Sample records for wedge high tibial

  1. Measurement of tibial slope angle after medial opening wedge high tibial osteotomy: case series

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    Ricardo Hideki Yanasse

    Full Text Available CONTEXT AND OBJECTIVE: In the past, changes in tibial slope were not considered when planning or evaluating osteotomies, and success in high tibial osteotomy was related to the alignment and amount of femorotibial angular correction. The aim here was to measure changes in tibial slope after medial opening wedge tibial osteotomy and investigate the effect of tibial slope angle on the clinical results. DESIGN AND SETTING: Retrospective review study on a series of cases, at the Department of Orthopedics and Traumatology, Faculdade de Medicina de Marília (Famema, Marília, Brazil. METHODS: Twenty-eight patients were studied, and a total of thirty-one knees. Lateral roentgenograms of the tibia were used pre and postoperatively to measure the tibial slope based on the proximal tibial anatomical axis. The clinical results were measured using the Lysholm knee score. RESULTS: There was an average increase in tibial slope angle after surgery of 2.38° (95% confidence interval: ± 0.73°. There was no correlation (r = -0.28 between the postoperative Lysholm knee score and the difference in tibial slope angle from before to after surgery (P = 0.13. CONCLUSION: Medial opening wedge tibial osteotomy led to a small increase in tibial slope. No significant correlation was found between increased tibial slope and short-term clinical results after high tibial osteotomy. Other clinical studies are needed in order to establish whether extension or flexion osteotomy could benefit patients with medial compartment gonarthrosis.

  2. Modified retro-tubercle opening-wedge versus conventional high tibial osteotomy. (United States)

    Keyhani, Sohrab; Abbasian, Mohammad Reza; Kazemi, Seyed Morteza; Esmailiejah, Ali Akbar; Seyed Hosseinzadeh, Hamid Reza; Shahi, Alisina; Shahi, Ali Sina; Firouzi, Farzad


    Despite the fact that common surgical techniques for the treatment of genu varum usually correct the malalignment in the affected knee, these methods have significant complications and cause problems in the long term. Retro-tubercle opening-wedge high tibial osteotomy is among the newer techniques for the treatment of genu varum. The goal of this study was to compare the results of retro-tubercle opening-wedge high tibial osteotomy with those of medial opening-wedge osteotomy. In a randomized, controlled trial, 72 patients with varus knees who were scheduled for surgery were assigned into either the retro-tubercle opening-wedge high tibial osteotomy (n=34) or medial opening-wedge osteotomy groups (n=38). Groups were matched for age and sex. The position of the patella was compared with respect to the tuberosity and the upper tibial slope pre- and postoperatively. Patients were followed for an average of 13 months (range, 10-21 months). In the retro-tubercle opening-wedge high tibial osteotomy group, the length of the patellar tendon did not significantly differ pre- and postoperatively (P≥.5); however, in the medial opening-wedge osteotomy group, a statistically significant shortening was noted in patellar tendon postoperatively (P≤.05). Similarly, the tibial plateau inclination showed a statistically significant difference postoperatively in the medial opening-wedge osteotomy group, while the difference in the retro-tubercle opening-wedge high tibial osteotomy group did not reach statistical significance.

  3. Sagittal osteotomy inclination in medial open-wedge high tibial osteotomy. (United States)

    Lee, Seung-Yup; Lim, Hong-Chul; Bae, Ji Hoon; Kim, Jae Gyoon; Yun, Se-Hyeok; Yang, Jae-Hyuk; Yoon, Jung-Ro


    Unlike postoperative changes in posterior tibial slope after medial open-wedge high tibial osteotomy, sagittal osteotomy inclination has not been examined. It has been recommended that the osteotomy line in the sagittal plane be parallel to the medial posterior tibial slope. The purpose of this study was to determine the frequency of parallel osteotomy in medial open-wedge high tibial osteotomy. To determine the sagittal osteotomy inclination, the angle between the medial joint line and the osteotomy line was measured in the lateral radiograph. A positive angle value indicates that the osteotomy is anteriorly inclined relative to the medial posterior tibial slope. Correlation between the sagittal osteotomy inclination and posterior tibial slope was also evaluated. The mean sagittal osteotomy inclination was 15.1 ± 7.5°. The majority 87.1 % of knees showed an anterior-inclined osteotomy. There was a significantly positive correlation between the postoperative posterior tibial slope and the sagittal osteotomy inclination (r, 0.33; 95 % confidence interval (CI) 0.19-0.46; P osteotomy inclination (r, 0.35; 95 % CI 0.21-0.47; P osteotomy in the sagittal plane relative to the medial joint line was planned, only 12.9 % of cases achieved osteotomy parallel to the medial posterior tibial slope in the sagittal plane. Because of high rate of the anterior-inclined osteotomy and their correlations with posterior tibial slope, surgeons should make all efforts to perform parallel osteotomy relative to medial posterior tibial slope. IV.

  4. Stress analysis of the tibial plateau according to the difference of blade path entry in opening wedge high tibial osteotomy

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    Lee, Jun Woo; Xin, YuanZhu; Yang, Seok Jo [Chungnam National University, Daejeon (Korea, Republic of); Ji, Jong Hun; Panchal, Karnav; Kwon, Oh Soo [The Catholic University of Korea, Daejeon (Korea, Republic of)


    High tibial osteotomy (HTO) has been used to successfully treat patients with genu varus deformities that can improve mechanical function and condition in the knee joint. Clinical studies have reported that bow legs often occur with a concentrated load on the varus of the tibia. This study aimed to analyze and verify the clinical test data result by utilizing the three-dimensional (3D) static finite element method (FEM). The 3D model of lower extremities, which include the femur, tibia, meniscus, and knee articular cartilage, was created using the images from a computer tomography scan and magnetic resonance imaging. In this report, we compared changes in stress distribution and force reaction on the tibial plateau because of critical problems caused by unexpected changes in the tibial posterior-slope angle because of HTO. The results showed that the 5 .deg. wedge-angle virtual opening wedge HTO without and with the posterior-slope angle shows has a load concentration of approximately 60% and 45% in the medial region, respectively.

  5. Open Wedge High Tibial Osteotomy and Combined Arthroscopic Surgery in Severe Medial Osteoarthritis and Varus Malalignment: Minimum 5-Year Results


    Yoo, Moon-Jib; Shin, Yong-Eun


    Purpose To evaluate the radiologic and functional outcomes of medial open wedge high tibial osteotomy (HTO) combined with arthroscopic procedure in patients with medial osteoarthritis. Materials and Methods From June 1996 to March 2010, 26 patients (32 knees) who underwent medial open wedge osteotomy and arthroscopic operation for medial osteoarthritis were retrospectively reviewed. Measurements included hip-knee-ankle (HKA) angle, femorotibial angle, medial proximal tibial angle, posterior t...

  6. Total knee arthroplasty after failed high tibial osteotomy: a systematic review of open versus closed wedge osteotomy. (United States)

    Han, Jae Hwi; Yang, Jae-Hyuk; Bhandare, Nikhl N; Suh, Dong Won; Lee, Jong Seong; Chang, Yong Suk; Yeom, Ji Woong; Nha, Kyung Wook


    Medial opening wedge high tibial osteotomy (HTO) has become increasingly popular as an alternative to lateral closing wedge osteotomy for the treatment of medial compartment knee osteoarthritis with varus deformity. The present systematic review was conducted to provide an objective analysis of total knee arthroplasty (TKA) outcomes following previous knee osteotomy (medial opening wedge vs. lateral closing wedge). A literature search of online databases (MEDLINE, EMBASE, Cochrane Library database) was made, in addition to manual search of major orthopaedic journals. The methodological quality of each of the studies was assessed on the Newcastle-Ottawa Scale and Effective Practice and Organization of Care. A total of ten studies were included in the review. There were eight studies with Level IV and two studies with Level III evidence. Eight studies reported clinical and radiologic scores. Comparative studies between TKA following medial opening and lateral closing wedge HTO did not demonstrate statistically significant clinical and radiologic differences. The revision rates were similar. However, more technical issues during TKA surgery after lateral closing wedge HTO were mentioned than the medial open wedge group. The quadriceps snip, tibial tubercle osteotomy, and lateral soft tissue release were more frequently needed in the lateral closing wedge HTO group. In addition, because of loss of proximal tibia bone geometry in the lateral closing wedge HTO group, concerns such as tibia stem impingement in the lateral tibial cortex was noted. The present systematic review suggests that TKA after medial opening and lateral closing wedge HTO showed similar performance. Clinical and radiologic outcome including revision rates did not statistically differ from included studies. However, there are more surgical technical concerns in TKA conversion from lateral closing wedge HTO than from the medial opening wedge HTO group. IV.

  7. High tibial closing wedge osteotomy for medial compartment osteoarthrosis of knee

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    Tuli S


    Full Text Available Background: Most patients of symptomatic osteoarthrosis of knee are associated with varus malalignment that is causative or contributory to painful arthrosis. It is rational to correct the malalignment to transfer the functional load to the unaffected or less affected compartment of the knee to relieve symptoms. We report the outcome of a simple technique of high tibial osteotomy in the medial compartment of osteoarthrosis of the knee. Materials and Methods: Between 1996 and 2004 we performed closing wedge osteotomy in 78 knees in 65 patients. The patients selected for osteotomy were symptomatic essentially due to medial compartment osteoarthrosis associated with moderate genu varum. Of the 19 patients who had bilateral symptomatic disease 11 opted for high tibial osteotomy of their second knee 1-3 years after the first operation. Preoperative grading of osteoarthrosis and postoperative function was assessed using Japanese Orthopaedic Association (JOA rating scale. Results: At a minimum follow-up of 2 years (range 2-9 years 6-10° of valgus correction at the site of osteotomy was maintained, there was significant relief of pain while walking, negotiating stairs, squatting and sitting cross-legged. Walking distance in all patients improved by two to four times their preoperative distance of 200-400 m. No patient lost any preoperative knee function. The mean JOA scoring improved from preoperative 54 (40-65 to 77 (55-85 at final follow-up. Conclusion: Closing wedge high tibial osteotomy performed by our technique can be undertaken in any setup with moderate facilities. Operation related complications are minimal and avoidable. Kirschner wire fixation is least likely to interfere with replacement surgery if it becomes necessary.

  8. Comparison of clinical and radiological outcomes between opening-wedge and closing-wedge high tibial osteotomy: A comprehensive meta-analysis (United States)

    Wu, Lingfeng; Lin, Jun; Jin, Zhicheng; Cai, Xiaobin; Gao, Weiyang


    High tibial osteotomy (HTO) has been widely used for clinical treatment of osteoarthritis of the medial compartment of the knee, and both opening-wedge and closing-wedge HTO are the most commonly used methods. However, it remains unclear which technique has better clinical and radiological outcomes in practice. To systematically evaluate this issue, we conducted a comprehensive meta-analysis by pooling all available data for the opening-wedge HTO and closing-wedge HTO techniques from the electronic databases including PubMed, Embase, Wed of Science and Cochrane Library. A total of 22 studies encompassing 2582 cases were finally enrolled in the meta-analysis. There was no significant difference regarding surgery time, duration of hospitalization, knee pain VAS, Lysholm score and HSS knee score (clinical outcomes) between the opening-wedge and closing-wedge HTO groups (P > 0.05). However, the opening-wedge HTO group showed wider range of motion than the closing-wedge HTO group (P = 0.003). Moreover, as for Hip-Knee-Ankle angle and mean angle of correction, no significant difference was observed between the opening-wedge and closing-wedge HTO groups (P > 0.05), while the opening-wedge HTO group showed greater posterior tibial slope angle (P < 0.001) and lesser patellar height than the closing-wedge HTO group (P < 0.001). On light of the above analysis, we believe that individualized surgical approach should be introduced based on the clinical characteristics of each patient. PMID:28182736

  9. Comparison of Lateral Closing-Wedge Versus Medial Opening-Wedge High Tibial Osteotomy on Knee Joint Alignment and Kinematics in the ACL-Deficient Knee. (United States)

    Ranawat, Anil S; Nwachukwu, Benedict U; Pearle, Andrew D; Zuiderbaan, Hendrik A; Weeks, Kenneth D; Khamaisy, Saker


    Lateral closing-wedge (LCW) and medial opening-wedge (MOW) high tibial osteotomies (HTOs) correct varus knee alignment and stabilize the anterior cruciate ligament (ACL)-deficient knee. Tibiofemoral and patellofemoral alignment and kinematics after HTO are not well quantified. To compare the effect of LCW and MOW HTO on tibiofemoral and patellofemoral alignment in the ACL-deficient knee. Controlled laboratory study. Anterior drawer, Lachman, and pivot-shift tests were performed on cadaveric specimens (N = 16), and anterior tibial translation and tibial rotation were measured for the native and ACL-sectioned knee. The right and left knee of each cadaveric specimen underwent an LCW and MOW HTO, respectively, and stability testing was repeated. All cadavers underwent pre- and postosteotomy computerized tomography with 3-dimensional computer modeling to determine the effect of HTO on posterior tibial slope, as well as tibial and patellofemoral axial plane alignment (tibial axial rotation and patellar axial tilt). Correction to neutral coronal alignment was obtained with both osteotomy techniques; however, larger posterior tibial slope neutralization was achieved with LCW compared with MOW (mean ± SD, 11° ± 3.8° vs 5° ± 5°). LCW demonstrated a greater decrease in anterior tibial translation (P rotation with pivot shift. Relative to MOW, LCW resulted in greater tibial axial rotation and patellar axial tilt (7.7° ± 4° and 5.6° ± 3.9° [LCW], 2.8° ± 2.3° and 2.4° ± 0.9° [MOW], respectively; P rotation and lateral patellar tilt, which may adversely affect the patellofemoral joint. More work is needed to understand the clinical and functional outcome of these biomechanical findings in the ACL-deficient knee. © 2016 The Author(s).

  10. Personalized implant for high tibial opening wedge: combination of solid freeform fabrication with combustion synthesis process. (United States)

    Zhim, Fouad; Ayers, Reed A; Moore, John J; Moufarrège, Richard; Yahia, L'Hocine


    In this work a new generation of bioceramic personalized implants were developed. This technique combines the processes of solid freeform fabrication (SFF) and combustion synthesis (CS) to create personalized bioceramic implants with tricalcium phosphate (TCP) and hydroxyapatite (HA). These porous bioceramics will be used to fill the tibial bone gap created by the opening wedge high tibial osteotomy (OWHTO). A freeform fabrication with three-dimensional printing (3DP) technique was used to fabricate a metallic mold with the same shape required to fill the gap in the opening wedge osteotomy. The mold was subsequently used in a CS process to fabricate the personalized ceramic implants with TCP and HA compositions. The mold geometry was designed on commercial 3D CAD software. The final personalized bioceramic implant was produced using a CS process. This technique was chosen because it exploits the exothermic reaction between P₂O₅ and CaO. Also, chemical composition and distribution of pores in the implant could be controlled. To determine the chemical composition, the microstructure, and the mechanical properties of the implant, cylindrical shapes were also fabricated using different fabrication parameters. Chemical composition was performed by X-ray diffraction. Pore size and pore interconnectivity was measured and analyzed using an electronic microscope system. Mechanical properties were determined by a mechanical testing system. The porous TCP and HA obtained have an open porous structure with an average 400 µm channel size. The mechanical behavior shows great stiffness and higher load to failure for both ceramics. Finally, this personalized ceramic implant facilitated the regeneration of new bone in the gap created by OWHTO and provides additional strength to allow accelerated rehabilitation.

  11. ACL injury while jumping rope in a patient with an unintended increase in the tibial slope after an opening wedge high tibial osteotomy. (United States)

    Jung, Kwang Am; Lee, Su Chan; Hwang, Seung Hyun; Song, Moon Bok


    High tibial osteotomy (HTO) is an accepted surgical technique for the treatment of medial compartmental arthrosis of the knee in younger patients. Compared to total knee arthroplasty, HTO may be a good choice in patients who wish to continue with heavy labor and/or impact sports. Based on the rehabilitation protocol after HTO, impact sports, such as running, jumping rope, and full sports activities, are generally permitted 6 months postoperatively. Jumping rope is an excellent form of aerobic exercise, and when done properly, jumping rope can lead to a dramatic improvement in rehabilitation and full sports activities. However, an adequate evaluation should be performed prior to initiating impact sports. We present the case of a ruptured anterior cruciate ligament that occurred in a patient with an unintended increase in the tibial slope after an opening wedge HTO who was jumping rope.

  12. Accuracy and initial stability of open- and closed-wedge high tibial osteotomy: a cadaveric RSA study.

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    Gaasbeek, R.D.A.; Welsing, R.T.C.; Verdonschot, N.J.J.; Rijnberg, W.J.; Loon, C.J.M. van; Kampen, A. van


    We analyzed the difference in angle-correction accuracy and initial stability between open-wedge (OWO) and closed-wedge tibial valgus osteotomy (CWO). Five fresh-frozen pairs of human cadaver lower limbs were used; their bone mineral density (BMD) was measured with DEXA and a planned 7 degrees valgu

  13. Medial opening wedge high tibial osteotomy alters knee moments in multiple planes during walking and stair ascent. (United States)

    Leitch, Kristyn M; Birmingham, Trevor B; Dunning, Cynthia E; Giffin, J Robert


    Medial opening wedge high tibial osteotomy is a surgical procedure intended to redistribute loads on the knee in patients with medial compartment knee osteoarthritis (OA). The surgery may affect moments in multiple planes during ambulation, with potential beneficial or detrimental effects on joint loads. The objective of this study was to investigate three-dimensional external knee moments before and after medial opening wedge high tibial osteotomy during level walking and during stair ascent. Fourteen patients with varus alignment and osteoarthritis primarily affecting the medial compartment of the tibiofemoral joint were assessed. Three-dimensional motion analyses during level walking and stair ascent was evaluated using inverse dynamics before, 6 and 12 months after surgery. Mean changes at 12 months suggested decreases in the peak knee adduction, flexion and internal rotation moments, with standardized response means ranging from 0.15 to 2.54. These decreases were observed despite increases in speed. Changes in alignment were associated with changes in the adduction and internal rotation moments, but not the flexion moment. Both pre- and postoperatively, the peak knee adduction moment was significantly lower (p=0.001) during stair ascent than during level walking, while the flexion and internal rotation moments were significantly higher (pplanes of motion during ambulation, suggesting substantial alterations of the loads on the knee during ambulation.

  14. Wedged tibial components for total knee arthroplasty. (United States)

    Jeffery, R S; Orton, M A; Denham, R A


    Severe coronal deformity of the knee is frequently associated with erosion of one tibial condyle. This can cause problems with fixation and alignment during total knee arthroplasty. If the tibia is cut to the level of the more worn side, valuable bone is sacrificed; if the less worn side is chosen, the deficiency must be filled with bone--graft, cement, or a prosthesis. Tibial components with an integral polyethylene wedge on the undersurface were introduced in 1980 for use in patients with a bony deficit on one tibial condyle. The authors believe that the Denham prosthesis (Biomet, Wales, U.K.) was the first knee arthroplasty to offer such spacers. Twenty-six patients with preoperative varus deformity in whom a wedged component was used were compared with 29 historic control subjects. None of the wedged components loosened after a median follow-up period of 8 years compared with loosening in five of the control subjects (P = .01). In three of the control subjects a fractured triangle of cement was present on the radiographs. Use of the wedges was not accompanied by an improvement in postoperative alignment. The authors conclude that the wedges resulted in improved fixation that was independent of postoperative alignment.

  15. Comparison between two angular stable locking plates for medial opening-wedge high tibial osteotomy: Decisive wedge locking plate versus TomoFix™. (United States)

    Shin, Young-Soo; Kim, Keong-Ho; Sim, Hyun-Bo; Yoon, Jung-Ro


    An adequate stable fixation implant should be used for medial opening-wedge high tibial osteotomy (MOWHTO) to promote rapid bone healing without complications. This study compared the radiographic and clinical outcomes as well as plate-specific complications between two angular stable locking plates in patients following MOWHTO. This prospective study involved 97 patients (50 with DWL(®), group I; 47 with TomoFix™, group II) undergoing MOWHTO for primary medial compartment osteoarthritis between 2010 and 2013. Clinical and radiographic evaluations were performed by using the HSS and WOMAC scores, and calculating mechanical femorotibial angle (mFTA), medial proximal tibial angle (MPTA), joint line convergence angle (JLCA), and posterior tibial slope (PTS) on radiographs both preoperatively and after 3 years. A statistically significant difference was observed for the MPTA at the last follow-up between the two groups (P = 0.033). Additionally, the last follow-up MPTA of group I was associated with the osteotomy technique (P = 0.004) and preoperative JLCA (P = 0.034) whereas the last follow-up MPTA of group II was associated with gender (P = 0.001) and BMI (P = 0.008). Furthermore, the results showed that group I had a higher rate of non-union (4%) compared to that in group II (0%). Both locking plates are useful tools in the treatment of medial compartment knee osteoarthritis with varus deformity in young, active patients. However, under special consideration of the complication we found in present study, the TomoFix™ seems to be a better alternative in using the MOWHTO for highly demanding patients. Copyright © 2016 The Japanese Orthopaedic Association. Published by Elsevier B.V. All rights reserved.

  16. Progression of medial compartmental osteoarthritis 2-8 years after lateral closing-wedge high tibial osteotomy. (United States)

    Huizinga, M R; Gorter, J; Demmer, A; Bierma-Zeinstra, S M A; Brouwer, R W


    The primary purpose of this study is to investigate the progression of medial osteoarthritis (OA) following lateral closing-wedge high tibial osteotomy (HTO). Secondary outcomes included functional and pain scores. This prospective cohort study analysed 298 patients treated with lateral closing-wedge HTO surgery for medial compartmental OA. OA progression was measured by comparing the minimum joint space width (mJSW) and Kellgren-Lawrence (KL) score on radiographs preoperatively and postoperatively. The WOMAC score and NRS score for pain were obtained preoperatively and postoperatively to assess secondary outcomes. Failure was defined as revision surgery; survival was estimated. Mean follow-up was 5.2 ± 1.8 years (range 2-8.5). Mean preoperative mJSW was 3.4 ± 1.6 mm, which changed nonsignificantly (p = 0.51) to 3.4 ± 1.7 mm postoperatively. Mean annual joint space narrowing was 0.02 ± 0.34 mm/year. Progression to 1 KL grade or more was seen in 132 (44 %) patients, and annual risk of KL progression was 8.6 %. No KL progression was seen in 56 % of patients. Mean NRS decreased from 7.3 ± 1.5 to 3.5 ± 2.5 (p < 0.001). WOMAC scores decreased from 48.0 ± 17.2 to 23.6 ± 19.7 (p < 0.001). Failure was seen in 21 patients. Compared to demographic data in the literature, valgus high tibial osteotomy seems to reduce the progression of OA, reduces pain and improves knee function in patients with medial compartment OA and a varus alignment. III.

  17. Open-wedge high tibial osteotomy: incidence of lateral cortex fractures and influence of fixation device on osteotomy healing. (United States)

    Dexel, Julian; Fritzsche, Hagen; Beyer, Franziska; Harman, Melinda K; Lützner, Jörg


    Open-wedge high tibial osteotomy (HTO) is an established treatment for young and middle-aged patients with medial compartment knee osteoarthritis and varus malalignment. Although not intended, a lateral cortex fracture might occur during this procedure. Different fixation devices are available to repair such fractures. This study was performed to evaluate osteotomy healing after fixation with two different locking plates. Sixty-nine medial open-wedge HTO without bone grafting were followed until osteotomy healing. In patients with an intact lateral hinge, no problems were noted with either locking plate. A fracture of the lateral cortex occurred in 21 patients (30.4 %). In ten patients, the fracture was not recognized during surgery but was visible on the radiographs at the 6-week follow-up. Lateral cortex fracture resulted in non-union with the need for surgical treatment in three out of eight (37.5 %) patients using the newly introduced locking plate (Position HTO Maxi Plate), while this did not occur with a well-established locking plate (TomoFix) (0 out of 13, p = 0.023). With regard to other adverse events, no differences between both implants were observed. In cases of lateral cortex fracture, fixation with a smaller locking plate resulted in a relevant number of non-unions. Therefore, it is recommended that bone grafting, another fixation system, or an additional lateral fixation should be used in cases with lateral cortex fracture. III.

  18. Intraoperative adjustment of alignment under valgus stress reduces outliers in patients undergoing medial opening-wedge high tibial osteotomy. (United States)

    Kim, Man Soo; Son, Jong Min; Koh, In Jun; Bahk, Ji Hoon; In, Yong


    A considerable percentage of outliers with under- or over-correction continue to be reported despite precise preoperative planning and cautious intraoperative correction of lower limb alignment in medial opening-wedge high tibial osteotomy (MOWHTO). The purpose of this study was to determine whether our novel technique for the intraoperative adjustment of alignment under valgus stress reduces the number of outliers in patients undergoing MOWHTO compared to the conventional technique, which corrects alignment according to the cable method only. One hundred seventeen consecutive knees were enrolled in this case-control study. The first 52 knees (51 patients) were corrected in accordance with preoperative plans using the Dugdale method with modification with an intraoperative cable (group 1). In the other 65 knees (60 patients), the angle was corrected using the Dugdale method and limb alignment was adjusted using the intraoperative cable technique by applying valgus stress to the knee joint (group 2). The postoperative weight bearing line ratios and mechanical axis of the lower limb were compared at postoperative one year. Each knee was evaluated according to the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score preoperatively and at postoperative one year. A significant reduction in the number of outliers was seen in group 2 compared to group 1 (group 1 = 48.1%, group 2 = 9.2%, p outliers compared to a technique that corrected alignment using the cable method in patients undergoing MOWHTO. Level III, retrospective comparative study.

  19. Osteotomy configuration of the proximal wedge and analysis of the affecting factors in the medial open-wedge high tibial osteotomy. (United States)

    Lee, Yong Seuk; Kang, Jong Yeal; Lee, Myung Chul; Elazab, Ashraf; Choi, Uk Hyun; Kang, Seo Goo; Lee, Kyoung Jae; Lee, Sahnghoon


    The purposes of this study were (1) to confirm the disparity of the measured thickness at the lateral hinge between anterior-posterior (AP) radiograph and 3D CT image, (2) to evaluate the affecting factors, and (3) to evaluate the differences between uniplanar and biplanar osteotomies. From 2012 to 2014, a prospective comparative study was performed with 30 patients who received uniplanar osteotomy (group I) and 35 patients who received biplanar osteotomy (group II). For measurement of the proximal wedge, postoperative AP radiograph and 3D CT images were used. In the AP radiograph, medial and lateral bony bridge thicknesses were measured. In the 3D CT, the anterior and posterior images parallel to the coronal plane were selected for the evaluation. Coronal osteotomy slope was measured with the anterior image of the 3D CT scan. Sagittal osteotomy slope was measured with the sagittal section of the CT scan. Differences between the lateral bony bridge thicknesses measured in AP radiograph and the posterolateral posterolateral bony bridge thicknesses measured in 3D CT were statistically significant in both groups. Negative correlation was observed in the biplanar osteotomy group. Differences of the sagittal osteotomy slope from the native tibial slope showed negative correlation in the biplanar osteotomy group. Thickness of the posterolateral bony bridge was smaller compared to the observed thickness on the AP radiograph image that is routinely used for the follow-up. The thickness would be getting smaller if osteotomy is performed with an abrupt angle on the coronal plane and reverse slope on the sagittal plane. Therefore, osteotomy with abrupt angle on the coronal plane and reverse slope on the sagittal plane should be avoided for the proper thickness of the posterolateral bony bridge. III.

  20. The prevention of a lateral hinge fracture as a complication of a medial opening wedge high tibial osteotomy: a case control study. (United States)

    Ogawa, H; Matsumoto, K; Akiyama, H


    We aimed to investigate factors related to the technique of medial opening wedge high tibial osteotomy which might predispose to the development of a lateral hinge fracture. A total of 71 patients with 82 osteotomies were included in the study. Their mean age was 62.9 years (37 to 80). The classification of the type of osteotomy was based on whether it extended beyond the fibular head. The level of the osteotomy was classified according to the height of its endpoint. At a mean follow-up of 20 months (6 to 52), a total of 15 lateral hinge fractures (18.3%) were identified. A sufficient osteotomy, in which both anterior and posterior tibial cortices were involved with extension into the lateral aspect of the plateau in relation to an anteroposterior line tangential to the medial edge of the fibular head in the CT axial plane, was seen in 48 knees (71.6%) in those without a lateral hinge fracture and in seven (46.7%) in those with a lateral hinge fracture. An osteotomy which ended above the level of the fibular head was seen in nine (13.4%) of the knees without a lateral hinge fracture and seven (46.7%) of the those with a lateral hinge fracture. There was a significant relationship between the absence of a lateral hinge fracture and both a sufficient osteotomy and one whose endpoint was at the level of the fibular head (p = 0.0451 and p = 0.0214, respectively). A sufficient osteotomy involving both the anterior and posterior cortices, whose endpoint is at the level of the fibular head, should be performed when undertaking a medial opening wedge high tibial osteotomy if a lateral hinge fracture is to be avoided as a complication. Cite this article: Bone Joint J 2017;99-B:887-93. ©2017 The British Editorial Society of Bone & Joint Surgery.

  1. Mechanism of bone incorporation of beta-TCP bone substitute in open wedge tibial osteotomy in patients.

    NARCIS (Netherlands)

    Gaasbeek, R.D.A.; Toonen, H.G.; Heerwaarden, R.J. van; Buma, P.


    A histological study was performed of bone biopsies from 16 patients (17 biopsies) treated with open wedge high tibial osteotomies for medial knee osteoarthritis. The open wedge osteotomies were filled with a wedge of osteoconductive beta tricalcium phosphate (beta-TCP) ceramic bone replacement. At

  2. Patellofemoral Osteoarthritis Progression and Alignment Changes after Open-Wedge High Tibial Osteotomy Do Not Affect Clinical Outcomes at Mid-term Follow-up. (United States)

    Goshima, Kenichi; Sawaguchi, Takeshi; Shigemoto, Kenji; Iwai, Shintaro; Nakanishi, Akira; Ueoka, Ken


    To evaluate the clinical and radiological outcomes of open-wedge high tibial osteotomy (OWHTO) with respect to the patellofemoral joint and to assess whether patellofemoral osteoarthritis (OA) progression and alignment changes after OWHTO affect clinical outcomes. Inclusion criteria were consecutive patients who underwent OWHTO from March 2005 to September 2013. Exclusion criteria were loss to follow-up within 2 years and absence of second-look arthroscopy findings at the time of plate removal. The clinical parameters, including anterior knee pain while climbing stairs, Japanese Orthopedic Association score, and Oxford Knee Score, were evaluated. Radiological outcomes, including weight-bearing line ratio, modified Blackburne-Peel ratio, posterior tibial slope, tilting angle, lateral shift ratio, and patellofemoral OA (Kellgren-Lawrence grade), were evaluated preoperatively and at the final follow-up. Cartilage status (International Cartilage Repair Society grade) was evaluated at the initial HTO and at plate removal. Fifty-three patients (60 knees) were included in this study. The mean follow-up was 58.2 ± 22.4 months. Two knees (3%) presented with mild anterior knee pain after OWHTO. The mean Japanese Orthopedic Association score (66.9 ± 11.2 to 91.2 ± 9.7) significantly improved (P < .001), and the mean Oxford Knee Score at the final follow-up was 42.0 ± 5.3. The mean modified Blackburne-Peel ratio (0.9 ± 0.1 to 0.7 ± 0.1, P < .001) and tilting angle (6.8 ± 3.7 to 5.6 ± 3.4, P = .033) significantly decreased after OWHTO, whereas no significant changes in posterior tibial slope (P = .511) and lateral shift ratio (P = .522) were observed. Radiologically, patellofemoral OA had progressed in 15 knees (27%), and arthroscopically patellofemoral cartilage degeneration had progressed in 27 knees (45%). However, there was no significant correlation between changes in patellofemoral alignment and clinical outcomes. Changes in patellofemoral alignment and

  3. Effect of the Osteotomy Length on the Change of the Posterior Tibial Slope With a Simple Distraction of the Posterior Gap in the Uni- and Biplanar Open-Wedge High Tibial Osteotomy. (United States)

    Lee, Yong Seuk; Kang, Jong Yeal; Lee, Myung Chul; Oh, Won Seok; Elazab, Ashraf; Song, Min Kyu


    To (1) determine the length of the osteotomy at the anterior and posterior cortex, (2) compare between uni- and biplanar osteotomy, and (3) evaluate the relationship between the extent of the osteotomy and change of the posterior tibial slope. A prospective comparative study of 24 uniplanar and 30 biplanar osteotomies was performed. To evaluate the length of osteotomy, osteotomy lines of the anterior and posterior cortex were analyzed in the 3-dimensional surface models. For slope measurement, the intramedullary axis of the proximal tibia (slope P), posterior cortical line of the proximal tibia (slope C), and anterior cortical line of the proximal fibula (slope F) were used. An analysis of the changes in the posterior tibial slope was performed independently using a pre- and postoperative lateral plane radiograph. In the uniplanar osteotomy, ratios of the osteotomized length to the total cortical length aligned with the osteotomized plane were larger in the anterior cortex (0.91 in uniplanar v 0.46 in biplanar; P = 0) and posterior cortex (0.97 in uniplanar v 0.79 ratio in biplanar; P = 0). Furthermore, the posterior tibial slope was maintained in both groups and the ratios between the anterior and posterior gap in both groups were 0.57 and 0.63, respectively. The maintenance of the slope was not related to any specific variables. Additionally, these phenomena did not differ between those patients who underwent uni- and those who underwent biplanar osteotomy. Increase in the posterior tibial slope was prevented with appropriate uni- or biplanar osteotomy with a simple distraction at the most posterior gap. However, in the uniplanar osteotomy, the ratio of the osteotomized length to the total cortical length was larger in both the anterior and posterior cortex. Copyright © 2016 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  4. An inexpensive and innovative correction of medial compartmental osteoarthritis knee joint by high tibial lateral closed wedge osteotomy in a rural set up

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    Prasad DV, Arun AA, Tushar Chaudhari, Sagar Jawale, Shakthi Panda, Abhinav Jadhav, Deepak Dathrange


    Full Text Available Osteoarthritis of Knee joint with Varus deformity causes considerable disability. Operative treatment aims at shifting the mechanical load bearing axis to the less affected compartment of the knee to relieve the symptoms. Exclusion Criteria: Non-walkers due to generalized arthropathies / medical comorbidities, Flexion deformity > 10 degrees, Range of motion 1cm lateral subluxation in standing A-P X rays of both knees. Methodology: 32 (12 Males and 20 Females cases of Medial compartment osteoarthritis presenting in our OPD between 2008-2012 were treated by HTOand cortical screw and SS wire fixation (TBW Technique. Results: Evaluation of results was done based on knee rating scale by Japanese orthopaedic association. 22 cases were Excellent, 8 cases were good. One case of failure, an iatrogenic intracondylar fracture of Tibia, and another secondary haematoma under the suture line, aspirated and complete healing was achieved. Patients had good range of motion, were able to squat and sit cross legged comfortably. Conclusion: HTO by Closed Medial wedge osteotomy and fixation with cortical screw and SS wire provides a good alternative to unicompartmental knee Arthroplasty and even Total knee Arthroplasty (may be up to 10-15 years in patients with Medial compartmental osteoarthritis. It is a cost effective technique with the use of minimum hardware and early postoperative mobilization in patients who cannot afford Knee Arthroplasty in a Rural set up.

  5. Relaxation of the MCL after an Open-Wedge High Tibial Osteotomy results in decreasing contact pressures of the knee over time. (United States)

    van Egmond, N; Hannink, G; Janssen, D; Vrancken, A C; Verdonschot, N; van Kampen, A


    The objective of this study was to investigate the effect of a medial open-wedge osteotomy (OWO) and the release of the superficial medial collateral ligament (MCL) on the tibiofemoral cartilage pressure, the MCL tension and the valgus laxity of the knee. Seven fresh-frozen, human cadaveric knees were used. Medial and lateral mean contact pressure (CP), peak contact pressure (peakCP), and contact area (CA) were measured using a pressure-sensitive film (I-Scan; Tekscan, Boston, MA). The MCL tension was measured using a custom-made device. These measurements were continuously recorded for 5 min after an OWO of 10°. After the osteotomy, the valgus laxity was measured with a handheld Newtonmeter. For one knee, the measurements were continued for 24 h. At the end, a complete release of the superficial MCL was performed and the measurements were repeated at 10°. There was relaxation of the MCL after the osteotomy; the tension dropped in 5 min with 10.7% (mean difference 20.5 N (95% CI 16.1-24.9)), and in 24 h, the tension decreased by 24.2% (absolute difference 38.8 N) (one knee). After the osteotomy, the mean CP, peakCP and CA increased in the medial compartment (absolute difference 0.17 MPa (95% CI 0.14-0.20), 0.27 MPa (95% CI 0.24-0.30), 132.9mm(2) (95% CI 67.7-198.2), respectively), and decreased in the lateral compartment (absolute difference 0.02 MPa (95% CI 0.03 -0.01), 0.08 MPa (95% CI 0.11 - 0.04), 47.0 mm(2) (95% CI -105.8 to 11.8), respectively). Only after a release of the superficial MCL, the mean CP, peak CP and CA significantly decreased in the medial compartment (absolute difference 0.17, 0.27 MPa, 119.8 mm(2), respectively), and increased in the lateral compartment (absolute difference 0.02, 0.11 MPa, 52.4 mm(2), respectively). After the release of the superficial MCL, a mean increase of 7.9° [mean difference - 0.1° (95% CI -1.9 to 1.6)] of the valgus laxity was found. A release of the superficial MCL helps achieve the goal of

  6. High tibial osteotomy in varus knees: indications and limits (United States)



    Opening wedge high tibial osteotomy (OWHTO) is a surgical procedure that aims to correct the weight-bearing axis of the knee, moving the loads laterally from the medial compartment. Conventional indications for OWHTO are medial compartment osteoarthritis and varus malalignment of the knee; recently OWHTO has been used successfully in the treatment of double and triple varus. OWHTO, in contrast to closing wedge high tibial osteotomy, does not require fibular osteotomy or peroneal nerve dissection, or lead to disruption of the proximal tibiofibular joint and bone stock loss. For these reasons, interest in this procedure has grown in recent years. The aim of this study is to review the literature on OWHTO, considering indications and prognostic factors (body mass index, grade of osteoarthritis, instability, range of movement and age), outcomes at mid-term follow-up, and limits of the procedure (slope modifications, patellar height changes and difficulties in conversion to a total knee arthroplasty). PMID:27602350

  7. The efficacy of open-wedge high tibial osteotomy for varus knee%开放胫骨高位楔形截骨术治疗膝关节内翻畸形

    Institute of Scientific and Technical Information of China (English)

    张海宁; 冷萍; 王英振; 吕成昱; 王湘达; 王昌耀


    sixteen weeks after operation. No complications such as plate broken or injury of nerve or blood vessel had occurred. The mean correct angle was 9. 5°. No degenerative changes had developed in other compartments of the knee. The mechanical axis of the lower extremities was maintained during the follow-up. The overall satisfactory rate was 83.3%.Statistically significant changes exist in the Lysholm score and varus degree. Conclusion The open-wedge high tibial osteotomy is suitable for the symptomatic genu varum in younger patients with good short-term and mid-term results.

  8. Patella height changes post high tibial osteotomy

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    Siew Ghim Gooi


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

  9. Arthroscopic and computer-assisted high tibial osteotomy using standard total knee arthroplasty navigation software. (United States)

    Thompson, Stephen R; Zabtia, Nazar; Weening, Bradley; Zalzal, Paul


    Opening-wedge high tibial osteotomy is an increasingly performed procedure for treatment of varus gonarthrosis and correction of malalignment during meniscal transplantation or cartilage restoration. Precise preoperative planning and meticulous surgical technique are required to achieve an appropriate mechanical axis correction. We describe our technique of arthroscopic and computer-assisted high tibial osteotomy using commonly available total knee arthroplasty navigation software as an intraoperative goniometer. We believe that our technique, by providing intraoperative real-time guidance of the degree of correction that is accurate and reliable, represents a useful tool for the surgeon who uncommonly performs high tibial osteotomy.

  10. Analysis of Knee Joint Line Obliquity after High Tibial Osteotomy. (United States)

    Oh, Kwang-Jun; Ko, Young Bong; Bae, Ji Hoon; Yoon, Suk Tae; Kim, Jae Gyoon


    The aim of this study was to evaluate which lower extremity alignment (knee and ankle joint) parameters affect knee joint line obliquity (KJLO) in the coronal plane after open wedge high tibial osteotomy (OWHTO). Overall, 69 knees of patients that underwent OWHTO were evaluated using radiographs obtained preoperatively and from 6 weeks to 3 months postoperatively. We measured multiple parameters of knee and ankle joint alignment (hip-knee-ankle angle [HKA], joint line height [JLH], posterior tibial slope [PS], femoral condyle-tibial plateau angle [FCTP], medial proximal tibial angle [MPTA], mechanical lateral distal femoral angle [mLDFA], KJLO, talar tilt angle [TTA], ankle joint obliquity [AJO], and the lateral distal tibial ground surface angle [LDTGA]; preoperative [-pre], postoperative [-post], and the difference between -pre and -post values [-Δ]). We categorized patients into two groups according to the KJLO-post value (the normal group [within ± 4 degrees, 56 knees] and the abnormal group [greater than ± 4 degrees, 13 knees]), and compared their -pre parameters. Multiple logistic regression analysis was used to examine the contribution of the -pre parameters to abnormal KJLO-post. The mean HKA-Δ (-9.4 ± 4.7 degrees) was larger than the mean KJLO-Δ (-2.1 ± 3.2 degrees). The knee joint alignment parameters (the HKA-pre, FCTP-pre) differed significantly between the two groups (p knee joint alignment and knee joint convergence angle evaluated by HKA-pre and FCTP-pre angle, respectively, were significant predictors of abnormal KJLO after OWHTO. However, -pre ankle joint parameters were not significantly associated with abnormal KJLO after OWHTO.

  11. Avaliação radiográfica da osteotomia proximal de abertura gradual da tíbia Radiographic assessment of the opening wedge proximal tibial osteotomy

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    Carlos Francisco Bittencourt Silva


    significant differences between the pre- and post-operative indices of tibial slope and patellar height in the patients were found. CONCLUSION: Opening wedge proximal tibial osteotomy is a technique that avoids the problems presented by high tibial osteotomy, as it is done without promoting changes in the extensor mechanism, ligament imbalance or deformities in the proximal tibia.

  12. Outcome of Tibial Closing Wedge Osteotomy in 55 Cranial Cruciate Ligament-Deficient Stifles of Small Dogs (<15 kg). (United States)

    Campbell, Kathryn A; Payne, John T; Doornink, Michael T; Haggerty, Jamie


    To describe the outcome of cranial closing wedge osteotomy (CWO) of the tibia for treatment of cranial cruciate ligament (CrCL)-deficient stifles in dogs with a body weight of 55 stifles). Medical records (2005-2014), radiographs, and owner questionnaire were used to identify the surgical procedure performed, associated complications and outcome in 45 dogs undergoing CWO in 55 stifles. Data for 55 stifles from 45 dogs were included. Bichon Frise was the most frequent dog breed (n=11). Mean pre- and postoperative tibial plateau angle (TPA) were 36.3° (95% CI 35.1-37.5) and 7.5° (95% CI 6.7-8.2), respectively. Pin and tension bands were placed in 38/55 stifles (69%). The most frequent complication at short-term follow-up (2 weeks) was incisional complications in 8 stifles; all resolved with systemic antibiotic administration alone. Data were available for all stifles at 8 week follow-up with an overall complication occurrence in 16/55 stifles (28%); 1 dog required revision surgery. Tibial osteotomy healing was evident on radiographs at 8 weeks postoperative in 53 stifles (96%), considered complete in 27 stifles, and good in 26 stifles. Follow-up owner questionnaire was available for 36 dogs at a mean of 24 months and 34/36 owners (94%) were satisfied with the procedure and considered their dog had a good quality of life with minimal long-term complications. Dogs with a body weight <15 kg undergoing CWO for treatment of a CrCL-deficient stifle had a good outcome based on clinical status, radiographic evaluation, and owner questionnaire. © Copyright 2016 by The American College of Veterinary Surgeons.

  13. High tibial slope correlates with increased posterior tibial translation in healthy knees. (United States)

    Schatka, Imke; Weiler, Andreas; Jung, Tobias M; Walter, Thula C; Gwinner, Clemens


    Notwithstanding the importance of the tibial slope (TS) for anterior tibial translation, little information is available regarding the implications on posterior laxity, particularly in healthy subjects. It was hypothesized that increased TS is associated with decreased posterior tibial translation (PTT) in healthy knees. A total of 124 stress radiographs of healthy knees were enrolled in this study. Tibial slope and the posterior tibial translation were evaluated using a Telos device with a 150-N force at 90° of knee flexion. Two blinded observers reviewed independently on two different occasions. One hundred and twenty-four patients [35 females and 89 males; 41 (range 18-75) years] were enrolled in this study, with a mean PTT of 2.8 mm (±1.9 mm; range 0-8 mm) and a mean TS of 8.6° (±2.6°; range 1°-14°). Pearson correlation showed a significant correlation between the PTT and TS in the overall patient cohort (P < 0.0001) with r = 0.76 and R (2) = 0.58. There was no statistical difference between female and male patients regarding the PTT or the TS. Subgrouping of the patient cohort (four groups with n = 31) according to their TS (groups I < 7°; II = 7°-8.5°; III = 9°-10.5°; IV ≥ 11°) revealed significant differences between each subgroup, respectively. Furthermore, there was a weak but significant correlation between age and PTT (P = 0.004, r = 0.26). In addition to the substantial variance in tibial slope and posterior laxity among healthy knees, high tibial slope significantly correlates with increased posterior tibial translation. Increasing age is further associated with a greater magnitude of posterior tibial translation. Consequently, knowledge of the tibial slope facilitates simple estimation of posterior knee laxity, which is mandatory for PCL reconstruction and knee arthroplasty.

  14. High tibial osteotomy in Sweden, 1998-2007

    DEFF Research Database (Denmark)

    W-Dahl, Annette; Robertsson, Otto; Lohmander, Stefan


    Most studies on high tibial osteotomies (HTOs) have been hospital-based and have included a limited number of patients. We evaluated the use and outcome-expressed as rate of revision to knee arthroplasty-of HTO performed in Sweden with 9 million inhabitants, 1998-2007.......Most studies on high tibial osteotomies (HTOs) have been hospital-based and have included a limited number of patients. We evaluated the use and outcome-expressed as rate of revision to knee arthroplasty-of HTO performed in Sweden with 9 million inhabitants, 1998-2007....

  15. Digital planning of high tibial osteotomy. Interrater reliability by using two different software. (United States)

    Schröter, Steffen; Ihle, Christoph; Mueller, Johannes; Lobenhoffer, Philipp; Stöckle, Ulrich; van Heerwaarden, Ronald


    The purpose of the study was to determine the interrater reliability as well as the correlation of mediCAD(®) and PreOPlan(®) in deformity analysis and digital planning of osteotomies. Digital radiographs were obtained from 81 patients planned to undergo an open wedge high tibial osteotomy. The JPEG files of the radiographs were imported to landmark-based software. Deformity analysis and planning of correction were performed by 1 experienced and 2 unexperienced observers. Osteotomy planning was aimed at correction to the predefined mechanical tibiofemoral angle of 3° valgus leg alignment. The interrater reliability of measurements was assessed using intraclass correlation coefficients (ICCs) and the confidence interval. The ICC of PreOPlan(®) was from 0.841 (mechanical lateral distal femur angle) to 0.993 (wedge-angle) and from 0.896 (joint line convergence angle) to 0.995 (mechanical tibiofemoral angle) of mediCAD(®). The ICC of height of wedge-base was 0.979 with PreOPlan(®) and 0.969 with mediCAD(®). Comparing PreOPlan(®) and mediCAD(®), the ICC of the height of wedge-base of the observers was 0.966, 0.956 and 0.969, respectively. The results show a high interrater reliability of digital planning software. Experience of the observer had no influence on results. Furthermore, a high interrater reliability and correlation of digital planning specific parameters was found. Surgeons need to master limb geometry measurements and osteotomy planning on digital radiographs as digital planning reports are used for intercolleagual correspondence, teaching purposes and as medicolegal documents. The digital planning software tested agrees with the actual demands and could be recommended for deformity analysis and planning of osteotomies. Diagnostic studies, Level I.

  16. Total knee arthroplasty after high tibial osteotomy. A systematic review

    NARCIS (Netherlands)

    T.M. van Raaij (Tom); M. Reijman (Max); A. Furlan (Alessandro); J.A.N. Verhaar (Jan)


    textabstractBackground: Previous osteotomy may compromise subsequent knee replacement, but no guidelines considering knee arthroplasty after prior osteotomy have been developed. We describe a systematic review of non-randomized studies to analyze the effect of high tibial osteotomy on total knee art

  17. Effect of a biplanar osteotomy on primary stability following high tibial osteotomy: a biomechanical cadaver study. (United States)

    Pape, Dietrich; Lorbach, Olaf; Schmitz, Christian; Busch, Lüder C; Van Giffen, Nicolien; Seil, Romain; Kohn, Dieter M


    Open-wedge high tibial osteotomy (HTO) is becoming increasingly popular for the treatment of varus gonarthrosis in the active patient. The various implants used in HTO differ with regard to its design, the fixation stability and osteotomy technique. It is assumed that the combination of a plate fixator with a biplanar, v-shaped osteotomy supports bone healing. So far, there are no biomechanical studies that quantify the stabilizing effect of a biplanar versus uniplanar osteotomy. We hypothesized that a significant increase in primary stability of bone-implant constructs is achieved when using a biplanar as opposed to a uniplanar osteotomy. Twenty-four fresh-frozen human tibiae were mounted in a metal cylinder, and open-wedge osteotomy (12 mm wedge size) was performed in a standardized fashion. Proximal and distal tibial segments were marked with tantalum markers of 0.8 mm diameter. Two different plates with locking screws were used for fixation: a short spacer plate (group 1, n = 12) and a plate fixator (group 2, n = 12). In six specimens of each group, a biplanar V-shaped osteotomy with a 110 degrees angulated anterior cut behind the tuberosity parallel to the ventral tibial shaft axis was performed. In the remaining six specimens of each group, a simple uniplanar osteotomy was performed in an oblique fashion. Axial compression of the tibiae was performed using a material testing machine under standardized alignment of the loading axis. Load-controlled cyclical staircase loading tests were performed. The specimens were radiographed simultaneously in two planes together with a biplanar calibration cage in front of a film plane with and without load after each subcycle. Radiostereometry allowed for serial quantification of plastic and elastic micromotion at the osteotomy site reflecting the stability provided by the combination of implant and osteotomy technique. No significant additional stabilizing effect of a biplanar osteotomy in craniocaudal and mediolateral

  18. Osteotomia tibial alta em pacientes com artrose do joelho High tibial osteotomy in patients with knee arthrosis

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    Roger Avakian


    Full Text Available OBJETIVO: Avaliar o tratamento da gonartrose medial com osteotomia tibial tipo cunha de fechamento lateral associado à liberação da articulação tibiofibular proximal. MÉTODOS: Realizamos esta técnica associado com liberação da articulação tibiofibular proximal no tratamento da gonartrose medial em 36 pacientes (41 joelhos de janeiro de 1995 a abril de 2003, com idade de 53,4 anos (média, seguidos por 51,6 meses (média. RESULTADOS: Na avaliação notamos que as osteotomias tibiais com cunha de fechamento lateral permitem correção satisfatória da deformidade fêmorotibial, com angulação femorotibial final em torno de 7º de valgo; o eixo mecânico foi desviado da região tibial medial (posição 1,2% para o centro do joelho (posição 50,5%; a inclinação tibial na incidência perfil pré-operatória de 9,8º foi corrigida para 6,5º (média; a mobilidade articular apresentou perda de 2,3º na extensão (média. CONCLUSÃO: A técnica permite correção satisfatória da deformidade em varo fêmorotibial, porém não é isenta de complicações (14,6%. O grau de satisfação (Lysholm dos pacientes teve incremento de 27,3 para 89. Assim, constitui uma parte essencial no arsenal de tratamento da gonartrose.PURPOSE: To assess medial gonarthrosis treatment with wedge-like side-closed tibial osteotomy combined with proximal tibial-fibular joint release. METHODS: we employed this technique combined with proximal tibial-fibular joint release in the treatment of medial gonarthrosis in 36 patients (41 knees, from January 1995 to April 2003, with mean age of 53.4 years, followed-up for 51.6 months (in average. RESULTS: In the assessment, we noticed that wedge-like side-closed tibial osteotomies allow for a satisfactory repair of the femorotibial deformity, with end femorotibial angle of about 7° valgus; the mechanical axis was dislocated from the medial region of the tibia (position: 1.2% to knee center (position: 50.5%; the 9.8° tibial

  19. Roentgen stereogrammetry in high tibial osteotomy for gonarthrosis

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


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

  20. High-resolution axial MR imaging of tibial stress injuries

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    Mammoto Takeo


    Full Text Available Abstract Purpose To evaluate the relative involvement of tibial stress injuries using high-resolution axial MR imaging and the correlation with MR and radiographic images. Methods A total of 33 patients with exercise-induced tibial pain were evaluated. All patients underwent radiograph and high-resolution axial MR imaging. Radiographs were taken at initial presentation and 4 weeks later. High-resolution MR axial images were obtained using a microscopy surface coil with 60 × 60 mm field of view on a 1.5T MR unit. All images were evaluated for abnormal signals of the periosteum, cortex and bone marrow. Results Nineteen patients showed no periosteal reaction at initial and follow-up radiographs. MR imaging showed abnormal signals in the periosteal tissue and partially abnormal signals in the bone marrow. In 7 patients, periosteal reaction was not seen at initial radiograph, but was detected at follow-up radiograph. MR imaging showed abnormal signals in the periosteal tissue and entire bone marrow. Abnormal signals in the cortex were found in 6 patients. The remaining 7 showed periosteal reactions at initial radiograph. MR imaging showed abnormal signals in the periosteal tissue in 6 patients. Abnormal signals were seen in the partial and entire bone marrow in 4 and 3 patients, respectively. Conclusions Bone marrow abnormalities in high-resolution axial MR imaging were related to periosteal reactions at follow-up radiograph. Bone marrow abnormalities might predict later periosteal reactions, suggesting shin splints or stress fractures. High-resolution axial MR imaging is useful in early discrimination of tibial stress injuries.

  1. The fate of fibular osteotomies performed during high tibial osteotomy. (United States)

    Bicer, Elcil Kaya; Basa, Can Doruk; Gunay, Huseyin; Aydogdu, Semih; Sur, Hakki


    High tibial osteotomy (HTO) is an important treatment alternative in isolated single compartment knee osteoarthritis. To achieve adequate mechanical axis corrections in the lower extremity fibula is also osteotomized concomitantly. The aim of this study was to compare the union rates of proximal and diaphyseal fibular osteotomies accompanying high tibial osteotomies. Sixty-seven knees of sixty-three patients who had undergone HTO were retrospectively evaluated. The patients were grouped according to the level of the fibular osteotomy (FO). In group I, the level of FO was proximal, and in group II, it was at the level of junction of middle and distal third of diaphysis. The union rates of FOs at two different levels were compared. The influence of the presence of displacement at the osteotomy site and apposition between bone ends on union was also evaluated. Fifty-nine of sixty-seven FOs (88.06 %) were united. The union rate of proximal FOs was significantly greater than diaphyseal osteotomies (p < 0.0001); 97.9 % of proximal FOs were united, whereas this ratio was 65 % for the diaphyseal FOs. The presence of displacement at the FO and apposition between bone ends significantly influenced the bony union rate (p values 0.035 and <0.0001, respectively). Union rates and nonunion characteristics of FO might differ according to its level, apposition of bone ends, and contact area. The fate of FO might also affect the union of HTO.

  2. Surgical accuracy in high tibial osteotomy: coronal equivalence of computer navigation and gap measurement. (United States)

    Schröter, S; Ihle, C; Elson, D W; Döbele, S; Stöckle, U; Ateschrang, A


    Medial opening wedge high tibial osteotomy (MOW HTO) is now a successful operation with a range of indications, requiring an individualised approach to the choice of intended correction. This manuscript introduces the concept of surgical accuracy as the absolute deviation of the achieved correction from the intended correction, where small values represent greater accuracy. Surgical accuracy is compared in a randomised controlled trial (RCT) between gap measurement and computer navigation groups. This was a prospective RCT conducted over 3 years of 120 consecutive patients with varus malalignment and medial compartment osteoarthritis, who underwent MOW HTO. All procedures were planned with digital software. Patients were randomly assigned into gap measurement or computer navigation groups. Coronal plane alignment was judged using the mechanical tibiofemoral angle (mTFA), before and after surgery. Absolute (positive) values were calculated for surgical accuracy in each individual case. There was no significant difference in the mean intended correction between groups. The achieved mTFA revealed a small under-correction in both groups. This was attributed to a failure to account for saw blade thickness (gap measurement) and over-compensation for weight bearing (computer navigation). Surgical accuracy was 1.7° ± 1.2° (gap measurement) compared to 2.1° ± 1.4° (computer navigation) without statistical significance. The difference in tibial slope increases of 2.7° ± 3.9° (gap measurement) and 2.1° ± 3.9° (computer navigation) had statistical significance (P osteotomy for individual cases. This work is clinically relevant because coronal surgical accuracy was not superior in either group. Therefore, the increased expense and surgical time associated with navigated MOW HTO is not supported, because meticulously conducted gap measurement yields equivalent surgical accuracy. I.

  3. The Effect of Malrotation of Tibial Component of Total Knee Arthroplasty on Tibial Insert during High Flexion Using a Finite Element Analysis

    Directory of Open Access Journals (Sweden)

    Kei Osano


    Full Text Available One of the most common errors of total knee arthroplasty procedure is a malrotation of tibial component. The stress on tibial insert is closely related to polyethylene failure. The objective of this study is to analyze the effect of malrotation of tibial component for the stress on tibial insert during high flexion using a finite element analysis. We used Stryker NRG PS for analysis. Three different initial conditions of tibial component including normal, 15° internal malrotation, and 15° external malrotation were analyzed. The tibial insert made from ultra-high-molecular-weight polyethylene was assumed to be elastic-plastic while femoral and tibial metal components were assumed to be rigid. Four nonlinear springs attached to tibial component represented soft tissues around the knee. Vertical load was applied to femoral component which rotated from 0° to 135° while horizontal load along the anterior posterior axis was applied to tibial component during flexion. Maximum equivalent stresses on the surface were analyzed. Internal malrotation caused the highest stress which arose up to 160% of normal position. External malrotation also caused higher stress. Implanting prosthesis in correct position is important for reducing the risk of abnormal wear and failure.

  4. Osteotomia alta da tíbia com cunha de abertura medial: relevância biomecânica da cortical oposta Open wedge tibial osteotomy: biomechanical relevance of the opposite cortex for the fixation method

    Directory of Open Access Journals (Sweden)

    Rafael Lara de Freitas


    Full Text Available OBJETIVO: Avaliar o impacto da integridade da cortical lateral osteo-tomia alta de tíbia (OAT com cunha de abertura. MÉTODOS: Modelos experimentais artificiais em poliuretano foram fixados com placa DCP® 4,5mm. Cunhas de abertura foram confeccionadas para simular a distração da osteotomia alta da tíbia. Realizadas falhas na cortical lateral para simular fraturas e fixadas com diferentes tipos de parafusos. Ensaios de torção e compressão axial foram realizados. 04 diferentes grupos foram constituídos. RESULTADOS: As medidas de torção registradas no grupo com cortical íntegra foram superiores àquelas obtidas no grupo com cortical rompida (p0,05. As medidas de compressão obtidas no grupo com cortical íntegra foram superiores aos demais grupos (p0,05. CONCLUSÃO: A cortical lateral íntegra agrega estabilidade às osteotomias com cunha de abertura medial. Modelo com cortical íntegra evidenciou superioridade biomecânica em rigidez nos ensaios de torção e compressão. Nos ensaios torcionais, os modelos com falha de continuidade cortical com parafusos de estabilização lateral de compressão ou de posição apresentaram equivalência aos modelos com cortical íntegra.OBJECTIVE: To evaluate the role of lateral tibial cortex integrity in open wedge tibial osteotomy (OWTO. METHODS: Experimental models of polyurethane fibers, simulating tibial models and modified with open wedge osteotomies were fixed with DCP® straight 4.5 mm plates. Four groups were constituted: two with cortical integrity and two with a gap in the lateral tibial cortex. Biomechanical analysis of torsion and axial compression were performed. RESULTS: The measures of twist recorded in the group with cortical integrity were higher than those obtained in the group with noncontinuous cortices (p 0.05. CONCLUSION: Integrity of lateral tibial cortex adds stability to open wedge tibial osteotomies. Models with lateral cortical integrity demonstrated superiority in

  5. Long-term results and comparison of the three different high tibial osteotomy and fixation techniques in medial compartment arthrosis. (United States)

    Polat, Gökhan; Balcı, Halil İbrahim; Çakmak, Mehmet Fevzi; Demirel, Mehmet; Şen, Cengiz; Aşık, Mehmet


    The purpose of this study is to report and analyze the long-term outcomes of the patients who underwent high tibial osteotomy (HTO) with three different techniques for the treatment of medial compartment arthrosis. A total of 187 patients (195 knees) who underwent HTO between 1990 and 2010 were retrospectively evaluated. Eighty-eight knees, opening-wedge osteotomy with Puddu plate (group A); 51 knees, transverse osteotomy below the tubercle with external fixator (group B); and 29 knees, closing-wedge osteotomy with staple fixation (group C) were included in the study. The patients (mean age 44.9 ± 10.6 years, mean follow-up of 12.4 ± 3.2 years) were called for final controls and survival rates of the knees, and functional evaluations of the patients were performed using Knee Society Score (KSS) and Hospital for Special Surgery (HSS) knee score assessments. In the comparison of the three groups, there were no differences regarding the mean age, preoperative arthrosis levels, or preoperative deformity analyses (n.s.). The main finding of these comparisons showed that the closing-wedge osteotomy has the greatest lateralization effect on mechanical axis deviation (MAD) (p = 0.024), the greatest valgization effect on medial proximal tibial angles (MPTA) (p = 0.026), and the lowest posterior tibial slope (PTS) angles (p = 0.032) in comparison to the other groups. There were no functional differences between the three groups in the long-term assessment of patients with KSS and HSS knee scores. According to the Kaplan-Meier survival analysis, the probability of the survival of the native knee joint after HTO was 93.4% in 5 years and 71.2% in 10 years in our study group. During the follow-up of the 168 knees, revision surgery with total knee replacement was needed in 27 knees (16%). The mean time from HTO to total knee replacement was 8.9 years in these patients. HTO has acceptable long-term clinical and functional results that should not be

  6. Measurement of photoneutron dose produced by wedge filters of a high energy linac using polycarbonate films. (United States)

    Hashemi, Seyed Mehdi; Hashemi-Malayeri, Bijan; Raisali, Gholamreza; Shokrani, Parvaneh; Sharafi, Ali Akbar; Torkzadeh, Falamarz


    Radiotherapy represents the most widely spread technique to control and treat cancer. To increase the treatment efficiency, high energy linacs are used. However, applying high energy photon beams leads to a non-negligible dose of neutrons contaminating therapeutic beams. In addition, using conventional linacs necessitates applying wedge filters in some clinical conditions. However, there is not enough information on the effect of these filters on the photoneutrons produced. The aim of this study was to investigate the change of photoneutron dose equivalent due to the use of linac wedge filters. A high energy (18 MV) linear accelerator (Elekta SL 75/25) was studied. Polycarbonate films were used to measure the dose equivalent of photoneutrons. After electrochemical etching of the films, the neutron dose equivalent was calculated using Hp(10) factor, and its variation on the patient plane at 0, 5, 10, 50 and 100 cm from the center of the X-ray beam was determined. By increasing the distance from the center of the X-ray beam towards the periphery, the photoneutron dose equivalent decreased rapidly for the open and wedged fields. Increasing of the field size increased the photoneutron dose equivalent. The use of wedge filter increased the proportion of the neutron dose equivalent. The increase can be accounted for by the selective absorption of the high energy photons by the wedge filter.

  7. A fully integrated high-Q Whispering-Gallery Wedge Resonator

    CERN Document Server

    Ramiro-Manzano, F; Pavesi, L; Pucker, G; Ghulinyan, M


    Microresonator devices which posses ultra-high quality factors are essential for fundamental investigations and applications. Microsphere and microtoroid resonators support remarkably high Q's at optical frequencies, while planarity constrains preclude their integration into functional lightwave circuits. Conventional semiconductor processing can also be used to realize ultra-high-Q's with planar wedge-resonators. Still, their full integration with side-coupled dielectric waveguides remains an issue. Here we show the full monolithic integration of a wedge-resonator/waveguide vertically-coupled system on a silicon chip. In this approach the cavity and the waveguide lay in different planes. This permits to realize the shallow-angle wedge while the waveguide remains intact, allowing therefore to engineer a coupling of arbitrary strength between these two. The precise size-control and the robustness against post-processing operation due to its monolithic integration makes this system a prominent platform for indu...

  8. Wedge Absorbers for Final Cooling for a High-Energy High-Luminosity Lepton Collider

    Energy Technology Data Exchange (ETDEWEB)

    Neuffer, David [Fermilab; Mohayai, Tanaz [IIT, Chicago (main); Snopok, Pavel [IIT, Chicago; Summers, Don [Mississippi U.


    A high-energy high-luminosity muon collider scenario requires a "final cooling" system that reduces transverse emittance to ~25 microns (normalized) while allowing longitudinal emittance increase. Ionization cooling using high-field solenoids (or Li Lens) can reduce transverse emittances to ~100 microns in readily achievable configurations, confirmed by simulation. Passing these muon beams at ~100 MeV/c through cm-sized diamond wedges can reduce transverse emittances to ~25 microns, while increasing longitudinal emittance by a factor of ~5. Implementation will require optical matching of the exiting beam into downstream acceleration systems.

  9. Genu Recurvatum Deformity in a Child due to Salter Harris Type V Fracture of the Proximal Tibial Physis Treated with High Tibial Dome Osteotomy

    Directory of Open Access Journals (Sweden)

    Theodoros Beslikas


    Full Text Available Salter-Harris type V fracture is a very rare injury in the immature skeleton. In most cases, it remains undiagnosed and untreated. We report a case of genu recurvatum deformity in a 15-year-old boy caused by a Salter-Harris type V fracture of the proximal tibial physis. The initial X-ray did not reveal fracture. One year after injury, genu recurvatum deformity was detected associated with significant restriction of knee flexion and limp length discrepancy (2 cm as well as medial and posterior instability of the joint. Further imaging studies revealed anterior bone bridge of the proximal tibial physis. The deformity was treated with a high tibial dome osteotomy combined with a tibial tubercle osteotomy stabilized with malleolar screws and a cast. Two years after surgery, the patient gained functional knee mobility without clinical instability. Firstly, this case highlights the importance of early identification of this rare lesion (Salter-Harris type V fracture and, secondly, provides an alternative method of treatment for genu recurvatum deformity.

  10. Genu Recurvatum Deformity in a Child due to Salter Harris Type V Fracture of the Proximal Tibial Physis Treated with High Tibial Dome Osteotomy. (United States)

    Beslikas, Theodoros; Christodoulou, Andreas; Chytas, Anastasios; Gigis, Ioannis; Christoforidis, John


    Salter-Harris type V fracture is a very rare injury in the immature skeleton. In most cases, it remains undiagnosed and untreated. We report a case of genu recurvatum deformity in a 15-year-old boy caused by a Salter-Harris type V fracture of the proximal tibial physis. The initial X-ray did not reveal fracture. One year after injury, genu recurvatum deformity was detected associated with significant restriction of knee flexion and limp length discrepancy (2 cm) as well as medial and posterior instability of the joint. Further imaging studies revealed anterior bone bridge of the proximal tibial physis. The deformity was treated with a high tibial dome osteotomy combined with a tibial tubercle osteotomy stabilized with malleolar screws and a cast. Two years after surgery, the patient gained functional knee mobility without clinical instability. Firstly, this case highlights the importance of early identification of this rare lesion (Salter-Harris type V fracture) and, secondly, provides an alternative method of treatment for genu recurvatum deformity.

  11. Osteotomia valgizante de tíbia com placa "calço" de Puddu: apresentação de técnica Valgus tibial osteotomy with "wedge" plate of Puddu: technique presentation

    Directory of Open Access Journals (Sweden)

    João Luiz Ellera Gomes


    Full Text Available O objetivo do presente trabalho é apresentar os resultados iniciais, obtidos com a osteotomia valgizante de adição de tíbia, fixada com placa calço descrita por Puddu. Foram operados 29 joelhos em 27 pacientes para correção de geno-varo, sendo que, em apenas um paciente o procedimento bilateral teve objetivo profilático. O seguimento foi de 3 a 28 meses com média de 14 meses. A osteotomia proximal de tíbia foi feita de forma oblíqua iniciando na inserção distal do ligamento colateral medial em direção ao tubérculo de Gerdy. A osteotomia foi aberta e fixada com uma placa calço de Puddu. O espaço aberto da osteotomia foi preenchido por enxerto autólogo de ilíaco. A carga total era dada com 45 dias de pós-operatório. Os resultados obtidos mostraram que entre 4 a 6 meses os pacientes tiveram uma significativa melhora na sintomatologia indutora do procedimento cirúrgico. A avaliação final mostrou 27 resultados satisfatórios e apenas 2 regulares. Como conclusão essa técnica tornou a osteotomia de tíbia um procedimento reprodutível com resultados previsíveis com excelente manutenção no pós-operatorio da correção obtida no trans-operatório.The objective of this paper is to present the initial results obtained with the valgus tibial osteotomy, fixed with the wedge plate described by Puddu. This surgery was performed in 29 knees, in 27 patients, for correction of genu-varum, and as a profilatic measure in only one patient. The follow up time was from 3 to 28 months with average of 14 months. The proximal tibial osteotomy was done in an oblique way with start in the distal insertion of the colateral medial ligament and directed to the Gerby tubercle. The osteotomy was opened and fixed with a wedge plate of Puddu. The space opened by the osteotomy was filled with autologous iliac graft. Total weightbearing was allowed 45 days after surgery. The results show that in 4 to 6 months patients had a significant improvement of

  12. Ten-year results of physical activity after high tibial osteotomy in patients with knee osteoarthritis. (United States)

    W-Dahl, Annette; Toksvig-Larsen, Sören; Lindstrand, Anders


    The purpose was to describe physical activity with respect to leisure and working activity in patients operated on by high tibial osteotomy using the hemicallotasis technique for knee osteoarthritis (OA), preoperatively and 10 years postoperatively. Seventy-nine patients, median age 55 (range 35-66), operated on by high tibial osteotomy using the hemicallotasis technique for knee OA 2001-2003 were included. Questionnaires for evaluation of physical and working activity, satisfaction as well as the Knee injury and Osteoarthritis Outcome Score (KOOS) were filled in preoperatively and 2 and 10 years postoperatively. Conversion to knee arthroplasty was obtained through the Swedish Knee Arthroplasty Register. Changes between two postoperative measurements were assessed by Wilcoxon's rank test. Twenty-five patients were converted to a total knee arthroplasty, and nine patients were lost to follow-up during the 10 years, resulted in 45 patients available for follow-up. Preoperatively, 33/45 patients were physically active mainly in heavy yard/household work, and 43/45 patients were working active. Ten years after the HCO, 23/45 patients were still active with golf, dancing, hiking, etc., and 23/45 were retired. At 10 years postoperatively compared to 2 years postoperatively, the patients experienced more problems with pain (89 compared to 69, p = <0.0001). Of 45 patients, 36 were satisfied with the high tibial osteotomy surgery in general 10 years postoperatively, while 13/45 were satisfied with their sport and recreational function. The 10-year results indicate that high tibial osteotomy using the hemicallotasis technique for knee OA is an option for selected patients that improves the level of physical activity, with mild deterioration over time, and gives the majority of the patients the possibility to be working active until retirement. Level IV.

  13. Dehydration of chlorite explains anomalously high electrical conductivity in the mantle wedges. (United States)

    Manthilake, Geeth; Bolfan-Casanova, Nathalie; Novella, Davide; Mookherjee, Mainak; Andrault, Denis


    Mantle wedge regions in subduction zone settings show anomalously high electrical conductivity (~1 S/m) that has often been attributed to the presence of aqueous fluids released by slab dehydration. Laboratory-based measurements of the electrical conductivity of hydrous phases and aqueous fluids are significantly lower and cannot readily explain the geophysically observed anomalously high electrical conductivity. The released aqueous fluid also rehydrates the mantle wedge and stabilizes a suite of hydrous phases, including serpentine and chlorite. In this present study, we have measured the electrical conductivity of a natural chlorite at pressures and temperatures relevant for the subduction zone setting. In our experiment, we observe two distinct conductivity enhancements when chlorite is heated to temperatures beyond its thermodynamic stability field. The initial increase in electrical conductivity to ~3 × 10(-3) S/m can be attributed to chlorite dehydration and the release of aqueous fluids. This is followed by a unique, subsequent enhancement of electrical conductivity of up to 7 × 10(-1) S/m. This is related to the growth of an interconnected network of a highly conductive and chemically impure magnetite mineral phase. Thus, the dehydration of chlorite and associated processes are likely to be crucial in explaining the anomalously high electrical conductivity observed in mantle wedges. Chlorite dehydration in the mantle wedge provides an additional source of aqueous fluid above the slab and could also be responsible for the fixed depth (120 ± 40 km) of melting at the top of the subducting slab beneath the subduction-related volcanic arc front.

  14. Three Years of High Resolution Year-Round Monitoring of Ice-Wedge Thermal Contraction Cracking in Svalbard (United States)

    Christiansen, H. H.


    Most likely ice-wedges are the most widespread periglacial landform in lowlands with continuous permafrost. With a changing climate it is important to understand better the geomorphological processes controlling ice- wedge growth and decay, as they might cause large changes to the surface of the landscape, particularly if the active layer thickness increases causing melting of the most ice-rich permafrost top layer. As most settlements on permafrost are located in lowland areas, ice-wedge formation can also influence the infrastructure. Understanding the processes of ice-wedge growth and their thaw transformation into ice-wedge casts are essential when using contemporary ice wedges as analogues of Pleistocene thermal contraction cracking in palaeoenvironmental reconstructions. As ice-wedges are largely controlled by winter conditions, improved understanding of the factors controlling their growth will enable better palaeoclimatic reconstructions both directly from ice-wedges, but also from ice-wedge casts, than just mean winter temperatures. Detailed studies of ice-wedge dynamics, including quantification of movement, have only been done in very few places in the Arctic. In high arctic Svalbard at 78°N climate at sea level locates these islands close to the southern limit of the continuous permafrost zone, with MAAT of as much as -4 to -6°C. However, thermal contraction cracking is demonstrated to be widespread in the Adventdalen study area in Svalbard. The year-round field access from the University Centre in Svalbard, UNIS, has enabled the collection of different continuous or high frequency ice-wedge process monitoring data since 2002 to improve the understanding of the geomorphological activity of this landform. In all the winters the air temperature was below -30°C for shorter or longer periods. During all the winters, the temperature in the top permafrost was below -15°C both in the ice-wedge top for shorter or longer periods. The snow cover was

  15. High Tibial Osteotomy: A Systematic Review and Current Concept (United States)

    Sabzevari, Soheil; Ebrahimpour, Adel; Roudi, Mostafa Khalilipour; Kachooei, Amir R.


    High tibia osteotomy is a common procedure in orthopedic surgery. A precise overview on indications, patients selection, pre-operative planning, surgical technique, methods of fixation, and complications have been presented. This paper focused on the points that should be considered to achieve good long-term outcomes. PMID:27517063

  16. Crosslink density, oxidation and chain scission in retrieved, highly cross-linked UHMWPE tibial bearings. (United States)

    Reinitz, Steven D; Currier, Barbara H; Levine, Rayna A; Van Citters, Douglas W


    Irradiated, thermally stabilized, highly cross-linked UHMWPE bearings have demonstrated superior wear performance and improved in vitro oxidation resistance compared with terminally gamma-sterilized bearings, yet retrieval analysis reveals unanticipated in vivo oxidation in these materials despite fewer or no measurable free radicals. There has been little evidence to date that the oxidation mechanism in thermally stabilized materials is the same as that in conventional materials, and so it is unknown whether oxidation in these materials is leading to chain scission and a degradation of mechanical properties, molecular weight, and crosslink density. The aim of this study was to determine whether measured in vivo oxidation in retrieved, highly cross-linked tibial bearings corresponds with a decreasing crosslink density. Analysis of three tibial bearing materials revealed that crosslink density decreased following in vivo duration, and that the change in crosslink density was strongly correlated with oxidation. The results suggest that oxidation in highly cross-linked materials is causing chain scissions that may, in time, impact the material properties. If in vivo oxidation continues over longer durations, there is potential for a clinically significant degradation of mechanical properties.

  17. Medial opening wedge distal femoral osteotomy for post-traumatic secondary knee osteoarthritis. (United States)

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


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

  18. Initial mechanical stability of cementless highly-porous titanium tibial components

    Energy Technology Data Exchange (ETDEWEB)

    Stone, Timothy Brandon [Los Alamos National Laboratory; Amer, Luke D [Los Alamos National Laboratory; Warren, Christopher P [Los Alamos National Laboratory; Cornwell, Phillip [Los Alamos National Laboratory; Meneghini, R Michael [UNIV OF CONNECTICUT HEALTH CENTER


    Cementless fixation in total knee replacement has seen limited use since reports of early failure surfaced in the late 80s and early 90s. However the emergence of improved biomaterials, particularly porous titanium and tantalum, has led to a renewed interest in developing a cementless tibial component to enhance long-term survivorship of the implants. Cement is commonly employed to minimize micromotion in new implants but represents a weak interface between the implant and bone. The elimination of cement and application of these new biomaterials, which theoretically provide improved stability and ultimate osseointegration, would likely result in greater knee replacement success. Additionally, the removal of cement from the procedure would help minimize surgical durations and get rid of the time needed for curing, thereby the chance of infection. The purpose of this biomechanical study was twofold. The first goal was to assess whether vibration analysis techniques can be used to evaluate and characterize initial mechanical stability of cementless implants more accurately than the traditional method of micromotion determination, which employs linear variable differential transducers (LVDTs). Second, an evaluative study was performed to determine the comparative mechanical stability of five designs of cementless tibial components under mechanical loading designed to simulate in vivo forces. The test groups will include a cemented Triathlon Keeled baseplate control group, three different 2-peg cementless baseplates with smooth, mid, and high roughnesses and a 4-peg cement/ess baseplate with mid-roughness.

  19. Comparison of Wear and Oxidation in Retrieved Conventional and Highly Cross-Linked UHMWPE Tibial Inserts. (United States)

    Currier, Barbara H; Currier, John H; Franklin, Katherine J; Mayor, Michael B; Reinitz, Steven D; Van Citters, Douglas W


    Two groups of retrieved tibial inserts from one manufacturer's knee system were analyzed to evaluate the effect of a highly cross-linked bearing surface on wear and in vivo oxidation. The two groups ((1) conventional gamma-inert sterilized and (2) highly cross-linked, coupled with the same rough (Ra=0.25) Ti-6Al-4V tray) were matched with statistically similar in vivo duration and patient variables. The retrieved inserts were analyzed for ketone oxidation and wear in the form of dimensional change. The difference in oxidation rate between highly cross-linked and conventional gamma-inert sterilized inserts did not reach statistical significance. Observations suggest that the majority of wear can be accounted for by the backside interface with the rough Ti-6Al-4V tray; however, wear measured by thickness-change rate was statistically indistinguishable between the two bearing materials.

  20. Clinical results of reversed V-shaped high tibial corticotomy with minimally invasive surgery without internal fixation devices. (United States)

    Madadi, Firooz; Eajazi, Alireza; Madadi, Firoozeh; Daftari Besheli, Laleh; Rokni, Reza; Abbasian, Mohammad Reza; Bigdeli, Mohammad Reza


    High tibial osteotomy is a method of treating knee osteoarthritis due to genu varum in advanced stages. High tibial osteotomy-associated problems continue to be reported. The purpose of this study was to investigate the clinical results of a new, innovative method of high tibial osteotomy with 3- to 13-year follow-up. Between 1996 and 2006, our new surgical method was performed on 293 patients with medial compartment osteoarthritis and genu varum. All patients were examined preoperatively, 6 months postoperatively, and at final follow-up. The Hospital for Special Surgery Knee Scoring System (HSS) was used at final follow-up, and limb alignment and patient satisfaction were reassessed. Immediate postoperative complications included varus recurrence, knee instability, and peroneal nerve palsy, and no signs of tibial nonunion or infection were observed. At final follow-up, 3 cases of genu recurvatum, 2 cases of peroneal nerve palsy, and 25 cases of loss of correction were observed. Average postoperative HSS score was 85 (range, 47-97), and 97.8% of the patients were satisfied. This new method is a good alternative for the correction of genu varum because it requires a small incision, is soft tissue friendly, is a corticotomy instead of an osteotomy, requires no internal or external fixation devices, has a shorter duration and an acceptable complication and recurrence rate, and results in satisfactory HSS scores and higher patient satisfaction rates.

  1. A 5° medial wedge reduces frontal but not saggital plane motion during jump landing in highly trained women athletes

    Directory of Open Access Journals (Sweden)

    Michael F Joseph


    Full Text Available Michael F Joseph1, Craig R Denegar1, Elaine Horn1, Bradley MacDougall1, Michael Rahl1, Jessica Sheehan1, Thomas Trojian2, Jeffery M Anderson1, James E Clark1, William J Kraemer11Department of Kinesiology, 2Department of Sports Medicine, University of Connecticut, Storrs, CT, USAAbstract: Lower extremity mechanics during landing have been linked to traumatic and nontraumatic knee injuries, particularly in women’s athletics. The effects of efforts to mitigate these risks have not been fully elucidated. We previously reported that a 5° medial wedge reduced ankle eversion and knee valgus. In the present report we further investigated the effect of a 5° medial wedge inserted in the shoes of female athletes on frontal plane hip motion, as well as ankle, knee, hip, and trunk saggital plane motion during a jump landing task. Kinematic data were obtained from 10 intercollegiate female athletes during jump landings from a 31 cm platform with and without a 5° medial wedge. Hip adduction was reduced 1.98° (95% CI 0.97–2.99° by the medial wedge but saggital plane motions were unaffected. A 5° medial wedge reduces frontal plane motion and takes the knee away from a position associated with anterior cruciate ligament injury and patellofemoral pain syndrome. Although frontal plane motion was not captured it is unlikely to have increased in a bilateral landing task. Thus, it is likely that greater muscle forces were generated in these highly trained athletes to dissipate ground reaction forces when a medial wedge was in place. Additional investigation in younger and lesser trained athletes is warranted to assess the impact of orthotic devices on knee joint mechanics.Keywords: jump landing, foot orthotic, lower extremity kinematics, knee biomechanics, knee injury

  2. Surgical treatment of tibial nonunion after wounding by high velocity missile and external fixators: A case report



    Introduction. The missiles of modern firearms can cause severe fractures of the extremity. High velocity missile fractures of the tibia are characterized by massive tissue destruction and primary contamination with polymorphic bacteria. Treatment of these fractures is often complicated by delayed healing, poor position healing, nonhealing and bone tissue infection. Case Outline. We present the management of tibial nonunion after wounding by high velocity missile and primary treatment by...

  3. Open-wedge osteotomy using an internal plate fixator in patients with medial-compartment gonarthritis and varus malalignment

    DEFF Research Database (Denmark)

    Niemeyer, Philipp; Schmal, Hagen; Hauschild, Oliver


    PURPOSE: Our purpose was to evaluate the 3-year clinical results of patients with medial-compartment osteoarthritis of the knee and varus malalignment who underwent open-wedge high tibial osteotomy (HTO) with an internal plate fixator (TomoFix; Synthes, Solothurn, Switzerland). Clinical results...... of patients reported discomfort related to the implant at some point during the follow-up period (40.6%). CONCLUSIONS: Open-wedge osteotomy by use of the TomoFix system leads to reliable 3-year results. Results do not depend on the severity of medial cartilage defects, whereas partial-thickness defects...

  4. Treatment of open tibial fracture with bone defect caused by high velocity missiles: a case report. (United States)

    Golubović, Zoran; Vukajinović, Zoran; Stojiljković, Predrag; Golubović, Ivan; Visnjić, Aleksandar; Radovanović, Zoran; Najman, Stevo


    Tibia fracture caused by high velocity missiles is mostly comminuted and followed by bone defect which makes their healing process extremely difficult and prone to numerous complications. A 34-year-old male was wounded at close range by a semi-automatic gun missile. He was wounded in the distal area of the left tibia and suffered a massive defect of the bone and soft tissue. After the primary treatment of the wound, the fracture was stabilized with an external fixator type Mitkovic, with convergent orientation of the pins. The wound in the medial region of the tibia was closed with the secondary stitch, whereas the wound in the lateral area was closed with the skin transplant after Thiersch. Due to massive bone defect in the area of the rifle-missile wound six months after injury, a medical team placed a reconstructive external skeletal fixator type Mitkovic and performed corticotomy in the proximal metaphyseal area of the tibia. By the method of bone transport (distractive osteogenesis), the bone defect of the tibia was replaced. After the fracture healing seven months from the secondary surgery, the fixator was removed and the patient was referred to physical therapy. Surgical treatment of wounds, external fixation, performing necessary debridement, adequate antibiotic treatment and soft and bone tissue reconstruction are essential in achieving good results in patients with the open tibial fracture with bone defect caused by high velocity missiles. Reconstruction of bone defect can be successfully treated by reconstructive external fixator Mitkovic.

  5. The role of subducting bathymetric highs on the oceanic crust to deformation of accretionary wedge and earthquake segmentation in the Java forearc (United States)

    Singh, S. C.; Mukti, M.; Deighton, I.


    Stratigraphic and structural observations of newly acquired seismic reflection data along the offshore south Java reveal the structural style of deformation along the forearc and the role of subducting bathymetric highs to the morphology of the forearc region. The forearc region can be divided in to two major structural units: accretionary wedge and forearc and forearc basin where a backthrust marks the boundary between the accretionary wedge and the forearc basin sediments. The continuous compression in the subduction zone has induced younger landward-vergent folds and thrusts within the seaward margin of the forearc basin sediments, which together with the backthrust is referred as the Offshore South Java Fault Zone (OSJFZ), representing the growth of the accretionary wedge farther landward. Seaward-vergent imbricated thrusts have deformed the sediments in the accretionary wedge younging seaward, and have developed fold-thrust belts in the accretionary wedge toward trench. Together with the backthrusts, these seaward-vergent thrusts characterize the growth of accretionary wedge in South of Java trench. Based on these new results, we suggest that accretionary wedge mechanic is not the first order factor in shaping the morphology of the accretionary wedge complex. Instead the subducting bathymetric highs play the main role in shaping the forearc that are manifested in the uplift of the forearc high and intense deformation along the OSJFZ. These subducting highs also induce compression within the accretionary sediments, evident from landward deflection of the subduction front at the trench and inner part of accretionary wedge in the seaward margin of the forearc basin. Intense deformation is also observed on the seaward portion of the accretionary wedge area where the bathymetric highs subducted. We suggest that these subducted bathymetric features define the segment boundaries for megathrust earthquakes, and hence reducing the maximum size of the earthquakes in the

  6. Change in the locus of dynamic loading axis on the knee joint after high tibial osteotomy. (United States)

    Kawakami, Hideo; Sugano, Nobuhiko; Yonenobu, Kazuo; Yoshikawa, Hideki; Ochi, Takahiro; Nakata, Ken; Toritsuka, Yukiyoshi; Hattori, Asaki; Suzuki, Naoki


    The purpose of this study was to visualise the locus of the dynamic loading axis on the knee joint, and to evaluate changes in this locus during gait after high tibial osteotomy (HTO) in three patients who underwent HTO for medial compartment osteoarthritis (OA) of a varus knee. The bone structure of the lower limb and the relative position of skin markers were acquired from CT images. Motion capture data was acquired using spherical skin markers. Skeletal model movement during gait was calculated based on the movement of the markers. The locus of the dynamic loading axis on the knee joint was defined as the point on the proximal tibia joint surface that intersected with the loading axis of the lower limb, which passed through the centre of the femoral head and the centroid of multiple points surrounded by the distal tibia joint surface contour. This system was able to visualise the locus of the dynamic loading axis on the knee joint and not only lateral but also anterior-posterior direction movement. After HTO, the locus shifted from a medial and posterior area of the medial joint edge of the knee to a central area of the knee joint surface. This indicates that HTO shifted the dynamic loading axis. Lateral movement of the dynamic loading axis in the early stance phase of gait was reduced within a year after HTO.

  7. Imaging of posterior tibial tendon dysfunction—Comparison of high-resolution ultrasound and 3 T MRI

    Energy Technology Data Exchange (ETDEWEB)

    Arnoldner, Michael A., E-mail: [Medical University of Vienna, Vienna General Hospital, Department of Biomedical Imaging and Image-guided Therapy, Währinger Gürtel 18-20, 1090 Vienna (Austria); Gruber, Michael [Medical University of Vienna, Vienna General Hospital, Department of Biomedical Imaging and Image-guided Therapy, Währinger Gürtel 18-20, 1090 Vienna (Austria); Syré, Stefanie [Medical University of Vienna, Vienna General Hospital, Department of Trauma-Surgery, Währinger Gürtel 18-20, 1090 Vienna (Austria); Kristen, Karl-Heinz [Foot & Ankle Centre Vienna, Alser Straße 43/8, 1080 Vienna (Austria); Trnka, Hans-Jörg [Foot & Ankle Centre Vienna, Alser Straße 43/8, 1080 Vienna (Austria); Orthopaedic Hospital Vienna, Speisinger Straße 109, 1130 Vienna (Austria); Kainberger, Franz; Bodner, Gerd [Medical University of Vienna, Vienna General Hospital, Department of Biomedical Imaging and Image-guided Therapy, Währinger Gürtel 18-20, 1090 Vienna (Austria)


    Highlights: • 18 MHz high-resolution ultrasound appears to be slightly more accurate than 3 T MRI in the diagnosis of PTTD. • High-resolution ultrasound is recommended as an initial diagnostic tool. • Long-lasting PTT discomfort may require MRI. • Other pathologies can mimic PTTD. - Abstract: Purpose: Posterior tibial tendon dysfunction is the most common cause of acquired asymmetric flatfoot deformity. The purpose of this study was to determine and compare the diagnostic value of MRI and high-resolution ultrasound (HR-US) in posterior tibial tendon dysfunction (PTTD), and assess their correlation with intraoperative findings. Materials and methods: We reviewed 23 posterior tibial tendons in 23 patients with clinical findings of PTTD (13 females, 10 males; mean age, 50 years) with 18 MHz HR-US and 3 T MRI. Surgical intervention was performed in nine patients. Results: HR-US findings included 2 complete tears, 6 partial tears, 10 tendons with tendinosis, and 5 unremarkable tendons. MRI demonstrated 2 complete tears, 7 partial tears, 10 tendons with tendinosis, and 4 unremarkable tendons. HR-US and MRI were concordant in 20/23 cases (87%). Image findings for HR-US were confirmed in six of nine patients (66.7%) by intraoperative inspection, whereas imaging findings for MRI were concordant with five of nine cases (55.6%). Conclusion: Our results indicate that HR-US can be considered slightly more accurate than MRI in the detection of PTTD.

  8. Rethinking wedges (United States)

    Davis, Steven J.; Cao, Long; Caldeira, Ken; Hoffert, Martin I.


    Abstract Stabilizing CO2 emissions at current levels for fifty years is not consistent with either an atmospheric CO2 concentration below 500 ppm or global temperature increases below 2 °C. Accepting these targets, solving the climate problem requires that emissions peak and decline in the next few decades, and ultimately fall to near zero. Phasing out emissions over 50 years could be achieved by deploying on the order of 19 'wedges', each of which ramps up linearly over a period of 50 years to ultimately avoid 1 GtC y-1 of CO2 emissions. But this level of mitigation will require affordable carbon-free energy systems to be deployed at the scale of tens of terawatts. Any hope for such fundamental and disruptive transformation of the global energy system depends upon coordinated efforts to innovate, plan, and deploy new transportation and energy systems that can provide affordable energy at this scale without emitting CO2 to the atmosphere. 1. Introduction In 2004, Pacala and Socolow published a study in Science arguing that '[h]umanity can solve the carbon and climate problem in the first half of this century simply by scaling up what we already know how to do' [1]. Specifically, they presented 15 options for 'stabilization wedges' that would grow linearly from zero to 1 Gt of carbon emissions avoided per year (GtC y-1 1 Gt = 1012 kg) over 50 years. The solution to the carbon and climate problem, they asserted, was 'to deploy the technologies and/or lifestyle changes necessary to fill all seven wedges of the stabilization triangle'. They claimed this would offset the growth of emissions and put us on a trajectory to stabilize atmospheric CO2 concentration at 500 ppm if emissions decreased sharply in the second half of the 21st century. The wedge concept has proven popular as an analytical tool for considering the potential of different technologies to reduce CO2 emissions. In the years since the paper was published, it has been cited more than 400 times, and

  9. Treatment of open tibial fracture with bone defect caused by high velocity missiles: A case report

    Directory of Open Access Journals (Sweden)

    Golubović Zoran


    Full Text Available Introduction .Tibia fracture caused by high velocity missiles is mostly comminuted and followed by bone defect which makes their healing process extremely difficult and prone to numerous complications. Case Outline. A 34-year-old male was wounded at close range by a semi-automatic gun missile. He was wounded in the distal area of the left tibia and suffered a massive defect of the bone and soft tissue. After the primary treatment of the wound, the fracture was stabilized with an external fixator type Mitkovic, with convergent orientation of the pins. The wound in the medial region of the tibia was closed with the secondary stitch, whereas the wound in the lateral area was closed with the skin transplant after Thiersch. Due to massive bone defect in the area of the rifle-missile wound six months after injury, a medical team placed a reconstructive external skeletal fixator type Mitkovic and performed corticotomy in the proximal metaphyseal area of the tibia. By the method of bone transport (distractive osteogenesis, the bone defect of the tibia was replaced. After the fracture healing seven months from the secondary surgery, the fixator was removed and the patient was referred to physical therapy. Conclusion. Surgical treatment of wounds, external fixation, performing necessary debridement, adequate antibiotic treatment and soft and bone tissue reconstruction are essential in achieving good results in patients with the open tibial fracture with bone defect caused by high velocity missiles. Reconstruction of bone defect can be successfully treated by reconstructive external fixator Mitkovic. [Projekat Ministarstva nauke Republike Srbije, br. III 41017 i br. III 41004

  10. Improvements in spinal alignment after high tibial osteotomy in patients with medial compartment knee osteoarthritis. (United States)

    Kim, Yoon Hyuk; Dorj, Ariunzaya; Han, Ahreum; Kim, Kyungsoo; Nha, Kyung Wook


    Since the correlation between spinal and lower extremity alignments is high, high tibial osteotomy (HTO) surgery may also affect spinal alignment, where the spinal alignment parameters are the most important parameters for the evaluation of spinal disorders. In this study, the effect of HTO surgery on spinal alignment during gait was investigated by comparing spinal alignment parameters between patients with knee osteoarthritis (OA) and healthy young controls. Eight patients (age, 55.0±5.1years; height, 160.3±7.0cm; weight, 71.3±14.1kg) with a medial compartment knee OA participated in the gait experiment two times approximately one week before and one year after HTO surgery and eight healthy young controls (age, 26.7±1.7years; height, 163.4±6.5cm; weight, 58.4±11.3kg) participated only once. Cervical curvature angle, thoracic curvature angle, lumbar curvature angle, coronal vertical axis, and coronal pelvic tilt in the coronal plane and cervical lordosis, thoracic kyphosis, lumbar lordosis, sagittal vertical axis, and sagittal pelvic tilt in the sagittal plane were estimated using motion analysis system with skin markers. All spinal alignment parameters after HTO surgery were significantly closer to those of healthy young subjects than those before HTO, especially in the coronal plane. These findings suggest that the HTO had a positive effect on spinal alignment, as well as lower extremity alignment, and moreover, reduced the abnormality that may result in spinal problems such as degeneration or pain.

  11. A long-term follow-up study of high tibial osteotomy for medial compartment osteoarthrosis

    Institute of Scientific and Technical Information of China (English)

    WU Li-dong 吴立东; Hans J Hahne; Toachim Hassenpflug


    Objective: To observe the long-term outcome of high tibial osteotomy (HTO) in treating medial compartment osteoarthrosis of knees. Methods: A retrospective study was carried out on 194 patients (215 knees) treated with HTO for medial compartment osteoarthritis at the Orthopaedic Hospital of Kiel University between 1985 and 1996. Results: One hundred and sixty-one knees (144 patients) were followed up for 1.5-12 years with an average of 7.5 years and their data were reviewed. The proportion of excellent outcome were 97.3%, 93.6% and 78.2% two, five and over five years after HTO, respectively. The revision rate of total knee arthroplasty (TKA) was 11.8% (19 knees retreated with TKA for HTO failure). The survivorship analysis of the 19 knees retreated with TKA showed an expected survival rate of 98.7%, 95.0% and 84.1% 2, 5 and 10 years after HTO, respectively. There were 5.6% complications (12 /161), including five superficial wound infections, one deep infection, five delayed bone healing, and one peroneal nerve palsy. Fifty patients (54 knees) missed follow-up, among them 10 patients (11 knees) died.Conclusions: HTO is an effective method in treating medial compartment osteoarthritis with a varus knee. Appropriate overcorrection of femorotibial alignment is the key for the success of the operation. But as the long-term effect is concerned, there is a trend of deterioration and some of the patients may have a second operation of revision with TKA.

  12. Posterior Tibial Tendon Dysfunction (United States)

    .org Posterior Tibial Tendon Dysfunction Page ( 1 ) Posterior tibial tendon dysfunction is one of the most common problems of the foot and ankle. It occurs when the posterior tibial tendon becomes inflamed or torn. As a result, the ...

  13. Radial wedge flange clamp (United States)

    Smith, Karl H.


    A radial wedge flange clamp comprising a pair of flanges each comprising a plurality of peripheral flat wedge facets having flat wedge surfaces and opposed and mating flat surfaces attached to or otherwise engaged with two elements to be joined and including a series of generally U-shaped wedge clamps each having flat wedge interior surfaces and engaging one pair of said peripheral flat wedge facets. Each of said generally U-shaped wedge clamps has in its opposing extremities apertures for the tangential insertion of bolts to apply uniform radial force to said wedge clamps when assembled about said wedge segments.

  14. Genu Recurvatum Deformity in a Child due to Salter Harris Type V Fracture of the Proximal Tibial Physis Treated with High Tibial Dome Osteotomy


    Theodoros Beslikas; Andreas Christodoulou; Anastasios Chytas; Ioannis Gigis; John Christoforidis


    Salter-Harris type V fracture is a very rare injury in the immature skeleton. In most cases, it remains undiagnosed and untreated. We report a case of genu recurvatum deformity in a 15-year-old boy caused by a Salter-Harris type V fracture of the proximal tibial physis. The initial X-ray did not reveal fracture. One year after injury, genu recurvatum deformity was detected associated with significant restriction of knee flexion and limp length discrepancy (2 cm) as well as medial and posterio...

  15. Experience with a new technique for managing severely overcorrected valgus high tibial osteotomy at total knee arthroplasty. (United States)

    Krackow, K A; Holtgrewe, J L


    Total knee arthroplasty (TKA) after valgus proximal tibial osteotomy poses no major difficulties in most cases. There is, however, a small subgroup of severely overcorrected patients in whom TKA is particularly difficult. These patients require special considerations. A complex ligament reconstruction has been developed to allow simultaneous implantation of a minimally constrained total knee prosthesis for patients with failed, severely overcorrected valgus high tibial osteotomies. The technique is described in five patients. The mean age of the group was 57 years and the average follow-up period was 34 months (range, 12-72 months). A 100-point knee-evaluation scale was used to rate the knees before and after TKA. The average pre- and postoperative scores were 50 and 94, respectively. None of the patients was noted to have any more than mild instability in any direction postoperatively. Despite this extensive reconstruction, the group functioned as well as most recipients of more standard primary TKAs and demonstrated it is possible to avoid highly constrained implants, custom prostheses, or major bone grafts.

  16. Association between knee alignment and knee pain in patients surgically treated for medial knee osteoarthritis by high tibial osteotomy. A one year follow-up study

    DEFF Research Database (Denmark)

    W-Dahl, Annette; Toksvig-Larsen, Sören; Roos, Ewa


    BACKGROUND: The association between knee alignment and knee pain in knee osteoarthritis (OA) is unclear. High tibial osteotomy, a treatment option in knee OA, alters load from the affected to the unaffected compartment of the knee by correcting malalignment. This surgical procedure thus offers...... the possibility to study the cross-sectional and longitudinal association of alignment to pain. The aims were to study 1) the preoperative association of knee alignment to preoperative knee pain and 2) the association of change in knee alignment with surgery to change in knee pain over time in patients operated...... on for knee OA by high tibial osteotomy. METHODS: 182 patients (68% men) mean age 53 years (34 - 69) with varus alignment having tibial osteotomy by the hemicallotasis technique for medial knee OA were consecutively included. Knee alignment was assessed by the Hip-Knee-Ankle (HKA) angle from radiographs...

  17. Trends in High Tibial Osteotomy and Knee Arthroplasty Utilizations and Demographics in Korea From 2009 to 2013. (United States)

    Koh, In Jun; Kim, Min Woo; Kim, Ju Hwan; Han, Sang Yup; In, Yong


    We analyzed the records of 29,895 high tibial osteotomies (HTOs), 12,589 unicompartmental knee arthroplasties (UKAs) and 363,386 total knee arthroplasties (TKAs) performed from 2009 to 2013 in Korea. They were compared with the latest nationwide registry reports of seven Western countries. Over the last 5 years, in Korea, the number of HTO, UKA and TKA increased by 210%, 138%, and 18%, respectively. The largest increase was observed in 55-64 year olds in HTO and UKA, while the largest increase in TKA was in ≥75 year olds. Females commonly had a three- to seven-fold higher rate in all procedures. Worldwide, the use of HTO and UKA decreased or remained stable, whereas that of TKA increased steadily, even in younger patients. Copyright © 2015 Elsevier Inc. All rights reserved.

  18. Suppressing the preferential σ-polarization oscillation in a high power Nd∶YVO4 laser with wedge laser crystal

    Institute of Scientific and Technical Information of China (English)

    Zheng Yao-Hui; Zhou Hai-Jun; Wang Ya-Jun; Wu Zhi-Qiang


    We observe the phenomenon of priority oscillation of the unexpected σ-polarization in high-power Nd∶YVO4 ring laser.The severe thermal lens of the σ-polarized lasing,compared with the π-polarized lasing,is the only reason for the phenomenon.By designing a wedge Nd∶YVO4 crystal as the gain medium,the unexpected σ-polarization is completely suppressed in the entire range of pump powers,and the polarization stability of the expected π-polarized output is enhanced.With the output power increasing from threshold to the maximum power,no σ-polarization lasing is observed.As a result,25.3 W of stable single-frequency laser output at 532 nm is experimentally demonstrated.

  19. Does proximal tibial osteotomy with a novel osteotomy system obtain coronal plane correction without affecting tibial slope and patellar height? (United States)

    Blackman, Andrew J; Krych, Aaron J; Engasser, William M; Levy, Bruce A; Stuart, Michael J


    To determine changes in tibial slope, patellar height, and coronal plane alignment after medial opening wedge proximal tibial osteotomy (PTO) using a modern osteotomy system. Patients undergoing medial opening wedge PTO for any indication with follow-up until radiographic union were identified. Pre- and post-operative tibial slope (referenced off the anterior tibial cortex, proximal tibial anatomic axis, and posterior tibial cortex), patellar height (Caton-Deschamps, Blackburne-Peel, and Insall-Salvati indices), and coronal plane [mechanical axis and weight-bearing line (WBL) ratio] measurements were taken by two observers and compared. Review of 27 patients demonstrated unchanged tibial slope and slightly decreased patellar height post-operatively (Caton-Deschamps: -0.10 ± 0.09; Blackburne-Peel: -0.11 ± 0.10). Coronal plane measurements showed 6.4° ± 1.8° mean change in mechanical axis. Mean post-operative WBL ratio was significantly lower (51.6 ± 11.5 %) than mean goal WBL ratio (62.2 ± 2.5 %). Preoperative mechanical axis >6° varus and osteoarthritis alone as the surgical indication were risk factors for undercorrection >10 %. Medial opening wedge PTO using a recently developed instrumentation system was found to have no effect on tibial slope. Patellar height was decreased after osteotomy using this system, although clinical significance of these findings is unknown. Coronal plane undercorrection of 10.6 % of the target WBL ratio was seen in the group as a whole, although secondary analysis of these results indicated that patients with medial compartment osteoarthritis and/or preoperative mechanical axis of >6° varus accounted for the majority of the cases of undercorrection. Retrospective case series, Level IV.

  20. Evaluation of a high-precision gear measuring machine for helix measurement using helix and wedge artifacts (United States)

    Taguchi, Tetsuya; Kondo, Yohan


    High-precision gears are required for advanced motion and power transmission. The reliability of the measured value becomes important as the gear accuracy increases, and the establishment of a traceability system is needed. Therefore, a high-precision gear measuring machine (GMM) with a smaller uncertainty is expected to improve the gear calibration uncertainty. For this purpose, we developed a prototype of a high-precision GMM that adopts a direct drive mechanism and other features. Then, the high measurement capability of the developed GMM was verified using gear artifacts. Recently, some new measurement methods using simple shapes such as spheres and planes have been proposed as standards. We have verified the tooth profile measurement using a sphere artifact and reported the results that the developed GMM had a high capability in tooth profile measurement. Therefore, we attempted to devise a new evaluation method for helix measurement using a wedge artifact (WA) whose plane was treated as the tooth flank, and the high measurement capability of the developed GMM was verified. The results will provide a part of information to fully assess measurement uncertainty as our future work. This paper describes the evaluation results of the developed GMM for helix measurement using both a helix artifact and the WA, and discusses the effectiveness of the WA as a new artifact to evaluate the GMMs.

  1. Posterior bicondylar tibial plateau fractures. (United States)

    Carlson, DuWayne A


    To present a case series of patients with posterior bicondylar tibial plateau fractures treated by direct fracture exposure and fixation through dual incisions. Retrospective clinical study. Level 1 trauma centers. Eight patients were identified that had posterior bicondylar tibial plateau fractures. Two patients had depressed posterolateral tibial plateau fractures with contained defects and did not have direct fracture exposure. One patient died of medical problems leaving 5 patients who underwent direct fracture exposure, reduction, and fixation. Posteromedial followed by posterolateral open reduction and internal fixation of posterior bicondylar tibial plateau fractures. At 6 to 24 months follow-up (mean 13 months), all patients returned to near full activities, each with aching after prolonged standing (8-hour shift). Range of motion averaged 2 degrees to 121 degrees of flexion. Three of 5 returned to manual labor jobs; the others were not employed at the time of injury. Posterior bicondylar tibial plateau fractures have a high association with lateral meniscal pathology and can be associated with anterior cruciate ligament injury. Reduction of the posterior plateau condyles is easiest with the knee in full extension. Flexion contractures can be a problem, and patients should be encouraged to regain/maintain knee extension. The dual-incision approach to these challenging fractures can result in good to excellent knee function for these patients.

  2. Consolidação da osteotomia valgizante proximal da tíbia com cunha de abertura fixada com placa "calço" de Anthony® Proximal tibial valgusing open-wedge osteotomy union fixated with Anthony® "support" plate

    Directory of Open Access Journals (Sweden)

    Cristiano Hossri Ribeiro


    Full Text Available OBJETIVO: Este estudo tem por finalidade verificar a consolidação da osteotomia valgizante da tíbia com cunha de abertura fixada com placa tipo calço de Anthony® (OVT, no tratamento da osteoartrose medial do joelho varo, a correção da deformidade e a resposta clínica ao tratamento cirúrgico. MÉTODOS: Vinte pacientes (vinte joelhos com osteoartrose do compartimento medial do joelho, com idade média de 48,4 ± 9,9, foram avaliados por um período mínimo de um ano. Os pacientes foram submetidos a avaliação radiográfica da consolidação e do eixo mecânico no pré e pós operatório, além da avaliação dos critérios de LYSHOLM. RESULTADOS: A consolidação da osteotomia ocorreu após 12 semanas em 100% dos casos sem complicações. A avaliação do LYSHOLM no pós operatório apresentou 80% de excelentes e bons resultados. A correção final média do eixo mecânico foi de 3,4 ± 3,3 graus de valgo. CONCLUSÃO: Concluímos que a consolidação da osteotomia supra-tuberositária da tíbia com cunha de abertura fixada com placa calço de Anthony® e com enxertia óssea tricortical ocorre num intervalo de três meses. A cirurgia é eficaz para a correção da deformidade em varo do joelho, e propicia melhora clínica significante para o paciente.OBJECTIVE: This paper aims to check the proximal tibial valgusing open-wedge osteotomy union with Anthony® plate for the treatment of bowleg with medial osteoarthrosis, final correction of the deformity and clinical improvement. METHODS: Twenty patients (twenty knees with medial osteoarthrosis of the knee, with mean age of 48.4 years, were evaluated for one year. The patients were submitted to the Lysholm's score, and also to X-ray studies before and after surgery. RESULTS: The osteotomy union occurred after 12 weeks in all cases without complications. The Lysholm's score was regarded as excellent or good in 80% of the cases. The postoperative mechanical alignment was 3.4 ± 3.3 valgus

  3. Structure of turbulent wedges created by isolated surface roughness (United States)

    Kuester, Matthew S.; White, Edward B.


    Isolated surface roughness in a laminar boundary layer can create a wedge of turbulence that spreads laterally into the surrounding laminar flow. Some recent studies have identified high- and low-speed streaks along the exterior of turbulent wedges. In this experiment, developing turbulent wedges are measured to observe the creation of these streaks. Naphthalene shear stress surface visualization and hotwire measurements are utilized to investigate the details of turbulent wedges created by cylinders in a laminar flat-plate boundary layer. Both the surface visualization and the hotwire measurements show high- and low-speed streaks in the wake of the cylinder that devolve into a turbulent wedge. The turbulent wedge spreading is associated with the emergence of these high- and low-speed streaks along the outside of the wedge. As the wedge evolves in the streamwise direction, these streaks persist inside of the core of the wedge, while new, lower amplitude streaks form along the outside of the wedge. Adding asymmetry to the cylinder moved the virtual origin closer to the roughness and increased the vortex shedding frequency, while adding small-scale roughness features did not strongly affect turbulent wedge development. Intermittency calculations additionally show the origin of the turbulent core inside of the wedge. The structure and spacing of the high-speed streaks along the extremities of the turbulent wedge give insight into the spreading angle of the turbulent wedge.

  4. Surgical treatment of tibial nonunion after wounding by high velocity missile and external fixators: A case report

    Directory of Open Access Journals (Sweden)

    Golubović Ivan


    Full Text Available Introduction. The missiles of modern firearms can cause severe fractures of the extremity. High velocity missile fractures of the tibia are characterized by massive tissue destruction and primary contamination with polymorphic bacteria. Treatment of these fractures is often complicated by delayed healing, poor position healing, nonhealing and bone tissue infection. Case Outline. We present the management of tibial nonunion after wounding by high velocity missile and primary treatment by external fixation in a 25-year-old patient. The patient was primarily treated with external fixation and reconstructive operations of the soft tissue without union of the fracture. Seven months after injury we placed a compression-distraction external fixator type Mitkovic and started with compression and distraction in the fracture focus after osteotomy of the fibula and autospongioplasty. We recorded satisfactory fracture healing and good functional outcome. Conclusion. Contamination and devitalization of the softtissue envelope increase the risk of infection and nonunion in fractures after wounding by high velocity missile. The use of the compression-distraction external fixator type Mitkovic may be an effective method in nonunions of the tibia after this kind of injury. [Projekat Ministarstva nauke Republike Srbije, br. III 41004

  5. [Tibial periostitis ("medial tibial stress syndrome")]. (United States)

    Fournier, Pierre-Etienne


    Medial tibial stress syndrome is characterised by complaints along the posteromedial tibia. Runners and athletes involved in jumping activities may develop this syndrome. Increased stress to stabilize the foot especially when excessive pronation is present explain the occurrence this lesion.

  6. Geometry and kinematics of extensional structural wedges (United States)

    Gui, Baoling; He, Dengfa; Zhang, Yongsheng; Sun, Yanpeng; Huang, Jingyi; Zhang, Wenjun


    Structural wedges in the compressive environment have been recognized and studied in different locations. However, extension structural wedges are less well-understood. Based on the normal fault-bend folding theory and inclined shear model, this paper quantitatively analyses deformations related to extensional structural wedges and builds a series of geometric models for them. An extensional structural wedge is a fault-block held by two or more normal faults, the action of which would fold its overlying strata. Extensional structural wedges of different shapes will lead to different deformation results for the overlying strata, and this paper illustrates both the triangular and quadrangular wedges and their related deformations. This paper also discusses differences between the extensional structural wedges and the normal fault-bend-folding. By analysing two seismic sections from Langfang-Gu'an Sag, East China, this paper provides two natural examples of the triangular and quadrangular extensional structural wedges, where the models can reasonably explain the overlying distinct highs and lows without obvious faults. The establishment of a geometric model of extensional structural wedges can provide reference and theoretical bases for future quantitative analysis of deformations in the extensional environment.

  7. Non-Newtonian viscosity wedge in film formation of EHL

    Institute of Scientific and Technical Information of China (English)



    This paper aims to evaluate the action of viscosity wedge in the oil film formation ofEHL at opposite sliding and zero entrainment. Using solvers developed for Newtonian and Eyringfluids, the film formation behavior originating from viscosity wedge is investigated. The numericalsimulation displays that lubricant film formation induced by viscosity wedge is different from that bythe well-known geometrical wedge with entrainment in classic EHL. The numerical analyses showthat at high opposite sliding speed the viscosity wedge acts as a leading role in film formation, thenon-Newtonian effects can have a pronounced influence on action of the viscosity wedge.

  8. Ultra-high-Q wedge-resonator on a silicon chip

    CERN Document Server

    Lee, Hansuek; Li, Jiang; Yang, Ki Youl; Jeon, Seokmin; Painter, Oskar; Vahala, Kerry J


    Ultra-high-Q optical resonators are being studied across a wide range of research subjects including quantum information, nonlinear optics, cavity optomechanics, and telecommunications. Here, we demonstrate a new, resonator on-a-chip with a record Q factor of 875 million, surpassing even microtoroids. Significantly, these devices avoid a highly specialized processing step that has made it difficult to integrate microtoroids with other photonic devices and to also precisely control their size. Thus, these devices not only set a new benchmark for Q factor on a chip, but also provide, for the first time, full compatibility of this important device class with conventional semiconductor processing. This feature will greatly expand the possible kinds of system on a chip functions enabled by ultra-high-Q devices.

  9. Salt wedge dynamics lead to enhanced sediment trapping within side embayments in high-energy estuaries (United States)

    Yellen, Brian; Woodruff, Jonathan D.; Ralston, David K.; MacDonald, D. G.; Jones, D. S.


    Off-river coves and embayments provide accommodation space for sediment accumulation, particularly for sandy estuaries where high energy in the main channel prevents significant long-term storage of fine-grained material. Seasonal sediment inputs to Hamburg Cove in the Connecticut River estuary (USA) were monitored to understand the timing and mechanisms for sediment storage there. Unlike in freshwater tidal coves, sediment was primarily trapped here during periods of low discharge, when the salinity intrusion extended upriver to the cove entrance. During periods of low discharge and high sediment accumulation, deposited sediment displayed geochemical signatures consistent with a marine source. Numerical simulations reveal that low discharge conditions provide several important characteristics that maximize sediment trapping. First, these conditions allow the estuarine turbidity maximum (ETM) to be located in the vicinity of the cove entrance, which increases sediment concentrations during flood tide. Second, the saltier water in the main channel can enter the cove as a density current, enhancing near-bed velocities and resuspending sediment, providing an efficient delivery mechanism. Finally, higher salinity water accumulates in the deep basin of the cove, creating a stratified region that becomes decoupled from ebb currents, promoting retention of sediment in the cove. This process of estuarine-enhanced sediment accumulation in off-river coves will likely extend upriver during future sea level rise.

  10. Fraturas do planalto tibial Tibial plateau fractures

    Directory of Open Access Journals (Sweden)

    Maurício Kfuri Júnior


    Full Text Available As fraturas do planalto tibial são lesões articulares cujos princípios de tratamento envolvem a redução anatômica da superfície articular e a restauração funcional do eixo mecânico do membro inferior. Contribuem para a tomada de decisões no tratamento dessas fraturas o perfil do paciente, as condições do envelope de tecidos moles, a existência de outros traumatismos associados e a infraestrutura disponível para abordagens cirúrgicas. Para as fraturas de alta energia, o tratamento estagiado, seguindo o princípio do controle de danos, tem como prioridade a manutenção do alinhamento do membro enquanto se aguarda a resolução das más condições de tecidos moles. Já nos traumas de baixa energia, desde que os tecidos moles não sejam um fator adverso, o tratamento deve ser realizado em tempo único, com osteossíntese definitiva. Fixação estável e movimento precoce são variáveis diretamente relacionadas com os melhores prognósticos. Desenvolvimentos recentes, como os implantes com estabilidade angular, substitutos ósseos e imagens tridimensionais para controle intraoperatório, deverão contribuir para cirurgias menos invasivas e melhores resultados.Tibial plateau fractures are joint lesions that require anatomical reduction of joint surface and functional restoration of mechanical axis of a lower limb. Patient profile, soft tissue conditions, presence of associated injuries and the available infrastructure for the treatment all contribute to the decision making about the best treatment for these fractures. High-energy fractures are usually approached in a staged manner respecting the principle of damage control, and are primarily targeted to maintain limb alignment while the resolution unfavorable soft tissue conditions is pending. Low-energy trauma can be managed on a single-stage basis, provided soft tissues are not an adverse factor, with open reduction and internal f-ixation. Stable fixation and early painless joint

  11. Portal dosimetry in wedged beams

    NARCIS (Netherlands)

    Spreeuw, H.; Rozendaal, R.; Camargo, P.; Mans, A.; Wendling, M.; Olaciregui-Ruiz, I.; Sonke, J.J.; Herk, M. van; Mijnheer, B.


    Portal dosimetry using electronic portal imaging devices (EPIDs) is often applied to verify high-energy photon beam treatments. Due to the change in photon energy spectrum, the resulting dose values are, however, not very accurate in the case of wedged beams if the pixel-to-dose conversion for the s

  12. Role of Joshi's external stabilization system with percutaneous screw fixation in high-energy tibial condylar fractures associated with severe soft tissue injuries

    Institute of Scientific and Technical Information of China (English)

    Ashish Kumar Gupta; Rahul Sapra; Rakesh Kumar; Som Prakash Gupta; Devwart Kaushik; Sahil Gaba; Mahesh Chand Bansal


    Purpose: The treatment of high-energy tibial condylar fractures which are associated with severe sott tissue injuries remains contentious and challenging.In this study, we assessed the results of Joshi's external stabilization system (JESS) by using the principle of ligamentotaxis and percutaneous screw fixation for managing high-energy tibial condylar fractures associated with severe soft tissue injuries.Methods: Between June 2008 and June 2010, 25 consecutive patients who were 17-71 years (mean, 39.7), underwent the JESS fixation for high-energy tibial condylar fractures associated with severe soft tissue injuries.Out of 25 patients, 2 were lost during follow-up and in 1 case early removal of frame was done, leaving 22 cases for final follow-up.Among them, 11 had poor skin condition with abrasions and blisters and 2 were open injuries (Gustilo-Anderson grade Ⅰ & Ⅱ).The injury mechanisms were motor vehicle accidents (n =19), fall from a height (n =2) and assault (n =1).The fractures were classified according to Schatzker classification system.Results: There were 7 type-Ⅴ, 14 type-Ⅵ and 1 type-Ⅳ Schatzker's tibial plateau fractures.The average interval between the injury and surgery was 6.8 days (range 2-13).The average hospital stay was 13 days (range, 7-22).The average interval between the surgery and full weight bearing was 13.6 weeks (range 11-20).The average range of knee flexion was 121° (range 105°-135°).The normal extension of the knee was observed in 20 patients, and an extensor lag of 5°-8° was noted in 2 patients.The complications included superficial pin tract infections (n =4) with no knee stiffness.Conclusion: JESS with lag screw fixation combines the benefit of traction, external fixation, and limited internal fixation, at the same time as allowing the ease of access to the soft tissue for wound checks, pin care, dressing changes, measurement of compartment pressure, and the monitoring of the neurovascular status.In a nutshell, JESS

  13. Ice Particle Impacts on a Moving Wedge (United States)

    Vargas, Mario; Struk, Peter M.; Kreeger, Richard E.; Palacios, Jose; Iyer, Kaushik A.; Gold, Robert E.


    This work presents the results of an experimental study of ice particle impacts on a moving wedge. The experiment was conducted in the Adverse Environment Rotor Test Stand (AERTS) facility located at Penn State University. The wedge was placed at the tip of a rotating blade. Ice particles shot from a pressure gun intercepted the moving wedge and impacted it at a location along its circular path. The upward velocity of the ice particles varied from 7 to 12 meters per second. Wedge velocities were varied from 0 to 120 meters per second. Wedge angles tested were 0 deg, 30 deg, 45 deg, and 60 deg. High speed imaging combined with backlighting captured the impact allowing observation of the effect of velocity and wedge angle on the impact and the post-impact fragment behavior. It was found that the pressure gun and the rotating wedge could be synchronized to consistently obtain ice particle impacts on the target wedge. It was observed that the number of fragments increase with the normal component of the impact velocity. Particle fragments ejected immediately after impact showed velocities higher than the impact velocity. The results followed the major qualitative features observed by other researchers for hailstone impacts, even though the reduced scale size of the particles used in the present experiment as compared to hailstones was 4:1.

  14. CyberKnife with tumor tracking: An effective alternative to wedge resection for high-risk surgical patients with stage I non-small cell lung cancer (NSCLC

    Directory of Open Access Journals (Sweden)

    Sean eCollins


    Full Text Available Published data suggests that wedge resection for stage I NSCLC results in improved overall survival compared to stereotactic body radiation therapy (SBRT. We report CyberKnife outcomes for high-risk surgical patients with biopsy-proven stage I NSCLC. PET/CT imaging was completed for staging. Three-to-five gold fiducial markers were implanted in or near tumors to serve as targeting references. Gross tumor volumes (GTVs were contoured using lung windows; the margins were expanded by 5 mm to establish the planning treatment volume (PTV. Treatment plans were designed using hundreds of pencil beams. Doses delivered to the PTV ranged from 42-60 Gy in 3 fractions. The 30-Gy isodose contour extended at least 1cm from the GTV to eradicate microscopic disease. Treatments were delivered using the CyberKnife system with tumor tracking. Examination and PET/CT imaging occurred at 3-month follow-up intervals. Forty patients (median age 76 with a median maximum tumor diameter of 2.6 cm (range, 1.4-5.0 cm and a mean post-bronchodilator percent predicted forced expiratory volume in 1 second (FEV1 of 57% (range, 21 - 111% were treated. A mean dose of 50 Gy was delivered to the PTV over 3 to 13 days (median, 7 days. The 30-Gy isodose contour extended a mean 1.9 cm from the GTV. At a median 44 months (range, 12 -72 months follow-up, the 3-year Kaplan-Meier locoregional control and overall survival estimates compare favorably with contemporary wedge resection outcomes at 91% and 75% , respectively. CyberKnife is an effective treatment approach for stage I NSCLC that is similar to wedge resection, eradicating tumors with 1 to 2 cm margins in order to preserve lung function. Prospective randomized trials comparing CyberKnife with wedge resection are necessary to confirm equivalence.

  15. A developed wedge fixtures assisted high precision TEM samples pre-thinning method: Towards the batch lamella preparation

    Directory of Open Access Journals (Sweden)

    Dandan Wang


    Full Text Available Ion milling, wedge cutting or polishing, and focused ion beam (FIB milling are widely-used techniques for the transmission electron microscope (TEM sample preparation. Especially, the FIB milling provides a site-specific analysis, deposition, and ablation of materials in the micrometer and nanometer scale. However, the cost of FIB tools has been always a significant concern. Since it is inevitable to use the FIB technique, the improvement of efficiency is a key point. Traditional TEM sample preparation with FIB was routinely implemented on a single sample each time. Aiming at cost efficiency, a new pre-thinning technique for batch sample preparation was developed in this paper. The present proposal combines the sample preparation techniques with multi-samples thinning, cross-section scanning electron microscopy (SEM, wedge cutting, FIB and other sample pre-thinning techniques. The new pre-thinning technique is to prepare an edge TEM sample on a grinding and polishing fixture with a slant surface. The thickness of the wedges sample can be measured to 1∼2 μm under optical microscope. Therefore, this fixture is superior to the traditional optical method of estimating the membrane thickness. Moreover, by utilizing a multi-sample holding fixture, more samples can be pre-thinned simultaneously, which significantly improved the productivity of TEM sample preparation.

  16. Tibial Plateau Fractures

    DEFF Research Database (Denmark)

    Elsøe, Rasmus

    This PhD thesis reported an incidence of tibial plateau fractures of 10.3/100,000/year in a complete Danish regional population. The results reported that patients treated for a lateral tibial plateau fracture with bone tamp reduction and percutaneous screw fixation achieved a satisfactory level...... with only the subgroup Sport significantly below the age matched reference population. The thesis reports a level of health related quality of life (Eq5d) and disability (KOOS) significantly below established reference populations for patients with bicondylar tibial plateau fracture treated with a ring...... fixator, both during treatment and at 19 months following injury. In general, the thesis demonstrates that the treatment of tibial plateau fractures are challenging and that some disabilities following these fractures must be expected. Moreover, the need for further research in the area, both with regard...

  17. Fastening of a High-Strength Composite Rod with a Splitted and Wedged End in a Potted Anchor 2. Finite-Element Analysis (United States)

    Kulakov, V. L.; Terrasi, G. P.; Arnautov, A. K.; Portnov, G. G.; Kovalov, A. O.


    A finite element analysis is carried out to determine the stress-strain state of anchors for round rods made of a high- modulus, high-strength unidirectional carbon-fiber reinforced plastic. The rods have splitted ends in which Duralumin wedges are glued. Three types of contact between the composite rods and a potted epoxy compound are considered: adhesion, adhesion-friction, and friction ones. The corresponding three-dimensional problems in the elastic statement are solved by the finite-element method (FEM) with account of nonlinear Coulomb friction. An analysis of stresses on the surface of the composite rod revealed the locations of high concentrations of operating stresses. The results of FEM calculations agree with experimental data.

  18. Solitary Tibial Osteolytic Lesion

    Directory of Open Access Journals (Sweden)

    Emilios E. Pakos


    Full Text Available We report an unusual case of solitary osteolytic tibial metastasis from a primary endometrial cancer in a 62-year-old woman. The primary cancer was treated with total abdominal hysterectomy and bilateral salpingo-oophorectomy combined with postoperative external beam radiotherapy, while the tibial metastasis was treated with an above knee amputation. The rarity of the case lies on the fact that metastases distally to the elbow and knee are uncommon and endometrial cancer rarely gives distal bone metastases and particularly solitary to the extremities.

  19. Analysis of long-term effect of high tibial osteotomy%胫骨结节高位截骨术远期疗效分析

    Institute of Scientific and Technical Information of China (English)

    郭振华; 郭瑞; 杨志波; 李向东


    Objective To investigate the long-term effect of high tibial osteotomy.Methods, 58 cases of knee osteoarthritis with varus knee patients from 1999 to 2015 received were selected.All patients were treated with high tibial osteotomy.Results the excellent and good rate was 89% in 1-5 years after surgery.The excellent and good rate of over 5 years is 73%. 3cases complications occurred in 58 patients.Complications were ifbular nerve damage,deep vein thrombosis,wound infection,and then have been effectively improved.No nonunion or delayed union occurred in all patients.Conclusion knee osteoarthritis with varus knee patients were early treated by high tibial osteotomy. It can make the patient get the ideal treatment effect, can relieve the patient's joint pain, delay the patient's condition development, it is worth in clinical application and promotion.%目的:探讨胫骨结节高位截骨术的远期疗效。方法选择1999年到2015年收治的58例膝关节骨性关节炎合并膝关节内翻患者,均接受胫骨高位截骨术治疗。结果术后随访1-5年优良率达89%,5年以上优良率73%。58例患者中3例发生并发症,并发症分别为腓总神经损伤、深静脉血栓形成、伤口感染,之后均得到有效改善。所有患者中无1例发生无骨不连或延迟愈合的情况。结论采用胫骨高位截骨术对早期膝关节骨性关节炎合并膝关节内翻患者进行治疗,可以使患者获得理想的治疗效果,可以解除患者的关节疼痛,延缓患者的病情发展,值得在临床中应用和推广。

  20. Wedges of Anxiety

    DEFF Research Database (Denmark)

    Hellström, Maria; Brandt, Eva


    The Heraclitian notion of a reality in constant flux seems to have settled even in the public consciousness. We are, to an ever-increasing extent, on the move; in motion between different places of abode, between domiciles and places of residence, between temporary addresses and provisory settlem...... cones of light, as the cut their way into the unknown, like wedges of anxiety...

  1. A non-randomized controlled clinical trial on autologous chondrocyte implantation (ACI) in cartilage defects of the medial femoral condyle with or without high tibial osteotomy in patients with varus deformity of less than 5°

    DEFF Research Database (Denmark)

    Bode, Gerrit; Schmal, Hagen; Pestka, Jan M


    PURPOSE: High tibial osteotomy (HTO) is a recommended concomitant surgery when treating cartilage lesions of the medial femoral condyle (MFC). Varus deformities of 5° and more were considered an indication for HTO in patients with cartilage defects. This study compares clinical outcome in patients...

  2. Hydrodynamics of slip wedge and optimization of surface slip property

    Institute of Scientific and Technical Information of China (English)


    The hydrodynamic load support generated by a slip wedge of a slider bearing was studied. The surface slip property was optimized so that a maximum hydrodynamic load support could be obtained. A multi-linearity method was given for the slip control equation of two-dimensional (2-D) wall slip. We investigated 2-D wall slip and the hydrodynamics of a finite length bearing with any values of the surface limiting shear stress. It was found that the hydrodynamic effect of the slip wedge is greater than the traditional geometrical convergent-wedge. Even though the geo- metrical gap is a parallel or divergent sliding gap, the slip wedge still gives rise to a very big hydrodynamic pressure. The optimized slip wedge can give rise to a hy- drodynamic load support as high as 2.5 times of what the geometrical conver- gent-wedge can produce. Wall slip usually gives a small surface friction.

  3. Hydrodynamics of slip wedge and optimization of surface slip property

    Institute of Scientific and Technical Information of China (English)

    MA GuoJun; WU ChengWei; ZHOU Ping


    The hydrodynamic load support generated by a slip wedge of a slider bearing was studied. The surface slip property was optimized so that a maximum hydrodynamic load support could be obtained. A multi-linearity method was given for the slip control equation of two-dimensional (2-D) wall slip. We investigated 2-D wall slip and the hydrodynamics of a finite length bearing with any values of the surface limiting shear stress. It was found that the hydrodynamic effect of the slip wedge is greater than the traditional geometrical convergent-wedge. Even though the geometrical gap is a parallel or divergent sliding gap, the slip wedge still gives rise to a very big hydrodynamic pressure. The optimized slip wedge can give rise to a hydrodynamic load support as high as 2.5 times of what the geometrical convergent-wedge can produce. Wall slip usually gives a small surface friction.

  4. Shock detachment from curved wedges (United States)

    Mölder, S.


    Curved shock theory is used to show that the flow behind attached shocks on doubly curved wedges can have either positive or negative post-shock pressure gradients depending on the freestream Mach number, the wedge angle and the two wedge curvatures. Given enough wedge length, the flow near the leading edge can choke to force the shock to detach from the wedge. This local choking can preempt both the maximum deflection and the sonic criteria for shock detachment. Analytical predictions for detachment by local choking are supported by CFD results.

  5. Shock detachment from curved wedges (United States)

    Mölder, S.


    Curved shock theory is used to show that the flow behind attached shocks on doubly curved wedges can have either positive or negative post-shock pressure gradients depending on the freestream Mach number, the wedge angle and the two wedge curvatures. Given enough wedge length, the flow near the leading edge can choke to force the shock to detach from the wedge. This local choking can preempt both the maximum deflection and the sonic criteria for shock detachment. Analytical predictions for detachment by local choking are supported by CFD results.

  6. Surgical treatment of a proximal diaphyseal tibial deformity associated with partial caudal and cranial cruciate ligament deficiency and patella baja. (United States)

    Vincenti, S; Knell, S; Pozzi, A


    Caudal cruciate ligament injury can be a complication following tibial plateau leveling osteotomy (TPLO) (Slocum und Slocum, 1993) especially if the post-operative Tibial Plateau Angle (TPA) is less than 5 degree. We describe a case of negative TPA associated with partial cranial and caudal ligament rupture treated with a center of rotation of angulation (CORA) based cranial tibial opening wedge osteotomy and tibial tuberosity transposition. A 13 kg, mixed breed dog was presented for right pelvic limb lameness. Radiographically a bilateral patella baja and a malformed tibia tuberosity along with a bilateral TPA of -8 degree were detected. Arthroscopically a partial rupture of the cranial and caudal cruciate ligaments were found. A cranial tibial opening wedge osteotomy of 23 degree and a fibular ostectomy were performed. The osteotomy was fixed with a 8 holes ALPS 9 (KYON, Switzerland) and a 3-holes 2.0mm UniLock plate (Synthes, Switzerland). Then a proximal tibial tuberosity transposition of 10mm was performed and fixed with a pin and tension band construct. The postoperative TPA was 15 degree. The radiographic controls at 6, 10 weeks, 6 months and 1 year after surgery revealed an unchanged position of the implants and progressive healing of the osteotomies. At the 6 and 12 months recheck evaluation the dog had no evidence of lameness or stifle pain and radiographs revealed complete healing of the osteotomy site and no implant failure. The diaphyseal CORA based osteotomy allowed accurate correction of a proximal tibial deformity associated with negative TPA.

  7. Optimal clinical implementation of the Siemens virtual wedge. (United States)

    Walker, C P; Richmond, N D; Lambert, G D


    Installation of a modern high-energy Siemens Primus linear accelerator at the Northern Centre for Cancer Treatment (NCCT) provided the opportunity to investigate the optimal clinical implementation of the Siemens virtual wedge filter. Previously published work has concentrated on the production of virtual wedge angles at 15 degrees, 30 degrees, 45 degrees, and 60 degrees as replacements for the Siemens hard wedges of the same nominal angles. However, treatment plan optimization of the dose distribution can be achieved with the Primus, as its control software permits the selection of any virtual wedge angle from 15 degrees to 60 degrees in increments of 1 degrees. The same result can also be produced from a combination of open and 60 degrees wedged fields. Helax-TMS models both of these modes of virtual wedge delivery by the wedge angle and the wedge fraction methods respectively. This paper describes results of timing studies in the planning of optimized patient dose distributions by both methods and in the subsequent treatment delivery procedures. Employment of the wedge fraction method results in the delivery of small numbers of monitor units to the beam's central axis; therefore, wedge profile stability and delivered dose with low numbers of monitor units were also investigated. The wedge fraction was proven to be the most efficient method when the time taken for both planning and treatment delivery were taken into consideration, and is now used exclusively for virtual wedge treatment delivery in Newcastle. It has also been shown that there are no unfavorable dosimetric consequences from its practical implementation.

  8. Bilateral tibial hemimelia I. (United States)

    Suganthy, J; Rassau, Marina; Koshi, Rachel; Battacharjee, Suranjan


    Congenital absence of tibia is a rare anomaly. We report a case of bilateral tibial hemimelia born to phenotypically normal parents. The two amputated legs with tibial dysplasia obtained from a 3-year-old boy were studied by radiography and anatomical dissection. The radiological evaluation revealed a normal hip joint. The lower end of femur was normal without any bifurcation, shortening or bowing. Fibula was present on both legs and there was no sign of bowing or doubling. Both right and left tibiae were absent. In addition, on the right side, five tarsal bones, two metatarsals and the corresponding digital rays were absent. On the left side, three tarsal bones were absent. Dissection of the amputated segments showed the presence of extensor digitorum longus, peroneus tertius, peroneus longus and brevis, gastrocnemius, and soleus. Following bilateral knee disarticulation the patient was fitted with prosthesis and is doing well.

  9. Tibial shaft fracture

    DEFF Research Database (Denmark)

    Larsen, Peter

    IV also showed a significant worse outcome in 3 of the 5 KOOS subscales compared to a reference population at 12-months follow-up. Moreover, this study showed that increasing difference in muscle strength for knee extension between legs was associated with a decreasing QOL. The results of this thesis...... suggested that regaining pre injured QOL and muscle strength following a tibial shaft fracture takes considerable time....

  10. Tibial hyperostosis: A diagnostic approach

    Energy Technology Data Exchange (ETDEWEB)

    Touraine, Sébastien, E-mail: [Radiologie ostéo-articulaire, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10 (France); Parlier-Cuau, Caroline, E-mail: [Radiologie ostéo-articulaire, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10 (France); Bousson, Valérie, E-mail: [Radiologie ostéo-articulaire, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10 (France); Sverzut, Jean-Michel, E-mail: [Radiologie ostéo-articulaire, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10 (France); Centre d’imagerie du centre cardiologique du Nord, 32-36 rue des Moulins Gémeaux, 93200 Saint-Denis (France); Genah, Idan, E-mail: [Radiologie ostéo-articulaire, Hôpital Lariboisière, 2 rue Ambroise Paré, 75475 Paris Cedex 10 (France); and others


    Tibial hyperostosis may be encountered in musculoskeletal imaging, incidentally or during the investigation of a leg pain. Hyperostosis involves the exuberant production of osseous tissue and results in cortical, periosteal and/or endosteal thickening of the bone. As a long bone with thick cortices, the tibia has a significant probability of being affected by ubiquitous bone diseases. As a tubular long bone, the tibia is likely to be involved in extensive infectious conditions such as osteomyelitis. As a bone of the lower limb, the tibia undergoes high stresses and may be affected by decrease in bone strength or repetitive submaximal stress. The tibia is also particularly involved in some bone sclerosing dysplasias and Paget's disease. In this work, we aim at highlighting the main conditions leading to tibial hyperostosis and try to provide key elements to narrow down the several diagnostic possibilities. Osteoid osteomas, fatigue or insufficiency fractures, infectious conditions, vascular lesions, sclerosing bone dysplasias and Paget's disease represent the main challenging diagnoses to discuss.

  11. Tibial hypoplasia with a bifid tibia: an unclassified tibial hemimelia. (United States)

    Shah, Krupa; Shah, Hitesh


    Tibial hemimelia is a rare congenital limb deficiency which is characterised by a hypoplastic/aplastic tibia. It actually represents a spectrum of anomalies, ranging from mild hypoplasia of the tibia to total absence of the tibia. Several classifications based on radiological description exist in the literature. The tibial hemimelia is usually described with preaxial mirror polydactyly, split hand/foot syndrome-ectrodactyly, polydactyly-triphalangeal thumb syndrome (Werner syndrome) and micromelia-trigonal brachycephaly syndrome. We describe a child with unclassified tibial hemimelia. The child had right incomplete tibial hemimelia with bifid tibia, left complete tibial hemimelia, bilateral split hands and left split foot. This is the first report of the bifid tibia in the literature.

  12. Dual-plane high tibial osteotomy to treat posterolateral corner injuries combined with varus deformity of knee joint%双平面胫骨高位截骨治疗伴下肢力线不良的膝关节后外复合体损伤

    Institute of Scientific and Technical Information of China (English)

    张辉; 冯华; 洪雷; 王雪松; 张晋; 刘心; 宋关阳


    necessary. Conclusion The dual⁃plane medial open wedge high tibial osteotomy can improve the alignment of lower extremity and the stability of knee joint, and 67%patients do not need a staged PLC and posterior cruciate ligament reconstruction.%目的:探讨双平面胫骨高位截骨在伴下肢力线不良的膝关节后外复合体损伤修复中的作用。方法2008年10月至2014年3月采用双平面胫骨高位截骨治疗的伴下肢力线不良的膝关节后外复合体损伤并随访2年以上的患者12例,男10例,女2例;年龄20~44岁,平均29.8岁;单膝11例,双膝1例。所有患者均有后十字韧带损伤,伴有膝关节过伸5膝,不伴膝关节过伸8膝。双平面胫骨高位截骨,在冠状面调整下肢力线通过胫骨平台62%的位置,在矢状面矫正膝关节过伸至膝关节完全伸直。术前和术后2年摄下肢负重位全长X线片,测量下肢机械轴通过胫骨平台的相对位置、股胫角和胫骨平台后倾角;摄膝关节应力位X线片,评估膝关节后向稳定性(胫骨后移距离)和内翻稳定性(外侧间隙张开程度);通过Opti_knee步态分析测量负重期膝关节内翻角,评估截骨对内翻步态矫正的效果。结果下肢机械轴通过胫骨平台的相对位置由术前19.6%±19.1%改善至42.6%±17.9%,股胫角由术前172.8°±4.2°改善至178.1°±4.2°,胫骨平台后倾角由术前10.2°±5.3°改善至18.4°±6.3°,手术前后差异均有统计学意义(P<0.05)。9例患者行膝关节应力位X线检查,胫骨后移距离由术前(11.4±5.3)mm改善至(8.1±6.9)mm,外侧间隙张开程度由术前(16.3±6.5)mm改善至(14.2±4.9)mm,差异均有统计学意义(P<0.05)。7例患者行步态分析,负重期膝关节内翻角由术前3.0°±2.6°改善至-2.7°±2.5°,差异有统计学意义(P<0.05)。8例患者主观认为不再需要二期韧带重建。结论双平面胫

  13. Comparison of wedge resection (Winograd procedure) and wedge resection plus complete nail plate avulsion in the treatment of ingrown toenails. (United States)

    Huang, Jia-Zhang; Zhang, Yi-Jun; Ma, Xin; Wang, Xu; Zhang, Chao; Chen, Li


    The present retrospective study compared the efficacy of wedge resection (Winograd procedure) and wedge resection plus complete nail plate avulsion for the treatment of ingrown toenails (onychocryptosis). Two surgical methods were performed in 95 patients with a stage 2 or 3 ingrown toenail. Each patient was examined weekly until healing and then at 1, 6, and 12 months of follow-up. The outcomes measured were surgical duration, healing time, recurrence rate, the incidence of postoperative infection, and cosmetic appearance after surgery. Of the 95 patients (115 ingrown toenails) included in the present study, 39 (41.1%) underwent wedge resection (Winograd procedure) and 56 (59%), wedge resection plus complete nail plate avulsion. The mean surgical duration for wedge resection (Winograd procedure) and wedge resection plus complete nail plate avulsion was 14.9 ± 2.4 minutes and 15.1 ± 3.2 minutes, respectively (p = .73). The corresponding healing times were 2.8 ± 1.2 weeks and 2.7 ± 1.3 weeks (p = .70). Recurrence developed in 3 (3.2%) patients after wedge resection (Winograd procedure) and in 4 (4.2%) after wedge resection plus complete nail plate avulsion. In addition, postoperative infection occurred in 3 (3.2%) patients after wedge resection (Winograd procedure) and 2 (2.1%) after wedge resection plus complete nail plate avulsion. Both of the surgical procedures were practical and appropriate for the treatment of ingrown toenails, being simple and associated with low morbidity and a high success rate. However, cosmetically, wedge resection (Winograd procedure) would be the better choice because the nail plate remains intact.

  14. Collagen turnover after tibial fractures

    DEFF Research Database (Denmark)

    Joerring, S; Krogsgaard, M; Wilbek, H


    Collagen turnover after tibial fractures was examined in 16 patients with fracture of the tibial diaphysis and in 8 patients with fracture in the tibial condyle area by measuring sequential changes in serological markers of turnover of types I and III collagen for up to 26 weeks after fracture...... collagen. A group comparison showed characteristic sequential changes in the turnover of types I and III collagen in fractures of the tibial diaphysis and tibial condyles. The turnover of type III collagen reached a maximum after 2 weeks in both groups. The synthesis of type I collagen reached a maximum...... after 2 weeks in the diaphyseal fractures and after 6 weeks in the condylar fractures. The degradation of type I collagen increased after 4 days and reached a maximum at 2 weeks in both groups. The interindividual variation was wide. On a group basis, the turnover of types I and III collagen had...

  15. Life at the wedge: the activity and diversity of arctic ice wedge microbial communities. (United States)

    Wilhelm, Roland C; Radtke, Kristin J; Mykytczuk, Nadia C S; Greer, Charles W; Whyte, Lyle G


    The discovery of polygonal terrain on Mars underlain by ice heightens interest in the possibility that this water-bearing habitat may be, or may have been, a suitable habitat for extant life. The possibility is supported by the recurring detection of terrestrial microorganisms in subsurface ice environments, such as ice wedges found beneath tundra polygon features. A characterization of the microbial community of ice wedges from the high Arctic was performed to determine whether this ice environment can sustain actively respiring microorganisms and to assess the ecology of this extreme niche. We found that ice wedge samples contained a relatively abundant number of culturable cells compared to other ice habitats (∼10(5) CFU·mL(-1)). Respiration assays in which radio-labeled acetate and in situ measurement of CO(2) flux were used suggested low levels of microbial activity, though more sensitive techniques are required to confirm these findings. Based on 16S rRNA gene pyrosequencing, bacterial and archaeal ice wedge communities appeared to reflect surrounding soil communities. Two Pseudomonas sp. were the most abundant taxa in the ice wedge bacterial library (∼50%), while taxa related to ammonia-oxidizing Thaumarchaeota occupied 90% of the archaeal library. The tolerance of a variety of isolates to salinity and temperature revealed characteristics of a psychrotolerant, halotolerant community. Our findings support the hypothesis that ice wedges are capable of sustaining a diverse, plausibly active microbial community. As such, ice wedges, compared to other forms of less habitable ground ice, could serve as a reservoir for life on permanently cold, water-scarce, ice-rich extraterrestrial bodies and are therefore of interest to astrobiologists and ecologists alike. .

  16. Group based prenatal care in a low-and high risk population in the Netherlands: a study protocol for a stepped wedge cluster randomized controlled trial. (United States)

    van Zwicht, Birgit S; Crone, Matty R; van Lith, Jan M M; Rijnders, Marlies E B


    CenteringPregnancy (CP) is a multifaceted group based care-model integrated in routine prenatal care, combining health assessment, education, and support. CP has shown some positive results on perinatal outcomes. However, the effects are less obvious when limited to the results of randomized controlled trials: as there are few trials and there is a variation in reported outcomes. Furthermore, former research was mostly conducted in the United States of America and in specific (often high risk) populations. Our study aims to evaluate the effects of CP in the Netherlands in a general population of pregnant women (low and high risk). Furthermore we aim to explore the mechanisms leading to the eventual effects by measuring potential mediating factors. We will perform a stepped wedge cluster randomized controlled trial, in a Western region in the Netherlands. Inclusion criteria are control period will receive individual care, women in the intervention period (starting at the randomized time-point) will be offered the choice between individual care or CP. Primary outcomes are maternal and neonatal morbidity, retrieved from a national routine database. Secondary outcomes are health behavior, psychosocial outcomes, satisfaction, health care utilization and process outcomes, collected through self-administered questionnaires, group-evaluations and individual interviews. We will conduct intention-to-treat analyses. Also a per protocol analysis will be performed comparing the three subgroups: control group, CP-participants and non-CP-participants, using multilevel techniques to account for clustering effects. This study contributes to the evidence regarding the effect of CP and gives a first indication of the effect and implementation of CP in both low and high-risk pregnancies in a high-income Western society other than the USA. Also, measuring factors that are hypothesized to mediate the effect of CP will enable to explain the mechanisms that lead to effects on maternal and

  17. Rotational alignment of the tibial component in total knee arthroplasty is better at the medial third of tibial tuberosity than at the medial border

    Directory of Open Access Journals (Sweden)

    Günther Klaus-Peter


    Full Text Available Abstract Background Correct rotational alignment of the femoral and tibial component is an important factor for successful TKA. The transepicondylar axis is widely accepted as a reference for the femoral component. There is not a standard reference for the tibial component. CT scans were used in this study to measure which of 2 tibial landmarks most reliably reproduces a correct femoro-tibial rotational alignment in TKA. Methods 80 patients received a cemented, unconstrained, cruciate-retaining TKA with a rotating platform. CT scans were performed 5-7 days postoperatively but before discharge. The rotational mismatch between the femoral and tibial components was measured. Furthermore, the rotational variance between the transepicondylar line, as a reference for the orientation of the femoral component and different tibial landmarks, was measured. Results There was notable rotational mismatch between the femoral and tibial components. The median mismatch was 0° (range: 16.2 degrees relative external to 14.4 degrees relative internal rotation of the femoral component. Using the transepicondylar line as a reference for femoral rotational alignment and the medial third of the tuberosity as a reference for tibial rotational alignment, 67.5% of all TKA had a femoro-tibial variance within ± 5 degrees, 85% within ± 10 degrees and 97.5% within ± 20 degrees. Using the medial border of the tibial tubercle as a reference this variance was greater, only 3.8% had a femoro-tibial variance within ± 5 degrees, 15% within ± 10 degrees and 68.8% within ± 20 degrees. Conclusion Using fixed bone landmarks for rotational alignment leads to a notable variance between femoral and tibial components. Referencing the tibial rotation on a line from the medial third of the tibial tubercle to the center of the tibial tray resulted in a better femoro-tibial rotational alignment than using the medial border of tibial tubercle as a landmark. Surgeons using fixed bearings


    Directory of Open Access Journals (Sweden)



    Full Text Available INTRODUCTION : High - energy tibial plateau fractures are infrequent and technically demanding to treat especially if those are shearing type, coronal plane, displaced fractures. The most widely used the Schatzker system of classification , [1] ( B ased on the AP radiograph is more than likely to miss postero - medial and postero - lateral shear fractures, best visible on the lateral, than the AP radiograph. These fractures have recently been characterised by two studies, highlighti ng their clinical relevance [ 2,3] and showing that less invasive surgery and indirect reduction techniques are often inadequate. Hohl described unicondylar c oronal plane splitting fractures of the medial tibial plateau, noted that these injuries be considered as fracture - dislocations. Connolly and others have suggested that the mechanism involved in this fracture pattern is one of knee flexion, varus, and inter nal rotation of the medial femoral condyle . [4,5,6 ] Consistent among these and other authors is that the occurrence of this fragment is relatively unusual and that the use of a posteriorly based exposure with direct fracture visualization, anatomic reductio n and absolute stability appears to result in satisfactory outcomes. Though variations of a postero - medial approach been previously described ( by Trickey et al and also by Burks et al.,, more recently, Lobenhoffer et al described direct posterior exposure , Wang et al described postero - medial approach and Luo et al. described the approach for the management of posterior bicondylar tibial plateau fractures . [7,8] These approaches have been used in isolation or as a dual - incision approach for treating tibial plateau fractures . [9,10,11,12,13,14, 15] PURPOSE : The purpose of this study is to describe this unfamiliar direct posterior surgical (Medial Gastrocnemius approach to a general orthopod, highlighting the relevant anatomy and presenting our experience using this approach in treating a

  19. The Tax Wedge in Slovenia: International Comparison and Policy Recommendations

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    Primož Dolenc


    Full Text Available When taxes on labor are introduced, a “tax wedge” appears between the labor costs paid by the employer (gross wage and the net wage received by an employee. At a certain level of wage, a higher tax wedge increases unemployment and decreases employment, all other things being equal. The paper tackles three main questions: the characteristics of the tax wedge, unemployment and employment rates in OECD countries in the recent past, tax wedge policy in the EU15 and the new EU members and the tax system and its effects on the unemployment and employment rates in Slovenia. We found that the OECD countries can be classified into two groups of countries if the tax wedge, the unemployment rate and the employment rate are taken into consideration. The first group is the high tax wedge, high unemployment rate and low employment rate group of countries, whereas the other group has the opposite characteristics. European member states (old and new have on average a higher tax burden on labor than the OECD average, consequently suffering from higher unemployment rates. Slovenia has an unreasonably high tax wedge; in the EU only Belgium and Germany have a higher tax burden. According to previous and our empirical findings we suggest that Slovenia could benefit from a reduction in the tax wedge.

  20. Results of total knee arthroplasty after high tibial osteotomy%胫骨高位截骨术后全膝关节置换的疗效分析

    Institute of Scientific and Technical Information of China (English)



    [目的]目前采用胫骨高位截骨术治疗膝关节内侧间室骨性关节炎已在临床广泛开展,对于其中预后不佳者可采用全膝关节置换,本文对其临床效果进行分析.[方法]对38例胫骨高位截骨术后接受全膝关节置换术患者进行回顾分析.术后随访时间平均8年,对其中期疗效进行评估.[结果]特种外科住院评分由术前平均39分提高到术后平均86.5分.优良率达87%.[结论]与未接受过胫骨高位截骨术患者相比,胫骨高位截骨术后接受全膝关节置换的中期疗效令人满意.%[Objective] High tibial osteotomy is a well accepted procedure for medial compartment osteoarthritis of knees.Over time its results deteriorate and some patients were reoperated with a total knee arthroplasty.To evaluate the results of total knee arthroplasty after a high tibial osteotomy.[Method] Thirty-eight knees were evaluated retrospectively for the results of a total knee arthroplasty after a high tibial osteotomy.They were followed up for an average of 8 years and the mid terra results assessed.[Result] The average Hospital for special surgery score increased to 86.5 points from 39 points pre-operatively.There were 87% excellent and good results.[Conclusion] Mid term results of total knee arthroplasty after hish tibial osteotomy are excellent and are comparable to those without a tibial osteotomy.

  1. Employment and productivity: The role of the tax wedge

    Directory of Open Access Journals (Sweden)

    Andrea FESTA


    Full Text Available After the economic crisis, many countries aim at reducing unemployment and foster productivity. To address these issues one of the most common policy indications recommends lowering the tax wedge on labour in order to increase employment and growth. As a consequence, a review of the empirical studies focused on the relation between tax wedge, employment and productivity is an useful and demanding exercise, especially in those European countries where the topic is on the front page of the domestic policy debate because the productivity growth is low and the tax wedge on labour is high.

  2. [Magnetic resonance imaging of tibial periostitis]. (United States)

    Meyer, X; Boscagli, G; Tavernier, T; Aczel, F; Weber, F; Legros, R; Charlopain, P; Martin, J P


    Tibial periostitis frequently occurs in athletes. We present our experience with MRI in a series of 7 patients (11 legs) with this condition. The clinical presentation and scintigraphic scanning suggested the diagnosis. MRI exploration of 11 legs demonstrated a high band-like juxta-osseous signal enhancement of SE and IR T2 weighted sequences in 6 cases, a signal enhancement after i.v. contrast administration in 4. Tibial periostitis is a clinical diagnosis and MRI and scintigraphic findings can be used to assure the differential diagnosis in difficult cases with stress fracture. MRI can visualize juxta-osseous edematous and inflammatory reactions and an increased signal would appear to be characteristic when the band-like image is fixed to the periosteum.

  3. Scattering of wedges and cones with impedance boundary conditions

    CERN Document Server

    Lyalinov, Mikhail


    This book is a systematic and detailed exposition of different analytical techniques used in studying two of the canonical problems, the wave scattering by wedges or cones with impedance boundary conditions. It is the first reference on novel, highly efficient analytical-numerical approaches for wave diffraction by impedance wedges or cones. The applicability of the reported solution procedures and formulae to existing software packages designed for real-world high-frequency problems encountered in antenna, wave propagation, and radar cross section.

  4. Tibial condylar valgus osteotomy (TCVO) for osteoarthritis of the knee: 5-year clinical and radiological results. (United States)

    Chiba, Ko; Yonekura, Akihiko; Miyamoto, Takashi; Osaki, Makoto; Chiba, Goji


    Tibial condylar valgus osteotomy (TCVO) is a type of opening-wedge high tibial osteotomy for advanced medial knee osteoarthritis (OA) with subluxated lateral joint. We report the concept, the current surgical technique with a locking plate, and the short-term clinical and radiological results of this procedure. 11 knees with medial OA and a widened lateral joint were treated by TCVO (KL stage III: 6, IV: 5). In this procedure, by the L-shaped osteotomy from the medial side of the proximal tibia to the intercondylar eminence and the valgus correction, lateralization of the mechanical axis and reduction of the subluxated lateral joint are obtained with early postoperative weight-bearing. Before, 6 months, 1, and 5 years after the operation, a visual analog scale (VAS), the Western Ontario and McMaster Universities Arthritis Index (WOMAC), alignment of the lower extremity, and congruency and stability of the femorotibial joint were investigated. The VAS improved from an average of 73 mm to 13 mm, and the total WOMAC score from 52 to 14 before to 5 years after the operation, respectively. The mechanical axis changed from 1 to 60%, and the FTA changed from 186° to 171°. The joint line convergence angle (JLCA) changed from 6° to 1°, and the angle difference of JLCA between varus and valgus stress improved from 8° to 4° after the procedure. Improvements in pain and activities of daily living were observed by TCVO along with valgus correction of the lower extremity and stabilization of the femorotibial joint.

  5. New machining and testing method of large angle infrared wedge mirror parts (United States)

    Su, Ying; Guo, Rui; Zhang, Fumei; Zhang, Zheng; Liu, Xuanmin; Zengqi, Xu; Li, Wenting; Zhang, Feng


    Large angle wedge parts were widely used in the optical system that was used for achieving a wide range of scanning. Due to the parts having the characteristic of large difference in the thickness of both ends and high density, the accuracy of the wedge angle was hard to ensure to reach second level in optical processing. Generally, wedge mirror angle was measured by contact comparison method which was easy to damage the surface. In view of the existence of two practical problems, in this paper, based on theoretical analysis, by taking three key measures that were the accurate positioning for the central position of the large angle wedge part, the accuracy control of angle precision machined of wedge mirror and fast and non destructive laser assisted absolute measurement of large angle wedge, the qualified rate of parts were increased to 100%, a feasible, controllable and efficient process route for large angle infrared wedge parts was found out.

  6. Pseudoarthrosis of medial tibial plateau fracture——role of alignment procedure

    Institute of Scientific and Technical Information of China (English)

    Ashish Devgan; Pradeep Kamboj; Vinay Gupta; Narender K Magu; Rajesh Rohilla


    Nonunion in tibial plateau fractures is very rare.Limited literature is available on Pubmed search on intraarticular tibial nonunion.Most of the cases reported have been following failed surgical treatment and none was neglected fractures.Three patients of isolated and neglected medial tibial plateau nonunion with almost similar demographic profile are reported in this paper.All the three patients were managed by minimally invasive compression fixation using lag screws supplemented with limb realignme nt procedure of high tibial osteotomy.We discussed theinjury mechanism,management and rehabilitation in such cases and reviewed the available literature regarding such a presentation.

  7. Medial tibial stress syndrome. (United States)

    Reshef, Noam; Guelich, David R


    MTSS is a benign, though painful, condition, and a common problem in the running athlete. It is prevalent among military personnel, runners, and dancers, showing an incidence of 4% to 35%. Common names for this problem include shin splints, soleus syndrome, tibial stress syndrome, and periostitis. The exact cause of this condition is unknown. Previous theories included an inflammatory response of the periosteum or periosteal traction reaction. More recent evidence suggests a painful stress reaction of bone. The most proven risk factors are hyperpronation of the foot, female sex, and history of previous MTSS. Patient evaluation is based on meticulous history taking and physical examination. Even though the diagnosis remains clinical, imaging studies, such as plain radiographs and bone scans are usually sufficient, although MRI is useful in borderline cases to rule out more significant pathology. Conservative treatment is almost always successful and includes several options; though none has proven more superior to rest. Prevention programs do not seem to influence the rate of MTSS, though shock-absorbing insoles have reduced MTSS rates in military personnel, and ESWT has shortened the duration of symptoms. Surgery is rarely indicated but has shown some promising results in patients who have not responded to all conservative options.

  8. American Society of Biomechanics Clinical Biomechanics Award 2013: tibiofemoral contact location changes associated with lateral heel wedging--a weight bearing MRI study. (United States)

    Barrance, Peter J; Gade, Venkata; Allen, Jerome; Cole, Jeffrey L


    Vertically open magnetic resonance imaging permits study of knee joint contact during weight bearing. Lateral wedging is a low cost intervention for knee osteoarthritis that may influence load distribution and contact. This study assessed the ability of feedback-assisted weight bearing magnetic resonance imaging to detect changes in tibiofemoral contact associated with lateral wedging. One knee in each of fourteen subjects with symptomatic knee osteoarthritis was studied, without specification of compartmental involvement. Knees were imaged during upright standing and at 20° knee flexion. Bilateral external heel wedges were used to provide non-wedged and 5° lateral wedging conditions. Computer modeling was used to measure the medial and lateral compartment contact patch center coordinates on the tibial plateau and the respective contact areas. Lateral heel wedging in flexion was associated with a significant anterior shift of the contact patch of the lateral femoral condyle. Changes with knee flexion were similar to previous reports: both medial and lateral contact centers moved posteriorly with flexion, and lateral condyle contact also moved laterally. Lateral condyle contact area significantly reduced with flexion, while lateral wedging did not significantly affect contact areas. In symptomatic knee osteoarthritis patients standing in knee flexion, weight bearing magnetic resonance imaging recorded an anterior shift of lateral condyle contact in response to lateral heel wedging. Future studies may investigate lateral wedging effects more specifically in candidates for this clinical intervention. Copyright © 2014 Elsevier Ltd. All rights reserved.

  9. Structure and Kinematics of the Indo-Burmese Wedge (United States)

    Maurin, T.; Rangin, C.


    The Burma subduction trench and the associated Indo Burmese wedge mark the present eastern boundary of the Indian plate in the northern Bengal area. The initiation, duration and history of the Bengal crust subduction beneath Burma is still debated. The aim of this paper is to provide a structural and kinematic analysis of the Indo- Burmese wedge in order to better constraints the Bengal crust subduction history beneath Burma. On the basis of field observations, seismic reflection data interpretation and well logs data we present a structural analysis of the Outer Indo-Burmese Wedge. We also constrain the onset of this Outer Wedge to be younger than 2Ma, implying a recent and fast westward growth (~10cm/yr) since Late Pliocene in close relationship with the onset of the Shillong plateau. Restoration process of a synthetic cross section through the Outer Wedge allowed us to estimate the amount of EW shortening accommodated in the Outer Wedge to be 5.1mm/yr since 2Ma. These results combined with previous available GPS data from central Myanmar suggest strain partitioning at wedge scale. The core of the wedge is affected by shear deformation and acts as a buttress for a frontal wedge that accommodates a more compressive strain component. Finally we propose that the main characteristic of the Indo-Burmese wedge growth mechanism is the progressive incorporation of the most internal part of the wedge, formerly affected by transpressive thin-skinned tectonics, to the buttress where they are subsequently affected by shear deformation. The crustal structure boarding the newly formed buttress seems to be guided by the subducting crust fabrics. We are in favour of a very recent (Late Miocene) onset of the present Indian crust subduction beneath Burma coeval with the global plate kinematics reorganisation related to the Indian/Australian plate spliting. This subduction postdates the Indo Burmese range onset that must have started in early Miocene. This range first began to

  10. Conceptual design of heavy ion beam compression using a wedge

    Directory of Open Access Journals (Sweden)

    Jonathan C. Wong


    Full Text Available Heavy ion beams are a useful tool for conducting high energy density physics (HEDP experiments. Target heating can be enhanced by beam compression, because a shorter pulse diminishes hydrodynamic expansion during irradiation. A conceptual design is introduced to compress ∼100  MeV/u to ∼GeV/u heavy ion beams using a wedge. By deflecting the beam with a time-varying field and placing a tailor-made wedge amid its path downstream, each transverse slice passes through matter of different thickness. The resulting energy loss creates a head-to-tail velocity gradient, and the wedge shape can be designed by using stopping power models to give maximum compression at the target. The compression ratio at the target was found to vary linearly with (head-to-tail centroid offset/spot radius at the wedge. The latter should be approximately 10 to attain tenfold compression. The decline in beam quality due to projectile ionization, energy straggling, fragmentation, and scattering is shown to be acceptable for well-chosen wedge materials. A test experiment is proposed to verify the compression scheme and to study the beam-wedge interaction and its associated beam dynamics, which will facilitate further efforts towards a HEDP facility.

  11. Effect of Laterally Wedged Insoles on the External Knee Adduction Moment across Different Reference Frames.

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    Satoshi Yamaguchi

    Full Text Available Biomechanical effects of laterally wedged insoles are assessed by reduction in the knee adduction moment. However, the degree of reduction may vary depending on the reference frame with which it is calculated. The purpose of this study was to clarify the effect of reference frame on the reduction in the knee adduction moment by laterally wedged insoles.Twenty-nine healthy participants performed gait trials with a laterally wedged insole and with a flat insole as a control. The knee adduction moment, including the first and second peaks and the angular impulse, were calculated using four different reference frames: the femoral frame, tibial frame, laboratory frame and the Joint Coordinate System.There were significant effects of reference frame on the knee adduction moment first and second peaks (P < 0.001 for both variables, while the effect was not significant for the angular impulse (P = 0.84. No significant interaction between the gait condition and reference frame was found in either of the knee adduction moment variables (P = 0.99 for all variables, indicating that the effects of laterally wedged insole on the knee adduction moments were similar across the four reference frames. On the other hand, the average percent changes ranged from 9% to 16% for the first peak, from 16% to 18% for the second peak and from 17% to 21% for the angular impulse when using the different reference frames.The effects of laterally wedged insole on the reduction in the knee adduction moment were similar across the reference frames. On the other hand, Researchers need to recognize that when the percent change was used as the parameter of the efficacy of laterally wedged insole, the choice of reference frame may influence the interpretation of how laterally wedged insoles affect the knee adduction moment.

  12. Calculating dose distributions and wedge factors for photon treatment fields with dynamic wedges based on a convolution/superposition method. (United States)

    Liu, H H; McCullough, E C; Mackie, T R


    A convolution/superposition based method was developed to calculate dose distributions and wedge factors in photon treatment fields generated by dynamic wedges. This algorithm used a dual source photon beam model that accounted for both primary photons from the target and secondary photons scattered from the machine head. The segmented treatment tables (STT) were used to calculate realistic photon fluence distributions in the wedged fields. The inclusion of the extra-focal photons resulted in more accurate dose calculation in high dose gradient regions, particularly in the beam penumbra. The wedge factors calculated using the convolution method were also compared to the measured data and showed good agreement within 0.5%. The wedge factor varied significantly with the field width along the moving jaw direction, but not along the static jaw or the depth direction. This variation was found to be determined by the ending position of the moving jaw, or the STT of the dynamic wedge. In conclusion, the convolution method proposed in this work can be used to accurately compute dose for a dynamic or an intensity modulated treatment based on the fluence modulation in the treatment field.

  13. Wedge wetting by electrolyte solutions (United States)

    Mußotter, Maximilian; Bier, Markus


    The wetting of a charged wedgelike wall by an electrolyte solution is investigated by means of classical density functional theory. As in other studies on wedge wetting, this geometry is considered as the most simple deviation from a planar substrate, and it serves as a first step toward more complex confinements of fluids. By focusing on fluids containing ions and surface charges, features of real systems are covered that are not accessible within the vast majority of previous theoretical studies concentrating on simple fluids in contact with uncharged wedges. In particular, the filling transition of charged wedges is necessarily of first order, because wetting transitions of charged substrates are of first order and the barrier in the effective interface potential persists below the wetting transition of a planar wall; hence, critical filling transitions are not expected to occur for ionic systems. The dependence of the critical opening angle on the surface charge, as well as the dependence of the filling height, of the wedge adsorption, and of the line tension on the opening angle and on the surface charge are analyzed in detail.

  14. Triangular metal wedges for subwavelength plasmon-polariton guiding at telecom wavelengths

    DEFF Research Database (Denmark)

    Boltasseva, Alexandra; Volkov, V.S.; Nielsen, Rasmus Bundgaard


    . Using scanning near-field optical imaging at the wavelengths in the range of 1.43 - 1.52 µm, we demonstrate low-loss (propagation length ~ 120 µm) and well-confined (mode width ≅ 1.3 µm) wedge plasmon-polariton guiding along triangular 6-µm-high and 70.5°- angle gold wedges. Experimental observations......We report on subwavelength plasmon-polariton guiding by triangular metal wedges at telecom wavelengths. A high-quality fabrication procedure for making gold wedge waveguides, which is also mass- production compatible offering large-scale parallel fabrication of plasmonic components, is developed...

  15. Ice wedges as climate archives - opportunities and limitations (United States)

    Opel, Thomas; Meyer, Hanno; Dereviagin, Alexander; Wetterich, Sebastian; Schirrmeister, Lutz


    Permafrost regions are assumed to play a major role for Global Climate Change as they are susceptible to recent warming in particular with regard to the potential release of stored fossil carbon. Permafrost serves as archive of past environmental and climate conditions (such as sedimentation processes, temperature and precipitation regimes as well as landscape and ecosystem development) over tens of thousands of years that can be traced by the study of the frozen deposits, paleontological content and ground ice. Ground ice comprises all types of ice contained in frozen ground, including pore ice, segregation ice and ice wedges. Here, we focus on ice wedges as the most promising climate archive that can be studied by stable water isotope methods analogously to glacier ice. They may be identified by their vertically oriented foliations. Ice wedges form by the repeated filling of wintertime thermal contraction cracks by snow melt water in spring. As the melt water quickly refreezes at negative ground temperature no isotopic fractionation takes place. Hence, the isotopic composition (δ18O, δD, d excess) of wedge ice is assumed to be representative of annual cold period climate conditions, i.e. winter and spring. Ice wedges are widely distributed in non-glaciated high northern latitudes, are diagnostic of permafrost and, in general, indicative of cold and stable climate conditions. They are found in continuous and discontinuous permafrost zones and may also have formed during and survived interglacials. They may provide unique paleo information that is not captured by other climate archives. Usually, ice wedges are dated by radiocarbon dating of organic material incorporated in the ice, but also 36Cl/Cl ratios have been successfully used to date ice wedges. Nevertheless reliable age determination is challenging when studying ice wedges. Here we tackle the potential of ice wedges from the Siberian and American Arctic to trace past climate changes from stable isotope

  16. Medial tibial stress syndrome: a critical review. (United States)

    Moen, Maarten H; Tol, Johannes L; Weir, Adam; Steunebrink, Miriam; De Winter, Theodorus C


    Medial tibial stress syndrome (MTSS) is one of the most common leg injuries in athletes and soldiers. The incidence of MTSS is reported as being between 4% and 35% in military personnel and athletes. The name given to this condition refers to pain on the posteromedial tibial border during exercise, with pain on palpation of the tibia over a length of at least 5 cm. Histological studies fail to provide evidence that MTSS is caused by periostitis as a result of traction. It is caused by bony resorption that outpaces bone formation of the tibial cortex. Evidence for this overloaded adaptation of the cortex is found in several studies describing MTSS findings on bone scan, magnetic resonance imaging (MRI), high-resolution computed tomography (CT) scan and dual energy x-ray absorptiometry. The diagnosis is made based on physical examination, although only one study has been conducted on this subject. Additional imaging such as bone, CT and MRI scans has been well studied but is of limited value. The prevalence of abnormal findings in asymptomatic subjects means that results should be interpreted with caution. Excessive pronation of the foot while standing and female sex were found to be intrinsic risk factors in multiple prospective studies. Other intrinsic risk factors found in single prospective studies are higher body mass index, greater internal and external ranges of hip motion, and calf girth. Previous history of MTSS was shown to be an extrinsic risk factor. The treatment of MTSS has been examined in three randomized controlled studies. In these studies rest is equal to any intervention. The use of neoprene or semi-rigid orthotics may help prevent MTSS, as evidenced by two large prospective studies.

  17. Pseudoarthrosis of medial tibial plateau fracture-role of alignment procedure

    Directory of Open Access Journals (Sweden)

    Devgan Ashish


    Full Text Available 【Abstract】 Nonunion in tibial plateau fractures is very rare. Limited literature is available on Pubmed search on intraarticular tibial nonunion. Most of the cases reported have been following failed surgical treatment and none was neglected fractures. Three patients of isolated and neglected medial tibial plateau nonunion with almost similar demo-graphic profile are reported in this paper. All the three pa-tients were managed by minimally invasive compression fixation using lag screws supplemented with limb realign-ment procedure of high tibial osteotomy. We discussed the injury mechanism, management and rehabilitation in such cases and reviewed the available literature regarding such a presentation. Key words: Fracture healing; Tibial fractures; Frac-ture fixation; Osteotomy

  18. Contact process in a wedge

    CERN Document Server

    Cox, J Theodore; Schinazi, Rinaldo B


    We prove that the supercritical one-dimensional contact process survives in certain wedge-like space-time regions, and that when it survives it couples with the unrestricted contact process started from its upper invariant measure. As an application we show that a type of weak coexistence is possible in the nearest-neighbor ``grass-bushes-trees'' successional model introduced in Durrett and Swindle (1991).

  19. Asymmetry in gait pattern following tibial shaft fractures

    DEFF Research Database (Denmark)

    Larsen, Peter; Læssøe, Uffe; Rasmussen, Sten


    INTRODUCTION: Despite the high number of studies evaluating the outcomes following tibial shaft fractures, the literature lacks studies including objective assessment of patients' recovery regarding gait pattern. The purpose of the present study was to evaluate whether gait patterns at 6 and 12 m...

  20. Assessment of computerized treatment planning system accuracy in calculating wedge factors of physical wedged fields for 6 MV photon beams. (United States)

    Muhammad, Wazir; Maqbool, Muhammad; Shahid, Muhammad; Hussain, Amjad; Tahir, Sajjad; Matiullah; Rooh, Gul; Ahmad, Tanveer; Lee, Sang Hoon


    Wedge filters are commonly used in external beam radiotherapy to achieve a uniform dose distribution within the target volume. The main objective of this study was to investigate the accuracy of the beam modifier algorithm of Theraplan plus (TPP version 3.8) treatment planning system and to confirm that either the beam hardening, beam softening and attenuation coefficients along with wedge geometry and measured wedge factor at single depth and multiple fields sizes can be the replacement of wedged profile and wedged cross-sectional data or not. In this regard the effect of beam hardening and beam softening was studied with physical wedges for 6 MV photons. The Normalized Wedge Factors (NWFs) were measured experimentally as well as calculated with the Theraplan plus, as a function of depth and field size in a water phantom for 15°, 30°, 45°, and 60° wedge filters. The beam hardening and softening was determined experimentally by deriving the required coefficients for all wedge angles. The TPP version 3.8 requires wedge transmission factor at single depth and multiple field sizes. Without incorporating the hardening and softening coefficients the percent difference between measured and calculated NFWs was as high as 7%. After the introduction of these parameters into the algorithm, the agreement between measured and TPP (V 3.8) calculated NWFs were improved to within 2 percent for various depths. Similar improvement was observed in TPP version 3.8 while calculating NWFs for various field sizes when the required coefficients were adjusted. In conclusion, the dose calculation algorithm of TPP version 3.8 showed good accuracy for a 6 MV photon beam provided beam hardening and softening parameters are taken into account. From the results, it is also concluded that, the beam hardening, beam softening and attenuation coefficients along with wedge geometry and measured wedge factor at single depth and multiple fields sizes can be the replacement of wedged profile and

  1. Casimir effect at nonzero temperature for wedges and cylinders

    CERN Document Server

    Ellingsen, Simen Å; Milton, Kimball A


    We consider the Casimir-Helmholtz free energy at nonzero temperature $T$ for a circular cylinder and perfectly conducting wedge closed by a cylindrical arc, either perfectly conducting or isorefractive. The energy expression at nonzero temperature may be regularized to obtain a finite value, except for a singular corner term in the case of the wedge which is present also at zero temperature. Assuming the medium in the interior of the cylinder or wedge be nondispersive with refractive index $n$, the temperature dependence enters only through the non-dimensional parameter $2\\pi naT$, $a$ being the radius of the cylinder or cylindrical arc. We show explicitly that the known zero temperature result is regained in the limit $aT\\to 0$ and that previously derived high temperature asymptotics for the cylindrical shell are reproduced exactly.

  2. Decollement controls on pro versus retro wedge deformation in mountain belts (United States)

    Grool, Arjan; Huismans, Ritske S.; Ford, Mary


    Doubly vergent orogens have a pro-wedge (lower plate) and a retro-wedge (upper plate). Most shortening is accommodated on the pro-wedge while retro-wedge shortening is typically limited. For example, the Eastern Pyrenees have experienced about 145 km of convergence, of which about 125 km (86%) was accommodated in the pro-wedge and about 20 km (14%) in the retro-wedge. Strain partitioning between pro- and retro-wedge is influenced by several factors, some of which have been identified in past work: Extensional inheritance and syn-orogenic sedimentation can help to increase the percentage of total shortening accommodated in the retro-wedge while erosion promotes pro-wedge shortening. We use high-resolution 2D numerical models to investigate factors that control pro- versus retro-wedge shortening. For a total convergence similar to the Eastern Pyrenees, our models predict that variations in extensional inheritance and syn-orogenic sedimentation will result in a maximum of 10% of total shortening being accommodated in the retro-wedge. Here, we investigate the role of 1) the rheology and 2) distribution of a decollement layer. Our models show that: 1) Decollement rheology has a first order control on strain distribution between the pro- and the retro-wedge. After 145 km of total convergence, a model with a weak frictional (φ=2, shale-like) decollement will only accommodate 9% of total shortening in the retro-wedge. In contrast in models with a weak viscous (μ=1018, salt-like) decollement retro-wedge shortening amounts to 18% and a stronger, but still weak, viscous decollement (μ=1019) leads to 21%. 2) Décollement distribution influences the timing of the first outward propagation of thick-skinned deformation in the retro-wedge. In the Eastern Pyrenees, thick-skinned deformation propagated out into the retro-wedge within 145 km of total convergence. In models with a decollement on both sides of the orogen this only occurred after 240 km. If, as in the Eastern

  3. MR imaging findings of medial tibial crest friction

    Energy Technology Data Exchange (ETDEWEB)

    Klontzas, Michail E., E-mail:; Akoumianakis, Ioannis D., E-mail:; Vagios, Ilias, E-mail:; Karantanas, Apostolos H., E-mail:


    Objective: Medial tibial condyle bone marrow edema (BME), associated with soft tissue edema (STe) surrounding the medial collateral ligament, was incidentally observed in MRI examinations of young and athletic individuals. The aim of the present study was to 1. Prospectively investigate the association between these findings and coexistence of localized pain, and 2. Explore the possible contribution of the tibial morphology to its pathogenesis. Methods: The medial tibial condyle crest was evaluated in 632 knee MRI examinations. The angle and depth were measured by two separate evaluators. The presence of STe and BME was recorded. A third evaluator blindly assessed the presence of pain at this site. Results: BME associated with STe was found in 24 patients (with no history of previous trauma, osteoarthritis, tumor or pes anserine bursitis). The mean crest angle was 151.3° (95%CI 147.4–155.3°) compared to 159.4° (95%CI 158.8–160°) in controls (Mann–Whitney test, P < 0.0001). MRI findings were highly predictive of localized pain (sensitivity 92% specificity 99%, Fisher's exact test, P < 0.0001). Conclusion: Friction at the medial tibial condyle crest is a painful syndrome. MRI is a highly specific and sensitive imaging modality for its diagnosis.

  4. Characterization of InGaAs and InAlAs layers on InP by four-crystal high resolution X-ray diffraction and wedge transmission electron microscopy

    Energy Technology Data Exchange (ETDEWEB)

    Houdre, R.; Gueissaz, F.; Gailhanou, M.; Ganiere, J.D.; Rudra, A.; Ilegems, M. (Inst. de Micro- et Optoelectronique, Ecole Polytechnique Federale de Lausanne (Switzerland))


    The indium desorption rates from InGaAs and InAlAs grown on InP substrates have been measured by wedge transmission electron microscopy as a function of the growth temperature. Desorption becomes significant at 545degC for both materials. No automatching effects could be observed under the growth conditions of the experiment. The bandgap of In{sub y}Al{sub 1-y}As has been measured at 77 K as a function of the indium content. The composition and the strain have been measured by four-crystal high resolution X-ray diffraction with symmetrical (004) and assymmetrical (115{+-}) Bragg reflections. The intrinsic bandgap follows the relation E{sub g}(y)=2.774-2.411y and the strained material the relation E{sub gs}(y)=0.671+5.236y-6.929y{sup 2}. (orig.).

  5. Contact Stress Generation on the UHMWPE Tibial Insert

    Directory of Open Access Journals (Sweden)

    S. Petrović Savić


    Full Text Available Total knee replacement (TKR is considered, during last years, as a very successful surgical technique for removing knee joint deformities and eliminating pain caused by cartilage damage. In literature, as primary causes for knee joint endoprothesis damage are cited complex movements which cause occurrences of complex stress conditions, sagital radius conformity, sliding, types of materials etc. Aim of this study is analysis of contact stresses that occur on tibial implant for 15°, 45° and 60° knee flexion and 50 kg, 75 kg, 100 kg and 125 kg weight. Knee joint prosthesis model and finite elements method (FEM analysis are done in software Catia V5. For this analysis we used ultra-high molecular weight polyethylene (UHMWPE for tibial implant material and AISI 316, AISI 317, AISI 321, 17-4PH, CoCrMo, Ti6Al4V and SAE A-286 for femoral component materials. Results show that area of maximal contact stress is identified in medial and lateral part of tibial implant. Von Mises stress values vary regarding of flexion degree and weight, but values are approximate for types of chosen materials. Contact stress location corresponds to damage that occur on tibial implant during exploitation.

  6. Osteotomía tibial valguizante: análisis de supervivencia


    Modrego Aranda, Francisco Javier


    Presentamos un estudio retrospectivo de 38 osteotomías tibiales valguizantes, en 32 pacientes con "genu-varo" artrósico. La supervivencia a los 180 meses fue del 58%. Cuando el paciente presentaba un peso mayor 1,32 veces al peso ideal la supervivencia disminuía al 53%. Y cuando la corrección angular en ángulo femoro-tibial era menor de 6º la supervivencia disminuía al 33% We evaluated the results in thirty-two patients (thirty-eight knees) who had had a high tibial osteotomy for var...

  7. Characterization of CNRS Fizeau wedge laser tuner (United States)

    A fringe detection and measurement system was constructed for use with the CNRS Fizeau wedge laser tuner, consisting of three circuit boards. The first board is a standard Reticon RC-100 B motherboard which is used to provide the timing, video processing, and housekeeping functions required by the Reticon RL-512 G photodiode array used in the system. The sampled and held video signal from the motherboard is processed by a second, custom fabricated circuit board which contains a high speed fringe detection and locating circuit. This board includes a dc level discriminator type fringe detector, a counter circuit to determine fringe center, a pulsed laser triggering circuit, and a control circuit to operate the shutter for the He-Ne reference laser beam. The fringe center information is supplied to the third board, a commercial single board computer, which governs the data collection process and interprets the results.

  8. Avaliação do ângulo de inclinação tibial e altura patelar após osteotomia tibial de abertura medial Assessment of tibial slope angle and patellar height after medial-opening tibial osteotomy

    Directory of Open Access Journals (Sweden)

    Alan de Paula Mozella


    Full Text Available OBJETIVO: Mensurar a variação do ângulo de inclinação tibial posterior e da altura patelar em pacientes submetidos à osteotomia valgizante tibial proximal com técnica de cunha de abertura medial. MÉTODOS: Foram analisadas radiografias panorâmicas de membros inferiores em anteroposterior e perfil do joelho pré e pós-operatórias de 46 pacientes com artrose unicompartimental do joelho, em que se realizou osteotomia tibial. RESULTADOS: Em 23 casos, utilizou-se fixador externo para confecção de cunha de abertura medial gradual e nos outros 23, foi utilizada placa bloqueada com batente como método de fixação. Foram excluídos deste estudo aqueles pacientes com doença tricompartimental do joelho e aqueles submetidos à osteotomias para tratamento de sequelas de fraturas. Após a cirurgia, a inclinação tibial proximal aumentou, em média, 1,7 graus (p OBJECTIVE: To measure the variation in posterior tibial slope angle and patellar height in patients who underwent proximal tibial valgus-producing osteotomy using the medial-opening wedge technique. METHODS: Anteroposterior panoramic radiographs of the lower limbs and lateral radiographs of the knee obtained before and after tibial valgus-producing osteotomy on 46 patients with unicompartmental arthrosis of the knee were analyzed. RESULTS: In 23 patients, an external fixator was used to gradually apply a medial-opening wedge; and in the other 23, a blocked plate with a stop bar was applied as a fixation method. Patients with tricompartmental knee disease and those who underwent osteotomy to treat fracture sequelae were excluded from this study. After surgery, the mean increase in the tibial slope was 1.7 degrees (p < 0.01 in the group in which the blocked plate with a stop bar was used; and 2.7 degrees (p < 0.05 in the group in which the external fixator was used. There was no statistical difference between the groups regarding the increase in the posterior tibial slope. CONCLUSION: The

  9. Tibial slope correction combined with second revision ACL produces good knee stability and prevents graft rupture. (United States)

    Dejour, David; Saffarini, Mo; Demey, Guillaume; Baverel, Laurent


    Revision ACL reconstruction requires careful analysis of failure causes particularly in cases of two previous graft ruptures. Intrinsic factors as excessive tibial slope or narrow femoral notch increase failure risks but are rarely addressed in revision surgery. The authors report outcomes, at minimum follow-up of 2 years, for second revision ACL reconstructions combined with tibial deflexion osteotomy for correction of excessive slope (>12°). Nine patients that underwent second revision ACL reconstruction combined with tibial deflexion osteotomy were retrospectively studied. The mean age was 30.3 ± 4.4 years (median 28; range 26-37), and mean follow-up was 4.0 ± 2.0 years (median 3.6; range 2.0-7.6). Autografts were harvested from the quadriceps tendon (n = 8) or hamstrings (n = 1), and tibial osteotomy was done by anterior closing wedge, without detachment of the patellar tendon, to obtain a slope of 3° to 5°. All patients had fused osteotomies, stable knees, and there were no intraoperative or postoperative complications. The mean posterior tibial slope decreased from 13.2° ± 2.6° (median 13°; range 12°-18°) preoperatively to 4.4° ± 2.3° (median 4°; range 2°-8°) postoperatively. The mean Lysholm score was 73.8 ± 5.8 (median 74; range 65-82), and the IKDC-SKF was 71.6 ± 6.1 (median 72.8; range 62.2-78.5). The satisfactory results of second revision ACL reconstruction combined with tibial deflexion osteotomy at minimum follow-up of 2 years suggest that tibia slope correction protects reconstructed ACL from fatigue failure in this study. The authors stress the importance of careful analysis failure causes prior to revision ACL reconstruction, and recommend correction of tibial slope if it exceeds 12°, to reduce the risks of graft retear. III.

  10. Isolating active orogenic wedge deformation in the southern Subandes of Bolivia (United States)

    Weiss, Jonathan R.; Brooks, Benjamin A.; Foster, James H.; Bevis, Michael; Echalar, Arturo; Caccamise, Dana; Heck, Jacob; Kendrick, Eric; Ahlgren, Kevin; Raleigh, David; Smalley, Robert; Vergani, Gustavo


    A new GPS-derived surface velocity field for the central Andean backarc permits an assessment of orogenic wedge deformation across the southern Subandes of Bolivia, where recent studies suggest that great earthquakes (>Mw 8) are possible. We find that the backarc is not isolated from the main plate boundary seismic cycle. Rather, signals from subduction zone earthquakes contaminate the velocity field at distances greater than 800 km from the Chile trench. Two new wedge-crossing velocity profiles, corrected for seasonal and earthquake affects, reveal distinct regions that reflect (1) locking of the main plate boundary across the high Andes, (2) the location of and loading rate at the back of orogenic wedge, and (3) an east flank velocity gradient indicative of décollement locking beneath the Subandes. Modeling of the Subandean portions of the profiles indicates along-strike variations in the décollement locked width (WL) and wedge loading rate; the northern wedge décollement has a WL of ~100 km while accumulating slip at a rate of ~14 mm/yr, whereas the southern wedge has a WL of ~61 km and a slip rate of ~7 mm/yr. When compared to Quaternary estimates of geologic shortening and evidence for Holocene internal wedge deformation, the new GPS-derived wedge loading rates may indicate that the southern wedge is experiencing a phase of thickening via reactivation of preexisting internal structures. In contrast, we suspect that the northern wedge is undergoing an accretion or widening phase primarily via slip on relatively young thrust-front faults.

  11. Tibial cortical lesions: A multimodality pictorial review

    Energy Technology Data Exchange (ETDEWEB)

    Tyler, P.A., E-mail: [Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP (United Kingdom); Mohaghegh, P., E-mail: [Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP (United Kingdom); Foley, J., E-mail: [Department of Radiology, Glasgow Royal Infirmary, 16 Alexandra Parade, Glasgow G31 2ES (United Kingdom); Isaac, A., E-mail: [Department of Radiology, King' s College Hospital, Denmark Hill, London SE5 9RS (United Kingdom); Zavareh, A., E-mail: [Department of Radiology, North Bristol NHS Trust, Frenchay, Bristol BS16 1LE (United Kingdom); Thorning, C., E-mail: [Department of Radiology, East Surrey Hospital, Canada Avenue, Redhill, Surrey RH1 5RH (United Kingdom); Kirwadi, A., E-mail: [Department of Radiology, Manchester Royal Infirmary, Oxford Road, Manchester M13 9WL (United Kingdom); Pressney, I., E-mail: [Department of Radiology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP (United Kingdom); Amary, F., E-mail: [Department of Histopathology, Royal National Orthopaedic Hospital, Brockley Hill, Stanmore HA7 4LP (United Kingdom); Rajeswaran, G., E-mail: [Department of Radiology, Chelsea and Westminster Hospital, 369 Fulham Road, London SW10 9NH (United Kingdom)


    Highlights: • Multimodality imaging plays an important role in the investigation and diagnosis of shin pain. • We review the multimodality imaging findings of common cortically based tibial lesions. • We also describe the rarer pathologies of tibial cortical lesions. - Abstract: Shin pain is a common complaint, particularly in young and active patients, with a wide range of potential diagnoses and resulting implications. We review the natural history and multimodality imaging findings of the more common causes of cortically-based tibial lesions, as well as the rarer pathologies less frequently encountered in a general radiology department.

  12. Measurement of tibial torsion by computer tomography

    Energy Technology Data Exchange (ETDEWEB)

    Jend, H.H.; Heller, M.; Dallek, M.; Schoettle, H. (Hamburg Univ. (Germany, F.R.))


    A CT procedure for objective measurements of tibial torsion independent of axial rotation in the nearby joints is described. Transverse sections in defined planes of the tibia permit easy calculation of normal and abnormal congenital or posttraumatic angles of torsion. In 69 limbs normal tibial torsion was 40/sup 0/+-9/sup 0/. In a series of 42 limbs with complicated healing of a fracture of both bones of the leg it is shown that tibial maltorsion is a deformity which in most cases leads to arthrosis of the ankle joint.

  13. Distal realignment (tibial tuberosity transfer). (United States)

    Feller, Julian Ashley


    Although tibial tuberosity (TT) transfer has for many years been the basis of many protocols for the management of patellar instability, the role of pure medial transfer in particular appears to be declining. In contrast, the greater recognition of the importance of patella alta as a predisposing factor to recurrent patellar dislocation has resulted in a resurgence in the popularity of distal TT transfer. When TT transfer is performed, the direction and amount of transfer is based on the patellar height and the lateralization of the TT relative to the trochlear groove. Patellar height is best assessed on a lateral radiograph with the knee in flexion using a ratio that uses the articular surface of the patella in relation to the height above the tibia. Assessment of lateralization of the TT relative to the trochlear groove can be made using either computed tomography or magnetic resonance imaging scans.

  14. [Retrograde nailing in a tibial fracture]. (United States)

    Valls-Mellado, M; Martí-Garín, D; Fillat-Gomà, F; Marcano-Fernández, F A; González-Vargas, J A


    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.

  15. Incidence and epidemiology of tibial shaft fractures

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsøe, Rasmus; Hansen, Sandra Hope


    Introduction: The literature lacks recent population-based epidemiology studies of the incidence, trauma mechanism and fracture classification of tibial shaft fractures. The purpose of this study was to provide up-to-date information on the incidence of tibial shaft fractures in a large...... and complete population and report the distribution of fracture classification, trauma mechanism and patient baseline demographics. Methods: Retrospective reviews of clinical and radiological records. Results: A total of 196 patients were treated for 198 tibial shaft fractures in the years 2009 and 2010....... The mean age at time of fracture was 38.5 (21.2SD) years. The incidence of tibial shaft fracture was 16.9/100,000/year. Males have the highest incidence of 21.5/100,000/year and present with the highest frequency between the age of 10 and 20, whereas women have a frequency of 12.3/100,000/year and have...

  16. Optical dating of relict sand wedges and composite-wedge pseudomorphs in Flanders, Belgium

    DEFF Research Database (Denmark)

    Buylaert, Jan-Pieter; Ghysels, Günther; Murray, Andrew S.;


    We report on quartz Optically Stimulated Luminescence (OSL) dating of the infill of 14 relict sand wedges and composite-wedge pseudomorphs at 5 different sites in Flanders, Belgium. A laboratory dose recovery test indicates that the single-aliquot regenerative-dose (SAR) procedure is suitable...... appear to have been commonplace in Flanders during the Late Pleniglacial (Oxygen Isotope Stage 2; OIS2); more specifically, around the Last Glacial Maximum (LGM, similar to 21 kyr ago) and the transition period between the LGM and the start of the Lateglacial (similar to 15 kyr ago). Optical dating...... at one site has revealed two significantly older wedge levels, the younger inset into the older; the younger wedge has an age of 36 +/- 4 kyr (Middle Pleniglacial; OIS3), the older wedge 129 +/- 11 kyr, which points to formation during the Late Saalian (OIS6). Our OSL ages of the wedges and host...

  17. Open tibial shaft fractures: II. Definitive management and limb salvage. (United States)

    Melvin, J Stuart; Dombroski, Derek G; Torbert, Jesse T; Kovach, Stephen J; Esterhai, John L; Mehta, Samir


    Definitive treatment of open fractures of the tibial diaphysis is challenging. The high-energy nature of these fractures, as well as the contamination of the fracture site and devitalization of the soft-tissue envelope, greatly increases the risk of infection, nonunion, and wound complications. The goals of definitive treatment include wound coverage or closure; prevention of infection; restoration of length, alignment, rotation, and stability; fracture healing; and return of function. Advances in orthobiologics, modern plastic surgical techniques, and fracture stabilization methods, most notably locked intramedullary nailing, have led to improved prognosis for functional recovery and limb salvage. Despite improved union and limb salvage rates, the prognosis for severe type III open fracture of the tibial shaft remains guarded, and outcomes are often determined by patient psychosocial variables.

  18. Asymmetry in gait pattern following tibial shaft fractures

    DEFF Research Database (Denmark)

    Larsen, Peter; Læssøe, Uffe; Rasmussen, Sten


    INTRODUCTION: Despite the high number of studies evaluating the outcomes following tibial shaft fractures, the literature lacks studies including objective assessment of patients' recovery regarding gait pattern. The purpose of the present study was to evaluate whether gait patterns at 6 and 12...... months post-operatively following intramedullary nailing of a tibial shaft fracture are different compared with a healthy reference population. PATIENTS AND METHODS: The study design was a prospective cohort study. The primary outcome measurement was the gait patterns at 6 and 12 months post...... fracture, gait asymmetry accompanied with slower speed and cadence are common during the first 6 months and become normalized compared with a healthy reference population between 6 and 12 months post-operatively....

  19. Gait characteristics and quality of life perception of patients following tibial plateau fracture. (United States)

    Warschawski, Yaniv; Elbaz, Avi; Segal, Ganit; Norman, Doron; Haim, Amir; Jacov, Elis; Grundshtein, Alon; Steinberg, Ely


    The purpose of the current study was to evaluate the long-term functional outcome as measured by gait patterns and quality of life assessment of patients with high-energy tibial plateau fracture compared to matched controls. Thirty-eight patients were evaluated in a case-controlled comparison. Twenty-two patients with tibial plateau fracture were evaluated after 3.1 (1.63) years (sd) from injury. Patients underwent a computerized spatiotemporal gait test and completed the SF-12 health survey. 16 healthy subjects, matched for age and gender served as a control group. The main outcome measures for this study were spatiotemporal gait characteristics, physical quality of life and mental quality of life. Significant differences were found in all gait parameters between patients with tibial plateau fracture and healthy controls. Patients with tibial plateau fracture walked slower by 18% compared to the control group (p life exist in patients following tibial plateau fracture. Patients following tibial plateau fracture present altered spatiotemporal gait patterns compared to healthy controls, as well as self-reported quality of life.

  20. Irritation induced bladder overactivity is suppressed by tibial nerve stimulation in cats. (United States)

    Tai, Changfeng; Chen, Mang; Shen, Bing; Wang, Jicheng; Roppolo, James R; de Groat, William C


    We investigated the effects of tibial nerve stimulation on bladder overactivity induced by acetic acid irritation. Cystometry was performed in 10 α-chloralose anesthetized female cats by infusing saline or acetic acid through a urethral catheter that was secured by a ligature around the urethra. Intravesical infusion of 0.25% acetic acid was used to irritate the bladder and induce bladder overactivity. Multiple cystometrograms were done before, during and after tibial nerve stimulation to determine the inhibitory effect on the micturition reflex. Infusion of 0.25% acetic acid irritated the bladder, induced bladder overactivity and significantly decreased bladder capacity to about 20% of control capacity measured during saline infusion. Tibial nerve stimulation at low (5 Hz) or high (30 Hz) frequency significantly increased bladder capacity to about 40% of saline control capacity when it was applied during acetic acid infusion cystometrogram. Bladder contraction amplitude was smaller during acetic acid irritation than during saline distention due to significantly smaller bladder capacity. Tibial nerve stimulation at 5 Hz increased bladder capacity and bladder contraction amplitude. Activation of somatic afferents in the tibial nerve of cats can partially reverse the bladder overactivity induced by intravesical administration of a chemical irritant that activates C-fiber afferent nerves. These data are consistent with clinical studies showing that tibial nerve neuromodulation is effective treatment for overactive bladder symptoms. Copyright © 2011 American Urological Association Education and Research, Inc. Published by Elsevier Inc. All rights reserved.

  1. Use of Wedge Absorbers in MICE

    Energy Technology Data Exchange (ETDEWEB)

    Neuffer, D. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); Summers, D. [Univ. of Mississippi, Oxford, MS (United States); Mohayai, T. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); IIT, Chicago, IL (United States); Snopok, P. [Fermi National Accelerator Lab. (FNAL), Batavia, IL (United States); IIT, Chicago, IL (United States); Rogers, C. [Science and Technology Facilities Council (STFC), Oxford (United Kingdom). Rutherford Appleton Lab. (RAL)


    Wedge absorbers are needed to obtain longitudinal cooling in ionization cooling. They also can be used to obtain emittance exchanges between longitudinal and transverse phase space. There can be large exchanges in emittance, even with single wedges. In the present note we explore the use of wedge absorbers in the MICE experiment to obtain transverse–longitudinal emittance exchanges within present and future operational conditions. The same wedge can be used to explore “direct” and “reverse” emittance exchange dynamics, where direct indicates a configuration that reduces momentum spread and reverse is a configuration that increases momentum spread. Analytical estimated and ICOOL and G4BeamLine simulations of the exchanges at MICE parameters are presented. Large exchanges can be obtained in both reverse and direct configurations.

  2. Benchmarking numerical models of brittle thrust wedges

    NARCIS (Netherlands)

    Buiter, Susanne J H; Schreurs, Guido; Albertz, Markus; Gerya, Taras V.; Kaus, Boris; Landry, Walter; le Pourhiet, Laetitia; Mishin, Yury; Egholm, David L.; Cooke, Michele; Maillot, Bertrand; Thieulot, Cedric|info:eu-repo/dai/nl/270177493; Crook, Tony; May, Dave; Souloumiac, Pauline; Beaumont, Christopher


    We report quantitative results from three brittle thrust wedge experiments, comparing numerical results directly with each other and with corresponding analogue results. We first test whether the participating codes reproduce predictions from analytical critical taper theory. Eleven codes pass the

  3. Verification of Varian Enhanced Dynamic Wedge implementation in masterplan treatment planning system. (United States)

    Pasquino, Massimo; Casanova Borca, Valeria; Tofani, Santi; Ozzello, Franca


    This paper investigates the accuracy of the two available calculation algorithms of the Oncentra MasterPlan three-dimensional treatment planning system (TPS)-- the pencil beam method and collapsed-cone convolution--in modeling the Varian enhanced dynamic wedge (EDW). Measurements were carried out for a dual high energy (6-15 MV) Varian DHX-S linear accelerator using ionization chambers for beam axis measurements (wedge factors and depth doses), film dosimetry for off-axis dose profiles measurements, and a diode matrix detector for two dimensional absolute dose distributions. Using both calculation algorithms, different configuration of symmetric and asymmetric fields varying the wedge's angle were tested. Accuracy of the treatment planning system was evaluated in terms of percentage differences between measured and calculated values for wedge factors, depth doses, and profiles. As far as the absolute dose distribution was concerned, the gamma index method (Low et al.) was used with 3% and 3 mm as acceptance criteria for dose difference and distance-to-agreement, respectively. Wedge factors and percentage depth doses were within 1% deviation between calculated and measured values. The comparison of measured and calculated dose profiles shows that the Van Dyk's acceptance criteria (Van Dyk et al.) are generally met; a disagreement can be noted for large wedge angles and field size limited to the low dose-low gradient region only. The 2D absolute dose distribution analysis confirms the good accuracy of the two calculation algorithms in modeling the enhanced dynamic wedge.

  4. Spatial and temporal distribution of deformation at the front of the Andean orogenic wedge in Bolivia and implications for incremental wedge evolution (United States)

    Weiss, J. R.; Brooks, B. A.; Vergani, G.; Arrowsmith, R.


    There is no consensus regarding how orogenic wedges accommodate deformation over seismo-tectonic timescales. Results from the Himalaya and Taiwan suggest differing mechanisms including localized deformation along a single wedge-front structure and distributed shortening across multiple structures respectively. Here we provide the first detailed constraints on the distribution and timing of deformation at the front of the Andean orogenic wedge using industry acquired seismic reflection data from the ~500-km-long thin-skinned fold-and-thrust belt of the Bolivian Subandes (BSA). Almost no information exists on the recent history of BSA wedge-front deformation despite the presence of multiple ~10-m-high topographic scarps on Holocene surfaces and a recent analysis of the GPS-derived velocity field, which suggests the frontal Mandeyapecua thrust fault system (MTFS) is capable of >Mw 8 earthquakes. We use stratigraphic relationships across fault-related folds to depict the onset of deformation for the complete suite of structures comprising the MTFS. For each structure we determine the uncertainty in timing using an envelope of seismic velocity models from ~70 well-logs and published Quaternary sedimentation rates for the region. We further explore fault geometry and fault slip parameters associated with the displacement field of seismic reflection horizons using elastic dislocation theory. Our analyses reveal the presence of at least eight distinct fault segments comprising the MTFS, including previously unrecognized subsurface thrust faults that have been active since ~1 Ma. Shortening rates are generally higher across the younger, northern portion of the fault system but across-strike, in a ~50-km-wide zone from west to east, no distinct pattern of deformation migration exists. We estimate the percentage of whole-wedge deformation accommodated by wedge-front structures using our new fault slip rates combined with the wedge-loading rate of ~10 mm/yr and place our

  5. A specially curved wedge for eliminating wedge angle effect in unsteady shock reflection (United States)

    Wang, He; Zhai, Zhigang; Luo, Xisheng; Yang, Jiming; Lu, Xiyun


    A curved wedge with a specific shape is designed and manufactured to guarantee the wedge angle unvaried during the cylindrically converging shock moving along the wedge. Thus the variation of the wedge angle caused by the wedge will be eliminated in unsteady shock reflection. Different initial wedge angles are considered to observe regular reflection and Mach reflection. When Mach reflection occurs, it is found that direct Mach reflection is persisted over the wedge without wave pattern transitions, which differs from our previous work with varied wedge angles [Zhang et al. "Reflection of cylindrical converging shock wave over a plane wedge," Phys. Fluids 28, 086101 (2016)]. Moreover, the Mach stem is nearly straight when the wedge angle is relatively large, and the trajectory of triple point can be well predicted by three-shock theory. It is believed that the straight Mach stem results from the coupling effect of the converging shock and the convexly curved wedge, which exert opposite effects on the Mach stem curvature. As the wedge angle reduces, the three-shock theory prediction deviates from the present results owing to the curved Mach stem. Stronger vortices are produced near the wall, which are caused by the interaction of two shear layers, and whether the stronger vortices will be generated near the wall depends on the reflection number of the shock wave over the tube wall and wedge. The length of disturbed shock front in the Mach reflection is found to increase nonlinearly due to the unsteady feature of the flow. The growth rate of length reduces as the shock converges because of the geometrical contraction effect. Further the lengths of the Mach stem and the disturbed shock front are compared, and the results show that although the difference exists between them, both of them show a similar variation tendency. Compared with our previous work with varied wedge angles, the variation of the wedge angle has great effects on the Mach stem length and wave

  6. Mantle wedge dynamics from seismic anisotropy (Invited) (United States)

    Long, M. D.; Wirth, E. A.


    The mantle wedge above subducting slabs plays a critical role in many of the physical processes associated with subduction, including water transport into the upper mantle and the generation and transport of melts. Our understanding of mantle wedge dynamics is incomplete; in particular, the mantle flow field above subducting slabs remains poorly understood. Because seismic anisotropy is a consequence of deformation, observations of anisotropy (such as shear wave splitting and P-to-SH converted waves) can constrain the geometry of the wedge flow field. Additionally, because the presence of water (either in nominally anhydrous minerals or as hydrous phases) can have a large effect on anisotropic structure, a detailed understanding of mantle wedge anisotropy can help to constrain processes related to water cycling in subduction systems. We present a global, synoptic view of anisotropy observations in subduction zone mantle wedges, compiled from a large number of individual studies, with the goal of understanding the first-order controls on wedge anisotropy and flow patterns. This compilation allows us to explicitly test the predictions made by many different conceptual models for wedge anisotropy, as well as to explore the relationships between observed anisotropy parameters and other parameters that describe subduction. We find that no simple model can explain all of the trends observed in the global data set. Mantle wedge flow is likely controlled by a combination of downdip motion of the slab, trench migration, ambient mantle flow, small-scale convection, proximity to slab edges, and slab morphology, with the relative contributions of these in any given subduction system controlled by the subduction kinematics and mantle rheology. There is also a likely contribution from B-type olivine and/or serpentinite fabric in many subduction zones, governed by the local thermal structure and volatile distribution.

  7. Long-range hybrid wedge plasmonic waveguide. (United States)

    Zhang, Zhonglai; Wang, Jian


    We design a novel long-range hybrid wedge plasmonic (LRHWP) waveguide composed of two identical dielectric nanowires symmetrically placed on two opposed wedges of a diamond shaped metal wire. With strong coupling between the dielectric nanowire mode and long-range surface plasmon polariton (SPP) mode, both deep subwavelength mode confinement and low propagation loss are achieved. On one hand, when compared to the previous long-range hybrid SPP waveguide, LRHWP waveguide can achieve smaller mode size with similar propagation length; on the other hand, when compared to the previous hybrid wedge SPP waveguide, LRHWP waveguide can provide an order of magnitude longer propagation length with similar level of mode confinement. The designed LRHWP waveguide also features an overall advantage of one-order improvement of Figure of Merit. We further evaluate in detail the impacts of possible practical fabrication imperfections on the mode properties. The obtained results of mode properties show that the proposed LRHWP waveguide with an optimized wedge tip angle of 140 degree is fairly tolerant to practical fabrication errors in geometry parameters such as misalignment in the horizontal direction, asymmetry in the vertical direction, variation of wedge tip angle, tilt or rotation of metal wire, and variation of wedge tip curvature radius.

  8. Studying wedge factors and beam profiles for physical and enhanced dynamic wedges

    Directory of Open Access Journals (Sweden)

    Ahmad Misbah


    Full Text Available This study was designed to investigate variation in Varian′s Physical and Enhanced Dynamic Wedge Factors (WF as a function of depth and field size. The profiles for physical wedges (PWs and enhanced dynamic wedges (EDWs were also measured using LDA-99 array and compared for confirmation of EDW angles at different depths and field sizes. WF measurements were performed in water phantom using cylindrical 0.66 cc ionization chamber. WF was measured by taking the ratio of wedge and open field ionization data. A normalized wedge factor (NWF was introduced to circumvent large differences between wedge factors for different wedge angles. A strong linear dependence of PW Factor (PWF with depth was observed. Maximum variation of 8.9% and 4.1% was observed for 60° PW with depth at 6 and 15 MV beams respectively. The variation in EDW Factor (EDWF with depth was almost negligible and less than two per cent. The highest variation in PWF as a function of field size was 4.1% and 3.4% for thicker wedge (60° at 6 and 15 MV beams respectively and decreases with decreasing wedge angle. EDWF shows strong field size dependence and significant variation was observed for all wedges at both photon energies. Differences in profiles between PW and EDW were observed on toe and heel sides. These differences were dominant for larger fields, shallow depths, thicker wedges and low energy beam. The study indicated that ignoring depth and field size dependence of WF may result in under/over dose to the patient especially doing manual point dose calculation.

  9. Epidemiology of tibial shaft fractures

    Directory of Open Access Journals (Sweden)

    Grecco Marco Aurélio Sertório


    Full Text Available In this work an epidemiological analysis on tibial shaft fractures was performed. During four years, our service treated 179 fractures, 132 in male, 47 in female, aged 14 to 83 years. The 21 to 30-year-old patiens were the more injured. Of these, 120 were open and 59 close fractures of which prevailing cause was road traffic accident. The study based on patients promptuaries analyses and radiographs. The fractures occurred 97 times in the middle third (54.18%; 102 times (56.98% presented simple fragments, and 57 (31.38% oblique lines. We treated close and open fractures, respectively, 48 and 38 cases with plaster cast immobilization; 3 and 67 with external fixation after plaster cast immobilization; 5 and 12 with osteosynthesis by means of plate and screws, and 2 and 3 with external fixation only. In both close and open fractures, respectively, 7 and 20 cases of pseudarthrosis and 1 and 11 of infections have occurred. With the data obtained we verified an actual validity of the epidemiological studies as a contribution for better identifying lesions features and their treatment and complications. This allows proceedings and apprenticeship refinement.

  10. Osteotomy of the knee (United States)

    Proximal tibial osteotomy; Lateral closing wedge osteotomy; High tibial osteotomy; Distal femoral osteotomy ... There are two types of surgery: Tibial osteotomy is surgery done on ... osteotomy is surgery done on the thigh bone above the knee ...

  11. Mantle wedge serpentinization effects on slab dips

    Directory of Open Access Journals (Sweden)

    Eh Tan


    Full Text Available The mechanical coupling between a subducting slab and the overlying mantle wedge is an important factor in controlling the subduction dip angle and the flow in mantel wedge. This paper investigates the role of the amount of mantle serpentinization on the subduction zone evolution. With numerical thermos-mechanical models with elasto-visco-plastic rheology, we vary the thickness and depth extent of mantle serpentinization in the mantle wedge to control the degree of coupling between the slab and mantle wedge. A thin serpentinized mantle layer is required for stable subduction. For models with stable subduction, we find that the slab dip is affected by the down-dip extent and the mantle serpentinization thickness. A critical down-dip extent exists in mantle serpentinization, determined by the thickness of the overriding lithosphere. If the down-dip extent does not exceed the critical depth, the slab is partially coupled to the overriding lithosphere and has a constant dip angle regardless of the mantle serpentinization thickness. However, if the down-dip extent exceeds the critical depth, the slab and the base of the overriding lithosphere would be separated and decoupled by a thick layer of serpentinized peridotite. This allows further slab bending and results in steeper slab dip. Increasing mantle serpentinization thickness will also result in larger slab dip. We also find that with weak mantle wedge, there is no material flowing from the asthenosphere into the serpentinized mantle wedge. All of these results indicate that serpentinization is an important ingredient when studying the subduction dynamics in the mantle wedge.

  12. Direct FVM Simulation for Sound Propagation in an Ideal Wedge

    Directory of Open Access Journals (Sweden)

    Hongyu Ji


    Full Text Available The sound propagation in a wedge-shaped waveguide with perfectly reflecting boundaries is one of the few range-dependent problems with an analytical solution. This provides a benchmark for the theoretical and computational studies on the simulation of ocean acoustic applications. We present a direct finite volume method (FVM simulation for the ideal wedge problem, and both time and frequency domain results are analyzed. We also study the broadband problem with large-scale parallel simulations. The results presented in this paper validate the accuracy of the numerical techniques and show that the direct FVM simulation could be applied to large-scale complex acoustic applications with a high performance computing platform.

  13. Opening- and Closing-Wedge Distal Femoral Osteotomy (United States)

    Chahla, Jorge; Mitchell, Justin J.; Liechti, Daniel J.; Moatshe, Gilbert; Menge, Travis J.; Dean, Chase S.; LaPrade, Robert F.


    Background: Lateral compartment osteoarthritis of the knee can be a challenging pathology in the younger, active population due to limited treatment options and high patient expectations. Distal femoral osteotomy (DFO) has been reported to be a potential treatment option. Purpose: To perform a systematic review on the survival, outcomes, and complications of DFO for treatment of genu valgum with concomitant lateral compartment osteoarthritis of the knee. Study Design: Systematic review; Level of evidence, 4. Methods: A systematic review of the literature was performed using the Cochrane Database of Systematic Reviews, the Cochrane Central Registry of Controlled Trials, PubMed, and MEDLINE from 1980 to present. Inclusion criteria were as follows: outcomes of opening- and closing-wedge DFOs performed for treatment of genu valgum with concomitant lateral compartment osteoarthritis of the knee, English language, minimum 2-year follow-up, and human studies. Data abstracted from the selected studies included type of osteotomy (opening vs closing), survival rate, patient-reported and radiographic outcomes, and complications. Results: Fourteen studies met the inclusion criteria and were considered for the review. A total of 9 closing-wedge and 5 opening-wedge DFO studies were included. All were retrospective studies and reported good to excellent patient-reported outcomes after DFO. Survival decreased with increasing time from surgery, with 1 study reporting a 100% survival rate at 6.5 years, compared with 21.5% at 20 years in another study. A low rate of complications was reported throughout the review. Conclusion: Highly heterogeneous literature exists for both opening- and closing-wedge DFOs for the treatment of isolated lateral compartment osteoarthritis with valgus malalignment. A mean survival rate of 80% at 10-year follow-up was reported, supporting that this procedure can be a viable treatment option to delay or reduce the need for joint arthroplasty. A low

  14. Long polymers near wedges and cones (United States)

    Hammer, Yosi; Kantor, Yacov


    We perform a Monte Carlo study of N -step self-avoiding walks, attached to the corner of an impenetrable wedge in two dimensions (d =2 ), or the tip of an impenetrable cone in d =3 , of sizes ranging up to N =106 steps. We find that the critical exponent γα, which determines the dependence of the number of available conformations on N for a cone or wedge with opening angle α , is in good agreement with the theory for d =2 . We study the end-point distribution of the walks in the allowed space and find similarities to the known behavior of random walks (ideal polymers) in the same geometry. For example, the ratio between the mean square end-to-end distances of a polymer near the cone or wedge and a polymer in free space depends linearly on γα, as is known for ideal polymers. We show that the end-point distribution of polymers attached to a wedge does not separate into a product of angular and radial functions, as it does for ideal polymers in the same geometry. The angular dependence of the end position of polymers near the wedge differs from theoretical predictions.

  15. Commissioning, clinical implementation and quality assurance of Siemen's Virtual Wedge. (United States)

    Rathee, S; Kwok, C B; MacGillivray, C; Mirzaei, M


    This report presents the results of commissioning, clinical implementation and quality assurance of Siemens Virtual Wedge. Our measurements show that: (1) wedge factors are within 2% of unity, (2) percentage depth doses are within 1% of open beam data, and (3) wedged beam profiles can be modeled similarly to a physical wedge and follow a well defined equation to facilitate modeling of an arbitrary wedge angle. The gantry angle dependence of wedge profiles is similar to open beam profiles. The output of wedged fields is linear with delivered monitor units within 1%. Quality assurance results indicate the wedge profiles are very stable over time. Day to day variations of two points measured along the wedge gradient direction are within 1.5%.

  16. The Effect of Patient-Specific Instrumentation Incorporating an Extramedullary Tibial Guide on Operative Efficiency for Total Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Oh-Ryong Kwon


    Full Text Available This retrospective study was to determine if patient-specific instrumentation (PSI for total knee arthroplasty (TKA leads to shortened surgical time through increased operating room efficiency according to different tibial PSI designs. 166 patients underwent primary TKA and were categorized into three groups as follows: PSI without extramedullary (EM tibial guide (group 1, n=48, PSI with EM tibial guide (group 2, n=68, and conventional instrumentation (CI group (group 3, n=50. Four factors were compared between groups, namely, operative room time, thickness of bone resection, tibial slope, and rotation of the component. The mean surgical time was significantly shorter in the PSI with EM tibial guide group (group 2, 63.9±13.6 min compared to the CI group (group 3, 82.8±24.9 min (P<0.001. However, there was no significant difference in the PSI without EM tibial guide group (group 1, 75.3±18.8 min. This study suggests that PSI incorporating an EM tibial guide may lead to high operative efficiency in TKA compared to CI. This trial is registered with KCT0002384.

  17. 胫骨高位截骨治疗膝内侧间室严重骨性关节炎%High Tibial Osteotomy for Medial Compartment Serious Osteoarthritis of the Knee

    Institute of Scientific and Technical Information of China (English)

    牛东生; 马宁; 杨景科


    目的:应用胫骨高位截骨术治疗膝内侧间室严重性关节炎并膝内翻畸形以缓解或消除关节疼痛,矫正畸形,恢复关节正常的生物力线排列。方法:自1992年5月~1998年2月应用胫骨高位截骨共施行手术18例(21膝),要求术前按适应证严格筛选病人,计算截骨角度。结果:本组病人平均随访3.2年,按Coventry疗效评定,优10例,良7例,可3例,差1例。结论:此手术可恢复内侧间室关节间隙及下肢正常生物力线,有利于退变软骨的恢复,疗效满意。%Objective: High tibial osteotomy treated medial compartment serious osteoarthritis of the knee with varus deformity,and relieving arthritic pain,correcting deformity and normal femoraltibial axial alignment.Methods:From May 1992 to February 1998,18 cases(21 knees) were operated on,We chose fit patients and planed osteotomy angle.Results:All cases were followed up for an average 3.2 years,according to Coventry's rating system,81% of the whole series had a good or excellent results.Conclusion:It increases the medial joint space width and corrects femoraltibial axial alignment,allows for healing of the articular cartilage.Satisfactory results were obtained.

  18. Long range hybrid tube-wedge plasmonic waveguide with extreme light confinement and good fabrication error tolerance. (United States)

    Ding, Li; Qin, Jin; Xu, Kai; Wang, Liang


    We studied a novel long range hybrid tube-wedge plasmonic (LRHTWP) waveguide consisting of a high index dielectric nanotube placed above a triangular metal wedge substrate. Using comprehensive numerical simulations on guiding properties of the designed waveguide, it is found that extreme light confinement and low propagation loss are obtained due to strong coupling between dielectric nanotube mode and wedge plasmon polariton. Comparing with previous studied hybrid plasmonic waveguides, the LRHTWP waveguide has longer propagation length and tighter mode confinement. In addition, the LRHTWP waveguide is quite tolerant to practical fabrication errors such as variation of the wedge tip angle and the horizontal misalignment between the nanotube and the metal wedge. The proposed LRHTWP waveguide could have many application potentials for various high performance nanophotonic components.

  19. Physeal growth arrest after tibial lengthening in achondroplasia


    Song, Sang-Heon; Agashe, Mandar Vikas; Huh, Young-Jae; Hwang, Soon-Young; Song, Hae-Ryong


    Background and purpose Bilateral tibial lengthening has become one of the standard treatments for upper segment-lower segment disproportion and to improve quality of life in achondroplasia. We determined the effect of tibial lengthening on the tibial physis and compared tibial growth that occurred at the physis with that in non-operated patients with acondroplasia. Methods We performed a retrospective analysis of serial radiographs until skeletal maturity in 23 achondroplasia patients who und...

  20. Arthroscopic treatment of tibial avulsion fracture of posterior cruciate ligament with high-strength suture%关节镜下高强线固定治疗后交叉韧带下止点撕脱骨折

    Institute of Scientific and Technical Information of China (English)

    朱伟民; 陆伟; 欧阳侃; 彭亮权; 柳海峰; 孙其凤; 冯文哲; 李皓; 王大平


    目的 介绍全关节镜下高强度线捆绑固定治疗后交叉韧带(PCL)下止点撕脱骨折的手术方法和临床效果.方法 关节镜下常规探查后,通过后内、后外入路将骨块修整、新鲜化后,采用PCL重建导向器引导并由关节外向关节内骨折块边缘钻孔制备两个骨道,引入高强度线,环线PCL打结后,从骨道引到前方,于胫骨前方皮下打结固定.术后在支具保护4~6周后开始康复训练.结果 2010年1月至2012年6月,采用此方法治疗PCL下止点撕脱骨折18例,结果显示骨折解剖复位、愈合良好.术后2例失访,16例得到随访,时间7~30个月(平均13.6个月).术后6周内膝关节屈曲可达90°,术后8周伸屈恢复正常,术后12周行走正常.术后无血管、神经并发症发生,平均3个月骨折愈合.Lysholm评分从术前(38.9±4.9)分增加到(95.2±3.8)分(t=27.3,P<0.001),IKDC评分从术前(57.1±10.3)分增加到(94.3±4.4)分(t=21.8,P<0.001),术后评分与术前比较均有统计学差异.KT3000检测后向位移从术前(3.6±0.39)mm下降到(1.1±0.27)mm,手术前后评分有统计学差异(t=17.5,P<0.001).15例患者均恢复术前运动水平.结论 全关节镜下高强度线捆绑固定手术方法能直接对PCL下止点撕脱骨折复位、硬固定,不需另外切开操作,骨块固定稳固,达到了切开直视下骨折直接复位固定的效果,固定可靠,利于术后早期康复锻炼,不需二次手术切开取内固定,手术快捷,功能恢复良好.%Objective To evaluate the outcome of arthroscopic treatment using high-strength line for tibial avulsion fracture of posterior cruciate ligament ( PCL) . Methods From January 2010 to June 2012, a total of 18 cases of PCL tibial avulsion fracture were enrolled and followed up after surgery. All the cases were treated by arthroscopy. Both the avulsed bone block and the tibia bone bed were refreshed. The procedure was completed with the assistance of PCL director drill guide

  1. Explicit reconstruction of the entanglement wedge

    CERN Document Server

    Kim, Jung-Wook


    The problem of bulk locality, or how the boundary encodes the bulk in AdS/CFT, is still a subject of study today. One of the major issues that needs more elucidation is the problem of subregion duality; what information of the bulk a given boundary subregion encodes. Although proofs given by two teams of researchers, Dong, Harlow, and Wall and Bao, and Kim, state that the entanglement wedge of the bulk should be reconstructible from boudnary subregions, no explicit procedure for reconstructing the entanglement wedge was as of yet given. In this paper, mode sum approach to obtaining smearing functions is generalised to include bulk reconstruction in the entanglement wedge of boundary subregions. It is generally expectated that solutions to the wave equation on a complicated coordinate patch are needed, but this hard problem has been transferred to a less hard but tractable problem of matrix inversion.

  2. The importance of tibial alignment: finite element analysis of tibial malalignment. (United States)

    Perillo-Marcone, A; Barrett, D S; Taylor, M


    The influence of the tibial plateau orientation on cancellous bone stress was examined by finite element analysis for a cemented device. The objectives of the study were i) to examine the effect of the plateau-ankle angle on the cancellous bone stress, ii) to analyze the significance of the anteroposterior angles of the tibial component on these stresses, and iii) to compare the finite element predictions with clinical data. In general, positioning the tibial plateau in valgus resulted in lower cancellous bone stresses. These results support previous clinical studies, which suggest that overall alignment in valgus results in lower migration rates and lower incidence of loosening.

  3. Hydroxyapatite-enhanced tibial prosthetic fixation. (United States)

    Toksvig-Larsen, S; Jorn, L P; Ryd, L; Lindstrand, A


    Sixty-two knees (60 patients) were randomized to four noncemented groups. In Groups 1, 3, and 4, the bone cuts were made with a cooled saw blade. In Group 1, 15 patients were operated on with the porous coated Osteonic 7000 tibial component. In Group 2, 15 patients were operated on with the same tibial component as in Group 1 but with the use of a standard saw blade. In Group 3, 16 patients were operated on with the hydroxyapatite-coated Osteonic tibial component, and in Group 4, 16 patients were operated on with the hydroxyapatite Duracon tibial component. All patients were followed up clinically and with roentgenstereometric analysis. There were no differences among the groups regarding clinical outcome. One knee was revised (Group 2) after 1 year because of loosening of the tibial component. The maximum migration at 1 year was 1.7 mm in Group 1, 1.9 mm in Group 2, 1.3 mm in Group 3, and 1 mm in Group 4. At the 2-year followup, the migrations were 1.8 mm, 1.5 mm, 1.4 mm, and 1 mm in Groups 1, 2, 3, and 4, respectively. The inducible displacement that occurred at 1 year was 0.6 mm in Group 1, 0.5 mm in Group 2, 0.4 mm in Group 3, and 0.4 mm in Group 4. The hydroxyapatite coating had a strong positive effect on the tibial component fixation. No prosthesis in the hydroxyapatite groups showed continuous migration.

  4. A review of dynamics modelling of friction wedge suspensions (United States)

    Wu, Qing; Cole, Colin; Spiryagin, Maksym; Sun, Yan Quan


    Three-piece bogies with friction wedge suspensions are the most widely used bogies in heavy haul trains. Fiction wedge suspensions play a key role in these wagon systems. This article reviews current techniques in dynamic modelling of friction wedge suspension with various motivations: to improve dynamic models of friction wedge suspensions so as to improve general wagon dynamics simulations; to seek better friction wedge suspension models for wagon stability assessments in complex train systems; to improve the modelling of other friction devices, such as friction draft gear. Relevant theories and friction wedge suspension models developed by using commercial simulation packages and in-house simulation packages are reviewed.

  5. Longitudinal tibial epiphyseal bracket in Nievergelt syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Burnstein, M.I.; De Smet, A.A.; Breed, A.L.; Thomas, J.R.; Hafez, G.R.


    A patient is described with lower extremity mesomelic dwarfism associated with bilateral congenital elbow, hip, and knee dislocations. Rhomboid-shaped tibiae and delayed ossification of the primary fibular ossification centers were demonstrated at birth. Plain films and magnetic resonance imaging revealed that the tibial deformities were due to the presence of longitudinal epiphyseal brackets. These brackets were observed at surgery and confirmed histologically. Recognition of the longitudinal epiphyseal bracket and its relationship to the tibial deformities seen in this patient with Nievergelt syndrome is important for planning surgical treatment. (orig.).

  6. Graphene Plasmons in Triangular Wedges and Grooves

    DEFF Research Database (Denmark)

    Gonçalves, P. A. D.; Dias, E. J. C.; Xiao, Sanshui


    and electric-field distributions. We have found that the dispersion of wedge/groove graphene plasmons follows the same functional dependence as their flat-graphene plasmon counterparts, but now scaled by a (purely) geometric factor in which all the information about the system’s geometry is contained. We...... and tunability of graphene plasmons guided along the apex of a graphene-covered dielectric wedge or groove. In particular, we present a quasi-analytic model to describe the plasmonic eigenmodes in such a system, including the complete determination of their spectrum and corresponding induced potential...

  7. Assessment of a multibeam Fizeau wedge interferometer for Doppler wind lidar. (United States)

    McKay, Jack A


    The Fabry-Perot interferometer is the standard instrument for the direct detection Doppler lidar measurement of atmospheric wind speeds. The multibeam Fizeau wedge has some practical advantages over the Fabry-Perot, such as the linear fringe pattern, and is evaluated for this application. The optimal Fizeau must have a resolving power of 10(6) or more. As the multibeam Fizeau wedge is pushed to such high resolving power, the interference fringes of the device become complicated by asymmetry and secondary maxima. A simple condition for the interferometer plate reflectance, optical gap, and wedge angle reveals whether a set of parameters will yield simple, Airy-like fringes or complex Fizeau fringes. Tilting of the Fizeau wedge improves the fringe shape and permits an extension of the regime of Airy-like fringes to higher resolving power. Sufficient resolving power for the wind lidar application is shown to be possible with a large-gap, low-finesse multibeam Fizeau wedge. Liabilities of the multibeam Fizeau wedge in the wind lidar application include a smaller acceptance solid angle and calibration sensitivity to localized deviations of the plates from the ideal.

  8. Robustness of oscillatory α2 dynamos in spherical wedges (United States)

    Cole, E.; Brandenburg, A.; Käpylä, P. J.; Käpylä, M. J.


    Context. Large-scale dynamo simulations are sometimes confined to spherical wedge geometries by imposing artificial boundary conditions at high latitudes. This may lead to spatio-temporal behaviours that are not representative of those in full spherical shells. Aims: We study the connection between spherical wedge and full spherical shell geometries using simple mean-field dynamos. Methods: We solve the equations for one-dimensional time-dependent α2 and α2Ω mean-field dynamos with only latitudinal extent to examine the effects of varying the polar angle θ0 between the latitudinal boundaries and the poles in spherical coordinates. Results: In the case of constant α and ηt profiles, we find oscillatory solutions only with the commonly used perfect conductor boundary condition in a wedge geometry, while for full spheres all boundary conditions produce stationary solutions, indicating that perfect conductor conditions lead to unphysical solutions in such a wedge setup. To search for configurations in which this problem can be alleviated we choose a profile of the turbulent magnetic diffusivity that decreases toward the poles, corresponding to high conductivity there. Oscillatory solutions are now achieved with models extending to the poles, but the magnetic field is strongly concentrated near the poles and the oscillation period is very long. By changing both the turbulent magnetic diffusivity and α profiles so that both effects are more concentrated toward the equator, we see oscillatory dynamos with equatorward drift, shorter cycles, and magnetic fields distributed over a wider range of latitudes. Those profiles thus remove the sensitive and unphysical dependence on θ0. When introducing radial shear, we again see oscillatory dynamos, and the direction of drift follows the Parker-Yoshimura rule. Conclusions: A reduced α effect near the poles with a turbulent diffusivity concentrated toward the equator yields oscillatory dynamos with equatorward migration and

  9. The cost of infection in severe open tibial fractures treated with a free flap

    DEFF Research Database (Denmark)

    Olesen, Ulrik Kähler; Pedersen, Nicolas Jones; Eckardt, Henrik


    PURPOSE: Open tibial fractures needing soft tissue cover are challenging injuries. Infection risk is high, making treatment difficult and expensive. Delayed skin closure has been shown to increase the infection rate in several studies. We aimed at calculating the direct and indirect cost of treat......PURPOSE: Open tibial fractures needing soft tissue cover are challenging injuries. Infection risk is high, making treatment difficult and expensive. Delayed skin closure has been shown to increase the infection rate in several studies. We aimed at calculating the direct and indirect cost...

  10. Triple plating of tibia in a complex bicondylar tibial plateau fracture

    Institute of Scientific and Technical Information of China (English)

    Atin Jaiswal; Naiman Deepak Kachchhap; Yashwant S Tanwar; Birendra Kumar; Sachin K Yadav


    High-energy tibial plateau fracture poses a significant challenge and difficulty for orthopaedic surgeons.Fracture of tibial plateau involves major weight bearing joint and may alter knee kinematics.Anatomic reconstruction of the proximal tibial articular surfaces,restoration of the limb axis (limb alignment) and stable fixation permitting early joint motion are the goals of the treatment.In cases of complex bicondylar tibial plateau fractures,isolated lateral plating is frequently associated with varus malalignment and better results have been obtained with bilateral plating through dual incisions.However sometimes a complex type of bicondylar tibial plateau fractures is encountered in which medial plateau has a biplaner fracture in posterior coronal plane as well as sagittal plane.In such fractures it is imperative to fix the medial plateau with buttressing in both planes.One such fracture pattern of the proximal tibia managed by triple plating through dual posteromedial and anterolateral incisions is discussed in this case report with emphasis on mechanisms of this type of injury,surgical approach and management.

  11. Irreducible tibial pilon fracture caused by incarceration of the fibula in the tibial medullary canal. (United States)

    Ellanti, Prasad; Hammad, Yassir; Kosutic, Damir; Grieve, Philip P


    Fractures can be irreducible for several reasons, including soft tissue or bone fragment interposition. We report an unusual fracture configuration of a comminuted tibial pilon fracture in which the distal fibular shaft fragment was occupying the medullary canal of the proximal tibial shaft fragment and inhibiting reduction and fixation. To the best of our knowledge, this has not been previously reported in a published study.

  12. Histological and histochemical evaluations on the effects of high incubation temperature on the embryonic development of tibial growth plate in broiler chickens. (United States)

    Oznurlu, Yasemin; Sur, Emrah; Ozaydin, Tugba; Celik, Ilhami; Uluisik, Deniz


    The effects of experimentally induced high incubation temperature on the embryonic development of growth plate of the chicken were investigated by means of histological and enzyme histochemical methods. In the experiments, 250 fertile eggs of Ross-308 broiler strain were divided into two groups, the control eggs were maintained under optimal conditions (37.8°C and 65% ± 2% relative humidity, rh) during the whole incubation period. Heat-stress imposed eggs were maintained under normal conditions (37.8°C and 65% ± 2% rh) until the 10th day of incubation, and then, continuously (24 h per day) exposed to high temperature (38.8°C and 65% ± 2% rh). Tissue samples were taken from 10 animals of each group at the 11th, 13th, 15th, 18th, 21st days of incubation. Tissue samples were processed by enzyme histochemical methods in addition to routine histological techniques. The relative tibia weights and tibia length were lower in the heat-stress group compared to the control group. The results of the measurements of the growth plate showed that the proliferative zone was narrowed whereas, the transitional and hypertrophic zone were thickened in the heat stress group. Alkaline phosphatase (ALP) density was significantly decreased in the heat-stress group compared to the control group. In conclusion, bone formation and growth plate formation are crucial for embryo development and 1°C higher from optimum may increase the incidence of skeletal disorders and leg problems in broiler chickens which is one of the major animal welfare concerns for the poultry industry. © 2016 Wiley Periodicals, Inc.

  13. Benchmarking numerical models of brittle thrust wedges

    NARCIS (Netherlands)

    Buiter, Susanne J H; Schreurs, Guido; Albertz, Markus; Gerya, Taras V.; Kaus, Boris; Landry, Walter; le Pourhiet, Laetitia; Mishin, Yury; Egholm, David L.; Cooke, Michele; Maillot, Bertrand; Thieulot, Cedric; Crook, Tony; May, Dave; Souloumiac, Pauline; Beaumont, Christopher


    We report quantitative results from three brittle thrust wedge experiments, comparing numerical results directly with each other and with corresponding analogue results. We first test whether the participating codes reproduce predictions from analytical critical taper theory. Eleven codes pass the s


    Institute of Scientific and Technical Information of China (English)

    姚伟岸; 张兵茹


    According to the Hellinger-Reissner variational principle and introducing proper transformation of variables, the problem on elastic wedge dissimilar materials can be led to Hamiltonian system, so the solution of the problem can be got by employing the separation of variables method and symplectic eigenfunction expansion under symplectic space, which consists of original variables and their dual variables. The eigenvalue - 1 is a special one of all symplectic eigenvalue for Hamiltonian system in polar coordinate. In general, the eigenvalue - is a single eigenvalue, and the classical solution of an elastic wedge dissimilar materials subjected to a unit concentrated couple at the vertex is got directly by solving the eigenfunction vector for eigenvalue - 1 . But the eigenvalue - 1 becomes a double eigenvalue when the vertex angles and modulus of the materials satisfy certain definite relationships and the classical solution for the stress distribution becomes infinite at this moment, that is, the paradox should occur. Here the Jordan form eigenfunction vector for eigenvalue - 1 exists, and solution of the paradox on elastic wedge dissimilar materials subjected to a unit concentrated couple at the vertex is obtained directly by solving this special Jordan form eigenfunction. The result shows again that the solutions of the special paradox on elastic wedge in the classical theory of elasticity are just Jordan form solutions in symplectic space under Hamiltonian system.


    Directory of Open Access Journals (Sweden)

    M. V. Demesсhenko


    Full Text Available Purpose: to identify anatomical landmarks on tibial articular surface to serve as reference in preparing tibial canal with respect to the center of ACL footprint during single bundle arthroscopic repair.Materials and methods. Twelve frozen knee joint specimens and 68 unpaired macerated human tibia were studied using anatomical, morphometric, statistical methods as well as graphic simulation.Results. Center of the tibial ACL footprint was located 13,1±1,7 mm anteriorly from posterior border of intercondylar eminence, at 1/3 of the distance along the line connecting apexes of internal and external tubercles and 6,1±0,5 mm anteriorly along the perpendicular raised to this point.Conclusion. Internal and external tubercles, as well as posterior border of intercondylar eminence can be considered as anatomical references to determine the center of the tibial ACL footprint and to prepare bone canals for anatomic ligament repair.

  16. Late Holocene stable-isotope based winter temperature records from ice wedges in the Northeast Siberian Arctic (United States)

    Opel, Thomas; Meyer, Hanno; Laepple, Thomas; Dereviagin, Alexander Yu.


    The Arctic is currently undergoing an unprecedented warming. This highly dynamic response on changes in climate forcing and the global impact of the Arctic water, carbon and energy balances make the Arctic a key region to study past, recent and future climate changes. Recent proxy-based temperature reconstructions indicate a long-term cooling over the past about 8 millennia that is mainly related to a decrease in solar summer insolation and has been reversed only by the ongoing warming. Climate model results on the other hand show no significant change or even a slight warming over this period. This model-proxy data mismatch might be caused by a summer bias of the used climate proxies. Ice wedges may provide essential information on past winter temperatures for a comprehensive seasonal picture of Holocene Arctic climate variability. Polygonal ice wedges are a widespread permafrost feature in the Arctic tundra lowlands. Ice wedges form by the repeated filling of thermal contraction cracks with snow melt water, which quickly refreezes at subzero ground temperatures and forms ice veins. As the seasonality of frost cracking and infill is generally related to winter and spring, respectively, the isotopic composition of wedge ice is indicative of past climate conditions during the annual cold season (DJFMAM, hereafter referred to as winter). δ18O of ice is interpreted as proxy for regional surface air temperature. AMS radiocarbon dating of organic remains in ice-wedge samples provides age information to generate chronologies for single ice wedges as well as regionally stacked records with an up to centennial resolution. In this contribution we seek to summarize Holocene ice-wedge δ18O based temperature information from the Northeast Siberian Arctic. We strongly focus on own work in the Laptev Sea region but consider as well literature data from other regional study sites. We consider the stable-isotope composition of wedge ice, ice-wedge dating and chronological

  17. Radiotherapy treatment planning with dynamic wedges--an algorithm for generating wedge factors and beam data. (United States)

    Thomas, S J; Foster, K R


    If the jaws of a linear accelerator are moved under computer control during irradiation, dose distributions similar to those with wedge filters can be produced. Varian linear accelerators utilize this effect to give a 'dynamic wedge', using segmented treatment tables (STTs). An algorithm is described to generate the dose per monitor unit at any point in a beam, using the STT values. Dynamically wedged beams are modelled as the superposition of static asymmetric beams, using an algorithm based on beam data measured for symmetric beams. Predictions of wedge factors, depth doses and profiles generated using the algorithm are compared with measurements. Good agreement is found between predictions and measurements. The calculation time is typically 5 ms/dose point on a PC with a 486DX processor.

  18. A comparison of exact TM plane wave diffraction by coated wedges and impedance wedges

    DEFF Research Database (Denmark)

    Andersen, Lars S.; Breinbjerg, Olav; Moore, John T.


    without interference from direct fields or reflected fields. Results have been obtained in the case of illumination by a transverse magnetic (TM) uniform plane wave. The analysis of the coated wedge is based on an integral equation formulation combined with a hybrid technique, while the analysis......The purpose of this work is to numerically investigate the accuracy of the standard impedance boundary condition (SIBC) approximation for edge diffraction. To this end, we compare the scattering by coated wedges and SIBC wedges for which the diffracted field from a single edge can be observed...... of the SIBC wedge is based on Maliuzhinets' solution. Comparisons have been carried out for a series of configurations including lossy coatings as well as lossless coatings permitting unattenuated propagation of surface waves. The results show that the presence of an edge in a coated structure does...

  19. Benchmarking numerical models of brittle thrust wedges (United States)

    Buiter, Susanne J. H.; Schreurs, Guido; Albertz, Markus; Gerya, Taras V.; Kaus, Boris; Landry, Walter; le Pourhiet, Laetitia; Mishin, Yury; Egholm, David L.; Cooke, Michele; Maillot, Bertrand; Thieulot, Cedric; Crook, Tony; May, Dave; Souloumiac, Pauline; Beaumont, Christopher


    We report quantitative results from three brittle thrust wedge experiments, comparing numerical results directly with each other and with corresponding analogue results. We first test whether the participating codes reproduce predictions from analytical critical taper theory. Eleven codes pass the stable wedge test, showing negligible internal deformation and maintaining the initial surface slope upon horizontal translation over a frictional interface. Eight codes participated in the unstable wedge test that examines the evolution of a wedge by thrust formation from a subcritical state to the critical taper geometry. The critical taper is recovered, but the models show two deformation modes characterised by either mainly forward dipping thrusts or a series of thrust pop-ups. We speculate that the two modes are caused by differences in effective basal boundary friction related to different algorithms for modelling boundary friction. The third experiment examines stacking of forward thrusts that are translated upward along a backward thrust. The results of the seven codes that run this experiment show variability in deformation style, number of thrusts, thrust dip angles and surface slope. Overall, our experiments show that numerical models run with different numerical techniques can successfully simulate laboratory brittle thrust wedge models at the cm-scale. In more detail, however, we find that it is challenging to reproduce sandbox-type setups numerically, because of frictional boundary conditions and velocity discontinuities. We recommend that future numerical-analogue comparisons use simple boundary conditions and that the numerical Earth Science community defines a plasticity test to resolve the variability in model shear zones.

  20. Benchmarking analogue models of brittle thrust wedges (United States)

    Schreurs, Guido; Buiter, Susanne J. H.; Boutelier, Jennifer; Burberry, Caroline; Callot, Jean-Paul; Cavozzi, Cristian; Cerca, Mariano; Chen, Jian-Hong; Cristallini, Ernesto; Cruden, Alexander R.; Cruz, Leonardo; Daniel, Jean-Marc; Da Poian, Gabriela; Garcia, Victor H.; Gomes, Caroline J. S.; Grall, Céline; Guillot, Yannick; Guzmán, Cecilia; Hidayah, Triyani Nur; Hilley, George; Klinkmüller, Matthias; Koyi, Hemin A.; Lu, Chia-Yu; Maillot, Bertrand; Meriaux, Catherine; Nilfouroushan, Faramarz; Pan, Chang-Chih; Pillot, Daniel; Portillo, Rodrigo; Rosenau, Matthias; Schellart, Wouter P.; Schlische, Roy W.; Take, Andy; Vendeville, Bruno; Vergnaud, Marine; Vettori, Matteo; Wang, Shih-Hsien; Withjack, Martha O.; Yagupsky, Daniel; Yamada, Yasuhiro


    We performed a quantitative comparison of brittle thrust wedge experiments to evaluate the variability among analogue models and to appraise the reproducibility and limits of model interpretation. Fifteen analogue modeling laboratories participated in this benchmark initiative. Each laboratory received a shipment of the same type of quartz and corundum sand and all laboratories adhered to a stringent model building protocol and used the same type of foil to cover base and sidewalls of the sandbox. Sieve structure, sifting height, filling rate, and details on off-scraping of excess sand followed prescribed procedures. Our analogue benchmark shows that even for simple plane-strain experiments with prescribed stringent model construction techniques, quantitative model results show variability, most notably for surface slope, thrust spacing and number of forward and backthrusts. One of the sources of the variability in model results is related to slight variations in how sand is deposited in the sandbox. Small changes in sifting height, sifting rate, and scraping will result in slightly heterogeneous material bulk densities, which will affect the mechanical properties of the sand, and will result in lateral and vertical differences in peak and boundary friction angles, as well as cohesion values once the model is constructed. Initial variations in basal friction are inferred to play the most important role in causing model variability. Our comparison shows that the human factor plays a decisive role, and even when one modeler repeats the same experiment, quantitative model results still show variability. Our observations highlight the limits of up-scaling quantitative analogue model results to nature or for making comparisons with numerical models. The frictional behavior of sand is highly sensitive to small variations in material state or experimental set-up, and hence, it will remain difficult to scale quantitative results such as number of thrusts, thrust spacing

  1. Oxidation and other property changes of retrieved sequentially annealed UHMWPE acetabular and tibial bearings. (United States)

    Reinitz, Steven D; Currier, Barbara H; Van Citters, Douglas W; Levine, Rayna A; Collier, John P


    This investigation analyzed retrieved sequentially crosslinked and annealed (SXL) ultra-high molecular weight polyethylene bearings to determine whether the material is chemically stable in vivo. A series of retrieved tibial and acetabular components were analyzed for changes in ketone oxidation, crosslink density, and free radical concentration. Oxidation was observed to increase with in vivo duration, and the rate of oxidation in tibial inserts was significantly greater than in acetabular liners. SXL acetabular bearings oxidized at a rate comparable to gamma-sterilized liners, while SXL tibial inserts oxidized at a significantly faster rate than their gamma-sterilized counterparts. A significant decrease in crosslink density with increased mean ketone oxidation index was observed, suggesting that in vivo oxidation may be causing material degradation. Furthermore, a subsurface whitened damage region was also found in a subset of the bearings, indicating the possibility of a clinically relevant decrease in mechanical properties of these components.

  2. Early tibial tray failure of a Duracon knee with retrieval analysis. (United States)

    Ho, Ta-Feng; Tsai, Ruey-Yug; Lee, Pei-Yuan; Ku, Ming-Chou


    We report a case of early tibial tray fracture of a Duracon knee prosthesis. Aside from the clinical, radiographic, and gross analysis of the failed prosthesis, we also performed analysis on the retrieved polyethylene component and the fractured tibial baseplate. In the analyses, we noted significant femoral component malalignment, uneven tray cementation, and inherent metallurgical weakness. It appears that the high compressive load on the medial tray resulted in bending fatigue failure. To avoid this complication, it is important to restore the normal alignment of the knee joint and use a polyethylene insert of higher conformity, at least 6 mm thick.

  3. Proximal tibial osteophytes and their relationship with the height of the tibial spines of the intercondylar eminence: paleopathological study

    Energy Technology Data Exchange (ETDEWEB)

    Hayeri, Mohammad Reza [Children' s National Medical Center, Department of Radiology, Washington, DC (United States); Shiehmorteza, Masoud; Trudell, Debra J.; Resnick, Donald [University of California San Diego, Department of Radiology, San Diego, CA (United States); Hefflin, Tori [Museum of Man San Diego, San Diego, CA (United States)


    Tibial spiking (i.e., spurring of tibial spines), eburnation, and osteophytes are considered features of osteoarthritis. This investigation employed direct inspection of the medial and lateral tibial plateaus in paleopathological specimens to analyze the frequency and morphological features of osteoarthritis and to define any relationship between the size of osteophytes and that of the intercondylar tibial spines. A total of 35 tibial bone specimens were evaluated for the degree of osteoarthritis and presence of eburnation. Each plateau was also divided into four quadrants and the presence and size of bone outgrowths were recorded in each quadrant. The ''medial/lateral tibial intercondylar spine index'' for each specimen was calculated as follows: (medial/lateral intercondylar tibial spine height)/(anteroposterior width of the superior tibial surface). The relationships between medial and lateral tibial height indexes with the degree of osteoarthritis were then tested. Osteophytes were observed more frequently in the anterior quadrants of both tibial plateaus than in the posterior quadrants (29 vs 16 for the medial tibial plateau [p = 0.01] and 28 vs 20 for the lateral tibial plateau [p = 0.04]). Eburnation was seen more frequently in the posterior regions of both tibial plateaus than in the anterior regions (17 vs 5, p < 0.01). In specimens with no signs of osteoarthritis the lateral intercondylar tibial index was significantly lower than that in specimens with some degree of osteoarthritis (p = 0.02). The medial intercondylar tibial index of the specimens with no signs of osteoarthritis was not significantly different from that of the specimens with some degree of osteoarthritis (p = 0.45). There was a positive correlation between the lateral spine height index and the overall grading of osteoarthritis, (r = 0.6, p < 0.01). In the anteromedial and posteromedial quadrants of the lateral tibial plateau, the association between the lateral

  4. Process Based Explanations for Correlations Between the Structural and Seismic Segmentation of the Cascadia Subduction Wedge (United States)

    Fuller, C. W.; Brandon, M. T.; Willett, S. D.


    Variations in the geological and geophysical characteristics of the Cascadia subduction wedge, the region between the trench and arc, result in along-strike wedge segmentation. We focus on explaining the large-scale structural segmentation and how processes causing this segmentation influence segmentation with respect to the seismic behavior of the wedge and subduction thrust. The relationships we develop illustrate the fundamental interplay of processes controlling long-term structure and short-term seismic behavior. Our conclusions are based on the results of numerical models designed to simulate the growth and evolution of the Cascadia subduction wedge through the accretion of a thin layer of sediment to the basaltic Coast Range Terrane (CRT) of the Cascadia margin. Two aspects of wedge structural segmentation are of interest: (1) segmentation with respect to the location or absence of large, continental shelf, forearc basins, and (2) segmentation with respect to the Coastal Range (CR) structural high. Our models illustrate that the form of the submarine portion of the Cascadia wedge, including the basins or lack thereof, is a consequence of the frictional behavior of this region of wedge, subduction thrust strength, wedge strength, and dip thrust. We propose that basin segments have stronger wedge material, a weaker thrust, or a steeper thrust than basin free segments. The presence of basins is significant because they stabilize the margin and prevent subduction and accretion related deformation. This stabilization allows the thrust to preferentially support thermally induced, fluid overpressures and undergo fault healing thus increasing the likelihood of large coseismic slip within basin segments. While no historical earthquake data supporting this argument exists for Cascadia, such behavior has been observed in many margins (Song and Simons, 2003; Wells et al., 2003). It is reasonable to assume that large earthquakes in Cascadia will have the same association

  5. Crustal and Fault Strengths from Critical Taper Measurements: Insights into the behavior of Accretionary Wedges using Distinct-Element Models (United States)

    Strayer, L.; Suppe, J.


    It is increasingly clear that many major faults are weak relative to quasistatic friction because of dynamical effects involving the microprocesses of high-velocity friction and the energetics of large-scale fault rupture. Even at the toes of accretionary wedges where velocity strengthening is expected, large displacements can occur dynamically. We seek to better understand the relationship between the large-scale strength of such faults and of the crust containing them over a timescale much greater than seismic cycles. Critical-taper theory provides straightforward quantitative relationships between accretionary wedge geometry and absolute basal fault and wedge strengths with minimal assumptions. Wedge tapers constrain the far-field stresses under which detachments slip and wedges grow during wedge-growing events, whether they are dynamical or quasistatic. To date most applications of wedge mechanics to accretionary wedges involve analog and numerical modeling with largely conceptual insight, for example illuminating the role of geological heterogeneity. Here we demonstrate that recent theoretical advances that are successful in extracting absolute wedge and detachment strengths from the geometry of active wedges can also be applied to extract large-scale strengths in distinct element numerical models in both mechanically homogeneous and heterogeneous wedges. The distinct element method (DEM) is an ideal tool for the study and modeling of critical taper wedges: model wedges can be initially cohesive (bonded) or cohesionless. Faults and folds form naturally as the result of progressive bond breakage during shortening and wedge growth. Heterogeneity can be introduced by creating layered groups of particles of differing mechanical properties. The DEM suffers to some extent in that macro material properties cannot be directly prescribed but rather must be defined by a modest number of micro-properties and the process in necessarily iterative and developing a wide

  6. Radiation pressure on a dielectric wedge

    CERN Document Server

    Mansuripur, Masud; Moloney, Jerome V


    The force of electromagnetic radiation on a dielectric medium may be derived by a direct application of the Lorentz law of classical electrodynamics. While the light's electric field acts upon the (induced) bound charges in the medium, its magnetic field exerts a force on the bound currents. We use the example of a wedge-shaped solid dielectric, immersed in a transparent liquid and illuminated at Brewster's angle, to demonstrate that the linear momentum of the electromagnetic field within dielectrics has neither the Minkowski nor the Abraham form; rather, the correct expression for momentum density has equal contributions from both. The time rate of change of the incident momentum thus expressed is equal to the force exerted on the wedge plus that experienced by the surrounding liquid.

  7. Graphene Plasmons in Triangular Wedges and Grooves

    CERN Document Server

    Gonçalves, P A D; Xiao, Sanshui; Vasilevskiy, M I; Mortensen, N Asger; Peres, N M R


    The ability to effectively guide electromagnetic radiation below the diffraction limit is of the utmost importance in the prospect of all-optical plasmonic circuitry. Here, we propose an alternative solution to conventional metal-based plasmonics by exploiting the deep subwavelength confinement and tunability of graphene plasmons guided along the apex of a graphene-covered dielectric wedge or groove. In particular, we present a quasi-analytic model to describe the plasmonic eigenmodes in such a system, including the complete determination of their spectrum and corresponding induced potential and electric field distributions. We have found that the dispersion of wedge/groove graphene plasmons follows the same functional dependence as their flat-graphene plasmons counterparts, but now scaled by a (purely) geometric factor in which all the information about the system's geometry is contained. We believe our results pave the way for the development of novel custom-tailored photonic devices for subwavelength waveg...

  8. Checking the virtual treatment modality Wedge from Siemens; Verificacion de la modalidad de tratamiento virtual WEDGE de SIEMENS

    Energy Technology Data Exchange (ETDEWEB)

    Suero Rodrigo, M. A.; Marques Fraguela, E.


    The treatment modality Virtual Wedge (VW) or implemented by Siemens virtual wedge in electron linear accelerators achieved dose distributions are similar but not identical, to those obtained with physical wedges. Among the advantages against the latter is the greater ease of use, wedge factor close to one, and lower peripheral dose. However, these benefits are to be effective requires a through quality control dependence because a larger number of parameters that control the generation of the beam, the dose monitor system and the movement of the jaws of the collimator. We performed a study of the wedge taking into account different configurations that can affect their behavior from the dosimetric point of view.

  9. Tibial crest fracture correction after tibial tuberosity advancement (TTA using a modified TTA technique

    Directory of Open Access Journals (Sweden)

    Tiago Carmagnani Prada


    Full Text Available Corrective osteotomies are challenging techniques that require specialized training and acquisition of specific materials. Nevertheless, they have been increasingly studied and used in clinical routine in the world. Several variations on the model and the application technique have been developed and refined in search of the improvement of surgical techniques and development of implants more affordable to purchase. The tibial tuberosity advancement (TTA consists on stabilization of tibial plateau perpendicular to the patellar tendon through the tibial tuberosity advancement. Our goal is to report a surgical complication of fracture of the tibial crest after TTA procedure. A dog with a confirmed diagnosis of rupture of the cranial cruciate ligament (CCLR was operated using conventional technique of TTA. After 3 days of surgery, the same animal had a fracture of the proximal tibial crest. The animal was sent back to surgery and was used a variation of TTA technique, with autologous iliac wing and three cortical screws. This variation of the technique was able to replace the original technique successfully.

  10. Finite element analysis of tibial fractures

    DEFF Research Database (Denmark)

    Wong, Christian Nai En; Mikkelsen, Mikkel Peter W; Hansen, Leif Berner


    INTRODUCTION: Fractures of the tibial shaft are relatively common injuries. There are indications that tibial shaft fractures share characteristics in terms of site, type and local fracture mechanisms. In this study, we aimed to set up a mathematical, computer-based model using finite element...... analysis of the bones of the lower leg to examine if such a model is adequate for prediction of fracture locations and patterns. In future studies, we aim to use these biomechanical results to examine fracture prevention, among others, and to simulate different types of osteosynthesis and the process...... of bony healing. The biomechanical results are the basis for fracture healing, biomechanical fall analysis and stability analysis of osteosynthesis. MATERIAL AND METHODS: A finite element model of the bony part of the lower leg was generated on the basis of computed tomography data from the Visible Human...

  11. Finite element analysis of tibial fractures

    DEFF Research Database (Denmark)

    Wong, Christian Nai En; Mikkelsen, Mikkel Peter W; Hansen, Leif Berner


    INTRODUCTION: Fractures of the tibial shaft are relatively common injuries. There are indications that tibial shaft fractures share characteristics in terms of site, type and local fracture mechanisms. In this study, we aimed to set up a mathematical, computer-based model using finite element...... analysis of the bones of the lower leg to examine if such a model is adequate for prediction of fracture locations and patterns. In future studies, we aim to use these biomechanical results to examine fracture prevention, among others, and to simulate different types of osteosynthesis and the process...... Project. The data consisted of 21,219 3D elements with a cortical shell and a trabecular core. Three types of load of torsion, a direct lateral load and axial compression were applied. RESULTS: The finite element linear static analysis resulted in relevant fracture localizations and indicated relevant...

  12. Baseline Vitamin D Status is Predictive of Longitudinal Change in Tibial BMD in Knee Osteoarthritis (OA) (United States)

    With its lack of effective treatment and high prevalence, the public health impact of OA is substantial. Peri-articular bone in OA can be evaluated with the medial:lateral tibial BMD ratio (M:L BMD) obtained from dual x-ray absorptiometry (DXA). Higher M:L BMD is associated with medial OA features...

  13. Anterior Tibial Artery Pseudoaneurysm: Case Report

    Directory of Open Access Journals (Sweden)

    Funda Tor


    Full Text Available The aneurysmsatic changes of the infrapopliteal arteries are rarely seen. They are pseudoaneurysms rather than true aneursyms. The most important cause of them is trauma. There is not a standart treatment for infrapopliteal aneursyms. In this study, we have evaluated a case operated for anterior tibial artery pseudoaneurysm developed after penetrant trauma and diagnosed two weeks later. [Cukurova Med J 2012; 37(3.000: 172-175

  14. Tibial forces measured in vivo after total knee arthroplasty. (United States)

    D'Lima, Darryl D; Patil, Shantanu; Steklov, Nikolai; Slamin, John E; Colwell, Clifford W


    An instrumented tibial prosthesis was developed to measure forces in vivo after total tibial arthroplasty. This prosthesis was implanted in a 67-kg, 80-year-old man. The prosthesis measured forces at the 4 quadrants of the tibial tray. Tibial forces were measured postoperatively during rehabilitation, rising from a chair, standing, walking, and climbing stairs. By the sixth postoperative week, the peak tibial forces during walking averaged 2.2 times body weight (BW). Stair climbing increased from 1.9 times BW on day 6 to 2.5 times BW at 6 weeks. This represents the first direct in vivo measurement of tibial forces, which should lead to refined surgical techniques and enhanced prosthetic designs. Technical design improvements will enhance function, quality of life, and longevity of total knee arthroplasty.

  15. Tibial Tubercle Osteotomy: Indication and Techniques. (United States)

    Grawe, Brian; Stein, Beth Shubin


    Osteotomy of the tibial tubercle is a versatile procedure that can be utilized for several common pathologies about the patellofemoral joint. Most commonly, tuberosity transfer is employed for the treatment of patellar instability or symptomatic overload of the patella. The osteotomy can be combined with soft tissue realignment procedures or cartilage reconstructive techniques. A precise understanding of the surgical anatomy and the biomechanics of the patellofemoral articulation is essential for producing a successful outcome during surgery. Tailoring the direction of transfer to the pathoanatomy of each patient is critical for producing a durable and lasting result following a tibial tubercle osteotomy. When evaluating a patient for a possible transfer, a thorough history and physical evaluation must be undertaken, along with imaging to the patellofemoral joint. Several useful advanced imaging techniques can also be used to guide the surgeon toward the most appropriated osteotomy for the patient. The purpose of this article is to review the indications for performing a tibial tubercle osteotomy, and highlighting the various techniques for transfer.

  16. Water Impact of Rigid Wedges in Two-Dimensional Fluid Flow

    Directory of Open Access Journals (Sweden)

    Sawan Shah


    Full Text Available A combined experimental and numerical investigation was conducted into impact of rigid wedges on water in two-dimensional fluid conditions. Drop test experiments were conducted involving symmetric rigid wedges of varying angle and mass impacted onto water. The kinematic behaviour of the wedge and water was characterised using high-speed video. Numerical models were analysed in LS-DYNA® that combined regions of Smoothed Particle Hydrodynamics particles and a Lagrangian element mesh. The analysis captured the majority of experimental results and trends, within the bounds of experimental variance. Further, the combined modelling technique presented a highly attractive combination of computational efficiency and accuracy, making it a suitable candidate for aircraft ditching investigations.

  17. Bending strength and holding power of tibial locking screws. (United States)

    Lin, J; Lin, S J; Chiang, H; Hou, S M


    The bending strength and holding power of two types of specially designed tibial locking devices, a both-ends-threaded screw and an unthreaded bolt, were studied and compared with four types of commercially available tibial interlocking screws: Synthes, Howmedica, Richards, and Osteo AG. To test bending strength, the devices were inserted into a high molecular weight polyethylene tube and loaded at their midpoint by a materials testing machine to simulate a three point bending test. Single loading yielding strength and cyclic loading fatigue life were measured. To test holding power, the devices were inserted into tubes made of polyurethane foam, and their tips were loaded axially to measure pushout strength. The devices were tested with two different densities of foam materials and two different sizes of pilot holes. Insertion torque and stripping torque of the screws were measured first. Pushout tests were performed with each screw inserted with a tightness equal to 60% of its stripping torque. Test results showed that the yielding strength and the fatigue life were related closely to the inner diameter of the screws. The stripping torque predicted the pushout strength more reliably than did the insertion torque. All tested devices showed greater holding power in the foam with the higher density and with the smaller pilot holes. The both-ends-threaded screw had the highest pushout strength and a satisfactory fatigue strength. The unthreaded bolt had the highest fatigue strength but only fair holding power. Clinical studies of the use of these two types of locking devices are worthwhile.

  18. Anterior and posterior tibial anesthetic block in diabetic foot surgery.

    Directory of Open Access Journals (Sweden)

    José Julio Ojeda González


    Full Text Available Fundament: Diabetes Mellitus is a disease of high and increasing prevalence and its complications follow a parallel course. Its morbidity is derived from its own complications which are produced at a long or short term and peripheral vascular disease hihglights among them.Objective: to check the usefulness of the anterior and posterior blockade of the tibia for the surgery of the diabetic foot. Method: Prospective study carried out from January to December 2003 at the University Hospital ¨Dr. Gustavo Aldereguía Lima¨ to patients who are carriers of a diabetic foot and who were initially assisted at the service of Angiology and later at the service of Anesthesiology when the surgical procedures were decided. All the patients were applied an anterior and posterior blockade of the tibial nerve . The variables measured were: age, weight, height, surgical time, type of surgery, cardiac frequency medium arterial pressure, and classification of patients according to the American Association of Anesthesiology All the patients were applied a scale for assessing pain in three different moments.Result: There was a predominance of females . The blockade of the posterior tibial nerve with lidocaine 1 % in different points permitted the performance of the surgical techniques proposed. The anesthetic procedure was favorable, and economic since the patients did not requiere of the use of analgesic in the post operatory stage.

  19. Systematic radiographic evaluation of tibial hemimelia with orthopedic implications

    Energy Technology Data Exchange (ETDEWEB)

    Kaplan-List, Katia [Rochester General Hospital, Department of Diagnostic Imaging, Rochester, NY (United States); Klionsky, Nina B. [University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY (United States); Golisano Children' s Hospital, Department of Radiology, Rochester, NY (United States); Sanders, James O. [University of Rochester Medical Center, School of Medicine and Dentistry, Rochester, NY (United States); Golisano Children' s Hospital, Department of Orthopaedics, Rochester, NY (United States); Golisano Children' s Hospital, Department of Pediatrics, Rochester, NY (United States); Katz, Michael E. [St. Mary' s Medical Center and Palm Beach Children' s Hospital, Department of Radiology, West Palm Beach, FL (United States)


    Tibial hemimelia is a rare lower-extremity pre-axial longitudinal deficiency characterized by complete or partial absence of the tibia. The reported incidence is 1 in 1 million live births. In this pictorial essay, we define tibial hemimelia and describe associated conditions and principles of preoperative imaging assessment for a child with tibial hemimelia. We also indicate the imaging findings that might influence the choice of treatment, describe the most widely used classification systems, and briefly discuss current treatment approaches. (orig.)

  20. Histological Analysis of the Tibial Anterior Cruciate Ligament Insertion


    Siebold, Rainer; Oka, Shinya; Traut, Ulrike; Schuhmacher, Peter; Kirsch, Joachim


    Objective: To describe the morphology of the tibial ACL insertion by histological assessment in the sagittal plane. Methods: For histology the native (undissected) tibial ACL insertion of 6 fresh-frozen cadaveric knees was cut into 4 sagittal sections parallel to the long axis of the medial tibial spine. The slices were stained with hematoxylin and eosin, Safranin O and Russell-Movat pentachrome. All slices were digitalized and analyzed at a magnification of ?20. Results: From medial to later...

  1. Seismic evidence for a cold serpentinized mantle wedge beneath Mount St Helens. (United States)

    Hansen, S M; Schmandt, B; Levander, A; Kiser, E; Vidale, J E; Abers, G A; Creager, K C


    Mount St Helens is the most active volcano within the Cascade arc; however, its location is unusual because it lies 50 km west of the main axis of arc volcanism. Subduction zone thermal models indicate that the down-going slab is decoupled from the overriding mantle wedge beneath the forearc, resulting in a cold mantle wedge that is unlikely to generate melt. Consequently, the forearc location of Mount St Helens raises questions regarding the extent of the cold mantle wedge and the source region of melts that are responsible for volcanism. Here using, high-resolution active-source seismic data, we show that Mount St Helens sits atop a sharp lateral boundary in Moho reflectivity. Weak-to-absent PmP reflections to the west are attributed to serpentinite in the mantle-wedge, which requires a cold hydrated mantle wedge beneath Mount St Helens (<∼700 °C). These results suggest that the melt source region lies east towards Mount Adams.

  2. Medial Closing-Wedge Distal Femoral Osteotomy for Genu Valgum With Lateral Compartment Disease. (United States)

    Wylie, James D; Maak, Travis G


    Lateral compartment disease combined with valgus alignment can lead to progressive knee joint degeneration. In the symptomatic patient with isolated lateral compartment disease, a varus-producing distal femoral osteotomy can unload the diseased lateral compartment. This osteotomy may be combined with other cartilage or meniscal restorative techniques to optimize knee joint preservation and pain relief. The osteotomy can be performed with a medial closing-wedge or lateral opening-wedge technique. Both techniques have been reported to improve knee-related quality of life in patients with lateral compartment disease. Advantages of the medial closing-wedge technique are direct bone apposition leading to inherent stability of the construct, as well as reliable bony healing, and less hardware irritation. Advantages of the lateral opening-wedge technique are a single bony cut and therefore more of an ability to adjust correction intraoperatively. However, this technique requires bone grafting and has a high rate of hardware irritation or removal. We present a surgical technique for the medial closing-wedge distal femoral osteotomy using an anteromedial-distal femoral locking plate.

  3. Dying Flow Bursts as Generators of the Substorm Current Wedge (United States)

    Haerendel, Gerhard


    Many theories or conjectures exist on the driver of the substorm current wedge, e.g. rerouting of the tail current, current disruption, flow braking, vortex formation, and current sheet collapse. Magnitude, spatial scale, and temporal development of the related magnetic perturbations suggest that the generator is related to the interaction of the flow bursts with the dipolar magnetosphere after onset of reconnection in the near-Earth tail. The question remains whether it is the flow energy that feeds the wedge current or the internal energy of the arriving plasma. In this presentation I argue for the latter. The current generation is attributed to the force exerted by the dipolarized magnetic field of the flow bursts on the preceding layer of high-beta plasma after flow braking. The generator current is the grad-B current at the outer boundary of the compressed high-beta plasma layers. It needs the sequential arrival of several flow bursts to account for duration and magnitude of the ionospheric closure current.

  4. Radiographic features of the development of the anterior tibial tuberosity. (United States)

    Vergara-Amador, E; Davalos Herrera, D; Moreno, L Á


    Few studies have evaluated the radiologic characteristics of the development of the anterior tibial tuberosity. This study aimed to evaluate the radiologic characteristics of the anterior tibial tuberosity in a pediatric population broken down into age groups. We assessed 210 plain-film X-rays of the knee from patients aged from 10 to 17 years, divided into groups according to age and sex, for the presence of ossification of the anterior tibial tuberosity, the distance between the anterior tibial tuberosity and the metaphysis, and fusion with the epiphysis. At 10 years of age, the anterior tibial tuberosity was ossified in 50% of the girls but in only 25% of the boys. In all the girls, the anterior tibial tuberosity was ossified at 11 years, fusion of the anterior tibial tuberosity with the epiphysis had started at 12 years, and fusion was complete by 17 years. In boys, the process is delayed by one year compared to girls. A single center of ossification was found in all cases. The ossification of the anterior tibial tuberosity starts distally, then the proximal part fuses with the rest of the epiphysis, and finally the distal part fuses with the tibia. The results of this study help enable a better analysis of the anterior tibial tuberosity in cases of knee pain. Copyright © 2016 SERAM. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Mantle flow in subduction systems: The mantle wedge flow field and implications for wedge processes (United States)

    Long, Maureen D.; Wirth, Erin A.


    The mantle wedge above subducting slabs is associated with many important processes, including the transport of melt and volatiles. Our understanding of mantle wedge dynamics is incomplete, as the mantle flow field above subducting slabs remains poorly understood. Because seismic anisotropy is a consequence of deformation, measurements of shear wave splitting can constrain the geometry of mantle flow. In order to identify processes that make first-order contributions to the pattern of wedge flow, we have compiled a data set of local S splitting measurements from mantle wedges worldwide. There is a large amount of variability in splitting parameters, with average delay times ranging from ~0.1 to 0.3 s up to ~1.0-1.5 s and large variations in fast directions. We tested for relationships between splitting parameters and a variety of parameters related to subduction processes. We also explicitly tested the predictions made by 10 different models that have been proposed to explain splitting patterns in the mantle wedge. We find that no simple model can explain all of the trends observed in the global data set. Mantle wedge flow is likely controlled by a combination of downdip motion of the slab, trench migration, ambient mantle flow, small-scale convection, proximity to slab edges, and slab morphology, with the relative contributions of these in any given subduction system controlled by the subduction kinematics and mantle rheology. There is also a likely contribution from B-type olivine and/or serpentinite fabric in many subduction zones, governed by the local thermal structure and volatile distribution.

  6. A non-invasive device to objectively measure tibial rotation: verification of the device. (United States)

    Lorbach, Olaf; Wilmes, P; Maas, S; Zerbe, T; Busch, L; Kohn, D; Seil, R


    The purpose of this study was the correlation of the results of a new measurement device for tibial rotation (Rotameter) in comparison with the measurements of a knee navigation system as standard method. In a biomechanical laboratory study, all soft tissues were removed from 20 human cadaveric knees leaving only the intact capsule and the bone. Specific tracers were bicortically fixed in the bone in order to measure tibial rotation using a knee navigation system. The knees were fixed to a custom-made inside-boot to rule out undesirable rotation of the reconstruction inside the Rotameter measurement device. Internal and external rotation values were measured at an applied torque of 5, 10 and 15 Nm. The different methods to evaluate tibial rotation were compared using the Pearson correlation coefficient. The correlations were deemed to be reliable if a value of >or=0.80 was achieved. At 5 Nm of applied torque, high correlations for the internal rotation, external rotation and the entire rotational range were found in the Pearson correlation coefficient between the Rotameter testing device in comparison with the knee navigation system as invasive reference method. These results were also confirmed at an applied torque of 10 and 15 Nm. In conclusion, the Rotameter testing device showed high correlations compared with the knee navigation system as an invasive standard method. It might be used as a non-invasive and easy alternative to investigate tibial rotation.

  7. Laparoscopic wedge resection of synchronous gastric intraepithelial neoplasia and stromal tumor: a case report. (United States)

    Mou, Yi-Ping; Xu, Xiao-Wu; Xie, Kun; Zhou, Wei; Zhou, Yu-Cheng; Chen, Ke


    Synchronous occurrence of epithelial neoplasia and gastrointestinal stromal tumor (GIST) in the stomach is uncommon. Only rare cases have been reported in the literature. We present here a 60-year-old female case of synchronous occurrence of gastric high-level intraepithelial neoplasia and GIST with the features of 22 similar cases and detailed information reported in the English-language literature summarized. In the present patient, epithelial neoplasia and GIST were removed en bloc by laparoscopic wedge resection. To the best of our knowledge, this is the first reported case treated by laparoscopic wedge resection.

  8. An automated optical wedge calibrator for Dobson ozone spectrophotometers (United States)

    Evans, R. D.; Komhyr, W. D.; Grass, R. D.


    The Dobson ozone spectrophotometer measures the difference of intensity between selected wavelengths in the ultraviolet. The method uses an optical attenuator (the 'Wedge') in this measurement. The knowledge of the relationship of the wedge position to the attenuation is critical to the correct calculation of ozone from the measurement. The procedure to determine this relationship is time-consuming, and requires a highly skilled person to perform it correctly. The relationship has been found to change with time. For reliable ozone values, the procedure should be done on a Dobson instrument at regular intervals. Due to the skill and time necessary to perform this procedure, many instruments have gone as long as 15 years between procedures. This article describes an apparatus that performs the procedure under computer control, and is adaptable to the majority of existing Dobson instruments. Part of the apparatus is usable for normal operation of the Dobson instrument, and would allow computer collection of the data and real-time ozone measurements.

  9. Arthroscopic guided biopsy and radiofrequency thermoablation of a benign neoplasm of the tibial spines area: a treatment option

    Directory of Open Access Journals (Sweden)

    Zoccali Carmine


    Full Text Available Abstract Background Lesions located in the area of the tibial spines are rare. In most cases, treatment follows histological diagnosis, but when imaging and clinical data are considered to be "very" characteristic for benign lesions, such as chondroblastoma or osteoid osteoma, treatment may be performed without biopsy. Traditional curettage requires opening the joint, which presents a high risk of contamination of the joint itself and surrounding structures, such as the popliteal area, with possible contamination of the neurovascular bundle when performing curettage with the posterior approach. In this case, the re-excision of a local recurrence would be extremely difficult. Results We describe a technique using arthroscopic guidance for radiofrequency thermoablation of a benign lesion in the tibial spines area. We report on an illustrative case. The patient so treated, reported immediate relief from the pain, and after two weeks, was free of pain. The biopsy performed before the treatment confirmed the radiological diagnosis of chondroblastoma. At one year of follow-up, the patient is without pain, with a 0-130°range of motion, has no activity limitations and is apparently free of disease. Conclusion This technique allows a radiofrequency thermoablation of a lesion in the tibial spines area and in the posterior tibial surface to be performed without opening the joint, monitoring the tibial plateau surface, probably decreasing the risk of cartilage damage. Unfortunately, in the case presented, the high pressure from the arthroscopy's pump broke the tibial plateau surface creating a communication to the tibial tunnel used for thermoablation.

  10. Knee abduction angular impulses during prolonged running with wedged insoles. (United States)

    Lewinson, Ryan T; Worobets, Jay T; Stefanyshyn, Darren J


    Wedged insoles may produce immediate effects on knee abduction angular impulses during running; however, it is currently not known whether these knee abduction angular impulse magnitudes are maintained throughout a run when fatigue sets in. If changes occur, this could affect the clinical utility of wedged insoles in treating conditions such as patellofemoral pain. Thus, the purpose of this study was to determine whether knee abduction angular impulses are altered during a prolonged run with wedged insoles. It was hypothesized that knee abduction angular impulses would be reduced following a prolonged run with wedged insoles. Nine healthy runners participated. Runners were randomly assigned to either a 6-mm medial wedge condition or a 6-mm lateral wedge condition and then ran continuously overground for 30 min. Knee abduction angular impulses were quantified at 0 and 30 min using a gait analysis procedure. After 2 days, participants returned to perform the same test but with the other wedge type. Two-way repeated-measures analysis of variance was used to evaluate main effects of wedge condition and time and interactions between wedge condition and time (α = 0.05). Paired t-tests were used for post hoc analysis (α = 0.01). No interaction effects (p = 0.958) were found, and knee abduction angular impulses were not significantly different over time (p = 0.384). Lateral wedge conditions produced lesser knee abduction angular impulses than medial conditions at 0 min (difference of 2.79 N m s, p = 0.006) and at 30 min (difference of 2.76 N m s, p < 0.001). It is concluded that significant knee abduction angular impulse changes within wedge conditions do not occur during a 30-min run. Additionally, knee abduction angular impulse differences between wedge conditions are maintained during a 30-min run.

  11. Plastic deformation of a wedge by a sliding punch (United States)

    Nepershin, R. I.


    We present a self-similar solution of the problem of deformation of an ideally plastic wedge by a sliding punch with regard to contact friction; such a solution generalizes the well-known solutions of the problem of wedge penetration into a plastic half-space and of compression of an ideally plastic wedge by a plane punch. The problem is of interest for modeling the processes of plastic deformation of rough surfaces of metal pieces by a rigid tool.

  12. Vibration frequencies of a constrained cantilever wedge (United States)

    Craver, W. Lionel, Jr.; Lu, Yangshan


    This paper presents the solution for the natural frequencies of a beam tapered in one direction, or a wedge, with both a rotational and a translational constraint at a position along the length of the beam. The eigenfrequencies were determined using an incremental search and bisection method, accurate to the fourth decimal place. The taper ratio was varied from 1.4 to 5.0 and the dimensionless spring constants were varied from 0 to 1000. Graphs are provided to illustrate some results.

  13. Impingement of water droplets on wedges and double-wedge airfoils at supersonic speeds (United States)

    Serafini, John S


    An analytical solution has been obtained for the equations of motion of water droplets impinging on a wedge in a two-dimensional supersonic flow field with a shock wave attached to the wedge. The closed-form solution yields analytical expressions for the equation of the droplet trajectory, the local rate of impingement and the impingement velocity at any point on the wedge surface, and the total rate of impingement. The analytical expressions are utilized to determine the impingement on the forward surfaces of diamond airfoils in supersonic flow fields with attached shock waves. The results presented include the following conditions: droplet diameters from 2 to 100 microns, pressure altitudes from sea level to 30,000 feet, free-stream static temperatures from 420 degrees r, free stream Mach numbers from 1.1 to 2.0, semiapex angles for the wedge from 1.14 degrees to 7.97 degrees, thickness-to-chord ratios for the diamond airfoil from 0.02 to 0.14, chord lengths from 1 to 20 feet, and angles of attack from zero to the inverse tangent of the airfoil thickness-to-chord ratio.

  14. P-wave anisotropy, mantle wedge flow and olivine fabrics beneath Japan (United States)

    Liu, Xin; Zhao, Dapeng


    We present a new 3-D anisotropic P-wave velocity (Vp) model for the crust and upper mantle of the Japan subduction zone obtained by inverting a large number of high-quality P-wave traveltime data of local earthquakes and teleseismic events. By assuming orthorhombic anisotropy with a vertical symmetry axis existing in the modeling space, isotropic Vp tomography and 3-D Vp azimuthal and radial anisotropies are determined simultaneously. According to a simple flow field and the obtained Vp anisotropic tomography, we estimate the distribution of olivine fabrics in the mantle wedge. Our results show that the forearc mantle wedge above the subducting Pacific slab beneath NE Japan exhibits an azimuthal anisotropy with trench-parallel fast velocity directions (FVDs) and Vhf > Vv > Vhs (here Vv is Vp in the vertical direction, Vhf and Vhs are P-wave velocities in the fast and slow directions in the horizontal plane), where B-type olivine fabric with vertical trench-parallel flow may dominate. Such an anisotropic feature is not obvious in the forearc mantle wedge above the Philippine Sea (PHS) slab under SW Japan, probably due to higher temperatures and more fluids there associated with the young and warm PHS slab subduction. Trench-normal FVDs and Vhf > Vv > Vhs are generally revealed in the mantle wedge beneath the arc and backarc in Japan, where E-type olivine fabric with FVD-parallel horizontal flow may dominate. Beneath western Honshu, however, the mantle wedge exhibits an anisotropy of Vv > Vhf > Vhs and so C-type olivine fabric may dominate, suggesting that the water content is the highest there, because both the PHS and Pacific slabs exist there and their dehydration reactions release abundant fluids to the overlying mantle wedge.

  15. Posterior cruciate ligament's tibial insertions: topographic anatomy and morphometric study

    Directory of Open Access Journals (Sweden)

    Julio Cesar Gali


    Full Text Available OBJECTIVE: To provide anatomical and morphometric basis of the posterior cruciate ligament's tibial insertions in order to assist the creation of anatomical tibial tunnels, in the ligament surgical reconstruction. MATERIAL AND METHODS: The topographic anatomy and morphometry of the posterior cruciate ligament's anterolateral and posteromedial bundles' tibial insertions were analyzed in 24 anatomical knee pieces. The pieces were photographed by a digital camera and the images obtained were studied by the software ImageJ, where the bundles' insertion areas were measured in square millimeters, and the length of structures and the distances between significant points were measured in millimeters. RESULTS: In 54.2% of the knees the insertion' shape was concave; in most pieces (41.6% the form of insertion was oval. The average posterior cruciate ligament's tibial insertion total area was 88.33 ± 21.66 mm2; the average anterolateral bundle's tibial insertion area was 46.79 ± 14.10 mm2 and it was 41.54 ± 9.75 mm2 for the posteromedial bundle. CONCLUSIONS: The anterolateral bundle has a tibial insertion area larger than the posteromedial bundle; the insertion areas of those bundles in our study, were smaller than the ones found in the literature. The variations in the posterior cruciate ligament's tibial insertion area suggest that there should be an indication for anatomical reconstructions of this ligament using single or double tibial tunnels according to individual characteristics.

  16. The soleal line: a cause of tibial pseudoperiostitis. (United States)

    Levine, A H; Pais, M J; Berinson, H; Amenta, P S


    An unusually prominent soleal line (a normal anatomic variant) may mimic periosteal reaction along the posterior margin of the proximal tibial shaft. This area of pseudoperiostitis is differentiated from hyperostoses arising from the anterior tibial tubercle and the interosseous membrane. It is always associated with normal, undisturbed architecture of the underlying bone.

  17. Global Existence of a Shock for the Supersonic Flow Past a Curved Wedge

    Institute of Scientific and Technical Information of China (English)

    Hui Cheng YIN


    This note is devoted to the study of the global existence of a shock wave for the supersonic flow past a curved wedge. When the curved wedge is a small perturbation of a straight wedge and the angle of the wedge is less than some critical value, we show that a shock attached at the wedge will exist globally.

  18. Molecular depth profiling by wedged crater beveling. (United States)

    Mao, Dan; Lu, Caiyan; Winograd, Nicholas; Wucher, Andreas


    Time-of-flight secondary ion mass spectrometry and atomic force microscopy are employed to characterize a wedge-shaped crater eroded by a 40-keV C(60)(+) cluster ion beam on an organic film of Irganox 1010 doped with Irganox 3114 delta layers. From an examination of the resulting surface, the information about depth resolution, topography, and erosion rate can be obtained as a function of crater depth for every depth in a single experiment. It is shown that when measurements are performed at liquid nitrogen temperature, a constant erosion rate and reduced bombardment induced surface roughness is observed. At room temperature, however, the erosion rate drops by ∼(1)/(3) during the removal of the 400 nm Irganox film and the roughness gradually increased to from 1 nm to ∼4 nm. From SIMS lateral images of the beveled crater and AFM topography results, depth resolution was further improved by employing glancing angles of incidence and lower primary ion beam energy. Sub-10 nm depth resolution was observed under the optimized conditions on a routine basis. In general, we show that the wedge-crater beveling is an important tool for elucidating the factors that are important for molecular depth profiling experiments.

  19. Ice-Creams and Wedge Graphs

    CERN Document Server

    Ackerman, Eyal; Pinchasi, Rom


    We show that for every compact convex set $S$ in the plane and every $0 < \\alpha < \\pi$, there exist a point $O$ and two supporting lines to $S$ passing through $O$ and touching $S$ at two \\emph{single points} $X$ and $Y$, respectively, such that $|OX|=|OY|$ and the angle between the two lines has measure $\\alpha$. As a consequence, we provide a simplified proof to the following result by Carmi, Katz, Lotker, and Ros\\'en \\cite{CKLR10}. Given a set of $\\frac{\\pi}{3}$-directional antennas (that is, antennas each of which can communicate along a wedge of angle $\\frac{\\pi}{3}$), one can always assign a direction to each antenna such that the resulting communication graph is connected, where two antennas can communicate if and only if each lies in the wedge assigned to the other. In fact we obtain a much stronger and optimal result (see Theorem \\ref{theorem:main}) saying in particular that one can chose the directions of the antennas so that the communication graph has diameter $\\le 4$.

  20. Management of closed tibial plateau fractures with percutaneous cancellous screw fixation

    Directory of Open Access Journals (Sweden)

    Tushar Agarwal


    Full Text Available Background: Tibial plateau fractures, intra-articular in nature and caused by high-velocity trauma, constitute approximately 1% of all fractures. Primary goal in the management of proximal tibial articular fracture aims for a stable, congruous, pain-free, mobile joint. Objective: To study the technique, results, and complications of percutaneous cancellous screw fixation for tibial plateau fractures. Materials and Methods: Twenty-three men and seven women aged 18-65 years (mean = 36.8 years underwent closed reduction and percutaneous screw fixation for closed tibial plateau fractures with <5 mm depression. According to the Schatzker classification, patients were grouped as type I (n = 18, type II (n = 4, type III (n = 0, type IV (n = 8, type V (n = 2, and type VI (n = 1. Closed reduction was achieved by manual ligamentotaxis technique under image intensifier control and fixed percutaneously with two cancellous screws (6.5 mm with or without washers in a parallel fashion. Results: Functional outcome was evaluated using the Mason Hohl evaluation system. A total score of 19-24 was considered as excellent, 13-18 as good, 7-12 as fair, and <6 as poor. Outcomes were excellent in 10 patients, good in 15, fair in 4, and poor in 1 patient. Patients were allowed partial weight bearing with walker after 1 month and full weight bearing after radiological union in approximately 3-4 months. The mean period of hospital stay was 5 (range 2-15 days. All the fractures united radiologically after a mean of 3 (range 2.5- 5 months. Patients were evaluated at a mean of 3 years after injury. No patient had any complication like infection, wound dehiscence, or hardware problem. Conclusion: Percutaneous cancellous screw fixation for closed tibial plateau fractures is minimally invasive. It reduces hospital stay and cost, enables early mobilization with minimal instrumentation, and achieves satisfactory outcomes.

  1. Histological analysis of the tibial anterior cruciate ligament insertion. (United States)

    Oka, Shinya; Schuhmacher, Peter; Brehmer, Axel; Traut, Ulrike; Kirsch, Joachim; Siebold, Rainer


    This study was performed to investigate the morphology of the tibial anterior cruciate ligament (ACL) by histological assessment. The native (undissected) tibial ACL insertion of six fresh-frozen cadaveric knees was cut into four sagittal sections parallel to the long axis of the medial tibial spine. For histological evaluation, the slices were stained with haematoxylin and eosin, Safranin O and Russell-Movat pentachrome. All slices were digitalized and analysed at a magnification of 20×. The anterior tibial ACL insertion was bordered by a bony anterior ridge. The most medial ACL fibres inserted from the medial tibial spine and were adjacent to the articular cartilage of the medial tibial plateau. Parts of the bony insertions of the anterior and posterior horns of the lateral meniscus were in close contact with the lateral part of the tibial ACL insertion. A small fat pad was located just posterior to the functional ACL fibres. The anterior-posterior length of the medial ACL insertion was an average of 10.8 ± 1.1 mm compared with the lateral, which was only 6.2 ± 1.1 mm (p flat and 'c-shaped' way. The most anterior part of the tibial ACL insertion was bordered by a bony anterior ridge and the most medial by the medial tibial spine. No posterolateral fibres nor ACL bundles have been found histologically. This histological investigation may improve our understanding of the tibial ACL insertion and may provide important information for anatomical ACL reconstruction.

  2. Tibial lengthening over humeral and tibial intramedullary nails in patients with sequelae of poliomyelitis: a comparative study. (United States)

    Chen, Daoyun; Chen, Jianmin; Jiang, Yao; Liu, Fanggang


    Leg discrepancy is common after poliomyelitis. Tibial lengthening is an effective way to solve this problem. It is believed lengthening over a tibial intramedullary nail can provide a more comfortable lengthening process than by the conventional technique. However, patients with sequelae of poliomyelitis typically have narrow intramedullary canals allowing limited space for inserting a tibial intramedullary nail and Kirschner wires. To overcome this problem, we tried using humeral nails instead of tibial nails in the lengthening procedure. In this study, we used humeral nails in 20 tibial lengthening procedures and compared the results with another group of patients who were treated with tibial lengthening over tibial intramedullary nails. The mean consolidation index, percentage of increase and external fixation index did not show significant differences between the two groups. However, less blood loss and shorter operating time were noted in the humeral nail group. More patients encountered difficulty with the inserted intramedullary nail in the tibial nail group procedure. The complications did not show a statistically significant difference between the two techniques on follow-up. In conclusion, we found the humeral nail lengthening technique was more suitable in leg discrepancy patients with sequelae of poliomyelitis.

  3. 49 CFR 215.113 - Defective plain bearing wedge. (United States)


    ... ADMINISTRATION, DEPARTMENT OF TRANSPORTATION RAILROAD FREIGHT CAR SAFETY STANDARDS Freight Car Components Suspension System § 215.113 Defective plain bearing wedge. A railroad may not place or continue in service a car, if a plain bearing wedge on that car is— (a) Missing; (b) Cracked; (c) Broken; or (d) Not...

  4. Characteristics of unilateral tibial plateau fractures among adult patients hospitalized at an orthopaedic trauma centre in China (United States)

    Liu, Yong; Liao, Zhengwen; Shang, Lei; Huang, Wenhua; Zhang, Dawei; Pei, Guoxian


    The aim of this study was to investigate the characteristics of unilateral tibial plateau fractures among hospitalized adult patients in Xijing Hospital, to evaluate the accuracy of Schatzker classification system and AO/OTA classification system to tibial plateau fractures. We retrospectively analysed clinical data on 274 patients admitted to Xijing Hospital between September 2006 and August 2015. The patients’ demographic characteristics, admission periods and seasons, external causes and fracture types were recorded and summarized. Then the characteristics of tibial plateau fractures and the accuracy rate of these two classification systems were analysed. Schatzker type II fractures and AO/OTA type 41-B3 fractures were the most common types. The external causes differed between genders, types of employment, urban-rural residents and both two systems. In addition, some fractures were difficult to classify using Schatzker or AO/OTA classification system. Rural male physical labourers aged between 30–59 years-old were most likely to suffer from unilateral tibial plateau fractures, due to traffic accidents, falls and indoor activity injuries, or falls from height. We should pay more attention to the related people and professions, which contributed to the high occurrence of tibial plateau fractures. Besides that, further improvements are required for both Schatzker and AO/OTA classification systems. PMID:28074894


    Directory of Open Access Journals (Sweden)

    Vijayashankar M


    Full Text Available BACKGROUND Closed Tibial Fractures is one of the commonest injuries among the young and active adults. Intramedullary interlocking nail of these fractures reduces morbidity and provides excellent alignment. OBJECTIVES This study was intended with the objective of assessing the efficacy of intramedullary interlocking nail in the treatment of closed tibial fractures. MATERIALS AND METHODS The study was done at a 300 bed tertiary care hospital situated in the heart of Chennai city where more number of orthopaedic cases are admitted. It was done as a hospital-based prospective study during the period of January 2008 to June 2009, among twenty patients admitted with closed tibial diaphyseal fractures. These patients underwent intramedullary interlocking nailing for fracture fixation in the Department of Orthopaedic Surgery, Southern Railway Headquarters Hospital, Chennai. Results: This study has included 20 patients with closed tibial diaphyseal fractures of which 60% of study participants showed excellent results, 20% with good results, fair in 15%, poor in 5%. The complication rate was a little high in this study, which included 10% malunion, 5% of infection and 5% of restriction of ankle and knee movements. Conclusion: Intramedullary interlocking nail is a reliable, versatile and effective treatment for closed tibial diaphyseal fractures as it minimizes the hospital stay and reduces the economic burden and enhances early return to work.

  6. Ground penetrating radar estimates of permafrost ice wedge depth (United States)

    Parsekian, A.; Slater, L. D.; Nolan, J. T.; Grosse, G.; Walter Anthony, K. M.


    Vertical ground ice wedges associated with polygonal patterning in permafrost environments form due to frost cracking of soils under harsh winter conditions and subsequent infilling of cracks with snow melt water. Ice wedge polygon patterns have implications for lowland geomorphology, hydrology, and vulnerability of permafrost to thaw. Ice wedge dimensions may exceed two meters width at the surface and several meters depth, however few studies have addressed the question of ice wedge depth due to challenges related to measuring the vertical dimension below the ground. Vertical exposures where ice wedges maybe observed are limited to rapidly retreating lake, river, and coastal bluffs. Coring though the ice wedges to determine vertical extent is possible, however that approach is time consuming and labor intensive. Many geophysical investigations have noted signal anomalies related to the presence of ice wedges, but no reliable method for extracting wedge dimensions from geophysical data has been yet proposed. Here we present new evidence that ground penetrating radar (GPR) may be a viable method for estimating ice wedge depth. We present three new perspectives on processing GPR data collected over ice wedges that show considerable promise for use as a fast, cost effective method for evaluating ice wedge depth. Our novel approaches include 1) a simple frequency-domain analysis, 2) an S-transform frequency domain analysis and 3) an analysis of the returned signal power as a radar cross section (RCS) treating subsurface ice wedges as dihedral corner retro-reflectors. Our methods are demonstrated and validated using finite-difference time domain FDTD) GPR forward models of synthetic idealized ice wedges and field data from permafrost sites in Alaska. Our results indicate that frequency domain and signal power data provide information that is easier to extract from raw GPR data than similar information in the time domain. We also show that we can simplify the problem by

  7. Two-dimensional electronic spectroscopy with birefringent wedges

    Energy Technology Data Exchange (ETDEWEB)

    Réhault, Julien; Maiuri, Margherita; Oriana, Aurelio; Cerullo, Giulio [IFN-CNR, Dipartimento di Fisica, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milano (Italy)


    We present a simple experimental setup for performing two-dimensional (2D) electronic spectroscopy in the partially collinear pump-probe geometry. The setup uses a sequence of birefringent wedges to create and delay a pair of phase-locked, collinear pump pulses, with extremely high phase stability and reproducibility. Continuous delay scanning is possible without any active stabilization or position tracking, and allows to record rapidly and easily 2D spectra. The setup works over a broad spectral range from the ultraviolet to the near-IR, it is compatible with few-optical-cycle pulses and can be easily reconfigured to two-colour operation. A simple method for scattering suppression is also introduced. As a proof of principle, we present degenerate and two-color 2D spectra of the light-harvesting complex 1 of purple bacteria.

  8. Finite Element Analysis of Mobile-bearing Unicompartmental Knee Arthroplasty: The Influence of Tibial Component Coronal Alignment

    Institute of Scientific and Technical Information of China (English)

    Guang-Duo Zhu; Wan-Shou Guo; Qi-Dong Zhang; Zhao-Hui Liu; Li-Ming Cheng


    Background:Controversies about the rational positioning of the tibial component in unicompartmental knee arthroplasty (UKA) still exist.Previous finite element (FE) studies were rare,and the results varied.This FE study aimed to analyze the influence of the tibial component coronal alignment on knee biomechanics in mobile-bearing UKA and find a ration range of inclination angles.Methods:A three-dimensional FE model of the intact knee was constructed from image data of one normal subject.A 1000 N compressive load was applied to the intact knee model for validating.Then a set of eleven UKA FE models was developed with the coronal inclination angles of the tibial tray ranging from l0° valgus to 10° varus.Tibial bone stresses and strains,contact pressures and load distribution in all UKA models were calculated and analyzed under the unified loading and boundary conditions.Results:Load distribution,contact pressures,and contact areas in intact knee model were validated.In UKA models,von Mises stress and compressive strain at proximal medial cortical bone increased significantly as the tibial tray was in valgus inclination >4°,which may increase the risk of residual pain.Compressive strains at tibial keel slot were above the high threshold with varus inclination >4°,which may result in greater risk of component migration.Tibial bone resection comer acted as a strain-raiser regardless of the inclination angles.Compressive strains at the resected surface slightly changed with the varying inclinations and were not supposed to induce bone resorption and component loosening.Contact pressures and load percentage in lateral compartment increased with the more varus inclination,which may lead to osteoarthritis progression.Conclusions:Static knee biomechanics after UKA can be greatly affected by tibial component coronal alignment.A range from 4° valgus to 4° varus inclination of tibial component can be recommended in mobile-bearing UKA.

  9. Load along the tibial shaft during activities of daily living. (United States)

    D'Angeli, V; Belvedere, C; Ortolani, M; Giannini, S; Leardini, A


    External load at the tibia during activities of daily living provides baseline measures for the improvement of the design of the bone-implant interface for relevant internal and external prostheses. A motion analysis system was used together with an established protocol with skin markers to estimate three-dimensional forces and moments acting on ten equidistant points along the tibial shaft. Twenty young and able-bodied volunteers were analysed while performing three repetitions of the following tasks: level walking at three different speeds, in a straight-line and with sudden changes of direction to the right and to the left, stair ascending and descending, squatting, rising from a chair and sitting down. Moment and force patterns were normalised to the percentage of body weight per height and body weight, respectively, and then averaged over all subjects for each point, about the three tibial anatomical axes, and for each task. Load patterns were found to be consistent over subjects, but different among the anatomical axes, tasks and points. Generally, moments were higher in the medio/lateral axis and influenced by walking speed. In all five walking tasks and in ascending stairs with alternating feet, the more proximal the point was the smaller the mean moment was. For the remaining tasks the opposite trend was observed. The overall largest value was observed in the medio/lateral direction at the ankle centre in level walking at high speed (9.1% body weight * height on average), nearly three times larger than that of the anterior/posterior axis (2.9) during level walking with a sidestep turn. The present results should be of value also for in-vitro mechanical tests and finite element models. Copyright © 2014 Elsevier Ltd. All rights reserved.

  10. A 2-year prospective study of patient-relevant outcomes in patients operated on for knee osteoarthritis with tibial osteotomy

    Directory of Open Access Journals (Sweden)

    Toksvig-Larsen Sören


    Full Text Available Abstract Background Tibial osteotomy is a treatment for younger and/or physically active patients suffering from uni-compartmental knee osteoarthritis. The open wedge osteotomy by the hemicallotasis technique includes the use of external fixation. The use of external fixation has several advantages, as early mobilization and the opportunity for optimal correction. However, the hemicallotasis technique has also been described as a cumbersome procedure for the patient. The aim of this study was to prospectively evaluate patient-relevant outcomes during the first 2 post-operative years. Especially the treatment period, during which external fixation was used, was closely monitored. Methods In an uncontrolled study, fifty-eight consecutive patients, 30 men and 28 women (mean age 54 years were operated on by the hemicallotasis technique were evaluated with the patient-relevant outcome measure Knee injury and Osteoarthritis Outcome Score (KOOS preoperatively, during the treatment with external fixation, one week after removal of the external fixation, at 6 months, and at one and two years postoperatively. Results At the 2-year postoperative follow-up, all subscales of the KOOS were improved (p Conclusion Tibial osteotomy by the hemicallotasis technique yields large improvement in self-rated pain, function and quality of life, which persists over two years. Surprisingly, large improvements occurred already during the immediate post-operative period when the external fixation was still used.

  11. Tibial bowing in children - what is normal? A radiographic study

    Energy Technology Data Exchange (ETDEWEB)

    Zbinden, Isabella [University of Basel, Department of Radiology, Basel (Switzerland); Rutz, Erich [University Children' s Hospital, Department of Orthopedic Surgery, Basel (Switzerland); Jacobson, Jon A. [University of Michigan, Department of Radiology, Ann Arbor, MI (United States); Magerkurth, Olaf [University Children' s Hospital, Department of Radiology, Basel (Switzerland); Kantonsspital Baden, Department of Radiology, Baden (Switzerland)


    To define osseous landmarks on tibia radiographs in order to establish age-related normal values characterizing physiological tibial bowing in children. Five hundred and twenty-six patients aged 0-17 years with normal radiographs of the lower legs were identified and retrospectively reviewed by two blinded radiologists. In anteroposterior (ap)/lateral (lat)-views, 3 lines defined tibial length and angulation. Line-A connecting proximal to distal corner of tibial metaphysic, lines B and C corresponding to corners of tibial metaphysis. Angle A/B defines proximal, A/C distal tibial-angulation. Tibial curvature is defined by distance of line-D parallel to A and tangential to tibial cortex. Normal values were calculated with linear-regression. Intra-/Interreader agreement were tested with a Bland-Altman-plot. Intrareader-agreement: Reader 1 showed a bias of -0.1, standard-deviation of bias was 1.9 and 95 %-limits-of-agreement -3.9- 3.7. Reader 2: -0.01, 2.4 and -4.7- 4.7. Interreader: 0.2, 1.6 and -2.9- 3.3. Angle-A/B ap was 80-100 , increasing with age (86.5-88); angle-AC ap was 82-107 (96.8-90.5), angle-AB lat was 81-107 (93.0-98.0); angle-AC lat was 76-102 (89.5-86.5); depth of curve ap was 0-11 % (8-3.5) and lat 2-13 %, (8.5-3.5). Age dependent tibial bowing can be assessed with this new measurement system and age-related normal-values characterizing physiological tibial bowing in children is established. (orig.)

  12. Laterally wedged insoles in knee osteoarthritis: do biomechanical effects decline after one month of wear?

    Directory of Open Access Journals (Sweden)

    Bennell Kim L


    Full Text Available Abstract Objective This study aimed to determine whether the effect of laterally wedged insoles on the adduction moment in knee osteoarthritis (OA declined after one month of wear, and whether higher reported use of insoles was associated with a reduced effect on the adduction moment at one month. Methods Twenty people with medial compartment OA underwent gait analysis in their own shoes wearing i no insoles and; ii insoles wedged laterally 5° in random order. Testing occurred at baseline and after one month of use of the insoles. Participants recorded daily use of insoles in a log-book. Outcomes were the first and second peak external knee adduction moment and the adduction angular impulse, compared across conditions and time with repeated measures general linear models. Correlations were obtained between total insole use and change in gait parameters with used insoles at one month, and change scores were compared between high and low users of insoles using general linear models. Results There was a significant main effect for condition, whereby insoles significantly reduced the adduction moment (all p Conclusion Effects of laterally wedged insoles on the adduction moment do not appear to decline after one month of continuous use, suggesting that significant wedge degradation does not occur over the short-term.

  13. PCL tibial avulsion with an associated medial meniscal tear in a child: a case report on diagnosis and management.

    LENUS (Irish Health Repository)


    Posterior cruciate ligament (PCL) injuries from tibial avulsions are rare in the paediatric setting. One would need a high index of suspicion as clinical examination may be difficult, especially in the early period. Magnetic resonance imaging is an excellent diagnostic modality for this condition and other associated injuries within the knee. We report a rare case in which the patient had a PCL avulsion off the tibial insertion site with an associated posterior horn medial meniscal tear off the posterior capsule. He was treated through open reduction and internal fixation of the avulsed fragment with suture repair of the meniscal tear. We emphasize the importance of diagnosing and managing associated intra-articular injuries when dealing with the rare condition of PCL tibial avulsion in the paediatric setting.

  14. Osteoarthritis Imaging by Quantification of Tibial Trabecular Bone

    DEFF Research Database (Denmark)

    Marques, Joselene

    The pathogenesis of osteoarthritis (OA) includes complex events in the whole joint. In this project, we combined machine-learning techniques in a texture analysis framework and evaluated it in a longitudinal study, where magnetic resonance images of knees were used to quantify the tibial trabecular...... bone in both a marker for OA diagnosis and another marker for prediction of tibial cartilage loss. By multiple-instance learning, we also investigated which region of the tibia provided the best prognosis for cartilage loss. The inferior part of the tibial bone was classified as the most relevant...

  15. Suprapatellar Nailing of Tibial Shaft Fractures in Total Knee Arthroplasty. (United States)

    Woyski, Dustin; Emerson, Jason


    Fractures of the tibial shaft in patients with ipsilateral total knee arthroplasty are rare but difficult to treat. Nonoperative treatment of these fractures with casting or bracing limits weight bearing for an extended period and can result in unacceptable malalignment. Operative fixation with plate and screws also limits early weight bearing and requires healing of soft tissue that is of poor quality. The authors present a method of internal fixation that uses a standard intramedullary tibial nail and suprapatellar instrumentation. This method can easily be performed, avoids the tibial baseplate, and does not require alteration of the instrumentation or intramedullary nail.


    Directory of Open Access Journals (Sweden)



    Full Text Available : Tibial plateau fractures are the common injuries that may be associated with poor outcomes and a high rate of complications. The problem rise significantly in high energy trauma and severe soft tissue injuries. Early technique of osteosysnthesis were based on extensive surgical approach. Introduction of minimally invasive plate osteosynthesis using locking compression plate conserves the vascularity of the bone but also leads to the overall improvement in the values of bone healing. MATERIALS AND METHODS: Inclusion criteria for this study were patients of either sex, tibial plateau fractures Schatzker’s Type V and VI, age group 15 to 60 years and compounding upto Gustilo and Anderson’s Grade II and excluded the patients where the compounding was grade III and displacement <2mm. The fractures were treated applying LCP percutaneously either medially or laterally depending on the side of comminution. RESULTS: In our study conducted on 45 patients 4 lost to follow up in first 6 months with displaced tibial plateau overall the functional result using Rasmussen’s criteria was acceptable in all of the cases with an average score of 26.38. All the patients in our series showed union with average time for union being 13.3 weeks. DISCUSSION: Our study confirms that minimally invasive locking compression plate osteosynthesis is a viable alternative as a treatment for open tibial plateau fractures Gustilo and Anderson’s type I and II. The incidence of infection in our study wad 10% which is comparable with most of the series in literature that select the high energy tibial plateau fractures. None of the patients had nonunion only one had delayed union and does not required bone grafting as the metaphyseal area has a good blood supply. There were superficial infection in 4 cases which resolved to the dressing and antibiotic treatment within 3 weeks. The mean range motion at knee joint was 5 degree to 130 degree.(1 CONCLUSION: This paper reports the

  17. Group sequential designs for stepped-wedge cluster randomised trials. (United States)

    Grayling, Michael J; Wason, James Ms; Mander, Adrian P


    The stepped-wedge cluster randomised trial design has received substantial attention in recent years. Although various extensions to the original design have been proposed, no guidance is available on the design of stepped-wedge cluster randomised trials with interim analyses. In an individually randomised trial setting, group sequential methods can provide notable efficiency gains and ethical benefits. We address this by discussing how established group sequential methodology can be adapted for stepped-wedge designs. Utilising the error spending approach to group sequential trial design, we detail the assumptions required for the determination of stepped-wedge cluster randomised trials with interim analyses. We consider early stopping for efficacy, futility, or efficacy and futility. We describe first how this can be done for any specified linear mixed model for data analysis. We then focus on one particular commonly utilised model and, using a recently completed stepped-wedge cluster randomised trial, compare the performance of several designs with interim analyses to the classical stepped-wedge design. Finally, the performance of a quantile substitution procedure for dealing with the case of unknown variance is explored. We demonstrate that the incorporation of early stopping in stepped-wedge cluster randomised trial designs could reduce the expected sample size under the null and alternative hypotheses by up to 31% and 22%, respectively, with no cost to the trial's type-I and type-II error rates. The use of restricted error maximum likelihood estimation was found to be more important than quantile substitution for controlling the type-I error rate. The addition of interim analyses into stepped-wedge cluster randomised trials could help guard against time-consuming trials conducted on poor performing treatments and also help expedite the implementation of efficacious treatments. In future, trialists should consider incorporating early stopping of some kind into

  18. Stable and Critical Noncohesive Coulomb Wedges: Exact Elastic Solutions (United States)

    Wang, K.; Hu, Y.


    The theory of critically tapered Coulomb wedge has been successfully applied to model active fold-and-thrust belts or submarine accretionary prisms. Brittle mountain building is episodic in nature, controlled by changes in basal friction, erosion and sedimentation, and hydrogeology. Sediment accretion may be modulated by great subduction earthquakes. Between deformation episodes and/or during transition between compressional and extensional tectonics, the Coulomb wedges are stable (i.e., supercritical), to which the critical taper theory does not apply. In this work, we provide an exact elastic solution for stable wedges based on Airy stress functions. The stress equilibrium equation and definition of basal friction and basal and internal pore fluid pressure ratios are exactly the same as those used for Dahlen's [1984] exact solution for critical noncohesive Coulomb wedges, but internal friction μ becomes irrelevant. Given elastic - perfectly Coulomb-plastic rheology, for stresses in a wedge on the verge of Coulomb failure there must co-exist a critical taper solution involving μ and a unique equivalent elastic solution not involving μ . Our elastic solution precisely reduces to Dahlen's critical taper solution for critical conditions. For stable conditions, normal stress perpendicular to the surface slope σ z and shear stress τ xz are identical with those in a critical taper, but the slope-parallel normal stress is different. The elastic solution is also generally applicable to purely elastic wedges and useful for modeling geodetic observations. A stable noncohesive Coulomb wedge differs from a general elastic wedge in that its upper and lower surfaces stay at zero curvature during loading. Dahlen, F.A. (1984), Noncohesive critical Coulomb wedges: An exact solution, JGR, 89, 10,125-10,133.

  19. Total knee arthroplasty and fractures of the tibial plateau (United States)

    Softness, Kenneth A; Murray, Ryan S; Evans, Brian G


    Tibial plateau fractures are common injuries that occur in a bimodal age distribution. While there are various treatment options for displaced tibial plateau fractures, the standard of care is open reduction and internal fixation (ORIF). In physiologically young patients with higher demand and better bone quality, ORIF is the preferred method of treating these fractures. However, future total knee arthroplasty (TKA) is a consideration in these patients as post-traumatic osteoarthritis is a common long-term complication of tibial plateau fractures. In older, lower demand patients, ORIF is potentially less favorable for a variety of reasons, namely fixation failure and the need for delayed weight bearing. In some of these patients, TKA can be considered as primary mode of treatment. This paper will review the literature surrounding TKA as both primary treatment and as a salvage measure in patients with fractures of the tibial plateau. The outcomes, complications, techniques and surgical challenges are also discussed.

  20. Tibial tubercle osteotomy for patello-femoral joint disorders. (United States)

    Hall, Matthew J; Mandalia, Vipul I


    Tibial tubercle osteotomy has a long history in the management of patella instability and patello-femoral arthritis. This review aims to provide a comprehensive review of the literature describing the biomechanics of the patello-femoral joint and the rationale behind the use of the tibial tubercle osteotomy in modern day practice. Several different tibial tubercle osteotomies are available and we aim to detail the concepts behind their use and the subsequent clinical results. With continued developments of chondrocyte implantation techniques, the potential to fill defects on the chondral surface of either the patella or trochlea in conjunction with a tibial tubercle osteotomy may well become more commonplace in a group that is commonly young and difficult to manage. Level of evidence III.

  1. PHILOS humerus plate for a distal tibial fracture. (United States)

    Twaij, Haider; Damany, Dev


    This report discusses the use of an alternative implant in the emergency fixation of a distal tibial fracture. We planned to fix the shear-type medial malleolar fracture in a closed, tri-malleolar fracture with a locking distal tibial plate. Intra-operatively, it was noted that the required plate was unavailable. A PHILOS humeral plate seemed to fit the contours of the distal tibia. The broad end of the PHILOS, when placed distally, gave options to place locking screws in the medial malleolar fragment. The fracture was stable after fixation. The patient made a full post-operative recovery and follow-up at 4 months was satisfactory. Despite adequate planning, there will be instances where one has to improvise. An understanding of the principles of fracture management can aid in finding solutions. PHILOS humeral plate may be used to stabilize a distal tibial fracture if an appropriate distal tibial locking plate is not available.

  2. Safe surgical technique: intramedullary nail fixation of tibial shaft fractures. (United States)

    Zelle, Boris A; Boni, Guilherme


    Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Recently, suprapatellar nailing in the semi-extended position has been suggested as a safe and effective surgical technique. Numerous reduction techiques are available to achieve an anatomic fracture alignment and the treating surgeon should be familiar with these maneuvers. Open reduction techniques should be considered if anatomic fracture alignment cannot be achieved by closed means. Favorable union rates above 90 % can be achieved by both reamed and unreamed intramedullary nailing. Despite favorable union rates, patients continue to have functional long-term impairments. In particular, anterior knee pain remains a common complaint following intramedullary tibial nailing. Malrotation remains a commonly reported complication after tibial nailing. The effect of postoperative tibial malalignment on the clinical and radiographic outcome requires further investigation.

  3. Complex interactions between diapirs and 4-D subduction driven mantle wedge circulation. (United States)

    Sylvia, R. T.; Kincaid, C. R.


    Analogue laboratory experiments generate 4-D flow of mantle wedge fluid and capture the evolution of buoyant mesoscale diapirs. The mantle is modeled with viscous glucose syrup with an Arrhenius type temperature dependent viscosity. To characterize diapir evolution we experiment with a variety of fluids injected from multiple point sources. Diapirs interact with kinematically induced flow fields forced by subducting plate motions replicating a range of styles observed in dynamic subduction models (e.g., rollback, steepening, gaps). Data is collected using high definition timelapse photography and quantified using image velocimetry techniques. While many studies assume direct vertical connections between the volcanic arc and the deeper mantle source region, our experiments demonstrate the difficulty of creating near vertical conduits. Results highlight extreme curvature of diapir rise paths. Trench-normal deflection occurs as diapirs are advected downward away from the trench before ascending into wedge apex directed return flow. Trench parallel deflections up to 75% of trench length are seen in all cases, exacerbated by complex geometry and rollback motion. Interdiapir interaction is also important; upwellings with similar trajectory coalesce and rapidly accelerate. Moreover, we observe a new mode of interaction whereby recycled diapir material is drawn down along the slab surface and then initiates rapid fluid migration updip along the slab-wedge interface. Variability in trajectory and residence time leads to complex petrologic inferences. Material from disparate source regions can surface at the same location, mix in the wedge, or become fully entrained in creeping flow adding heterogeneity to the mantle. Active diapirism or any other vertical fluid flux mechanism employing rheological weakening lowers viscosity in the recycling mantle wedge affecting both solid and fluid flow characteristics. Many interesting and insightful results have been presented based

  4. The medial tibial stress syndrome. A cause of shin splints. (United States)

    Mubarak, S J; Gould, R N; Lee, Y F; Schmidt, D A; Hargens, A R


    The medial tibial stress syndrome is a symptom complex seen in athletes who complain of exercise-induced pain along the distal posterior-medial aspect of the tibia. Intramuscular pressures within the posterior compartments of the leg were measured in 12 patients with this disorder. These pressures were not elevated and therefore this syndrome is a not a compartment syndrome. Available information suggests that the medial tibial stress syndrome most likely represents a periostitis at this location of the leg.

  5. Patient-specific instrumentation improves tibial component rotation in TKA. (United States)

    Silva, Alcindo; Sampaio, Ricardo; Pinto, Elisabete


    To compare the femoral and tibial components rotational alignment in total knee arthroplasty (TKA) performed either with conventional or with patient-specific instrumentation. Forty-five patients underwent primary TKA and were prospectively randomized into two groups: 22 patients into the conventional instrumentation group (group A) and 23 patients into the Signature™ patient-specific instrumentation group (group B). All patients underwent computed tomography of the operated knee in the first week after surgery to measure the components rotation. The femoral component rotation was 0.0° (-0.25, 1.0) in group A, and 0.0° (0.0, 1.0) in group B. The tibial component rotation was -16.0° (-18.5, 11.8) in group A, and -16.0° (-19.0, -14.0) in group B. There were no significant differences between the two groups in tibial and femoral components rotation. The difference between the tibial component rotation and the neutral tibial rotation was similar in both groups [2.0° (-0.5, 6.3) in group A and 2.0° (-1.0, 4.0) in group B], but the dispersion around the median was different between the two groups. The amplitude of the difference between tibial rotation and neutral position was 27° (-13, 14) in group A and 9° (-3, 6) in group B. There is a smaller chance of internal malrotation of the tibial component with the Signature™ patient-specific instrumentation system, with less dispersion and amplitude of the tibial component rotation around the neutral position. II.

  6. Physeal growth arrest after tibial lengthening in achondroplasia (United States)


    Background and purpose Bilateral tibial lengthening has become one of the standard treatments for upper segment-lower segment disproportion and to improve quality of life in achondroplasia. We determined the effect of tibial lengthening on the tibial physis and compared tibial growth that occurred at the physis with that in non-operated patients with acondroplasia. Methods We performed a retrospective analysis of serial radiographs until skeletal maturity in 23 achondroplasia patients who underwent bilateral tibial lengthening before skeletal maturity (lengthening group L) and 12 achondroplasia patients of similar height and age who did not undergo tibial lengthening (control group C). The mean amount of lengthening of tibia in group L was 9.2 cm (lengthening percentage: 60%) and the mean age at the time of lengthening was 8.2 years. The mean duration of follow-up was 9.8 years. Results Skeletal maturity (fusion of physis) occurred at 15.2 years in group L and at 16.0 years in group C. The actual length of tibia (without distraction) at skeletal maturity was 238 mm in group L and 277 mm in group C (p = 0.03). The mean growth rates showed a decrease in group L relative to group C from about 2 years after surgery. Physeal closure was most pronounced on the anterolateral proximal tibial physis, with relative preservation of the distal physis. Interpretation Our findings indicate that physeal growth rate can be disturbed after tibial lengthening in achondroplasia, and a close watch should be kept for such an occurrence—especially when lengthening of more than 50% is attempted. PMID:22489887

  7. Displaced tibial shaft fractures treated with ASIF compression internal fixation

    DEFF Research Database (Denmark)

    Gebuhr, Peter Henrik; Larsen, T K; Petersen, O C


    Fifty-one tibial shaft fractures treated by ASIF compression osteosynthesis were seen at follow-up at a median time of 46 weeks after injury. Twenty-four were open fractures and the patients received prophylactic antibiotics. The median stay in hospital was 15 days for open fractures and 6 days...... for closed fractures. There were complications in 26 cases, with deep infection in 9 cases. At present we cannot advocate the use of ASIF compression osteosynthesis for displaced tibial fractures....

  8. Flow braking and the substorm current wedge (United States)

    Birn, J.; Hesse, M.; Haerendel, G.; Baumjohann, W.; Shiokawa, K.


    Recent models of magnetotail activity have associated the braking of earthward flow with dipolarization and the reduction and diversion of cross-tail current, that is, the signatures of the substorm current wedge. Estimates of the magnitude of the diverted current by Haerendel [1992] and Shiokawa et al. [1997, 1998] tend to be lower than results from computer simulations of magnetotail reconnection and tail collapse [Birn and Hesse, 1996], despite similar underlying models. An analysis of the differences between these estimates on the basis of the simulations gives a more refined picture of the diversion of perpendicular into parallel currents. The inertial currents considered by Haerendel [1992] and Shiokawa et al. [1997] contribute to the initial current reduction and diversion, but the dominant and more permanent contribution stems from the pressure gradient terms, which change in connection with the field collapse and distortion. The major effect results from pressure gradients in the z direction, rather than from the azimuthal gradients [Shiokawa et al., 1998], combined with changes in By and Bx. The reduction of the current density near the equatorial plane is associated with a reduction of the curvature drift which overcompensates changes of the magnetization current and of the gradient B drift current. In contrast to the inertial current effects, the pressure gradient effects persist even after the burst of earthward flow ends.

  9. Irreducible Salter Harris type II distal tibial physeal fracture secondary to interposition of the posterior tibial tendon: a case report. (United States)

    Soulier, Robert; Fallat, Lawrence


    Pediatric distal tibial fractures generally occur without significant long-term sequelae, and patients are commonly able to return to their preinjury activities after proper management. The literature reports excellent outcomes after anatomical reduction of distal tibial and ankle physeal fractures with closed or open treatment. Treatment options include simple immobilization of nondisplaced fractures, and closed or open reduction for restoration of anatomic alignment of displaced fractures. Soft tissue interposition within the fracture can threaten successful closed reduction, and may warrant open management if closed reduction fails to produce a satisfactory result. Despite the documented possibility of soft tissue interposition preventing closed reduction of pediatric ankle fractures, there is a paucity of literature reporting this complication. We report a unique case of an irreducible Salter-Harris type II distal tibial physeal fracture secondary to interposition of the posterior tibial tendon. Copyright 2010 American College of Foot and Ankle Surgeons. Published by Elsevier Inc. All rights reserved.

  10. Precision of tibial cartilage morphometry with a coronal water-excitation MR sequence

    Energy Technology Data Exchange (ETDEWEB)

    Hyhlik-Duerr, A. [Musculoskeletal Research Group, Institute of Anatomy, Ludwig-Maximilians-Universitaet, Muenchen (Germany); Klinik fuer Orthopaedie und Sportorthopaedie der Technischen Universitaet, Muenchen (Germany); Faber, S.; Reiser, M. [Klinik fuer Orthopaedie und Sportorthopaedie der Technischen Universitaet, Muenchen (Germany); Burgkart, R. [Institut fuer Medizinische Informatik und Systemforschung (MEDIS), GSF-Forschungszentrum fuer Umwelt und Gesundheit, Neuherberg, Oberschleissheim (Germany); Stammberger, T.; Englmeier, K.H. [Institut fuer Medizinische Informationsverarbeitung, Biometrie und Epidemiologie, Klinikum Grosshadern, Marchioninistrasse 15, D-81377 Munich (Germany); Maag, K.P. [Institut fuer Radiologische Diagnostik, Klinikum der Ludwig-Maximilians-Universitaet, Muenchen (Germany); Eckstein, F. [Musculoskeletal Research Group, Institute of Anatomy, Ludwig-Maximilians-Universitaet, Muenchen (Germany)


    The aim of this study was to analyze the precision of tibial cartilage morphometry, by using a fast, coronal water-excitation sequence with high spatial resolution, to compare the reproducibility of 3D thickness vs volume estimates, and to test the technique in patients with severe osteoarthritis. The tibiae of 8 healthy volunteers and 3 patients selected for total knee arthroplasty were imaged repeatedly with a water-excitation sequence (image time 6 h 19 min, resolution 1.2 x 0.31 x 0.31 mm{sup 3}), with the knee being repositioned between each replicate acquisition. After 3D reconstruction, the cartilage volume, the mean, and the maximal tibial cartilage thickness were determined by 3D Euclidean distance transformation. In the volunteers, the precision of the volume measurements was 2.3 % (CV%) in the medial and 2.6 % in the lateral tibia. The reproducibility of the mean cartilage thickness was similar (2.6 and 2.5 %, respectively), and that of the maximal thickness lower (6.5 and 4.4 %). The patients showed a considerable reduction in volume and thickness, the precision being comparable with that in the volunteers. We find that, using a new imaging protocol and computational algorithm, it is possible to determine tibial cartilage morphometry with high precision in healthy individuals as well as in patients with osteoarthritis. (orig.)

  11. Casimir Effect for a Semitransparent Wedge and an Annular Piston

    CERN Document Server

    Milton, Kimball A; Kirsten, Klaus


    We consider the Casimir energy due to a massless scalar field in a geometry of an infinite wedge closed by a Dirichlet circular cylinder, where the wedge is formed by $\\delta$-function potentials, so-called semitransparent boundaries. A finite expression for the Casimir energy corresponding to the arc and the presence of both semitransparent potentials is obtained, from which the torque on the sidewalls can be derived. The most interesting part of the calculation is the nontrivial nature of the angular mode functions. Numerical results are obtained which are closely analogous to those recently found for a magnetodielectric wedge, with the same speed of light on both sides of the wedge boundaries. Alternative methods are developed for annular regions with radial semitransparent potentials, based on reduced Green's functions for the angular dependence, which allows calculations using the multiple-scattering formalism. Numerical results corresponding to the torque on the radial plates are likewise computed, whic...

  12. Electrodynamic Casimir effect in a medium-filled wedge. (United States)

    Brevik, Iver; Ellingsen, Simen A; Milton, Kimball A


    We re-examine the electrodynamic Casimir effect in a wedge defined by two perfect conductors making dihedral angle alpha=pi/p. This system is analogous to the system defined by a cosmic string. We consider the wedge region as filled with an azimuthally symmetric material, with permittivity and permeability epsilon1, micro1 for distance from the axis ra. The results are closely related to those for a circular-cylindrical geometry, but with noninteger azimuthal quantum number mp. Apart from a zero-mode divergence, which may be removed by choosing periodic boundary conditions on the wedge, and may be made finite if dispersion is included, we obtain finite results for the free energy corresponding to changes in a for the case when the speed of light is the same inside and outside the radius a , and for weak coupling, |epsilon1-epsilon2|cosmic string, situated along the cusp line of the pre-existing wedge.


    Institute of Scientific and Technical Information of China (English)

    FANG Qi-hong; LIU You-wen


    The system of a wedge disclination dipole interacting with an internal crack was investigated. By using the complex variable method, the closed form solutions of complex potentials to this problem were presented. The analytic formulae of the physics variables, such as stress intensity factors at the tips of the crack produced by the wedge disclination dipole and the image force acting on disclination dipole center were obtained.The influence of the orientation, the dipole arm and the location of the disclination dipole on the stress intensity factors was discussed in detail. Furthermore, the equilibrium position of the wedge disclination dipole was also examined. It is shown that the shielding or antishielding effect of the wedge disclination to the stress intensity factors is significant when the disclination dipole moves to the crack tips.

  14. Reactive Atom Plasma Processing of Slumped Glass Wedges Project (United States)

    National Aeronautics and Space Administration — The Reactive Atom Plasma (RAPTM) process will be evaluated as a rapid and practical method for fabricating precision wedges in glass sheets. The glass sheets are to...

  15. CHIRP seismic reflection study of falling-stage (forced regressive) sediment wedges on the New Jersey outer continental shelf (United States)

    Santra, M.; Goff, J.; Ron, S.; Austin, J.


    High-resolution (1-12 kHz), deep-towed and hull-mounted CHIRP seismic data were collected on the New Jersey outer shelf in 2001, 2002 and 2006 as part of Office of Naval Research-funded projects. These data have imaged two well-developed, offlapping sedimentary wedges (named outer-shelf wedge and deep-shelf wedge) that are now postulated to have developed on the falling-stage limb of the last glacial cycle, during some time prior to the Last Glacial Maximum (20-22 kyrs BP). These wedges formed atop the high-amplitude, regional R horizon, a complex erosional unconformity that formed about 40,000 years ago. The outer shelf wedge is also characterized in part by an enigmatic, erose boundary separating layered horizons below from a mostly transparent section above. New Jersey shelf wedges appear analogous to forced-regressive units imaged on the Rhone shelf edge, as well as Eocene sections documented from seismic-scale outcrops on Spitsbergen Island. These examples can reach thicknesses up to 100 m on the shelf edge and uppermost slope, but usually thin rapidly downslope. Such wedges represent one of two documented mechanisms involving sand transport across a shelf margin into deeper water settings, the other being a canyonized shelf-edge. Our study will includes analysis of the CHIRP data and, if available, additional ground truth provided by short cores collected in summer 2007 at numerous intra-wedge stratigraphic horizons. Our goals are to understand the external and internal geometry of the wedges and sediment pathways across the paleo-shelf. These data should allow us to characterize margin segments that build during sea-level fall by slope-apron accretion rather than by the formation of channel-levee complexes. The literature is heavily weighted by the latter and their associated canyon systems, but information on shelf-edge attached slope aprons and how they contribute to deep-water sedimentation, and in particular the delivery of clean sands to slope settings

  16. Optical refractometry based on Fresnel diffraction from a phase wedge. (United States)

    Tavassoly, M Taghi; Saber, Ahad


    A method that utilizes the Fresnel diffraction of light from the phase step formed by a transparent wedge is introduced for measuring the refractive indices of transparent solids, liquids, and solutions. It is shown that, as a transparent wedge of small apex angle is illuminated perpendicular to its surface by a monochromatic parallel beam of light, the Fresnel fringes, caused by abrupt change in refractive index at the wedge lateral boundary, are formed on a screen held perpendicular to the beam propagation direction. The visibility of the fringes varies periodically between zero and 1 in the direction normal to the wedge apex. For a known or measured apex angle, the wedge refractive index is obtained by measuring the period length by a CCD. To measure the refractive index of a transparent liquid or solution, the wedge is installed in a transparent rectangle cell containing the sample. Then, the cell is illuminated perpendicularly and the visibility period is measured. By using modest optics, one can measure the refractive index at a relative uncertainty level of 10(-5). There is no limitation on the refractive index range. The method can be applied easily with no mechanical manipulation. The measuring apparatus can be very compact with low mechanical and optical noises.

  17. Anatomical variation of posterior slope of tibial plateau in adult Eastern Indian population. (United States)

    Medda, Shyamalendu; Kundu, Rajib; Sengupta, Sohini; Pal, Ananda Kisor


    Upper surface of the proximal tibial end, tibial plateau, has a slope directed posteroinferiorly relative to the long axis of the middle of the shaft. It has important consideration in surgeries such as knee arthroplasty, high tibial osteotomy, and medical imaging of the knee joint. The aim of the present study was to estimate the tibial plateau angle (TPA) by plain radiograph in the adult Eastern Indian population as during literature review, we were unable to find any study, except one (without specific reference axis), on this variable among the Indian population. A sample was taken from adult patients attending the outpatient department of orthopedics of the institute with minor knee problems. Measurement of the TPA was done in the true lateral radiographs of the knee joints of the selected subjects by a standardized method. TPA varied widely from 6° to 24°, with the mean ± standard deviation value 13.6° ±3.5°. Student's unpaired t-test revealed no significant difference of TPA between left and right knees, both in male (P = 0.748) and female (P = 0.917) separately and in the entire study population irrespective of gender (P = 0.768). Comparison of TPA between male (13.3° ± 3.3°) and female (13.9° ± 3.4°) by Student's unpaired t-test showed no sexual dimorphism (P = 0.248). There were poor correlations of TPA with age and body mass index. The present study described the variations of the TPA in the adult Eastern Indian population (range 6°-24°, mean ± SD 13.6° ± 3.5°, no laterality, no sexual dimorphism, poor correlation with age and BMI). Knowledge of this study could be used in different orthopedic surgeries and imaging technique in or around the knee joint.

  18. Wedge excision of the nail fold in the treatment of ingrown toenail. (United States)

    Persichetti, Paolo; Simone, Pierfranco; Li Vecchi, Giancarlo; Di Lella, Filippo; Cagli, Barbara; Marangi, Giovanni Francesco


    Many treatment modalities of ingrown toenail are reported in the literature, often associated with unacceptably high recurrence rate. The authors present their technique, which aims at reducing the convexity of the nail fold. After complete removal of the nail plate and accurate debridement of the granulomatous tissue, a wedge-shaped ellipsis of skin and subcutaneous tissue, lateral to the affected nail fold, is removed. Approximation of the margins of the resulting defect determines eversion of the nail fold. One hundred twenty ingrown toenails were treated with the wedge excision of the nail fold at the outpatient clinic of the department of plastic surgery, Campus Bio-Medico University, Rome, Italy, between January 1998 and January 2002. Six recurrences were observed. In addition to the high cure rate, short postoperative pain duration, and morbidity as well as low risk of postoperative infection, the remarkable esthetic results achievable with this method are indicated.

  19. Effects of laterally wedged insoles on symptoms and disease progression in medial knee osteoarthritis: a protocol for a randomised, double-blind, placebo controlled trial

    Directory of Open Access Journals (Sweden)

    Osborne Richard


    Full Text Available Abstract Background Whilst laterally wedged insoles, worn inside the shoes, are advocated as a simple, inexpensive, non-toxic self-administered intervention for knee osteoarthritis (OA, there is currently limited evidence to support their use. The aim of this randomised, double-blind controlled trial is to determine whether laterally wedges insoles lead to greater improvements in knee pain, physical function and health-related quality of life, and slower structural disease progression as well as being more cost-effective, than control flat insoles in people with medial knee OA. Methods/Design Two hundred participants with painful radiographic medial knee OA and varus malalignment will be recruited from the community and randomly allocated to lateral wedge or control insole groups using concealed allocation. Participants will be blinded as to which insole is considered therapeutic. Blinded follow up assessment will be conducted at 12 months after randomisation. The outcome measures are valid and reliable measures recommended for OA clinical trials. Questionnaires will assess changes in pain, physical function and health-related quality-of-life. Magnetic resonance imaging will measure changes in tibial cartilage volume. To evaluate cost-effectiveness, participants will record the use of all health-related treatments in a log-book returned to the assessor on a monthly basis. To test the effect of the intervention using an intention-to-treat analysis, linear regression modelling will be applied adjusting for baseline outcome values and other demographic characteristics. Discussion Results from this trial will contribute to the evidence regarding the effectiveness of laterally wedged insoles for the management of medial knee OA. Trial registration ACTR12605000503628; NCT00415259.

  20. One-way successive plate cross wedge rolling machine

    Institute of Scientific and Technical Information of China (English)


    In our last paper(Sci China Ser E-Tech Sci,2009,52(11):3117-3121) we designed the precision forming machine with rolling plate CWR(cross wedge rolling).This kind of machine colligates the advantages of high rigidity and small floor space for roller CWR machine and those of simple die manufacture and high precision for plate CWR machine.At the same time,it abandons the shortcomings of complex die manufacture and poor precision for roller CWR machine,and those of poor rigidity and large floor space for plate CWR machine.During rolling,the upper and lower rolling plates of the machine make reciprocating slide toward or away from each other,so the inertial forces should be overcome,which will cause great energy loss,besides,large floor space is needed when the rolled workpiece is large.In order to solve the above problems,this paper presents the one-way successive plate CWR machine,whose rolling plates need not make reciprocating slide.Hence,it has high energy utilization efficiency and production efficiency.Furthermore,the roll scale can be removed automatically.In particular,the machine can produce large axisymmetrical workpieces.

  1. Hydrodynamic controls on oxygen dynamics in a riverine salt wedge estuary, the Yarra River estuary, Australia (United States)

    Bruce, L. C.; Cook, P. L. M.; Teakle, I.; Hipsey, M. R.


    Oxygen depletion in coastal and estuarine waters has been increasing rapidly around the globe over the past several decades, leading to decline in water quality and ecological health. In this study we apply a numerical model to understand how salt wedge dynamics, changes in river flow and temperature together control oxygen depletion in a micro-tidal riverine estuary, the Yarra River estuary, Australia. Coupled physical-biogeochemical models have been previously applied to study how hydrodynamics impact upon seasonal hypoxia; however, their application to relatively shallow, narrow riverine estuaries with highly transient patterns of river inputs and sporadic periods of oxygen depletion has remained challenging, largely due to difficulty in accurately simulating salt wedge dynamics in morphologically complex areas. In this study we overcome this issue through application of a flexible mesh 3-D hydrodynamic-biogeochemical model in order to predict the extent of salt wedge intrusion and consequent patterns of oxygen depletion. The extent of the salt wedge responded quickly to the sporadic riverine flows, with the strength of stratification and vertical density gradients heavily influenced by morphological features corresponding to shallow points in regions of tight curvature ("horseshoe" bends). The spatiotemporal patterns of stratification led to the emergence of two "hot spots" of anoxia, the first downstream of a shallow region of tight curvature and the second downstream of a sill. Whilst these areas corresponded to regions of intense stratification, it was found that antecedent conditions related to the placement of the salt wedge played a major role in the recovery of anoxic regions following episodic high flow events. Furthermore, whilst a threshold salt wedge intrusion was a requirement for oxygen depletion, analysis of the results allowed us to quantify the effect of temperature in determining the overall severity and extent of hypoxia and anoxia. Climate

  2. Observation of long-term results of total knee arthroplasty after failed high tibial osteotomy%胫骨高位截骨术失败后行全膝关节假体置换术的长期疗效观察

    Institute of Scientific and Technical Information of China (English)

    郭林; 杨柳; Jean Louis Briard; 段小军; 陈光兴; 张颖


    Objective To evaluate the long-term clinical result and operating techniques of total knee arthroplasty(TKA) after failed high tibial osteetomy (HTO). Methods There were 18 patients (19 knees) undergone TKA from March 1990 to June 1992 after failed HTO in Center Medico-Chirurgical du Cedre. All patients had severe medial and lateral compartmental degeneration, and four patients had moderate degree of bone loss of lateral plateau. All patients were evaluated with postoperative roentgeno-gram and Knee Society Scoring System (KSS). X-ray was used to measure hip knee ankle angle (HKA), α angle, β angle, index of patella AP/AT and pente de tibial (PDT). Results Tibal tubercle osteoto-my and medial translation were done in 11 knees because of severe valgus and lateral subluxation of patel-la during TKA. Partial restrained knee prosthesises were put into five knees because of poor soft tissue condition or unbalance of collateral ligaments. Of all, two patients died and the other 16 patients were successfully followed up, which showed severe polyethylene wear in seven knees at follow-up, with no re-vision for mild symptom. The average KSS score was 147.2 points, with excellence rate of 82%. Con-dusions TKA after HTO has good therapeutic results. Patellofemoral malalignment and severe valgus deformity are commonly seen, when tibial tubercle osteotomy combined with medial translation may be needed. Severe valgus deformity of knee causes difficulties to ligament balance and tibial osteotomy, so,implantation of knee prosthesises with higher restriction is needed.%目的 针对胫骨高位截骨术(high tibial osteotomy,HTO)失败后行全膝人工关节置换术(total knee arthmplasty,TKA)进行长期疗效观察,分析其远期临床疗效及术中注意事项.方法 选择法国Medico-Chirurgical du Cedre中心1990年3月-1992年6月18例(19膝)HTO术后失败的患者并行TKA治疗.所有关节均有内外侧间室退变,4例伴有外侧胫骨平台中度骨缺损.采

  3. Transferring motor branches from proximal tibial nerve for treatment of high fibular nerve injuries: an anatomical study%胫神经肌支转位治疗高位腓总神经损伤的解剖学研究

    Institute of Scientific and Technical Information of China (English)

    陈维波; 缪道一


    Objective To observe the anatomy of proximal tibial nerve, so as to assess the feasibility of transferring motor branches from proximal tibial nerve for treatment of the high fibular nerve or long-segment injuries. Methods Totally 23 sides of lower limbs from 12 adult cadavers were included in the present study. The branching pattern, length, diameter of motor branches of the tibial nerve in the proximal leg, location of original point relative to fibular head level and the distance from original point to the fibular neck were examined. Intraneural dissection from the bifurcation of the common fibular nerve to the proximal (deep fibular nerve and superficial fibular nerve) was performed, and then the maximum dissected length and the diameter of deep fibular nerves were observed. The deep fibular nerve was severed at the top site and simulating transfer was performed; the feasibility of suturing the motor branches from proximal tibial nerve and the deep fibular nerve was assessed. Results There were three main motor branches at the proximal leg, including the branches to the lateral and medial head of the gastrocnemius and to the soleus muscle, with the length being (36. 3 ± 9. 6) mm, (44. 7±8. 6) mm and (53. 2 ± 9. 9) mm, respectively. The maximum length of intraneural dissection of the common fibular nerve was (59. 3 ± 7. 2) mm. After dissection, the branches to the soleus muscle and the lateral head of the gastrocnemius were long enough for direct nerve suture with the deep fibular division in all cadavers without tension. The branches to the medial head of the gastrocnemius were long enough for nerve suture in 21 sides (91. 3%). Conclusion After intraneural dissection of the common fibular nerve, the motor branches from proximal tibial nerve can be transferred to restore the deep fibular nerve for treating high fibular nerve injuries. The branch to the soleus muscle is the best choice considering its length and diameter.%目的 对近端胫神经的肌支

  4. Measured Two-Dimensional Ice-Wedge Polygon Thermal Dynamics (United States)

    Cable, William; Romanovsky, Vladimir; Busey, Robert


    Ice-wedge polygons are perhaps the most dominant permafrost related features in the arctic landscape. The microtopography of these features, that includes rims, troughs, and high and low polygon centers, alters the local hydrology, as water tends to collect in the low areas. During winter, wind redistribution of snow leads to an increased snowpack depth in the low areas, while the slightly higher areas often have very thin snow cover, leading to differences across the landscape in vegetation communities and soil moisture between higher and lower areas. These differences in local surface conditions lead to spatial variability of the ground thermal regime in the different microtopographic areas and between different types of ice-wedge polygons. To study these features in depth, we established temperature transects across four different types of ice-wedge polygons near Barrow, Alaska. The transects were composed of five vertical array thermistor probes (VATP) beginning in the center of each polygon and extending through the trough to the rim of the adjacent polygon. Each VATP had 16 thermistors from the surface to a depth of 1.5 m. In addition to these 80 subsurface temperature measurement points per polygon, soil moisture, thermal conductivity, heat flux, and snow depth were all measured in multiple locations for each polygon. Above ground, a full suite of micrometeorological instrumentation was present at each polygon. Data from these sites has been collected continuously for the last three years. We found snow cover, timing and depth, and active layer soil moisture to be major controlling factors in the observed thermal regimes. In troughs and in the centers of low-center polygons, the combined effect of typically saturated soils and increased snow accumulation resulted in the highest mean annual ground temperatures (MAGT). Additionally, these areas were the last part of the polygon to refreeze during the winter. However, increased active layer thickness was not

  5. Outcome of limb reconstruction system in open tibial diaphyseal fractures

    Directory of Open Access Journals (Sweden)

    Anand Ajmera


    Full Text Available Background: Management of open tibial diaphyseal fractures with bone loss is a matter of debate. The treatment options range from external fixators, nailing, ring fixators or grafting with or without plastic reconstruction. All the procedures have their own set of complications, like acute docking problems, shortening, difficulty in soft tissue management, chronic infection, increased morbidity, multiple surgeries, longer hospital stay, mal union, nonunion and higher patient dissatisfaction. We evaluated the outcome of the limb reconstruction system (LRS in the treatment of open fractures of tibial diaphysis with bone loss as a definative mode of treatment to achieve union, as well as limb lengthening, simultaneously. Materials and Methods: Thirty open fractures of tibial diaphysis with bone loss of at least 4 cm or more with a mean age 32.5 years were treated by using the LRS after debridement. Distraction osteogenesis at rate of 1 mm/day was done away from the fracture site to maintain the limb length. On the approximation of fracture ends, the dynamized LRS was left for further 15-20 weeks and patient was mobilized with weight bearing to achieve union. Functional assessment was done by Association for the Study and Application of the Methods of Illizarov (ASAMI criteria. Results: Mean followup period was 15 months. The mean bone loss was 5.5 cm (range 4-9 cm. The mean duration of bone transport was 13 weeks (range 8-30 weeks with a mean time for LRS in place was 44 weeks (range 24-51 weeks. The mean implant index was 56.4 days/cm. Mean union time was 52 weeks (range 31-60 weeks with mean union index of 74.5 days/cm. Bony results as per the ASAMI scoring were excellent in 76% (19/25, good in 12% (3/25 and fair in 4% (1/25 with union in all except 2 patients, which showed poor results (8% with only 2 patients having leg length discrepancy more than 2.5 cm. Functional results were excellent in 84% (21/25, good in 8% (2/25, fair in 8% (2/25. Pin

  6. Coulomb theory applied to accretionary and nonaccretionary wedges: Possible causes for tectonic erosion and/or frontal accretion (United States)

    Lallemand, Serge E.; Schnürle, Philippe; Malavieille, Jacques


    Based on observations from both modem convergent margins and sandbox modeling, we examine the possible conditions favoring frontal accretion and/or frontal and basal tectonic erosion. Mean characteristic parameters (μ, μ*b and λ) are used to discuss the mechanical stability of 28 transects across the frontal part of convergent margins where the Coulomb theory is applicable. Natural observations reveal that "typical accretionary wedges" are characterized by low tapers with smooth surface slope and subducting plate, low convergence rates and thick trench sediment, while "nonaccretionary wedges" display large tapers with irregular surface slopes and rough subducting plate, high convergence rates and almost no trench fill. Sandbox experiments were performed to illustrate the effects of seamounts/ridges in the subduction zone on the deformation of an accretionary wedge. These experiments show that a wedge of sand is first trapped and pushed in front of the seamount which acts as a moving bulldozer. This is followed by a tunnelling effect of the subducting seamount through the frontal wedge material, which results in considerable sand reworking. At an advanced subduction stage, the décollement jumps back from a high level in the wedge to its former basal position. We conclude that a high trench sedimentation rate relative to the convergence rate leads to frontal accretion. In contrast, several conditions may favor tectonic erosion of the upper plate. First, oceanic features, such as grabens, seamounts or ridges, may trap upper plate material during their subduction process. Second, destabilization of the upper plate material by internal fluid overpressuring causing hydrofracturing is probably another important mechanism.

  7. Precision forming machine with rolling plate cross wedge rolling

    Institute of Scientific and Technical Information of China (English)


    Roller cross wedge rolling(CWR)machines have high rigidity, but sector dies are difficult to process. Plate CWR machines have low rigidity and need large floor space, but plate dies are easy to process. Neither roller CWR machine nor plate CWR machine can produce larger workpieces. Based on the above conclusions, this paper presents the mechanical principle of the precision forming machine with rolling plate CWR. Then, its design principle and machine construction are presented. There are a top press roller above the upper sliding plate and a bottom press roller under the lower sliding plate. The press rollers make rolling contact with the sliding plates. The plate dies are mounted on the upper and lower sliding plates, respectively. Furthermore, the axes of both press rollers and centerline of work-piece always keep in the identical vertical plane during forming process. These make the machine retain advantages of high rigidity for roller CWR machine and simpleness of manufacturing dies for plate CWR machine, and abandon defects of poor rigidity for plate CWR machine and difficulty of manufac-turing dies for roller CWR machine. Moreover, the machine can produce larger workpieces.

  8. Precision forming machine with rolling plate cross wedge rolling

    Institute of Scientific and Technical Information of China (English)

    SONG YuQuan; LI ZhiGang; WANG MingHui; GUAN XiaoFang


    Roller cross wedge rolling (CWR) machines have high rigidity, but sector dies are difficult to process.Plate CWR machines have low rigidity and need large floor space, but plate dies are easy to process.Neither roller CWR machine nor plate CWR machine can produce larger workpieces.Based on the above conclusions, this paper presents the mechanical principle of the precision forming machine with rolling plate CWR.Then, its design principle and machine construction are presented.There are a top press roller above the upper sliding plate and a bottom press roller under the lower sliding plate.The press rollers make rolling contact with the sliding plates.The plate dies are mounted on the upper and lower sliding plates, respectively.Furthermore, the axes of both press rollers and centerline of work-piece always keep in the identical vertical plane during forming process.These make the machine re-tain advantages of high rigidity for roller CWR machine and simpleness of manufacturing dies for plate CWR machine, and abandon defects of poor rigidity for plate CWR machine and difficulty of manufac-turing dies for roller CWR machine.Moreover, the machine can produce larger workpieces.

  9. The effect of proximal tibial slope on dynamic stability testing of the posterior cruciate ligament- and posterolateral corner-deficient knee. (United States)

    Petrigliano, Frank A; Suero, Eduardo M; Voos, James E; Pearle, Andrew D; Allen, Answorth A


    Proximal tibial slope has been shown to influence anteroposterior translation and tibial resting point in the posterior cruciate ligament (PCL)-deficient knee. The effect of proximal tibial slope on rotational stability of the knee is unknown. Change in proximal tibial slope produced via osteotomy can influence both static translation and dynamic rotational kinematics in the PCL/posterolateral corner (PLC)-deficient knee. Controlled laboratory study. Posterior drawer, dial, and mechanized reverse pivot-shift (RPS) tests were performed on hip-to-toe specimens and translation of the lateral and medial compartments measured utilizing navigation (n = 10). The PCL and structures of the PLC were then sectioned. Stability testing was repeated, and compartmental translation was recorded. A proximal tibial osteotomy in the sagittal plane was then performed achieving either +5° or -5° of tibial slope variation, after which stability testing was repeated (n = 10). Analysis was performed using 1-way analysis of variance (ANOVA; α = .05). Combined sectioning of the PCL and PLC structures resulted in a 10.5-mm increase in the posterior drawer, 15.5-mm increase in the dial test at 30°, 14.5-mm increase in the dial test at 90°, and 17.9-mm increase in the RPS (vs intact; P slope (high tibial osteotomy [HTO] +5°) in the PCL/PLC-deficient knee reduced medial compartment translation by 3.3 mm during posterior drawer (vs deficient; P slope (HTO -5°) caused a 4.8-mm increase in medial compartment translation (vs deficient state; P slope diminished static posterior instability of the PCL/PLC-deficient knee as measured by the posterior drawer test but had little effect on rotational or dynamic multiplanar stability as assessed by the dial and RPS tests, respectively. Conversely, decreasing posterior slope resulted in increased posterior instability and a significant increase in the magnitude of the RPS. These results suggest that increasing posterior tibial slope may improve

  10. A Numerical Study on the Asymmetric Water Entry of A Wedge Section

    Institute of Scientific and Technical Information of China (English)

    M. S. Seif; S. M. Mousaviraad; S. H. Saddathosseini


    The effect of the asymmetric water entry over a submerged part of a ship on the hydrodynamic impact is investigated numerically. A wedge body is considered and the problem is assumed to be two-dimensional. The results of symmetric and asymmetric impacts are compared. The effect is found significant in the numerical simulation. The maximum hydrodynamic pressure at a heel angle of 10 degrees becomes about 95% more than that of the symmetric entry. The result of the present work proves the importance of asymmetrical hydrodynamic impact loading for structural design of a ship. Besides, the numerical procedure is not limited to a wedge type cross section and it is possible to apply it for any real geometry of ships and high-speed craft.

  11. Plasmonic angular momentum on metal-dielectric nano-wedges in a sectorial indefinite metamaterial

    CERN Document Server

    Jin, Dafei


    We present an analytical study to the structure-modulated plasmonic angular momentum trapped on periodic metal-dielectric nano-wedges in the core region of a sectorial indefinite metamaterial. Employing a transfer-matrix calculation and a conformal-mapping technique, our theory is capable of dealing with realistic configurations of arbitrary sector numbers and rounded wedge tips. We demonstrate that in the deep-subwavelength regime strong electric field carrying high azimuthal variation can exist within only ten-nanometer length scale close to the structural center, and is naturally bounded by a characteristic radius of the order of hundred-nanometer away from the center. These extreme confining properties suggest that the structure under investigation may be superior to the conventional metal-dielectric waveguides or cavities in terms of nanoscale photonic manipulation.

  12. Effect of ultrasonic power on wedge bonding strength and interface microstructure

    Institute of Scientific and Technical Information of China (English)

    WANG Fu-liang; LI Jun-hui; HAN Lei; ZHONG Jue


    During the aluminum wire wedge bonding, the ultrasonic power and bonding strength were obtained. Based on those data, the relationship between ultrasonic power and bonding strength was studied. The results show that: 1) ultrasonic power is affected by ultrasonic power ratio and other uncontrolled factors such as asymmetric substrate quality, unstable restriction on the interface between wedge tool and aluminum wire; 2) when ultrasonic power is less than 1.0 W, increasing ultrasonic power leads to increasing bonding strength and decreasing failure bonding; on the contrary, when ultrasonic power is greater than 1.6 W, increasing power leads to decreasing bonding strength and increasing failure bonding; 3) only when ultrasonic power is between 1.0 W and 1.6 W, can stable and high yield bonding be reached. Finally, the microstructure of bonding interface was observed, and a ring-shaped bond pattern is founded in the center and friction scrape besides the ring area.

  13. Analytic Study of Magnetohydrodynamic Flow and Boundary Layer Control Over a Wedge

    Institute of Scientific and Technical Information of China (English)

    M. Chandrasekar; S. Baskaran


    A genuine variational principle developed by Gyarmati, in the field of thermodynamics of irreversible processes unifying the theoretical requirements of technical, environmental and biological sciences is employed to study the effects of uniform suction and injection on MHD flow adjacent to an isothermal wedge with pressure gradient in the presence of a transverse magnetic field. The velocity distribution inside the boundary layer has been considered as a simple polynomial function and the variational principle is formulated. The Euler-Lagrange equation is reduced to a simple polynomial equation in terms of momentum boundary layer thickness. The velocity profiles, displacement thickness and the coefficient of skin friction are calculated for various values of wedge angle parameter m, magnetic parameter ε and suction/injection parameter H. The present results are compared with known available results and the comparison is found to be satisfactory. The present study establishes high accuracy of results obtained by this variational technique.

  14. On the Effect of Structural Response on the Hydrodynamic Loading of a Free-Falling Wedge (United States)

    Ikeda, Christine; Taravella, Brandon; Judge, Carolyn


    High-speed planing craft are subjected to repeated slamming events in waves that can be very extreme depending on the wave topography, impact angle of the ship, forward speed of the ship, encounter angle, and height out of the water. The current work examines this fluid-structure interaction problem through the use of wedge drop experiments and a theoretical prediction. The experimental program consisted of two 20° deadrise angle wedges dropped from a range of heights, 0 . 15 code assumes a rigid structure, therefore, the results between the code and the first experiment are in good agreement. The second experiment shows pressure magnitudes that are lower than the predictions due to the energy required to deform the structure. This work is funded by the Office of Naval Research and the state of Louisiana Board of Regents Industrial Ties and Reseach Subprogram.

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

    Directory of Open Access Journals (Sweden)

    E. Revelo Jiron


    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

  16. Alternative method for direct measurement of tibial slope

    Directory of Open Access Journals (Sweden)

    Stijak Lazar


    Full Text Available Background/Aim. The tibial slope is one of the most frequently cited anatomical causes of anterior cruciate ligament trauma. The aim of this study was to determine the possibility of direct measuring of the tibial slope of the knee without prior soft tissue dissection in cadavers. Methods. Measurement was performed on the two groups of samples: osteological and cadaveric. The osteological group consisted of 102 matured tibiae and measurement was performed: indirectly by sagittal photographing of the tibia, and directly by a set of parallel bars. The cadaveric group consisted of 50 cadaveric knees and measurement was performed directly by a set of parallel bars. The difference and correlation between indirect and the direct measurements were observed, which included also measuring of the difference and correlation of the tibial slope on the medial and lateral condyles. Results. A statistically significant difference between the direct and indirect method of measuring (p 0.05. However, the slope on the medial condyle, as well as indirect measurement showed a statistically significant difference (p < 0.01. Conclusion. By the use of a set of parallel bars it is possible to measure the tibial slope directly without removal of the soft tissue. The results of indirect, photographic measurement did not statistically differ from the results of direct measurement of the tibial slope.

  17. Spontaneous collapse of the tibial plateau: radiological staging

    Energy Technology Data Exchange (ETDEWEB)

    Carpintero, P.; Leon, F.; Zafra, M. [University Hospital ' ' Reina Sofia' ' , Orthopaedic Department, Cordoba (Spain); Montero, R.; Carreto, A. [University Hospital ' ' Reina Sofia' ' , Radiology Department, Cordoba (Spain)


    This paper proposes a radiological staging system for necrosis of the tibial plateau, similar to those already developed for the hip and the medial femoral condyle. We retrospectively studied the clinical case histories and radiographic findings of 14 patients (15 affected knees) with histologically proven osteonecrosis of the tibial plateau. Stage I was marked by normal radiograph, but increased uptake in bone scan and subchondral areas of abnormal marrow signal intensity in magnetic resonance imaging (MRI), as reported in other osteonecrosis sites. Stage II was characterised by cystic and sclerotic changes, and stage III fracture of the medial rim of the medial tibial plateau and tibial plateau collapse were present. Stage IV was marked by joint narrowing. These changes appeared earlier and were more pronounced when there was genu varum/valgum or involvement of the lateral tibial plateau. The radiological evolution of the disease appears to follow a four-stage course over a period of roughly one year from the onset of symptoms. (orig.)

  18. Effects of coronal plane conformity on tibial loading in TKA: a comparison of AGC© flat versus conforming articulations. (United States)

    Berend, Michael E; Small, Scott R; Ritter, Merrill A; Buckley, Christine A; Merk, James C; Dierking, W Kurt


    Conforming articulations potentially decrease polyethylene contact stresses in total knee arthroplasty (TKA); however, less is known about the effect of coronal geometry on tibial loading and clinical failure. This study examined the relationship between coronal plane geometry and loading patterns in the proximal tibia. Composite tibiae were implanted with modular, metal-backed tibial trays and were compressively loaded with conforming and nonconforming ultra-high molecular weight polyethylene (UHMWPE) tibial bearings and comparable femoral components. Changes in strain on the proximal tibia were quantified using a photoelastic strain analysis method. In balanced loading, coronally dished components created a strain increase in the anterior medial tibia while creating a significant strain decrease in the posterior tibia. Proximal tibial strains were decreased and centralized in conforming versus flat articulations. This centralization of loading may lead to a reduction in edge loading during gait. Lower strains were observed with coronally dished implants in key regions corresponding to the clinical overload of the tibia leading to aseptic loosening.

  19. The evolving energy budget of accretionary wedges (United States)

    McBeck, Jessica; Cooke, Michele; Maillot, Bertrand; Souloumiac, Pauline


    The energy budget of evolving accretionary systems reveals how deformational processes partition energy as faults slip, topography uplifts, and layer-parallel shortening produces distributed off-fault deformation. The energy budget provides a quantitative framework for evaluating the energetic contribution or consumption of diverse deformation mechanisms. We investigate energy partitioning in evolving accretionary prisms by synthesizing data from physical sand accretion experiments and numerical accretion simulations. We incorporate incremental strain fields and cumulative force measurements from two suites of experiments to design numerical simulations that represent accretionary wedges with stronger and weaker detachment faults. One suite of the physical experiments includes a basal glass bead layer and the other does not. Two physical experiments within each suite implement different boundary conditions (stable base versus moving base configuration). Synthesizing observations from the differing base configurations reduces the influence of sidewall friction because the force vector produced by sidewall friction points in opposite directions depending on whether the base is fixed or moving. With the numerical simulations, we calculate the energy budget at two stages of accretion: at the maximum force preceding the development of the first thrust pair, and at the minimum force following the development of the pair. To identify the appropriate combination of material and fault properties to apply in the simulations, we systematically vary the Young's modulus and the fault static and dynamic friction coefficients in numerical accretion simulations, and identify the set of parameters that minimizes the misfit between the normal force measured on the physical backwall and the numerically simulated force. Following this derivation of the appropriate material and fault properties, we calculate the components of the work budget in the numerical simulations and in the

  20. Computational analysis of asymmetric water entry of wedge and ship section at constant velocity (United States)

    Rahaman, Md. Mashiur; Ullah, Al Habib; Afroz, Laboni; Shabnam, Sharmin; Sarkar, M. A. Rashid


    Water impact problems receive much attention due to their short duration and large unsteady component of hydrodynamic loads. The effect of water entry has several important applications in various aspects of the naval field. Significant attention has been given to various water entry phenomena such as ship slamming, planning hulls, high-speed hydrodynamics of seaplanes, surface-piercing propellers and the interaction of high-speed liquid drops with structural elements. Asymmetric water entry may be caused by various natural phenomena such as weather conditions or strong winds. Since the determination of hydrodynamic impact load plays a vital role in designing safe and effcient vessels, an accurate and reliable prediction method is necessary to investigate asymmetric water entry problems. In this paper, water entry of a two-dimensional wedge and ship section at constant velocity in asymmetric condition will be analysed numerically and the effects of asymmetric impact on the velocity and pressure distribution will be discussed. The finite volume method is employed to solve the dynamic motion of the wedge in two-phase flow. During the water entry, the air and water interface is described implicitly by the volume of fluid (VOF) scheme. The numerical code and method was first validated for symmetric condition by one of the present author is applied for asymmetric wedge and ship section. The free surface, velocity and pressure distribution for asymmetric water entry are investigated and visualized with contour plots at different time steps.

  1. Reliability of the radiographic union scale in tibial fractures (RUST

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    Fernando Antonio Silva de Azevedo Filho

    Full Text Available ABSTRACT OBJECTIVE: This study aimed to evaluate the inter- and intra observer reproducibility of the radiographic score of consolidation of the tibia shaft fractures. METHODS: Fifty-one sets of radiographs in anteroposterior (AP and profile (P of the tibial shaft treated with intramedullary nail were obtained. The analysis of X-rays was performed in two stages, with a 21-day interval between assessments by a group of nine evaluators. To evaluate the reproducibility of RUST score between the evaluators, the intra-class correlation coefficient (ICC with a 95% confidence interval was used. ICC values range from +1, representing perfect agreement, to -1, complete disagreement. RESULTS: There was a significant correlation among all evaluators: ICC = 0.87 (95% CI 0.81 to 0.91. The intraobserver agreement proved to be substantial with ICC = 0.88 (95% CI 0.85 to 0.91 . CONCLUSION: This study confirms that the RUST scale shows a high degree of reliability and agreement.

  2. Effect of wedge filter and field size on photoneutron dose equivalent for an 18 MV photon beam of a medical linear accelerator

    Energy Technology Data Exchange (ETDEWEB)

    Mesbahi, Asghar [Medical Physics Department, Medical School, Tabriz University of Medical Sciences, Tabriz (Iran, Islamic Republic of); Radiation Therapy Department, Imam Hospital, Tabriz (Iran, Islamic Republic of)], E-mail:; Keshtkar, Ahmad [Medical Physics Department, Medical School, Tabriz University of Medical Sciences, Tabriz (Iran, Islamic Republic of); Mohammadi, Ehsan [Radiation Therapy Department, Imam Khomeini Hospital, Tehran (Iran, Islamic Republic of); Mohammadzadeh, Mohammad [Radiation Therapy Department, Imam Hospital, Tabriz (Iran, Islamic Republic of)


    Photoneutrons produced during radiation therapy with high energy photons is the main source of unwanted out-of-field received doses of patients. To analyze the neutron dose equivalent (NDE) for wedged beams and its variation with field size, Monte Carlo (MC) modeling of an 18 MV photon beam was performed using MCNPX MC code. The results revealed that the NDE is on average 6.5 times higher for wedged beams. For open beams, the NDE decreased with increasing field size especially for field sizes >20x20 cm{sup 2}. While, for wedged beams, the NDE increased with field size. It was suggested that the increase of NDE for wedged beams should be taken into account in radiation-induced secondary cancer risk estimations and radiation protection calculations.

  3. Implementation of enhanced dynamic wedge in the focus rtp system. (United States)

    Miften, M; Wiesmeyer, M; Beavis, A; Takahashi, K; Broad, S


    The FOCUS RTP system implementation of Varian's enhanced dynamic wedge (EDW) is presented. Calculations of both dose distributions and wedge factors (WFs) are based on segmented treatment tables (STTs). Calculating dose requires a "transmission matrix" derived from an STT to model the modified fluence from the source. The dose calculation is then performed using either the Clarkson or convolution/superposition algorithms. An initial "primary dose/monitor unit (MU) fraction" WF estimate at the weight point of symmetric and asymmetric fields is calculated from the STT as the ratio of MU delivered on the axis of the weight point divided by total MU delivered for the treatment field. In our approach, we go beyond this initial estimate with a "scatter dose" correction. This requires measured 60 degrees WFs for 5 fields. Scatter corrections derived from measured WFs are interpolated for other wedge angles and field sizes in much the same way as arbitrary wedge angle STTs are derived from a "golden STT" using the "ratio of tangents" formalism. Dose comparisons with measured distributions show good agreement to within 3% or 3 mm for 6-MV beams and all EDW angles. Agreement with measurements to within 1% is obtained for WFs in all symmetric and asymmetric fields for 6- and 10-MV beams. For large wedge angles and field sizes, this represents a significant improvement over the 3% to 4% errors often observed using the MU fraction model alone.

  4. In vitro comparison of tibial plateau leveling osteotomy with and without use of a tibial plateau leveling jig. (United States)

    Schmerbach, Kay Ingo; Boeltzig, Christian Konrad Matthias; Reif, Ullrich; Wieser, Jan Carsten; Keller, Thomas; Grevel, Vera


    To evaluate the influence of a tibial plateau leveling jig on osteotomy orientation, fragment reduction, and postoperative tibial plateau angle (TPA) during tibial plateau leveling osteotomy (TPLO). In vitro experimental study. Large-breed canine cadavers (n=20). TPLO was performed on 40 hindlimbs using 4 methods. Group 1: Jig; dogs in dorsal recumbency with the osteotomy parallel to the distal jig pin. Groups 2-4: No jig; dogs in lateral recumbency with the osteotomy in a vertical orientation (group 2: tibia parallel to the table top; group 3: controlled superimposition of the femoral condyles; group 4: internal rotation of the tibia). Postoperative TPA, fragment reduction, and osteotomy orientation relative to the tibial plateau were compared. Positive or negative values denoted deviation from parallel relative to the tibial plateau. Postoperative TPA, fragment reduction, and proximodistal osteotomy orientation were not significantly different between groups. Craniocaudal osteotomy orientation was significantly different (Ptable surface. TPLO without use of a jig reduces surgical trauma, is less time consuming, and reduces cost.

  5. [Anatomical quantification of the tibial part of the plantar aponeurosis]. (United States)

    Hiramoto, Y


    The metrical analysis of the anatomical characteristics is important because of its objectiveness. As it is concerned with the organs belonging to the locomotor system, the metrical method of the bones has already been systematized by Martin (1928), whereas the same kind of method for use on other organs remains undeveloped. The author aims to establish the metrical method of the plantar aponeurosis. The method for measuring the tibial part of the aponeurosis developed in this paper is sufficiently applicable for obtaining its principal anatomical characteristics. The results show that the tibial portion of the plantar aponeurosis becomes statistically significantly wider and thinner in its anterior part, and that the thickness of the tibial portion of the aponeurosis in the anterior part is larger on the right side than on the left side.

  6. Somatotopic mapping of chordotonal organ neurons in a primitive ensiferan, the New Zealand tree weta Hemideina femorata: II. complex tibial organ. (United States)

    Nishino, Hiroshi; Field, Laurence H


    Most ensiferan insects possess sets of highly specialized chordotonal organs in the proximal tibiae to detect conspecific auditory/vibratory signals or approach of predators. To date, most auditory/vibratory afferents have been classified according to their physiological properties and axonal projection morphology, but not to somatotopic origins. Hence, the functional specialization of identified receptor cells in the tibial organs remains uncertain. To address this question from an anatomical aspect, we investigated the structure of the weta, Hemideina femorata, tibial organs (the most elaborated tibial chordotonal organs among ensiferans) and their central projections by staining small numbers of receptor afferents from identified tibial organs. These organs comprise the "complex tibial organ," including the subgenual organ (primary vibration detector) and its posterior complement, the accessory organ, and the crista acustica (primary auditory organ) and its proximal complement, the intermediate organ. Unlike reports of a membranous organ structure for homologs in other ensiferans, weta tibial organs contain receptor cells embedded in thick solid masses. Primary afferents project ipsilaterally to the medial ventral association center of thoracic ganglia, where axon terminals are arrayed topographically in different areas specific to each organ, except for almost complete overlap of afferents originating from the distal part of the crista acustica and from the intermediate organ. In contrast to somatotopic reflection of sensilla position on limbs, as known for mechanoreceptor hairs, the somatotopic projection map of the insect ear reveals topographic association with acoustic tracheae or tibial cuticular attachment sites, which in turn must reflect determinants of response sensitivity (e.g., frequency or threshold).

  7. Neuroanatomy and physiology of the complex tibial organ of an atympanate ensiferan, Ametrus tibialis (Brunner von Wattenwyl, 1888) (Gryllacrididae, Orthoptera) and evolutionary implications. (United States)

    Strauss, Johannes; Lakes-Harlan, Reinhard


    We investigated the neuroanatomy and physiology of the complex tibial organ of an atympanate ensiferan, the Gryllacridid Ametrus tibialis. This represents the first analysis of internal mechanoceptors in Gryllacridids. The complex tibial organ is tripartite consisting of a subgenual organ, intermediate organ and a homologue organ to the crista acustica of tympanate ensiferan taxa of Tettigoniidae, Haglidae, and Anostostomatidae. The crista homologue contains 23 +/- 2 receptor neurons in the foreleg. It is associated with the leg trachea and found serially in all three thoracic leg pairs. Central projections of the sensory nerve of the complex tibial organ bifurcate in two lobes in the prothoracic ganglion, which do not reach the midline. The axonal endings project into the mVAC, the main vibratory-auditory neuropile of Ensifera. Recordings of the tibial nerve show that the tibial organ is sensitive to vibrational stimuli with a minimum threshold of 0.02 to 0.05 ms(-2) at 200-500 Hz, but rather insensitive to airborne sound. The main function of the tibial organ is therefore vibration sensing, although the specific function of the crista homologue remains unclear. The presence of the crista acustica homologue is interpreted in phylogenetic context. Because ensiferan phylogeny is unresolved, two alternative scenarios can be deduced: (a) the crista homologue is a precursor structure which was co-opted as an auditory system and represent a morphologically highly specialized structure before acquisition of its new function; (b) a previously functional tibial ear is evolutionary reduced but the neuronal structures are maintained. Based on comparison of neuroanatomical details, the crista acustica homologue of A. tibialis could present the neuronal complement of an ear evolutionary precursor structure, which was successively made sensitive to airborne sound by elaboration of cuticular tympana, auditory spiracle and trachea for sound propagation.


    Directory of Open Access Journals (Sweden)

    Bharath Raju


    Full Text Available BACKGROUND AND OBJECTIVES: Tibial plateau fractures are one of the most common intra-articular fractures. They are the outcome of indirect coronal or direct compressive forces. The incidence of tibial plateau fractures is 1.3% of all fractures. These fractures have varied degree of fracture configuration involving medial, lateral or both tibial plateaus with varied degree of intra-articular depressions and displacements. Due to speedy vehicles and mechanization there has been increase in the number of tibial plateau fractures. Knee joints being one of the major weight bearing joints of human body, these fractures are of big importance. METHODS: We studied 30 cases of tibial plateau fractures treated by MIPPO at kempegowda institute of medical sciences from June 2012 to April 2014 with minimum follow up of up to 6months. RESULTS: All the selected patients were evaluated both clinically as well as radiologically. The lab investigations were done and then they were taken up for the surgery. The fractures were classified as per schatzker’s classification and treated accordingly. In the post-op period early range of movements were started and the patients were non weight bearing till 6 weeks. Till 12 weeks partial weight bearing was allowed and full weight bearing was allowed after radiological union of the fracture. CONCLUSION: Tibial plateau fractures when treated with MIPPO give articular anatomical reduction, rigid fixation and early mobolisation of the knee joint. This prevents development of osteoarthritis and includes all the advantages of minimally invasive procedure and so better patient compliance.

  9. 21 CFR 888.3590 - Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (United States)


    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Knee joint tibial (hemi-knee) metallic resurfacing... Knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis. (a) Identification. A knee joint tibial (hemi-knee) metallic resurfacing uncemented prosthesis is a device intended to be...

  10. Partial wedge resection of nail, nail bed and nail matrix in ingrown toenail treatment

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    Mustafa Dönmez


    Full Text Available Objectives: Ingrown toenail is a frequent problem which can be seen in all ages. There are many treatment methods both surgical and nonsurgical. In this study we evaluated the results of wedge resection of ingrown toe nail.Patients and Methods: A total of 80 toenails of 74 patients (55 female, 19 male who complaint with discharge and deformity of their toenail underwent partial wedge resection of the nail and nail matrix. According to the Heifetz’s staging system, 34 toenails were grade II, 46 toenails were grade III. There was active drainage due to an infectious process in all effected toe nails. All patients were operated after 10 day of oral antibiotic treatment. We evaluated the recurrence, postoperative infection, patient satisfaction and time to return to work.Results: The mean follow up period was 8 months (4-12 months. There was no recurrence in any patient. Two patients came with wound drainage in postoperative 14th day. Intravenous antibiotic treatment, debridement and wound dressing with rifampicine every other day were accomplished. All patients expressed their satisfaction with surgery.Conclusion: In treatment of ingrown toenail; wedge resection of nail, nail matrix and nail bed is a very effective treatment. Recurrence rate following this technique is negligible if it is done properly and it has high patient satisfaction.

  11. Extension of a double-wedged orogen potentially leads to the current South China Sea (United States)

    Wu, G.; Lavier, L. L.


    The South China Sea (SCS) is surrounded by South China on the NW, Palawan and Reed Bank on the SE, as well as several microplates, resembling a jigsaw puzzle. In an attempt to better understand its evolution, we designed simplified thermomechanical models to simulate extension of a double-wedge-shaped orogen with highlands on both sides and lowland in the center to mimic the geological condition of the proto-SCS. We imposed constant extension rates on both sides and Gaussian-shaped thermal impulse in the center. We also varied the strength of lower crust but did not explicitly incorporate mid-ocean ridges and searfloor spreading mechanisms. We currently used symmetric double-wedge, but further tests are planed for asymmetric double-wedges. Our preliminary results show that the models produced many structures that resemble those of SCS, such as 1) a series of domino or conjugate faults sitting above a subsurface detachment (or décollement), 2) exhumed domes of middle-lower crust, 3) extreme thinning of both upper crust and lower crust, and 4) propagation of extension towards NW and SE margins. Our models suggest that superimposition of these modeled characteristics produced during several phases of extension of the SCS that may be due to thermal impulsion, magmatic events, and subduction related relaxation potentially produces high resemblance of the SCS.

  12. CFD Simulations of the IHF Arc-Jet Flow: Compression-Pad/Separation Bolt Wedge Tests (United States)

    Gokcen, Tahir; Skokova, Kristina A.


    This paper reports computational analyses in support of two wedge tests in a high enthalpy arc-jet facility at NASA Ames Research Center. These tests were conducted using two different wedge models, each placed in a free jet downstream of a corresponding different conical nozzle in the Ames 60-MW Interaction Heating Facility. Panel test articles included a metallic separation bolt imbedded in the compression-pad and heat shield materials, resulting in a circular protuberance over a flat plate. As part of the test calibration runs, surface pressure and heat flux measurements on water-cooled calibration plates integrated with the wedge models were also obtained. Surface heating distributions on the test articles as well as arc-jet test environment parameters for each test configuration are obtained through computational fluid dynamics simulations, consistent with the facility and calibration measurements. The present analysis comprises simulations of the non-equilibrium flow field in the facility nozzle, test box, and flow field over test articles, and comparisons with the measured calibration data.

  13. Multidirectional Tibial Tubercle Transfer Technique: Rationale and Biomechanical Investigation. (United States)

    Sarin, Vineet K; Camisa, William; Leasure, Jeremi M; Merchant, Alan C

    This study describes a new surgical technique to transfer the tibial tubercle, explains the rationale for its development, and reports the results of initial biomechanical testing. The design goals were to create a tibial tubercle osteotomy that would provide equivalent or better initial fixation compared with traditional techniques, yet would be more flexible, reproducible, accurate, less invasive, and safer. The results of the biomechanical analysis suggest that initial fixation with this novel tubercle transfer technique is as strong as traditional Elmslie-Trillat and anteromedialization procedures.

  14. Ischial hypoplasia, tibial hypoplasia and facial abnormalities: a new syndrome?

    Energy Technology Data Exchange (ETDEWEB)

    Nishimura, G. [Department of Radiology, Dokkyo University School of Medicine (Japan); Haga, Yoshihiko [Department of Orthopaedics, Shizuoka Children`s Hospital, Shizuoka (Japan); Aoki, Katsuhiko [Department of Radiology, Shizuoka Children`s Hospital, Shizuoka (Japan); Hasegawa, Tomoko [Division of Clinical Genetics, Shizuoka Children`s Hospital, Shizuoka (Japan)


    A child with facial abnormalities, short stature and a variety of skeletal alterations is reported. The facial abnormalities comprised low-set ears, short nose with a long philtrum, micrognathia and cleft palate. The skeletal alterations included ischial hypoplasia, malformations of the cervical spine, hypoplasia of the lesser trochanters, tibial hypoplasia with bowing of the lower legs, tibio-fibular diastasis with malformed distal tibial epiphyses, clubfeet and brachymesophalangy. The constellation of clinical and radiological findings in the present patient do not fit any known malformation syndrome. (orig.) With 4 figs., 8 refs.

  15. Tibial and fibular angles in homozygous sickle cell disease

    Energy Technology Data Exchange (ETDEWEB)

    Akamaguna, A.I.; Odita, J.C.; Ugbodaga, C.I.; Okafor, L.A.


    Measurements of the tibial and fibular angles made on ankle radiographs of 34 patients with sickle cell disease were compared with those of 36 normal Nigerians. Widening of the fibular angle, which is an indication of tibiotalar slant, was demonstrated in about 79% of sickle cell disease patients. By using fibular angle measurements as an objective method of assessing subtle tibiotalar slant, it is concluded that the incidence of this deformity is much higher among sickle cell disease patients than previously reported. The mean values of tibial and fibular angles in normal Nigerians are higher than has been reported amongst Caucasians.

  16. Dislocation Nucleation and Pileup under a Wedge Contact at Nanoscale

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    Y. F. Gao


    Full Text Available Indentation responses of crystalline materials have been found to be radically different at micrometer and nanometer scales. The latter is usually thought to be controlled by the nucleation of dislocations. To explore this physical process, a dislocation mechanics study is performed to determine the conditions for the nucleation of a finite number of dislocations under a two-dimensional wedge indenter, using the Rice-Thomson nucleation criterion. The configurational force on the dislocation consists of the applied force, the image force, and the interaction force between dislocations. Dislocations reach equilibrium positions when the total driving force equals the effective Peierls stress, giving a set of nonlinear equations that can be solved using the Newton-Raphson method. When the apex angle of the wedge indenter increases, the critical contact size for dislocation nucleation increases rapidly, indicating that dislocation multiplication near a blunt wedge tip is extremely difficult. This geometric dependence agrees well with experimental findings.

  17. Indentation tectonics in the accretionary wedge of middle Manila Trench

    Institute of Scientific and Technical Information of China (English)

    LI Jiabiao; JIN Xianglong; RUAN Aiguo; WU Shimin; WU Ziyin; LIU Jianhua


    Based on the multibeam morpho-tectonic analysis of the Manila Trench accretionary wedge and its indentation tectonics and the contrasting researches with other geological and geophysical data, three tectonic zones of the wedge are established, faulting features, tectonic distribution and stress mechanism for the indentation tectonicsareanalyzed,oblique subduction along Manila Trench with convergent stress of NW55. Is presented, and the relationship of the ceasing of Eastern Subbasin spreading of South China Sea Basin to the formation of subduction zone of Manila Trench is discussed. By the model analysis and regional research, it is found that the seamount subduction along Manila Trenchoes not lead to the erosion of the accretionary wedge and the oblique subduction actually is a NWWtrending obducfion of Luzon micro-plate that results from the NWW-trending displacement of the Philippine Sea plate.

  18. Surface Geophysical Measurements for Locating and Mapping Ice-Wedges

    DEFF Research Database (Denmark)

    Ingeman-Nielsen, Thomas; Tomaskovicova, Sonia; Larsen, S.H.


    With the presently observed trend of permafrost warming and degradation, the development and availability of effective tools to locate and map ice-rich soils and massive ground ice is of increasing importance. This paper presents a geophysical study of an area with polygonal landforms in order...... to test the applicability of DC electrical resistivity tomography (ERT) and Ground Penetrating Radar (GPR) to identifying and mapping ice-wedge occurrences. The site is located in Central West Greenland, and the ice-wedges are found in a permafrozen peat soil with an active layer of about 30 cm. ERT...... and GPR measurements give a coherent interpretation of possible ice-wedge locations, and active layer probing show a tendency for larger thaw depth in the major trench systems consistent with a significant temperature (at 10 cm depth) increase in these trenches identified by thermal profiling. Three...

  19. Modeling and Stability Analysis of Wedge Clutch System

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    Jian Yao


    Full Text Available A wedge clutch with unique features of self-reinforcement and small actuation force was designed. Its self-reinforcement feature, associated with different factors such as the wedge angle and friction coefficient, brings different dynamics and unstable problem with improper parameters. To analyze this system, a complete mathematical model of the actuation system is built, which includes the DC motor, the wedge mechanism, and the actuated clutch pack. By considering several nonlinear factors, such as the slip-stick friction and the contact or not of the clutch plates, the system is piecewise linear. Through the stability analysis of the linearized system in clutch slipping phase, the stable condition of the designed parameters is obtained as α>arctan⁡(μc. The mathematical model of the actuation system is validated by prototype testing. And with the validated model, the system dynamics in both stable and unstable conditions is investigated and discussed in engineering side.

  20. Tricritical wedge filling transitions with short-ranged forces

    Energy Technology Data Exchange (ETDEWEB)

    Romero-Enrique, J M [Departamento de Fisica Atomica, Molecular y Nuclear, Area de Fisica Teorica, Universidad de Sevilla, Apartado de Correos 1065, 41080 Sevilla (Spain); Parry, A O [Department of Mathematics, Imperial College 180 Queen' s Gate, London SW7 2BZ (United Kingdom)


    We show that the 3D wedge filling transition in the presence of short-ranged interactions can be first order or second order depending on the strength of the line tension associated with the wedge bottom. This fact implies the existence of a tricritical point characterized by a short-distance expansion which differs from the usual continuous filling transition. Our analysis is based on an effective one-dimensional model for the 3D wedge filling, which arises from the identification of the breather modes as the only relevant interfacial fluctuations. From such analysis we find a correspondence between continuous 3D filling at bulk coexistence and 2D wetting transitions with random-bond disorder.

  1. Flow Analysis for the Falkner–Skan Wedge Flow

    DEFF Research Database (Denmark)

    Bararnia, H; Haghparast, N; Miansari, M


    the constant coefficients in the approximated solution. The effects of the polynomial terms of HAM are considered and the accuracy of the results is shown, which increases with the increasing polynomial terms of HAM. Analytical results for the dimensionless velocity and temperature profiles of the wedge flow......In this article an analytical technique, namely the homotopy analysis method (HAM), is applied to solve the momentum and energy equations in the case of a two-dimensional incompressible flow passing over a wedge. The trail and error method and Padé approximation strategies have been used to obtain...

  2. Molecular Depth Profiling with Cluster SIMS and Wedges (United States)

    Mao, Dan; Wucher, Andreas; Winograd, Nicholas


    Secondary ion mass spectrometry and atomic force microscopy are employed to characterize a wedge-shaped crater eroded by 40 keV C60+ bombardment of a 395-nm thin film of Irganox 1010 doped with four delta layers of Irganox 3114. The wedge structure creates a laterally magnified cross section of the film. From an examination of the resulting surface, information about depth resolution, topography and erosion rate can be obtained as a function of crater depth in a single experiment. This protocol provides a straightforward way to determine the parameters necessary to characterize molecular depth profiles, and to obtain an accurate depth scale for erosion experiments. PMID:19968247

  3. Surgical treatment of idiopathic syringomyelia: Silastic wedge syringosubarachnoid shunting technique

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    Teck M Soo


    Conclusions: Shunting procedures for the syringomyelia disease spectrum have been criticized due to the inconsistent long-term outcomes. This surgical technique used to treat symptomatic idiopathic syringomyelia has been devised based on our intraoperative experience, surgical outcomes, and evaluation of the literature. The purpose of the wedges is to preserve patency of the communication between the syrinx cavity and the expanded subarachnoid space by preventing healing of the myelotomy edges and by maintaining an artificial conduit between the syrinx cavity and the subarachnoid space. Although short-term results are promising, continued long-term follow up is needed to determine the ultimate success of the silastic wedge shunting procedure.

  4. Three-dimensional wedge filling in ordered and disordered systems

    Energy Technology Data Exchange (ETDEWEB)

    Greenall, M J [Department of Mathematics, Imperial College London, 180 Queen' s Gate, London SW7 2BZ (United Kingdom); Parry, A O [Department of Mathematics, Imperial College London, 180 Queen' s Gate, London SW7 2BZ (United Kingdom); Romero-Enrique, J M [Department of Mathematics, Imperial College London, 180 Queen' s Gate, London SW7 2BZ (United Kingdom)


    We investigate interfacial structural and fluctuation effects occurring at continuous filling transitions in 3D wedge geometries. We show that fluctuation-induced wedge covariance relations that have been reported recently for 2D filling and wetting have mean-field or classical analogues that apply to higher-dimensional systems. Classical wedge covariance emerges from analysis of filling in shallow wedges based on a simple interfacial Hamiltonian model and is supported by detailed numerical investigations of filling within a more microscopic Landau-like density functional theory. Evidence is presented that classical wedge covariance is also obeyed for filling in more acute wedges in the asymptotic critical regime. For sufficiently short-ranged forces mean-field predictions for the filling critical exponents and covariance are destroyed by pseudo-one-dimensional interfacial fluctuations. We argue that in this filling fluctuation regime the critical exponents describing the divergence of length scales are related to values of the interfacial wandering exponent {zeta}(d) defined for planar interfaces in (bulk) two-dimensional (d = 2) and three-dimensional (d = 3) systems. For the interfacial height l{sub w} {approx} {theta}-{alpha}){sup -{beta}}{sub w}, with {theta} the contact angle and {alpha} the wedge tilt angle, we find {beta}{sub w} = {zeta}(2)/2(1-{zeta}(3)). For pure systems (thermal disorder) we recover the known result {beta}{sub w} = 1/4 predicted by interfacial Hamiltonian studies whilst for random-bond disorder we predict the universal critical exponent {beta} {approx} even in the presence of dispersion forces. We revisit the transfer matrix theory of three-dimensional filling based on an effective interfacial Hamiltonian model and discuss the interplay between breather, tilt and torsional interfacial fluctuations. We show that the coupling of the modes allows the problem to be mapped onto a quantum mechanical problem as conjectured by previous authors

  5. Anatexis of accretionary wedge, Pacific-type magmatism, and formation of vertically stratified continental crust in the Altai Orogenic Belt (United States)

    Jiang, Y. D.; Schulmann, K.; Sun, M.; Å típská, P.; Guy, A.; Janoušek, V.; Lexa, O.; Yuan, C.


    Granitoid magmatism and its role in differentiation and stabilization of the Paleozoic accretionary wedge in the Chinese Altai are evaluated in this study. Voluminous Silurian-Devonian granitoids intruded a greywacke-dominated Ordovician sedimentary succession (the Habahe Group) of the accretionary wedge. The close temporal and spatial relationship between the regional anatexis and the formation of granitoids, as well as their geochemical similarities including rather unevolved Nd isotopic signatures and the strong enrichment of large-ion lithophile elements relative to many of the high field strength elements, may indicate that the granitoids are product of partial melting of the accretionary wedge rocks. Whole-rock geochemistry and pseudosection modeling show that regional anatexis of fertile sediments could have produced a large amount of melts compositionally similar to the granitoids. Such process could have left a high-density garnet- and/or garnet-pyroxene granulite residue in the deep crust, which can be the major reason for the gravity high over the Chinese Altai. Our results show that melting and crustal differentiation can transform accretionary wedge sediments into vertically stratified and stable continental crust. This may be a key mechanism contributing to the peripheral continental growth worldwide.

  6. Fixation strength of biocomposite wedge interference screw in ACL reconstruction: effect of screw length and tunnel/screw ratio. A controlled laboratory study

    Directory of Open Access Journals (Sweden)

    Herrera Antonio


    Full Text Available Abstract Background Primary stability of the graft is essential in anterior cruciate ligament surgery. An optimal method of fixation should be easy to insert and provide great resistance against pull-out forces. A controlled laboratory study was designed to test the primary stability of ACL tendinous grafts in the tibial tunnel. The correlation between resistance to traction forces and the cross-section and length of the screw was studied. Methods The tibial phase of ACL reconstruction was performed in forty porcine tibias using digital flexor tendons of the same animal. An 8 mm tunnel was drilled in each specimen and two looped tendons placed as graft. Specimens were divided in five groups according to the diameter and length of the screw used for fixation. Wedge interference screws were used. Longitudinal traction was applied to the graft with a Servohydraulic Fatigue System. Load and displacement were controlled and analyzed. Results The mean loads to failure for each group were 295,44 N (Group 1; 9 × 23 screw, 564,05 N (Group 2; 9 × 28, 614,95 N (Group 3; 9 × 35, 651,14 N (Group 4; 10 × 28 and 664,99 (Group 5; 10 × 35. No slippage of the graft was observed in groups 3, 4 and 5. There were significant differences in the load to failure among groups (ANOVA/P Conclusions Longer and wider interference screws provide better fixation in tibial ACL graft fixation. Short screws (23 mm do not achieve optimal fixation and should be implanted only with special requirements.

  7. Non-linear critical taper model and determination of accretionary wedge strength (United States)

    Yang, Che-Ming; Dong, Jia-Jyun; Hsieh, Yuan-Lung; Liu, Hsueh-Hua; Liu, Cheng-Lung


    The critical taper model has been widely used to evaluate the strength contrast between the wedge and the basal detachment of fold-and-thrust belts and accretionary wedges. However, determination of the strength parameters using the traditional critical taper model, which adopts the Mohr-Coulomb failure criterion, is difficult, if not impossible. In this study, we propose a modified critical taper model that incorporates the non-linear Hoek-Brown failure criterion. The parameters in the proposed critical Hoek-Brown wedge CHBW model can be directly evaluated via field investigations and laboratory tests. Meanwhile, the wedge strength is a function of the wedge thickness, which is oriented from stress non-linearity. The fold-and-thrust belt in western central Taiwan was used as an example to validate the proposed model. The determined wedge strength was 0.86 using a representative wedge thickness of 5.3 km; this was close to the inferred value of 0.6 from the critical taper. Interestingly, a concave topographic relief is predicted as a result of the wedge thickness dependency of the wedge strength, even if the wedge is composed of homogeneous materials and if the strength of the detachment is uniform. This study demonstrates that the influence of wedge strength on the critical taper angle can be quantified by the spatial distribution of strength variables and by the consideration of the wedge thickness dependency of wedge strength.

  8. Age variations in the properties of human tibial trabecular bone

    DEFF Research Database (Denmark)

    Ding, Ming; Dalstra, M; Danielsen, CC;


    We tested in compression specimens of human proximal tibial trabecular bone from 31 normal donors aged from 16 to 83 years and determined the mechanical properties, density and mineral and collagen content. Young's modulus and ultimate stress were highest between 40 and 50 years, whereas ultimate...

  9. Aetiology, imaging and treatment of medial tibial stress syndrome

    NARCIS (Netherlands)

    Moen, M.H.


    The work contained is this thesis discusses aetiology, imaging and treatment of a common leg injury: medial tibial stress syndrome (MTSS). Although a common injury, the number of scientific articles on this topic is relatively low as is explained in chapter 1. This chapter also highlights that the m

  10. Tibial inlay for posterior cruciate ligament reconstruction: a systematic review. (United States)

    Papalia, Rocco; Osti, Leonardo; Del Buono, Angelo; Denaro, Vincenzo; Maffulli, Nicola


    Although no consensus has been reached regarding the management of PCL deficiency, in vitro and in vivo studies have investigated whether the tibial inlay technique restores the anatomical site of insertion of the PCL, prevents elongation, stretching, graft failure, and improves long-term PCL stability. A systematic search using PubMed, Ovid, the Cochrane Reviews, and Google Scholar databases using 'posterior cruciate ligament tear', 'Tibial inlay technique' and 'posterior cruciate ligament reconstruction' as keywords identified 71 publications, of which 10 were relevant to the topic, and included a total of 255 patients. The tibial inlay technique restores the anatomic insertion site of the PCL, eliminates the killer turn effect, and places the graft at lower potential risk for abrasion and subsequent rupture. It has the disadvantages of increased operating time and risk to the posterior neurovascular structures. There was no evidence of an association between outcome results and Coleman methodology score, but the Coleman methodology scores correlated positively with the level-of-evidence rating. The methodological quality of the studies included has not improved over the years. Given the few reported published findings, we cannot ascertain whether this procedure may provide a consistent alternative to commonly used PCL surgical strategies. The lack of published randomized clinical trials and few reported findings did not allow to ascertain whether the tibial inlay for posterior cruciate ligament reconstruction may provide a consistent alternative to commonly used PCL surgical strategies and to demonstrate procedure efficacy.

  11. Osteoarthritis Imaging by Quantification of Tibial Trabecular Bone

    DEFF Research Database (Denmark)

    Marques, Joselene

    The pathogenesis of osteoarthritis (OA) includes complex events in the whole joint. In this project, we combined machine-learning techniques in a texture analysis framework and evaluated it in a longitudinal study, where magnetic resonance images of knees were used to quantify the tibial trabecul...

  12. Anterior cruciate ligament reconstruction failure after tibial shaft malunion. (United States)

    LaFrance, Russell M; Gorczyca, John T; Maloney, Michael D


    Anterior cruciate ligament (ACL) reconstruction is common, with >100,000 procedures performed each year in the United States. Several factors are associated with failure, including poor surgical technique, graft incorporation failure, overly aggressive rehabilitation, and trauma. Tibial shaft fracture is also common and frequently requires operative intervention. Failure to reestablish the anatomic alignment of the tibia may cause abnormal forces across adjacent joints, which can cause degenerative joint disease or attritional failure of the surrounding soft tissues. This article describes a case of ACL reconstruction failure after a tibial fracture that resulted in malunion. Excessive force across the graft from lower-extremity malalignment and improper tunnel placement likely contributed to the attritional failure of the graft. This patient required a staged procedure for corrective tibial osteotomy followed by revision ACL reconstruction. This article describes ACL reconstruction failure, tibial shaft malunions, their respective treatments, the technical details of each procedure, and the technical aspects that must be considered when these procedures are done in a staged manner by 2 surgeons.

  13. Olanzapine-induced tender pitting pre-tibial edema

    Directory of Open Access Journals (Sweden)

    Kaliaperumal Mathan


    Full Text Available Antipsychotic-induced edema is uncommonly encountered in clinical practice. We report a case of tender pitting pre-tibial edema with olanzapine in a woman with no medical comorbidities. The peculiar distribution of edema resulted in diagnostic confusion necessitating specific investigations. Eventually, the edema resolved following complete stoppage of the drug, but caused distress to the patient and the caregiver.

  14. Preliminary evaluation of the tibial tuberosity-trochlear groove measurement

    DEFF Research Database (Denmark)

    Miles, James Edward; Kirpensteijn, Jolle; Svalastoga, Eiliv Lars

    guide surgical treatment. The TTTG measures tibial tuberosity position relative to the axis of the femoral trochlea. A preliminary investigation of TTTG measurement was performed using the red fox (Vulpes vulpes) cadavers as a morphologically similar and homogenous substitute for dog cadavers. CT...

  15. Multichannel recording of tibial-nerve somatosensory evoked potentials

    NARCIS (Netherlands)

    de Wassenberg, W. J. G. van; Kruizinga, W. J.; van der Hoeven, J. H.; Leenders, K. L.; Maurits, N. M.


    Study aims. -The topography of the peaks of tibial.-nerve somatosensory evoked potential (SEP) varies among healthy subjects, most likely because of differences in position and orientation of their cortical generator(s). Therefore, amplitude estimation with a standard one- or two-channel derivation

  16. Active Aerothermoelastic Control of Hypersonic Double-wedge Lifting Surface

    Institute of Scientific and Technical Information of China (English)

    Laith K Abbas; Chen Qian; Piergiovanni Marzocca; Gürdal Zafer; Abdalla Mostafa


    Designing reentry space vehicles and high-speed aireraft requires special attention to the nonlinear thermoelastic and aerodynamic instability of their structural components. The thermal effects are important since temperature environment brings dramatic influences on the static and dynamic behaviors of flight structures in supersonic/hypersonic regimes and is likely to cause instability, catastrophic failure and oscillations resulting in structural failure due to fatigue. In order to understand the dynamic behaviors of these "hot"structures, a double-wedge lifting surface with combining freeplay and cubic structural nonlinearities in both plunging and pitching degrees-of-freedom operating in supersonic/hypersonic flight speed regimes has been analyzed. A third order piston theory aerodynamic isused to estimate the applied nonlinear unsteady aerodynamic loads. Also considered is the loss of torsiunal stiffness that may be incurredby lifting surfaces subject to axial stresses induced by aerodynamic heating. The aerodynamic heating effects are estimated based on theadiabatic wall temperature due to high speed airstreams. As a recently emerging technology, the active aerothermoelastic control isaimed at providing solutions to a large number of problems involving the aeronautica Faerospace flight vehicle structures. To preventsuch damaging phenomena from occurring, an application of linear and nonlinear active control methods on both flutter boundary andpost-flutter behavior has been fulfilled. In this paper, modeling issues as well as numerical simulation have been presented and pertinent conclusions outlined. It is evidenced that a serious loss of torsional stiffness may induce the dynamic instability; however active controlcan be used to expand the flutter boundary and convert unstable limit cycle oscillations (LCO) into the stable LCO and/or to shift the transition between these two states toward higher flight Mach numbers.

  17. Laboratory investigation of water extraction effects on saltwater wedge displacement

    Directory of Open Access Journals (Sweden)

    S. Noorabadi


    Full Text Available There is a close connection between saltwater intrusion into aquifers and groundwater extraction. Freshwater extraction in coastal aquifers is one of the most important reasons for the saltwater intrusion into these aquifers. Condition of extraction system such as well depth, discharge rate, saltwater concentration and etc. could affect this process widely. Thus, investigating different extraction conditions comprises many management advantages.  In the present study, the effects of freshwater extraction on saltwater interface displacement have been investigated in a laboratory box. Three different well depths (H were considered with combinations of 3 different extraction rates (Q and 3 saltwater concentrations (C for detailed investigation of the effects of these factors variations on saltwater displacement. SEAWAT model has been used to simulate all the scenarios to numerically study of the process. The experimental and numerical results showed that when the C and Q rates were small and the well depth was shallow, the saltwater interface wouldn’t reach the extraction well, so the extracted water remained uncontaminated. When the C and Q rates were increased and the well was deepened, the salinity of the extracted water became higher. When the Q and C rates were high enough, in the shallow well depth, the final concentration of the extracted water was low but a huge part of the porous media was contaminated by the saltwater, furthermore when the well was deepened enough, the final concentration of the extracted water was increased but a small part of the porous media was contaminated by the saltwater. Finally, the results showed that when the Q and H rates were high enough, the extraction well behaved like a barrier and didn’t allow the advancing saltwater wedge toe to be intruded beyond the wells.

  18. Do ethnicity and gender influence posterior tibial slope? (United States)

    Bisicchia, Salvatore; Scordo, Gavinca M; Prins, Johan; Tudisco, Cosimo


    Ethnicity and gender can affect posterior tibial slope; however, studies on this topic have limitations and are in disagreement. The aim of the present study was to evaluate posterior tibial slope in a large group of consecutive patients, determining whether ethnicity and gender can influence its value. Secondly, to determine intra- and inter-rater reliability of the two radiographic methods adopted. Posterior tibial slope was calculated (rater 1) in lateral view X-rays of the knee according to the posterior tibial cortex (PTC) and tibial proximal anatomical axis (TPAA) methods. Data were matched with ethnicity and gender. For determination of intra- and inter-rater reliability, 50 random X-rays were selected, and blindly measured by two other raters (2 and 3). A total of 581 radiographs were included (413 white and 168 black knees). Comparing white and black subjects, a statistically significant difference was found for both PTC (4.9 ± 1.2 vs 7.1 ± 2.9, p < 0.0001), and for TPAA (7.7 ± 1.1 vs 10.2 ± 3.0, p < 0.0001). In white subjects, an influence of gender was found only for TPAA (6.4 ± 1.1 in males vs 7.6 ± 1.1 in females, p < 0.0001). In black subjects, an influence of gender was found only for PTC (7.4 ± 3.0 in males vs 6.2 ± 2.9 in females, p = 0.01). Intra-rater reliability was good for both methods for rater 1, and very good for rater 2. Inter-rater reliability among the 3 raters was very good for both methods. Differences in posterior tibial slope between different ethnic groups exist. Differences observed between genders are conflicting and might be too small to have implications in clinical practice. The TPAA method is recommended for the evaluation of posterior tibial slope because of higher intra- and inter-rater reliability. Level of evidence 3 Case-control study.

  19. External fixation in the treatment of open tibial shaft fractures

    Directory of Open Access Journals (Sweden)

    Golubović Zoran


    Full Text Available Background/Aim. Besides the conquasant fractures, open tibia shaft fractures belong to the group of the most severe fractures of tibia. Open tibia shaft fracture is one of the most common open fractures of long bones. They most frequently occur as a result of traffic accidents caused by the influence of a strong direct force. Methods. Within the period from January, 2000 to December 31, 2005. at the Clinic for Orthopaedics and Traumatology, Clinical Center Nis, 107 patients with open tibial fractures were treated. We analyzed 96 patients with open tibial fracture. In the series analyzed, the male sex was prevalent - there were 74 men (77.08%. The mean age was 47.3 years. The youngest patient was 17 years old, while the oldest patient was 79. According to the classification of the Gustilo et al. in the analysed group there were 30 (31.25% open tibial fractures of the I degree, 31 (32.29% of the II degree, 25 (26.05% of the III A degree, 8 (8.33% of the III B degree and 2 (2.08% of the III C degree. In 95 of the patients the treatment of open tibia shaft fractures consisted of the surgical treatment of wound and the external fixation of the fractured bone using "Mitkovic" type external fixator with a convergent method of pin applications. One primary amputations had been done in patients with grade IIIC open tibial fracture with large soft tissue defect. Results. Of the 96 open tibial fractures available for follow-up, 73 (76.04% healed without severe complications (osteitis, pseudoarthrosis, valgus malunion and amputation. Ther were nine (9.38% soft tissue pin track infections and six (6.25% superficial wound infections. The mean time of union was 21 (14-36 week. Among severe local complications associated with open tibial fractures, in eight patients (8.33% was registered osteitis, and in nine patients (9.38% fracture nonunion and the development of pseudoarthrosis. Three of the patients (3.13% had more than 10 degree valgus malunion. In one

  20. Great Earthquakes and Orogenic Wedge Front Processes in the Bolivian Backarc (United States)

    Brooks, B. A.; Arrowsmith, R.; Echalar, A.; Yagupsky, D.; Ericksen, T. L.; Weiss, J. R.; Ahlgren, K.; Bevis, M. G.; Whipple, K. X.


    The potential for earthquakes greater than Mw 8 rupturing the decollement below Bolivia's Southern Subandes orogenic wedge has been recently recognized although great events are not documented in historical seismicity catalogs and paleoseismologic studies in this part of Bolivia are non-existent. Here, we present the first evidence for a recent surface-rupturing event of at least 7m at the range-front Mandeyapecua fault near the town of Carandaiti. SRTM topography and published industry sub-surface data demonstrate that the ~500km long fault has at least three main segments, each greater than 100 km, with total relief of 10s of meters. We acquired kinematic GPS and terrestrial laser scanner surveys at 26 sites along the 2 northern segments of the fault. Everywhere the profiles of the frontal scarp are very similar to one another: relief is ~8-12m and scarp face inclination is ~7 degrees. Moreover, the slope faces are unbroken and have constant dip, consistent with a single event rupturing each site. We estimate paleo- Mw using thrust earthquake scaling relations and an across-strike rupture length of 85-100km (the locked zone from the geodetic studies). A rupture aspect ratio of ~1:1 sets the lower limit at ~ Mw 8.0 although, if a single event is responsible, then minimum magnitude is more likely Mw ~ 8.2-8.4. Regional geomorphic studies constrain the age of the faulted lithofacies from 1.6 to 4.4ka and minimum short-term slip rates from 4.3 to 1.8 mm/yr. For comparison, published dates and seismic reflection data yield a Quaternary slip rate of 2.4mm/yr. Each of these estimates is significantly less than the geodetically-determined, currently accumulating slip rate of ~10mm/yr. The implication, then, is that some of the other structures within the wedge must be active, although, as yet, we have found no field evidence for this. We use minimum work orogenic models to investigate the physical controls on fault activity in the wedge and show that, whereas for high

  1. locally fabricated metal step wedge for quality assurance in ...

    African Journals Online (AJOL)


    materials, as well as to investigate an alternative wedge material. The values of the ... The use of low performance x-ray machines. b. ... machine in the Radiology Department of. JUTH is .... the x-ray beam, while ms determines the interaction.

  2. Stark effect in a wedge-shaped quantum box

    CERN Document Server

    Reyes-Esqueda, J A; Castillo-Mussot, M; Vazquez, G J; Reyes-Esqueda, Jorge-Alejandro; Mendoza, Carlos I.; Castillo-Mussot, Marcelo del; Vazquez, Gerardo J.


    The effect of an external applied electric field on the electronic ground state energy of a quantum box with a geometry defined by a wedge is studied by carrying out a variational calculation. This geometry could be used as an approximation for a tip of a cantilever of an atomic force microscope. We study theoretically the Stark effect as function of the parameters of the wedge: its diameter, angular aperture and thickness; as well as function of the intensity of the external electric field applied along the axis of the wedge in both directions; pushing the carrier towards the wider or the narrower parts. A confining electronic effect, which is sharper as the wedge dimensions are smaller, is clearly observed for the first case. Besides, the sign of the Stark shift changes when the angular aperture is changed from small angles to angles theta>pi. For the opposite field, the electronic confinement for large diameters is very small and it is also observed that the Stark shift is almost independent with respect t...

  3. Thoracoscopic pulmonary wedge resection without post-operative chest drain

    DEFF Research Database (Denmark)

    Holbek, Bo Laksafoss; Hansen, Henrik Jessen; Kehlet, Henrik


    : Forced expiratory volume in 1 s (FEV1) ≥60 % of expected, FEV1/forced vital capacity ≥70 %, tumour diameter ≤2 cm, distance from tumour to visceral pleura ≤3 cm, ≤2 separate wedges, no air leak on an intraoperative air leakage test and absence of severe adhesions, bullous/emphysematous disease, pleural...

  4. Wedges, Cones, Cosmic Strings, and the Reality of Vacuum Energy

    CERN Document Server

    Fulling, S A; Truong, P N; Wagner, J


    One of J. Stuart Dowker's most significant achievements has been to observe that the theory of diffraction by wedges developed a century ago by Sommerfeld and others provided the key to solving two problems of great interest in general-relativistic quantum field theory during the last quarter of the twentieth century: the vacuum energy associated with an infinitely thin, straight cosmic string, and (after an interchange of time with a space coordinate) the apparent vacuum energy of empty space as viewed by an accelerating observer. In a sense the string problem is more elementary than the wedge, since Sommerfeld's technique was to relate the wedge problem to that of a conical manifold by the method of images. Indeed, Minkowski space, as well as all cone and wedge problems, are related by images to an infinitely sheeted master manifold, which we call Dowker space. We review the research in this area and exhibit in detail the vacuum expectation values of the energy density and pressure of a scalar field in Dowk...

  5. Discrete dislocation plasticity analysis of the wedge indentation of films

    NARCIS (Netherlands)

    Balint, D. S.; Deshpande, V. S.; Needleman, A.; Van der Giessen, E.


    The plane strain indentation of single crystal films on a rigid substrate by a rigid wedge indenter is analyzed using discrete dislocation plasticity. The crystals have three slip systems at +/- 35.3 degrees and 90 degrees with respect to the indentation direction. The analyses are carried out for

  6. Fixed Points of Maps of a Nonaspherical Wedge

    Directory of Open Access Journals (Sweden)

    Merrill Keith


    Full Text Available Abstract Let be a finite polyhedron that has the homotopy type of the wedge of the projective plane and the circle. With the aid of techniques from combinatorial group theory, we obtain formulas for the Nielsen numbers of the selfmaps of .

  7. Magnetic and structural instabilities of ultrathin Fe(100) wedges

    Energy Technology Data Exchange (ETDEWEB)

    Bader, S.D.; Li, Dongqi; Qiu, Z.Q.


    An overview is provided of recent efforts to explore magnetic and related structural issues for ultrathin Fe films grown epitaxially as wedge structures onto Ag(100) and Cu(100). Experiments were carried out utilizing the surface magneto-optic Kerr effect (SMOKE). Ordinary bcc Fe is lattice-matched to the primitive unit cell of the Ag(100) surface. Fe wedges on Ag(100) can be fabricated whose thick end has in-plane magnetic easy axes due to the shape anisotropy, and whose thin end has perpendicular easy axes due to the surface magnetic anisotrophy. A spin-reorientation transition can thus be studied in the center of the wedge where the competing anisotropies cancel. The goal is to test the Mermin-Wagner theorem which states that long-range order is lost at finite temperatures in an isotropic two-dimensional Heisenberg system. Fe wedges on Cu(100) can be studied in like manner, but the lattice matching permits fcc and tetragonally-distorted fcc phases to provide structural complexity in addition to the interplay of competing magnetic anisotropies. The results of these studies are new phase identifications that help both to put previous work into perspective and to define issues to pursue in the future.

  8. Mechanical strength, fatigue life, and failure analysis of two prototypes and five conventional tibial locking screws. (United States)

    Hou, Sheng-Mou; Wang, Jaw-Lin; Lin, Jinn


    To investigate the effects of the design and microstructure on the mechanical strength of tibial locking devices. The mechanical strength of two prototypes of specially developed locking devices (a both-ends-threaded screw and an unthreaded bolt) was tested and compared with that of five types of commercially available tibial locking screws (Synthes, Howmedica, Richards, Osteo AG, and Zimmer) with similar dimensions. The devices were inserted into a polyethylene tube and loaded at their midpoint by a materials testing machine to simulate a three-point bending test. Single-loading yielding strength and cyclic-loading fatigue life were then measured. Failure analysis of the fractured screws was performed to investigate the microstructure and potential causes of the fatigue fracture. Test results showed that both yielding strength and fatigue life were closely related to the section modulus of the inner diameter of screws. Among the threaded screws, the both-ends-threaded screws had a higher yielding strength and longer fatigue life than the Osteo AG, Howmedica, Richards, and Zimmer screws. The unthreaded bolts had a lower yielding strength than Synthes screws, but they demonstrated the longest fatigue life among all. In failure analysis of broken screws, no metallurgical or manufacturing defects were found except for surface microimperfections. The implants investigated in this study are manufactured with high-quality materials and manufacturing processes. The main cause of hardware failure was mechanical overloading. The five commercially used tibial locking screws had a relatively short fatigue life under high loading. Removing the screw threads might substantially increase the fatigue life of the locking devices. In unthreaded bolts, this increase might be tenfold to a hundredfold.

  9. Posterior tibial tendon dysfunction and flatfoot: analysis with simulated walking. (United States)

    Watanabe, Kota; Kitaoka, Harold B; Fujii, Tadashi; Crevoisier, Xavier; Berglund, Lawrence J; Zhao, Kristin D; Kaufman, Kenton R; An, Kai-Nan


    Many biomechanical studies investigated pathology of flatfoot and effects of operations on flatfoot. The majority of cadaveric studies are limited to the quasistatic response to static joint loads. This study examined the unconstrained joint motion of the foot and ankle during stance phase utilizing a dynamic foot-ankle simulator in simulated stage 2 posterior tibial tendon dysfunction (PTTD). Muscle forces were applied on the extrinsic tendons of the foot using six servo-pneumatic cylinders to simulate their action. Vertical and fore-aft shear forces were applied and tibial advancement was performed with the servomotors. Three-dimensional movements of multiple bones of the foot were monitored with a magnetic tracking system. Twenty-two fresh-frozen lower extremities were studied in the intact condition, then following sectioning peritalar constraints to create a flatfoot and unloading the posterior tibial muscle force. Kinematics in the intact condition were consistent with gait analysis data for normals. There were altered kinematics in the flatfoot condition, particularly in coronal and transverse planes. Calcaneal eversion relative to the tibia averaged 11.1±2.8° compared to 5.8±2.3° in the normal condition. Calcaneal-tibial external rotation was significantly increased in flatfeet from mean of 2.3±1.7° to 8.1±4.0°. There were also significant changes in metatarsal-tibial eversion and external rotation in the flatfoot condition. The simulated PTTD with flatfoot was consistent with previous data obtained in patients with PTTD. The use of a flatfoot model will enable more detailed study on the flatfoot condition and/or effect of surgical treatment.

  10. Localização do ponto de entrada tibial Localization of the tibial entry point

    Directory of Open Access Journals (Sweden)

    Pedro José Labronici


    Full Text Available OBJETIVO: Verificar, através de um questionário, o ponto de entrada da haste intramedular na região proximal da tíbia. Métodos: 230 participantes que tratam fraturas da tíbia foram entrevistados. O questionário foi formulado com três segmentos que poderiam ser respondidos com um formato "sim" ou "não" e um quarto, com duas figuras que representavam uma radiografia em anteroposterior (AP e lateral que poderiam ser respondidas com um formato "A", "B" ou "C". RESULTADOS: A razão mais frequente foi a "facilidade de acesso" (67,8%, seguida do "melhor acesso para inserção da haste" (60,9% e em terceiro "prevenir a dor no joelho" (27,4%. Existiu relação significativa entre as razões de escolha do acesso como "prevenir dor no joelho" e "evitar tendinites" com os pontos A e C da figura esquemática de radiografia em AP, principalmente o ponto C (crista tibial medial. Observou-se que não existiu diferença significativa nos tipos de acesso em relação ao ligamento patelar, nas figuras esquemáticas de radiografia em AP e perfil entre as faixas etárias. CONCLUSÃO: Observou-se que quanto maior a faixa etária maior a proporção de escolher a pergunta "evitar deformidade em valgo". As razões de aspecto médico (prático foram relacionadas com o tipo de acesso no ligamento transpatelar, enquanto que as razões de aspecto paciente (funcional foram relacionadas com o acesso parapatelar medial. O acesso transpatelar foi escolhido pela maioria dos participantes (66,5%.OBJETIVE: To assess, through a questionnaire, the intramedullary nail entry point in the proximal aspect of the tibia. Me-thods: 230 attendees who treat tibial fractures were interviewed. The questionnaire was created with three sections that could be answered with "Yes" or "No" answers and a fourth section that had two figures representing anteroposterior (AP and lateral view x-rays that could be answered with a format "A, "B" or "C". RESULTS: The most frequent reason was "ease

  11. Wedges, cones, cosmic strings and their vacuum energy (United States)

    Fulling, S. A.; Trendafilova, C. S.; Truong, P. N.; Wagner, J.


    One of J Stuart Dowker’s most significant achievements has been to observe that the theory of diffraction by wedges developed a century ago by Sommerfeld and others provided the key to solving two problems of great interest in general-relativistic quantum field theory during the last quarter of the 20th century: the vacuum energy associated with an infinitely thin, straight cosmic string, and (after an interchange of time with a space coordinate) the apparent vacuum energy of empty space as viewed by an accelerating observer. In a sense the string problem is more elementary than the wedge, since Sommerfeld’s technique was to relate the wedge problem to that of a conical manifold by the method of images. Indeed, Minkowski space, as well as all cone and wedge problems, are related by images to an infinitely sheeted master manifold, which we call Dowker space. We review the research in this area and exhibit in detail the vacuum expectation values of the energy density and pressure of a scalar field in Dowker space and the cone and wedge spaces that result from it. We point out that the (vanishing) vacuum energy of Minkowski space results, from the point of view of Dowker space, from the quantization of angular modes, in precisely the way that the Casimir energy of a toroidal closed universe results from the quantization of Fourier modes; we hope that this understanding dispels any lingering doubts about the reality of cosmological vacuum energy. This article is part of a special issue of Journal of Physics A: Mathematical and Theoretical in honour of Stuart Dowker’s 75th birthday devoted to ‘Applications of zeta functions and other spectral functions in mathematics and physics’.

  12. [Characterization of the latent periods of excitation and shortening of anterior tibial muscle of white rats depending on the blood level of triiodothyronine]. (United States)

    Stanishevs'ka, T I; Soboliev, V I


    In experiments in situ it was shown an expressed negative correlation between the duration of latent periods of excitation and contraction of the anterior tibial muscle of white rats and the blood level of free triiodothyronine. The difference in mean values of latent periods at starting and final points of scale of physiological fluctuations of triiodothyronine level amounted 15.5% and 37.0% respectively. In parallel with lengthening of latent period of anterior tibial muscle excitation it was found an increase in latent period of this muscle contraction. Interestingly, at high values of the latent periods of excitation such dependence disappeared.

  13. Recent movements along the Main Boundary Thrust of the Himalayas: Normal faulting in an over-critical thrust wedge? (United States)

    Mugnier, Jean-Louis; Huyghe, Pascale; Chalaron, Edouard; Mascle, Georges


    The Main Boundary Thrust (MBT) is one of the major Himalayan thrusts occurring during the Cainozoic, and it is presently incorporated within the Himalayan thrust wedge (Lesser and Outer Himalayas) displaced above the Indian lithosphere. Nonetheless the MBT shows recent normal displacement along most of its length. We suggest that the orientation of the major principal stress within the Himalayan thrust wedge deviates significantly from the horizontal and when this deviation exceeds the dip of the vectors normal to back-tilted thrusts, the normal component of displacement may act along these faults. Steep north-dipping segments of the MBT therefore show a normal component of displacement if a geometrical definition is used, but they are faults in a compressional regime where the major principal stress axis has deviated from the horizontal. Micro-structural data recorded along the Surkhet-Ghorahi segment of the MBT are consistent with a strong deviation of the state of stress. The presence of such peculiar normal faulting along the MBT is used to calibrate the mechanical characteristics of the belt considered as a Coulomb wedge. The following characteristics are suggested: (a) very poor strength contrast between basal decollement and rocks in the wedge body, (b) a high pore fluid pressure ratio (probably close to 0.8-0.9) and a higher fluid pressure ratio (close to 1.0) along the active normal faults if a high internal friction angle (close to the Byerlee value) is considered. The strong deviation in principal stress direction may have recently increased, due to a taper of the Himalayan wedge exceeding the stability boundary and may be controlled by erosion and isostatic uplift rebound of the Himalayan range.

  14. A staged surgical treatment outcome of type 3 open tibial fractures. (United States)

    Aslan, Ahmet; Uysal, Emin; Ozmeriç, Ahmet


    Aim. In these case series which are about type 3 open tibial fractures formed with three different high energy trauma etiologies in different parts of tibia. We aimed to assess our three-stage treatment approach and discuss final results of our elective surgery management with three different fixation methods. Patients and Methods. We assessed 19 patients with type 3 open tibial fractures between 2009 and 2012. Our treatment protocol consisted of three stages. Early intervention in operating room, which including vascular repairs or soft tissue closure, was done if necessary. Definitive surgery was performed using internal or external fixation in the first 15 days. Patients were followed up for at least one year. Last conditions of all our cases were evaluated according to modified Johner and Wruhs criteria. Results. Nine cases were type 3A, seven cases were type 3B, and three cases were type 3C in terms of fracture typing. All patients were followed up for at least one year and mean follow up time was 15 months. In terms of functional and clinical outcome, six cases were evaluated as excellent, eight cases as good, two cases as fair, and three cases as poor. Discussion. Staged treatment option in type 3 open tibial fractures seems to be a good method in reducing complication and achieving the best result. We think that definitive staged treatment protocol including internal fixation with plating or intramedullary nailing (IMN) of the fractures is a reliable method, especially to avoid complications as a result of external fixator and to provide patient rapport.

  15. Functional outcome of tibial fracture with acute compartment syndrome and correlation to deep posterior compartment pressure. (United States)

    Goyal, Saumitra; Naik, Monappa A; Tripathy, Sujit Kumar; Rao, Sharath K


    To measure single baseline deep posterior compartment pressure in tibial fracture complicated by acute compartment syndrome (ACS) and to correlate it with functional outcome. Thirty-two tibial fractures with ACS were evaluated clinically and the deep posterior compartment pressure was measured. Urgent fasciotomy was needed in 30 patients. Definite surgical fixation was performed either primarily or once fasciotomy wound was healthy. The patients were followed up at 3 mo, 6 mo and one year. At one year, the functional outcome [lower extremity functional scale (LEFS)] and complications were assessed. Three limbs were amputated. In remaining 29 patients, the average times for clinical and radiological union were 25.2 ± 10.9 wk (10 to 54 wk) and 23.8 ± 9.2 wk (12 to 52 wk) respectively. Nine patients had delayed union and 2 had nonunion who needed bone grafting to augment healing. Most common complaint at follow up was ankle stiffness (76%) that caused difficulty in walking, running and squatting. Of 21 patients who had paralysis at diagnosis, 13 (62%) did not recover and additional five patients developed paralysis at follow-up. On LEFS evaluation, there were 14 patients (48.3%) with severe disability, 10 patients (34.5%) with moderate disability and 5 patients (17.2%) with minimal disability. The mean pressures in patients with minimal disability, moderate disability and severe disability were 37.8, 48.4 and 58.79 mmHg respectively (P < 0.001). ACS in tibial fractures causes severe functional disability in majority of patients. These patients are prone for delayed union and nonunion; however, long term disability is mainly because of severe soft tissue contracture. Intra-compartmental pressure (ICP) correlates with functional disability; patients with relatively high ICP are prone for poor functional outcome.

  16. Vertebral Osteotomies in Ankylosing Spondylitis-Comparison of Outcomes Following Closing Wedge Osteotomy versus Opening Wedge Osteotomy: A Systematic Review. (United States)

    Ravinsky, Robert A; Ouellet, Jean-Albert; Brodt, Erika D; Dettori, Joseph R


    Study Design Systematic review. Study Rationale To seek out and assess the best quality evidence available comparing opening wedge osteotomy (OWO) and closing wedge osteotomy (CWO) in patients with ankylosing spondylitis to determine whether their results differ with regard to several different subjective and objective outcome measures. Objective The aim of this study is to determine whether there is a difference in subjective and objective outcomes when comparing CWO and OWO in patients with ankylosing spondylitis suffering from clinically significant thoracolumbar kyphosis with respect to quality-of-life assessments, complication risks, and the amount of correction of the spine achieved at follow-up. Methods A systematic review was undertaken of articles published up to July 2012. Electronic databases and reference lists of key articles were searched to identify studies comparing effectiveness and safety outcomes between adult patients with ankylosing spondylitis who received closing wedge versus opening wedge osteotomies. Studies that included pediatric patients, polysegmental osteotomies, or revision procedures were excluded. Two independent reviewers assessed the strength of evidence using the GRADE criteria and disagreements were resolved by consensus. Results From a total of 67 possible citations, 4 retrospective cohorts (class of evidence III) met our inclusion criteria and form the basis for this report. No differences in Oswestry Disability Index, visual analog scale for pain, Scoliosis Research Society (SRS)-24 score, SRS-22 score, and patient satisfaction were reported between the closing and opening wedge groups across two studies. Regarding radiological outcomes following closing versus opening osteotomies, mean change in sagittal vertical axis ranged from 8.9 to 10.8 cm and 8.0 to 10.9 cm, respectively, across three studies; mean change in lumbar lordosis ranged from 36 to 47 degrees and 19 to 41 degrees across four studies; and mean change

  17. Tibial torsion in non-arthritic Indian adults: A computer tomography study of 100 limbs

    Directory of Open Access Journals (Sweden)

    Mullaji Arun


    Full Text Available Background: Knowledge of normal tibial torsion is mandatory during total knee replacement (TKR, deformity correction and fracture management of tibia. Different values of tibial torsion have been found in different races due to biological and mechanical factors. Value of normal tibial torsion in Indian limbs is not known, hence this study to determine the norm of tibial torsional value in normal Indian population. Materials and Methods: Computer tomography (CT scans were performed in 100 non-arthritic limbs of 50 Indian adults (42 males, eight females; age 26-40 years. Value of tibial torsion was measured using dorsal tangent to tibial condyles proximally and bimalleolar axis distally. Results: Normal tibial torsion was found to be 21.6 ± 7.6 (range 4.8 to 39.5 with none of the values in internal rotation. Right tibia was externally rotated by 2 degrees as compared to the left side ( P 0.029. No significant difference was found in male and female subjects. Value of tibial torsion was less than in Caucasian limbs, but was comparable to Japanese limbs when studies using similar measurement technique were compared. Conclusions: Indian limbs have less tibial torsion than Caucasian limbs but the value of tibial torsion is comparable to Japanese limbs.

  18. Staged minimally invasive plate osteosynthesis of proximal tibial fractures with acute compartment syndrome. (United States)

    Kim, Joon-Woo; Oh, Chang-Wug; Oh, Jong-Keon; Kyung, Hee-Soo; Park, Kyeong-Hyeon; Kim, Hee-June; Jung, Jae-Wook; Jung, Young-Soo


    High-energy proximal tibial fractures often accompany compartment syndrome and are usually treated by fasciotomy with external fixation followed by secondary plating. However, the initial soft tissue injury may affect bony union, the fasciotomy incision or external fixator pin sites may lead to postoperative wound infections, and the staged procedure itself may adversely affect lower limb function. We assess the results of staged minimally invasive plate osteosynthesis (MIPO) for proximal tibial fractures with acute compartment syndrome. Twenty-eight patients with proximal tibial fractures accompanied by acute compartment syndrome who underwent staged MIPO and had a minimum of 12 months follow-up were enrolled. According to the AO/OTA classification, 6 were 41-A, 15 were 41-C, 2 were 42-A and 5 were 42-C fractures; this included 6 cases of open fractures. Immediate fasciotomy was performed once compartment syndrome was diagnosed and stabilization of the fracture followed using external fixation. After the soft tissue condition normalized, internal conversion with MIPO was done on an average of 37 days (range, 9-158) after index trauma. At the time of internal conversion, the external fixator pin site grades were 0 in 3 cases, 1 in 12 cases, 2 in 10 cases and 3 in 3 cases, as described by Dahl. Radiographic assessment of bony union and alignment and a functional assessment using the Knee Society Score and American Orthopedic Foot and Ankle Society (AOFAS) score were carried out. Twenty-six cases achieved primary bony union at an average of 18.5 weeks. Two cases of nonunion healed after autogenous bone grafting. The mean Knee Society Score and the AOFAS score were 95 and 95.3 respectively, at last follow-up. Complications included 1 case of osteomyelitis in a patient with a grade IIIC open fracture and 1 case of malunion caused by delayed MIPO due to poor wound conditions. Duration of external fixation and the external fixator pin site grade were not related to the

  19. A two-choice strategy through a medial tibial approach for the treatment of pilon fractures with posterior or anterior fragmentation

    Directory of Open Access Journals (Sweden)

    Di Giorgio Luigi


    Full Text Available 【Abstract】Objective: The anterolateral approach to the tibia has been popularized for the management of tibial pilon fractures. For complex fracture patterns a combined anterolateral/anteromedial approach is suitable buta high rate of complicat ion has been reported. In our retrospective study a two-choice strategy adopting a medial tibial approach was proposed for the treatment of pilon fractures with anterior or posterior fragmentation. Methods: Based on an anatomic study of tibial pilon fractures, we retrospectively analyzed the fractures with primary posterior, posterior-lateral or anterior, anterior-lateral (Tillaux-Chaput involvement of the distal tibia. This retrospective study consisted of 18 patients with a closed tibial plafond fracture. The inclusion criteria were: (1 presence of an anterior/anterolateral type fragment or a posterior (Volkmann type fragment involving >25% of the articular surface, (2 a minimum follow-upof 12 months, (3 a fibula f racture associated with a medial column fracture of the distaltibia, and (4 soft tissue conditions at the time of operation that did not compromise the choice of surgical access (Tscher ne classi fication for closed fr actures: grade 0 and grade 1. Tibial plafond fractures were classified into two groups: one presenting anterior and the other with posterior rim (Volkmann fragments. Resul ts: Most patients achieved a good clinical recovery in terms of range of motion and Olerud-Molander scale scores. Only three patient s presented a grade 2 osteoarthritis at the 12 month follow-up. Conclusion: Our two-choice strategy highlights concepts which have been previously debated and described in the literature. But a new extended protocol for surgical approach to the distal tibia, including more fracture patterns and their association should be further investigated. Key words: Tibial fractures; Fracture fixation; Surgical procedures, operative; Intraoperative complications

  20. 胫神经近端肌支移位治疗高位坐骨神经损伤的应用解剖%The anatomical study of transfer of motor branches from proximal segment of the tibial nerve for treatment of high-level sciatic nerve injury

    Institute of Scientific and Technical Information of China (English)

    李明恒; 钟红发; 陈荣春


    Objective To explore the feasibility of transfer of motor branches from the proximal tibial nerve to treat high-level sciatic nerve injuries in an anatomical study. Methods 30 sides of lower limbs from 15 embalmed adult cadavers were used to dissect and the motor branches from proximal tibial nerve were measured for following parameters, such as length, diameter, the location of original point relative to the level of the fibular head and the distance from original point to the fibular neck. Intraneural dissection the common peroneous nerve from the bifurcation to the proximal was performed to isolate the division of the deep and superficial peroneous division;the maximum length of intraneural dissection that could be dissected and the diameter of deep peroneous nerves were also measured. Results There were three main motor branches at the proximal leg:the branches destined to the lateral and medial heads of the gastrocnemius and to the soleus muscle. The length of these branches was (36.3 ± 9.6) mm, (44.7 ± 8.6) and (53.2 ± 9.9)mm respectively. The maximum length of intraneural dissection of the common peroneous nerve was (59.3 ± 7.2) mm. After dissection, branches to the soleus muscle and the lateral head of the gastrocnemius were adequate for direct nerve suture with the deep peroneous division in all cadavers without tension. And in 28 sides of lower limbs (93.3 percent), branches to the medial head of the gastrocnemius were adequate for nerve suture. Conclusion After intraneural dissection of the common fibular nerve, the motor branches from the proximal part of the tibial nerve can be harvested and transfered to restore the deep peroneous nerve in the treatment of high sciatic nerve injuries. Considering the length and diameter, branches to the soleus muscle were the best choice for the proposed transfer.%目的:探讨胫神经的近端肌支移位治疗某些高位坐骨神经损伤的解剖学可行性。方法选取15具(30侧)福尔马林固定

  1. Influence of Prosthetic Sagittal Alignment on Trans-Tibial Amputee Gait and Compensating Pattern:A Case Study

    Institute of Scientific and Technical Information of China (English)

    JIA Xiaohong; WANG Rencheng; ZHANG Ming; LI Xiaobing


    This study relates the gait asymmetry,residual limb comfort,and energy cost dunng walking and identifies a compensating pattem for the trans-tibial amputees when the prostheses are misaligned.One male subject with a trans-tibial amputation volunteered for the study.The knee joint moments at the prosthetic side,the phase symmetry index,and the interface pressures were discussed under three sagittalal ignment settings.The results show that the subject changes the knee joint moment,gait symmetry,and interface pressure with a misaligned prosthesis to improve his comfort and movement dudng walking.A high-quality liner reduces the gait sensitivity to misalignment and enhances the amputee's ability to compensate for misalignment.Since different people have different compensation pattems,more cases will be studied in future work.

  2. Tibial rotation in anterior cruciate ligament reconstructed knees during single limb hop and drop landings. (United States)

    Webster, Kate E; Feller, Julian A


    Alterations in knee joint kinematics have been suggested as a potential mechanism that influences the development of osteoarthritis of the knee after anterior cruciate ligament reconstruction. Whilst previous work has shown changes in internal-external tibial rotation during level walking, many patients aim to return to high impact activities following surgery. This study examined tibial rotation during single limb hop and drop landings in anterior cruciate ligament reconstructed knees compared to a control group, and also evaluated the influence of graft type (hamstring or patellar tendon). In 48 participants (17 patellar tendon graft, 18 hamstring graft and 13 controls) internal-external rotation was measured during single limb hop and drop landings in a gait laboratory at mean of 10 months after surgery. There was no difference between the two graft types and both patient groups had less internal rotation when compared to the control group. For 60% of patients, internal rotation values were at least 5° less than the control group mean. Anterior cruciate ligament reconstructed knees with both hamstring tendon and patellar tendon grafts show altered rotational kinematic patterns during high impact dynamic load activities. Copyright © 2011 Elsevier Ltd. All rights reserved.

  3. 脉冲 Er:YAG 激光与常规涡轮高速车针治疗楔状缺损的效果比较%The Effect Comparasion between the Pulse Er:YAG Laser and the Conventional Turbine High-speed Dental Bur to the Remedy of Teeth Wedge-shaped Defect

    Institute of Scientific and Technical Information of China (English)

    范伟; 贺慧霞


    目的:比较Er:YAG激光与常规涡轮机高速车针治疗楔状缺损的效果。方法收集我院口腔科就诊的、双侧多个同名牙楔状缺损患者85例382颗牙,随机分为激光组和涡轮机组各191牙,其中每位患者每侧至少2颗牙采用激光表面预备,对侧高速涡轮机预备,脉冲照射采用激光剂量为300 mJ,20 Hz间歇操作。涡轮机组采用高速车针制备固位型,自体对照,两组均预备后光固化树脂黏充填。比较两组治疗后1周、1个月、6个月、12个月术后充填物保存率、边缘着色、继发龋等指标,评价其临床治疗效果。结果两组术中疼痛牙齿发生率激光组(16.7%)显著少于涡轮机组(74.8%),差异有统计学意义(P<0.05);术后1周、1个月激光组分别有35牙和12牙出现冷热刺激痛,而涡轮机组发生刺激痛分别为83牙和44牙,两者差异有统计学意义( P<0.05);术后6个月和12个月修复体保存率激光组显著高于涡轮机组,差异有统计学意义( P<0.05);但边缘适合性、边缘着色和继发龋发生率两组差异无统计学意义。结论激光组较涡轮机组在楔状缺损治疗中疼痛发生率低、治疗后疼痛反应轻;修复体保存率高。300 mJ,20 Hz的Er:YAG激光治疗楔状缺损具有无痛、安全、高效的优点。%Objective To compare the effects of Er: YAG laser and conventional high-speed burr in treatment of wedge-shaped tooth defects and to evaluate its applicability and reliability .Methods 382 bilateral multiple teeth with wedge-shaped defects in 85 patients were randomly divided into two groups with 191 teeth in each:laser group and the turbine burr group .At least two teeth of one side in all patients were irradiated by pulsed Er:YAG laser with doses of 300 mj, 20 Hz.Meanwhile, the caries cavities on the contralateral were prepared by high-speed burr .Then the prepared caries defects in both

  4. One strategy for arthroscopic suture fixation of tibial intercondylar eminence fractures using the Meniscal Viper Repair System

    Directory of Open Access Journals (Sweden)

    Ochiai Satoshi


    Full Text Available Abstract Background Principles for the treatment of tibial intercondylar eminence fracture are early reduction and stable fixation. Numerous ways to treatment of this fracture have been invented. We designed a simple, low-invasive, and arthroscopic surgical strategy for tibial intercondylar eminence fracture utilizing the Meniscal Viper Repair System used for arthroscopic meniscal suture. Methods We studied 5 patients, who underwent arthroscopic suture fixation that we modified. The present technique utilized the Meniscal Viper Repair System for arthroscopic suture of the meniscus. With one handling, a high-strength ultra-high molecular weight polyethylene(UHMWPE suture can be passed through the anterior cruciate ligament (ACL and the loops for suture retrieval placed at both sides of ACL. Surgical results were evaluated by the presence or absence of bone union on plain radiographs, postoperative range of motion of the knee joint, the side-to-side differences measured by Telos SE, and Lysholm scores. Results The reduced position achieved after surgery was maintained and good function was obtained in all cases. The mean distance of tibia anterior displacement and assessment by Lysholm score showed good surgical results. Conclusion This method simplified the conventional arthroscopic suture fixation and increased its precision, and was applicable to Type II fractures that could be reduced, as well as surgically indicated Types III and IV. The present series suggested that our surgical approach was a useful surgical intervention for tibial intercondylar eminence fracture.

  5. Posterior Tibial Tendon Dysfunction: An Overlooked Cause of Foot Deformity (United States)

    Bubra, Preet Singh; Keighley, Geffrey; Rateesh, Shruti; Carmody, David


    Posterior tibial tendon dysfunction is the most common cause of adult acquired flatfoot. Degenerative changes in this tendon, lead to pain and weakness and if not identified and treated will progress to deformity of the foot and degenerative changes in the surrounding joints. Patients will complain of medial foot pain, weakness, and a slowly progressive foot deformity. A “too many toes” sign may be present and patients will be unable to perform a single heal raise test. Investigations such X-ray, ultrasound and magnetic resonance imaging will help stage the disease and decide on management. The optimal manage may change based on the progression of deformity and stage of disease. Early identification and prompt initiation of treatment can halt progression of the disease. The purpose of this article is to examine the causes, signs, symptoms, examinations, investigations and treatment options for posterior tibial tendon dysfunction. PMID:25810985

  6. MR evaluation of femoral neck version and tibial torsion

    Energy Technology Data Exchange (ETDEWEB)

    Koenig, James Karl; Dwek, Jerry R. [University of California, San Diego, Children' s Hospital and Health Center, Department of Radiology, San Diego, CA (United States); Pring, Maya E. [Rady Children' s Hospital, Department of Pediatric Orthopedic Surgery, San Diego, CA (United States)


    Abnormalities of femoral neck version have been associated with a number of hip abnormalities in children, including slipped capital femoral epiphysis, proximal femoral focal deficiency, coxa vara, a deep acetabulum and, rarely, developmental dysplasia of the hip. Orthopedic surgeons also are interested in quantifying the femoral neck anteversion or retroversion in children especially to plan derotational osteotomies. Historically, the angle of femoral version and tibial torsion has been measured with the use of radiography and later by CT. Both methods carry with them the risks associated with ionizing radiation. Techniques that utilize MR are used less often because of the associated lengthy imaging times. This article describes a technique using MRI to determine femoral neck version and tibial torsion with total scan times of approximately 10 min. (orig.)

  7. [Treatment of tibial pseudoarthrosis. Complications after intramedullary, allogeneic fibular grafting]. (United States)

    Helfen, T; Prall, W C; Mutschler, W; Thaller, P H


    A 24-year-old woman underwent cosmetic bilateral tibial lengthening with severe complications. In all, 15 operations, including allogeneic fibular grafting of both tibia, were required to treat unstable bilateral non-union, malalignment, and osteomyelitis of the right tibia.The present article describes the surgical strategy of revision to achieve good recovery with full consolidation and proper alignment of the lower leg. Furthermore, the indications for allogeneic bone grafting, which was described by Erich Lexer 100 years ago, are discussed. For surgical revision, a T-external fixator was used on the right leg, while a customized tibial nail was used on the left leg. Using these techniques, full consolidation and proper alignment was achieved. Allogeneic bone grafts in upper extremity defects cannot be recommended.

  8. Electrodynamic Casimir Effect in a Medium-Filled Wedge II

    CERN Document Server

    Ellingsen, Simen Adnoy; Milton, Kimball A


    We consider the Casimir energy in a geometry of an infinite magnetodielectric wedge closed by a circularly cylindrical arc embedded in another magnetodielectric medium, under the condition that the speed of light be the same in both media. An expression for the Casimir energy corresponding to the arc is obtained and it is found that in the limit where the reflectivity of the boundaries tends to unity the finite part of the Casimir energy of a perfectly conducting wedge-shaped sheet closed by a circular cylinder is regained. The energy of the latter geometry possesses divergences due to the presence of sharp corners. We argue how this is a pathology of the assumption of ideal conductor boundaries, and that no analogous term enters in the present geometry.

  9. MHD Casson nanofluid flow past a wedge with Newtonian heating (United States)

    Ahmad, Kartini; Hanouf, Zahir; Ishak, Anuar


    The problem of steady Casson nanofluid flow past a wedge is studied in this paper. The presence of magnetic field along with Newtonian heating at the surface is considered. The governing partial differential equations are first transformed into a set of nonlinear ordinary differential equations by similarity transformations, before being solved numerically using the Keller-box method. The effects of the wedge angle Ω from 0° (horizontal plate) to 180° (vertical plate) as well as of as the magnetic parameter M on the non-Newtonian fluid flow and heat transfer characteristics are investigated. It is found that the surface temperature is slightly higher for the flow over a horizontal plate compared to that over a vertical plate. It is also found that the magnetic field decreases the surface temperature but increases the skin friction. The flow of a Newtonian fluid is found to give higher skin friction as compared to that of Casson fluid.

  10. Wedge Diffraction as an Instance of Radiative Shielding

    CERN Document Server

    Grzesik, J A


    The celebrated Sommerfeld wedge diffraction solution is reexamined from a null interior field perspective. Exact surface currents provided by that solution, when considered as disembodied half-plane laminae radiating into an ambient, uniform space both inside and outside the wedge proper, do succeed in reconstituting both a specular, mirror field above the exposed face, and a shielding plane-wave field of a sign opposite to that of the incoming excitation which, under superposition, creates both the classical, geometric-optics shadow, and a strictly null interior field at the dominant, plane-wave level. Both mirror and shadow radiated fields are controlled by the residue at just one simple pole encountered during a spectral radiative field assembly, fixed in place by incidence direction $\\phi_{0}$ as measured from the exposed face. The radiated fields further provide diffractive contributions drawn from two saddle points that track observation angle $\\phi.$ Even these, more or less asymptotic contributions, a...

  11. Wedge Splitting Test and Fracture Energy on Particulate Reinforced Composites

    Energy Technology Data Exchange (ETDEWEB)

    Na, Seong Hyeon; Kim, Jae Hoon; Choi, Hoon Seok [Chungnam National Univ., Daejeon (Korea, Republic of); Park, Jae Beom; Kim, Shin Hoe; Jung, Gyoo Dong [Agency for Defense Developmen, Daejeon (Korea, Republic of)


    The effect of temperature on the fracture energy, crack propagation, and crack tip opening displacement(CTOD) was determined for particulate reinforced composites using the wedge splitting test. The materials that were used consisted of a polymer binder, an oxidizing agent, and aluminum particles. The test rate of the wedge splitting specimen was 50 mm/min, the temperature conditions were 50℃, room temperature, -40℃, and -60℃. The fracture energy, calculated from splitting load-crack mouth opening displacement(CMOD) curves, increased with decreasing temperature from 50℃ to -40℃. In addition, the strength of the particulate reinforced composites increased sharply at -60℃, and the composites evidenced brittle fracture due to the glass transition temperature. The strain fields near the crack tip were analyzed using digital image correlation.

  12. Posterior Tibial Tendon Dysfunction and Flatfoot: Analysis with Simulated Walking


    Watanabe, Kota; Kitaoka, Harold B; Fujii, Tadashi; Crevoisier, Xavier M.; Berglund, Lawrence J.; Zhao, Kristin D.; Kaufman, Kenton R.; An, Kai-Nan


    Many biomechanical studies investigated pathology of flatfoot and effects of operations on flatfoot. The majority of cadaveric studies are limited to the quasistatic response to static joint loads. This study examined the unconstrained joint motion of the foot and ankle during stance phase utilizing a dynamic foot-ankle simulator in simulated stage 2 posterior tibial tendon dysfunction (PTTD). Muscle forces were applied on the extrinsic tendons of the foot using six servo-pneumatic cylinders ...

  13. Human tibial torsion - Morphometric assessment and clinical relevance

    Directory of Open Access Journals (Sweden)

    Swati Gandhi


    Full Text Available Background: Tibial torsion is an important anatomical parameter in clinical practice and displays variability among individuals. These variations are extremely significant in view of alignment guides such as those related to rotational landmarks of tibia in total knee arthroplasty. Further, precise knowledge and information pertaining to angle of tibial torsion also helps in correction of traumatic malunion or congenital maltorsion of tibia. Methods: The present study was carried out to determine the angle of tibial torsion in 100 adult dry tibia bones in the Department of Anatomy, Government Medical College, Amritsar. The study group comprised 50 males and 50 females with equal number of right- and left-sided bones. The measurements were meticulously recorded and the data were subjected to statistical analysis. The results were analyzed and discussed in the light of existing literature. Results: On the right side, it was found to be 29.84° ± 4.86°° (range = 22.00° -38.00° in males and 28.92° ± 5.10°° (range = 15.00°-38.00° in females. On the left side, it was found to be 28.00° ± 4.94°° (range = 20.00°-40.00°° in males and 28.12° ± 4.28°° (range = 20.00°-37.00°° in females. Conclusion: The present study is an endeavor to provide baseline data with reference to the angle of tibial torsion in the Indian population. The results of the study assume special importance in view of the technical advancements in reconstructive surgical procedures in orthopedic practice.

  14. Aetiology, imaging and treatment of medial tibial stress syndrome


    Moen, M.H.


    The work contained is this thesis discusses aetiology, imaging and treatment of a common leg injury: medial tibial stress syndrome (MTSS). Although a common injury, the number of scientific articles on this topic is relatively low as is explained in chapter 1. This chapter also highlights that the most probable cause of MTSS is bone overload and not traction induced periostitis. In chapter 2 a review of the literature on MTSS is provided until 2009. Chapters 3 and 4 discuss different common a...

  15. Pigmented villonodular synovitis after TKA associated with tibial component loosening. (United States)

    Chung, Byung June; Park, Yong Bum


    There is no known causal link between total knee arthroplasty (TKA) and pigmented villonodular synovitis (PVNS). There also is no known relationship between PVNS and implant loosening after TKA in the literature. This article presents a case of PVNS in a patient undergoing revision TKA for tibial component loosening. A 74-year-old woman who had undergone cemented bilateral TKA 5 years earlier presented with painful swelling in her right knee. At the time of the primary TKA, no abnormal signs were found in the synovial membrane. Routine follow-up radiographs did not indicate implant loosening. At the patient's final follow-up examination before revision surgery, a radiolucent lesion was found below the tibial component. During revision surgery, there was focal proliferation of the synovial tissue with heavy pigmentation around the anteromedial part of the tibial component. The abnormal tissue was removed, and the tibial component was exchanged. The articular surface of the polyethylene was not damaged, and backside wear was not found. For the revision surgery, 5-mm thick medial metal block and extension stem were used. Histological analysis of the resected tissue revealed the typical appearance of PVNS. We present a typical case of PVNS found during revision TKA 5 years after primary TKA. It is hoped this report will encourage surgeons to consider PVNS in the differential diagnosis of patients who present with painful swelling of the knee and to consider PVNS as one of the causes of implant loosening after TKA. Further research about causal factors between PVNS and implant loosening are needed. Copyright 2011, SLACK Incorporated.

  16. Tibial acceleration profiles during the menstrual cycle in female athletes. (United States)

    Hohmann, Erik; Bryant, Adam L; Livingstone, Elisabeth; Reaburn, Peter; Tetsworth, Kevin; Imhoff, Andreas


    Fluctuating levels of endogenous estrogen are thought to have an adverse effect on lower limb biomechanics, given the observed higher rate of ACL injury at certain phases of the menstrual cycle. The purpose of this study was to investigate the effects of fluctuating endogenous estrogen levels during the menstrual cycle on acceleration transients at the proximal tibia in young physically active females. Eleven females aged 16-18 years participated in this study and were compared to a male control group. Female subjects were tested at each of the four phases of the menstrual cycle: menses, follicular, ovulation and luteal. On each test occasion, acceleration transients at the proximal tibia were measured while subjects performed an abrupt deceleration task (simulated netball landing). No significant differences were found between the different phases of the menstrual cycle for peak tibial acceleration (PTA; P = 0.57), and time to zero tibial acceleration (TZTA; P = 0.59). However, there was a significant difference for time to peak tibial acceleration (TPTA) between menstruation and follicular (P = 0.04), menstruation and ovulation (P = 0.001), menstruation and luteal phase (P = 0.002), and follicular phase and ovulation (P = 0.007). In the male control group, no significant between-test session differences were observed for PTA (P = 0.48), TZTA (P = 0.08) and TPTA (P = 0.29). While there were no significant between-group differences for PTA (P = 0.21) and TZTA (P = 0.48), significant between-group differences were observed for TPTA (P = 0.001). The results of this project strongly suggest that serum estrogen fluctuations have an effect on tibial acceleration profiles in young female athletes during different phases of the menstrual cycle.

  17. Safe surgical technique: intramedullary nail fixation of tibial shaft fractures


    Zelle, Boris A.; Boni, Guilherme


    Statically locked, reamed intramedullary nailing remains the standard treatment for displaced tibial shaft fractures. Establishing an appropriate starting point is a crucial part of the surgical procedure. Recently, suprapatellar nailing in the semi-extended position has been suggested as a safe and effective surgical technique. Numerous reduction techiques are available to achieve an anatomic fracture alignment and the treating surgeon should be familiar with these maneuvers. Open reduction ...

  18. Distal tibial pilon fractures (AO/OTA type B, and C treated with the external skeletal and minimal internal fixation method

    Directory of Open Access Journals (Sweden)

    Milenković Saša


    Full Text Available Background/Aim. Distal tibial pilon fractures include extra-articular fractures of the tibial metaphysis and the more severe intra-articular tibial pilon fractures. There is no universal method for treating distal tibial pilon fractures. These fractures are treated by means of open reduction, internal fixation (ORIF and external skeletal fixation. The high rate of soft-tissue complications associated with primary ORIF of pilon fractures led to the use of external skeletal fixation, with limited internal fixation as an alternative technique for definitive management. The aim of this study was to estimate efficacy of distal tibial pilon fratures treatment using the external skeletal and minimal internal fixation method. Methods. We presented a series of 31 operated patients with tibial pilon fractures. The patients were operated on using the method of external skeletal fixation with a minimal internal fixation. According to the AO/OTA classification, 17 patients had type B fracture and 14 patients type C fractures. The rigid external skeletal fixation was transformed into a dynamic external skeletal fixation 6 weeks post-surgery. Results. This retrospective study involved 31 patients with tibial pilon fractures, average age 41.81 (from 21 to 60 years. The average follow-up was 21.86 (from 12 to 48 months. The percentage of union was 90.32%, nonunion 3.22% and malunion 6.45%. The mean to fracture union was 14 (range 12-20 weeks. There were 4 (12.19% infections around the pins of the external skeletal fixator and one (3.22% deep infections. The ankle joint arthrosis as a late complication appeared in 4 (12.90% patients. All arthroses appeared in patients who had type C fractures. The final functional results based on the AOFAS score were excellent in 51.61%, good in 32.25%, average in 12.90% and bad in 3.22% of the patients. Conclusion. External skeletal fixation and minimal internal fixation of distal tibial pilon fractures is a good method for

  19. Modal Analysis in Lined Wedge-Shaped Ducts (United States)

    Mechel, F. P.


    It has been suggested to describe the sound field in a wedge-shaped duct in a cylindrical co-ordinate system in which the boundaries of the wedge lie in a co-ordinate surface. This suggestion was developed in a companion paper [1]. The wave equation can be separated only if the boundaries are ideally reflecting (rigid or soft). Two solutions were proposed in reference [1] for absorbing boundaries. In the first solution the sound field is composed of “ideal modes” (modes in a wedge with ideally reflecting boundaries); the boundary condition at the absorbing boundary then leads to a system of equations for the mode amplitudes. The problem with this method lies in the fact that there is no radial orthogonality of the ideal modes so that the precision of the field synthesis by ideal modes is doubtful. In the second method in reference [1] one defines “fictitious modes” which satisfy the boundary conditions at the flanks exactly and which are based on hypergeometric functions as radial functions, but which produce a “rest” in the wave equation. It was described how this rest can be minimized; this procedure leads to slow numerical integrations. In the present paper, the wedge is subdivided into duct sections with parallel walls (the boundary is stepped); the fields in the sections are composed of duct modes (modes in a straight lined duct); the mode amplitudes are determined from the boundary conditions at the section limits. The advantages of the present method are (analytically) the duct modes are orthogonal across the sections, so the mode amplitudes can be determined with the usual precision of a modal analysis, and (numerically) no numerical integrations are needed.

  20. Large scale test of wedge shaped micro strip gas counters

    Energy Technology Data Exchange (ETDEWEB)

    Ackermann, M.; Atz, S.; Aulchenko, V.; Bachmann, S.; Baiboussinov, B.; Barthe, S.; Beaumont, W.; Beckers, T.; Beissel, F.; Benhammou, Y.; Bergdolt, A.M.; Bernier, K.; Bluem, P.; Bondar, A.; Bouhali, O.; Boulogne, I.; Bozzo, M.; Brom, J.M.; Camps, C.; Chorowicz, V.; Coffin, J.; Commichau, V.; Contardo, D.; Croix, J.; Troy, J. de; Drouhin, F.; Eberle, H.; Fluegge, G.; Fontaine, J.-C.; Geist, W.; Goerlach, U.; Gundlfinger, K.; Hangarter, K.; Haroutunian, R.; Helleboid, J.M.; Henkes, Th.; Hoffer, M.; Hoffman, C.; Huss, D.; Ischebeck, R.; Jeanneau, F.; Juillot, P.; Junghans, S.; Kapp, M.R.; Kaercher, K.; Knoblauch, D.; Kraeber, M.; Krauth, M.; Kremp, J.; Lounis, A.; Luebelsmeyer, K.; Maazouzi, C.; Macke, D.; Metri, R.; Mirabito, L.; Mueller, Th.; Nagaslaev, V.; Neuberger, D.; Nowack, A.; Pallares, A.; Pandoulas, D.; Petertill, M.; Pooth, O.; Racca, C.; Ripp, I.; Ruoff, E.; Sauer, A.; Schmitz, P.; Schulte, R.; Schultz von Dratzig, A.; Schunk, J.P.; Schuster, G.; Schwaller, B.; Shektman, L.; Siedling, R.; Sigward, M.H.; Simonis, H.J.; Smadja, G.; Stefanescu, J.; Szczesny, H.; Tatarinov, A.; Thuemmel, W.H.; Tissot, S.; Titov, V.; Todorov, T.; Tonutti, M.; Udo, F.; Velde, C. Vander. E-mail:; Doninck, W. van; Dyck, Ch. van; Vanlaer, P.; Lancker, L. van; Verdini, P.G.; Weseler, S.; Wittmer, B.; Wortmann, R.; Zghiche, A.; Zhukov, V


    In order to check the system aspects of the forward-backward MSGC tracker designed for the future CMS experiment at LHC, 38 trapezoidal MSGC counters assembled in six multi-substrates detector modules were built and exposed to a muon beam at the CERN SPS. Results on the gain uniformity along the wedge-shaped strip pattern and across the detector modules are shown together with measurements of the detection efficiency and the spatial resolution.

  1. Large scale test of wedge shaped micro strip gas counters

    CERN Document Server

    Ackermann, M; Aulchenko, V M; Bachmann, S; Baibusinov, B O; Barthe, S; Beaumont, W; Beckers, T; Beissel, F; Benhammou, Ya; Bergdolt, A M; Bernier, K; Blüm, H P; Bondar, A E; Bouhali, O; Boulogne, I; Bozzo, M; Brom, J M; Camps, C; Chorowicz, V; Coffin, J P; Commichau, V; Contardo, D; Croix, J; De Troy, J G; Drouhin, F; Eberle, H; Flügge, G; Fontaine, J C; Geist, Walter M; Goerlach, U; Gundlfinger, K; Hangarter, K; Haroutunian, R; Helleboid, J M; Henkes, T; Hoffer, M; Hoffmann, C; Huss, D; Ischebeck, R; Jeanneau, F; Juillot, P; Junghans, S; Kapp, M R; Kärcher, K; Knoblauch, D; Kräber, M H; Krauth, M; Kremp, J; Lounis, A; Lübelsmeyer, K; Maazouzi, C; Macke, D; Metri, R; Mirabito, L; Müller, T; Nagaslaev, V; Neuberger, D; Nowak, A; Pallarès, A; Pandoulas, D; Petertill, M; Pooth, O; Racca, C; Ripp, I; Ruoff, E; Sauer, A; Schmitz, P; Schulte, R; Schultz von Dratzig, A; Schunk, J P; Schuster, G; Schwaller, B; Shekhtman, L I; Siedling, R; Sigward, M H; Simonis, H J; Smadja, G; Stefanescu, J; Szczesny, H; Tatarinov, A A; Thümmel, W H; Tissot, S; Titov, V; Todorov, T; Tonutti, M; Udo, Fred; Van der Velde, C; Van Doninck, W K; Van Dyck, C; Vanlaer, P; Van Lancker, L; Verdini, P G; Weseler, S; Wittmer, B; Wortmann, R; Zghiche, A; Zhukov, V


    In order to check the system aspects of the forward-backward MSGC tracker designed for the future CMS experiment at LHC, 38 trapezoidal MSGC counters assembled in six multi-substrates detector modules were built and exposed to a muon beam at the CERN SPS. Results on the gain uniformity along the wedge-shaped strip pattern and across the detector modules are shown together with measurements of the detection efficiency and the spatial resolution. (8 refs).

  2. DNS of compressible turbulent boundary layer over a blunt wedge

    Institute of Scientific and Technical Information of China (English)

    LI Xinliang; FU Dexun; MA Yanwan


    Direct numerical simulation of spatially evolving compressible boundary layer over a blunt wedge is performed in this paper. The free-stream Mach number is 6 and the disturbance source produced by wall blowing and suction is located downstream of the sound-speed point. Statistics are studied and compared with the results in incompressible flat-plate boundary layer. The mean pressure gradient effects on the vortex structure are studied.

  3. Water-saturated physical modeling of accretionary wedges (United States)

    Yamada, Y.; Zhang, M.; Nakajima, H.; Driss, E.


    Accretionary wedges have been an important research target from view points of earthquake mechanism at the subduction zone, sediment deformation that is closely coupled with hydrology, and resource exploration such as methane hydrates. The knowledge obtained from the study may also be useful for site selection of geological disposal of hazardous materials including radioactive nuclear wastes, in coastal areas of tectonically unstable island arc systems like Japan. The wedges have been well-investigated with analogue models in particular sandbox experiments that typically use dry granular materials, thus the inter-granular pore space of the sandbox experiments is filled with air. In natural sediments, however, the pore space is filled with formation water and its pressure has special effects on structural development. In order to accurately simulate the in-situ conditions and to examine the effects of water on the deformation process of accretionary wedge, a new apparatus was recently constructed in AIST, Japan, to perform physical analog experiments of accretionary wedges under water-saturated condition. For comparisons, equivalent experiments with dry materials were also conducted. The physical properties of the materials were also measured with tri-axial compression tests to interpret the experimental observations. Preliminary results obtained from this study showed that the fundamental parameters on structural geometry, such as taper angle and fault spacing, can be correlated well in wet and dry experiments. These are also in good agreement with physical properties obtained by the tri-axial compression tests, suggesting that the internal friction coefficient decreases as the overburden pressure increases. In the under water models, buoyancy decreases apparent grain density and overburden pressure thus the internal friction coefficient also decreases. This also agrees with the structural geometry of the experimental results. These results suggest that under

  4. Wedge-local quantum fields on a nonconstant noncommutative spacetime

    Energy Technology Data Exchange (ETDEWEB)

    Much, A. [Max-Planck-Institute for Mathematics in the Sciences, 04103 Leipzig (Germany) and Institute for Theoretical Physics, University of Leipzig, 04009 Leipzig (Germany)


    Within the framework of warped convolutions we deform the massless free scalar field. The deformation is performed by using the generators of the special conformal transformations. The investigation shows that the deformed field turns out to be wedge-local. Furthermore, it is shown that the spacetime induced by the deformation with the special conformal operators is nonconstant noncommutative. The noncommutativity is obtained by calculating the deformed commutator of the coordinates.

  5. Heel and foot reconstruction using reverse-flow posterior tibial flap. (United States)

    Satoh, K; Sakai, M; Hiromatsu, N; Ohsumi, N


    Island flaps supplied by the intermuscular cutaneous perforator (IMCP) from a deep vessel, such as the peroneal flap pedicled by IMCP from the peroneal vessel or the anterior tibial flap supplied by IMCP from the anterior tibial vessel, are reported to be useful in reconstructive procedures for soft-tissue defects of the lower leg. However, the posterior tibial flap, pedicled by IMCP from the posterior tibial vessel, has not yet been fully described. The posterior tibial flap can be used either as a normal-flow or as a reverse-flow flap. It is particularly versatile as a reverse-flow flap for reconstruction of soft-tissue defects of the heel and foot. Three reverse-flow posterior tibial flaps were clinically applied, without venous anastomosis, to reconstruct heel and foot defects, and all three survived completely. The operative procedure and its characteristics are described.

  6. Bilateral synchronous tibial periosteal osteosarcoma with familial incidence. (United States)

    Maheshwari, Aditya V; Jelinek, James S; Seibel, Nita L; Meloni-Ehrig, Aurelia M; Kumar, Dhruv; Henshaw, Robert M


    Multifocal or multicentric osteosarcoma (OS) has been described as tumor occurrence at two or more sites in a patient without visceral metastasis. These may be synchronous (more than one lesion at presentation) or metachronous (new tumor developing after the initial treatment). The incidence of multifocal OS has ranged from 1.5 to 5.4% in large series, with the synchronous type being rarer. Similarly, periosteal OS is another rare subtype of surface OS and constitutes less than 2% of all OS. An 11-year-old female was diagnosed with bilateral synchronous tibial periosteal OS, which were confirmed by CT-guided biopsies. After neoadjuvant chemotherapy, the patient underwent a staged wide local resection of the tumors. The defect was reconstructed with a proximal tibial replacement on the left side and autologous bone grafting on the right side. The patient did well after surgery and is free of disease at 5.5 years of follow-up. However, her brother also developed a right tibial periosteal osteosarcoma 4 years after her index surgery. Genetic analysis of blood sample from both patients showed a similar missense mutation in at least one allele of TP53 gene (exon 8). To the best of our knowledge, a case of bilateral 'synchronous' periosteal OS with a familial incidence has not been reported before.

  7. Suprapatellar nailing of tibial fractures-Indications and technique. (United States)

    Franke, J; Hohendorff, B; Alt, V; Thormann, U; Schnettler, R


    Intramedullary nailing is the standard procedure for surgical treatment of closed and Gustilo-Anderson Grade I-II° open fractures of the tibial shaft. The use of intramedullary nailing for the treatment of proximal metaphyseal tibia fractures is frequently followed by postoperative malalignment, whereas plate osteosynthesis is associated with higher rates of postoperative infection. Intramedullary nailing of tibial fractures is generally performed through an infrapatellar approach. The injured extremity must be positioned at a minimum of 90° of flexion in the knee joint to achieve optimal exposure of the correct entry point. The tension of the quadriceps tendon causes a typical apex anterior angulation of the proximal fragment. The suprapatellar approach improves reduction of the fracture and reduces the occurrence of malalignment during intramedullary nailing of extra-articular proximal tibial fractures. The knee is positioned in 20° of flexion to neutralise traction forces secondary to the quadriceps muscle, thus preventing an apex anterior angulation of the proximal fragment. An additional advantage of the technique is that it allows the surgeon to avoid or minimise further soft tissue damage because of the distance between the optimal incision point and the usual area of soft tissue damage.

  8. A cluster randomised stepped wedge trial to evaluate the effectiveness of a multifaceted information technology-based intervention in reducing high-risk prescribing of non-steroidal anti-inflammatory drugs and antiplatelets in primary medical care: The DQIP study protocol

    Directory of Open Access Journals (Sweden)

    Dreischulte Tobias


    Full Text Available Abstract Background High-risk prescribing of non-steroidal anti-inflammatory drugs (NSAIDs and antiplatelet agents accounts for a significant proportion of hospital admissions due to preventable adverse drug events. The recently completed PINCER trial has demonstrated that a one-off pharmacist-led information technology (IT-based intervention can significantly reduce high-risk prescribing in primary care, but there is evidence that effects decrease over time and employing additional pharmacists to facilitate change may not be sustainable. Methods/design We will conduct a cluster randomised controlled with a stepped wedge design in 40 volunteer general practices in two Scottish health boards. Eligible practices are those that are using the INPS Vision clinical IT system, and have agreed to have relevant medication-related data to be automatically extracted from their electronic medical records. All practices (clusters that agree to take part will receive the data-driven quality improvement in primary care (DQIP intervention, but will be randomised to one of 10 start dates. The DQIP intervention has three components: a web-based informatics tool that provides weekly updated feedback of targeted prescribing at practice level, prompts the review of individual patients affected, and summarises each patient's relevant risk factors and prescribing; an outreach visit providing education on targeted prescribing and training in the use of the informatics tool; and a fixed payment of 350 GBP (560 USD; 403 EUR up front and a small payment of 15 GBP (24 USD; 17 EUR for each patient reviewed in the 12 months of the intervention. We hypothesise that the DQIP intervention will reduce a composite of nine previously validated measures of high-risk prescribing. Due to the nature of the intervention, it is not possible to blind practices, the core research team, or the data analyst. However, outcome assessment is entirely objective and automated. There will

  9. On the acoustic wedge design and simulation of anechoic chamber (United States)

    Jiang, Changyong; Zhang, Shangyu; Huang, Lixi


    This study proposes an alternative to the classic wedge design for anechoic chambers, which is the uniform-then-gradient, flat-wall (UGFW) structure. The working mechanisms of the proposed structure and the traditional wedge are analyzed. It is found that their absorption patterns are different. The parameters of both structures are optimized for achieving minimum absorber depth, under the condition of absorbing 99% of normal incident sound energy. It is found that, the UGFW structure achieves a smaller total depth for the cut-off frequencies ranging from 100 Hz to 250 Hz. This paper also proposes a modification for the complex source image (CSI) model for the empirical simulation of anechoic chambers, originally proposed by Bonfiglio et al. [J. Acoust. Soc. Am. 134 (1), 285-291 (2013)]. The modified CSI model considers the non-locally reactive effect of absorbers at oblique incidence, and the improvement is verified by a full, finite-element simulation of a small chamber. With the modified CSI model, the performance of both decorations with the optimized parameters in a large chamber is simulated. The simulation results are analyzed and checked against the tolerance of 1.5 dB deviation from the inverse square law, stipulated in the ISO standard 3745(2003). In terms of the total decoration depth and anechoic chamber performance, the UGFW structure is better than the classic wedge design.

  10. Wave dynamic processes in cellular detonation reflection from wedges

    Institute of Scientific and Technical Information of China (English)

    Zongmin Hu; Zonglin Jiang


    When the cell width of the incident deto-nation wave (IDW) is comparable to or larger than theMach stem height,self-similarity will fail during IDWreflection from a wedge surface.In this paper,the det-onation reflection from wedges is investigated for thewave dynamic processes occurring in the wave front,including transverse shock motion and detonation cellvariations behind the Mach stem.A detailed reactionmodel is implemented to simulate two-dimensional cel-lular detonations in stoichiometric mixtures of H2/O2diluted by Argon.The numerical results show that thetransverse waves,which cross the triple point trajec-tory of Mach reflection,travel along the Mach stem andreflect back from the wedge surface,control the size ofthe cells in the region swept by the Mach stem.It is theenergy carried by these transverse waves that sustainsthe triple-wave-collision with a higher frequency withinthe over-driven Mach stem.In some cases,local wavedynamic processes and wave structures play a dominantrole in determining the pattern of cellular record,lead-ing to the fact that the cellular patterns after the Machstem exhibit some peculiar modes.

  11. Neurofibromin deficiency-associated transcriptional dysregulation suggests a novel therapy for tibial pseudoarthrosis in NF1. (United States)

    Paria, Nandina; Cho, Tae-Joon; Choi, In Ho; Kamiya, Nobuhiro; Kayembe, Kay; Mao, Rong; Margraf, Rebecca L; Obermosser, Gerlinde; Oxendine, Ila; Sant, David W; Song, Mi Hyun; Stevenson, David A; Viskochil, David H; Wise, Carol A; Kim, Harry K W; Rios, Jonathan J


    Neurofibromatosis type 1 (NF1) is an autosomal dominant disease caused by mutations in NF1. Among the earliest manifestations is tibial pseudoarthrosis and persistent nonunion after fracture. To further understand the pathogenesis of pseudoarthrosis and the underlying bone remodeling defect, pseudoarthrosis tissue and cells cultured from surgically resected pseudoarthrosis tissue from NF1 individuals were analyzed using whole-exome and whole-transcriptome sequencing as well as genomewide microarray analysis. Genomewide analysis identified multiple genetic mechanisms resulting in somatic biallelic NF1 inactivation; no other genes with recurring somatic mutations were identified. Gene expression profiling identified dysregulated pathways associated with neurofibromin deficiency, including phosphoinositide 3-kinase (PI3K) and mitogen-activated protein kinase (MAPK) signaling pathways. Unlike aggressive NF1-associated malignancies, tibial pseudoarthrosis tissue does not harbor a high frequency of somatic mutations in oncogenes or other tumor-suppressor genes, such as p53. However, gene expression profiling indicates that pseudoarthrosis tissue has a tumor-promoting transcriptional pattern, despite lacking tumorigenic somatic mutations. Significant overexpression of specific cancer-associated genes in pseudoarthrosis highlights a potential for receptor tyrosine kinase inhibitors to target neurofibromin-deficient pseudoarthrosis and promote proper bone remodeling and fracture healing.

  12. Ingenious method of external fixator use to maintain alignment for nailing a proximal tibial shaft fracture. (United States)

    Behera, Prateek; Aggarwal, Sameer; Kumar, Vishal; Kumar Meena, Umesh; Saibaba, Balaji


    Fractures of the tibia are one of the most commonly seen orthopedic injuries. Most of them result from a high velocity trauma. While intramedullary nailing of tibial diaphyseal fractures is considered as the golden standard form of treatment for such cases, many metaphyseal and metaphyseal-diaphyseal junction fractures can also be managed by nailing. Maintenance of alignment of such fractures during surgical procedure is often challenging as the pull of patellar tendon tends to extend the proximal fragment as soon as one flexes the knee for the surgical procedure. Numerous technical modifications have been described in the literature for successfully nailing such fractures including semi extended nailing, use of medial plates and external fixators among others. In this study, it was aimed to report two cases in which we used our ingenious method of applying external fixator for maintaining alignment of the fracture and aiding in the entire process of closed intramedullary nailing of metaphyseal tibial fractures by the conventional method. We were able to get good alignment during and after the closed surgery as observed on post-operative radiographs and believe that further evaluation of this technique may be of help to surgeons who want to avoid other techniques.

  13. Autogenous tibial strut grafts used in severe kyphoscoliosis:surgical policies and preliminary results

    Institute of Scientific and Technical Information of China (English)

    CHEN Hui; QIU Yong; WANG Bin; YU Yang; ZHU Ze-zhang ZHU Li-hua


    Background Surgery for severe kyphoscoliosis is frequently unsatisfying because of loss of correction, high rate of pseudarthrosis and neurological complications.Several authors reported that the anterior fusion with strut grafts might improve the surgical outcome.This article describes and assesses the surgical strategies and the application of autogenous tibial strut in the treatment of severe kyphoscoliosis.Results The mean preoperative and postoperative kyphosis was 82°and 52°respectively, and the mean scoliosis was 84°and 44°respectively.Complications included pseudarthrosis (2 cases, one with graft fracture and the other with hook displacement), posterior elements fractures (4), pleura penetrations (3, in the plastic surgery of the thoracic cage), dura tear (2), exudative pleuritis (2, in the anterior surgery), and tibia fracture of the harvesting site (1).The mean loss of correction in coronal and sagittal plane was 6° and 7° respectively.Except for 1 case, the patients with incomplete paraplegia showed improvements to varying extents.Conclusion Autogenous tibial strut can provide excellent support to the kyphoscoliotic spine: it reduces pseudarthrodic rate, loss of correction and complications of graft harvest, it also prevents the occurrence of neurological impairment.

  14. Observations of the Columbia River salt wedge and estuarine turbidity maximum using AUVs (United States)

    McNeil, C. L.; Shcherbina, A.; Litchendorf, T.; Sanford, T. B.; Martin, D.; Baptista, A. M.; Lopez, J.; Crump, B.


    We present detailed observations of the salt wedge and estuarine turbidity maxima (ETM) in the North Channel of the Columbia River estuary (OR, USA) under conditions of high river discharge during May 2012. Measurements were made using two REMUS-100 autonomous underwater vehicles (AUVs; Hydroid, Inc.) equipped with SBE-49 CTDs (Seabird-Electronics, Inc.) for water temperature and salinity, upward/downward looking ADCPs (Teledyne RDI, Inc.) for currents, and ECO Puck triplets (WET Labs, Inc.) for optical backscatter measurement of turbidity. The acoustic backscatter intensity from the ADCP was also used as a proxy measurement for suspended sediments and was found to correlate quite well with the optical backscatter measurements. Daily forecasts of tidal currents in the estuary were used to simulate the AUV path in advance of deployment to aid data collection. Repeat AUV sections were made along and across the channel during flood tide. The turbidity and height above riverbed of the bottom boundary layer was observed to increase toward the deeper waters at the center of the channel. An ETM-like feature was observed ahead of the advancing salt wedge front with locally higher turbidity levels, presumably the result of flocculation and resuspension. To visualize better the repeat section measurements we made data movies. Each frame of the movie is our best estimate of a synoptic snapshot of along-section tracer distribution at a given point in time. These snapshots were created by re-location of non-synoptic AUV measurements to account for the advection of water parcels. An example data movie showing the intrusion of the salt wedge during the flood tide will be presented.

  15. Numerical modeling of mantle wedge processes and exhumation of UHP mantle in subduction zones (United States)

    Gorczyk, W.; Gerya, T. V.; Guillot, S.; Connolly, J. A.; Yuen, D.


    The upwelling of subduction generated partially molten rocks is potentially a mechanism for the exhumation of UHP rocks through the mantle wedge. We investigated this processes using a 2-D coupled petrological- thermomechanical model that incorporates slab dehydration and water transport as well as partial melting of mantle and crustal rocks. This approach allows us to study the dynamics of mantle wedge processes including evolution of partially molten plumes and their interaction with surrounding dry mantle. To study the internal structure of the plumes we used ultra-high resolution numerical simulations with 10 billion active markers to detail the internal structure of natural plumes originating from the slab. The plumes consist of partially molten hydrated peridotite, dry solid mantle and subducted oceanic crust, which may comprise up to 12 volume % of the plume. As the plumes grow and mature these materials mix chaotically resulting in attenuation and duplication of the original layering on scales of 1-1000 m. Comparison of numerical results with geological observations from the Horoman ultramafic complex in Japan suggests that mixing and differentiation processes related to development of partially molten plumes above slabs may be responsible for strongly layered lithologically mixed (marble cake) structure of asthenospheric mantle wedges. The recent discovery of garnet bearing peridotites in the subduction zone of the Great Antilles in Hispaniola has raised questions about the process that leads to their exhumation. To evaluate whether upwelling plumes are a plausible exhumation mechanism we investigated the dynamics of subduction of slow spreading ridges. The results show that subduction of strongly serpentinized oceanic plate causes strong dehydration of the slab and leads to a rheological weakening of the interface between subducting and overriding plate. This weakening triggers trench retreat and massive asthenospheric upwelling into the gap between the

  16. Role of the fibula in the stability of diaphyseal tibial fractures fixed by intramedullary nailing


    John G. Galbraith; Daly, Charles J.; Harty, James A; Dailey, Hannah L.


    Background: For tibial fractures, the decision to fix a concomitant fibular fracture is undertaken on a case-by-case basis. To aid in this clinical decision-making process, we investigated whether loss of integrity of the fibula significantly destabilises midshaft tibial fractures, whether fixation of the fibula restores stability to the tibia, and whether removal of the fibula and interosseous membrane for expediency in biomechanical testing significantly influences tibial interfragmentary m...

  17. Aneurisma verdadeiro bilateral de artéria tibial posterior True bilateral aneurysm of the posterior tibial artery

    Directory of Open Access Journals (Sweden)

    Silvio Romero de Barros Marques


    Full Text Available Neste artigo, faz-se o relato de um caso de aneurisma verdadeiro bilateral da artéria tibial posterior em paciente de 57 anos. Os aneurismas surgiram em épocas diferentes. Os aspectos clínicos, diagnósticos e terapêuticos deste caso são discutidos. Este relato é importante, pois os autores não têm conhecimento de caso semelhante na literatura consultada.This article reports a case of true bilateral aneurysm of the tibial posterior artery in a 57 year-old patient. The aneurysms occurred at different times. The clinical, diagnostic and therapeutic aspects of this case are discussed. This report is important because the authors did not find a similar description in the literature.

  18. Theoretical and experimental investigation of a new CFRP tendon wedge-anchor%新型CFRP筋夹片式锚具理论与试验研究

    Institute of Scientific and Technical Information of China (English)

    诸葛萍; 强士中


    A new theory for CFRP tendon wedge-anchor was presented and a new CFRP tendon wedge-anchor system was developed. The wedge-anchor system consists of a soft metal (aluminum alloy or copper) sleeve coated with sand, four steel wedges and a stee} barrel. In the theoretical analysis, the anchor components were divided into segments along the length, and the analytical modes of all components are established with the independence between the four wedges considered. The anchorage performance was evaluated through static test. Analytical and test results for the stress of the barrel were compared. The results show that the theory can evaluate the stress and transverse displacement and provide a reasonable prediction for the carrying capacity of the wedge-anchor system. The wedge-anchor can be applied to anchor high strength CFRP tendons, the average anchorage efficiency coefficient of the wedge-anchor system was as high as 94.9% in the test, and the wedge-anchor system is reliable.%提出CFRP筋夹片式锚具新的计算理论,并以此理论为依据设计一种新型CFRP筋夹片式锚具,它由锚杯、四片式夹片、涂砂铝套管或涂砂铜套管组成。在理论推导过程中,将夹片式锚具各组件在长度方向上分成多个等份,对其中各组件任意等份建立力学计算模型,并考虑各夹片间的独立性;通过静载试验对夹片式锚具的锚固性能进行测试,并分析比较锚杯拉应力的理论计算与试验实测结果。结果表明,该CFRP筋夹片式锚具计算理论能计算锚具各点的应力及横向位移,并能预测锚具极限承载力;此夹片式锚具适用于锚固高强CFRP筋,它的平均锚固效率系数达到94.9%,且性能稳定;锚杯拉应力的理论计算与试验实测结果较吻合。

  19. Control of structural inheritance on thrust initiation and material transfer in accretionary wedges (United States)

    Leever, Karen; Geersen, Jacob; Ritter, Malte; Lieser, Kathrin; Behrmann, Jan


    Faults in the incoming sediment layer are commonly observed in subduction zone settings and well developed in the incoming plate off Sumatra. To investigate how they affect the structural development of the accretionary wedge, we conducted a series of 2D analogue tectonic experiments in which a 2 cm thick quartz sand layer on top of a thin detachment layer of glass beads was pulled against a rigid backstop by a basal conveyor belt in a 20cm wide box with glass walls. A gap at the base of the back wall avoids entrainment of the glass beads. At regular spacing of either 2.3, 5.5 or 7.8 cm (fractions of the thrust sheet length in the reference model), conjugate pairs of weakness zones dipping 60deg were created by cutting the sand layer with a thin (1 mm) metal blade. Both the undisturbed sand and the pre-cuts have an angle of internal friction of ~29o, but their cohesion is different by 50 Pa (110 Pa for the undisturbed material, 60 Pa along the pre-cuts). Friction of the glass beads is ~24deg. The experiments are monitored with high resolution digital cameras; displacement fields derived from digital image correlation are used to constrain fault activity. In all experiments, a critically tapered wedge developed with a surface slope of 7.5deg. In the reference model (no weakness zones in the input section), the position of new thrust faults is controlled by the frontal slope break. The average length of the thrust sheets is 11 cm and the individual thrusts accommodate on average 8 cm displacement each. The presence of weakness zones causes thrust initiation at a position different from the reference case, and affects their dip. For a fault spacing of 7.8 cm (or 75% of the reference thrust sheet length), every single incoming weakness zone causes the formation of a new thrust, thus resulting in thrust sheets shorter than the equilibrium case. In addition, less displacement is accommodated on each thrust. As a consequence, the frontal taper is smaller than expected

  20. Ultrasound measurement of the size of the anterior tibial muscle group: the effect of exercise and leg dominance

    LENUS (Irish Health Repository)

    McCreesh, Karen


    Abstract Background Knowledge of normal muscle characteristics is crucial in planning rehabilitation programmes for injured athletes. There is a high incidence of ankle and anterior tibial symptoms in football players, however little is known about the effect of limb dominance on the anterior tibial muscle group (ATMG). The purpose of this study was to assess the effect of limb dominance and sports-specific activity on ATMG thickness in Gaelic footballers and non-football playing controls using ultrasound measurements, and to compare results from transverse and longitudinal scans. Methods Bilateral ultrasound scans were taken to assess the ATMG size in 10 Gaelic footballers and 10 sedentary controls (age range 18-25 yrs), using a previously published protocol. Both transverse and longitudinal images were taken. Muscle thickness measurements were carried out blind to group and side of dominance, using the Image-J programme. Results Muscle thickness on the dominant leg was significantly greater than the non-dominant leg in the footballers with a mean difference of 7.3%, while there was no significant dominance effect in the controls (p < 0.05). There was no significant difference between the measurements from transverse or longitudinal scans. Conclusions A significant dominance effect exists in ATMG size in this group of Gaelic footballers, likely attributable to the kicking action involved in the sport. This should be taken into account when rehabilitating footballers with anterior tibial pathology. Ultrasound is a reliable tool to measure ATMG thickness, and measurement may be taken in transverse or longitudinal section.

  1. Effects of Shoe Heel Height on Loading and Muscle Activity for Trans-Tibial Amputees During Standing

    Institute of Scientific and Technical Information of China (English)

    JIA Xiaohong; WANG Rencheng; Winson Lee


    This study accesses the effects of shoe heel heights on loading, muscle activity, and plantar foot pressure of trans-tibial amputees during standing. Five male subjects with unilateral trans-tibial amputation volunteered to participate in this study. Three pairs of shoes with zero, 20 mm, and 40 mm heel heights were used. The loading line of the prosthetic side, the plantar foot pressure, and the surface electromyography (EMG) of 10 muscles were simultaneously recorded. With increasing shoe heel heights during standing, the loading line of the prosthetic side shifted from the anterior to the posterior side of the knee center, the peak pressure was increased in the medial forefoot region, and the peak pressure was reduced in the heel region. The EMG of the medial and lateral gastrocnemius of the sound leg almost doubled and that of the rectus fomris, vastus lateralis, and vastus medialis of the prosthetic side increased to different extents with in-creasing heel heights from zero to 40 mm. These results show a high correlation with human physical be-havior. Changing of the heel heights for trans-tibial amputees during standing actually had similar effects to altering the prosthetic sagittal alignment. The results suggest that an alignment change is necessary to ac-commodate heel height changes and that prosthesis users should be cautious when choosing shoes.

  2. Correlation between tibial nerve ultrastructural abnormalities and post-mercury poison-induced muscular pain in rats

    Institute of Scientific and Technical Information of China (English)

    Ping Dai; Yongtian Zhou; Xudong Xu; Jingyun Du; Lin Xie; Juan Li; Mingyi Xu


    BACKGROUND: The pathways induced/activated by mercury poisoning that lead to muscle pain remain unclear. The present study addressed the structural changes observed in the peripheral nerve following mercury poisoning. OBJECTIVE: To establish the mercury poison rat model, rats were intragastrically administered mercury. The correlation between post-mercury poison-induced muscular pain and tibial nerve morphological changes were observed. DESIGN: Observational contrast animal study.SETTING: Shangdong Academy of Occupational Health and Occupational Medicine.MATERIALS: Thirty adult Sprague Dawley rats of equal gender. Mercury chloride (HgCl2, analytical grade: 99.99%; batch number: 990402) was provided by Shanghai Chemical Reagent Factory, and sodium dimercaptopropanesulfonate (DMPS) injection by Shanghai Harvest Pharmaceutical Co., Ltd. (batch number: 0309011).METHODS: This study was performed at the Animal Experimental Center of Shangdong Academy of Occupational Health and Occupational Medicine from December 2005 to January 2006. Rats were randomly divided into high-dose mercury, low-dose mercury, and control groups, with 10 rats in each group. Rats in the two mercury groups were intragastrically administered 17 mg/kg and 8.5 mg/kg HgCl2 solution, respectively, once a day to establish a rat model of subacute mercury poisoning. Rats in the control group were intragastrically administered 2 mL saline, once a day. Intragastric administration in the three groups lasted for (20 ± 2) days. After model establishment, rats in the two mercury groups were injected DMPS once a day to remove mercury. The injection lasted for 3 days after every 4-day interval. Seven days was regarded as one treatment cycle, and there were two treatment cycles in total.MAIN OUTCOME MEASURES: Mercury-induced muscular pain status; ultrastructural changes of the right tibial nerve following model establishment and mercury removal under transmission electron microscope.RESULTS: Thirty rats were

  3. Chronology and palaeoenvironmental implications of the ice-wedge pseudomorphs and composite-wedge casts on the Magdalen Islands (eastern Canada)

    DEFF Research Database (Denmark)

    Remillard, A.M.; Hetu, B.; Bernatchez, P.


    The Magdalen Islands are a valuable terrestrial record, evidencing the complex glacial and periglacial history of the Gulf of St. Lawrence. Thirteen structures interpreted as ice-wedge pseudomorphs or composite-wedge casts were observed at four sites on the southern Magdalen Islands and testify...

  4. Local and Widespread Hyperalgesia After Isolated Tibial Shaft Fractures Treated with Intramedullary Nailing

    DEFF Research Database (Denmark)

    Larsen, Peter; Elsøe, Rasmus; Graven-Nielsen, Thomas


    OBJECTIVES: Knee pain is accepted as a common complication to intramedullary nailing of tibial fractures. However, no studies have systematically studied the pain sequel following tibial fractures. The objective of this study was to assess pain and hyperalgesia from 6 weeks to 12 months postopera......OBJECTIVES: Knee pain is accepted as a common complication to intramedullary nailing of tibial fractures. However, no studies have systematically studied the pain sequel following tibial fractures. The objective of this study was to assess pain and hyperalgesia from 6 weeks to 12 months...

  5. Observation of wedge waves and their mode transformation by laser ultrasonic technique

    Institute of Scientific and Technical Information of China (English)

    Jing Jia; Zhonghua Shen; Lijuan Wang; Ling Yuan


    Wedge waves (WWs) in wedges, including their dispersion characteristics and mode transformation, are investigated using the laser ultrasound technique. Pulsed laser excitation and optical deflection beam method for detection are used to record WWs. Numerous WWs are detected by scanning the excitation laser along the wedge tip. Dispersions of WWs are obtained by using the two-dimensional (2D) Fourier transformation method, and different WW orders are revealed on the wedges. Mode transformation is determined by fixing the distance between the excitation and detection position, as well as by scanning the samples along the normal direction of the wedge tip.%@@ Wedge waves (WWs) in wedges, including their dispersion characteristics and mode transformation, are investigated using the laser ultrasound technique. Pulsed laser excitation and optical deflection beam method for detection are used to record WWs. Numerous WWs are detected by scanning the excitation laser along the wedge tip. Dispersions of WWs are obtained by using the two-dimensional (2D) Fourier transformation method, and different WW orders are revealed on the wedges. Mode transformation is determined by fixing the distance between the excitation and detection position, as well as by scanning the samples along the normal direction of the wedge tip.

  6. A meta-analysis into the effect of lateral-wedged insoles with subtalar strapping versus traditional insoles in adults with medial knee osteoarthritis.

    Directory of Open Access Journals (Sweden)

    L. Duvenhage


    Full Text Available To  systematically  identify,  collate,  and  analyze  the  current available evidence  for  the  effectiveness  of  lateral-wedged  insoles,  with subtalar strapping,  on  reducing  pain,  improving  function  and  improving  the femoral-tibial  angle  (FTA,  in  adults  with  medial  knee osteoarthritis compared to traditional insoles without subtalar strapping.Six computerised databases, namely Cochrane Library, CiNAHL, PEDro, BIOMED central,  PubMed  and  ScienceDirect  were  searched. The  included articles were  then  all  rated  using  the  PEDro  scale  to  determine  their meth-odological quality.  Homogeneous data were pooled in a meta-analysis using Review Manager (REVMAN software.  Where statistical pooling of the results was not possible, findings were summarised in narrative form. Three randomised controlled trials were selected for this review. The average PEDro score was 5.7. A meta-analysis demonstrated that lateral-wedged insoles with subtalar strapping significantly reduced pain in the short-term (p=0.004. The review found that lateral-wedge insoles with subtalar strapping significantly decreased pain in the short-term and seemed to have a positive effect on the FTA in the long-term, when compared to traditional insoles without  subtalar strapping. The lateral-wedge insole with subtalar strapping may provide a financially feasible adjunctive self-management treatment for knee OA and should be considered before invasive procedures such as surgery.


    African Journals Online (AJOL)


    tion regarding the mechanism of injury, which can give a good idea of the amount of energy ... A systematic examination should look for the following features: • Skin .... pressure. Clinical suspicion must remain high. The incidence of the com-.

  8. Exploration of Salt Wedge Dynamics in the Columbia River Estuary Using Optical Measurements of Internal Ship Wakes. (United States)

    Holman, R. A.; Greydanus, S. J.


    In May of 2013 and beyond, Argus optical measurements of the mouth of the Columbia River estuary and plume were collected as part of the RIVET II multi-investigator field experiment. One surprise was the strength of eddy and internal wave signatures observed in movies computed from one-minute averages of high-frequency snapshots (such that gravity waves were averaged out but slicks and variable surface roughness remained). In particular, passing ships left wakes that propagated away at speeds on the order of 0.5 m/s, much slower than gravity waves and presumably surface manifestations of internal waves associated with the time-varying salt-wedge. Thus, these internal ship wakes appear to act as probes of internal stratification dynamics. This paper will explore the time variations of these internal wakes and relate them to corresponding variations in the estuary salt wedge.

  9. The age of formation of the mirabilite and sand wedges in the Hexi Corridor and their paleoclimatic interpretation

    Institute of Scientific and Technical Information of China (English)

    WANG Nai'ang; ZHANG Jianming; CHENG Hongyi; GUO Jianying; ZHAO Qiang


    Sand wedges in the Hexi Corridor mainly formed in an alluvial gravel stratum of the late Pleistocene and the radiocarbon ages of the eolian sand infilling wedge prove that they were a product of the last ice age. During their period of formation, the mean annual air temperature in the Hexi Corridor was about -5.3℃, i. e. about 13℃ lower than that of the present. This estimated value iscoincident with the decrease in air temperature predicated from mirabilite (Na2SO4·10H2O) sedimentary layer in study area, and also agrees with research on theestimated amplitude of air temperature lowering in middle and high latitudes ofthe Northern Hemisphere during the last glacial period. The annual precipitation in the Western Hexi Corridor at that time was probably about 100-200 mm, i.e.about 100 mm more than at present.

  10. Simulation of arrested salt wedges with a multi-layer Shallow Water Lattice Boltzmann model (United States)

    Prestininzi, P.; Montessori, A.; La Rocca, M.; Sciortino, G.


    The ability to accurately and efficiently model the intrusion of salt wedges into river beds is crucial to assay its interaction with human activities and the natural environment. We present a 2D multi-layer Shallow Water Lattice Boltzmann (SWLB) model able to predict the salt wedge intrusion in river estuaries. The formulation usually employed for the simulation of gravity currents is here equipped with proper boundary conditions to handle both the downstream seaside outlet and the upstream river inlet. Firstly, the model is validated against highly accurate semi-analytical solutions of the steady state 1D two-layer Shallow Water model. Secondly, the model is applied to a more complex, fully 3D geometry, to assess its capability to handle realistic cases. The simple formulation proposed for the shear interlayer stress is proven to be consistent with the general 3D viscous solution. In addition to the accuracy, the model inherits the efficiency of the Lattice Boltzmann approach to fluid dynamics problems.

  11. Composite wedge failure using photogrammetric measurements and DFN-DEM modelling

    Directory of Open Access Journals (Sweden)

    Viviana Bonilla-Sierra


    Full Text Available Analysis and prediction of structural instabilities in open pit mines are an important design and operational consideration for ensuring safety and productivity of the operation. Unstable wedges and blocks occurring at the surface of the pit walls may be identified through three-dimensional (3D image analysis combined with the discrete fracture network (DFN approach. Kinematic analysis based on polyhedral modelling can be used for first pass analysis but cannot capture composite failure mechanisms involving both structurally controlled and rock mass progressive failures. A methodology is proposed in this paper to overcome such limitations by coupling DFN models with geomechanical simulations based on the discrete element method (DEM. Further, high resolution photogrammetric data are used to identify valid model scenarios. An identified wedge failure that occurred in an Australian coal mine is used to validate the methodology. In this particular case, the failure surface was induced as a result of the rock mass progressive failure that developed from the toe of the structure inside the intact rock matrix. Analysis has been undertaken to determine in what scenarios the measured and predicted failure surfaces can be used to calibrate strength parameters in the model.

  12. Compact multi-projection 3D display using a wedge prism (United States)

    Park, Soon-gi; Lee, Chang-Kun; Lee, Byoungho


    We propose a compact multi-projection system based on integral floating method with waveguide projection. Waveguide projection can reduce the projection distance by multiple folding of optical path inside the waveguide. The proposed system is composed of a wedge prism, which is used as a waveguide, multiple projection-units, and an anisotropic screen made of floating lens combined with a vertical diffuser. As the projected image propagates through the wedge prism, it is reflected at the surfaces of prism by total internal reflections, and the final view image is created by the floating lens at the viewpoints. The position of view point is decided by the lens equation, and the interval of view point is calculated by the magnification of collimating lens and interval of projection-units. We believe that the proposed method can be useful for implementing a large-scale autostereoscopic 3D system with high quality of 3D images using projection optics. In addition, the reduced volume of the system will alleviate the restriction of installment condition, and will widen the applications of a multi-projection 3D display.

  13. Enhanced performance of fast-response 3-hole wedge probes for transonic flows in axial turbomachinery

    Energy Technology Data Exchange (ETDEWEB)

    Delhaye, D.; Paniagua, G. [von Karman Institute for Fluid Dynamics, Turbomachinery and Propulsion Department, Rhode-Saint-Genese (Belgium); Fernandez Oro, J.M. [Universidad de Oviedo, Area de Mecanica de Fluidos, Gijon (Spain); Denos, R. [European Commission, Directorate General for Research, Brussels (Belgium)


    The paper presents the development and application of a three-sensor wedge probe to measure unsteady aerodynamics in a transonic turbine. CFD has been used to perform a detailed uncertainty analysis related to probe-induced perturbations, in particular the separation zones appearing on the wedge apex. The effects of the Reynolds and Mach numbers are studied using both experimental data together with CFD simulations. The angular range of the probe and linearity of the calibration maps are enhanced with a novel zonal calibration technique, used for the first time in compressible flows. The data reduction methodology is explained and demonstrated with measurements performed in a single-stage high-pressure turbine mounted in the compression tube facility of the von Karman Institute. The turbine was operated at subsonic and transonic pressure ratios (2.4 and 5.1) for a Reynolds number of 10{sup 6}, representative of modern engine conditions. Complete maps of the unsteady flow angle and rotor outlet Mach number are documented. These data allow the study of secondary flows and rotor trailing edge shocks. (orig.)

  14. Enhanced performance of fast-response 3-hole wedge probes for transonic flows in axial turbomachinery (United States)

    Delhaye, D.; Paniagua, G.; Fernández Oro, J. M.; Dénos, R.


    The paper presents the development and application of a three-sensor wedge probe to measure unsteady aerodynamics in a transonic turbine. CFD has been used to perform a detailed uncertainty analysis related to probe-induced perturbations, in particular the separation zones appearing on the wedge apex. The effects of the Reynolds and Mach numbers are studied using both experimental data together with CFD simulations. The angular range of the probe and linearity of the calibration maps are enhanced with a novel zonal calibration technique, used for the first time in compressible flows. The data reduction methodology is explained and demonstrated with measurements performed in a single-stage high-pressure turbine mounted in the compression tube facility of the von Karman Institute. The turbine was operated at subsonic and transonic pressure ratios (2.4 and 5.1) for a Reynolds number of 106, representative of modern engine conditions. Complete maps of the unsteady flow angle and rotor outlet Mach number are documented. These data allow the study of secondary flows and rotor trailing edge shocks.

  15. The Influence of Localized Glacial Erosion on Exhumation Paths in Accreting Coulomb Wedges: Insights from Particle Velocimetry Analysis of Sandbox Models (United States)

    Newman, P. J.; Davis, K.; Haq, S. S. B.; Ridgway, K.


    Glacial erosion can have an impact on the location and development of faults in mountain belts. The rapid removal and deposition of rock, in some cases, is thought to affect the initiation of slip on older fault structures, or cause the development of new structures within the older part of the wedge. We present cross-sectional data from both erosional and non-erosional sandbox models of Coulomb wedges in order to quantify the impact of localized erosion on the location of and slip on deformational structures, as well as the general path of material through a wedge. To do this, we employ Lagrangian particle tracking velocimetry (PTV) using the open-source Python PTV toolkit trackpy, among a suite of other data analysis tools. We are able to extract robust and reliable sets of particle trajectories from a series of images without the need for predefined markers or marker-beds, instead identifying and tracking natural variations in sand color as individual particles. By comparing the motion of particles in cross-section to the local surface topography over an entire experiment, we determine a high-resolution record of exhumation rates, in addition to simple uplift rates. These comparisons are further informed by the use of high-definition Eulerian particle image velocimetry (PIV), which provides quantitative data about the distribution of deformation and instantaneous material displacements throughout a cross-sectional view of a Coulomb wedge. This allows us to interpret these pathways in relation to the behavior of active structures and general wedge morphology. In our experiments, we observe that localized glacial erosion has an impact on material pathways, in the form of an increased rate of exhumation locally, more vertical trajectories towards surface below the zone of erosion, and reactivation of older structures to maintain force balance within the entire wedge.

  16. Modes of continental extension in a crustal wedge

    KAUST Repository

    Wu, Guangliang


    © 2015 Elsevier B.V. We ran numerical experiments of the extension of a crustal wedge as an approximation to extension in an orogenic belt or a continental margin. We study the effects of the strength of the lower crust and of a weak mid-crustal shear zone on the resulting extension styles. A weak mid-crustal shear zone effectively decouples upper crustal extension from lower crustal flow. Without the mid-crustal shear zone, the degree of coupling between the upper and the lower crust increases and extension of the whole crust tends to focus on the thickest part of the wedge. We identify three distinct modes of extension determined by the strength of the lower crust, which are characterized by 1) localized, asymmetric crustal exhumation in a single massif when the lower crust is weak, 2) the formation of rolling-hinge normal faults and the exhumation of lower crust in multiple core complexes with an intermediate strength lower crust, and 3) distributed domino faulting over the weak mid-crustal shear zone when the lower crust is strong. A frictionally stronger mid-crustal shear zone does not change the overall model behaviors but extension occurred over multiple rolling-hinges. The 3 modes of extension share characteristics similar to geological models proposed to explain the formation of metamorphic core complexes: 1) the crustal flow model for the weak lower crust, 2) the rolling-hinge and crustal flow models when the lower crust is intermediate and 3) the flexural uplift model when the lower crust is strong. Finally we show that the intensity of decoupling between the far field extension and lower crustal flow driven by the regional pressure gradient in the wedge control the overall style of extension in the models.

  17. Modes of continental extension in a crustal wedge (United States)

    Wu, Guangliang; Lavier, Luc L.; Choi, Eunseo


    We ran numerical experiments of the extension of a crustal wedge as an approximation to extension in an orogenic belt or a continental margin. We study the effects of the strength of the lower crust and of a weak mid-crustal shear zone on the resulting extension styles. A weak mid-crustal shear zone effectively decouples upper crustal extension from lower crustal flow. Without the mid-crustal shear zone, the degree of coupling between the upper and the lower crust increases and extension of the whole crust tends to focus on the thickest part of the wedge. We identify three distinct modes of extension determined by the strength of the lower crust, which are characterized by 1) localized, asymmetric crustal exhumation in a single massif when the lower crust is weak, 2) the formation of rolling-hinge normal faults and the exhumation of lower crust in multiple core complexes with an intermediate strength lower crust, and 3) distributed domino faulting over the weak mid-crustal shear zone when the lower crust is strong. A frictionally stronger mid-crustal shear zone does not change the overall model behaviors but extension occurred over multiple rolling-hinges. The 3 modes of extension share characteristics similar to geological models proposed to explain the formation of metamorphic core complexes: 1) the crustal flow model for the weak lower crust, 2) the rolling-hinge and crustal flow models when the lower crust is intermediate and 3) the flexural uplift model when the lower crust is strong. Finally we show that the intensity of decoupling between the far field extension and lower crustal flow driven by the regional pressure gradient in the wedge control the overall style of extension in the models.


    Institute of Scientific and Technical Information of China (English)


    The sand wedges in Hexi Corridor occur in the alluvial gravel stratum of bajada and high terraces. The 14C ages of eolian sand in sand wedges prove that they formed during the Last Ice Age, with the mean annual air temperature about 5.6℃. The common 14C and AMS 14C dating ages of terrestrial branch relicts in Huahai clay-mirabilite interlayer are ( 11 600 ±280) a B. P. and (1118 ±54) a B.P. respectively, proving that the mirabilite formed at the cold episode of the Last Glacial Maximum(LGM) and Younger Dryers(YD) in Huahai Lake. It is pointed out that the mean annual air temperature in Hexi Corridor during LGM was about - 3℃ - - 7℃ ,11℃ - 15℃ lower than that of present, and that during YD was about 0℃ - 2℃,6℃ - 8℃ lower than at present. This decreasing temperature values are generally coincident with those inferred by pollen, sand wedge and ice core in the northern China, and also with the research on temperature-falling amplitude of middle and high latitude on the Northern Hemisphere recently.

  19. Heat conduction problem of an evaporating liquid wedge

    Directory of Open Access Journals (Sweden)

    Tomas Barta


    Full Text Available We consider the stationary heat transfer near the contact line of an evaporating liquid wedge surrounded by the atmosphere of its pure vapor. In a simplified setting, the problem reduces to the Laplace equation in a half circle, subject to a non-homogeneous and singular boundary condition. By classical tools (conformal mapping, Green's function, we reformulate the problem as an integral equation for the unknown Neumann boundary condition in the setting of appropriate fractional Sobolev and weighted space. The unique solvability is then obtained by means of the Fredholm theorem.

  20. Interpretation and inverse analysis of the wedge splitting test

    DEFF Research Database (Denmark)

    Østergaard, Lennart; Stang, Henrik


    Determination of the stress-crack opening relationship, s(w) a material parameter in the fictitious crack model by Hillerborg has proven to be problematic and is still not a simple task to perform. However, this paper demonstrates that the cracked non-linear hinge model by Olesen may be applied...... to the wedge splitting test and that it is well suited for the interpretation of test results in terms of s(w). A fine agreement between the hinge and FEM-models has been found. It has also been found that the test and the hinge model form a solid basis for inverse analysis. The paper also discusses possible...

  1. Magmatism significantly alters the thermal structure of the wedge (United States)

    Rees Jones, D. W.; Katz, R. F.; Rudge, J. F.; Tian, M.


    The temperature structure of the mantle wedge is typically modelled as a balance between thermal diffusion and advection by the solid mantle [e.g., 1]. The thermal state of the wedge promotes melting and melt transport in the natural system, but the thermal consequences of these processes have been neglected from previous models. We show that advective transport of sensible and latent heat by liquid magma can locally alter the temperature structure from canonical models by up to 200K. Liquids are liberated from the subducting slab by de-volatilization reactions. They trigger melting and become silicic en route to the surface, where they cause arc volcanism. These liquids transport heat advectively, and consume or supply latent heat as they melt or freeze. To analyse these effects, we parameterise melting in the presence of volatile species. We combine this with a one-dimensional "melting-column model," previously used to understand mid-ocean ridge volcanism. Our calculations highlight the thermal and chemical response to melt transport across the mantle wedge. Finally, we solve two-dimensional geodynamic models with a prescribed slab flux [2]. These models allow us to identify the most thermally significant fluxes of melt in the system. Perturbations of 200K are found at the base of the overriding lithosphere. This thermal signature of melt migration should be considered when interpreting heat flow, petrologic and seismic data [e.g., 3]. Such a thermal perturbation is likely to affect the chemistry of arc volcanoes, the solid mantle flow and, perhaps, the location of the volcanos themselves [4]. [1] van Keken, P. E., Currie, C., King, S. D., Behn, M. D., Cagnioncle, A., He, J., et al. (2008). A community benchmark for subduction zone modeling. PEPI, doi:10.1016/j.pepi.2008.04.015 [2] Wilson, C. R., Spiegelman, M., van Keken, P. E., & Hacker, B. R. (2014). Fluid flow in subduction zones: The role of solid rheology and compaction pressure. EPSL, doi:10.1016/j

  2. Inverse analysis of the wedge-splitting test

    DEFF Research Database (Denmark)

    Skocek, Jan; Stang, Henrik


    The amount of information which it is possible to retrieve from the wedge-splitting test is investigated. Inverse analysis is undertaken based on the analytical hinge model for various multi-linear softening curves. This showed that the commonly used bi-linear softening curve can be replaced...... by an tip to quad-linear curve, which is reflected by increased accuracy of the test simulation. Furthermore it was demonstrated that the next refinement of the softening curve leads to convergence problems due to problems with local minima. Finally, the semi-analytically obtained results are verified using...

  3. Electric monopoles in generalised B\\wedge F theories

    CERN Document Server

    Temple-Raston, M


    A tensor product generalisation of B\\wedge F theories is proposed to give a Bogomol'nyi structure. Non-singular, stable, finite-energy particle-like solutions to the Bogomol'nyi equations are studied. Unlike Yang-Mills(-Higgs) theory, the Bogomol'nyi structure does not appear as a perfect square in the Lagrangian. Consequently, the Bogomol'nyi energy can be obtained in more than one way. The added flexibility permits electric monopole solutions to the field equations.

  4. Medial tibial pain: a dynamic contrast-enhanced MRI study. (United States)

    Mattila, K T; Komu, M E; Dahlström, S; Koskinen, S K; Heikkilä, J


    The purpose of this study was to compare the sensitivity of different magnetic resonance imaging (MRI) sequences to depict periosteal edema in patients with medial tibial pain. Additionally, we evaluated the ability of dynamic contrast-enhanced imaging (DCES) to depict possible temporal alterations in muscular perfusion within compartments of the leg. Fifteen patients with medial tibial pain were examined with MRI. T1-, T2-weighted, proton density axial images and dynamic and static phase post-contrast images were compared in ability to depict periosteal edema. STIR was used in seven cases to depict bone marrow edema. Images were analyzed to detect signs of compartment edema. Region-of-interest measurements in compartments were performed during DCES and compared with controls. In detecting periosteal edema, post-contrast T1-weighted images were better than spin echo T2-weighted and proton density images or STIR images, but STIR depicted the bone marrow edema best. DCES best demonstrated the gradually enhancing periostitis. Four subjects with severe periosteal edema had visually detectable pathologic enhancement during DCES in the deep posterior compartment of the leg. Percentage enhancement in the deep posterior compartment of the leg was greater in patients than in controls. The fast enhancement phase in the deep posterior compartment began slightly slower in patients than in controls, but it continued longer. We believe that periosteal edema in bone stress reaction can cause impairment of venous flow in the deep posterior compartment. MRI can depict both these conditions. In patients with medial tibial pain, MR imaging protocol should include axial STIR images (to depict bone pathology) with T1-weighted axial pre and post-contrast images, and dynamic contrast enhanced imaging to show periosteal edema and abnormal contrast enhancement within a compartment.

  5. Posterior cruciate ligament reconstruction by means of tibial tunnel: anatomical study on cadavers for tunnel positioning

    Directory of Open Access Journals (Sweden)

    Antônio Altenor Bessa de Queiroz


    Full Text Available Objective:To determine the reference points for the exit of the tibial guidewire in relation to the posterior cortical bone of the tibia.Methods:Sixteen knees from fresh cadavers were used for this study. Using a viewing device and a guide marked out in millimeters, three guidewires were passed through the tibia at 0, 10 and 15 mm distally in relation to the posterior crest of the tibia. Dissections were performed and the region of the center of the tibial insertion of the posterior cruciate ligament (PCL was determined in each knee. The distances between the center of the tibial insertion of the PCL and the posterior tibial border (CB and between the center of the tibial insertion of the PCL and wires 1, 2 and 3 (CW1, CW2 and CW3 were measured.Results:In the dissected knees, we found the center of the tibial insertion of the PCL at 1.09 ± 0.06 cm from the posterior tibial border. The distances between the wires 1, 2 and 3 and the center of the tibial insertion of the PCL were respectively 1.01 ± 0.08, 0.09 ± 0.05 and 0.5 ± 0.05 cm.Conclusion:The guidewire exit point 10 mm distal in relation to the posterior crest of the tibia was the best position for attempting to reproduce the anatomical center of the PCL.

  6. Immediate weight-bearing after osteosynthesis of proximal tibial fractures may be allowed

    DEFF Research Database (Denmark)

    Haak, Karl Tobias; Palm, Henrik; Holck, Kim;


    Immediate weight-bearing following osteosynthesis of proximal tibial fractures is traditionally not allowed due to fear of articular fracture collapse. Anatomically shaped locking plates with sub-articular screws could improve stability and allow greater loading forces. The purpose of this study...... was to investigate if immediate weight-bearing can be allowed following locking plate osteosynthesis of proximal tibial fractures....

  7. Arthroscopically assisted osteosynthesis of tibial plateau fractures in patients older than 55 years

    NARCIS (Netherlands)

    Roerdink, WH; Oskam, J; Vierhout, PAM


    Purpose: To evaluate the end results of arthroscopically assisted osteosynthesis of tibial plateau fractures in patients older than 55 years of age. Type of Study: Case series. Methods: Over a 5-year period, 201 consecutive patients presented with tibial plateau fracture; 131 of these patients were

  8. Chemotherapy affects the pattern of failure after shear loading of the proximal tibial growth plate.

    NARCIS (Netherlands)

    Leeuwen, B.L.; Hartel, R.M.; Jansen, H.W.B.; Verkerke, G.J.; Veth, R.P.H.; Kamps, W.A.; Hoekstra, H.J.


    INTRODUCTION: Tibial bones are shorter and less resistant to shear forces after treatment with doxorubicin, methotrexate, or cisplatin. We investigated the pattern of failure after shear loading of the proximal tibial growth plate in rats treated with these chemotherapeutic agents. MATERIALS AND MET

  9. The effect of shoe design and lateral wedging on knee loading

    DEFF Research Database (Denmark)

    Mølgaard, Carsten; Kersting, Uwe G.

    -dimensional gait analysis. Barefoot walking, walking in a running shoe, an Oxford-type leather shoe, and a rocker shoe were analyzed. The shoes were tested both with and without a 10-degree full length laterally wedged insole. Results: Similar, significant reductions in the peak knee adduction moment with lateral...... wedges were observed in all three types of shoes. However, differences between shoe design were of similar magnitude as the effect of laterally wedged insoles. Only marginal changes in muscle activity for lateral hamstrings during barefoot toe-out walking and gastrocnemius when using the Oxford wedged...

  10. Tibial slope in total ankle arthroplasty: Anterior or lateral approach. (United States)

    Usuelli, Federico Giuseppe; Maccario, Camilla; Indino, Cristian; Manzi, Luigi; Gross, Christopher Edward


    A new total ankle arthroplasty (TAA) system performed through a lateral approach provides direct visualization of the centre of rotation, allowing for accurate reconstruction of the joint alignment and less bone resection. Radiographic references are needed to describe deformities and plan the surgical procedures. The tibial slope is an important factor when treating malalignment. The aim of this study is to show if there is any difference regarding the post-operative tibial slope (β angle) measurement comparing a fixed-bearing TAA through a lateral approach and a mobile-bearing TAA through an anterior approach. The study included 217 ankles. Between May 2011 and April 2015, 77 patients underwent a TAA with a mobile-bearing implant through an anterior approach and 45 with a fixed-bearing implant through a lateral approach: in these patients the β angle was measured 2 and 12 months postoperatively. 95 subjects with unilateral post-traumatic ankle arthritis composed the control group: in these patients we measured the anterior distal tibial angle (ADTA) of the controlateral, non arthritic tibiotalar joint. In the mobile-bearing group, the mean β angle at 2 and 12 months postoperatively was 86.4±3.1 and 86.8±3.1 (p-value=0.12). In the fixed-bearing group, the mean β angle at 2 and 12 months postoperatively was 83.1±5.4 and 83.9±6.5 (p-value=0.26). A statistically significant difference was found between the β angle of the two groups. In the control group the mean ADTA was 84.9±2.5. A non-statistically significant difference was observed only between β angle of the fixed-bearing group and the ADTA of the control group. Regarding the tibial slope, fixed-bearing TAA through a lateral approach showed a more anatomic placement. In contrast, β angle in mobile-bearing group appeared more reproducible than fixed-bearing group. Copyright © 2016 European Foot and Ankle Society. Published by Elsevier Ltd. All rights reserved.

  11. Expected long-term outcome after a tibial shaft fracture

    DEFF Research Database (Denmark)

    Faergemann, C; Frandsen, P A; Röck, N D


    these expectations with the outcome measured in patients. METHODS: There were five groups of nonpatients: (1) 42 orthopedic surgeons, (2) 36 physiotherapists, (3) 42 students, (4) 49 white collar workers, and (5) 38 blue collar workers. Outcome was measured by Sickness Impact Profile (SIP). The SIP scores were...... compared with SIP scores obtained from 33 patients with a unilateral tibial fracture. RESULTS: Marked variation was observed between the groups. CONCLUSION: Physiotherapists expected the lowest degree of disability and orthopedic surgeons the highest. In the three groups of students, white collar workers...

  12. Double segmental tibial fractures——an unusual fracture pattern

    Institute of Scientific and Technical Information of China (English)

    Kamal Bali; Vishal Kumar; Sandeep Patel; Sameer Aggarwal


    A case of a 50-year-old pedestrian who was hit by a bike and suffered fractures of both bones of his right leg was presented. Complete clinical and radiographic assessment showed double segmental fractures of the tibia and multisegmental fractures of the fibula. Review of the literature revealed that this fracture pattern was unique and only a single case was reported so far. Moreover, we discussed the possible mechanisms which can lead to such an injury. We also discussed the management of segmental tibial fracture and the difficulties encountered with them. This case was managed by modern osteosynthesis tech nique with a pleasing outcome.

  13. An outcome of surgical management of the tibial plateau fractures

    Directory of Open Access Journals (Sweden)

    Biju Ravindran


    Full Text Available Background: Advance in mechanization and acceleration of travel has been accompanied by an increase in number and severity of fractures and those of the tibial plateau are not an exception. As it is one of the major weight bearing joints of the body, fractures around it will be of at most importance. Aims: (1 To restore articular congruity and limb alignment by open reduction and rigid internal fixation. (2 To enable early knee motion and improve quadriceps and hamstring power. (3 To study the role of surgical treatment and functional outcome in tibial plateau fractures and its complications. Settings and Design: A prospective study was carried out, 32 cases of the tibial plateau fractures, which were admitted from August 2010 to April 2012 at Department of Orthopedics of our Hospital. Materials and Methods: 32 patients underwent surgical treatment for tibial plateau fractures. Fractures were classified according to the Schatzker′s system. The indications for surgery were defined as the presence of displacement, depression and instability being more than 4 mm, 10 mm and 10 degrees. The mean follow-up was 12 months. The selected patients were evaluated and were taken up for surgery. The indicated fractures were treated with closed reduction and internal fixation with percutaneous cannulated cancellous screws, external fixator, open reduction and internal fixation with buttress plate with or without bone grafting. The range of motion was started soon after surgery. The patients were advised nonweight bearing up to 6-8 weeks. Total weight bearing deferred until 12 weeks or complete union of fracture. Statistical Analysis: All parameters before and after the treatment were expressed in mean ± standard deviation and analyzed by the Student′s t-test using SPSS version 16. Results: The knee range of motion was excellent to very good and weight bearing after complete union was satisfactory. Malunion in two cases, knee stiffness in three

  14. Chronic venous disease as a clinical manifestation of tibial osteochondroma

    Directory of Open Access Journals (Sweden)

    Marcelo Fernandes Lima


    Full Text Available Osteochondromas are the most common type of benign tumor of the skeleton. They most frequently affect the distal extremity of the femur, with the tibia being the second most commonly affected long bone. Vascular complications of these lesions are rare, but pseudoaneurysm formation is the most frequently reported of them. In this case report, we describe a case of compression of the popliteal neurovascular bundle by a tibial osteochondroma in a diabetic patient who had been admitted to hospital to treat an infected lesion on his left foot and complained of edema and paresthesia of the left lower limb.

  15. Clinical features of a rare anatomical variation of the posterior tibial and fibular arteries

    Directory of Open Access Journals (Sweden)

    Pedro Oliveira Portilho

    Full Text Available Abstract The posterior tibial artery normally arises from tibial-fibular trunk at the popliteal fossa, together with the fibular artery. The classic course of the posterior tibial artery is to run between the triceps surae muscle and muscles of the posterior compartment of the leg before continuing its course posteriorly to the medial malleolus, while the fibular artery runs through the lateral margin of the leg. Studies of both arteries are relevant to the fields of angiology, vascular surgery and plastic surgery. To the best of our knowledge, we report the first case of an anastomosis between the posterior tibial artery and the fibular artery in their distal course. The two arteries joined in an unusual “X” format, before division of the posterior tibial artery into plantar branches. We also provide a literature review of unusual variations and assess the clinical and embryological aspects of both arteries in order to contribute to further investigations regarding these vessels.

  16. A Patient with Unilateral Tibial Aplasia and Accessory Scrotum: A Pure Coincidence or Nonfortuitous Association?

    Directory of Open Access Journals (Sweden)

    Zoran Gucev


    Full Text Available Tibial aplasia is an uncommon lower limb malformation that can occur isolated or be part of a more complex malformation pattern. We describe a 9-year-old boy born after uneventful pregnancy and delivery. Family history was negative for maternal diabetes and other malformations. The patient presented with left tibial aplasia and homolateral prexial foot polydactyly. He also displayed enamel dysplasia and bifid scotum with cryptorchidism. Literature review failed to identify a significant syndromic association between lower limb defects of the tibial type and the genital anomalies reported here. The combination of tibial aplasia with midline genital malformations further supports the hypothesis that the tibial ray development mirrors the morphogenetic process of the radial structures. Accordingly, the malformation pattern observed in the present patient may be pathogenetically explained by an insult occurring during late blastogenesis.

  17. Tibial tunnel and pretibial cysts following ACL graft reconstruction: MR imaging diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Ghazikhanian, Varand [Brigham and Women' s Hospital, Musculoskeletal Imaging and Intervention, Department of Radiology, Boston, MA (United States); Beltran, Javier [Maimonides Medical Center, Brooklyn, NY (United States); Nikac, Violeta [Maimonides Medical Center, Department of Radiology, Brooklyn, NY (United States); Bencardino, Jenny T. [NYU Hospital for Joint Diseases, New York, NY (United States); Feldman, Marina


    Tunnel cyst formation is a rare complication after anterior cruciate ligament reconstruction, usually occurring 1-5 years post-operatively, which may occasionally be symptomatic. There are multiple proposed theories regarding the etiology of tunnel cysts. Theories include necrosis, foreign-body reaction, lack of complete graft osteo-integration, and intravasation of articular fluid. It is important to know if the tunnel cysts are communicating or not communicating with the joint, as surgical management may be different. Imaging characteristics on magnetic resonance images (MRI) include tibial tunnel widening, multilocular or unilocular cyst formation in the graft or tibial tunnel, with possible extension into the pretibial space, intercondylar notch, and/or popliteal fossa. The MR imaging differential diagnosis of tibial tunnel cysts includes infection, foreign-body granuloma, or tibial screw extrusion. Importantly, to the best of our knowledge, graft failure or instability has not been reported in association with tibial tunnel cysts. (orig.)

  18. Growth and mixing dynamics of mantle wedge plumes (United States)

    Gorczyk, Weronika; Gerya, Taras V.; Connolly, James A. D.; Yuen, David A.


    Recent work suggests that hydrated partially molten thermal-chemical plumes that originate from subducted slab as a consequence of Rayleigh-Taylor instability are responsible for the heterogeneous composition of the mantle wedge. We use a two-dimensional ultrahigh-resolution numerical simulation involving 10 × 109 active markers to anticipate the detailed evolution of the internal structure of natural plumes beneath volcanic arcs in intraoceanic subduction settings. The plumes consist of partially molten hydrated peridotite, dry solid mantle, and subducted oceanic crust, which may compose as much as 12% of the plume. As plumes grow and mature these materials mix chaotically, resulting in attenuation and duplication of the original layering on scales of 1-1000 m. Comparison of numerical results with geological observations from the Horoman ultramafic complex in Japan suggests that mixing and differentiation processes related to development of partially molten plumes above slabs may be responsible for the strongly layered lithologically mixed (marble cake) structure of asthenospheric mantle wedges.

  19. Relation of the auroral substorm to the substorm current wedge (United States)

    McPherron, Robert L.; Chu, Xiangning


    The auroral substorm is an organized sequence of events seen in the aurora near midnight. It is a manifestation of the magnetospheric substorm which is a disturbance of the magnetosphere brought about by the solar wind transfer of magnetic flux from the dayside to the tail lobes and its return through the plasma sheet to the dayside. The most dramatic feature of the auroral substorm is the sudden brightening and poleward expansion of the aurora. Intimately associated with this expansion is a westward electrical current flowing across the bulge of expanding aurora. This current is fed by a downward field-aligned current (FAC) at its eastern edge and an upward current at its western edge. This current system is called the substorm current wedge (SCW). The SCW forms within a minute of auroral expansion. FAC are created by pressure gradients and field line bending from shears in plasma flow. Both of these are the result of pileup and diversion of plasma flows in the near-earth plasma sheet. The origins of these flows are reconnection sites further back in the tail. The auroral expansion can be explained by a combination of a change in field line mapping caused by the substorm current wedge and a tailward growth of the outer edge of the pileup region. We illustrate this scenario with a complex substorm and discuss some of the problems associated with this interpretation.

  20. Intramedullary nailing in distal tibial fracture

    Directory of Open Access Journals (Sweden)

    Damian Arroquy


    Methods The inclusion criteria of this study were skeletally mature patients with displaced fractures of the distal tibia treated with intramedullary nail with a minimum follow up of one year. Gustilo III open fractures and type C fractures of the AO classification (complete articular Stroke were excluded. The sample comprised 35 patients remained. The follow-up was 29.2 months. We evaluated the time of consolidation, malunion and complications. The functional results were described according to the AOFAS score. Results Of the 35 patients with fracture of the distal third of the tibia all of them presented fracture healing. The average time to union was 17.2 weeks (range: 11-26. Of the total sample, 5 patients had delayed union, requiring dynamic nail on average at 12 weeks. The malunion was present in 4 (11.4% patients. We found no  difference (p = 0.201 in the time to union between fractures associated with fractures of the fibula treated (13sem or not (17sem. The AOFAS score was 86 points. Conclusion Intramedullary nailing with multiple distal locks like a good alternative treatment for distal tibia fractures AO type A or B, with low complication rate and a high rate of consolidation.


    Directory of Open Access Journals (Sweden)

    Isaac Sunder


    Full Text Available : Tibial pilon fracture – Spectrum of injury ranging from fractures caused by low energy rotational foces to fractures caused by high energy axial compression forces due to RTA/ fall from height with significant metaphyseal communition articular communition with diaphyseal extension. Almost 80% patients will have fibula fracture. The aim of the study is study the efficacy of LP PD DTP in the management of closed pilon fractures (OTA type A Type B and Type C 1 and open pilon fractures (Grade 1 Grade II Grade III A (Gustilo Anterson grading. 1. I have studied 21 patients of pilon fracture classified using AO/OTA classification Type A-metaphyseal; Type B–Partially articular; Type C Metaphyseal fracture with articular involvement. 2. Used LP/ PC/ Distal tibial plate using MIPPO technique in OTA–A, B and C 1 closed & grade I II Grade III A compound fractures. OBSERVATIONS: 1. In contrary to stages protocol (Ist external fixation with fibular plating after 2-3 Weeks ORIF/MIPPO with/Without bone grafting, it is done percutaneously or minimally invasive and it can be done on day 1 without any major soft tissue problem & post-operative infection. 2. Duration of stay in the hospital can be reduced. 3. Since it is done through calcaneal traction or femoral distractor – fibula length restored & plating may not be necessary all the time and fibula plating can be avoid if the soft tissue condition is not favorable for plating laterally. 4. Since it is done through calcaneal traction/femoral distractor inspite of ground glass communition–good reduction is almost always possible. 5. Since MIPPO–need for bone grafting in less. 6. As in staged protocol more time is spent in soft tissue healing and after 2–3 weeks, fractures reduction if difficult and almost impossible with indirect reduction and may warrant open reduction. I conclude that LP PC distal tibial plate using MIPPO technique offers several advantages over two staged protocol and improved

  2. Arthrofibrosis of the knee following a fracture of the tibial plateau. (United States)

    Haller, J M; Holt, D C; McFadden, M L; Higgins, T F; Kubiak, E N


    The aim of this study was to report the incidence of arthrofibrosis of the knee and identify risk factors for its development following a fracture of the tibial plateau. We carried out a retrospective review of 186 patients (114 male, 72 female) with a fracture of the tibial plateau who underwent open reduction and internal fixation. Their mean age was 46.4 years (19 to 83) and the mean follow-up was16.0 months (6 to 80). A total of 27 patients (14.5%) developed arthrofibrosis requiring a further intervention. Using multivariate regression analysis, the use of a provisional external fixator (odds ratio (OR) 4.63, 95% confidence interval (CI) 1.26 to 17.7, p = 0.021) was significantly associated with the development of arthrofibrosis. Similarly, the use of a continuous passive movement (CPM) machine was associated with significantly less development of arthrofibrosis (OR = 0.32, 95% CI 0.11 to 0.83, p = 0.024). The effect of time in an external fixator was found to be significant, with each extra day of external fixation increasing the odds of requiring manipulation under anaesthesia (MUA) or quadricepsplasty by 10% (OR = 1.10, p = 0.030). High-energy fracture, surgical approach, infection and use of tobacco were not associated with the development of arthrofibrosis. Patients with a successful MUA had significantly less time to MUA (mean 2.9 months; sd 1.25) than those with an unsuccessful MUA (mean 4.86 months; sd 2.61, p = 0.014). For those with limited movement, therefore, performing an MUA within three months of the injury may result in a better range of movement. Based our results, CPM following operative fixation for a fracture of the tibial plateau may reduce the risk of the development of arthrofibrosis, particularly in patients who also undergo prolonged provisional external fixation. ©2015 The British Editorial Society of Bone & Joint Surgery.

  3. Growth of the deposit wedge in the mountain reservoir (United States)

    Chen, Y.; Song, G.


    The sedimentary problem of mountain reservoirs in Taiwan is getting serious year by year.Due to eroded sediments enter downstream reservoirs,the loss of sediment transport capacity may cause deposition of sediment in reservoirs.This phenomenon make problems to small mountain reservoirs.To realize the interaction between deposit wedges and mountain reservoirs,we selected Wushe reservoir which is situated in central Taiwan for a case study. Wushe reservoir is long and narrow.In recent years,most sediment is introduced during rain events that now accompany climate change are very important in sediment supply.In this thesis,we collected data of underwater landform and sub-bottom bedding information by using high resolution Multibeam Survey System(MBS) and seismic-reflection system.Up to now,we already had the bathymetric data for more than ten years,moreover,in 2010,we used 3.5kHz sub-bottom seismic profiler to analysis the sedimentary bedding situation in this area.These methods provide us accurate reservoir topography,sediment accumulation and the major ways of sediment transportation.The study purposes are as follows: First,according to the available underwater data for last ten years,we recognize the geomorphological characters of sedimentation as well as complete the mappings.Comparing to bathymetric images each year,we evaluate the carried ways of sediment.The flow water which enters this area transports along the thalweg,which in eastern reservoir.The range of water level variation cause alteration of sedimentary morphology,it also affects the scope of alluvial fan.The alluvial fan is located in the middle of the reservoir,the edge of it had moved forward 500 meters for last ten years.The annual mean of forward velocity was 50 meters,the elevation of fan edge also accelerated 10 meters per year.In a word,the large volume of the sedimentary delta is in Wushe reservoir now. Second,trying to clarify the composition of sedimentation and explain the sub

  4. Bone transport for limb reconstruction following severe tibial fractures

    Directory of Open Access Journals (Sweden)

    Julian Fürmetz


    Full Text Available A common treatment of tibial defects especially after infections is bone transport via external fixation. We compare complications and outcomes of 25 patients treated with a typical Ilizarov frame or a hybrid system for bone reconstruction of the tibia. Average follow up was 5.1 years. Particular interest was paid to the following criteria: injury type, comorbidities, development of osteitis and outcome of the different therapies. The reason for segmental resection was a second or third grade open tibia fractures in 24 cases and in one case an infection after plate osteosynthesis. Average age of the patients was 41 years (range 19 to 65 years and average defect size 6.6 cm (range 3.0 to 13.4 cm. After a mean time of 113 days 23 tibial defects were reconstructed, so we calculated an average healing index of 44.2 days/cm. Two patients with major comorbidities needed a below knee amputation. The presence of osteitis led to a more complicated course of therapy. In the follow up patients with an Ilizarov frame had better results than patients with hybrid systems. Bone transport using external fixation is suitable for larger defect reconstruction. With significant comorbidities, however, a primary amputation or other methods must be considered.

  5. Posterior coronal plating for tibial fractures: technique and advantages

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    Montu Jain


    Full Text Available Objective:Tibial shaft fractures are straightforward to treat but when associated with soft tissue injury particularly at the nail entry/plate insertion site or there is significant comminution proximally or a large butterfly fragment/a second split component in the posterior coronal plane, it is a challenge to the treating surgeon. The aim of the present report is to describe the technique of posterior coronal plating in such a scenario and its advantages. Methods:Between July 2008 and June 2011, 12 patients were pro spectively treated by this approach using 4.5 mm broad dynamic compression plates. Results:The time of bony consolidation and full weight bearing averaged 21.7 weeks (range, 16-26 weeks. Patients were followed up for at least 24 months (range, 24-48 months. At 1 year postoper atively, no loss in reduction or alignment was observed. Mean Hospital for Lower Extremity Measurement Functional Score was 72.8 (range, 64-78. All patients were satisfied with their treatment outcomes. Conclusion:Direct posterior approach and fixation using prone position helps to visualise the fracture fragments and provide rigid fixation. The approach is simple and extensile easily, apart from advantages of less soft tissue and hardware problems compared to standard medial or lateral plating. Key words: Tibial fractures; Bone plates; Orthopedic procedures

  6. A multiaxial force-sensing implantable tibial prosthesis. (United States)

    Kirking, Bryan; Krevolin, Janet; Townsend, Christopher; Colwell, Clifford W; D'Lima, Darryl D


    Accurate in vivo measurement of tibiofemoral forces is important in total knee arthroplasty. These forces determine polyethylene stresses and cold-flow, stress distribution in the implant, and stress transfer to the underlying implant bone interface. Theoretic estimates of tibiofemoral forces have varied widely depending on the mathematical models used. The six degrees of freedom of motion, complex articular surface topography, changing joint-contact position, intra- and extra-articular ligaments, number of muscles crossing the knee joint, and the presence of the patellofemoral joint contribute to the difficulty in developing reliable models of the knee. A prototype instrumented total knee replacement tibial prosthesis was designed, manufactured, and tested. This prosthesis accurately measured all six components of tibial forces (R2>0.997). The prosthesis was also instrumented with an internal microtransmitter for wireless data transmission. Remote powering of the sealed implanted electronics was achieved using magnetic coil induction. This device can be used to validate existing models of the knee that estimate these forces or to develop more accurate models. In conjunction with kinematic data, accurate tibiofemoral force data may be used to design more effective knee-testing rigs and wear simulators. Additional uses are intraoperative measurement of forces to determine soft-tissue balancing and to evaluate the effects of rehabilitation, external bracing, and athletic activities, and activities of daily living.

  7. Radiographic predictors of compartment syndrome in tibial plateau fractures. (United States)

    Ziran, Bruce H; Becher, Stephen John


    The purpose of this article was to evaluate the relationship of radiographic features of tibial plateau fractures to the development of compartment syndrome. We hypothesized that the direction and degree of initial displacement of the femur on the tibia, and the amount of tibial widening (TW), were correlated with the development of compartment syndrome. Retrospective case-control study. Single level 1 trauma center. Retrospective evaluation of 158 patients with 162 plateau fractures. Grouping with and without compartment syndrome. The following data were obtained: age, sex, Schatzker and OTA/AO classification, open/closed status, TW, and femoral displacement (FD). A univariate statistical and a logistical regression analysis were performed to determine significance. The overall rate of compartment syndrome was 11%. Univariate analysis found both the TW and FD to be significant with respect to development of compartment syndrome (P compartment syndrome. Logistic regression found FD and Schatzker grade to be significant. Our study is the first to identify easily obtained radiographic parameters that correlate to the occurrence compartment syndrome. There may also be a relationship between TW and FD, as noted by regression result. This study helps to assess which patients with a fracture are at higher risk for developing a compartment syndrome. Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.

  8. Effect of interstitial low level laser therapy on tibial defect (United States)

    Lee, Sangyeob; Ha, Myungjin; Hwang, Donghyun; Yu, Sungkon; Jang, Seulki; Park, Jihoon; Radfar, Edalat; Kim, Hansung; Jung, Byungjo


    Tibial defect is very common musculoskeletal disorder which makes patient painful and uncomfortable. Many studies about bone regeneration tried to figure out fast bone healing on early phase. It is already known that low level laser therapy (LLLT) is very convenient and good for beginning of bone disorder. However, light scattering and absorption obstruct musculoskeletal therapy which need optimal photon energy delivery. This study has used an interstitial laser probe (ILP) to overcome the limitations of light penetration depth and scattering. Animals (mouse, C57BL/6) were divided into three groups: laser treated test group 1 (660 nm; power 10 mW; total energy 5 J) and test group 2 (660 nm; power 20 mW; total energy 10 J); and untreated control group. All animals were taken surgical operation to make tibial defect on right crest of tibia. The test groups were treated every 48 hours with ILP. Bone volume and X-ray attenuation coefficient were measured on 0, 14th and 28th day with u-CT after treatment and were used to evaluate effect of LLLT. Results show that bone volume of test groups has been improved more than control group. X-ray attenuation coefficients of each groups have slightly different. The results suggest that LLLT combined with ILP may affect on early phase of bone regeneration and may be used in various musculoskeletal disease in deep tissue layer.

  9. Duality in nonlinear B$\\wedge$F models equivalence between self-dual and topologically massive Born-Infeld B$\\wedge$F models

    CERN Document Server

    Menezes, R; Ribeiro, R F; Wotzasek, C


    We study the dual equivalence between the nonlinear generalization of the self-dual ($NSD_{B\\wedge F}$) and the topologically massive $B\\wedge F$ models with particular emphasis on the nonlinear electrodynamics proposed by Born and Infeld. This is done through a dynamical gauge embedding of the nonlinear self-dual model yielding to a gauge invariant and dynamically equivalent theory. We clearly show that nonpolinomial $NSD_{B\\wedge F}$ models can be mapped, through a properly defined duality transformation, into $TM_{B\\wedge F}$ actions. The general result obtained is then particularized for a number of examples, including the Born-Infeld-BF (BIBF) model that has experienced a revival in the recent literature.

  10. The role of aerothermochemistry in double cone and double wedge flows (United States)

    Swantek, Andrew

    In this work, hypervelocity flows over double cone and double wedge geometries are studied. The flow configurations established over the double cone/double wedge models are extremely sensitive to thermochemistry, and thus serve as ideal benchmarks for validating chemical models. The goals of this research are: i) to investigate the coupling between the fluid mechanics and thermochemistry in these flow fields by varying freestream flow composition and enthalpy, ii) to implement a diagnostic suite for time-resolved surface and freestream measurements, iii) to investigate the nature of flow field unsteadiness across various test conditions, and lastly iv) to extend the experimental database for shock wave boundary/layer interactions. An expansion tube is used to generate flows with enthalpies ranging from 2.2-8.0 MJ/kg (2-4 km/s) and Mach numbers from 4-7. The expansion tube is a novel impulse facility for accelerating a test gas to these velocities, while maintaining a minimally dissociated freestream. Additionally, the facility allows variation of the freestream composition (between nitrogen and air), while maintaining freestream test parameters (Mach number, density, enthalpy) to within 0.5%. Two models are used: a 25-55 degree double cone model and a 30-55 degree double wedge. There are four diagnostic components to this research which aim to enable a better understanding of these canonical flow fields. Single frame, high resolution schlieren photography is used to visualize various flow features including: the separation zone formed in the corner, the triple point interaction, and a supersonic shear layer. From these images, a separation zone length scaling parameter is determined. This parameter, derived for wedge geometries, is successfully applied to conical geometries by using a judicious choice of flow properties for scaling. In the wedge image series, nitrogen test conditions exhibit a distinct increase in bow shock standoff distance. Additionally, aft

  11. First direct dating of Late Pleistocene ice-wedges by AMS

    NARCIS (Netherlands)

    Vasil'chuk, YK; van der Plicht, J; Jungner, H; Sonninen, E; Vasil'chuk, AC; Vasil'chuk, Yurij K.; Vasil'chuk, Alla C.


    We present the first direct dating by C-14-accelerator mass spectrometry of three Late Pleistocene syngenetic ice-wedges from the Seyaha cross-section. They are representative of permafrost with multistage ice-wedges from the North of Western Siberia. The most important result is the clear vertical

  12. Revisit the classical Newmark displacement method for earthquake-induced wedge slide (United States)

    Yang, Che-Ming; Cheng, Hui-Yun; Wu, Wen-Jie; Hsu, Chang-Hsuan; Dong, Jia-Jyun; Lee, Chyi-Tyi


    Newmark displacement method has been widely used to study the earthquake-induced landslides and adopted to explore the initiation and kinematics of catastrophic planar failure in recent years. However, surprisingly few researchers utilize the Newmark displacement method to study the earthquake-induced wedge slide. The classical Newmark displacement method for earthquake-induced wedge sliding assumed the wedge is rigid and the vertical acceleration, as well as the horizontal acceleration perpendicular to the sliding direction, is neglected. Moreover, the friction coefficients on the weak planes are assumed as unchanged during sliding. The purpose of this study is to test the reasonableness of the aforementioned assumptions. This study uses Newmark displacement method incorporating the rigid wedge method (RWM) and maximum shear stress method (MSSM) to evaluate the influence of wedge deformation. We design the geometry of the wedge and input the synthetic seismicity to trigger the wedge slide. The influence for neglecting the vertical and horizontal (perpendicular to the sliding direction) accelerations is also assessed. Besides, this research incorporates the velocity-displacement dependent friction law in the analysis to evaluate the influence of constant friction coefficient assumption. Result of this study illustrated that the aforementioned assumptions have significant effects on the calculated permeant displacement, moving speed, and failure initiation. To conclude, this study provides new insights on the initiation and kinematics of an earthquake induced wedge slide.

  13. Enhancement of linear and second-order hyperpolarizabilities in wedge-shaped nanostructures (United States)

    Jayabalan, J.; Singh, Manoranjan P.; Rustagi, K. C.


    Analytical solutions for the wave functions for free electrons inside a wedge-shaped quantum dot are reported. For silver wedge-shaped quantum dots, linear and second-order hyperpolarizabilities are calculated for various apex angles. It is found that linear and nonlinear hyperpolarizabilities both increase with decreasing apex angle.

  14. Duwamish Waterways Navigation Improvement Study: Analysis of Impacts on Water Quality and Salt Wedge Characteristics. (United States)


    dissolved oxygen consumption in the saltwater wedge is emphasized. A section has also been prepared discussing sediment transport in the estuary...biomass produced and sedimented 23 1,000 800 00 0 400 Xi. . *-*’* 200 ox- :~. ---0 - .....’ ~ ’J FIGURE 6 Annual Dissolved Oxygen Consumption in the wedge

  15. Reflection of a converging cylindrical shock wave segment by a straight wedge (United States)

    Gray, B.; Skews, B.


    As a converging cylindrical shock wave propagates over a wedge, the shock wave accelerates and the angle between the shock wave and the wedge decreases. This causes the conditions at the reflection point to move from what would be the irregular reflection domain for a straight shock wave into the regular reflection domain. This paper covers a largely qualitative study of the reflection of converging shock wave segments with Mach numbers between 1.2 and 2.1 by wedges inclined at angles between 15° and 60° from experimental and numerical results. The sonic condition conventionally used for predicting the type of reflection of straight shock waves was found to also be suitable for predicting the initial reflection of a curved shock wave. Initially regular reflections persisted until the shock was completely reflected by the wedge, whereas the triple point of initially irregular reflections was observed to return to the wedge surface, forming transitioned regular reflection. After the incident shock wave was completely reflected by the wedge, a shock wave focusing mechanism was observed to amplify the pressure on the surface of the wedge by a factor of up to 100 for low wedge angles.

  16. A quantum hybrid with a thin antenna at the vertex of a wedge (United States)

    Carlone, Raffaele; Posilicano, Andrea


    We study the spectrum, resonances and scattering matrix of a quantum Hamiltonian on a "hybrid surface" consisting of a half-line attached by its endpoint to the vertex of a concave planar wedge. At the boundary of the wedge, outside the vertex, homogeneous Dirichlet conditions are imposed. The system is tunable by varying the measure of the angle at the vertex.

  17. Immediate and 1 week effects of laterally wedge insoles on gait biomechanics in healthy females. (United States)

    Weinhandl, Joshua T; Sudheimer, Sarah E; Van Lunen, Bonnie L; Stewart, Kimberly; Hoch, Matthew C


    It is estimated that approximately 45% of the U.S. population will develop knee osteoarthritis, a disease that creates significant economic burdens in both direct and indirect costs. Laterally wedged insoles have been frequently recommended to reduce knee abduction moments and to manage knee osteoarthritis. However, it remains unknown whether the lateral wedge will reduce knee abduction moments over a prolonged period of time. Thus, the purposes of this study were to (1) examine the immediate effects of a laterally wedged insole in individuals normally aligned knees and (2) determine prolonged effects after the insole was worn for 1 week. Gait analysis was performed on ten women with and without a laterally wedged insole. After participants wore the wedges for a week, a second gait analysis was performed with and without the insole. The wedged insole did not affect peak knee abduction moment, although there was a significant increase in knee abduction angular impulse after wearing the insoles for 1 week. Furthermore, there was a significant increase in vertical ground reaction force at the instance of peak knee abduction moment with the wedges. While the laterally wedged insole used in the current study did not alter knee abduction moments as expected, other studies have shown alterations. Future studies should also examine a longer acclimation period, the influence of gait speed, and the effect of different shoe types with the insole.

  18. Pan-Arctic ice-wedge degradation in warming permafrost and its influence on tundra hydrology (United States)

    Liljedahl, Anna K.; Boike, Julia; Daanen, Ronald P.; Fedorov, Alexander N.; Frost, Gerald V.; Grosse, Guido; Hinzman, Larry D.; Iijma, Yoshihiro; Jorgenson, Janet C.; Matveyeva, Nadya; Necsoiu, Marius; Raynolds, Martha K.; Romanovsky, Vladimir E.; Schulla, Jörg; Tape, Ken D.; Walker, Donald A.; Wilson, Cathy J.; Yabuki, Hironori; Zona, Donatella


    Ice wedges are common features of the subsurface in permafrost regions. They develop by repeated frost cracking and ice vein growth over hundreds to thousands of years. Ice-wedge formation causes the archetypal polygonal patterns seen in tundra across the Arctic landscape. Here we use field and remote sensing observations to document polygon succession due to ice-wedge degradation and trough development in ten Arctic localities over sub-decadal timescales. Initial thaw drains polygon centres and forms disconnected troughs that hold isolated ponds. Continued ice-wedge melting leads to increased trough connectivity and an overall draining of the landscape. We find that melting at the tops of ice wedges over recent decades and subsequent decimetre-scale ground subsidence is a widespread Arctic phenomenon. Although permafrost temperatures have been increasing gradually, we find that ice-wedge degradation is occurring on sub-decadal timescales. Our hydrological model simulations show that advanced ice-wedge degradation can significantly alter the water balance of lowland tundra by reducing inundation and increasing runoff, in particular due to changes in snow distribution as troughs form. We predict that ice-wedge degradation and the hydrological changes associated with the resulting differential ground subsidence will expand and amplify in rapidly warming permafrost regions.

  19. Comparison of dosimetric characteristics of Siemens virtual and physical wedges for ONCOR linear accelerator

    Directory of Open Access Journals (Sweden)

    Attalla Ehab


    Full Text Available Dosimetric properties of virtual wedge (VW and physical wedge (PW in 6- and 10-MV photon beams from a Siemens ONCOR linear accelerator, including wedge factors, depth doses, dose profiles, peripheral doses, are compared. While there is a great difference in absolute values of wedge factors, VW factors (VWFs and PW factors (PWFs have a similar trend as a function of field size. PWFs have stronger depth dependence than VWF due to beam hardening in PW fields. VW dose profiles in the wedge direction, in general, match very well with those of PW, except in the toe area of large wedge angles with large field sizes. Dose profiles in the nonwedge direction show a significant reduction in PW fields due to off-axis beam softening and oblique filtration. PW fields have significantly higher peripheral doses than open and VW fields. VW fields have similar surface doses as the open fields, while PW fields have lower surface doses. Surface doses for both VW and PW increase with field size and slightly with wedge angle. For VW fields with wedge angles 45° and less, the initial gap up to 3 cm is dosimetrically acceptable when compared to dose profiles of PW. VW fields in general use less monitor units than PW fields.

  20. Investigation of a Wedge Adhesion Test for Edge Seals

    Energy Technology Data Exchange (ETDEWEB)

    Kempe, Michael; Wohlgemuth, John; Miller, David; Postak, Lori; Booth, Dennis; Phillips, Nancy


    Many photovoltaic (PV) technologies have been found to be sensitive to moisture that diffuses into a PV package. Even with the use of impermeable frontsheets and backsheets, moisture can penetrate from the edges of a module. To limit this moisture ingress pathway from occurring, manufacturers often use a low permeability polyisobutylene (PIB) based edge seal filled with desiccant to further restrict moisture ingress. Moisture ingress studies have shown that these materials are capable of blocking moisture for the 25-year life of a module; but to do so, they must remain well-adhered and free of cracks. This work focuses on adapting the Boeing Wedge test for use with edge seals laminated using glass substrates as part of a strategy to assess the long-term durability of edge seals. The advantage of this method is that it duplicates the residual stresses and strains that a glass/glass module may have when the lamination process results in some residual glass bending that puts the perimeter in tension. Additionally, this method allows one to simultaneously expose the material to thermal stress, humidity, mechanical stress, and ultraviolet radiation. The disadvantage of this method generally is that we are limited by the fracture toughness of the glass substrates that the edge seal is adhered to. However, the low toughness of typical uncrosslinked or sparsely crosslinked PIB makes them suitable for this technique. We present data obtained during the development of the wedge test for use with PV edge seal materials. This includes development of the measuring techniques and evaluation of the test method with relevant materials. We find consistent data within a given experiment, along with the theoretical independence of fracture toughness measurements with wedge thickness. This indicates that the test methodology is reproducible. However, even though individual experimental sets are consistent, the reproducibility between experimental sets is poor. We believe this may be

  1. Investigation of a wedge adhesion test for edge seals (United States)

    Kempe, Michael; Wohlgemuth, John; Miller, David; Postak, Lori; Booth, Dennis; Phillips, Nancy


    Many photovoltaic (PV) technologies have been found to be sensitive to moisture that diffuses into a PV package. Even with the use of impermeable frontsheets and backsheets, moisture can penetrate from the edges of a module. To limit this moisture ingress pathway from occurring, manufacturers often use a low permeability polyisobutylene (PIB) based edge seal filled with desiccant to further restrict moisture ingress. Moisture ingress studies have shown that these materials are capable of blocking moisture for the 25-year life of a module; but to do so, they must remain well-adhered and free of cracks. This work focuses on adapting the Boeing Wedge test for use with edge seals laminated using glass substrates as part of a strategy to assess the long-term durability of edge seals. The advantage of this method is that it duplicates the residual stresses and strains that a glass/glass module may have when the lamination process results in some residual glass bending that puts the perimeter in tension. Additionally, this method allows one to simultaneously expose the material to thermal stress, humidity, mechanical stress, and ultraviolet radiation. The disadvantage of this method generally is that we are limited by the fracture toughness of the glass substrates that the edge seal is adhered to. However, the low toughness of typical uncrosslinked or sparsely crosslinked PIB makes them suitable for this technique. We present data obtained during the development of the wedge test for use with PV edge seal materials. This includes development of the measuring techniques and evaluation of the test method with relevant materials. We find consistent data within a given experiment, along with the theoretical independence of fracture toughness measurements with wedge thickness. This indicates that the test methodology is reproducible. However, even though individual experimental sets are consistent, the reproducibility between experimental sets is poor. We believe this may be

  2. Inhibition of bladder overactivity by a combination of tibial neuromodulation and tramadol treatment in cats (United States)

    Zhang, Fan; Mally, Abhijith D.; Ogagan, P. Dafe; Shen, Bing; Wang, Jicheng; Roppolo, James R.; de Groat, William C.


    Our recent study in cats revealed that inhibition of bladder overactivity by tibial nerve stimulation (TNS) depends on the activation of opioid receptors. TNS is a minimally invasive treatment for overactive bladder (OAB), but its efficacy is low. Tramadol (an opioid receptor agonist) is effective in treating OAB but elicits significant adverse effects. This study was to determine if a low dose of tramadol (expected to produce fewer adverse effects) can enhance the TNS inhibition of bladder overactivity. Bladder overactivity was induced in α-chloralose-anesthetized cats by an intravesical infusion of 0.25% acetic acid (AA) during repeated cystometrograms (CMGs). TNS (5 Hz) at two to four times the threshold intensity for inducing toe movement was applied during CMGs before and after tramadol (0.3–7 mg/kg iv) to examine the interaction between the two treatments. AA irritation significantly reduced bladder capacity to 24.8 ± 3.3% of the capacity measured during saline infusion. TNS alone reversibly inhibited bladder overactivity and significantly increased bladder capacity to 50–60% of the saline control capacity. Tramadol administered alone in low doses (0.3–1 mg/kg) did not significantly change bladder capacity, whereas larger doses (3–7 mg/kg) increased bladder capacity (50–60%). TNS in combination with tramadol (3–7 mg/kg) completely reversed the effect of AA. Tramadol also unmasked a prolonged (>2 h) TNS inhibition of bladder overactivity that persisted after termination of the stimulation. The results suggest a novel treatment strategy for OAB by combining tibial neuromodulation with a low dose of tramadol, which is minimally invasive with a potentially high efficacy and fewer adverse effects. PMID:22496406


    Directory of Open Access Journals (Sweden)

    Hajar Razi


    Full Text Available Though bone is known to adapt to its mechanical challenges, the relationship between the local mechanical stimuli and the adaptive tissue response seems so far unclear. A major challenge appears to be a proper characterization of the local mechanical stimuli of the bones (e.g. strains. The finite element modeling is a powerful tool to characterize these mechanical stimuli not only on the bone surface but across the tissue. However, generating a predictive finite element model of biological tissue strains (e.g., physiological-like loading encounters aspects that are inevitably unclear or vague and thus might significantly influence the predicted findings. We aimed at investigating the influence of variations in bone alignment, joint contact surfaces and displacement constraints on the predicted strains in an in vivo mouse tibial compression experiment. We found that the general strain state within the mouse tibia under compressive loading was not affected by these uncertain factors. However, strain magnitudes at various tibial regions were highly influenced by specific modeling assumptions. The displacement constraints to control the joint contact sites appeared to be the most influential factor on the predicted strains in the mouse tibia. Strains could vary up to 150% by modifying the displacement constraints. To a lesser degree, bone misalignment (from 0 to 20° also resulted in a change of strain (+300 µε = 40%. The definition of joint contact surfaces could lead to up to 6% variation. Our findings demonstrate the relevance of the specific boundary conditions in the in vivo mouse tibia loading experiment for the prediction of local mechanical strain values using finite element modeling.

  4. Radiographic study on the tibial insertion of the posterior cruciate ligament

    Directory of Open Access Journals (Sweden)

    Julio Cesar Gali


    Full Text Available OBJECTIVE: To establish the radiographic distances from posterior cruciate ligament (PCL tibial insertions centers to the lateral and medial tibial cortex in the anteroposterior view, and from these centers to the PCL facet most proximal point on the lateral view, in order to guide anatomical tunnels drilling in PCL reconstruction and for tunnel positioning postoperative analysis.STUDY DESIGN: Controlled laboratory study.METHODS: Twenty cadaver knees were evaluated. The PCL's bundles tibial insertions were identified and marked out using metal tags, and the knees were radiographed. On these radiographs, the bundles insertion sites center location relative to the tibial mediolateral measure, and the distances from the most proximal PCL facet point to the bundle's insertion were determined. All measures were calculated using the ImageJ software.RESULTS: On the anteroposterior radiographs, the mean distance from the anterolateral (AL bundle insertion center to the medial tibial edge was 40.68 ± 4.10 mm; the mean distance from the posteromedial (PM bundle insertion center to the medial tibial edge was 38.74 ± 4.40 mm. On the lateral radiographs, the mean distances from the PCL facet most proximal point to AL and PM bundles insertion centers were 5.49 ± 1.29 mm and 10.53 ± 2.17 mm respectively.CONCLUSIONS: It was possible to establish a radiographic pattern for PCL tibial bundles insertions, which may be useful for intraoperative tunnels locations control and for postoperative tunnels positions analysis.

  5. Ultrasound Guidance in Performing a Tendoscopic Surgery to Treat Posterior Tibial Tendinitis: A Useful Tool?

    Directory of Open Access Journals (Sweden)

    Akinobu Nishimura


    Full Text Available A 25-year-old man with a pronation-external rotation type of fracture was surgically treated using a fibular plate. Five years later, he underwent resection of bone hyperplasia because of the ankle pain and limitation of range of motion. Thereafter, the left ankle became intermittently painful, which persisted for about one year. He presented at the age of 43 with persistent ankle pain. Physical and image analysis findings indicated a diagnosis of posttraumatic posterior tibial tendinitis, which we surgically treated using tendoscopy. Endoscopic findings showed tenosynovitis and fibrillation on the tendon surface. We cleaned and removed the synovium surrounding the tendon and deepened the posterior tibial tendon groove to allow sufficient space for the posterior tibial tendon. Full weight-bearing ambulation was permitted one day after surgery and he returned to his occupation in the construction industry six weeks after surgery. The medial aspect of the ankle was free of pain and symptoms at a review two years after surgery. Although tendoscopic surgery for stage 1 posterior tibial tendon dysfunction has been reported, tendoscopic surgery to treat posttraumatic posterior tibial tendinitis has not. Our experience with this patient showed that tendoscopic surgery is useful not only for stage 1 posterior tibial dysfunction, but also for posttraumatic posterior tibial tendinitis.

  6. Impact of Fixed-Bearing and Mobile-Bearing Tibial Insert in Unicondylar Knee Arthroplasty

    Directory of Open Access Journals (Sweden)

    Mehmet Faruk Çatma


    Full Text Available INTRODUCTION: The aim of the study is to investigate the impact of fixed or mobile-bearing tibial inserts on patellofemoral arthrosis and evaluate which one to be preferred for patients with patellofemoral arthrosis. METHODS: Operated in our clinic between January 2009 and February 2013, 33 with patellofemoral arthritis together with anteromedial compartment arthritis were included in the study. Patellofemoral joints of patients were evaluated according to the scoring system defined by Fulkerson-Shea. RESULTS: Unicondylar knee arthroplasty with fixed-bearing tibial insertsand 22 (66,6% (male: 3, female: 19 and unicondylar knee arthroplasty with mobile-bearing tibial inserts 11 (33,9 % (male: 2, female: 9 were implanted.Average knee flexion was found to be 116,5 (100-135 degrees in 22 patients with mobile-bearing tibial inserts, and 114,5 (95-135 in 11 patients with fixed-bearing tibial inserts. DISCUSSION AND CONCLUSION: Patellofemoral arthrosis is an important factor for unicondylar knee arthroplasty prognosis and one of the determinants of patient satisfaction. Significantly less patellofemoral complaints were seen with UKA with fixed-bearing tibial insert compared to mobile-bearing tibial insert.

  7. [Suprapatellar approach to tibial medullary nailing with electromagnetic field-guided distal locking]. (United States)

    Rueger, J M; Rücker, A H; Hoffmann, M


    Closed tibial shaft fractures are the domain of intramedullary nailing. With the introduction of new nail designs and technologies, even small, dislocated distal fragments can be anatomically aligned and safely fixed. Unsolved or to a lesser degree controlled are the problems of distal locking in the freehand technique, which can still be difficult and can lead to a significant radiation exposure, and how to control very short proximal tibial fragments in metaphyseal tibial fractures or tibial segmental fractures, where the proximal fracture line also runs through the metaphysis.By using a suprapatellar approach, i.e. a skin incision proximal to the patella with an entry point into the tibial bone from within the knee at the same site as for a standard infrapatellar approach, and then nailing the tibia in a semi-extended position, i.e. the knee is only flexed 10-20°, the intraoperative dislocation of a short proximal fragment can be avoided. The main indications for semi-extended tibial nailing are a short diaphyseal fragment in an isolated tibial shaft fracture, a segmental fracture where the proximal fracture line is metaphyseal and in patients where infrapatellar soft tissues are compromised.The use of the electromagnetic guidance system SureShot® generates reliable and reproducible results, reduces the operating time and is independent from radiation for distal locking.

  8. The effect of shoe design and lateral wedging on knee loading

    DEFF Research Database (Denmark)

    Mølgaard, Carsten; Kersting, Uwe G.

    The increasing number of patients with developing osteoarthritis is accompanied by a growing scientific interest in non-operative early treatment strategies. It is generally believed that laterally wedged insoles can change the distribution of the knee loading, but the importance of footwear design......-dimensional gait analysis. Barefoot walking, walking in a running shoe, an Oxford-type leather shoe, and a rocker shoe were analyzed. The shoes were tested both with and without a 10-degree full length laterally wedged insole. Results: Similar, significant reductions in the peak knee adduction moment with lateral...... wedges were observed in all three types of shoes. However, differences between shoe design were of similar magnitude as the effect of laterally wedged insoles. Only marginal changes in muscle activity for lateral hamstrings during barefoot toe-out walking and gastrocnemius when using the Oxford wedged...

  9. Bonding mechanism of ultrasonic wedge bonding of copper wire on Au/Ni/Cu substrate

    Institute of Scientific and Technical Information of China (English)

    TIAN Yan-hong; WANG Chun-qing; Y. Norman ZHOU


    The ultrasonic wedge bonding with d25 μm copper wire was achieved on Au/Ni plated Cu substrate at ambient temperature. Ultrasonic wedge bonding mechanism was investigated by using SEM/EDX, pull test, shear test and microhardness test. The results show that the thinning of the Au layer occurs directly below the center of the bonding tool with the bonding power increasing. The interdiffusion between copper wire and Au metallization during the wedge bonding is assumed negligible, and the wedge bonding is achieved by wear action induced by ultrasonic vibration. The ultrasonic power contributes to enhance the deformation of copper wire due to ultrasonic softening effect which is then followed by the strain hardening of the copper wedge bonding.

  10. Synovial C-Shaped Tibial Footprint of the Anterior Cruciate Ligament (United States)

    Janovsky, César; Kaleka, Camila Cohen; Alves, Maria Teresa Seixas; Ferretti, Mario; Cohen, Moises


    Background: Although numerous anatomic studies about the anterior cruciate ligament (ACL) structure and attachments have been performed, these studies have not reached consensus on the ACL footprint. Purpose: To investigate the existing controversy regarding the morphology of the tibial ACL insertion (footprint) and confirm histologically that the tibial ACL footprint is not completely filled with ligament tissue. Study Design: Descriptive laboratory study. Methods: The tibial ACL footprint was dissected from 20 different fresh-frozen cadaveric knees (all males; mean age, 68.8 ± 5.4 years [range, 55-80 years]; mean weight, 78 ± 6.6 kg [range, 45-93 kg]). Two knees, 1 with severe osteoarthritis and 1 with previous knee surgery, were excluded. The tibial ACL insertion was observed, and this area was longitudinally divided into 4 parallel slices (0%-25%, 25-50%, 50%-75%, and 75%-100%), embedded in paraffin wax, and stained with hematoxylin-eosin, alcian blue, and picrosirius-polarization. The specimens were measured using a microscope to determine the distances from the anterior to the posterior border of the ACL ligament tibial insertion and the distance from the posterior border to the end of the ligament fibers of the ACL ligament tibial insertions. Results: The 18 evaluated knee specimens confirmed the finding of a C-shaped tibial insertion of the ACL. The measurements showed that the ligament (vertical parallel collagen fibers) occupied only 30.8% of the complete insertion. The remaining area was filled with synovial tissue, demonstrating histologically the “C” shape. Conclusion: This study confirms macroscopically the C-shaped tibial insertion of the ACL and shows histologically that synovial tissue is an indirect insertion filling the major part of the footprint. Clinical Relevance: This anatomic study suggests a different shape of the ACL tibial footprint, which may be useful for new perspectives regarding ACL reconstruction surgery research. PMID

  11. Improved tibial component rotation in TKA using patient-specific instrumentation. (United States)

    Heyse, Thomas J; Tibesku, Carsten O


    Patient-specific instrumentation (PSI) was introduced in an attempt to reduce positional outliers of components in total knee arthroplasty (TKA). It was hypothesized that PSI could help with the positioning of tibial components in optimal rotational alignment. A magnetic resonance imaging (MRI) analysis of 58 patients following TKA was conducted. Of these, 30 operations were performed using PSI and 28 using conventional instrumentation. The rotation of the tibial components was determined in MRI using three different reference lines: a tangent to the dorsal tibial condyles, the tibial epicondylar line, and the tibial tubercle. Deviations >9° were considered outliers. Also internal rotation >1° was considered an outlier. Data were analyzed statistically for positional outliers using the Chi-squared test. There was excellent inter- and intraobserver reliability with low standard deviations for the determination of tibial component rotation using the tangent to the dorsal condyles and the tibial epicondylar line as reference. Using the dorsal tangent as reference, there were eight components in excessive external rotation (28.6 %) and one component being in relative internal rotation (5.4°) in the conventional group, while there were two components in excessive external rotation in the PSI group (6.7 %). Using the tibial epicondyles as reference, there were seven components in excessive external rotation (21.4 %) and one component being in relative internal rotation (4.4°) in the conventional group; while there were two components in excessive external rotation in the PSI group (6.7 %). These differences were statistically significant (p rotational tibial component alignment during TKA. Anatomy of the proximal tibia does not deliver clear landmarks that are prominent and consistent. This makes both, MRI analysis as well as cutting jig production and intraoperative placement a challenge.

  12. The accuracy of intramedullary tibial guide of sagittal alignment of PCL-substituting total knee arthroplasty. (United States)

    Han, Hyuk-Soo; Kang, Seung-Baik; Jo, Chris H; Kim, Sun-Hong; Lee, Jung-Ha


    Experimental and clinical studies on the accuracy of the intramedullary alignment method have produced different results, and few have addressed accuracy in the sagittal plane. Reported deviations are not only attributable to the alignment method but also to radiological errors. The purpose of this study was to evaluate the accuracy of the intramedullary alignment method in the sagittal plane using computed tomography (CT) and 3-dimensional imaging software. Thirty-one TKAs were performed using an intramedullary alignment method involving the insertion of a long 8-mm diameter rod into the medullary canal to the distal metaphysis of the tibia. All alignment instruments were set to achieve an ideal varus/valgus angle of 0° in the coronal plane and a tibial slope of 0° in the sagittal plane. The accuracy of the intramedullary alignment system was assessed by measuring the coronal tibial component angle and sagittal tibial slope angles, i.e., angles between the tibial anatomical axis and the tangent to the medial and lateral tibial plateau or the cut-surface. The mean coronal tibial component angle was 88.5° ± 1.2° and the mean tibial component slope in the sagittal plane was 1.6° ± 1.2° without anterior slope. Our intramedullary tibial alignment method, which involves passing an 8-mm diameter long rod through the tibial shaft isthmus, showed good accuracy (less than 3 degrees of variation and no anterior slope) in the sagittal plane in neutral or varus knees.

  13. Clock face model applied to tibial intraneural ganglia in the popliteal fossa

    Energy Technology Data Exchange (ETDEWEB)

    Spinner, Robert J. [Mayo Clinic, Department of Neurologic Surgery, Rochester, MN (United States); Mayo Clinic, Department of Orthopedics, Rochester, MN (United States); Mayo Clinic, Rochester, MN (United States); Hebert-Blouin, Marie-Noelle [Mayo Clinic, Department of Neurologic Surgery, Rochester, MN (United States); Maniker, Allen H. [Beth Israel Hospital, Department of Neurosurgery, New York, NY (United States); Amrami, Kimberly K. [Mayo Clinic, Department of Neurologic Surgery, Rochester, MN (United States); Mayo Clinic, Department of Radiology, Rochester, MN (United States)


    Tibial intraneural ganglia occurring in the popliteal fossa are often misdiagnosed because of their relative rarity. Their joint connection is typically not recognized and therefore not treated, leading to recurrence. This is a retrospective clinical study. Magnetic resonance images (MRIs) of six patients with confirmed tibial intraneural ganglia arising from the superior tibiofibular joint were analyzed and were compared to ten individuals with normal tibial nerves who were imaged with MRI. All studies were interpreted as left-sided. A previously designed clock face model introduced for peroneal intraneural ganglia was used to describe the superior tibiofibular joint connection (tail sign). A single axial image was sought to determine the normal anatomic and pathologic relationships of the tibial nerve and tibial articular branch to the superior tibiofibular joint. In all patients with intraneural ganglia, a single conventional axial image at the mid-fibular head level could reliably demonstrate: (1) intraneural cyst within the articular branch at the superior tibiofibular joint connection (tail sign) between 8 and 9 o'clock and intraneural cyst within the tibial nerve, (2) the central location of the tibial nerve posterior to the tibia, and (3) popliteus muscle denervation changes and atrophy (popliteus sign). This technique can provide radiologists and surgeons with rapid and reproducible information for diagnosis and treatment planning of tibial intraneural ganglia. Similar to its use with the clock face model in peroneal intraneural ganglia, a standard axial image at the mid-fibular head level can be used to interpret key features of tibial intraneural ganglia and identify the joint connection. Improved identification of the presence of a joint connection will change the therapeutic approach of this pathology and reduce cyst recurrences. (orig.)

  14. Direct contribution of axial impact compressive load to anterior tibial load during simulated ski landing impact. (United States)

    Yeow, C H; Lee, P V S; Goh, J C H


    Anterior tibial loading is a major factor involved in the anterior cruciate ligament (ACL) injury mechanism during ski impact landing. We sought to investigate the direct contribution of axial impact compressive load to anterior tibial load during simulated ski landing impact of intact knee joints without quadriceps activation. Twelve porcine knee specimens were procured. Four specimens were used as non-impact control while the remaining eight were mounted onto a material-testing system at 70 degrees flexion and subjected to simulated landing impact, which was successively repeated with incremental actuator displacement. Four specimens from the impacted group underwent pre-impact MRI for tibial plateau angle measurements while the other four were subjected to histology and microCT for cartilage morphology and volume assessment. The tibial plateau angles ranged from 29.4 to 38.8 degrees . There was a moderate linear relationship (Y=0.16X; R(2)=0.64; p<0.001) between peak axial impact compressive load (Y) and peak anterior tibial load (X). The anterior and posterior regions in the impacted group sustained surface cartilage fraying, superficial clefts and tidemark disruption, compared to the control group. MicroCT scans displayed visible cartilage deformation for both anterior and posterior regions in the impacted group. Due to the tibial plateau angle, increased axial impact compressive load can directly elevate anterior tibial load and hence contribute to ACL failure during simulated landing impact. Axial impact compressive load resulted in shear cartilage damage along anterior-posterior tibial plateau regions, due to its contribution to anterior tibial loading. This mechanism plays an important role in elevating ACL stress and cartilage deformation during impact landing.

  15. Preoperative determination of tibial nail length: An anthropometric study

    Institute of Scientific and Technical Information of China (English)

    Renjit Thomas Issac; Hitesh Gopalan; Mathew Abraham; Cherian John; Sujith Mathew Issac; Diju Jacob


    Objective:To assess the correlation between five anthropometric parameters and the distance from tibial tuberosity to medial malleolus in 100 volunteers.Methods:Six anthropometric parameters were measured in 50 male and 50 female medical students using a metallic scale:medial knee joint line to ankle joint line (K-A),medial knee joint line to medial malleolus (K-MM),tibial tuberosity to ankle joint (TT-A),tibial tuberosity to medial malleolus (TT-MM),olecranon to 5th metacarpal head (O-MH) and body height (BH).Nail size predicted based upon TT-MM measurement was chosen as ideal nail size.A constant was derived for each of the six anthropometric parameters which was either added or subtracted to each measurement to derive nail size.A regression equation was applied to BH measurements.Nail sizes calculated were compared with that obtained from TT-MM measurement and accuracy was evaluated.Accuracy of O-MH and BH regression equations recommended by other authors were calculated in our data.Results:Adding 11 mm to TT-A distance had highest accuracy (81%) and correlation (0.966) in predicting nails correctly.Subtracting 33 mm from K-MM measurement and 25 mm from K-A distance derived accurate sizes in 69% and 76% respectively.Adding 6 mm to O-MH distance had a poor accuracy of 51%.Nail size prediction based upon body height regression equation derived correct nail sizes in only 34% of the cases.Regression equation analysis by other authors based on O-MH and BH distances yielded correct sizes in 11% and 5% of the cases respectively.Conclusion:TT-A,K-A and K-MM measurements can be used simultaneously to increase accuracy of nail size prediction.This method would be helpful in determining nail size preoperatively especially when one anatomic landmark is difficult to palpate.

  16. Sagittal patellar tilt and concomitant quadriceps hypotrophy after tibial nailing. (United States)

    Aksahin, Ertugrul; Yilmaz, Serdar; Karasoy, Ismail; Duran, Semra; Yuksel, H Yalcin; Dogan, Ozgur; Yildirim, A Ozgur; Bicimoglu, Ali


    The aim of the study was to analyse the patellofemoral alignment in the sagittal plane following tibial fracture surgery with intramedullary nailing and its relationship to parapatellar muscle status. The patellofemoral MRI results of 27 patients (15 males and 12 females) treated with locked intramedullary nailing following tibia shaft fracture were reviewed. The mean age of the patients was 41.8 (±15) years. The patella-patellar tendon angle (P-PT) and the distance between the inferior patellar pole and the tibial tubercle (DP-TT) were evaluated for both the operated extremity and the contralateral normal side. MRI assessment of the infrapatellar fat pad, quadriceps, sartorius, gracilis, semi-membranosus muscles and biceps muscles was also carried out. The correlation between the changes in skeletal muscle mass, the volume of the infrapatellar fat pad and the alterations in the DP-TT distances and P-PT angles were analysed. The quadriceps muscle cross-sectional diameter had a mean of 157.2 mm(2) (115.6/319.5) in the operated extremity, and it was 193 mm(2) (77.6/282.2) in the non-operated normal side (p = 0.001). For the Gracilis muscle, the mean was 84.4 mm(2) (19.7/171) at the operated extremity and 75.7 mm(2) (26.9/238.2) on the normal side (p = 0.05). The cross-sectional areas of the semi-membranosus, sartorius and biceps muscles in the operated and non-operated extremity were not noticeably different (n.s). The P-PT angle was 153° (129.7/156.4) in the operated extremity and 145.7° (137.6/163.4) in the non-operated normal extremity (p hypotrophy negatively correlated (r = -0.4, p = 0.02) with the P-PT angle but positively correlated with the increase in gracilis muscle volume (r = 0.4, p = 0.03). This study revealed that patellofemoral joint kinematics in the operated extremity was diminished in the sagittal plane correlating with the quadriceps muscle volume loss and gracilis muscle hypertrophy. The modalities focused on both preventing

  17. Thrust fault growth within accretionary wedges: New Insights from 3D seismic reflection data (United States)

    Orme, H.; Bell, R. E.; Jackson, C. A. L.


    The shallow parts of subduction megathrust faults are typically thought to be aseismic and incapable of propagating seismic rupture. The 2011 Tohoku-Oki earthquake, however, ruptured all the way to the trench, proving that in some locations rupture can propagate through the accretionary wedge. An improved understanding of the structural character and physical properties of accretionary wedges is therefore crucial to begin to assess why such anomalously shallow seismic rupture occurs. Despite its importance, we know surprisingly little regarding the 3D geometry and kinematics of thrust network development in accretionary prisms, largely due to a lack of 3D seismic reflection data providing high-resolution, 3D images of entire networks. Thus our current understanding is largely underpinned by observations from analogue and numerical modelling, with limited observational data from natural examples. In this contribution we use PSDM, 3D seismic reflection data from the Nankai margin (3D Muroto dataset, available from the UTIG Academic Seismic Portal, Marine Geoscience Data System) to examine how imbricate thrust fault networks evolve during accretionary wedge growth. Previous studies have reported en-echelon thrust fault geometries from the NW part of the dataset, and have related this complex structure to seamount subduction. We unravel the evolution of faults within the protothrust and imbricate thrust zones by interpreting multiple horizons across faults and measuring fault displacement and fold amplitude along-strike; by doing this, we are able to investigate the three dimensional accrual of strain. We document a number of local displacement minima along-strike of faults, suggesting that, the protothrust and imbricate thrusts developed from the linkage of smaller, previously isolated fault segments. We also demonstrate that the majority of faults grew upward from the décollement, although there is some evidence for downward fault propagation. Our observations

  18. Big mantle wedge, anisotropy, slabs and earthquakes beneath the Japan Sea (United States)

    Zhao, Dapeng


    The Japan Sea is a part of the western Pacific trench-arc-backarc system and has a complex bathymetry and intense seismic activities in the crust and upper mantle. Local seismic tomography revealed strong lateral heterogeneities in the crust and uppermost mantle beneath the eastern margin of the Japan Sea, which was determined using P and S wave arrival times of suboceanic earthquakes relocated precisely with sP depth phases. Ambient-noise tomography revealed a thin crust and a thin lithosphere beneath the Japan Sea and significant low-velocity (low-V) anomalies in the shallow mantle beneath the western and eastern margins of the Japan Sea. Observations with ocean-bottom seismometers and electromagnetometers revealed low-V and high-conductivity anomalies at depths of 200-300 km in the big mantle wedge (BMW) above the subducting Pacific slab, and the anomalies are connected with the low-V zone in the normal mantle wedge beneath NE Japan, suggesting that both shallow and deep slab dehydrations occur and contribute to the arc and back-arc magmatism. The Pacific slab has a simple geometry beneath the Japan Sea, and earthquakes occur actively in the slab down to a depth of ∼600 km beneath the NE Asian margin. Teleseismic P and S wave tomography has revealed that the Philippine Sea plate has subducted aseismically down to the mantle transition zone (MTZ, 410-660 km) depths beneath the southern Japan Sea and the Tsushima Strait, and a slab window is revealed within the aseismic Philippine Sea slab. Seismic anisotropy tomography revealed a NW-SE fast-velocity direction in the BMW, which reflects corner flows induced by the fast deep subduction of the Pacific slab. Large deep earthquakes (M > 7.0; depth > 500 km) occur frequently beneath the Japan Sea western margin, which may be related to the formation of the Changbai and Ulleung intraplate volcanoes. A metastable olivine wedge is revealed within the cold core of the Pacific slab at the MTZ depth, which may be related

  19. The use of sternal wedge osteotomy in pectus surgery: when is it necessary? (United States)

    Kara, Murat; Gundogdu, Ahmet Gokhan; Kadioglu, Salih Zeki; Cayirci, Ertug Can; Taskin, Necati


    The Ravitch procedure is a well-established surgical procedure for correction of chest wall deformities. Sternal wedge osteotomy is an important part of this procedure. We studied the incidence of wedge osteotomy with respect to the type of chest wall deformity in patients undergoing surgical correction with the use of a recently developed chest wall stabilization system. A total of 47 patients, 39 (83%) male and 8 (17%) female with a mean age of 14.9 ± 2.1 years, underwent the Ravitch procedure. Twenty-four (51.1%) had pectus carinatum, 19 (40.4%) had pectus excavatum, and 4 (8.5%) had pectus arcuatum. A conventional or oblique sternal wedge osteotomy was performed as indicated, followed by chest wall stabilization using the MedXpert system. Of the 47 patients, 27 (57.4%) had a sternal wedge osteotomy. All cases of pectus arcuatum and redo cases underwent sternal wedge osteotomy. Pectus excavatum cases tended to have a greater incidence of wedge osteotomy compared to pectus carinatum cases (68.4% vs. 41.7%, p = 0.052). Patients with more resected ribs had a greater rate of wedge osteotomy (63.4%) compared to those with fewer resected ribs (16.7%, p = 0.043). A sternal wedge osteotomy is more commonly performed in patients with pectus excavatum compared to those with pectus carinatum. All redo and pectus arcuatum cases need a wedge osteotomy for proper correction. Wedge osteotomy is very likely in more aggressive corrections with more rib resections. © The Author(s) 2016.

  20. Medial tibial pain. A prospective study of its cause among military recruits. (United States)

    Milgrom, C; Giladi, M; Stein, M; Kashtan, H; Margulies, J; Chisin, R; Steinberg, R; Swissa, A; Aharonson, Z


    In a prospective study of 295 infantry recruits during 14 weeks of basic training, 41% had medial tibial pain. Routine scintigraphic evaluation in cases of medial tibial bone pain showed that 63% had abnormalities. A stress fracture was found in 46%. Only two patients had periostitis. None had ischemic medial compartment syndrome. Physical examination could not differentiate between cases with medial tibial bone pain secondary to stress fractures and those with scintigraphically normal tibias. When both pain and swelling were localized in the middle one-third of the tibia, the lesion most likely proved to be a stress fracture.

  1. Fast optical 3D form measurement of aspheres including determination of thickness and wedge and decenter errors (United States)

    Stover, E.; Berger, G.; Wendel, M.; Petter, J.


    A method for non-contact 3D form testing of aspheric surfaces including determination of decenter and wedge errors and lens thickness is presented. The principle is based on the absolute measurement capability of multi-wavelength interferometry (MWLI). The approach produces high density 3D shape information and geometric parameters at high accuracy in short measurement times. The system allows inspection of aspheres without restrictions in terms of spherical departures, of segmented and discontinuous optics. The optics can be polished or ground and made of opaque or transparent materials.

  2. Vertebral body or intervertebral disc wedging: which contributes more to thoracolumbar kyphosis in ankylosing spondylitis patients? (United States)

    Liu, Hao; Qian, Bang-Ping; Qiu, Yong; Wang, Yan; Wang, Bin; Yu, Yang; Zhu, Ze-Zhang


    Abstract Both vertebral body wedging and disc wedging are found in ankylosing spondylitis (AS) patients with thoracolumbar kyphosis. However, their relative contribution to thoracolumbar kyphosis is not fully understood. The objective of this study was to compare different contributions of vertebral and disc wedging to the thoracolumbar kyphosis in AS patients, and to analyze the relationship between the apical vertebral wedging angle and thoracolumbar kyphosis. From October 2009 to October 2013, a total of 59 consecutive AS patients with thoracolumbar kyphosis with a mean age of 38.1 years were recruited in this study. Based on global kyphosis (GK), 26 patients with GK < 70° were assigned to group A, and the other 33 patients with GK ≥ 70° were included in group B. Each GK was divided into disc wedge angles and vertebral wedge angles. The wedging angle of each disc and vertebra comprising the thoracolumbar kyphosis was measured, and the proportion of the wedging angle to the GK was calculated accordingly. Intergroup and intragroup comparisons were subsequently performed to investigate the different contributions of disc and vertebra to the GK. The correlation between the apical vertebral wedging angle and GK was calculated by Pearson correlation analysis. The duration of disease and sex were also recorded in this study. With respect to the mean disease duration, significant difference was observed between the two groups (P < 0.01). The wedging angle and wedging percentage of discs were significantly higher than those of vertebrae in group A (34.8° ± 2.5° vs 26.7° ± 2.7°, P < 0.01 and 56.6% vs 43.4%, P < 0.01), whereas disc wedging and disc wedging percentage were significantly lower than vertebrae in group B (37.6° ± 7.0° vs 50.1° ± 5.1°, P < 0.01 and 42.7% vs 57.3%, P < 0.01). The wedging of vertebrae was significantly higher in group B than in group A (50.1° ± 5.1° vs 26.7° ± 2.7°, P < 0

  3. Risk Factors of Medial Tibial Stress Syndrome(MTSS)

    Institute of Scientific and Technical Information of China (English)

    Sae Yong Lee


    @@ Background According to Mubarak[1,2],who first coined the term medial tibial stress syndrome (MTSS)in 1982,the definition of MTSS is " a symptom complex in athletes who experience exercise-induced pain along thedistalposteromedialaspectofthetibia."Previous studies have shown that MTSS accounts for 6 to 15