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Sample records for vascularised fibular rotatory

  1. Limb conservation using non vascularised fibular grafts.

    Science.gov (United States)

    Omololu, B; Ogunlade, S O; Alonge, T O

    2002-01-01

    This paper highlights the use of non-vascularised fibular graft in limb reconstruction from bone loss due to trauma and infection. Bone loss can occur from severe high velocity injuries due to road traffic accidents, severe neglected infections, and osteolytic tumours. In majority of cases, the surgeon is left with the only option of an amputation especially where there is no access to microvascular surgery and microvascular bone grafting devices. This is a major problem in the West African subregion hence the need for this article. We present illustrative cases of limb conservation in an adult involved in a high velocity trauma and a child with a destructive osteolytic infection culminating in bone loss. The patients are still been followed up in our surgical outpatient clinics.

  2. Limb conservation using non vascularised fibular grafts | Omololu ...

    African Journals Online (AJOL)

    This paper highlights the use of non-vascularised fibular graft in limb reconstruction from bone loss due to trauma and infection. Bone loss can occur from severe high velocity injuries due to road traffic accidents, severe neglected infections, and osteolytic tumours. In majority of cases, the surgeon is left with the only option ...

  3. Vascularised Fibular Graft for a Radial Defect following Tumour ...

    African Journals Online (AJOL)

    HP

    Conclusion: Free vascularised fibular graft is a viable option for bridging large bone defects in developing countries. As long ... Various methods have been described for reconstruction of large segmental bone defects following trauma or surgical ... also no fever, weight loss, chronic cough or night sweats. He visited some ...

  4. Management of combined nonunion and limb-length discrepancy after vascularised fibular grafting.

    Science.gov (United States)

    Abdel-Ghani, H; Ebeid, W; El-Barbary, H

    2010-02-01

    We describe the management of nonunion combined with limb-length discrepancy following vascularised fibular grafting for the reconstruction of long-bone defects in the lower limb after resection of a tumour in skeletally immature patients. We operated on nine patients with a mean age of 13.1 years (10.5 to 14.5) who presented with a mean limb-length discrepancy of 7 cm (4 to 9) and nonunion at one end of a vascularised fibular graft, which had been performed previously, to reconstruct a bone defect after resection of an osteosarcoma. Reconstruction was carried out using a ring fixator secured with correction by half pins of any malalignment, compression of the site of nonunion and lengthening through a metaphyseal parafocal osteotomy without bone grafting. The expected limb-length discrepancy at maturity was calculated using the arithmetic method. Solid union and the intended leg length were achieved in all the patients. Excessive scarring and the distorted anatomy from previous surgery in these patients required other procedures to be performed with minimal exposures and dissection in order to avoid further compromise to the vascularity of the graft or damage to neurovascular structures. The methods which we chose were simple and effective in addressing these complex problems.

  5. Salvage of foot with extensive giant cell tumour with transfer of vascularised fibular bone graft

    Directory of Open Access Journals (Sweden)

    Jose Tharayil

    2011-01-01

    Full Text Available Though giant cell tumor is not uncommon in young adults, simultaneous involvement of multiple mid-foot bones is very uncommon and very difficult to treat. For reconstruction of large segmental bony defects following tumour excision, free vascularized bone graft is an excellent surgical option. We report a case with extensive involvement of all the tarsal bones and metatarsal bases in a young adult. After excision his foot was reconstructed with vascularised bone flap. We were able to save his foot after a wide local excision and reconstruction with free fibula graft. Graft united early and showed excellent remodelling because of good vascularity. We feel that this method deserves consideration as a last attempt to salvage functional foot in disease like this.

  6. Vascularised fibular grafts as a salvage procedure in failed intercalary reconstructions after bone tumour resection of the femur.

    Science.gov (United States)

    Campanacci, Domenico Andrea; Puccini, Serena; Caff, Giuseppe; Beltrami, Giovanni; Piccioli, Andrea; Innocenti, Marco; Capanna, Rodolfo

    2014-02-01

    Vascularised fibular grafts (VFGs) are widely used for primary reconstruction of long bones after bone tumour resections. The biological properties of VFGs are such that they can be a useful option even in failed intercalary reconstructions. The purpose of the current study was to investigate the results and the morbidity of VFGs as a salvage procedure in failed previous reconstructions after intercalary bone tumour resection of the femur. Our series included 12 patients, treated from April 1989 to March 2005, with an average age of 23 years (range 10-43 years) at presentation. The initial diagnosis was osteosarcoma in 10 cases and Ewing's sarcoma in two cases. All patients received chemotherapy and none received radiation therapy. Seven patients received VFG as biologic augmentation in intercalary allograft non-union and in the other five patients, a combination of allograft and VFG was used to replace a cement spacer with hardware failure (four patients) and a failed intercalary prosthesis (one patient). Three patients died during follow-up, in all cases because of metastatic disease. At an average follow-up of 147 months (range 11-260 months), the remaining nine patients were continuously disease-free. Complete healing of the osteotomy of both allograft and VFG was observed in 10 patients at final follow-up. Two major complications were observed that required surgical revision, eventually healing in one case and leading to a poor functional outcome in one case. Significant hypertrophy of the VFG was detected in seven of nine evaluable patients. At final follow-up the mean Musculoskeletal Tumour Society (MSTS)'93 functional score of the nine evaluable patients was 90% (range 66-100%). These results indicate that VFG is a valid salvage procedure in failed intercalary reconstructions of the femur after bone resection. Copyright © 2013 Elsevier Ltd. All rights reserved.

  7. Limb conservation using non vascularised fibular grafts

    African Journals Online (AJOL)

    graft in limb reconstruction from bone loss due to trauma and infection. Bone loss can occur from severe high .... preserved in a diluted blood with normal saline till ; anastomosis was commenced. He also had cable grafting of the ... arm muscles was performed at the same time. The forearm was supported in below elbow ...

  8. Reconstruction of the cervical spine with two osteocutaneous fibular flap after radiotherapy and resection of osteoclastoma

    DEFF Research Database (Denmark)

    Kaltoft, Britta; Kruse, Anders; Jensen, Lisa Toft

    2012-01-01

    Transfer of a vascularised free fibular bone for reconstruction of the cervical spine has been described previously.(1-4) However, this is the first report of a reconstruction with both an osteocutaneous fibular flap for anterior stabilisation and a double-islanded osteocutaneous fibular flap for...

  9. Management of Bone Gaps with Intramedullary Autologous Fibular ...

    African Journals Online (AJOL)

    Wound infections, fibrotic tissue envelopes and soft tissue contracture were problems in 4 patients. Median Post operative residual limb length discrepancy was 1.6cm. Conclusion: It is safe to conclude that the use of non vascularised fibular strut graft is a cheap and effective armamentarium in the reconstruction of long ...

  10. Benign paediatric mandibular tumours: experience in reconstruction using vascularised fibula.

    Science.gov (United States)

    Rashid, Mamoon; Tamimy, Muhammad Sarmad; Ehtesham-Ul-Haq; Sarwar, Saad Ur Rahman; Rizvi, Syed Taokeer Ahmed

    2012-12-01

    The majority of the paediatric oral and maxillofacial tumours are benign and the mandible is involved in one-third of these cases. A review of the literature reveals only a handful of studies pertaining exclusively to benign paediatric mandibular tumours. The basis of this study was to fulfil the need to assess the suitability of major mandibular reconstructions using a vascularised fibular graft in cases of benign tumours in children. From April 1999 to April 2011 we have managed 18 cases of benign paediatric mandibular tumours. All the reconstructions were done using vascularised fibular graft. The age of these patients ranged from 8 to 16 years. The most common pathology seen in our series was Ameloblastoma, followed by Giant Cell Granuloma and vascular malformation. Other cases included fibrous dysplasia, aneurysmal bone cyst and odontogenic myxoma. Five of these were recurrent lesions. The mean length of the fibula harvested was 12 ± 2 cm. All the flaps in this series survived. Bone union occurred in all cases by 6 weeks. All the patients have maintained a satisfactory chin contour of the mandible during the follow-up period with minimal distortion occurring secondary to contralateral native mandibular growth in two cases. We conclude that, for benign paediatric mandibular tumours requiring major bone resection, the vascularised fibula is an excellent reconstructive option with the advantages of having a good bone stock, possibility for osteotomy, long pedicle length and potential for growth along with the possibility of dental rehabilitation. Copyright © 2012 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  11. Posterolateral Corner Reconstruction Alone Using a Fibular-Based Technique in a Patient with Persistent Unstable Revision Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Joseph T. Cline

    2015-01-01

    Full Text Available Posterolateral rotatory instability is a relatively uncommon cause of unstable total knee arthroplasty (TKA. In most cases, surgical treatment requires revision TKA into a more constrained design or thicker polyethylene liner. We present a case of a patient with unstable TKA who remained unstable after increasing thickness of the polyethylene liner and undergoing more constrained TKA. After several revision surgeries, the patient was still unstable. Posterolateral corner reconstruction with a fibular-based technique using a tibialis anterior allograft was performed. At 1-year follow-up, the patient was stable and asymptomatic and with excellent function. A soft-tissue procedure only (fibular-based posterolateral corner reconstruction can be effective at restoring posterolateral rotatory stability in a patient with persistent instability after revision TKA.

  12. [Management of fibular hemimelia].

    Science.gov (United States)

    Bradish, C F

    1999-12-01

    Fibular hemimelia is a congenital longitudinal deficiency that represents a spectrum of deformities. The management of this condition is controversial and our treatment options are changing with developments in limb reconstruction techniques. For the severely affected child with a predicted limb length discrepancy greater than 25 cm at maturity and with a poor foot and ankle amputation is generally agreed to be the best option. For less severely affected limbs, particularly those with a predicted limb discrepancy of 10 cm or less and with a foot with 3 or more rays which can be made plantigrade, limb reconstruction is recommended. Controversy remains about the best way to manage children with an intermediate deformity.

  13. Fibular hemimelia: a case report.

    Science.gov (United States)

    Eze, K C; Akhigbe, A O; Awosanya, G O G

    2007-09-01

    Fibular hemimelia is the congenital absence of the fibula and it is the most common congenital absence of long bone of the extremities. Shortening of the extremity is obvious at birth with leg-length discrepancy. On plain radiograph of the leg and foot, significant fibular deficiency (hypoplasia) or absence of the fibula can be seen. In this case report, a 6-month-old baby boy with fibular hemimelia is presented. The radiological diagnosis and differential diagnosis are discussed. The treatments which include repeated corrective osteotomies and leg-lengthening surgery are costly and associated with residual deformity.

  14. Vascularisation in regenerative therapeutics and surgery.

    Science.gov (United States)

    Jeyaraj, Rebecca; G, Natasha; Kirby, Georgia; Rajadas, Jayakumar; Mosahebi, Ash; Seifalian, Alexander M; Tan, Aaron

    2015-09-01

    Vascularisation is often deemed the holy grail of tissue engineering because it is one of the key preconditions that determine the in vivo viability of tissue constructs. Given that a well-developed vascular network allows greater complexity in tissue design and helps regulate tissue metabolism, it appears that the overall outcome of engineered tissue implants depends on the success of microvessel formation, maturation and patterning. Current approaches to vascularising tissue include both in vivo and ex vivo techniques, where blood vessel formation is either spontaneous or guided by physical or biochemical factors. The success of these strategies can then be monitored and evaluated for clinical benefit through numerous standard and novel strategies. Despite the impressive progress in the field of tissue engineering in recent times, there are still numerous technical, immunological, surgical and ethical challenges to overcome. Future prospects in this field are likely to depend on the adoption of a wide-ranging approach incorporating a combination of salient themes such as genetic manipulation, modular assembly and bioreactor coupling. Where applicable, the potential contributions of nanobiotechnology to tissue vascularisation will be discussed as appropriate. Copyright © 2015 Elsevier B.V. All rights reserved.

  15. Reconstructive surgery for fibular deficiency.

    Science.gov (United States)

    Shatilov, O E; Rozkov, A V; Cheminova, T V

    1991-08-01

    Three types of fibular deficiency are described which determine the nature of the surgery and prosthesis required. The surgical management of 50 patients who had a total of 103 operations is described.

  16. Demonstrating the fibular collateral ligament.

    OpenAIRE

    Pridmore, S A

    1980-01-01

    A posture is described which allows palpation of the fibular collateral ligament of the knee as an isolated structure. Visual identification is also possible. This is of interest to the clinician and student of surface anatomy.

  17. Congenital fibular deficiency.

    Science.gov (United States)

    Hamdy, Reggie C; Makhdom, Asim M; Saran, Neil; Birch, John

    2014-04-01

    Congenital fibular deficiency (CFD) is characterized by a wide spectrum of manifestations ranging from mild limb length inequality (LLI) to severe shortening, with foot and ankle deformities and associated anomalies. The etiology of CFD remains unclear. Treatment goals are to achieve normal weight bearing, a functional plantigrade foot, and equal limb length. The recent Birch classification system has been proposed to provide a treatment guide: the functionality of the foot, LLI, and associated anomalies should be taken into account for decision-making. Treatment options include orthosis or epiphysiodesis, Syme or Boyd amputation and prosthetic rehabilitation, limb lengthening procedures, and foot and ankle reconstruction. The outcome of amputation for severe forms of CFD has shown favorable results and fewer complications compared with those of limb lengthening. Nevertheless, advances in the limb lengthening techniques may change our approach to treating patients with CFD and might extend the indications for reconstructive procedures to the treatment of severe LLI and foot deformities.

  18. Bimalleolar ankle fracture with proximal fibular fracture

    NARCIS (Netherlands)

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

    2005-01-01

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

  19. Fibular a/hypoplasia: review and documentation of the fibular developmental field.

    Science.gov (United States)

    Lewin, S O; Opitz, J M

    1986-01-01

    Fibular aplasia and/or hypoplasia is documented as a developmental field defect and the extent of the fibular developmental field is delineated. The term fibular a/hypoplasia denotes the clinical spectrum of fibular deficiency in different patients and also implies that aplasia can be present in one limb and hypoplasia in the other. Causal heterogeneity of fibular a/hypoplasia is demonstrated, thereby defining it as a developmental field defect. Most cases of fibular a/hypoplasia are isolated, sporadic events. An autosomal dominant form of isolated fibular a/hypoplasia with ankle joint anomaly is reviewed. Fibular a/hypoplasia may be part of more complex sporadic dysostoses; sporadic syndromes, an aneuploidy syndrome; several autosomal dominant and autosomal recessive conditions. Fibular a/hypoplasia is also postulated to occur as a result of disruption or teratogenic insult; in animals, fibular development can be disturbed by radiation, busulfan, and retinoic acid. Clinical data allow evaluation of the extent of the fibular developmental field of the lower limb. This appears to include the pubic portion of the pelvis, proximal femur (distal half being apparent tibial developmental territory), patella, anterior cruciate ligament, and lateral and/or axial foot rays (but "never" the hallux and almost never associated with polydactyly). The rare cases of fibuloulnar dimelia allow confirmation of the well known homology of mesomelic limb segments responsible for concordant ulnar and fibular (and radial and tibial) defect, if both upper and lower limbs are involved in a given condition. Because fibular a/hypoplasia is the commonest of the mesomelic paraxial hemimelias, is usually nonsyndromal, and in most cases is apparently nongenetic (ie, with negligible recurrence risk), we propose that in humans, as in several other tetrapods, the fibula is undergoing regressive evolution and hence is developmentally especially labile.

  20. Surgical reconstruction for fibular hemimelia.

    Science.gov (United States)

    Paley, Dror

    2016-12-01

    Fibular hemimelia presents with foot deformity and leg length discrepancy. Previous classifications have focused on the degree of fibular deficiency rather than the type of foot deformity. Published methods of surgical reconstruction have often failed due to residual or recurrent foot deformity. The purpose of this report is to introduce new classification and reconstruction methods. The Paley SHORDT procedure is used to stabilize the ankle when there is a hypoplastic distal fibula with a dynamic valgus deformity. It involves shortening and realignment of the distal tibia relative to the fibula. In contrast, the Paley SUPERankle procedure is used when there is a fixed equinovalgus foot deformity. The SUPERankle uses a supramalleolar shortening-realignment osteotomy and/or subtalar osteotomies with anlage resection. Due to the bony instead of soft tissue correction of deformity, residual or recurrent deformity is prevented. Weakening of gastro-soleus and peroneal muscles is avoided by shortening of the tibia instead of tendon lengthening. The limitation of ankle motion is related to ankle dysplasia rather than surgery or lengthening. A plantigrade-stable foot and ankle leads to an excellent functional result comparable or better than a Syme's amputation with prosthetic fitting. Serial lengthening procedures combined with the SHORDT or SUPERankle reconstruction lead to limb length equalization with a plantigrade, painless, functional foot.

  1. Use of intramedullary fibular strut graft: a novel adjunct to plating in the treatment of osteoporotic humeral shaft nonunion.

    Science.gov (United States)

    Vidyadhara, S; Vamsi, K; Rao, Sharath K; Gnanadoss, James J; Pandian, S

    2009-08-01

    Humeral shaft fractures respond well to conservative treatment and unite without much problem. Since it is uncommon, there is not much discussion regarding the management of nonunion in the literature, and hence this is a challenge to the treating orthopaedic surgeon. Osteoporosis of the fractured bone and stiffness of the surrounding joints compounds the situation further. The Ilizarov fixator, locking compression plate, and vascularised fibular graft are viable options in this scenario but are technically demanding. We used a fibular strut graft for bridging the fracture site in order to enhance the pull-out strength of the screws of the dynamic compression plate. Six patients in the study had successful uneventful union of the fracture at the last follow-up. The fibula is easy to harvest and produces less graft site morbidity. None of the study patients needed additional iliac crest bone grafting. This is the largest reported series of patients with osteoporotic atrophic nonunion of humerus successfully treated solely using the combination of an intramedullary fibular strut graft and dynamic compression plate.

  2. Vascularised endosteal bone tissue in armoured sauropod dinosaurs.

    Science.gov (United States)

    Chinsamy, Anusuya; Cerda, Ignacio; Powell, Jaime

    2016-04-26

    The presence of well-vascularised, endosteal bone in the medullary region of long bones of nonavian dinosaurs has been invoked as being homologous to medullary bone, a specialised bone tissue formed during ovulation in birds. However, similar bone tissues can result as a pathological response in modern birds and in nonavian dinosaurs, and has also been reported in an immature nonavian dinosaur. Here we report on the occurrence of well-vascularised endosteally formed bone tissue in three skeletal elements of armoured titanosaur sauropods from the Upper Cretaceous of Argentina: i) within the medullary cavity of a metatarsal, ii) inside a pneumatic cavity of a posterior caudal vertebra, iii) in intra-trabecular spaces in an osteoderm. We show that considering the criteria of location, origin (or development), and histology, these endosteally derived tissues in the saltasaurine titanosaurs could be described as either medullary bone or pathological bone. Furthermore, we show that similar endosteally formed well-vascularised bone tissue is fairly widely distributed among nondinosaurian Archosauriformes, and are not restricted to long bones, but can occur in the axial, and dermal skeleton. We propose that independent evidence is required to verify whether vascularised endosteal bone tissues in extinct archosaurs are pathological or reproductive in nature.

  3. Management of forme fruste fibular hemimelia.

    Science.gov (United States)

    Maffulli, N; Fixsen, J A

    1996-01-01

    Children with fibular hypoplasia and three-or four-ray feet have a forme fruste of congenital short tibia with absent or dysplastic fibula. We outline the criteria for management of this condition. Although fibular deficiency can be considered benign, two thirds of our patients underwent operation. Leg length inequality may require epiphysiodesis, leg lengthening, or simply a shoe raise. Only very occasionally, when the foot is nonfunctional, is amputation through the ankle undertaken.

  4. FIBULAR HEMIMELIA: A RARE CASE REPORT.

    Science.gov (United States)

    Sisay, Samuel; Admassie, Daniel

    2015-07-01

    Fibular hemimelia is a rare congenital absence of the fibula that may occur as an isolated anomaly or as a part of a malformation syndrome. Shortening of the extremity is obvious at birth with leg-length discrepancy. On plain radiograph of the leg and foot, significant deficiency or absence of the fibula can be seen. In this case report, a 6 year old boy with fibular hemimelia is presented. Radiological diagnosis and differential diagnosis are discussed.

  5. Plating, nailing, external fixation, and fibular strut grafting for non-union of humeral shaft fractures.

    Science.gov (United States)

    Padhye, Kedar P; Kulkarni, Vidhisha S; Kulkarni, G S; Kulkarni, Milind G; Kulkarni, Sunil; Kulkarni, Ruta; Patil, Mayur D; Ravi, Priyanka Y

    2013-12-01

    To compare various treatment modalities (plating, Ilizarov external fixation, and non-vascular fibular cortical strut grafting) for non-union of humeral shaft fractures. Records of 9 women and 26 men aged 24 to 71 (mean, 42) years who presented with non-union of humeral shaft fractures were reviewed. The humeral shaft fractures were secondary to low-energy trauma (n=22) or vehicular accidents (n=13) and involved the proximal (n=9), middle (n=15), and distal (n=11) regions. 13 of the fractures were open. Infection was evident in 8 of the non-unions. For non-unions with infection (n=8), a 2-stage procedure entailing temporary Ilizarov fixation followed by plating was used. For non-unions without infection (n=23), one-stage plating and cancellous bone grafting was used. For non-unions of osteoporotic bone (n=4), one-stage non-vascularised fibular strut grafting was used. Outcome was measured using the Disabilities of the Arm, Shoulder and Hand (DASH) scoring system. The 35 patients were followed up for a mean of 16 (range, 6-60) months. All achieved bone union except for one (who had persistent infection). Respectively for non-unions with infection, nonunions without infection, and non-unions of osteoporotic bone, the mean times to bone union were 6.5 (range, 4-10), 5 (range, 4-8), and 10 (range, 6-14) months, the mean improvement in DASH score was 30, 43, and 18, and malalignment was noted in 5, 2, and one patient. Three patients had a preoperative radial nerve palsy for which standard tendon transfer was performed 6 weeks after treatment for non-union. Compression plating achieved the best results. An external fixator may be used temporarily for infected non-unions. Fibular strut grafting may be used when non-unions warrant additional stability.

  6. Bare bone graft with vascularised iliac crest for mandibular reconstruction.

    Science.gov (United States)

    Sarukawa, Shunji; Noguchi, Tadahide; Oh-iwa, Ichiro; Sunaga, Ataru; Uda, Hirokazu; Kusama, Mikio; Sugawara, Yasushi

    2012-01-01

    "Bare bone graft" with a vascularised iliac crest is a procedure involving no soft tissue for intraoral lining, and the intraoral defect is covered with epithelial cells through secondary healing of the exposed bone. A vascularised iliac crest flap is transferred to a segmental mandibular defect intraorally in the position of the osteotomized stump upwardly. Granulation tissue is usually observed on the stump of the bone graft about 1 week after surgery. When sufficient granulation is observed after approximately 4 weeks, "resurfacing" is performed to prevent interference of hypergranulation tissue with epithelization. Resurfacing involves wiping the granulation tissue from the surface of the bone and covering with a plastic prosthesis fitted to the alveolus. A total of 11 patients underwent bare bone graft with a vascularised iliac crest. Resurfacing was performed at an average of 2.1 times for each patient. All wounds in the oral cavity were completely epithelialized from 2 weeks to 3 months after surgery. Complications with the recipient side occurred in four patients. Bare bone graft with the iliac crest is one favourable option for mandibular reconstruction utilising the particular shape of the bone without the attached soft tissue. Copyright © 2011 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  7. Fibular Hemimelia: More Than Just An Absent Bone.

    Science.gov (United States)

    Fordham, Lynn A.; Applegate, Kimberly E.; Wilkes, David C.; Chung, Charles J.

    1999-01-01

    Fibular hemimelia is a congenital deficiency or absence of the fibula. There is a spectrum of disease from mild fibular hypoplasia to fibular aplasia. The ipsilateral tibia may be hypoplastic, bowed or normal. Fibular hemimelia can be an isolated deformity of the lower leg but frequently it is associated with proximal focal femoral deficiency, deficiencies of the lateral aspect of the foot, or is part of a malformation syndrome. In this article, we review the embryology of the extremities, discuss proposed etiologies for fibular hemimelia, highlight associated abnormalities, and present the radiographic and imaging findings. Surgical treatment options and long-term outcomes are discussed.

  8. Ectrodactyly with fibular aplasia : A separate entity?

    NARCIS (Netherlands)

    Menke, Leonie A.; Bijlsma, Emilia K.; van Essen, Anthonie J.; van den Boogaard, Marie-Jose H.; van Rijn, Rick R.; Cobben, Jan Maarten

    2008-01-01

    E/FA is the combination of ectrodactyly (split hand/foot malformation, SHFM) and fibular aplasia. It is a rare disorder considered to be inherited in an autosomal dominant fashion with reduced penetrance and variable expression. In order to determine recurrence risks for the two patients we

  9. Fibular dimelia with deficiency of the tibia.

    Science.gov (United States)

    Kumar, A; Kruger, L M

    1993-01-01

    Longitudinal deficiency of the tibia associated with fibular dimelia is a very rare condition. We report our experience with six patients and outline management of this anomaly. Knee disarticulation is advised in cases with an associated normal femur, and femorofibular fusion is advised in cases of associated ipsilateral proximal focal femoral deficiency (PFFD) or congenital short femur. Fibulocalcaneal fusion and Boyd type amputation provide good end-bearing stumps.

  10. Morphometric characteristics of the fibular incisura in adult Kenyans ...

    African Journals Online (AJOL)

    To describe the morphometry of the fibular incisura in a sample Kenyan population, a total of 156 tibiae were obtained for the present study from the Department of Human Anatomy, University of Nairobi and the osteology collection of the National Museums of Kenya, Nairobi. The height, width and depth of the fibular ...

  11. Fibular osteosynthesis of neglected femoral neck fracture in a young ...

    African Journals Online (AJOL)

    In order to preserve the femoral head in femoral neck non-union in young adults, the preferred option of treatment is open reduction and internal fixation. Where there are no facilities for microvascular surgery, nonvascularized fibular strut grafts can be used with screws. This paper describes the use of fibular strut graft and ...

  12. Prognostic significance of tumour vascularisation on survival of patients with advanced ovarian carcinoma

    OpenAIRE

    Labiche, Alexandre; Elie, Nicolas; Herlin, Paulette; Denoux, Yves; Crouet, Hubert; Heutte, Natacha; Joly, Florence; Héron, Jean-François; Gauduchon, Pascal; Henry-Amar, Michel

    2009-01-01

    Objective. The prognostic significance of microvessel density in ovarian cancer is still a matter of debate. Classically, the degree of vascularisation is assessed in areas of high vascular density (hot spots), considered as regions of increased probability of metastasis. Since ovarian tumours have a particular progression and dissemination behaviour, vascularisation outside hot spots may also contribute to their evolution. Methods. In the present study, the degree of ...

  13. Prenatal diagnosis of type 1 fibular hemimelia.

    Science.gov (United States)

    Yakut, Zeynep Ilerisoy; Ipek, Ali; Akkaya, Hatice; Arslan, Halil

    2014-10-01

    Fibular hemimelia (FH) is a congenital longitudinal limb deficiency characterized by complete or partial absence of the fibula. Typically, it has been diagnosed at birth, when the neonate is seen to have lower limb shortening and a foot with missing toes. Although it is the most frequent lower limb deficiency anomaly, there are few published reports of prenatally diagnosed cases. Most of these published cases have involved the complete absence of the fibula, which is relatively easy to diagnose with antenatal ultrasound. In our opinion, our case is the first case of unilateral partial absence of the fibula detected using prenatal ultrasound imaging. Herein, we report a FH case associated with foot equinovalgus, and absence of the fourth and fifth foot rays diagnosed at 24 weeks' gestation. The anomaly was confirmed after birth by X-ray, and conservative orthopedic management was chosen. Our case shows that partial limb defects can also be detected by prenatal ultrasound imaging.

  14. [Surgical treatment of fibular nerve injury].

    Science.gov (United States)

    Matejcík, V

    2001-08-01

    In the submitted retrospective study the authors present the results of 40 operations in 40 patients who were treated in the course of 15 years (from 1985-1999) on account of 40 injuries of the fibular nerve, historically known as an injury difficult to treat. The paper gives a basic outline of the surgical treatment. From a total number of 40 in 20 patients external neurolysis was performed. In the remaining 20 patients reconstruction operations of the injured nerves were made whereby 8 operations involved suture of the peripheral nerve, and 12 operations were made using a nerve graft in case of complete and persisting neurological deficiency and absence of action potentials on EMG. The mechanism of injury comprised nerve injury caused by elongation with or without fracture, "sharp" or "blunt" injuries, shotgun injuries, compressions and iatrogenic injuries. If spontaneous repair did not occur within 2-6 months after injury the patients were operated and in 27 of 40 improvement was achieved preventing instability of the foot and in 25 of 40 protective sensitivity developed. Analysis of the effectiveness of surgery was focused on the following indicators: time of operation after injury, patient's age, character of injury, level of injury, type of surgical operation. After neurolysis in 18 of 20 patients (90%) a useful grade of improvement was achieved despite severe preoperative motor deficiency. In 8 patients an "end to end" suture was made and in 6 (75%) the restoration was grade 3 or more. 12 patients needed a reconstruction operation by means of nerve grafts, the length of the graft varied from 4 to 20 cm. The grafts were shorter than 5 cm and in 2 patients, with a cut in 1 and with a iatrogenic injury in 1 patient. In both these patients the function was restored to grade M4. In 1 of 4 patients (20%) with a graft of 6 to 12 cm and in none of 6 with grafts from 13 to 20 cm restoration grade 3 or more was achieved. In those instances the authors observed however

  15. Detection of Extraterrestrial Life. Method II- Optical Rotatory Dispersion

    Science.gov (United States)

    1963-01-01

    The object of this study is to develop polarimetric methods to detect the presence of DNA (deoxyribonucleic acid) or its congeners in soil suspensions, and through these methods determine the existence of life (as known terrestrially) on other planets. The cotton region associated with optically active organic compounds is being used to detect and characterize the compounds above. An apparatus has been designed and assembled which can measure optical rotations in systems which strongly attenuate incident-polarized, monochromatic light. This instrument was used to measure the optical rotatory dispersion spectra of nucleosides, a polynucleotide, and proteins whose optical density at 260 microns approached 1.0. This work is discussed in the final report on Contract NASR-85, Detection of Extraterrestrial Life, Method II: Optical Rotatory Dispersion. Recent work in Melpar laboratories has reaffirmed these rotatory dispersion spectra. Based upon the analysis of the optical components associated with this apparatus, however, these measurements must be considered as qualitative rather than quantitative. The reason for this is discussed in greater detail subsequently in this report. In addition, an evaluation of the theoretical and instrumental aspects of making rotatory-dispersion measurements in the cotton region has resulted in a procedure for measuring optical rotation.

  16. Page 1 Dependence of Optical Rotatory Power on Chemical Consin ...

    Indian Academy of Sciences (India)

    Dependence of Optical Rotatory Power on Chemical Consin–XXX 71 is the highest of all the compounds given in Table II, namely, 243: 35°. This strongly supports formula I for oxymethylene camphor as this shows a complete conjugation between the keto and the ethylenic bonds which is however not the case with formula ...

  17. Management of congenital fibular deficiency by Ilizarov technique.

    Science.gov (United States)

    Miller, L S; Bell, D F

    1992-01-01

    Between April 1987 and January 1990, 11 patients with congenital fibular deficiency underwent tibial lengthening of 12 involved limbs by the Ilizarov technique. The average follow-up was 23.2 months. The mean lengthening was 8.3 cm, representing an average lengthening of 31%. No knee or ankle subluxation occurred despite preoperative cruciate ligament laxity and ankle abnormalities in all patients. The most significant complications included regenerate bone deformation and delayed consolidation. With the Ilizarov technique, the limb length discrepancy, angular and rotational deformities, and foot and ankle deformities frequently associated with congenital fibular deficiency can be addressed simultaneously.

  18. Reconstruction of the lateral malleolus in a type-Ib fibular hemimelia with a microvascular proximal fibular flap: a case report.

    Science.gov (United States)

    Cavadas, Pedro C; Thione, Alessandro

    2015-07-01

    Fibular hemimelia, or fibular hypoplasia-aplasia, is the most frequent congenital long-bone deficiency. There is still some debate on reconstruction versus amputation for the severe type Ib and type II cases. Limb-length discrepancy can be corrected with Ilizarov methods, but ankle stability remains a problem. The absence of the lateral malleolus destabilizes the mortise in valgus and ankle fusion is usually needed. A case of lateral malleolus reconstruction in a teenage patient with severe type-Ib fibular hemimelia using a contralateral free proximal fibular epiphyseal transfer is reported.

  19. Tibial and fibular nerves evaluation using intraoperative electromyography in rats.

    Science.gov (United States)

    Nepomuceno, André Coelho; Politani, Elisa Landucci; Silva, Eduardo Guandelini da; Salomone, Raquel; Longo, Marco Vinicius Losso; Salles, Alessandra Grassi; Faria, José Carlos Marques de; Gemperli, Rolf

    2016-08-01

    To evaluate a new model of intraoperative electromyographic (EMG) assessment of the tibial and fibular nerves, and its respectives motor units in rats. Eight Wistar rats underwent intraoperative EMG on both hind limbs at two different moments: week 0 and week 12. Supramaximal electrical stimulation applied on sciatic nerve, and compound muscle action potential recorded on the gastrocnemius muscle (GM) and the extensor digitorum longus muscle (EDLM) through electrodes at specifics points. Motor function assessment was performaced through Walking Track Test. Exposing the muscles and nerves for examination did not alter tibial (p=0.918) or fibular (p=0.877) function between the evaluation moments. Electromyography of the GM, innervated by the tibial nerve, revealed similar amplitude (p=0.069) and latency (p=0.256) at week 0 and at 12 weeks, creating a standard of normality. Meanwhile, electromyography of the EDLM, innervated by the fibular nerve, showed significant differences between the amplitudes (p=0.003) and latencies (p=0.021) at the two different moments of observation. Intraoperative electromyography determined and quantified gastrocnemius muscle motor unit integrity, innervated by tibial nerve. Although this study was not useful to, objectively, assess extensor digitorum longus muscle motor unit, innervated by fibular nerve.

  20. Unilateral proximal focal femoral deficiency, fibular aplasia, tibial ...

    African Journals Online (AJOL)

    Rabah M. Shawky

    2014-04-30

    Apr 30, 2014 ... Unilateral proximal focal femoral deficiency, fibular aplasia, tibial campomelia and oligosyndactyly in an Egyptian child – Probable. FFU syndrome. Rabah M. ... Our patient is an Egyptian male child, fifteen months old, the third in order of .... 4th and 5th metatarsal bones are absent), absent middle phalanx.

  1. Unilateral proximal focal femoral deficiency, fibular aplasia, tibial ...

    African Journals Online (AJOL)

    ... dominant mutation with possible gonadal mosaicism and with variable expression in the family, as limb anomaly in one child and cyanotic congenital heart disease in another child. Keywords: Short femur; Limb anomaly; FFU syndrome; Proximal focal femoral deficiency; Fibular aplasia; Tibial campomelia; Oligosyndactyly ...

  2. Adult outcomes following amputation or lengthening for fibular deficiency.

    Science.gov (United States)

    Walker, Janet L; Knapp, Dwana; Minter, Christin; Boakes, Jennette L; Salazar, Juan Carlos; Sanders, James O; Lubicky, John P; Drvaric, David M; Davids, Jon R

    2009-04-01

    Fibular deficiency results in a small, unstable foot and ankle as well as a limb-length discrepancy. The purpose of this study was to assess outcomes in adults who, as children, had had amputation or limb-lengthening, commonly used treatments for fibular deficiency. Retrospective review of existing data collected since 1950 at six pediatric orthopaedic centers identified 248 patients with fibular deficiency who were twenty-one years of age or older at the time of the review. Excluding patients with other anomalies and other treatments (with the excluded group including six who had had lengthening and then amputation), we identified ninety-eight patients who had had amputation or limb-lengthening for the treatment of isolated unilateral fibular deficiency. Sixty-two patients (with thirty-six amputations and twenty-six lengthening procedures) completed several questionnaires, including one asking general demographic questions, the Beck Depression Inventory-II, the Quality of Life Questionnaire, and the American Academy of Orthopaedic Surgeons Lower Limb Questionnaire including the Short Form-36. A group of twenty-eight control subjects completed the Beck Depression Inventory-II and the Quality of Life Questionnaire. There were forty men and twenty-two women. The average age at the time of the interview was thirty-three years. There were more amputations in those with fewer rays and less fibular preservation. Lengthening resulted in more surgical procedures (6.3 compared with 2.4 in patients treated with amputation) and more days in the hospital (184 compared with sixty-three) (both pfibular deficiency reported signs of depression. The only significant difference between treatment groups shown by the Quality of Life Questionnaire was in the scores on the Job Satisfiers content scale, with the amputees scoring better than the patients treated with lengthening (p=0.015). The American Academy of Orthopaedic Surgeons Lower Limb Module did not demonstrate differences in

  3. The Nature of Foot Ray Deficiency in Congenital Fibular Deficiency.

    Science.gov (United States)

    Reyes, Bryan A; Birch, John G; Hootnick, David R; Cherkashin, Alex M; Samchukov, Mikhail L

    Absent lateral osseous structures in congenital fibular deficiency, including the distal femur and fibula, have led some authors to refer to the nature of foot ray deficiency as "lateral" as well. Others have suggested that the ray deficiency is in the central portion of the midfoot and forefoot.We sought to determine whether cuboid preservation and/or cuneiform deficiency in the feet of patients with congenital fibular deficiency implied that the ray deficiency is central rather than lateral in patients with congenital fibular deficiency. We identified all patients with a clinical morphologic diagnosis of congenital fibular deficiency at our institution over a 15-year period. We reviewed the records and radiographs of patients who had radiographs of the feet to allow determination of the number of metatarsals, the presence or absence of a cuboid or calcaneocuboid fusion, the number of cuneiforms present (if possible), and any other osseous abnormalities of the foot. We excluded patients with 5-rayed feet, those who had not had radiographs of the feet, or whose radiographs were not adequate to allow accurate assessment of these radiographic features. We defined the characteristic "lateral (fifth) ray present" if there was a well-developed cuboid or calcaneocuboid coalition with which the lateral-most preserved metatarsal articulated. Twenty-six patients with 28 affected feet met radiographic criteria for inclusion in the study. All affected feet had a well-developed cuboid or calcaneocuboid coalition. The lateral-most ray of 25 patients with 26 affected feet articulated with the cuboid or calcaneocuboid coalition. One patient with bilateral fibular deficiency had bilateral partially deficient cuboids, and the lateral-most metatarsal articulated with the medial remnant of the deformed cuboids. Twenty-one of 28 feet with visible cuneiforms had 2 or 1 cuneiform. Although the embryology and pathogenesis of congenital fibular deficiency remain unknown, based on the

  4. Adult Traumatic Atlantoaxial Rotatory Fixation: A Case Report

    Directory of Open Access Journals (Sweden)

    Zaw Min Han

    2014-01-01

    Full Text Available We presented a very rare case of adult Fielding type I atlantoaxial rotatory fixation (AARF. We performed awake manual reduction of the dislocation without need for anesthesia, achieving excellent outcomes, and no previous reports have described awake reduction without the need for anesthesia. AARF in this case was attributed to excessive extension and rotation forces applied to the cervical spine. For the management of adult Fielding type I AARF, early diagnosis and early reduction may lead to excellent outcomes.

  5. Chronic neglected irreducible atlantoaxial rotatory subluxation in adolescence

    Science.gov (United States)

    Padalkar, Pravin

    2016-01-01

    Atlantoaxial rotatory fixation (AARF) is a rare condition and delayed diagnosis. We report a case of chronic neglected atlantoaxial rotatory subluxation in adolescence child that was treated by serial skull traction followed by posterior fusing by method pioneered by Goel et al. A 15-year-old male presented with signs of high cervical myelopathy 2 years after trauma to neck childhood. There was upper cervical kyphosis, direct tenderness over C2 spinous process, atrophy of both hand muscles with weakness in grip strength. Reflexes in upper and lower extremities were exaggerated. Imaging showed Type 3 (Fielding and Hawkins) rotatory atlantoaxial dislocation (AAD). Treatment options available were 1. Staged anterior Transoral release & reduction followed by posterior fusion described by Govender and Kumar et al, 2. Posterior open reduction of joint and fusion, 3. Occipitocervical fusion with decompression. Our case was AARF presented to us with almost 2-year post injury. Considering complications associated with anterior surgery and posterior open reduction, we have opted for closed reduction by serially applying weight to skull traction under closed neurological monitoring. We have serially increased weight up to 15 kg over a period of 1 week before. We have achieved some reduction which was confirmed by traction lateral radiographs and computerized axial tomography scan. Residual subluxation corrected intra-operatively indirectly by using reduction screws in Goel et al. procedure. Finally performed for C1-C2 fusion to take care of Instability. We like to emphasis here role of closed reduction even in delayed and neglected cases. PMID:27630481

  6. [Treatment strategy of rotatory dislocation of atlantoaxial articulation in children].

    Science.gov (United States)

    Kang, Hui; Cai, Xian-hua; Xu, Feng; Huang, Yong

    2012-03-01

    To analyze appropriate strategy about treatment of rotatory dislocation of atlantoaxial articulation in children. From March 2005 to February 2009, 36 patients with rotatory dislocation of atlantoaxial articulation were retrospectively analyzed, including 25 males and 11 females, with the average age of 7.8 years (ranged 3 - 14 years). According to Fielding-Hawkins clinical classification, type I 24 cases, type II 8 cases, type III 2 cases, type IV 2 cases. All of the patients were assessed rotatory dislocation of atlantoaxial articulation and whether or not upper cervical spine malformation by X-ray, MRI and CT scan and three-dimensional reconstruction. Thirty-two cases received observational treatments which were reduction after cervical traction, without appearance of the deformity, without neurological symptoms. And another 4 serious cases (irreducible atlantoaxial dislocation or with os odontoideum) received posterior atlantoaxial fixed autograft fusion. Rotation of atlas decreased from 16.0° ± 4.4° (range, 5° to 26°) pre-therapy to 4.5° ± 1.5° (range, 0° to 8°) post-therapy in 35 cases, rotation of atlas had significant difference between pre-therapy and post-therapy (t = 14.75, P dislocation of atlantoaxial articulation in children. However, operative treatment should be considered in the following situations: irreducible atlantoaxial dislocation or patients with os odontoideum.

  7. Prognostic significance of tumour vascularisation on survival of patients with advanced ovarian carcinoma.

    Science.gov (United States)

    Labiche, Alexandre; Elie, Nicolas; Herlin, Paulette; Denoux, Yves; Crouet, Hubert; Heutte, Natacha; Joly, Florence; Héron, Jean-François; Gauduchon, Pascal; Henry-Amar, Michel

    2009-04-01

    The prognostic significance of microvessel density in ovarian cancer is still a matter of debate. Classically, the degree of vascularisation is assessed in areas of high vascular density (hot spots), considered as regions of increased probability of metastasis. Since ovarian tumours have a particular progression and dissemination behaviour, vascularisation outside hot spots may also contribute to their evolution. In the present study, the degree of tumour vascularisation was estimated both in whole histogical sections and in hot spots, in 235 patients with ovarian carcinoma, using fully automatic image analysis methods. Six parameters were estimated: mean microvessel density (MVD) and mean microvessel surface fraction (MSP) on the whole section, mean and maximum values of MVD and MSP inside hot spots (MVDHS1, MSPHS1 and MVDHS2, MSPHS2). Relationships between vascular parameters and clinicopathologic features were analysed. In stage III-IV patients multivariate analysis showed that stage IV disease (hazards ratio (HR)=1.72, p=0.001), post-surgical residual disease 1cm (HR=2.86, p<0.001), upper MVD tercile (HR=1.45, p<0.022) and medial MVDHS1 tercile (HR=1.36, p=0.060) retained an independent prognostic value upon overall survival. Our results suggest that quantification of blood vessels, both on the whole histological section and in hot spots might be helpful in evaluating prognosis in advanced ovarian carcinomas.

  8. Intercalary Reconstructions with Vascularised Fibula and Allograft after Tumour Resection in the Lower Limb

    Directory of Open Access Journals (Sweden)

    Katharina Rabitsch

    2013-01-01

    Full Text Available Reconstruction with massive bone allograft and autologous vascularised fibula combines the structural strength of the allograft and the advantages of fibula’s intrinsic blood supply. We retrospectively analysed the outcome of twelve patients (4 male, 8 female who received reconstruction with massive bone allograft and autologous vascularised fibula after tumour resection in lower limb. Mean age was 17.8 years (range 11–31 years, with following primaries: Ewing’s sarcoma (n=6, osteosarcoma (n=4, liposarcoma grade 2 (n=1, and adamantinoma (n=1. Mean followup was 38.7 months (median 25.7 months; range 2–88 months. Seven tumours were located in the femur and five in the tibia. The mean length of bone defect was 18.7 cm (range 15–25 cm. None of the grafts had to be removed, but there occurred four fractures, four nonunions, and two infections. Two patients developed donor side complication, in form of flexion deformity of the big toe. The event-free survival rate was 51% at two-year followup and 39% at three- and five-year followup. As the complications were manageable, and full weight bearing was achieved in all cases, we consider the combination of massive bone allograft and autologous vascularised fibula a stable and durable reconstruction method of the diaphysis of the lower limbs.

  9. Long-term sequel of posterolateral rotatory instability of the elbow: a case report

    Directory of Open Access Journals (Sweden)

    Cheng Chun-Ying

    2010-01-01

    Full Text Available Abstract The natural course of untreated posterior lateral rotatory instability of the elbow is unclear. A case of elbow arthrosis with progressing deformity and flexion contracture after an episode of elbow dislocation about 20 years ago presented the possibility the long term outcome of untreated posterior lateral rotatory instability of the elbow.

  10. Clinical Results and Complications of Lower Limb Lengthening for Fibular Hemimelia

    OpenAIRE

    Mishima, Kenichi; Kitoh, Hiroshi; Iwata, Koji; Matsushita, Masaki; Nishida, Yoshihiro; Hattori, Tadashi; Ishiguro, Naoki

    2016-01-01

    Abstract Fibular hemimelia is a rare but the most common congenital long bone deficiency, encompassing a broad range of anomalies from isolated fibular hypoplasia up to substantial femoral and tibial shortening with ankle deformity and foot deficiency. Most cases of fibular hemimelia manifest clinically significant leg length discrepancy (LLD) with time that requires adequate correction by bone lengthening for stable walking. Bone lengthening procedures, especially those for pathological bone...

  11. [Compression syndrome of the superficial fibular nerve. Case report].

    Science.gov (United States)

    Piza-Katzer, H; Pilz, E

    1997-05-01

    The case of a female patient complaining of dysaesthesia and paraesthesia on the dorsum of her right foot and digits which failed to respond to conservative treatment is presented. 10 cm above the lateral malleolus, a muscle bulge of 2 cm was detected. Hoffmann-Tinel's sign was positive at this site. The diagnosis of nerve entrapment was confirmed by a conduction velocity block. Through an incision centered over the muscle bulge, the superficial fibular nerve was identified. It was found to be compressed by fascia. Fascial release and epineuriotomy resulted in complete recovery. Entrapment of the sensory superficial fibular nerve in the patient is thought to have been caused by prolonged work-related kneeling and squatting over many years.

  12. Vascularized fibular graft in infected tibial bone loss

    OpenAIRE

    C Cheriyan Kovoor; R Jayakumar; V V George; Vinod Padmanabhan; A J Guild; Sabin Viswanath

    2011-01-01

    Background : The treatment options of bone loss with infections include bone transport with external fixators, vascularized bone grafts, non-vascularized autogenous grafts and vascularized allografts. The research hypothesis was that the graft length and intact ipsilateral fibula influenced hypertrophy and stress fracture. We retrospectively studied the graft hypertrophy in 15 patients, in whom vascularized fibular graft was done for post-traumatic tibial defects with infection. Materials...

  13. Vertical distraction osteogenesis of fibular bone flap in reconstructed mandible.

    Science.gov (United States)

    Eski, Muhitdin; Turegun, Murat; Deveci, Mustafa; Gokce, Hasan Suat; Sengezer, Mustafa

    2006-12-01

    Excellent functional and aesthetic results can be achieved in mandibular reconstructions with using free fibular bone flap. However, the vertical deficiency between the reconstructed segment and the occlusal plane made dental rehabilitation impossible in some cases. We encountered this problem in our 3 patients who had mandibular reconstruction with fibular flap due to extensive bone defect result from gunshot injury. To overcome this segmental vertical distraction of the reconstructed mandible was performed. Fibular bone segments (40-70 mm) were distracted with using extraoral distraction device after a latency period of 5-7 days. The rate of distraction was 1 mm/day, and the rhythm was 4 times (4 x 0.25 mm). Distraction was continued until the desired height was achieved, and the distractor left in place for 12 weeks for bony consolidation. No minor or major complications were encountered. The increase of vertical height was between 9 and 13 mm, and it was stable during the follow-up period (7-22 months). Following the vertical distraction and vestibuloplasty operations, the dental restoration of the patients was performed with mandibular removable partial dentures.

  14. Chronic neglected irreducible atlantoaxial rotatory subluxation in adolescence

    Directory of Open Access Journals (Sweden)

    Pravin Padalkar

    2016-01-01

    Full Text Available Atlantoaxial rotatory fixation (AARF is a rare condition and delayed diagnosis. We report a case of chronic neglected atlantoaxial rotatory subluxation in adolescence child that was treated by serial skull traction followed by posterior fusing by method pioneered by Goel et al. A 15-year-old male presented with signs of high cervical myelopathy 2 years after trauma to neck childhood. There was upper cervical kyphosis, direct tenderness over C2 spinous process, atrophy of both hand muscles with weakness in grip strength. Reflexes in upper and lower extremities were exaggerated. Imaging showed Type 3 (Fielding and Hawkins rotatory atlantoaxial dislocation (AAD. Treatment options available were 1. Staged anterior Transoral release & reduction followed by posterior fusion described by Govender and Kumar et al, 2. Posterior open reduction of joint and fusion, 3. Occipitocervical fusion with decompression. Our case was AARF presented to us with almost 2-year post injury. Considering complications associated with anterior surgery and posterior open reduction, we have opted for closed reduction by serially applying weight to skull traction under closed neurological monitoring. We have serially increased weight up to 15 kg over a period of 1 week before. We have achieved some reduction which was confirmed by traction lateral radiographs and computerized axial tomography scan. Residual subluxation corrected intra-operatively indirectly by using reduction screws in Goel et al. procedure. Finally performed for C1-C2 fusion to take care of Instability. We like to emphasis here role of closed reduction even in delayed and neglected cases.

  15. A Female Newborn Infant with FATCO Syndrome Variant (Fibular Hypoplasia, Tibial Campomelia, Oligosyndactyly) – A Case Report

    OpenAIRE

    Smets, Gitte; Vankan, Yoeri; Demeyere, Annick

    2016-01-01

    Congenital limb deficiencies are common birth defects occurring in 1 in 2000 neonates, characterized by the aplasia or hypoplasia of bones of the limbs. Fibular hemimelia is a rare congenital deficiency or absence of the fibula. The disease spectrum ranges from mild fibular hypoplasia to fibular aplasia. Fibular aplasia, tibial campomelia, and oligosyndactyly (FATCO syndrome) are purely descriptive terms for a syndrome of unknown genetic basis and inheritance. We report on a newborn female wi...

  16. Tibio-fibular synostosis - a viable option in the management of ...

    African Journals Online (AJOL)

    ... non-union of the right tibia (8cm) following a road traffic accident. This was complicated by a chronic ulcer seating on scar tissue with extensive skin and soft tissue scarification and muscle atrophy. He was successfully managed by proximal tibio-fibular synostosis with radiological evidence of distal tibio-fibular synostosis.

  17. Altering the architecture of tissue engineered hypertrophic cartilaginous grafts facilitates vascularisation and accelerates mineralisation.

    Directory of Open Access Journals (Sweden)

    Eamon J Sheehy

    Full Text Available Cartilaginous tissues engineered using mesenchymal stem cells (MSCs can be leveraged to generate bone in vivo by executing an endochondral program, leading to increased interest in the use of such hypertrophic grafts for the regeneration of osseous defects. During normal skeletogenesis, canals within the developing hypertrophic cartilage play a key role in facilitating endochondral ossification. Inspired by this developmental feature, the objective of this study was to promote endochondral ossification of an engineered cartilaginous construct through modification of scaffold architecture. Our hypothesis was that the introduction of channels into MSC-seeded hydrogels would firstly facilitate the in vitro development of scaled-up hypertrophic cartilaginous tissues, and secondly would accelerate vascularisation and mineralisation of the graft in vivo. MSCs were encapsulated into hydrogels containing either an array of micro-channels, or into non-channelled 'solid' controls, and maintained in culture conditions known to promote a hypertrophic cartilaginous phenotype. Solid constructs accumulated significantly more sGAG and collagen in vitro, while channelled constructs accumulated significantly more calcium. In vivo, the channels acted as conduits for vascularisation and accelerated mineralisation of the engineered graft. Cartilaginous tissue within the channels underwent endochondral ossification, producing lamellar bone surrounding a hematopoietic marrow component. This study highlights the potential of utilising engineering methodologies, inspired by developmental skeletal processes, in order to enhance endochondral bone regeneration strategies.

  18. Altering the architecture of tissue engineered hypertrophic cartilaginous grafts facilitates vascularisation and accelerates mineralisation.

    Science.gov (United States)

    Sheehy, Eamon J; Vinardell, Tatiana; Toner, Mary E; Buckley, Conor T; Kelly, Daniel J

    2014-01-01

    Cartilaginous tissues engineered using mesenchymal stem cells (MSCs) can be leveraged to generate bone in vivo by executing an endochondral program, leading to increased interest in the use of such hypertrophic grafts for the regeneration of osseous defects. During normal skeletogenesis, canals within the developing hypertrophic cartilage play a key role in facilitating endochondral ossification. Inspired by this developmental feature, the objective of this study was to promote endochondral ossification of an engineered cartilaginous construct through modification of scaffold architecture. Our hypothesis was that the introduction of channels into MSC-seeded hydrogels would firstly facilitate the in vitro development of scaled-up hypertrophic cartilaginous tissues, and secondly would accelerate vascularisation and mineralisation of the graft in vivo. MSCs were encapsulated into hydrogels containing either an array of micro-channels, or into non-channelled 'solid' controls, and maintained in culture conditions known to promote a hypertrophic cartilaginous phenotype. Solid constructs accumulated significantly more sGAG and collagen in vitro, while channelled constructs accumulated significantly more calcium. In vivo, the channels acted as conduits for vascularisation and accelerated mineralisation of the engineered graft. Cartilaginous tissue within the channels underwent endochondral ossification, producing lamellar bone surrounding a hematopoietic marrow component. This study highlights the potential of utilising engineering methodologies, inspired by developmental skeletal processes, in order to enhance endochondral bone regeneration strategies.

  19. Vascularisation to improve translational potential of tissue engineering systems for cardiac repair.

    Science.gov (United States)

    Dilley, Rodney J; Morrison, Wayne A

    2014-11-01

    Cardiac tissue engineering is developing as an alternative approach to heart transplantation for treating heart failure. Shortage of organ donors and complications arising after orthotopic transplant remain major challenges to the modern field of heart transplantation. Engineering functional myocardium de novo requires an abundant source of cardiomyocytes, a biocompatible scaffold material and a functional vasculature to sustain the high metabolism of the construct. Progress has been made on several fronts, with cardiac cell biology, stem cells and biomaterials research particularly promising for cardiac tissue engineering, however currently employed strategies for vascularisation have lagged behind and limit the volume of tissue formed. Over ten years we have developed an in vivo tissue engineering model to construct vascularised tissue from various cell and tissue sources, including cardiac tissue. In this article we review the progress made with this approach and others, together with their potential to support a volume of engineered tissue for cardiac tissue engineering where contractile mass impacts directly on functional outcomes in translation to the clinic. It is clear that a scaled-up cardiac tissue engineering solution required for clinical treatment of heart failure will include a robust vascular supply for successful translation. This article is part of a directed issue entitled: Regenerative Medicine: the challenge of translation. Copyright © 2014 Elsevier Ltd. All rights reserved.

  20. Leg lengthening in patients with congenital fibular hemimelia.

    Science.gov (United States)

    Jasiewicz, Barbara; Kacki, Wojciech; Koniarski, Arkadiusz; Kasprzyk, Marcin; Zarzycka, Maja; Tesiorowski, Maciej

    2002-08-30

    Background. Anisomelia in patients with congenital fibular deficiencies is a difficult orthopedic problem due to concomitant deformities of the angle and knee. The goal of the present study was to analyze outcomes of tibia lengthening in these patients. Material and methods. In the period 1989-2001 we performed lengthening of 26 limbs in 21 patients with congenital fibular deficiency (11 female, 10 male, average age 10.1 years). Under the Achterman-Kalamchi classification, 8 tibiae were Type 1, 3 were Type 1b, and 10 were Type 2 (including one case with bilateral defect). The average baseline shortening was 4.6 cm, i.e. 15.3%. The Ilizarov method was used in 24 cases, chondrial lengthening in the others. We measured time of lengthening, time of stabilization, total healing time, amount of lengthening, and the lengthening index, as well as the range of ankle and knee movement, the positioning of the foot, and the axis of the tibia at each stage. Problems and complications were classified according to Paley. The average follow-up was 4.9 years Results. The mean time of lengthening was 101 days, stabilization time 177 days, total healing time 269 days, mean lengthening 5.6 cm (22.9%). As of the last examination only 7 patients did not require follow-up surgery, 6 with Type 1a and 1 with Type 1b. Conclusions. Tibia lengthening with axis correction constitutes an alternative to amputation in congenital fibular deficiency. It is a difficult procedure, however, encumbered by a significant risk of complications.

  1. The fibular collateral ligament of the knee: a detailed review.

    Science.gov (United States)

    Song, Young-Bin; Watanabe, Koichi; Hogan, Elizabeth; D'Antoni, Anthony V; Dilandro, Anthony C; Apaydin, Nihal; Loukas, Marios; Shoja, Mohammadali M; Tubbs, R Shane

    2014-07-01

    The fibular collateral ligament (FCL) is one of the larger ligaments of the knee. The FCL, along with the popliteus tendon, arcuate popliteal ligament, and joint capsule, make up the posterolateral corner of the knee. Recently, there has there been an increased awareness and research on the structures of the posterolateral corner of the knee, particularly the FCL. Studying the detailed structure of the FCL may provide a better understanding that can lead to better diagnosis and treatments following injury. Therefore, this article reviews the FCL, which appears to be the primary restraint to varus rotation but is poorly oriented to resist external rotation of the knee. © 2013 Wiley Periodicals, Inc.

  2. Rotatory power of sodium vapour oriented by laser radiation

    Energy Technology Data Exchange (ETDEWEB)

    Bicchi, P. (Siena Univ. (Italy). Ist. di Fisica); Moi, L.; Zambon, B. (Consiglio Nazionale delle Ricerche, Pisa (Italy). Lab. di Fisica Atomica e Moleculare)

    1979-01-11

    In this paper the rotatory power of sodium vapour is studied when laser light is used as pumping as well as analysis light. The possibility of having an analysis light whose frequency may be varied in a range larger than the interval between the D/sub 1/ and D/sub 2/ atomic lines allows us to get for the first time the complete shape of the rotation curve and to measure a rotation different from zero even for frequencies very far from the resonance ones. The complete orientation in the vapour caused by the laser pumping-light power permits to obtain very high rotation values. In a cell containing Na and 200 Torr of Ne, we measured, at 185/sup 0/C, 10/sup 0//cm of specific rotation. The dependence of the optical activity on the buffer gas pressure and on the frequency of the pumping light is also studied.

  3. [Versatility of the microvascular fibular flap in limb reconstruction].

    Science.gov (United States)

    de la Parra-Márquez, Miguel; Zorola-Tellez, Oscar; Cárdenas-Rodríguez, Silvia; Rangel-Flores, Jesús María; Sánchez-Terrones, Gerardo

    2016-01-01

    The structural characteristics of the fibula, strength, shape, length and limited donor site morbidity make it more suitable for reconstructing long bone defects larger than 6cm in the limbs. A descriptive study was conducted using a non-probabilistic sample of consecutive cases undergoing on limb reconstruction with free fibular flap in the period from January 2010 to January 2015 in the Mexican Institute of Social Security No. 21, Monterrey Nuevo Leon. The mean age of the ten cases included was 25 years, with the most common diagnosis being trauma in 4 patients, osteosarcoma in 2, followed by one congenital pseudoarthrosis of the tibia, one non-union fracture, and one gunshot wounds, respectively. The most common location was tibia, followed by humerus, radius, ulna and femur. This study has shown that the fibular free flap can be an excellent option for management of long bone defects, regardless of cause of the injury. One or more skin islands can be added for coverage in exposure of deep tissue and osteosynthesis material, thus preserving the septocutaneous perforators. Copyright © 2015 Academia Mexicana de Cirugía A.C. Published by Masson Doyma México S.A. All rights reserved.

  4. Clinical Results and Complications of Lower Limb Lengthening for Fibular Hemimelia

    Science.gov (United States)

    Mishima, Kenichi; Kitoh, Hiroshi; Iwata, Koji; Matsushita, Masaki; Nishida, Yoshihiro; Hattori, Tadashi; Ishiguro, Naoki

    2016-01-01

    Abstract Fibular hemimelia is a rare but the most common congenital long bone deficiency, encompassing a broad range of anomalies from isolated fibular hypoplasia up to substantial femoral and tibial shortening with ankle deformity and foot deficiency. Most cases of fibular hemimelia manifest clinically significant leg length discrepancy (LLD) with time that requires adequate correction by bone lengthening for stable walking. Bone lengthening procedures, especially those for pathological bones, are sometimes associated with severe complications, such as delayed consolidation, fractures, and deformities of the lengthened bones, leading to prolonged healing time and residual LLD at skeletal maturity. The purpose of this study was to review our clinical results of lower limb lengthening for fibular hemimelia. This study included 8 Japanese patients who diagnosed with fibular hemimelia from physical and radiological findings characteristic of fibular hemimelia and underwent single or staged femoral and/or tibial lengthening during growth or after skeletal maturity. LLD, state of the lengthened callus, and bone alignment were evaluated with full-length radiographs of the lower limb. Previous interventions, associated congenital anomalies, regenerate fractures were recorded with reference to medical charts and confirmed on appropriate radiographs. Successful lengthening was defined as the healing index fibular hemimelia. PMID:27227952

  5. Clinical Results and Complications of Lower Limb Lengthening for Fibular Hemimelia: A Report of Eight Cases.

    Science.gov (United States)

    Mishima, Kenichi; Kitoh, Hiroshi; Iwata, Koji; Matsushita, Masaki; Nishida, Yoshihiro; Hattori, Tadashi; Ishiguro, Naoki

    2016-05-01

    Fibular hemimelia is a rare but the most common congenital long bone deficiency, encompassing a broad range of anomalies from isolated fibular hypoplasia up to substantial femoral and tibial shortening with ankle deformity and foot deficiency. Most cases of fibular hemimelia manifest clinically significant leg length discrepancy (LLD) with time that requires adequate correction by bone lengthening for stable walking. Bone lengthening procedures, especially those for pathological bones, are sometimes associated with severe complications, such as delayed consolidation, fractures, and deformities of the lengthened bones, leading to prolonged healing time and residual LLD at skeletal maturity. The purpose of this study was to review our clinical results of lower limb lengthening for fibular hemimelia.This study included 8 Japanese patients who diagnosed with fibular hemimelia from physical and radiological findings characteristic of fibular hemimelia and underwent single or staged femoral and/or tibial lengthening during growth or after skeletal maturity. LLD, state of the lengthened callus, and bone alignment were evaluated with full-length radiographs of the lower limb. Previous interventions, associated congenital anomalies, regenerate fractures were recorded with reference to medical charts and confirmed on appropriate radiographs. Successful lengthening was defined as the healing index fibular hemimelia.

  6. Vascularized fibular graft in infected tibial bone loss

    Directory of Open Access Journals (Sweden)

    C Cheriyan Kovoor

    2011-01-01

    Full Text Available Background : The treatment options of bone loss with infections include bone transport with external fixators, vascularized bone grafts, non-vascularized autogenous grafts and vascularized allografts. The research hypothesis was that the graft length and intact ipsilateral fibula influenced hypertrophy and stress fracture. We retrospectively studied the graft hypertrophy in 15 patients, in whom vascularized fibular graft was done for post-traumatic tibial defects with infection. Materials and Methods : 15 male patients with mean age 33.7 years (range 18 - 56 years of post traumatic tibial bone loss were analysed. The mean bony defect was 14.5 cm (range 6.5 - 20 cm. The mean length of the graft was 16.7 cm (range 11.5 - 21 cm. The osteoseptocutaneous flap (bone flap with attached overlying skin flap from the contralateral side was used in all patients except one. The graft was fixed to the recipient bone at both ends by one or two AO cortical screws, supplemented by a monolateral external fixator. A standard postoperative protocol was followed in all patients. The hypertrophy percentage of the vascularized fibular graft was calculated by a modification of the formula described by El-Gammal. The followup period averaged 46.5 months (range 24 - 164 months. The Pearson correlation coefficient (r was worked out, to find the relationship between graft length and hypertrophy. The t-test was performed to find out if there was any significant difference in the graft length of those who had a stress fracture and those who did not and to find out whether there was any significant difference in hypertrophy with and without ipsilateral fibula union. The Chi square test was performed to identify whether there was any association between the stress fracture and the fibula union. Given the small sample size we have not used any statistical analysis to determine the relation between the percentage of the graft hypertrophy and stress fracture. Results : Graft

  7. Use of vascularised cartilage as an additional interposition in temporomandibular ankylosis surgery: Rationale, advantages and potential benefits

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    Jagannathan Mukund

    2008-01-01

    Full Text Available Context: Surgery for the release of temporomandibular joint (TMJ ankylosis is a commonly performed procedure. Various interposition materials have been tried with varying success rates. However, none of these procedures attempt to recreate the architecture of the joint as the glenoid surface is usually left raw. Aims: We aimed to use a vascularised cartilage flap and to line the raw surface of the bone to recreate the articular surface of the joint. Settings and Design: There is a rich blood supply in the region of the helical root, based on branches from the Superficial Temporal Artery (STA, which enables the harvest of vascularised cartilage from the helical root for use in the temporomandibular joint. Materials and Methods: Two cases, one adult and the other a child, of unilateral ankylosis were operated upon using this additional technique. The adult patient had a bony segment excised along with a vascularised cartilage flap for lining the glenoid. The child was managed with an interposition graft of costochondral cartilage following the release of the ankylosis, in addition to the vascularised cartilage flap for lining the glenoid. Results: The postoperative mouth opening was good in both the cases with significant reduction in pain. However, the long-term results of this procedure are yet to be ascertained. Conclusions: The vascularised cartilage flap as an additional interposition material in temporomandibular joint surgery enables early and painless mouth-opening with good short-term results. The potential applicability of this flap in various pathologies of the temporomandibular joint is enormous.

  8. Residual malformations and leg length discrepancy after treatment of fibular hemimelia

    OpenAIRE

    Soucacos Panayotis N; Beris Alexandros E; Korompilias Anastasios V; Alaseirlis Dimosthenis A

    2011-01-01

    Abstract Background Fibular hemimelia has been reported as the most common congenital longitudinal deficiency of the long bones. Previous studies have focused on the best treatment options for this congenital condition. There is very little to our knowledge in the literature focused on residual persisting malformations and leg length discrepancy after treatment. Methods Seven patients presenting fibular hemimelia in eight fibulae received treatment between years 1988 and 2001. Pre-treatment a...

  9. Bilateral fibular hemimelia with recto-vestibular fistula associated with amniotic bands.

    Science.gov (United States)

    Datta, K; Panja, S; Sarkar, Sumantra; Ghosh, Prakash C; Mirza, A

    2008-07-01

    Fibular Hemimelia is a rare congenital disorder of deficiency to complete absence of fibula. It has been associated with post axial skeletal anomalies like shortening of femur, absence of lateral rays of foot and syndactyle, polydactyle etc. We report this case because of associated amniotic constriction bands over both the forearm, suggesting amniotic bands may be one of the causal factors of Fibular Hemimelia due to insult to the growing limb bud.

  10. Classification of Cruciate Ligament Dysplasia and the Severity of Congenital Fibular Deficiency.

    Science.gov (United States)

    Walker, Janet L; Milbrandt, Todd A; Iwinski, Henry J; Talwalkar, Vishwas R

    2016-12-22

    Dysplasia of the cruciate ligaments has been found in many patients with congenital fibular deficiency. A recent classification system has shown that radiographic tibial spine changes can predict the hypoplasia and aplasia of the cruciate ligaments. We used this radiographic classification to determine the frequency of these abnormalities and how they correlate with the severity of fibular deficiency and lateral femoral condylar hypoplasia. Using a hospital database search for fibular deficiency, 99 patients ≥6 years with unilateral fibular deficiency were identified. Existing radiographs of both knees were available for 75 patients and reviewed for the tibial spine changes and Achterman and Kalamchi classification of the fibular deficiency. Measurements of femoral condyle heights in 74 of 75 patients were recorded before any surgery to the distal femoral physis to assess lateral femoral condylar hypoplasia. Twenty-two patients had hypoplasia of the lateral tibial spine+normal medial spine, 29 had absence of the lateral tibial spine+hypoplastic medial spine, and 11 had absence of both tibial spines. Five tibial spines were normal and 8 were unclassifiable. The severity of the tibial spine dysplasia, particularly absence of the lateral tibial spine, correlated with the severity of the fibular deficiency. (Pfibular absence (P=0.039) and foot ray deficiency (P=0.036). The severity of cruciate ligament dysplasia in fibular deficiency is directly correlated with the severity of fibular absence, lateral femoral condylar hypoplasia, and the absence of foot rays. This suggests that the embryological factors involved have a complex interplay for all of these clinical findings. Level III.

  11. In vitro incidence of fibular penetration with and without the use of a jig during tibial plateau leveling osteotomy.

    Science.gov (United States)

    Flynn, Patrick; Duncan, Colleen G; Palmer, Ross H; Duerr, Felix M

    2014-05-01

    To determine the incidence of fibular penetration during placement of the Synthes® locking TPLO plate with and without the use of a jig. Cadaveric, experimental study. Cadaveric paired pelvic limbs (n = 8) from skeletally mature dogs. Limbs were assigned to 1 of 2 groups (jig-less-TPLO = no jig used; jig-TPLO = jig used). Synthes® locking TPLO plates were applied using proximal screws of excessive length to facilitate identification of fibular penetration. Screw tip locations were identified by dissection and frequency of fibular penetration was compared between groups. None of the jig-TPLO limbs and 6 (75%) of jig-less-TPLO limbs had fibular penetration, a difference that was statistically significant. Fibular penetration was most frequently associated with the most proximal screw. A significantly higher incidence of fibular penetration occurs when Synthes® locking TPLO is performed without use of a jig. © Copyright 2014 by The American College of Veterinary Surgeons.

  12. Evaluating E. coli degradation using a rotatory disk photoreactor

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    Gina María Hincapié Mejía

    2010-04-01

    Full Text Available Degradation of the bacterium E. coli was studied using a rotatory disk photoreactor manufactured in stainless steel to ascertain this photoreaction system’s behaviour in different operating conditions. The photoreactor was equipped with 6 black light bulbs (BLB used as a source of UV light and fitted with 7 removable disks made of common frosted glass impregnated with TiO2 photocatalyzer which were coupled to a rotation system. TiO2 was impregnated on the disks using the sol-gel method varying molar precursor gel ratios. Abrasion resistance, disk adhesion and surface uniformity tests were carried out for selecting the film presenting the best characteristics. Bacterial photodegradation studies were carried out using the following variable parameters: the disks’ rotation speed, radiation intensity and the number of discs which were directly related to the concentration of photo-catalyzer in the system. Up to 64.3% degradation was achieved in 4 hours using 7 disks, low intensity and low rotation speed.

  13. Residual increased valgus stress angulation and posterolateral rotatory translation after simple elbow dislocation.

    Science.gov (United States)

    Kerschbaum, Maximilian; Thiele, Kathi; Scheibel, Markus; Gerhardt, Christian

    2017-07-01

    Purpose of this study was to evaluate increased valgus stress angulation and increased posterolateral rotatory translation after simple elbow dislocation and the associated clinical instability. Ten patients [three women, seven men; mean age 38 ± 11 years; mean follow-up 54 months (median 47 months; range 23-111 months)] with conservatively treated simple elbow dislocations were included into this study. The elbow function was graded by using the subjective elbow value (SEV), the Oxford Elbow Score (OES), the Mayo Elbow Performance Score (MEPS), as well as the DASH Score. Range of motion (ROM) and clinical signs of valgus and posterolateral rotatory instability (PLRI) were evaluated. Additionally, in all patients sonographic and fluoroscopic evaluation of valgus stress angulation and posterolateral rotatory translation was performed. Functional scores showed excellent to good results in all patients (SEV: 92 %; OES: mean 44 ± 5 points; MES: mean 91 ± 9 points; DASH Score: mean, 4 ± 4 points). The ROM did not reveal any significant differences compared to the non-affected side. Overall, three patients presented signs of clinical instability (valgus instability: n = 1; PLRI: n = 2). Sonographically, a slightly but not significantly increased valgus stress angulation in comparison with the non-affected side was measured (n.s.). The posterolateral rotatory translation was significantly increased compared to the non-affected side (p < 0.05). In this context, sonographically, four of ten patients revealed a valgus stress angulation and seven of ten patients a posterolateral rotatory translation more than 50 % compared to the non-affected. In four patients an increased valgus stress angulation and in four patients an increased posterolateral rotatory translation could be seen fluoroscopically. Patients after conservatively treated simple elbow dislocations show good clinical and functional results. However, a sufficient anatomical ligamentary

  14. Biomechanical Evaluation of the Effect of Intramedullary Fibular Graft in Proximal Humeral Fractures

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    Tugrul Bulut

    2017-01-01

    Full Text Available Aim: The aim of this study is to investigate the biomechanical effect of intramedullary fibular grafts in two-part proximal humeral fracture models. We also investigated two different positions of an intramedullary fibular graft in terms of fracture stability. Material and Method: A total of 21 two-part humeral neck fracture models were randomly separated into 3 groups. All fracture models were fixed with anatomic locking plates and 3.5mm locking screws. An intramedullary fibular graft was placed parallel to the long axis of the humerus in group I and at an approximately 135 degree angle, so as to support the calcar and medial column of the humeral neck, in group II. No fibular graft was used in the control group. All models were tested with a uniaxial electromechanic device at 20 degrees abduction that mimics the primary axial loads and shear forces with early active abduction. Values of loading and stiffness were measured. Results: No statistically significant difference was found for loading and stiffness values between groups. Discussion: These results were interpreted to mean that the presence or positioning of a fibular graft makes no additional contribution to the stability of two-part proximal humeral neck fractures with an anatomically reduced medial column fixed by a locking plate and screws. In conclusion, it is not necessary to utilize an intramedullary fibular graft in proximal humerus fractures when anatomic reduction is obtained. An unaccompanied locking plate and screws are adequate for these cases. Although using a fibular graft in proximal humerus fractures is a popular technique, it should be reserved for unstable osteoporotic fractures in which the medial column cannot be reduced.

  15. Priority of fibular reconstruction in patients with oral cavity cancer undergoing segmental mandibulectomy.

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    Chih-Hung Lin

    Full Text Available BACKGROUND: The fibula osteoseptocutaneous free flap is generally used for segmental mandibular reconstructions following resection of oral cavity squamous cell carcinoma (OSCC. However, less complex reconstructions may be feasible for patients with predicted poor survival. Herein, we sought to identify the main risk factors (RFs associated with poor prognosis in OSCC patients undergoing segmental mandibulectomy to help decide between fibular and non-fibular reconstructions. METHODS: Between 1996 and 2011, we examined the 5-year control, distant metastases, and survival rates in 310 consecutive, previously untreated patients with primary OSCC who underwent segmental mandibulectomy. RESULTS: Margin status was the only independent RF for 5-year local control. Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent RFs for poor 5-year survival. In the entire study cohort, 23% of the patients had 2 or 3 adverse RFs; such a high-risk group was characterized by a poor prognosis and may be suitable for non-fibular reconstructions. Overall, 70% of the study patients were cT1-4N0, cT1N2, cT2N1, or had tumor depth <15 mm; less than 5% of patients in this subgroup had 2 or 3 adverse RFs and were thus candidates for fibular reconstructions. Among the remaining 30% of patients who showed both advanced clinical stage (cT2N2, cT3-4N1-2 and tumor depth ≥15 mm, 70% exhibited 2 or 3 adverse RFs. CONCLUSIONS: Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent predictors of poor prognosis in OSCC patients undergoing segmental mandibulectomy. The preoperative or intraoperative identification of adverse RFs may help decide between fibular and non-fibular mandibular reconstruction. High-risk patients bearing 2 or 3 adverse RFs have poor prognosis and should not be considered as candidates for fibular reconstructions.

  16. Evaluation of Fibular Fracture Type vs Location of Tibial Fixation of Pilon Fractures.

    Science.gov (United States)

    Busel, Gennadiy A; Watson, J Tracy; Israel, Heidi

    2017-06-01

    Comminuted fibular fractures can occur with pilon fractures as a result of valgus stress. Transverse fibular fractures can occur with varus deformation. No definitive guide for determining the proper location of tibial fixation exists. The purpose of this study was to identify optimal plate location for fixation of pilon fractures based on the orientation of the fibular fracture. One hundred two patients with 103 pilon fractures were identified who were definitively treated at our institution from 2004 to 2013. Pilon fractures were classified using the AO/OTA classification and included 43-A through 43-C fractures. Inclusion criteria were age of at least 18 years, associated fibular fracture, and definitive tibial plating. Patients were grouped based on the fibular component fracture type (comminuted vs transverse), and the location of plate fixation (medial vs lateral) was noted. Radiographic outcomes were assessed for mechanical failures. Forty fractures were a result of varus force as evidenced by transverse fracture of the fibula and 63 were due to valgus force with a comminuted fibula. For the transverse fibula group, 14.3% mechanical complications were noted for medially placed plate vs 80% for lateral plating ( P = .006). For the comminuted fibular group, 36.4% of medially placed plates demonstrated mechanical complications vs 16.7% for laterally based plates ( P = .156). Time to weight bearing as tolerated was also noted to be significant between groups plated medially and laterally for the comminuted group ( P = .013). Correctly assessing the fibular component for pilon fractures provides valuable information regarding deforming forces. To limit mechanical complications, tibial plates should be applied in such a way as to resist the original deforming forces. Level of Evidence Level III, comparative study.

  17. Priority of fibular reconstruction in patients with oral cavity cancer undergoing segmental mandibulectomy.

    Science.gov (United States)

    Lin, Chih-Hung; Kang, Chung-Jan; Tsao, Chung-Kan; Wallace, Christopher Glenn; Lee, Li-Yu; Lin, Chien-Yu; Wang, Hung-Ming; Ng, Shu-Hang; Yen, Tzu-Chen; Liao, Chun-Ta

    2014-01-01

    The fibula osteoseptocutaneous free flap is generally used for segmental mandibular reconstructions following resection of oral cavity squamous cell carcinoma (OSCC). However, less complex reconstructions may be feasible for patients with predicted poor survival. Herein, we sought to identify the main risk factors (RFs) associated with poor prognosis in OSCC patients undergoing segmental mandibulectomy to help decide between fibular and non-fibular reconstructions. Between 1996 and 2011, we examined the 5-year control, distant metastases, and survival rates in 310 consecutive, previously untreated patients with primary OSCC who underwent segmental mandibulectomy. Margin status was the only independent RF for 5-year local control. Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent RFs for poor 5-year survival. In the entire study cohort, 23% of the patients had 2 or 3 adverse RFs; such a high-risk group was characterized by a poor prognosis and may be suitable for non-fibular reconstructions. Overall, 70% of the study patients were cT1-4N0, cT1N2, cT2N1, or had tumor depth <15 mm; less than 5% of patients in this subgroup had 2 or 3 adverse RFs and were thus candidates for fibular reconstructions. Among the remaining 30% of patients who showed both advanced clinical stage (cT2N2, cT3-4N1-2) and tumor depth ≥15 mm, 70% exhibited 2 or 3 adverse RFs. Level IV/V metastases, extracapsular spread, and tumor depth ≥15 mm were independent predictors of poor prognosis in OSCC patients undergoing segmental mandibulectomy. The preoperative or intraoperative identification of adverse RFs may help decide between fibular and non-fibular mandibular reconstruction. High-risk patients bearing 2 or 3 adverse RFs have poor prognosis and should not be considered as candidates for fibular reconstructions.

  18. Traumatic atlantoaxial rotatory fixation associated with C2 articular facet fracture in adult patient: Case report

    Directory of Open Access Journals (Sweden)

    Mehdi Bellil

    2014-01-01

    Full Text Available Traumatic atlantoaxial rotatory fixation is a very rare injury in adults which is often misdiagnosed initially. Its combination with C2 fractures is predominated by dens lesions. Therapeutic management is challenging because of the difficulty to achieve optimal reduction and permanent stability. We report a rare case of traumatic atlantoaxial rotatory fixation in a 56-year-old women associated with C2 articular facet fracture successfully treated by conservative means after patient-awake manual reduction with optimal functional and radiographic outcome.

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

    Science.gov (United States)

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

    2005-09-01

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

  20. Optical Rotatory Dispersion: New Twists on AN Old Topic

    Science.gov (United States)

    Vaccaro, Patrick

    2017-06-01

    Among the many physicochemical properties used to distinguish chiral molecules, perhaps none has had as profound and sustained an impact in the realm of chemistry as the characteristic interactions that take place with polarized light. Of special note is the dispersive (non-resonant) phenomenon of circular birefringence (CB), the manifestation of which first was reported over two centuries ago and which still is employed routinely - in the more familiar guise of specific optical rotation - to gauge the enantiomeric purity of the products emerging from asymmetric syntheses. Concerted experimental and theoretical efforts designed to probe such electronic optical activity in isolated chiral molecules will be presented, with special emphasis directed towards the marked influence that intramolecular (vibrational and conformational) dynamics and intermolecular (environmental) perturbations can exert upon the intrinsic chiroptical response. Requisite isolated-molecule measurements have been made possible by our continuing development of cavity ring-down polarimetry (CRDP), an ultrasensitive polarimetric scheme that has permitted the first quantitative analyses of optical rotatory dispersion (ORD or wavelength-resolved CB) to be performed in rarefied (gaseous) media. Various technical aspects of CRDP will be discussed to illustrate the unique capabilities and practical limitations afforded by this novel methodology. Comparison of specific rotation values acquired for a broad spectrum of rigid and flexible chiral species under complementary isolated and solvated conditions will highlight the intimate coupling that exists among electronic and nuclear degrees of freedom as well as the pronounced, yet oftentimes counterintuitive, effects incurred by subtle solute-solvent interactions. The disparate nature of optical activity extracted from different surroundings will be demonstrated, with quantum-chemical calculations serving to elucidate the structural, electronic, and

  1. Successful conservative treatment for neglected rotatory atlantoaxial dislocation.

    Science.gov (United States)

    Chechik, Ofir; Wientroub, Shlomo; Danino, Barry; Lebel, David E; Ovadia, Dror

    2013-06-01

    Rotatory atlantoaxial subluxation (RAS) is a rare condition that is often misdiagnosed and therefore incorrectly managed. We describe our experience and propose an algorithm for treating neglected RAS nonoperatively. All consecutive children with neglected (>6 wk) RAS were treated in our department between 2005 and 2010 by cervical traction using a Gleason traction device and nonsteroidal anti-inflammatory drugs and muscle relaxants. When reduction was not achieved, the Gleason device was replaced by a halo device without manipulative reduction, and weight was added as necessary until reduction was successful. Fixation of reduction was either by a sternooccipital mandibular immobilizer or a halo vest for 3 to 4 months. All 5 children (4 boys and 1 girl, aged 4 to 11 y) were successfully treated for neglected RAS. The mean duration from symptom onset (eg, limited neck range of motion, discomfort) to treatment initiation was 11.6 weeks (range, 6 to 16 wk). Closed reduction was achieved by a Gleason or a noninvasive halo device within 1 to 2 weeks in 4 cases. The fifth case was reduced after 5 weeks of traction using a halo with a 5 kg weight. All children had symmetrical full range of motion, normal neurological examination, and were fully engaged in educational and sports activities without recurrent dislocations at final follow-up (mean, 30 mo; range, 18 to 49 mo). Conservative treatment by gradual and prolonged traction without manipulative reduction in neglected RAS might be a successful method. Reduction can often be achieved within 2 weeks of treatment onset. Level IV (retrospective case series).

  2. Prenatal diagnosis of congenital femoral deficiency and fibular hemimelia.

    Science.gov (United States)

    Radler, Christof; Myers, Abigail K; Hunter, Renee J; Arrabal, Pedro P; Herzenberg, John E

    2014-10-01

    Routine ultrasonography can detect congenital femoral deficiency (CFD) and fibular hemimelia (FH), but prenatal detection rate and its relation to deformity severity have never been reported. Whether mothers prefer prenatal diagnosis is also unknown. We aimed to determine whether mothers prefer prenatal diagnosis, to report detection rates for CFD and/or FH, and to correlate detection rates to severity of limb shortening. Surveys were mailed to 171 mothers who gave birth to children with CFD/FH between 2000 and 2008. Bilateral femoral and tibial lengths were measured on postnatal radiographs. We calculated corresponding femoral/tibial lengths at gestational weeks 20 and 30. Sixty-five surveys were returned, and 56 radiographs were reviewed. Most mothers (63%) preferred prenatal diagnosis as it enables prenatal counseling. Congenital limb shortening was detected in 24 cases (37%) and was not detected in 41 cases (63%). Detection rate was 52% (12 of 23) in CFD cases, 23% (three of 13) in FH cases, and 30% (six of 20) in combined cases. CFD cases with severe shortening had a higher detection rate. Ultrasonographers should measure both femoral and tibial lengths. Unilateral shortening should result in pediatric orthopedic consultation to estimate limb-length discrepancy at maturity and discuss treatment. © 2014 John Wiley & Sons, Ltd.

  3. [Prosthesis use in pediatric patients with fibular hipoplasia].

    Science.gov (United States)

    Aparicio, Omar Carlos González; García, Felipe Haces; Leonori, Romáin Capdevila; García, Víctor Rosas

    2007-01-01

    To assess the prosthesis adaptability at use of pedestal and transtibial prosthesis, recognize the average average age of amputation surgery, and the complications of the amputation in patients with fibular hemimelia. 47 patients were evaluated, initially to adjust pedestal prosthesis and when this was not tolerated, we realize amputation and adaptation of transtibial prosthesis, we valued the average age of amputation surgery, the associate complications and the prosthesis adaptability we use the K system for functional ambulation. Of the 12 patients to actually use pedestal prosthesis 9 (75%) had a K.2 level, 3 (25%) had a K-3 level, of the 35 patients to use transtibial prosthesis 1 (3%) had a K-2 level, 19 (54%) K-3 level, and 15 (43%) in the K-4 level. The average age to amputation surgery was 3.9 years old, one case had a complication. The early prosthesis adaptability provides advantages in the functional ambulation, as demonstrated on the results. The goal of the transtibial amputation is to facilitate the prosthesis adaptability, is due to take advantage of the best functional adaptation the child in the first years of life, circumstance that improves the integral rehabilitation of the patient.

  4. Prospective intraoperative syndesmotic evaluation during ankle fracture fixation: stress external rotation versus lateral fibular stress.

    Science.gov (United States)

    Matuszewski, Paul E; Dombroski, Derek; Lawrence, J Todd R; Esterhai, John L; Mehta, Samir

    2015-04-01

    We hypothesized that the method of stress external rotation more accurately reproduces the mechanism of injury, and therefore this diagnostic method more likely detects ankle instability than the fibular stress examination. Prospective cohort comparison study. Level 1 trauma center. Twenty-eight consecutive patients with unstable ankle fractures presenting within 7 days from the time of injury. Previous ankle surgical history or age younger than 18 years was excluded. Stress external rotation and lateral fibular stress examination was performed intraoperatively. Radiographic measurement of the tibiofibular clear space, tibiofibular overlap, and medial clear space were recorded. After normalization of the fluoroscopic measurements, there was no difference in detecting changes in tibiofibular clear space or tibiofibular overlap. However, there was a significant difference in detecting medial clear space widening with stress external rotation. Compared with lateral fibular stress, stress external rotation demonstrated a 35% increase (P stress external rotation. Untreated instability impacts patient outcomes. The difference in widening with stress external rotation was significantly greater than lateral fibular stress and appreciable on standard fluoroscopic views. Stress external rotation radiographs are a more reliable indicator of mortise instability than traditional lateral fibular stress. Diagnostic Level IV. See Instructions for Authors for a complete description of levels of evidence.

  5. Evaluation of osteosynthesis with dual fibular bone grafting for neglected femoral neck fractures.

    Science.gov (United States)

    Jaiswal, Atin; Pruthi, K K; Goyal, R K; Pathak, Vineet; Habib, Masood; Tanwar, Yashwant S; Singh, Satyaprakash; Chaterjee, Rupak

    2013-06-01

    Femoral neck fractures in young adults is an unsolved problem and neglected femoral neck fractures presents more challenge to the orthopaedics surgeon if femoral head salvage is attempted. We reviewed the operative results of neglected femoral neck fractures in young adults with fixation with dual fibular bone grafting Purpose of study was evaluation of epidemiological, clinical, functional, rehabilitative outcome and complications in such patients. Twentyeight patients in age group 18-50 years were operated having fracture neck femur by dual fibular bone grafting in the Department of Orthopaedics, S.N. Medical College, Agra in (May 2005-February 2008) and divided into two groups. Group A: comprised of 8 patients treated by dual fibular bone grafting alone and Group B: comprised of 18 patients treated by dual fibular bone grafting with single cancellous hip screw. All the patients of the present series were having neglected intracapsular fracture, neck femur which were treated by dual fibular bone grafting with or without cancellous hip screw fixation. Majority of the patients had good to fair result according to Larson method with average time of union 16 weeks. All patients had useful range of movement at hip. Satisfactory union was achieved in all patients except two. Double bone grafting is a simple and cost effective modality of treatment for late femoral neck fracture with good results. It is a stable and biological method of fixation with preservation of natural femoral head with fewer complications.

  6. [OCT Angiography in Exudative AMD with Detachment of Vascularised Retinal Pigment Epithelium].

    Science.gov (United States)

    Gunnemann, Frederic; Rothaus, Kai; Farecki, Marie-Louise; Faatz, Henrik; Book, Benedikt; Lommatzsch, Albrecht; Pauleikoff, Daniel

    2017-09-01

    Background The aim of the following extended case study was to analyse whether choroidal neovascularisation (CNV) in vascularised epithelial detachments (PED) in OCT angiography (OCT-A) can be better visualised in OCT-A than in the established angiographic methods during the course of anti-VEGF therapy and if possible used to quantify the CNV size and flow area. These findings were compared with other SD-OCT characteristics of the lesion (PED height, retinal thickness). Patients and Methods 8 patients with PED and associated CNV were diagnosed with multimodal imaging and additionally OCT angiography was performed. The CNV region in the B-scan of the OCT-A was detected with a fine segmentation setting (20 µm) parallel and just below the retinal pigment epithelium (RPE). The CNV area was manually marked, and the size of the CNV and the vessel section (flow area) were analysed with the evaluation tool of the device. This measurement was performed both initially and after anti-VEGF therapy (3 injections). At the same time, the visual acuity (logMAR) and the SD-OCT parameters of PED height and retinal thickness were determined before and after therapy and also statistically compared. Results Initially, the size of CNV in OCT-A showed a large phenotypic range of variation (0.33 - 1.35 mm 2 , mean 0.71 mm 2 ). This decreased significantly under therapy (after therapy 0.44 - 0.84 mm 2 , mean 0.57 mm 2 , p = 0.02). The proportion of the vessels analysed within the CNV (flow area) varied as well (0.21 - 0.88 mm 2 , mean 0.45) and decreased under therapy (0.08 - 0.44 mm 2 after therapy), mean 0.27 mm 2 , p = 0.07). The height of PED in SD-OCT was initially different (initially 274 - 1459 µm, mean 607 µm), but showed only small changes (132 - 1317 µm, mean 524 µm, p = 0.09) under therapy. This also applied to the mean retinal thickness (before therapy 315 µm, after therapy 294 µm, p = 0.5). Mean visual

  7. Review of vascularised bone tissue-engineering strategies with a focus on co-culture systems.

    Science.gov (United States)

    Liu, Yuchun; Chan, Jerry K Y; Teoh, Swee-Hin

    2015-02-01

    Poor angiogenesis within tissue-engineered grafts has been identified as a main challenge limiting the clinical introduction of bone tissue-engineering (BTE) approaches for the repair of large bone defects. Thick BTE grafts often exhibit poor cellular viability particularly at the core, leading to graft failure and lack of integration with host tissues. Various BTE approaches have been explored for improving vascularisation in tissue-engineered constructs and are briefly discussed in this review. Recent investigations relating to co-culture systems of endothelial and osteoblast-like cells have shown evidence of BTE efficacy in increasing vascularization in thick constructs. This review provides an overview of key concepts related to bone formation and then focuses on the current state of engineered vascularized co-culture systems using bone repair as a model. It will also address key questions regarding the generation of clinically relevant vascularized bone constructs as well as potential directions and considerations for research with the objective of pursuing engineered co-culture systems in other disciplines of vascularized regenerative medicine. The final objective is to generate serious and functional long-lasting vessels for sustainable angiogenesis that will enable enhanced cellular survival within thick voluminous bone grafts, thereby aiding in bone formation and remodelling in the long term. However, more evidence about the quality of blood vessels formed and its associated functional improvement in bone formation as well as a mechanistic understanding of their interactions are necessary for designing better therapeutic strategies for translation to clinical settings. Copyright © 2012 John Wiley & Sons, Ltd.

  8. Proximal femoral focal deficiency (PFFD) and fibular A/hypoplasia (FA/H): a model of a developmental field defect.

    Science.gov (United States)

    Sorge, G; Ardito, S; Genuardi, M; Pavone, V; Rizzo, R; Conti, G; Neri, G; Katz, B E; Opitz, J M

    1995-02-13

    Proximal femoral focal deficiency (PFFD) and fibular a/hypoplasia (FAH) are distinct malformations of the lower limbs. Both can occur as isolated defects or in association with other limb malformations. In fact, fibular defects frequently are present in PFFD, and, conversely, femoral abnormalities can be found in the presence of a typical FAH picture. We report on 5 patients with a variable combination of femoral and fibular defects. In one of them unilateral PFFD was associated with lateral foot defects, in the absence of fibular abnormalities, and with a phenotype similar to that observed in the femoral hypoplasia/unusual face syndrome (FH/UFS). Another patient had isolated PFFD on one side, with controlateral absence of femur, fibula, and tibia. Another patient had a PFFD, fibular hypoplasia, and abnormalities of fibular foot rays, and the last 2 patients, a father and son, had, respectively, bilateral foot malformations plus fibular and tibial hypoplasia in the father and a PFFD in the son. These observations represent a further demonstration of the existence of a fibular developmental field, and contribute to the definition of its spatial boundaries. The variable involvement of elements comprised in the developmental field can be explained by multifactorial etiology.

  9. [Fibular transfer in a nine-week-old infant for complete congenital absence of the tibia].

    Science.gov (United States)

    Karakurt, Lokman; Yilmaz, Erhan; Avci, Mustafa; Serin, Erhan

    2002-01-01

    The treatment of complete congenital absence of the tibia is controversial. The goal of the treatment is to construct a satisfactorily functioning knee joint, for which fibular transfer was described as an appropriate method. We performed reconstructive surgery using a modified Browns procedure in a nine-week-old boy with Jones type 1 congenital longitudinal deficiency of the tibia. In his final control at three years of age a good outcome was obtained according to the criteria by Epps et al. To our knowledge, this is the youngest patient to receive fibular transfer in the literature, to which we ascribed the satisfactory outcome.

  10. Mal de Hansen, anticorpos antifosfolípides e obstrução das artérias fibulares Leprosy, antiphospholipid antibodies and bilateral fibular arteries obstruction

    Directory of Open Access Journals (Sweden)

    Liz Wallin

    2009-04-01

    Full Text Available Pacientes com Mal de Hansen (MH podem se apresentar com quadro clínico e laboratorial sugestivo de doenças reumáticas, o que exige um exercício cuidadoso de diagnósticos diferenciais. Descreve-se aqui o caso de uma jovem com MH que se apresentou com lesões cutâneas sugestivas de vasculite, obstrução de vasos fibulares, FAN e anticorpos antifosfolípides positivos sem muitos estigmas da doença cutânea, ilustrando essa dificuldade.Patients with Hansen's disease (HD may present themselves with clinical and laboratorial features that resemble rheumatic disorders. This requires a careful exercise of differential diagnosis. We describe here a case of a young woman with HD that presented with vasculitic like lesions, fibular vessels obstruction, ANA and antiphospholipid antibodies without typical signs of cutaneous disease, illustrating this clinical difficulty.

  11. A synergistic negative effect of gestational smoke-exposure and small litter size on rat placental efficiency, vascularisation and angiogenic factors mRNA expression.

    Directory of Open Access Journals (Sweden)

    Zhen-Yan Chen

    Full Text Available Smoking increases the risk of pregnancy complications such as spontaneous abortion and low birth weight (LBW. By cigarette smoke exposure (gestational day, GD3-17, normal-litter-size pregnancy with low birth weight (NP-LBW and small-litter-size pregnancy with normal birth weight (SP-NBW in rats were induced. The placental weight in SP-NBW was twice the weight of the normal in contrast with the smaller placenta in NP-LBW. Compared with the normal, placental efficiency (expressed as fetus-to-placenta weight ratio and placental vascularisation were significantly decreased in smoke exposed placentas with more obvious decrease in SP-NBW. For NP-LBW, decreased placental vascularisation was due to decreased labyrinth vascularisation which was caused by both decreased number density and diameter of fetal capillary. For SP-NBW, decreased placental vascularisation was due to reduced proportion of labyrinth in placenta and decreased labyrinth vascularisation which was caused by decreased fetal capillary number density. Real time RT-PCR analysis showed a tendency for decreased placental mRNA level of vascular endothelial growth factor (VEGF, angiopoietin-1 (Ang1 and tyrosine kinase receptor-2 (Tie2 in NP-LBW(P<0.1, and the tendency became obvious in SP-NBW(P<0.05. A tendency for decreased placental mRNA level of fms-like tyrosine kinase-1(Flt1 and angiopoietin-2 (Ang2 was also observed in SP-LBW(P<0.1. Our data demonstrated the synergistic negative effect of gestational smoke-exposure and small litter size on placental efficiency, placental vascularisation and placental angiogenic growth factor mRNA expression in rat.

  12. Seasonal Changes in Testes Vascularisation in the Domestic Cat (Felis domesticus: Evaluation of Microvasculature, Angiogenic Activity, and Endothelial Cell Expression

    Directory of Open Access Journals (Sweden)

    Graça Alexandre-Pires

    2012-01-01

    Full Text Available Some male seasonal breeders undergo testicular growth and regression throughout the year. The objective of this study was to understand the effect of seasonality on: (i microvasculature of cat testes; (ii angiogenic activity in testicular tissue in vitro; and (iii testicular endothelial cells expression throughout the year. Testicular vascular areas increased in March and April, June and July, being the highest in November and December. Testes tissue differently stimulated in vitro angiogenic activity, according to seasonality, being more evident in February, and November and December. Even though CD143 expression was higher in December, smaller peaks were present in April and July. As changes in angiogenesis may play a role on testes vascular growth and regression during the breeding and non-breeding seasons, data suggest that testicular vascularisation in cats is increased in three photoperiod windows of time, November/December, March/April and June/July. This increase in testicular vascularisation might be related to higher seasonal sexual activity in cats, which is in agreement with the fact that most queens give birth at the beginning of the year, between May and July, and in September.

  13. Effets des radiofréquences sur le système nerveux central chez lʼhomme : EEG, sommeil, cognition, vascularisation

    Science.gov (United States)

    Ghosn, Rania; Villégier, Anne-Sophie; Selmaoui, Brahim; Thuróczy, Georges; de Sèze, René

    2013-05-01

    Most of clinical studies on radiofrequency electromagnetic fields (RF) were directed at mobile phone-related exposures, usually at the level of the head, at their effect on some physiological functions including sleep, brain electrical activity (EEG), cognitive processes, brain vascularisation, and more generally on the cardiovascular and endocrine systems. They were frequently carried out on healthy adults. Effects on the amplitude of EEG alpha waves, mainly during sleep, look reproducible. It would however be important to define more precisely whether and how the absence of electromagnetic disturbance between RF exposure and the recording systems is checked. No consensus arises about cognitive effects. Some effects on cerebral vascularisation need complementary work.

  14. Reconstruction of the lateral malleolus using a reverse-flow vascularized fibular head: a case report.

    Science.gov (United States)

    Rajacic, N; Dashti, H

    1996-01-01

    We report a case of a 7-year-old girl in whom a vascularized fibular head with preserved epiphyseal and metaphyseal blood supply was used to reconstruct the missing lateral malleolus. Two-year follow-up showed good bony stability and growth potential of the transplanted epiphyseal plate.

  15. Reconstruction of multiple metacarpal bone defect using segmentated free fibular bone flap: Case report

    Directory of Open Access Journals (Sweden)

    Rahmi Evinc

    2014-04-01

    Full Text Available In this report we present a case of blast injury to hand, including multiple metacarpal bone defect. Bone defects were reconstructed using fibular flap. Structural integrity of metacarpal bones was preserved with good functional results. [Hand Microsurg 2014; 3(1.000: 29-32

  16. Fibular on-lay graft in the management of radial giant cell tumour--a case report.

    Science.gov (United States)

    Alonge, T O; Omololu, A B; Ogunlade, S O

    2001-01-01

    The management of bone loss following tumour resection poses a problem particularly in the upper limb where limb preservation is paramount. For bone loss less than 6cm, nonvascularized fibular graft has been advocated whereas in bone defects larger than this, vascularized fibular graft is the preferred option. In this case study, we have used a nonvascularized fibular on-lay graft (supplemented with cancellous bone graft) in the management of a distal radial bone loss of ten centimeters following resection of a giant cell tumour with remarkable success.

  17. The role of fibular fixation in the treatment of tibia diaphysis distal third fractures.

    Science.gov (United States)

    Rouhani, A; Elmi, A; Akbari Aghdam, H; Panahi, F; Dokht Ghafari, Y

    2012-12-01

    Combined fractures of the distal third of tibia diaphysis and fibula diaphysis are a common orthopedic injury. There is an ongoing debate about the necessity of fibular fixation when associated to distal third tibial fracture. This study aims at evaluating the role of fibular fixation in the treatment of distal third tibial fractures. We hypothesized that fixation of the fibula increases the stability of fixation in distal third tibial and fibular fractures. In a randomized clinical trial, 53 patients with concomitant fractures of tibia and ipsilateral fibula at distal third level were recruited in this study during a 23-month period. Patients were randomized in two groups: patients with fibular fixation (case group) and without fibular fixation (control group). The patients were followed up for at least 6 months postoperatively. There were seven cases exhibiting malalignment on immediate postoperative radiographs. Six of them were in group II (control group) and one was in group I (case group) (P=0.084). We didn't find nonunion in group I and we found three patients in group II (P=0.141). Infection was one in group I and two in group II on gustillo II injuries (P=0.516). Despite its low count of patients, our study didn't show any advantage to fix the fibula fracture associated to distal third of tibia diaphysis fracture. It didn't show either an increase of complication after fibula open reduction and internal fixation. Level III. Randomized prospective study. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  18. Patterns of astragalar fibular facet orientation in extant and fossil primates and their evolutionary implications.

    Science.gov (United States)

    Boyer, Doug M; Seiffert, Erik R

    2013-07-01

    A laterally sloping fibular facet of the astragalus (=talus) has been proposed as one of few osteological synapomorphies of strepsirrhine primates, but the feature has never been comprehensively quantified. We describe a method for calculating fibular facet orientation on digital models of astragali as the angle between the planes of the fibular facet and the lateral tibial facet. We calculated this value in a sample that includes all major extant primate clades, a diversity of Paleogene primates, and nonprimate euarchontans (n = 304). Results show that previous characterization of a divide between extant haplorhines and strepsirrhines is accurate, with little overlap even when individual data points are considered. Fibular facet orientation is conserved in extant strepsirrhines despite major differences in locomotion and body size, while extant anthropoids are more variable (e.g., low values for catarrhines relative to non-callitrichine platyrrhines). Euprimate outgroups exhibit a mosaic of character states with Cynocephalus having a more obtuse strepsirrhine-like facet and sampled treeshrews and plesiadapiforms having more acute haplorhine-like facets. Surprisingly, the earliest species of the adapiform Cantius have steep haplorhine-like facets as well. We used a Bayesian approach to reconstruct the evolution of fibular facet orientation as a continuous character across a supertree of living and extinct primates. Mean estimates for crown Primatomorpha (97.9°), Primates (99.5°), Haplorhini (98.7°), and Strepsirrhini (108.2°) support the hypothesis that the strepsirrhine condition is derived, while lower values for crown Anthropoidea (92.8°) and Catarrhini (88.9°) are derived in the opposite direction. Copyright © 2013 Wiley Periodicals, Inc.

  19. Fabrication of PMMA doped with griseofulvin material and its optical rotatory dispersion

    Science.gov (United States)

    Pan, Xue-Feng; Tao, Wei-Dong; Yan, Fei-Biao; Bai, Gui-Ru

    2006-01-01

    Chiral molecule C17H17CIO6 was incorporated in MMA by sol-gel process and its optical polarization response was measured. The optical rotatory dispersion was measured with self-manufactured apparatus. The results show that the maximum and minimum rotation angles of the chiral PMMA are 69° at the wavelength of 450 nm and 17° at the wavelength of 700 nm, respectively. The experimental results accord with the simulation results by the Boltzmann formula.

  20. Spontaneous rotatory atlantoaxial dislocation without neurological compromise in a child with Down syndrome: a case report

    OpenAIRE

    Au-Yong, Iain; Boszczyk, Bronek; Mehdian, Hossein; Kerslake, Robert

    2008-01-01

    Spontaneous atlantoaxial dislocation is a rare recognised complication of Down syndrome. In the majority of cases, dislocation takes place in an anteroposterior direction and is often associated with abnormalities of odontoid development or ossification. Rotatory atlantoaxial dislocation is extremely rare in Down syndrome and this is to our knowledge the first reported case in which modern imaging methods have been described; surface shaded reformats derived from a multislice CT scan were of ...

  1. [LUCL reconstruction using a triceps tendon graft to treat posterolateral rotatory instability of the elbow].

    Science.gov (United States)

    Dehlinger, F I; Ries, C; Hollinger, B

    2014-08-01

    Re-establishment of radial stability within the elbow joint in cases of arthroscopically or clinically confirmed posterolateral rotatory instability. Posttraumatic or chronic degenerative posterolateral rotatory instability at least grade I-II according to O'Driscoll. Elbow stiffness or elbow arthritis and lateral epicondylitis, if a posterolateral rotatory instability has been excluded as the reason for the symptoms. Reconstruction or augmentation of the insufficient lateral ulnar collateral ligament (LUCL) with an autologous triceps tendon graft. A stripe of the triceps tendon is fixed at the epicondylus humeri radialis and at the base of the annular ligament at the proximal radial ulna with tenodesis screws or buttons, then the extensor origins, which were detached before are fixated as well. Postoperative treatment with an elbow orthesis for 6 weeks, in the first 4 weeks limitation of complete extension and flexion, full weight bearing after 3 months. Retrospective analysis of 47 LUCL reconstructions from 2008-2010 with good results concerning pain reduction and acceptance, improvement of the Mayo Elbow Performance Score from 49 to 82, low complication rate with one elbow stiffness, one temporary ulnar nerve lesion, and one recurrent instability.

  2. Perfusion pattern and time of vascularisation with CEUS increase accuracy in differentiating between benign and malignant tumours in 216 musculoskeletal soft tissue masses

    Energy Technology Data Exchange (ETDEWEB)

    De Marchi, Armanda, E-mail: armanda.demarchi@tiscali.it [Department of Imaging, Azienda Ospedaliera Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126 Torino (Italy); Prever, Elena Brach del, E-mail: elena.brach@unito.it [Department of OrthopaedicOncology and ReconstructiveSurgery, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126 Torino (Italy); Cavallo, Franco, E-mail: franco.cavallo@unito.it [Department of Public health and Paediatrics, University of Turin, Via Santena 5-bis, 10126 Torino (Italy); Pozza, Simona, E-mail: simona.pozza@tin.it [Department of Imaging, Azienda Ospedaliera Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126 Torino (Italy); Linari, Alessandra, E-mail: linaralessandra@libero.it [Department of Pathology, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, Regina Margherita Hospital, Piazza Polonia, 10126 Torino (Italy); Lombardo, Paolo, E-mail: pao.lombardo82@gmail.com [Department of DiagnosticImaging and Radiotherapy of the University of Turin, Azienda Ospedaliero-Universitaria Città della Salute e della Scienza di Torino, Via Genova 3, 10126 Torino (Italy); Comandone, Alessandro, E-mail: alessandro.comandone@gradenigo.it [Department of Oncology, Gradenigo Hospital, Corso Regina Margherita, 8/10.10153 Torino (Italy); Piana, Raimondo, E-mail: raimondo.piana@libero.it [Department of OrthopaedicOncology and ReconstructiveSurgery, Azienda Ospedaliero Universitaria Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126 Torino (Italy); Faletti, Carlo [Department of Imaging, Azienda Ospedaliera Città della Salute e della Scienza, CTO Hospital, Via Zuretti 29, 10126 Torino (Italy)

    2015-01-15

    Introduction: Musculoskeletal Soft Tissue Tumours (STT) are frequent heterogeneous lesions. Guidelines consider a mass larger than 5 cm and deep with respect to the deep fascia potentially malignant. Contrast Enhanced Ultrasound (CEUS) can detect both vascularity and tumour neoangiogenesis. We hypothesised that perfusion patterns and vascularisation time could improve the accuracy of CEUS in discriminating malignant tumours from benign lesions. Materials and methods: 216 STT were studied: 40% benign lesions, 60% malignant tumours, 56% in the lower limbs. Seven CEUS perfusion patterns and three types of vascularisation (arterial-venous uptake, absence of uptake) were applied. Accuracy was evaluated by comparing imaging with the histological diagnosis. Univariate and multivariate analysis, Chi-square test and t-test for independent variables were applied; significance was set at p < 0.05 level, 95% computed CI. Results: CEUS pattern 6 (inhomogeneous perfusion), arterial uptake and location in the lower limb were associated with high risk of malignancy. CEUS pattern has PPV 77%, rapidity of vascularisation PPV 69%; location in the limbs is the most sensitive indicator, but NPV 52%, PPV 65%. The combination of CEUS-pattern and vascularisation has 74% PPV, 60% NPV, 70% sensitivity. No correlation with size and location in relation to the deep fascia was found. Conclusion: US with CEUS qualitative analysis could be an accurate technique to identify potentially malignant STT, for which second line imaging and biopsy are indicated in Referral Centers. Intense inhomogeneous enhancement with avascular areas and rapid vascularisation time could be useful in discriminating benign from malignant SST, overall when the lower limbs are involved.

  3. Ipsilateral fibular transfer for a large tibial defect caused by a gunshot injury: case report.

    Science.gov (United States)

    Goren, David; Sapir, Oleg; Stern, Avraham; Nyska, Meir

    2005-05-01

    Segmental bony defects in open fractures of the tibia are bridged with bone grafting, free vascularized fibular grafts, or an external ring fixator. A 33-year-old man sustained a gunshot injury to his left leg, resulting in Gustillo type IIIB open fractures of the tibia and fibula. The tibia had a segmental massive defect of 19 cm in the midshaft. Debridement and immediate application of an Ilizarov external fixator were performed. The midportion of the ipsilateral fractured fibula served as a bridging vascularized graft for the tibial defect. Good bony union and fibular hypertrophy were obtained. Use of a fractured fibula from a zone previously injured by a gunshot has not been reported. This case demonstrates the successful transfer of a fractured fibula for the bridging of an ipsilateral tibial defect caused by a gunshot injury.

  4. Causal study of isolated ulnar-fibular deficiency in Hungary, 1975-1984.

    Science.gov (United States)

    Czeizel, A E; Vitéz, M; Kodaj, I; Lenz, W

    1993-06-01

    A population-based and validated data set of 114 cases with isolated ulnar-fibular deficiency was evaluated in Hungary, 1975-1984. Ulnar-fibular type had the third most common birth prevalence (0.07 per 1000) among isolated congenital limb deficiency types. This type is relatively rarely associated with nonlimb defects, a single limb is affected in two-thirds of cases, nearly all other cases had femur-fibula-ulna (FFU) dysostosis. Upper and lower limbs, right and left sides, are equally affected, however, there is an obvious male excess (71%). Case-control analysis indicated a lower birth weight due to intrauterine growth retardation, higher birth order, lower socioeconomic status of parents, and a more frequent reported subfertility. The family study identified one familial cluster (one siboccurrence) among 331 first-degree relatives.

  5. Bilateral total knee replacement in a congenital amputee with bilateral fibular deficiency.

    Science.gov (United States)

    Dudhniwala, A G; Singh, S; Morgan-Jones, R

    2011-12-01

    We present the first ever reported case of bilateral total knee replacements in a congenital amputee with bilateral fibular deficiency. A 60 year old woman with bilateral fibular hemimelia presented with advanced osteoarthritis in both her knees for which bilateral total knee replacements was performed. The left knee replacement was followed up at 12 months and the right knee at 7 years. Oxford knee scores improved from 14 to 40 for the left knee and were 37 for the right knee. She was able to walk independently to a distance beyond 400 m. Modification in the surgical procedure and postoperative rehabilitation is discussed. Mid-term follow-up of 7 years reaffirms total knee replacement as a viable option for below knee amputees with knee osteoarthritis. Copyright © 2010 Elsevier B.V. All rights reserved.

  6. Fibular grafting with cannulated hip screw fixation in late femoral neck fracture in young adults

    Directory of Open Access Journals (Sweden)

    Goyal R

    2006-01-01

    Full Text Available Background: We reviewed the operative results of fibular bone graft with cannulated hip screw fixation in femoral neck fracture in young adults. Method: Sixteen young adults with femoral neck fracture were treated by fibular bone graft with cannulated hip screw fixation. All the fractures were more than 3 weeks old. Results: Results were assessed in 15 patients while one patient died due to complications not related to surgery. Union occurred in all 15 patients. One patient had intra-operative complication in the form of screw cut out with graft in the joint space. The average fallow up was 24.4 months. Out of 15 patients assessed clinico-radiologically 11 showed good results, 3 had fair while 1 had poor result. Conclusion: We conclude that this is a simple and cost effective procedure for late femoral fleck fracture in young adults with good results.

  7. MINIMUM INCISION PERCUTANEOUS PLATE OSTEOSYNTHESIS FOR DISTAL FIBULAR FRACTURES: A PROSPECTIVE STUDY

    Directory of Open Access Journals (Sweden)

    Ramkumar Reddy

    2015-09-01

    Full Text Available Distal fibular fractures are usually communitted and most of the times osteoporotic especially if they are occurring in females and in geriatric age group. These fractures are usu ally associated with other fractures, which necessitates them to be fixed accurately. Owing to the fact that distal fragment is subcutaneous with scanty soft tissue over bone, which pose these fracture fixations become difficult by open methods in view of wound healing. A prospective study of 26 patients with distal fibular fractures were treated with MIPPO with hook plate were healed with less complications and better outcome. With this background we suggest a minimally invasive incision over proximal frag ment where sufficient soft tissue cover is present. From there pushing the special hook plate subperiosteally to distal fragment, hooking the tip of fibula and fixing the proximal fragment after reduction gives a simple and effective stable fixation

  8. Residual malformations and leg length discrepancy after treatment of fibular hemimelia

    Directory of Open Access Journals (Sweden)

    Soucacos Panayotis N

    2011-09-01

    Full Text Available Abstract Background Fibular hemimelia has been reported as the most common congenital longitudinal deficiency of the long bones. Previous studies have focused on the best treatment options for this congenital condition. There is very little to our knowledge in the literature focused on residual persisting malformations and leg length discrepancy after treatment. Methods Seven patients presenting fibular hemimelia in eight fibulae received treatment between years 1988 and 2001. Pre-treatment average leg length discrepancy was 5.3 cm. All patients presented associated congenital deformities of the ipsilateral leg. Six patients received surgical treatment. Average post-treatment follow up was 9.7 years. Residual malformations and leg length discrepancy were recorded for all patients. It is a retrospective case series study at one institution by two of the presenting authors as senior surgeons. Results Average leg length gained after successful bone lengthening in six patients was 5.06 cm. Although there was a significant functional improvement, a number of residual malformations and leg length inequality was recorded. Residual average leg length discrepancy of 3.1 cm was observed in five patients who completed surgical treatment. Five patients presented a limp. Residual anterior-medial bowing of the tibia was observed in four patients. Calf atrophy was present in all seven patients. Valgus deformity of the ankle was remained in two patients. Conclusions Treatment of fibular hemimelia, even in cases graded as successful, showed to be accompanied by a number of persisting residual deformities and recurrent leg length inequality. Although the number of patients is limited, the high rate of this phenomenon is indicative of the significance of the report. The family and the patients themselves should have the right expectations and will be more co-operative when well informed about this instance. A report of common post-treatment residual deformities

  9. Paraksiyal fibular hemimeli tedavisine farklı cerrahi yaklaşım

    OpenAIRE

    Bayram, Huseyin; Herdem, Mustafa; Gulsen, Mahir; Sarpel, Yaman; Tan, Ismet; Baytok, Gurbuz

    2004-01-01

    In the congenital fibular deficiency which is an important reason of the lower limb discrepancy, the severity of deformity, the age and the difference between the lengths are affecting the treatment of choice. The treatment of choice in cases of excessive lenght inequality is amputation by using the heel skin flap and then prostheses. In this paper we reported the outcome of the surgical treatment in order to obtain an acceptable shortness and walking status for a 13 years old case of congeni...

  10. Residual malformations and leg length discrepancy after treatment of fibular hemimelia.

    Science.gov (United States)

    Alaseirlis, Dimosthenis A; Korompilias, Anastasios V; Beris, Alexandros E; Soucacos, Panayotis N

    2011-09-27

    Fibular hemimelia has been reported as the most common congenital longitudinal deficiency of the long bones. Previous studies have focused on the best treatment options for this congenital condition. There is very little to our knowledge in the literature focused on residual persisting malformations and leg length discrepancy after treatment. Seven patients presenting fibular hemimelia in eight fibulae received treatment between years 1988 and 2001. Pre-treatment average leg length discrepancy was 5.3 cm. All patients presented associated congenital deformities of the ipsilateral leg. Six patients received surgical treatment. Average post-treatment follow up was 9.7 years. Residual malformations and leg length discrepancy were recorded for all patients. It is a retrospective case series study at one institution by two of the presenting authors as senior surgeons. Average leg length gained after successful bone lengthening in six patients was 5.06 cm. Although there was a significant functional improvement, a number of residual malformations and leg length inequality was recorded. Residual average leg length discrepancy of 3.1 cm was observed in five patients who completed surgical treatment. Five patients presented a limp. Residual anterior-medial bowing of the tibia was observed in four patients. Calf atrophy was present in all seven patients. Valgus deformity of the ankle was remained in two patients. Treatment of fibular hemimelia, even in cases graded as successful, showed to be accompanied by a number of persisting residual deformities and recurrent leg length inequality. Although the number of patients is limited, the high rate of this phenomenon is indicative of the significance of the report. The family and the patients themselves should have the right expectations and will be more co-operative when well informed about this instance. A report of common post-treatment residual deformities should be valuable in best possible treatment planning of fibular

  11. Foetal fibular hemimelia with focal femoral deficiency following prenatal misoprostol use: A case report.

    Science.gov (United States)

    Pallavee, P; Samal, Rupal; Begum, Jasmina; Ghose, Seetesh

    2016-08-01

    Misoprostol is a well known abortifacient. It can cause teratogenicity like Mobius sequence and terminal transverse limb defects. We report a rare case of proximal focal femoral deficiency with fibular hemimelia in a woman who had attempted abortion with self-administered misoprostol and later continued the pregnancy. Though the absolute risk of congenital malformations with its use is low ∼1%, this should be clearly communicated to the women requesting abortion to help them make fully informed reproductive health decisions.

  12. [Application of three-dimensional virtual technology in mandibular defects reconstruction with free fibular flap].

    Science.gov (United States)

    Chen, Xu-bing; Liu, Zhao-gang; Yuan, Jian-bing; Tian, Hong-wei

    2015-08-01

    To present a method for mandibular defects reconstruction with free fibular flap by three-dimensional virtual technology. In 11 patients (8 with ameloblastomas, 1 with ossifying fibroma, 2 with carcinoma of the mandibular gingiva ), three-dimensional virtual technology was simulated with software. The osteotomies were translated into rapid prototyping guides. The solid model of the mandible and the surgical guides were the same as the full size and the shape, and made by using rapid prototyping machine. During operation, the bridging plate could be pre-bended on the repaired mandibular model. One group resected the diseased mandibular according to the model of the osteotomy which was planned before operation, the other group used auxiliary guide for accurate osteotomy of the fibula bone with contact pedicle. The fibular segments were reshaped and fixed with prefabricated titanium plate, and transplanted into the defect for vascular anastomosis. All the bone flaps and osteocutaneous flaps survived. During operation, the fibula flap could be cut in appropriate length. Cutting, remodeling and reposition of the fibula could be accelerated by surgery guides. Postoperative follow-up was 1 to 24 months. Imaging examination showed that the shape of mandible and mandibular angle were good, and the temporomandibular joint and occlusion returned to normal. Three-dimensional virtual technology is useful in reconstruction of mandibular defect with vascularized fibular flap.

  13. Mechanical analysis of the vascularized fibular graft prosthetic composite (VFGPC) for internal hemipelvectomy reconstruction.

    Science.gov (United States)

    Morris, Jonathan; Yang, Rui; Roth, Michael; Gill, Jonathan; Gorlick, Richard; Lo, Yungtai; Hoang, Bang H; Garfein, Evan; Geller, David S

    2017-06-01

    The vascularized fibular graft prosthetic composite (VFGPC) is used for reconstruction after internal hemipelvectomy. The purpose of this study was to create a mathematical model that calculates the mechanical effects of the vascularized fibular graft on the VFGPC. The effects of the VFG positioning were calculated based on three-dimensional static analyzes to determine the direction, magnitude, and distribution of the forces through the prosthesis and VFG. The shear stress (SS) and cyclic loads to failure (CLF) were calculated. By varying the location of the VFG on the sacrum the zone of acceptable placement was calculated. Utilization of the VFG decreased the forces through the implant by 15-35% and decreased SS 20-54%, depending on stance. The CLF improved by 94%. The zone of acceptable placement for the VFG was found to be between 0° and 15° of the vertical axis in the sagittal plane and 0° and 30° of the posterior axis in coronal plane. Determining the position of the VFG pre-operatively allows for the creation of a customized cutting jig can be utilized to create graft allowing for accurate fibular osteotomies, minimization of ischemia time, and decreased intra-operative handling of the graft. © 2017 Wiley Periodicals, Inc.

  14. Congenital longitudinal deficiency of the fibula (fibular hemimelia). Parental refusal of amputation.

    Science.gov (United States)

    Letts, M; Vincent, N

    1993-02-01

    Fibular hemimelia with significant limb-length inequality is usually best treated with foot ablation and prosthetic fitting. Parents tend to be reluctant to agree to allow their child's foot to be amputated at an early age, especially when the foot is near normal and the limb length is not grossly abnormal. Experience with some families of children with fibular hemimelia who initially refused amputation of the affected limb prompted a retrospective review of the treatment experience with these children. Twenty-four children with 36 affected limbs were treated during the last three decades. Amputation of the foot was performed for 16 limbs in 12 of the 24 patients. The 12 patients whose limbs were not amputated were reviewed in detail. Six of these children were advised to have an amputation, but their families refused to consent. These children were managed by specially designed prostheses to incorporate their foot deformity and limb-length inequality. Four patients required subsequent corrective surgical procedures in an attempt to stabilize the feet or lengthen the limb. To facilitate treatment decisions for both the clinic team as well as the involved families, the authors propose a more practical classification of fibular hemimelia.

  15. Dual fibular grafting - A new technique of fixation of the femoral neck fractures

    Directory of Open Access Journals (Sweden)

    Yadav S

    2005-01-01

    Full Text Available Background: To achieve osteosynthesis of femoral neck fractures is a challenge to the treating surgeon. Plethora of devices and methods has been described. Method: A new technique of achieving union of femoral neck fractures by dual-fibular fixation has been reported in 150 patients. The age of the patients ranged from 6-75 years. Results: Nearly two-third of these were Garden type II and III with an average follow-up of 120 months. In this series 67% had good to excellent long term results. Conclusion: Two fibular struts provide autologous bone, filling the whole of the osteopenic femoral neck and prevent the rotational forces. Since the total fixation is biologically active, the technique has proved advantageous even when stable / desirable reduction is not possible and adequate fixation is not achieved, because of posterior communition at the fracture site or due to osteoporosis. Being autologous bone, the twin-fibular graft is advantageous even when there is ′subsequent loss of reduction′ of the fracture. It is, therefore, suggested that this simple, inexpensive and biological technique has many advantages over the existing methods of fixation of these fractures.

  16. 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.

  17. Atlanto-axial rotatory fixation caused by spontaneous intracerebral haemorrhage in a child.

    Science.gov (United States)

    Kombogiorgas, Dimitris; Hussain, Ihsan; Sgouros, Spyros

    2006-09-01

    Atlanto-axial rotatory fixation is rare in children and usually associated with upper respiratory tract infection or trauma. We present a patient who developed the condition acutely as a consequence of rapidly evolving hemiplegia secondary to intracerebral haemorrhage. A previously well 12-year-old boy suddenly developed left hemiparesis within 30 min. Soon after, he developed painful torticollis. On examination, a dense left hemiplegia was associated with left facial and hypoglossal weakness. On computerised tomography (CT) scan there was an intracerebral haemorrhage in the deep aspect of the right frontal lobe in the corona radiata, with extension in the ventricular system. The plain radiographs of the cervical spine, and CT scan later, confirmed the presence of C1-C2 rotatory subluxation. The haematoma was aspirated stereotactically through a burr hole, and at the same session, the subluxation was reduced by manipulation and traction of the cervical spine. The patient was treated with a hard collar. The torticollis did not recur. The hemiparesis resolved within 6 months. A subsequent magnetic resonance imaging and magnetic resonance angiography scan indicated possible arterio-venous malformation (AVM) at the site of the haemorrhage, which was confirmed with digital subtraction angiography. The AVM was surgically excised 1 year from the original haemorrhage. In the absence of any other predisposing factor, it is postulated that the acute atlanto-axial rotatory subluxation was secondary to the acute loss of muscular tone due to the acute hemiparesis. This explains that the subluxation has not recurred a year after, while the hemiparesis has completely resolved.

  18. Initial Fibular Displacement as a Predictor of Medial Clear Space Widening in Weber B Ankle Fractures.

    Science.gov (United States)

    Cavanaugh, Zachary S; Gupta, Simran; Sathe, Vinayak M; Geaney, Lauren E

    2017-11-01

    The diagnosis of medial ankle instability in Weber B ankle fractures remains controversial. Manual stress and gravity stress radiographs as well as magnetic resonance imaging (MRI) are used, but there is no consensus gold standard. The purpose of this study was to determine the relationship between initial fibular displacement and medial clear space widening on a gravity stress radiograph as a predictor of instability. A retrospective review was conducted of all patients with isolated Weber B ankle fractures with both initial injury radiographs and gravity stress view from August 1, 2014, through April 1, 2016. A total of 17 patients were identified. On the mortise view of initial injury radiographs, medial clear space (MCS), superior clear space, lateral fibular displacement (LFDP), and fibular shortening (FS) were measured, and on the lateral view, anterior to posterior fibular gap (A to P FG) was measured. MCS was again measured on the gravity stress view (MCS-W). Statistical analyses identified the correlations of each displacement variable relative to MCS-W as well as the sensitivity and specificity of each parameter. A cutoff point for MCS-W was set as less than 5.0 mm (n = 8) and 5.0 mm or more (n = 9). Strong significant correlations with MCS-W were found for A to P FG (0.84, P < .001), with a trend for LFDP (0.62, P = .008), but no significance with FS (0.38, P = .84). Linear regression analysis revealed significant ability to predict MCS-W for both LFDP ( P = .002) and A to P FG ( P = .001) but not FS. Receiver operating characteristic analysis for A to P FG using a threshold value of 1.0 mm yielded sensitivity and specificity of 100% in predicting an MCS-W of 5.0 mm or more. The initial fibular displacement was a strong predictor of MCS-W in Weber B ankle fractures. On lateral radiographs, an A to P FG greater than 1.0 mm showed a sensitivity and specificity of 100% in predicting an MCS-W of 5.0 mm or more on gravity stress view. Level III case series

  19. Spontaneous rotatory atlantoaxial dislocation without neurological compromise in a child with Down syndrome: a case report

    Science.gov (United States)

    Au-Yong, Iain; Boszczyk, Bronek; Mehdian, Hossein

    2008-01-01

    Spontaneous atlantoaxial dislocation is a rare recognised complication of Down syndrome. In the majority of cases, dislocation takes place in an anteroposterior direction and is often associated with abnormalities of odontoid development or ossification. Rotatory atlantoaxial dislocation is extremely rare in Down syndrome and this is to our knowledge the first reported case in which modern imaging methods have been described; surface shaded reformats derived from a multislice CT scan were of fundamental importance in making the diagnosis. Electronic supplementary material The online version of this article (doi:10.1007/s00586-008-0596-y) contains supplementary material, which is available to authorized users. PMID:18236086

  20. Problems with dental implants that were placed on vertically distracted fibular free flaps after resection: a report of six cases.

    Science.gov (United States)

    Lizio, Giuseppe; Corinaldesi, Giuseppe; Pieri, Francesco; Marchetti, Claudio

    2009-09-01

    We report the clinical outcome of dental implants placed on vertically distracted fibular free flaps that were used to reconstruct maxillary and mandibular defects after resection. Distraction osteogenesis (DO) of fibular free flaps was used for six patients (5 men, 1 woman) a mean of 19 months (range 11-38) after 5 mandibular and 1 maxillary reconstructions. A mean of 5 months (range 2-11) after removal of the distractor, 35 implants were inserted and loaded with implant-supported fixed prostheses. The mean (range) follow-up period was 39 (17-81) months. The course of the DO and the clinical and radiographic outcomes of the implants were assessed. Of six vertically distracted fibular free flaps, there was one case of vector lingual tipping during the consolidation phase and a fracture of the basal fibular cortex that necessitated additional grafting with iliac bone to stabilise the distracted area. The mean (range) vertical bone gain was 14 (12-15) mm. Four of 35 implants (11%) failed during the follow-up period. The mean peri-implant bone resorption was 2.5mm. Cumulative implant survival was 31/35 (89%) and survival after loading 31/33 (94%). Distraction osteogenesis of fibular free flaps caused a remarkable number of complications and pronounced resorption of bone around the implants, probably as a result of the formation of granulomatous tissue; a careful peri-implant follow-up and the maintenance of oral hygiene are essential.

  1. Prevention of recurrence of tibia and ankle deformities after bone lengthening in children with type II fibular hemimelia.

    Science.gov (United States)

    Popkov, Arnold; Aranovich, Anna; Popkov, Dmitry

    2015-07-01

    This study aimed to evaluate development of the tibia after Ilizarov lengthening and deformity correction depending on whether or not the simultaneous resection of fibular anlage was performed in children with fibular aplasia type II, who did not undergo early surgery. The study analyses results of reconstructive treatment in 38 children at the age of over four years. Two groups of children are compared: bifocal tibial lengthening with the Ilizarov device (group I) and bifocal lengthening associated with resection of the fibular anlage (group II). The results were estimated at 12 months and in the long-term exceeding three years. Radiological data of measurement of the anatomical lateral distal tibial angle (aLDTA) show surgical correction of deformities achieved in both groups. During the further limb growth a tendency to normalisation of the aLDTA was observed only in the group II. Quick relapse of the angular deformities of the tibial shaft in the first group occurred mainly during further growth of the limb regardless of complete correction at the time of treatment. On the other hand, there were no recurrences of diaphyseal deformities in the group II. In children with congenital fibular deficiency of type II at the age of four years, the bone lengthening and deformity correction should be associated with fibular anlage resection. That approach improves conditions for distal tibia development and prevents or decreases significantly the recurrence of deformities of the tibia and ankle joint in long-term follow-up.

  2. On the transferability of atomic contributions to the optical rotatory power of hydrogen peroxide, methyl hydroperoxide and dimethyl peroxide

    DEFF Research Database (Denmark)

    Sánchez, Marina; Alkorta, Ibon; Elguero, José

    2014-01-01

    The chirality of molecules expresses itself, for example, in the fact that a solution of a chiral molecule rotates the plane of linear polarised light. The underlying molecular property is the optical rotatory power (ORP) tensor, which according to time-dependent perturbation theory can be calcul...

  3. A Japanese Male Patient with ‘Fibular Aplasia, Tibial Campomelia and Oligodactyly’: An Additional Case Report

    Science.gov (United States)

    Kitaoka, Taichi; Namba, Noriyuki; Kim, Ji Yoo; Kubota, Takuo; Miura, Kohji; Miyoshi, Yoko; Hirai, Haruhiko; Kogo, Mikihiko; Ozono, Keiichi

    2009-01-01

    We report a male infant with FATCO syndrome, an acronym for fibular aplasia, tibial campomelia, and oligosyndactyly. Courtens et al. reported an infant with oligosyndactyly of the left hand, complete absence of the right fibula, bowing of the right tibia, and absence of the right fifth metatarsal and phalanges. They noted 5 patients with similar clinical features, and proposed the FATCO syndrome. Our patient had a left-sided cleft lip, cleft palate, oligosyndactyly of the right hand and bilateral feet, and bilateral anterior bowing of the limbs associated with overlying skin dimpling. Radiographs showed a short angulated tibia with left fibular aplasia and right fibular hypoplasia. We consider our case the 6th patient with FATCO syndrome, and the cleft lip and palate, not reported in the previous 5 patients, may allow us to further understand the development of the extremities and facies. PMID:23926365

  4. Infant bone age estimation based on fibular shaft length: model development and clinical validation

    Energy Technology Data Exchange (ETDEWEB)

    Tsai, Andy; Stamoulis, Catherine; Bixby, Sarah D.; Breen, Micheal A.; Connolly, Susan A.; Kleinman, Paul K. [Boston Children' s Hospital, Harvard Medical School, Department of Radiology, Boston, MA (United States)

    2016-03-15

    Bone age in infants (<1 year old) is generally estimated using hand/wrist or knee radiographs, or by counting ossification centers. The accuracy and reproducibility of these techniques are largely unknown. To develop and validate an infant bone age estimation technique using fibular shaft length and compare it to conventional methods. We retrospectively reviewed negative skeletal surveys of 247 term-born low-risk-of-abuse infants (no persistent child protection team concerns) from July 2005 to February 2013, and randomized them into two datasets: (1) model development (n = 123) and (2) model testing (n = 124). Three pediatric radiologists measured all fibular shaft lengths. An ordinary linear regression model was fitted to dataset 1, and the model was evaluated using dataset 2. Readers also estimated infant bone ages in dataset 2 using (1) the hemiskeleton method of Sontag, (2) the hemiskeleton method of Elgenmark, (3) the hand/wrist atlas of Greulich and Pyle, and (4) the knee atlas of Pyle and Hoerr. For validation, we selected lower-extremity radiographs of 114 normal infants with no suspicion of abuse. Readers measured the fibulas and also estimated bone ages using the knee atlas. Bone age estimates from the proposed method were compared to the other methods. The proposed method outperformed all other methods in accuracy and reproducibility. Its accuracy was similar for the testing and validating datasets, with root-mean-square error of 36 days and 37 days; mean absolute error of 28 days and 31 days; and error variability of 22 days and 20 days, respectively. This study provides strong support for an infant bone age estimation technique based on fibular shaft length as a more accurate alternative to conventional methods. (orig.)

  5. Recurrence of axial malalignment after surgical correction in congenital femoral deficiency and fibular hemimelia.

    Science.gov (United States)

    Radler, Christof; Antonietti, Giorgio; Ganger, Rudolf; Grill, Franz

    2011-11-01

    Recurrent genu valgum deformity complicates treatment of congenital femoral deficiencies (CFD) and fibular hemimelia (FH). We analysed factors influencing recurrence. Patients who underwent limb lengthening or deformity correction for CFD and/or FH were reviewed. Radiographs after surgery and after a minimum of a further six months were analysed. Change in parameters of mechanical axis deviation per month (∆ MAD/month) and of angle per month were calculated. These parameters were tested against cofactors patient age, baseline MAD, type of CFD and FH, severity of ball-and-socket joints, ankle-joint stiffness, absence of cruciate ligaments and resection of the fibular anlage. Recurrent valgus deformity was found in 23 of the 42 limbs included with a mean change of MAD of 23.4 mm (5-60 mm). There was no significant difference between patients with ∆ MAD/month 1 mm regarding MAD in the first radiograph and patient age. CFD cases Pappas types VII and VIII showed a ∆ MAD/month of 1.6 mm, whereas milder cases of Pappas IX showed a ∆ MAD/month of 0.8. Mild FH (type Ia) showed a mean ∆ MAD/month of 0.39 mm, whereas mean ∆ MAD/month for FH type Ib/II was 0.72 mm. In FH type II cases, mean ∆ MAD/month was 0.79 mm after resection of the fibular anlage compared with 1.98 mm in those without resection. Recurrence in FH and CFD was not dependent on patient age but partly on FH and CFD type. Limbs with more severe ball-and-socket knee joints showed more recurrence. Overcorrection depending deformity type should be performed.

  6. Vascularized proximal fibular epiphyseal transfer for Bayne and Klug type III radial longitudinal deficiency in children.

    Science.gov (United States)

    Yang, Jiantao; Qin, Bengang; Li, Ping; Fu, Guo; Xiang, Jianping; Gu, Liqiang

    2015-01-01

    Treatment of Bayne and Klug type III radial longitudinal deficiency with fibular epiphyseal transplantation in children has had limited success to date. The purpose of this investigation was to review the authors' results of microvascular epiphyseal transplantation for radial longitudinal deficiency. Between 2007 and 2009, four children with a mean age of 4.3 years (range, 3.3 to 5.8 years) who had a type III radial longitudinal deficiency underwent microsurgical reconstruction of the distal radius with vascularized proximal fibular transplantation, including the physis, partial superior tibiofibular joint, and a variable length of the diaphysis. All of the grafts were supplied by the inferior lateral genicular artery. In all patients, the range of motion of the digits, wrist, forearm, and elbow; the length of the forearm; and the deviation of the wrist were evaluated. The mean duration of follow-up was 42 months (range, 24 to 65 months). All four transfers survived and united with the host bone within 3 months postoperatively. An average correction of 28 degrees in the hand-forearm angle was obtained. Forearm length was 67.9 percent that of the normal side on average at the final follow-up. The overall range of wrist motion was approximately 55 percent that of the contralateral extremity. No major complications were observed. Vascularized proximal fibular epiphyseal transfer, based on the inferior lateral genicular artery, is a technically feasible method for treatment of type III radial longitudinal deficiency, which maintains hand-forearm alignment, provides excellent function, and minimizes the length discrepancy between the distal radius and ulna. Therapeutic, IV.

  7. Bilateral transverse (bowdler) fibular spurs with hypophosphatasia in an adolescent girl

    Energy Technology Data Exchange (ETDEWEB)

    Uras, Ismail; Uras, Nurdan; Karadag, Ahmet; Yavuz, Osman Yuksel; Atalar, Hakan [Fatih University Faculty of Medicine, Ankara (Turkmenistan)

    2005-03-15

    Hypophosphatasia is a clinically heterogeneous inheritable disorder characterized by defective bone mineralization and the deficiency of serum and tissue liver/bone/kidney alkaline phosphatase activities. Due to the mineralization defect of the bones, various skeletal findings can be radiologically observed in hypophosphatasia. Bowing and Bowdler spurs of long bones are the characteristic findings. The Bowdler spurs reported on in the previous pertinent literature were observed in the perinatal aged patients and these lesions have rarely involved adolescents. We herein report on a 14-year-old girl with fibular Bowdler spurs.

  8. Bilateral transverse (Bowdler) fibular spurs with hypophosphatasia in an adolescent girl.

    Science.gov (United States)

    Uras, Ismail; Uras, Nurdan; Karadag, Ahmet; Yavuz, Osman Yuksel; Atalar, Hakan

    2005-01-01

    Hypophosphatasia is a clinically heterogeneous inheritable disorder characterized by defective bone mineralization and the deficiency of serum and tissue liver/bone/kidney alkaline phosphatase activities. Due to the mineralization defect of the bones, various skeletal findings can be radiologically observed in hypophosphatasia. Bowing and Bowdler spurs of long bones are the characteristic findings. The Bowdler spurs reported on in the previous pertinent literature were observed in the perinatal aged patients and these lesions have rarely involved adolescents. We herein report on a 14-year-old girl with fibular Bowdler spurs.

  9. [Applications of myo-periosteal fibular bone bridging for traumatic transtibial amputation].

    Science.gov (United States)

    Song, Dengxin; Zhang, Qianfa; Zhu, Cheng; He, Xiaowen; Liao, Xiaohui; Yi, Chengla

    2013-11-01

    To compare the effectiveness between the myo-periosteal fibular bone bridging and traditional transtibial amputation in the treatment of amputation below knee so as to provide theoretical basis for choosing transtibial amputation in clinical application. Between November 2001 and November 2011, 38 patients with mangled lower extremity were treated by transtibial amputation. Among 38 patients, 17 (group A) underwent myo-periosteal fibular bone bridging (the operation techniques of an attached peroneal muscle myo-periosteal fibular strut bridge between the end of the tibia and fibula below knee amputation), and other 21 (group B) underwent traditional transtibial amputation. There was no significant difference in age, gender, injury cause, amputation cause, side, and disease duration between 2 groups (P > 0.05). The quality of life (QOL) was analyzed using 36-item short form health survey (SF-36), and prosthesis satisfaction by Trinity amputation and prosthesis experience scale (TAPES). Healing of incision by first intention was obtained in all patients of 2 groups; no necrosis, infection, or poor stumps was observed. The mean follow-up time was 22 months (range, 14-30 months) in group A, and 26 months (range, 15-30 months) in group B. The patients achieved good healing of bone bridging, no bone nonunion occurred. The healing time was (5.1 +/- 1.1) months in group A and (3.3 +/- 0.6) months in group B, showing significant difference between 2 groups (t=9.82, P=-0.00). Spur occurred at the distal fibula in an 11-year-old boy of group B after 2 years of operation, which blocked use of prosthesis; prosthesis was well used in the other patients. After 12 months of operation, SF-36 score was 55.84 +/- 14.01 in group A and 49.93 +/- 12.78 in group B, showing significant difference (P 0.05). TAPES score was 12.12 +/- 2.23 in group A and 10.10 +/- 2.00 in group B, showing significant difference (t=2.891, P=0.006). It is a very effective method to treat traumatic amputation

  10. [Treatment of Gustilo III distal tibiofibula fractures through trans-fibular anterior-lateral approach].

    Science.gov (United States)

    Xu, Hua; Ma, Hai-Tao; Bi, Da-Wei; Wang, Hui; Zhu, Yuan; Yang, Yu-Sheng

    2012-08-01

    To explore the methods and therapeutic effects of trans-fibular anterior-lateral approach combined with external fixation in the treatment of Gustilo III distal tibiofibula fractures. From 2007 to 2010,9 patients including 7 males and 2 females with the mean age of 40 years(ranging from 29 to 51 years). All patients received internal fixation of fibula after debridement on the first phase, external fixator were used to fix tibia across ankle joint, and removed after successful skin graft; The second phase tibia was used to fix through the lateral incision used in phase I. Early functional exercise was encouraged ,the union condition and functional results of the ankle joint was evealuated. The criteria of the AOFAS Foot and Ankle Surgery was used to evaluate the effects. All patients were followed up,and the duration ranged for 8 to 37 months(averaged 21 months). Nine patients were achieved bony union, the average healing time was 24 weeks. No plate rupture or screw loosening was found. According to the AOFAS Foot and Ankle Surgery evaluation system, 3 cases got excellent results, 4 good cases and 2 fair. Trans-fibular anterior-lateral approach combined with external fixation for Gustilo III distal tibiofibula fractures can receive satisfactory reset, debond ankle joint eralier and imporove the clinical effects.

  11. Limb-saving surgery by intraoperative radiation and vascularized fibular graft for osteosarcoma

    Energy Technology Data Exchange (ETDEWEB)

    Inoue, Osamu; Arakaki, Akira; Asato, Jun; Shimabukuro, Hiroyuki; Shingaki, Yoshisada; Asato, Hideki; Ibaraki, Kunio; Nakano, Masao (University of the Ryukyus, Okinawa (Japan))

    1992-03-01

    Various limb-saving surgeries for osteosarcomas have been performed owing to the high survival rate achieved by chemotherapy. However, reconstruction by endoprosthesis after radical resection of the tumor in the distal femur or proximal tibia was often complicated by early or late severe problems. The radicality of intraoperative radiation by Lineac 50 Gy for osteosarcoma has been proved clinically by Yamamuro et al, while radiation therapy often ensued pathological fractures. Therefore, for osteosarcomas in four distal femurs and one proximal tibia, we have adopted a vascularized fibular graft to reinforce the irradiated bone and to prevent the collapse of the joint surface. Resected osseous parts were irradiated in four cases with resultant infections in two cases. Intraoperative irradiation without resection was performed on one case with an uneventful short course. Although the ranges of motion in three survivous were limited, the prospect of limb-saving surgery by intraoperative irradiation and incorporated vascularized fibular grafts seem favorable as they promise longer durability. (author).

  12. Donor site morbidity after harvest of free osteofasciocutaneous fibular flaps with an extended skin island.

    Science.gov (United States)

    Papadopulos, Nikolaos A; Schaff, Juergen; Bucher, Hans; Groener, Reinhard; Geishauser, Max; Biemer, Edgar

    2002-08-01

    Since 1993, a total of 41 free osteofasciocutaneous fibular flaps with an extended skin island (average dimensions, 16.9 cm long [range, 12-22 cm] x 10.7 cm wide [range, -16 cm], or 180.8 cm [range, 112-352 cm ]) have been used in by the authors in various clinical applications. To evaluate donor site morbidity, the 41 patients involved were asked to answer a questionnaire and to present themselves for clinical and radiological examination. The subjective findings reported by these patients, and the examinations, showed that donor site morbidity was moderate. Apart from some occurrence of mild edema and pain, as well as modest motor weakness of the great toe, and deficiency of distal nervous segments, only 7 patients were found to have a slightly positive anterior drawer of the talus (anterior subluxation of the talus), but no instability. In conclusion, donor site morbidity after harvest of osteofasciocutaneous fibular flaps for different clinical indications, where extended skin islands were needed, is moderate.

  13. Outcome of eight-plate hemiepiphysiodesis on genu valgum and height correction in bilateral fibular hemimelia.

    Science.gov (United States)

    Das, Sakti; Ganesh, G Shankar; Pradhan, Sudhakar; Mohanty, Ram N

    2014-01-01

    Fibular hemimelia is the most common lower extremity congenital longitudinal deficiency leading to cosmetic deformity, pain, and gait disturbance. Eight-plate hemiepiphysiodesis has proven to be successful in correcting angular deformity of the knee; it is an easy surgical technique and yields a more rapid rate of correction. The aim of this study was to determine the effectiveness of eight-plate hemiepiphysiodesis in bilateral genu valgum resulting from fibular hemimelia and overall height improvement in two girls and four boys with a mean age of 22 months who were followed up for a period of 18 months. The variables studied were arm span, the total height ratio, intermalleolar distance, tibiofemoral angle, and activity. All the parameters improved significantly. The mean improvement in the valgus was 7.41°. The mean intermalleolar distance reduced by 19.5 cm, and all patients achieved a significant improvement in lower limb function. Although there was significant improvement in total height, it still lagged behind arm span at the time of final follow-up. The results of eight-plate hemiepiphysiodesis were found to be satisfactory. We conclude that it is a reasonable treatment option for young patients with an adequate growth potential.

  14. Anterograde Intra-Arterial Urokinase Injection for Salvaging Fibular Free Flap

    Directory of Open Access Journals (Sweden)

    Dae-Sung Lee

    2013-05-01

    Full Text Available We present a case of a 57-year-old male patient who presented with squamous cell carcinoma on his mouth floor with cervical and mandibular metastases. Wide glossectomy with intergonial mandibular ostectomy, and sequential reconstruction using fibular osteomyocutaneous free flap were planned. When the anastomosis between the peroneal artery of the fibular free flap and the right lingual artery was performed, no venous flow was observed at the vena comitans. Then re-anastomosis followed by topical application of papaverine and lidocaine was attempted. However, the blood supply was not recovered. Warm saline irrigation over 30 minutes was also useless. Microvascular thromboses of donor vessels were clinically suspected, so a solution of 100,000 units of urokinase was infused once through a 26-gauge angiocatheter inserted into the recipient artery just at the arterial anastomotic site, until the solution gushed out through the flap vena comitans. Immediately after the application of urokinase, arterial flow and venous return were restored. There were no complications during the follow-up period of 11 months. We believe that vibrating injuries from the reciprocating saw during osteotomies and flap insetting might be the cause of microvascular thromboses. The use of urokinase may provide a viable option for the treatment of suspicious intraoperative arterial thrombosis.

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

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    Sujit Kumar Tripathy

    2016-01-01

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

  16. Complete 180° rotatory dislocation in a mobile-bearing knee prothesis.

    Science.gov (United States)

    Turki, Hussein W; Trick, Lorence

    2011-06-01

    Dislocation of the rotator platform in mobile-bearing total knee arthroplasty is a well-documented, albeit uncommon, phenomenon. A review of the literature has revealed multiple case reports describing spin out to 90° or complete extrusion of the polyethylene component. Closed reduction may be attempted in the acute presentation followed by revision if instability persists. We present a case of a 57-year-old woman who had a partial rotatory subluxation of her polyethylene component and underwent closed reduction resulting in a full 180° spinout. To our knowledge, this has not been described in the literature and should be considered as a possibility after closed reduction attempts. She was treated successfully with open exploration and poly exchange using a larger component. Copyright © 2011 Elsevier Inc. All rights reserved.

  17. Optical-rotatory-dispersion measurement approach using the nonlinear behavior of the geometric phase.

    Science.gov (United States)

    Ginya, Makoto; Kimura, Makoto; Iwata, Tetsuo

    2017-02-20

    We propose a method for high-sensitivity optical rotatory dispersion (ORD) measurement of optically active samples that takes advantage of the nonlinear behavior of the geometric phase (GP). To measure the GP as a function of wavelength, we use a multichannel Fourier transform spectrometer (MC-FTS) that is based on Savart plate birefringent-polarization interference, into which we newly insert a zeroth-order quarter-wave plate (QWP). The modified MC-FTS allows us to measure the wavelength dependence of the GP and thus that of the optical rotation angle due to the sample. In this paper, we describe the proposed approach and demonstrate proof-of-principle experiments.

  18. Atlantoaxial Rotatory Fixed Dislocation: Report on a Series of 32 Pediatric Cases.

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    Wang, Shenglin; Yan, Ming; Passias, Peter G; Wang, Chao

    2016-06-01

    Retrospective case series of atlantoaxial rotatory fixed dislocation (AARFD). To describe clinical features and the surgical treatment of AARFD. The classification and treatment strategy for atlantoaxial rotatory fixation (AARF) were previously described and remained controversial. AARF concomitant with atlantoaxial dislocation has different clinical features and treatment strategy with the most AARF. Due to deficiency of the transverse ligament or odontoid, the atlantoaxial remains unstable even after the torticollis relieved or cured. Because of the rarity, treatment strategy for this special condition has not been specialized and fully explored in the literatures. Thirty-two children with AARFD (sustained torticollis more than 6 weeks and atlanto-dental internal more than 5 mm) were retrospectively reviewed. Treatment methodology, pearls, and pitfalls of the treatment were discussed. Thirty-two cases had sustained torticollis for an average of 5.7 months. ADI of them ranged from 8 to 22 mm, with a mean of 11.3 mm. Eight cases presented with signs and symptoms of spinal cord dysfunction. All 32 cases underwent surgery and had no spinal cord or vertebral artery injury. The surgery included posterior reduction and fusion (reducible dislocation and torticollis, 16 cases), and transoral release followed by posterior reduction and fusion (irreducible dislocation and torticollis, 16 cases). The average follow-up time was 42 months. Solid fusion and torticollis healing were achieved in 31 patients (96.9%) as detected radiologically. Two cases (6.3%, 2/32) suffered complications (cerebrospinal fluid leakage and recurred torticollis followed by revision). AARFD had distinct clinical features relative to common presentations of AARF. Because of deficiency of the transverse ligament or odontoid and subsequent atlantoaxial dislocation, surgical treatments are applied for this condition, including transoral release and posterior C1-2 reduction and fusion. AARFD cases

  19. Vertebral rotatory subluxation in degenerative scoliosis: facet joint tropism is related.

    Science.gov (United States)

    Bao, Hongda; Zhu, Feng; Liu, Zhen; Bentley, Mark; Mao, Saihu; Zhu, Zezhang; Ding, Yitao; Qiu, Yong

    2014-12-15

    A cross-sectional study. To identify facet tropism as one of the possible risk factors leading to vertebral rotatory subluxation (VRS). VRS has been considered as one of the prognostic factors for degenerative scoliosis. Although several risk factors of VRS, including age and Cobb angle, have been investigated, few studies exist that have evaluated the correlation between VRS and anatomical structures of the vertebral column. This retrospective study recruited 23 patients diagnosed with degenerative lumbar scoliosis with VRS and 20 patients with degenerative scoliosis without VRS. The lateral translation on coronal radiographs was measured and 5 mm was used as the cutoff value to define rotatory subluxation. Computed tomographic scans for facet joints were made for all lumbar levels. The difference between right and left facet angles was recorded as ΔFA. Facet tropism was defined as a difference between the bilateral facet angles of more than 10°. In this study, VRS was most commonly found at the L3-L4 level (49%) and, with decreasing frequency at L2-L3 (24%), L4-L5 (20%), and L1-L2 (7%). On the convex side of the main curve, face joints at levels with VRS were more coronally oriented compared with those at levels without VRS (41.64° ± 11.65° vs. 36.30° ± 10.99°, P = 0.034). ΔFA was also significantly different between levels with and without VRS (P = 0.005). A strong correlation was found between ΔFA and lateral translation, with a coefficient of 0.33 (P scoliosis should be considered to be related to VRS.

  20. Amputation of an ectopic partially formed foot attached to the ankle in a case of fibular deficiency.

    Science.gov (United States)

    Khare, Ghanshyam N; Goel, Satish C; Singh, Saurabh

    2008-12-01

    A rare case of an ectopic partially formed foot attached to the ankle and associated with fibular deficiency and scoliosis due to congenital hemivertebra is reported. The ectopic partially formed foot was amputated and the child was given a below-knee caliper to prevent further deformity of the foot.

  1. Effects of mature adipocyte-derived dedifferentiated fat (DFAT) cells on generation and vascularisation of dermis-like tissue after artificial dermis grafting.

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    Soejima, Kazutaka; Kashimura, Tsutomu; Asami, Takashi; Kazama, Tomohiko; Matsumoto, Taro; Nakazawa, Hiroaki

    2015-02-01

    Although artificial dermis (AD) is effective for skin reconstruction, it requires two separate procedures, because the AD must be vascularised before skin grafts. To shorten the period of the dermis-like tissue generation before the secondary skin grafting must be beneficial. Dedifferentiated fat (DFAT) cells are isolated from mature adipose cell suspensions and have potential to differentiate into multiple cell types including endothelial cells. This study aimed to investigate effects of DFAT cells on dermal regeneration after AD grafts in rats. The effects of combination use of DFAT cells and basic fibroblast growth factor (bFGF) were also tested to mimic clinical situations. DFAT cells were isolated from SD rats. Full-thickness wounds were created on the back of rats followed by AD grafting. Five groups were established; Group I: control, Group II: treated with DFAT cells, Group III: treated with bFGF, Group IV: treated with both of DFAT cells and bFGF, and Group V: treated with Green fluorescent protein (GFP)-labelled DFAT cells and bFGF. Histological evaluation was serially performed. Group IV showed markedly promoted vascularisation of dermis-like tissue. In particular, capillary infiltration into the dermis was obtained within 2 days. Immunohistochemical examination revealed that the transplanted DFAT cells had differentiated into endothelial cells and participated in angiogenesis. Group IV also showed a marked increase in the thickness of the dermis like tissue. The present results suggest that the use of DFAT cells under bFGF treatment could be beneficial to shorten the period required for dermal regeneration and vascularisation and contribute to use AD more effectively and safely.

  2. Reconstruction of maxillary and mandibular defects using prefabricated microvascular fibular grafts and osseointegrated dental implants -- a prospective study.

    Science.gov (United States)

    Jaquiéry, Claude; Rohner, Dennis; Kunz, Christoph; Bucher, Peter; Peters, Françoise; Schenk, Robert K; Hammer, Beat

    2004-10-01

    The fibular flap can be used for a variety of indications. Recently, the treatment of four patients with severely atrophied upper jaws using a method to prefabricate the vascularized fibular graft has been published. This technique consists of a two-stage operation procedure that allows simultaneous prosthodontic rehabilitation and immediate placement of dental implants. In this paper eight patients with 29 ITI implants (Straumann AG, Waldenburg, Switzerland) who had reconstruction of either the upper or lower jaw are presented. The aim of the study was (i) to evaluate the behavior of the newly formed soft tissue around implants inserted in the fibula by applying periodontal parameters, (ii) to monitor prospectively the integration of the implants in the fibular graft, and (iii) to assess the osseous integration of the fibular graft used for reconstruction of the upper or lower jaw. Two implants failed during the observation time because of avascular bone at the distal end of the fibular graft. Stabilization of the graft, however, was never compromised. Due to the prefabrication firmly attached gingiva-like soft tissue could be provided preventing periimplant soft tissue inflammation and facilitating oral hygiene. After 1 year of observation the mean attachment level was similar to implants placed in original bone whereas vertical bone loss measured radiographically was lower in the present study. This may indicate that the remodeling of a bicortical bone requires a longer period of time compared with the bone of the alveolar crest. The prospective 1-year results are promising but long-term evaluation of periodontal and radiological parameters are required.

  3. Unusual extended fibular origin of the human soleus muscle: possible morpho-physiologic significance based on comparative anatomy.

    Science.gov (United States)

    Barberini, F; Bucciarelli-Ducci, C; Zani, A; Cerasoli, D

    2003-09-01

    A bilateral anomalous extended origin of the soleus muscle was observed in a 73-year-old female cadaver. It arose from the head, neck, and proximal two-thirds of the medial crest of the fibula and ran through the posterior intermuscular septum of the leg, from the lateral border of the fibula. The soleus muscle formed the vault of a muscular tunnel, overcoming the deep flexor muscles of the leg that was about 15 cm in length and directed inferiorly and laterally. The extended fibular origin delimited a blind recess lateral to the muscular tunnel and parallel to the posterior surface of the fibula. This recess measured 6.5 cm in length and extended 3.5 cm above the inferior opening of the muscular tunnel; the superior portion of the flexor hallucis longus was housed within it between the portions of the extended origin from the medial crest of the fibula and posterior intermuscular septum. The neurovascular bundle of the posterior leg coursed in the muscular tunnel. The tibial origin and calcaneal insertion of the soleus muscle were normal. Phylogenetic studies of the muscles of the lower limbs in mammals indicate that the fibular origin of soleus is more constant than the tibial origin and, in primates, the fibular origin is the only one observed in most monkeys. The case reported might be considered a conspicuous enlargement of the fibular origin observed in primates. This large fibular origin of the soleus muscle may prove to be a difficulty during surgery when accessing the proximal two-thirds of the fibula for ligation of the peroneal artery. Copyright 2003 Wiley-Liss, Inc.

  4. The fibular head projection is of limited use as a radiographic landmark in preoperative planning of total knee arthroplasty

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    Matziolis, Doerte; Meiser, Marius; Matziolis, Georg [University Hospital Jena, Orthopedic Department, Eisenberg (Germany); Sieber, Norbert [Radiology Practice Eisenberg, Eisenberg (Germany); Teichgraeber, Ulf [University Hospital Jena, Institute of Diagnostic and Interventional Radiology, Eisenberg (Germany)

    2017-10-15

    The projection of the fibular head is recommended as a quality indicator of a correct radiographic projection. However, this landmark has yet to be sufficiently validated. The MRIs of 334 knee joints were included. On the MRIs, the distance between the FH and lateral tibial cortical bone was simulated in projections parallel to surgically relevant axes. Then, the Pearson correlation coefficient between the distance of the FH to the lateral tibial cortical bone and the projection plane causing this was determined. A projection of the knee joint perpendicular to Akagi's line projected the center of the fibular head on average 4.8 ± 2.9 mm laterally of the tibial cortical bone, parallel to the maximum mediolateral axis of the tibia 7.5 ± 3.4 mm, parallel to the posterior condylar axis 5.6 ± 3.6 mm and parallel to the surgical epicondylar axis 6.1 ± 3.5 mm laterally of the tibial cortical bone. An almost linear correlation was seen, with 1.9 tilting of the projection plane per mm change in distance between the fibular head and tibial cortical bone. At the same time, the interindividual scatter was over 60 . The rule of thumb for a partial overlap of the fibular head by the tibia in the case of a correct antero-posterior projection plane was also confirmed. However, a considerable interindividual variability of the position of the FH was found, which limits a conclusion regarding the quality of the radiographic projection on the basis of the position of the fibular head. (orig.)

  5. Novel Synchronous Linear and Rotatory Micro Motors Based on Polymer Magnets with Organic and Inorganic Insulation Layers

    Directory of Open Access Journals (Sweden)

    Andreas WALDSCHIK

    2008-12-01

    Full Text Available In this work, we report on the development of several synchronous motors with rotatory or linear movements. The synchronous micro motors are brushless DC motors or stepper motors with electrically controlled commutation consisting of a stator and a rotor. The rotor is mounted onto the stator and is adjusted by an integrated guidance. Inside the stator different coil systems are realized, like double layer sector coils or special nested coils. The coil systems can be controlled by three or six phases depending on the operational mode. Furthermore, inorganic insulation layers were used in order to reduce the thickness of the system. By this means four layers of electrical conductors can be realized especially for the 2D devices. The smallest diameter of the rotatory motor is 1 mm and could be successfully driven.

  6. Indications for free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head

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    Kawamura Kenji

    2007-08-01

    Full Text Available Abstract Background The present study aimed to determine the indications for free vascularized fibular grafting for the treatment of osteonecrosis of the femoral head. Methods Seventy-one hips (60 patients were clinically followed for a minimum of 3 years. Average follow-up period was 7 years. Etiologies were alcohol abuse in 31 hips, steroid use in 27, idiopathic in 7 and trauma in 6. Preoperative staging of the necrotic lesion was done using the Steinberg's classification system. The outcomes of free vascularized fibular grafting were determined clinically using the Harris hip-scoring system, radiographically by determining progression, and survivorship by lack of conversion to total hip replacement. Results The average preoperative Harris hip score was 56 points and the average score at the latest follow-up examination was 78 points. Forty-seven hips (67% were clinically rated good to excellent, 4 hips (6% were rated fair, and 20 hips (28% were rated poor. Thirty-six hips (51% did not show radiographic progression while 35 hips (49% did, and with an overall survivorship of 83% at 7 years. Steroid-induced osteonecrosis was significantly associated with poor scores and survival rate (68%. Preoperative collapse was significantly associated with poor scores, radiographic progression and poor survival rate (72%. A large extent of osteonecrosis greater than 300 degrees was significantly associated with poor scores, radiographic progression and poor survival rate (67%. There was no relationship between the distance from the tip of the grafted fibula to the subchondral bone of the femoral head and postoperative radiographic progression. Conclusion In conclusion, small osteonecrosis (less than 300 degrees of the femoral head without preoperative collapse (Steinberg's stages I and II is the major indication for free vascularized fibular grafting. Steroid-induced osteonecrosis is a relative contraindication. Large osteonecrosis (greater than 300 degrees

  7. Fibular allograft and anterior plating for dislocations/fractures of the cervical spine

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    Ramnarain A

    2008-01-01

    Full Text Available Background: Subaxial cervical spine dislocations are common and often present with neurological deficit. Posterior spinal fusion has been the gold standard in the past. Pain and neck stiffness are often the presenting features and may be due to failure of fixation and extension of fusion mass. Anterior spinal fusion which is relatively atraumatic is thus favored using autogenous grafts and cages with anterior plate fixation. We evaluated fresh frozen fibular allografts and anterior plate fixation for anterior fusion in cervical trauma. Materials and Methods: Sixty consecutive patients with single-level dislocations or fracture dislocations of the subaxial cervical spine were recruited in this prospective study following a motor vehicle accident. There were 38 males and 22 females. The mean age at presentation was 34 years (range 19-67 years. The levels involved were C5/6 ( n = 36, C4/5 ( n = 15, C6/7 ( n = 7 and C3/4 ( n = 2. There were 38 unifacet dislocations with nine posterior element fractures and 22 were bifacet dislocations. Twenty-two patients had neurological deficit. Co-morbidities included hypertension ( n = 6, non-insulin-dependent diabetes mellitus ( n = 2 and asthma ( n = 1. All patients were initially managed on skull traction. Following reduction further imaging included Computerized Tomography and Magnetic Resonance Imaging. Patients underwent anterior surgery (discectomy, fibular allograft and plating. All patients were immobilized in a Philadelphia collar for eight weeks (range 7-12 weeks. Eight patients were lost to follow-up within a year. Follow-up clinical and radiological examinations were performed six-weekly for three months and subsequently at three-monthly intervals for 12 months. Pain was analyzed using the visual analogue scale (VAS. The mean follow-up was 19 months (range 14-39 months. Results: Eight lost to followup, hence 52 patients were considered for final evaluation. The neurological recovery was 1.1 Frankel

  8. [Wrist joint reconstruction with vascularized fibular head graft after resection of distal radius giant cell tumor].

    Science.gov (United States)

    Bi, Zhenggang; Pan, Qi; Fu, Chunjiang; Han, Xinguang

    2010-12-01

    To observe the effectiveness of wrist joint reconstruction with vascularized fibular head graft after resection of distal radius giant cell tumor. Between March 2000 and March 2009, 31 cases of distal radius giant cell tumor were treated with extended resection and vascularized fibular head graft for repairing defects of the distal radius, and reconstructing wrist joint. There were 14 males and 17 females with an average age of 37.2 years (range, 15-42 years). The disease duration ranged from 1 month to 2 years and 3 months with an average of 8 months. The size of tumor was 6.5 cm x 3.5 cm-8.0 cm x 4.5 cm. The range of motion (ROM) of wrist joint was as follows: extension 5-15 degrees (mean, 10.7 degrees), flexion 9-21 degrees (mean, 14.2 degrees), radial inclination 0-10 degrees (mean, 8.6 degrees), and ulnar inclination 0-15 degrees (mean, 7.9 degrees). The ROM of forearm was as follows: pronation 15-50 degrees (mean, 28.7 degrees) and supination 10-25 degrees (mean, 16.5 degrees). The histopathological examination revealed that there were 5 cases of stage I, 17 of stage II, and 9 of stage III. All patients achieved primary healing of incision and were followed up 1-9 years with an average of 4.5 years. The X-ray films showed that bone healing time was 12-16 weeks with an average of 13 weeks. No tumors recurrence was observed. The ROM of wrist joint was as follows at 1 year after operation: extension 20-50 degrees (mean, 29.0 degrees), flexion 30-50 degrees (mean, 35.0 degrees), radial inclination 10-20 degrees (mean, 16.5 degrees), and ulnar inclination 20-25 degrees (mean, 23.5 degrees). The ROM of forearm was as follows: pronation 40-90 degrees (mean, 68.3 degrees) and supination 30-80 degrees (mean, 59.6 degrees). There were significant differences in the ROM between before operation and after operation (P wrist score, the results were excellent in 17 cases, good in 12, and fair in 2. Wrist joint reconstruction with vascularized fibular head graft can restore

  9. FATCO Syndrome Variant - Fibular Hypoplasia, Tibial Campomelia and Oligosyndactyly –– A Case Report

    Science.gov (United States)

    Kaur, Randeep; Gupta, Manu; Bhatty, Shiraz; Paul, Rajesh

    2014-01-01

    The word aplasia/hypoplasia is used for partial or total absence of a bone. Fibula, a lower limb bone is one of the most common to be involved with this and its incidence is amongst the highest in long bone deficiencies. FATCO syndrome consisting of fibular aplasia, tibial campomelia and oligosyndactyly has been described in the literature but only one has been reported from India as per our literature review. However, it is important to know multiple regional involvement can occur along with this syndrome and prove to be a major difficulty for the child and the parents both. Due to the rarity of reports on this rare syndrome and difficulty in treatment it is important that each such case should be described to make the management easier. PMID:25386471

  10. Overlap between Fibular Aplasia, Tibial Campomelia, and Oligosyndactyly and Fuhrmann's Syndromes in an Egyptian Female Infant.

    Science.gov (United States)

    Abdalla, Ebtesam M; El-Beheiry, Ahmed A

    2017-06-01

    We report a rare congenital limb defect with combined features of both fibular aplasia, tibial campomelia, and oligosyndactyly (FATCO) and Fuhrmann's syndromes. A female newborn infant, born to nonconsanguineous Egyptian parents, presented with isolated abnormalities of the lower limbs comprising bilateral shortening and anterior bowing of the lower limbs at the distal third of the tibia and split foot. Radiographic examination revealed complete absence of both fibulae, anterolateral bowing and shortening of the tibia, bowing of the femora, and absence of several metatarsal and phalangeal bones. The upper limbs were clinically and radiologically normal, and the infant had neither facial dysmorphism nor other associated visceral anomalies. The presented case highlights an extremely rare limb deficiency syndrome, and together with additional case reports, it could be useful to further delineate this condition.

  11. Congenital bilateral fibular deficiency with facial dysmorphia, brachydactyly and mental retardation in a girl.

    Science.gov (United States)

    Stoll, C; Alembik, Y; Repetto, M

    1998-01-01

    Congenital bilateral fibular deficiency with facial dysmorphia, brachydactyly and mental retardation in which are combined in a syndrome or which do not fit in any of the known syndromes. We report a child with congenital bilateral deficiency of the fibula and an unusual combination of features. The patient, a girl, was born after an uneventful pregnancy at term to young healthy parents. Absent fibulae were noted at birth. At age 4 she was found to have growth retardation with delayed bone age, overlapping, short toes, syndactyly of the toes, clinodactyly of the 5th and 2nd fingers, syndactyly of the three last fingers and facial dysmorphia. Mental retardation was present. Karyotype and laboratory investigations were normal. Differential diagnosis included syndromes with aplasia or hypoplasia of fibula, but none of these syndromes seemed to include the girl's features.

  12. Intramedullary fibular and impaction allografting in revision total elbow arthroplasty with endosteal deficiency.

    Science.gov (United States)

    Papadonikolakis, Anastasios; McKenna, Mark; Warme, Winston J; Matsen, Frederick A

    2012-03-01

    One of the many reasons for failed revision elbow replacement is loss of the normally irregular shape of the endosteal surface leading to reduced ability to provide rotational control of the humeral or ulnar component within the intramedullary canal. The endosteal bone loss of the distal humerus or proximal ulna compromises the rotational stability of the stem in the intramedullary canal. In these cases, impaction cancellous allografting techniques, similar to the ones used in revision total hip arthroplasties, are commonly used to address the osseous deficiency, but these methods are not optimal for providing rotational control of the prosthetic stem. We describe a technique of restoring the irregular shape of the endosteal bone using intramedullary fibular allografting to enhance the rotational control of the prosthetic stem within the intramedullary bone canal.

  13. Hardware complications in oromandibular defects: Comparing scapular and fibular based free flap reconstructions.

    Science.gov (United States)

    Tsang, Gordon F Z; Zhang, Han; Yao, Christopher; Kolarski, Mirko; Gullane, Patrick J; Irish, Jonathan C; Brown, Dale H; Chepeha, Douglas B; Goldstein, David P; Gilbert, Ralph W; de Almeida, John R

    2017-08-01

    Despite improvements in surgical technique and technology, hardware complications occur relatively frequently. This study analyzes hardware complications in patients undergoing oromandibular reconstruction using scapular (SFF) or fibular (FFF) free flaps. Retrospective data for 178 patients was obtained (1999-2014) at University Hospital Network (Toronto, Canada). Univariable and multivariable analyses were performed to identify risk factors for hardware complications. Patients with FFF reconstruction (n=129) had significantly more hardware complications than those with SFF (n=49) (16% vs. 2%;p=0.01). Surgical site infection (SSI) (OR=7.05; phardware complications on univariable analysis. Flap type (OR=0.12; p=0.04) was an independent predictor of plate complication after adjusting for SSI. A subgroup analysis suggested a trend towards fewer hardware complications with SFF stratified by mandibular defect type. Scapular free flaps are associated with a lower rate of hardware-related complications in oromandibular reconstruction. Copyright © 2017 Elsevier Ltd. All rights reserved.

  14. Contrast-Enhanced Microtomographic Characterisation of Vessels in Native Bone and Engineered Vascularised Grafts Using Ink-Gelatin Perfusion and Phosphotungstic Acid

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    Sarah Sutter

    2017-01-01

    Full Text Available Objectives. Bone ischemia and necrosis are challenging to treat, requiring investigation of native and engineered bone revascularisation processes through advanced imaging techniques. This study demonstrates an experimental two-step method for precise bone and vessel analysis in native bones or vascularised bone grafts using X-ray microtomography (μCT, without interfering with further histological processing. Methods. Distally ligated epigastric arteries or veins of 6 nude rats were inserted in central channels of porous hydroxyapatite cylinders and these pedicled grafts were implanted subcutaneously. One week later, the rats were perfused with ink-gelatin and euthanised and the femurs, tibias, and grafts were explanted. Samples were scanned using μCT, decalcified, incubated with phosphotungstic acid (PTA for contrast enhancement, rescanned, and processed histologically. Results. Contrast-enhanced μCT displayed the course and branching of native bone vessels. Histologically, both central (−17% and epiphyseal vessels (−58% appeared smaller than in μCT scans. Hydroxyapatite cylinders were thoroughly vascularised but did not display bone formation. Grafts with a central artery had more (+58% and smaller (−52% vessel branches compared to grafts with a vein. Conclusions. We present a relatively inexpensive and easy-to-perform two-step method to analyse bone and vessels by μCT, suitable to assess a variety of bone-regenerative strategies.

  15. Multi-fasciculated anterior talo-fibular ligament: reassessment of normal findings

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    Delfaut, E.M.; Boutry, N.; Cotten, A. [Department of Musculo-Skeletal Radiology, Roger Salengro Hospital, CHRU Lille, Bd du Professeur Jules Leclercq, 59037, Lille (France); Demondion, X. [Department of Musculo-Skeletal Radiology, Roger Salengro Hospital, CHRU Lille, Bd du Professeur Jules Leclercq, 59037, Lille (France); Department of Anatomy, Faculty of Medicine, Roger Salengro Hospital, CHRU Lille, Place de Verdun, 59037, Lille Cedex (France); Cotten, H. [Pathology Laboratory, 128 Bd de la Liberte, 59000, Lille (France); Mestdagh, H. [Department of Orthopaedic Surgery, Roger Salengro Hospital, CHRU Lille, Bd du Professeur Jules Leclercq, 59037, Lille Cedex (France)

    2003-08-01

    The aims of this study were to (a) provide an accurate description of the anterior talo-fibular ligament (ATFL) multifasciculated feature by means of cadaver study, and (b) to further delineate contour and signal variations on MR images related to this feature in a group of asymptomatic subjects. After MR imaging, three cadaveric feet were frozen and cut in the coronal plane. The ATFL were harvested and sent to pathology. Another cadaveric foot was dissected. The MR imaging was performed in 3 healthy volunteers and 19 patients without pathology of the ATFL. For both cadaveric feet and subjects, MR imaging protocol consisted of axial and coronal proton-density (PD) and T2-weighted turbo-spin-echo (TSE) sequences (TR/TE: 3500 ms/17-119 ms). On MR images, ATFL signal and fascicle numbers were assessed, respectively, in the axial and coronal planes. Gross anatomy and pathology confirmed the ATFL bifasciculated aspect. On cadaveric coronal MR images, 3 of 4 ATFLs were bifasciculated and one of four was striated. On patients' coronal MR images, 2 of 22 of the ATFL were monofasciculated, 12 of 22 bifasciculated, and 8 of 22 striated. On axial MR images, 16 of 22 of the ATFL demonstrated a low signal intensity and 8 of 22 an intraligamentous subtle increased signal intensity. Two of 22 of the ATFL had contour irregularities. Isolated anterior talo-fibular intraligamentous signal abnormalities or contour irregularities on axial PD and T2-weighted MR images with an otherwise normal ATFL aspect on coronal MR images and no other MRI criteria for ankle sprain may reflect normal anatomy. (orig.)

  16. Free fibular strut graft in neglected femoral neck fractures in adult

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    Azam Md Quamar

    2009-01-01

    Full Text Available Background: Neglected femoral neck fracture in adults still poses a formidable challenge. Existing treatment options varies from osteotomy (with or without graft to osteosynthesis using various implants and grafting techniques (muscle pedicle, vascularized, and nonvascularized fibula. The aim of this study was to assess outcome of nonvascularized fibular strut graft and cancellous screw fixation in neglected femoral neck fractures in the younger age group. Materials and Methods: Medical records of 32 patients of neglected femoral neck fracture, in the age group of 22-45 years (mean 37.8 years, operated between May 1994 to December 2001, were retrospectively reviewed. After the application of inclusion and exclusion criteria, 28 patients having three years minimum follow-up (mean 4.6 years were included. Delay between injury and operation varied from four weeks to 42 weeks (mean 16.4 weeks. Closed reduction was achieved in 17 patients; open reduction through Watson-Jones anterolateral approach was performed in the remaining 15 patients in whom closed reduction failed. The fracture was transfixed with three parallel guide wires. Appropriate sized cannulated lag screw (7 mm was then inserted in two of the wires. Selection of the third guide wire for fibula depended on the space available in both anteroposterior and lateral view. Results: Satisfactory bony union was obtained in 25 patients, of whom in four cases, the union occurred in 10-20° (mean 15° of varus. Nonunion occurred in three patients (9.37%, and aseptic necrosis occurred in another six patients (18.75%. Of the 25 patients where union was achieved, five patients showed excellent results; 14 good and six had poor functional result, as evaluated using modified Anglen criteria. Conclusion: Nonvascularized fibular strut graft along with cancellous screws provides a dependable and technically less-demanding alternative procedure for neglected femoral neck fractures in young adults. Fibula

  17. Oral rehabilitation with dental implants and quality of life following mandibular reconstruction with free fibular flap.

    Science.gov (United States)

    Jacobsen, Hans-Christian; Wahnschaff, Falko; Trenkle, Thomas; Sieg, Peter; Hakim, Samer G

    2016-01-01

    Bony reconstruction of jaw defects using the free fibular flap and dental rehabilitation mostly requires insertion of dental implants within the transferred fibula bone. The aim of this paper was to discuss results of the implant stability with data on the possible benefit for the patient's quality of life after such treatment. For clinical outcome of implants, we evaluated 26 patients with a total number of 94 dental implants after a follow-up period of 12 to 132 months. A group of 38 patients who underwent mandibular reconstruction with free fibular flap could be included in the life-quality study. Evaluation included 23 patients with and 15 patients without implant-borne restoration. The quality of life was assessed using the standard QLQ C-30 questionnaire and the H&N35 module of the European Organisation for Research and Treatment of Cancer (EORTC). Of implants, 94.7 % were stable at the time of investigation and could be used for prosthesis. Patients with dental implants reported improvement of life quality along with better scores in most function and symptom scales; however, only values for global health status (QL2), absence of dyspnea (DY) and absence of feeding tube (HNFE) were significantly better than in the control group. Dental implant insertion in fibula grafts along with implant-borne restoration is a proven concept and might lead to improved quality of life following ablative surgery of the jaw. The effect on the quality of life is not as predictable as on the implant stability. Patients with bony defects of the jaw require bony reconstruction. This allows further masticatory rehabilitation using dental implants and might lead to improved quality of life.

  18. Improved rotatory-flow technique applied to cod (Gadus morrhua L. )

    Energy Technology Data Exchange (ETDEWEB)

    Lindahl, P.E.; Oloesson, S.; Schwanbom, E.

    1976-01-01

    An improved version of rotatory-flow apparatus is described, allowing tests of fitness with fish of different size at constant temperature. Cod (Gadus morrhua, L.) was used as experimental animal, and its treatment and behavior during different phases of the test are described in some detail. Each test results in determination of the ''critical rev min/sup -1/'' at which the fish is just brought to rotate with the water. The mean of a series of 10 critical rev min/sup -1/ with the same fish, multiplied by the interior circumference of the rotational tube used, gives the ''critical peripheral velocity'' of the specimen. Critical peripheral velocities of a sample of fish, plotted against the standard length of the fish, arrange themselves along a straight line which intersects the vertical axis near the origin. Divided by the corresponding standard lengths the critical peripheral velocities give ''reaction quotients,'' the mean of which describe the reaction of the whole sample of fish. Optimal experimental conditions have been found by investigating the effects of systematic variation in streaming velocity, relationship between rotational tube diameter and fin-breadth, temperature and effects of repetition of test-series on successive days etc. on the results of testing. Changes in temperature of 3 to 6C induced significant changes in mean reaction quotients only when the upper critical temperature of cod was reached.

  19. Development of the wake behind a circular cylinder impulsively started into rotatory and rectilinear motion

    Science.gov (United States)

    Chen, Yen-Ming; Ou, Yuh-Roung; Pearlstein, Arne J.

    1993-01-01

    The temporal development of a 2D viscous incompressible flow generated by a circular cylinder started impulsively into steady rotatory and rectilinear motion is studied by integration of a velocity/vorticity formulation of the governing equations, using an explicit finite-difference/pseudo-spectral technique and an implementation of the Biot-Savart law. Results are presented for a Reynolds number of 200 (based on the cylinder diameter 2a and the magnitude U of the rectilinear velocity) for several values of the angular/rectilinear speed ratio alpha = omega(a)/U (where omega is the angular speed) up to 3.25. Several aspects of the kinematics and dynamics of the flow not considered earlier are discussed. For higher values of alpha, the results indicate that for Re = 200, vortex shedding does indeed occur for alpha = 3.25. However, consecutive vortices shed by the body can be shed from the same side and be of the same sense, in contrast to the nonrotating case, in which mirror-image vortices of opposite sense are shed alternately on opposite sides of the body. The implications of the results are discussed in relation to the possibility of suppressing vortex shedding by open or closed-loop control of the rotation rate.

  20. Treatment of Atlantoaxial Rotatory Fixation With Botulinum Toxin Muscle Block and Manipulation

    Directory of Open Access Journals (Sweden)

    Chia-Hung Lin

    2010-04-01

    Full Text Available Slippage after reduction of atlantoaxial rotatory fixation (AARF is usually treated with repeated cervical traction and brace immobilization. To date, no data have been published on the management of muscle spasm during treatment. Here, we describe the case of a 7-year-old girl with AARF for 1 month who visited our hospital for treatment. During physical examination, spasm of the sternocleidomastoid muscle was noted. The patient was treated with manipulative reduction, and slippage after reduction was managed with botulinum spasticity block of the sternocleidomastoid and splenius capitis muscles, and repeated manipulation. Cervical orthosis immobilization with a rehabilitation program of isometric contract–relax exercise for the neck was conducted for 3 months. The subject had full recovery from AARF at 1-year follow-up. This report demonstrates that, in selected cases of slippage after reduction from AARF, conservative management with manipulation under anesthesia is a good method, and the muscle components may play a crucial role in AARF.

  1. Endoscopic fibular groove deepening for stabilisation of recurrent peroneal tendons instability in a patient with open physes.

    Science.gov (United States)

    Maqdes, Ali; Steltzlen, Camille; Pujol, Nicolas

    2017-06-01

    This is a report of a rare case of recurrent traumatic peroneal tendon dislocation in a patient with open physes. Through fibular tendon endoscopy, an intramuscular needle was introduced under direct visualisation and implanted inferiorly to the growth plate while reclining the tendons posteriorly. A fibular groove deepening was performed in order to stabilize the tendons. The patient was able to return to full activity after 3 months. MRI taken 12 months after surgery showed neither signs of recurrence of the lesion nor growth plate disturbance. This is a first case report of peroneal tendons stabilisation by tendoscopic retro-malleolar groove deepening in a child. Level of evidence Case report, Level IV.

  2. A case with proximal femoral focal deficiency (PFFD) and fibular A/hypoplasia (FA/H) associated with urogenital anomalies.

    Science.gov (United States)

    Ergin, Hacer; Semerci, C Nur; Bican, Mevlüt; Düzcan, Füsun; Yagci, A Baki; Erdogan, Kadri Murat; Tufan, A Cevik

    2006-01-01

    Malformations of the lower limbs are rare and heterogeneous anomalies. Some congenital anomalies involving face, gastrointestinal system, skeletal system, urogenital system, heart, lung and diaphragma associated with lower limb malformations have been described in the literature. Here, we report a case of left proximal femoral focal deficiency (PFFD) together with fibular aplasia associated with left undescended testis and hypospadias. The putative embryologic mechanisms of lower limb defects and their possible association with lower urogenital tract malformations are also discussed.

  3. The Effect of Postoperative Corticosteroid Administration on Free Vascularized Fibular Grafting for Treating Osteonecrosis of the Femoral Head

    OpenAIRE

    Hao Ding; Sheng-Bao Chen; Sen Lin; You-Shui Gao; Chang-Qing Zhang

    2013-01-01

    Free vascularized fibular grafting (FVFG) has been reported to be an effective method of treating osteonecrosis of the femoral head (ONFH). This study evaluated whether postoperative maintenance doses of corticosteroids had an adverse effect on FVFG outcomes in patients with corticosteroid-induced ONFH. We retrospectively reviewed the records of 39 patients (67 hips) who had received maintenance doses of corticosteroids following FVFG. This group was matched to a group of patients who had not...

  4. The Vascularized Fibular Graft in the Pediatric Upper Extremity: A Durable, Biological Solution to Large Oncologic Defects

    OpenAIRE

    Zelenski, Nicki; Brigman, Brian E.; Levin, L. Scott; Erdmann, Detlev; Eward, William C.

    2013-01-01

    Skeletal reconstruction after large tumor resection is challenging. The free vascularized fibular graft (FVFG) offers the potential for rapid autograft incorporation as well as growing physeal transfer in pediatric patients. We retrospectively reviewed eleven pediatric patients treated with FVFG reconstructions of the upper extremity after tumor resection. Eight male and three female patients were identified, including four who underwent epiphyseal transfer. All eleven patients retained a fun...

  5. The long-term function of the knee in patients with fibular hemimelia and anterior cruciate ligament deficiency.

    Science.gov (United States)

    Crawford, D A; Tompkins, B J; Baird, G O; Caskey, P M

    2012-03-01

    Most patients (95%) with fibular hemimelia have an absent anterior cruciate ligament (ACL). The purpose of this study was to assess the long-term outcome of such patients with respect to pain and knee function. We performed a retrospective review of patients with fibular hemimelia and associated ACL deficiency previously treated at our institution. Of a possible 66 patients, 23 were sent the Musculoskeletal Outcomes Data Evaluation and Management System (MODEMS) questionnaire and Lysholm knee score to complete. In all, 11 patients completed the MODEMS and nine completed the Lysholm score questionnaire. Their mean age was 37 years (27 to 57) at review. Five patients had undergone an ipsilateral Symes amputation. There was no significant difference in any subsections of the Short-Form 36 scores of our patients compared with age-matched controls. The mean Lysholm knee score was 90.2 (82 to 100). A slight limp was reported in six patients. No patients had episodes of locking of the knee or required a supportive device for walking. Four had occasional instability with sporting activities. These results suggest that patients with fibular hemimelia and ACL deficiency can live active lives with a similar health status to age-matched controls.

  6. Tibial and fibular mid-shaft bone traits in young and older sprinters and non-athletic men.

    Science.gov (United States)

    Rantalainen, Timo; Duckham, Rachel L; Suominen, Harri; Heinonen, Ari; Alén, Markku; Korhonen, Marko T

    2014-08-01

    High impact loading is known to prevent some of the age-related bone loss but its effects on the density distribution of cortical bone are relatively unknown. This study examined the effects of age and habitual sprinting on tibial and fibular mid-shaft bone traits (structural, cortical radial and polar bone mineral density distributions). Data from 67 habitual male sprinters aged 19-39 and 65-84 years, and 60 non-athletic men (referents) aged 21-39 and 65-80 years are reported. Tibial and fibular mid-shaft bone traits (strength strain index SSI, cortical density CoD, and polar and radial cortical density distributions) were assessed with peripheral quantitative computed tomography. Analysis of covariance (ANCOVA) adjusted for height and body mass indicated that the sprinters had 21 % greater tibial SSI (P training appears to maintain tibial bone strength, but not radial cortical density distribution into older age. Fibular bone strength appeared unaffected by habitual sprinting.

  7. Ipsilateral vascularised ulnar transposition autograft for limb-sparing surgery of the distal radius in 2 dogs with osteosarcoma : clinical communication

    Directory of Open Access Journals (Sweden)

    G.S. Irvine-Smith

    2006-06-01

    Full Text Available Canine osteosarcoma is the most commonly diagnosed primary bone tumour in the dog, affecting mainly large and giant breed dogs with the predilection site being the metaphysis of long bones, specifically the distal radius, proximal humerus, distal femur and proximal tibia and fibula. Treatment options are either palliative or curative intent therapy, the latter limb amputation or limb-sparing surgery together with chemotherapy. This article describes the use of an ipsilateral vascularised ulnar transposition autograft as well as chemotherapy in 2 dogs with osteosarcoma of the distal radius. Both dogs showed minimal complications with the technique and both survived over 381 days following the surgery. Complications seen were loosening of the screws and osteomyelitis. The procedure was well tolerated with excellent limb use. This technique is indicated for use in cases with small tumour size that have not broken through the bone cortex.

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

    Science.gov (United States)

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

    2017-09-19

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

  9. Lateral femoral notch depth is not associated with increased rotatory instability in ACL-injured knees: a quantitative pivot shift analysis.

    Science.gov (United States)

    Kanakamedala, Ajay C; Burnham, Jeremy M; Pfeiffer, Thomas R; Herbst, Elmar; Kowalczuk, Marcin; Popchak, Adam; Irrgang, James; Fu, Freddie H; Musahl, Volker

    2017-11-08

    A deep lateral femoral notch (LFN) on lateral radiographs is indicative of ACL injury. Prior studies have suggested that a deep LFN may also be a sign of persistent rotatory instability and a concomitant lateral meniscus tear. Therefore, the purpose of this study was to evaluate the relationship between LFN depth and both quantitative measures of rotatory knee instability and the incidence of lateral meniscus tears. It was hypothesized that greater LFN depth would be correlated with increased rotatory instability, quantified by lateral compartment translation and tibial acceleration during a quantitative pivot shift test, and incidence of lateral meniscus tears. ACL-injured patients enrolled in a prospective ACL registry from 2014 to 2016 were analyzed. To limit confounders, patients were only included if they had primary ACL tears, no concurrent ligamentous or bony injuries requiring operative treatment, and no previous knee injuries or surgeries to either knee. Eighty-four patients were included in the final analysis. A standardized quantitative pivot shift test was performed pre-operatively under anesthesia in both knees, and rotatory instability, specifically lateral compartment translation and tibial acceleration, was quantified using tablet image analysis software and accelerometer sensors. Standard lateral radiographs and sagittal magnetic resonance images (MRI) of the injured knee were evaluated for LFN depth. There were no significant correlations between LFN depth on either imaging modality and ipsilateral lateral compartment translation or tibial acceleration during a quantitative pivot shift test or side-to-side differences in these measurements. Patients with lateral meniscus tears were found to have significantly greater LFN depths than those without on conventional radiograph and MRI (1.0 vs. 0.6 mm, p quantitative measures of rotatory instability. Concomitant lateral meniscus injury was associated with significantly greater LFN depth. Based on

  10. Use of Paley Classification and SUPERankle Procedure in the Management of Fibular Hemimelia.

    Science.gov (United States)

    Kulkarni, Ruta M; Arora, Nitish; Saxena, Sagar; Kulkarni, Sujay M; Saini, Yadwinder; Negandhi, Rajiv

    2017-05-26

    Fibular hemimelia is the most common deficiency involving the long bones. Paley classification is based on the ankle joint morphology, identifies the basic pathology, and helps in planning the surgical management. Reconstruction surgery encompasses foot deformity correction and limb length equalization. The SUPERankle procedure is a combination of bone and soft tissue procedures that stabilizes the foot and addresses all deformities. We retrospectively reviewed 29 consecutive patients (29 limb segments), surgically treated between December 2000 and December 2014. Among the 29 patients, 27 were treated with reconstructive procedures. Type 1 (8 patients) cases were treated with only limb lengthening, and correction of tibial deformities. Type 2 (7 patients) cases were treated by distal tibial medial hemiepiphysiodesis or supramalleolar varus osteotomy. In type 3 (10 patients) cases, the foot deformity was corrected using the SUPERankle procedure. Type 4 (2 patients) cases were treated with supramalleolar osteotomy along with posteromedial release and lateral column shortening. In a second stage, limb lengthening was performed, using the Ilizarov technique. In the remaining 2 patients (type 3A and type 3C), amputation was performed using Syme technique as a first choice of treatment. The results were evaluated using Association for the Study and Application of Methods of Ilizarov scoring. Excellent results were obtained in 15 of 27 (55%) patients. Six (22%) patients had good results, 4 (14.8%) had fair results, and 2 (7%) had poor results. Mean limb length discrepancy at initial presentation was 3.55 cm (range: 2 to 5.5 cm) which significantly improved to 1.01 cm (range: 0 to 3 cm) after treatment (P=0.015). Our results and a review of the literature clearly suggest that limb reconstruction according to Paley classification, is an excellent option in the management of fibular hemimelia. Our 2-staged procedure (SUPERankle procedure followed by limb lengthening) helps

  11. Malleolus externus plasty for joint reconstruction in fibular aplasia: preliminary report of a new technique.

    Science.gov (United States)

    Weber, Michael; Siebert, Christian H; Goost, Hans; Johannisson, Reiner; Wirtz, Dieter

    2002-07-01

    The instability of the upper and the lower ankle joint represents a serious problem in patients with fibular aplasia. None of the previous techniques demonstrated at least sufficient results. In this report we present a new technique of malleolus externus plasty applied in a 5 1/2-year-old boy with fibular aplasia (type II according to Coventry and Johnson or type Ib according to Achtermann and Kalamchi) with a 6 cm length deficiency of the lower leg and 1 cm of the upper leg. Furthermore, he showed a tibial antecurvation deformity of 20 degrees, a fourth ray foot with adduction deformity of the hindfoot, cutane syndactyly D 2-4, and a hallux varus. This new technique works on the following principle. A triangular iliac crest transplant is implanted with an apophysis and the annexing fascia glutealis, including the osseous part of the transplant, in the lateral distal tibia in a way that the growing apophyseal part lays distally covering the lateral talus. Gluteal fascia annexed to the apophysis was used for the reconstruction of a lateral tendon. Using a ring fixator the transplant is fixed and coincidentally the lower leg lengthened and the axis corrected. The axis deformity and the leg-length deficiency of 7 cm were equalized. The fixator could be removed after 6 months. Radiologically, an entire integration of the iliac crest transplant was found. Magnetic resonance imaging showed it had sufficient circulation. The reexamination 2.5 years later demonstrated a simultaneous growth of the malleolus externus and the distal tibia and stable ankle joints with sufficient mobility and full weight-bearing capability. For support of the foot the boy uses ready-made shoes with curved arch supports. In conclusion, using this new technique an individually adapted lateral malleolus with growth-potential can be constructed that stabilizes the foot and the ankle joints. Thus, reluxations of the foot specifically in relation to lengthening of lower legs can be avoided with

  12. Posttraumatic Atlantoaxial Rotatory Dislocation in a Healthy Adult Patient: A Case Report and Review of the Literature

    Science.gov (United States)

    Maida, Giuseppe; Marcati, Eleonora; Sarubbo, Silvio

    2012-01-01

    Atlantoaxial rotatory dislocation (AARD) is a rare complication in adults usually leading to pain, spinal cord injury, or death. Clinical and radiological diagnosis is difficult and often delayed. We report a rare case of posttraumatic AARD in a neurological intact 27-year-old male in which initial radiographic evaluation was negative. A computed tomography (CT) scan was promptly done because the patient showed a severe torticollis. Therefore, early diagnosis, immobilisation, and surgical fusion and arthrodesis were performed. After surgery, cervical pain and torticollis were resolved and the patient remained neurologically intact with a CT scan documentation of fusion at the 3-year followup. PMID:23227389

  13. Posttraumatic Atlantoaxial Rotatory Dislocation in a Healthy Adult Patient: A Case Report and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Giuseppe Maida

    2012-01-01

    Full Text Available Atlantoaxial rotatory dislocation (AARD is a rare complication in adults usually leading to pain, spinal cord injury, or death. Clinical and radiological diagnosis is difficult and often delayed. We report a rare case of posttraumatic AARD in a neurological intact 27-year-old male in which initial radiographic evaluation was negative. A computed tomography (CT scan was promptly done because the patient showed a severe torticollis. Therefore, early diagnosis, immobilisation, and surgical fusion and arthrodesis were performed. After surgery, cervical pain and torticollis were resolved and the patient remained neurologically intact with a CT scan documentation of fusion at the 3-year followup.

  14. Cervical Rotatory Manipulation Decreases Uniaxial Tensile Properties of Rabbit Atherosclerotic Internal Carotid Artery

    Science.gov (United States)

    Qi, Ji; Zhang, Lei; Chen, Chao; Mondal, Shubhro; Ping, Kaike; Chen, Yili

    2017-01-01

    Objective. To investigate the effects of one of the Chinese massage therapies, cervical rotatory manipulation (CRM), on uniaxial tensile properties of rabbit atherosclerotic internal carotid artery (ICA). Methods. 40 male purebred New Zealand white rabbits were randomly divided into CRM-Model group, Non-CRM-Model group, CRM-Normal group, and Non-CRM-Normal group. After modeling (atherosclerotic model) and intervention (CRM or Non-CRM), uniaxial tensile tests were performed on the ICAs to assess the differences in tensile mechanical properties between the four groups. Results. Both CRM and modeling were the main effects affecting physiological elastic modulus (PEM) of ICA. PEM in CRM-Model group was 1.81 times as much as Non-CRM-Model group, while the value in CRM-Model group was 1.34 times as much as CRM-Normal group. Maximum elastic modulus in CRM-Model group was 1.80 times as much as CRM-Normal group. Max strains in CRM-Model group and Non-CRM-Model group were 30.98% and 28.71% lower than CRM-Normal group and Non-CRM-Normal group, respectively. However, whether treated with CRM or not, the uniaxial tensile properties of healthy ICAs were not statistically different. Conclusion. CRM may decrease the uniaxial tensile properties of rabbit arteriosclerotic ICA, but with no effect on normal group. The study will aid in the meaningful explanation of the controversy about the harmfulness of CRM and the suitable population of CRM. PMID:28303160

  15. Condylus tertius with atlanto-axial rotatory fixation: an unreported association

    Energy Technology Data Exchange (ETDEWEB)

    Udare, Ashlesha Satish [M.G.M. Hospital, Department of Radiology, Kamothe, Navi Mumbai (India); Global Hospital Super Speciality and Transplant Centre, Department of Radiology, Mumbai (India); Navi Mumbai, Maharashtra (India); Bansal, Divya; Patel, Bhavin [M.G.M. Hospital, Department of Radiology, Kamothe, Navi Mumbai (India); Mondel, Prabath Kumar [P.D. Hinduja Hospital, Department of Radiology, Mahim, Mumbai (India); Aiyer, Siddharth [Shatabdi Hospital, Department of Orthopedics, Chembur, Mumbai (India)

    2014-04-15

    The ''condylus tertius'' or the ''third occipital condyle'' is an embryological remnant of the proatlas sclerotome. Anatomically, it is attached to the basion and often articulates with the anterior arch of the atlas and the odontoid apex; hence, it is also called the ''median occipital condyle''. It is a rare anomaly of the cranio-vertebral junction (CVJ) that can lead to instability and compression of important surrounding neurovascular structures. We report a case of a 16-year-old boy who presented with suboccipital neck pain, torticollis and right sided hemiparesis. Plain radiographs revealed an increased atlanto-dental interspace (ADI) with a retroflexed odontoid. Open mouth view showed asymmetry of the articular processes of the atlas with respect to the dens. Computed tomography (CT) of the CVJ delineated the third occipital condyle. Furthermore, on dynamic CT study, a type 3 atlanto-axial rotatory fixation (AARF) was clearly demonstrated. Magnetic resonance imaging (MRI) of the CVJ revealed severe right-sided spinal cord compression by the retroflexed and rightward deviated dens. It also revealed disruption of the left alar and transverse ligaments. The patient was treated with 8 weeks of cranial traction and reasonable alignment was obtained. This was followed by C1-C2 lateral mass screw fixation and C1-C2 interlaminar wiring to maintain the alignment. A review of the literature did not reveal any cases of condylus tertius associated with non-traumatic AARF. An accurate knowledge of the embryology and imaging features of this rare CVJ anomaly is useful in the prompt diagnosis and management of such patients. (orig.)

  16. Closed manual reduction maneuver of atlantoaxial rotatory dislocation in pediatric age.

    Science.gov (United States)

    Akbay, Atilla; Bilginer, Burçak; Akalan, Nejat

    2014-06-01

    The purposes of this study were to characterize the clinical and radiological features of type 1 and type 2 atlantoaxial rotatory dislocations (AARD) and to evaluate the outcome of the manual reduction maneuver for these types of dislocations in pediatric patients. This study considered 12 pediatric patients with AARD who were treated between January 2003 and March 2013. The diagnosis was established by clinical findings and 3D-CT. All of the patients were treated by closed manual reduction and then a cervical orthosis was performed. All of the patients were followed up at regular intervals. The causes of the AARD were trauma (91.67 %) and infection (8.33 %). The time between onset of symptoms and admission to the hospital ranged from 16 days to 6 months. In radiological evaluation, the mean rotational angulation of the patients was 30.58°. The 3D-CT examination showed that six patients (50 %) had type 1 dislocation and six patients (50 %) had type 2 dislocation. All of the patients were treated by closed manual reduction and then a cervical orthosis was performed. For 11 patients (91.67 %), dislocation was successfully reducted and maintained. One patient (8.33 %) underwent surgery, following recurrence of the second closed reduction maneuver. This preceding treatment method has successfully produced a fast and recurrence-free alignment on all except one of our patients. This technique can be a useful treatment alternative in carefully selected AARD cases. Future research is encouraged to improve decision making in the application of this treatment method and provide additional validation of the current findings.

  17. Cervical Rotatory Manipulation Decreases Uniaxial Tensile Properties of Rabbit Atherosclerotic Internal Carotid Artery

    Directory of Open Access Journals (Sweden)

    Shaoqun Zhang

    2017-01-01

    Full Text Available Objective. To investigate the effects of one of the Chinese massage therapies, cervical rotatory manipulation (CRM, on uniaxial tensile properties of rabbit atherosclerotic internal carotid artery (ICA. Methods. 40 male purebred New Zealand white rabbits were randomly divided into CRM-Model group, Non-CRM-Model group, CRM-Normal group, and Non-CRM-Normal group. After modeling (atherosclerotic model and intervention (CRM or Non-CRM, uniaxial tensile tests were performed on the ICAs to assess the differences in tensile mechanical properties between the four groups. Results. Both CRM and modeling were the main effects affecting physiological elastic modulus (PEM of ICA. PEM in CRM-Model group was 1.81 times as much as Non-CRM-Model group, while the value in CRM-Model group was 1.34 times as much as CRM-Normal group. Maximum elastic modulus in CRM-Model group was 1.80 times as much as CRM-Normal group. Max strains in CRM-Model group and Non-CRM-Model group were 30.98% and 28.71% lower than CRM-Normal group and Non-CRM-Normal group, respectively. However, whether treated with CRM or not, the uniaxial tensile properties of healthy ICAs were not statistically different. Conclusion. CRM may decrease the uniaxial tensile properties of rabbit arteriosclerotic ICA, but with no effect on normal group. The study will aid in the meaningful explanation of the controversy about the harmfulness of CRM and the suitable population of CRM.

  18. Dislocation of the fibular head in an unusual sports injury: a case report

    Directory of Open Access Journals (Sweden)

    Ahmad Riaz

    2008-05-01

    Full Text Available Abstract Introduction One of the primary functions of the proximal tibiofibular joint is slight rotation to accommodate rotational stress at the ankle. Proximal tibiofibular joint dislocation is a rare injury and accounts for less than 1% of all knee injuries. This dislocation has been reported in patients who had been engaged in football, ballet dancing, equestrian jumping, parachuting and snowboarding. Case presentation A 20-year-old man was injured whilst playing football. He felt a pop in the right knee and was subsequently unable to bear weight on it. The range of movement in his knee joint was limited. Anterior-posterior and lateral X-rays of the knee revealed anterolateral dislocation of the proximal tibiofibular joint. Comparison views confirmed the anterolateral dislocation. He had a failed manipulation under anaesthesia and the joint needed an open reduction in which the fibular head was levered back into place. Operative findings revealed a horizontal type of joint. Conclusion An exceedingly rare dislocation of a horizontal type of proximal tibiofibular joint was presented following a football injury. This dislocation was irreducible by a closed method.

  19. [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.

  20. New method to determine the optical rotatory dispersion of inorganic crystals applied to some samples of Carpathian Quartz.

    Science.gov (United States)

    Dimitriu, Dan Gheorghe; Dorohoi, Dana Ortansa

    2014-10-15

    A new method to determine the optical rotatory dispersion (ORD) in the visible range, based on a channeled spectrum obtained with a uniax inorganic crystal introduced between two crossed polarizers with its optical axis parallel to the light propagation direction is detailed in this paper. When the studied inorganic crystals are transparent, this method permits the estimation of the optical rotatory dispersion in the visible range, for which the cheap polarizers are available. The speed of the measurements is very high, because the estimations are made from the channeled spectrum obtained for a single arrangement of the optical components. By using a computer, ORD is quickly determined for the visible range. The results obtained by this method for some Carpathian Quartz samples are consistent with those from literature. The proposed method can be also applied in UV and IR spectral ranges, when the anisotropic layers are transparent and the linearly polarized radiations can be obtained. Copyright © 2014 Elsevier B.V. All rights reserved.

  1. PIP joint volar rotatory dislocation: An anatomical study to explore extensor system lesions and the Stener effect.

    Science.gov (United States)

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

    2013-06-01

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

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

    Directory of Open Access Journals (Sweden)

    Sébastien Touraine

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

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

    Science.gov (United States)

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

    2013-01-01

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

  4. Giant Cell Tumor of Distal Radius: En Bloc Resection and Partial Wrist Arthrodesis Using Non-Vascularized Fibular Autograft

    Directory of Open Access Journals (Sweden)

    Davod Jafari

    2017-05-01

    Full Text Available Background Despite several surgical techniques introduced for the treatment of distal radial giant cell tumor (GCT, most appropriate treatments remain to be discovered. Objectives The current study reported on the results of en bloc resection and partial wrist arthrodesis using non-vascularized fibular shaft. Methods Between 2004 and 2014, 7 patients with distal radial GCT (Campanacci grade III were treated by en bloc resection and partial wrist arthrodesis using non-vascularized fibular shaft. Arthrodesis was performed using an intramedullary pin. Patients were followed for 59 ± 38 months. At the last visit, active range of wrist motions, modified musculoskeletal tumor society (MSTS scoring system, instability and grip strength compared to contralateral side were measured. Also, time of union, need for further operations and recurrence of the tumor were evaluated. Results After 8.3 ± 0.5 months, complete union was achieved. The ranges of wrist flexion, wrist extension, ulnar deviation, radial deviation, supination, and pronation averaged 16.7 ± 2.6, 7.5 ± 6.1, 7.5 ± 6.1, 6.7 ± 5.2, 33.3 ± 6.8, and 30.8 ± 8.6 degrees, respectively. The mean modified MSTS score was 75.8 ± 8%. Grip strength was 53.3 ± 6.8% of the contralateral side. Graft-related complications did not occur. Recurrence occurred in 2 patients, including one bony recurrence at the graft-wrist junction and one soft tissue recurrence (28.6%. Conclusions Replacement of excised distal radius with non-vascularized fibular shaft autograft following en bloc resection and partial arthrodesis, using an intramedullary pin, could serve as an appropriate treatment of distal radial GCT.

  5. Clinical and radiological outcomes of unstable proximal humeral fractures treated with a locking plate and fibular strut allograft.

    Science.gov (United States)

    Panchal, Karnav; Jeong, Jae-Jung; Park, Sang-Eun; Kim, Weon-Yoo; Min, Hyung-Ki; Kim, Ju-Yeong; Ji, Jong-Hun

    2016-03-01

    To evaluate the clinical and radiological outcomes of unstable proximal humeral fractures (PHFs) treated with a locking plate and fibular strut allograft. This study included 36 patients [7 men, 29 women; mean age, 68 years (range, 22-94 years)] with unstable PHFs with medial column disruption. All patients were treated with open reduction and internal fixation using a locking plate and fibular strut allograft. Post-operative assessment included clinical outcomes, shoulder range of motion, radiographic examination, and any complications. Post-operative radiological assessment including the humerus neck-shaft angle (NSA) and the humeral head height was performed. At the mean two year follow-up visit, the mean American Shoulder and Elbow Society (ASES) and University of California, Los Angeles (UCLA) scores were 77 and 28, respectively. According to the UCLA rating scale, the result was excellent in six, good in 20, fair in six, and poor in four cases. According to the Paavolainen method, 31 patients had good results with an NSA of 130 ± 10°; three patients showed fair results with an NSA of 100-120°, and two patients experienced a poor result with an NSA of humeral head height, the mean loss of reduction was measured as 1.6 mm (from 10.8 or 9.2 mm). Varus collapse and avascular necrosis of the humeral head was noted in two patients for each condition. For unstable proximal humerus fractures, particularly in elderly patients with severe osteoporosis or in younger patients with a four-part fracture, locking plate fixation with a fibular strut allograft provided rigid medial support and showed satisfactory clinical and radiological outcomes.

  6. Syme amputation for the treatment of fibular deficiency. An evaluation of long-term physical and psychological functional status.

    Science.gov (United States)

    Birch, J G; Walsh, S J; Small, J M; Morton, A; Koch, K D; Smith, C; Cummings, D; Buchanan, R

    1999-11-01

    Syme amputation is an accepted treatment for fibular deficiency. With improvement in limb-lengthening procedures, there has been renewed interest in limb salvage for these patients. The purpose of the present study was to evaluate the physical and psychological results in ten young adults who had had a Syme amputation for the treatment of fibular deficiency when they were children. The evaluation consisted of physical examination, prosthetic assessment, psychological testing, and physical performance testing of knee extension and flexion with use of a Cybex-II dynamometer. Five patients reported no difficulty with the involved limb since the Syme amputation, four had had minor secondary procedures (three medial distal femoral or proximal tibial hemiepiphyseodeses, one reconstruction with an autologous patellar ligament graft, one revision of the stump, and one tibial osteotomy) on the affected extremity, and one had mild instability of the knee that had been treated nonoperatively. All ten patients had an appropriate, functional Syme prosthesis, and none reported difficulty with walking or running. On psychological testing, this group generally did not differ from the norm with regard to occupational satisfaction, personal growth, relationships with family members and peers, and recreational behavior. The patients' overall assessment of self-reported quality of life and self-esteem was similar to that of normative adult samples. In general, these patients were leading active, productive lives and had always done so. On the basis of the results of this study, we concluded that young adults who have had a Syme amputation apparently are not limited in their ability to pursue and achieve personal goals. In order to justify recommending limb salvage rather than early Syme amputation for the treatment of fibular deficiency, the results of multistaged lengthening and reconstruction would have to match the functional, psychological, and cost-effective results for the

  7. [Resection of an aneurysmal bone cyst in the proximal humerus with a non-vascularized fibular graft. Case report].

    Science.gov (United States)

    Lima-Ramírez, P G; Chavarría-Jacinto, J; Martínez-Asención, P; Montiel-Jarquín, A J; Barragán-Hervella, R G; Salvatori-Rubí, J J; Domínguez-Cid, M I

    2015-01-01

    An aneurysmal bone cyst is a benign lesion involving the marrow of long bones; it accounts for 6% of primary bone lesions and may occur as a secondary lesion with other benign or malignant bone tumors. We describe herein the case of a seven year-old female with an aneurysmal bone cyst which was diagnosed clinically, radiographically and with a CAT scan, and confirmed with histopathology. Resection was performed using the eggshell technique and a non-vascularized left fibular bone graft. The patient did well up to the fourth postoperative year, which is consistent with what has been reported in world literature.

  8. Limb sparing reconstructive surgery and Ilizarov lengthening in fibular hemimelia of Achterman-Kalamchi type II patients.

    Science.gov (United States)

    El-Sayed, Mohamed M; Correll, Johannes; Pohlig, Kristian

    2010-01-01

    The aim of this study is to evaluate the long-term results of management of fibular hemimelia (Achterman-Kalamchi type-II) using the Ilizarov method. We reviewed 157 consecutive patients (180 limb segments) with a mean follow-up period of 10.7 years (1.2-21 years). The results were favorable. Although, this type of management is technically demanding and entails a lengthy procedure with many complications anticipated, the Ilizarov lengthening after limb reconstruction is still an option for management of this type of limb deficiency.

  9. Proximal femoral focal deficiency associated with fibular duplication and diplopodia and complete agenesis of the tibia: a case report.

    Science.gov (United States)

    Chawathe, Vivek S; Gaur, Anil K; Athani, Badrinath D; Gupta, Shefali

    2017-07-01

    A 14-year-old boy reported with congenital deformity of the left lower limb, with gross shortening, hip and knee flexion deformities, ankle with equinus deformity, and polydactyly of the left foot. Radiologic examination showed proximal femoral focal deficiency, double fibula, and duplication of the tarsal bones, and a diagnosis of 'proximal femoral focal deficiency associated with fibular duplication and diplopodia with complete agenesis of tibia' was made. Such association of deformities is very rare and poses difficulties in rehabilitation of the case. This patient was managed with elective knee disarticulation, early prosthetic fitment, and gait training.

  10. Fibular dimelia and mirror polydactyly of the foot in a girl presenting additional features of the VACTERL association

    OpenAIRE

    Bernardi, Pricila; Graziadio, Carla; Rosa, Rafael Fabiano Machado; Pfeil, Juliana Nunes; Zen, Paulo Ricardo Gazzola; Paskulin, Giorgio Adriano

    2010-01-01

    CONTEXT: The association between fibular dimelia and mirror polydactyly of the foot is considered to be a very rare lower-limb abnormality. On the other hand, VACTERL is an acronym for a nonrandom association of congenital anomalies for which the etiology is still poorly understood. CASE REPORT: The patient was a seven-month-old white girl whose mother had used misoprostol in the second month of pregnancy to induce abortion. On clinical evaluation, she was small for her age and presented hypo...

  11. Fibular taping does not influence ankle dorsiflexion range of motion or balance measures in individuals with chronic ankle instability.

    Science.gov (United States)

    Wheeler, Todd J; Basnett, Curtis R; Hanish, Michael J; Miriovsky, Daniel J; Danielson, Erin L; Barr, J B; Threlkeld, A Joseph; Grindstaff, Terry L

    2013-11-01

    To determine the effects of fibular taping on ankle dorsiflexion range of motion (ROM) and dynamic balance in individuals with chronic ankle instability (CAI). Single-blind, randomized crossover. Twenty-three individuals (age=23.4 ± 2.5 years, height=171.6 ± 12.4 cm, mass=71.5±13.1 kg) with CAI were allocated to either a fibular taping intervention or sham taping intervention (tape applied without tension) over the course of two visits. Weight-bearing ankle dorsiflexion ROM and components of the Star Excursion Balance Test (SEBT) were measured before and after intervention. There was not a significant change in ankle dorsiflexion ROM when comparing the taping interventions (F1,43=1.03, P=.32), but both interventions resulted in a small increase (F1,43=8.07, P=.007) in dorsiflexion ROM (pre=36.7° ± 6.9°, post=37.7° ± 6.2°). This increase in ROM did not exceed the established minimal detectable change for dorsiflexion ROM. Fibular taping with tension produced an increase (F1,41=5.84, P=.02) (pre=69.0 ± 9.1%, post=70.6±8.6%) in posterolateral reach distance when compared to taping without tension (pre=72.7 ± 11.0%, post=71.4 ± 9.6%), but this increase did not exceed the established minimal detectable change. There was not a significant change in dynamic balance between groups for the anterior (F1,41=2.33, P=.14) and posteromedial (F1,41=.41, P=.53) reach directions. Although small changes in ankle dorsiflexion ROM and posterolateral reach distances were observed, these changes did not exceed established minimal detectable change values for these measures. These results suggest that the benefits of fibular taping are not related to an increase in ankle dorsiflexion ROM or dynamic balance. Copyright © 2013 Sports Medicine Australia. Published by Elsevier Ltd. All rights reserved.

  12. Immediate effects of Mulligan's fibular repositioning taping on postural control in athletes with and without chronic ankle instability.

    Science.gov (United States)

    Someeh, Marjan; Norasteh, Ali Asghar; Daneshmandi, Hassan; Asadi, Abbas

    2015-05-01

    To determine whether fibular repositioning tape influenced the postural control performance in athletes with and without chronic ankle instability (CAI). Research laboratory. A cross-sectional study, within subjects experimental study design between 4 ankle conditions (taped and untaped: CAI and healthy athletes). Sixteen volunteer professional athletes with unilateral CAI (10 men and 6 women; age 23.2 ± 3 y, height 175.4 ± 10.3 cm, and weight 73 ± 14.5 kg) and sixteen volunteer healthy professional athletes (10 men and 6 women; age 22.8 ± 1.7 y, height 173.6 ± 12.2 cm, and weight 66.4 ± 11.4 kg). Fibular repositioning taping (FRT). Star excursion balance test (postural control) in anteromedial (AM), medial (M), and posteromedial (PM) directions were measured for the both group in two conditions: tape and untape. FRT improved significantly postural control (M, AM and PM) in both groups (p postural control in athletes with CAI and healthy athletes. Therefore, FRT can be an effective management for athletes who suffer from CAI. Also, this type of taping can apply immediately prior to activity and sport event to increase joint awareness of ankle. Copyright © 2014 Elsevier Ltd. All rights reserved.

  13. Fibular aplasia, tibial campomelia, and oligosyndactyly in a male newborn infant: a case report and review of the literature.

    Science.gov (United States)

    Courtens, Winnie; Jespers, Ann; Harrewijn, Inge; Puylaert, Dirk; Vanhoenacker, Filip

    2005-04-30

    We report on a male newborn with a rarely described congenital limb deficiency syndrome consisting of shortening and anterior bowing of the right lower limb at the distal third of the tibia with associated overlying soft tissue dimpling, oligodactyly of the right foot, and a left-sided oligosyndactyly of the hand. The right hand and left lower limb were clinically normal. Radiographic examination revealed complete absence of the right fibula, absence of the right-sided Vth ray, and anterior bowing and shortening of the right-sided tibia. Femora, humeri, ulnae, and radii were normal. The infant had neither facial dysmorphia nor other associated anomalies. A limb deficiency syndrome comparable to this case has been reported in a female by Hecht and Scott, the only report classified under OMIM 246570 so far. We found two other reports describing three cases comparable to our case and the female reported by Hecht and Scott, and reviewed these cases. The major common findings in all the five cases consist of fibular aplasia, tibial campomelia, and oligosyndactyly. Therefore, we propose to name it fibular aplasia-tibial campomelia-oligosyndactyly (FATCO) syndrome. Additional case reports are needed for further delineation of this rare limb deficiency syndrome.

  14. Unilateral axis facet hypertrophy--a rare case of irreducible rotatory atlantoaxial dislocation and a review of the literature.

    Science.gov (United States)

    Atalay, Basar; Türe, Ugur

    2014-04-01

    Fixed atlantoaxial dislocations are difficult to treat and there is no consensus in the treatment protocol. Unilateral enlargement of the atlas-axis facet complex in fixed atlantoaxial dislocations is a very rare condition. These pathologies are usually quite unstable and surgical treatment is necessary in unreductable cases. A 52-year-old woman with a diagnosis of irreducible-fixed rotatory atlantoaxial dislocation presented with acute onset of dizziness, loss of balance, and tetraparesis. She was under 8 years of conservative follow-up. Review of radiology revealed unilateral C2 superior facet hypertrophy compressing the medulla and obstructing the vertebral artery. To treat this condition, we have used a posterior midline approach and removed the lateral portions of the posterior rim of the foramen magnum and the assimilated posterior arch of C1. The V3 segments of the vertebral arteries were exposed bilaterally. The atlantoaxial joint complex on the left was hypertrophied compressing V3. We have removed hypertrophied lateral mass of the atlas and the hypertrophic superior articular facet of C2 for decompression. Patency of both vertebral arteries were checked intraoperatively by Doppler and indocyanine green angiography. We have fixated craniocervical junction on the same session. Patient was neurologically intact and she had confirmed fusion on the surgical site after three years of follow-up. This is a rare case of unilateral hypertrophy of the C2 superior articular facet in a fixed atlantoaxial rotatory dislocation. Progressive compression of medulla and the left vertebral artery leaded to clinical worsening of neurology in this case after 8 years of follow-up. Surgical treatment was necessary for neurological decompression and to establish stability.

  15. Periosteal ossification of the vascular pedicle after reconstruction of continuity defects of the mandible and the maxilla with fibular free flaps: a retrospective study

    NARCIS (Netherlands)

    Karagozoglu, K.H.; Winters, H.A.H.; Forouzanfar, T.; Schulten, E.A.J.M.

    2013-01-01

    Periosteal ossification of the vascular pedicle of a fibular free flap after reconstruction of mandibular and maxillary continuity defects has been thought to be rare. The purpose of this study was to evaluate its incidence and contributory factors to its development.

  16. Congenital fibular deficiency: a review of thirty years' experience at one institution and a proposed classification system based on clinical deformity.

    Science.gov (United States)

    Birch, John G; Lincoln, Todd L; Mack, Philip W; Birch, Craig M

    2011-06-15

    Congenital longitudinal deficiency of the fibula is the most common lower extremity congenital deficiency, with a broad spectrum of severity and subsequent reconstructive treatment. Published classification schemes do not accurately predict reconstructive treatment currently in practice. We reviewed all medical records of patients with a dominant deformity of congenital fibular deficiency who were managed at our institution between 1971 and 2005. We assessed the impact of limb-length inequality, foot deformity, bilateral extremity involvement, and extent of fibular preservation on the treatment of the limb deficiency. One hundred and four patients (including twenty-two with bilateral congenital fibular deficiency) with 126 affected extremities had adequate radiographs to be included in the study. Femoral shortening was noted in seventy (85.4%) of eighty-two patients with unilateral limb involvement. Limb-length discrepancy prior to any treatment remained proportional in forty-seven (82.5%) of fifty-seven patients during an average duration of follow-up of ten years and ten months (range, two years to fifteen years and six months). Limb salvage with foot preservation was deemed feasible in thirty-eight (97.4%) of thirty-nine five-rayed feet, thirty (81.1%) of thirty-seven four-rayed feet, twenty (48.8%) of forty-one three-rayed feet, and one of nine feet having fewer than three rays. Twenty-two (41.5%) of fifty-three limbs with an absent or vestigial fibula were not treated with amputation. Of the twenty-two patients with bilateral fibular deficiency, twelve (54.5%) had preservation of both feet, three (13.6%) had unilateral amputation, and seven (31.8%) had bilateral amputation. We propose a simplified classification for congenital fibular deficiency based on the clinical status of the foot and the magnitude of limb shortening as a percentage of the contralateral limb on radiographs. This classification may be effectively applied in infancy to allow the physician

  17. Arthroscopic Reinsertion of Lateral Collateral Ligament, Anterior Capsular Plication, and Coronoid Tunneling Technique for Chronic Elbow Posterolateral Rotatory Instability.

    Science.gov (United States)

    Arrigoni, Paolo; D'Ambrosi, Riccardo; Nicoletti, Simone; Randelli, Pietro

    2016-06-01

    Posterolateral rotatory instability (PLRI) of the elbow is a chronic condition that results from lateral collateral ligament complex injury and presents with pain, clicking, and subluxation within the flexion and extension arcs of elbow motion. The primary cause involves a lesion of the lateral collateral ligament complex and its avulsion from the lateral epicondyle. In most cases, it is the result of trauma such as a fall on an outstretched hand or any other mechanism that imparts axial compression, valgus force, and supination. Several surgical techniques have been described for the treatment of PLRI, but there is no consensus regarding the ideal surgical treatment. The advantages of an arthroscopic approach for the treatment of PLRI are first diagnostic. Arthroscopy allows for visualization and diagnosis of every compartment of the elbow. The main steps of the surgical procedure consist of reinsertion of the lateral collateral ligament, anterior capsular plication, and coronoid tunneling. By use of this technique, it is possible to perform an anatomic repair and provide stability of the elbow.

  18. Performance evaluation of a rotatory dual-head PET system with 90o increments for small animal imaging

    Science.gov (United States)

    Meng, F.; Zhu, S.; Li, L.; Wang, J.; Cao, X.; Cao, X.; Chen, X.; Liang, J.

    2017-09-01

    A rotatory dual-head positron emission tomography (PET) system with 90o increments has been built up by our lab. In this study, a geometric calibration phantom was designed and then used to calibrate the geometric offset of the system. With the geometric calibration, the artifacts in the reconstructed images were greatly eliminated. Then, we measured the imaging performance including resolution, sensitivity and image quality. The results showed that the full width at half maximum (FWHMs) of the point source were about 1.1 mm in three directions. The peak absolute sensitivity in the center of the field of view varied from 5.66% to 3.17% when the time window was fixed to 10 ns and the energy window was changed from 200-800 keV to 350-650 keV. The recovery coefficients ranged from 0.13 with a standard deviation of 17.5% to 0.98 with a standard deviation of 15.76%. For the air-filled and water-filled chamber, the spill-over ratio was 14.48% and 15.38%, respectively. The in vivo mouse experiment was carried out and further demonstrated the potential of our system in small animal studies.

  19. Surgical management of post-traumatic atlantoaxial rotatory fixation due to C2 facet fracture: 5 clinical cases.

    Science.gov (United States)

    Peyriere, H; Graillon, T; Pesenti, S; Tropiano, P; Blondel, B; Fuentes, S

    2017-02-01

    Report the results of surgical treatment of post-traumatic atlantoaxial rotatory fixation (AARF) due to C2 articular facet fracture in adults. The records of five patients treated since 2009 for AARF due to a C2 articular facet fracture were analyzed retrospectively. Three women and two men with an average age of 60 years (27-82) were included, one of whom initially had neurological deficits. In all cases, the surgical strategy consisted of posterior fixation: Harms-type in four cases and trans-articular with hooks in one case. Dislocations due to fracture of the C2 articular facet are rare in adults; various treatment strategies have been described. In our experience, posterior screw fixation leads to satisfactory clinical and radiological outcomes. Fusion is not necessary in these cases because the dislocation is related to an asymmetric fracture without ligament damage. Posterior fixation provides satisfactory reduction of these injuries and leads to satisfactory bone union. This surgical treatment can be performed early on after the trauma and is an interesting alternative to conservative treatment. Copyright © 2016. Published by Elsevier Masson SAS.

  20. Development of the wake behind a circular cylinder impulsively started into rotatory and rectilinear motion: Intermediate rotation rates

    Science.gov (United States)

    Chen, Yen-Ming; Ou, Yuh-Roung; Pearlstein, Arne J.

    1991-01-01

    The temporal development of two-dimensional viscous incompressible flow generated by a circular cylinder started impulsively into steady rotatory and rectilinear motion is studied by integration of a velocity/vorticity formulation of the governing equations, using an explicit finite-difference/pseudo-spectral technique and an implementation of the Biot-Savart law. Results are presented for a Reynolds number of 200 (based on the cylinder diameter 2a and the magnitude U of the rectilinear velocity) for several values of the angular/rectilinear speed ratio alpha = (omega x a)/U (where omega is the angular speed) up to 3.25. Several aspects of the kinematics and dynamics of the flow not considered earlier are discussed. For higher values of alpha, the results indicate that for Re = 200, vortex shedding does indeed occur for alpha = 3.25. The shedding process is; however, very different from that which gives rise to the usual Karman vortex street for alpha = 0. In particular, consecutive vortices shed by the body can be shed from the same side and be of the same sense, in contrast to the nonrotating case, in which mirror-image vortices of opposite sense are shed alternately on opposite sides of the body. The implications of the results are discussed in relation to the possibility of suppressing vortex shedding by open or closed-loop control of the rotation rate.

  1. Talocalcaneal coalition in patients who have fibular hemimelia or proximal femoral focal deficiency. A comparison of the radiographic and pathological findings.

    Science.gov (United States)

    Grogan, D P; Holt, G R; Ogden, J A

    1994-09-01

    The prevalence of congenital anomalies of the foot was studied in ninety-nine children (105 limbs) who had fibular hemimelia or proximal femoral focal deficiency, or both. Twenty-six of these patients had had a Syme amputation at our institution and the specimens were analyzed anatomically; they were found to include fourteen talocalcaneal coalitions (54 per cent). The preoperative radiographs of these same patients, however, revealed only four such coalitions (15 per cent). Thirty-seven of the ninety-nine patients had had a Syme amputation previously at another facility (with subsequent follow-up at our institution), and ten of them (ten feet) had radiographs that were adequate for analysis of congenital anomalies. Forty-two feet that had not yet been amputated were also analyzed radiographically. Nine of these fifty-two feet included in the radiographic analysis had a talocalcaneal coalition, a radiographic prevalence similar to that found on the preoperative radiographs of the twenty-six patients included in the anatomical analysis. The true prevalence of talocalcaneal coalition remains to be determined; however, this can be done only at the time of skeletal maturity. Examination of the twenty-six amputation specimens revealed only one talocalcaneal coalition in the nine patients who had proximal femoral focal deficiency alone, six such coalitions in the eight patients who had only fibular hemimelia, and seven coalitions in the nine patients who had both proximal femoral focal deficiency and fibular hemimelia. These findings should be useful in the evaluation of the radiographic anatomy of the feet in children who have proximal femoral focal deficiency or fibular hemimelia, or both, particularly if limb-lengthening is considered as a treatment option.

  2. A new reconstructive technique for intercalary defects of long bones: the association of massive allograft with vascularized fibular autograft. Long-term results and comparison with alternative techniques.

    Science.gov (United States)

    Capanna, Rodolfo; Campanacci, Domenico A; Belot, Nicolas; Beltrami, Giovanni; Manfrini, Marco; Innocenti, Marco; Ceruso, Massimo

    2007-01-01

    In 1988, the excellent results obtained with the use of vascularized fibular autograft as a salvage procedure in massive allograft failures caused by non-union or massive resorption prompted a trial of an original reconstructive technique for intercalary defects based on the primary combination of the two types of graft. The authors believe the excellent final results and the ability to avoid further salvage surgical procedures justify the primary application of this more complicated technique despite longer surgical times.

  3. Assessment of the role of fibular fixation in distal-third tibia-fibula fractures and its significance in decreasing malrotation and malalignment.

    Science.gov (United States)

    Prasad, Manish; Yadav, Sanjay; Sud, Ajaydeep; Arora, Naresh C; Kumar, Narender; Singh, Shambhu

    2013-12-01

    In the treatment of distal-third tibia/fibula fractures treated by interlocking nailing, the role of fibular fixation is not clearly defined. This study aimed to assess the benefits of fibular fixation in such fractures. Sixty patients with fractures of the lower third of the leg were enrolled into the study and divided into two groups based on whether the fibula was fixed (group A) or not (group B). Fracture tibia was treated with interlocked intramedullary nailing and fibular fixation was done using a 3.5-mm Limited Contact Dynamic Compression Plate (LC-DCP). The two groups were compared for differences in rotation at ankle, angulation at the fracture site, time of union and complications. Clinical and functional outcomes were assessed regularly. Merchant-Dietz criteria were used to assess ankle function. The demographics of the two groups were similar. Average valgus angulation was significantly less in group A (average 5°) versus group B (average 9°). The degree of rotational malalignment at the ankle in group A was average 7° versus average 15° in group B. The outcome of two groups for clinical ankle score, time of union and complications showed no significant differences. Fixation of the fibula along with interlocking nailing of the tibia decreases the malalignment of the tibia and malrotation of the ankle in distal-third fractures of the tibia and fibula as compared with only interlocking nailing. Copyright © 2013 Elsevier Ltd. All rights reserved.

  4. Quantification of the vascularisation of the orbital implants of coralinehydroxyapatite with {sup 99m} Tc-MDP; Cuantificacion de la vascularizacion de los implantes orbitales dehidroxiapatita coralina con {sup 99m} Tc-MDP

    Energy Technology Data Exchange (ETDEWEB)

    Rodriguez, J.L.; Solano, M.E.; Alvarez, I.; Perez, G. [Centro deInvestigaciones Clinicas 34 no.4501 e/45 y 47 Kohly, Playa C. Habana (Cuba)

    1998-12-31

    The use of ocular implants of hydroxyapatite has been increased in the last times owing to that they are well tolerated by the organism and that on the integration they show good mobility on the artificial eye with very few complications. The gammagraphy with {sup 99m} Tc-MDP can be used for the evaluation of vascularisation and its relative quantification above on these implants. In this pilot essay 10 normal persons and 37 patients were studied who had an implant of Cuban coraline hydroxyapatite (Coraline HAP-200). Thermography with {sup 99m} Tc-MDP was realized between 4 and 18 months after surgery then were obtained plane images in anterior viewing. It was measured the implant vascularisation and it was calculated for each case the relative captivation index (RCI) starting from two regions of ocular interest. As result all patients tolerated the implant without complications. The relation of the activity implant with respect to the contralateral region was 2.31{+-}0.63 (mean {+-} SD) with a range of 1.17-4.09. The relation between the left intra orbital captivation and the right in the normal persons was 1.01 {+-}0.66 (mean {+-} SD). In conclusion, we obtained that the ICR can be very useful in order to measure the integration level of this type of implant.Moreover, it was proved that the implants with Cuban coraline hydroxyapatite showed an acceptable level of integration in all the patients. (Author)

  5. One-stage treatment and reconstruction of Gustilo Type III open tibial shaft fractures with a vascularized fibular osteoseptocutaneous flap graft.

    Science.gov (United States)

    Zhen, Ping; Hu, Yun-Yu; Luo, Zhuo-Jing; Liu, Xing-Yan; Lu, Hao; Li, Xu-Sheng

    2010-12-01

    This study evaluated the usefulness of a single-stage, free-fibular vascularized osteoseptocutaneous flap transfer for Type III open tibial shaft fractures with segmental bone loss for the reconstruction of combined bone and soft tissue defects. Nonrandomized retrospective study. University Level I trauma center. All Gustilo Type III open tibial shaft fractures with segmental bone loss that were treated at one institution between 2000 and 2007 were identified from a trauma registry. The study group consisted of 28 patients with Type III open tibial fractures: 27 were Gustilo-Anderson Type IIIB and one was Grade IIIC. The cause of tibial injury included eight industrial accidents, seven motor vehicle accidents, five crushing injuries caused by heavy objects, five falls from a height, and three motorcycle crashes. The lengths of the preoperative segmental tibial bone loss ranged from 9 to 17 cm and the size of the associated soft tissue defects ranged from 8 × 6 cm to 15 × 7 cm. The free fibular vascularized osteoseptocutaneous flap was used to graft and reconstruct combined bone and soft tissue defects. The radical wound débridement, soft tissue and bone revision, fracture stabilization, and early soft tissue coverage were achieved by this technique in a one-stage procedure. The average duration from injury to one-stage reconstruction was 15.8 hours (range, 5.3 hours to 6.5 days). Radiographic and functional evaluation of the lower extremity. All free fibular osteoseptocutaneous flaps survived completely. The average time to overall union for the entire group was 32 weeks after surgery (range, 26-41 weeks). None of the patients in this series had a nonunion. Acceptable radiographic alignment, defined as 5° of angulation in any plane, was obtained in 22 patients (78.6%). Malunion affected six (21.4%) fractures. According to the lower extremity functional assessment, excellent and good results were achieved for 82.1% (23 of 28), fair results were seen in 14

  6. Absolute configuration of an axially chiral sulfonate determined from its optical rotatory dispersion, electronic circular dichroism, and vibrational circular dichroism spectra.

    Science.gov (United States)

    Covington, Cody L; Raghavan, Vijay; Smuts, Jonathan P; Armstrong, Daniel W; Polavarapu, Prasad L

    2017-11-01

    The absolute configuration (AC) of an axially chiral sulfonate (aCSO), 3,5-dimethyl-2-(naphthalen-1-yl)-6-(naphthalen-1-yl)benzenesulfonate (labeled as aCSO5), was investigated using optical rotatory dispersion (ORD), electronic circular dichroism (ECD), and vibrational circular dichroism (VCD) spectroscopies. All three methods led to the same conclusion and the AC of aCSO5 is reliably determined to be (-)-(aR, aR), or conversely (+)-(aS, aS). © 2017 Wiley Periodicals, Inc.

  7. Faraday rotation dispersion measurements of diamagnetic organic liquids and simultaneous determination of natural optical rotatory dispersion using a pulsed magnetic field.

    Science.gov (United States)

    Suwa, Masayori; Miyamoto, Kayoko; Watarai, Hitoshi

    2013-01-01

    We constructed an apparatus to measure the wavelength dispersion of the Faraday rotation in the visible region, and determined the Verdet constants of diamagnetic organic liquids, including aliphatic compounds, benzene derivatives, and naphthalene derivatives. These three groups were easily distinguished by the magnitudes of their Verdet constants. Based on the theory developed by Serber, we determined the enhancing effect of π*←π transitions on the visible-light Faraday rotation angles observed for aromatic compounds. Furthermore, we propose a novel approach for simultaneously observing Faraday rotation dispersion and natural optical rotatory dispersion.

  8. ACL Deficiency Increases Forces on the Medial Femoral Condyle and the Lateral Meniscus with Applied Rotatory Loads.

    Science.gov (United States)

    McDonald, Lucas S; Boorman-Padgett, James; Kent, Robert; Stone, Kyle; Wickiewicz, Thomas L; Pearle, Andrew D; Imhauser, Carl W

    2016-10-19

    The articular surfaces and menisci act with the anterior cruciate ligament (ACL) to stabilize the knee joint. Their role in resisting applied rotatory loads characteristic of instability events is unclear despite commonly observed damage to these intra-articular structures in the acute and chronic ACL injury settings. Ten fresh-frozen human cadaveric knees were mounted to a robotic manipulator. Combined valgus and internal rotation torques were applied in the presence and absence of a 300-N compressive load. Forces carried by the individual menisci and via cartilage-to-cartilage contact on each femoral condyle in ACL-intact and ACL-sectioned states were measured using the principle of superposition. In response to applied valgus and internal rotation torques in the absence of compression, sectioning of the ACL increased the net force carried by the lateral meniscus by at most 65.8 N (p meniscus increased by 25.7 N (p medial femoral condyle by at most 38.9 N (p = 0.006) and 46.7 N (p = 0.040) in the absence and presence of compression, respectively. Additionally, the lateral shear force carried by cartilage-to-cartilage contact on the medial femoral condyle increased by at most 21.0 N (p = 0.005) and by 28.0 N (p = 0.025) in the absence and presence of compression, respectively. Forces carried by the medial meniscus and by cartilage-to-cartilage contact on the lateral femoral condyle changed by meniscus and medial femoral condyle-and the anterior shear and lateral shear forces, respectively-in response to multiplanar valgus and internal rotation torque. These loading patterns provide a biomechanical rationale for clinical patterns of intra-articular derangement such as lateral meniscal injury and osseous remodeling of the medial compartment seen with ACL insufficiency. Copyright © 2016 by The Journal of Bone and Joint Surgery, Incorporated.

  9. Fibular dimelia and mirror polydactyly of the foot in a girl presenting additional features of the VACTERL association

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    Pricila Bernardi

    Full Text Available CONTEXT: The association between fibular dimelia and mirror polydactyly of the foot is considered to be a very rare lower-limb abnormality. On the other hand, VACTERL is an acronym for a nonrandom association of congenital anomalies for which the etiology is still poorly understood. CASE REPORT: The patient was a seven-month-old white girl whose mother had used misoprostol in the second month of pregnancy to induce abortion. On clinical evaluation, she was small for her age and presented hypotonia, anteverted nares, long philtrum and carp-like mouth. Her left hand had a reduction defect, with absence of the extremities of the second, third and fifth fingers and camptodactyly of the fourth finger. The ipsilateral lower limb presented significant shortening, especially rhizomelic shortening. Her left foot had a mirror configuration with seven toes and no identifiable hallux. The pelvis was hypoplastic. Esophageal atresia with tracheoesophageal fistula and imperforate anus were detected during the neonatal period. Abdominal ultrasound identified agenesis of the right kidney and left pyelocaliceal duplication. Radiographic evaluation on the left side showed iliac and femoral hypoplasia, absence of the tibia with a duplicated fibula and seven metatarsals and toes with no identifiable hallux on the foot. Echocardiography demonstrated an atrial septal defect. Based on the literature, we believe that the spectrum of malformations presented by our patient may be related to the vascular disruptive effect of the misoprostol. However, we cannot rule out the possibility that this association might simply be a coincidence.

  10. Hydatid disease of scapula and upper third of humerus treated by en bloc excision and fibular bone grafting

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    Chari P

    2007-01-01

    Full Text Available 35-year-old male patient presented with gradually increasing painful swelling of the right shoulder, which was incised and drained and wound persisted as a discharging sinus on the anterolateral aspect of the deltoid region with seropurulent discharge. A clinical diagnosis of tuberculosis of the shoulder was made. Plain skiagram of the right shoulder revealed multicystic lesion involving the entire scapula and upper third of the humerus with loss of joint space and pathological fracture at the junction of upper one-third and lower two-thirds of the humerus. A clinico-radiological diagnosis of hydatid disease was made. In view of the extensive involvement of the scapula with stiff shoulder and an active sinus, a two-stage surgical procedure was performed. Stage 1 consisted of en bloc excision of the scapula, upper half of the humerus and lateral end of the clavicle. Stage II surgery, consisting of fibular bone grafting. Tablet albendazole (400 mg, thrice daily was given as systemic scolicidal agent. This case is reported in view of it′s rarity and to highlight the management.

  11. Effect of fibular repositioning taping in adult basketball players with chronic ankle instability: a randomized, placebo-controlled, crossover trial.

    Science.gov (United States)

    Alves, Yanina; Ribeiro, Fernando; Silva, Anabela G

    2017-07-05

    Chronic ankle instability presents a high incidence and prevalence in basketbal players. It's important to develop strategies to reduce the functional and mechanical limitations resulting from this condition. To compare the effect of Mulligan ́s fibular repositioning taping with a placebo taping immediatly after application and after a running test (Yo-Yo IRT). 16 adult basketball players (10 male, 6 female) with chronic ankle instability and mean age 21.50 ± 2.76 years old. Assessment of static postural control (15 seconds of unipedal stance test with eyes closed in a force platform), functional performance (figure 8 hop test and lateral hop test) and neuromuscular control (peroneus longus latency time in sudden inversion) in two conditions: Mulligan and Placebo. No significant effect was found for the intervantion factor in both hop tests (p>0.170), but there was a significant effect for the time factor (ptaping and Placebo taping in postural control and functional performance in basketball players with chronic ankle instability. However, Mulligan's taping appears to reduce peroneus longus latency time after a running when compared with a placebo taping.

  12. The effect of postoperative corticosteroid administration on free vascularized fibular grafting for treating osteonecrosis of the femoral head.

    Science.gov (United States)

    Ding, Hao; Chen, Sheng-Bao; Lin, Sen; Gao, You-Shui; Zhang, Chang-Qing

    2013-01-01

    Free vascularized fibular grafting (FVFG) has been reported to be an effective method of treating osteonecrosis of the femoral head (ONFH). This study evaluated whether postoperative maintenance doses of corticosteroids had an adverse effect on FVFG outcomes in patients with corticosteroid-induced ONFH. We retrospectively reviewed the records of 39 patients (67 hips) who had received maintenance doses of corticosteroids following FVFG. This group was matched to a group of patients who had not received corticosteroids treatment after operation. The mean follow-up duration was 5.4 years for the postoperative corticosteroid administration group (PCA group) and 5.0 years for the control group. At the latest follow-up, the average increase in Harris hip score was 11.1 ± 8.7 points for all hips in the PCA group and 12.6 ± 7.4 points for all hips in the control group (P > 0.05). In the PCA group, through radiographic evaluation, 49 hips were improved, 10 hips appeared unchanged, and 8 hips appeared worse. In the control group, 47 hips were improved, 13 hips appeared unchanged, and 7 hips appeared worse. The results suggested that postoperative maintenance doses of corticosteroids do not have an adverse effect on FVFG outcomes in patients with corticosteroid-induced ONFH.

  13. The Effect of Postoperative Corticosteroid Administration on Free Vascularized Fibular Grafting for Treating Osteonecrosis of the Femoral Head

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    Hao Ding

    2013-01-01

    Full Text Available Free vascularized fibular grafting (FVFG has been reported to be an effective method of treating osteonecrosis of the femoral head (ONFH. This study evaluated whether postoperative maintenance doses of corticosteroids had an adverse effect on FVFG outcomes in patients with corticosteroid-induced ONFH. We retrospectively reviewed the records of 39 patients (67 hips who had received maintenance doses of corticosteroids following FVFG. This group was matched to a group of patients who had not received corticosteroids treatment after operation. The mean follow-up duration was 5.4 years for the postoperative corticosteroid administration group (PCA group and 5.0 years for the control group. At the latest follow-up, the average increase in Harris hip score was 11.1 ± 8.7 points for all hips in the PCA group and 12.6 ± 7.4 points for all hips in the control group (P>0.05. In the PCA group, through radiographic evaluation, 49 hips were improved, 10 hips appeared unchanged, and 8 hips appeared worse. In the control group, 47 hips were improved, 13 hips appeared unchanged, and 7 hips appeared worse. The results suggested that postoperative maintenance doses of corticosteroids do not have an adverse effect on FVFG outcomes in patients with corticosteroid-induced ONFH.

  14. The Vascularized Fibular Graft in the Pediatric Upper Extremity: A Durable, Biological Solution to Large Oncologic Defects

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    Nicki Zelenski

    2013-01-01

    Full Text Available Skeletal reconstruction after large tumor resection is challenging. The free vascularized fibular graft (FVFG offers the potential for rapid autograft incorporation as well as growing physeal transfer in pediatric patients. We retrospectively reviewed eleven pediatric patients treated with FVFG reconstructions of the upper extremity after tumor resection. Eight male and three female patients were identified, including four who underwent epiphyseal transfer. All eleven patients retained a functional salvaged limb. Nonunion and graft fracture were the most common complications relating to graft site (27%. Peroneal nerve palsy occurred in 4/11 patients, all of whom received epiphyseal transfer. Patients receiving epiphyseal transplant had a mean annual growth of 1.7 cm/year. Mean graft hypertrophy index increased by more than 10% in all cases. Although a high complication rate may be anticipated, the free vascularized fibula may be used to reconstruct large skeletal defects in the pediatric upper extremity after oncologic resection. Transferring the vascularized physis is a viable option when longitudinal growth is desired.

  15. Plating of pilon fractures based on the orientation of the fibular shaft component: A biomechanical study evaluating plate stiffness in a cadaveric fracture model.

    Science.gov (United States)

    Busel, Gennadiy A; Watson, J Tracy

    2017-06-01

    To evaluate mechanically superior method of pilon fracture fixation by comparing axial stiffness between anterolateral and medial tibial locking plates in a cadaveric fracture model. Eight matched pairs of fresh frozen cadaver specimens (lower limb after through-knee disarticulation) were used to eliminate confounder of bone quality. Simulated pilon fractures were created so that each pair represented either varus or valgus fracture pattern (AO 43-A2) with associated fibular fractures (transverse or comminuted). Specimens were plated with DePuy anterolateral or medial locking plate and axial load applied, measuring displacement at the fracture site. Each lower extremity was tested with a fracture wedge in place and removed to mimic comminution. Average force at which failure occurred was compared between the two fixation methods, for varus and valgus fracture pattern respectively, with the use of a Mann-Whitney U test. On average, medial plate fixation of varus fractures resulted in 2.27 times (range of 1.6-3.9) greater load prior to failure as compared to anterolateral plate. Similarly, valgus simulated fractures tolerated 1.6 times (range 1.12-2.34) higher force prior to failure if anterolateral plate was applied versus medial plate. Analysis utilizing the Mann-Whitney U test for fracture patterns vs plate configuration approached statistical significance (p = 0.081 varus failure and p = 0.386 valgus failure). Lateral plate fixation is biomechanically superior for pilon fractures resulting from valgus force as evident by comminuted fibular fracture. Similarly, medial plate location resulted in improved stiffness in compression for varus type fractures, evident by transverse fibular fracture. We approached statistical significance, however our lack of power regarding adequate sample size is an issue that is consistent with other biomechanical studies in this area.

  16. Stress distribution and micromotion analyses of immediately loaded implants of varying lengths in the mandible and fibular bone grafts: a three-dimensional finite element analysis.

    Science.gov (United States)

    Wu, Jacqueline Chia-Hsuan; Chen, Chen-Sheng; Yip, Shing-Wai; Hsu, Ming-Lun

    2012-01-01

    The aim of the present study was to compare the biomechanical effects of different lengths of implants in an immediate loading condition in mandibular and fibular bone. Three-dimensional (3D) nonlinear finite element analysis (FEA) was used to examine the complex irregular structures. The variables of this research were the two different bone types (mandible and fibula) and three different implant lengths. Simplified half models were constructed for 3D FEA. Three different implant lengths (6 mm, 10 mm, and 15 mm) were inserted into the mandibular and fibular bone models, which were made to simulate immediate implant loading conditions. A load of 125 N was applied to the center of the suprastructure at a 45-degree angle relative to the long axis of the implant, and the resultant maximum von Mises equivalent (EQV) stresses, stress distribution, strain energy, and micromotion were measured. In the mandible, the maximum EQV stresses were 115.636 MPa, 155.943 MPa, and 157.105 MPa with the 6-mm, 10-mm, and 15-mm implants, respectively. The mean EQV stresses were 64.145 MPa, 77.925 MPa, and 78.500 MPa, respectively. In the fibula, the maximum EQV stresses were 174.04 MPa, 157.456 MPa, and 144.353 MPa with the 6-mm, 10-mm, and 15-mm implants, respectively. The mean EQV stresses were 82.329 MPa, 73.526 MPa, and 74.050 MPa, respectively. The micromotion in the fibula models was lower than that seen in the mandible models. EQV stress in the fibular bone was different from that in the mandible. Short implants can be an option for oral rehabilitation in the mandible; however, implants in the fibula should probably have bicortical engagement.

  17. Geriatric proximal humeral fracture patients show similar clinical outcomes to non-geriatric patients after osteosynthesis with endosteal fibular strut allograft augmentation.

    Science.gov (United States)

    Hinds, Richard M; Garner, Matthew R; Tran, Wesley H; Lazaro, Lionel E; Dines, Joshua S; Lorich, Dean G

    2015-06-01

    Osteosynthesis of proximal humeral fractures is challenging in geriatric patients. The purpose of this investigation was to compare postoperative clinical outcomes between cohorts of geriatric (aged ≥65 years) and non-geriatric proximal humeral fracture patients treated via locked plating with endosteal fibular strut allograft augmentation. From March 2007 to January 2013, 71 adult patients with 2-, 3-, and 4-part proximal humeral fractures according to the Neer classification underwent osteosynthesis with locked plating and fibular allograft augmentation and had at least 12 months of clinical follow-up. All patients followed the same postoperative rehabilitation protocol. We compared the following between geriatric and non-geriatric patients: Disabilities of the Arm, Shoulder and Hand scores; University of California, Los Angeles shoulder ratings; Constant-Murley scores; and range of motion; as well as injury characteristics and radiographic outcomes. Geriatric patients comprised 48% of the study cohort (34 of 71 patients). The mean age of the geriatric and non-geriatric cohorts was 74 years and 53 years, respectively. Geriatric patients showed significantly reduced forward flexion (147° vs 159°, P = .04) when compared with non-geriatric patients. There were no significant differences in functional scores, radiographic outcomes, or complication rates between the 2 cohorts, although in 1 geriatric patient, osteonecrosis developed and screw penetration through the collapsed head was present 3 years after surgery. Osteosynthesis of proximal humeral fractures via locked plating with fibular strut allograft augmentation results in similar clinical outcomes between geriatric and non-geriatric patients. We believe that enhanced stability provided by this fixation construct allows early intensive postoperative therapy and results in excellent outcomes despite patient age. Copyright © 2015 Journal of Shoulder and Elbow Surgery Board of Trustees. Published by Elsevier

  18. Doğuştan tam tibia yokluğu olan dokuz haftalık bebekte fibular transfer

    OpenAIRE

    Karakurt, Lokman; Yilmaz, Erhan; Mustafa AVCI; Serin, Erhan

    2004-01-01

    The treatment of complete congenital absence of the tibia is controversial. The goal of the treatment is to construct a satisfactorily functioning knee joint, for which fibular transfer was described as an appropriate method. We performed reconstructive surgery using a modified Brown’s procedure in a nine-week-old boy with Jones type 1 congenital longitudinal deficiency of the tibia. In his final control at three years of age a good outcome was obtained according to the criteria by Epps et al...

  19. Estudo radiomorfológico do tendão fibular longo junto ao osso cuboide Radiomorphological study of the peroneus longus tendon adjacent to the cuboid bone

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    Carlos Eduardo Affonso Grinbaum

    2009-06-01

    Full Text Available OBJETIVO: Relatar os aspectos morfológicos e avaliar, radiograficamente, o segmento do tendão do músculo fibular longo em contato com o osso cuboide, em cadáveres, e relatar a incidência do ossículo fibular em seu interior, utilizando-se, em alguns casos, da análise histológica. MATERIAIS E MÉTODOS: Foram estudados 50 segmentos tendinosos, sendo radiografados para determinar a presença ou não de ossículo acessório no interior do tendão. As peças nas quais a presença era duvidosa foram seccionadas e submetidas a avaliação macroscópica. Nos casos em que ainda persistiam dúvidas, as peças foram histologicamente avaliadas em hematoxilina-eosina. Um segmento que demonstrou a presença de ossificação também foi analisado histologicamente, a título de ilustração. RESULTADOS: Todos os fragmentos apresentavam dilatação fusiforme na área de curvatura sob o cuboide. Após o estudo radiográfico, 29 desses fragmentos não tinham ossificação, 13 tinham ossificação e 8 eram duvidosos. Após a análise macroscópica, uma peça apresentou ossificação e cinco, não. As duas peças restantes continuaram indefinidas, sendo então analisadas histologicamente, e não se observou ossificação. CONCLUSÃO: Todas as peças demonstraram espessamento local na curvatura sob o cuboide. Entretanto, após análise quantitativa, nos dois casos submetidos ao estudo histológico foi verificado que o tendão era composto de fibrocartilagem e revestido por cartilagem hialina na superfície de contato com o osso. Assim, os segmentos apresentaram o ossículo fibular do ponto de vista morfológico em 28%, e do ponto de vista radiográfico, em 26% dos casos.OBJECTIVE: To describe morphological aspects, and radiographically evaluate the segment of the peroneus longus tendon adjacent to the cuboid bone, in cadavers, and reporting the incidence of a fibular ossicle, in some cases with the help of histological analysis. MATERIALS AND METHODS: Fifty

  20. Ressecção ampla e transposição fibular no tratamento do TCG da extremidade distal do rádio Wide resection and fibular transposition in the treatment of GCT on radius distal end

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    Alex Guedes

    2009-01-01

    Full Text Available OBJETIVO: Avaliação funcional e oncológica do tratamento do TCG do segmento distal do rádio (estadio B3 mediante ressecção ampla e reconstrução com enxerto autólogo avascular da extremidade proximal da fíbula. MÉTODOS: A função residual foi avaliada mediante escore ISOLS, medida do arco residual global do punho operado, do percentual residual da força de preensão da mão e da preensão entre o polegar e o indicador. O controle oncológico foi avaliado mediante exame clínico do membro operado e avaliação por imagens do punho e do tórax. RESULTADOS: 17 pacientes avaliados, dez do sexo feminino (58,8% e sete do sexo masculino (41,2% com idades entre 16 e 61 anos (média de 32,3 anos, todos destros. Na avaliação funcional (ISOLS observamos 11 resultados excelentes, dois bons e um ruim; os três casos que demandaram artrodese evoluíram com escore excelente. O arco residual global foi de 196,2 ± 116,6º. O arco residual do punho operada correspondeu a 58,9% do controle. A força de preensão da mão correspondeu a 55,4 ± 17,4% do controle. O percentual de "pinça" foi de 80,6 ± 14,8% do controle. Não constatamos recidiva ou metástases nesta casuística. CONCLUSÃO: A técnica propiciou resultados funcionais alentadores, assegurando o retorno dos pacientes às suas atividades. A ausência de recidiva local e/ou metástases, observada inclusive nos pacientes com seguimento mais longo, permite sugerir que a técnica parece ser segura no controle oncológico do tumor.OBJECTIVE: To functionally and oncologically assess the treatment of GCT on radius distal end (stage B3 following wide resection and reconstruction with avascular autologous graft from proximal fibular end. METHODS: The residual function was assessed using ISOLS score, measurement of the global residual arch of the operated wrist, residual percentage of the hand apprehension strength between thumb and index fingers. The oncologic monitoring was assessed by clinical

  1. Deficiência Congénita Femural e Hemimélia Fibular – Amputação e Protetização

    OpenAIRE

    Costa, MJ

    2011-01-01

    As malformações congénitas dos membros inferiores têm uma grande variedade de apresentação clínica associada a grande leque de dismetria dos membros. As classificações de Paley para a hemimélia fibular e para a deficiência femural congénita, dão orientação para o tratamento destes doentes: cirurgia de alongamento versus cirurgia de amputação. Em qualquer das situações, as crianças têm de ser protetizadas para poderem fazer marcha, correr e brincar. A protetização de uma c...

  2. Reconstrucción tibial: transferencia sóleo-peroné ipsilateral. Tibialización peroneal Tibial reconstruction: ipsilateral soleus-fibula transfer. Fibular tibialization

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    E. Revelo Jiron

    2009-12-01

    Full Text Available Las transferencias óseas peroneales en forma libre o ipsilateral han sido propuestas para la reconstrucción de grandes defectos tibiales. Están también descritas varias modificaciones al respecto, siendo una de ellas la constitución de un colgajo compuesto soleo-peroné realizado como transferencia libre. En este estudio presentamos nuestra experiencia con esta variante, pero en forma ipsilateral. logrando la reconstrucción del defecto tibial por medio de la tibialización peroneal. Escogimos realizar un colgajo compuesto soleo-peroné ipsilateral a flujo anterógrado o retrogrado para la reconstrucción de una serie personal de 14 pacientes consecutivos, 13 hombre y 1 mujer, con edad media de 30 años, y con amplios defectos tibiales y de tejidos blandos causados por accidentes de transito en 12 casos, 1 por proyectil balístico y 1 por artefacto explosivo artesanal. El promedio de tamaño del defecto tibial fue de 9.4 cm. Elegimos la forma ipsilateral por no disponer de infraestructura adecuada para realizar una transferencia libre. La serie de estudio se realizó durante el periodo comprendido entre Abril de 1995 y Abril del 2005. Todos los colgajos sobrevivieron. Dos pacientes desarrollaron pseudoartrosis. El apoyo completo y la marcha en 12 pacientes, se logró en un periodo promedio de 9 meses. El seguimiento postoperatorio ha sido de 3 a 6 años. Doce pacientes se han incorporado a la vida activa. Discutimos algunos aspectos prácticos de la técnica como resultado de la experiencia quirúrgica obtenida de esta serie personal. Consideramos que el método es fiable, fácil de realizar y proporciona excelentes resultados.Fibular flaps such as in there free form or as ipsilateral transfers have been proposed for reconstruction of large tibial defects. Several modifications have been described for the use of this flap. In this study we will present our experience using the ipsilateral transfer of an osteomuscular soleous fibular flap

  3. Fibular hydatid cyst

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    Arti Hamidreza

    2007-01-01

    Full Text Available Hydatid disease is caused by the tapeworm Echinococcus. Genus Echinococcus has different species including Echinococcus vogeli, Echinococcus granulosus and Echinococcus multilucularis . Echinococcus granulosus is the most common cause of hydatid disease in humans. This disease occurs either through direct ingestion of parasite eggs from contact with infected dogs or indirectly from the ingestion of contaminated water or food. Infestation of hydatid disease in humans most commonly occurs in the liver (55-70%, followed by the lungs (18-35%. Bone hydatidosis however is very rare (3%. We present herein a case of hydatid cyst of the fibula, which is an uncommon site for the occurrence of this disease.

  4. Step-by-step surgical technique for mandibular reconstruction with fibular free flap: application of digital technology in virtual surgical planning.

    Science.gov (United States)

    Succo, G; Berrone, M; Battiston, B; Tos, P; Goia, F; Appendino, P; Crosetti, E

    2015-06-01

    At present, mandibular reconstruction with a fibular free flap is the gold standard for functional and esthetic rehabilitation after oncological surgery. The purpose of this study was to describe the computer-assisted mandibular reconstruction procedure adopting the customized solution Synthes ProPlan CMF. The study reports five consecutive patients with benign or malignant disease requiring mandibular reconstruction using a microvascular fibular free flap, pre-operative virtual planning, construction of cutting guides and customized laser pre-bent titanium plates. The surgical technique is discussed in a step-by-step fashion. The average post-operative hospital stay was 18 ± 3 days. Ischemia time was recorded in all five cases, with an average of 75 ± 8 min. No problems were encountered in any surgical step and there were no major complications. Excellent precision of cutting guides and a good fit of pre-bent plates were found on both the mandible and fibula. There was excellent precision in bone to bone contact and position between mandible and fibula graft. Measurement data from the pre-operative and post-operative CT scans were compared. The average difference (Δ) between programed segment lengths and CT control segment lengths was 0.098 ± 0.077 cm. Microsurgical mandibular reconstruction using a virtual surgical planning yields significantly shorter ischemia times and allows more precise osteotomies. The technology is becoming increasingly recognized for its ability to optimize surgical outcomes and minimize operating time. Considering that the extent of resection can be wider than predicted, this results in safer modeling of the fibula only after frozen sections have demonstrated the radicality of resection.

  5. Does Maximal External Tibial Component Rotation Influence Tibiofemoral Load Distribution in the Primary Knee Arthroplasty Setting: A Comparison of Neutral vs Maximal Anatomical External Rotatory States.

    Science.gov (United States)

    Manning, William A; Ghosh, Kanishka M; Blain, Alasdair P; Longstaff, Lee M; Rushton, Steven P; Deehan, David J

    2017-06-01

    Tibial component rotation at time of knee arthroplasty can influence conformity, load transmission across the polyethylene surface, and perhaps ultimately determined survivorship. Optimal tibial component rotation on the cut surface is reliant on standard per operative manual stressing. This subjective assessment aims to balance constraint and stability of the articulation through a full arc of movement. Using a cadaveric model, computer navigation and under defined, previously validated loaded conditions mimicking the in vivo setting, the influence of maximal tibial component external rotation compared with the neutral state was examined for changes in laxity and tibiofemoral continuous load using 3D displacement measurement and an orthosensor continuous load sensor implanted within the polyethylene spacer in a simulated single radius total knee arthroplasty. No significant difference was found throughout arc of motion (0-115 degrees of flexion) for maximal varus and/or valgus or rotatory laxity between the 2 states. The neutral state achieved equivalence for mediolateral load distribution at each point of flexion. We have found that external rotation of the tibial component increased medial compartment load in comparison with the neutral position. Compared with the neutral state, external rotation consistently effected a marginal, but not significant reduction in lateral load under similar loading conditions. The effects were most pronounced in midflexion. On the basis of these findings, we would advocate for the midtibial tubercle point to determine tibial component rotation and caution against component external rotation. Copyright © 2017 Elsevier Inc. All rights reserved.

  6. Stabilization of juxta-physeal distal tibial and fibular fractures in a juvenile tiger using a hybrid circular-linear external fixator.

    Science.gov (United States)

    Coomer, Alastair R; Lewis, Daniel D; Wiedner, Ellen; Isaza, Ramiro; Winter, Matthew D; Aloisio, Fabio; Pool, Roy

    2012-02-01

    To report stabilization of closed, comminuted distal metaphyseal transverse fractures of the left tibia and fibula in a tiger using a hybrid circular-linear external skeletal fixator. Clinical report. Juvenile tiger (15 months, 90 kg). From imaging studies, the tiger had comminuted distal metaphyseal transverse fractures of the left tibia and fibula, with mild caudolateral displacement and moderate compression. Multiple fissures extended from the fractures through the distal metaphyses, extending toward, but not involving the distal tibial and fibular physes. A hybrid circular-linear external skeletal fixator was applied by closed reduction, to stabilize the fractures. The fractures healed and the fixator was removed 5 weeks after stabilization. Limb length and alignment were similar to the normal contralateral limb at hospital discharge, 8 weeks after surgery. Two weeks later, the tiger had fractures of the right tibia and fibula and was euthanatized. Necropsy confirmed pathologic fractures ascribed to copper deficiency. Closed application of the hybrid construct provided sufficient stability to allow this 90 kg tiger's juxta-articular fractures to heal with minimal complications and without disrupting growth from the adjacent physes. © Copyright 2011 by The American College of Veterinary Surgeons.

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

    Directory of Open Access Journals (Sweden)

    CHEN Xu

    2012-02-01

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

  8. Biological reconstruction after resection of bone tumors of the proximal tibia using allograft shell and intramedullary free vascularized fibular graft: long-term results.

    Science.gov (United States)

    Innocenti, Marco; Abed, Yasser Y; Beltrami, Giovanni; Delcroix, Luca; Manfrini, Marco; Capanna, Rodolfo

    2009-01-01

    Reconstruction after excision of bone tumor of the proximal tibia is a challenging issue for the reconstructive surgeon. The combined use of a free fibular flap and allograft can provide a reliable reconstructive option in this location. This article describes the authors' long-term follow-up using this technique. Twenty-seven patients that had resection of proximal tibia bone tumors underwent reconstruction using this technique. Only 21 patients that had primary reconstruction were included in this study. All patients had their surgeries performed at least 24 months before the end of the study. The average age at time of operation was 18.1 years. The average follow-up time was 139.3 months. Limb salvage was 82.7%. The average length of the resected tibial segment was 15.3 cm and that of the residual proximal tibia remaining after resection was 2.7 cm. The average time of union of fibula was 5.4 months and for union of allograft was 19.1 months. Primary union of the allograft was achieved in 90.5% of cases. Full weight-bearing was achieved at an average of 21.6 months. Ten patients (47.6%) had 14 local complications. The (MTSRS) average score at final follow-up was 27.3. Local recurrences occurred in two patients (9.5%). Distant metastasis to the lung occurred in three patients (14.3%). One patient died of disease. This technique provides good long-term results in reconstruction of proximal tibia. The viability of the fibula is a cornerstone in both success of reconstruction as well as successful management of complications.

  9. Colgajo libre osteoseptocutáneo de peroné en la reconstrucción primaria de la radionecrosis masiva mandibular Fibular osteoseptocutaneous free flap in the primary reconstruction after massive radionecrosis of the mandible

    Directory of Open Access Journals (Sweden)

    P. Infante Cossío

    2004-06-01

    Full Text Available Resumen: Una de las complicaciones más serias del uso de la radioterapia en el tratamiento del carcinoma epidermoide de la cavidad oral, es la osteorradionecrosis. En este trabajo, presentamos cuatro pacientes afectos de osteorradionecrosis masiva de la mandíbula que habían fracasado inicialmente con medidas conservadoras y que fueron tratados con resección radical y reconstrucción primaria con un colgajo libre osteoseptocutáneo de peroné. El defecto mandibular tras la resección ósea midió una media de 10 cm e incluyó mucosa intraoral, piel o ambos. En dos casos de reconstrucción, se empleó el colgajo libre de peroné con doble paleta para reconstruir defectos extensos intra y extraorales. Se realizaron osteotomías en el peroné vascularizado en todos los casos para recrear el contorno mandibular. Todos los colgajos sobrevivieron completamente. Tres pacientes curaron primariamente con buenos resultados estéticos y funcionales. Una paciente falleció en el primer mes tras la operación por una pancreatitis aguda y fallo renal. En un paciente se han insertado implantes osteointegrados. En nuestra experiencia, el colgajo libre osteoseptocutáneo de peroné puede ser una opción ideal para la reconstrucción en un solo tiempo de defectos complejos mandibulares compuestos en pacientes afectos de osteorradionecrosis masiva.Abstract: Osteoradionecrosis is one of the most serious complications after radiation therapy of squamous carcinoma of the oral cavity. In this article, we report four cases of massive osteoradionecrosis of the mandible, all of whom had failed initial conservative management and treated with radical resection and primary reconstructed with fibular osteoseptocutaneous free flap. Mandible defects after radical resection were around 10 cm long and included intraoral mucosa, skin or both. A doubled-paddle peroneal tissue transfer was used in two cases for reconstruction of an extensive extra- or intraoral defects. The

  10. The treatment of congenital pseudarthrosis of the tibia with ipsilateral fibular transfer to make a one-bone lower leg: a review of the literature and case report with a 23-year follow-up.

    Science.gov (United States)

    Peterson, Hamlet A

    2008-06-01

    The surgical making of a one-bone lower leg is, in a way, an operation of necessity or last resort. It has been attempted for many conditions and by many techniques. This is a review of the literature and a case report of transferring a congenitally pseudarthritic fibula to replace an ipsilateral pseudarthritic tibial diaphysis without exposing the fibular vascular pedicle, or using microvascular techniques, and with the specific aim of purposely creating a true one-bone lower leg, the tibula. The concept and surgical technique used here leave the contralateral leg undisturbed and are less demanding, time consuming, and costly than a vascularized pedicle graft or bone transport. This procedure is new and can also be applied when the fibula is normal and to repair tibial diaphyseal deficiency from any cause in both children and adults.

  11. Análise da influência da bandagem funcional de tornozelo no tempo de reação do fibular longo em sujeitos saudáveis Analysis of ankle taping influence in the peroneal reaction time in healthy subjects

    Directory of Open Access Journals (Sweden)

    Maurício Couto Meurer

    2010-06-01

    Full Text Available OBJETIVOS: O objetivo deste estudo foi analisar a influência da bandagem funcional de tornozelo no tempo de reação do fibular longo de indivíduos sadios. MÉTODOS: A amostra foi composta por oito indivíduos do gênero masculino, fisicamente ativos, sem histórias prévias de lesões de tornozelo e, com os resultados negativos aos testes de instabilidade articular de tornozelo. Foram usados como instrumentos da pesquisa, a bandagem funcional de tornozelo tipo bota fechada, para realizar o teste uma plataforma capaz de inclinar 30o no plano frontal simulando a entorse lateral do tornozelo e um eletromiógrafo de oito canais (Bortec Electronics Incorporation, Canadá para aquisições dos sinais eletromiográficos. Os sinais EMG foram coletados juntamente com o sinal da plataforma (sincronismo. A coleta dos dados foi realizada em dois momentos, primeiramente sem a bandagem e logo após com a bandagem. RESULTADOS: Os indivíduos tinham idade média de 23,3 anos (± 2,8, massa corpórea de 74,4kg (± 9,4, estatura de 1,7m (± 0,4 e IMC de 23,7kg/m2 (± 2,4. O estudo encontrou diferença estatisticamente significativa p = 0,018 na situação da bandagem funcional de tornozelo com diminuição do tempo de reação do fibular longo. CONCLUSÃO: Acreditamos que esta melhora se deva ao íntimo contato da bandagem com os receptores cutâneos do tornozelo, aumentando a ativação do reflexo fibular, com consequente ganho proprioceptivo e, assim, aumentando a habilidade dos sujeitos em responder a situações súbitas de entorses. O estudo demonstrou diminuição no tempo de reação do fibular longo de indivíduos sadios com o uso da bandagem funcional de tornozelo quando submetidos à inclinação lateral súbita do tornozelo.OBJECTIVE: The aim of this study was to analyze the influence of the ankle functional tape on long fibular reaction time in health subjects. METHODS: The sample was composed of eight physically active male subjects, without ankle

  12. Doble injerto microvascularizado de peroné para reconstrucción bilateral mandibular por osteorradionecrosis Double-barrel microvascularised fibular graft for bilateral mandibular reconstruction due to osteoradionecrosis

    Directory of Open Access Journals (Sweden)

    L. Pingarrón Martín

    2010-06-01

    Full Text Available La osteorradionecrosis mandibular supone una complicación grave del tratamiento radioterápico, que a menudo origina una seria deformidad facial. La dificultad para la masticación, la articulación y la deglución son también frecuentes. A pesar de los avances realizados en la última década en radioterapia para tumores de la cabeza y el cuello, las complicaciones por osteorradionecrosis aún se producen. La indicación para una cirugía radical no está claramente definida, pero esta modalidad de tratamiento debe instaurarse cuando las medidas conservadoras han fracasado o cuando prevalece la necrosis ósea y de partes blandas. Las fracturas patológicas o fístulas persistentes son claros indicadores para un abordaje radical. En este artículo se presenta un caso de osteorradionecrosis bilateral mandibular tratada con amplia extirpación quirúrgica y reconstrucción en dos tiempos con dos injertos microvascularizados de peroné.Osteoradionecrosis of the mandible is a serious complication of radiotherapy that often leads to severe facial deformity. Difficulties in mastication, articulation, and swallowing are also common. Despite major improvements in radiation therapy of head and neck cancers during the last decade, osteoradionecrosis complications still occur. The indication for radical surgery is not clearly defined, but this kind of treatment should only be instituted when conservative methods fail or when severe bone and soft-tissue necrosis prevails. Pathological fractures or persistent fistulas are strong indications for a more radical surgical approach. This article reports a case of bilateral osteoradionecrosis of the mandible treated with radical escision and reconstruction in two stages with two fibular osteoseptocutaneous free flaps.

  13. Resistência à torção de dois instrumentos endodônticos rotatórios de níquel-titânio Torsional resistance of two nickel-titanium rotatory endodontic instruments

    Directory of Open Access Journals (Sweden)

    Cristiane da COSTA

    2000-06-01

    Full Text Available Os autores compararam a resistência à torção entre os instrumentos rotatórios de níquel-titânio Quantec Series 2000 e Pow-R, valendo-se de quarenta instrumentos para cada marca divididos em oito para cada um dos seguintes tamanhos nº 15, nº 20, nº 25, nº 35 e nº 40 com 21 mm e conicidade .02. Com a ajuda de um troptômetro modificado cada instrumento foi fixado em um madril e preso à 3 mm de sua ponta, previamente marcada com uma caneta de tinta permanente, na base do aparelho por uma morsa. Em seguida ativou-se a manivela que continha a escala em graus até notar-se sinal característico da fratura do instrumento registrando-se o valor da quantidade de movimento até este momento. Após tabulação dos dados procedeu-se a análise estatística de acordo com o teste t de Student com nível de significância de 1%. Os resultados mostraram haver diferença estatisticamente significante ao comparar-se limas de mesmo número confrontadas as duas marcas, favorável para o instrumento Pow-R.The authors compared the torsional resistance between the Quantec Series 2000 and Pow-R nickel-titanium rotatory instruments, using forty instruments of each brand, divided in eight of each one of the following numbers: nº 15, nº 20, nº 25, nº 35 and nº 40 with 21 mm and taper .02. Each instrument was fixed in the mandrel of a modified tropometer and held 3 mm away from its tip, on a spot that had been previously stamped with a permanent ink pen, by apprehension claws localized on the base of the equipment. Then the graduated handle was activated until a characteristic break sign of the instrument was noticed, the quantity of movement up to this moment being recorded. After the values were tabulated, the statistical analysis was carried out according to the Student t test. The results revealed a statistically significant difference when instruments of the same number, from both evaluated brands, were compared, favouring the Pow-R instruments.

  14. Suppression of instability in rotatory hydromagnetic convection

    Indian Academy of Sciences (India)

    is the position vector and &0Y#0Y 0 and K0 stand for values of density, viscosity, magnetic diffusivity and thermal conductivity at the lower boundary z И 0. Clearly, the initial stationary states whose stability we wish to examine is characterized by the following solutions for the velocity, temperature, magnetic field, density and.

  15. Suppression of instability in rotatory hydromagnetic convection

    Indian Academy of Sciences (India)

    Recently discovered hydrodynamic instability [1], in a simple Bénard configuration in the parameter regime 02 > 1 under the action of a nonadverse temperature gradient, is shown to be suppressed by the simultaneous action of a uniform rotation and a uniform magnetic field both acting parallel to gravity for oscillatory ...

  16. Peroneal nerve palsy due to compartment syndrome after facial plastic surgery Paralisia de nervo fibular devido a síndrome compartimental após cirurgia plástica da face

    Directory of Open Access Journals (Sweden)

    Clécio O. Godeiro-Júnior

    2007-09-01

    índrome compartimental crônica. Ele fazia uso de anabolizantes e venlafaxina, não relatado no início do quadro, e a agitação poderia ser explicada por uma síndrome serotoninérgia desencadeada pela interação deste último medicamento e haloperidol. A rabdomiólise secundária a estes eventos causou edema e isquemia nos compartimentos anteriores de ambos os membros inferiores, levando a uma compressão secundária do nervo fibular. O caso em questão ilustra a importância do diagnóstico precoce da síndrome compartimental pois, caso contrário, mesmo com fasciotomia, uma complicação permanente devido à compressão de nervos periféricos pode se estabelecer.

  17. 243 MORPHOMETRIC CHARACTERISTICS OF THE FIBULAR ...

    African Journals Online (AJOL)

    Misiani

    In this regard, the FI and the distal fibula form an anatomical unit whose stability depends largely on the FI's morphometry. (Taser et al.,, 2009). Pertinent to this is thepopulational, inter-individual and sexual variability of osteometric dimensions. (Igbigbi, 2003). It would therefore be important to avail data on the morphometry.

  18. Análise comparativa entre instrumentação rotatória (GT, manual e associação de ambas no preparo de canais achatados Comparative analysis of rotatory (GT and manual root canal preparation and association of both techniques in instrumentation of flattened root canals

    Directory of Open Access Journals (Sweden)

    Silvana Beltrami Gonçalves

    2003-03-01

    Full Text Available A instrumentação do canal radicular tem sido considerada uma das fases mais importantes do tratamento endodôntico, portanto muitas técnicas e instrumentos têm sido desenvolvidos para esse fim. O propósito desse estudo foi avaliar a limpeza de canais radiculares instrumentados com três diferentes técnicas. Foram selecionados trinta incisivos inferiores, onde a abertura coronária foi realizada. Posteriormente, os canais foram preenchidos com tinta nanquim (corante, previamente acondicionada em tubetes anestésicos, sendo a mesma levada ao interior do canal radicular com auxílio de uma seringa carpule e uma agulha para anestesia. Após 48 horas, tempo esperado para que o corante secasse no canal, os dentes foram divididos em três grupos: G1 - instrumentação rotatória com GT; G2 - instrumentação manual e G3 - associação de ambas (mista. Após a instrumentação, os dentes foram seccionados longitudinalmente e realizada a avaliação da limpeza dos canais, através da remoção de corante nos terços cervical, médio e apical. Os resultados demonstraram que não houve diferença estatisticamente significante na limpeza do canal entre as três técnicas de instrumentação estudadas, nos três terços avaliados.Root canal preparation has been considered one of the most important steps in root canal therapy, thus many techniques and instruments have been developed. The aim of this study was to evaluate the cleaning of the root canal through three different instrumentation techniques. Thirty mandibular incisors were selected and submitted to lingual access cavities. Afterwards, the canals were filled with India ink dye previously stored in carpules, which was inserted into the root canal by means of anesthetic syringe and anesthetic needles. After 48 hours, during which the dye was allowed to dry inside the root canal, the teeth were divided in three groups: G1- GT rotatory instrumentation; G2- manual instrumentation; G3- association

  19. Avaliação retrospectiva dos casos de síndrome de Grisel (fixação rotatória C1-C2 no IOT-HCFMUSP Evaluación retrospectiva de casos de síndrome de Grisel (fijación rotatoria C1-C2 en IOT-FMUSP Retrospective evaluation of Grisel's syndrome (C1-C2 rotatory fixation at IOT-HCFMUSP

    Directory of Open Access Journals (Sweden)

    Fabiano Cortese Paula Gomes

    2011-01-01

    tratamiento más utilizado fue el uso del collar cervical (20 casos, seguido por la tracción (6 casos y la artrodesis C1-C2 (6 casos. CONCLUSIÓN: La fijación rotatoria C1-C2 es una enfermedad mucho más frecuente en la infancia, causada generalmente por una contractura del músculo esternocleidomastoideo seguida de una IVAS. En la mayoría de los casos, la fijación es reversible solamente con tratamiento conservador, principalmente si el tratamiento fuere precoz. En casos con evolución tardía, puede ser necesaria la tracción mentoniana o craneana y, en los casos irreductibles, la artrodesis C1-C2.OBJECTIVE: To evaluate the profile, treatment and complications of patients with C1-C2 rotatory fixation. METHODS: A total of 35 patients with diagnosis of C1-C2 rotatory fixation at IOT-HCFMUSP, between 1982 and 2008, were retrospectively studied. Age, gender, clinical features, classification, type of treatment and complications were evaluated. RESULTS: Of a total of 35 cases, 19 were girls and 16 were boys, with a mean age of 6.9 years. The most common symptom was pain (85%, followed by deformity (71% and loss of cervical mobility (62%. According to Fielding and Hawkins classification, we found 11 cases type I, 14 cases type II, and 5 cases type III. There were no type IV cases. In 5 cases we couldn't obtain classification. The use of collar was the most used treatment (20 cases. Traction was performed in 6 cases and C1-C2 arthrodesis in 6 cases. CONCLUSION: C1-C2 rotatory fixation is a disorder more common in children. The cause is a contracture of the sternocleidomastoid muscle, usually after an upper airway tract infection. The fixation is reduced with conservative treatment, mainly with early treatment. When treatment starts late, the use of cervical traction can be necessary and for irreducible cases C1-C2 arthrodesis.

  20. Lymphatic Vascularisation and Involvement of Lyve-1+ Macrophages in the Human Onchocerca Nodule

    Science.gov (United States)

    Attout, Tarik; Hoerauf, Achim; Dénécé, Gaëlle; Debrah, Alexander Yaw; Marfo-Debrekyei, Yeboah; Boussinesq, Michel; Wanji, Samuel; Martinez, Valérie; Mand, Sabine; Adjei, Ohene; Bain, Odile

    2009-01-01

    Onchocerciasis, caused by the filarial nematode Onchocerca volvulus, is a parasitic disease leading to debilitating skin disease and blindness, with major economic and social consequences. The pathology of onchocerciasis is principally considered to be a consequence of long-standing host inflammatory responses. In onchocerciasis a subcutaneous nodule is formed around the female worms, the core of which is a dense infiltrate of inflammatory cells in which microfilariae are released. It has been established that the formation of nodules is associated with angiogenesis. In this study, we show using specific markers of endothelium (CD31) and lymphatic endothelial cells (Lyve-1, Podoplanin) that not only angiogenesis but also lymphangiogenesis occurs within the nodule. 7% of the microfilariae could be found within the lymphatics, but none within blood vessels in these nodules, suggesting a possible route of migration for the larvae. The neovascularisation was associated with a particular pattern of angio/lymphangiogenic factors in nodules of onchocerciasis patients, characterized by the expression of CXCL12, CXCR4, VEGF-C, Angiopoietin-1 and Angiopoietin-2. Interestingly, a proportion of macrophages were found to be positive for Lyve-1 and some were integrated into the endothelium of the lymphatic vessels, revealing their plasticity in the nodular micro-environment. These results indicate that lymphatic as well as blood vascularization is induced around O. volvulus worms, either by the parasite itself, e.g. by the release of angiogenic and lymphangiogenic factors, or by consecutive host immune responses. PMID:20011036

  1. Scapular Free Vascularised Bone Flaps for Mandibular Reconstruction: Are Dental Implants Possible?

    Directory of Open Access Journals (Sweden)

    Martin Lanzer

    2015-09-01

    Full Text Available Objectives: Free fibula flap remains the flap of choice for reconstruction of mandibular defects. If free fibula flap is not possible, the subscapular system of flaps is a valid option. In this study, we evaluated the possibility of dental implant placement in patients receiving a scapular free flap for oromandibular reconstruction. Material and Methods: We retrospectively reviewed 10 patients undergoing mandible reconstruction with a subscapular system free-tissue (lateral border of the scapula transfer at the University Hospital Zürich between January 1, 2010 and January 1, 2013. Bone density in cortical and cancellous bone was measured in Hounsfield units (HU. Changes of bone density, height and width were analysed using IBM SPSS Statistics 22. Comparisons of bone dimensions as well as bone density were performed using a chi-square test. Results: Ten patients were included. Implantation was conducted in 50%. However, all patients could have received dental implants considering bone stock. Loss of bone height and width were significant (P < 0.001. There was a statistical significant increase in bone density in cortical (P < 0.001 and cancellous (P = 0.004 bone. Conclusions: Dental implants are possible after scapular free flap reconstruction of oromandibular defects. Bone height and width were reduced, while bone density increased with time.

  2. Distracción osteogénica vertical de injerto microvascularizado de peroné para reconstrucción mandibular y optimización de la rehabilitación implantológica Vertical distraction osteogenesis of microvascularised fibular grafts for mandibular reconstruction and optimisation of rehabilitation implantology

    Directory of Open Access Journals (Sweden)

    G.Y. Cho Lee

    2010-06-01

    Full Text Available Introducción: En la actualidad, se considera que el injerto microvascularizado de peroné es la mejor opción de tratamiento para las reconstrucciones mandibulares de defectos óseos mayores de 6 cm. No obstante, debido a su limitada altura, presenta una importante desventaja en cuanto a la rehabilitación protésica, particularmente en aquellos casos de resecciones mandibulares parciales con una hemimandíbula contralateral dentada. Material y métodos: Presentamos un caso clínico de mixoma mandibular tratado mediante resección quirúrgica y reconstrucción mandibular primaria mediante injerto microvascularizado de peroné, al que se sometió a distracción osteogénica vertical para optimizar la posterior rehabilitación implantológica. Resultados: La discrepancia de altura se solucionó completamente y se colocaron tres implantes osteointegrados en el área distraída, lo cual permitió una rehabilitación protésica muy satisfactoria, tanto estética como funcionalmente. Conclusiones: La distracción osteogénica vertical de peroné constituye una excelente opción terapéutica para igualar la altura del peroné a la del reborde alveolar de la hemimandíbula dentada contralateral, tras la reconstrucción de defectos mandibulares extensos, de cara a una posterior rehabilitación implantológica, lo que permite llevar a cabo ésta con resultados, tanto funcionales como estéticos, muy satisfactorios. Además, no presenta los inconvenientes de otras técnicas empleadas en estos pacientes, como el peroné en doble barra (mayor dificultad técnica y mayor riesgo de trombosis en el pedículo y el empleo de injertos "onlay" (morbilidad añadida en la zona de toma del injerto.Introduction: Free vascularized fibular flap is considered the treatment of choice in mandibular reconstruction for extensive bone defects. But, when the reconstruction involves a dentate mandible, the fibula has the limit as it doesn't offer sufficient bone height to

  3. Fibular Hemimelia: A Case Report | Eze | Nigerian Journal of ...

    African Journals Online (AJOL)

    The radiological diagnosis and differential diagnosis are discussed. The treatments which include repeated corrective osteotomies and leg-lengthening surgery are costly and associated with residual deformity. Keywords: Fibula, Hemimelia, Radiology, Diagnosis Nigerian Journal of Clinical Practice Vol. 10 (3) 2007 pp.

  4. Management of fibular hemimelia: amputation or limb lengthening

    National Research Council Canada - National Science Library

    Naudie, D; Hamdy, R C; Fassier, F; Morin, B; Duhaime, M

    1997-01-01

    .... There were 12 boys and 10 girls, all with associated anomalies in the lower limbs. Twelve patients (13 limb segments) had early amputation and prosthetic fitting and ten had tibial lengthening using the Ilizarov technique...

  5. Fibular deficiency and the indications for Syme's amputation.

    Science.gov (United States)

    Oppenheim, W L

    1991-08-01

    Recent literature on the subject is reviewed, and the role of Syme's amputation, reconstructive surgery and prosthetic management is discussed in relation to the severity of the condition. Amputation, which should be performed between 18 months and two years old is specifically recommended for total fibula absence with ankle instability. The operative technique is detailed.

  6. Internal lengthening device for congenital femoral deficiency and fibular hemimelia.

    Science.gov (United States)

    Shabtai, Lior; Specht, Stacy C; Standard, Shawn C; Herzenberg, John E

    2014-12-01

    Patients with congenital limb shortening can present with joint instability, soft tissue contractures, and significant leg length discrepancy. Classically, lengthening is done with external fixation, which can result in scarring, pin site infection, loss of motion, and pain. We therefore developed an alternative to this approach, a new, controllable, internal lengthening device for patients with congenital limb shortening. We evaluated this device in terms of (1) healing index, (2) complications, (3) accuracy of the device's external controller, and (4) adjacent-joint ROM. Between January 2012 and May 2013, we treated 66 patients for congenital limb shortening, of whom 21 were treated using this device. During this period, general indications for using the device were patients with leg length discrepancies of 2 cm or more, with intramedullary canals able to withstand rods of at least 12.5-mm diameter and 230-mm length, without active infection in the affected bone, able to comply with the need for frequent lengthening, and without metal allergies or an implanted pacemaker. We included only those patients who had completed their course of treatment and were currently fully weightbearing, leaving 18 patients (21 bone segments) available for followup at a minimum of 6 months after limb lengthening (mean, 14 months; range, 6-22 months). Mean age was 19 years (range, 9-49 years). Sixteen femurs and five tibias were lengthened a mean of 4.4 cm (range, 2.1-6.5 cm). Mean distraction index was 1.0 mm/day (range, 0.5-1.8 mm/day). Healing index, complications, device accuracy, and ROM were recorded. To date, 10 of the 21 devices have been removed. This was typically done 12-24 months after insertion when the bone was solidly healed on all four cortices. Mean healing index was 0.91 months/cm (range, 0.2-2.0 months/cm). There were seven complications requiring an additional unplanned surgery, including one hip flexion contracture, three femurs with delayed healing, one tibia with delayed healing, one hip subluxation/dislocation, and one knee subluxation. The external controller was accurate as programmed and actual lengthening amounts were consistent. ROMs of the hip, knee, and ankle were essentially maintained. This device is completely internal, allowing for satisfactory joint motion during treatment in most patients. Lengthening was achieved in an accurate, controlled manner, and all patients reached their goal length. Complications remain a concern, as is the case with all approaches to this complex patient population. Both future comparative studies and longer-term followup are needed. Level IV, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.

  7. Unilateral proximal focal femoral deficiency, fibular aplasia, tibial ...

    African Journals Online (AJOL)

    Rabah M. Shawky

    2014-04-30

    Apr 30, 2014 ... a Pediatric Department, Genetics Unit, Ain Shams University, Egypt b Radio Diagnosis ... Abstract We report a fifteen month old Egyptian male child, the third in order of birth of healthy non consanguineous parents ... family, as limb anomaly in one child and cyanotic congenital heart disease in another child.

  8. Radiological features of the distal tibio-fibular syndesmosis

    Energy Technology Data Exchange (ETDEWEB)

    Weissman, J.A.; Lazis, A.K.

    1980-07-01

    One hundred and thirty-nine patients admitted for treatment of injuries to the ankle joint were examined by contrast arthrography. In each case the normal side was examined for comparison, in addition to the injured joint. Direct (50%) and indirect (36,2%) signs of abnormalities of the distal tibiofibular syndesmosis are described.

  9. fibular osteosynthesis of neglected femoral neck fracture in a young

    African Journals Online (AJOL)

    fracture of his right hip was made he discharged himself against medical advice and went to traditional bone setters for further management. Three months later, he came back to our out-patient clinic with a completely displaced non-united fracture of his right hip. There were femoral neck resorption and patchy sclerosis in.

  10. Efeitos da fadiga muscular induzida por exercícios no tempo de reação muscular dos fibulares em indivíduos sadios Efectos de la fatiga muscular inducida por ejercicios sobre el tiempo de reacción muscular peronea en individuos sanos Effects of the exercise-induced muscular fatigue on the time of muscular reaction of the fibularis in healthy individuals

    Directory of Open Access Journals (Sweden)

    Bruno Araújo Rego Santos Silva

    2006-04-01

    Full Text Available A fadiga muscular (FM é um fenômeno comum nas atividades esportivas e diárias, resultando numa piora da performance motora. Ela é considerada um dos fatores causadores de lesões músculo-esqueléticas. A entorse de tornozelo é um exemplo: a FM afetaria tanto o sistema aferente quanto o eferente. Vários estudos têm analisado a influência da FM no controle neuromuscular (CNM; entretanto, existe pouca pesquisa sobre essa influência na velocidade de reação dos músculos. O objetivo deste estudo foi verificar os efeitos da FM no tempo de reação muscular (TRM dos músculos fibulares, que são os primeiros a responder a um estresse em inversão do tornozelo. Foram estudados 14 indivíduos saudáveis masculinos (idade: 20-35 anos, que tiveram seus TRM avaliados por meio de eletromiografia (EMG de superfície. O início da atividade muscular foi definido como a média de repouso + 3x o desvio-padrão (DP. O TRM dos fibulares foi mensurado após uma inversão súbita de 20º realizada numa plataforma. A inversão súbita foi realizada antes e depois da fadiga muscular, que foi induzida por exercícios localizados dos fibulares até a exaustão. Os resultados mostraram que houve um aumento significativo do tempo de reação muscular após a fadiga (p La fatiga muscular (FM es un fenómeno común en las actividades diarias, produciendo un empeoramiento de la actuación. Se la considera una de las causas de factores lesionantes musculares de esqueleto. El esguince del tobillo es un ejemplo: La FM afectaría tanto el sistema aferente cuanto el eferente. Varios estudios han estado analizando la influencia de FM en el comando neuromuscular (CNM, sin embargo, la existen pocas investigaciones sobre la influencia en la velocidad de reacción de los músculos. El objetivo de ese estudio era verificar los efectos de FM en el tiempo de reacción muscular (TRM de los músculos peroneos, que son los primeros en responder a una tensión en la inversi

  11. Helical computed tomography and the vascularisation of pulmonary sequestration; La Angio-TC en los secuestros pulmonares

    Energy Technology Data Exchange (ETDEWEB)

    Mestre, J.; Marcos, J. [Policlinica Miramar. Palma de Mallorca (Spain)

    2000-07-01

    The authors studied the vascularization in three cases of pulmonary sequestration by means of helical computed tomography (CT) with CT angiography. The technique provided precise images of the anomalous systemic blood flow, suggesting that it is a valid substitute for conventional angiography in the preoperative study of pulmonary sequestrations. (Author)

  12. Femoral head vascularisation in Legg-Calve-Perthes disease: comparison of dynamic gadolinium-enhanced subtraction MRI with bone scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Lamer, Sylvie; Dorgeret, Sophie; Brillet, Pierre-Yves; Hassan, Max; Sebag, Guy H. [Department of Paediatric Radiology, Hopital Robert Debre, 48 boulevard Serurier, 75935 Paris Cedex (France); Lariboisiere-Saint-Louis University, Paris (France); Khairouni, Abdeslam; Mazda, Keyvan; Bacheville, Eric; Pennecot, Georges F. [Department of Paediatric Orthopaedics, Hopital Robert Debre, Paris (France); Bloch, Juliette [Department of Biostatistics, Hopital Robert Debre, Paris (France)

    2002-08-01

    Heading AbstractBackground. It has been reported that MRI using a dynamic gadolinium-enhanced subtraction technique can allow the early identification of ischaemia and the pattern of revascularisation in Legg-Calve-Perthes (LCP) disease with increased spatial and contrast resolution. Therefore, dynamic gadolinium-enhanced subtraction (DGS) MRI may be a possible non-ionising substitute for bone scintigraphy.Objective. The purpose of this prospective study was to compare DGS MRI and bone scintigraphy in the assessment of femoral head perfusion in LCP disease.Materials and methods. Twenty-six DGS MR images and bone scintigraphies of 25 hips in 23 children were obtained at different stages of LCP disease; three stage I, 12 stage II, six stage III and five stage IV (Waldenstroem classification). The extent of necrosis, epiphyseal revascularisation pathways (lateral pillar, medial pillar, and/or transphyseal perfusion) and metaphyseal changes were analysed.Results. Total agreement between both techniques was noted in the depiction of epiphyseal necrosis (kappa=1), and metaphyseal abnormalities (kappa=0.9). DGS MRI demonstrated better revascularisation in the lateral (kappa=0.62) and medial pillars (kappa=0.52). The presence of basal transphyseal reperfusion was more conspicuous with MRI.Conclusions. DGS MRI allows early detection of epiphyseal ischaemia and accurate analysis of the different revascularisation patterns. These changes are directly related to the prognosis of LCP disease and can aid therapeutic decision making. (orig.)

  13. Anatomy and Histology of the Knee Anterolateral Ligament.

    Science.gov (United States)

    Helito, Camilo Partezani; Demange, Marco Kawamura; Bonadio, Marcelo Batista; Tírico, Luis Eduardo Passarelli; Gobbi, Riccardo Gomes; Pécora, José Ricardo; Camanho, Gilberto Luis

    2013-12-01

    Reconstruction of the anterior cruciate ligament (ACL) is one of the most common procedures in orthopaedic surgery. However, even with advances in surgical techniques and implants, some patients still have residual anterolateral rotatory laxity after reconstruction. A thorough study of the anatomy of the anterolateral region of the knee is needed. To study the anterolateral region and determine the measurements and points of attachments of the anterolateral ligament (ALL). Descriptive laboratory study. Dissections of the anterolateral structures of the knee were performed in 20 human cadavers. After isolating the ALL, its length, thickness, width, and points of attachments were determined. The femoral attachment of the ALL was based on the anterior-posterior and proximal-distal distances from the attachment of the lateral collateral ligament (LCL). The tibial attachment point was based on the distance from the Gerdy tubercle to the fibular head and the distance from the lateral tibial plateau. The ligaments from the first 10 dissections were sent for histological analysis. The ALL was found in all 20 knees. The femoral attachment of the ALL at the lateral epicondyle averaged 3.5 mm distal and 2.2 mm anterior to the attachment of the LCL. Two distal attachments were observed: one inserts into the lateral meniscus, the other between the Gerdy tubercle and the fibular head, approximately 4.4 mm distal to the tibial articular cartilage. The mean measurements for the ligament were 37.3 mm (length), 7.4 mm (width), and 2.7 mm (thickness). The histological analysis of the ligaments revealed dense connective tissue. The ALL is consistently present in the anterolateral region of the knee. Its attachment to the femur is anterior and distal to the attachment of the LCL. Moving distally, it bifurcates at close to half of its length. The ALL features 2 distal attachments, one at the lateral meniscus and the other between the Gerdy tubercle and the fibular head. The ALL may be

  14. Long-term results after repair and augmentation ligamentoplasty of rotatory subluxation of the scaphoid.

    Science.gov (United States)

    Schweizer, Andreas; Steiger, Regula

    2002-07-01

    Twenty-two patients had scapholunate ligament repairs combined with a new augmentation ligamentoplasty for chronic scapholunate dissociation. All were evaluated by physical and radiologic examination after a mean postoperative follow-up period of 63 months (range, 12-134 mo). According to Green and O'Brien and Johnson and Carrera scores 5/8 had excellent, 13/12 good, and 4/2 fair results. Thirteen were free of pain; 6 had mild pain and 3 had moderate pain. Nineteen returned to their original occupation. There was an average loss of 10 degrees of flexion, 9 degrees of extension, and 11% of grip force compared with the opposite wrist. Radiologic examination showed an average decrease of 12 degrees of the scapholunate and 10 degrees of the radiolunate angles compared with the levels before surgery. No signs of degenerative osteoarthritis were found in 16 (73%) cases. Five wrists showed a distinct pattern of midcarpal degeneration correlating with notable dorsal intercalated segment instability after surgery, and 2 cases had signs of radioscaphoid degeneration.

  15. Translatory-rotatory motion of a gyrostat in a Newtonian force field

    Science.gov (United States)

    Sansaturio, M. E.; Vigueras, A.

    The paper deals with a system made of two gyrostats attracting one another according to Newton's law. The Hamiltonian is expressed in the modified canonical variables of Delaunay and Serret-Andoyer. After straightforward eliminations and changes of variables, the problem is integrated in a particular case to the first order of perturbation by means of an infinitesimal contact transformation.

  16. Ipsilateral Femoral Fracture Non-Union and Delayed Union Treated By Hybrid Plate Nail Fixation and Vascularized Fibula Bone Grafting: A Case Report

    Directory of Open Access Journals (Sweden)

    CK Chan

    2013-07-01

    Full Text Available Non-union is a well recognized complication of femoral neck fractures. The decision whether to attempt fracture fixation or to resort to hip replacement is particularly difficult in patients in the borderline age group in whom complex attempts at gaining union may fail and later present a difficult revision. On the other hand the patient may be young enough that arthroplasty best be avoided . Besides, presence of ipsilateral femoral shaft fracture with delayed union in addition to the femoral neck non-union will pose major problems at operation. We share our experience in treating a femoral neck fracture non-union with ipsilateral femoral shaft delayed union in the shaft and in the distal femur in a fifty years old patient. The fracture was treated with an angle blade plate and supracondylar nail supplemented with a free vascularised fibular bone grafting and autologous cancellous graft. There was radiological union at fourth month. At sixth months, the patient was free of pain and able to walk without support. Thus, we would like to suggest that vascularised fibula bone grafting with supracondylar nailing is a viable option for this pattern of fracture.

  17. Isolated fracture of the fibular shaft due to alpine skiing; a specific injury

    OpenAIRE

    Yıldız, Atıl Atilla, Ozkan Kose, Ferhat Guler, H

    2013-01-01

    Although musculoskeletal injuries of lower leg due to alpine skiing is well known and widely reported, an acute isolated fibula fracture as a specific ski injury has not been reported in the relevant literature. Herein, we present a case of isolated fibula fracture which is missed at initial admission, and discuss the mechanism of injury and relationship with alpine skiing equipment.

  18. Solid variant aneurysmal bone cyst in the distal fibular metaphysis: radiologic and pathologic challenges to diagnosis

    Directory of Open Access Journals (Sweden)

    Elizabeth M. Johnson, MD

    2017-09-01

    Full Text Available Solid variant aneurysmal bone cyst is a rare benign bone lesion, representing a small fraction of all aneurysmal bone cysts. The imaging appearance and histologic features may overlap with other benign and malignant neoplasms, posing a diagnostic dilemma for clinicians, pathologists, and radiologists. We present a case of solid variant aneurysmal bone cyst of the distal fibula and review the radiologic and histologic features important for diagnosis.

  19. Fibular fracture stabilization with a guidewire as supplementary fixation in tibia fractures.

    Science.gov (United States)

    Dombroski, Derek; Scolaro, John A; Pulos, Nicholas; Beingessner, Daphne M; Dunbar, Robert; Mehta, Samir

    2012-11-01

    We present a novel technique of intramedullary fixation of the fibula using a humeral guide wire as an adjunct to tibial fixation, in the setting of tibial shaft fracture. Not only does this technique aid in determining length, alignment, and rotation of the tibial fracture, but it may also help the support of the lower extremity as whole by stabilizing the lateral column. In addition, this technique can be used to help maintain reduction of the fibula when there is concern for the soft tissues of the lower extremity secondary to swelling or injury. Our clinical case series demonstrates this safe, effective, and cost-sensitive technique to be used in the treatment of select concurrent fractures of the tibia and fibula.

  20. Solid variant aneurysmal bone cyst in the distal fibular metaphysis: radiologic and pathologic challenges to diagnosis

    OpenAIRE

    Elizabeth M. Johnson, MD; Jamie T. Caracciolo, MD

    2017-01-01

    Solid variant aneurysmal bone cyst is a rare benign bone lesion, representing a small fraction of all aneurysmal bone cysts. The imaging appearance and histologic features may overlap with other benign and malignant neoplasms, posing a diagnostic dilemma for clinicians, pathologists, and radiologists. We present a case of solid variant aneurysmal bone cyst of the distal fibula and review the radiologic and histologic features important for diagnosis.

  1. The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    McKean, D.; Thomee, E.; Grant, D.; Teh, J.L.; Mansour, R. [Oxford University Hospitals NHS Trust, Nuffield Orthopaedic Centre, Headington, Oxford (United Kingdom); Yoong, P. [Royal Berkshire NHS Foundation Trust, Royal Berkshire Hospital, Reading (United Kingdom); Yanny, S. [Buckinghamshire Healthcare NHS Trust, Stoke Mandeville Hospital, Aylesbury (United Kingdom)

    2015-10-15

    To describe the patterns of injury associated with injury to the popliteofibular ligament injury. A retrospective review was performed of 180 MRI scans undertaken for acute knee trauma. Scans were excluded if the time of injury was over 4 weeks from the time of the scan, or if there was a history of septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. An agreed criterion for assessing the structures of the posterolateral ligamentous complex was defined and in each scan, the popliteofibular ligament (PFL) was scored as normal or injured. The menisci, ligaments, and tendons of each knee were also assessed. The mean age was 25.7 years (range, 9-65 years) and 72.2 % (n = 130) patients were male. The PFL was injured in 36 cases (20 %). There is a significant association between PFL injury and ACL rupture (p = 0.0001), ITB injury (p = 0.0001), PCL injury (p = 0.0373), in addition to associations with injury to other posterolateral corner structures including the lateral collateral ligament (p = 0.0001), biceps femoris tendon (p = 0.0014), and popliteus tendon (p = 0.0014). Of our series of PFL injuries, nine cases (25 %) were associated with further injuries of posterolateral corner structures and in 27 cases (75 %) the PFL was the only posterolateral corner structure torn. PFL injury is not uncommon in acute knee trauma and is associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, and injury to other structures within the posterolateral corner. (orig.)

  2. The popliteal fibular ligament in acute knee trauma: patterns of injury on MR imaging.

    Science.gov (United States)

    McKean, D; Yoong, P; Yanny, S; Thomee, E; Grant, D; Teh, J L; Mansour, R

    2015-10-01

    To describe the patterns of injury associated with injury to the popliteofibular ligament injury. A retrospective review was performed of 180 MRI scans undertaken for acute knee trauma. Scans were excluded if the time of injury was over 4 weeks from the time of the scan, or if there was a history of septic arthritis, inflammatory arthropathy, previous knee surgery, or significant artefact. An agreed criterion for assessing the structures of the posterolateral ligamentous complex was defined and in each scan, the popliteofibular ligament (PFL) was scored as normal or injured. The menisci, ligaments, and tendons of each knee were also assessed. The mean age was 25.7 years (range, 9-65 years) and 72.2% (n = 130) patients were male. The PFL was injured in 36 cases (20%). There is a significant association between PFL injury and ACL rupture (p = 0.0001), ITB injury (p = 0.0001), PCL injury (p = 0.0373), in addition to associations with injury to other posterolateral corner structures including the lateral collateral ligament (p = 0.0001), biceps femoris tendon (p = 0.0014), and popliteus tendon (p = 0.0014). Of our series of PFL injuries, nine cases (25%) were associated with further injuries of posterolateral corner structures and in 27 cases (75%) the PFL was the only posterolateral corner structure torn. PFL injury is not uncommon in acute knee trauma and is associated with significant internal derangement of the knee, especially anterior cruciate ligament rupture, ITB sprain, and injury to other structures within the posterolateral corner.

  3. Two-step grafting significantly enhances the survival of foetal dopaminergic transplants and induces graft-derived vascularisation in a 6-OHDA model of Parkinson's disease.

    Science.gov (United States)

    Büchele, Fabian; Döbrössy, Máté; Hackl, Christina; Jiang, Wei; Papazoglou, Anna; Nikkhah, Guido

    2014-08-01

    Following transplantation of foetal primary dopamine (DA)-rich tissue for neurorestaurative treatment of Parkinson's disease (PD), only 5-10% of the functionally relevant DAergic cells survive both in experimental models and in clinical studies. The current work tested how a two-step grafting protocol could have a positive impact on graft survival. DAergic tissue is divided in two portions and grafted in two separate sessions into the same target area within a defined time interval. We hypothesized that the first graft creates a "DAergic" microenvironment or "nest" similar to the perinatal substantia nigra that stimulates and protects the second graft. 6-OHDA-lesioned rats were sequentially transplanted with wild-type (GFP-, first graft) and transgenic (GFP+, second graft) DAergic cells in time interims of 2, 5 or 9days. Each group was further divided into two sub-groups receiving either 200k (low cell number groups: 2dL, 5dL, 9dL) or 400k cells (high cell number groups: 2dH, 5dH, 9dH) as first graft. During the second transplantation, all groups received the same amount of 200k GFP+ cells. Controls received either low or high cell numbers in one single session (standard protocol). Drug-induced rotations, at 2 and 6weeks after grafting, showed significant improvement compared to the baseline lesion levels without significant differences between the groups. Rats were sacrificed 8weeks after transplantation for post-mortem histological assessment. Both two-step groups with the time interval of 2days (2dL and 2dH) showed a significantly higher survival of DAergic cells compared to their respective standard control group (2dL, +137%; 2dH, +47%). Interposing longer intervals of 5 or 9days resulted in the loss of statistical significance, neutralising the beneficial two-step grafting effect. Furthermore, the transplants in the 2dL and 2dH groups had higher graft volume and DA-fibre-density values compared to all other two-step groups. They also showed intense growth of GFP+ vessels - completely absent in control grafts - in regions where the two grafts overlap, indicating second-graft derived angiogenesis. In summary, the study shows that two-step grafting with a 2days time interval significantly increases DAergic cell survival compared to the standard protocol. Furthermore, our results demonstrate, for the first time, a donor-derived neoangiogenesis, leading to a new understanding of graft survival and development in the field of cell-replacement therapies for neurodegenerative diseases. Copyright © 2014 Elsevier Inc. All rights reserved.

  4. Influence of Physical and Chemical Modification on the Optical Rotatory Dispersion and Biological Activity of Chitosan Films

    Directory of Open Access Journals (Sweden)

    A. B. Shipovskaya

    2013-01-01

    Full Text Available The optical and bactericidal properties of acetic and basic chitosan films were studied. By the ORD technique, we found that these films differed in the values of their specific optical rotation and of their rotary and dispersive constants. A sign inversion of was observed when the acetic chitosan films were heat-treated. The bactericidal activity of the initial and dehydrated acetic films was analyzed, and their moisture content and optical and biological activities were compared.

  5. Solvent Effects on Emission Yield and Lifetime for Coumarin Laser Dyes. Requirements for a Rotatory Decay Mechanism.

    Science.gov (United States)

    1983-10-31

    mothyl > R - hydrogen); (4) a diminished tendency toward non-radiative decay for NH2 - (j) and Ni- subsituted dyes with additional ortho ring...argue against a major role for electron photoejeotion from excited coumarin singlets, despite the fact that the solvated electron may be a product of

  6. Traumatic atlantoaxial rotatory dislocation and displaced ossiculum terminale epiphysiolysis treated with a halo device: a case report.

    Science.gov (United States)

    Walbom, Jonas; Kruse, Anders

    2016-07-01

    The horizontal synchondroses of the infant axis are biomechanical weak regions in trauma. We report the case of a 6-year-old girl who presented with delayed atlantoaxial dislocation and displaced ossiculum terminale epiphysiolysis after a fall from a tree. The patient was treated with halo traction for 3 days after which a CT scan showed normal position of the C1/C2 joint, and an acceptable position of the ossiculum terminale whereafter a halo brace was applied. Because of delayed union on CT scans, the treatment was prolonged to a total of 21 weeks. At final follow-up 26 months after halo brace removal, the patient demonstrated normal range of movement of the neck on clinical examination and radiographs of the cervical spine including lateral flexion/extension radiographs showed no sign of instability of the atlantoaxial joint. Conservative treatment with a halo device versus surgical treatment is discussed.

  7. Endodontic Treatment of Maxillary Premolar with Three Root Canals Using Optical Microscope and NiTi Rotatory Files System.

    Science.gov (United States)

    Relvas, João Bosco Formiga; de Carvalho, Fredsom Marcio Acris; Marques, André Augusto Franco; Sponchiado, Emílio Carlos; Garcia, Lucas da Fonseca Roberti

    2013-01-01

    The aim of the study was to report a clinical case of endodontic treatment of a maxillary first premolar with three root canals using an optical microscope and rotary instrumentation technique. The main complaint of the patient, a 16-year-old girl, was pain in tooth 14. After clinical and radiographic examination, irreversible pulpitis was diagnosed. An alteration in the middle third of the pulp chamber radiographically observed suggested the presence of three root canals. Pulp chamber access and initial catheterization using size number 10 K-files were performed. The optical microscope and radiographic examination were used to confirm the presence of three root canals. PathFiles #13, #16, and #19 were used to perform catheterization and ProTaper files S1 and S2 for cervical preparation. Apical preparation was performed using F1 file in the buccal canals and F2 in the palatal canal up to the working length. The root canals were filled with Endofill sealer by thermal compaction technique using McSpadden #50. The case has been receiving follow-up for 12 months and no painful symptomatology or periapical lesions have been found. The use of technological tools was able to assist the endodontic treatment of teeth with complex internal anatomy, such as three-canal premolars.

  8. Unilateral proximal focal femoral deficiency, fibular aplasia, tibial campomelia and oligosyndactyly in an Egyptian child – Probable FFU syndrome

    Directory of Open Access Journals (Sweden)

    Rabah M. Shawky

    2014-07-01

    Full Text Available We report a fifteen month old Egyptian male child, the third in order of birth of healthy non consanguineous parents, who has normal mentality, normal upper limbs and left lower limb. The right lower limb has short femur, and tibia with anterior bowing, and an overlying skin dimple. The right foot has also oligosyndactyly (three toes, and the foot is in vulgus position. There is limited abduction at the hip joint, full flexion and extension at the knee, limited dorsiflexion and plantar flexion at the ankle joint. The X-ray of the lower limb and pelvis shows proximal focal femoral deficiency, absent right fibula with shortening of the right tibia and anterior bowing of its distal third. The acetabulum is shallow. He has a family history of congenital cyanotic heart disease. Our patient represents most probably the first case of femur fibula ulna syndrome (FFU in Egypt with unilateral right leg affection. We suggest that the condition in our patient may be due to a rare autosomal dominant mutation with possible gonadal mosaicism and with variable expression in the family, as limb anomaly in one child and cyanotic congenital heart disease in another child.

  9. Talocrural dislocation with associated weber type C fibular fracture in a collegiate football player: a case report

    National Research Council Canada - National Science Library

    Ricci, R Daniel; Cerullo, James; Blanc, Robert O; McMahon, Patrick J; Buoncritiani, Anthony M; Stone, David A; Fu, Freddie H

    2008-01-01

    .... A below-knee, fiberglass splint was applied to stabilize the ankle joint complex. Subtalar dislocation, Maisonneuve fracture, malleolar fracture, deltoid ligament rupture, syndesmosis disruption...

  10. The accessory peroneal (fibular) muscles: peroneus quartus and peroneus digiti quinti. A systematic review and meta-analysis.

    Science.gov (United States)

    Yammine, Kaissar

    2015-08-01

    The denomination of "accessory peroneal muscle" (APM) refers usually to two muscles: the peroneus quartus (PQua) and the peroneus digit quinti (PQui) which were believed to be variants of a same muscle. Their morphology and prevalence show high variation in relevant literature mainly owing to the diverse terminology used to describe this muscle group. The aim of this meta-analysis is to generate more accurate description and frequency of those muscles. A total of 46 studies (3,928 legs/ankles) met the inclusion criteria. The aggregate results were: (a) a true APM prevalence of 16 % with 10.2 % for PQua vs. 34.3 % for PQui; (b) a crude prevalence of 16.6 % for PQua vs. 21.5 % for PQui; (c) a bilateral prevalence of 1.73 % for PQua vs. 12.5 % for PQui; (d) the PQua was significantly more prevalent in Indian populations compared to all other ancestries, and the PQui is significantly more prevalent in Europeans and Americans compared to Japanese and Korean populations; (e) though a tendency for higher frequency was found in males and on the right specimens, no significance was found for gender and side; for (f) the "surgical" occurrence of PQua in studies dealing with peroneal tendon surgery was 5.5 % where peroneal tendon pathology seems to be not associated with the presence of an APM; (g) the MRI prevalence of APM was 10.6 %; (h) APMs took origin from peroneus brevis in 60 %, from the distal fibula in 36 % and from other structures in 4 %; (i) APMs took insertion on retrotroclear eminence of the calcaneum in 53.4 %, on peroneal trochlea in 6.6 %, merged with a peroneal tendon in 9.3 %, and inserted on the extensor apparatus of the 5th toe in 18.4 %. Despite the acknowledged limitation owing to the varied terminology used to describe this accessory muscle group, the significant differences found between the aggregate frequency estimates of each muscle do not support the hypothesis that both muscles are variants of a same structure.

  11. Staged Surgery for Severe Soft Tissue and Bone Loss of the Knee

    Directory of Open Access Journals (Sweden)

    CK Chan

    2010-07-01

    Full Text Available A 20- year-old female student was involved in a motor vehicle accident. She sustained a severe friction injury to the left knee that resulted in considerable soft tissue and bone loss. There was also damage to the knee extensor mechanism, tibialis anterior muscle, femoral trochlea, the anterior half of the tibial plateau extending distally to the proximal tibia and skin. However, there was no crushing of the limb or resultant neurovascular deficit but cancellous bone and the remainder of the joint were exposed. Repeated surgical debridement was performed and was followed by covering of the soft tissue using a latissimus dorsi free flap and skin grafts. The bony defect was reconstituted with antibiotic bone cement to prevent flap adherence and shrinkage, enhance stability and prevent fracture. The cement was later removed at the time of arthrodesis at which time an ipsilateral double barrel vascularised fibular graft supplemented with autogenously cancellous bone and a ring fixator was used. Computer tomography confirmed union at three months post procedure. The fixator was then removed and a tibialis posterior transfer was performed.

  12. Architecture of blood vessels in the mouse infraorbital nerve

    National Research Council Canada - National Science Library

    Ishizuka, Atsumi; Ando, Yoshinori; Fujimura, Akira

    2011-01-01

    We examined the normal intraneural vascularisation of the infraorbital nerve from the infraorbital foramen to the peripheral vibrissae to know a normal intraneural vascularisation in a peripheral pure sensory nerve...

  13. Comparison of the Success Rate of Laryngeal Mask Air Way Insertion in Classic & Rotatory Methods in Pediatric Patients Undergoing General Anesthesia

    OpenAIRE

    Aghdashi, Mir Mousa; Valizade Hasanloei, Mohammad Amin; Abbasivash, Rahman; Shokouhi, Shahram; Salehi Gharehvaran, Shahram

    2017-01-01

    Background Laryngeal mask airway (LMA) is frequently used as a replacement method for endotracheal intubation. Few studies have investigated placement of laryngeal mask airway in pediatric surgical patients. In the present study, we aimed at comparing the success rate of 2 techniques, classic versus rotational, in the correct placement of laryngeal mask airway in pediatric patients. Methods After obtaining approval from the research committee of Faculty of Medicine, and receiving clearance fr...

  14. Comparison of the Success Rate of Laryngeal Mask Air Way Insertion in Classic & Rotatory Methods in Pediatric Patients Undergoing General Anesthesia.

    Science.gov (United States)

    Aghdashi, Mir Mousa; Valizade Hasanloei, Mohammad Amin; Abbasivash, Rahman; Shokouhi, Shahram; Salehi Gharehvaran, Shahram

    2017-04-01

    Laryngeal mask airway (LMA) is frequently used as a replacement method for endotracheal intubation. Few studies have investigated placement of laryngeal mask airway in pediatric surgical patients. In the present study, we aimed at comparing the success rate of 2 techniques, classic versus rotational, in the correct placement of laryngeal mask airway in pediatric patients. After obtaining approval from the research committee of Faculty of Medicine, and receiving clearance from the ethics board of the University, this randomized controlled clinical trial (RCT) was administered on children of 2 months to 8 years with ASA class I & II undergoing lower abdominal surgical procedures in Motahari hospital in Urmia. General anesthesia using muscle relaxant was the preferred anesthesia technique for all the patients. Demographic data were recorded. Success rate, number of trials for correct placement, cuff leak pressure, and blood stain on the cuff of the laryngeal mask airway after its removal were all recorded. In the present study, 116 children were evaluated and placed into 2 groups. According to the results of the t test, no significant effect of age, weight, or average number of trials in mask placement was observed between the 2 groups (P > 0.05). According to the results of the Fisher's exact test, no significant difference was detected between the 2 groups in blood staining on the cuff (P > 0.05); no leak was recorded in any of the LMA placement methods (classic or rotational). Both insertion techniques work well in pediatric surgical patients. Success rate and complications were comparable between the 2 groups.

  15. Analysis of the compatibility of dental implant systems in fibula free flap reconstruction.

    Science.gov (United States)

    Carbiner, Ramin; Jerjes, Waseem; Shakib, Kaveh; Giannoudis, Peter V; Hopper, Colin

    2012-06-21

    As a result of major ablative surgery, head and neck oncology patients can be left with significant defects in the orofacial region. The resultant defect raises the need for advanced reconstruction techniques. The reconstruction in this region is aimed at restoring function and facial contour. The use of vascularised free flaps has revolutionised the reconstruction in the head and neck. Advances in reconstruction techniques have resulted in continuous improvement of oral rehabilitation. For example, endosteal implants are being used to restore the masticatory function by the way of prosthetic replacement of the dentition. Implant rehabilitation usually leads to improved facial appearance, function, restoration of speech and mastication. Suitable dental implant placement's site requires satisfactory width, height and quality of bone. Reconstruction of hard tissue defects therefore will need to be tailored to meet the needs for implant placement.The aim of this feasibility study was to assess the compatibility of five standard commercially available dental implant systems (Biomet 3i, Nobel Biocare, Astra tech, Straumann and Ankylos) for placement into vascularised fibula graft during the reconstruction of oromandibular region.Radiographs (2D) of the lower extremities from 142 patients in the archives of the Department of Radiology in University College London Hospitals (UCLH) were analysed in this study. These radiographs were from 61 females and 81 males. Additionally, 60 unsexed dry fibular bones, 30 right sided, acquired from the collection of the Department of Anatomy, University College London (UCL) were also measured to account for the 3D factor.In the right fibula (dry bone), 90% of the samples measured had a width of 13.1 mm. While in the left fibula (dry bone), 90% of the samples measured had a width of 13.3 mm. Fibulas measured on radiographs had a width of 14.3 mm in 90% of the samples. The length ranges of the dental implants used in this study were: 7

  16. Utilization of diesel fuel, anhydrous ethanol and additives blend of a stationary diesel engine with rotatory pump; Utilizacao de mistura ternaria alcool, diesel e aditivo em motores do ciclo diesel com bomba de injecao rotativa

    Energy Technology Data Exchange (ETDEWEB)

    Reyes Cruz, Yordanka; Cavado Osorio, Alberto [Centro de Pesquisas de Petroleo (CEINPET), Havana (Cuba); Belchior, Carlos Rodrigues Pereira; Pereira, Pedro P.; Pinto, Nauberto Rodrigues [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Centro de Tecnologia. Dept. de Engenharia Naval e Mecanica; Aranda, Donato A. Gomes [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Escola de Quimica

    2008-07-01

    In this paper is analyzed the performance and fuel consumption of a stationary Diesel engine, with rotary diesel fuel injection pump, using (diesel fuel + anhydrous ethanol + 0.5% additive) blend. The engine performance parameters and fuel consumption tests were performed at the Termic Machine Laboratory, located in Federal University of Rio de Janeiro, and evaluated using a MWM Series 10 model 4.10 TCA. Two test cycles were used for this test program: the tests were carried out starting from the base diesel S-500, used as a reference; the engine operated with (diesel fuel S-500 - 8% anhydrous ethanol - DIOLEFECT additive (0,5% SPAN80 + 0,1% Biomix-D)) blend. The results indicate that: the reduction levels in power and torque of engine are approximately the same which is (2,55{+-}2%), the brake specific fuel consumption increased in 1,8%. (author)

  17. Analysis and experimental study of rotatory Amaranth dryer prototype based on solar thermal energy; Analisis y estudio experimental de una secadora rotativa para granos de amaranto con aprovechamiento termico de la energia solar

    Energy Technology Data Exchange (ETDEWEB)

    Lema, A. I.; Adoro, J. A.; Fasulo, A. J.; Lara, M. A.

    2004-07-01

    The performance of a rotary Amaranth dryer prototype based on solar thermal energy is analysed in this work. Many experiments were made on this prototype in order to analyse the Amaranth seed behaviour under different drying conditions. By means of mass and energy balances, models were developed, which allow to evaluate the performance and efficiency of the rotary dryer. The thermal energy used in the drying process is provided by an air solar collector made of polyethylene and wood. The solar collector design is optimised in order to satisfy the heating requirements of the dryer, running simulations with a computational model previously developed. (Author)

  18. Effets de la photoactivation par irradiation synchrotron sur la micro vascularisation et sur les tissus cérébraux chez la souris saine ou porteuse d'un gliome : développements en microscopie biphotonique et essais précliniques.

    OpenAIRE

    Ricard, Clément

    2008-01-01

    Brain tumors are the third most frequent pathology encountered in neurology following stroke and dementia. Approximately 10 new cases are encountered each year in a population of 100.000. Glioblastoma are the most aggressive among brain tumors and despite medical progress they suffer of a poor prognosis (median survival time is 12 months; five years survival rate is 2%).One of the challenges in neuro-oncology is the development of new curative treatments against glioblastoma. One of them, the...

  19. Efeito da crioterapia na resposta eletromiográfica dos músculos tibial anterior, fibular longo e gastrocnemio lateral de atletas após o movimento de inversão do tornozelo

    OpenAIRE

    Alonso,Carolina Saenz; Macedo,Christiane de Souza Guerino; Guirro,Rinaldo Roberto de Jesus

    2013-01-01

    A crioterapia é utilizada para tratamento de traumas no tornozelo/pé em atletas; entretanto, sua ação sobre o controle motor apresenta controvérsias. Este estudo objetivou verificar o efeito da crioterapia na resposta eletromiográfica dos músculos do tornozelo de atletas após inversão. A amostra foi composta por 20 voluntários: 10 universitários atletas de basquetebol e 10 universitários não atletas. Todos foram submetidos à inversão do tornozelo em plataforma para a análise do sinal eletromi...

  20. Vascularized Fibula Flaps for Mandibular Reconstruction: An ...

    African Journals Online (AJOL)

    For decades, osseous vascularised flaps have been used for reconstruction of the mandible with the vascularised fibula flap (VFF) remaining the commonly used osseous free flap, reasons ranging from its adequate bone and pedicle length to its receptive dental implant placement quality. This report considers a modest use ...

  1. The use of free autogenous rib grafts in maxillofacial reconstruction ...

    African Journals Online (AJOL)

    Background: Hard tissue defects in the maxillofacial region due to trauma or ablative surgery result in functional and cosmetic problems. State-of-theart methods for reconstruction include the use of vascularised tissue. Objective: To review our results with the use of non-vascularised rib grafts for maxillofacial reconstruction.

  2. A COMPARATIVE STUDY ON MANAGEMENT OF INFECTED GAP NONUNION WITH MASQUELET-2-STAGED INDUCED MEMBRANE TECHNIQUE VERSUS CONVENTIONAL DISTRACTION OSTEOSYNTHESIS

    Directory of Open Access Journals (Sweden)

    Satish Koti

    2016-07-01

    Full Text Available BACKGROUND Management of segmental long bone defects is a challenging task. Attempting limb reconstruction in the presence of significant bone loss usually involves surgery, which is technically difficult, time-consuming, physically and psychologically demanding for the patient, and with no guarantee of a satisfactory outcome. Amputation, external fixators, vascularised fibular grafts, acute limb shortening, and various quantities of allograft and autograft have historically been the mainstays of treatment. For the past 4 decades, Vascularised Fibular Grafting (VFG and distraction osteosynthesis with ring external factor (Ilizarov technique stood the test of time to become standard techniques for the management of large long bone defects. More recently, Masquelet described the use of a cement spacer placed within the osseous void followed by staged bone grafting within the induced biomembrane formed around the spacer as a potential treatment strategy to manage these large defects. The main aim of the study is to compare the efficacy of the two philosophically different methods, conventional distraction osteosynthesis, and Masquelet technique in the management of tibial bone defect incurred due to traumatic bone loss, traumatic fractures complicated by infection, and chronic osteomyelitis of tibia. METHOD Prospective observational study on male and female patients admitted in the Department of Orthopaedics in our tertiary level hospital from November 2012 to September 2014. All patients who have tibial bone defect incurred due to traumatic bone loss, traumatic fractures complicated by infection, and chronic osteomyelitis of tibia are included in the study. Children of age less than 5 years and elderly patients of age more than 85 years are excluded from the present study. Patients with tibial bone defects resulting from injury or surgical intervention are selected into the study and assigned either group D or group M. The patients in group D (n

  3. Vanishing corneal vessels

    Science.gov (United States)

    Nicholson, Luke; Chana, Rupinder

    2013-01-01

    We wish to highlight the importance of acknowledging the accompanying effects of topical phenylephrine drops on the eye other than its intended mydriasis. We reported a case of a 92-year-old woman with a corneal graft who was noted to have superficial corneal vascularisation which was not documented previously. After the instillation of topical tropicamide 1% and phenylephrine 2.5%, for funduscopy, the corneal vascularisation was not visible. When reassessed on another visit, tropicamide had no effect on the vessels and only phenylephrine did. We wish to highlight that when reviewing patients in cornea clinics, instilling phenylephrine prior to being seen may mask important corneal vascularisation. PMID:24121816

  4. Congenital pseudarthrosis ofthe tibia - treatInent with free va ...

    African Journals Online (AJOL)

    caution and resect bone generously. Inadequate fixation. In the initial cases the proxi- mal end of the fibular graft was impacted into the tibial medullary caviry, while the distal fibular end was slotted into the tibial conex and fixed with circumferential den- tal wires. A Hoffman exoskeleton was added for final stabilisation (Fig.

  5. Bone Gap Management Using Linear Rail System (LRS): Initial ...

    African Journals Online (AJOL)

    Background: Vascularized fibular grafting, free fibular graft, tibia profibula synostosis, amputation with a good prosthesis and Ilizarov technique are some of the suitable options for managing bone gaps that result from trauma or treatment of tumours, bone infection, congenital pseudoarthrosis and repeated failed ...

  6. Untitled

    African Journals Online (AJOL)

    F Open tibia and fibular fracture Stretching and strapping 5 weeks Chronic leg ulcer. M Hip dislocation + close ipsi Stretching and strapping 52 weeks Chronic hip dislocation lateral femoral fracture and fracture malunion. M Open tibia and fibular fracture Stretching and strapping 2 days Chronic ostcomyelitis. F Fracture neck ...

  7. Case report

    African Journals Online (AJOL)

    ebutamanya

    22 janv. 2015 ... de nappes cellulaires peu cohésives. La vascularisation est riche, réalisant un aspect angiomateux. Cette vascularisation est spéciale, caractérisée par un aspect ramifié, souvent en « bois de cerf ». La lumière vasculaire n'est pas toujours visible. L'anisocaryose est modérée. L'activité mitotique est élevée ...

  8. Arcuate sign of posterolateral knee injuries: anatomic, radiographic, and MR imaging data related to patterns of injury

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Josephine; Trudell, Debra; Resnick, Donald L. [Department of Radiology, Veterans Affairs Medical Center, University of California, San Diego, CA (United States); Papakonstantinou, Olympia [Department of Radiology, Veterans Affairs Medical Center, University of California, San Diego, CA (United States); Department of Radiology/MRI Unit, University Hospital of Heraklion (Greece); Brookenthal, Keith R. [Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA (United States)

    2003-11-01

    The ''arcuate sign'' is considered a pathognomonic sign for injuries of the posterolateral (PL) corner of the knee. The purpose of our study was to identify different patterns of injury to the fibular head that may associate with injuries to specific ligaments and tendons of the PL corner of the knee. The anatomic relations between the insertions of fibular collateral ligament (FCL), biceps femoris tendon (BFT), popliteofibular ligament (PFL), and arcuate ligament in normal cadaveric knees were also investigated. Magnetic resonance imaging was performed in two cadaveric knees which subsequently were dissected. Radiopaque markers were placed upon the fibular insertions of the FCL, BFT, PFL, and arcuate ligament in the dissected knees, and knee radiographs were then obtained. Twelve patients with radiographic or MR imaging evidence of isolated injury to the PL corner of the knee were retrospectively reviewed, with regard to avulsion fractures and marrow edema in the fibular head and the integrity of the ligaments of the PL corner of the knee. The PFL and arcuate ligament were seen to attach directly to the posterior and medial aspect of the styloid process of the fibular head. The FCL and BFT attached as a conjoined structure on the lateral aspect of the fibular head lateral, anterior and inferior to the attachment site of the PFL and arcuate ligament. Injury to the arcuate ligament or PFL was diagnosed in 8 patients who presented with a small avulsion fracture of the styloid process of the fibula (n=2), bone marrow edema in the medial aspect of the fibular head (n=3), or both (n=3). In 4 patients with injury to the conjoined tendon or FCL, a larger avulsion fragment and more diffuse proximal fibular edema were seen. Radiographic and MR imaging findings in injuries of the posterolateral corner of the knee may suggest injury to specific structures inserting in the fibular head. (orig.)

  9. Vascularized pedicle graft of ipsilateral fibula for recurrent congenital pseudoarthrosis of the tibia

    Directory of Open Access Journals (Sweden)

    Seyed Esmail Hassanpour

    2007-07-01

    Full Text Available

    We have performed the ipsilateral vascularized fibular transfer for the treatment of congenital pseudoarthrosis of the tibia (CPT. In the case under study, the conventional treatment by intramedullary rod and autogenous iliac bone grafting had failed. The follow up took place during the next 4 years and the patient can now walk without assistance. Combining a pedicle ipsilateral fibular transfer with an internal fixation and iliac bone graft may be a good option for the treatment of congenital pseudoarthrosis of tibia.
    KEY WORDS: Congenital pseudoarthrosis, tibia, vascularized fibular graft, bone graft.

  10. Deuteration effect on the rotary power of hydrogen bonded compounds

    Energy Technology Data Exchange (ETDEWEB)

    Kolbe, A.; Kolbe, A. (Akademie der Wissenschaften der DDR, Halle/Saale. Inst. fuer Biochemie der Pflanzen; Martin-Luther-Universitaet Halle-Wittenberg, Halle (German Democratic Republic). Sektion Chemie)

    1982-01-01

    The variation of the rotatory power caused by deuteration in menthol, isopulegol, ..cap alpha..-terpineol-(4), elemol, and diphenylacetyl-L-leucin has been investigated. The results and a brief discussion are given.

  11. The effectiveness of shoe modifications for intoeing.

    Science.gov (United States)

    Knittel, G; Staheli, L T

    1976-10-01

    Shoe wedges have no immediate clinically significant effect on the angle of gait in children. The circular Torqheel was found to be more effetive, but still corrected only a quarter of the apparent rotatory deformity during gait.

  12. Primary Anterolateral Ligament Rupture in Patients Requiring Revision Anterior Cruciate Ligament Reconstruction: A Retrospective Magnetic Resonance Imaging Review

    OpenAIRE

    Carr, James Bradley; Yildirim, Baris; Richter, Dustin L.; Etier, Brian Edward; Diduch, David R.; Anderson, Mark W.; Pierce, Jennifer

    2017-01-01

    Objectives: After anterior cruciate ligament reconstruction (ACLR), only 60% of patients are able to return to their pre-injury level of sports with nearly 15% experiencing persistent rotatory instability. Young patients returning to pivoting sports experience high rates of graft tear and subsequent need for revision ACLR. Recently, the anterolateral ligament (ALL) has gained attention as an important rotatory stabilizer about the knee in prevention of the pivot shift phenomenon. It is theori...

  13. Precise and Rapid Detection of Optical Activity for Accumulative Femtosecond Spectroscopy

    Directory of Open Access Journals (Sweden)

    Nuernberger P.

    2013-03-01

    Full Text Available We present a fast and sensitive polarimeter combining common-path optical heterodyne interferometry and accumulative spectroscopy to detect rotatory power. The sensitivity of rotatory detection is determined to be 0.10 milli-degrees for a measurement time of only one second and an interaction length of 250 μm. Its suitability for femtosecond studies is demonstrated in a non-resonant two-photon photodissociation experiment.

  14. Doppler echography and utilization of intravenous echo enhancer in the follow-up of hepato carcinoma with percutaneous radiological techniques; Ecografia Doppler y empleo del ecopotenciador intravenoso en el seguimiento del hepatocarcinoma con tecnicas radiologicas percutaneas

    Energy Technology Data Exchange (ETDEWEB)

    Forner, J.; Flored de la Torre, M.; Senis, C.; Lozano de Arnilla, M. C.; Ferrer, S.; Celma, M. I. [Hospital General Universitario de Valencia. Valencia (Spain)

    2002-07-01

    To evaluate the utilization of Doppler ultrasound scan in conjunction with echographic enhancer in the follow-up of hepato carcinomas treated by means of radiological intervention techniques. We treated 20 hepatic nodules diagnosed with hepato carcinoma either by means of chemo embolization or percutaneously (either injection of acetic acid or radio-frequency thermo-ablation). Doppler ultrasound scan was performed before and after the treatment by means of sectorial and convex multifrequency probes. Evaluated were the absence, presence and degree of vascularisation, as well as its distribution and characteristics. In all cases, a contrast-en-handed spiral CT was performed. Both studies served as a pattern for comparison before and after treatment. In post-treatment enhanced-echo-Doppler controls of the 18 patients treated with acetic acid, vascularisation was not demonstrated in 7 cases, peripheral vascularisation was detected in 4 cases, perforation vascularisation in another four, and central vascularisation was detected in 3 cases. Contrast-enhanced spiral CT demonstrated superimposed findings, except in one cases, in which the spiral CT detected central capitation of the nodule.With enhanced echo-Doppler, peripheral vascularisation was detected. In both nodules treated by means of radio-frequency thermo ablation, there was detected neither vascularisation in the echo-Doppler nor captation of contrast media in the CT. Doppler ultrasound scan is a good method of follow-up for treated hepato carcinomas. The utilization of echoenhancers increases its ability to detect vascularization it being comparable to that of contrast-enhanced CT. As such, Doppler ultrasound scan together with echoenhancers can help us both in the selection of treatment and evaluation of therapeutic response. (Author) 35 refs.

  15. The knee joint line position measured from the tibial side in Chinese people.

    Science.gov (United States)

    Tang, Qiheng; Zhou, Yixin; Yang, Dejin; Tang, Jing; Shao, Hongyi

    2011-10-01

    A magnetic resonance imaging study of 50 Chinese normal knees was conducted to determine the knee joint line position. The distances from the fibular head and the tibial tubercle to the joint line were measured, and each distance value was converted to a ratio relative to the anteroposterior tibial widths at the levels of the insertion of the patellar tendon and the apex of the fibular head. The distance to the joint line was 11.99 ± 1.20 mm from the fibular head and 20.48 ± 1.64 mm from the tibial tubercle. The fibular head and tibial tubercle are reliable landmarks. The distances and ratios can be used to determine the knee joint line position in revision surgery for the Chinese population. Copyright © 2011 Elsevier Inc. All rights reserved.

  16. Composite Bone and Soft Tissue Loss Treated with Distraction Histiogenesis

    Science.gov (United States)

    2010-01-01

    requiring removal. The first major complication included prema- ture fibular consolidation leading to syndesmosis sublux- ation during tibia...distraction. This required repeat fibular osteotomy and syndesmosis fixation. The second major complication was a scarred tibialis anterior tendon within the... deficiency after acute trauma: the role of bone transport. Orthop. Clin. North Am. 25:753– 763, 1994. 4. Watson, J. T., Anders, M., Moed, B. R. Management

  17. Postoperative Hyperbaric Oxygen Treatment of Peripheral Nerve Damage,

    Science.gov (United States)

    1992-08-28

    the median nerve, 32 cases involved the radial nerves, seven cases involved fibular nerves and one case involved femoral nerves. Follow up visits ranged...Satisfactory. 7. Poor. 8. Percentage outstanding or excellent. 9. Brachial plexus. 10. Ulnar nerve. 11. Median nerve. 12. Radial nerve. 13. Fibular nerve...sufficient oxygen, thus attaining the treatment objective of improving or correcting oxygen deficiency state. The axons of the peripheral nerves do not hav-ý

  18. Physical Fitness Symposium, 12-14 October 1970, United States Army Infantry School, Fort Benning, Georgia

    Science.gov (United States)

    1970-10-14

    caualog growth deficiencies of Che tibia plateau and ligamnt instability. Years of research and rehabilitation work have led ae to conclude that...laBcdiately following injury sc that the proper treatasnt aay be inatituted. Injuries to the ■adial collateral llgaaent and fibular collateral...collateral and fibular collateral ligaaenta do heal with acar tiaaue but ueually in a poaltion of elongation which allows abnoraal aobility to be

  19. Terminal hemimelia of the lower extremity: absent lateral ray and a normal fibula

    OpenAIRE

    Baek, Goo Hyun; Kim, Jae Kwang; Chung, Moon Sang; Lee, Sang Ki

    2007-01-01

    Congenital lateral ray deficiency is considered to be a manifestation of fibular hemimelia. However, we have noted patients with absent lateral ray but stable knee and ankle joints, and named this condition terminal hemimelia of the lower extremity. This study was undertaken to further define this group of patients and to compare these patients with fibular hemimelia patients. Four boys and one girl of mean age six years two months were in the terminal hemimelic group and four boys and three ...

  20. Terminal hemimelia of the lower extremity: absent lateral ray and a normal fibula.

    Science.gov (United States)

    Baek, Goo Hyun; Kim, Jae Kwang; Chung, Moon Sang; Lee, Sang Ki

    2008-04-01

    Congenital lateral ray deficiency is considered to be a manifestation of fibular hemimelia. However, we have noted patients with absent lateral ray but stable knee and ankle joints, and named this condition terminal hemimelia of the lower extremity. This study was undertaken to further define this group of patients and to compare these patients with fibular hemimelia patients. Four boys and one girl of mean age six years two months were in the terminal hemimelic group and four boys and three girls of mean age eight years seven months in the fibular hemimelic group at the final evaluation. Clinical features commonly observed in the fibular hemimelia such as knee valgus, knee instability, tibial bowing, ball and socket ankle, ankle instability, tarsal coalition, leg length inequality were compared between both groups. Terminal hemimelia of the lower extremity was the same as fibular hemimelia in clinical features below the ankle joint. However, terminal hemimela was found to be milder than fibular hemimelia in terms of limb shortening. The clinical features above the ankle joint were different between both groups. Knees and ankles were stable, and gait disturbance were rarely noticed in patients with terminal hemimelia of the lower extremity.

  1. Suitability of carbon fiber-reinforced polyetheretherketone cages for use as anterior struts following corpectomy.

    Science.gov (United States)

    Heary, Robert F; Parvathreddy, Naresh K; Qayumi, Zainab S; Ali, Naiim S; Agarwal, Nitin

    2016-08-01

    OBJECTIVE Fibular allograft remains a widely used strut for corpectomy surgeries. The amount of graft material that can be packed into an allograft strut has not been quantified. Cages are an alternative to fibular allograft for fusion surgeries. The authors of this study assessed the suitability of carbon fiber-reinforced polyetheretherketone (CFRP) cages for anterior corpectomy surgeries. They further explored the parameters known to affect fusion rates in clinical practice. METHODS Six fibular allografts were tested at standard lengths. Three sets of carbon fiber cages (Bengal, DePuy Spine), each with a different footprint size but the same lengths, were tested. The allografts and cages were wrapped in adhesive, fluid-tight transparent barriers and filled with oil. The volume and weight of the oil instilled as well as the implant footprints were measured. The fibular allografts and cages were tested at 20-, 40-, and 50-mm lengths. Two investigators independently performed all measurements 5 times. Five CFRP cubes (1 × 1 × 1 cm) were tested under pure compression, and load versus displacement curves were plotted to determine the modulus of elasticity. RESULTS Significantly more oil fit in the CFRP cages than in the fibular allografts (p Carbon fiber-reinforced polyetheretherketone cages can accommodate much more graft material than can fibular allografts. In clinical practice, the ability to deliver greater amounts of graft material following a corpectomy may improve fusion rates.

  2. Angiogenesis in gliomas.

    Directory of Open Access Journals (Sweden)

    Elzbieta Czykier

    2008-02-01

    Full Text Available Brain gliomas are characterized by invasive growth and neovascularisation potential. Angiogenesis plays a major role in the progression of gliomas and its determination has a great prognostic value. The aim of the study was to assess the vascularisation of chosen brain gliomas and to estimate how it is correlated with tumour histological type, malignancy grade, location and size, and with age and sex of patients. Tumour vascularisation analysis was based on the determination of microvascular proliferation (MVP and microvessel density (MVD. Microvascular proliferation was measured with immunohistochemical methods using mouse monoclonal antibodies to detect cell proliferation antigens. The following antibodies were used Ki-67 and PCNA (DAKO. Identification of vessels was performed by CD31 antibody and anti-human von Willebrand factor (DAKO. The highest microvascular proliferation and microvascular density were observed in multiform glioblastomas and the lowest in oligodendrogliomas. Significant correlation was observed between the vascularisation and malignancy grade.

  3. Scaffold Characteristics for Functional Hollow Organ Regeneration

    Directory of Open Access Journals (Sweden)

    Daniel Eberli

    2010-01-01

    Full Text Available Many medical conditions require surgical reconstruction of hollow organs. Tissue engineering of organs and tissues is a promising new technique without harvest site morbidity. An ideal biomaterial should be biocompatible, support tissue formation and provide adequate structural support. It should degrade gradually and provide an environment allowing for cell-cell interaction, adhesion, proliferation, migration, and differentiation. Although tissue formation is feasible, functionality has never been demonstrated. Mainly the lack of proper innervation and vascularisation are hindering contractility and normal function. In this chapter we critically review the current state of engineering hollow organs with a special focus on innervation and vascularisation.

  4. Towards a measurement of active muscle control for lumbar stabilisation.

    Science.gov (United States)

    Jull, G; Richardson, C; Toppenberg, R; Comerford, M; Bui, B

    1993-01-01

    No measure described to date reflects the ability of muscles to stabilise the lumbar spine. A static model was developed in supine crook lying, to measure active rotatory control with trunk loading in the sagittal plane via low, unilateral leg load. The hypothesis was that excessive lumbar movement indicates an inability of the stabilising muscles to automatically co-ordinate appropriate muscle force to support the spine. A computerised sensor was developed to monitor lumbar positional change. A rotatory stability index was calculated from pressure variations on taking leg load. Preliminary trials showed that this static model identified individuals with poor active rotatory control. Further development of the measurement model is warranted. Copyright © 1993 Australian Physiotherapy Association. Published by . All rights reserved.

  5. Spontaneous natural optical activity in disordered media

    CERN Document Server

    Pinheiro, F A; Papasimakis, N; Zheludev, N I

    2016-01-01

    We demonstrate natural optical activity in disordered ensembles of non-chiral plasmonic resonators. We show that the statistical distributions of rotatory power and spatial dichroism are strongly dependent on the scattering mean free path in diffusive random media. This result is explained in terms of the intrinsic geometric chirality of disordered media, as they lack mirror symmetry. We argue that chirality and natural optical activity of disordered systems can be quantified by the standard deviation of both rotatory power and spatial dichroism. Our results are based on microscopic electromagnetic wave transport theory coupled to vectorial Green's matrix method for pointlike scatterers, and are independently confirmed by full-wave simulations.

  6. Spontaneous natural optical activity in disordered media

    Science.gov (United States)

    Pinheiro, F. A.; Fedotov, V. A.; Papasimakis, N.; Zheludev, N. I.

    2017-06-01

    We theoretically demonstrate natural optical activity in disordered ensembles of nonchiral plasmonic resonators. We show that the statistical distributions of rotatory power and spatial dichroism are strongly dependent on the scattering mean free path in diffusive random media. This result is explained in terms of the intrinsic geometric chirality of disordered media, as they lack mirror symmetry. We argue that chirality and natural optical activity of disordered systems can be quantified by the standard deviation of both rotatory power and spatial dichroism. Our results are based on microscopic electromagnetic wave transport theory coupled to vectorial Green's matrix method for pointlike scatterers and are independently confirmed by full-wave simulations.

  7. L'infiltration d'une dilution ideale des solutions avec epineph rine au ...

    African Journals Online (AJOL)

    The author describes a simple procedure for diluting an anesthesic solution with epinephrine from a concentration of 1/100 000 to a concentration of 1/800 000 to obtain an effective local hemostasis without affecting vitality of the peripheral vascularisation of the skin flaps removed. Keywords: Infiltration - Solution avec ...

  8. Reconstruction of the maxilla using a fibula graft and virtual planning techniques.

    Science.gov (United States)

    Rude, Kristian; Thygesen, Torben H; Sørensen, Jens Ahm

    2014-05-14

    Use of a vascularised free fibula flap has been a popular method of osseous reconstruction because of its adequate length and acceptance of dental implants. In this article we describe a case of maxillary reconstruction in which virtual planning techniques and rapid prototyping were used to insert a microvascular osteomyocutaneous fibula graft, Medpor implant, and immediate dental implants. 2014 BMJ Publishing Group Ltd.

  9. Reconstruction of the maxilla using a fibula graft and virtual planning techniques

    DEFF Research Database (Denmark)

    Rude, Kristian; Thygesen, Torben H; Sørensen, Jens Ahm

    2014-01-01

    Summary Use of a vascularised free fibula flap has been a popular method of osseous reconstruction because of its adequate length and acceptance of dental implants. In this article we describe a case of maxillary reconstruction in which virtual planning techniques and rapid prototyping were used...

  10. Peritoneal splenosis mimicking carcinomatosis | Limaiem | Pan ...

    African Journals Online (AJOL)

    Splenosis is an uncommon benign condition resulting from heterotopic autotransplantation of splenic tissues onto exposed vascularised intra- and extraperitoneal surfaces following splenic trauma and surgeries. Splenosis may be mistaken for carcinomatosis upon standard imaging techniques. A 69-year-old female patient ...

  11. Assessment of the perfusion of glioblastomas before and during radiotherapy: longitudinal comparison between H{sub 2}-{sup 15}O positron emission tomography and perfusion MRI; Evaluation de la perfusion des glioblastomes en avant et pendant la radiotherapie: comparaison longitudinale entre la tomographie par emission de positons H2 15O et l'IRM de perfusion

    Energy Technology Data Exchange (ETDEWEB)

    Laprie, A.; Ken, S.; Moyal Cohen-Jonathan, E. [Departement de radiotherapie, institut Claudius-Regaud, 31 - Toulouse (France); Laprie, A.; Ken, S.; Lotterie, J.A.; Franceries, X.; Celsis, P.; Payoux, P.; Berry, I. [Inserm imagerie cerebrale et handicaps neurologiques UMR 825, 31 - Toulouse (France); Lotterie, J.A.; Berry, I. [Departement de biophysique, centre hospitalier universitaire de Rangueil, 31 - Toulouse (France); Barcelo, C. [Departement de radiologie, centre hospitalier universitaire de Purpan, 31 - Toulouse (France)

    2010-10-15

    The authors report the comparison of different perfusion imagery modalities for patients suffering form glioblastomas and included in a phase-1 clinic trial comprising conformational radiotherapy concomitant with the use of a farnesyl-transferase inhibitor (tipifarnib). With these different techniques, perfusion MRI and perfusion positron emission tomography, the authors made respectively a qualitative and quantitative assessment of the tumour vascularisation. Short communication

  12. Angiogenesis, proteases and angiogenic factors during the inception of pregnancy. Crucial contributors or trivial bystanders?

    NARCIS (Netherlands)

    Plaisier, Geertruida Maria

    2008-01-01

    Vascularised, receptive endometrium is essential for implantation and for the success of the embryo-maternal interaction. Disturbances in vascular development may play an important role in frequently occurring pathologies during pregnancy, such as early pregnancy wastage, pre-eclampsia and

  13. Predictive factors for premature loss of Martin 2.7 mandibular reconstruction plates

    NARCIS (Netherlands)

    van der Rijt, E. E. M.; Noorlag, R.; Koole, R.; Abbink, J. H.; Rosenberg, A. J. W. P.

    Mandibular reconstruction with a plate, with or without a vascularised free (bone) flap, is commonly used to treat patients with a segmental mandibular defect. Common complications are loosening of the osteosynthesis screws, malposition, intraoral or extraoral exposure, or infection. To define

  14. Next-generation sequencing of a 40 Mb linkage interval reveals TSPAN12 mutations in patients with familial exudative vitreoretinopathy.

    NARCIS (Netherlands)

    Nikopoulos, K.; Gilissen, C.F.H.A.; Hoischen, A.; Nouhuys, C.E. van; Boonstra, F.N.; Blokland, E.A.W.; Arts, P.J.W.; Wieskamp, N.A.W.; Strom, T.M.; Ayuso, C.; Tilanus, M.A.D.; Bouwhuis, S.; Mukhopadhyay, A.; Scheffer, H.; Hoefsloot, L.H.; Veltman, J.A.; Cremers, F.P.M.; Collin, R.W.J.

    2010-01-01

    Familial exudative vitreoretinopathy (FEVR) is a genetically heterogeneous retinal disorder characterized by abnormal vascularisation of the peripheral retina, often accompanied by retinal detachment. To date, mutations in three genes (FZD4, LRP5, and NDP) have been shown to be causative for FEVR.

  15. Placenta as a source of hematopoietic stem cells

    NARCIS (Netherlands)

    E.A. Dzierzak (Elaine); C. Robin (Catherine)

    2010-01-01

    textabstractThe placenta is a large, highly vascularised hematopoietic tissue that functions during the embryonic and foetal development of eutherian mammals. Although recognised as the interface tissue important in the exchange of oxygen, nutrients and waste products between the foetus and mother,

  16. Gingival Tissue Color Related With Facial Skin and Acrylic Resin ...

    African Journals Online (AJOL)

    Research into the degree of epithelial vascularisation, keratinisation and melanin pigmentation of the various zones in the mouth in this environment is required which may explain the reason for the dark colour observed in the attached gingival. Key Word: Gingival tissue colour, denture, skin, acrylic resin, Nigerians ...

  17. A simple procedure for management of urethrocutaneous fistulas ...

    African Journals Online (AJOL)

    Midline relaxing incision was used for large fistulas and then covered with a vascularised flap dartos-based flap [flip flap] in 19 and tunica vaginalis in 16. If a patient had more than one small fistula adjacent to each other, they were joined into a large single fistula and then repaired. Results: We have successfully repaired all ...

  18. The Optimal Timing for Pancreatic Islet Transplantation into Subcutaneous Scaffolds Assessed by Multimodal Imaging

    Directory of Open Access Journals (Sweden)

    Andrea Gálisová

    2017-01-01

    Full Text Available Subcutaneously implanted polymeric scaffolds represent an alternative transplantation site for pancreatic islets (PIs with the option of vascularisation enhancement by mesenchymal stem cells (MSC. Nevertheless, a proper timing of the transplantation steps is crucial. In this study, scaffolds supplemented with plastic rods were implanted into diabetic rats and two timing schemes for subsequent transplantation of bioluminescent PIs (4 or 7 days after rod removal were examined by multimodal imaging. The cavities were left to heal spontaneously or with 10 million injected MSCs. Morphological and vascularisation changes were examined by MRI, while the localisation and viability of transplanted islets were monitored by bioluminescence imaging. The results show that PIs transplanted 4 days after rod removal showed the higher optical signal and vascularisation compared to transplantation after 7 days. MSCs slightly improved vascularisation of the graft but hindered therapeutic efficiency of PIs. Long-term glycaemia normalisation (4 months was attained in 80% of animals. In summary, multimodal imaging confirmed the long-term survival and function of transplanted PIs in the devices. The best outcome was reached with PIs transplanted on day 4 after rod removal and therefore the suggested protocol holds a potential for further applications.

  19. Phaeochrornocytorna: A Case Report | Meiring | South African ...

    African Journals Online (AJOL)

    As he was mildly hypertensive between paroxysms, a phentolamine test was carried out, utilising 5 mg well diluted, intravenously, over 5 minutes under basal conditions. This, too, was negative. An aortogram failed to demonstrate convincingly tumour vascularisation, but there was a mild hypertensive crisis during this ...

  20. Phaeochrornocytorna

    African Journals Online (AJOL)

    As he was mildly hypertensive between paroxysms, a phentolamine test was carried out, utilising 5 mg well diluted, intravenously, over 5 minutes under basal con- ditions. This, too, was negative. An aortogram failed to demonstrate convincingly tumour vascularisation, but there was a mild hypertensive crisis during this ...

  1. Radio-Histologic Diagnostic Challenge in Ossifying Fibroma and ...

    African Journals Online (AJOL)

    Based on the history, clinical and radiographic features a diagnosis of ossifying fibroma was reached. ... showed a non-capsulated lesion containing multiple trabeculae of metaplastic bone dispersed in a reactive moderately cellular vascularised fibrous stroma that was consistent with the diagnosis of fibrous dysplasia.

  2. [Physiopathology of osteochondritis of the hip].

    Science.gov (United States)

    Duriez, J

    1977-03-01

    The author has investigated to know whether Perthes disease is a localised epiphyseal distrophy or a symptom of a general perturbance of chondral tissue. The complexity of the structure of the femoral head is recalled as well as the development of its vascularisation. Pathogenic factors are discussed. It is concluded that Perthe's disease is probably a localisation of a general disease.

  3. [Preservation of the foot in a five-year-old child with bilateral congenital deficiency of the tibia].

    Science.gov (United States)

    Bombaci, Hasan; Görgeç, Mücahit; Yanik, Serhat

    2006-01-01

    Congenital tibial deficiency is a rare anomaly causing shortening and varus deformity of the lower extremity. Recent limb lengthening and foot repositioning techniques enable functional results with preservation of the foot. We present a five-year-old boy with bilateral congenital tibial deficiency of type 2 according to the Jones classification, who was treated with tibia-fibular fusion without Syme amputation. His ambulation depended on crawling. Radiographic examination showed a normally developed fibula with thickening in the distal portion, and only proximal tibia with absence of the distal part. He also had bilateral stiff equinovarus deformity. In a series of operations, he underwent bilateral tibia-fibular fusion and fibular osteotomy, subtalar arthrodesis and metatarsal osteotomy in the right foot, and subtalar arthrodesis in the left foot. At the end of a six-year treatment and follow-up, walking was achieved despite some degree of limping.

  4. Limb salvage treatment for congenital deficiency of the tibia.

    Science.gov (United States)

    Wada, Akifusa; Fujii, Toshio; Takamura, Kazuyuki; Yanagida, Haruhisa; Urano, Noriko; Yamaguchi, Toru

    2006-01-01

    Nine limb salvage treatments were performed in 7 patients with congenital deficiency of the tibia. All feet showed equinovarus deformity and were centralized in a slightly equinus position by placing the distal end of the fibula into the posterior facet of the calcaneus. Tibiofibular fusion was performed in 4 patients with partial deficiency, and fibular transfer (fibular centralization; Brown procedure) in 5 with complete deficiency of the tibia. Callus distraction lengthening was performed repeatedly for leg-length discrepancy on either the femur or the centralized fibula. Satisfactory functional and cosmetic results were obtained in all limbs with partial deficiency, whereas in limbs with completely deficiency, none of the 5 knees treated by fibular transfer achieved a satisfactory functional result because of insufficient quadriceps strength, progressive knee flexion contracture, and persistent ligamentous instability. Nevertheless, in these 5 cases, all patients were ultimately able to withstand weight-bearing.

  5. Chronic ankle instability: evaluation with stress radiography, CT and CT arthrography; Instabilite chronique externe de la cheville. Apport des radiographies dynamiques, de la tomodensitometrie et de l`arthro-tomodensitometrie

    Energy Technology Data Exchange (ETDEWEB)

    Faure, Ch.; Deplus, F.; Bochu, M. [Hopital Edouard-Herriot, 69 - Lyon (France); Besse, J.L.; Moyen, B. [Centre Hospitalier Lyon-Sud, 69 -Pierre-Benite (France)

    1997-09-01

    We retrospectively evaluated the anterior talo-fibular ligament and the tarsal sinus of 17 patients who had complained of chronic ankle external instability. This study based on both surgery and CT-arthrography findings shows the pathologic or normal aspects of the talo-fibular anterior ligament (normal, lax, fibrosis residue, ruptured). It confirms the good anatomic analysis of the tarsal sinus, i particular the anterior talo-calcaneal interosseous ligament and the search for fibrosis. We underline that capsular distension due to subtalar laxity is not detected with medical imaging. Compared with surgery (all patients), CT arthrography demonstrated the different aspects of the anterior talo fibular ligament injuries (normal, lax, discontinuous). (authors). 12 refs.

  6. Angiopoietin 2 expression in the cornea and its control of corneal neovascularisation.

    Science.gov (United States)

    Ferrari, Giulio; Giacomini, Chiara; Bignami, Fabio; Moi, Davide; Ranghetti, Anna; Doglioni, Claudio; Naldini, Luigi; Rama, Paolo; Mazzieri, Roberta

    2016-07-01

    To define proangiogenic angiopoietin 2 (ANG2) expression and role(s) in human and mouse vascularised corneas. Further, to evaluate the effect of ANG2 inhibition on corneal neovascularisation (CNV). CNV was induced in FVB mice by means of intrastromal suture placement. One group of animals was sacrificed 10 days later; corneas were immunostained for ANG2 and compared with (i) mouse non-vascularised corneas and (ii) human vascularised and non-vascularised corneas. A second group of CNV animals was treated systemically with an anti-ANG2 antibody. After 10 days, the corneas were whole-mounted, stained for CD31 and LYVE1 and lymphatic/blood vessels quantified. In another set of experiments, the corneal basal Bowman membrane was either (i) removed or (ii) left in place. After 2 or 10 days the corneas were removed and immunostained for collagen IV, ANG2, CD31, LYVE1, CD11b and MRC1 markers. In human beings and mice, ANG2 is expressed only in the epithelium, and, mildly, in the endothelium, of the avascular cornea. Instead, it is expressed in the epithelium, endothelium and stroma of vascularised corneas. Disruption of the Bowman membrane is associated with a significant increase of (i) ANG2 stromal expression and (ii) proangiogenic macrophage infiltration in the corneal stroma. Finally, blocking ANG2 significantly reduced hemangiogenesis, lymphangiogenesis and macrophage infiltration. Balancing proper healing and good vision is crucial in the cornea, constantly exposed to potential injuries. In this paper, we suggest the existence of a mechanism regulating the onset of inflammation (and associated CNV) depending on injury severity. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

  7. A new method for tibial torsion measurement by computerized tomography.

    Science.gov (United States)

    Madadi, Firooz; Madadi, Firoozeh; Maleki, Arash; Shamie, Arya Nick; Washington, Eleby Rudolph; Yazdanshenas, Hamed

    2016-03-01

    Computerized tomography (CT) is the gold standard technique for tibial torsion assessment. This study compared two methods of tibial torsion assessment and proposed a new method, which could be of value in cases of abnormal fibular changes. The CT-scanograms of 60 participants were assessed by using two different techniques, differed in determination of the distal tibial axis. The interobserver reliability was 0.861 and 0.863 in the first and second methods, respectively. The intraobserver reliability in both measurement methods was 0.868. We proposed a reliable method, independent of the fibular midpoint, in assessment of tibial torsion by CT.

  8. Compression Neuropathy of the Peroneal Nerve Secondary to a Ganglion Cyst

    Directory of Open Access Journals (Sweden)

    Eyup Cagatay Zengin

    2016-01-01

    Full Text Available An 43-year-old man presented to our outpatient clinic with a three-month history of pain over the fibular head area and gait difficulty and foot drop. Physical examination and electromyogram studies verified a peroneal nerve palsy. Magnetic resonance imaging revealed a lobulated, multilocular, cystic-appearing mass extending around the fibular neck. Surgical decompression of the nerve with removal of the mass and careful articular branch ligation was performed. Surgical pathology reports confirmed the diagnosis of a ganglion cyst. The patient regained full motor function within six months of the decompression.

  9. [A rare injury of the ankle in competition skiiers].

    Science.gov (United States)

    Fritschy, D

    1994-01-01

    Ankle ligamentous injuries have become rare since high and rigid boots are used in alpine skiing because tibio-talar and foot movements are almost impossible. However, in extreme competition conditions, external rotation of the ankle is possible in the ski boot. These are slalom accidents where the leg is forced suddenly in external rotation when straddling a gate. This movement leads to a collision between talus and distal fibula opening the tibio-fibular joint. The anterior tibio-fibular ligament is first torn. We report a series of 13 cases collected in a 17 years experience in the FIS-World Cup.

  10. Analgesic activity of crude aqueous extract of the root bark of ...

    African Journals Online (AJOL)

    Objective: The analgesic activity of crude aqueous extract of the root bark of Zanthoxylum xanthozyloides was studied in mice and rats with the view to verifying the claim in folklore medicine that the extract has analgesic activity. Method: The extract was obtained by Soxhlet extraction and rotatory evaporation, followed by ...

  11. Stress and Strain Gradients in a Low Carbon Steel Deformed under Heavy Sliding

    DEFF Research Database (Denmark)

    Zhang, Xiaodan; Hansen, Niels; Huang, Xiaoxu

    A recent study [1] has shown that a microstructure can be refined to a record low of 5 nm and that dislocation glide is still a controlling mechanism at this length scale. In this study, by heavy rotatory sliding of a low carbon steel a gradient structure has been produced extending to about 2.5 mm...

  12. Structure and Subunit Arrangement of the A-type ATP Synthase Complex from the Archaeon Methanococcus jannaschii Visualized by Electron Microscopy

    NARCIS (Netherlands)

    Coskun, Ünal; Chaban, Yuriy L.; Lingl, Astrid; Müller, Volker; Keegstra, Wilko; Boekema, Egbert J.; Grüber, Gerhard; Gruber, 27460

    2004-01-01

    In Archaea, bacteria, and eukarya, ATP provides metabolic energy for energy-dependent processes. It is synthesized by enzymes known as A-type or F-type ATP synthase, which are the smallest rotatory engines in nature. Here, we report the first projected structure of an intact A1A0 ATP synthase from

  13. Accurate measurement of the optical activity of alanine crystals and the determination of their absolute chirality

    Science.gov (United States)

    Ishikawa, Kazuhiko; Terasawa, Yukana; Tanaka, Masahito; Asahi, Toru

    2017-05-01

    Wavelength dependence measurements of the chiroptical properties in alanine crystals have so far been unsuccessful using conventional spectroscopic techniques. We describe our attempts to measure the wavelength dependence of the optical activity in L- and D-alanine crystals along each crystallographic axis, and to determine the absolute chirality of alanine crystals by correlating the absolute structure to the optical activity using an x-ray diffractometer and a generalized high accuracy universal polarimeter. We have succeeded in accurately measuring the optical rotatory dispersion in the direction, which shows that the optical rotation of the D-alanine crystal is dextrorotatory and that of the L-alanine crystal is laevorotatory, thereby determining the absolute chirality. Furthermore, comparison with the optical activity in solution shows that the optical activity in alanine crystals is different not only in value, but also in the sign. These results have led us to conclude that the optical rotatory power in the crystalline state should not be simply the summation of molecular optical rotatory power values. We propose the necessity of a theory, which contains the contribution of molecular interactions within the crystal, in order to calculate the optical rotatory power of the crystalline state.

  14. Effects of geometric ratios and fibre orientation on the natural ...

    African Journals Online (AJOL)

    The present investigation aims to examine the influence of geometric ratios and fibre orientation on the natural frequencies of fibre-reinforced laminated composite plates using finite element method based on Yang's theory and his collaborators. The transverse shear and rotatory inertia effects were taken into consideration ...

  15. Optical activity of chirally distorted nanocrystals

    Energy Technology Data Exchange (ETDEWEB)

    Tepliakov, Nikita V.; Baimuratov, Anvar S.; Baranov, Alexander V.; Fedorov, Anatoly V. [Department of Optical Physics and Modern Natural Science, ITMO University, Saint Petersburg 197101 (Russian Federation); Rukhlenko, Ivan D., E-mail: rukhlenko.ivan@gmail.com [Department of Optical Physics and Modern Natural Science, ITMO University, Saint Petersburg 197101 (Russian Federation); Monash University, Clayton Campus, Victoria 3800 (Australia)

    2016-05-21

    We develop a general theory of optical activity of semiconductor nanocrystals whose chirality is induced by a small perturbation of their otherwise achiral electronic subsystems. The optical activity is described using the quantum-mechanical expressions for the rotatory strengths and dissymmetry factors introduced by Rosenfeld. We show that the rotatory strengths of optically active transitions are decomposed on electric dipole and magnetic dipole contributions, which correspond to the electric dipole and magnetic dipole transitions between the unperturbed quantum states. Remarkably, while the two kinds of rotatory strengths are of the same order of magnitude, the corresponding dissymmetry factors can differ by a factor of 10{sup 5}. By maximizing the dissymmetry of magnetic dipole absorption one can significantly enhance the enantioselectivity in the interaction of semiconductor nanocrystals with circularly polarized light. This feature may advance chiral and analytical methods, which will benefit biophysics, chemistry, and pharmaceutical science. The developed theory is illustrated by an example of intraband transitions inside a semiconductor nanocuboid, whose rotatory strengths and dissymmetry factors are calculated analytically.

  16. Forearm Fractures in Children

    NARCIS (Netherlands)

    J.W. Colaris (Joost)

    2014-01-01

    markdownabstract__Abstract__ The forearm consists of the radius and ulna which are connected by the proximal and distal radioulnar joints, the interosseous membrane and several muscles. Forearm rotation, consisting of pronation and supination, is a rotatory motion of the radius around the ulna

  17. Dynamic Model of a Wind Turbine for the Electric Energy Generation

    Directory of Open Access Journals (Sweden)

    José de Jesús Rubio

    2014-01-01

    Full Text Available A novel dynamic model is introduced for the modeling of the wind turbine behavior. The objective of the wind turbine is the electric energy generation. The analytic model has the characteristic that considers a rotatory tower. Experiments show the validity of the proposed method.

  18. Page 1 Subject Index Large amplitude Effects of transverse shear ...

    Indian Academy of Sciences (India)

    Effects of transverse shear and rotatory inertia on large amplitude vibration of composite plates and shells 367. Loss of coolant accident. Safety of nuclear power plants 263. Markov chains. Computer-aided reliability analysis of fault- tolerant systems 209. Metal matrix composites. Recent research and development, future ...

  19. The Effect of Dextromethorphan on the Testes of Adult Sprague ...

    African Journals Online (AJOL)

    Dextromethorphan (DM) is a dextro-rotatory isomer of levophanol and a major constituent of over 125 over the counter (OTC) cough syrups. In-vivo and ex-vivo studies have shown that DM has pain suppressive properties comparable to ketamine via its N-methyl-D-Aspartate (NMDA) receptor antagonism. There is a wide ...

  20. The medial collateral ligament of the elbow joint

    DEFF Research Database (Denmark)

    Floris, S; Olsen, Bo Sanderhoff; Dalstra, Michel

    1998-01-01

    . On morphologic evaluation the MCL is divided into the anterior bundle and the posterior bundle. The anterior bundle can be divided into anterior and posterior bands. The maximum valgus and internal rotatory instability after transection of the anterior band, 11.7 degrees and 11.2 degrees, respectively, were...

  1. Dynamic response to moving concentrated masses of uniform ...

    African Journals Online (AJOL)

    ... moving force solution could be misleading. Also the analysis show that the response amplitudes of both moving force and moving mass problems decrease both with increasing Foundation modulus K and with increasing Rotatory inertia correction factor Ro. Journal of the Nigerian Association of Mathematical Physics Vol.

  2. Enkele toepassingen van de cupulometrie

    NARCIS (Netherlands)

    Vis, Kasper van der

    1955-01-01

    In this thesis an attempt is made to get a further insight into the clinical significance of cupulometria, the new vestibular turning tests as described by oan Egntond, Groen and Jongkees. In a short historical survey the development of the rotatory examination of the labyrinth is described, in

  3. Modified Pippard relationship describing the Raman frequency shifts ...

    Indian Academy of Sciences (India)

    1/)( /) for the rotatory lattice (librational) mode in ammonia solid II near its melting point. We have used our calculated Raman frequencies of this mode for pressures of 3.65, 5.02 and 6.57 kbars for this crystalline system. The values of ...

  4. Chondromyxoid fibroma of distal 1/3 rd of fibula a rare tumour at rare ...

    African Journals Online (AJOL)

    Chondromyxoid fibromas are rare, benign tumours account for <1% of primary bone neoplasms. Most commonly affected in 2nd and 3rdof life. We report one such case of chondromyxoid fibroma in distal fibula of a 15-year-old girl. The patient was managed with lower 3rd fibulectomy and fibular turnoplasty from middle 3rd ...

  5. Common peroneal nerve entrapment with the communication ...

    African Journals Online (AJOL)

    Sciatic nerve divides into tibial nerve and common peroneal nerve at the level of superior angle of popliteal fossa and variations in its branching pattern are common. The most common nerve entrapment syndrome in the lower limbs is common peroneal nerve entrapment at fibular head. Invariably it can also be trapped in ...

  6. Bilateral high division of the sciatic nerve: incidence and clinical ...

    African Journals Online (AJOL)

    Introduction: The sciatic nerve (L4-S3) comprised of the tibial and common fibular (peroneal) components contained in the same epineural sheath usually leaves the pelvis via the greater sciatic foramen beneath the piriformis muscle. They usually separate in the lower thigh above the popiteal fossa. Variations in this ...

  7. Anatomical variations in the level of bifurcation of the sciatic nerve in ...

    African Journals Online (AJOL)

    Background: The sciatic nerve, the largest nerve in the body is derived from the sacral plexus. It is composed of tibial and common fibular nerves; the division of this nerve varies; it may occur within the pelvis, gluteal region, upper, mid and lower part of thigh. Injury of the nerve may lead to loss of sensation in posterior thigh, ...

  8. * Department of Radiology, University of Benin Teaching Hospital ...

    African Journals Online (AJOL)

    Department of Radiology, University of Benin Teaching Hospital, Benin City, Edo State,. Nigeria. **Department of Radiodiagnosis, Lagos University Teaching Hospital, Idi-Araba, Lagos, Nigeria. ABSTRACT. Fibular hemimelia is the congenital absence of the fibula and it is the most common congenital absence of long.

  9. Experience with Perforator Based Flaps for Wound Cover of the Leg ...

    African Journals Online (AJOL)

    Background: Open fractures of the distal third of the tibia and fibular offer a challenge to the orthopedic surgeon because of skin coverage. The reconstructive surgeon's help is often required in trying to achieve this. There are several options: - local flap, free flap or a cross leg flap. Local flaps have always had limitations ...

  10. An Irreducible Ankle Fracture Dislocation: The Bosworth Injury

    NARCIS (Netherlands)

    T. Schepers (Tim); T. Hagenaars (Tjebbe); D. den Hartog (Dennis)

    2012-01-01

    textabstractIrreducible fracture dislocations of the ankle are rare and represent true orthopedic emergencies. We present a case of a fracture dislocation that was irreducible owing to a fixed dislocation of the proximal fibular fragment posterior to the lateral ridge of the tibia. This particular

  11. Evaluation of the lower limb vasculature before free fibula flap transfer. A prospective blinded comparison between magnetic resonance angiography and digital subtraction angiography

    NARCIS (Netherlands)

    Klein, Steven; Van Lienden, Krijn P; Van't Veer, Marcel; Smit, Jeroen M; Werker, Paul M N

    2013-01-01

    Introduction The aim of this study was to compare magnetic resonance angiography (MRA) with digital subtraction angiography (DSA) in the preoperative assessment of crural arteries and their skin perforators prior to free fibular transfer. Patients and methods Fifteen consecutive patients, scheduled

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

    African Journals Online (AJOL)

    2010-06-29

    Jun 29, 2010 ... The patients were exposed to the same postoperative. ABSTRACT. Objectives: The level of fibular ... was exposed subperiosteally and 1 cm of it was resected using a bone cutter. The wound was then .... and Ebraheim,[1] have observed that in cadavers, the peroneal nerve and its branches are at the ...

  13. 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.

  14. A modified Larson’s method of posterolateral corner reconstruction of the knee reproducing the physiological tensioning pattern of the lateral collateral and popliteofibular ligaments

    Directory of Open Access Journals (Sweden)

    Niki Yasuo

    2012-06-01

    Full Text Available Abstract Background Consensus has been lacking as to how to reconstruct the posterolateral corner (PLC of the knee in patients with posterolateral instability. We describe a new reconstructive technique for PLC based on Larson's method, which reflects the physiological load-sharing pattern of the lateral collateral ligament (LCL and popliteofibular ligament (PFL. Findings Semitendinosus graft is harvested, and one limb of the graft comprises PFL and the other comprises LCL. Femoral bone tunnels for the LCL and popliteus tendon are made at their anatomical insertions. Fibular bone tunnel is prepared from the anatomical insertion of the LCL to the proximal posteromedial portion of the fibular head, which corresponds to the insertion of the PFL. The graft end for popliteus tendon is delivered into the femoral bone tunnel and secured on the medial femoral condyle. The other end for LCL is passed through the fibular tunnel from posterior to anterior. While the knee is held in 90 of flexion, the graft is secured in the fibular tunnel using a 5 mm interference screw. Then, the LCL end is passed into the femoral bone tunnel and secured at the knee in extension. Conclusions Differential tension patterns between LCL and PFL is critical when securing these graft limbs. Intrafibular fixation of the graft using a small interference screw allows us to secure these two graft limbs independently with intended tension at the intended flexion angle of the knee.

  15. A new locus for postaxial polydactyly type A/B on chromosome 7q21-q34.

    NARCIS (Netherlands)

    Galjaard, R.J.; Smits, A.P.T.; Tuerlings, J.H.A.M.; Bais, A.G.; Bertolli Avella, A.M.; Breedveld, G.J.; Graaff, E. de; Oostra, B.A.; Heutink, P.

    2003-01-01

    Postaxial polydactyly (PAP) is the occurrence of one or more extra ulnar or fibular digits or parts of it. In PAP-A, the extra digit is fully developed and articulates with the fifth or an additional metacarpal/metatarsal, while it is rudimentary in PAP-B. Isolated PAP usually segregates as an

  16. Isolated postaxial polydactyly type B with mosaicism of a submicroscopic unbalanced translocation leading to an extended phenotype in offspring.

    NARCIS (Netherlands)

    Galjaard, R.J.; Linde, H. van der; Eussen, B.H.; Vries, L.B.A. de; Wouters, C.W.; Oostra, B.A.; Graaff, E. de; Heutink, P.

    2003-01-01

    Postaxial polydactyly (PAP) is characterized by the presence of one or more extra ulnar or fibular digits or parts of it. PAP type B presents frequently as a skin tag on the hand(s). It is usually an isolated malformation, but in 6.6% it is associated with other congenital abnormalities, mostly well

  17. Valgusdeformitet i anklen som følge af distal fibula-epifysefraktur

    DEFF Research Database (Denmark)

    Al-Aubaidi, Zaid

    2011-01-01

    Ankle fracture with involvement of the growth plate is the second most common paediatric fracture after the distal radius. The most common fracture type according to Salter Harris (SH) is type II of the distal tibia combined with green stick of the fibula. Isolated fracture of the distal fibular...

  18. Disease: H00846 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available H00846 Fuhrmann syndrome; Fibular aplasia or hypoplasia, femoral bowing and poly-,... syn-, and oligodactyly Fuhrmann syndrome is a non-lethal limb malformation disorder with various degrees of limb aplasia/hypoplasia... and joint dysplasia. Major manifestations include hypoplasia of the pelvis, aplasia or hypoplasia

  19. The mangled lower leg

    NARCIS (Netherlands)

    Hoogendoorn, Jochem Maarten

    2002-01-01

    A surgeon faced with a patient presenting with an open tibial/fibular fracture in combination with severe damage of the surrounding soft tissues, has to make the difficult decision whether to attempt salvage or to perform an immediate amputation of the leg. Until late in the nineteenth century the

  20. Small saphenous vein: where does reflux go?

    Directory of Open Access Journals (Sweden)

    Guillermo Gustavo Rossi

    2013-06-01

    Full Text Available BACKGROUND: The anatomy of small saphenous vein (SSV is very variable because of its complex embryological origin. SSV incompetence often causes reflux that goes to the perforating veins, sometimes not respecting the anatomical course. OBJECTIVE: To analyze differences in reflux direction and reentry in the SSV. METHODS: In this prospective, observational study, 60 lower limbs with SSV incompetence of 43 patients were assessed using a color Doppler ultrasound protocol. RESULTS: Reentry variations were grouped into four types and subtypes. Percentage results were: Type A, perforating veins on the medial side = 25/60 cases (41.66%; subtypes: Cockett, Sherman, paratibial and vertex; Type B, lateral malleolus and perforating veins on the lateral side (fibular 17-26 cm = 15/60 cases (25%; subtypes: fibular and malleolus; Type C, two branches = 19/60 cases (31.66%; subtypes: gastrocnemius and Cockett, gastrocnemius and malleolus, and/or fibular, Cockett and malleolus, Cockett-vertex and fibular; Type D, reflux in the superficial system = 1/60 cases (1.66%. CONCLUSION: On most of the lower limbs assessed, reflux did not follow the classical anatomic course. Our findings demonstrated a high degree of variation in reflux/reentry, but no SSV anatomical variations. Reflux seems to, either look for the most accessible anatomical connection for reentry or be originated in the distal area and then reach the SSV.

  1. Computed Tomography Assessment of Peroneal Tendon Displacement and Posteromedial Structure Entrapment in Pilon Fractures.

    Science.gov (United States)

    Fokin, Alex; Huntley, Samuel R; Summers, Spencer H; Lawrie, Charles M; Miranda, Alejandro D; Caban-Martinez, Alberto J; Steinlauf, Steven D

    2016-11-01

    To determine the proportion of (1) peroneal tendon displacement (PTD) and posteromedial structure entrapment (PMSE) cases in a sample of pilon fractures, (2) missed diagnoses of PTD and PMSE on computed tomography (CT) by radiologists and attending orthopaedic trauma surgeons, and PTD and PMSE cases by (3) OTA/AO classification, and (4) fibular fracture. Retrospective cohort review. Regional level 1 Trauma Center. Two hundred patients treated between July 2008 and November 2014. Axial and reconstructed CT images were used in bone and soft tissue windows to identify PTD and PMSE. Medical charts were reviewed to identify OTA/AO fracture classification, the presence of concomitant fibular fracture, whether radiologist CT interpretation noted PTD or PMSE, and whether attending orthopaedic trauma surgeons' operative notes mentioned recognition of and management of PTD or PMSE. From the retrospective review of CT, PTD was identified in 11.0% and PMSE in 19.0% of all pilon fractures. Of the 22 patients with PTD, 59.1% sustained a concomitant fibular fracture and 90.9% sustained a 43-C fracture. Patients with PTD sustained more 43-C fractures (90.9% vs. 62.9%) but significantly fewer fibular fractures (59.1% vs. 80.3%; P = 0.023) than patients without PTD. Of the 38 patients with PMSE, 81.6% sustained a fibular fracture and 86.8% sustained a 43-C fracture. PMSE was more common in patients with 43-C fractures (86.8% vs. 61.1%). The final preoperative radiologist CT interpretation commented on PTD and PMSE in 50.0% of cases. Higher energy pilon fractures (43-C) are associated with higher incidence of PMSE and PTD. Concomitant fibula fracture may play a protective role in PTD in the setting of pilon fractures. Both attending radiologists and attending orthopaedic trauma surgeons frequently fail to recognize the diagnoses of PTD and PMSE. Prognostic level III. See Instructions for Authors for a complete description of levels of evidence.

  2. Correlation of histology of healed fractures and tissue surrounding implants with ultrasonographic and radiographic appearance.

    Science.gov (United States)

    Risselada, M; van Bree, H; Kramer, M; Chiers, K; Duchateau, L; Verleyen, P

    2008-05-01

    To determine if there was histological correlation with ultrasonographic images of healed fractures and implant-associated tissue after fracture treatment by plate osteotomy. Eight adult dogs were included in this retrospective study. Ultrasonography (B-mode and power Doppler) and radiography were performed before plate removal. Surgical biopsies were taken of the fracture site and the tissue adjacent to the plate. These were stained with haematoxylin and eosin to assess histomorphology and bone content and immunolabelled with CD31 to assess vascularity. Ultrasound and radiographic diagnoses of a healed fracture correlated with histological finding of bone healing. Ultrasonography and histology findings of vascularity were also highly correlated. The tissue surrounding the surgical implants was significantly more vascularised on both ultrasonography and histology than that at the fracture site itself. Ultrasonography can be used to diagnose fracture healing in plated fractures. Power Doppler ultrasonography examination of fracture healing should be performed away from surgical implants to avoid false-positive results of vascularisation.

  3. [POSSIBILITIES OF VACUUM THERAPY APPLICATION IN DISORDERS OF VENOUS OUTFLOW IN ISLET GRAFTS].

    Science.gov (United States)

    Badyul, P O; Samoylenko, G E; Nor, N M; Slesarenko, K S

    2015-07-01

    The experience of "distressed" (problematic) flaps application in 33 patients with soft tissue defects over 2010-2014 years were analysed. It was proposed to use the local negative pressure for the prevention and treatment of complications associated with venous insufficiency or trombosis in using of plastics with vascularised complexes of tissues. Vacuum-therapy was conducted with the help of negative pressure apparatus "AGATE-Dnepr" (Ukraine) by attaching silver-containing polyurethane sponge on the operating zone, covering the flap with the surrounding skin netting band "Grassolind". The recommended standard of negative pressure of 75-125 mm Hg, both in impulse and in continuous mode was used. The high efficiency of vacuum-therapy for survival of grafts has been demonstrated. Thus, it might be considered as an effective element of prevention and treatment of complications associated with venous insufficiency or trombosis using of vascularised tissue complex plastics of defects.

  4. Longitudinal three-dimensional visualisation of autoimmune diabetes by functional optical coherence imaging

    DEFF Research Database (Denmark)

    Berclaz, Corinne; Schmidt-Christensen, Anja; Szlag, Daniel

    2016-01-01

    AIMS/HYPOTHESIS: It is generally accepted that structural and functional quantitative imaging of individual islets would be beneficial to elucidate the pathogenesis of type 1 diabetes. We here introduce functional optical coherence imaging (FOCI) for fast, label-free monitoring of beta cell...... tomographic acquisition. In addition, the phase sensitivity allows simultaneous label-free acquisition of vascularisation. RESULTS: We demonstrate that FOCI allows longitudinal quantification of progressive autoimmune insulitis, including the three-dimensional quantification of beta cell volume, inflammation...... and vascularisation. The substantially increased backscattering of islets is dominated by the insulin-zinc nanocrystals in the beta cell granules. This translates into a high specificity for the functional beta cell volume of islets. Applying FOCI to a spontaneous mouse model of type 1 diabetes, we quantify...

  5. Amniotic membrane transplantation for acute ocular chemical burns in a child.

    Science.gov (United States)

    Thanikachalam, S; Kaliaperumal, Subashini; Srinivasan, Renuka; Sahu, Pramod Kumar

    2011-08-01

    An ocular burn injury with calcium hydroxide with opaque cornea and limbal ischaemia of more than 270 degrees which was treated byamniotic membrane transplantation on the 6th day following injury is reported. Postoperatively the ocular surface remained stable with no inflammation, vascularisation or infection. Amniotic membrane restored conjunctival surface much earlier than corneal surface and prevented symblepharon formation. We believe that amniotic membrane transplantation may be considered in acute phase of severe chemical injury for a more favourable prognosis.

  6. Case report

    African Journals Online (AJOL)

    abp

    Les pseudarthroses de l'extrémité distale du fémur sont relativement rares du fait de la qualité de la vascularisation de cette région. La prise en charge d'une telle complication pose un certain nombre de difficultés. Le traitement chirurgical fait appel à plusieurs techniques conservatrices, le traitement par prothèse peut ...

  7. Alternaria Keratitis after Deep Anterior Lamellar Keratoplasty

    OpenAIRE

    Mekhla Naik; Mohd. Shahbaaz,; Jay Sheth; Sunderamoorthy, S. K.

    2014-01-01

    To describe a case of Alternaria keratitis in a 30-year-old male patient who presented with bilateral vascularised central corneal opacity and underwent deep anterior lamellar keratoplasty (DALK) in the left eye. Patient was treated for recurrent epithelial defect with a bandage contact lens in the follow-up visits after DALK. Subsequently, patient presented with pigmented fungal keratitis, which on culture examination of the corneal scrapping demonstrated Alternaria species. Patient had to u...

  8. The role of fibrinolysis inhibition in engineered vascular networks derived from endothelial cells and adipose-derived stem cells.

    Science.gov (United States)

    Mühleder, Severin; Pill, Karoline; Schaupper, Mira; Labuda, Krystyna; Priglinger, Eleni; Hofbauer, Pablo; Charwat, Verena; Marx, Uwe; Redl, Heinz; Holnthoner, Wolfgang

    2018-02-12

    Co-cultures of endothelial cells with mesenchymal stem cells currently represent one of the most promising approaches in providing oxygen and nutrient supply for microvascular tissue engineering. Still, to translate this model into clinics several in vitro parameters including growth medium and scaffold degradation need to be fine-tuned. We recently described the co-culture of adipose-derived stem cells with endothelial cells in fibrin, resulting in capillary formation in vitro as well as their perfusion in vivo. Here, we aimed to further characterise microvascular tube formation in fibrin by determining the role of scaffold degradation, thrombin concentration and culture conditions on vascularisation. We observed that inhibition of cell-mediated fibrin degradation by the commonly used inhibitor aprotinin resulted in impaired vascular network formation. Aprotinin had no effect on laminin and collagen type IV deposition or formation of tube-like structures in scaffold-free co-culture, indicating that poor vascularisation of fibrin clots is primarily caused by inhibition of plasminogen-driven fibrinolysis. Co-culture in plasminogen- and factor XIII-depleted fibrin did not result in different vascular network density compared to controls. Furthermore, we demonstrate that thrombin negatively affects vascular network density at high concentrations. However, only transient activation of incorporated endothelial cells by thrombin could be observed, thus excluding a long-term inflammatory response in tissue-engineered micro-capillaries. Finally, we show that vascularisation of fibrin scaffolds in basal medium is undermined because of increased fibrinolytic activity leading to scaffold destabilisation without aprotinin. Taken together, our data reveal a critical role of fibrinolysis inhibition in in vitro cell-mediated vascularisation of fibrin scaffolds.

  9. Infliximab treatment in a case of rheumatoid scleromalacia perforans

    Directory of Open Access Journals (Sweden)

    R. Herrera-Esparza

    2011-06-01

    Full Text Available Rheumatoid disease can cause ocular inflammation of the conjunctiva, sclera, and uveal tract. The sclera is an avascular layer covered by the episclera that is highly vascularised and can be affected by inflammation. Frequently, ophthalmic involvement in rheumatoid arthritis (RA and spondyloartrhophaties results of a systemic and chronic inflammation that can produce devastating effects. Clinically, episcleritis looks similar to conjunctivitis, although there is no discharge. A common symptom of episcleritis is redness, and patients may also complain of foreign body...

  10. Rôle de la plasticité vasculaire dans le remodelage musculaire chez l’enfant

    OpenAIRE

    Gitiaux, Cyril

    2015-01-01

    Skeletal muscle is highly vascularised. Beyond oxygen and nutriment supply, new functions for vessels have been recently identified, through the interactions that vessel cells (endothelial cells) establish with muscle cells, particularly with muscle stem cells (satellite cells). These latter closely interact with endothelial cells for their expansion and their differentiation, then with periendothelial cells for their self-renewal and return to quiescence. During skeletal muscle regeneration ...

  11. Longitudinal three-dimensional visualisation of autoimmune diabetes by functional optical coherence imaging.

    Science.gov (United States)

    Berclaz, Corinne; Schmidt-Christensen, Anja; Szlag, Daniel; Extermann, Jerome; Hansen, Lisbeth; Bouwens, Arno; Villiger, Martin; Goulley, Joan; Schuit, Frans; Grapin-Botton, Anne; Lasser, Theo; Holmberg, Dan

    2016-03-01

    It is generally accepted that structural and functional quantitative imaging of individual islets would be beneficial to elucidate the pathogenesis of type 1 diabetes. We here introduce functional optical coherence imaging (FOCI) for fast, label-free monitoring of beta cell destruction and associated alterations of islet vascularisation. NOD mouse and human islets transplanted into the anterior chamber of the eye (ACE) were imaged with FOCI, in which the optical contrast of FOCI is based on intrinsic variations of the index of refraction resulting in a faster tomographic acquisition. In addition, the phase sensitivity allows simultaneous label-free acquisition of vascularisation. We demonstrate that FOCI allows longitudinal quantification of progressive autoimmune insulitis, including the three-dimensional quantification of beta cell volume, inflammation and vascularisation. The substantially increased backscattering of islets is dominated by the insulin-zinc nanocrystals in the beta cell granules. This translates into a high specificity for the functional beta cell volume of islets. Applying FOCI to a spontaneous mouse model of type 1 diabetes, we quantify the modifications of the pancreatic microvasculature accompanying the progression of diabetes and reveal a strong correlation between increasing insulitis and density of the vascular network of the islet. FOCI provides a novel imaging technique for investigating functional and structural diabetes-induced alterations of the islets. The label-free detection of beta cell volume and infiltration together with vascularisation offers a unique extension to study ACE-transplanted human islets. These results are contributing to a deeper understanding of human islet transplant rejection and label-free in vivo monitoring of drug efficacy.

  12. Thérapie génique de l'angiogenèse tumorale ciblée par des cellules endothéliales immatures

    OpenAIRE

    Collet, Guillaume

    2012-01-01

    Vascular endothelial growth factors (VEGFs) are over-expressed upon hypoxia in solid tumors. Major actors directing pathologic neo-vascularisation, they regulate the stromal reaction. Novel strategies that target and inhibit VEGF bring promise to modern anti-cancer therapies. They aim to control rather than destroy tumor angiogenesis. Consequently, the challenge is to selectively trap VEGFs, over-produced upon hypoxia, in the tumor microenvironment. The thesis presented in this manuscript foc...

  13. The pro-angiogenic properties of multi-functional bioactive glass composite scaffolds

    KAUST Repository

    Gerhardt, Lutz Christian

    2011-06-01

    The angiogenic properties of micron-sized (m-BG) and nano-sized (n-BG) bioactive glass (BG) filled poly(D,L lactide) (PDLLA) composites were investigated. On the basis of cell culture work investigating the secretion of vascular endothelial growth factor (VEGF) by human fibroblasts in contact with composite films (0, 5, 10, 20 wt %), porous 3D composite scaffolds, optimised with respect to the BG filler content capable of inducing angiogenic response, were produced. The in vivo vascularisation of the scaffolds was studied in a rat animal model and quantified using stereological analyses. The prepared scaffolds had high porosities (81-93%), permeability (k = 5.4-8.6 × 10-9 m2) and compressive strength values (0.4-1.6 MPa) all in the range of trabecular bone. On composite films containing 20 wt % m-BG or n-BG, human fibroblasts produced 5 times higher VEGF than on pure PDLLA films. After 8 weeks of implantation, m-BG and n-BG containing scaffolds were well-infiltrated with newly formed tissue and demonstrated higher vascularisation and percentage blood vessel to tissue (11.6-15.1%) than PDLLA scaffolds (8.5%). This work thus shows potential for the regeneration of hard-soft tissue defects and increased bone formation arising from enhanced vascularisation of the construct. © 2011 Elsevier Ltd.

  14. Comparison of prognostic value of Roper Hall and Dua classification systems in acute ocular burns.

    Science.gov (United States)

    Gupta, Noopur; Kalaivani, Mani; Tandon, Radhika

    2011-02-01

    To compare the predictive outcome of ocular burns using two different prognostic classification systems, that is, Dua and Roper Hall classification. In a prospective, randomised, controlled clinical trial, the extent of acute ocular burns in 100 patients was graded by Roper Hall and Dua classifications. Patients were randomised in two groups of 50 each to receive conventional medical therapy alone or additional amniotic membrane transplantation (AMT). Moderate burns were graded similarly (grade II and III) under both systems, while severe burns were classified differently and compared further. Baseline parameters (size of epithelial defect, corneal haze, limbal ischaemia, conjunctival involvement and visual acuity) and outcome variables (healing of epithelial defect, corneal clarity, corneal vascularisation, visual outcome and symblepharon) after 1 year were noted and compared. There was no difference in terms of time taken and rate of healing of epithelial defect, but there was a significant difference in extent of corneal vascularisation between grades IV, V and VI (pburns than either grade V (p=0.045) or grade VI (p=0.024) burns, and final visual acuity was significantly better in these patients (p=0.043). On comparison of patients with grade IV burns (with and without AMT), the outcome in terms of extent of corneal vascularisation was significantly better (p=0.0124) in patients who received AMT. Dua classification by providing further subclassification of grade IV ocular burns by Roper Hall into three separate grades has a superior prognostic predictive value in severe ocular burns.

  15. The role of the anterolateral ligament in ACL insufficient and reconstructed knees on rotary stability

    DEFF Research Database (Denmark)

    Tavlo, Mette; Eljaja, S; Tranum-Jensen, Jørgen

    2016-01-01

    Studies suggest that the anterolateral ligament (ALL) is important for knee stability. The purpose was to clarify ALL's effect on rotatory and anterior-posterior stability in the anterior cruciate ligament (ACL)-insufficient and reconstructed knees and the effect of reconstruction...... of an insufficient ALL. Eighteen cadaveric knees were included. Stability was tested for intact (+ALL), detached (-ALL) and reconstructed (+ reALL) ALL, with ACL removed (-ACL) and reconstructed (+ACL) in six combinations. All were tested in 0, 30, 60, and 90 °C flexion. Anterior-posterior stability was measured...... with a rolimeter. Rotation with a torque of 8.85 Nm was measured photographically. The ALL was well defined in 78% of knees. ACL reconstruction had a significant effect on anterior-posterior stability. Detaching the ALL had a significant effect on internal rotatory stability and on anterior-posterior stability...

  16. Eye movement analysis system using computerized image recognition.

    Science.gov (United States)

    Yamanobe, S; Taira, S; Morizono, T; Yagi, T; Kamio, T

    1990-03-01

    A new technique for an eye movement analysis system utilizing infrared video recording and a computerized image recognition method is presented. The system consists of an infrared lighting apparatus, a very small infrared video charge-coupled device camera, a video tape recorder, an analogue-digital converter, and microcomputers. This system makes it possible to simultaneously analyze the slow-phase velocity quantitatively not only of the horizontal and vertical but also of the rotatory components of the energy-induced nystagmus. The maximum slow-phase velocity of the rotatory component of energy-induced nystagmus was found to be 4.1 degrees per second on an average in this study.

  17. The anterolateral complex of the knee: a pictorial essay.

    Science.gov (United States)

    Herbst, Elmar; Albers, Marcio; Burnham, Jeremy M; Shaikh, Humza S; Naendrup, Jan-Hendrik; Fu, Freddie H; Musahl, Volker

    2017-04-01

    Injuries to the anterolateral complex of the knee can result in increased rotatory knee instability. However, to diagnose and treat patients with persistent instability properly, surgeons need to understand the multifactorial genesis as well as the complex anatomy of the anterolateral aspect of the knee in its entirety. While recent research focused primarily on one structure (anterolateral ligament-ALL), the purpose of this pictorial essay is to provide a detailed layer-by-layer description of the anterolateral complex of the knee, consisting of the iliotibial band with its superficial, middle, deep, and capsulo-osseous layer as well as the anterolateral joint capsule. This may help surgeons to not only understand the anatomy of this particular part of the knee, but may also provide guidance when performing extra-articular procedures in patients with rotatory knee instability. Level of evidence V.

  18. Svimmelhed, der er relateret til øjensygdomme

    DEFF Research Database (Denmark)

    Lund-Andersen, Henrik

    2013-01-01

    Dizziness stands for vertigo (rotatory and nautic) and dysbalance/unstability. Vertigo originates from the vestibular central nervous system; no eye disease, but nystagmus is often present. Dysbalance/unstability: normal ophthalmological findings exclude ophthalmological pathogenesis. Ophthalmolo......Dizziness stands for vertigo (rotatory and nautic) and dysbalance/unstability. Vertigo originates from the vestibular central nervous system; no eye disease, but nystagmus is often present. Dysbalance/unstability: normal ophthalmological findings exclude ophthalmological pathogenesis....... Ophthalmological pathology, especially recently developed may be involved. Uncorrected glasses, eye drops (by systemic absorption), flickering light, and migraine may also cause dysbalance/unstability. Rapid referral to specialist is recommended by fast development of: decreased visual acuity, visual field defects...

  19. Management of complex elbow dislocations: a mechanistic approach.

    Science.gov (United States)

    Wyrick, John D; Dailey, Steven K; Gunzenhaeuser, Jacob M; Casstevens, E Christopher

    2015-05-01

    Complex elbow dislocations (ie, fracture-dislocations) are challenging injuries to treat and may result in significant patient morbidity. Chronic instability, posttraumatic arthrosis, and poor functional outcomes are frequent. Orthopaedic surgeons should strive to optimize elbow function through restoration of articular congruity and stability coupled with early rehabilitation. Although most of these injuries require surgical management, not all complex elbow dislocations are equivalent. Understanding elbow biomechanics and the injury mechanism provides valuable insight into the variations of pathology that may be observed. Identifying the particular fracture pattern, such as an axial loading, valgus posterolateral rotatory, or varus posteromedial rotatory injury mechanism, helps guide appropriate treatment. Copyright 2015 by the American Academy of Orthopaedic Surgeons.

  20. Agarsenone, a Cadinane Sesquiterpenoid from Commiphora erythraea.

    Science.gov (United States)

    Santoro, Stefano; Superchi, Stefano; Messina, Federica; Santoro, Ernesto; Rosati, Ornelio; Santi, Claudio; Marcotullio, M Carla

    2013-07-26

    Agarsenone (1), a new cadinane sesquiterpenoid, was isolated from the resin of Commiphora erythraea. The structures of 1 and its decomposition products agarsenolides (2a and 2b) and myrrhone (3) were established by extensive NMR spectroscopic analysis. The absolute configuration of 3 and the relative and absolute configurations of 1 were assigned by comparison of experimental and calculated optical rotatory dispersion and electronic circular dichroism spectra.

  1. Knee Dislocation: A Case Report, Diagnostic Vascular Work-Up, and Literature Review

    Directory of Open Access Journals (Sweden)

    Matthijs R. Douma

    2017-01-01

    Full Text Available Knee dislocation is an uncommon, potentially limb-threatening, knee injury. Most often caused by high-velocity trauma, it can also result from low- or even ultra-low-velocity trauma. Rapid identification of the injury, reduction, and definitive management are necessary to minimize neurovascular damage. We present a case of rotatory anterolateral knee dislocation sustained during a twisting sports-related event. Special emphasis is placed on diagnosing vascular injuries associated with knee dislocations.

  2. The influence of a vestibular dysfunction on the motor development of hearing-impaired children.

    Science.gov (United States)

    De Kegel, Alexandra; Maes, Leen; Baetens, Tina; Dhooge, Ingeborg; Van Waelvelde, Hilde

    2012-12-01

    To identify the predictive ability of vestibular function test results on motor performance among hearing-impaired children. Cross-sectional study. Fifty-one typically developing children and 48 children with a unilateral (n = 9) or bilateral hearing impairment (n = 39) of more than 40 dB HL between 3 and 12 years were tested by the Movement Assessment Battery for Children-Second Edition (M ABC-2), clinical balance tests, posturography, rotatory chair testing, and vestibular evoked myogenic potential (VEMP). From the group of hearing-impaired children, 23 had cochlear implants. Balance performance on M ABC-2, clinical balance tests, as well as the sway velocity assessed by posturography in bipedal stance on a cushion with eyes closed and in unilateral stance differed significantly between both groups. Presence of a VEMP response is an important clinical parameter because comparison of the motor performance among hearing-impaired children between those with present and absent VEMPs showed significant differences in balance performance. The three most important predictor variables on motor performance by bivariate regression analyses are the vestibular-ocular reflex (VOR) gain value of the rotatory chair test at 0.01 and 0.05 Hz frequency, as well as the VEMP asymmetry ratio. Multivariate regression analyses suggest that the VOR asymmetry value of the rotatory chair test at 0.05 Hz and the etiology of the hearing loss seem to have additional predictive value. Hearing-impaired children are at risk for balance deficits. A combination of rotatory chair testing and VEMP testing can predict the balance performance. Copyright © 2012 The American Laryngological, Rhinological, and Otological Society, Inc.

  3. 6ESI_Revised

    Indian Academy of Sciences (India)

    The ethereal layer was washed with water and dried over anhydrous Na2SO4. It was concentrated to dryness on a rotatory evaporator and crude product chromatographed on silica using hexane: ethyl acetate (8:2) as the eluent. Yield: 70% (4.82 g). Anal. Calc. for C10H8N2O: C, 69.74; H, 4.69; N, 16.28%. Found: C, 69.49 ...

  4. Modified Pippard relationship describing the Raman frequency shifts ...

    Indian Academy of Sciences (India)

    Unknown

    Abstract. We relate in this study the thermal expansivity, αP, to the Raman frequency shift (1/ν)(∂ν/∂P)T for the rotatory lattice (librational) mode in ammonia solid II near its melting point. We have used our calculated Raman frequencies of this mode for pressures of 3⋅65, 5⋅02 and 6⋅57 kbars for this crystalline system.

  5. Basic biomechanic principles of knee instability

    OpenAIRE

    Zlotnicki, Jason P.; Naendrup, Jan-Hendrik; Ferrer, Gerald A.; Debski, Richard E.

    2016-01-01

    Motion at the knee joint is a complex mechanical phenomenon. Stability is provided by a combination of static and dynamic structures that work in concert to prevent excessive movement or instability that is inherent in various knee injuries. The anterior cruciate ligament (ACL) is a main stabilizer of the knee, providing both translational and rotatory constraint. Despite the high volume of research directed at native ACL function, pathogenesis and surgical reconstruction of this structure, a...

  6. [Grisel's syndrome after otoplasty].

    Science.gov (United States)

    Durst, F; Staudenmaier, R; Pilge, H; Lauen, J; Prodinger, P; Holzapfel, K; Pickhard, A

    2012-02-01

    Grisel's syndrome is known as a very rare complication of ENT surgery. It is described as non-traumatic atlantoaxial rotatory subluxation, often seen after tonsillectomy or adenoidectomy in children. Therapy is staged according to the Fielding classification. We report the case of a 9-year-old female patient with Grisel's syndrome after otoplasty. The diagnosis was confirmed by CT scan. Manual reposition was performed under general anaesthesia, followed by temporary immobilization with a Minerva orthesis.

  7. Effect of geometric nonlinearity on the free flexural vibrations of moderately thick rectangular plates

    Science.gov (United States)

    Raju, K. K.; Rao, G. V.; Raju, I. S.

    1978-01-01

    The effect of geometric nonlinearity on the free flexural vibrations of moderately thick rectangular plates is studied in this paper. Finite element formulation is employed to obtain the non-linear to linear period ratios for some rectangular plates. A conforming finite element of rectangular shape wherein the effects of shear deformation and rotatory inertia are included, is developed and used for the analysis. Results are presented for both simply supported and clamped boundary conditions.

  8. Analysis of functional CT scan in cervical vertebral disease

    Energy Technology Data Exchange (ETDEWEB)

    Hirofuji, Eiichi; Tanaka, Seisuke; Tomihara, Mitsuo; Kita, Hiroshi; Yamasaki, Hiroyuki

    1982-12-01

    The atlantoaxial joint showed displacement in various directions in rheumatoid arthritis and cervical spondylosis. The displacements were promoted by anterior flexion and rotatory movements, exerting great influences on the spnial cord. The intervertebral space between the 5th and 6th vertebra showed narrowing of the vertebral canal in cervical spondylosis and was promoted by posterior flexion to affect the spinal cord to a great extent. Functional CT scan was useful for observation of pathologic conditions of vertebral diseases.

  9. Functional anatomy of the lateral collateral ligament complex of the elbow

    DEFF Research Database (Denmark)

    Seki, Atsuhito; Olsen, Bo Sanderhoff; Jensen, Steen Lund

    2002-01-01

    significant laxity to torque in external rotation with a mean 8.5 degree at 40 degree of flexion. No significant laxity was observed during application of valgus or internal rotational torque. Further transection of the posterior band resulted in gross instability with dislocation of the ulnohumeral joint...... of conjoint point is hypothesized for the function of the LCL complex to restrain posterolateral rotatory instability....

  10. An Evaluation of the Correlation between the Free Moments Applied on the Lower Extremity and the Knee Extensor Mechanism Force in Pronated Foot Subjects during the Stance Phase of Gait

    OpenAIRE

    Farzaneh Yazdani; Mohsen Razeghi; Samaneh Ebrahimi

    2016-01-01

    Background: Due to the rotatory nature of the excessive subtalar pronation and the possible impairment of the tibial rotation-knee flexion mechanism, changes of the free moment (FM) and changes of the extensor mechanism force are expected in hyper-pronated foot subjects. The purpose of this study was to evaluate the correlation between the FM applied on the lower extremity and the knee extensor mechanism force in subjects with flexible pronated feet. Methods: Fifteen asympto...

  11. AB-INITIO CALCULATION OF ELECTRONIC CIRCULAR-DICHROISM FOR TRANS-CYCLOOCTENE USING LONDON ATOMIC ORBITALS

    DEFF Research Database (Denmark)

    Bak, Keld L.; Hansen, Aage E.; Ruud, K.

    1995-01-01

    The second-quantization magnetic dipole operator that arises when London atomic orbitals are used as basis functions is derived. In atomic units, the magnetic dipole operator is defined as the negative of the first derivative of the electronic Hamiltonian containing the interaction with the exter......The second-quantization magnetic dipole operator that arises when London atomic orbitals are used as basis functions is derived. In atomic units, the magnetic dipole operator is defined as the negative of the first derivative of the electronic Hamiltonian containing the interaction...... that the length expression for the rotatory strength in linear response calculations gives gauge-origin-independent results. Sample calculations on ti ans-cyclooctene and its fragments are presented. Compared to conventional orbitals, the basis set convergence of the rotatory strengths calculated in the length...... form using London atomic orbitals is favourable. The rotatory strength calculated for trans-cyclooctene agrees nicely with the corresponding experimental circular dichroism spectrum, but the spectra for the fragment molecules show little resemblance with that of trans-cyclooctene....

  12. Traumatic atlantoaxial dislocation with Hangman fracture.

    Science.gov (United States)

    Chaudhary, Saad B; Martinez, Maximilian; Shah, Neel P; Vives, Michael J

    2015-04-01

    Traumatic bilateral-atlantoaxial dislocations are rare injuries. Hangman fractures, conversely, represent 4% to 7% of all cervical fractures and frequently involve a combination C1-C2 fracture pattern. Presently, there is no report in the English literature of a traumatic C2-spondylolisthesis associated with a C1-C2 rotatory dislocation. This injury complex cannot be cataloged using current classification schemes and no established treatment recommendations exist. To report a unique case of a Hangman fracture associated with bilateral C1-C2 rotatory-dislocation, which does not fit into existing classification systems, and discuss our treatment approach. A clinical case report and review of the literature. Chart review and analysis of relevant literature. There were no study-specific conflicts of interest. A 26-year-old man sustained a traumatic C2-spondylolisthesis along with C1-C2 rotatory subluxation in an automobile collision. The patient was originally placed in a halo crown and vest and then taken for an open reduction and stabilization through a posterior approach for persistent C1-C2 subluxation. The patient is currently 16 months postoperative and back to work as a plumber. The injury complex encountered cannot be described using the available classification systems. Our treatment included initial stabilization with halo placement, followed by a posterior C1, C2, and C3 segmental reduction and fixation resulting in radiographic fusion and a good clinical outcome. Copyright © 2015 Elsevier Inc. All rights reserved.

  13. Clinical features of otolith organ-specific vestibular dysfunction.

    Science.gov (United States)

    Fujimoto, Chisato; Suzuki, Sayaka; Kinoshita, Makoto; Egami, Naoya; Sugasawa, Keiko; Iwasaki, Shinichi

    2018-01-01

    To elucidate the clinical features and vestibular symptoms of patients with otolith organ dysfunction in the presence of normal function of the semicircular canals. We reviewed the clinical records of 277 consecutive new patients with balance disorders who underwent testing of cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) as well as caloric testing and video head impulse testing (vHIT). We identified 76 patients who showed normal caloric responses and normal vHIT findings in each SCC plane, but abnormal responses in cVEMP and/or oVEMP testing. Benign paroxysmal positional vertigo (BPPV) was the most common diagnosis. 37% of patients could not be categorized into any of the established clinical entities that could cause a balance disorder and did not show sensorineural hearing loss. The most common clinical manifestation in the idiopathic cases was recurrent rotatory vertigo with a duration of 1-12 h. The most common diagnosis of otolith organ-specific vestibular dysfunction was BPPV. The most common clinical manifestation in the idiopathic cases was recurrent rotatory vertigo. Specific dysfunction of the otolith organs occurs in association with some of the undiagnosed patients with recurrent rotatory vertigo. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

  14. A Toddler with Bilateral Fractures of the Fibula.

    Science.gov (United States)

    Haygood, Tamara Miner; Wong, Jason; Kumar, Rajendra; John, Susan

    2009-01-01

    Stress fractures are uncommon, and bilateral stress fractures are rare. The diagnosis of stress fracture can be difficult as conventional radiographs usually show evidence of the fracture repair instead of the fracture. A stress fracture must be differentiated from more serious processes, particularly osteomyelitis and bone malignancies. In young children there may be no obvious cause, and imaging can greatly facilitate the diagnosis. We present a case of a toddler referred for evaluation for a possible bone malignancy but who was diagnosed with bilateral fibular stress fractures. Only one case of bilateral fibular stress fracture has been described in a toddler. However, unlike this case, our patient lacked an apparent explanation for the injury.

  15. [Retrograde nailing in a tibial fracture].

    Science.gov (United States)

    Valls-Mellado, M; Martí-Garín, D; Fillat-Gomà, F; Marcano-Fernández, F A; González-Vargas, J A

    2014-01-01

    We describe a case of a severely comminuted type iiia open tibial fracture, with distal loss of bone stock (7 cm), total involvement of the tibial joint surface, and severe instability of the fibular-talar joint. The treatment performed consisted of thorough cleansing, placing a retrograde reamed calcaneal-talar-tibial nail with proximal and distal blockage, as well as a fibular-talar Kirschner nail. Primary closure of the skin was achieved. After 3 weeks, an autologous iliac crest bone graft was performed to fill the bone defect, and the endomedullary nail, which had protruded distally was reimpacted and dynamized distally. The bone defect was eventually consolidated after 16 weeks. Currently, the patient can walk without pain the tibial-astragal arthrodesis is consolidated. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  16. Primary Osteosarcoma of the Distal Fibula treated with Distal Fibulectomy with a Five-Year Follow-up: A Case Report

    Directory of Open Access Journals (Sweden)

    Saadon I

    2017-07-01

    Full Text Available Musculoskeletal tumours of the lower limbs especially malignant tumours are not common. The fibula is the site of primary bone tumours as reported in 2.4% of lower limb tumours with the proximal third being more frequently involved than the distal segment. Osteosarcoma is the most common primary malignant bone tumour of non- haematopoietic origin, with distal fibular involvement in 0.47% of patients. The advances in imaging techniques and neo-adjuvant chemotherapy have now made it possible to accurately define the extent of tumour and plan limb salvage with tumour resection. The purpose of this case report is to highlight the successful outcome of limb salvage procedure with a five year follow up in an 11-year old boy with distal fibular osteosarcoma. Limb salvage surgery with distal fibulectomy and retention of the foot are a good alternative to radical amputation.

  17. Nerve conduction studies in spastic paraplegia, optic atrophy, and neuropathy (SPOAN) syndrome.

    Science.gov (United States)

    Amorim, Simone; Heise, Carlos Otto; Santos, Silvana; Macedo-Souza, Lúcia Ines; Zatz, Mayana; Kok, Fernando

    2014-01-01

    SPOAN (spastic paraplegia, optic atrophy, and neuropathy) syndrome is an autosomal recessive neurodegenerative disorder identified in a large consanguineous Brazilian family. Twenty-seven patients with SPOAN syndrome (20 women), aged 4-58 years, underwent nerve conduction studies (NCS) of the median, ulnar, tibial, and fibular nerves, and sensory NCS of the median, ulnar, radial, sural, and superficial fibular nerves. Sensory nerve action potentials were absent in the lower limbs and absent in >80% of upper limbs. Motor NCS had reduced amplitudes and borderline velocities in the upper limbs and absent compound muscle action potentials (CMAPs) in the lower limbs. The neuropathy in SPOAN syndrome is a severe, early-onset sensory-motor axonal polyneuropathy. Normal NCS seem to rule-out this condition. Copyright © 2013 Wiley Periodicals, Inc.

  18. Surface Projection of Interosseous Foramen of the Leg: Cadaver Study

    OpenAIRE

    Eric Arguello; Carissa Stoddard; Hao Liu; Mike Richardson; Andrea Hartis

    2016-01-01

    Purpose. This study was conducted to identify the surface projection of the interosseous foramen and associated structures of the proximal leg using the average clinician's thumb width as a quick measurement to assist in differential diagnosis and treatment. Methods. Twelve cadavers (5 males and 7 females, age range = 51?91 years, and mean age = 76.9) were dissected for analysis. Location and size of interosseous foramen, location of anterior tibial artery, location of deep fibular nerve, and...

  19. Transmalleolar Approach for Arthroscopy-Assisted Headless Screw Fixation of an Osteochondral Talar Dome Fracture.

    Science.gov (United States)

    Izadi, Ebrahim; Anwar, Rahij; Phillips, Sarah; Kavarthapu, Venu

    2018-02-15

    Displaced osteochondral fractures of the body of talus quite often require a malleolar osteotomy to gain access to the fracture fragment during internal fixation. We describe a case report in which access to a displaced osteochondral fracture of the lateral talar dome was achieved using an arthroscopy-assisted fibular tunnel approach. This technique resulted in satisfactory fracture healing and a satisfactory clinical outcome. Copyright © 2017 The American College of Foot and Ankle Surgeons. All rights reserved.

  20. Intermediate ray deficiency?a new type of lower limb hypoplasia

    OpenAIRE

    Koczewski, Pawe?; Shadi, Milud; Kotwicki, Tomasz; Tomaszewski ,Marek; Korbel, Krzysztof

    2012-01-01

    Objective Diagnosis of fibular hemimelia is based on the identification of absence or shortening of the fibula in relation to the tibia. Despite the existence of different classifications of this congenital deficiency, certain morphological forms defy proper classification. One such form is absence of foot rays with leg shortening in the presence of an entire fibula. In these cases, foot morphology suggests that central foot rays, not lateral ones, are affected by the deficiency; thus justify...

  1. Leg perforators and leg length: an anatomic study focusing on topography and angiogenesis.

    Science.gov (United States)

    Boriani, Filippo; Bruschi, Stefano; Fraccalvieri, Marco; Cipriani, Riccardo

    2010-07-01

    The highly variable anatomic distribution of lower leg perforators is explored, with a standardization based on leg length. The possibility of a correlation between leg length and number of perforators is investigated. Twenty-two lower limbs of cadavers were utilized for an anatomic study on the leg perforators branching from the three major vascular axes, anterior tibial, posterior tibial, and fibular. The parameters considered were the number of vascular pedicles per each major axis, the caliber, the distance of the fascial hole from the bony landmark (knee joint line), and the route of the vessels (muscular, septal). Arteries taken into account had a caliber of 0.5 mm or greater, with a maximum of 1.7 and a mean of 0.78. The perforators of the anterior tibial artery distribute along the entire length of the leg, but the peak of concentration is between second and third tenth and around the middle tenth. The fibular system provides perforators between the fourth and seventh tenth. The posterior tibial perforators concentrate to the middle third and to the supramalleolar region. A correlation exists between leg length and number of perforating vessels for the tibial vascular systems, possibly due to neoangiogenesis during growth, at the level of the metaphyseal plates. On the contrary no relationship was noticed for the fibular artery, whose perforators concentrate far from the growth cartilages. Some tenths where perforators concentrate are identifiable. Tibial systems have a perforator incidence depending on leg length, which, on the contrary, does not influence the number of fibular perforators. (c) 2010 Wiley-Liss, Inc.

  2. Hypertrophy and pseudohypertrophy of the lower leg following chronic radiculopathy and neuropathy: imaging findings in two patients

    Energy Technology Data Exchange (ETDEWEB)

    Beuckeleer, L. de; Schepper, A. de [Department of Radiology, University Hospital Antwerp, Edegem (Netherlands); Vanhoenacker, F. [Department of Radiology, University Hospital Antwerp, Edegem (Netherlands)]|[Department of Radiology, AZ St. Maarten, Campus Duffel, Duffel (Belgium); Schepper, A. Jr. de [Department of Radiology, University Hospital Antwerp, Edegem (Netherlands)]|[Department of Radiology, AZ Middelheim, Antwerpen (Belgium); Seynaeve, P. [Department of Radiology, AZ Middelheim, Antwerpen (Belgium)

    1999-04-01

    Enlargement of the ipsilateral muscle compartment is an exceptional finding in patients with chronic radiculopathy, peripheral nerve injury, anterior horn cell diseases, or acquired peripheral neuropathy. We report radiographic, ultrasonographic, CT and MRI findings in a patient with chronic S1 radiculopathy and another with chronic neuropathy of the common fibular nerve (L4-S2), both presenting with painless enlargement of the calf muscles. (orig.) With 2 figs., 7 refs.

  3. Isolated lateral collateral ligament complex injury in rock climbing and Brazilian Jiu-jitsu.

    Science.gov (United States)

    Davis, Bryan A; Hiller, Lucas P; Imbesi, Steven G; Chang, Eric Y

    2015-08-01

    We report two occurrences of high-grade tears of the lateral collateral ligament complex (LCLC), consisting of the anterolateral ligament (ALL) and fibular collateral ligament (FCL). One injury occurred in a rock climber and the other in a martial artist. Increasing awareness of isolated injuries of the LCLC will allow for appropriate diagnosis and management. We review and discuss the anatomy of the LCLC, the unique mechanism of isolated injury, as well as physical and imaging examination findings.

  4. Isolated Proximal Tibiofibular Dislocation during Soccer

    Directory of Open Access Journals (Sweden)

    Casey Chiu

    2015-01-01

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

  5. Calcifications simulating peroneus longus tendinitis

    Energy Technology Data Exchange (ETDEWEB)

    Carvalho, A. de; Illum, F.; Joergensen, J.

    1984-06-01

    In two patients with sprains of the ankle joint calcification adjacent to the posterior tibial margin was evident in the lateral projection of a standard radiographic examination. Calcifying peroneus longus tendinitis was suggested. Further tangential views and computed tomography (CT) scan disclosed, however, that the calcifications in both patients were located in the tibial insertion of the posterior and inferior tibio-fibular ligament. In such cases, a correct diagnosis will avoid unnecessary treatment for a non-existent tendinitis.

  6. Disease: H00846 [KEGG MEDICUS

    Lifescience Database Archive (English)

    Full Text Available H00846 Fuhrmann syndrome; Fibular aplasia or hypoplasia, femoral bowing and poly-, ...syn-, and oligodactyly Fuhrmann syndrome is a non-lethal limb malformation disorder with various degrees of limb aplasia/hypoplasia... and joint dysplasia. Major manifestations include hypoplasia of the pelvis, aplasia or hypoplasia... of fibulae, severe bowing of femora, absence of nails, and polydactyly. Skeletal dysplasia...ption) Fuhrmann W, Fuhrmann-Rieger A, de Sousa F Poly-, syn- and oligodactylyl, aplasia or hypoplasia of fibula, hypoplasia

  7. Anatomical popliteofibular ligament reconstruction of the knee joints: an all-arthroscopic technique.

    Science.gov (United States)

    Song, Guan-Yang; Zhang, Hui; Zhang, Jin; Li, Yue; Feng, Hua

    2015-10-01

    Injuries to the posterolateral corner of the knee present with variable injury patterns that have produced a number of reconstructive procedures in the literature. The present paper describes an all-arthroscopic technique that anatomically reconstructs the popliteofibular ligament (PFL) using either a semitendinosus autograft or an anterior tibialis allograft. During the surgery, the fibular insertion site as well as the distal portion of PFL is feasible to be identified under arthroscopy without any additional skin incision. Level of evidence V.

  8. Dimensions and attachments of the ankle ligaments: evaluation for ligament reconstruction.

    Science.gov (United States)

    Wenny, Raphael; Duscher, Dominik; Meytap, Emmy; Weninger, Patrick; Hirtler, Lena

    2015-06-01

    For operative reconstruction, precise anatomic information on the dimensions of the ankle ligaments is important and can help to optimize these procedures. The purpose of this study was to investigate the length and width dimensions of the ankle ligaments and to contrast the results with the published literature. Seventeen non-paired adult, formalin-fixed ankle specimen were dissected to expose the capsuloligamentous structures. The following ligaments were investigated: tibiofibular syndesmosis (anterior and posterior tibiofibular ligament/ATiFL and PTiFL), lateral ankle ligaments (anterior and posterior talofibular ligament, calcaneofibular ligament/ATFL, PTFL and CFL), medial ankle ligaments (deltoid ligament, anterior and posterior tibiotalar ligament/ATTL and PTTL). After identification of the ligaments, the dimensions were measured with a ruler and a sliding caliper. Additionally, the attachment area and the center of insertion (COI) were evaluated. The dimensions of the ligaments were recorded. Measurements were calculated and discussed according to the existing literature. The tibial COI of the ATiFL was situated 8.35 ± 2.05 mm from the inferior articular surface of the tibia and 5.04 ± 1.32 mm from the fibular notch. Its fibular COI was situated 25.45 ± 5.84 mm from the tip of the lateral malleolus and 3.12 ± 1.01 mm from the malleolar articular surface. The calcaneal COI of the CFL was situated 20.63 ± 3.56 mm anterior and 5.73 ± 1.89 mm plantar to the superior edge of the calcaneal. Its fibular attachment of the CFL was directly at the tip of the lateral malleolus, dorsal to the fibular attachment of the ATFL. Studies of the therapeutic options in severe ankle ligament injuries have shown better results in anatomical reconstructions compared to other operative treatments. To optimize these procedures, exact anatomical information on the dimensions of the ankle ligaments should be beneficial.

  9. Foot neuropathy in rheumatoid arthritis patients: clinical, electrophysiological, and ultrasound studies

    Directory of Open Access Journals (Sweden)

    Abd El-Samad I El-Hewala

    2016-01-01

    Conclusion Peripheral nerve affection is common in the rheumatoid foot, irrespective of the disease activity status. The most common neuropathies were posterior tarsal tunnel syndrome, peroneal nerve entrapment at the fibular neck, and pure sensory axonal neuropathy. A positive power Doppler signal and bone erosions of the ankle joint, detected by MSUS, were associated with RA disease activity. Electrophysiology was superior to MSUS for the diagnosis of posterior tarsal tunnel syndrome.

  10. Exercise Related Leg Pain (ERLP): a Review of The Literature

    OpenAIRE

    Reinking, Mark F.

    2007-01-01

    Exercise related leg pain (ERLP) is a regional pain syndrome described as pain between the knee and ankle which occurs with exercise. Indiscriminant use of terminology such as “shin splints” has resulted in ongoing confusion regarding the pathoanatomic entities associated with this pain syndrome. Each of the pathoanatomic entities – medial tibial stress syndrome, chronic exertional compartment syndrome, tibial and fibular stress fractures, tendinopathy, nerve entrapment, and vascular patholog...

  11. Oromandibular reconstruction with chimeric double-skin paddle flap based on peroneal vessel axis for synchronous opposite double oral cancer.

    Science.gov (United States)

    Huang, Shih-Tsai; Liu, Wen-Chung; Chen, Lee-Wei; Yang, Kuo-Chung

    2015-05-01

    Synchronous double oral cancer represents the minority of cases of head and neck cancer. After tumor ablation, 2 separate oromandibular defects, even combined with a through-and-through oral defect, pose a serious reconstructive challenge. The ideal method for reconstruction remains controversial. Based on the peroneal vessel axis, a chimeric double-skin paddle peroneal fasciocutaneous or fibular osteomyocutaneous flap could be designed to accomplish the difficult reconstruction. Six male patients, each with 2 separate oromandibular defects after tumor ablation of synchronous double oral cancer, received double-skin paddle flap reconstruction with 3 peroneal fasciocutaneous and 3 fibular osteomyocutaneous flaps. All 6 flaps survived; however, complications included 1 skin paddle lost due to insufficient perfusion of a visible perforator, and 1 superficial necrosis occurring over the tip of a longer skin paddle. One postoperative intraoral infection and 1 donor site infection were also reported. During follow-up, 3 months later, 1 patient succumbed to local recurrence and bony metastasis. One patient developed a new cancer in the maxillary gingiva, and another had osteoradionecrosis 8 months later. Four patients gained acceptable cosmesis with good oral competence. A chimeric flap based on the peroneal artery could provide a segment of fibular bone, 1 or 2 skin paddles, and a cuff of the flexor hallucis longus muscle simultaneously. For 1-stage reconstruction of separate oromandibular defects after tumor ablation of synchronous double oral cancer, this design could provide all components at 1 transfer.

  12. Aneurysmal Bone Cyst In Metacarpal of a Child

    Directory of Open Access Journals (Sweden)

    Pankaj Singh

    2013-10-01

    Full Text Available Introduction: Aneurysmal bone cyst is a rare, rapidly growing, and destructive benign bone tumor that rarely involves the bones of the hand. Various treatment options for aneurysmal bone cyst have been reported in the literature, but controversy exists regarding optimal treatment. Case Report: A six year old boy presented with a history of pain and local swelling over his third metacarpal of five months’ duration. Physical and radiographic examination of the hand was consistent with aneurysmal bone cyst. After biopsy, pathologic examination confirmed the diagnosis of aneurysmal bone cyst. En- block resection of the tumor and autologous fibular strut graft fixation with Kirschner wires was performed. The hand was immobilized in a short arm cast for three weeks; after the patient received three weeks of physiotherapy, the kirschner wires were removed six weeks postoperatively. Excellent clinical and functional results were obtained with no recurrence after two years of follow-up with en-block resection and reconstruction by autologous graft. Conclusion: Aneurysmal bone cyst in third metacarpal of child of age six is rare entity and decision making for management poses difficulties. Our experience with En-block resection of tumor and autologus fibular sturt grafting was quite satisfactory with excellent clinical result, and we recommend this is as one modality of treatment of ABC in metacarpal of child. Keywords: Aneurysmal Bone cyst; metacarpal; child; fibular graft.

  13. Distraction osteogenesis of free flap reconstructed mandible following ameloblastoma resection for optimal functional rehabilitation

    Science.gov (United States)

    Bousdras, V. A.; Kalavrezos, N.

    2014-01-01

    This case highlights the use of a custom-made distractor (Synthes GmbH, Oberdorf, Switzerland), used to increase bone height prior to rehabilitation with implant placement, in a patient following excision of an ameloblastoma and reconstruction of her mandible with a fibular flap. A 27-year-old patient had her mandible reconstructed following wide resection of an ameloblastoma. Although a 2.0 LOCK reconstruction plate (Synthes GmbH, Oberdorf, Switzerland) was used for fixation of the fibular bone, the vertical deficiency between the reconstructed segment and the occlusal plane made oral rehabilitation impossible. To overcome this, the fibular bone segment was vertically distracted following a latency period of 4 days. Distractor was left in place for 20 weeks for bone consolidation. Following device removal implants were placed. The novelty of this approach included fixation of the lower arm of the distractor on the LOCK plate. The distractor was unidirectional with two arms of different length. The lower arm composed of a 2.0 mini-plate to fit exactly on the 2.0 LOCK plate whereas the upper arm used a standard 1.5 mini-plate. Advantages of this custom-made distractor included: (i) No need for removal of the reconstruction plate, (ii) no need for an extraoral surgical approach, and (iii) no need for additional drilling to fit the lower arm of the distractor. Technical details and limitations are presented. PMID:25593885

  14. Salvage of humeral nonunions with onlay bone plate allograft augmentation.

    Science.gov (United States)

    Hornicek, F J; Zych, G A; Hutson, J J; Malinin, T I

    2001-05-01

    Eight women and one man were treated for 10 established diaphyseal humeral nonunions. Six patients sustained fractures in motor vehicle accidents and two patients sustained fractures in a fall. Two of the fractures were open. One patient with multiple myeloma originally was treated conservatively and received local radiation, followed by open reduction and internal plate fixation. The other patients previously were treated with fracture braces, intramedullary nails, dynamic compression plates, or a combination of these techniques. After removal of the surgical hardware and fibrous tissue at the nonunion site, stable fixation was accomplished using a cortical long bone plate allograft (femoral and tibial) or fibular shaft allograft and a dynamic compression plate. All humeral nonunions had united at an average of 2.9 months. Radiographic incorporation of the allograft cortical bone plate and fibular shaft into the host cortex occurred in all but one patient by 3 months. Graft to host junction healing was accomplished by incorporation of the cortical allograft plate into the host cortex, resulting in an increased diameter of the bone. Cortical allograft bone plates and fibular grafts provide structural and probably osteoinductive support to enhance healing of these nonunions.

  15. Radiology of postnatal skeletal development. Pt. 9

    Energy Technology Data Exchange (ETDEWEB)

    Ogden, J.A.

    1984-03-01

    Ossification usually begins in the proximal tibia within the first three months following birth. The initial secondary ossification is centrally located and spherical. Expansion and maturation then changes the ossification center to a more elliptical shape. Variability in this expansion medially and laterally may create marginal irregularity in the first few years, followed by a smooth border by five to six years. Subsequently ossification extends into the tibial spines as a single conical mass which eventually divides into two separate extensions. The physis remains relatively transverse throughout development although contouring occurs under each tibial weight-bearing compartment. Peripheral lappet formation appears within a few months. Anteriorly there is an undulation at the site of the cartilaginous tibial tuberosity. The proximal fibular physis begins as a transverse contour, but changes to one with peripheral lappet formation and multiple undulations. Secondary ossification begins just above the physis and extends proximally into the rest of the physis. However, the fibular styloid, similar to the ulnar styloid, does not ossify until late in skeletal maturation. The proximal fibular physis usually is situated 5 to 10 mm distal to the tibial physis. The tibiofibular joint morphology has considerable morphologic variation, and the joint may communicate with the knee joint.

  16. Differential diagnosis and recovery of acute bilateral foot drop in a patient with a history of low back pain: A case report.

    Science.gov (United States)

    Lomaglio, Melanie; Canale, Bob

    2017-06-01

    Acute bilateral foot drop is rare and may be due to peripheral or central lesions. The purpose of this case report was to describe the differential diagnosis and recovery of a patient with low back pain (LBP) that awoke with bilateral foot drop. A 39-year-old man with a history of LBP awoke with a steppage gait pattern. Spinal imaging and tapping were negative for sinister pathologies. A subsequent history taken by the physical therapist uncovered that the patient had previously taken a narcotic and slept in a kneeling position to relieve his LBP. Strength and sensory testing revealed isolated impairments in the fibular nerve distribution, and bilateral fibular palsy was suspected and later confirmed with electrophysiological studies. Surgical fibular nerve decompression was performed, and the patient underwent physical therapy. Five months later the patient demonstrated antigravity strength and a partial return of sensation. By 17 months, his Lower Extremity Functional Scale had improved from 17/80 to 78/80, revealing a near complete recovery. The patient's history of LBP was a "red herring" that delayed the diagnosis and caused undue stress to the patient. This case stresses the importance of a thorough history and clinical examination.

  17. Amniotic membrane transplantation as an adjunct to medical therapy in acute ocular burns.

    Science.gov (United States)

    Tandon, Radhika; Gupta, Noopur; Kalaivani, Mani; Sharma, Namrata; Titiyal, Jeewan S; Vajpayee, Rasik B

    2011-02-01

    To evaluate the role of amniotic membrane transplantation in patients with acute ocular burns. In a prospective, randomised, controlled clinical trial, 100 patients with grade II to IV acute ocular burns (Roper Hall Classification) were recruited. 50 patients with grade II-III burns were graded as moderate burns, and 50 patients with grade IV burns were graded as severe burns. Both groups were individually randomised into control group (n=25) and study group (n=25). The corresponding grade of ocular surface burn by Dua classification was noted. The eyes in the study group underwent amniotic membrane transplantation in addition to conventional medical therapy. In the control group, conventional medical therapy along with mechanical release of early adhesions as and when necessary was instituted. Rate of healing of corneal epithelial defect, visual acuity, extent of corneal vascularisation, corneal clarity and formation of symblepharon were compared in both groups. In patients with moderate ocular burns treated with amniotic membrane transplantation, the rate of epithelial healing was significantly better than the group treated with standard medical therapy alone (p=0.0004). There was no overall difference in the final visual outcome, symblepharon formation, corneal clarity and vascularisation with or without amniotic membrane transplantation. Amniotic membrane transplantation in eyes with acute ocular burns promotes faster healing of epithelial defect in patients with moderate grade burns. There seems to be no definite long-term advantage of amniotic membrane transplantation over medical therapy and mechanical release of adhesions in terms of final visual outcome, appearance of symblepharon and corneal vascularisation when compared in a controlled clinical setting.

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

    Energy Technology Data Exchange (ETDEWEB)

    Schoierer, Oliver; Bender, Daniel; Schmidmaier, Gerhard [University Hospital Heidelberg, Heidelberg Trauma Research Group, Department of Orthopaedic and Trauma Surgery, Heidelberg (Germany); Bloess, Konstantin; Kauczor, Hans-Ulrich; Weber, Marc-Andre [University Hospital Heidelberg, Department of Diagnostic and Interventional Radiology, Heidelberg (Germany); Burkholder, Iris [University of Applied Sciences of the Saarland, Department of Nursing and Health, Saarbruecken (Germany)

    2014-02-15

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

  19. Tooth morphology, implantation and replacement system of Hoplias malabaricus (Teleostei, Characiformes, Erythrinidae

    Directory of Open Access Journals (Sweden)

    RM. Hassunuma

    Full Text Available The oropharyngeal cavity of Hoplias malabaricus, an ichthyophagous freshwater fish, is anatomically adapted to predation. Macroscopic and microscopic analyses were conducted in order to study the morphology and system of implantation and replacement of teeth. The results showed that this teleost has conical and caniniform teeth, with an orthodentin crown covered by an enameloid cap and a vascularised orthodentin in the root. With regard to the implantation system, there is a junction between the tooth and the bone tissue, as a typical physiological dental ankylosis. The teeth are replaced by a resorption process of multinucleated giant cells that actively eliminate the dentin and bone tissue.

  20. Utility of color Doppler transrectal ultrasound in the diagnosis of prostate cancer: a study of 101 cases; Utilidad de la ecografia transrectal con Doppler color en el diagnostico del cancer de prostata. Estudio de 101 casos

    Energy Technology Data Exchange (ETDEWEB)

    Morales, F. J.; Jornet, J.; Cervera, J.; Labrador, T. [Instituto Valenciano de Oncologia. Valencia (Spain)

    2001-07-01

    To determine the value of color Doppler ultrasound in the detection of prostate cancer. To relate asymmetries in vascularisation with the results of directed biopsy. Between May and November 2000, we studied 101 patients suspected of having prostate cancer. The selection criteria were a prostate-specific antigen level of over 3 ng/ml, suspicious digital rectal examination or both. The volume, capsule and internal architecture were assessed, focusing on nodules, suspicious hypoechoic areas and asymmetric color intensity. Sextant biopsies were carried out with an 18-gauge needle and samples were also taken of the areas of increased color intensity. (Author) 16 refs.

  1. Vascularization of soft tissue engineering constructs

    DEFF Research Database (Denmark)

    Pimentel Carletto, Rodrigo

    with mechanical properties in the range of soft tissues has not been fully achieved. My project focused on the fabrication and the active perfusion of hydrogel constructs with multi-dimensional vasculature and controlled mechanical properties targeting soft tissues. Specifically, the initial part of the research...... nanotechnology-based paradigm for engineering vascularised liver tissue for transplantation”) and the Danish National Research Foundation and Villum Foundation’s Center for Intelligent Drug delivery and sensing Using microcontainers and Nanomechanics (Danish National Research Foundation (DNRF122)....

  2. [Color Doppler sonography of focal abdominal lesions].

    Science.gov (United States)

    Licanin, Zoran; Lincender, Lidija; Djurović, V; Salihefendić, Nizama; Smajlović, Fahrudin

    2004-01-01

    Color Doppler sonography (CDS--spectral, color and power), harmonic imaging techniques (THI, PHI), possibility of 3D analysis of picture, usage of contrast agents, have raised the values of ultrasound as a diagnostic method to a very high level. THI--non-linear gray scale modality, is based on the processing of higher reflected frequencies, that has improved a picture resolution, which is presented with less artifacts and limiting effects of obesity and gases. Ultrasound contrast agents improve analysis of micro and macro circulation of the examined area, and with the assessment of velocity of supply in ROI (wash in), distribution and time of signal weakening (wash out), are significantly increasing diagnostic value of ultrasound. Besides the anatomical and topographic presentation of examined region (color, power), Color Doppler sonography gives us haemodynamic-functional information on vascularisation of that region, as well as on pathologic vascularisation if present. Avascular aspect of a focal pathologic lesion corresponds to a cyst or haematoma, while coloration and positive spectral curve discover that anechogenic lesions actually represents aneurysms, pseudoaneurysms or AVF. In local inflammatory lesion, abscess in an acute phase, CDS shows first increased, and then decreased central perfusion, while in a chronic phase, a pericapsular vascularisation is present. Contribution of CDS in differentiation of hepatic tumors (hemangioma, HCC and metastasis) is very significant. Central color dots along the peripheral blood vessels and the blush phenomenon are characteristics of capillary hemangioma, peritumoral vascular ring "basket" of HCC, and "detour" sign of metastasis. The central artery, RI from 0.45 to 0.60 and radial spreading characterize FNH. Hepatic adenoma is characterized by an intratumoral vein, and rarely by a vascular hallo. Further on, blood velocity in tumor defined by Color Doppler, distinguishes malignant from benign lesion, where 40 cm/s is a

  3. [The application of highly hydrophilic contact lenses in the Fuchs-Steven-Johnson syndrome (author's transl)].

    Science.gov (United States)

    Schulz, E

    1979-01-01

    In 3 patients with status after Fuchs-Steven-Johnson syndrome highly hydrophilic contact lenses (72% H2O-up take) were adapted and worn permanently. 2 patients had worn already for a long time usual HEMA-lenses. The lenses showed themselves to be favorable against mechanical irritation from cilia and accessory eyelashes and from scarring conjunctival conditions, and they affected favorably the signs of dessication of the cornea. Corneal defects healed, and the patients had subjectively no complaints. It is sometimes necessary to replace the tears. An increase in the corneal vascularisation already present could not be observed during the 18 months observation time.

  4. Not just a red eye.

    Science.gov (United States)

    Juniat, Valerie; Andrew, Nigel

    2014-04-03

    A 70-year-old woman presented to the Eye Casualty department with a 10-day history of worsening pain and redness in her right eye, associated with progressively reduced vision. History revealed that the patient had recently completed a course of chemotherapy for metastatic breast cancer. Anterior examination of the right eye revealed a vascularised iris mass causing pupillary distortion, intraocular inflammation and raised intraocular pressure. She was diagnosed with a right iris metastasis secondary to breast cancer. Ocular management consisted of topical steroids and intraocular pressure-lowering agents, which improved her ocular symptoms. She subsequently received primary radiotherapy, which has successfully reduced the size of the tumour.

  5. [Multiple non-responding ESWL lithiasis in ectopic pelvic kidney: laparotomic surgical management].

    Science.gov (United States)

    Abed El Rahman, D; Zanetti, G; Cozzi, G; Cozzi, L A; Abed El Rahman, S; Maggioni, A; Rocco, F

    2010-01-01

    A 34 year-old male with multiple lithiasis of ectopic pelvic left kidney, which for 5 years had been causing pain in the left iliac region irradiating to ipsilateral inguinal region and testis. 4 ESWL treatments were unsuccessful. The diagnostic imaging (Angio-CT + Uro-CT) showed ectopic pelvic left kidney with abnormal vascularisation, characterised by multiple lithiasis extending in total area of 4x2 cm with shorter ureter. Right kidney was in normal position. A left pyelocalicolithotomy after DJ stent positioning was performed.

  6. Syrian war shrapnel injury: cubital nerve defect grafting during humanitarian surgical mission. Clinical case presentation

    Directory of Open Access Journals (Sweden)

    Argentina Vidrașcu

    2016-07-01

    Full Text Available Background and aim of this clinical case presentation is to reveal the importance of early nerve injury diagnosis and surgical treatment in war wounded patients. Methods. The author treated patients in Amman Charity Hospital were among different plastic surgery cases where limb nerve injuries with nerve grafting indication. The presented case was treated with autologus sural nerve graft. Results were evaluated at 3 months after the surgery and revealed detectable nerve conductibility at the Electromiography test. In conclusion, in cases with delayed nerve repair surgical treatment in war wounded patients, the vascularised nerve graft can be a better solution for nerve defect surgical treatment.

  7. Guide of principles in main dog and cat skin’s afections topical aplications

    Directory of Open Access Journals (Sweden)

    Faltinski, F.,

    2009-06-01

    Full Text Available The report is an attempt to remember of the updated general principles in the main dermatologic affects topical applications’ in in dog and cat. Initially are presented: general principles about drug topic formulation’s application, with the describing of skin’s anatomical bases and functions, active substance’s physic-chemicalproprieties, factors that affects transdermal passage, methods of transdermal amplification. Also are presented: characteristics of dog and cat’s skin, skin’s specific vascularisation, ecology and histochemy. In the last chapter are presented the main known dermatologic entities in dog and cat.

  8. Hyperthermia and massage are effect for the gingivitis improvement; Onnetsu to massaji ga shinikuen kaizen ni koka

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1999-10-01

    It was confirmed that Kao and research group of Nosaka professor of Iwate Medical Univ. faculty of dentistry that hyperthermia and massage at the 40 degrees C for the gingival activate the gingival lymph duct function and that it improves the gingivitis was effective. By causing the microcirculation disorder of the gingival, the research of the vascularisation is main until now for the gingivitis. Present research demonstrated that the recovery of the lymph duct function was effective for the gingivitis improvement for the first time in the world. (translated by NEDO)

  9. Mammalian bone palaeohistology: a survey and new data with emphasis on island forms

    Directory of Open Access Journals (Sweden)

    Christian Kolb

    2015-10-01

    Full Text Available The interest in mammalian palaeohistology has increased dramatically in the last two decades. Starting in 1849 via descriptive approaches, it has been demonstrated that bone tissue and vascularisation types correlate with several biological variables such as ontogenetic stage, growth rate, and ecology. Mammalian bone displays a large variety of bone tissues and vascularisation patterns reaching from lamellar or parallel-fibred to fibrolamellar or woven-fibred bone, depending on taxon and individual age. Here we systematically review the knowledge and methods on cynodont and mammalian bone microstructure as well as palaeohistology and discuss potential future research fields and techniques. We present new data on the bone microstructure of two extant marsupial species and of several extinct continental and island placental mammals. Extant marsupials display mainly parallel-fibred primary bone with radial and oblique but mainly longitudinal vascular canals. Three juvenile specimens of the dwarf island hippopotamid Hippopotamus minor from the Late Pleistocene of Cyprus show reticular to plexiform fibrolamellar bone. The island murid Mikrotia magna from the Late Miocene of Gargano, Italy displays parallel-fibred primary bone with reticular vascularisation and strong remodelling in the middle part of the cortex. Leithia sp., the dormouse from the Pleistocene of Sicily, is characterised by a primary bone cortex consisting of lamellar bone and a high amount of compact coarse cancellous bone. The bone cortex of the fossil continental lagomorph Prolagus oeningensis and three fossil species of insular Prolagus displays mainly parallel-fibred primary bone and reticular, radial as well as longitudinal vascularisation. Typical for large mammals, secondary bone in the giant rhinocerotoid Paraceratherium sp. from the Late Oligocene of Turkey is represented by dense Haversian bone. The skeletochronological features of Sinomegaceros yabei, a large-sized deer

  10. Bioreactor Technology in Cardiovascular Tissue Engineering

    Science.gov (United States)

    Mertsching, H.; Hansmann, J.

    Cardiovascular tissue engineering is a fast evolving field of biomedical science and technology to manufacture viable blood vessels, heart valves, myocar-dial substitutes and vascularised complex tissues. In consideration of the specific role of the haemodynamics of human circulation, bioreactors are a fundamental of this field. The development of perfusion bioreactor technology is a consequence of successes in extracorporeal circulation techniques, to provide an in vitro environment mimicking in vivo conditions. The bioreactor system should enable an automatic hydrodynamic regime control. Furthermore, the systematic studies regarding the cellular responses to various mechanical and biochemical cues guarantee the viability, bio-monitoring, testing, storage and transportation of the growing tissue.

  11. Kirner's deformity of all fingers in a 5-year-old girl: soft-tissue enhancement with normal bones on contrast-enhanced MRI

    Energy Technology Data Exchange (ETDEWEB)

    Brune, Thomas [Department of Paediatrics, University of Magdeburg (Germany); Zentrum fuer Kinderheilkunde, Wienerstrasse, 39112, Magdeburg (Germany); Schiborr, Manfred; Maintz, David [Department of Radiology, University of Muenster (Germany); Marquardt, Thorsten; Frosch, Michael; Harms, Erik [Department of Paediatrics, University of Muenster (Germany)

    2003-10-01

    Kirner's deformity is an uncommon, but characteristic volar-radial incurvature of the distal phalanx of the little finger. We report a 5-year-old girl with dystelephalangy of all fingers. Some members of the mother's family showed dystelephalangy of the little fingers; the father's family history was unaffected. Contrast-enhanced MRI showed enhancement of the soft tissues of the distal phalanges, but no bone deformities. This leads to the assumption that the radial and volar deviation of the distal phalanges is the result of a chronic inflammatory process or a vascularisation disorder of the soft tissue. (orig.)

  12. Visualization of mouse nodal cilia and nodal flow.

    Science.gov (United States)

    Nonaka, Shigenori

    2013-01-01

    The earliest left-right asymmetry in mouse development arises in 7.5 days, at the ventral surface of the embryonic node. The node cells possess monocilia beating in rotatory fashion to generate fluid flow from the right to the left (nodal flow). The direction of nodal flow will determine the side of expression of nodal, the responsible gene for "leftness." Nodal flow is visualized by combination of DIC (differential interference contrast) and microbeads in culture medium. Node cilia movement is visualized by DIC, a high-speed camera, and image processing. Copyright © 2013 Elsevier Inc. All rights reserved.

  13. Ab initio calculations of anharmonic vibrational circular dichroism intensities of trans-2,3-dideuteriooxirane

    DEFF Research Database (Denmark)

    Bak, KL; Bludsky, O.; Jorgensen, P

    1995-01-01

    A priori theory is derived for anharmonic calculations of vibrational circular dichroism (VCD). The anharmonic VCD expression is gauge origin independent and reduce to the magnetic field perturbation theory expression in the double-harmonic approximation. The theory has been implemented using...... for the atomic axial tensors and using second-order Moller-Plesset theory for the atomic polar tensors and the force fields, The changes of the vibrational rotatory strengths from anharmonicities are small, and do not explain the previously observed large discrepancies between the double-harmonic results...

  14. Surgical Treatment of Acute Grade III Medial Collateral Ligament Injury Combined With Anterior Cruciate Ligament Injury: Anatomic Ligament Repair Versus Triangular Ligament Reconstruction.

    Science.gov (United States)

    Dong, Jiangtao; Wang, Xiao Feng; Men, Xiaoqian; Zhu, Junjun; Walker, Garth N; Zheng, Xiao Zuo; Gao, Jin Bao; Chen, Baicheng; Wang, Fei; Zhang, Yingze; Gao, Shi Jun

    2015-06-01

    The purpose of this study was to evaluate the clinical results of medial collateral ligament (MCL) anatomic ligament repair (ALR) and triangular ligament reconstruction (TLR) in treating acute grade III MCL injury with respect to imaging and functional results. Between January 2009 and October 2011, a total of 69 patients with an acute grade III MCL tear combined with an anterior cruciate ligament tear were divided into 2 groups: those who underwent ALR and those who underwent TLR. Single-bundle anterior cruciate ligament reconstruction was also performed in all patients. A radiographic stress-position imaging test was performed to evaluate excessive medial opening of the knee. In addition, the Slocum test was carried out to assess anteromedial rotatory instability before surgery and at follow-up. The subjective symptoms and functional outcomes were evaluated preoperatively and postoperatively with International Knee Documentation Committee (IKDC) assessment. Sixty-four patients with a mean follow-up period of 34 months were included in the final analysis. The measurement results for medial opening at the last follow-up appointment decreased significantly from the pretreatment measurements and fell within the normal range, without a statistically significant difference between the 2 groups (P > .05). The overall incidence of anteromedial rotatory instability was reduced to 21.9% compared with 62.5% preoperatively. However, the incidence of anteromedial rotatory instability in the TLR group (9.4%) decreased significantly compared with that in the ALR group (34.4%) (P .05). The comparison of IKDC extension and flexion deficit scores between the 2 groups showed no significant differences. Eleven patients in the ALR group and 4 in the TLR group complained of medial knee pain. The comparison between the 2 groups showed no significant difference (P > .05). The clinical outcomes of this study showed that no major difference existed in the ALR and TLR groups based on IKDC

  15. Laxity of the elbow after experimental excision of the radial head and division of the medial collateral ligament. Efficacy of ligament repair and radial head prosthetic replacement

    DEFF Research Database (Denmark)

    Jensen, Steen Lund; Deutch, Søren R; Olsen, Bo Sanderhoff

    2003-01-01

    We studied the stabilising effect of prosthetic replacement of the radial head and repair of the medial collateral ligament (MCL) after excision of the radial head and section of the MCL in five cadaver elbows. Division of the MCL increased valgus angulation (mean 3.9 +/- 1.5 degrees) and internal...... that the radial head is a constraint secondary to the MCL for both valgus displacement and internal rotation. Isolated repair of the ligament is superior to isolated prosthetic replacement and may be sufficient to restore valgus and internal rotatory stability after excision of the radial head in MCL...

  16. Free vibration of arches flexible in shear.

    Science.gov (United States)

    Austin, W. J.; Veletsos, A. S.

    1973-01-01

    An analysis reported by Veletsos et al. (1972) concerning the free vibrational characteristics of circular arches vibrating in their own planes is considered. The analysis was based on a theory which neglects the effects of rotatory inertia and shearing deformation. A supplementary investigation is conducted to assess the effects of the previously neglected factors and to identify the conditions under which these effects are of practical significance or may be neglected. A simple approximate procedure is developed for estimating the natural frequencies of arches, giving due consideration to the effects of the previously neglected factors.

  17. Formation of bioactive benzofuran via oxidative coupling, using coconut water (Cocos nucifera L. as biocatalyst

    Directory of Open Access Journals (Sweden)

    Luís Cezar Rodrigues

    2017-04-01

    Full Text Available The capacity of simple coconut water, which contains natural peroxidases, to act as a biocatalyst for the oxidative coupling-cyclization of p-(OH-phenylpropanoids, was evaluated in this work. As a result, dimeric forms of isoeugenol (licarin A and methyl p-coumarate (methyl dehydrodicoumarate were obtained. The products of the reactions were characterized by optical rotatory dispersion, and 1H-NMR and 13C-NMR spectroscopy. The oxidative coupling-cyclization mechanism for coniferyl alcohol is proposed.

  18. Quantification of antiangiogenic treatment effects on tissue heterogeneity in glioma tumour xenograft model using a combination of DCE-MRI and 3D-ultramicroscopy

    Energy Technology Data Exchange (ETDEWEB)

    Dominietto, Marco [University and ETH Zurich, Institute for Biomedical Engineering, Zurich (Switzerland); University of Basel, Biomaterials Science Center, Allschwil (Switzerland); Dobosz, Michael; Renner, Anja; Scheuer, Werner [Roche Innovation Center Penzberg, Discovery Oncology, Pharmaceutical Research and Early Development (pRED), Penzberg (Germany); Buergi, Sandra; Rudin, Markus [University and ETH Zurich, Institute for Biomedical Engineering, Zurich (Switzerland); Zahlmann, Gudrun [pRED, Oncology DTA, Innovation Center Basel, F. Hoffmann-La Roche Ltd, Basel (Switzerland)

    2017-07-15

    This study aimed at assessing the effects of an anti-angiogenic treatment, which neutralises vascular endothelial growth factor (VEGF), on tumour heterogeneity. Murine glioma cells have been inoculated into the right brain frontal lobe of 16 mice. Anti-VEGF antibody was administered to a first group (n = 8), while a second group (n = 8) received a placebo. Magnetic resonance acquisitions, performed at days 10, 12, 15 and 23 following the implantation, allowed the derivation of a three-dimensional features dataset characterising tumour heterogeneity. Three-dimensional ultramicroscopy and standard histochemistry analysis have been performed to verify in vivo results. Placebo-treated mice displayed a highly-vascularised area at the tumour periphery, a monolithic necrotic core and a chaotic dense vasculature across the entire tumour. In contrast, the B20-treated group did not show any highly vascularised regions and presents a fragmented necrotic core. A significant reduction of the number of vessel segments smaller than 17 μm has been observed. There was no difference in overall tumour volume and growth rate between the two groups. Region-specific analysis revealed that VEGF inhibition affects only: (1) highly angiogenic compartments expressing high levels of VEGF and characterised by small capillaries, and also (2) the formation and structure of necrotic regions. These effects appear to be transient and limited in time. (orig.)

  19. Scleral contact lens management of bilateral exposure and neurotrophic keratopathy.

    Science.gov (United States)

    Grey, Fiona; Carley, Fiona; Biswas, Susmito; Tromans, Cindy

    2012-12-01

    We report an interesting case of therapeutic scleral lens management of bilateral exposure and neurotrophic keratopathy resulting from bilateral cranial nerve (CN) palsies including V, VI and VII, which caused lagophthalmos and anaesthetic corneas. Subsequent development of severe exposure keratitis with vascularisation and keratinisation of the inferior cornea was previously treated with intensive ocular lubrication, botulinum toxin injections to the upper eyelid levator muscle, temporary tarsorrhophies, bilateral amniotic membrane grafts, punctal plugs, lid taping, gold eyelid weights and soft bandage contact lenses. Corneal integrity was re-established but visual acuity remained significantly compromised by corneal vascularisation, scarring and keratin deposits. Visions on presentation to the contact lens department were R 1.90 logMAR, L 1.86 logMAR. Therapeutic, high Dk, non-fenestrated, saline filled, scleral lenses were fitted. Daily wear of these lenses have protected and hydrated the cornea, enabling corneal surface recovery whilst retaining visual and social function. The visual acuities 6 months post-scleral fitting with lenses in situ are R 0.90 logMAR and L logMAR 0.70. Copyright © 2012 British Contact Lens Association. Published by Elsevier Ltd. All rights reserved.

  20. Prediction of ovarian response and IVF/ICSI outcome by three-dimensional ultrasonography and power Doppler angiography.

    Science.gov (United States)

    Mercé, Luis T; Barco, María J; Bau, Santiago; Troyano, Juan M

    2007-05-01

    The objective was to evaluate whether three-dimensional ultrasonography (3D-US) and power Doppler angiography (PDA) measurements can predict ovarian response and/or are associated with IVF/ICSI outcome. A prospective clinical study in 65 women undergoing IVF cycles. Ovarian volume (OV), number of antral follicles > or =2mm (NAF) and PDA indices: vascularisation index (VI), flow index (FI), and vascularisation flow index (VFI) were evaluated by 3D-US and PDA on the day of pituitary suppression control. These measurements, age and BMI were correlated with the number of follicles>10mm on the hCG day and the number of oocytes retrieved. Ovarian volume, NAF, VI, FI and FVI correlate significantly (P<0.01) with the number of follicles and oocytes recovered. Ovarian volume and the number of antral follicles predicted significantly the number of follicles (R=0.67; adjusted R(2)=0.43) and oocytes retrieved (R=0.63; adjusted R(2)=0.37). The oestradiol peak and the number of follicles, oocytes and Grade 1 embryos transferred were higher in the pregnant group. Three-dimensional ultrasound and PDA make it easier to evaluate all the sonographic parameters implied in ovarian response. Ovarian volume and the number of antral follicles are the only independent predictors of the number of follicles developed and oocytes retrieved.

  1. [Preoperative assessment of renal vascular anatomy for donor nephrectomy: Is CT superior to MRI?].

    Science.gov (United States)

    Arvin-Berod, A; Bricault, I; Terrier, N; Skowron, O; Cadi, P; Boillot, B; Thuillier, C; Cluze, C; Descotes, J-L; Rambeaud, J-J; Long, J-A

    2011-01-01

    computed tomography angiography (CTA) and magnetic resonance angiography (MRA) are both used in the preoperative assessment of vascular anatomy before donor nephrectomy. Our objective was to determine retrospectively and to compare the sensitivity of CTA and MRA imaging in preoperative renal vascularisation in living kidney donors. between 1999 and 2007, 42 kidney donors were assessed in our center: 27 by MRA, 10 by CTA, and five by both techniques. Images were interpreted using multiplanar reconstructions. Results were compared retrospectively with peroperative findings; discordant cases were re-examined by an experienced radiologist. Numbers of vessels detected with imaging methods was compared with numbers actually found at the operating time. MRA showed 35/43 arteries (Se 81.4 %) and 33/34 veins (Se 97.1 %), and CTA showed 18/18 arteries (Se 100 %) and 15/16 veins (Se 93.8 %). The presence of multiple arteries was detected in only one third of cases (3/9) on MRI scans; this difference was statistically significant. The missed arteries were not detected on second examination of the MRI scans with the knowledge of peroperative findings. MRA is less sensitive than CTA for preoperative vascularisation imaging in living renal donors, especially in the detection of multiple renal arteries. 2010 Elsevier Masson SAS. All rights reserved.

  2. Over-expression of Oct4 and Sox2 transcription factors enhances differentiation of human umbilical cord blood cells in vivo

    Energy Technology Data Exchange (ETDEWEB)

    Guseva, Daria [Kazan State Medical University, Kazan, Republic of Tatarstan (Russian Federation); Hannover Medical School, Hannover (Germany); Rizvanov, Albert A.; Salafutdinov, Ilnur I.; Kudryashova, Nezhdana V. [Kazan Federal University, Kazan, Republic of Tatarstan (Russian Federation); Palotás, András, E-mail: palotas@asklepios-med.eu [Kazan Federal University, Kazan, Republic of Tatarstan (Russian Federation); Asklepios-Med (Private Medical Practice and Research Center), Szeged (Hungary); Islamov, Rustem R., E-mail: islamru@yahoo.com [Kazan State Medical University, Kazan, Republic of Tatarstan (Russian Federation)

    2014-09-05

    Highlights: • Gene and cell-based therapies comprise innovative aspects of regenerative medicine. • Genetically modified hUCB-MCs enhanced differentiation of cells in a mouse model of ALS. • Stem cells successfully transformed into micro-glial and endothelial lines in spinal cords. • Over-expressing oct4 and sox2 also induced production of neural marker PGP9.5. • Formation of new nerve cells, secreting trophic factors and neo-vascularisation could improve symptoms in ALS. - Abstract: Gene and cell-based therapies comprise innovative aspects of regenerative medicine. Even though stem cells represent a highly potential therapeutic strategy, their wide-spread exploitation is marred by ethical concerns, potential for malignant transformation and a plethora of other technical issues, largely restricting their use to experimental studies. Utilizing genetically modified human umbilical cord blood mono-nuclear cells (hUCB-MCs), this communication reports enhanced differentiation of transplants in a mouse model of amyotrophic lateral sclerosis (ALS). Over-expressing Oct4 and Sox2 induced production of neural marker PGP9.5, as well as transformation of hUCB-MCs into micro-glial and endothelial lines in ALS spinal cords. In addition to producing new nerve cells, providing degenerated areas with trophic factors and neo-vascularisation might prevent and even reverse progressive loss of moto-neurons and skeletal muscle paralysis.

  3. Assessment of wrist joint inflammation in patients with rheumatoid arthritis by quantitative two- and three-dimensional power Doppler ultrasonography.

    Science.gov (United States)

    Lai, Kuo-Lung; Chen, Der-Yuan; Chen, Yi-Hsing; Huang, Wen-Nan; Hsieh, Tsu-Yi; Hsieh, Chia-Wei; Chen, Yi-Ming; Hung, Wei-Ting; Chen, Hsin-Hua

    2014-01-01

    We aimed to compare the use of computer-aided quantification methods with 3 different power Doppler ultrasonography (PDUS) modes to assess wrist inflammation in patients with rheumatoid arthritis (RA). This study enrolled 49 patients (60 hand joints) with RA. Clinical parameters (rheumatoid factor [RF], erythrocyte sedimentation rate [ESR], and C-reactive protein [CRP]) were measured and pain was evaluated by a visual analogue scale (VAS, range: 0 to 10). Imaging of the affected wrist joints was performed with 2D- and 3D-PDUS imaging. The 2D imaging used a volumetric transducer and a linear transducer and the 3D imaging employed a volumetric transducer. Software was used to calculate the vascularisation index (VI), flow index (FI), and vascularisation flow index (VFI) under different measurement conditions. There were 8 males and 41 females, with an average age of 47.59±15.17 years, and average VAS score of 3.63±2.22. In 2D-PDUS with a linear probe, there were significant correlations of ESR with VI and VFI, and of CRP with area, VI, and VFI (pwrist inflammation. These results suggest that use of a 3D transducer, which is more expensive and time-consuming, is not necessary for assessment of wrist inflammation.

  4. Arterial spin labeling MR imaging for characterisation of renal masses in patients with impaired renal function: initial experience

    Energy Technology Data Exchange (ETDEWEB)

    Pedrosa, Ivan [Beth Israel Deaconess Medical Center and Harvard Medical School, Department of Radiology, Boston, MA (United States); UT Southwestern Medical Center, Department of Radiology, Dallas, TX (United States); Rafatzand, Khashayar; Robson, Philip; Alsop, David C. [Beth Israel Deaconess Medical Center and Harvard Medical School, Department of Radiology, Boston, MA (United States); Wagner, Andrew A. [Beth Israel Deaconess Medical Center and Harvard Medical School, Surgery, Division of Urology, Boston, MA (United States); Atkins, Michael B. [Beth Israel Deaconess Medical Center and Harvard Medical School, Hematology/Oncology, Boston, MA (United States); Rofsky, Neil M. [University of Texas Southwestern Medical Center, Departments of Radiology, Dallas, TX (United States)

    2012-02-15

    To retrospectively evaluate the feasibility of arterial spin labeling (ASL) magnetic resonance imaging (MRI) for the assessment of vascularity of renal masses in patients with impaired renal function. Between May 2007 and November 2008, 11/67 consecutive patients referred for MRI evaluation of a renal mass underwent unenhanced ASL-MRI due to moderate-to-severe chronic or acute renal failure. Mean blood flow in vascularised and non-vascularised lesions and the relation between blood flow and final diagnosis of malignancy were correlated with a 2-sided homogeneous variance t-test and the Fisher Exact Test, respectively. A p value <0.05 was considered statistically significant. Seventeen renal lesions were evaluated in 11 patients (8 male; mean age = 70 years) (range 57-86). The median eGFR was 24 mL/min/1.73 m{sup 2} (range 7-39). The average blood flow of 11 renal masses interpreted as ASL-positive (134 +/- 85.7 mL/100 g/min) was higher than that of 6 renal masses interpreted as ASL-negative (20.5 +/- 8.1 mL/100 g/min)(p = 0.015). ASL-positivity correlated with malignancy (n = 3) or epithelial atypia (n = 1) at histopathology or progression at follow up (n = 7). ASL detection of vascularity in renal masses in patients with impaired renal function is feasible and seems to indicate neoplasia although the technique requires further evaluation. (orig.)

  5. Dual-energy contrast-enhanced digital mammography in routine clinical practice in 2013.

    Science.gov (United States)

    Badr, S; Laurent, N; Régis, C; Boulanger, L; Lemaille, S; Poncelet, E

    2014-03-01

    To date, analysis of the vascularisation of breast lesions mainly relies on MR imaging. However, the accessibility of MRI is sometimes limited and has led to the development of new means of imaging, such as dual-energy contrast-enhanced mammography, which provides data on the vascularisation of the breast along with the usual morphological information. The purpose of this paper is to present this new imaging technique as well as the recent references, illustrated by clinical reports derived from our everyday practice to focus on the advantages and disadvantages of this new breast exploration. Dual-energy contrast-enhanced mammography is a recent, seemingly promising technique, in the management of breast cancer. The main advantages consist of its easy installation, the good tolerance and the comfort in the interpretation of difficult to read mammograms. However, the indications and the role of dual-energy contrast-enhanced mammography still have to be determined within the diagnostic strategy of breast tumours. New studies are expected, especially to compare dual-energy contrast-enhanced mammography with breast MRI. Copyright © 2013 Éditions françaises de radiologie. Published by Elsevier Masson SAS. All rights reserved.

  6. Type I keratoprosthesis for visual rehabilitation of patients with xeroderma pigmentosum

    Science.gov (United States)

    Ummar, Shiji; Bhalekar, Swapnil; Sangwan, Virender

    2014-01-01

    A 6-year-old girl, a case of xeroderma pigmentosum (XP), presented with a visual acuity (VA) of 20/20 and 20/400 in the right and left eye, respectively. For a diagnosis of vascularised corneal scar, penetrating keratoplasty was performed in the left eye twice and ultimately graft failed following multiple episodes of rejection. Type I keratoprosthesis was performed in the left eye. She continues to maintain VA of 20/40 in the left eye for more than a year. Similarly, a 24-year-old man, a case of XP, presented with VA of finger counting at 1 metre in both eyes. Ocular examination showed bilateral vascularised corneal scar and conjunctivalisation. Type I keratoprosthesis was performed as primary procedure in the left eye. He maintains a VA of 20/30 for more than a year. Type I keratoprosthesis could be a primary procedure for visual rehabilitation in patients with XP with severe ocular surface disease. PMID:24488667

  7. Juvenile nasopharyngeal angiofibroma - study of the tumor extension and vascularization through computerized tomography (CT) scan and angiography and the patient's age; Nasoangiofibroma juvenil - estudo da extensao e vascularizacao do tumor pela tomografia computadorizada e angiografia, e da idade do paciente

    Energy Technology Data Exchange (ETDEWEB)

    Sennes, Luiz Ubirajara

    1997-07-01

    The juvenile nasopharyngeal angiofibroma is a rare benign tumor that affects male adolescents. It is a fibro-vascular tumor with an exuberant intra tumor blood flow and irrigated by several arteries. It originates from the lateral and posterior region of the nasal cavity and, due to its characteristic multidirectional growth, widely affects the paranasal sinuses and skull base, sometimes invading the cranial fossa or the cheek. The determinant factors of its growth and vascularisation are unknown. Attempting to clarify them, 33 patients from the University of Sao Paulo Medicine were studied from 1983 to 1995, with complete history and radiological documentation (CT scan and angiography), as well as with histological confirmation of the diagnosis. In order to take only tumors with natural evolution, patients with recidivant tumor and those already submitted to any previous treatment were excluded. The parameters evaluate were: patient age and tumor extension (by classification, degree of invasion and number of compromised sites in CT scan) and vascularisation (by number and degree of participation of bilateral arteries in angiography). The se data were tabled and correlated one with each other. (author)

  8. Inhibition of neuroblastoma tumor growth by targeted delivery of microRNA-34a using anti-disialoganglioside GD2 coated nanoparticles.

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    Amanda Tivnan

    Full Text Available Neuroblastoma is one of the most challenging malignancies of childhood, being associated with the highest death rate in paediatric oncology, underlining the need for novel therapeutic approaches. Typically, patients with high risk disease undergo an initial remission in response to treatment, followed by disease recurrence that has become refractory to further treatment. Here, we demonstrate the first silica nanoparticle-based targeted delivery of a tumor suppressive, pro-apoptotic microRNA, miR-34a, to neuroblastoma tumors in a murine orthotopic xenograft model. These tumors express high levels of the cell surface antigen disialoganglioside GD2 (GD(2, providing a target for tumor-specific delivery.Nanoparticles encapsulating miR-34a and conjugated to a GD(2 antibody facilitated tumor-specific delivery following systemic administration into tumor bearing mice, resulted in significantly decreased tumor growth, increased apoptosis and a reduction in vascularisation. We further demonstrate a novel, multi-step molecular mechanism by which miR-34a leads to increased levels of the tissue inhibitor metallopeptidase 2 precursor (TIMP2 protein, accounting for the highly reduced vascularisation noted in miR-34a-treated tumors.These novel findings highlight the potential of anti-GD(2-nanoparticle-mediated targeted delivery of miR-34a for both the treatment of GD(2-expressing tumors, and as a basic discovery tool for elucidating biological effects of novel miRNAs on tumor growth.

  9. Hypoxia-controlled EphA3 marks a human endometrium-derived multipotent mesenchymal stromal cell that supports vascular growth.

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    Catherine To

    Full Text Available Eph and ephrin proteins are essential cell guidance cues that orchestrate cell navigation and control cell-cell interactions during developmental tissue patterning, organogenesis and vasculogenesis. They have been extensively studied in animal models of embryogenesis and adult tissue regeneration, but less is known about their expression and function during human tissue and organ regeneration. We discovered the hypoxia inducible factor (HIF-1α-controlled expression of EphA3, an Eph family member with critical functions during human tumour progression, in the vascularised tissue of regenerating human endometrium and on isolated human endometrial multipotent mesenchymal stromal cells (eMSCs, but not in other highly vascularised human organs. EphA3 affinity-isolation from human biopsy tissue yielded multipotent CD29+/CD73+/CD90+/CD146+ eMSCs that can be clonally propagated and respond to EphA3 agonists with EphA3 phosphorylation, cell contraction, cell-cell segregation and directed cell migration. EphA3 silencing significantly inhibited the ability of transplanted eMSCs to support neovascularisation in immunocompromised mice. In accord with established roles of Eph receptors in mediating interactions between endothelial and perivascular stromal cells during mouse development, our findings suggest that HIF-1α-controlled expression of EphA3 on human MSCs functions during the hypoxia-initiated early stages of adult blood vessel formation.

  10. Endometrial and Subendometrial Vascularity by Three-Dimensional (3D) Power Doppler and Its Correlation with Pregnancy Outcome in Frozen Embryo Transfer (FET) Cycles.

    Science.gov (United States)

    Mishra, Vineet V; Agarwal, Ritu; Sharma, Urmila; Aggarwal, Rohina; Choudhary, Sumesh; Bandwal, Pradeep

    2016-10-01

    To study the role of endometrial and subendometrial blood flow measured by 3D power Doppler as predictors of pregnancy in frozen embryo transfer (FET) cycles. A hospital-based prospective study of two hundred and twenty-one (221) women undergoing FET cycles with a triple-line endometrium ≥7 mm on day 14 endometrial and subendometrial blood flow was assessed using 3D power Doppler, and various indices endometrial volume, subendometrial volume and their vascularisation index (VI), flow index (FI) and vascularisation flow index (VFI) were obtained and compared between the pregnant and the non-pregnant group. Primary outcome was clinical pregnancy. Out of 221 women, 97(43.89 %) became pregnant, while 124 (56.10 %) failed to become pregnant. The endometrial volume was comparable between the two groups. Endometrial VI, FI and VFI were significantly higher in the pregnant as compared to the non-pregnant group. There was a significant difference in subendometrial VI and VFI between the two groups, but FI was similar. Endometrial and subendometrial vascularity by 3D power Doppler can be a useful parameter in predicting pregnancy in FET cycles.

  11. Medial Clamp Tine Positioning Affects Ankle Syndesmosis Malreduction.

    Science.gov (United States)

    Cosgrove, Christopher T; Putnam, Sara M; Cherney, Steven M; Ricci, William M; Spraggs-Hughes, Amanda; McAndrew, Christopher M; Gardner, Michael J

    2017-08-01

    To determine whether the position of the medial clamp tine during syndesmotic reduction affected reduction accuracy. Prospective cohort. Urban Level 1 trauma center. Seventy-two patients with operatively treated syndesmotic injuries. Patients underwent operative fixation of their ankle syndesmotic injuries using reduction forceps. The position of the medial clamp tine was then recorded with intraoperative fluoroscopy. Malreduction rates were then assessed with bilateral ankle computerized tomography. Fibular position within the incisura was measured with respect to the uninjured side to determine whether a malreduction had occurred. Malreductions were then analyzed for associations with injury pattern, patient demographics, and the location of the medial clamp tine. A statistically significant association was found between medial clamp position and sagittal plane syndesmosis malreduction. In reference to anterior fibular translation, there was a 0% malreduction rate in the 18 patients where the clamp tine was placed in the anterior third, a 19.4% malreduction rate in the middle third, and 60% malreduction rate in the posterior third (P = 0.006). In reference to posterior fibular translation, there was a 11.1% malreduction when clamp placement was in the anterior third, a 16.1% malreduction rate in the middle third, and 60% malreduction rate in the posterior third (P = 0.062). There were no significant associations between medial clamp position and coronal plane malreductions (overcompression or undercompression) (P = 1). When using reduction forceps for syndesmotic reduction, the position of the medial clamp tine can be highly variable. The angle created with off-axis syndesmotic clamping is likely a major culprit in iatrogenic malreduction. Sagittal plane malreduction appears to be highly sensitive to clamp obliquity, which is directly related to the medial clamp tine placement. Based on these data, we recommend placing the medial clamp tine in the anterior third

  12. Intermediate ray deficiency--a new type of lower limb hypoplasia.

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    Koczewski, Paweł; Shadi, Milud; Kotwicki, Tomasz; Tomaszewski, Marek; Korbel, Krzysztof

    2013-03-01

    Diagnosis of fibular hemimelia is based on the identification of absence or shortening of the fibula in relation to the tibia. Despite the existence of different classifications of this congenital deficiency, certain morphological forms defy proper classification. One such form is absence of foot rays with leg shortening in the presence of an entire fibula. In these cases, foot morphology suggests that central foot rays, not lateral ones, are affected by the deficiency; thus justifying the hypothesis concerning the existence of a separate type of hypoplasia, which may be named "intermediate ray deficiency" (IRD). Nine patients with IRD, with an average age of 9.4 years at diagnosis (2.9-15), were analyzed. Clinical and radiographic parameters of the leg and foot were recorded according to the Stanitski classification of fibular hemimelia. The position of the lateral and medial malleoli was assessed. Axial alignment was analyzed according to the Paley method. The number of foot rays in eight cases was 4, while in one case, it was 3. Talocalcaneal synostosis was observed in seven cases. The shape of the ankle joint was spherical in six cases, horizontal in two cases and valgus in one case. The position of the lateral malleolus was slightly higher compared to normal. An average functional leg length discrepancy was 4.4 cm. The average percentage of fibular shortening was 9.5 %, tibial shortening 8.7 % and femoral shortening 3.3 %. In all of the cases, slight knee valgus was observed on the femoral level (average 3.3°) and tibial level (average 2.0°). As a result, criteria for IRD diagnosis were proposed. "Intermediate ray deficiency" might be defined as a separate type of lower limb hypoplasia.

  13. MR imaging in congenital lower limb deformities

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    Laor, T. [Dept. of Radiology, Children`s Hospital and Harvard Medical School, Boston, MA (United States); Jaramillo, D. [Dept. of Radiology, Children`s Hospital and Harvard Medical School, Boston, MA (United States); Hoffer, F.A. [Dept. of Radiology, Children`s Hospital and Harvard Medical School, Boston, MA (United States); Kasser, J.R. [Dept. of Orthopedics, Children`s Hospital and Harvard Medical School, Boston, MA (United States)

    1996-06-01

    Treatment for children with cogenital deformities of the lower extremities may vary, depending on the state of the unossified skeletal structures and surrounding soft tissues. The purpose of our study was to demonstrate the spectrum of the osteochondral and extrasosseous abnormalities as depicted with MR imaging. We retrospectively reviewed MR examinations of 13 limbs of ten children (aged 1 month-9 years, mean 2.1 years) with longitudinal and transverse deformities of the lower extremities. The lesions imaged were fibular hemimelia (n=5), tibial hemimelia (n=5), and congenital constriction bands (n=3). Each examination was assessed for abnormalities in the osteocartilaginous and extraosseous (articular or periarticular components such as ligaments, tendons, and menisci; the muscles and the arteries) structures. Abnormalities were seen in all patients. Osteocartilaginous abnormalities in the patients with longitudinal deformities included abnormal distal femoral epiphyses, abnormal proximal tribial physes, hypertrophied and dislocated proximal fibular epiphyses, unsuspected fibular and tibial remnants, and absence or coalition of the tarsal bones. No osteocartilaginous abnormalities were seen in the patients with congential constriction bands. Articular abormalities in patients with either form of hemimelia included absent cruciate ligaments and menisci, dislocated or absent cartilaginous patellae, absent patellar tendons, and abnormal collateral ligaments. All but one limb imaged had absent or attenuated muscle groups. Of the nine MR arteriograms performed at the level of the knee, eight were abnormal. The normal popliteal trifurcation was absent or in an abnormal location. We conclude that MR imaging of children with congenital lower extremity deformities shows many osteochondral and extraosseous abnormalities that are not depicted by conventional radiogrpahy. This information can help to plan early surgical intervention and prosthetic rehabilitation. (orig.)

  14. Regeneração de nervo periférico após anastomose término-lateral, com manutenção do epineuro, em ratos

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    Rosseto Marcelo

    2001-01-01

    Full Text Available A reinervação dos nervos periféricos pode ser realizada através de anastomoses término - terminais ou término-laterais, e este fenômeno tem sido amplamente estud ado. As anastomoses nervosas término-laterais tem sido utilizadas com pouca freqüência em relação as anastomoses término-terminais e contestada por alguns autores quanto a possibilidade de reinervação, quando a integridade do epineuro é mantida. Devido a estas divergências, estudou-se o efeito do epineuro na reinervação em anastomoses término-laterais, em ratos. Foram utilizados 20 ratos Wistar, adultos, distribuídos em dois grupos (A e B. No grupo A, 10 animais foram submetidos à secção do nervo fibular no membro pélvico direito e fixação desde à musculatura; no membro pélvico esquerdo foi realizada a secção do nervo fibular e anastomasado término-lateral com o nervo tibial. No grupo B, os procedimentos foram idênticos aos realizados no grupo A, sendo somente invertido os membros pélvicos. No nonagésimo dia do ato operatório, foi realizada uma biópsia em cada nervo fibular para análise histológica à microscópia óptica, onde a reinervação foi objeto de estudo. A reinervação ocorreu mostrando que a integridade do epineuro não impediu a regeneração axonal.

  15. "Footdrop in the farmers: Clinical and electromyographical study "

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    Ghaffarpour M

    2002-08-01

    Full Text Available Footdrop is a relatively common deficit among the neurological disorders, which has different causes with various levels of involvement in neuromuscular system, including central nervous system (brain cortex, spinal cord, fifth lumbar root, peripheral nerves and muscles. Peroneal nerve injury at the fibular head has been reported to the most common cause of foot drop, which can be due to infarct, tumor or leprosy but the vast majority of lesions are traumatic. In this article, we report seventeen patients with foot drop in farmers. All of the patients except one, were male with age ranges between 15 to 25 years. They had been doing certain farming activities (harvesting or weeding for 1-5 days before developing foot drop. Electrophysiological studies have been done in only seven of them due to patient’s unwillingness. Nerve conduction velocity and amplitudes distal to the fibular head were normal, but stimulation above the fibular head showed reduced nerve conduction velocity and amplitudes (mean 22.4 m/s in the abnormal side versus 51.5 m/s in the normal side, mean peak to peak amplitude 3.6 mv in the symptomatic side versus 10.4 in the contralateral side respectively. Forty-three percent of patients had also conduction block. F wave latency increased on the affected side in comparison to the normal side (mean 4.7 m/s. The new and perhaps interesting findings in our cases are unilateral involvement and occurrence of peroneal palsy on the side of dominant hand, indicating that type of the hand activity is probably more important in inducing foot drop than the position of seating during harvesting or weeding. We suggest further investigation in this setting in order to find the mechanisms of nerve injury and prophylactic measures.

  16. Morphological features of the fibula in Jomon hunter-gatherers from the shell mounds of the Pacific coastal area.

    Science.gov (United States)

    Hagihara, Yasuo; Nara, Takashi

    2016-08-01

    The Jomon, one of the ancestral populations of modern Japanese, were hunter-gatherers inhabiting the Japanese archipelago from 11,000 to 300 BC. We evaluated changes in the diaphyseal morphology of the fibula from the middle to the final phase of the Jomon period, compared to the morphology of other historical and modern populations from the Japanese archipelago, to elucidate temporal changes in habitual activities and possible division of labor among males and females. Jomon specimens of 107 males and 97 females were obtained from the shell mounds of the Pacific coastal area of East Japan, distinguishing between middle (3,000-2,000 BC) and late-final (2,000-300 BC) phases of the Jomon period. Mid-shaft morphology of the fibula and tibia were compared to morphological measurements of specimens from Yayoi (37 males, 28 females), medieval (56 males, 56 females), early modern (51 males, 50 females), and modern (125 males, 68 females) periods. Largest values of fibular areas and relative fibular-to-tibial areas were identified in males from the late-final Jomon phase, compared to the middle Jomon phase and after the Yayoi period. These period-specific differences in fibular area were smaller in females, with the largest between-sex difference identified in the late-final Jomon phase. Results confirm a change in the habitual activity pattern of males in the late-final phase. Males of the late-final Jomon phase likely did more long-distance traveling to the inland/mountainous region, as part of an ecological change that occurred during the middle to the late-final Jomon phase. Am J Phys Anthropol 160:708-718, 2016. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  17. The Community Orthopaedic Surgeon Taking Trauma Call: Pediatric Ankle Fracture Pearls and Pitfalls.

    Science.gov (United States)

    Parikh, Shital N; Mehlman, Charles T

    2017-11-01

    Pediatric ankle fractures are common and have unique fracture characteristics because of the presence of distal tibial and fibular physes. When displaced (>3 mm widening of the physis or >2 mm intra-articular gap/step-off), these fractures are typically treated with anatomical reduction and internal fixation. Computed tomography is recommended for preoperative evaluation and surgical planning for intra-articular fractures. These fractures in younger children with substantial growth remaining should be followed closely to monitor for any growth disturbance. Pearls and pitfalls related to the treatment of these fractures would emphasize the physeal-respecting approach to their management.

  18. Congenital agenesis of the superficial posterior compartment calf muscles in a 13-month-old infant.

    Science.gov (United States)

    Kang, Jin Young; Jang, Dae-Hyun

    2014-11-01

    Muscle agenesis may induce cosmetic and functional deficits, particularly if the muscle is an axial limb or a large muscle. Limb muscle agenesis is a rare condition. Here, the authors report the case of a 13-mo-old girl with unilateral atrophic calf and gait abnormality. Magnetic resonance imaging confirmed agenesis of the posterior superficial compartment of the calf. The patient showed an out-toeing calcaneal gait and fibular length discrepancy secondarily during growth. Normal embryology and the differential diagnostic point of foot deformity as well as the clinical implications of calf agenesis are described.

  19. [Comparison of two minimally invasive internal fixed methods for the treatment of distal tibio-fibula fractures].

    Science.gov (United States)

    Feng, Yong-Zeng; Hong, Jian-Jun; Peng, Lei; Shui, Xiao-Long; Tang, Jun; Chen, Lin-Wei; Guo, Xiao-Shan

    2011-02-01

    To compare the outcome of two minimally invasive internal fixed methods for the treatment of distal tibio-fibula fractures. The clinical data of 50 patients with distal tibio-fibula fractures from March 2006 to March 2009 was analyzed retrospectively. Twenty-eight patients were treated with minimally invasive percutaneous locking compression plate fixing tibia combining elastic stable intramedullary nailing fixing fibular (Group P + E). There were 18 male and 10 female patients with a mean age of (45 ± 6) years. Twenty-two patients were treated with interlocking intramedullary nail fixing tibia combining elastic stable intramedullary nailing fixing fibular (Group N + E). There were 12 male and 10 female patients with a mean age of (43 ± 9) years. The index of peri-operation, pain score at 3 d postoperative, bone union time, the clinical outcomes and complications postoperative were statistically compared. There were no statistical significance on operation time, blood loss perioperative and pain score at 3 d postoperative. Bone union time in Group N + E was significantly longer than in Group P + E [(21.1 ± 3.0) weeks vs. (15.4 ± 2.9) weeks]. Meanwhile, the function of ankle score (44.3 ± 1.7 vs. 41.8 ± 2.5) and the line of foot score (8.6 ± 2.3 vs. 6.8 ± 3.6) in Group P + E were respectively significantly higher than that in Group N + E. However, there were no statistical difference on ankle pain, buckling add stretch restricted, turn inward add evaginate restricted and the rate of good and fair between the two groups. There were 3 cases of complications postoperation in Group P + E, significantly less than the 8 cases of Group N + E. Minimally invasive percutaneous locking compression plate fixing tibia combining elastic stable intramedullary nailing fixing fibular shows superiority in treatment of distal tibio-fibula fractures. However, interlocking intramedullary nail fixing tibia combining elastic stable intramedullary nailing fixing fibular has the

  20. Outcome of Distal Both Bone Leg Fractures Fixed by Intramedulary Nail for Fibula & MIPPO in Tibia.

    Science.gov (United States)

    Gupta, Anil; Anjum, Rashid; Singh, Navdeep; Hackla, Shafiq

    2015-04-01

    Fractures of the distal third of the tibia are mostly associated with a fibular fracture that often requires fixation. The preferred treatment of distal tibial fracture is the minimally invasive percutaneous plate osteosynthesis (MIPPO) procedure. However, there are no clear cut guidelines on fixation of the fibular fracture and currently most orthopedic surgeons use a plate osteosynthesis for the fibula as well. A common complication associated with dual plating is an increased chance of soft tissue necrosis, infection, and in some cases resulting in an exposed implant. We conducted a prospective study to analyze the results of fractures of the distal in both leg bones managed by the MIPPO procedure for tibial fractures and a rush nail for fibular fractures. The study was conducted in a tertiary care hospital from November 2012 to May 2014, a total of 30 fractures in 30 patients (18 males, 12 females) with a mean age of 42.4 years (26-60 years) were treated in our institution in the aforesaid time period with MIPPO for tibia and rush nail for fibular fractures. All the cases were operated on by a single surgeon in emergency within 24 hours. The patients with skin blistering and compound fractures were excluded from this study. Rehabilitative measures were proceeded as per patient's pain profile, isometric and isotonic exercises were started on the first post-operative day, with full weight bearing at 10-12 weeks after assessing clinical and radiological union. Regular follow up of patients was done, radiographs were taken at the immediate post-operative period and at 3, 6, 12 and 24 weeks. All the patients were available for regular follow up. Radiological and clinical union proceeded normally in all the patients, no patients had signs of any deep infection, delayed union or nonunion, three patients had a superficial infection of the tibial incision that healed with a change in antibiotic. The use of dual plating for fixation of the lower tibia and fibula

  1. Recurrent aneurysmal bone cyst of talus resulted in tibiotalocalcaneal arthrodesis

    Science.gov (United States)

    Vosoughi, Amir R; Mozaffarian, Kamran; Erfani, Mohammad A

    2017-01-01

    Aneurysmal bone cyst (ABC), a locally benign aggressive lytic lesion of either primary or secondary origin, seldom involves the talus. Herein, we present a 25-year-old man with recurrent ABC of the talus after curettage and bone grafting, which was managed by total resection followed by filling the defect using fibular graft and finally tibiotalocalcaneal arthrodesis due to articular surface involvement. At 18 mo postoperatively, no recurrence was detected. Arthrodesis might be a good option in cases with recurrent ABC of the talus especially with articular surface involvement. PMID:29026835

  2. Painful, pediatric sacral aneurysmal bone cyst treated by curettage and fresh frozen allograft.

    Science.gov (United States)

    Aydın, Murat; Toğral, Güray; Kekeç, Fevzi; Arıkan, Murat; Güngör, Şafak

    2016-08-01

    In this article, we report a rarely localized sacral aneurysmal bone cyst (ABC) successfully treated by curettage and bone grafting with fresh frozen fibular allograft (FFA) in a 14-year-old girl patient. The cyst was at S1-2 level and treated with aggressive curettage and bone grafting with two FFAs. All complaints of the patient resolved at the 24th month of treatment and bony union of the cystic cavity was observed radiologically. Curettage and FFA may be safely used for filling the cavity in the treatment of sacral ABC in pediatric age to provide a structural and biological reinforcement.

  3. Giant recurrent aneurysmal bone cyst of the mandible.

    Science.gov (United States)

    Banu, Khurshida; Sham, Mohammed Ehtaih; Hari, Sri; Sharad, Veena

    2012-07-01

    The Aneurysmal bone cyst (ABC) is an infrequent but well defined lesion occurring most commonly in the long bones, the pelvis and vertebrae. Only 1-2% of the lesions are known to occur in the maxillofacial region. Clinically, the lesion usually occurs in young adults below 20 years of age. Though there does not seem to be any marked gender predilection and slight preponderance towards females has been reported. Here we present a case of giant recurrent aneurysmal bone cyst in a 19 year old male patient treated by segmental resection and reconstruction with vascularized fibular graft.

  4. Prenatal Diagnosis of a Congenital Postaxial Longitudinal Limb Defect: A Case Report

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    Joana Pauleta

    2010-01-01

    Full Text Available Introduction. Although congenital longitudinal fibular deficiency is one of the most common long bone deficiencies, there are few published cases of its prenatal diagnosis. Case report. A right longitudinal deficiency of the fibula associated with tibial shortening, foot equinovalgus, and absence of the fourth and fifth foot rays diagnosed at 22 weeks gestation is described. Sequential ultrasonographic surveillance was performed without obstetric complications. The anomaly was confirmed after birth, and conservative orthopaedic management was decided. Conclusion. Though rarely seen, postaxial longitudinal limb defect may be detected by ultrasound. The correct approach can only be decided after birth, when the functional impact of the anomaly can be fully evaluated.

  5. Prenatal Diagnosis of a Congenital Postaxial Longitudinal Limb Defect: A Case Report

    Science.gov (United States)

    Pauleta, Joana; Melo, Maria Antonieta; Graça, Luís Mendes

    2010-01-01

    Introduction. Although congenital longitudinal fibular deficiency is one of the most common long bone deficiencies, there are few published cases of its prenatal diagnosis. Case report. A right longitudinal deficiency of the fibula associated with tibial shortening, foot equinovalgus, and absence of the fourth and fifth foot rays diagnosed at 22 weeks gestation is described. Sequential ultrasonographic surveillance was performed without obstetric complications. The anomaly was confirmed after birth, and conservative orthopaedic management was decided. Conclusion. Though rarely seen, postaxial longitudinal limb defect may be detected by ultrasound. The correct approach can only be decided after birth, when the functional impact of the anomaly can be fully evaluated. PMID:20592750

  6. Arthrography, talar tilt and surgical findings after inversion trauma of the ankle

    Energy Technology Data Exchange (ETDEWEB)

    van Moppes, F.I.; van den Hoogenband, C.R.; van Engelshoven, J.M.; Betts-Brown, A.

    1981-04-01

    Both inversion stress examination under general anesthesia and arthrography are sensitive indicators of lateral ankle ligament pathology (91%, 96% resp.). Arthrography is significantly superior to inversion stress examination done under local anesthesia (96%, 70% resp.). Peroneus tendon sheath filling is always pathological, but although this does not always indicate calcaneo-fibular ligament rupture, such rupture cannot be excluded in its absence. Talar tilt difference cannot be correlated with the extent of ligamentous rupture and therefore inversion stress examination, while providing valuable additional information, must be regarded as a secondary technique to ankle arthrography.

  7. Arthrographical diagnosis of the tear of the ventral tibio-fibula syndesmosis in the ankle joint. Indication, technique and results from 114 cases

    Energy Technology Data Exchange (ETDEWEB)

    Wrazidlo, W.; Karl, E.L.; Koch, K.

    1988-05-01

    We describe 114 cases based on 2020 arthrographies of the ankle joint for diagnosing fresh tears of the tibio-fibula syndesmosis without bone lesions. Comparison of the arthrographical diagnosis with the intraoperative diagnosis showed good agreement. Diagnosis of the isolated tear of the tibio-fibular syndesmosis revealed a sensitivity of 90% and a specificity of 67%. The technical procedure and the isolated tear of the tibiofibular syndesmosis in combination with other capsuleligament lesions are presented, using typical X-ray images as examples.

  8. Nerve growth factor with fibrin glue in end-to-side nerve repair in rats Fator de crescimento nervoso em cola de fibrina no reparo término-lateral de nervos em ratos

    Directory of Open Access Journals (Sweden)

    Daniel Nunes e Silva

    2012-04-01

    Full Text Available PURPOSE: To determine the effects of end-to-side nerve repair performed only with fibrin glue containing nerve growth in rats. METHODS: Seventy two Wistar rats were divided into six equal groups: group A was not submitted to nerve section; group B was submitted to nerve fibular section only. The others groups had the nerve fibular sectioned and then repaired in the lateral surface of an intact tibial nerve, with different procedures: group C: ETS with sutures; group D: ETS with sutures and NGF; group E: ETS with FG only; group F: ETS with FG containing NGF. The motor function was accompanied and the tibial muscle mass, the number and diameter of muscular fibers and regenerated axons were measured. RESULTS: All the analyzed variables did not show any differences among the four operated groups (p>0.05, which were statistically superior to group B (p0.05. CONCLUSION: The end-to-side nerve repair presented the same recovery pattern, independent from the repair used, showing that the addition of nerve growth factor in fibrin glue was not enough for the results potentiating.OBJETIVO: Determinar os efeitos do reparo nervoso término-lateral realizado apenas com cola de fibrina contendo fator de crescimento nervoso em ratos. MÉTODOS: Setenta e dois ratos Wistar foram distribuídos em seis grupos: A - não submetido à secção nervosa; B - secção do nervo fibular (sem reparo; Os outros grupos tiveram o nervo fibular seccionado e então reparado na superfície lateral do nervo tibial intacto, com diferentes procedimentos: C - RNTL com suturas; D - RNTL com suturas e FCN; E - RNTL apenas com CF; F - RNTL com CF contendo FCN. A função motora foi acompanhada e a massa do músculo tibial, o número e o diâmetro das fibras musculares e axônios regenerados foram medidos. RESULTADOS: Não houve diferença entre as variáveis avaliadas nos quatro grupos operados (p>0,05, os quais foram superiores ao grupo B (p0,05. CONCLUSÕES: O reparo nervoso t

  9. Vascularized epiphyseal transplant.

    Science.gov (United States)

    Innocenti, Marco; Delcroix, Luca; Romano, G Federico; Capanna, Rodolfo

    2007-01-01

    In skeletally immature patients, the transfer of vascularized epiphysis along with a variable amount of adjoining diaphysis may provide the potential for growth of such a graft, preventing future limb length discrepancy. This article describes the authors' experience with the vascularized transfer of the proximal fibular epiphysis in the reconstruction of large bone defects including the epiphysis in a series of 27 patients ranging in age from 2 to 11 years. The follow-up, ranging from 2 to 14 years, has been long enough to allow some evaluation of the validity, indications, and limits of this reconstructive option.

  10. Vascularized fibula grafts for reconstruction of bone defects after resection of bone sarcomas

    DEFF Research Database (Denmark)

    Petersen, Michael Mørk; Hovgaard, Dorrit; Elberg, Jens Jørgen

    2010-01-01

    We evaluated the results of limb-sparing surgery and reconstruction of bone defects with vascularized fibula grafts in 8 consecutive patients (mean age at operation 13.6 years (range 4.1-24.2 years), female/male = 6/2) with bone sarcomas (BS) (osteosarcoma/Ewing's sarcoma/chondrosarcoma= 4/3/1) o...... (n = 2), and hip dislocation (n = 1). Limb-sparing surgery with reconstruction of bone defects using vascularized fibular grafts in BS cases is feasible with acceptable clinical results, but fractures should be expected in many patients....

  11. Osteomyoplastic Transtibial Amputation: The Ertl Technique.

    Science.gov (United States)

    Taylor, Benjamin C; Poka, Attila

    2016-04-01

    Amputation may be required for management of lower extremity trauma and medical conditions, such as neoplasm, infection, and vascular compromise. The Ertl technique, an osteomyoplastic procedure for transtibial amputation, can be used to create a highly functional residual limb. Creation of a tibiofibular bone bridge provides a stable, broad tibiofibular articulation that may be capable of some distal weight bearing. Several different modified techniques and fibular bridge fixation methods have been used; however, no current evidence exists regarding comparison of the different techniques. Additional research is needed to elucidate the optimal patient population, technique, and postoperative protocol for the Ertl osteomyoplastic transtibial amputation technique.

  12. A 72-year-old patient with bilateral Maisonneuve fractures

    Directory of Open Access Journals (Sweden)

    Thomas Dienstknecht

    2012-07-01

    Full Text Available Maisonneuve fractures result from a disruption of the medial ankle structures and a proximal fibular fracture. Patient complaints can be misleading and there is a significant rate of delayed diagnosed injuries. We present a case of bilateral Maisonneuve fractures after a fall due to a syncopal collapse. A precise clinical examination led to this rare diagnosis. The injuries were treated with syndesmotic screw fixation, removal of hardware followed after 6 weeks. The patient was asymptomatic at threemonths follow up. Patients with bilateral injuries undergoing standard surgical treatment can gain full recovery, but high suspicion in clinical examination is needed to detect this uncommon bilateral injury.

  13. Exercise Related Leg Pain (ERLP): a Review of The Literature.

    Science.gov (United States)

    Reinking, Mark F

    2007-08-01

    Exercise related leg pain (ERLP) is a regional pain syndrome described as pain between the knee and ankle which occurs with exercise. Indiscriminant use of terminology such as "shin splints" has resulted in ongoing confusion regarding the pathoanatomic entities associated with this pain syndrome. Each of the pathoanatomic entities - medial tibial stress syndrome, chronic exertional compartment syndrome, tibial and fibular stress fractures, tendinopathy, nerve entrapment, and vascular pathology - which manifest as ERLP are each described in terms of relevant anatomy, epidemiology, clinical presentation, associated pathomechanics, and intervention strategies. Evidence regarding risk factors for ERLP general and specific pathoanatomic entities are presented in the context of models of sports injury prevention.

  14. Novel Suture Anchor Technique with Continuous Locking Stitch for Collateral Ligament Repair.

    Science.gov (United States)

    Tokunaga, Susumu; Abe, Yoshihiro

    2016-06-01

    Collateral ligaments are difficult to repair due to large amount of fraying in detached ligaments and attenuated stumps that may not provide enough strength after the repair. Although strong locking sutures are used to repair the ligament with proper tension, these damages can cause pull-out failure or relaxation of the repaired ligaments even from undersized load that may extend postoperative splinting or casting time. Furthermore, current suture techniques can repair varus or valgus instability of the elbow and radial or ulnar instability of the fingers, but these techniques do not offer rotatory stability of these areas. We have developed a novel suture anchor technique that has overcome this problem of current suture techniques, and this can be used to correct rotatory instability in the elbow and fingers. We used this procedure in seven cases with injury of collateral ligament in the elbow and eight cases with detached collateral ligaments of finger joint. No patient experienced rerupture or any kind of residual instability. We believe that the proposed method can produce much stronger repair and may shorten the postoperative immobilization period.

  15. Laboratory examinations for the vestibular system.

    Science.gov (United States)

    van de Berg, Raymond; Rosengren, Sally; Kingma, Herman

    2018-02-01

    In the last decades, researchers suggested that clinical assessment of labyrinthine function in detail became easy thanks to video head impulse tests (VHITs), vestibular evoked myogenic potential test (VEMP) and video-oculography (VOG). It has been argued that they can replace electronystagmography, the caloric and rotatory chair tests. This review addresses the latest evaluations of these tests and the opportunities they offer, but also the limitations in clinical practice. The VHIT and suppression head impulse test (SHIMP) are under ideal circumstances able to accurately identify deficits of the VOR in 3D. However, in a relevant part of the patient population, pupil tracking is inaccurate, video-goggles slip and VOR quantification is problematic. The dissociation between the VHIT and caloric test suggests that these tests are complementary. A new 3D-VOG technique claims to quantify eye torsion better than before, opening multiple diagnostic possibilities. VEMPs remain difficult to standardize. Variability in normal cervical vestibular-evoked myogenic potential amplitude is large. VEMPs become smaller or absent with age, raising questions of whether there is a lower normal limit at all. Recent research shows that the labyrinth is directly stimulated in the MRI offering new opportunities for diagnostics and research. In clinical practice, the VHIT, SHIMP, VEMP and new 3D-VOG techniques improve diagnostic power. Unfortunately, technical issues or variability prevent reliable quantitative evaluation in a part of the regular patient population. The traditional caloric and rotatory chair test can still be considered as valuable complementary tests.

  16. Spontaneous Ankylosis of Occiput to C2 following Closed Traction and Halo Treatment of Atlantoaxial Rotary Fixation

    Science.gov (United States)

    Krengel, Walter F.; Kim, Paul H.; Wiater, Brett

    2015-01-01

    Study Design Case report. Objective We report a case of spontaneous atlantoaxial rotatory fixation (AARF) presenting 9 months after onset in an 11-year-old boy. Methods This is a retrospective case report of spontaneous ankylosis of occiput to C2 following traction, manipulative reduction, and halo immobilization for refractory atlantoaxial rotatory fixation. Results The patient underwent traction followed by close manual reduction and placement of halo immobilization after 6 months of severe spontaneous-onset AARF that had been refractory to chiropractic manipulation and physical therapy. Imaging demonstrated dislocation of the left C1–C2 facet joint and remodeling changes of the C2 superior facet prior to reduction, followed by near complete reduction of the dislocation after manipulation and halo placement. Symptoms and clinical appearance were satisfactorily improved and the halo vest was removed after 3 months. At late follow-up, computed tomography demonstrated complete bony ankylosis of the occiput to C2. The patient was found to be HLA B27-positive, but he had no family history of ankylosing spondyloarthropathy or other joint symptoms. The underlying reasons for spontaneous fusion of the occiput to C2 could include the traction, HLA-B27-related spondyloarthropathy, or arthropathic changes caused by traction, reduction, the inciting insult, or immobilization. Conclusion When discussing treatment of childhood refractory AARF by traction, closed manipulation, and halo immobilization, the possibility of developing “spontaneous” ankylosis needs to be considered. PMID:26131392

  17. Lumbar lordosis rehabilitation for pain and lumbar segmental motion in chronic mechanical low back pain: a randomized trial.

    Science.gov (United States)

    Diab, Aliaa A; Moustafa, Ibrahim M

    2012-05-01

    The purpose of this study was to investigate the effects of lumbar extension traction with stretching and infrared radiation compared with stretching and infrared radiation alone on the lumbar curve, pain, and intervertebral movements of patients with chronic mechanical low back pain (CMLBP). This randomized clinical study with 3-month follow-up was completed at the Cairo University research laboratory. Eighty patients (age ranged from 40 to 50 years) with CMLBP and a hypolordotic lumbar spine were randomly assigned to traction or a comparison group. The comparison group (n = 40) received stretching exercises and infrared radiation, whereas the traction group (n = 40) received lumbar extension traction in addition to stretching exercises and infrared radiation. The absolute rotatory angle, intervertebral movements, and visual analog scale were measured for all patients at 3 intervals. The results revealed a statistically significant difference between the groups at 2 follow-up time points compared with the baseline values for the translational and sagittal rotational movements of L3-L4, L4-L5, L5-S1, and L2-L3 (posttreatment) and absolute rotatory angle (P .01). Lumbar extension traction with stretching exercises and infrared radiation was superior to stretching exercises and infrared radiation alone for improving the sagittal lumbar curve, pain, and intervertebral movement in CMLBP. Copyright © 2012 National University of Health Sciences. Published by Mosby, Inc. All rights reserved.

  18. Extension traction treatment for patients with discogenic lumbosacral radiculopathy: a randomized controlled trial.

    Science.gov (United States)

    Moustafa, Ibrahim M; Diab, Aliaa A

    2013-01-01

    To investigate the effects of lumbar extension traction in patients with unilateral lumbosacral radiculopathy due to L5-S1 disc herniation. A randomized controlled study with six-month follow-up. University research laboratory. Sixty-four patients with confirmed unilateral lumbosacral radiculopathy due to L5-S1 disc herniation and a lumbar lordotic angle less than 39°, randomly assigned to traction or control group. The control group (n = 32) received hot packs and interferential therapy, whereas the traction group (n = 32) received lumbar extension traction in addition to hot packs and interferential therapy. Absolute rotatory angle, back and leg pain rating scale, Oswestry Disability Index, Modified Schober test, H-reflex (latency and amplitude) and intervertebral movements were measured for all patients three times (before treatment, after 10 weeks of treatment and at six-month follow-up). There was a significant difference between the traction group and the control group adjusted to baseline values at 10 weeks post treatment with respect to: absolute rotatory angle (P traction group receiving lumbar extension traction in addition to hot packs and interferential therapy had better effects than the control group with regard to pain, disability, H-reflex parameters and segmental intervertebral movements.

  19. Optical current transducer with bulk type Bi12SiO20 faraday sensor for power systems

    Science.gov (United States)

    Katsukawa, Hiroyuki; Yokoi, Seigo

    1997-01-01

    Two types of optical current transducers (OCTs) have a bulk Faraday sensor inserted into the gap of an iron core and a porcelain insulator with optical fiber. The sensor consists of Bi12SiO20 (BSO) single crystal, a polarizer, and an analyzer. The OCTs satisfied the target performance requirement for fault location and metering and demonstrated maintained performance at some power utilities in Japan and the US. We have developed a fault location system that immediately detects the fault current with the OCTs, there by locating the fault section. The OCT can easily replace the existing support insulators for the disconnecting switch without any modifications to structure height or bus-bar. For metering requiring 0.3% class accuracy, use of a BSO with right optical rotatory power combined with BSO with left optical rotatory power results in a Faraday sensor with improved temperature characteristics. The OCT demonstrated 0.3% class accuracy for metering described in the current transformer Specifications of IEEE C57 13, 1993.

  20. Coronal 2D MR cholangiography overestimates the length of the right hepatic duct in liver transplantation donors

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bohyun [University of Ulsan College of Medicine, Department of Radiology, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul (Korea, Republic of); Ajou University School of Medicine, Department of Radiology, Ajou University Medical Center, Suwon (Korea, Republic of); Kim, Kyoung Won; Kim, So Yeon; Park, So Hyun [University of Ulsan College of Medicine, Department of Radiology, Asan Medical Center, 88, Olympic-ro 43-gil, Songpa-gu, Seoul (Korea, Republic of); Lee, Jeongjin [Soongsil University, School of Computer Science and Engineering, Seoul (Korea, Republic of); Song, Gi Won; Jung, Dong-Hwan; Ha, Tae-Yong; Lee, Sung Gyu [University of Ulsan College of Medicine, Department of Surgery, Division of Hepatobiliary and Liver Transplantation Surgery, Asan Medical Center, Seoul (Korea, Republic of)

    2017-05-15

    To compare the length of the right hepatic duct (RHD) measured on rotatory coronal 2D MR cholangiography (MRC), rotatory axial 2D MRC, and reconstructed 3D MRC. Sixty-seven donors underwent coronal and axial 2D projection MRC and 3D MRC. RHD length was measured and categorized as ultrashort (≤1 mm), short (>1-14 mm), and long (>14 mm). The measured length, frequency of overestimation, and the degree of underestimation between two 2D MRC sets were compared to 3D MRC. The length of the RHD from 3D MRC, coronal 2D MRC, and axial 2D MRC showed significant difference (p < 0.05). RHD was frequently overestimated on the coronal than on axial 2D MRC (61.2 % vs. 9 %; p <.0001). On coronal 2D MRC, four (6 %) with short RHD and one (1.5 %) with ultrashort RHD were over-categorized as long RHD. On axial 2D MRC, overestimation was mostly <1 mm (83.3 %), none exceeding 3 mm or over-categorized. The degree of underestimation between the two projection planes was comparable. Coronal 2D MRC overestimates the RHD in liver donors. We suggest adding axial 2D MRC to conventional coronal 2D MRC in the preoperative workup protocol for living liver donors to avoid unexpected confrontation with multiple ductal openings when harvesting the graft. (orig.)

  1. Orientation relationship between the T structure and the icosahedral quasicrystal in the Zn-Mg-Al alloy system

    Energy Technology Data Exchange (ETDEWEB)

    Nakayama, Kei, E-mail: k.n@aoni.waseda.jp; Watanabe, Junya [Department of Electronic and Physical system, Waseda University, 3-4-1, Okubo, Shinjuku-ku, Tokyo, 169-8555 (Japan); Koyama, Yasumasa, E-mail: ykoyama@waseda.jp [Department of Electronic and Physical system, Waseda University, 3-4-1, Okubo, Shinjuku-ku, Tokyo, 169-8555 (Japan); Kagami Memorial Laboratory for Materials Science and Technology, Waseda University, 2-8-26, Nishiwaseda, Shinjuku-ku, Tokyo, 169-0051 (Japan)

    2016-08-26

    To understand the crystallographic relation between the Bergman-type icosahedral quasicrystal and its approximant-T structure, we have investigated the crystallographic features of prepared Zn-Mg-Al alloy samples, mainly by transmission electron microscopy. It was found that there existed three kinds of regions: that is, C14-Laves, approximant-T, and icosahedral-quasicrystal regions, in Zn-Mg-Al alloy samples with the composition of Zn-36at.%Mg-9at.%Al. Among these regions, in particular, we tried to determine an orientation relationship between neighboring icosahedral-quasicrystal and approximant-T regions. Based on the determined relationship, for instance, four threefold rotatory-inversion axes in the T structure were found to be parallel to four of ten threefold rotatory-inversion axes in the icosahedral quasicrystal. It was thus understood that the atomic arrangements of the Bergman-type icosahedral quasicrystal and its approximant-T structure are likely to resemble each other.

  2. Medial collateral ligament reconstruction using bone-patellar tendon-bone allograft for chronic medial knee instability combined with multi-ligament injuries: a new technique.

    Science.gov (United States)

    Zheng, Xiaozuo; Li, Tong; Wang, Juan; Dong, Jiangtao; Gao, Shijun

    2016-07-22

    The medial collateral ligament (MCL) is the main static stabilizer of the medial knee. The surgical treatment was recommended in cases with serious medial collateral ligament insufficiency combined with multi-ligament injuries and chronic symptomatic medial instability. Several surgical techniques have been described for the MCL reconstruction, while potential problems including donor site morbidity, complicated procedure, and high risk of femoral tunnel collision were reported. In order to minimize such potential limitations, we describe a new medial reconstruction technique for MCL injury using bone-patellar tendon-bone (BPTB) allograft. A longitudinal incision at the medial knee was made. The centers of femoral and tibial attachments were gained through repeated isometricity test. Then, the bone grooves were made around the femoral and tibial centers. The appropriate BPTB allograft was selected, and both ends were trimmed. The prepared bone blocks were embedded into the grooves and fixed with cancellous screws. The programmed rehabilitation exercises were performed after the operation. A strong graft and bone-to-bone healing on both femoral and tibial attachment sites were obtained, and femoral tunnel collision during multi-ligament reconstruction was avoided. Satisfactory valgus and rotatory stability were gained. This novel MCL reconstruction technique using BPTB allograft can be safely performed, and the clinical outcome was favorable with satisfactory valgus and rotatory stability. More cases and additional follow-up results are needed to verify the overall effect of this technique.

  3. Distribution of Force in the Medial Collateral Ligament Complex During Simulated Clinical Tests of Knee Stability.

    Science.gov (United States)

    Schafer, Kevin A; Tucker, Scott; Griffith, Timothy; Sheikh, Saad; Wickiewicz, Thomas L; Nawabi, Danyal H; Imhauser, Carl W; Pearle, Andrew D

    2016-05-01

    Pivot-shift injury commonly results in combined anterior cruciate ligament (ACL)/medial collateral ligament (MCL) injury, yet the contribution of the components of the MCL complex to restraining multiplanar rotatory loads forming critical subcomponents of the pivot shift is not well understood. To quantify the role of the MCL complex in restraining multiplanar rotatory loads. Controlled laboratory study. A robotic manipulator was used to apply combined valgus and internal rotation torques in a simplified model of the pivot-shift examination in 12 cadaveric knees (49 ± 11 years). Tibiofemoral kinematics were recorded with the ACL intact. Loads borne by the superficial MCL (sMCL), posterior oblique ligament (POL), deep MCL (dMCL), and ACL were determined via the principle of superposition. The POL bore about 50% of the load carried by the ACL in response to the combined torques at 5° and 15° of flexion. The POL bore load during the internal rotation component of the combined torques, while the sMCL carried load during the valgus and internal rotation phases of the simulated pivot. Load in the dMCL was always knee stability in the ACL-competent knee. Both the sMCL and POL work together with the ACL to resist combined moments, which form key components of the pivot-shift examination. © 2016 The Author(s).

  4. Nonfocal Symptoms in Patients with Transient Ischemic Attack or Ischemic Stroke: Occurrence, Clinical Determinants, and Association with Cardiac History.

    Science.gov (United States)

    Plas, Gerben J J; Booij, Heleen A; Brouwers, Paul J A M; Brusse-Keizer, Marjolein; Koudstaal, Peter J; Dippel, Diederik W J; den Hertog, Heleen M

    2016-01-01

    Transient ischemic attacks (TIAs) accompanied by nonfocal symptoms are associated with a higher risk of cardiovascular events, in particular cardiac events. Reported frequencies of TIAs accompanied by nonfocal symptoms range from 18 to 53%. We assessed the occurrence of nonfocal symptoms in patients with TIA or minor ischemic stroke in a neurological outpatient clinic in terms of clinical determinants, cardiac history, and atrial fibrillation (AF). We included 1,265 consecutive patients with TIA or minor stroke who visited the outpatient clinic. During these visits, we systematically asked for nonfocal symptoms. Nonfocal symptoms included decreased consciousness, amnesia, positive visual phenomena, non-rotatory dizziness, and paresthesias. Relative risks for the presence of nonfocal symptoms in relation to clinical determinants, AF, and cardiac history were calculated. In 243 (19%) of 1,265 patients, TIA or minor ischemic stroke was accompanied by one or more nonfocal symptoms. Non-rotatory dizziness, paresthesia, and amnesia were the most common nonfocal symptoms. In patients with an event of the posterior circulation or obesity, the qualifying TIA or minor stroke was more frequently accompanied by nonfocal symptoms, and in patients with significant carotid stenosis, nonfocal symptoms occurred less frequently. AF was related only with amnesia. Nonfocal symptoms are present in one out of 5 patients with TIA or ischemic stroke, in particular when located in the posterior circulation. A cardiac history or AF was not directly related to nonfocal symptoms. A heterogeneous etiology is suggested. © 2016 S. Karger AG, Basel.

  5. Avaliação do tempo de resposta eletromiográfica em atletas de voleibol e não atletas que sofreram entorse de tornozelo Evaluación del tiempo de respuesta electromiográfica en atletas de voleibol y no atletas que han sufrido esguince de tobillo Evaluation of the time for the electromyographic response in volleyball athletes and non-athletes who had ankle sprain

    Directory of Open Access Journals (Sweden)

    Adriana Moré Pacheco

    2005-12-01

    Full Text Available A proposta deste estudo foi examinar o tempo de resposta eletromiográfica dos músculos fibulares, na inversão repentina do pé, em tornozelos com presença de lesão e saudáveis. Três grupos foram testados, um de atletas normais (grupo 1, um de atletas com história recente de entorse de tornozelo (grupo 2 e o outro de não atletas com história recente de entorse de tornozelo (grupo 3. Para cada sujeito dos três grupos, ambos os tornozelos foram testados. Os sujeitos que sofreram entorse de tornozelo (grupos 2 e 3 não apresentavam sintomas de lesão durante os últimos dois meses antes do teste. Uma plataforma capaz de produzir uma inversão repentina lateral de 20° do tornozelo no plano frontal simulava um evento de entorse de tornozelo. Eletrodos de eletromiografia de superfície foram colocados na pele sobre os músculos fibulares. Os tempos de resposta eletromiográfica dos músculos fibulares foram obtidos e comparados entre os grupos. Para o grupo 1, a média dos tempos de resposta eletromiográfica foi de 71ms para a perna direita e 69ms para a perna esquerda. Para o grupo 2, a média dos tempos de resposta eletromiográfica foi de 72ms para o tornozelo sem lesão e 74ms para o tornozelo com a lesão. Para o grupo 3, a média dos tempos de resposta eletromiográfica foi de 72ms para o tornozelo sem lesão e 73ms para o tornozelo com a lesão. Os resultados indicaram que não houve diferença estatisticamente significante entre as pernas direita e esquerda no grupo 1 e entre os tornozelos sem lesão e com lesão dos grupos 2 e 3 para os músculos fibulares. Os achados do presente estudo sugerem que a resposta eletromiográfica dos músculos fibulares, durante o deslocamento angular repentino do tornozelo, não foi influenciada pela entorse de tornozelo.La propuesta de este estudio era examinar el tiempo de la respuesta electromiográfica de los musculos fibulares, en el esguince agudo del pie, en los tobillos con la presencia de l

  6. Surface Projection of Interosseous Foramen of the Leg: Cadaver Study

    Directory of Open Access Journals (Sweden)

    Eric Arguello

    2016-01-01

    Full Text Available Purpose. This study was conducted to identify the surface projection of the interosseous foramen and associated structures of the proximal leg using the average clinician’s thumb width as a quick measurement to assist in differential diagnosis and treatment. Methods. Twelve cadavers (5 males and 7 females, age range = 51–91 years, and mean age = 76.9 were dissected for analysis. Location and size of interosseous foramen, location of anterior tibial artery, location of deep fibular nerve, and corresponding arterial branches were measured and converted into thumb widths. Results. Mean thumb width measured among the cadavers was 17.94±3.9 mm. The interosseous foramen measured was approximately 1 thumb width vertically (18.47±3.0 mm and 1/2 thumb width horizontally (7.32±2.1 mm and was located approximately 1 thumb width distally to the tibial tuberosity (20.81±6.8 mm and 2 thumb widths (37.47±4.7 mm lateral to the tibial ridge. The anterior tibial artery and deep fibular nerve converged approximately 4 thumb widths (74.31±14.8 mm inferior to the tibial tuberosity and 2 thumb widths (33.46±4.9 mm lateral to the tibial ridge. Conclusion. Clinicians may identify anatomical structures of the proximal leg with palpation using the thumb width for measurement.

  7. Double muscle innervation using end-to-side neurorrhaphy in rats Dupla inervação muscular com neurorrafia término-lateral em ratos

    Directory of Open Access Journals (Sweden)

    Elisangela Jeronymo Stipp-Brambilla

    2012-01-01

    neurorrafia término-lateral e a manutenção da inervação. TIPO DE ESTUDO E LOCAL: Estudo experimental desenvolvido no Centro de Pesquisa Experimental da Faculdade de Medicina de Botucatu, Unesp. MÉTODOS: Cem ratos foram distribuídos em cinco grupos: G1, controle; G2, secção do nervo fibular; G3, o nervo tibial foi seccionado e o coto proximal suturado na lateral do nervo fibular íntegro; G4, 120 dias após a cirurgia do G3, o nervo fibular foi seccionado proximal à neurorrafia; G5, 120 dias após a cirurgia do G3, os nervos fibular e tibial foram seccionados proximal à neurorrafia. RESULTADOS: Após 150 dias da cirurgia, não foi observada variação na massa do músculo tibial ou no diâmetro das fibras musculares no G3, porém, houve redução do diâmetro da fibra axonal do nervo fibular distal à neurorrafia. Embora, no G4, tenha ocorrido atrofia do músculo tibial cranial 30 dias após a secção do nervo fibular, os resultados do teste eletrofisiológico e da medida do diâmetro axonal confirmaram a ocorrência de reinervação muscular. CONCLUSÃO: Estes resultados sugerem que a dupla inervação muscular não ocorreu através da neurorrafia término-lateral; o nervo tibial não foi capaz de manter a inervação muscular após a secção do nervo fibular; contudo, ocorreu reinervação muscular 30 dias após a secção do nervo fibular.

  8. The Mulligan ankle taping does not affect balance performance in healthy subjects: a prospective, randomized blinded trial.

    Science.gov (United States)

    de-la-Morena, Jose Maria Delfa; Alguacil-Diego, Isabel Maria; Molina-Rueda, Francisco; Ramiro-González, Maria; Villafañe, Jorge Hugo; Fernández-Carnero, Josué

    2015-05-01

    [Purpose] The aim of this study was to evaluate the immediate effects of Mulligan fibular taping on static and dynamic postural balance in healthy subjects using computerized dynamic posturography (CDP). [Subjects and Methods] Forty-four volunteers (26 males and 18 females) aged 21 ±2 years participated in the study. The Mulligan tape was applied by a specialist in this technique. The placebo group received a treatment with a similar tape but with several cuts to avoid the fibular repositioning effect produced by Mulligan tape. The Sensory Organization Test (SOT) and the Motor Control Test (MCT) were performed by each subject at baseline and after the interventions. Outcome measures included equilibrium and strategy scores from each trial and condition of the SOT, and speed of reaction (latency period) from the MCT. [Results] Mulligan ankle taping did not have an impact on postural control during static and dynamic balance in subjects with healthy ankles when compared with placebo taping. [Conclusion] There was no difference in, equilibrium and strategy (SOT) and speed of reaction (MCT) in any of the subjects in this study. Therefore, this study suggests that Mulligan ankle taping does not have an impact on balance in healthy subjects.

  9. Morphofunctional evaluation of end-to-side neurorrhaphy through video system magnification.

    Science.gov (United States)

    de Barros, Rui Sergio Monteiro; Brito, Marcus Vinicius Henriques; de Brito, Marcelo Houat; de Aguiar Lédo Coutinho, Jean Vitor; Teixeira, Renan Kleber Costa; Yamaki, Vitor Nagai; da Silva Costa, Felipe Lobato; Somensi, Danusa Neves

    2018-01-01

    The surgical microscope is an essential tool for microsurgery. Nonetheless, several promising alternatives are being developed, including endoscopes and laparoscopes with video systems. However, these alternatives have only been used for arterial anastomoses so far. The aim of this study was to evaluate the use of a low-cost video-assisted magnification system in end-to-side neurorrhaphy in rats. Forty rats were randomly divided into four matched groups: (1) normality (sciatic nerve was exposed but was kept intact); (2) denervation (fibular nerve was sectioned, and the proximal and distal stumps were sutured-transection without repair); (3) microscope; and (4) video system (fibular nerve was sectioned; the proximal stump was buried inside the adjacent musculature, and the distal stump was sutured to the tibial nerve). Microsurgical procedures were performed with guidance from a microscope or video system. We analyzed weight, nerve caliber, number of stitches, times required to perform the neurorrhaphy, muscle mass, peroneal functional indices, latency and amplitude, and numbers of axons. There were no significant differences in weight, nerve caliber, number of stitches, muscle mass, peroneal functional indices, or latency between microscope and video system groups. Neurorrhaphy took longer using the video system (P microscope group than in the video group. It is possible to perform an end-to-side neurorrhaphy in rats through video system magnification. The success rate is satisfactory and comparable with that of procedures performed under surgical microscopes. Copyright © 2017 Elsevier Inc. All rights reserved.

  10. Complications of resection and reconstruction in giant cell tumour of distal end of radius - An analysis

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    Saraf S

    2005-01-01

    Full Text Available Background: The bulk of literature on the subject focuses on the resection of the tumor followed by reconstruction using autologous fibula, however, papers analyzing the failures of this procedure are scanty. The aim is to analyze the various factors responsible for the failures. Methods: Study included 42 patients of aggressive GCT of distal radius, resected and reconstructed using nonvascularised autologous fibula. Host graft junction was fixed using screws (6, intramedullary nail (21 and plate (15. The minimum follow-up was 2 years or till a complication occurred requiring second surgery. Result: The major complications were recurrence in 6 cases (spillage of tumor tissue in 3, poor biopsy site 2, recurrence along the nail tract one case; failure of host graft union in 8 cases due to inadequate contact at host graft junction, poor implant selection, inadequate immobilization and infection; significant instability at wrist in 6 cases due to poor stabilization at carpo fibular junction in addition to inherent instability due to poor congruity between fibulocarpal articulations. Conclusion: Reconstruction of distal end of radius using auto fibula has much higher complication rates than usually believed. A meticulous planning and its execution is must to minimize the problems. Use of dynamic plate for host graft junction and fixation of fibular head to adjacent ulna/carpal bones improves the results.

  11. The functional anatomy of the human anterior talofibular ligament in relation to ankle sprains

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    Kumai, T; Takakura, Y; Rufai, A; Milz, S; Benjamin, M

    2002-01-01

    The anterior talofibular ligament is the most commonly injured ligament in the ankle. Despite considerable interest in the clinical outcome of treatment protocols, we do not know whether the distinctive pattern of localization of the injuries relates to regional differences in the structure and molecular composition of the ligament. To address this issue, ligaments were examined by histology and immunohistochemistry. Differences in the structure of its two attachments (i.e. entheses) were evaluated with quantitative, morphometric techniques, and regional differences in the distribution of collagens, glycosaminoglycans and proteoglycans weredetermined qualitatively by immunolabelling. Morphometric analyses showed that bone density was less at the fibular attachment, but that enthesis fibrocartilage was more prominent. Immunohistochemistry revealed the presence of a fibrocartilage (containing type II collagen and aggrecan) at the site where the ligament wraps around the lateral talar articular cartilage ina plantarflexed and inverted foot: the fibrocartilage is regarded as an adaptation to resisting compression. We propose that avulsion fractures are less common at the talar end of the ligament because (1) bone density is greater here than at the fibular enthesis, and (2) stress is dissipated away from the talar enthesis by the ‘wrap-around’ fibrocartilaginous character of the ligament near the talar articular facet. PMID:12090392

  12. Repair of Minor Tissue Defect in Hand by Transfer of Free Tissue Flap from the Toe

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    Haitao Tan

    2014-03-01

    Full Text Available Background:   To introduce our experience of using the free neurovascular flap from great and second toe. Methods:   Thirteen patients (fifteen fingers sought surgical treatment for soft tissue defects of the hand at our medical institutin between March 2006 and September 2009. In two patients, fibular side skin-nail flaps of great toe were applied to cover the dorsal defect of distal thumb. In twelve, in the treatment of pulp defect of finger with fibular side flap of great toe or tibial side flap of second toe. In one, in the treatment of defect of distal middle with composite flap with distal digital bone of second toe. Results:   All flaps were survived. The average subjective satisfaction score was 8.08 (range 4-10. Nine patients (69% experienced cold intolerance, and 2 patients (15% dysesthesia. The Semmes-Weinstein sensitivity score was between 3.47and 4.72 on the flap, and 0-4.18 on the donor site. The mean two-point discrimination was 6.8 mm (range 4-12. Grip strength was 10% less than in the unaffected hand. The proximal interphalangeal mobility loss was less than 15 degrees. Conclusions:   Our results indicated that these free flaps from toe are useful for patients with a small soft-tissue defect in hand.

  13. Rapsyn congenital myasthenic syndrome worsened by fluoxetine.

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    Visser, Amy C; Laughlin, Ruple S; Litchy, William J; Benarroch, Eduardo E; Milone, Margherita

    2017-01-01

    Fluoxetine is a selective serotonin reuptake inhibitor and long-lived open channel blocker of the acetylcholine receptor, often used in the treatment of slow-channel congenital myasthenic syndromes (CMS). We report a 42-year-old woman who had a history of episodic limb weakness that worsened after initiation of fluoxetine for treatment of depression. Genetic testing for CMS revealed a homozygous pathogenic mutation in the rapsyn (RAPSN) gene (p.Asn88Lys). Electrodiagnostic testing was performed before and 1 month after discontinuation of fluoxetine. The 2 Hz repetitive nerve stimulation of the fibular and spinal accessory nerves showed a baseline decrement of 36% and 14%, respectively. One month after discontinuing fluoxetine, the spinal accessory nerve decrement was no longer present, and the decrement in the fibular nerve was improved at 17%. This case demonstrates worsening of both clinical and electrophysiologic findings in a patient with CMS secondary to a RAPSN mutation treated with fluoxetine. Muscle Nerve 55: 131-135, 2017. © 2016 Wiley Periodicals, Inc.

  14. Recurrent Ameloblastoma in the Free Fibula Flap: Review of Literature and an Unusual Case Report.

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    Basat, Salih Onur; Öreroğlu, Ali Rıza; Orman, Cagdas; Aksan, Tolga; Üsçetin, İlker; Akan, Mithat

    2015-09-01

    Ameloblastoma is the second most common odontogenic tumor of the oral cavity with the primary site being the mandible. The ratio of maxillomandibular involvement however is 5:1 in favor of the mandible. The most common complaint is a painless swelling over the mandibular area. Despite its benign nature, ameloblastoma has a high local recurrence rate, with the most recurrences seen within 5 years after operation. Biopsy and radiological evaluation may be helpful in differentiating the subtypes of ameloblastoma. Differentiation is important because some subtypes are more aggressive than the others. Preoperative planning may be done according to this classification, which can help decrease the recurrence rate. In our case, a 26-year-old female patient with recurrent ameloblastoma which developed on the fibular flap is presented. The free fibular flap and the left parasymphyseal part of the mandible were totally excised. Ameloblastoma was confirmed on pathological examination. We reconstructed the left mandibular site with a reconstruction plate and recurrence was not seen during follow up period.

  15. Mother’s fibula in son’s forearm: use of maternal bone grafting for aneurysmal bone cyst not amenable to curettage – a case report with review of literature

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    Ansari Mohammed Tahir

    2016-01-01

    Full Text Available It has always been a challenge to reconstruct large bone gaps. The aim of this case report is to highlight the success of homologous maternal bone grafting in a large cystic lesion. A six and half years old boy presented to us with an aneurysmal bone cyst (ABC of the right radius, not amenable to curettage. We excised the lesion in toto, which created an 11 cm bone loss. Considering the age of the patient, we reconstructed the bone gap with maternal fibular graft. Accordingly, 12 cm of fibular graft was harvested and fashioned to fit into the bone gap. It was fixed with an intramedullary K-wire. No cancellous graft was used in the procedure. The limb was kept in the above elbow cast till incorporation of the fibula was noted on the radiographs. Six months following surgery the skiagram showed that the fibula was incorporated. Mobilization of the elbow and wrist was started along with strengthening of the forearm muscles. K-wire was removed at nine months. At the latest follow up of 24 months, the fibula is fully incorporated, the child regained full range of motion and strength of elbow. We discuss the techniques adopted in this particular case along with the review of literature.

  16. Aneurysmal Bone Cyst In Metacarpal of a Child.

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    Singh, Pankaj; Kumar, Rupesh

    2013-01-01

    Aneurysmal bone cyst is a rare, rapidly growing, and destructive benign bone tumor that rarely involves the bones of the hand. Various treatment options for aneurysmal bone cyst have been reported in the literature, but controversy exists regarding optimal treatment. A six year old boy presented with a history of pain and local swelling over his third metacarpal of five months' duration. Physical and radiographic examination of the hand was consistent with aneurysmal bone cyst. After biopsy, pathologic examination confirmed the diagnosis of aneurysmal bone cyst. En- block resection of the tumor and autologous fibular strut graft fixation with Kirschner wires was performed. The hand was immobilized in a short arm cast for three weeks; after the patient received three weeks of physiotherapy, the kirschner wires were removed six weeks postoperatively. Excellent clinical and functional results were obtained with no recurrence after two years of follow-up with en-block resection and reconstruction by autologous graft. Aneurysmal bone cyst in third metacarpal of child of age six is rare entity and decision making for management poses difficulties. Our experience with En-block resection of tumor and autologus fibular sturt grafting was quite satisfactory with excellent clinical result, and we recommend this is as one modality of treatment of ABC in metacarpal of child.

  17. Postaxial hypoplasia of the lower extremity.

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    Stevens, P M; Arms, D

    2000-01-01

    Congenital deficiency of the fibula may present a variety of patterns. In a series of 20 patients with this diagnosis, we have observed limb-length inequality and a spectrum of musculoskeletal anomalies involving the ipsilateral hip, femur, knee, tibia/fibula, ankle, and foot. Considering the frequently associated abnormalities of the lower extremity, the term postaxial hypoplasia may be more descriptive than the traditional terms fibular hemimelia or fibular a/hypoplasia. By raising the awareness of associated deformities, the clinician is better prepared to advise patients and to intercede accordingly. Based on our experience, we advocate a modular treatment approach combining limb lengthening with hemiepiphysiodesis of the distal femur and/or ankle to correct valgus alignment and establish a neutral mechanical axis. Contralateral epiphysiodesis as an adjunct may be preferable to double or repeated lengthening. The goal is to achieve symmetry and stable joints at skeletal maturity with a minimal number of well-timed surgical interventions. By using this strategy and with minimal morbidity, 10 of our patients who have reached skeletal maturity have achieved a satisfactory outcome.

  18. Vertical distraction osteogenesis of fibula transplants for mandibular reconstruction--a preliminary study.

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    Klesper, Bernd; Lazar, Frank; Siessegger, Matthias; Hidding, Johannes; Zöller, Joachim E

    2002-10-01

    When reconstructing the mandible after tumour resection with a fibular graft, the mandible is often vertically deficient, making placement of dental implants impossible. Segmental vertical distraction of the reconstructed mandible was performed in nine patients following tumour surgery between February 1998 and 2001. Their age was 14-65 years (average 46.3); all underwent radiotherapy with a dose of up to 55.6 Gy prior to tumour resection. Mandibular discontinuity was repaired with a microvascular fibular bone graft. All grafts had a vertical bone deficit ranging from 9 to 12 mm when compared with the non-resected part of the mandibles. All patients underwent segmental vertical distraction of the transplants. The distraction devices were applied intraorally. Distraction of 1.0 mm/day was performed using a Martin distractor (TRACK 1.5) followed by 12 weeks retention time. The increase of vertical bone height was stable and enabled placement of dental implants without any complications. Vertical distraction osteogenesis may become a common procedure in the treatment of alveolar ridge deficiency resulting from transplanting fibulae for mandibular reconstruction following tumour surgery.

  19. Meniscofibular Ligament: Morphology and Functional Significance of a Relatively Unknown Anatomical Structure

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    K. Natsis

    2012-01-01

    Full Text Available Purpose. A relatively unknown ligamentous structure of the posterolateral corner of the knee joint, the so-called meniscofibular ligament (MFL, was investigated as regards its macroscopic morphology, its histological features, and its reaction to knee movements. Material and Methods. MFL was exposed on 21 fresh-frozen unpaired knee joints. Its microscopic morphology was examined utilizing for comparison the fibular collateral and the popliteofibular ligament. Results. MFL was encountered in 100% of the specimens as a thin striplike fibrous band extending between the lower border of the lateral meniscus and the head of the fibula. MFL was tense during knee extension and external rotation of the tibia, whereas its histological features were similar to those of fibular collateral and popliteofibular ligament. Discussion. Its precise histological nature is studied as well as its tension alterations during knee movements. The potential functional significance of the MFL with respect to its role in avoidance of lateral meniscus and lateral coronary ligament tears is discussed. Conclusions. MFL presumably provides an additional protection to the lateral meniscus during the last stages of knee extension, as well as to the lateral coronary ligament reducing the possibility of a potential rupture.

  20. Meniscofibular Ligament: Morphology and Functional Significance of a Relatively Unknown Anatomical Structure

    Science.gov (United States)

    Natsis, K.; Paraskevas, G.; Anastasopoulos, N.; Papamitsou, T.; Sioga, A.

    2012-01-01

    Purpose. A relatively unknown ligamentous structure of the posterolateral corner of the knee joint, the so-called meniscofibular ligament (MFL), was investigated as regards its macroscopic morphology, its histological features, and its reaction to knee movements. Material and Methods. MFL was exposed on 21 fresh-frozen unpaired knee joints. Its microscopic morphology was examined utilizing for comparison the fibular collateral and the popliteofibular ligament. Results. MFL was encountered in 100% of the specimens as a thin striplike fibrous band extending between the lower border of the lateral meniscus and the head of the fibula. MFL was tense during knee extension and external rotation of the tibia, whereas its histological features were similar to those of fibular collateral and popliteofibular ligament. Discussion. Its precise histological nature is studied as well as its tension alterations during knee movements. The potential functional significance of the MFL with respect to its role in avoidance of lateral meniscus and lateral coronary ligament tears is discussed. Conclusions. MFL presumably provides an additional protection to the lateral meniscus during the last stages of knee extension, as well as to the lateral coronary ligament reducing the possibility of a potential rupture. PMID:22811916