardized response mean, and minimal detectable change for the SF-36 and WOMAC demonstrated that the WOMAC was more sensitive to change than the SF-36 was, particularly in the physical function domain (minimal detectable change, 9.1) and the pain domain (minimal detectable change, 5.5). Only one of the eight domains of the SF-36, bodily pain, demonstrated a change in outcome that exceeded the minimal detectable change, which was 2.38. Both the WOMAC and the SF-36 demonstrated adequate responsiveness to change over time in patients with acetabular dysplasia treated with periacetabular osteotomy, although the WOMAC was more sensitive to change. These results indicate that the WOMAC is sufficiently responsive to be used as a joint-specific measure for assessing changes following periacetabular osteotomy for the treatment of acetabular dysplasia.

  17. Pre-programmed robotic osteotomies for fibula free flap mandible reconstruction: A preclinical investigation.

    Science.gov (United States)

    Chao, Albert H; Weimer, Katie; Raczkowsky, Joerg; Zhang, Yaokun; Kunze, Mirko; Cody, Dianna; Selber, Jesse C; Hanasono, Matthew M; Skoracki, Roman J

    2016-03-01

    Bony free flap reconstruction of the facial skeleton remains a challenging area of reconstructive surgery. Despite technological advances that have aided planning and execution of these procedures, surgical inaccuracy is not insignificant. One source of error that has not been wholly addressed is that attributable to a human operator. In this study, we investigate the feasibility and accuracy of performing osteotomies robotically in pre-programmed fashion for fibula free flap mandible reconstruction as a method to reduce inaccuracies related to human error. A mandibular defect and corresponding free fibula flap reconstruction requiring six osteotomies were designed on a CAD platform. A methodology was developed to translate this virtual surgical plan data to a robot (KUKA, Augsburgs, Germany), which then executed osteotomies on three-dimensional (3D) printed fibula flaps with the aid of dynamic stereotactic navigation. Using high-resolution computed tomography, the osteotomized segments were compared to the virtually planned segments in order to measure linear and angular accuracy. A total of 18 robotic osteotomies were performed on three 3D printed fibulas. Compared to the virtual preoperative plan, the average linear variation of the osteotomized segments was 1.3 ± 0.4 mm, and the average angular variation was 4.2 ± 1.7°. This preclinical study demonstrates the feasibility of pre-programmed robotic osteotomies for free fibula flap mandible reconstruction. Preliminarily, this method exhibits high degrees of linear and angular accuracy, and may be of utility in the development of techniques to further improve surgical accuracy. © 2015 Wiley Periodicals, Inc.

  18. Midterm outcome after correction of hallux valgus deformity using scarf osteotomy in adult population

    Directory of Open Access Journals (Sweden)

    Laura Ibrahim Alolayan

    2017-01-01

    Full Text Available Context: Determining the efficacy of any surgical treatment is the key to achieve better practice and best outcomes for patients. Aims: This study is designed to address midterm outcome in adult patients with moderate-to-severe hallux valgus (HV, who underwent scarf osteotomy from 2012 to 2014. Settings and Design: This is a retrospective cohort study in which charts of all adult patients with moderate-to-severe HV who underwent scarf osteotomy from 2011 to 2014 were reviewed. Subjects and Methods: Between 2011 and 2014, 39 patients (41 feet who underwent scarf osteotomy for correction of HV deformity were retrospectively evaluated. Standard weight-bearing dorsoplantar radiographs were obtained pre- and postoperatively. HV angle (HVA, intermetatarsal angle (IMA and distal metatarsal articular angles (DMAA were measured pre- and postoperatively to evaluate the efficacy of the surgery. The complication rate was reported. The average follow-up was 13.5 months, and the patients' mean age was 37 years. Statistical Analysis Used: Data were compared using Chi-square test or Fisher's exact test whichever was appropriate. All tests were two-sided, and a P> 0.01 was considered statistically significant. Results: The average preoperative HVA and IMA were 32° and 14.3°, which improved to 11° and 7.9°, respectively. The changes were statistically significant (P 0.18. Conclusions: This study suggests that scarf osteotomy surgery is a very versatile osteotomy in correcting moderate-to-severe HV deformity. It offers a greater degree of correction and stability, lower rate of complications and good outcome. However, long-term follow-up studies are still needed.

  19. Experimental Fracture Model versus Osteotomy Model in Metacarpal Bone Plate Fixation

    Directory of Open Access Journals (Sweden)

    S. Ochman

    2011-01-01

    Full Text Available Introduction. Osteotomy or fracture models can be used to evaluate mechanical properties of fixation techniques of the hand skeleton in vitro. Although many studies make use of osteotomy models, fracture models simulate the clinical situation more realistically. This study investigates monocortical and bicortical plate fixation on metacarpal bones considering both aforementioned models to decide which method is best suited to test fixation techniques. Methods. Porcine metacarpal bones (=40 were randomized into 4 groups. In groups I and II bones were fractured with a modified 3-point bending test. The intact bones represented a further control group to which the other groups after fixation were compared. In groups III and IV a standard osteotomy was carried out. Bones were fixated with plates monocortically (group I, III and bicortically (group II, IV and tested for failure. Results. Bones fractured at a mean maximum load of 482.8 N ± 104.8 N with a relative standard deviation (RSD of 21.7%, mean stiffness was 122.3 ± 35 N/mm. In the fracture model, there was a significant difference (=0.01 for maximum load of monocortically and bicortically fixed bones in contrast to the osteotomy model (=0.9. Discussion. In the fracture model, because one can use the same bone for both measurements in the intact state and the bone-plate construct states, the impact of inter-individual differences is reduced. In contrast to the osteotomy model there are differences between monocortical and bicortical fixations in the fracture model. Thus simulation of the in vivo situation is better and seems to be suitable for the evaluation of mechanical properties of fixation techniques on metacarpals.

  20. Periacetabular osteotomy. Good pain relief in symptomatic hip dysplasia, 32 patients followed for 4 years.

    Science.gov (United States)

    Pogliacomi, Francesco; Stark, André; Wallensten, Richard

    2005-02-01

    When surgical treatment of dysplastic hip osteoarthrosis is necessary, osteotomy is preferable to fusion or THR. We evaluated periacetabular osteotomy as a method of choice. We treated 36 symptomatic dysplastic hip joints (32 patients) with the Bernese periacetabular osteotomy (PAO) between 1994 and 2001. We used the ilio-inguinal (I-I) approach in 32 hips and a modified Smith-Petersen (S-P) approach in 4. The patients were followed for mean 4 (1.5-8) years. In 1 patient with coxa valga, a varus femoral osteotomy was performed 1 year after PAO. 2 hips, in which we used the modified S-P approach, necessitated a capsulotomy. The median Merle d'Aubignè score increased from 13 points preoperatively to 16 points postoperatively. This improvement in terms of pain, motion and ambulation was accompanied by spatial reorientation and correction. The lateral center edge angle of Wiberg (CE) improved from an average of 7 degrees to 28 degrees. The anterior center edge angle of Lequesne (FP) improved from an average of 18 degrees to 28 degrees. The acetabular index angle (AC) improved from an average of 22 degrees to 10 degrees. Major complications included 1 partial lesion of the sciatic nerve, 1 malunion and 1 combined nonunion of the pubic and ischiatic osteotomy. 2 patients underwent subsequent total hip replacement (THR) for progressive osteoarthrosis with pain. We found good radiographic correction of deformities, improvement of hip function and pain relief with an acceptable complication rate. With appropriate patient selection, this procedure is the most physiological treatment of symptomatic hip dysplasia in young adults. In addition to relieving symptoms, it may prevent and postpone the development of secondary osteoarthrosis.

  1. Treatment of moderate hallux valgus by percutaneous, extra-articular reverse-L Chevron (PERC) osteotomy.

    Science.gov (United States)

    Lucas y Hernandez, J; Golanó, P; Roshan-Zamir, S; Darcel, V; Chauveaux, D; Laffenêtre, O

    2016-03-01

    The aim of this study was to report a single surgeon series of consecutive patients with moderate hallux valgus managed with a percutaneous extra-articular reverse-L chevron (PERC) osteotomy. A total of 38 patients underwent 45 procedures. There were 35 women and three men. The mean age of the patients was 48 years (17 to 69). An additional percutaneous Akin osteotomy was performed in 37 feet and percutaneous lateral capsular release was performed in 22 feet. Clinical and radiological assessments included the type of forefoot, range of movement, the American Orthopedic Foot and Ankle (AOFAS) score, a subjective rating and radiological parameters. The mean follow-up was 59.1 months (45.9 to 75.2). No patients were lost to follow-up. The mean AOFAS score increased from 62.5 (30 to 80) pre-operatively to 97.1 (75 to 100) post-operatively. A total of 37 patients (97%) were satisfied. At the last follow up there was a statistically significant decrease in the hallux valgus angle, the intermetatarsal angle and the proximal articular set angle. The range of movement of the first metatarsophalangeal joint improved significantly.. There was more improvement in the range of movement in patients who had fixation of the osteotomy of the proximal phalanx. Preliminary results of this percutaneous approach are promising. This technique is reliable and reproducible. Its main asset is that it maintains an excellent range of movement. The PERC osteotomy procedure is an effective approach for surgical management of moderate hallux valgus which combines the benefits of percutaneous surgery with the versatility of the chevron osteotomy whilst maintaining excellent first MTPJ range of motion. ©2016 The British Editorial Society of Bone & Joint Surgery.

  2. The early functional outcome of Mau osteotomy for the correction of moderate-severe hallux valgus

    Directory of Open Access Journals (Sweden)

    Tanujan Thangarajah

    2013-11-01

    Full Text Available Hallux valgus is one of the commonest conditions of the foot and has been reported to affect nearly half of the adult population. It is most effectively treated by a corrective osteotomy of which there a numerous subtypes. The Mau osteotomy confers the greatest structural stability but is not thought to provide adequate correction of moderate-severe deformities. Accordingly, complications such as under correction and non-union are common. The aim of this study was to determine the functional outcome in patients with moderate-severe hallux valgus following a Mau osteotomy. A retrospective review of 23 patients with moderate-severe hallux valgus treated by Mau osteotomy was conducted. Patients were assessed clinically by the American Orthopedic Foot and Ankle Society (AOFAS scoring system and radiologically by measuring the first intermetatarsal (IM and hallux abductovalgus angles (HAV. The mean AOFAS score had improved from 47 preoperatively to 92 postoperatively (P<0.01. Additionally, preoperative HAV and IM angles improved from 39° and 15° respectively to 15° and 9° respectively (P<0.01. There were no cases of undercorrection or non-union. In this series, the Mau osteotomy was able to achieve good correction of the IM and HAV angles in patients with moderate-severe hallux valgus. This was reflected in a significantly higher postoperative AOFAS score. Contrary to other studies there were no cases of undercorrection and despite allowing patients to fully weight-bear postoperatively there were no cases of non-union.

  3. Analysis of Factors Associated With Sagittal Balance in Normal Asymptomatic Individuals: A Retrospective Study in a Population of East China.

    Science.gov (United States)

    Yang, Mingyuan; Yang, Changwei; Zhai, Xiao; Zhao, Jian; Zhu, Xiaodong; Li, Ming

    2017-02-15

    A retrospective study. To determine primary contributors to sagittal balance and establish a predictive equation of sagittal balance in normal asymptomatic subjects. Sagittal balance has been verified to be associated with health-related quality of life. Although many studies have been performed to explore factors contributing to sagittal balance in various disease states, no study has been conducted in normal asymptomatic subjects in East China. Medical records of 340 asymptomatic healthy volunteers were reviewed from January 2014 to August 2015, including 311 for exploring the risk factors and predictive equation, and 29 for validation. Demographic and radiological parameters were evaluated. Correlation analysis between spinopelvic parameters was pursued. Regression analyses were performed to establish predictive radiographic parameters for sagittal balance. Paired t test was conducted to test the regression equation. There was a very good correlation between T1 sagittal angle and maxTK, maxLL and SS, SS and PI, and PT and PI; a moderate correlation between maxTK and maxLL, and maxLL and PI; a weak correlation between T1 sagittal angle and age, age and maxTK, age and SS, age and PT, age and SVA, T1 sagittal angel and SVA, SVA and PT, and SVA and PI; and very weak correlation between T1 sagittal angle and maxLL, maxLL and PT, SVA and LL, and PT and SS. Age, T1 sagittal angle, maxLL, PT, and PI were primary contributors to sagittal balance, which could be predicted by the regression equation: SVA = 0.294 × age + 0.367 × T1 sagittal angle - 1.149 × maxLL-0.704 × PT + 1.378 × PI - 34.164. No significant difference was found between actual SVA and predicted SVA using our equation (P = 0.307). Age, T1 sagittal angle, maxLL, PT, and PI were primary contributors to maintaining sagittal balance in normal asymptomatic subjects, and sagittal balance could be predicted by calculation using the equation derived in this study. 2.

  4. Algebraic techniques for diagonalization of a split quaternion matrix in split quaternionic mechanics

    Energy Technology Data Exchange (ETDEWEB)

    Jiang, Tongsong, E-mail: jiangtongsong@sina.com [Department of Mathematics, Linyi University, Linyi, Shandong 276005 (China); Department of Mathematics, Heze University, Heze, Shandong 274015 (China); Jiang, Ziwu; Zhang, Zhaozhong [Department of Mathematics, Linyi University, Linyi, Shandong 276005 (China)

    2015-08-15

    In the study of the relation between complexified classical and non-Hermitian quantum mechanics, physicists found that there are links to quaternionic and split quaternionic mechanics, and this leads to the possibility of employing algebraic techniques of split quaternions to tackle some problems in complexified classical and quantum mechanics. This paper, by means of real representation of a split quaternion matrix, studies the problem of diagonalization of a split quaternion matrix and gives algebraic techniques for diagonalization of split quaternion matrices in split quaternionic mechanics.

  5. Additive operator-difference schemes splitting schemes

    CERN Document Server

    Vabishchevich, Petr N

    2013-01-01

    Applied mathematical modeling isconcerned with solving unsteady problems. This bookshows how toconstruct additive difference schemes to solve approximately unsteady multi-dimensional problems for PDEs. Two classes of schemes are highlighted: methods of splitting with respect to spatial variables (alternating direction methods) and schemes of splitting into physical processes. Also regionally additive schemes (domain decomposition methods)and unconditionally stable additive schemes of multi-component splitting are considered for evolutionary equations of first and second order as well as for sy

  6. Splitting in schizophrenia and borderline personality disorder

    National Research Council Canada - National Science Library

    Pec, Ondrej; Bob, Petr; Raboch, Jiri

    2014-01-01

    .... A purpose of this study is to examine relationships between psychological process of splitting and disturbed cognitive and affective functions in schizophrenia and borderline personality disorder (BPD...

  7. Surgical outcome after using a modified technique of the pi-procedure for posterior sagittal suture closure

    NARCIS (Netherlands)

    Engel, M.; Freudlsperger, C.; Hoffmann, J.; Muhling, J.; Castrillon-Oberndorfer, G.; Seeberger, R.

    2012-01-01

    Fusion of the sagittal suture is the most prevalent form of craniosynostosis. Due to the variety of deformities of scaphocephaly depending on the location of the fused sagittal suture, the surgical procedure has to be adjusted to the individual case. In this study, 38 patients with a predominantly

  8. Method for carbon dioxide splitting

    Energy Technology Data Exchange (ETDEWEB)

    Miller, James E.; Diver, Jr., Richard B.; Siegel, Nathan P.

    2017-02-28

    A method for splitting carbon dioxide via a two-step metal oxide thermochemical cycle by heating a metal oxide compound selected from an iron oxide material of the general formula A.sub.xFe.sub.3-xO.sub.4, where 0.ltoreq.x.ltoreq.1 and A is a metal selected from Mg, Cu, Zn, Ni, Co, and Mn, or a ceria oxide compound of the general formula M.sub.aCe.sub.bO.sub.c, where 0

  9. Salt splitting with ceramic membranes

    Energy Technology Data Exchange (ETDEWEB)

    Kurath, D. [Pacific Northwest National Lab., Richland, WA (United States)

    1996-10-01

    The purpose of this task is to develop ceramic membrane technologies for salt splitting of radioactively contaminated sodium salt solutions. This technology has the potential to reduce the low-level waste (LLW) disposal volume, the pH and sodium hydroxide content for subsequent processing steps, the sodium content of interstitial liquid in high-level waste (HLW) sludges, and provide sodium hydroxide free of aluminum for recycle within processing plants at the DOE complex. Potential deployment sites include Hanford, Savannah River, and Idaho National Engineering Laboratory (INEL). The technical approach consists of electrochemical separation of sodium ions from the salt solution using sodium (Na) Super Ion Conductors (NaSICON). As the name implies, sodium ions are transported rapidly through these ceramic crystals even at room temperatures.

  10. Flexion Osteotomy in Genu Recurvatum Following Post-Polio Syndrome: Use of an Old Technique in a New Condition

    Directory of Open Access Journals (Sweden)

    Abolfazle Bagherifard

    2017-05-01

    Full Text Available Introduction Post-polio syndrome (PPS can have devastating functional effects on the walking ability of patients decades after the acute disease. Genu recurvatum, as a consequence of PPS, is one such disability which can be treated through different measures. Case Presentation A 43-year-old woman with a history of supracondylar extension osteotomy of the left femur at the age of 22 was admitted to our hospital for a flexion contracture of the left knee due to poliomyelitis. She was able to walk without assistance for 20 years after the osteotomy until one year ago, when she started to experience progressive genu recurvatum. In the clinical and laboratory workup, she was diagnosed with PPS. Accordingly, we decided to perform supracondylar flexion osteotomy. Conclusions Supracondylar flexion osteotomy in patients with genu recurvatum, as a consequence of PPS, is a valuable treatment, which can relieve the patients' dependence on walking aids and improve their symptoms.

  11. Cementless total hip arthroplasty for patients previously treated with femoral osteotomy for hip dysplasia: the incidence of periprosthetic fracture

    National Research Council Canada - National Science Library

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

    2016-01-01

    Femur deformities can make stem fixation difficult in total hip arthroplasty (THA). We report the clinical results of cementless THA using a press-fit stem in patients who had previously undergone femoral osteotomy for hip...

  12. Total hip arthroplasty (S-ROM stem and subtrochanteric osteotomy for Crowe type IV developmental dysplasia of the hip

    Directory of Open Access Journals (Sweden)

    Liangtao Li

    2016-01-01

    Conclusions: In the primary THA for the treatment of irreducible DDH, subtrochanteric oblique osteotomy combined with the freely-rotatable S-ROM stem provided favorable short term outcomes by affording both morphological and functional advantages.

  13. Radiological Outcome of Patients with Splay Foot Following First and Fifth Metatarsal Osteotomies Performed Simultaneously on the Same Foot

    Directory of Open Access Journals (Sweden)

    Hadi Mohammed

    2012-12-01

    Conclusion: The results suggest a very good radiological outcome in symptomatic patients following simultaneous first and fifth metatarsal osteotomies. All the angles measured postoperatively, except the distal metatarsal articular angle, showed a statistically significant reduction.

  14. Salt splitting using ceramic membranes

    Energy Technology Data Exchange (ETDEWEB)

    Kurath, D.E. [Pacific Northwest National Lab., Richland, WA (United States)

    1997-10-01

    Many radioactive aqueous wastes in the DOE complex have high concentrations of sodium that can negatively affect waste treatment and disposal operations. Sodium can decrease the durability of waste forms such as glass and is the primary contributor to large disposal volumes. Waste treatment processes such as cesium ion exchange, sludge washing, and calcination are made less efficient and more expensive because of the high sodium concentrations. Pacific Northwest National Laboratory (PNNL) and Ceramatec Inc. (Salt Lake City UT) are developing an electrochemical salt splitting process based on inorganic ceramic sodium (Na), super-ionic conductor (NaSICON) membranes that shows promise for mitigating the impact of sodium. In this process, the waste is added to the anode compartment, and an electrical potential is applied to the cell. This drives sodium ions through the membrane, but the membrane rejects most other cations (e.g., Sr{sup +2}, Cs{sup +}). The charge balance in the anode compartment is maintained by generating H{sup +} from the electrolysis of water. The charge balance in the cathode is maintained by generating OH{sup {minus}}, either from the electrolysis of water or from oxygen and water using an oxygen cathode. The normal gaseous products of the electrolysis of water are oxygen at the anode and hydrogen at the cathode. Potentially flammable gas mixtures can be prevented by providing adequate volumes of a sweep gas, using an alternative reductant or destruction of the hydrogen as it is generated. As H{sup +} is generated in the anode compartment, the pH drops. The process may be operated with either an alkaline (pH>12) or an acidic anolyte (pH <1). The benefits of salt splitting using ceramic membranes are (1) waste volume reduction and reduced chemical procurement costs by recycling of NaOH; and (2) direct reduction of sodium in process streams, which enhances subsequent operations such as cesium ion exchange, calcination, and vitrification.

  15. [The effects of orthognathic surgery on mandibular movements in patients with mandibular prognathism].

    Science.gov (United States)

    Sinobad, Vladimir; Dodić, Slobodan; Strajnić, Ljiljana; Vukadinović, Miroslav

    2012-01-01

    Mandibular prognathism, one of the most severe dentofacial deformities, affects the person's appearance, psychological health and the quality of life in the most sensitive age period. The aim of this study was to evaluate the effects of sagittal split ramus osteotomy on the range of mandibular border movements in the early postoperative period. The study was conducted on 20 patients, of mean age 20.8 years, with mandibular prognathism. All patients included in this study were operated on by bilateral sagittal spliting ramus osteotomy according to Obwegeser and Dal Pont followed by mandibular immobilization during eight weeks. In all patients mandibular border movements were recorded before and six months after surgery using the computerized pantograph Arcus-Digma (KaVo EWL GmbH, Leutkirch, Germany). The analysis of the chosen kinematic parameters revealed that sagittal split ramus osteotomy followed by eight weeks of mandibular immobilization had severe effects on the mouth opening. Six months after surgery the range of maximal mouth opening decreased for approximately 13.9 mm in relation to the preoperative stage. On the contrary, the ranges of maximal protrusion and the border of laterotrusive excursions increased significantly after surgery. In patients with mandibular prognathism where enormous mandibular growth was the main causal factor of the deformity, the sagittal split ramus osteotomy yielded good results. The rigid fixation of bone fragments and reduced period of mandibular immobilization followed by appropriate physical therapy could considerably contribute to a more rapid recovery of mandibular kinematics in the postoperative period.

  16. Quantitative analysis of the long- and short-arm crescentic shelf bunionectomy osteotomies in fresh cadaveric matched pair specimens.

    Science.gov (United States)

    Gocke, Sean P; Rottier, Francis J; Havey, Robert M; Renner, Susan M; Patwardhan, Avinash G; Carandang, Gerard

    2011-01-01

    Two variations of crescentic shelf osteotomies have been described for the treatment of moderate to severe hallux abductovalgus: a short arm and a long arm. This study tested the hypothesis that the short-arm osteotomy will have a greater moment to failure and angular stiffness than the long arm. Eighteen first metatarsal specimens were dissected from 9 matched pairs of fresh frozen cadaveric specimens. One metatarsal from each pair received a short-arm osteotomy, whereas the other received a long-arm osteotomy. Each osteotomy was fixed with 2 screws. The short arm was fixed with 1 oblique screw and 1 dorsal-to-plantar screw. The long arm was fixed with 2 dorsal-to-plantar screws: 1 at the proximal aspect and 1 at the distal aspect of the shelf. Each specimen was loaded in a materials testing machine to measure moment to failure and angular stiffness. The base of the first metatarsal was potted and load applied to the plantar aspect of the metatarsal head at a constant rate until failure of the osteotomy. The mean maximum moment to failure of the short arm was significantly greater than the long arm (2.04 ± 0.96 Newton meter [Nm] vs. 1.48 ± 0.67 Nm, P = .03). The mean angular stiffness was significantly greater for short arm versus long arm (23.8 ± 19.11 Nm/radian vs. 0.98 ± 9.08 Nm/radian, P = .01). We report statistically significant data supporting the short-arm crescentic shelf osteotomy to have a greater moment to failure and angular stiffness compared with the long-arm crescentic shelf osteotomy. Copyright © 2011 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  17. The place of intertrochanteric osteotomy in the treatment of idiopathic necrosis of the head of the femur

    OpenAIRE

    Cañadell, J.M. (J. M.); Aguilella, R. (R.); Azcarate, J. (J.); Valenti, J.R. (José Ramón)

    1986-01-01

    The authors present their experience of the use of intertrochanteric osteotomy for the treatment of idiopathic necrosis of the head of the femur. The results obtained from 102 osteotomies performed on 81 patients with the disease are analysed. The mean follow-up is 4.2 years. The results show a statistically significant clinical improvement after operation. Patients presenting with Ficat and Arlet Stage II involvement fared much better than those with more severe changes. Better results were ...

  18. A Modified Technique of Fixation for Proximal Femoral Valgus Osteotomy in Abnormal Bone: A Report of Two Cases

    Directory of Open Access Journals (Sweden)

    Logheswaren S

    2017-07-01

    Full Text Available The ideal size of intramedullary device to fix corrective osteotomy of proximal femur in abnormal bone in children and small patients may not be easily available. We report the successful use of Rush rod in combination with multiple Kirschner wires to fix the corrective osteotomy of coxa vara and shepherd crook deformity in two patients with osteogenesis imperfecta and fibrous dysplasia. The union was achieved on time, neck shaft angle and rotation were maintained.

  19. The evaluation of surgical factors related to recovery period of upper lip hypoaesthesia after Le Fort I osteotomy

    OpenAIRE

    Ueki, Koichiro; Hashiba, Yukari; Marukawa, Kohei; Nakagawa, Kiyomasa; Alam, S.; Yamamoto, Etsuhide

    2008-01-01

    Purpose: It is unclear whether surgical factors can affect the upper lip sensitivity. The aim of this study was to assess the factors that can affect the recovery period of hypoaesthesia of the upper lip after Le Fort I osteotomy, using trigeminal somatosensory evoked potential (TSEP) objectively. Patients and methods: Twenty-nine patients with mandibular prognathism underwent Le Fort I osteotomy with and without artificial pterygoid plate fracture. Trigeminal nerve hypoaesthesia at the regio...

  20. Bilateral varus osteotomies in hip deformities: are early interventions superior?: A long-term follow-up

    OpenAIRE

    Haverkamp, D.; Marti, R. K.

    2006-01-01

    Coxa valga (with or withour excessive femoral anteversion) combined with acetabular dysplasia is a well-known cause of early osteoarthritis. Many authors have stated that the best result of an osteotomy can be achieved at an early stage of these osteoarthritic changes. In this study, we present 26 patients with a symmetrical hip deformity for which we performed a therapeutic osteotomy on the symptomatic hip. The contralateral hip had the same anatomical predisposition to develop an OA, but th...

  1. CT study on bony interface after Le Fort I osteotomy; Examination of bony interface in maxillary advancement and impaction

    Energy Technology Data Exchange (ETDEWEB)

    Goto, Satoshi; Kawamura, Hiroshi; Motegi, Katsutoshi (Tohoku Univ., Sendai (Japan). School of Dentistry)

    1994-04-01

    Bony contact after the maxilla had been mobilized by Le Fort I osteotomy was evaluated by computed tomographic examination of 52 Japanese dry skulls. The lateral piriform wall and the base of the zygomatic process of the maxilla which consist of thick bone are important areas to achieve good stability. Some cases of maxillary advancement and/or impaction lacked an osseous interface at the posterior wall. Preoperative CT along the osteotomy-line is recommended to achieve better postoperative stability. (author).

  2. Sagittal range of motion after a spinal fracture : does ROM correlate with functional outcome?

    NARCIS (Netherlands)

    Post, RB; Leferink, VJM

    2004-01-01

    Literature regarding the effect of a spinal fracture and its treatment in terms of resulting spinal range of motion (ROM) is scarce. However, there is need for data regarding sagittal spinal ROM, since many patients who sustain a spinal fracture are concerned about the back mobility they will have

  3. Postoperative change in sagittal balance after Kyphoplasty for the treatment of osteoporotic vertebral compression fracture.

    Science.gov (United States)

    Yokoyama, Kunio; Kawanishi, Masahiro; Yamada, Makoto; Tanaka, Hidekazu; Ito, Yutaka; Kawabata, Shinji; Kuroiwa, Toshihiko

    2015-04-01

    The influence of vertebral cement augmentation on spinal sagittal balance is unknown. The present study aimed to analyze the changes in total spinal alignment after Kyphoplasty in VCF patients. The study involved 21 VCF patients who underwent Kyphoplasty. In all patients, lateral radiographs of the entire spine were taken preoperatively and 1 month after surgery, to measure the pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), lumbar lordosis (LL), sagittal vertical axis (SVA), and spinosacral angle (SSA). These parameters were compared between VCF patients and 30 healthy volunteers. In VCF patients, the parameters were compared before and after Kyphoplasty. In VCF patients, preoperative SVA was 7.00 ± 3.9 cm, showing a significant shift to anterior sagittal balance as compared to the healthy group (1.45 ± 2.7 cm) (P Kyphoplasty, SVA decreased to 5.02 ± 2.91 (P = 0.0007) and LL and SSA increased (LL P = 0.028; SSA P = 0.0031). Postoperative decrease of SVA was correlated with the kyphotic change of treated vertebra (r = 0.792, P Kyphoplasty to 2.38 ± 2.3 postoperatively (P Kyphoplasty plays a role not only in reducing pain associated with fractures but also in improving sagittal imbalance in the treatment of painful vertebral compression fracture.

  4. Comparison of radiological spino-pelvic sagittal parameters in skiers and non-athletes.

    Science.gov (United States)

    Todd, Carl; Kovac, Peter; Swärd, Anna; Agnvall, Cecilia; Swärd, Leif; Karlsson, Jon; Baranto, Adad

    2015-10-17

    The purpose of the present study is to compare the radiological parameters of the spino-pelvic sagittal alignment in young elite skiers and non-athletes of a similar age. The sample group (n = 102) consisted of elite Alpine and Mogul skiers (n = 75) and a non-athletic population (n = 27), mean age for both groups was 17.7 (±1.4) years (skiers mean age 18.3 SD 1.1 and controls 16.4 SD 0.6). Radiological measurements of the spino-pelvic sagittal alignment were examined from plain radiographs taken in the long-standing position. There were no significant differences reported in the pelvic parameters between both groups. A difference was reported in the sagittal vertebral axis between skiers (8.0 cm SD 46.0) and the control group (-2.0 cm SD 39.0), which may be of clinical significance, in spite of being statistically non-significant. Type I spinal curves according to Roussouly were shown to be more prevalent in the skiers (18.2%) compared with the control group (0.0%) and were statistically significant (p = 0.03). Elite young skiers are shown to have a more prevalent type I spine and a different spino-pelvic sagittal alignment compared to a healthy non-sporting population of a similar age.

  5. INFLUENCE OF THE SAGITTAL BALANCE ON THE CLINICAL OUTCOME IN SPINAL FUSION

    Directory of Open Access Journals (Sweden)

    Marcela Almeida Campos Coutinho

    2016-03-01

    Full Text Available ABSTRACT Objective: Evaluates which radiographic parameters of the sagittal and spinopelvic balance influence the clinical and functional outcomes of a sample of patients undergoing spinal fusion. Methods: We studied 32 patients who underwent spinal fusion. Radiographs of the total spine were obtained from all patients. The clinical and functional parameters studied were analysis of pain by visual analogic scale (VAS and Oswestry and SRS-30 questionnaires. We analyzed the correlation between the clinical and functional parameters and radiographic parameters of the sagittal and spinopelvic balance. Results: There was no significant correlation between parameters pelvic incidence (PI, pelvic tilt (PT, lumbar lordosis (LL and difference between PI and LL (PI-LL and clinical parameters (p > 0.05 and r <0.2. Significant correlation were identified only between Sagittal Vertical Axis (SVA and Satisfaction with Treatment domain of SRS-30 (r = 0.402 e p = 0.023 and between thoracic kyphosis (TK and the total SRS-30 (r = 0.419 and p = 0.017. Conclusions: According to the study results, it was not possible to precisely characterize the role of the parameters of the sagittal and spinopelvic balance in the post-operative analysis of the clinical outcome of spinal fusion. There was a significant correlation only between SVA and the Satisfaction with Treatment domain of SRS-30 and between TK and total SRS-30.

  6. Effect of Cervical Sagittal Balance on Laminoplasty in Patients With Cervical Myelopathy.

    Science.gov (United States)

    Kato, Minori; Namikawa, Takashi; Matsumura, Akira; Konishi, Sadahiko; Nakamura, Hiroaki

    2017-04-01

    Retrospective clinical study. We evaluated the relationship between cervical sagittal alignment parameters and clinical status in patients with cervical myelopathy and analyzed the effect of cervical sagittal balance on cervical laminoplasty. Patients with cervical myelopathy (n = 110) who underwent laminoplasty were included in this study. The relationship between cervical sagittal alignment parameters and clinical status was evaluated. The changes in radiographic cervical sagittal parameters and clinical status 2 years after surgery were compared between patients with preoperative C2-7 SVA ≥35 mm (group A) and those with preoperative C2-7 SVA SVA had no correlation with defined health-related quality of life evaluation scores. At 2-year follow-up, the improvement in SF-36 physical component summary was significantly lower in group A than in group B. The postoperative change of C2-7 SVA did not significantly differ in 2 groups. Patients in group A maintained cervical regional balance after laminoplasty but experienced extensive postoperative neck pain. Our patients with a C2-7 SVA of ≥35 mm maintained cervical regional balance after laminoplasty and their improvement in myelopathy was equivalent to that in patients with a C2-7 SVA of SVA of ≥35 mm experienced severe postoperative neck pain. C2-7 SVA is a parameter worth considering because it can lead to poor QOL and axial neck pain after laminoplasty.

  7. Comparison of Sagittal Spinopelvic Alignment between Lumbar Degenerative Spondylolisthesis and Degenerative Spinal Stenosis.

    Science.gov (United States)

    Lim, Jae Kwan; Kim, Sung Min

    2014-06-01

    The purpose of this study was to evaluate the differences in sagittal spinopelvic alignment between lumbar degenerative spondylolisthesis (DSPL) and degenerative spinal stenosis (DSS). Seventy patients with DSPL and 72 patients with DSS who were treated with lumbar interbody fusion surgery were included in this study. The following spinopelvic parameters were measured on whole spine lateral radiographs in a standing position : pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), lumbar lordosis angle (LL), L4-S1 segmental lumbar angle (SLL), thoracic kyphosis (TK), and sagittal vertical axis from the C7 plumb line (SVA). Two groups were subdivided by SVA value, respectively. Normal SVA subgroup and positive SVA subgroup were divided as SVA value (SVA of DSPL was significantly greater than that of DSS (p=0.001). In sub-group analysis between the positive (34.3%) and normal SVA (65.7%), there were significant differences in LL/PI and SLL/PI (pSVA (87.5%), there were significant differences in PT/PI, SS/PI, LL/PI and SLL/PI ratios (p<0.05) in the DSS group. Patients with lumbar degenerative spondylolisthesis have the propensity for sagittal imbalance and higher pelvic incidence compared with those with degenerative spinal stenosis. Sagittal imbalance in patients with DSPL is significantly correlated with the loss of lumbar lordosis, especially loss of segmental lumbar lordosis.

  8. [Progressive Intracranial Hypertension due to Superior Sagittal Sinus Thrombosis Following Mild Head Trauma: A Case Report].

    Science.gov (United States)

    Suto, Yuta; Maruya, Jun; Watanabe, Jun; Nishimaki, Keiichi

    2015-07-01

    Cerebral venous sinus thrombosis after mild head trauma without skull fracture or intracranial hematoma is exceptionally rare. We describe an unusual case of progressive intracranial hypertension due to superior sagittal sinus thrombosis following mild head trauma. A 17-year-old boy presented with nape pain a day after a head blow during a gymnastics competition (backward double somersault). On admission, he showed no neurological deficit. CT scans revealed no skull fractures, and there were no abnormalities in the brain parenchyma. However, his headache worsened day-by-day and he had begun to vomit. Lumbar puncture was performed on Day 6, and the opening pressure was 40 cm of water. After tapping 20 mL, he felt better and the headache diminished for a few hours. MR venography performed on Day 8 revealed severe flow disturbance in the posterior third of the superior sagittal sinus with multiple venous collaterals. Because of the beneficial effects of lumbar puncture, we decided to manage his symptoms of intracranial hypertension conservatively with repeated lumbar puncture and administration of glycerol. After 7 days of conservative treatment, his symptoms resolved completely, and he was discharged from the hospital. Follow-up MR venography performed on Day 55 showed complete recanalization of the superior sagittal sinus. The exact mechanism of sinus thrombosis in this case is not clear, but we speculate that endothelial damage caused by shearing stress because of strong rotational acceleration or direct impact to the superior sagittal sinus wall may have initiated thrombus formation.

  9. Assessment of masticatory function in patients with non-sagittal occlusal discrepancies.

    Science.gov (United States)

    Choi, T-H; Kim, B-I; Chung, C J; Kim, H-J; Baik, H-S; Park, Y-C; Lee, K-J

    2015-01-01

    Non-sagittal occlusal discrepancies such as posterior cross-bite and anterior openbite are common types of malocclusion, but studies on masticatory function related to those malocclusions have been scarce. The aim of this study was to quantify the masticatory performance in patients with non-sagittal discrepancies compared to those with normal occlusion, using both objective and subjective measures. Maximum bite force and contact area using Dental Prescale(®) system as a static objective assessment, Mixing Ability Index (MAI) as a dynamic objective evaluation and food intake ability (FIA) as a subjective assessment were analysed from 21 people in normal occlusion (Group N) and 64 patients with posterior cross-bite (Group C), anterior openbite (Group O) or both (Group B). The differences of the maximum bite force, the contact area, the MAI and the FIA were compared, and their correlations were figured out. The non-sagittal malocclusion groups showed lower values in the maximum bite force, the contact area, the MAI and the FIA compared to those in the normal group (P masticatory function in patients with non-sagittal discrepancies is significantly reduced both objectively and subjectively. © 2014 John Wiley & Sons Ltd.

  10. Measurement of lumbar spine intervertebral motion in the sagittal plane using videofluoroscopy.

    Science.gov (United States)

    Harvey, Steven; Hukins, David; Smith, Francis; Wardlaw, Douglas; Kader, Deiary

    2016-08-10

    Static radiographic techniques are unable to capture the wealth of kinematic information available from lumbar spine sagittal plane motion. Demonstration of a viable non-invasive technique for acquiring and quantifying intervertebral motion of the lumbar spine in the sagittal plane. Videofluoroscopic footage of sagittal plane lumbar spine flexion-extension in seven symptomatic volunteers (mean age = 48 yrs) and one asymptomatic volunteer (age = 54 yrs) was recorded. Vertebral bodies were digitised using customised software employing a novel vertebral digitisation scheme that was minimally affected by out-of-plane motion. Measurement errors in intervertebral rotation (± 1°) and intervertebral displacement (± 0.5 mm) compare favourably with the work of others. Some subjects presenting with an identical condition (disc prolapse) exhibited a similar column ver