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Sample records for distal radius endoprosthesis

  1. Distal radius fractures: current concepts.

    PubMed

    Schneppendahl, Johannes; Windolf, Joachim; Kaufmann, Robert A

    2012-08-01

    Despite the frequency of distal radius fractures, the optimal treatment remains without consensus opinion. A trend toward increased distal radius fracture open reduction and internal fixation has been identified, with biomechanical and clinical studies suggesting treatment advantages of certain fixation methods over others. Well-controlled patient trials are still missing to lend objective findings to management algorithms. This article reviews the literature over the past 5 years to guide our management regarding this common upper-extremity injury. PMID:22763062

  2. Treatment of distal radius fractures.

    PubMed

    Lichtman, David M; Bindra, Randipsingh R; Boyer, Martin I; Putnam, Matthew D; Ring, David; Slutsky, David J; Taras, John S; Watters, William C; Goldberg, Michael J; Keith, Michael; Turkelson, Charles M; Wies, Janet L; Haralson, Robert H; Boyer, Kevin M; Hitchcock, Kristin; Raymond, Laura

    2010-03-01

    The clinical practice guideline is based on a systematic review of published studies on the treatment of distal radius fractures in adults. None of the 29 recommendations made by the work group was graded as strong; most are graded as inconclusive or consensus; seven are graded as weak. The remaining five moderate-strength recommendations include surgical fixation, rather than cast fixation, for fractures with postreduction radial shortening >3 mm, dorsal tilt >10 degrees , or intra-articular displacement or step-off >2 mm; use of rigid immobilization rather than removable splints for nonsurgical treatment; making a postreduction true lateral radiograph of the carpus to assess dorsal radial ulnar joint alignment; beginning early wrist motion following stable fixation; and recommending adjuvant treatment with vitamin C to prevent disproportionate pain. PMID:20190108

  3. Treatment of distal radius fractures.

    PubMed

    Murray, Jayson; Gross, Leeaht

    2013-08-01

    The American Academy of Orthopaedic Surgeons has developed Appropriate Use Criteria (AUC) for treating distal radius fractures (DRF). Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The DRF AUC clinical patient scenarios were derived from patient indications that generally accompany a DRF, as well as from current evidence-based clinical practice guidelines and supporting literature. The 216 indications and 10 treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. Next, the Review Panel, a separate group of volunteer physicians, independently reviewed these materials to ensure that they were representative of patient scenarios that clinicians are likely to encounter in daily practice. Finally, the multidisciplinary Voting Panel (made up of specialists and nonspecialists) rated the appropriateness of treatment of each patient scenario using a 9-point scale to designate a treatment as Appropriate (median rating, 7 to 9), May Be Appropriate (median rating, 4 to 6), or Rarely Appropriate (median rating, 1 to 3). PMID:23908256

  4. Management of Complications of Distal Radius Fractures

    PubMed Central

    Chung, Kevin C.; Mathews, Alexandra L.

    2015-01-01

    Synopsis Treating a fracture of the distal radius may require the surgeon to make a difficult decision between surgical treatment and nonsurgical management. The use of surgical fixation has recently increased owing to complications associated with conservative treatment. However, conservative action may be necessary depending on certain patient factors. The treating surgeon must be aware of the possible complications associated with distal radius fracture treatments to prevent their occurrence. Prevention can be achieved with a proper understanding of the mechanism of these complications. This article discusses the most recent evidence on how to manage and prevent complications following a fracture of the distal radius. PMID:25934197

  5. Arthroscopic management of distal radius fractures.

    PubMed

    Wiesler, Ethan R; Chloros, George D; Mahirogullari, Mahir; Kuzma, Gary R

    2006-11-01

    Arthroscopy has the advantage of providing a direct and accurate assessment of the articular surfaces and detecting the presence of injuries associated with distal radius fractures. Current indications, although numerous and potentially expanding, also are controversial. This report presents a global view of the current status of arthroscopy in the management of distal radius fractures. The rationale of arthroscopic treatment, the available evidence, and finally the diagnosis and treatment are discussed. PMID:17095385

  6. Distal radius fracture: diagnosis, treatment, and controversies.

    PubMed

    Tang, Jin Bo

    2014-07-01

    This article presents the diagnosis and treatment of distal radius fractures with emphasis on (1) current common principles, (2) the author's current practices, and (3) controversies. The author emphasizes that displaced distal radius fractures should be approached first with a trial of closed reduction, with or without percutaneous pinning. If this reduction is unstable or unsuccessful, open reduction is indicated. Early treatments include percutaneous pinning through the distal radioulnar joint, early or delayed reattachment/repair of the avulsed dorsal periphery of the triangular fibrocartilage complex (TFCC), reattachment of the TFCC to the ulna fovea, and late reconstruction. PMID:24996466

  7. Exposure of the forearm and distal radius.

    PubMed

    Klausmeyer, Melissa A; Mudgal, Chaitanya

    2014-11-01

    Approaches to the forearm use internervous planes to allow adequate bone exposure and prevent muscle denervation. The Henry approach utilizes the plane between muscles supplied by the median and radial nerves. The Thompson approach utilizes the plane between muscles supplied by the radial and posterior interosseous nerves. The distal radius may be approached volarly. The extended flexor carpi radialis approach is useful for intraarticular fractures, subacute fractures, and malunions. The distal radius can be approached dorsally by releasing the third dorsal compartment and continuing the dissection subperiosteally. Choice of approach depends on the injury pattern and the need for exposure. PMID:25440071

  8. Ulnar Shortening Osteotomy for Distal Radius Malunion

    PubMed Central

    Kamal, Robin N.; Leversedge, Fraser J.

    2014-01-01

    Background Malunion is a common complication of distal radius fractures. Ulnar shortening osteotomy (USO) may be an effective treatment for distal radius malunion when appropriate indications are observed. Methods The use of USO for treatment of distal radius fracture malunion is described for older patients (typically patients >50 years) with dorsal or volar tilt less than 20 degrees and no carpal malalignment or intercarpal or distal radioulnar joint (DRUJ) arthritis. Description of Technique Preoperative radiographs are examined to ensure there are no contraindications to ulnar shortening osteotomy. The neutral posteroanterior (PA) radiograph is used to measure ulnar variance and to estimate the amount of ulnar shortening required. An ulnar, mid-sagittal incision is used and the dorsal sensory branch of the ulnar nerve is preserved. An USO-specific plating system with cutting jig is used to create parallel oblique osteotomies to facilitate shortening. Intraoperative fluoroscopy and clinical range of motion are checked to ensure adequate shortening and congruous reduction of the ulnar head within the sigmoid notch. Results Previous outcomes evaluation of USO has demonstrated improvement in functional activities, including average flexion-extension and pronosupination motions, and patient reported outcomes. Conclusion The concept and technique of USO are reviewed for the treatment of distal radius malunion when specific indications are observed. Careful attention to detail related to surgical indications and to surgical technique typically will improve range of motion, pain scores, and patient-reported outcomes and will reduce the inherent risks of the procedure, such as ulnar nonunion or the symptoms related to unrecognized joint arthritis. Level of Evidence: Level IV PMID:25097811

  9. The Epidemiology of Distal Radius Fractures

    PubMed Central

    Nellans, Kate W.; Kowalski, Evan; Chung, Kevin C.

    2012-01-01

    Distal radius fractures are one of the most common types of fractures, accounting for around 25% of fractures in the pediatric population and up to 18% of all fractures in the elderly age group. Although the pediatric and elderly populations are at the greatest risk for this injury, distal radius fractures still have a significant impact on the health and well-being of young adults. Data from the past 40 years has documented a trend towards an overall increase in the prevalence of this injury. For the pediatric population, this increase can likely be attributed to a surge in sports related activities. The growth of the elderly population and a rise in the number of active elderly are directly responsible for the increase seen in this age group. Understanding the epidemiology of this fracture is an important step towards the improvement of the treatment strategies and preventative measures which target this debilitating injury. PMID:22554654

  10. Fractures of distal radius: an overview.

    PubMed

    Meena, Sanjay; Sharma, Pankaj; Sambharia, Abhishek Kumar; Dawar, Ashok

    2014-01-01

    Fractures of distal radius account for up to 20% of all fractures treated in emergency department. Initial assessment includes a history of mechanism of injury, associated injury and appropriate radiological evaluation. Treatment options include conservative management, internal fixation with pins, bridging and non-bridging external fixation, dorsal or volar plating with/without arthroscopy assistance. However, many questions regarding these fractures remain unanswered and good prospective randomized trials are needed. PMID:25657938

  11. Fractures of Distal Radius: An Overview

    PubMed Central

    Meena, Sanjay; Sharma, Pankaj; Sambharia, Abhishek Kumar; Dawar, Ashok

    2014-01-01

    Fractures of distal radius account for up to 20% of all fractures treated in emergency department. Initial assessment includes a history of mechanism of injury, associated injury and appropriate radiological evaluation. Treatment options include conservative management, internal fixation with pins, bridging and non-bridging external fixation, dorsal or volar plating with/without arthroscopy assistance. However, many questions regarding these fractures remain unanswered and good prospective randomized trials are needed. PMID:25657938

  12. External fixation of distal radius fractures.

    PubMed

    Slutsky, David J

    2007-12-01

    External fixation has been used for the treatment of distal radius fractures for more than 50 years. Although the fixator configurations have undergone considerable modification over time, the type of fixator itself is not as important as the underlying principles that provide the foundation for external fixation. Although volar plate fixation is currently in vogue, the indications for external fixation remain largely unchanged. Newer fixator designs have also expanded the traditional usage to include nonbridging applications that allow early wrist motion. The following discussion focuses on the myriad uses for external fixation as well as the shortcomings and potential pitfalls. PMID:18070654

  13. [Arthroscopic treatment of distal radius fracture].

    PubMed

    Lindau, T

    2006-11-01

    The orthopaedic surgeons cannot predict the functional results after a distal intra articular radius fracture. The intra-articular incongruity of more than 1 mm is associated with the development of secondary osteoarthrosis. The wrist arthroscopy became an essential help for the reduction of these fractures. The hand is normally in an upright position with a traction of approximately 4-5 kg which facilitates the reduction of the extra-articular fracture component. It is possible to use a technique of horizontal traction. The arthroscopy allows the reduction and control of the fixing of the various fragments, but also the treatment associated lesions associated. One randomized study, which compared 34 arthroscopically treated fractures with 48 openly treated, concluded that the arthroscopy-treated group had better outcome, better reduction, better grip strength and better range of motion than the openly treated group. The treatment of intra articular distal radius fractures with arthroscopic assistance is thus the guaranteeing of the most anatomical reduction of articular surface. It allows the diagnosis and the treatment of the associated lesions, decreases the peripheral fibrous scars of soft tissues by avoiding initially extensive approaches and finally gives better functional results. PMID:17361885

  14. [Arthroscopic treatment of distal radius fracture.

    PubMed

    Lindau, T

    2006-11-01

    The orthopaedic surgeons cannot predict the functional results after a distal intra articular radius fracture. The intra-articular incongruity of more than 1 mm is associated with the development of secondary osteoarthrosis. The wrist arthroscopy became an essential help for the reduction of these fractures. The hand is normally in an upright position with a traction of approximately 4-5 kg which facilitates the reduction of the extra-articular fracture component. It is possible to use a technique of horizontal traction. The arthroscopy allows the reduction and control of the fixing of the various fragments, but also the treatment associated lesions associated. One randomized study, which compared 34 arthroscopically treated fractures with 48 openly treated, concluded that the arthroscopy-treated group had better outcome, better reduction, better grip strength and better range of motion than the openly treated group. The treatment of intra articular distal radius fractures with arthroscopic assistance is thus the guaranteeing of the most anatomical reduction of articular surface. It allows the diagnosis and the treatment of the associated lesions, decreases the peripheral fibrous scars of soft tissues by avoiding initially extensive approaches and finally gives better functional results. PMID:17349390

  15. Ultrasound-Assisted Distal Radius Fracture Reduction

    PubMed Central

    Socransky, Steve; Skinner, Andrew; Bromley, Mark; Smith, Andrew; Anawati, Alexandre; Middaugh, Jeff; Ross, Peter

    2016-01-01

    Introduction Closed reduction of distal radius fractures (CRDRF) is a commonly performed emergency department (ED) procedure. The use of point-of-care ultrasound (PoCUS) to diagnose fractures and guide reduction has previously been described. The primary objective of this study was to determine if the addition of PoCUS to CRDRF changed the perception of successful initial reduction. This was measured by the rate of further reduction attempts based on PoCUS following the initial clinical determination of achievement of best possible reduction. Methods  We performed a multicenter prospective cohort study, using a convenience sample of adult ED patients presenting with a distal radius fracture to five Canadian EDs. All study physicians underwent standardized PoCUS training for fractures. Standard clinically-guided best possible fracture reduction was initially performed. PoCUS was then used to assess the reduction adequacy. Repeat reduction was performed if deemed indicated. A post-reduction radiograph was then performed. Clinician impression of reduction adequacy was scored on a 5 point Likert scale following the initial clinically-guided reduction and following each PoCUS scan and the post-reduction radiograph. Results  There were 131 patients with 132 distal radius fractures. Twelve cases were excluded prior to analysis. There was no significant difference in the assessment of the initial reduction status by PoCUS as compared to the clinical exam (mean score: 3.8 vs. 3.9; p = 0.370; OR 0.89; 95% CI 0.46 to 1.72; p = 0.87). Significantly fewer cases fell into the uncertain category with PoCUS than with clinical assessment (2 vs 12; p = 0.008). Repeat reduction was performed in 49 patients (41.2%). Repeat reduction led to a significant improvement (p < 0.001) in the PoCUS determined adequacy of reduction (mean score: 4.3 vs 3.1; p < 0.001). In this group, the odds ratio for adequate vs. uncertain or inadequate reduction assessment using PoCUS was 12.5 (95% CI 3

  16. Ultrasound-Assisted Distal Radius Fracture Reduction.

    PubMed

    Socransky, Steve; Skinner, Andrew; Bromley, Mark; Smith, Andrew; Anawati, Alexandre; Middaugh, Jeff; Ross, Peter; Atkinson, Paul

    2016-01-01

    Introduction Closed reduction of distal radius fractures (CRDRF) is a commonly performed emergency department (ED) procedure. The use of point-of-care ultrasound (PoCUS) to diagnose fractures and guide reduction has previously been described. The primary objective of this study was to determine if the addition of PoCUS to CRDRF changed the perception of successful initial reduction. This was measured by the rate of further reduction attempts based on PoCUS following the initial clinical determination of achievement of best possible reduction. Methods  We performed a multicenter prospective cohort study, using a convenience sample of adult ED patients presenting with a distal radius fracture to five Canadian EDs. All study physicians underwent standardized PoCUS training for fractures. Standard clinically-guided best possible fracture reduction was initially performed. PoCUS was then used to assess the reduction adequacy. Repeat reduction was performed if deemed indicated. A post-reduction radiograph was then performed. Clinician impression of reduction adequacy was scored on a 5 point Likert scale following the initial clinically-guided reduction and following each PoCUS scan and the post-reduction radiograph. Results  There were 131 patients with 132 distal radius fractures. Twelve cases were excluded prior to analysis. There was no significant difference in the assessment of the initial reduction status by PoCUS as compared to the clinical exam (mean score: 3.8 vs. 3.9; p = 0.370; OR 0.89; 95% CI 0.46 to 1.72; p = 0.87). Significantly fewer cases fell into the uncertain category with PoCUS than with clinical assessment (2 vs 12; p = 0.008). Repeat reduction was performed in 49 patients (41.2%). Repeat reduction led to a significant improvement (p < 0.001) in the PoCUS determined adequacy of reduction (mean score: 4.3 vs 3.1; p < 0.001). In this group, the odds ratio for adequate vs. uncertain or inadequate reduction assessment using PoCUS was 12.5 (95% CI 3

  17. [Distal radius fractures: conservative or surgical treatment?].

    PubMed

    Mark, G; Ryf, C

    1993-07-01

    The "classical" Colles fracture of the distal radius is the most common fracture in the adult. In order to reduce the still rather high rate of permanent disability, this fracture involving a functionally important joint requires accurate reduction. The AO-fracture classification introduced by Müller not only defines the severity of an injury, but also allows for decision-making as to the most adequate treatment. Besides the purely conservative management by closed reduction and plaster cast for the type-A fractures, we have a number of other treatment modalities for the more complex-B and C-type fractures, such as closed reduction and percutaneous K-wire application or the use of the small external fixator as well as open reduction and internal fixation by plates and screws for a few selected indications. PMID:8211844

  18. An Asian Perspective on the Management of Distal Radius Fractures

    PubMed Central

    Sebastin, Sandeep J.; Chung, Kevin C.

    2012-01-01

    Synopsis There is little data with regards to the epidemiology, pathology, or management of distal radius fractures from centers in Asia. Asia includes five advanced economies, namely Hong Kong SAR, Japan, Korea, Singapore, and Taiwan and a number of emerging economies prominent among which are China, India, Malaysia, Philippines, and Thailand. This article examines the available epidemiological data from Asia, and compares the management of distal radius fractures in the advanced and emerging Asian economies and how they match up to the current management in the west. It concludes by offering solutions for improving outcomes of distal radius fractures in both the advanced and emerging economies of Asia. PMID:22554658

  19. Primary nonunion of the distal radius fractures in healthy children.

    PubMed

    Song, Kwang Soon; Lee, Si Wook; Bae, Ki Cheor; Yeon, Chang Jin; Naik, Premal

    2016-03-01

    There are no published case series of nonunion of distal radius fractures in healthy children because of the rarity of its occurrence. We searched for all reported cases of this condition in Pubmed, Google scholar, and SCOPUS. We found three series, which included one previously reported by our group. The aim of the present study was to define the predisposing factors leading to nonunion after treatment of distal radius fractures in healthy children. We also aimed to emphasize that nonunion should be included in the list of complications of distal radius fractures in children and be mentioned in the textbook of pediatric trauma. PMID:26583931

  20. An Asian perspective on the management of distal radius fractures.

    PubMed

    Sebastin, Sandeep J; Chung, Kevin C

    2012-05-01

    There is limited data regarding the epidemiology, pathology, and management of distal radius fractures from centers in Asia. The advanced economies in Asia include Hong Kong, Japan, Korea, Singapore, and Taiwan, whereas the prominent emerging economies are China, India, Malaysia, Philippines, and Thailand. This article examines the available epidemiological data from Asia, compares the management of distal radius fractures in the advanced and emerging Asian economies and how they compare with the current management in the west. It concludes by offering solutions for improving outcomes of distal radius fractures in Asia. PMID:22554658

  1. Fixed Lunate Flexion Deformity in Distal Radius Fractures.

    PubMed

    Lee, Sanglim; Yu, Jae-Ha; Jeon, Suk Ha

    2016-06-01

    Carpal malalignments in malunion of distal radius fracture are considered as an adaptive response of the carpus to loss of normal architecture of the distal radius. This condition leads to mechanical overload, ligament attenuation and progressive dynamic instability around the wrist joint. Radial corrective osteotomy is suggested as a treatment option of carpal malalignment after distal radius malunion. In radiocarpal malalignment, the lunate is usually observed in flexion in contrast to its extension posture in the more common midcarpal malalignment. We report two cases of fixed lunate flexion deformity after a distal radius fracture, in which reduction and fixation of fresh fracture or corrective osteotomy of malunion were not successful. Arthritic changes were observed in the radiolunate joint on arthroscopy. Thus, fixed flexion deformity of the lunate might be associated with posttraumatic arthritic change in the radiolunate joint. PMID:27247752

  2. Fixed Lunate Flexion Deformity in Distal Radius Fractures

    PubMed Central

    Lee, Sanglim; Yu, Jae-Ha

    2016-01-01

    Carpal malalignments in malunion of distal radius fracture are considered as an adaptive response of the carpus to loss of normal architecture of the distal radius. This condition leads to mechanical overload, ligament attenuation and progressive dynamic instability around the wrist joint. Radial corrective osteotomy is suggested as a treatment option of carpal malalignment after distal radius malunion. In radiocarpal malalignment, the lunate is usually observed in flexion in contrast to its extension posture in the more common midcarpal malalignment. We report two cases of fixed lunate flexion deformity after a distal radius fracture, in which reduction and fixation of fresh fracture or corrective osteotomy of malunion were not successful. Arthritic changes were observed in the radiolunate joint on arthroscopy. Thus, fixed flexion deformity of the lunate might be associated with posttraumatic arthritic change in the radiolunate joint. PMID:27247752

  3. Distal Radius Radiographic Indices and Perilunate Fracture Dislocation

    PubMed Central

    Bagherifard, Abolfazl; Jafari, Davod; Keihan Shokouh, Hassan; Motavallian, Ebrahim; Najd Mazhar, Farid

    2016-01-01

    Background Distal radius radiographic indices may play a role as risk factors in pathogenesis of Kienbock’s disease, scaphoid fracture and nonunion. Perilunate fracture dislocations are devastating wrist injuries, and their relationship and distal radius indices have not been addressed in the literature. Objectives The aim of this study was to evaluate the possible role of distal radius radiographic indices including radial height, radial inclination, ulnar variance and volar tilt as risk factors in the perilunate fracture dislocation injury of the wrist. Patients and Methods We studied distal radius radiographic indices including radial height, radial inclination, ulnar variance and volar tilt in 43 patients with perilunate fracture dislocations and compared them with 44 wrists in the control group. Results The mean values of the radial height, radial inclination, ulnar variance and volar tilt were 12.74 (5 - 18), 24.20 (7 - 35), -0.73 (-5 - 4) and 12.28 (2 - 20) in the patient group. These values were 12.68 (9 - 22), 23.22 (17 - 30), -0.11 (-4 - 3) and 11.05 (-3 - 20), respectively in the control group. There was no statistically significant difference between the two groups. Conclusions This study did not show that distal radius anatomical indices including the radial height, radial inclination, ulnar variance and volar tilt influence perilunate fracture dislocation as risk factors.

  4. Radiographic Predictors of DRUJ Instability with Distal Radius Fractures

    PubMed Central

    Omokawa, Shohei; Iida, Akio; Fujitani, Ryotaro; Onishi, Tadanobu; Tanaka, Yasuhito

    2014-01-01

    Because the distal radioulnar joint (DRUJ) is an inherently unstable joint, the diagnosis and treatment of DRUJ instability is often difficult in a clinical hand surgery practice. Several soft tissue stabilizers are recognized, of which the deep limbs of the radioulnar ligament are primary stabilizers. This article discusses the predictors of DRUJ instability in distal radius fractures based on our clinical and biomechanical analyses. PMID:24533238

  5. A Unified Approach to Outcomes Assessment for Distal Radius Fractures.

    PubMed

    Waljee, Jennifer F; Ladd, Amy; MacDermid, Joy C; Rozental, Tamara D; Wolfe, Scott W

    2016-04-01

    Distal radius fractures are one of the most common upper extremity injuries. Currently, outcome assessment after treatment of these injuries varies widely with respect to the measures that are used, timing of assessment, and the end points that are considered. A more consistent approach to outcomes assessment would provide a standard by which to assess treatment options and best practices. In this summary, we review the consensus regarding outcomes assessment after distal radius fractures and propose a systematic approach that integrates performance, patient-reported outcomes, pain, complications, and radiographs. PMID:26952734

  6. Bidirectional Dislocation of the Distal Radioulnar Joint After Distal Radius Fracture: Case Report.

    PubMed

    Arimitsu, Sayuri; Moritomo, Hisao

    2016-02-01

    We report a patient with bidirectional dislocation of the distal radioulnar joint after malunited distal radius fracture, in which the ulnar head dislocated dorsally during forearm pronation and palmarly during supination without manual compression of the ulnar head. The patient had chronic ulnar wrist pain and experienced a painful clunk during forearm rotation. The distal radioulnar joint ballottement test was positive in both the dorsal and palmar directions. Her distal radius was malunited with a 20° dorsal angulation and 18° pronation deformity. A corrective osteotomy of the radius with open repair of the triangular fibrocartilage complex foveal avulsion yielded success. At the 7-year follow-up, there was almost a normal range of wrist and forearm motion, 83% grip strength, no arthritis, and a stable distal radioulnar joint. PMID:26723478

  7. Hemiarthroplasty for Complex Distal Radius Fractures in Elderly Patients

    PubMed Central

    Vergnenègre, Guillaume; Hardy, Jérémy; Mabit, Christian; Charissoux, Jean-Louis; Marcheix, Pierre-Sylvain

    2015-01-01

    Background In elderly patients, distal radius fractures frequently occur in osteoporotic bone and may be nonreconstructable. It is our hypothesis that a hemiarthroplasty replacment of the articular surface can provide satisfactory results in terms of range of motion, pain, and function for immediate salvage of a fracture that is not amenable to internal fixation. Methods Between July 2009 and January 2012, eight elderly patients were treated with insertion of a Sophia distal radius implant (Biotech, Paris, France). Inclusion criteria consisted of an isolated AO type C2 distal radius fracture in patients over 70 years old. All patients were reviewed by an independent surgeon. Results The mean follow-up was 25 months (range, 17–36 months). Mean wrist range of motion (ROM) was 45° (40–50°) of flexion, 44° (40–50°) of extension, and a mean pronation-supination arc of 160°. Mean grip force was 18 kgf. The mean QuickDASH (Disabilities of the Arm, Shoulder and Hand) was 18.2/100 (6.82–29.55), and the mean visual analog scale (VAS) was 2.33 (0–4). X-ray images did not demonstrate implant loosening or ulnar translation of the carpus. Conclusions The Sophia hemiarthroplasty provided rapid recovery of independence in elderly patients with a nonreconstructable comminuted distal radius fracture. PMID:26261741

  8. Ultrasound-Guided Reduction of Distal Radius Fractures

    PubMed Central

    Sabzghabaei, Anita; Shojaee, Majid; Arhami Dolatabadi, Ali; Manouchehrifar, Mohammad; Asadi, Mahdi

    2016-01-01

    Introduction: Distal radius fractures are a common traumatic injury, particularly in the elderly population. In the present study we examined the effectiveness of ultrasound guidance in the reduction of distal radius fractures in adult patients presenting to emergency department (ED). Methods: In this prospective case control study, eligible patients were adults older than 18 years who presented to the ED with distal radius fractures. 130 consecutive patient consisted of two group of Sixty-Five patients were prospectively enrolled for around 1 years. The first group underwent ultrasound-guided reduction and the second (control group) underwent blind reduction. All procedures were performed by two trained emergency residents under supervision of senior emergency physicians. Results: Baseline characteristics between two groups were similar. The rate of repeat reduction was reduced in the ultrasound group (9.2% vs 24.6%; P = .019). The post reduction radiographic indices were similar between the two groups, although the ultrasound group had improved volar tilt (mean, 7.6° vs 3.7°; P = .000). The operative rate was reduced in the ultrasound groups (10.8% vs 27.7%; P = .014). Conclusion: Ultrasound guidance is effective and recommended for routine use in the reduction of distal radius fractures. PMID:27299141

  9. Reverse wedge osteotomy of the distal radius in Madelung's deformity.

    PubMed

    Mallard, F; Jeudy, J; Rabarin, F; Raimbeau, G; Fouque, P-A; Cesari, B; Bizot, P; Saint-Cast, Y

    2013-06-01

    Madelung's deformity results from a growth defect in the palmar and ulnar region of the distal radius. It presents as an excessively inclined radial joint surface, inducing "spontaneous progressive palmar subluxation of the wrist". The principle of reverse wedge osteotomy (RWO) consists in the reorientation of the radial joint surface by taking a circumferential bone wedge, the base of which is harvested from the excess of the radial and dorsal cortical bone of the distal radius, then turning it over and putting back this reverse wedge into the osteotomy so as to obtain closure on the excess and opening on the deficient cortical bone. RWO corrects the palmar subluxation of the carpus and improves distal radio-ulnar alignment. All five bilaterally operated patients were satisfied, esthetically and functionally. Its corrective power gives RWO a place apart among the surgical techniques currently available in Madelung's deformity. PMID:23622863

  10. [Disorders of the distal radioulnar joint following fractures of the distal end of the radius].

    PubMed

    Prommersberger, K-J; van Schoonhoven, J

    2008-03-01

    After a fracture of the distal radius, whether healed in an anatomic position or malunited, many patients complain about problems on the ulnar side of the wrist with pain and decreased range of forearm rotation. In addition many patients are unhappy with the unpleasant appearance of the wrist joint. The complaints are related to tears of the triangular fibrocartilaginous complex, instability, and/or incongruity of the distal radioulnar joint and degenerative changes. Malunion of the distal radius must be taken into account when discussing treatment options. The purpose of this paper is to describe a treatment algorithm with respect to the clinical symptoms, the pathology as well as the presence or absence of a deformity of the distal radius. PMID:18283425

  11. Multipurpose external fixator for intraarticular fracture of distal radius.

    PubMed

    Siripakarn, Yongyuth; Siripakarn, Zongyuti

    2010-12-01

    Fracture of distal radius is one of a complicated injury which can be difficult in reduction and maintaining its alignment and may result in malunion and shortening following a variety of fixation. Since Anderson's and O'neil described the use of sustain traction by extraskeletal device anchored to the radius and the first metacarpal of the hand. Vidal et al [1979] demonstrated that the ligamentotaxis could be used to reduce the fracture around the wrist, ankle, hip and knee. The external fixation frame can maintain radial length and inclination by the pullout force from the radial styloid. External fixation is useful for management of complex intraarticular fracture of distal radius. There are few types of commercially available fixator. It is important to use one that allow versatility and follow biomechanic principles of ligamentotaxis, which can be used to reduce the severe comminution and the most difficult fracture by distraction and stabilization effectively. The ideal characteristic of the external fixation are: Telescoping connecting frame fixed externally compose of two joints which can be easily adjust in any direction, two pins clamp connected to the external connecting rod. Our TU Multipurpose external fixator can be designed as a multiplana, can be used as a bridge or non bridge fixation, and can be adjusted to any direction which require for the treatment of distal radius fracture. It is differed to other commercially available devices. PMID:21294433

  12. [Results following percutaneous intramedullary pin fixation in distal radius fractures].

    PubMed

    Kirchner, R; Hüttl, T; Krüger-Franke, M; Rosemeyer, B

    1994-01-01

    42 distal radius fractures have been submitted to further examination after percutaneous intramedullary pin fixation. The outcome were 95.3% of very good to good anatomic results and 90.5% of satisfying functional results. This showed the close link between the radiological-anatomical and functional results. The success of the treatment was very acceptable, although the Morbus Sudeck as the major complication--with 7.2%--was still relatively frequently observed. It could be seen that particularly fractures at the risk of dislocation with smash zone constituted an indication for the percutaneous intramedullary pin fixation, that is to say all fractures for which a retention is primarily difficult. It constitutes a supplement, as well as an extension to the therapy of the distal radius fractures. PMID:7516105

  13. Medical management of fragility fractures of the distal radius.

    PubMed

    Morgan, Emily N; Crawford, David A; Scully, William F; Noce, Nicholas J

    2014-12-01

    Fragility fractures of the distal radius represent an opportunity to diagnose and treat osteoporosis before further fractures occur. The goal of this study was to determine the prevalence of prescriptions for calcium/vitamin D supplementation and the prevalence of dual-energy x-ray absorptiometry (DEXA) scans in patients who sustained fragility fractures of the distal radius. A further goal was to determine the prevalence of patients who received prescriptions for the treatment of osteoporosis after DEXA scans. The authors performed a retrospective review of all patients 50 years and older who sustained a fragility fracture of the distal radius and were treated by the orthopedic surgery service at the authors' institution from 2004 to 2010. After a fragility fracture of the distal radius, fewer than 25% of previously unidentified at-risk patients received a prescription for vitamin supplementation and underwent a DEXA scan. Women were 7 times more likely than men to receive calcium/vitamin D supplementation, 14 times more likely to undergo a DEXA scan for the evaluation of osteoporosis, and 25 times more likely to receive a prescription for bisphosphonates. Patients who underwent a DEXA scan were 9 times more likely to receive pharmacologic treatment than those who did not undergo this scan. More than half of patients did not receive a prescription for calcium/vitamin D supplementation and did not undergo DEXA scanning as recommended by current National Osteoporosis Foundation guidelines. Most patients who received prescriptions or underwent DEXA scans did so before rather than after fracture, indicating poor compliance with National Osteoporosis Foundation guidelines. PMID:25437080

  14. Plate presetting arthroscopic reduction technique for the distal radius fractures.

    PubMed

    Abe, Yukio; Tsubone, Tetsu; Tominaga, Yasuhiro

    2008-09-01

    Wrist arthroscopy for the distal radius fractures is an effective adjunct to evaluate the reduction of intraarticular fragments and soft tissue injuries. In recent years, volar locking plate fixation has become popular, and arthroscopic procedures for distal radius fracture reduction have become problematic because vertical traction has to be both on and off during surgery. We developed a plate presetting arthroscopic reduction technique to simplify the combination of plating and arthroscopy. The fracture was reduced, and anatomic alignment was regained under an image intensifier, and then the volar locking plate was preset. Wrist arthroscopy was introduced under vertical traction, and the intraarticular condition was assessed. If dislocations of the intraarticular fragments were residual, they were reduced arthroscopically, and soft tissue injuries were treated subsequently. Finally, the traction was removed, and the plate was securely fixed. Since May 2005, the authors have used this technique in more than 50 patients. This article will review the history, indications, contraindications, technique, rehabilitation, and complications for the plate presetting arthroscopic reduction technique for distal radius fractures. PMID:18776773

  15. Intrafocal pin plate fixation of distal ulna fractures associated with distal radius fractures.

    PubMed

    Foster, Brian J; Bindra, Randy R

    2012-02-01

    Subcapital ulnar fractures in association with distal radius fractures in elderly patients increase instability and pose a treatment challenge. Fixation of the ulnar fracture with traditional implants is difficult due to the subcutaneous location, comminution, and osteoporosis. We describe an intrafocal pin plate that provides fixation by a locking plate on the distal ulna and intramedullary fixation within the shaft. The low profile and percutaneous technique make this device a useful alternative for treatment of subcapital ulna fractures in the elderly. PMID:22192166

  16. Volar, Intramedullary, and Percutaneous Fixation of Distal Radius Fractures.

    PubMed

    Alluri, Ram; Longacre, Matthew; Pannell, William; Stevanovic, Milan; Ghiassi, Alidad

    2015-11-01

    Background The management of extra-articular distal radius fractures is highly variable, with no clear consensus regarding their optimal management. Purpose To assess comparatively the biomechanical stability of Kirschner wire (K-wire) fixation, volar plating, and intramedullary nailing for unstable, extra-articular distal radius fractures with both (1) constant and (2) cyclical axial compression, simulating forces experienced during early postoperative rehabilitation. Methods Twenty-six volar locking plate, intramedullary nail, and K-wire bone-implant constructs were biomechanically assessed using an unstable extra-articular distal radius bone model. Bone implant models were created for each type of construct. Three samples from each construct underwent compressive axial loading until fixation failure. The remaining samples from each construct underwent fatigue testing with a 50-N force for 2,000 cycles followed by repeat compressive axial loading until fixation failure. Results Axial loading revealed the volar plate was significantly stiffer than the intramedullary nail and K-wire constructs. Both the volar plate and intramedullary nail required greater than 300 N of force for fixation failure, while the K-wire construct failed at less than 150 N. Both the volar plate and intramedullary nail demonstrated less than 1 mm of displacement during cyclic loading, while the K-wire construct displaced greater than 3 mm. Postfatigue testing demonstrated the volar plate was stiffer than the intramedullary nail and K-wire constructs, and both the volar plate and intramedullary nail required greater than 300 N of force for fixation failure while the K-wire construct failed at less than 150 N. Conclusions Volar plating of unstable extra-articular distal radius fractures is biomechanically stiffer than K-wire and intramedullary fixation. Both the volar plate and intramedullary nail demonstrated the necessary stability and stiffness to maintain anatomic

  17. [Differential treatment of fractures of the distal radius].

    PubMed

    Oestern, H J; Hüls, E

    1994-01-01

    Treatment of distal fractures of the radius has undergone considerable change during recent years. The cause for this lies primarily in the poor results of conservative treatments. In addition to osseous instability, the fractures of the radius are frequently combined with ligamentary instability as well, thereby exceeding the ability of conservative treatment. Among the many classifications, the AO classification of these fractures has proven to be the best and most widely accepted. This classification allows the recommendation of suitable procedures of treatment. The problem with inadequately healed fractures of the radius lies in the inherent unphysiological loading of the joint in the characteristic dorsal tilted position. This leads to a pathological displacement of the radius of flexion and extension and thereby to an overloading of the dorsal joint cartilage. The shortening of the radius leads to a mechanical impingement of the triangular fibrocartilagenous complex. The Kirschner wire fixation is particularly indicated in type A and type C fractures when combined with an external fixator. Of great importance here is the crossing of the K-wires, best accomplished by inserting an additional wire in a proximal to distal direction to achieve maximal mechanical stability. Biodegradable fixation devices are not yet in widespread use, as high costs and possible foreign body reactions have prevented their acceptance. The plate osteosynthesis has its domain in the treatment of volar luxation fractures (B3) and the partially articular fractures of the radius (B2). The domain of the external fixator, on the other hand, lies in the C2 and C3 fractures in combination with the K-wire osteosynthesis. Changing the mode of treatment to a plate osteosynthesis after two to three weeks allows a functional postoperative treatment. By use of a differentiated treatment regimen, the complication rate can be significantly reduced whose cause frequently lies in repeatedly attempted

  18. Radiographic Outcomes of Volar Locked Plating for Distal Radius Fractures

    PubMed Central

    Mignemi, Megan E.; Byram, Ian R.; Wolfe, Carmen C.; Fan, Kang-Hsien; Koehler, Elizabeth A.; Block, John J.; Jordanov, Martin I.; Watson, Jeffry T.; Weikert, Douglas R.; Lee, Donald H.

    2013-01-01

    Purpose To assess the ability of volar locked plating to achieve and maintain normal radiographic parameters for articular stepoff, volar tilt, radial inclination, ulnar variance, and radial height in distal radius fractures. Methods We performed a retrospective review of 185 distal radius fractures that underwent volar locked plating with a single plate design over a 5-year period. We reviewed radiographs and recorded measurements for volar tilt, radial inclination, ulnar variance, radial height, and articular stepoff. We used logistic regression to determine the association between return to radiographic standard norms and fracture type. Results At the first and final postoperative follow-up visits, we observed articular congruence less than 2 mm in 92% of fractures at both times. Normal volar tilt (11°) was restored in 46% at the first follow-up and 48% at the final one. Radial inclination (22°) was achieved in 44% at the first follow-up and 43% at the final one, and ulnar variance (01 ± 2 mm) was achieved in 53% at the first follow-up and 53% at the final one. In addition, radial height (14 ± 1mm) was restored in 14% at the first follow-up and 12% at the final one. More complex, intra-articular fractures (AO class B and C and Frykman types 3, 4, 7, and 8) were less likely to be restored to normal radiographic parameters. However, because of the small sample size for some fracture types, it was difficult to discover significant associations between fracture type and radiographic outcome. Conclusions Volar locked plating for distal radius fractures achieved articular stepoff less than 2 mm in most fractures but only restored and maintained normal radiographic measurements for volar tilt, radial inclination, and ulnar variance in 50% of fractures. The ability of volar locked plating to restore and maintain ulnar variance and volar tilt decreased with more complex intra-articular fracture types. PMID:23218558

  19. Management of Intercarpal Ligament Injuries Associated with Distal Radius Fractures.

    PubMed

    Desai, Mihir J; Kamal, Robin N; Richard, Marc J

    2015-08-01

    The prevalence of ligamentous injury associated with fractures of the distal radius is reported to be as high as 69% with injury to the scapholunate interosseous ligament and lunotriquetral interosseous ligament occurring in 16% to 40% and 8.5% to 15%, respectively. There is a lack of consensus on which patients should undergo advanced imaging, arthroscopy, and treatment and whether this changes their natural history. Overall, patients with high-grade intercarpal ligament injuries are shown to have longer-term disability and sequelae compared with those with lower-grade injuries. This article reviews the diagnosis and treatment options for these injuries. PMID:26205702

  20. Normal Age-Related Alterations on Distal Radius Radiography

    PubMed Central

    Namazi, Hamid; Khaje, Rohallah

    2015-01-01

    Background: The present study was designed to ascertain serial changes on distal radius radiographic parameters attributable to aging. Methods: In this prospective study, the sample consisted of 120 healthy individuals who were divided into four age groups each containing 15 males and 15 females. In the two below-20-year-old groups, only ulnar variance could be investigated. Wrist radiography was taken and then parameters of the distal radius were measured and compared based on age and sex. Results: Average UV was -2.48 mm and -1.6 mm in the 2-9 and 10-19-year-old age groups, respectively. Also, in the two above-20-year-old groups, the average radial inclination (RI), palmar tilt (PT), radial length (RL), and UV was 23.7º, 12.4º, 10.5 and +1.1 mm, respectively. Considering ulnar variance, no significant difference was found between the 2-9- and 10-19-year-old groups, as well as among the two above-20-year-old groups. However, a significant difference was observed between the below 20 and above 20 groups. The study results showed no significant differences between males and females in any of the study groups. Discussion: There is significant ulnar variance change toward less negative ulnar variance with aging until maturity. PMID:26550588

  1. Use of an ulnar head endoprosthesis for treatment of an unstable distal ulnar resection: review of mechanics, indications, and surgical technique.

    PubMed

    Berger, Richard A; Cooney, William P

    2005-11-01

    Resection of the distal ulna for post-traumatic arthritis can lead to an unstable forearm joint through loss of the normal articular contact through the distal radioulnar joint and loss of soft tissue constraint. The resulting convergence instability can lead to residual pain, weakness, and loss of function. Restabilization of the forearm joint with implantation of an ulnar head endoprosthesis can re-establish the mechanical continuity of the forearm, reducing pain and improving strength and function. The anatomy, mechanics,rationale, and indications for surgical replacement of the distal ulna are presented. Important tenets of proper ulnar head implant insertion are given to provide a guide for use of the implant. Preliminary results after 2 years of clinical experience are encouraging. PMID:16274870

  2. Conservative Treatment Is Sufficient for Acute Distal Radioulnar Joint Instability With Distal Radius Fracture.

    PubMed

    Lee, Sang Ki; Kim, Kap Jung; Cha, Yong Han; Choy, Won Sik

    2016-09-01

    Treatments for acute distal radioulnar joint (DRUJ) instability with distal radius fracture vary from conservative to operative treatment, although it seems to be no consensus regarding which treatment is optimal. This prospective randomized study was designed to compare the clinical outcomes for operative and conservative treatment of acute DRUJ instability with distal radius fracture, according to the presence or absence and type of ulnar styloid process fracture and the degree of its displacement. Between July 2008 and February 2013, we enrolled 157 patients who exhibited an unstable DRUJ during intraoperative manual stress testing (via the ballottement test) after fixation of the distal radius. Patients were classified according to the type of the ulnar styloid process fracture, using preoperative wrist radiography, and each group was divided into subgroups, according to their treatment method. We then compared the clinical outcomes between the conservative and operative treatments, using their range of motion; Disabilities of the Arm, Shoulder, and Hand score; modified Mayo wrist score; and grip strength. At 3 months after surgery, among patients without ulnar styloid process fracture, the flexion-extension range was 79 ± 15° after supination sugar-tong splinting (group A-1), 91 ± 14° after DRUJ transfixation (group A-2), and 89 ± 10° after arthroscopic triangular fibrocartilage complex repair (group A-3); the operative treatments provided greater joint motion ranges than conservative treatment. The groups with ulnar styloid process fractures at the tip (group B) or base (group C) also exhibited better clinical outcomes after the operative treatments, compared with after the conservative treatment. However, at the final follow-up, groups A-1, A-2, and A-3 exhibited similar flexion-extension ranges (122 ± 25°, 119° ± 18°, and 120° ± 16°, respectively) and modified Mayo wrist scores (87 ± 7, 89 ± 8, and 85 ± 9). Thus, the conservative and

  3. Effects of distal radius malunion on distal radioulnar joint mechanics--an in vivo study.

    PubMed

    Crisco, Joseph J; Moore, Douglas C; Marai, G Elisabeta; Laidlaw, David H; Akelman, Edward; Weiss, Arnold-Peter C; Wolfe, Scott W

    2007-04-01

    Patients with a malunited distal radius often have painful and limited forearm rotation, and may progress to arthritis of the distal radioulnar joint (DRUJ). The purpose of this study was to determine if DRUJ congruency and mechanics were altered in patients with malunited distal radius fractures. In nine subjects with unilateral malunions, interbone distances and dorsal and palmar radioulnar ligament lengths were computed from tomographic images of both forearms in multiple forearm positions using markerless bone registration (MBR) techniques. The significance of the changes were assessed using a generalized linear model, which controlled for forearm rotation angle (-60 degrees to 60 degrees ). In the malunited forearm, compared to the contralateral uninjured arm, we found that ulnar joint space area significantly decreased by approximately 25%, the centroid of this area moved an average of 1.3 mm proximally, and the dorsal radioulnar ligament elongated. Despite our previous findings of insignificant changes in the pattern of radioulnar kinematics in patients with malunited fractures, we found significant changes in DRUJ joint area and ligament lengthening. These findings suggest that alterations in joint mechanics and soft tissues may play an important role in the dysfunction associated with these injuries. PMID:17262830

  4. A biomechanical approach to distal radius fractures for the emergency radiologist.

    PubMed

    Bunch, Paul M; Sheehan, Scott E; Dyer, George S; Sodickson, Aaron; Khurana, Bharti

    2016-04-01

    Distal radius fractures are the most common upper extremity fracture and account for approximately one sixth of all fractures treated in US emergency departments. These fractures are associated with significant morbidity and have a major economic impact. Radiographic evaluation of distal radius fractures is frequently performed in the emergency department setting, has a profound impact on initial management, and is essential to assessing the quality and relative success of the initial reduction. While the most appropriate definitive management of distal radius fractures remains controversial, overarching treatment principles reflect distal radius injury mechanisms and biomechanics. An intuitive understanding of the biomechanics of the distal radius and of common mechanisms of injury informs and improves the emergency radiologist's ability to identify key imaging findings with important management implications and to communicate the critical information that emergency physicians and orthopedic surgeons need to best manage distal radius fractures. PMID:26564022

  5. Percutaneous pinning of fractures of the distal radius.

    PubMed

    Alm-Paulsen, Paal Sandoe; Rod, Oyvind; Rød, Kristian; Rajabi, Benjamin; Russwurm, Harald; Finsen, Vilhjalmur

    2012-09-01

    Reduction of fractures of the distal radius is often supplemented with percutaneous pinning, but there is little evidence that this affects the clinical outcome. A total of 43 patients with pinned, and 296 with conservatively-treated, fractures were reviewed a mean of 6 (range 3-13) years after injury. We found controls among the conservatively-treated patients who matched 30 of the patients with pinned fractures with respect to age, sex, trauma energy, and radiographic measurements at injury. Clinical and radiological results of the two groups were compared and contrasted. There was a trend for better radiological results in patients with pinned fractures, but not significantly so, and no difference in clinical variables. We identified seven published randomised studies in which pinning was compared with reduction and plaster of Paris alone. Most reported better radiological results at review. The three smallest studies with the shortest follow-up reported better clinical outcome for pinned fractures, while the remaining four studies found no significant clinical benefit from pinning. Although the radiological results were improved by percutaneous pinning in addition to reduction and plaster of Paris, the clinical outcome in extra-articular and simple intra-articular fractures seemed unaffected. PMID:22694081

  6. Incidence and Mortality after Distal Radius Fractures in Adults Aged 50 Years and Older in Korea

    PubMed Central

    2016-01-01

    The purpose of this study was to assess the incidence and mortality of distal radius fracture among patients 50 years of age and older with diagnosis code (ICD10; S52.5, S52.6) and treatment code using a nationwide claims database from 2008 to 2012. All patients were followed using patient identification code to identify deaths. Standardized mortality ratios (SMRs) of distal radius fracture were calculated based on age and gender-specific rates in the entire Korean population. The number of distal radius fractures increased by 54.2% over the 5-year study (48,145 in 2008 and 74,240 in 2012). The incidence of distal radius fracture increased from 367.4/100,000 in 2008 to 474.1/100,000 in 2012. The cumulative mortality rate over the first 12 months after distal radius fracture was decreased from 2.0% (968/48,145) in 2008 to 1.4% (1,045/74,240) in 2012. The mean year mortality over 5 years in men (2.6%, 1,279/50,128) over the first 12 months was 1.7-times higher than in women (1.5%, 3,952/257,045). The mean of SMR of distal radius fracture at 1 year post-fracture was 1.45 in men and 1.17 in women. This study using a nationwide database demonstrates that the distal radius fractures are increasing with a decreasing mortality in Korea. PMID:27051250

  7. Outcomes Following Operative Treatment of open Fractures of the Distal Radius: A Case Control Study

    PubMed Central

    MacKay, Brendan J; Montero, Nicole; Paksima, Nader; Egol, Kenneth A

    2013-01-01

    Purpose To report radiographic, clinical, and patient-based functional outcomes following contemporary operative treatment of patients who sustained an open distal radius fracture and compare them to a similar group of patients treated operatively for closed distal radius fractures. Methods Over five years, 601 patients with a distal radius fracture presented to our academic medical center, including one Level 1 trauma hospital, and were prospectively enrolled in an upper extremity trauma database. Patients with open distal radius fractures underwent irrigation, debridement, and operative fixation within 24 hours of presentation. Closed distal radius fractures requiring operative fixation were treated electively. Retrospective review of the database identified eighteen open fractures of the distal radius (11 type I, 6 type II, 1 type IIIa). The open fracture patients were individually matched with eighteen closed distal radius fracture patients who underwent surgical fixation based on age, sex, injury to dominant extremity, fracture pattern, and method of fracture fixation. Clinical, radiographic, patient- based functional outcomes, and complications were recorded at routine postoperative intervals. Results Follow-up was greater than 77% in both groups at all time points. The open and closed groups were similar in regards to age, gender, BMI, race, tobacco use, income, employment status, hand dominance, injury to dominant extremity, mechanism of injury, fracture classification, method of fracture fixation, and presence of concomitant injury. Postoperative complications and reoperation rates were similar between the open and closed groups. Union rates and radiographic alignment one year postoperatively were similar between the open and closed fracture groups. At final follow-up, range of motion parameters, grip strengths, DASH indices, and subjective pain scores were similar between both groups. Discussion Open distal radius fractures treated with early debridement

  8. Use of High-Speed X ray and Video to Analyze Distal Radius Fracture Pathomechanics.

    PubMed

    Gutowski, Christina; Darvish, Kurosh; Liss, Frederic E; Ilyas, Asif M; Jones, Christopher M

    2015-10-01

    The purpose of this study is to investigate the failure sequence of the distal radius during a simulated fall onto an outstretched hand using cadaver forearms and high-speed X ray and video systems. This apparatus records the beginning and propagation of bony failure, ultimately resulting in distal radius or forearm fracture. The effects of 3 different wrist guard designs are investigated using this system. Serving as a proof-of-concept analysis, this study supports this imaging technique to be used in larger studies of orthopedic trauma and protective devices and specifically for distal radius fractures. PMID:26410645

  9. Synchronous Multicentric Giant Cell Tumour of Distal Radius and Sacrum with Pulmonary Metastases

    PubMed Central

    Tandra, Varun Sharma; Kotha, Krishna Mohan Reddy; Satyanarayana, Moorthy Gadisetti Venkata; Vadlamani, Kali Varaprasad; Yerravalli, Vyjayanthi

    2015-01-01

    Giant cell tumour (GCT) is an uncommon primary bone tumour, and its multicentric presentation is exceedingly rare. We report a case of a 45-year-old female who presented to us with GCT of left distal radius. On the skeletal survey, osteolytic lesion was noted in her right sacral ala. Biopsy confirmed both lesions as GCT. Pulmonary metastasis was also present. Resection-reconstruction arthroplasty for distal radius and thorough curettage and bone grafting of the sacral lesion were done. Multicentric GCT involving distal radius and sacrum with primary sacral involvement is not reported so far to our knowledge. PMID:26106496

  10. Synchronous Multicentric Giant Cell Tumour of Distal Radius and Sacrum with Pulmonary Metastases.

    PubMed

    Tandra, Varun Sharma; Kotha, Krishna Mohan Reddy; Satyanarayana, Moorthy Gadisetti Venkata; Vadlamani, Kali Varaprasad; Yerravalli, Vyjayanthi

    2015-01-01

    Giant cell tumour (GCT) is an uncommon primary bone tumour, and its multicentric presentation is exceedingly rare. We report a case of a 45-year-old female who presented to us with GCT of left distal radius. On the skeletal survey, osteolytic lesion was noted in her right sacral ala. Biopsy confirmed both lesions as GCT. Pulmonary metastasis was also present. Resection-reconstruction arthroplasty for distal radius and thorough curettage and bone grafting of the sacral lesion were done. Multicentric GCT involving distal radius and sacrum with primary sacral involvement is not reported so far to our knowledge. PMID:26106496

  11. The Evolution of Distal Radius Fracture Management – A Historical Treatise

    PubMed Central

    Diaz-Garcia, Rafael J.; Chung, Kevin C.

    2012-01-01

    Distal radius fractures have been a common affliction for millennia, but their treatment is a more recent development as a result of human erudition. While immobilization has served as the only available treatment for most of our history, many advances have been made in the management of distal radius fractures over the last century as the field of orthopedics has grown. Yet, the topic remains hotly contested in the literature, and research continues to focus upon it given the frequency of the injury. In this article, we chronicle the evolution of distal radius fracture treatment in hopes of providing context for the future that lies ahead. PMID:22554653

  12. Bilateral Distal Radius Fracture in Third Trimester of Pregnancy with Accelerated Union: A Rare Case Report

    PubMed Central

    TV, Ravikumar; P, Rahul; Samorekar, Bheemsingh

    2015-01-01

    Bilateral distal radius fracture is a rare entity. There is no literature reporting a bilateral distal radius fracture in pregnancy. Fracture healing is influenced by hormones. Hormonal changes of pregnancy will affect the healing of a fracture. A 28-year-old female at 34 wk of pregnancy sustained a bilateral distal radius fracture after a self fall. One side was managed conservatively and open reduction was done for the other side. Both fractures united at four weeks. This case is unique in three ways. First distal radius fractures commonly occur in elderly postmenopausal females due to oestrogen deficiency. In this case a distal radius fracture occurred following a self fall in third trimester of pregnancy – a hyperestrogenic state. Second the time taken for union was only four weeks signifying the hormonal effects on pregnancy on fracture healing. Third the occurrence of bilateral distal radius fracture itself is very rare in adults. In pregnancy there is a faster rate of fracture healing due to effects of oestrogen and increased cardiac output. Fractures in pregnancy require special attention. Surgical intervention should be done with a multidisciplinary approach. While management of fractures in pregnancy, effect of hormonal and physiological changes should be kept in mind. PMID:26023611

  13. Assessment of penetration of dorsal screws after fixation of the distal radius using ultrasound: cadaveric study.

    PubMed

    Williams, D; Singh, J; Heidari, N; Ahmad, M; Noorani, A; Di Mascio, L

    2016-02-01

    Introduction Volar locking plates are used to treat unstable and displaced fractures of the distal radius. Potential advantages of stable anatomical reduction (eg early mobilisation) can be limited by penetration of dorsal screws, leading to synovitis and potential rupture of extensor tendons. Despite intraoperative imaging, penetration of dorsal screws continues to be a problem in volar plating of the distal radius. Ultrasound is a well recognised, readily available, diagnostic tool used to assess soft-tissue impingement by orthopaedic hardware. In this cadaveric study, we wished to ascertain the sensitivity and specificity of ultrasound for identification of protrusion of dorsal screws after volar plating of the distal radius. Methods Four adult, unpaired phenol-embalmed cadaveric distal radii were used. A VariAx™ Distal Radius Volar Locking Plate system (Stryker, Kalamazoo, MI, USA) was employed for instrumented fixation. A portable SIUI CTS 900 ultrasound machine (Providian Medical, Eastlake, OH, USA) was used to image the dorsal cortex to ascertain screw penetration. Results Specificity and sensitivity of ultrasound for detection of screw protrusion through the dorsal cortex was 100%. Conclusions Ultrasound was found to be a safe and accurate method for assessment of dorsal-screw penetration through the dorsal cortex of the radius after volar plating of the distal radius. It also aids diagnosis of associated tendon disorders (eg tenosynovitis) that might cause pain and limit wrist function. PMID:26829667

  14. Outcome Analysis of Fernandez Osteotomy in Malunited Extra-Articular Fractures of Distal Radius.

    PubMed

    Bhattacharyya, A; Kumar, S

    2016-07-01

    Deformity of wrist is very common after mal union of extra articular fractures over distal end of Radius. It causes limitation of movements too in different directions with or without pain. Deformity may be treated by different types of corrective osteotomy. We treated cases of this type of malunion with Fernandez osteotomy. This study is to observe the amount of correction and recovery of functional status in patients with malunited distal radius fractures treated with Fernandez osteotomy. This is a prospective study. We treated 10 cases of malunited radius with Fernandez osteotomy from February 2013 to October 2014 in the Departments of Orthopaedics, Medical College and Hospital, Kolkata, India. There were six males and four females with mean age of thirty years (with range from twenty to forty years. Indications for surgical intervention include pain and functional deficit severe enough to interfere significantly with daily activities. Radius is exposed through distal dorsal radial incision and radial osteotomy done two and half centimetre proximal to the wrist joint and after achieving correction; gap is filled with iliac bone graft and fixed with contoured distal radius T-plate. Follow up was for an average one year and three months. Results were excellent in one, satisfactory in four cases, good in four cases and bad in one case. Fernandez osteotomy is valuable option for correction of malunited distal radius fracture especially in young demanding patients. PMID:27612904

  15. Prebending of a titanium elastic intramedullary nail in the treatment of distal radius fractures in children.

    PubMed

    Cai, Haoqi; Wang, Zhigang; Cai, Haiqing

    2014-01-01

    The aims of this study were to introduce a method to treat distal radius diaphyseal metaphyseal junction fractures by prebending an elastic intramedullary nail and to evaluate the factors influencing fracture apposition. Fifty-two consecutive patients (4 to 15 years old) with a distal radius diaphyseal metaphyseal junction fracture were included. The nail was inserted and advanced into the proximal radial fragment as normal. After bending the nail distally about 90° at the site predetermined to lie at the distal segment, the elastic intramedullary nail was advanced until the prebent part completely entered the marrow cavity. The fracture angular deformity was fully corrected in anterior-posterior and lateral views. The apposition rate was 90% to 100% in lateral view, >50% in anterior-posterior view. The operation time was 16.73 ± 6.253 minutes. The average time of fracture healing was 5 months (range, 4-7 months). During 12 to 19 months of follow-up, firm fracture healing and good remodeling were observed, and there was no impaired forearm rotation function or secondary fracture. Our study showed the treatment of distal radius diaphyseal metaphyseal junction fractures by prebent intramedullary nail could make up for the deficiency of Kirschner wires and steel plates and keep the fracture stable. Fracture type and the anatomical features of the distal radius were associated with fracture apposition. PMID:24833151

  16. Pearls and Pitfalls of the Volar Locking Plating for Distal Radius Fractures.

    PubMed

    Im, Jin-Hyung; Lee, Joo-Yup

    2016-06-01

    Volar locking plate fixation has been widely accepted method for the treatment of unstable distal radius fractures. Although the results of volar locking plate fixation are encouraging, it may cause implant-related complications such as flexor or extensor tendon injuries. In depth understanding of anatomy of the distal radius is mandatory in order to obtain adequate fixation of the fracture fragments and to avoid these complications. This article will review the anatomic characteristics of the distal radius because selecting proper implant and positioning of the plate is closely related to the volar surface anatomy of the distal radius. The number and the length of distal locking screws are also important to provide adequate fixation strength to maintain fracture fixation. We will discuss the pros and cons of the variable-angle locking plate, which was introduced in an effort to provide surgeons with more freedom for fixation. Finally, we will discuss about correcting radial length and volar tilt by using eccentric drill holes and distal locking first technique. PMID:27454625

  17. Optimal Positioning for Volar Plate Fixation of a Distal Radius Fracture: Determining the Distal Dorsal Cortical Distance.

    PubMed

    Vosbikian, Michael M; Ketonis, Constantinos; Huang, Ronald; Ilyas, Asif M

    2016-01-01

    Distal radius fractures are currently among the most common fractures of the musculoskeletal system. With a population that is living longer, being more active, and the increasing incidence of osteoporosis, these injuries will continue to become increasingly prevalent. When operative fixation is indicated, the volar locking plate has recently become the treatment of choice. However, despite its success, suboptimal position of the volar locking plate can still result in radiographic loss of reduction. The distal dorsal cortical distance is being introduced as an intraoperative radiographic tool to help optimize plate position and minimize late loss of fracture reduction. PMID:26614937

  18. Korean Type Distal Radius Anatomical Volar Plate System: A Preliminary Report

    PubMed Central

    Kim, Jeong Hwan; Kim, Jihyeung; Kim, Min Bom; Rhee, Seung Hwan; Gong, Hyun Sik; Lee, Young Ho

    2014-01-01

    Background Distal radius fracture is the most common fracture of the upper extremity, and approximately 60,000 distal radius fractures occur annually in Korea. Internal fixation with an anatomical volar locking plate is widely used in the treatment of unstable distal radius fractures. However, most of the currently used distal radius anatomical plate systems were designed based on the anatomical characteristics of Western populations. Recently, the Korean-type distal radius anatomical volar plate (K-DRAVP) system was designed and developed based on the anatomical characteristics of the distal radius of Koreans. The purpose of this study was to evaluate the preliminary results of the new K-DRAVP system, and to compare its radiologic and functional results with those of the other systems. Methods From March 2012 to October 2012, 46 patients with acute distal radius fractures who were treated with the K-DRAVP system at three hospitals were enrolled in this study. Standard posteroanterior and lateral radiographs were obtained to assess fracture healing, and three radiographic parameters (volar tilt, radial inclination, and radial length) were assessed to evaluate radiographic outcomes. The range of motion and grip strength, the Gartland and Werley scoring system, and the disabilities of the arm, shoulder and hand (DASH) questionnaire were used to assess clinical and functional outcomes. Results All radiologic parameters were restored to normal values, and maintained without any loosening or collapse until the time of final follow-up. Grip strength was restored to 84% of the value for the unaffected side. The mean range of motion of the wrist at final follow-up was restored to 77%-95% of the value for the unaffected side. According to the Gartland and Werley scoring system, there were 16 excellent, 26 good, and 4 fair results. The mean DASH score was 8.4 points. There were no complications after surgery. Conclusions The newly developed K-DRAVP system could be used to

  19. Technical tips for (dry) arthroscopic reduction and internal fixation of distal radius fractures.

    PubMed

    Del Piñal, Francisco

    2011-10-01

    Contrary to general belief, arthroscopic assisted reduction in distal radius fractures can be done in an expeditious manner and with minimal consumption of operating room resources. This article presents the steps for a pleasant arthroscopic experience in detail. The technique proposed combines the benefits of rigid fixation with volar locking plates (for the extra-articular component) and arthroscopic control of the reduction (for the articular component). It is important that the operation be carried out using the dry arthroscopic technique. However, arthroscopy is just an addition to conventional methods. Thorough knowledge of and facility with classic techniques of distal radius fracture treatment is essential for a good result. PMID:21971058

  20. Two peg spade plate for distal radius fractures: A novel technique

    PubMed Central

    Hardikar, Sharad M; Prakash, Sreenivas; Hardikar, Madan S; Kumar, Rohit

    2015-01-01

    Background: The management of distal radius fractures raises considerable debate among orthopedic surgeons. The amount of axial shortening of the radius correlates with the functional disability after the fracture. Furthermore, articular incongruity has been correlated with the development of arthritis at the radiocarpal joint. We used two peg volar spade plate to provide a fixed angle subchondral support in comminuted distal radius fractures with early mobilization of the joint. Materials and Methods: Forty patients (26 males and 14 females) from a period between January 2009 and December 2011 were treated with two peg volar spade plate fixation for distal radius fracture after obtaining reduction using a mini external fixator. Patients were evaluated using the demerit point system of Gartland and Werley and Sarmiento modification of Lindstrom criteria at final followup of 24 months. Results: The average age was 43.55 years (range 23-57 years). Excellent to good results were seen in 85% (n = 34) and in all patients when rated according to the demerit point system of Gartland and Werley and Sarmiento modification of Lindstrom criteria, respectively. Complications observed were wrist stiffness in 5% (n = 2) and reflex sympathetic dystrophy in 2.5% (n = 1). Conclusions: The two peg volar spade plate provides a stable subchondral support in comminuted intraarticular fractures and maintains reduction in osteoporotic fractures of the distal radius. Early mobilization with this implant helps in restoring wrist motion and to prevent development of wrist stiffness. PMID:26538760

  1. Is sparing the pronator quadratus muscle possible in volar plating of the distal radius?

    PubMed

    Heidari, N; Clement, H; Kosuge, D; Grechenig, W; Tesch, N P; Weinberg, A M

    2012-06-01

    We measured the length of the distal radius that can be exposed by mobilizing the distal edge of pronator quadratus (PQ) without detaching its radial attachment. Measurements were made in 20 cadaveric upper limbs from the distal margin of the radius in line with the scaphoid and lunate fossae to the distal margin of the PQ, before and after mobilization of the muscle from its distal attachment. The mean distance from the distal edge of the PQ to the scaphoid fossa was 13.1 mm and to the lunate fossa was 10.7 mm. This increased to a mean of 26.2 mm for the scaphoid and a mean of 23.8 mm for the lunate fossa following mobilization of PQ. Subperiosteal retrograde release of the PQ from its distal margin will allow for the placement of a volar plate and insertion of locking peri-articular screws in the great majority of volar locking plate systems on the market. PMID:22067296

  2. OSTEOTOMY OF THE DISTAL RADIUS USING A FIXED-ANGLE VOLAR PLATE

    PubMed Central

    de Oliveira, Ricardo Kaempf; Binz, Mário Arthur Rockenbach; Ferreira, Marco Tonding; Ruschel, Paulo Henrique; Serrano, Pedro Delgado; Praetzel, Rafael Pêgas

    2015-01-01

    Objective: Skewed consolidation of the distal radius, due to sequelae of fractures, may cause functional incapacity, thus leading such patients to present pain, loss of strength and diminished mobility. Based on the excellent results obtained from surgical treatment of unstable fractures of the distal radius through a volar approach and use of rigid fixation with a fixed-angle volar plate, we started to use the same method for osteotomy of the distal radius. Methods: A retrospective review was conducted, and 20 patients treated between February 2002 and October 2009 were found. The mean length of follow-up was 43.9 months (range: 12 to 96 months). The surgical indications were persistent pain, deformity and functional limitation subsequent to a dorsally displaced fracture. Results: The mean preoperative deformity was 27° of dorsal tilt of the distal radius, 87° of ulnar tilt, and 7.3 mm of shortening of the radius. All the osteotomies consolidated and the final mean volar tilt was 6.2°, with ulnar tilt of 69.3° and shortening of 1 mm. The mean mobility of the wrist increased by 19.9° (flexion) and by 24° (extension). Mean forearm supination increased by 23.5° and pronation by 21.7°. Grip strength increased from 13.4 to 34.5 pounds. Conclusion: Use of a fixed-angle volar plate for a volar approach towards osteotomy of the distal radius enables satisfactory correction of the deformities and eliminates the need for removal of the synthesis material caused by tendon complications PMID:27042618

  3. Epidemiology and changed surgical treatment methods for fractures of the distal radius

    PubMed Central

    2013-01-01

    Background and purpose The incidence of fractures of the distal radius may have changed over the last decade, and operative treatment has been commoner during that time. We investigated the incidence of fractures of the distal radius and changing trends in surgical treatment during the period 2004–2010. Patients and methods Registry data on 42,583 patients with a fracture of the distal radius from 2004 to 2010 were evaluated regarding diagnosis, age, sex, and surgical treatment. Results The crude incidence rate was 31 per 104 person-years with a bimodal distribution. After the age of 45 years, the incidence rate in women increased rapidly and leveled off first at a very high age. The incidence rate in postmenopausal women was lower than previously reported. In men, the incidence was low and it increased slowly until the age of 80 years, when it amounted to 31 per 104 person-years. The number of surgical procedures increased by more than 40% despite the fact that there was reduced incidence during the study period. In patients ≥ 18 years of age, the proportion of fractures treated with plating increased from 16% to 70% while the use of external fixation decreased by about the same amount. Interpretation The incidence rate of distal radius fractures in postmenopausal women appears to have decreased over the last few decades. There has been a shift in surgical treatment from external fixation to open reduction and plating. PMID:23594225

  4. Failure characteristics of the isolated distal radius in response to dynamic impact loading.

    PubMed

    Burkhart, Timothy A; Andrews, David M; Dunning, Cynthia E

    2012-06-01

    We examined the mechanical response of the distal radius pre-fracture and at fracture under dynamic impact loads. The distal third of eight human cadaveric radii were potted and placed in a custom designed pneumatic impact system. The distal intra-articular surface of the radius rested against a model scaphoid and lunate, simulating 45° of wrist extension. The scaphoid and lunate were attached to a load cell that in turn was attached to an impact plate. Impulsive impacts were applied at increasing energy levels, in 10 J increments, until fracture occurred. Three 45° stacked strain gauge rosettes were affixed along the length of the radius quantifying the bone strains. The mean (SD) fracture energy was 45.5 (16) J. The mean (SD) resultant impact reaction force (IRFr) at failure was 2,142 (1,229) N, resulting in high compressive strains at the distal (2,718 (1,698) µε) and proximal radius (3,664 (1,890) µε). We successfully reproduced consistent fracture patterns in response to dynamic loads. The fracture energy and forces reported here are lower and the strains are higher than those previously reported and can likely be attributed to the controlled, incremental, dynamic nature of the applied loads. PMID:22083972

  5. Self-reported disability following distal radius fractures: the influence of hand dominance.

    PubMed

    Beaulé, P E; Dervin, G F; Giachino, A A; Rody, K; Grabowski, J; Fazekas, A

    2000-05-01

    The purpose of this study was to record the spectrum of self-reported disability following distal radius fractures and to gauge for differences in hand dominance in the use of subjective outcome data. Items were generated through patient interviews, literature review, and peer consultation. Fifty-three items were evaluated by a group of 55 patients recovering from a fracture of the distal radius, which established the prevalence, mean severity score, and overall severity score (or impact) of each item as it related to physical function and social/emotional impact. Hand dominance, age, and gender were also recorded. The results confirm that many patients who sustain distal radius fractures experience substantial impairment across a spectrum of quality of life domains. Because patients who sustain a dominant wrist injury are likely to report greater functional impairment across a wider range of activities, they also possess a greater potential for improvement. The practical implication is that outcome studies for the treatment of distal radius fractures should take hand dominance into account. PMID:10811752

  6. Distal radius anatomy applied to the treatment of wrist fractures by plate: a review of recent literature

    PubMed Central

    Obert, Laurent; Loisel, François; Gasse, Nicolas; Lepage, Daniel

    2015-01-01

    Few studies on the anatomy of the radial epiphysis have been published in the past 10 years. However, with the availability of new intra- and extra-medullary implants and the recent rash of avoidable iatrogenic injuries, now is the time for a more detailed description of the metaphyseal-epiphyseal regions in the distal radius. Published studies on distal radius anatomy in recent years have focused on three aspects: distal limit and watershed line, dorsal tubercle, and wrist columns. Furthermore, a fresh look at distal radius biomechanics shows that the loads experienced by the distal radius vary greatly. This information should be taken into account during volar plating of distal radius fractures. PMID:27163070

  7. Biomechanical Performance of Variable and Fixed Angle Locked Volar Plates for the Dorsally Comminuted Distal Radius

    PubMed Central

    Martineau, D; Shorez, J; Beran, C; Dass, A G; Atkinson, P

    2014-01-01

    Background The ideal treatment strategy for the dorsally comminuted distal radius fracture continues to evolve. Newer plate designs allow for variable axis screw placement while maintaining the advantages of locked technology. The purpose of this study is to compare the biomechanical properties of one variable axis plate with two traditional locked constructs. Methods Simulated fractures were created via a distal 1 cm dorsal wedge osteotomy in radius bone analogs. The analogs were of low stiffness and rigidity to create a worst-case strength condition for the subject radius plates. This fracture-gap model was fixated using one of three different locked volar distal radius plates: a variable axis plate (Stryker VariAx) or fixed axis (DePuy DVR, Smith & Nephew Peri-Loc) designs. The constructs were then tested at physiologic loading levels in axial compression and bending (dorsal and volar) modes. Construct stiffness was assessed by fracture gap motion during the different loading conditions. As a within-study control, intact bone analogs were similarly tested. Results All plated constructs were significantly less stiff than the intact control bone models in all loading modes (p<0.040). Amongst the plated constructs, the VariAx was stiffest axially (p=0.032) and the Peri-Loc was stiffest in bending (p<0.024). Conclusion In this analog bone fracture gap model, the variable axis locking technology was stiffer in axial compression than other plates, though less stiff in bending. PMID:25328471

  8. [Intra-articular fracture of the distal radius: results following osteosynthesis with a support plate].

    PubMed

    Ferguson, G A; Leutenegger, A; Mark, G; Breiter, H; Rüedi, T

    1989-01-01

    The treatment of comminuted intra-articular fractures of the distal radius often requires an operative fixation. Beside the recently recommended external fixator, the support plate fixation offers a helpful alternative to treatment. Between 1980 and 1986, 30 wrists in 29 patients with intra-articular fractures of the distal radius were stabilized with a buttress plate an the Kantonsspital Chur, Switzerland. The mean follow-up-time was 15 months. These follow-ups showed that the buttress plate in treatment of complicated intra-articular fractures allows a satisfactory reduction and stabilization with restoration of the articular congruity and the possibility for early active assisted motion. Buttress plate fixation still remains a demanding technique, which in complicated cases, should be reserved for the experienced surgeon. PMID:2500786

  9. The cadaveric anatomy of the distal radius: implications for the use of volar plates

    PubMed Central

    McCann, PA; Clarke, D; Amirfeyz, R; Bhatia, R

    2012-01-01

    INTRODUCTION Fractures of the distal radius are common upper limb injuries, representing a substantial proportion of the trauma workload in orthopaedic units. With ever increasing advancements in implant technology, operative intervention is becoming more frequent. As growing numbers of surgeons are performing operative fixation of distal radial fractures, an accurate understanding of the relevant surgical anatomy is paramount. The flexor carpi radialis (FCR) tendon forms the cornerstone of the Henry approach to the volar cortex of the distal radius. A number of key neurovascular structures around the wrist are potentially at risk during this approach, especially when the FCR is mobilised and placed under retractors. METHODS In order to clarify the safe margins of the FCR approach, ten fresh frozen human cadaver limbs were dissected. The location of the radial artery, the median nerve, the palmar cutaneous branch of the median nerve and the superficial branch nerve were measured with respect to the FCR tendon. Measurements were taken on a centre-to-centre basis in the coronal plane at the watershed level. In addition, the distances between the tendons of brachioradialis, abductor pollicis longus and flexor pollicis longus, and the radial artery and median nerve were measured to create a complete picture of the anatomy of the FCR approach to the distal radius. RESULTS The structure most at risk was the palmar cutaneous branch of the median nerve. It was located on average 3.4mm from the FCR tendon. The radial artery and the main trunk of the median nerve were located 7.8mm and 8.9mm from the tendon. The superficial branch of the radial nerve was 24.4mm from the FCR tendon and 11.1mm from the brachioradialis tendon. CONCLUSIONS Operative intervention is not without complication. We believe a more accurate understanding of the surgical anatomy is key to the prevention of neurovascular damage arising from the surgical management of distal radial fractures. PMID

  10. Measurement of Malrotation on Direct Radiography in Pediatric Distal Radius Fractures

    PubMed Central

    Duymus, Tahir Mutlu; Mutlu, Serhat; Komur, Baran; Mutlu, Harun; Yucel, Bulent; Parmaksizoglu, Atilla Sancar

    2016-01-01

    Abstract The aim of this prospective study was to test a mathematical method of measuring the malrotation of pediatric distal radius fractures (PDRFs) from direct radiographs. A total of 70 pediatric patients who presented at the Emergency Department with a distal radius fracture were evaluated. For 38 selected patients conservative treatment for PDRF was planned. Anteroposterior and lateral radiographs were taken of all of the patients for comparison before and after reduction. Radius bone diameters were measured in the coronal and sagittal planes on the healthy and fractured sides. Using the diameter values on the healthy side and the new diameter values on the fractured side in the rotation formula, the degree of malrotation between the fracture ends was calculated. The mean follow-up period was 13.5 months. Patients’ mean age was 10.00 ± 3.19 years (range, 4–12 years). The rotation degree in the sagittal plane significantly differed between the proximal (26.52°±2.84°) and distal fracture ends (20.96°±2.73°) (P = 0.001). The rotation degree in the coronal plane significantly differed between the proximal (26.70°±2.38°) and distal fracture ends (20.26°±2.86°) (P = 0.001). The net rotation deformity of the fracture line was determined to be 5.55°± 3.54° on lateral radiographs and 5.44°± 3.35° on anteroposterior radiographs, no significant difference was observed between measurements (P >0.05). The malrotation deformity in PDRF occurs with greater rotation in the proximal fragment than in the distal fragment. The net rotation deformity created between the fracture ends can be calculated on direct radiographs. Level of Evidence: Diagnostic, Level II PMID:27149480

  11. Inter- and intra-observer agreement of the AO classification for operatively treated distal radius fractures.

    PubMed

    van Buijtenen, Jesse M; van Tunen, Mischa L C; Zuidema, Wietse P; Heilbron, Emile A; de Haan, Jeroen; de Vet, Henrica C W; Derksen, Robert J

    2015-11-01

    The reproducibility of the AO classification for distal radius fractures remains a topic of debate. Previous studies showed variable reproducibility results. Important treatment decisions depend on correct classification, especially in comminuted, intra-articular fractures. Therefore, reliable reproducibility results need to be undisputedly determined. Hence, the study objective was to assess inter- and intra-observer agreement of the AO classification for operatively treated distal radius fractures. A database of 54 radiographs of all AO types (A, B and C) and groups (A2-3, B1-3, and C1-3) of distal radius fractures was assessed in twofold. Likewise, a subset of 152 radiographs of solely C-type groups (C1-3) was assessed. All fractures were classified by six observers with different experience levels: three consultant trauma surgeons, one sixth-year trauma surgery resident, a consultant trauma radiologist, and an intern with limited experienced. The inter-observer agreement of both main types and groups was moderate (κ = 0.49 resp. κ = 0.48) in combination with a good intra-observer agreement (κ = 0.68 resp. κ = 0.70). The inter-observer agreement of the subset C-type fractures group was fair (κ = 0.27) with moderate intra-observer agreement (κ = 0.43). According to these results, the reproducibility of the AO classification of main types and groups of distal radius fractures based on conventional radiographs is insufficient (κ < 0.50), especially at group level of C-type fractures. PMID:26614083

  12. Volar Plate Fixation of Intra-Articular Distal Radius Fractures: A Retrospective Study

    PubMed Central

    Fok, Margaret W. M.; Klausmeyer, Melissa A.; Fernandez, Diego L.; Orbay, Jorge L.; Bergada, Alex Lluch

    2013-01-01

    Background Intra-articular fractures of the distal radius represent a therapeutic challenge as compared with the unstable extra-articular fractures. With the recent development of specifically designed internal fixation materials for the distal radius, treatment of these fractures by fragment-specific implants using two or more incisions has been advocated. Purpose The purpose of this study was to investigate the efficacy of a fixed-angle locking plate applied through a single volar approach in maintaining the radiographic alignment of unstable intra-articular fractures as well as to report the clinical outcomes. We only excluded those with massive comminution, as is discussed in greater detail in the text. Patients and Methods This is a multicentered, retrospective study involving three hospitals situated in Spain, Switzerland, and the United States. In the period between January 2000 and March 2006, 97 patients with 101 intra-articular distal radius fractures, including 13 volarly displaced and 88 dorsally angulated fractures were analyzed. Over 80% were C2/C3 fractures, based on the AO classification. 16 open fractures were noted. Results With an average follow-up of 28 months (range 24-70 months), the range of movement of the wrist was very satisfactory, and the mean grip strength was 81% of the opposite wrist. The Disabilities of the Arm, Shoulder, and Hand (DASH) score was 8. The complications rate was < 5%, including loss of reduction in two patients. All fractures healed by 3 months postinjury. Conclusions Irrespective of the direction and amount of initial displacement, a great majority of intra-articular fractures of the distal radius can be managed with a fixed-angle volar plate through a single volar approach. Level IV retrospective case series PMID:24436824

  13. Mid-term functional outcome after the internal fixation of distal radius fractures

    PubMed Central

    2012-01-01

    Background Distal radius fracture is a common injury with a variety of operative and non-operative management options. There remains debate as to the optimal treatment for a given patient and fracture. Despite the popularity of volar locking plate fixation, there are few large cohort or long term follow up studies to justify this modality. Our aim was to report the functional outcome of a large number of patients at a significant follow up time after fixation of their distal radius with a volar locking plate. Methods 180 patients with 183 fractures and a mean age of 62.4 years were followed up retrospectively at a mean of 30 months (Standard deviation = 10.4). Functional assessment was performed using the Disabilities of the Arm, Shoulder and Hand (DASH) and modified MAYO wrist scores. Statistical analysis was performed to identify possible variables affecting outcome and radiographs were assessed to determine time to fracture union. Results The median DASH score was 2.3 and median MAYO score was 90 for the whole group. Overall, 133 patients (74%) had a good or excellent DASH and MAYO score. Statistical analysis showed that no specific variable including gender, age, fracture type, post-operative immobilisation or surgeon grade significantly affected outcome. Complications occurred in 27 patients (15%) and in 11 patients were major (6%). Conclusion This single centre large population series demonstrates good to excellent results in the majority of patients after volar locking plate fixation of the distal radius, with complication rates comparable to other non-operative and operative treatment modalities. On this basis we recommend this mode of fixation for distal radius fractures requiting operative intervention. PMID:22280557

  14. New Technique for Dorsal Fragment Reduction in Distal Radius Fractures by Using Volar Bone Fenestration

    PubMed Central

    TSUCHIYA, Fumika; NAITO, Kiyohito; MOGAMI, Atsuhiko; OBAYASHI, Osamu

    2013-01-01

    Introduction: For intra-articular distal radius fractures (AO Classification, type B2) with a displaced dorsal fragment, there remains much discussion on the fixation method for the dorsal fragment. To reduce the displaced dorsal fragment, we developed a new technique consisting of fenestration of the volar bone cortex, reduction using an intramedullary procedure, and fixation using a volar plate. This avoids necessity of dorsal approach. Technical Note: We performed this surgical technique in 2 patients and achieved a good reduced position without much injury to the bone cortex at the site of volar plate placement. This surgical technique allows reduction of the dorsal fragment using an intramedullary procedure by only a volar approach, and, therefore, does not affect the dorsal soft tissue (extensor tendon). For intra-articular distal radius fractures, complete reduction of the articular surface is extremely difficult, and, in patients with a remaining gap on the articular surface, a variable angle locking screw system may be useful. In the 2 patients, the angle of the locking screw was adjusted to catch the displaced dorsal fragment, and adequate reduction and fixation could be achieved. Conclusion: This technique using fenestration of the volar bone cortex allows reduction and fixation of the displaced dorsal fragment in distal radius fractures and thus avoids the necessity of a dorsal approach. PMID:27298898

  15. Trace metal analysis following locked volar plating for unstable fractures of the distal radius.

    PubMed

    Rylander, Lucas S; Milbrandt, Joseph C; Armington, Evan; Wilson, Marty; Olysav, David J

    2010-01-01

    An increase in the utilization of metallic devices for orthopaedic interventions from joint replacement to fracture fixation has raised concern over local metal ion release and possible systemic sequelae due to dissemination of these ions. Our purpose was to determine whether serum titanium concentrations were elevated in patients who had previously received a locked volar distal radius plate. Our hypothesis was that the simple presence of titanium alone in a relatively fixed implant was not enough to raise serum titanium levels. Twenty-two potential subjects who had received a volar locked distal radius plate were identified through review of a single surgeon's operative logs. Eleven met inclusion criteria. Serum titanium levels were measured in these subjects and compared to both current and historical control groups. We found no difference between controls and our study group with the exception of one control subject who is employed as a welder. This is in contrast to previous studies from our institution which found increases in titanium levels in hip and spine implants. We conclude that a locking titanium volar distal radius plate does not raise serum titanium levels in this population. PMID:21045978

  16. Cartilage defect of lunate facet of distal radius after fracture treated with osteochondral autograft from knee.

    PubMed

    Mall, Nathan A; Rubin, David A; Brophy, Robert H; Goldfarb, Charles A

    2013-07-01

    We describe using an osteochondral autograft from the lateral femoral condyle of the knee to treat a symptomatic die-punch lesion of the lunate facet of the distal radius. An 18-year-old woman who sustained a distal radius fracture remained symptomatic after nonoperative treatment and diagnostic wrist arthroscopy with microfracture. We used a commercial harvesting system to transfer an osteochondral plug into a cartilage defect involving the lunate facet of the distal radius. At final follow-up, 34 months after surgery, the patient was assessed with a visual analog scale (VAS) and Disabilities of the Arm, Shoulder, and Hand (DASH) scores and with a comprehensive physical examination. Magnetic resonance arthrogram was used to assess articular cartilage status. VAS pain score improved from 7 before surgery to 0.5 after surgery. Postoperative DASH score was 0. The patient was asymptomatic and had satisfactory wrist motion without mechanical symptoms. Magnetic resonance arthrogram showed the transferred osteochondral autograft incorporated in excellent position. PMID:24078947

  17. Functional limitation immediately after cast immobilization and closed reduction of distal radius fractures: preliminary report.

    PubMed

    Byl, N N; Kohlhase, W; Engel, G

    1999-01-01

    The majority of research on distal radius fractures consists of retrospective, descriptive studies of patients with unstable fractures requiring fixation. The purpose of this investigation was to report on impairments in flexibility, grip strength, and motor control and on the presence of swelling and atrophy immediately after cast immobilization of closed reductions of simple distal radius fractures. Sixteen adult subjects from Kaiser Permanente Medical Center, San Francisco, entered the study, and 13 completed it. At the initial evaluation, upper extremity ranges of motion, grip strength, forearm circumferences, two-point discrimination, and motor reaction times were measured on the uninvolved side. The same measurements were taken on the affected side within 48 hours after cast removal. All but one subject worked throughout the casting period. There were significant postcasting impairments in forearm rotation (40% deficit in pronation and supination); wrist flexion, extension, and radial and ulnar deviation (50% reduction in all motions); grip strength (-32 kg, or approximately 24% of the strength of the unaffected side); and forearm circumference (-1.1 cm) and wrist circumference (+1.5 cm). Patients complained of awkwardness of the involved hand. These measured impairments immediately after immobilization of simple radius fractures were greater than the reported impairments in patients after reduction of radius fractures with fixation 6 to 27 months after injury. To prevent long-term disability and recover flexibility, strength, and function, patients with simple distal radius fractures should be referred to a hand, occupational, or physical therapist for evaluation, education, and treatment after immobilization. Longitudinal studies are needed to quantify long-term functional recovery with regard to the type of fracture and the degree of impairment measured immediately after casting. PMID:10459528

  18. Acute plastic bowing of the radius with a distal radioulnar joint injury: a case report.

    PubMed

    Uehara, Masashi; Yamazaki, Hiroshi; Kato, Hiroyuki

    2010-01-01

    Acute plastic bowing is an incomplete fracture with a deformation that shows no obvious macroscopic fracture line or cortical discontinuity. Although cases of acute plastic bowing of the ulna with a dislocation of the radial head have been previously reported, we present here a rare case of acute plastic bowing of the radius with a distal radioulnar joint injury in a 16-year-old boy. Internal fixation of the detached fragment to the ulnar styloid and repair of the triangular fibrocartilagenous complex resulted in the disappearance of wrist pain. In cases of distal radioulnar joint injuries in children or adolescents, radiographs of the entire forearm should be taken to evaluate the existence of radial bowing. PMID:21089197

  19. Automated Classification of Epiphyses in the Distal Radius and Ulna using a Support Vector Machine.

    PubMed

    Wang, Ya-hui; Liu, Tai-ang; Wei, Hua; Wan, Lei; Ying, Chong-liang; Zhu, Guang-you

    2016-03-01

    The aim of this study was to automatically classify epiphyses in the distal radius and ulna using a support vector machine (SVM) and to examine the accuracy of the epiphyseal growth grades generated by the support vector machine. X-ray images of distal radii and ulnae were collected from 140 Chinese teenagers aged between 11.0 and 19.0 years. Epiphyseal growth of the two elements was classified into five grades. Features of each element were extracted using a histogram of oriented gradient (HOG), and models were established using support vector classification (SVC). The prediction results and the validity of the models were evaluated with a cross-validation test and independent test for accuracy (PA ). Our findings suggest that this new technique for epiphyseal classification was successful and that an automated technique using an SVM is reliable and feasible, with a relative high accuracy for the models. PMID:27404614

  20. Vascularized proximal fibular autograft for treatment of post-traumatic segmental bony defects in the distal radius.

    PubMed

    Shimizu, Takamasa; Yajima, Hiroshi; Kobata, Yasunori; Shigematsu, Koji; Kawamura, Kenji; Takakura, Yoshinori

    2008-11-01

    Vascularized proximal fibular autograft is reported as one of the reconstructive procedures for the wrists following tumor resection in the distal end of the radius. However, it is rarely performed for the treatment of segmental bony defects in the distal radius after trauma. A 19-year-old man who had traumatic bony defects in the distal radius involving the articular surface underwent vascularized proximal fibular grafting for reconstruction of the wrist. After surgery, he regained wrist functions, with 40 degrees of flexion, 45 degrees of extension, 90 degrees of pronation, and 45 degrees of supination. No evidence of instability or degenerative changes was noted in the reconstructed wrist at 3 years after surgery. Vascularized proximal fibular autograft appears a useful procedure both for reconstruction of the wrist in cases with segmental bony defects in the distal radius after trauma, as well as for after tumor resection. PMID:18925543

  1. Distal Radius Volar Rim Fracture Fixation Using DePuy-Synthes Volar Rim Plate.

    PubMed

    Kachooei, Amir Reza; Tarabochia, Matthew; Jupiter, Jesse B

    2016-03-01

    Background To assess the results of distal radius fractures with the involvement of the volar rim fixed with the DePuy-Synthes Volar Rim Plate. Case Description We searched for the patients with volar rim fracture and/or volar rim fractures as part of a complex fracture fixed with a volar rim plate. Ten patients met the inclusion criteria: three patients with type 23B3, six patients with type 23C, and one patient with very distal type 23A. The mean follow-up was 14 months (range: 2-26). Fractures healed in all patients. Of the three patients with isolated volar rim fractures (type 23B3), two patients had no detectable deficits in motion. These patients had an average Gartland and Werley score of 9 (range: 2-14). Of the other seven patients (six with type 23C and one with type 23A fracture), three patients healed with full range of motion and four had some deficits in range of motion. Two patients had excellent results, three had good results, and two had fair results using the Gartland and Werley categorical rating. One patient healed with a shortened radius and ulnar impingement requiring a second surgery for ulnar head resection arthroplasty. Literature Review Results after nonoperative treatment of volar rim fractures are not satisfactory and often require subsequent corrective osteotomy. Satisfactory outcomes are achieved when the fragments are well reduced and secured regardless of the device type. Clinical Relevance Volar rim plates give an adequate buttress of the volar radius distal to volar projection of the lunate facet and do not interfere with wrist mobility. Furthermore, the dorsal fragments can be fixed securely through the volar approach eliminating the need for a secondary posterior incision. However, patients should be informed of the potential problems and the need to remove the plate if symptoms develop. PMID:26855829

  2. MRI of bone marrow in the distal radius: in vivo precision of effective transverse relaxation times

    NASA Technical Reports Server (NTRS)

    Grampp, S.; Majumdar, S.; Jergas, M.; Lang, P.; Gies, A.; Genant, H. K.

    1995-01-01

    The effective transverse relaxation time T2* is influenced by the presence of trabecular bone, and can potentially provide a measure of bone density as well as bone structure. We determined the in vivo precision of T2* in repeated bone marrow measurements. The T2* measurements of the bone marrow of the distal radius were performed twice within 2 weeks in six healthy young volunteers using a modified water-presaturated 3D Gradient-Recalled Acquisition at Steady State (GRASS) sequence with TE 7, 10, 12, 20, and 30; TR 67; flip angle (FA) 90 degrees. An axial volume covering a length of 5.6 cm in the distal radius was measured. Regions of interest (ROIs) were determined manually and consisted of the entire trabecular bone cross-section extending proximally from the radial subchondral endplate. Reproducibility of T2* and area measurements was expressed as the absolute precision error (standard deviation [SD] in ms or mm2) or as the relative precision error (SD/mean x 100, or coefficient of variation [CV] in %) between the two-point measurements. Short-term precision of T2* and area measurements varied depending on section thickness and location of the ROI in the distal radius. Absolute precision errors for T2* times were between 1.3 and 2.9 ms (relative precision errors 3.8-9.5 %) and for area measurements between 20 and 55 mm2 (relative precision errors 5.1-16.4%). This MR technique for quantitative assessment of trabecular bone density showed reasonable reproducibility in vivo and is a promising future tool for the assessment of osteoporosis.

  3. Prophylactic corticosteroid injection in ulnar wrist pain in distal radius fracture

    PubMed Central

    Saied, Alireza; Heshmati, Afshin; Sadeghifar, Amirreza; Mousavi, Alia Ayatollahi; Arabnejad, Fateme; Pooladsanj, Alireza

    2015-01-01

    Background: Ulnar sided wrist pain is one of the most common complications of distal radius fractures. The simplest method for decreasing pain for this affliction is corticosteroid injection. The present study was designed to assess the effect of corticosteroid injection in the prevention of ulnar sided wrist pain. Materials and Methods: In this clinical trial patients with distal radius fractures scheduled for closed reduction and percutaneous pin fixation were divided into control and corticosteroid groups. In the corticosteroid group, the patient received a single betamethasone injection in the dorsoulnar side of the wrist before reduction, while the control group received placebo. The patients were to be followed for at least 6 months. Results: 82 patients were followed for 6 months. At the end of the 3 months followup the difference between the two groups about the number of individuals without ulnar sided wrist pain was statistically significant (P = 0.038), so that less patients in the control group were painless, while this was not the case in the 6 months followup (P = 0.507), but in the both time frames the mean grip power, visual analog pain score and the disabilities of the arm, shoulder and hand (DASH) score showed statistically significant difference between the two groups, so that the corticosteroid groups demonstrated greater power grip and less scores in pain and DASH (P < 0.05). Conclusion: Based on the findings of the present study it seems that prophylactic corticosteroid injection will be associated with a decrease in the severity of wrist pain in patients with acute distal radius fractures. With regard to the decrease in the number of painless individuals, it seems that the decrease is not persistent. Overall the need for a study with longer followup is obvious. PMID:26229158

  4. Nerve Stimulator Guided Axillary Block in Painless Reduction of Distal Radius Fractures; a Randomized Clinical Trial

    PubMed Central

    Alimohammadi, Hossein; Shojaee, Majid; Samiei, Mehdi; Abyari, Somayeh; Vafaee, Ali; Mirkheshti, Alireza

    2013-01-01

    Introduction: Given the high prevalence of upper extremity fractures and increasing need to perform painless reduction in the emergency departments, the use of analgesic methods with fewer complications and more satisfaction appears to be essential. The aim of this study is comparison the nerve stimulator guided axillary block (NSAB) with intravenous sedation in induction of analgesia for painless reduction of distal radius fractures. Methods: In the present randomized clinical trial, 60 patients (18-70 years of age) suffered from distal radius fractures, were divided into two equal groups. One group received axillary nerve block by nerve stimulator guidance and the other procedural sedation and analgesia (PSA) using midazolam/fentanyl. Onset of analgesia, duration of analgesic effect, total procedure time and pain scores were recorded using visual analogue scale (VAS) and the outcomes were compared. Chi-squared and student t test were performed to evaluate differences between two groups. Results: Sixty patients were randomly divided into two groups (83.3% male). The mean age of patients was 31 ±0.7 years. While the onset of analgesia was significantly longer in the NSAB group, the mean total time of procedure was shorter than PSA (p<0.001). The NSAB group needed a shorter post-operative observation time (P<0.001). Both groups experienced equal pain relief before, during and after procedure (p>0.05). Conclusion: It seems that shorter post-operative monitoring time and consequently lesser total time of procedure, make nerve stimulator guided axillary block as an appropriate alternative for procedural sedation and analgesia in painless reduction of distal radius fractures in emergency department. PMID:26495329

  5. [Efficacy of compound Xiatianwu tablets in elderly patients with osteoporotic distal radius fractures].

    PubMed

    Zhang, Bin; Chen, Gang; Li, Hai-long; Ren, Hai-peng; Yang, Tao; Chen, Min; Guo, Li-gang

    2015-06-01

    Xiatianwu tablet is based on the theory of traditional Chinese medicine (TCM), combined with modern TCM pharmacology and selected 33 famous traditional Chinese crude drugs to compose. Its recipe helps cure rheumatism, relax tendons, promote blood circulation to relieve pain, et al. Although Xiatianwu tablets are widely applied to clinical remedy such as rheumatic arthritis, lumbar disc hernia, osteoarthritis and so on, there is no report about its application in fracture. This article is to observe the efficacy of compound Xiatianwu tablets in elderly patients with osteoporotic distal radius fractures and its impact on the wrist function and complications. 180 elderly patients with osteoporotic distal radius fractures, from January 2011 to June 2014, were divided into observation group and control group by the method of random number table, each group had 90 cases. The control group were gave Caltrate D after manipulative reduction and plaster immobilization, observation group were treated with compound Xiatianwu tablets in the basis of the control group. Efficacy, wrist function and complication rates were observed in two groups after treatment. The excellent and good rate was 95.56% in observation group better than 77.78% in control group, the difference was statistically significant (χ2 = 4.712, P < 0.05). The complication rate in observation group was significantly lower compared with the control group (P < 0.05). This study shows that compound Xiatianwu tablets can improve the efficacy in elderly patients with osteoporotic distal radius fractures, reduce the incidence of complications and relieve the pain of patients which plays a significant role in improving the quality of life. PMID:26591540

  6. Distal radius geometry and skeletal strength indices after peripubertal artistic gymnastics

    PubMed Central

    Scerpella, T. A.

    2011-01-01

    Summary Development of optimal skeletal strength should decrease adult bone fragility. Nongymnasts (NON) were compared with girls exposed to gymnastics during growth (EX/GYM), using peripheral quantitative computed tomography (pQCT) to evaluate postmenarcheal bone geometry, density, and strength. Pre- and perimenarcheal gymnastic loading yields advantages in indices of postmenarcheal bone geometry and skeletal strength. Introduction Two prior studies using pQCT have reported bone density and size advantages in Tanner I/II gymnasts, but none describe gymnasts’ bone properties later in adolescence. The current study used pQCT to evaluate whether girls exposed to gymnastics during late childhood growth and perimenarcheal growth exhibited greater indices of distal radius geometry, density, and skeletal strength. Methods Postmenarcheal subjects underwent 4% and 33% distal radius pQCT scans, yielding: 1) vBMD and cross-sectional areas (CSA) (total bone, compartments); 2) polar strength-strain index; 3) index of structural strength in axial compression. Output was compared for EX/GYM vs. NON, adjusting for gynecological age and stature (maturity and body size), reporting means, standard errors, and significance. Results Sixteen postmenarcheal EX/GYM (age 16.7 years; gynecological age 3.4 years) and 13 NON (age 16.2 years; gynecological age 3.6 years) were evaluated. At both diaphysis and metaphysis, EX/GYM exhibited greater CSA and bone strength indices than NON; EX/GYM exhibited 79% larger intramedullary CSA than NON (p<0.05). EX/GYM had significantly higher 4% trabecular vBMD; differences were not detected for 4% total vBMD and 33% cortical vBMD. Conclusions Following pre-/perimenarcheal gymnastic exposure, relative to nongymnasts, postmenarcheal EX/GYM demonstrated greater indices of distal radius geometry and skeletal strength (metaphysis and diaphysis) with greater metaphyseal trabecular vBMD; larger intramedullary cavity size was particularly striking. PMID

  7. Surgery versus conservative treatment in patients with type A distal radius fractures, a randomized controlled trial

    PubMed Central

    2014-01-01

    Background Fractures of the distal radius are common and account for an estimated 17% of all fractures diagnosed. Two-thirds of these fractures are displaced and require reduction. Although distal radius fractures, especially extra-articular fractures, are considered to be relatively harmless, inadequate treatment may result in impaired function of the wrist. Initial treatment according to Dutch guidelines consists of closed reduction and plaster immobilisation. If fracture redisplacement occurs, surgical treatment is recommended. Recently, the use of volar locking plates has become more popular. The aim of this study is to compare the functional outcome following surgical reduction and fixation with a volar locking plate with the functional outcome following closed reduction and plaster immobilisation in patients with displaced extra-articular distal radius fractures. Design This single blinded randomised controlled trial will randomise between open reduction and internal fixation with a volar locking plate (intervention group) and closed reduction followed by plaster immobilisation (control group). The study population will consist of all consecutive adult patients who are diagnosed with a displaced extra-articular distal radius fracture, which has been adequately reduced at the Emergency Department. The primary outcome (functional outcome) will be assessed by means of the Disability Arm Shoulder Hand Score (DASH). Secondary outcomes comprise the Patient-Rated Wrist Evaluation score (PRWE), quality of life, pain, range of motion, radiological parameters, complications and cross-overs. Since the treatment allocated involves a surgical procedure, randomisation status will not be blinded. However, the researcher assessing the outcome at one year will be unaware of the treatment allocation. In total, 90 patients will be included and this trial will require an estimated time of two years to complete and will be conducted in the Academic Medical Centre Amsterdam and

  8. Solid variant of aneurysmal bone cist on the distal extremity of the radius in a child.

    PubMed

    Ferreira, Adriano Jander; de Almeida Leitão, Sebastião; Rocha, Murilo Antônio; Nascimento, Valdênia das Graças; Lima, Giovanni Bessa Pereira; de Meneses, Antonio Carlos Oliveira

    2016-01-01

    The solid variant of aneurismal bone cysts (ABC) is considered rare. It occurs with greater frequency in pediatric patients and in the tibia, femur, pelvis and humerus. We present a case of a metaphyseal lytic lesion on the distal extremity of the radius in a child whose radiograph was requested after low-energy trauma. The hypothesis of a pathological bone fracture secondary to an aneurysmal bone cyst was suggested. After biopsy, the child underwent intralesional excision without bone grafting and the histopathological findings were compatible with the solid variant of aneurysmal bone cyst. PMID:27274493

  9. A Simple 3-Dimensional Printed Aid for a Corrective Palmar Opening Wedge Osteotomy of the Distal Radius.

    PubMed

    Honigmann, Philipp; Thieringer, Florian; Steiger, Regula; Haefeli, Mathias; Schumacher, Ralf; Henning, Julia

    2016-03-01

    The reconstruction of malunited distal radius fractures is often challenging. Virtual planning techniques and guides for drilling and resection have been used for several years to achieve anatomic reconstruction. These guides have the advantage of leading to better operative results and faster surgery. Here, we describe a technique using a simple implant independent 3-dimensional printed drill guide and template to simplify the surgical reconstruction of a malunited distal radius fracture. PMID:26787406

  10. Defining the role of intramedullary nailing for fractures of the distal radius: a systematic review.

    PubMed

    Jordan, R W; Saithna, A

    2015-10-01

    This article is a systematic review of the published literature about the biomechanics, functional outcome and complications of intramedullary nailing of fractures of the distal radius. We searched the Medline and EMBASE databases and included all studies which reported the outcome of intramedullary (IM) nailing of fractures of the distal radius. Data about functional outcome, range of movement (ROM), strength and complications, were extracted. The studies included were appraised independently by both authors using a validated quality assessment scale for non-controlled studies and the CONSORT statement for randomised controlled trials (RCTs). The search strategy revealed 785 studies, of which 16 were included for full paper review. These included three biomechanical studies, eight case series and five randomised controlled trials (RCTs). The biomechanical studies concluded that IM nails were at least as strong as locking plates. The clinical studies reported that IM nailing gave a comparable ROM, functional outcome and grip strength to other fixation techniques. However, the mean complication rate of intramedullary nailing was 17.6% (0% to 50%). This is higher than the rates reported in contemporary studies for volar plating. It raises concerns about the role of intramedullary nailing, particularly when comparative studies have failed to show that it has any major advantage over other techniques. Further adequately powered RCTs comparing the technique to both volar plating and percutaneous wire fixation are needed. PMID:26430012

  11. Treatment of scaphoid nonunion with vascularised and nonvascularised dorsal bone grafting from the distal radius

    PubMed Central

    Medina, Carlos Eduardo Gonzalez; Mattar, Rames; Ulson, Heitor Jose Rizzardo; de Resende, Marcelo Rosa; Etchebehere, Mauricio

    2009-01-01

    We conducted a prospective randomised study comparing the clinical, functional and radiographic results of 46 patients treated for scaphoid nonunion using a vascularised bone graft from the dorsal and distal aspect of the radius (group I), relative to 40 patients treated by means of a conventional non-vascularised bone graft from the distal radius (group II). Surgical findings included 30 sclerotic, poorly-vascularised scaphoids in group I versus 20 in group II. Bone fusion was achieved in 89.1% of group I and 72.5% of group II patients (p = 0.024). Functional results were good to excellent in 72.0% of the patients in group I and 57.5% in group II. Considering only patients with sclerotic, poorly-vascularised scaphoids, the mean final outcome scores obtained were 7.5 and 6.0 for groups I and group II, respectively. We conclude that vascularised bone grafting yields superior results and is more efficient when there is a sclerotic, poorly-vascularised proximal pole in patients in scaphoid nonunion. PMID:19730861

  12. Multiple ruptures of the extensor tendons after volar fixation for distal radius fracture: a case report.

    PubMed

    Caruso, Giancarlo; Vitali, Andrea; del Prete, Ferdinando

    2015-12-01

    A 62-year-old woman was admitted to our hospital after a bicycle accident with a displaced left (non-dominant) distal radius fracture. After closed reduction a long cast was applied. Due to loss of reduction, twenty-four days later open reduction internal fixation with locking compression plate (LCP) was performed. The patient returned to her normal activities but nineteen months after surgery showed functional impairment of the left thumb for Extensor Pollicis Longus (EPL) injury for which she necessitated transposition surgery. Twenty-six months after ORIF, functional deficit of the extension of the third and fourth left finger was noted secondary to injury of extensor tendons. Ultrasound and CT scan showed protrusion of the angular stability screws in LCP plate that caused a progressive wear resulting in rupture of the extensor tendons. Another tendon transposition surgery was performed with dorsal approach while the plate was removed utilising the original volar incision. Reconstruction of distal radius fractures with volar plating, requires accurate plate application with precise measurement of the length of the screws in order to prevent dorsal protrusion and thus avoiding tendon injuries. PMID:26738455

  13. A new volar plate DiPhos-RM for fixation of distal radius fracture: preliminary report.

    PubMed

    Tarallo, Luigi; Mugnai, Raffaele; Adani, Roberto; Catani, Fabio

    2013-03-01

    We analyzed the efficiency of a new plate DiPhos-RM in CFR-PEEK [carbon-fiber-reinforced poly (etheretherketone)] for the volar fixation of distal radius fractures. The new plate's composition has the advantage of x-ray absolute transparency, therefore allowing to monitor the healing of the fracture. The desired combination of high strength and low rigidity is obtained through the use of the polymer composites CFR-PEEK. In this preliminary study (from March 2012 to June 2012), 10 cases of intra-articular distal radius fractures were treated with DiPhos-RM produced by Lima Corporate (Italy). The fractures were classified according to the AO classification, 4 fractures were type C1, 3 type C2, and 3 were A2. A preoperative computed tomography scan was carried out in all patients. One patient also underwent a postoperative computed tomography scan. Grip strength, range of motion, and DASH score were evaluated at follow-up. There were no cases of hardware failure. Specifically, no loss of position or alignment of fixed-angle locking screws or breakage of the plate were observed. Radiographic union was present at an average of 6 weeks (range, 5 to 8 wk). The overall preliminary experience with this new plate is favorable. The new plate is easy to apply and provides the surgeon dual options of fixed-angle or variable-angle screws. It was rigid enough to maintain the reduction also in AO type C articular fractures. PMID:23423235

  14. Redisplacement of Distal Radius Fracture after Initial Closed Reduction: Analysis of Prognostic Factors

    PubMed Central

    Jung, Ho-Wook; Hong, Hanpyo; Jung, Hong Jun; Kim, Jin Sam; Park, Ho Youn; Bae, Kun Hyung

    2015-01-01

    Background To evaluate risk factors of redisplacement and remind surgeons of key factors regarding conservative treatment of distal radius fracture. Methods A total of 132 patients who received conservative treatment for distal radius fractures between March 2008 and February 2011 were included in this study. Radial inclination, radial length, volar tilting angle, ulnar variance, fragment translation, and presence of dorsal metaphyseal comminution were measured on the X-rays taken immediately after reduction, one week after injury during the first follow-up outpatient clinic visit, and after the gain of radiological union. Secondary displacement was defined as a loss of reduction during the follow-up period, and was divided into 'early' and 'late' categories. We analyzed the influence of initial displacement radiologic variables, dorsal cortex comminution, and patient age on the development of secondary displacement. Results Development of secondary displacement was significantly associated only with initial displacement radiologic variables (p < 0.001), development of the late secondary displacement was significantly associated with age (p = 0.005), and initial displacement radiologic variables were associated significantly with a serial increase in ulnar variance (p = 0.003). Conclusions Greater displacement on the initial radiographs indicates a higher possibility of development for secondary displacement, and older patients had a higher probability of late secondary displacement development. Furthermore, dorsal comminutions did not affect secondary displacement directly. PMID:26330962

  15. Treatment of intra-articular fractures of the distal radius: fluoroscopic or arthroscopic reduction?

    PubMed

    Varitimidis, S E; Basdekis, G K; Dailiana, Z H; Hantes, M E; Bargiotas, K; Malizos, K

    2008-06-01

    In a randomised prospective study, 20 patients with intra-articular fractures of the distal radius underwent arthroscopically- and fluoroscopically-assisted reduction and external fixation plus percutaneous pinning. Another group of 20 patients with the same fracture characteristics underwent fluoroscopically-assisted reduction alone and external fixation plus percutaneous pinning. The patients were evaluated clinically and radiologically at follow-up of 24 months. The Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and modified Mayo wrist score were used at 3, 9, 12 and 24 months postoperatively. In the arthroscopically- and fluoroscopically-assisted group, triangular fibrocartilage complex tears were found in 12 patients (60%), complete or incomplete scapholunate ligament tears in nine (45%), and lunotriquetral ligament tears in four (20%). They were treated either arthroscopically or by open operation. Patients who underwent arthroscopically- and fluoroscopically-assisted treatment had significantly better supination, extension and flexion at all time points than those who had fluoroscopically-assisted surgery. The mean DASH scores were similar for both groups at 24 months, whereas the difference in the mean modified Mayo wrist scores remained statistically significant. Although the groups are small, it is clear that the addition of arthroscopy to the fluoroscopically-assisted treatment of intra-articular distal radius fractures improves the outcome. Better treatment of associated intra-articular injuries might also have been a reason for the improved outcome. PMID:18539672

  16. Ulnar Shortening Osteotomy After Distal Radius Fracture Malunion: Review of Literature.

    PubMed

    Barbaric, Katarina; Rujevcan, Gordan; Labas, Marko; Delimar, Domagoj; Bicanic, Goran

    2015-01-01

    Malunion of distal radius fracture is often complicated with shortening of the radius with disturbed radio- ulnar variance, frequently associated with lesions of triangular fibrocartilage complex and instability of the distal radioulnar joint. Positive ulnar variance may result in wrist pain located in ulnar part of the joint, limited ulnar deviation and forearm rotation with development of degenerative changes due to the overloading that occurs between the ulnar head and corresponding carpus. Ulnar shortening osteotomy (USO) is the standard procedure for correcting positive ulnar variance. Goal of this procedure is to minimize the symptoms by restoring the neutral radio - ulnar variance. In this paper we present a variety of surgical techniques available for ulnar shorthening osteotomy, their advantages and drawbacks. Methods of ulnar shortening osteotomies are divided into intraarticular and extraarticular. Intraarticular method of ulnar shortening can be performed arthroscopically or through open approach. Extraarticular methods include subcapital osteotomy and osteotomy of ulnar diaphysis, which depending on shape can be transverse, oblique, and step cut. All of those osteotomies can be performed along wrist arthroscopy in order to dispose and treat possibly existing triangular fibrocartilage complex injuries. At the end we described surgical procedures that can be done in case of ulnar shorthening osteotomy failure. PMID:26157524

  17. Ulnar Shortening Osteotomy After Distal Radius Fracture Malunion: Review of Literature

    PubMed Central

    Barbaric, Katarina; Rujevcan, Gordan; Labas, Marko; Delimar, Domagoj; Bicanic, Goran

    2015-01-01

    Malunion of distal radius fracture is often complicated with shortening of the radius with disturbed radio- ulnar variance, frequently associated with lesions of triangular fibrocartilage complex and instability of the distal radioulnar joint. Positive ulnar variance may result in wrist pain located in ulnar part of the joint, limited ulnar deviation and forearm rotation with development of degenerative changes due to the overloading that occurs between the ulnar head and corresponding carpus. Ulnar shortening osteotomy (USO) is the standard procedure for correcting positive ulnar variance. Goal of this procedure is to minimize the symptoms by restoring the neutral radio - ulnar variance. In this paper we present a variety of surgical techniques available for ulnar shorthening osteotomy, their advantages and drawbacks. Methods of ulnar shortening osteotomies are divided into intraarticular and extraarticular. Intraarticular method of ulnar shortening can be performed arthroscopically or through open approach. Extraarticular methods include subcapital osteotomy and osteotomy of ulnar diaphysis, which depending on shape can be transverse, oblique, and step cut. All of those osteotomies can be performed along wrist arthroscopy in order to dispose and treat possibly existing triangular fibrocartilage complex injuries. At the end we described surgical procedures that can be done in case of ulnar shorthening osteotomy failure. PMID:26157524

  18. [Conservative treatment of distal radius fracture. Consequences of an uncritical follow-up].

    PubMed

    Huber-Wagner, S; Beirer, M; Neu, J

    2014-11-01

    A 74-year-old woman sustained a fracture of the distal radius with an additional fracture of the styloid process of the ulna due to a fall. After reduction under local anesthesia immobilization treatment in a forearm cast was initiated. Despite increasing secondary dislocation during radiological x-ray follow-up control, the bone was described as correctly aligned by the treating physician and non-operative treatment was continued. After a total treatment period of 9 months including 7 months of physiotherapy the patient still presented a limited range of motion and local soft tissue swelling of the right wrist. The patient filed a complaint for wrong treatment of the distal radius fracture resulting in severe pain and considerable deformity of the right wrist leading to a significant handicap during activities of daily living. The expert opinion of the arbitration board ascertained a case of medical malpractice in terms of the indications. Due to the initial presence of criteria of radiological instability, an operative treatment had already been indicated at the first presentation. In addition, secondary dislocation during radiological follow-up examination should have led to conversion of treatment in favor of surgery. The arbitration board furthermore concluded that iatrogenic malpractice led to a severe deformity of the right wrist which would result in a loss of grip strength and future arthritic deformation of the wrist. Legal aspects of the case are discussed. PMID:25277732

  19. Pilon fractures of the wrist. Displaced intra-articular fractures of the distal radius.

    PubMed

    Porter, M L; Tillman, R M

    1992-02-01

    22 patients who sustained high energy wrist injuries are reported. These complex injuries resulted in articular disruption of the distal radius. Associated injuries included scapho-lunate dissociation (18%), central die-punch injuries (14%), ulnar fractures (41%) and diastasis at the distal radioulnar joint (23%). Nine fractures (41%) were open and almost a third of patients had other skeletal injuries. All patients were treated by external fixation and reviewed after a mean follow-up of 2 1/2 years. There were no excellent results and only ten good ones (45%). The mean functional impairment was 32%. The external fixator was effective in maintaining extra-articular alignment, but not in ensuring accurate reduction of the articular surface. Residual incongruity of the joint surface was an adverse prognostic feature. All five patients (22%) with an articular step of more than 2 mm. developed symptomatic arthritis. Failure to restore the joint line did not account for all the unsatisfactory results; persistent scapho-lunate dissociation and problems at the distal radioulnar joint were also important. PMID:1640147

  20. Devising for a distal radius fracture fixation focus on the intra-articular volar dislocated fragment

    PubMed Central

    Sugiyama, Yoichi; Naito, Kiyohito; Obata, Hiroyuki; Kinoshita, Mayuko; Aritomi, Kentaro; Kaneko, Kazuo; Obayashi, Osamu

    2016-01-01

    Introduction Distal radius fracture (DRF) accompanied by intra-articular volar displaced fragment is difficult to reduce. This volar fragment remains when treated with a simple buttress effect alone, and V-shaped deformity may remain on the articular surface. We attempted to improve dorsal rotational deviation of volar fragment by osteosynthesis applying the condylar stabilizing technique. We report the surgical procedure and results. Materials and methods The subjects were 10 cases of DRF accompanied by intra-articular volar displaced fragments surgically treated (mean age: 69 years old). The fracture type based on the AO classification was B3 in 1 case, C1 in 4, C2 in 2, and C3 in 3 cases. All cases were treated with a volar locking plate. Reduction was applied utilizing the angle stability of the volar locking plate, similarly to the condylar stabilizing technique. On the final follow-up, we evaluated clinical and radiologic evaluation. To evaluate V-shaped valley deformity of the articular surface, the depth of the lunate fossa of the radius was measured using computed tomography (CT). Results The duration of postoperative follow-up was 11 (6–24) months. Mayo wrist score was 93 (Excellent in 10 cases). No general complication associated with a volar locking plate was noted in any case. Volar tilt on radiography were 11° (4–14). The depth of the lunate fossa on CT was 3.9 ± 0.7 mm in the patients. Conclusion This procedure may be useful for osteosynthesis of distal radius fracture accompanied by intra-articular volar displaced fragments. PMID:27144008

  1. Primary Wrist Hemiarthroplasty for Irreparable Distal Radius Fracture in the Independent Elderly.

    PubMed

    Herzberg, Guillaume; Burnier, Marion; Marc, Antoine; Izem, Yadar

    2015-08-01

    Background Volar plating for acute distal radius fractures (DRF) in the elderly has been recommended. Some studies have suggested that open reduction with internal fixation (ORIF) in this situation results in frequent complications. Our purposes were to provide a definition of irreparable DRF in independent elderly patients and to review the results of a preliminary retrospective series of wrist hemiarthroplasty (WHA) in this patient population. Materials Between 2011 and 2014, 11 consecutive independent elderly patients (12 wrists) with irreparable intra-articular DRF were treated with primary WHA at the acute stage. A resection of the ulnar head was associated in nine wrists. A total of 11 wrists with more than 2 years of follow-up form the basis of this paper. Description of Technique The approach was dorsal longitudinal. An osteotome longitudinally entered the dorsal aspect of the fracture medial to the Lister tubercle. Two thick osteoperiosteal flaps were elevated radially and ulnarly in a fashion similar to opening a book. The distal radius articular surface was excised. The implant was pressed into the radial canal with attention to restoring distal radius length. The two osteoperiosteal flaps were brought back together and sutured so as to close, again like a book, the osseous and soft tissues around the implant. Results At mean follow-up of 30 months, average visual analog scale (VAS) pain was 1/10. Mean QuickDASH (Disabilities of the Arm, Shoulder and Hand) score was 32, and mean Patient-Rated Wrist Evaluation (PRWE) score was 24. Mean forearm rotation arc was 151°. Mean active flexion-extension arc was 60°. Mean active extension was 34°. Mean grip strength was 14 kg (64% of contralateral wrist). Mean Lyon wrist score was 73%. Bone healing around the implants was satisfactory in all but one case. Conclusions Out data suggest that treatment of irreparable DRF in the independent elderly patient with a bone-preserving WHA may be a viable

  2. Primary Wrist Hemiarthroplasty for Irreparable Distal Radius Fracture in the Independent Elderly

    PubMed Central

    Herzberg, Guillaume; Burnier, Marion; Marc, Antoine; Izem, Yadar

    2015-01-01

    Background Volar plating for acute distal radius fractures (DRF) in the elderly has been recommended. Some studies have suggested that open reduction with internal fixation (ORIF) in this situation results in frequent complications. Our purposes were to provide a definition of irreparable DRF in independent elderly patients and to review the results of a preliminary retrospective series of wrist hemiarthroplasty (WHA) in this patient population. Materials Between 2011 and 2014, 11 consecutive independent elderly patients (12 wrists) with irreparable intra-articular DRF were treated with primary WHA at the acute stage. A resection of the ulnar head was associated in nine wrists. A total of 11 wrists with more than 2 years of follow-up form the basis of this paper. Description of Technique The approach was dorsal longitudinal. An osteotome longitudinally entered the dorsal aspect of the fracture medial to the Lister tubercle. Two thick osteoperiosteal flaps were elevated radially and ulnarly in a fashion similar to opening a book. The distal radius articular surface was excised. The implant was pressed into the radial canal with attention to restoring distal radius length. The two osteoperiosteal flaps were brought back together and sutured so as to close, again like a book, the osseous and soft tissues around the implant. Results At mean follow-up of 30 months, average visual analog scale (VAS) pain was 1/10. Mean QuickDASH (Disabilities of the Arm, Shoulder and Hand) score was 32, and mean Patient-Rated Wrist Evaluation (PRWE) score was 24. Mean forearm rotation arc was 151°. Mean active flexion-extension arc was 60°. Mean active extension was 34°. Mean grip strength was 14 kg (64% of contralateral wrist). Mean Lyon wrist score was 73%. Bone healing around the implants was satisfactory in all but one case. Conclusions Out data suggest that treatment of irreparable DRF in the independent elderly patient with a bone-preserving WHA may be a viable

  3. Fixed-Angle Volar Plate Fixation for Distal Radius Fractures in Immunosuppressed Patients

    PubMed Central

    Peterson, Erik D.

    2008-01-01

    The aim of this study was to define the outcome and complications following open reduction and internal fixed-angle plating of distal radius fractures for patients on chronic immunosuppression medications. A retrospective study identified 11 patients with distal radius fractures that had been on chronic immunosuppressive medication. The mean patient age was 59.9 years (40–82 years). According to the Orthopedic Trauma Association classification, there was one 23A3, one 23B3, and nine 23C type fractures. There were two open fractures. All patients received preoperative antibiotics and underwent reduction and fixation with a volar, fixed-angle plate. Postoperative measurements included postoperative and final radiographic indices, wrist flexion and extension, forearm rotation, and grip strength. Clinical follow-up averaged 13 months, and radiographic follow-up averaged 14.9 months. Statistical analysis was performed comparing means of various parameters with a two-sided t test with an alpha value ≤0.05. All fractures healed, and there were no infections. The final mean ulnar variance, volar tilt, and radial inclination were −0.1 mm (ulnar negative; −2.0 to +2.5 mm), 13° (5–23°), and 21° (15–27°), respectively. The mean articular gap or step was 0.4 mm. There was a small but significant decrease between the final and postoperative mean ulnar variance (p = 0.03). Mean wrist flexion was 47°, extension 47°, pronation 77°, and supination was 76°. Grip strength averaged 16.3 kg versus 25.1 kg for the opposite extremity. The one major complication included a postoperative carpal tunnel syndrome. Fixed-angle volar plate fixation for distal radius fractures in patients with chronic immunosuppression was associated with union (with acceptable radiographic alignment), no wound-healing problems or infections, and with functional wrist and forearm motion and grip strength. PMID:18780023

  4. [Technique and results of modified percutaneous bore wire osteosynthesis of the distal radius].

    PubMed

    Habernek, H; Schmid, L

    1992-07-01

    A modified technique for percutaneous K-wire pinning of distal radius fractures is presented. With this method, three to four K-wires are introduced from the radial styloid process towards and through the dorsal, volar and ulnar proximal cortical wall, respectively. After the fracture fragments have been demonstrated to be stable, the wires are cut, bent over and fixed. Then a dorsal plaster splint is applied, which should be worn for 4-6 weeks, depending on whether or not there is a dorsal comminution zone. Fifty-five patients have been operated on by this method. At follow-up 6 months after the operation, no secondary dislocation, wire migration, infection, Sudeck syndrome or functional disturbance was seen. The advantage of this method is emphasized as compared with the usual, previously published method. PMID:1502573

  5. Common Myths and Evidence in the Management of Distal Radius Fractures

    PubMed Central

    Diaz-Garcia, Rafael J.; Chung, Kevin C.

    2012-01-01

    Distal radius fractures are the most common fracture treated by physicians, yet there are questions regarding their optimal management. Over 200 years have been spent discussing fracture patterns, biomechanics and treatment strategies regarding DRFs. But research has revealed many controversies regarding long-held beliefs. These “common myths” have been propagated and thought of as fact but in reality, are not based on the best-available evidence. This review article aims to illustrate some of the major controversies that have come to light regarding the management of DRFs. As we strive to provide optimal care in a world of evidence-based medicine, we must shift our thinking and accept that some of the ideas we have been indoctrinated with may be flawed heuristic approach. PMID:22554655

  6. Retrospective Comparison of Percutaneous Fixation and Volar Internal Fixation of Distal Radius Fractures

    PubMed Central

    Lozano-Calderón, Santiago A.; Doornberg, Job N.

    2007-01-01

    A change in the practice of a single surgeon provided an opportunity for retrospective comparison of comparable cohorts treated with percutaneous fixation (17 patients) or a volar plate and screws (23 patients) an average of 30 months after surgery. The final evaluation was performed according to the Gartland and Werley and Mayo rating systems and the DASH questionnaire. There were no significant differences on the average scores for the percutaneous and volar plating groups, respectively: Gartland and Werley, 4 vs 5; Mayo, 82 vs 83; and DASH score 13 for both cohorts. Motion, grip, and radiographical parameters were likewise comparable. Volar internal plate and screw fixation can achieve results comparable to percutaneous fixation techniques in the treatment of fractures of the distal radius. PMID:18780085

  7. [Arthroscopic management of intra-articular fractures of the distal radius].

    PubMed

    Cognet, J-M; Martinache, X; Mathoulin, C

    2008-09-01

    The use of arthroscopy in the management of intra-articular fractures of the distal radius has become established over the last ten years, but the operative technique is not yet standardised. We report our experience with this technique and give a stage by stage description of the operative procedure. The arthroscopic part of the procedure consists firstly of an evaluation of the bony, cartilaginous and ligamentous injuries and secondly direct visual control of the reduction. The choice of bone fixation depends on the individual preferences of the surgeon but may be influenced by the configuration of the fracture. A literature review reiterates the advantages of arthroscopic assistance in managing these fractures without revealing any disadvantages. However, mastery of the arthroscopic techniques is vital before the full advantages of this type of management can be realised. PMID:18774328

  8. [Arthroscopically assisted osteosynthesis of dorsally tilted intraarticular distal radius fractures--technique and results].

    PubMed

    Lutz, M; Wieland, T; Deml, C; Erhart, S; Rudisch, A; Klestil, T

    2014-10-01

    The present paper describes the indication and application of an arthroscopically assisted osteosynthesis for distal radius fractures. Visualisation of articular incongruency is emphasised with special regard to articular fracture fragment reduction. In addition to that, classification of soft tissue injuries and treatment options are discussed. The final clinical and radiological results of 17 patients are presented: DASH and PRWE averaged 4.9 and 6.0 respectively. Active range of motion measured 123° for flexion/extension, 51° for radial and ulnar deviation and 163° for pronosupination, which is 87%, 98% and 97%, respectively, compared with the opposite wrist. Radial inclination at final follow-up was 23°, palmar tilt measured 6° and ulnar variance averaged -1.2 mm. The scapholunate gap at follow-up was 1.6 mm, and the scapholunate angle measured 57°. PMID:25290269

  9. Accuracy of 3D Virtual Planning of Corrective Osteotomies of the Distal Radius.

    PubMed

    Stockmans, Filip; Dezillie, Marleen; Vanhaecke, Jeroen

    2013-11-01

    Corrective osteotomies of the distal radius for symptomatic malunion are time-tested procedures that rely on accurate corrections. Patients with combined intra- and extra-articular malunions present a challenging deformity. Virtual planning and patient-specific instruments (PSIs) to transfer the planning into the operating room have been used both to simplify the surgery and to make it more accurate. This report focuses on the clinically achieved accuracy in four patients treated between 2008 and 2012 with virtual planning and PSIs for a combined intra- and extraarticular malunion of the distal radius. The accuracy of the correction is quantified by comparing the virtual three-dimensional (3D) planning model with the postoperative 3D bone model. For the extraarticular malunion the 3D volar tilt, 3D radial inclination and 3D ulnar variance are measured. The volar tilt is undercorrected in all cases with an average of -6 ± 6°. The average difference between the postoperative and planned 3D radial inclination was -1 ± 5°. The average difference between the postoperative and planned 3D ulnar variances is 0 ± 1 mm. For the evaluation of the intraarticular malunion, both the arc method of measurement and distance map measurement are used. The average postoperative maximum gap is 2.1 ± 0.9 mm. The average maximum postoperative step-off is 1.3 ± 0.4 mm. The average distance between the postoperative and planned articular surfaces is 1.1 ± 0.6 mm as determined in the distance map measurement. There is a tendency to achieve higher accuracy as experience builds up, both on the surgeon's side and on the design engineering side. We believe this technology holds the potential to achieve consistent accuracy of very complex corrections. PMID:24436834

  10. Accuracy of 3D Virtual Planning of Corrective Osteotomies of the Distal Radius

    PubMed Central

    Stockmans, Filip; Dezillie, Marleen; Vanhaecke, Jeroen

    2013-01-01

    Corrective osteotomies of the distal radius for symptomatic malunion are time-tested procedures that rely on accurate corrections. Patients with combined intra- and extra-articular malunions present a challenging deformity. Virtual planning and patient-specific instruments (PSIs) to transfer the planning into the operating room have been used both to simplify the surgery and to make it more accurate. This report focuses on the clinically achieved accuracy in four patients treated between 2008 and 2012 with virtual planning and PSIs for a combined intra- and extraarticular malunion of the distal radius. The accuracy of the correction is quantified by comparing the virtual three-dimensional (3D) planning model with the postoperative 3D bone model. For the extraarticular malunion the 3D volar tilt, 3D radial inclination and 3D ulnar variance are measured. The volar tilt is undercorrected in all cases with an average of –6 ± 6°. The average difference between the postoperative and planned 3D radial inclination was –1 ± 5°. The average difference between the postoperative and planned 3D ulnar variances is 0 ± 1 mm. For the evaluation of the intraarticular malunion, both the arc method of measurement and distance map measurement are used. The average postoperative maximum gap is 2.1 ± 0.9 mm. The average maximum postoperative step-off is 1.3 ± 0.4 mm. The average distance between the postoperative and planned articular surfaces is 1.1 ± 0.6 mm as determined in the distance map measurement. There is a tendency to achieve higher accuracy as experience builds up, both on the surgeon's side and on the design engineering side. We believe this technology holds the potential to achieve consistent accuracy of very complex corrections. PMID:24436834

  11. Biomechanical Comparison of Different Volar Fracture Fixation Plates for Distal Radius Fractures

    PubMed Central

    Sobky, Kareem; Baldini, Todd; Thomas, Kenneth; Bach, Joel; Williams, Allison

    2007-01-01

    The purpose of this study was to compare the biomechanical properties of four volar fixed-angle fracture fixation plate designs in a novel sawbones model as well as in cadavers. Four volar fixed angle plating systems (Hand Innovations DVR-A, Avanta SCS/V, Wright Medical Lo-Con VLS, and Synthes stainless volar locking) were tested on sawbones models using an osteotomy gap model to simulate a distal radius fracture. Based on a power analysis, six plates from each system were tested to failure in axial compression. To simulate loads with physiologic wrist motion, six plates of each type were then tested to failure following 10,000 cycles applying 100N of compression. To compare plate failure behavior, two plates of each type were implanted in cadaver wrists and similar testing applied. All plate constructs were loaded to failure. All failed with in apex volar angulation.The Hand Innovations DVR-A plate demonstrated significantly more strength in peak load to failure and failure after fatigue cycling (p value < 0.001 for single load and fatigue failure). However, there was no significant difference in stiffness among the four plates in synthetic bone. The cadaveric model demonstrated the same mode of failure as the sawbones. None of the volar plates demonstrated screw breakage or pullout, except the tine plate (Avanta SCS/V) with 1 mm of pullout in 2 of 12 plates. This study demonstrates the utility of sawbones in biomechanical testing and indicates that volar fixation of unstable distal radius fractures with a fixed angle device is a reliable means of stabilization. PMID:18780084

  12. Opening Wedge Osteotomy for Distal Radius Malunion: Dorsal or Palmar Approach?

    PubMed Central

    Rothenfluh, Esin; Schweizer, Andreas; Nagy, Ladislav

    2013-01-01

    Background There are various technical variations to consider when performing a corrective osteotomy of a distal radius malunion. We chose two of the more commonly reported techniques and compared the results of volar (palmar) osteotomy and fixation with dorsal osteotomy and fixation. Method Within a continuous cohort of patients who had undergone corrective osteotomy for a malunited Colles fracture, two groups could be identified retrospectively. In 8 patients a dorsal approach was used. A structural trapezoidal graft, subtending the amount of correction, was inserted into the osteotomy gap and stabilization was performed with a thin round-hole mini-fragment plate. In 14 patients a palmar approach and a palmar fixed-angle plate was used for correction of the malunion and for angular stable rigid fixation of the two fragments. The osteotomy gap was loosely filled with nonstructural cancellous bone chips. A retrospective comparison of the two groups was performed to see whether the outcome was affected by the use of either operative technique.The demographics, the preoperative amount of deformity, range of motion, pain, and force were comparable for both groups. All osteotomies healed without loss of correction. After a minimal follow-up of one year, radiographic appearance, objective functional parameters were assessed and subjective data (Disabilities of the Arm, Shoulder, and Hand [DASH] score and special pain and function questionnaire) obtained. Results These data did not show statistical difference for the two groups except for the amount of final wrist flexion. This parameter was significantly better in patients who had palmar approaches and fixed-angle plates. Conclusion Corrective osteotomies of distal radius malunions can be done in either way. It might result in some better flexion, if performed volarly. PMID:24436789

  13. Distal radius fractures-Design of locking mechanism in plate system and recent surgical procedures.

    PubMed

    Inagaki, Katsunori; Kawasaki, Keikichi

    2016-05-01

    Recently, many studies have emphasized the importance of the comprehension of detailed functional anatomy of the distal forearm and wrist joint, and their biomechanics. A significant contribution which yields good functional outcomes of surgical treatment was the development of the locking plate technology; this technology has facilitated the improvement of the surgical technique for the fixation of fractures. This article reviews the locking mechanism and design of the fixation screws and plate, and the details of the surgical technique including the double-tired subchondral support procedure as it is applied to common fractures. Arthroscopic-assisted surgical procedures can be used to reduce the intra-articular fracture fragments after realignment of the distal radius with the locking plate. This technique is also useful at the time of fixation to assess soft tissue injury. The combination of arthroscopic-assisted reduction and locking plate fixation is now indicated for AO type C2 and C3 intra-articular comminuted fractures. PMID:27006135

  14. The Effects of Screw Length on Stability of Simulated Osteoporotic Distal Radius Fractures Fixed with Volar Locking Plates

    PubMed Central

    Wall, Lindley B.; Brodt, Michael D.; Silva, Matthew J.; Boyer, Martin I.; Calfee, Ryan P.

    2013-01-01

    Purpose Volar plating for distal radius fractures has caused extensor tendon ruptures secondary to dorsal screw prominence. This study was designed to determine the biomechanical impact of placing unicortical distal locking screws and pegs in an extra-articular fracture model. Methods Volar-locking distal radius plates were applied to 30 osteoporotic distal radius models. Radii were divided into 5 groups based on distal locking fixation: bicortical locked screws, 3 lengths of unicortical locked screws (abutting the dorsal cortex [full length], 75% length, and 50% length to dorsal cortex), and unicortical locked pegs. Distal radius osteotomy simulated a dorsally comminuted, extra-articular, fracture. Each constructs stiffness was determined under physiologic loads (axial compression, dorsal bending volar bending) before and after 1000 cycles of axial conditioning and prior to axial loading to failure (2mm of displacement) and subsequent catastrophic failure. Results Cyclic conditioning did not alter constructs stiffness. Stiffness to volar bending and dorsal bending forces were similar between groups. Final stiffness(N/mm) under axial load was statistically equivalent for all groups: bicortical screws(230), full-length unicortical screws(227), 75% length unicortical screws(226), 50% length unicortical screws(187), unicortical pegs(226). Force(N) at 2 mm displacement was significantly less for 50% length unicortical screws(311) compared to bicortical screws(460), full-length unicortical screws(464), 75% length unicortical screws(400), and unicortical pegs(356). Force(N) to catastrophic fracture was statistically equivalent between groups but mean values for pegs(749) and 50% length unicortical(702) screws were 16-21% less than means for bicortical(892), full-length unicortical(860), and 75% length(894) unicortical constructs. Discussion Locked unicortical distal screws of at least 75% length produce construct stiffness similar to bicortical fixation. Unicortical

  15. Pathologic fracture of the distal radius in a 25-year-old patient with a large unicameral bone cyst

    PubMed Central

    2014-01-01

    Background Distal radius fractures (DRF) are often referred to as osteoporosis indicator fractures as their incidence increases from age 45. In the group of young adults, distal radius fractures normally result from high-energy trauma. Wrist fractures in young patients without adequate trauma thus raise suspicion of a pathologic fracture. In this report we present the case of a fractured unicameral bone cyst (UBC) at the distal radius in a young adult. To the author’s best knowledge, this is the first detailed report in an UBC at the distal radius causing a pathologic DRF in an adult patient. Case presentation A 25-year-old otherwise healthy male presented to our Emergency Department after a simple fall on his right outstretched hand. Extended diagnostics revealed a pathologic, dorsally displaced, intra-articular distal radius fracture secondary to a unicameral bone cyst occupying almost the whole metaphysis of the distal radius. To stabilize the fracture, a combined dorsal and volar approach was used for open reduction and internal fixation. A tissue specimen for histopathological examination was gathered and the lesion was filled with an autologous bone graft harvested from the ipsilateral femur using a reamer-irrigator-aspirator (RIA) system. Following one revision surgery due to an intra-articular step-off, the patient recovered without further complications. Conclusions Pathologic fractures in young patients caused by unicameral bone cysts require extended diagnostics and adequate treatment. A single step surgical treatment is reasonable if fracture and bone cyst are treated appropriately. Arthroscopically assisted fracture repair may be considered in intra-articular fractures or whenever co-pathologies of the carpus are suspected. PMID:24925068

  16. Radiographic and Arthroscopic Assessment of DRUJ Instability Due to Foveal Avulsion of the Radioulnar Ligament in Distal Radius Fractures

    PubMed Central

    Nakamura, Toshiyasu; Iwamoto, Takuji; Matsumura, Noboru; Sato, Kazuki; Toyama, Yoshiaki

    2014-01-01

    Background As the triangular fibrocartilage complex (TFCC) anchors the distal radius to the ulna via the radioulnar ligament (RUL), a severely displaced distal fragment of the radius may be associated with a foveal avulsion of the TFCC. The purpose of this retrospective study was to assess, radiographically and arthroscopically, the relationship between displacement of the radius, the ulnar styloid, and avulsion of the RUL resulting in distal radioulnar joint (DRUJ) instability. Materials and Methods Twenty-nine wrists of 29 patients with intra- and extra-articular distal radius fractures/malunion who underwent reduction or a corrective osteotomy of the displaced/malunited fracture, and/or wrist arthroscopy, were assessed radiographically and arthroscopically. Radial translation, radial inclination, radial shortening, volar or dorsal tilt, and the presence of an ulnar styloid fracture with more than 4 mm of displacement were measured from the initial films. Radiocarpal arthroscopy was used to assess peripheral lesions of the TFCC, while DRUJ arthroscopy was used to assess the foveal attachment. The relationship between displacement of the distal radius or the ulnar styloid fracture and the TFCC injury, including avulsion of the RUL, was recorded. Results Univariate analysis revealed that increased radial translation, decreased radial inclination, increased radial shortening, and an ulnar styloid fragment radially displaced by more than 4 mm were significant predictors of RUL avulsion at the fovea. Volar or dorsal tilt of the radius and ulnar variance did not correlate with RUL avulsion or TFCC injuries. Multiple logistic regression analysis revealed that radial translation was an independent risk factor of foveal avulsion of the RUL. Conclusions Increased radial translation and radial shortening and decreased radial inclination of the distal fragment can be associated with a foveal avulsion of the RUL. Radial translation can be an independent risk

  17. Radiographic and Arthroscopic Assessment of DRUJ Instability Due to Foveal Avulsion of the Radioulnar Ligament in Distal Radius Fractures.

    PubMed

    Nakamura, Toshiyasu; Iwamoto, Takuji; Matsumura, Noboru; Sato, Kazuki; Toyama, Yoshiaki

    2014-02-01

    Background As the triangular fibrocartilage complex (TFCC) anchors the distal radius to the ulna via the radioulnar ligament (RUL), a severely displaced distal fragment of the radius may be associated with a foveal avulsion of the TFCC. The purpose of this retrospective study was to assess, radiographically and arthroscopically, the relationship between displacement of the radius, the ulnar styloid, and avulsion of the RUL resulting in distal radioulnar joint (DRUJ) instability. Materials and Methods Twenty-nine wrists of 29 patients with intra- and extra-articular distal radius fractures/malunion who underwent reduction or a corrective osteotomy of the displaced/malunited fracture, and/or wrist arthroscopy, were assessed radiographically and arthroscopically. Radial translation, radial inclination, radial shortening, volar or dorsal tilt, and the presence of an ulnar styloid fracture with more than 4 mm of displacement were measured from the initial films. Radiocarpal arthroscopy was used to assess peripheral lesions of the TFCC, while DRUJ arthroscopy was used to assess the foveal attachment. The relationship between displacement of the distal radius or the ulnar styloid fracture and the TFCC injury, including avulsion of the RUL, was recorded. Results Univariate analysis revealed that increased radial translation, decreased radial inclination, increased radial shortening, and an ulnar styloid fragment radially displaced by more than 4 mm were significant predictors of RUL avulsion at the fovea. Volar or dorsal tilt of the radius and ulnar variance did not correlate with RUL avulsion or TFCC injuries. Multiple logistic regression analysis revealed that radial translation was an independent risk factor of foveal avulsion of the RUL. Conclusions Increased radial translation and radial shortening and decreased radial inclination of the distal fragment can be associated with a foveal avulsion of the RUL. Radial translation can be an independent risk

  18. Variation in practice habits in the treatment of pediatric distal radius fractures.

    PubMed

    Bernthal, Nicholas M; Mitchell, Scott; Bales, Joshua G; Benhaim, Prosper; Silva, Mauricio

    2015-09-01

    Distal radius fractures are widespread in the pediatric population. Standardized treatment protocols have not been well defined. We sought to examine the diversity of current practice patterns in the treatment of these fractures by surveying hand, pediatric, and general orthopedic surgeons. Hand, pediatric, and general orthopedic surgeons were surveyed using an internet-based questionnaire on the management of pediatric distal radius fractures. Each surgeon was asked to select a criterion from among choices of 'acceptable' alignment criteria at the onset of the survey. Ten cases were then provided to represent a broad spectrum of injuries from minimally angulated torus fractures to complete, displaced fractures. In addition to the variation in injury pattern, the patients in the survey differed in age at the time of injury (3-15 years of age). For each case, surgeons were asked to select a preferred treatment, first on the basis of injury films, and then again after reviewing 1-week follow-up radiographs. A total of 781 surgeons completed the survey. In patients younger than 9 years of age, a residual sagittal angulation of 20° or less, coronal angulation of 10° or less, and 1 cm or less of bayonet apposition was deemed 'acceptable' by 88, 90, and 69% of respondents, respectively. In older patients, these percentages were 58, 64, and 29%, respectively. When specific cases were reviewed, 20.3% of surgeons recommended treatment different from their own theoretical 'acceptable' criteria. When subspecialty training was analyzed, hand surgeons and general orthopedic surgeons were 2.9 and 1.6 times more likely to recommend surgery, respectively, as compared with pediatric surgeons after viewing the initial radiograph. Private practice surgeons were 1.5 times more likely to recommend surgery compared with academic surgeons based on the initial injury radiographs. Our survey highlights the discordance between theoretical acceptable criteria of surgeons and their

  19. Interindividual anatomical variations affect the plate-to-bone fit during osteosynthesis of distal radius fractures.

    PubMed

    Yoneda, Hidemasa; Iwatsuki, Katsuyuki; Hara, Tatsuya; Kurimoto, Shigeru; Yamamoto, Michiro; Hirata, Hitoshi

    2016-06-01

    We hypothesized that interindividual variations in the teardrop, which represents the volar projection of the lunate facet of the distal radius, cause unsatisfactory fitting of the volar locking plate to the bone. This can cause flexor tendon ruptures. Herein, we conducted a cross-sectional study and measured the ratio of teardrop height and the teardrop inclination angle as parameters of teardrop configuration for 200 standardized lateral radiographs (average age of the patients, 51 years). We also quantified the influence of the teardrop morphology by analyzing the fit of three locking plates to three radii with differing teardrop inclination angles using a three-dimensional computer-aided design system. The average ratios of the teardrop height and teardrop inclination angle were 0.42° (0.30-0.56°) and 28.8° (9.9-44.9°), respectively. The teardrop inclination angle was moderately correlated with age in men but not in women. In the plate-to-bone fit analyses, the fit of all the plates was significantly different between bones, with the configuration of the radius with the lowest teardrop inclination angle being the closest approximation to that of each plate. We demonstrated the interindividual variation in the shape of the teardrop and its influence on the fit of the volar plate, highlighting the importance of careful plate selection for achieving osteosynthesis of bones with a high teardrop inclination angle. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:953-960, 2016. PMID:26648456

  20. Comparison of conservative and operative treatment for distal radius fracture: a meta-analysis of randomized controlled trials

    PubMed Central

    Song, Jian; Yu, Ai-Xi; Li, Zong-Huan

    2015-01-01

    Background: The authors conducted a meta-analysis to compare the effectiveness and safety of conservative and operative treatment for distal radius fracture. Methods: PubMed, EMBASE, and the Cochrane Library were searched to identify the relevant studies published up to February of 2015. All randomized controlled trials published to compare the conservative and operative treatment were included in the study. Results were pooled using meta-analysis to compare the efficacy and safety of conservative and operative treatment for distal radius fracture. Results: The databases were derived from seven qualified studies that included a total of 523 patients in which 269 cases adopted conservative treatment while 253 cases adopted operative treatment. Overall, compared with the conservative treatment- treated the distal radius fracture, operative therapies resulted in significantly better radiographic (P<0.05), however, no significant differences of the functional outcomes and complication rate were observed between the two methods (P>0.05). Conclusion: Surgical treatment seems to be more effective distal radius fracture compared with conservative treatment when the radiographic outcomes were analyzed, and no significant differences were deteched in the functional outcomes and complication rate. PMID:26770293

  1. Use of a new exsanguination tourniquet in internal fixation of distal radius fractures.

    PubMed

    Norman, Doron; Greenfield, Inbal; Ghrayeb, Nabil; Peled, Eli; Dayan, Lior

    2009-12-01

    We describe our experience using a new device that results in a bloodless field in open repair of distal radius fractures. The device, an exsanguinating tourniquet (HemaClear model/40, OHK Medical Devices, Haifa, Israel), replaces the traditional methods of limb elevation, Esmarch bandaging, pneumatic tourniquet pressurizing and the associated components. HemaClear/40 is an elastic silicon ring with a tubular elastic sleeve rolled onto it. The device has attached straps that, when pulled, unroll the sleeve, rolling the ring mesially on the limb. The pressure exerted by rolling HemaClear/40 is supra-systolic thereby exsanguinating the limb and occluding the arterial inflow. Our experience in 49 patients demonstrated quick application, superior exsanguination and that the device could be placed on the forearm instead of the upper arm. No side effects or complications were noted. In our opinion, the fact that HemaClear/40 is a sterile, single-patient device makes it superior over the traditional technology. PMID:19956041

  2. Arthroscopic study of injuries in articular fractures of distal radius extremity

    PubMed Central

    Araf, Marcelo; Mattar, Rames

    2014-01-01

    OBJECTIVE: To analyze the incidence of wrist ligament and cartilage associated fractures of the distal radius, through arthroscopy, correlating with AO/ASIF classification. METHODS: Thirty patients aged between 20 and 50 years old, with closed fracture from groups B and C according to AO/ASIF classification were selected. All of them were submitted to wrist arthroscopy to address intra-articular injuries and reduction and osteosynthesis of the fracture. RESULTS: A high incidence of intra-articular injuries was noticed, and 76.6% of them presented injury of the triangular fibrocartilage complex, 36.6% of the intrinsic scapholunate ligament, 6.6% of the intrinsic triquetrolunate ligament, and 33% articular cartilage injury larger than three millimeters. Patients with fractures from type C according to AO/ASIF classification presented a higher incidence of ligament injuries. CONCLUSION: There is no relationship between the presence of chondral injury and the AO/ASIF classification of the fractures in the cases reported in this study. Level of Evidence III, Non Randomized Controlled Trial. PMID:25061421

  3. Arthroscopic management of volar lunate facet fractures of the distal radius.

    PubMed

    Wiesler, Ethan R; Chloros, George D; Lucas, Robert M; Kuzma, Gary R

    2006-09-01

    The clinical outcome of an intraarticular distal radius fracture is generally thought to be associated with the following factors: amount of radial deformity, joint congruity, and associated soft-tissue injuries. The proposed technique to manage this fracture pattern that involves a displaced volar lunate facet fragment uses wrist arthroscopy and pinning. Distraction of the fracture before arthroscopy is accomplished either by external fixation or by the arthroscopy tower. A freer elevator is introduced dorsally to disimpact the fragments, and next, a nerve hook is used to reduce the volar lunate facet, which is subsequently pinned to the radial styloid. The remaining fragments are reduced with interfragmentary pin fixation, and this anatomical articular construct is fixed to the radial metaphysis. The advantages of this technique are: (a) accurate assessment of articular congruency by direct visualization, (b) identification and repair of associated lesions, and (c) minimal soft tissue disruption. Potential disadvantages of external fixation supplemented by interfragmentary pins may be that it does not provide for rigid stable fixation, and therefore, does not allow for early motion compared to open reduction and internal fixation. Furthermore, it is technically challenging, and is therefore suggested as an alternative for the aforementioned fracture pattern. PMID:16974217

  4. Corrective distal radius osteotomy following fracture malunion using a fixed-angle volar locking plate.

    PubMed

    Opel, S; Konan, S; Sorene, E

    2014-05-01

    Post-traumatic distal radius deformity may cause severe morbidity, and corrective osteotomy is often necessary to realign the functional axis of the wrist to correct symptomatic malunion. The aim of this retrospective study was to review the short-term results of a single surgeon’s series of distalradius corrective osteotomies following fracture malunion using a fixed-angle volar locking plate for 20 patients(16 women) of an average age of 57 (range 19–83) years [corrected].At short-term follow up (average 14 months, range 12-15 months), no complications were noted and radiological union was confirmed in all cases at an average of 3 months. The average post-operative Disability of the Arm, Shoulder and Hand score was 13.48 (range 0-48.33) and an objective improvement was noted in movements at the wrist joint. A statistically significant improvement was achieved in ulnar variance, radial inclination, dorsal tilt, and supination. PMID:24051477

  5. Stabilization of Volar Ulnar Rim Fractures of the Distal Radius: Current Techniques and Review of the Literature.

    PubMed

    O'Shaughnessy, Maureen A; Shin, Alexander Y; Kakar, Sanjeev

    2016-05-01

    Background Distal radius fractures involving the lunate facet can be challenging to manage. Reports have shown the volar carpal subluxation/dislocation that can occur if the facet is not appropriately stabilized. Literature Review Recent emphasis in the literature has underscored the difficulty in managing this fracture fragment, suggesting standard volar plates may not be able to adequately stabilize the fragment. This article reviews the current literature with a special emphasis on fixation with a specifically designed fragment-specific hook plate to secure the lunate facet. Case Description An extended flexor carpi radialis volar approach was made which allows access to the distal volar ulnar fracture fragment. Once provisionally stabilized with Kirschner wire fixation, a volar hook plate was applied to capture this fragment. Additional fracture stabilization was used as deemed necessary to stabilize the remaining distal radius fracture. Clinical Relevance The volar marginal rim fragment remains a challenge in distal radius fracture management. Use of a hook plate to address the volar ulnar corner allows for stable fixation without loss of reduction at intermediate-term follow-up. PMID:27104076

  6. Morphology of distal radius curvatures: a CT-based study on the Malaysian Malay population

    PubMed Central

    Singh, Taran Singh Pall; Sadagatullah, Abdul Nawfar; Yusof, Abdul Halim

    2015-01-01

    INTRODUCTION The purpose of this study was to examine the differing curves of the volar distal radius of healthy Malaysian Malays, so as to obtain detailed morphological information that will further the understanding of volar plate osteosynthesis in Malaysian Malays. METHODS Computed tomography with three-dimensional reconstruction was performed on the wrists of 16 healthy Malaysian Malay volunteers. Profile measurements were made using a software program. A novel parameter, the pronator quadratus curve angle, was explored and introduced in this study. Interclass correlation coefficients were calculated to assess the level of agreement between the data collected by the principal investigator and that collected by an independent radiologist. RESULTS The mean ± standard deviation of the arc radii on the radial aspect was 17.50° ± 5.40°, while the median (interquartile range [IQR]) of the arc radii on the ulnar aspect was 25.27° (IQR 5.80°). The mean ± standard deviation of the curvature of the pronator quadratus line was 40.52° ± 2.48°. The arc radii on the radial aspect was significantly lower than the arc radii on the ulnar aspect (p = 0.001). Different radial and ulnar arcs were observed in 56.25% of the radii; the arc was deeper on the ulnar aspect in 93.75% of the radii. CONCLUSION Based on the findings of this study, the likelihood of achieving anatomical reduction with uniformly curved, fixed-angle volar plates is questionable. Changes in the design of these implants may be needed to optimise their usage in the Malaysian Malay population. PMID:25814075

  7. Comparing Morbidities of Bone Graft Harvesting from the Olecranon Process and the Distal Radius

    PubMed Central

    Micev, Alan J.; Slikker, William; Ma, Madeleine; Richer, Ross J.; Cohen, Mark S.

    2016-01-01

    Background: The aim of this study is to compare donor-site morbidities between patients who underwent bone graft harvesting from either the olecranon process (OP) or the distal radius (DR). Methods: We evaluated 44 patients who underwent bone graft harvesting from the OP (25 cases) or the DR (19 cases) for various procedures in the ipsilateral upper extremity. Follow-up averaged 14 (OP group) and 19 months (DR group). Outcome measures included visual analog scales (VAS) for graft harvest-site pain and scar appearance, joint motion, and x-rays of the graft harvest and recipient sites. The VAS scores ranged from 0 to 10 with a low score reflecting no pain and excellent satisfaction and a high score reflecting severe pain and poor satisfaction. Results: The VAS scores for pain averaged 0.4 (OP) and 0.5 (DR), and the VAS scores for scar appearance averaged 0.3 (OP) and 0.7 (DR). These differences were not significant. Within each group, there were no significant differences between the operative and nonoperative limbs for elbow or wrist motion. Early graft harvest-site complications involved 1 superficial wound infection (OP) and 1 wound dehiscence (DR). A graft harvest-site defect was detected by x-ray in 84% of OP cases and in 67% of DR cases. Bone healing at the graft recipient sites was observed in more than 87% of cases in both groups. Conclusions: Bone graft harvesting from either the OP or the DR led to comparable patient- and evaluator-determined outcomes with low risks of complications. Surgeons can safely use either option. PMID:27014552

  8. [Retrospective analysis of consecutively treated distal radius fractures with the external fixator].

    PubMed

    Melik, N; Togninalli, D; Biegger, P

    1994-12-01

    The purpose of this study was to determine retrospectively some subjective and objective parameters following the operative treatment of 32 patients with "complex" (intraarticular and/or comminuted) fractures of the distal radius using the small AO external fixation device. The mean follow-up period was 20 months (minimum 4, maximum 48) and the mean age of the subjects was 62 years (minimum 27, maximum 91). Subjective results such as "general feeling", mobility, strength and pain, expressed with a scoring system (% of maximum obtainable points), showed an overall good result and ranged between 71% (pain), 81% (strength) and 91% (mobility and "general feeling"). Regarding the objective results, no major skin or soft tissue distress (Sudeck dystrophy) was noted. However, there was a general tendency towards a mobility deficit of the wrist operated on, which was statistically significant (P < 0.01) for flexion, extension, supination and abduction (respectively, -17.7%, -12.4%, -7.1% and -12.5%). The late standard radiological and lateral controls showed a mean radial angle of +2.13 degrees (B or lateral radial angle) and +23.13 degrees (A or AP angle), respectively. The analysis of data, as expressed by time after operation (< or > than 10 months), showed no relevant difference between the two groups (age of both similar), as expressed by age (< or > than 60 years); the data only showed differences in strength and pain (scores by 92% vs 82% for force and 92% vs 76% for pain) and in flexion and extension (-22.8% and -14%, P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:7855610

  9. Comparison of Risk of Carpal Tunnel Syndrome in Patients with Distal Radius Fractures After 7 Treatments

    PubMed Central

    Zhao, Huan-Li; Wang, Gui-Bin; Jia, Yue-Qing; Zhu, Shi-Cai; Zhang, Feng-Fang; Liu, Hong-Mei

    2015-01-01

    Background To compare risk of carpal tunnel syndrome (CTS) in distal radius fracture (DRF) patients after 7 treatments using bridging external fixation (BrEF), non-bridging external fixation (non-BrEF), plaster fixation, K-wire fixation, dorsal plating fixation, volar plating fixation, and dorsal and volar plating by performing a network meta-analysis. Material/Methods An exhaustive search of electronic databases identified randomized controlled trails (RCTs) closely related to our study topic. The published articles were screened, based on predefined inclusion and exclusion criteria, to select high-quality studies for the present network meta-analysis. Data extracted from the selected studies were analyzed using STATA version 12.0 software. Results The literature search and selection process identified 12 eligible RCTs that contained a total of 1370 DRF patients (394 patients with BrEF, 377 patients with non-BrEF, 89 patients with K-wire fixation, 192 patients with plaster fixation, 42 patients with dorsal plating fixation, 152 patients with volar plating fixation, and 124 patients with dorsal and volar plating fixation). Our network meta-analysis results demonstrated no significant differences in CTS risk among the 7 treatments (P>0.05). The value of surface under the cumulative ranking curve (SUCRA), however, suggested that dorsal plating fixation is the optimal treatment, with the lowest risk of CTS in DRF patients (dorsal plating fixation: 89.2%; dorsal and volar plating: 57.8%; plaster fixation: 50.9%; non-BrEF: 50.6%; volar plating fixation: 39.6%; BrEF: 38.4%; K-wire fixation: 23.6%). Conclusions Our network meta-analysis provides evidence that dorsal plating fixation significantly decreases the risk of CTS and could be the method of choice in DRF patients. PMID:26391617

  10. A comparative study of fragment specific versus volar plate fixation of distal radius fractures

    PubMed Central

    Sammer, Douglas M.; Fuller, Douglas S.; Kim, Myra Hyungjin; Chung, Kevin C.

    2015-01-01

    Background There are many plating systems available for treating distal radius fractures (DRFs), and the decision of which type to use can be difficult. This is a prospective cohort study that compares outcomes of two commonly used fixation systems: fragment specific fixation (FSF) and a fixed-angle volar locking plate system (VLPS). Methods Two cohorts of consecutive DRFs were prospectively evaluated. The first cohort was treated with FSF and the second with a VLPS. Radiographic, functional, and patient-rated outcomes (MHQ) were collected immediately post-operatively, and at six and twelve months post-operatively. Complications were recorded and graded by severity. Results Fourteen DRFs treated with FSF and eighty-five DRFs treated with the VLPS were enrolled. At final follow-up, radial inclination was similar in both cohorts (23° vs. 25°); however, volar tilt was worse in the FSF cohort (−10° vs. 10°, p<0.05). Additionally, the majority of the FSF cohort demonstrated a loss of relative radial length (63% of cohort with positive ulnar variance). Grip strength, pinch strength, MHQ scores, and most ROM measurements were superior in the VLPS cohort at 6 months, although not all differences were statistically significant. By 12 months the differences in functional and patient-rated outcomes were smaller, suggesting that the FSF cohort tended to reach the outcomes of the VLPS cohort over time. Complications requiring re-operation were higher in the FSF cohort (p<0.05). Conclusions The VLPS results in more stable fixation and better objective and subjective outcomes early in the post-operative period. It has fewer complications requiring re-operation than FSF. PMID:18971728

  11. Quantitative bone ultrasound at the distal radius in adults with cystic fibrosis.

    PubMed

    Roggen, Inge; Louis, Olivia; Van Biervliet, Stephanie; Van Daele, Sabine; Robberecht, Eddy; De Wachter, Elke; Malfroot, Anne; De Waele, Kathleen; Gies, Inge; Vanbesien, Jesse; De Schepper, Jean

    2015-01-01

    It is of clinical importance to identify bone disease related to cystic fibrosis (CF) early in its course to allow therapeutic interventions that optimize bone health. To test the technical (precision) and clinical (percentage of abnormal results, correlation with clinical parameters) performance of a commercial quantitative ultrasound apparatus for radial measurements, speed of sound (SOS) was measured at the distal third of the left radius with the Omnisense 7000p apparatus (Sunlight Medical, Tel-Aviv, Israel) in a group of young adult CF patients with regular follow-up at the Brussels and Ghent University Hospital. Sixty-three (37 males) CF patients at a median (range) age of 23.5 y (18.1-39.9) were included. SOS, SOS z-score and SOS t-score were respectively 4017 ± 97 m/s, -0.31 ± 0.74 and -0.60 ± 0.78 in males and 4086 ± 97 m/s, -0.19 ± 0.75 and -0.51 ± 0.95 in females. Mean SOS t-score was significantly lower compared with the manufacturer's reference data for males (p < 0.0001) and females (p = 0.01). SOS z- and t-scores correlated with weight z-score and body mass index z-score in females. No significant correlation was found between SOS and forced expiratory volume in 1 s (%). Neither diabetes mellitus nor liver disease was found to influence SOS. Radial quantitative ultrasound has a precision of 0.55%. The SOS is in the low normal range in 14% of CF patients and is influenced by weight in female patients, but not by the severity of the lung disease. PMID:25438860

  12. SURGICAL TREATMENT OF DISTAL RADIUS FRACTURES WITH A VOLAR LOCKED PLATE: CORRELATION OF CLINICAL AND RADIOGRAPHIC RESULTS

    PubMed Central

    Xavier, Claudio Roberto Martins; Dal Molin, Danilo Canesin; dos Santos, Rafael Mota Marins; dos Santos, Roberto Della Torre; Neto, Julio Cezar Ferreira

    2015-01-01

    Objectives: To analyze and correlate the clinical and radiographic results from patients with distal radius fractures who underwent surgical treatment with a fixed-angle volar locked plate. Methods: Sixty-four patients with distal radius fractures were evaluated. They all underwent surgical treatment with a volar locked plate for the distal radius, with a minimum of six months of postoperative follow-up. They underwent a physical examination that measured range of motion and grip strength, answered the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire and underwent radiographic examination. Results: In the physical examination on the patients, all the range-of-motion measurements were reduced. Grip strength measured in kgf was on average 85.8% of the strength on the unaffected side. The mean DASH score was 15.99. A significant relationship was found between lower DASH scores and losses of extension and grip strength. On the radiographs, the mean values in relation to the unfractured side were 84.0% for radial inclination, 85.4% for radial length and 86.8% for volar deviation of the radius. Loss of radial length was correlated with losses of extension and grip strength. PMID:27027046

  13. STATISTICAL ANALYSIS ON FUNCTIONAL AND RADIOGRAPHIC RESULTS AFTER USE OF LOCKED VOLAR PLATE FOR FRACTURES OF THE DISTAL RADIUS

    PubMed Central

    Machado, Daniel Gonçalves; da Cruz Cerqueira, Sergio Auto; Rodarte, Rodrigo Ribeiro Pinho; de Souza Araújo Netto, Carlos Alberto; de Mathias, Marcelo Bezerra

    2015-01-01

    Objectives: To evaluate the functional results from using a fixed-angle locked volar plate for treating fractures of the distal extremity of the radius, using the DASH (disorders of the arm, shoulder and hand) questionnaire and its radiographic correlation with the Lidström classification. Methods: Thirty patients with unstable fractures of the distal extremity of the radius were evaluated after they had undergone a surgical procedure consisting of open reduction and internal fixation using a fixed-angle locked volar plate, at the Military Police Central Hospital of Rio de Janeiro between 2008 and 2009. The results were assessed based on range of motion, DASH protocol scores and radiographies with the Lidström classification. Results: The mean age of the patients in the study was 51 years. The mean DASH score was 11.9 points. It was observed that the radiographic findings did not influence the DASH score. It was found that flexion, pronation, supination and radial deviation correlated with the DASH score. Conclusions: The study showed that subjective functional outcomes using the DASH protocol, obtained from using a locked volar plate to treat fractures of the distal extremity of the radius, are influenced by the range of motion, and especially by the flexion, supination, pronation and radial deviation of the wrist after surgery. There is no correlation between the radiological parameters of either the normal or the operated radius, and the subjective functional outcomes assessed using the DASH protocol. PMID:27042637

  14. Assessing angulation on digital images of radiographs of fractures of the distal radius: visual estimation versus computer software measurement.

    PubMed

    Robertson, G A J; Robertson, B F M; Thomas, B; McEachan, J; Davidson, D M

    2011-03-01

    We assessed the reliability of visual estimation of angles on computer images of radiographs, and compared their accuracy with the measurement of angles using computer software for ten distal radius fractures. We asked 73 clinicians to visually estimate the dorsal angulation on ten computerized radiographs of fractures of the distal radius. The reliability of these estimations was calculated. Their accuracy was compared to a 'gold standard' obtained by consensus agreement between three consultants measuring these angles using the software. Inter-observer reliability was calculated as ICC = 0.51 and intra-observer reliability as r = 0.76. The visual estimations were less accurate with a mean percentage error of 31% (range, 7-83%). As angulation increased the estimation accuracy improved. Although reliability and accuracy of such estimation was better for clinicians with greater experience, actual measurement was more reliable and accurate. PMID:21169298

  15. Distal Radius Fracture Hematoma Block with Combined Lidocaine and Bupivacaine can induce Seizures while within Therapeutic Window: A Case Report

    PubMed Central

    Dezfuli, Bobby; Edwards, Christopher J.; DeSilva, Gregory L

    2012-01-01

    Introduction: Hematoma blocks are effective pain management modalities for closed reduction of distal radius fractures. Complications of hematoma blocks are associated with systemic reaction to anesthetic used. Case Report: We present a case report of an elderly patient who received a hematoma block of lidocaine and bupivacaine for a distal radius fracture and subsequently developed a generalized tonic clonic seizure. The dose of both lidocaine and bupivacaine were well within the suggested dose limit. The episode was self limiting and patient had the cast applied. Conclusions: We conclude that hematoma blocks with a combination of anesthetics may decrease the threshold to neurologic complications, especially in elderly patients. Precautions and ready treatment measures should be made available while performing closed reduction

  16. Distal radius fixation through a mini-invasive approach of 15 mm. PART 1: a series of 144 cases.

    PubMed

    Lebailly, Frédéric; Zemirline, Ahmed; Facca, Sybille; Gouzou, Stéphanie; Liverneaux, Philippe

    2014-08-01

    The volar Henry approach is becoming the gold standard for distal radius fracture fixation. It decreases the incidence of nonunion, limits complications especially complex regional pain syndrome (CRPS) type I, and allows early mobilization of the wrist. Nonetheless, it has some disadvantages such as the size of the incision, which is not esthetically pleasing, and the loss of ligamentotaxis. This is why some authors have developed a mini-invasive approach. The aim of this work was to evaluate the feasibility of the anterior mini-invasive approach of 15 mm in a clinical series of 144 cases of distal radius fracture. All patients were operated under regional anesthesia using the same techniques by five surgeons of the same team. According to the AO classification, there were 83 type A fractures, 2 type B, and 59 type C. A volar plate (Step One(®), Newclip Technics™, Haute-Goulaine, France) was used in all cases. The 2 proximal metaphyseal screws and the 2 distal central epiphyseal screws were monoaxial locking. The 2 distal ulnar and radial epiphyseal screws were placed in polyaxial locking at 20° angulation maximum. Skin closure without drainage was performed. No postoperative immobilization was prescribed, and patients were encouraged to use their upper limb immediately postoperative. No postoperative physiotherapy was prescribed. The mean follow-up was 4.1 months. The final size of the incision was on average 16.1 mm. Mean pain score was 1.8. The Quick DASH score was average 25. Average range of motion was more than 85 %, and global force of the hand was 67 % compared with contralateral side. On X-ray, the mean radial slope was 22°, the mean radial tilt was 8.3°, and the mean radioulnar variance/index was -0.4 mm. There were nine cases of CRPS type I, which all resolved. Specific complications included two secondary displacements and nine tenosynovitis cases. No tendon rupture was noted. Two intra-articular distal radioulnar joint screws had to be removed at

  17. Possibility of Fixation of a Distal Radius Fracture With a Volar Locking Plate Through a 10 mm Approach.

    PubMed

    Naito, Kiyohito; Zemirline, Ahmed; Sugiyama, Yoichi; Obata, Hiroyuki; Liverneaux, Philippe; Kaneko, Kazuo

    2016-06-01

    The management of distal radius fractures has dramatically improved due to the development of a locking plate system. In addition, mini-invasive surgery has been performed in a lot of surgical fields in recent years. The aim of the present study is to investigate the possibility of fixation of a distal radius fracture with a volar locking plate through a 10 mm approach. Eighteen patients with distal radius fracture (mean age: 66 y; range, 28 to 88 y; 8 males and 10 females) were operated on using a volar locking plate. The incision for plating was always 10 mm long. The clinical, cosmetic, and radiologic outcomes were investigated. At 3 months' follow-up, the range of motion of the wrist joint was 67.5 degrees in flexion, 65.6 degrees in extension, 88.3 degrees in pronation, and 88.3 degrees in supination. The % grip strength compared to the healthy side ranged from 35% to 100%. The VAS, Q-DASH, and modified Mayo scores were 0.7, 8.5, and 93.3, respectively (excellent in all 18 patients). Bone union was achieved on plain x-ray radiography and cosmetic problems were satisfied in all patients. Our results suggest that it is possible to achieve fixation of a distal radius fracture with a volar locking plate through a 10 mm approach. However, its applicability to surgery must be carefully examined. If any difficulties in plate installation or approach occur during this intervention, it will be necessary to consider switching to a conventional approach. We believe that surgeons must not adhere to a mini-invasive approach. PMID:27015408

  18. Osteosynthesis in Distal Radius Fractures with Conventional Bridging External Fixator; Tips and Tricks for Getting Them Right

    PubMed Central

    Chilakamary, Vamshi Krishna; Koppolu, Kiran Kumar; Rapur, Shivaprasad

    2016-01-01

    Background Distal radius fractures are the commonest fractures occurring in the upper extremity, accounting for 15-20% of patients treated in emergency department. Although distal radial fractures were described 200 years ago, they still remain as unsolved fractures with no clear guidelines. It is often reported that anatomical reduction has a bearing on the functional outcome. Aim To study the management of distal end radius fracture by utilizing the principle of ligamentotaxis where in the reduction obtained by closed means is maintained by external fixator till solid bony union occurs. Materials and Methods A total of 26 cases were selected for study by scrutiny of the inclusion and exclusion criteria. Most of our cases were treated with external fixator within 8 hrs of injury. Small A.O external fixator (bridging ex-fix) with 2 pins each in radius and 2nd metacarpal percutaneously was used for all the cases. Selective k wire fixation was done in cases of instability. Fixator was removed after 6 weeks. Guided physiotherapy was ensured in all the cases. Patients were followed up for an average of 9 months. Results Modified Gartland and Werley scoring system was used to evaluate the overall functional results. Excellent to good results were achieved in 88.45% of our cases while fair result was in 11.54 %. One case had pin loosening and two other cases had malunion. Conclusion External fixator used for ligamentotaxis is an effective method of treating unstable extraarticular and complex intraarticular fractures of distal radius. Improved anatomical restoration with early rehabilitation has produced favourable functional outcome in our series. The complications like pin tract infection is rare due to the availability of superior antibiotics and sterile surgical technique. complications like wrist and finger stiffness has improved with physiotherapy. PMID:26894133

  19. Effectiveness of external fixator combined with T-plate internal fixation for the treatment of comminuted distal radius fractures.

    PubMed

    Han, L R; Jin, C X; Yan, J; Han, S Z; He, X B; Yang, X F

    2015-01-01

    This study compared the efficacy between external fixator combined with palmar T-plate internal fixation and simple plate internal fixation for the treatment of comminuted distal radius fractures. A total of 61 patients classified as type C according to the AO/ASIF classification underwent surgery for comminuted distal radius fractures. There were 54 and 7 cases of closed and open fractures, respectively. Moreover, 19 patients received an external fixator combined with T-plate internal fixation, and 42 received simple plate internal fixation. All patients were treated successfully during 12-month postoperative follow-up. The follow-up results show that the palmar flexion and dorsiflexion of the wrist, radial height, and palmar angle were significantly better in those treated with the external fixator combined with T-plate compared to those treated with the simple plate only (P < 0.05); however, there were no significant differences in radial-ulnar deviation, wrist range of motion, or wrist function score between groups (P > 0.05). Hence, the effectiveness of external fixator combined with T-plate internal fixation for the treatment of comminuted distal radius fractures was satisfactory. Patients sufficiently recovered wrist, forearm, and hand function. In conclusion, compared to the simple T-plate, the external fixator combined with T-plate internal fixation can reduce the possibility of the postoperative re-shifting of broken bones and keep the distraction of fractures to maintain radial height and prevent radial shortening. PMID:25867441

  20. A prospective study of a modified pin-in-plaster technique for treatment of fractures of the distal radius

    PubMed Central

    Mirghasemi, S. A.; Rashidinia, S.; Sadeghi, M. S.; Talebizadeh, M.; Rahimi, N.

    2015-01-01

    Objectives There are various pin-in-plaster methods for treating fractures of the distal radius. The purpose of this study is to introduce a modified technique of ‘pin in plaster’. Methods Fifty-four patients with fractures of the distal radius were followed for one year post-operatively. Patients were excluded if they had type B fractures according to AO classification, multiple injuries or pathological fractures, and were treated more than seven days after injury. Range of movement and functional results were evaluated at three and six months and one and two years post-operatively. Radiographic parameters including radial inclination, tilt, and height, were measured pre- and post-operatively. Results The average radial tilt was 10.6° of volar flexion and radial height was 10.2 mm at the sixth month post-operatively. Three cases of pin tract infection were recorded, all of which were treated successfully with oral antibiotics. There were no cases of pin loosening. A total of 73 patients underwent surgery, and three cases of radial nerve irritation were recorded at the time of cast removal. All radial nerve palsies resolved at the six-month follow-up. There were no cases of median nerve compression or carpal tunnel syndrome, and no cases of tendon injury. Conclusion Our modified technique is effective to restore anatomic congruity and maintain reduction in fractures of the distal radius. Cite this article: Bone Joint Res 2015;4:176–180 PMID:26541833

  1. Effect and nursing study of traditional Chinese medicine preparation huayu zhitong powder in the treatment of distal radius fracture.

    PubMed

    Wang, Yun; Ning, Huaxiu; Wang, Zhigang

    2015-03-01

    This paper aims to discuss the effect of traditional Chinese medicine preparation Huayu Zhitong powder in the treatment of distal radius fracture. In this paper, 200 patients with distal radius fracture were randomly divided into treatment group and control group. Patients in treatment group orally took Huayu Zhitong powder, while patients in control group were treated with traditional Shangke Jiegu tablets with traditional Chinese medicine composition. After fixed in a cast plaster, patients in the two groups were supervised the disappearance time of pain by adopting NRS (Numerical rating scale) from scale 0 to 10. Besides, they returned at day 5 and day 8 respectively, and then they were observed the swelling affected part. At day 14, day 28, and day 56 after reduction they respectively took an x-ray. Then they would be graded according to the growth of osteotylus and the clinical effects were evaluated based on the grade. Finally, the treatment group worked better in relief effect than the control group. At day 8, the treatment group worked better in detumescence than the control group. At day 28, the recovery effect in treatment group was found to be better than the other. From these, it is shown that the traditional Chinese medicine works much better in the treatment of distal radius fracture than traditional treatment medicine. Thus it is of great worth spreading for use. PMID:25796150

  2. FIXATION OF FRACTURES OF THE DISTAL EXTREMITY OF THE RADIUS USING THE MODIFIED KAPANDJI TECHNIQUE: EVALUATION OF THE RADIOLOGICAL RESULTS

    PubMed Central

    Neto, Antonio Piva; Lhamby, Fabio Colla

    2015-01-01

    To demonstrate a simple and efficacious option for treating fractures of the distal extremity of the radius using Kirschner wires. Methods: Between September 2008 and April 2009, 48 patients with fractures of the distal extremity of the radius, classified as A3 according to the AO classification, were treated surgically using a modification of the Kapandji technique. Results: Out of the 48 wrists operated, 42 (87.5%) presented postoperative measurements within the acceptable limits. We used the parameters of McQuenn and Caspers who considered that the radial angulation should be wider than 19° and the volar angulation should be narrower than -12°. All the postoperative volar inclination measurements were narrower than -3°. The mean preoperative radial inclination was 13.14° and the mean postoperative value was 21.18°. The mean preoperative volar inclination was 28.75° and the mean postoperative value was 3.31°. The mean preoperative radial height was 5.25 mm and the mean postoperative value was 9.48 mm. Conclusion: The technique described here had excellent stability for treating fractures of the distal extremity of the radius classified as A3. It was easy to implement and minimally invasive, with minimal surgical complications, and it was inexpensive. PMID:27027023

  3. Comparison of external fixation, locking and non-locking palmar plating for unstable distal radius fractures in the elderly

    PubMed Central

    Schmelzer-Schmied, N.; Wieloch, P.; Martini, A. K.

    2008-01-01

    This study compares the effectiveness of locking and non-locking palmar plating and external fixation for unstable distal radius fractures in the elderly. In a retrospective match-paired study, 45 patients aged 50 to 70 years who underwent surgery for C1/C2 distal radius fractures were evaluated. The surgical procedures were external fixation or plating with locking or non-locking palmar plates. Radiological and functional outcomes were assessed. Outcomes according to Gartland and Werley, Martini and the Disability of the Arm, Shoulder and Hand (DASH) questionnaire were compared. The locking palmar plate fixation method demonstrated significantly better radiological and functional results in comparison to external fixation and the non-locking palmar plating methods. The subjective assessment of plate fixation proved to be better than that of external fixation. Complications and reoperations were fewer for both plate fixation groups. Our data indicates that most displaced intra-articular distal radius fractures can be treated successfully with the locking palmar plate. PMID:18193224

  4. Statistical analysis on the concordance of the radiological evaluation of fractures of the distal radius subjected to traction☆

    PubMed Central

    Machado, Daniel Gonçalves; da Cruz Cerqueira, Sergio Auto; de Lima, Alexandre Fernandes; de Mathias, Marcelo Bezerra; Aramburu, José Paulo Gabbi; Rodarte, Rodrigo Ribeiro Pinho

    2016-01-01

    Objective The objective of this study was to evaluate the current classifications for fractures of the distal extremity of the radius, since the classifications made using traditional radiographs in anteroposterior and lateral views have been questioned regarding their reproducibility. In the literature, it has been suggested that other options are needed, such as use of preoperative radiographs on fractures of the distal radius subjected to traction, with stratification by the evaluators. The aim was to demonstrate which classification systems present better statistical reliability. Results In the Universal classification, the results from the third-year resident group (R3) and from the group of more experienced evaluators (Staff) presented excellent correlation, with a statistically significant p-value (p < 0.05). Neither of the groups presented a statistically significant result through the Frykman classification. In the AO classification, there were high correlations in the R3 and Staff groups (respectively 0.950 and 0.800), with p-values lower than 0.05 (respectively <0.001 and 0.003). Conclusion It can be concluded that radiographs performed under traction showed good concordance in the Staff group and in the R3 group, and that this is a good tactic for radiographic evaluations of fractures of the distal extremity of the radius. PMID:26962498

  5. Dorsally Comminuted Fractures of the Distal End of the Radius: Osteosynthesis with Volar Fixed Angle Locking Plates

    PubMed Central

    Selhi, Harpal Singh; Devgan, Ashish; Magu, Narender Kumar; Yamin, Mohammad

    2013-01-01

    Background. Dorsally comminuted distal radius fractures are unstable fractures and represent a treatment challenge. The objective of this study was to evaluate the functional and radiological outcome of dorsally comminuted fractures of the distal radius fixed with a volar locking plate. Patients and Methods. Thirty-three consecutive patients with dorsally comminuted fractures of the distal end of the radius were treated by open reduction and internal fixation with AO 2.4 mm (n = 19)/3.5 mm (n = 14) volar locking distal radius plate (Synthes, Switzerland, marketed by Synthes India Pvt. Ltd.). There were 7 type A3, 8 type C2, and 18 type C3 fractures. The patients were followed up at 6 weeks, 3 months, 6 months, and 1 year postoperatively. Subjective assessment was done as per Disabilities Arm, Shoulder, and Hand (DASH) questionnaire. Functional evaluation was done by measuring grip strength and range of motion around the wrist; the radiological determinants were radial angle, radial length, volar angle, and ulnar variance. The final assessment was done as per Demerit point system of Saito. Results. There were 23 males and 10 females with an average age of 44.12 ± 18.63 years (18–61 years). Clinicoradiological consolidation of the fracture was observed in all cases at a mean of 9.6 weeks (range 7–12 weeks). The average final extension was 58.15° ± 7.83°, flexion was 54.62° ± 11.23°, supination was 84.23° ± 6.02°, and pronation was 80.92° ± 5.54°. Demerit point system of Saito yielded excellent results in 79% (n = 26), good in 18% (n = 6), and fair in 3% (n = 1) patients. Three patients had loss of reduction but none of the patients had tendon irritation or ruptures, implant failure, or nonunion at the end of an one-year followup. Conclusion. Volar locking plate fixation for dorsally comminuted distal radius fractures results in good to excellent functional outcomes despite a high incidence of loss of reduction and fracture collapse. PMID:24959352

  6. Standing placement of transphyseal screw in the distal radius in 8 Thoroughbred yearlings

    PubMed Central

    Modesto, Rolf B.; Rodgerson, Dwayne H.; Masciarelli, Amanda E.; Spirito, Michael

    2015-01-01

    This retrospective study describes placement of distal radial transphyseal screws in Thoroughbred yearlings with carpal varus deformities while standing, and identifes short- and long-term complications following the procedure. Data gathered from 2009 to 2013 identified 8 yearlings that met the inclusion criteria. Horses were sedated intravenously and a single 4.5-mm cortical screw was placed in the distal lateral radial physis following application of local anesthetic and surgical preparation of a pre-placed hole. All horses were evaluated weekly after surgery and screw removal was performed standing and under sedation when correction of the angular limb deformity was achieved. The mean time for screw removal was 46 days. No short- or long-term complications were identified. Findings indicate that placing a single transphyseal screw in the lateral aspect of the distal radial physis with the horse standing is a viable option to treat varus angular limb deformity of the carpus in horses. PMID:26028683

  7. Use of mineralized collagen bone graft substitutes and dorsal locking plate in treatment of elder metaphyseal comminuted distal radius fracture

    NASA Astrophysics Data System (ADS)

    Liu, Ke-Bin; Huang, Kui; Teng, Yu; Qu, Yan-Zheng; Cui, Wei; Huang, Zhen-Fei; Sun, Ting-Fang; Guo, Xiao-Dong

    2014-03-01

    Bone graft may be needed to fill bone defect in elderly patients with a metaphyseal comminuted distal radius fracture. In this retrospective, nonrandomized, single-surgeon study, we evaluated the clinical and radiologic outcomes of using both dorsal locking plates with or without augmentation with mineralized collagen (MC) bone graft for elderly patients with dorsally metaphyseal comminuted radius fractures. Patients in group 1 ( n = 12) were treated with dorsal locking plates with MC bone graft application into the metaphyseal bone defect, and those in group 2 ( n = 12) only with dorsal locking plates. Clinical and radiologic parameters were determined at three and 12 months after surgery. At final follow-up, no significant difference was noted between the 2 groups in terms of palmar tilt and radial inclination ( p = 0.80); however, ulnar variance increased significantly in the group 2 treated with dorsal locking plates without augmentation ( p < 0.05). Functionally, there was no significant difference between the groups. Our preliminary study suggests that combination of MC as bone-graft substitutes and dorsal locking plates may be a usefully alternative for elderly patients with metaphyseal comminuted distal radius fracture.

  8. High Prevalence of Osteoporosis in Men with Distal Radius Fracture: A Cross-Sectional Study of 233 Men.

    PubMed

    Egund, Lisa; McGuigan, Fiona; Önnby, Karin; Giwercman, Aleksander; Akesson, Kristina

    2016-09-01

    Distal radius fracture is an early indicator of osteoporosis, yet little is known about men with this fracture and osteoporosis prevalence. The purpose of this cross-sectional, controlled study was to evaluate bone mineral density (BMD) in men, from working age to the elderly, with distal radius fracture. Recruitment was as follows: men who fractured during 1999-2000 were evaluated retrospectively in 2003 and men who fractured during 2003-2007 were followed prospectively for one year post-fracture. A total of 233 patients, response rate 40 %, were enrolled and compared with 643 controls. Fractures from all degrees of trauma were included. BMD was measured at femoral neck, total hip, and lumbar spine. Mean age at fracture was 52 years (21-88 years). Men aged 40-64 years had 5.4-6.7 % lower BMD at all sites compared to controls (p = 0.001) and in >65 years BMD was lower by 10.7-13.8 % (p < 0.001), while not significant at <40 years (1.4-2.8 %; p = 0.228-0.487). Osteoporosis was more prevalent at all ages (20-39 years: 8.5 vs 1.5 %; 40-64 years: 16.8 vs 5.1 %; >65 years: 23.3 vs 8.3 %) BMD did not differ with trauma level. Already from age 40, men with a distal radius fracture had lower BMD, the difference becoming more pronounced with increasing age. Also, the prevalence of osteoporosis was higher, surprisingly even in the youngest age group. PMID:27106578

  9. Titanium integration with bone, welding, and screw head destruction complicating hardware removal of the distal radius: report of 2 cases.

    PubMed

    Van Nortwick, Sara S; Yao, Jeffrey; Ladd, Amy L

    2012-07-01

    Increasingly, surgeons treat distal radius fractures with locking plate systems. Recent case reports have focused on technical insertion errors resulting in removal difficulties: poor drilling orientation or cross-threading, destruction of the screw head, and filling of the screw recess with tissue. We report 2 complications of titanium locked plate removal secondary to in vivo reactions including titanium integration with bone and mechanical binding between the titanium screw and plate. We clarify and discuss terminology relevant to implant removal, including cold-welding, galling, fretting, and anodization. Even with optimal technique, in situ reactions can complicate titanium implant removal. PMID:22652178

  10. Recent Update in the Diagnosis and Treatment of Bone Frailty in Patients with a Distal Radius Fracture.

    PubMed

    Shin, Young Ho; Gong, Hyun Sik

    2016-10-01

    Distal radius fracture (DRF) is the most common upper extremity fracture in the elderly. Patients with a DRF have a two to fourfold higher risk of a subsequent fracture than those with no history of fractures, and DRFs occur on average 15 years earlier than hip fractures. Therefore, patients with a DRF offer physicians an important opportunity to diagnose and treat osteoporosis to prevent a secondary fracture. In this review, we provide recent update in the diagnosis and treatment of bone frailty in patients with a DRF. PMID:27595946

  11. Stainless steel versus titanium volar multi-axial locking plates for fixation of distal radius fractures: a randomised clinical trial

    PubMed Central

    2014-01-01

    Background Distal radius fractures are among the most common fractures seen in the hospital emergency department. Of these, over 40% are considered unstable and require some form of fixation. In recent years with the advent of low profile plating, open reduction and internal fixation (ORIF) using volar plates has become the surgical treatment of choice in many hospitals. However, it is currently unknown which plating system has the lowest complication rate and/or superior clinical and radiological outcomes following surgery. Few studies have compared different types of plates, which may have various features, different plate and screw designs or may be manufactured from different materials (for example, stainless steel or titanium). This study will specifically investigate and compare the clinical and radiological outcomes and complication rates of two commonly used volar plating systems for fixation of distal radius fractures: one made from stainless steel (Trimed™ Volar Plate, Trimed™, California, USA) and the other made from titanium (Medartis® Aptus Volar Plate, Medartis®, Basel, Switzerland). The primary aim of this study is to determine if there is a difference on the Patient Reported Wrist Evaluation six months following ORIF using a volar plate for adult patients with a distal radius fracture. Methods/Design This study will implement a randomized prospective clinical trial study design evaluating the outcomes of two different types of volar plates: one plate manufactured from stainless steel (Trimed™ Volar Plate) and one plate manufactured from titanium (Medartis® Aptus Volar Plate). The surgery will be performed at a major trauma hospital in Brisbane, Australia. Outcome measures including function, adverse events, range of movement, strength, disability, radiological findings and health-related quality of life will be collected at 6 weeks, 3, 6, 12 and 24 months following surgery. A parallel economic analysis will also be performed. This

  12. Sex- and Maturity-Related Differences in Cortical Bone at the Distal Radius and Midshaft Tibia Evaluated by Quantitative Ultrasonography.

    PubMed

    Baptista, Fátima; Rebocho, Lurdes M; Cardadeiro, Graça; Zymbal, Vera; Rosati, Nicoletta

    2016-09-01

    Boys usually have higher values of bone mineral density measured by dual-energy X-ray absorptiometry than girls, but contradictorily also have a greater incidence of fractures during growth. The purpose of this study was to investigate sex- and maturity-related differences in bone speed of sound (SoS) at the radius and tibia in a sample of 625 healthy children aged 10-14 y and to analyze the contributions of physical activity (PA) to possible dissimilarities. Radial and tibial SoS was evaluated by quantitative ultrasound, maturity was estimated as the years of distance from the peak height velocity age, and PA was assessed by accelerometry. Comparisons between sexes and maturity groups (low: below average [<-2.5 y], high: average or above [≥-2.5 y]) were made by two-sample t-tests with unequal variances. Girls in the high-maturity group had higher SoS at the radius and tibia compared with girls in the low-maturity group (p < 0.001). There were no SoS differences at the radius or tibia between the high- and low-maturity groups in boys. Within high-maturity children, girls had higher SoS than boys at the radius and tibia (p < 0.001). There were no differences at the radius and tibia between girls and boys with low maturity. The results were not modified after controlling for PA. Regardless of PA, the results provide insight into sex- and maturity-related differences in bone SoS at the distal radius and midshaft tibia from maturity less than 2.5 y from the peak height velocity age, with boys having lower SoS. PMID:27181690

  13. Free deep circumflex iliac artery vascularised bone flap for reconstruction of the distal radius: planning with CT angiography.

    PubMed

    Ting, Jeannette W C; Rozen, Warren M; Leong, James; Crock, John

    2010-01-01

    Distal radius fractures in the younger population are often comminuted and intra-articular, which can increase the complexity of their management. In addition, these patients tend to place high demands on their wrists, and the prevention of functional arthritis necessitates excellent anatomical reduction. Complicated cases such as these are often limited in their management options. We present a complex case of distal radius fracture and bone loss in which initial therapy with nonvascularized bone graft failed, and osteomyelitis was a further complicating factor. With the aid of preoperative planning with computed tomographic angiography (CTA), a deep circumflex iliac artery (DCIA) bone flap was able to be assessed as a reconstructive option. The use of preoperative CTA, the first description of such imaging in this role, was able to delineate the bone to be harvested, confirm its vascular supply, and plan flap harvest. The use of a vascularized bone flap in this setting was thus undertaken and was able to provide an autologous anatomical support for the wrist while reducing the risk of recurrent infection and still preserving internal fixation. This unique application of the free DCIA bone flap was potentiated by CTA, achieving complete healing and good functional outcomes. PMID:20017201

  14. Comparison of treatment of unstable intra articular fractures of distal radius with locking plate versus non-locking plate fixation

    PubMed Central

    Kumar, Sunil; Chopra, R.K.; Sehrawat, Sunil; Lakra, Akshay

    2014-01-01

    Introduction Unstable intra articular fractures of distal radius are frequently being managed with open reduction and internal fixation. Of late in some biomechanical studies locking plates have been shown to be better in terms of maintenance of radiological parameters in comparison to non-locking plates. We conducted this study to know whether this biomechanical superiority of locking plates is converted in to better clinical outcomes. Materials and methods A study was conducted in 60 patients (30 in each group) with unstable intra articular fractures of distal radius who were treated by open reduction and internal fixation with locking plates and non-locking plates. Patients were evaluated for radiological parameters (intra articular step off, radial height, radial tilt, volar tilt) and functional parameters (flexion, extension, radial deviation, ulnar deviation, pronation, supination grip strength) at two year follow up. Overall outcome was evaluated by scoring systems of Gartland and Werley and modified Green O' Brien. Results The change in radiological parameters from immediate post op to latest at two year in locking plate group was not significant for radial height, radial tilt, volar tilt, but ulnar variance whereas in non-locking plate there was significant change in radial height, volar tilt, ulnar variance but no significant change in radial inclination. In clinical and functional outcome no significant difference was found at two year follow up. Conclusions Locking plates maintain the radiological parameters better than non-locking plates but functional outcome are same for both plates at two year after surgery. PMID:25983474

  15. Ten Years’ Follow-Up on Combined Palmar and Dorsal Internal Fixation of Complex Distal Radius Fractures

    PubMed Central

    Iselin, Lukas Daniel; Massy-Budmiger, Anne-Sophie; Droeser, Raoul A.; Mett, Tobias R.; Babst, Reto; Rikli, Daniel A.

    2016-01-01

    Abstract Complex distal intra-articular radial fractures (AO Type C3) are rare, but are life-changing injuries. They are usually related to high-velocity trauma mechanisms in a working male population. We surveyed a cohort of these fractures treated in our institution to assess the functional long-term outcome. Twelve consecutive patients with comminuted intra-articular distal radial fractures were treated at our institution. Osteosynthesis was performed by a single senior surgeon with volar and dorsal extended approaches. The intermediate and final control included conventional X-ray, range of motion (ROM), grip strength, and the Disabilities of the Arm, Shoulder, and Hand index (DASH), as well as the Patient-rated Wrist Evaluation (PRWE) score for functional outcome at 1 and 10 years’ of follow-up. At 10 years’ follow-up, anatomic reconstruction with a step or gap of <1 mm was achieved in 10 of the 12 above-mentioned patients, whereas 2 patients were lost to follow-up. ROM was good to excellent in 8 patients. Median grip strength was 107% of the contralateral side. Median DASH-Index and PRWE were 2.3 and 6 respectively, at 10 years. Eight patients returned to premorbid heavy labor. One patient was retired at the time of injury. Combined volar and dorsal approaches allow achieving anatomical reconstruction in comminuted intra-articular distal radius fractures and reveal good functional outcomes at intermediate and long-time follow-up. PMID:27149450

  16. Ten Years' Follow-Up on Combined Palmar and Dorsal Internal Fixation of Complex Distal Radius Fractures.

    PubMed

    Iselin, Lukas Daniel; Massy-Budmiger, Anne-Sophie; Droeser, Raoul A; Mett, Tobias R; Babst, Reto; Rikli, Daniel A

    2016-05-01

    Complex distal intra-articular radial fractures (AO Type C3) are rare, but are life-changing injuries. They are usually related to high-velocity trauma mechanisms in a working male population.We surveyed a cohort of these fractures treated in our institution to assess the functional long-term outcome.Twelve consecutive patients with comminuted intra-articular distal radial fractures were treated at our institution. Osteosynthesis was performed by a single senior surgeon with volar and dorsal extended approaches. The intermediate and final control included conventional X-ray, range of motion (ROM), grip strength, and the Disabilities of the Arm, Shoulder, and Hand index (DASH), as well as the Patient-rated Wrist Evaluation (PRWE) score for functional outcome at 1 and 10 years' of follow-up.At 10 years' follow-up, anatomic reconstruction with a step or gap of <1 mm was achieved in 10 of the 12 above-mentioned patients, whereas 2 patients were lost to follow-up. ROM was good to excellent in 8 patients. Median grip strength was 107% of the contralateral side. Median DASH-Index and PRWE were 2.3 and 6 respectively, at 10 years. Eight patients returned to premorbid heavy labor. One patient was retired at the time of injury.Combined volar and dorsal approaches allow achieving anatomical reconstruction in comminuted intra-articular distal radius fractures and reveal good functional outcomes at intermediate and long-time follow-up. PMID:27149450

  17. [Osteosynthesis by plate in fractures of the distal end of the radius].

    PubMed

    Piétu, G; Raynaud, G

    1994-01-01

    The authors recall the place of apposed plate fixation of fractures of the lower end of the radius, most of which are anterior. The ideal indication is the simple fracture by articular or supra-articular, compression-flexion. The importance of modelling and positioning of the plate is emphasised. The use of other types of fixation for composite systems is possible in complex fractures. Anatomical reconstruction must be obtained to ensure a satisfactory functional result. PMID:8161162

  18. External fixation of intra-articular fracture of the distal radius in young and old adults.

    PubMed

    Huch, K; Hünerbein, M; Meeder, P J

    1996-01-01

    Forty patients (18-89 years old, mean 58 years) with comminuted intra-articular fractures of the distal radial end (AO-type C 2 or C 3) treated with external fixation could be followed for an average of 2.3 years. After 3 weeks, the distraction was released, and after another 3 weeks, the device was removed. Complications seen were one malunion, one radial shaft fracture caused by excentric drilling of a Schanz screw, one Sudeck atrophy, and one subcutaneous pin-track infection. Radial and ulnar deviations were reduced to 52% and 71% of the untreated wrist, whereas the range of motion in the other planes reached about 80% or more of the healthy side. In all, 82.5% of the patients showed good or excellent radiological and functional results. This study demonstrates that external fixation of distal radial C 2 and 3 fractures for 6 weeks results in good recovery for young patients and elderly patients with osteoporosis. PMID:8775708

  19. [Secondary dislocations in fractures of the distal end of the radius].

    PubMed

    Zdun, H; Kanchanlall, W

    1990-01-01

    In the group of 31 patients treated by immobilization of the forearm we observed 71% of secondary dislocations and in group of 46 with the full-arm plaster 65% of secondary dislocation occurred. In the group of 20 patients with the full-arm plaster and the X-ray done between the 7th and 10th day after reduction to correct possible dislocation, followed always by the new, similar plaster cast, we observed 40% of secondary dislocations. Whenever the full-arm plaster was used Sudeck syndrome was observed very rarely. No direct relationship between kind of plaster used and the degree of shortening of the radius length after healing of the fracture was found. Comminuted fractures and osteoporosis are in favour for secondary dislocations. PMID:1369865

  20. Aspects of Current Management of Distal Radius Fractures in the Elderly Individuals

    PubMed Central

    Arora, Rohit; Gabl, Markus; Erhart, Stefanie; Schmidle, Gernot; Dallapozza, Christian; Lutz, Martin

    2011-01-01

    Diatal radius fractures (DRFs) are typical fractures of relatively fit persons with osteoporotic bone who remain active into older age. Traditionally, DRFs in older patients have been treated with closed reduction and cast immobilization. Considering the increasing life expectancy of the elderly population, appropriate management of these fractures is of growing importance. Decision making for surgical or nonsurgical approach to osteoporotic DRFs is difficult. These decisions are often made based on the data from treatments of much younger patients. The current literature concerning the treatment of DRFs in the elderly individuals is more controversial. Some investigators have recommended open reduction internal fixation (ORIF) as treatment for unstable DRFs in older patients, while others have suggested that elderly patients should be treated nonsurgically even if there is an unstable fracture situation because fracture reduction is not associated with functional outcomes as in younger patients. This article reviews the different treatment options for DRFs in the elderly individuals reported in the recent literature. PMID:23569689

  1. 3D Simulation of Ultrasound in the Ultra-Distal Human Radius

    NASA Astrophysics Data System (ADS)

    Kaufman, Jonathan J.; Luo, Gangming; Siffert, Robert S.

    The overall objective of this research is to develop an ultrasonic method for non-invasive assessment of the ultradistal radius (UDR). The specific objective of this study was to examine the propagation of ultrasound through the UDR and determine the relationships between bone mass and ultrasound, as well as the ability of ultrasound to discriminate between fracture and non-fracture cases. High-resolution peripheral-QCT (HR-pQCT) images were obtained from a set of 110 subjects that were part of a larger study on osteoporosis. Twenty-three of the subjects had experienced a UDR fracture within the past 2 years; the other 87 subjects served as controls. Each 3D image was used to simulate ultrasound measurements that would result from propagation through the UDR, from its anterior to its posterior surfaces. The simulation was carried out using Wave3000 (CyberLogic, Inc., New York, USA), which solves the full 3D viscoelastic wave equation using a finite difference time domain method. Bone mineral density associated with each radius was computed for each subject, and an ultrasound parameter known as net time delay (NTD) was evaluated. NTD has been shown to be highly correlated with total bone mass in both in vitro and clinical studies. Significant correlations were found between NTD and total bone mass (R2 = 0.91, p < 0.001). The data also showed a statistically significant difference in the NTD for the fracture and non-fracture cases (i.e., a decrease in mean NTD of 14% (P < 0.001), with a t-test statistic of 3.8). The study shows that ultrasound is correlated with bone mass at the UDR, as well as with fracture incidence. Therefore ultrasound may prove useful as a simple and convenient method for non-invasive assessment of osteoporosis and fracture risk. Work is ongoing to compare the simulated ultrasound data with clinical ultrasound measurements made on the same individuals.

  2. [Palmar wrist arthroscopy for evaluation of concomitant carpal lesions in operative treatment of distal intraarticular radius fractures].

    PubMed

    Hohendorff, B; Eck, M; Mühldorfer, M; Fodor, S; Schmitt, R; Prommersberger, K-J

    2009-10-01

    Fractures of the distal radius, which currently are treated with palmar locking plates, are often accompanied by carpal lesions. Tears of the scapholunate interosseus ligament (SL) can affect the outcome. Between January 2007 and May 2008, 28 patients with distal intraarticular fractures of the radius were included in a prospective study. Preoperative CT-arthrography was performed. SL tears were found in 11 patients, with 10 partial and one complete rupture observed. A tear of the triangular fibrocartilage complex (TFCC) was detected in 16 patients. Every patient was operated with a palmar locking plate through a palmar approach between the flexor carpi radialis tendon and the radial artery. Then, a palmar wrist arthroscopy using a palmar portal was performed. Eleven SL tears with 9 partial and two total ruptures were diagnosed by arthroscopy. Ten lesions were associated with a C1-fracture with a fracture line projected onto the scapholunate interval. The TFCC was appraisable by palmar wrist arthroscopy only in 4 patients. Three of the SL tears detected by CT-arthrography could not be confirmed by palmar wrist arthroscopy. One complete rupture and one partial lesion confirmed by palmar wrist arthroscopy were found by CT-arthrography to be intact. Palmar wrist arthroscopy affords certainty when assessing the SL ligament. In this study, an assessment of ulnocarpal structures was not possible. For assessment of the ulnocarpal structures, CT-arthrography was superior to palmar wrist arthroscopy. However, the latter is an alternative during emergency treatment or when CT-arthrography is not available. PMID:19790024

  3. [Biomechanics of combined Kirschner wire osteosynthesis in the human model of unstable dorsal, distal radius fractures (Colles type)].

    PubMed

    Fritz, T; Heyer, T; Krieglstein, C; Mattern, R; Kallieris, D; Friedl, W

    1997-05-01

    In an experimental study, the biomechanical qualities of the combined Kirschner wire osteosynthesis (KWO) in the unstable Colles' fracture were analyzed. This type of pin fixation is our preferred osteosynthesis in the treatment of unstable Colles' fracture because it allows immediate functional therapy. It represents a modification of Kapandji's dynamic KWO, compensating for the insufficient volar stability by means of the conventional static KWO. Clinical experience according to the anatomical and functional results, was very encouraging suggesting that a clinical concept based on the biomechanical principles of combined KWO and its single components should be constituted. Simulation of the unstable Colles' fracture was realized by dorsal wedge osteotomy of the distal end of the radius using cadaveric material. This fracture model was subsequently pinned using the different KWO types and tested by a standardized vector energy testing device regarding its stability in the four main loading directions. The combined KWO unifies the advantage of volar stability of the conventional KWO with the high dorsal stability of dynamic KWO. The main functional principle of dynamic KWO with regard to its axial stability consists in the repositioning of the dorsal bone fragmentation zone and hence the reconstitution of cortical load transmission. Besides its good stabilization, dynamic KWO also leads to optimal alignment of the distal metaphyseal fragment. Furthermore, the experiments yielded important information about technical aspects of the surgical procedure, which helps us to avoid anatomical and functional deficiencies. Based on these experimental findings, the surgical technique of combined KWO was standardized. PMID:9303839

  4. WHAT IS THE BEST RADIOGRAPHIC VIEW FOR “DIE PUNCH” DISTAL RADIUS FRACTURES? A CADAVER MODEL STUDY

    PubMed Central

    Falcochio, Diego Figueira; Crepaldi, Bruno Eiras; Trindade, Christiano Augusto; da Costa, Antonio Carlos; Chakkour, Ivan

    2015-01-01

    Objective: the aim of this study is try to show the best view for distal radius fractures so called die-punch fractures. Methods: There has been used a human cadaver radius bone from the Salvador Arena Tissue Bank. This bone was cleaned up after removing the soft tissues and osteotomies created displaced lunate fossa fractures of 0, 1, 2, 3 and 5 mm. We have fixed this fragment with adhesive tape. Then the joint deviation were significantly increased with step-offs of 1 mm. Radiographs were then taken into 5 different positions: postero-anterior view, lateral view, oblique views and tangencial view for each of the deviations. The resulting lunate fossa depression in each X-ray film was analyzed by the AutoCAD 2010® software. Results: The tangencial view was the best one to see the 1mm and 3mm bone degrees and the second one view to see the 2mm and 5 mm degrees. The pronated oblique view was the best to see the 2mm degrees and the oblique supinated view wasn't able to see the degrees between 1 and 2mm. Conclusion: The tangencial view was the best one to see the 1mm and 3mm bone degrees and the second one view to see the 2mm and 5 mm degrees. PMID:27027079

  5. Surgical Technique of Corrective Osteotomy for Malunited Distal Radius Fracture Using the Computer-Simulated Patient Matched Instrument.

    PubMed

    Murase, Tsuyoshi

    2016-06-01

    The conventional corrective osteotomy for malunited distal radius fracture that employs dorsal approach and insertion of a trapezoidal bone graft does not always lead to precise correction or result in a satisfactory surgical outcome. Corrective osteotomy using a volar locking plate has recently become an alternative technique. In addition, the use of patient-matched instrument (PMI) via computed tomography simulation has been developed and is expected to simplify surgical procedures and improve surgical precision. The use of PMI makes it possible to accurately position screw holes prior to the osteotomy and simultaneously perform the correction and place the volar locking plate once the osteotomy is completed. The bone graft does not necessarily require a precise block form, and the problem of the extensor tendon contacting the dorsal plate is avoided. Although PMI placement and soft tissue release technique require some degree of specialized skill, they comprise a very useful surgical procedure. On the other hand, because patients with osteoporosis are at risk of peri-implant fracture, tandem ulnar shortening surgery should be considered to avoid excessive lengthening of the radius. PMID:27454626

  6. Treatment of Scaphoid Nonunions with Closed-Wedge Osteotomy of the Distal Radius: Report of Six Cases

    PubMed Central

    2007-01-01

    Background The ideal treatment of nonunion of the scaphoid remains unresolved and controversial. It was hypothesized that scaphoid nonunion could be treated successfully using a closed-wedge osteotomy of the distal radius which reduces the inclination of the joint surface and decreases the pressure between the radial and scaphoid surfaces with a reduction of the force applied by the styloid process. We present a preliminary report in six patients with nonunion of the carpal scaphoid using this procedure. The main objective of the osteotomy is to achieve fusion, alleviate pain, and improve function. Materials and Methods Six closed-wedge osteotomies to reduce the inclination of the distal radial surface were performed in patients with scaphoid waist nonunion and a viable proximal pole, without posttrauma osteoarthritis or with moderate posttraumatic osteoarthritis confined to the radio-scaphoid joint. The present series of six patients (all men) were followed for at least 8 months (mean follow-up 14.2 months, range 8–21 months). Results Solid union was achieved in five patients. Postoperatively, three patients were pain-free, two presented mild pain for heavy work, and one had moderate pain. This type of osteotomy reduced the inclination of the joint surface (radial angulation) 6.2° on average. There was an improvement in joint flexion from a preoperative mean of 40° to 52.5° at last follow-up, in extension from 40.8° to 66.7°, in radial deviation from 15° to 22.5°, and in ulnar deviation from 30.8° to 41.7°. Conclusions This preliminary study suggests that a closed-wedge osteotomy of the distal radius could be an alternative approach for patients with scaphoid waist nonunion and a viable proximal pole, without posttrauma osteoarthritis or with moderate posttraumatic osteoarthritis confined to the radio-scaphoid joint. The number of cases was small; however, further studies with a much larger series are needed before routine use of wedge osteotomy in

  7. Ultrasound Imaging Improves Identification of Prominent Hardware in the Surgical Treatment of Distal Radius Fractures: A Cadaveric and Prospective Clinical Study.

    PubMed

    Watchmaker, Jacqueline D; Daley, Roger A; Watchmaker, Greg P; Grindel, Steven I

    2016-03-01

    Background Volarly applied locking plates are one of several current treatment options for displaced fractures of the distal radius. Presently, surgeons use intraoperative depth gauges and fluoroscopy to select and confirm proper screw length. The contour of the dorsal cortex beneath the extensor compartments along with fracture comminution may limit the accuracy of screw length selection. Question/Purpose To evaluate the accuracy of ultrasound (US) and fluoroscopy in the detection of dorsally prominent screws placed during volar plating of experimentally created distal radius fractures and extend this prospectively into the clinical setting. Patients and Methods Distal radius fractures were experimentally induced in fresh cadaveric arms. The fractures were then internally fixated with volar locking plates utilizing fluoroscopic imaging. US imaging of the dorsal surface of the radius was then performed followed by dorsal dissection and direct caliper measurements to quantitate screw tips as recessed, flush, or protruding from the dorsal cortex. A small, prospective clinical study was also conducted to validate the clinical usefulness of using US to provide additional information regarding screw tip prominence. Results Our study demonstrated that US was able to detect dorsally prominent screw tips not visible on fluoroscopy. Cadaveric dissection showed a higher statistical correlation between US imaging and actual prominence than between fluoroscopy and actual prominence. Conclusions US examination after volar plate fixation of comminuted distal radius fractures may detect dorsal screw tip prominence when screw lengths are selected to engage the dorsal cortex. Level of Evidence IV. PMID:26855834

  8. Success Rate and Complications of Comminuted Intra-Articular Distal Radius Fracture Treatment via Closed Reduction and Use of a Mini-External Fixator

    PubMed Central

    Karimi Nasab, Mohammad Hossein; Shayesteh Azar, Masoud; Fazel Moghaddam, Samira; Taghipour, Mehrdad

    2015-01-01

    Background: Intra-articular fracture of the distal radius is extremely common; however, the management of this fracture is controversial. Objectives: With regard to the importance of intra-articular fracture of the distal radius and the best treatment method for the fracture, we sought to assess the success rate following the treatment of comminuted intra-articular fractures of the distal radius via closed reduction and use of a mini-external fixator. Patients and Methods: This longitudinal retrospective study was undertaken at our department of orthopedics via assessment of radiographs and patient files of those referred from 2006 to 2013. Radiographic criteria included the degree of angulation and shortening of the radius. Data were analyzed using SPSS 18 software and were presented as mean ± standard deviation (SD). The significance level was set at P ≤ 0.05. Results: Overall, ≥ 2 mm shortening of the radius was seen in 28% of the patients, 53% had 2 - 5 mm radial shortening and 19% of the patients had more than 5 mm shortening of the radius. Most of the participants had acceptable outcomes. The mean angulation was 6.28 ± 2.85 degrees and the mean shortening was 3.92 ± 2.22. Thirty-nine percent of the patients had an angulation of less than 5 mm, 56% and 5% had an angulation of 5 - 10 mm and more than 10 mm, respectively. Conclusions: The results of our study showed that the mini-external fixator is a good and effective treatment option for obtaining radial length, angulation and bony union in intra-articular fractures of the distal radius. PMID:26839853

  9. Reliability Analysis of the Distal Radius and Ulna Classification for Assessing Skeletal Maturity for Patients with Adolescent Idiopathic Scoliosis

    PubMed Central

    Cheung, Jason Pui Yin; Samartzis, Dino; Cheung, Prudence Wing Hang; Cheung, Kenneth M. C.; Luk, Keith D. K.

    2015-01-01

    Study Design Prospective radiographic study. Objective To test the reliability of the Distal Radius and Ulna Classification (DRU). Methods This single-center study included prospectively recruited subjects with adolescent idiopathic scoliosis managed with bracing. The left-hand radiographs were measured using the DRU classification by two examiners. Intra- and interobserver reliability analysis were performed using intraclass correlation (ICC) analysis. Results From these clinics, 161 patients (124 females and 37 males) with left-hand radiographs were included in the study. The mean age was 13.3 years (standard deviation: 1.5). There was excellent intra- (ICC: 0.93 to 0.95) and interobserver (ICC: 0.97) reliability. Conclusions The DRU classification scheme has been shown to be accurate in determining the peak growth phase and growth cessation. It has now been confirmed to be a reliable tool. Future prospective studies should be performed to investigate its application in deciding when to apply bracing or operative treatment. PMID:26933618

  10. Progress and prediction of occupational performance in women with distal radius fractures: a one-year follow-up.

    PubMed

    Nielsen, Tove Lise; Dekkers, Merete Klindt

    2013-03-01

    Abstract To describe the occupational performance and pain during the first year after a distal radius fracture, an observational follow-up study was performed among 37 mainly elderly Danish women. They were assessed at cast removal and reassessed at three and 12 months post-injury with COPM, DASH, and validated questions on pain. The number of performance problems fell from median 18 at cast removal to median 3 at 12 months. COPM performance and satisfaction scores improved significantly to 8.6 and 9.2 at 12 months. Also the DASH score improved significantly to 14.2 at 12 months. The largest improvements in occupational performance and disability took place within the first three months. Pain decreased significantly during the follow-up period. In spite of these positive results, at 12 months 78% of the women still had performance problems and 62% still had some degree of pain due to the fracture. At cast removal, a number of ≥10 performance problems at 12 months could be predicted in women with ≥20 performance problems (RR 2.41) or with a pain intensity described as "moderate" or worse (RR 3.71). The findings of this study suggest that occupational therapy services might still be of relevance perhaps as follow-up sessions through the first year post-injury. PMID:23216334

  11. Variation in the Incidence of Distal Radius Fractures in the US Elderly as Related to Slippery Weather Conditions

    PubMed Central

    Giladi, Aviram M.; Shauver, Melissa J.; Ho, Allison; Zhong, Lin; Kim, H. Myra; Chung, Kevin C.

    2014-01-01

    Background Distal radius fractures (DRFs) are costly and debilitating injuries, especially for the elderly. DRFs often occur from falls and more commonly occur outdoors. Inclement weather, especially in the winter, may increase the risk of fall-related injuries. Small community studies have reported increased risk of DRF due to inclement winter weather; however, larger studies are lacking. Methods We analyzed a sample of 2007 Medicare claims for DRF. Weather data were collected for the date and location of each DRF in our analysis cohort. A novel slipperiness score (0–7, 7 indicates the most slippery weather) was used as a measure of the severity of slippery outdoor conditions. Negative binomial regression models evaluated the correlation between slipperiness and DRF occurrence. Results Risk of DRF was higher in winter months (Incidence Rate Ratio=1.2, 95%CI 1.14–1.26, p<0.001). Days with average temperature ≤ 32°F (IRR=1.36, 95%CI 1.19–1.54, p<0.001), snow/ice on ground at the start of the day (IRR=1.45, 95%CI 1.25–1.68, p<0.001), and freezing rain (IRR=1.24, 95%CI 1.03–1.49, p=0.025) all had an increased risk of DRF. Risk of sustaining a DRF was increased 21% on days with a slipperiness score of 5 or above (IRR=1.21, 95%CI 1.08–1.20, p=0.007). Additionally, for each increase in slipperiness score above 4, the IRR of DRF increased as well. Conclusions Weather events that create slippery walking conditions, most often occurring in winter months, result in an increased risk of DRF in the US elderly. This finding can be used to support resource allocation as well as awareness and prevention campaigns. Level of Evidence IV; retrospective cohort PMID:24469166

  12. External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients

    PubMed Central

    Ma, Chuang; Deng, Qiang; Pu, Hongwei; Cheng, Xinchun; Kan, Yuhua; Yang, Jing; Yusufu, Aihemaitijiang; Cao, Li

    2016-01-01

    The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius (IFDR) in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after 1 week and 3, 6 and 12 months. After 3 months, the plating group had better pronation (P=0.001), supination, (P=0.047) and extension (P=0.043) scores. These differences were somewhat attenuated by 6 months and disappeared at 1 year. The plating group had a greater occurrence of wound infection (P=0.043), tendonitis, (P=0.024) and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the “gross motor” category (walking upstairs, bending over, walking 500 yards; P=0.023). Internal fixation was more advantageous than external fixation in the early rehabilitation period; after 1 year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries. PMID:27408765

  13. External fixation is more suitable for intra-articular fractures of the distal radius in elderly patients.

    PubMed

    Ma, Chuang; Deng, Qiang; Pu, Hongwei; Cheng, Xinchun; Kan, Yuhua; Yang, Jing; Yusufu, Aihemaitijiang; Cao, Li

    2016-01-01

    The purpose of this study was to compare the functional outcomes, psychological impact, and complication rates associated with external fixation and volar or dorsal plating in relation to the functional parameters following treatment of intra-articular fractures of the distal radius (IFDR) in patients older than 65 years. We hypothesized that using volar or dorsal plating would improve functional outcomes, but that it would be associated with more complications and equivalent functional outcomes when compared with the external fixation group. A total of 123 consecutive patients suffering from IFDR were recruited into the study. The patients were measured for clinical, radiological, and psychosocial functioning outcomes and were followed up after 1 week and 3, 6 and 12 months. After 3 months, the plating group had better pronation (P=0.001), supination, (P=0.047) and extension (P=0.043) scores. These differences were somewhat attenuated by 6 months and disappeared at 1 year. The plating group had a greater occurrence of wound infection (P=0.043), tendonitis, (P=0.024) and additional surgery compared with the external fixation group. The only TNO-AZL Adult Quality of Life scores in the plating group that were lower than those in the external fixation group were in the "gross motor" category (walking upstairs, bending over, walking 500 yards; P=0.023). Internal fixation was more advantageous than external fixation in the early rehabilitation period; after 1 year the outcomes were similar. The plating group showed significantly higher levels of wound infection and tendonitis and had a greater need for additional surgeries. PMID:27408765

  14. Comparison of Locked Volar Plating Versus Pinning and External Fixation in the Treatment of Unstable Intraarticular Distal Radius Fractures

    PubMed Central

    Katt, Brian A.; Carothers, Joshua T.

    2007-01-01

    Introduction We retrospectively compared the outcomes of open reduction and internal fixation (ORIF) with volar locking plate versus standard external fixation and percutaneous pinning in treating similar unstable distal radius fractures with a minimum 2-year follow-up. Methods The ORIF group included 41 patients with an average follow-up of 29 months. The external fixation group comprised 14 patients with an average follow-up of 33 months. Average age at presentation was 45 years in the external fixation group and 48 years in the ORIF group. The male/female ratios were 16:25 among the ORIF group and 6:8 in the external fixation group. The two groups were compared for clinical and functional outcomes measured by the disabilities of the arm, shoulder, and hand (DASH) score. Pain scores were similar. Radiographic measurements were also evaluated between groups. Results Final ranges of motion and grip strengths were similar between the two groups. The mean DASH score of the locked volar plate group was 9 compared to 23 for the external fixation group. Radiographically, volar tilt and radial length were significantly better in the patients treated with ORIF. The ORIF group required less therapy visits. No complications occurred in the locked volar plate group whereas two patients had pin tract infections and one had prolonged finger stiffness in the external fixation group. Conclusion Locked volar plating compares favorably to external fixation and pinning for amenable fracture patterns. Whereas grip and range-of-motion data were similar, DASH scores, frequency of rehabilitation, and some radiographic parameters were superior in patients treated with ORIF. PMID:18780086

  15. Arthroscopically assisted reduction with volar plating or external fixation for displaced intra-articular fractures of the distal radius in the elderly patients.

    PubMed

    Hattori, Yasunori; Doi, Kazuteru; Estrella, Emmanuel P; Chen, Guofen

    2007-01-01

    Twenty-eight patients older than 70 years with AO type C fracture of the distal radius were treated with arthroscopically assisted reduction combined with volar plating or external fixation. The patients were followed up for an average of 24.9 +/- 16.1 months. The average score was 80.1 +/- 10.5 according to the modified system of Green and O'Brien. Eight patients had an excellent result, 11 had a good result, seven had a fair result, and two had a poor result. Twenty-three patients were able to return to their previous activities level or occupation without any restriction. On the basis of these results, we concluded that arthroscopically assisted reduction combined with volar plating or external fixation is one of the useful options for the treatment of a displaced intra-articular fracture of the distal radius in elderly patients who are physiologically young or active. PMID:17613178

  16. In vivo comparison between computed tomography and magnetic resonance image analysis of the distal radius in the assessment of osteoporosis.

    PubMed

    Cortet, B; Boutry, N; Dubois, P; Bourel, P; Cotten, A; Marchandise, X

    2000-01-01

    In a prospective case-control cross-sectional study, we investigated the usefulness of both computed tomography (CT) and magnetic resonance (MR) image analysis of the distal radius for distinguishing a small sample of fractured osteoporotic women from control women regardless of bone mineral density. The study population included 12 subjects who were divided into two groups according to their bone status. The first group consisted of six women with at least one vertebral fracture occurring in the absence of high-energy trauma, and the second group consisted of six women without disease affecting bone mass or bone metabolism. Cross-sectional and coronal slices were obtained from both CT and MR systems. For CT images, the slice thickness was 1000 jim and the plane resolution was approx 200 jim x 200 jim. MR images were obtained from a 1.5-T imager with a two-dimensional spin-echo Ti-weighted sequence leading to a slice thickness of 2000 jim and a plane resolution of 195 jim x 195 jim. Bone texture analysis was performed using fractal and structural methods leading to the measurement of 23 features. Most of the structural variables derived from histomorphometric parameters and were measured after segmentation from a binary or a skeletonized image. Bone densitometry was measured by dual-energy X-ray absorptiometry both at the lumbar spine and the nondominant femoral neck. On cross-sectional slices, 12 variables, mainly obtained from structural analysis, were significantly different between the two groups for CT images (p < 0.05) against two variables only for MR images (p < 0.05). The number of variables statistically different between the two groups was significantly higher for CT images compared with MR images (p = 0.003). In the same way, odds ratios for fracture per 1 control group standard deviation decrease were significant for 10 variables on CT images, whereas, in contrast, none of the variables measured on MRI images led to significant odds ratios. The results

  17. Deterioration of trabecular plate-rod and cortical microarchitecture and reduced bone stiffness at distal radius and tibia in postmenopausal women with vertebral fractures.

    PubMed

    Wang, Ji; Stein, Emily M; Zhou, Bin; Nishiyama, Kyle K; Yu, Y Eric; Shane, Elizabeth; Guo, X Edward

    2016-07-01

    Postmenopausal women with vertebral fractures have abnormal bone microarchitecture at the distal radius and tibia by HR-pQCT, independent of areal BMD. However, whether trabecular plate and rod microarchitecture is altered in women with vertebral fractures is unknown. This study aims to characterize the abnormalities of trabecular plate and rod microarchitecture, cortex, and bone stiffness in postmenopausal women with vertebral fractures. HR-pQCT images of distal radius and tibia were acquired from 45 women with vertebral fractures and 45 control subjects without fractures. Trabecular and cortical compartments were separated by an automatic segmentation algorithm and subjected to individual trabecula segmentation (ITS) analysis for measuring trabecular plate and rod morphology and cortical bone evaluation for measuring cortical thickness and porosity, respectively. Whole bone and trabecular bone stiffness were estimated by finite element analysis. Fracture and control subjects did not differ according to age, race, body mass index, osteoporosis risk factors, or medication use. Women with vertebral fractures had thinner cortices, and larger trabecular area compared to the control group. By ITS analysis, fracture subjects had fewer trabecular plates, less axially aligned trabeculae and less trabecular connectivity at both the radius and the tibia. Fewer trabecular rods were observed at the radius. Whole bone stiffness and trabecular bone stiffness were 18% and 22% lower in women with vertebral fractures at the radius, and 19% and 16% lower at the tibia, compared with controls. The estimated failure load of the radius and tibia were also reduced in the fracture subjects by 13% and 14%, respectively. In summary, postmenopausal women with vertebral fractures had both trabecular and cortical microstructural deterioration at the peripheral skeleton, with a preferential loss of trabecular plates and cortical thinning. These microstructural deficits translated into lower

  18. A NEW APPROACH TO PARTIALKNEE ENDOPROSTHESIS IN PRIMARY BONE SARCOMAS

    PubMed Central

    Penna, Valter; Toller, Eduardo Areas; Pinheiro, Carla; Becker, Ricardo Gehrke

    2015-01-01

    Partial knee endoprosthesis to bone sarcomas resections seems to be a good solution to treat this immature skeletal patients. The purpose of this study is to evaluate the functional score in fourteen patients, advantages and the technique indications. Methods: Retrospective analysis was done to assess in this group of patients the functional evolution and the possible complications of the procedure. 14 patients between 10 and 22 years functionally evaluated in Ennekin/ISOLS (International Society of Limb Salvage) criteria, being all of them operated in the same institution by the same surgeon. Were used distal femur and proximal tibia partial endoprosthesis. Results: General analysis demonstrated that the functional results were over than 67 percent (ISOLS criteria) in 78,6 percent of the patients, being considered excellent. 21,4 percent were considered good results, being between 50 and 66 percent. Bone storage was preserved when avoiding the adjacent segment resection. Surgery time was not prolonged in ligament reconstruction. Conclusion: Knee partial endoprosthesis are less damage to bone storage in young patients. The critics about the bad functional results are being supplied by new surgical techniques, excellent rehabilitation protocols, implants technology and the consequent learning curve. This option of treatment permits the preservation of healthy bone and provides the possibility of a revision replacement less aggressive. PMID:26998452

  19. Use of Relative vs Fixed Offset Distance to Define Region of Interest at the Distal Radius and Tibia in High-Resolution Peripheral Quantitative Computed Tomography.

    PubMed

    Shanbhogue, Vikram V; Hansen, Stinus; Halekoh, Ulrich; Brixen, Kim

    2015-01-01

    Although the region of interest in high-resolution peripheral quantitative computed tomography, defined based on the manufacturer's protocol for in vivo scanning, provides consistency and is practically convenient, it does not take into account possible variation in morphology in the regions adjacent to the measurement site. This study aimed at compare the morphologic variation in measurements using the standard fixed offset distance to define the distal starting slice against those obtained by using a relative measurement position scaled to the individual bone length at the distal radius and tibia in normal healthy adult subjects. A total of 40 healthy adult subjects (median height, 175.3 cm; range: 150.0-196.0 cm) were included in the study. High-resolution peripheral quantitative computed tomography at the distal radius and tibia was performed in all subjects, the region of interest defined by, first, the standard measurement protocol, where the most distal CT slice was 9.5 mm and 22.5 mm from the end plate of the radius and tibia, respectively, and second, the relative measurement method, where the most distal CT slice was at 4% and 7% of the radial and tibial lengths, respectively. Volumetric densities and microarchitectural parameters were compared between the 2 methods. Measurements of the total and cortical volumetric density and cortical thickness at the radius and tibia and cortical porosity, trabecular volumetric density, and trabecular number at the tibia were significantly different between the 2 methods (all p < 0.001). The predicted morphologic variation with varying measurement position was substantial at both the radius (up to 34%) and the tibia (up to 36%). A lack of consideration to height (and in turn the bone lengths) in the standard patient protocol could lead to the introduction of systematic errors in radial and tibial measurements. Although this may not be of particular significance in longitudinal studies in the same individual, it

  20. A Comparative Study between Closed Reduction and Cast Application Versus Percutaneous K- Wire Fixation for Extra-Articular Fracture Distal end of Radius

    PubMed Central

    Venkatesh, Raghu Begur; Narayanappa, Roshan Kumar Bangalore

    2016-01-01

    Introduction In extra-articular distal radius fractures closed reduction and casting has been the mainstay of treatment, difficulty lies in predicting and maintaining the proper reduction at final union. Percutaneous K-wire stabilization is also a widely accepted treatment option, but there is no consensus on its outcome in comparison to closed reduction and casting. Aim To evaluate the results of closed reduction and casting versus closed reduction with percutaneous K wire fixation and casting in the treatment of the distal radius extra-articular fracture with reference to the restoration of radial height, radial inclination, volar tilt of the distal articular surface and to assess the functional outcome of the same measured by the Gartland and Werley demerit scoring system. Materials and Methods Prospective study was conducted on 60 patients attending the Department of Orthopaedics, from December 2013 to May 2015 with extra-articular fractures (AO type 23-A2 and 23-A3) of distal radius and fulfilling all the inclusion and exclusion criteria. The cases were randomly divided into two equal groups of 30 patients, the first group treated by closed reduction and below elbow cast application, while the second group were treated by closed reduction percutaneous K-wire application and below elbow cast application. The radiological outcome of both groups were evaluated by measuring the Volar inclination, Radial inclination and Radial height, while the functional outcome was evaluated by the demerit scoring system of Gartland and Werley. Results The Cast application group had 13 excellent, 9 good, 7 fair and 1 poor result the mean outcome score of the group was 5.2. The K wiring group had 11 excellent, 13 good, 5 fair and 1 poor result, the mean score of the group was 5.17. The unpaired student’s t-test on the values obtained from both groups yielded a p-value of 0.9816. The mean radial height in the Cast application group was 8.033mm while the mean in the k wiring group

  1. Correlation between dorsovolar translation and rotation of the radius on the distal radioulnar joint during supination and pronation of forearm.

    PubMed

    Lee, Sang Ki; Song, Young Dong; Choy, Won Sik

    2015-09-01

    This study aimed to describe the patterns of movements about radius and ulna in individual degrees of forearm rotation. And, we also determined the effect of forearm rotation on translation and rotation of the radius with reference to the ulna, and to measure the relationship between forearm rotation, translation and rotation of the radius. Computed tomography of multiple, individual forearm positions, from 90° pronation to 90° supination, was conducted in 26 healthy volunteers (mean age, 43.9 years) to measure dorsovolar translation and rotation of the radius in the DRUJ in each forearm position. The mean dorsovolar translations were within 1.99 mm at 90° pronation to -2.03 mm at 90° supination. The rotations of the radius were 71.20° at 90° pronation and -46.63° at 90° supination. There were strong correlations between degrees of forearm rotation and dorsovolar translation (r=0.861, p<0.001) and rotation of the radius (r=0.960, p<0.001), suggesting that the DRUJ, carpal joints, and rotatory laxity of the carpal ligament, especially in supination, contribute to forearm supination and pronation. These findings provide an understanding of wrist kinematics, are may be useful in reconstructive wrist surgery to achieve normal range of motion, and are may be helpful for the design of DRUJ reconstruction using prostheses. PMID:26435248

  2. The effect of static muscle forces on the fracture strength of the intact distal radius in vitro in response to simulated forward fall impacts.

    PubMed

    Reeves, Jacob M; Burkhart, Timothy A; Dunning, Cynthia E

    2014-08-22

    The distal radius fracture (DRF) is a particularly dominant injury of the wrist, commonly resulting from a forward fall on an outstretched hand. In an attempt to reduce the prevalence, costs, and potential long-term pain/deformities associated with this injury, in vivo and in vitro investigations have sought to classify the kinematics and kinetics of DRFs. In vivo forward fall work has identified a preparatory muscle contraction that occurs in the upper extremity prior to peak impact force. The present investigation constitutes the first attempt to systematically determine the effect of static muscle forces on the fracture threshold of the distal radius in vitro. Paired human cadaveric forearm specimens were divided into two groups, one that had no muscle forces applied (i.e., right arms) and the other that had muscle forces applied to ECU, ECRL, FCU and FCR (i.e., left arms), with magnitudes based on peak muscle forces and in vivo lower bound forward fall activation patterns. The specimens were secured in a custom-built pneumatic impact loading device and subjected to incremental impacts at pre-fracture (25 J) and fracture (150 J) levels. Similar fracture forces (6565 (866)N and 8665 (5133)N), impulses (47 (6)Ns and 57 (30)Ns), and energies (152 (38)J and 144 (45)J) were observed for both groups of specimens (p>0.05). Accordingly, it is suggested that, at the magnitudes presently simulated, muscle forces have little effect on the way the distal radius responds to forward fall initiated impact loading. PMID:24927979

  3. Percutaneous fixation with Kirschner wires versus volar locking plate fixation in adults with dorsally displaced fracture of distal radius: randomised controlled trial

    PubMed Central

    Achten, Juul; Parsons, Nick R; Rangan, Amar; Griffin, Damian; Tubeuf, Sandy; Lamb, Sarah E

    2014-01-01

    Objectives To compare the clinical effectiveness of Kirschner wire fixation with locking plate fixation for patients with a dorsally displaced fracture of the distal radius. Design A multicentre two arm parallel group assessor blind randomised controlled trial with 1:1 treatment allocation. Setting 18 trauma centres in the United Kingdom. Participants 461 adults with a dorsally displaced fracture of the distal radius within 3 cm of the radiocarpal joint that required surgical fixation. Patients were excluded if the surgeon thought that the surface of the wrist joint was so badly displaced it required open reduction. Interventions Kirschner wire fixation: wires are passed through the skin over the dorsal aspect of the distal radius and into the bone to hold the fracture in the correct anatomical position. Locking plate fixation: a locking plate is applied through an incision over the volar (palm) aspect of the wrist and secured to the bone with fixed angle locking screws. Main outcome measures Primary outcome measure: validated patient rated wrist evaluation (PRWE). This rates wrist function in two (equally weighted) sections concerning the patient’s experience of pain and disability to give a score out of 100. Secondary outcomes: disabilities of arm, shoulder, and hand (DASH) score, the EuroQol (EQ-5D), and complications related to the surgery. Results The baseline characteristics of the two groups were well balanced, and over 90% of patients completed follow-up. The wrist function of both groups of patients improved by 12 months. There was no clinically relevant difference in the patient rated wrist score at three, six, or 12 months (difference in favour of the plate group was −1.3, 95% confidence interval −4.5 to 1.8; P=0.40). Nor was there a clinically relevant difference in health related quality of life or the number of complications in each group. Conclusions Contrary to the existing literature, and against the rapidly increasing use of locking plate

  4. A rare combined injury of dorsal fracture-dislocation of four carpometacarpal joints and trapezium, trapezoid and distal radius bone fractures.

    PubMed

    Touloupakis, Georgios; Stuflesser, Wilfried; Antonini, Guido; Ferrara, Fabrizio; Crippa, Cornelio; Lettera, Maria Gabriella

    2016-01-01

    Incorrect or delayed diagnosis and treatment of the carpometacarpal fracture-dislocations is often associated with poor prognosis. We present a rare case of unusual pattern of injury, involving dorsal dislocation of four ulnar carpometacarpal joints, associated with fracture of the trapezium, a burst fracture of the trapezoid  bone and an extra-articular fracture of the third distal  of the radius. The first surgical intervention was followed by unsatisfactory results, confirmed by the CT scans. A second surgery followed and an open reduction and pinning with K wires performed. Post-operative follow up lasting for nine months revealed a very good surgical outcome. PMID:27163903

  5. Is minimally invasive application by intramedullary osteosynthesis in comparison with volar plating real benefit in the treatment of distal radius fractures?

    PubMed Central

    Vlček, Martin; Jaganjac, Edib; Pech, Jan; Jonáš, David; Kebrle, Radek

    2014-01-01

    Purpose of the study: Can minimally invasive intramedullary osteosynthesis of distal radius fractures provide better therapeutic results than multidirectional locking plates. Retrospective study of 68 patients operated for distal radius fractures, 18 were treated with intramedullary X-screw (XSCR) fixation and 50 with the multidirectional angle-stable plate system (APTUS). The evaluation at 1-year follow-up included functional status of the wrist and hand, and radiographic findings. In the XSCR group, the functional outcomes of the treated extremity did not achieve values comparable with those of the uninjured side in any of the parameters measured. The radiographic findings did not meet the requirements of successful healing due to failure to restore an anatomical volar tilt in 22.2% cases. In the APTUS group, comparable values of the injured and the uninjured side were achieved in radial deviation, ulnar deviation, pronation, supination and grip strength. The radiographic criteria of successful healing were met by all fractures treated by locking plate osteosynthesis. Implant migration associated with secondary displacement of bone fragments was recorded in 33.3 % of the XSCR patients and only in 4.0 % of the APTUS patients. The overall evaluation show that intramedullary osteosynthesis does not produce better treatment outcomes compared with plate osteosynthesis in indicated types of fractures. PMID:24856379

  6. Can Total Wrist Arthroplasty Be an Option for Treatment of Highly Comminuted Distal Radius Fracture in Selected Patients? Preliminary Experience with Two Cases

    PubMed Central

    Schmidt, Ingo

    2015-01-01

    We present two case reports of successful primary shortening of the forearm and total wrist arthroplasty (TWA) using the new angle-stable Maestro Wrist Reconstructive System (WRS) for treatment of highly comminuted distal radius fracture in selected autonomous patients. In a 56-year-old male patient with adequate bone stock, insertion of the noncemented Maestro WRS was combined with ulnar shortening osteotomy. In an 84-year-old female patient with poor osteoporotic bone stock, insertion of the radial cemented Maestro WRS was combined with ulnar head resection. Both patients could resume their work without additional surgery after TWA. At the 1-year follow-up, there were no changes in position of either implant without signs of loosening, no impingement, and no instability of the distal radioulnar joint or the distal ulna stump. All clinical parameters (DASH score, pain through VAS, and grip strength) were satisfactory. Both patients reported that they would have the same procedure again. Further experience is needed to validate this concept. PMID:26491587

  7. Tangential View and Intraoperative Three-Dimensional Fluoroscopy for the Detection of Screw-Misplacements in Volar Plating of Distal Radius Fractures

    PubMed Central

    Rausch, Sascha; Marintschev, Ivan; Graul, Isabel; Wilharm, Arne; Klos, Kajetan; Hofmann, Gunther O.; Florian Gras, Marc

    2015-01-01

    Background: Volar locking plate fixation has become the gold standard in the treatment of unstable distal radius fractures. Juxta-articular screws should be placed as close as possible to the subchondral zone, in an optimized length to buttress the articular surface and address the contralateral cortical bone. On the other hand, intra-articular screw misplacements will promote osteoarthritis, while the penetration of the contralateral bone surface may result in tendon irritations and ruptures. The intraoperative control of fracture reduction and implant positioning is limited in the common postero-anterior and true lateral two-dimensional (2D)-fluoroscopic views. Therefore, additional 2D-fluoroscopic views in different projections and intraoperative three-dimensional (3D) fluoroscopy were recently reported. Nevertheless, their utility has issued controversies. Objectives: The following questions should be answered in this study; 1) Are the additional tangential view and the intraoperative 3D fluoroscopy useful in the clinical routine to detect persistent fracture dislocations and screw misplacements, to prevent revision surgery? 2) Which is the most dangerous plate hole for screw misplacement? Patients and Methods: A total of 48 patients (36 females and 13 males) with 49 unstable distal radius fractures (22 x 23 A; 2 x 23 B, and 25 x 23 C) were treated with a 2.4 mm variable angle LCP Two-Column volar distal radius plate (Synthes GmbH, Oberdorf, Switzerland) during a 10-month period. After final fixation, according to the manufactures' technique guide and control of implant placement in the two common perpendicular 2D-fluoroscopic images (postero-anterior and true lateral), an additional tangential view and intraoperative 3D fluoroscopic scan were performed to control the anatomic fracture reduction and screw placements. Intraoperative revision rates due to screw misplacements (intra-articular or overlength) were evaluated. Additionally, the number of surgeons

  8. Fracture severity of distal radius fractures treated with locking plating correlates with limitations in ulnar abduction and inferior health-related quality of life

    PubMed Central

    Tsitsilonis, Serafim; Machó, David; Manegold, Sebastian; Krapohl, Björn Dirk; Wichlas, Florian

    2016-01-01

    Introduction/background: The operative treatment of distal radius fractures has significantly increased after the introduction of locking plates. The aim of the present study was the evaluation of health-related quality of life, functional and radiological outcome of patients with distal radius fractures treated with the locking compression plate (LCP). Materials and methods: In the present study 128 patients (130 fractures) that were operatively treated with the LCP (2.4 mm/3.5 mm, Synthes®) were retrospectively evaluated. Mean follow-up was 22.7 months (SD 10.6). The fractures were radiographically evaluated (radial inclination, palmar tilt, ulnar variance) pre-, postoperatively and at the last follow-up visit. Range of motion (ROM) was documented. Grip strength was assessed with the use of a JAMAR dynamometer. The score for disabilities of the arm, shoulder and hand (DASH) and the Gartland-Werley score (GWS) were evaluated. Health-associated quality of life was assessed with use of SF-36 Health Survey. Results: Postoperative reduction was excellent; at the last follow-up visit only minimal reduction loss was observed. Except for pronation, a statistically significant decrease of ROM was present; in most cases that was not disturbing for the patients. The injured side achieved 83.9% of grip strength of the intact side. Mean DASH was 18.9 and mean GWS was 3.5. Health-associated quality of life was generally not compromised. However, limitations in ulnar abduction correlated with inferior quality of life. Fracture severity correlated with inferior quality of life, despite the absence of correlation with the functional and radiological outcome. Complication rate was low. Conclusions: Fracture severity seems to affect ulnar abduction and therefore patient quality of life, despite almost anatomical reduction; the objective and subjective scores were in most cases excellent. Modern everyday activities, such as keyboard typing, could be associated with the present

  9. Predicting surface strains at the human distal radius during an in vivo loading task--finite element model validation and application.

    PubMed

    Bhatia, Varun A; Edwards, W Brent; Troy, Karen L

    2014-08-22

    Bone strains resulting from physical activity are thought to be a primary driver of bone adaptation, but cannot be directly noninvasively measured. Because bone adapts nonuniformly, physical activity may make an important independent structural contribution to bone strength that is independent of bone mass and density. Our objective was to create and validate methods for subject-specific finite element (FE) model generation that would accurately predict the surface strains experienced by the distal radius during an in vivo loading task, and to apply these methods to a group of 23 women aged 23-35 to examine variations in strain, bone mass and density, and physical activity. Four cadaveric specimens were experimentally tested and specimen-specific FE models were developed to accurately predict periosteal surface strains (root mean square error=16.3%). In the living subjects, when 300 N load was simulated, mean strains were significantly inversely correlated with BMC (r=-0.893), BMD (r=-0.892) and physical activity level (r=-0.470). Although the group of subjects was relatively homogenous, BMD varied by two-fold (range: 0.19-0.40 g/cm(3)) and mean energy-equivalent strain varied by almost six-fold (range: 226.79-1328.41 με) with a simulated 300 N load. In summary, we have validated methods for estimating surface strains in the distal radius that occur while leaning onto the palm of the hand. In our subjects, strain varied widely across individuals, and was inversely related to bone parameters that can be measured using clinical CT, and inversely related to physical activity history. PMID:24882740

  10. Predicting Surface Strains at the Human Distal Radius during an In Vivo Loading Task – Finite Element Model Validation and Application

    PubMed Central

    Bhatia, Varun A.; Edwards, W. Brent; Troy, Karen L.

    2014-01-01

    Bone strains resulting from physical activity are thought to be a primary driver of bone adaptation, but cannot be directly noninvasively measured. Because bone adapts nonuniformly, physical activity may make an important independent structural contribution to bone strength that is independent of bone mass and density. Our objective was to create and validate methods for subject-specific finite element (FE) model generation that would accurately predict the surface strains experienced by the distal radius during an in vivo loading task, and to apply these methods to a group of 23 women age 23-35 to examine variations in strain, bone mass and density, and physical activity. Four cadaveric specimens were experimentally tested and specimen-specific FE models were developed to accurately predict periosteal surface strains (Root mean square error=16.3%). In the living subjects, when a 300 N load was simulated, mean strains were significantly inversely correlated with BMC (r=−0.893), BMD (r=−0.892) and physical activity level (r=−0.470). Although the group of subjects was relatively homogenous, BMD varied by two-fold (range: 0.19 – 0.40 g/cm3) and mean energy-equivalent strain varied by almost six-fold (range: 226.79 – 1328.41 με) with a simulated 300 N load. In summary, we have validated methods for estimating surface strains in the distal radius that occur while leaning onto the palm of the hand. In our subjects, strain varied widely across individuals, and was inversely related to bone parameters that can be measured using clinical CT, and inversely related to physical activity history. PMID:24882740

  11. Deficits in distal radius bone strength, density and microstructure are associated with forearm fractures in girls: an HR-pQCTstudy

    PubMed Central

    Määttä, M.; Macdonald, H. M.; Mulpuri, K.

    2016-01-01

    Summary Forearm fractures are common during growth. We studied bone strength in youth with a recent forearm fracture. In girls, suboptimal bone strength was associated with fractures. In boys, poor balance and physical inactivity may lead to fractures. Prospective studies will confirm these relationships and identify targets for prevention strategies. Introduction The etiology of pediatric forearm fractures is unclear. Thus, we examined distal radius bone strength, microstructure, and density in children and adolescents with a recent low- or moderate-energy forearm fracture and those without forearm fractures. Methods We assessed the non-dominant (controls) and non-fractured (cases) distal radius (7 % site) using high-resolution peripheral quantitative computed tomography (HR-pQCT) (Scanco Medical AG) in 270 participants (girls: cases n=47, controls n=61 and boys: cases n=88, controls n=74) aged 8–16 years. We assessed standard anthropometry, maturity, body composition (dual energy X-ray absorptiometry (DXA), Hologic QDR 4500 W) physical activity, and balance. We fit sex-specific logistic regression models for each bone outcome adjusting for maturity, ethnicity, height, and percent body fat. Results In girls, impaired bone strength (failure load, ultimate stress) and a high load-to-strength ratio were associated with low-energy fractures (odds ratios (OR) 2.8–4.3). Low total bone mineral density (Tt.BMD), bone volume ratio, trabecular thickness, and cortical BMD and thickness were also associated with low-energy fractures (ORs 2.0–7.0). In boys, low Tt.BMD, but not bone strength, was associated with low-energy fractures (OR=1.8). Boys with low-energy fractures had poor balance and higher percent body fat compared with controls (p<0.05). Boys with fractures (both types) were less active than controls (p<0.05). Conclusions Forearm fracture etiology appears to be sex-specific. In girls, deficits in bone strength are associated with fractures. In boys, a

  12. Treatment of reducible unstable fractures of the distal radius: randomized clinical study comparing the locked volar plate and external fixator methods: study protocol

    PubMed Central

    2014-01-01

    Background Various treatments are available for reducible unstable fractures of the distal radius, such as closed reduction combined with fixation by external fixator (EF), and rigid internal fixation using a locked volar plate (VP). Although there are studies comparing these methods, there is no conclusive evidence indicating which treatment is best. The hypothesis of this study is that surgical treatment with a VP is more effective than EF from the standpoint of functional outcome (patient-reported). Methods/Design The study is randomized clinical trial with parallel groups and a blinded evaluator and involves the surgical interventions EF and VP. Patients will be randomly assigned (assignment ratio 1:1) using sealed opaque envelopes. This trial will include consecutive adult patients with an acute (up to 15 days) displaced, unstable fracture of the distal end of the radius of type A2, A3, C1, C2 or C3 by the Arbeitsgemeinschaft für Osteosynthesefragen–Association for the Study of Internal Fixation classification and type II or type III by the IDEAL32 classification, without previous surgical treatments of the wrist. The surgical intervention assigned will be performed by three surgical specialists familiar with the techniques described. Evaluations will be performed at 2, and 8 weeks, 3, 6 and 12 months, with the primary outcomes being measured by the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and measurement of pain (Visual Analog Pain Scale and digital algometer). Secondary outcomes will include radiographic parameters, objective functional evaluation (goniometry and dynamometry), and the rate of complications and method failure according to the intention-to-treat principle. Final postoperative evaluations (6 and 12 months) will be performed by independent blinded evaluators. For the Student’s t-test, a difference of 10 points in the DASH score, with a 95% confidence interval, a statistical power of 80%, and 20% sampling error

  13. Distal Radius Fracture (Broken Wrist)

    MedlinePlus

    ... choice depends on many factors, such as the nature of the fracture, your age and activity level, ... causing the cast to loosen. Depending on the nature of the fracture, your doctor may closely monitor ...

  14. Comparison and combination of scaling index method and Minkowski functionals in the analysis of high resolution magnetic resonance images of the distal radius in vitro

    NASA Astrophysics Data System (ADS)

    Sidorenko, Irina N.; Bauer, Jan; Monetti, Roberto; Mueller, Dirk; Rummeny, Ernst J.; Eckstein, Felix; Raeth, Christoph W.

    2008-03-01

    High resolution magnetic resonance (HRMR) imaging can reveal major characteristics of trabecular bone. The quantification of this trabecular micro architecture can be useful for better understanding the progression of osteoporosis and improve its diagnosis. In the present work we applied the scaling index method (SIM) and Minkowski Functionals (MF) for analysing tomographic images of distal radius specimens in vitro. For both methods, the correlation with the maximum compressive strength (MCS) as determined in a biomechanical test and the diagnostic performance with regard to the spine fracture status were calculated. Both local SIM and global MF methods showed significantly better results compared to bone mineral density measured by quantitative computed tomography. The receiver operating characteristic analysis for differentiating fractured and non-fractured subjects revealed area under the curve (AUC) values of 0.716 for BMD, 0.897 for SIM and 0.911 for MF. The correlation coefficients with MCS were 0.6771 for BMD, 0.843 for SIM and 0.772 for MF. We simulated the effect of perturbations, namely noise effects and intensity variations. Overall, MF method was more sensitive to noise than SIM. A combination of SIM and MF methods could, however, increase AUC values from 0.85 to 0.89 and correlation coefficients from 0.71 to 0.82. In conclusion, local SIM and global MF techniques can successfully be applied for analysing HRMR image data. Since these methods are complementary, their combination offers a new possibility of describing MR images of the trabecular bone, especially noisy ones.

  15. UK DRAFFT - A randomised controlled trial of percutaneous fixation with kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius

    PubMed Central

    2011-01-01

    Background Fractures of the distal radius are extremely common injuries in adults. However, the optimal management remains controversial. In general, fractures of the distal radius are treated non-operatively if the bone fragments can be held in anatomical alignment by a plaster cast or orthotic. However, if this is not possible, then operative fixation is required. There are several operative options but the two most common in the UK, are Kirschner-wire fixation (K-wires) and volar plate fixation using fixed-angle screws (locking-plates). The primary aim of this trial is to determine if there is a difference in the Patient-Reported Wrist Evaluation one year following K-wire fixation versus locking-plate fixation for adult patients with a dorsally-displaced fracture of the distal radius. Methods/design All adult patients with an acute, dorsally-displaced fracture of the distal radius, requiring operative fixation are potentially eligible to take part in this study. A total of 390 consenting patients will be randomly allocated to either K-wire fixation or locking-plate fixation. The surgery will be performed in trauma units across the UK using the preferred technique of the treating surgeon. Data regarding wrist function, quality of life, complications and costs will be collected at six weeks and three, six and twelve months following the injury. The primary outcome measure will be wrist function with a parallel economic analysis. Discussion This pragmatic, multi-centre trial is due to deliver results in December 2013. Trial registration Current Controlled Trials ISRCTN31379280 UKCRN portfolio ID 8956 PMID:21914196

  16. Treatment of unstable distal radius fractures: non-invasive dynamic external fixator versus volar locking plate – functional and radiological outcome in a prospective case-controlled series

    PubMed Central

    Bajwa, Ali S.; Rammappa, Manju; Lee, Ling; Nanda, Rajesh

    2015-01-01

    Introduction: Distal radius fracture (DRF) is a common injury and various treatment modalities including open reduction and internal fixation (ORIF) with volar locking plate are available. More recently, a non-invasive external fixator has been used. Aims: To prospectively compare the use of a non-invasive external fixator with early dynamisation for DRF against ORIF with volar locking plate control group. Methods: Consecutive patients with closed DRF were included in a prospective case-controlled study. Patients were assigned to non-invasive external fixator or ORIF. Minimum follow-up was two years. Follow-up was at weeks 2, 4, 6, 8, 12, 26 and at one and two-year post-operatively. The outcome measures included demographic details, injury mechanism, AO fracture type, risk factors, body mass index (BMI), ulnar styloid fracture and dorsal comminution, radiographs, grip strength and DASH score. Results: Consecutive 50 patients were treated either with non-invasive external fixator (25/50) or with ORIF (25/50) and the mean age of the two groups was 53 years (SD 17.1) and 49 years (SD 19.5), respectively. Demographics were matched in two groups. In the non-invasive external fixator group, there were 10 AO Type-A, 5 Type-B and 10 Type-C fractures. The ORIF group included 8 Type-A, 6 Type-B and 11 Type-C fractures. The mean DASH score at three-months and one-year post-injury in non-invasive fixator group was 12.2 (SD 3.1) and 3.5 (SD 0.7), respectively, significantly greater than those of ORIF group 14.5 (SD 5.6) and 11.2 (SD 4.4), respectively (p < 0.05). Conclusion: DRF treated with non-invasive external fixator can give functional results superior to ORIF at three-months and the trend is maintained at one and two-year post-operatively. PMID:27163089

  17. Semiconstrained distal radioulnar joint prosthesis.

    PubMed

    Savvidou, Christiana; Murphy, Erin; Mailhot, Emilie; Jacob, Shushan; Scheker, Luis R

    2013-02-01

    Distal radioulnar joint (DRUJ) problems can occur as a result of joint instability, abutment, or incongruity. The DRUJ is a weight-bearing joint; the ulnar head is frequently excised either totally or partially, and in some cases it is fused, because of degenerative, rheumatoid, or posttraumatic arthritis. Articles about these procedures report the ability to pronate and supinate, but they rarely discuss grip strength, and even less do they address lifting capacity. We report the long term results of the first 35 patients who underwent total DRUJ arthroplasty with the Aptis DRUJ prosthesis after 5 years follow-up. Surgical indications were all causes of dysfunctional DRUJ (degenerative, posttraumatic, autoimmune, congenital). We recorded data for patient demographics, range of motion (ROM), strength, and lifting capacity of the operated and of the nonoperated extremity. Pain and functional assessments were also recorded. The Aptis DRUJ prosthesis, a bipolar self-stabilizing DRUJ endoprosthesis that restores forearm function, consists of a semiconstained and modular implant designed to replace the function of the ulnar head, the sigmoid notch of the radius, and the triangular fibrocartilage ligaments. The surgical technique is presented in detail. The majority of the patients regained adequate ROM and improved their strength and lifting capacity to the operated side. Pain and activities of daily living were improved. Twelve patients experienced complications, most commonly being extensor carpi ulnaris (ECU) tendinitis, ectopic bone formation, bone resorption with stem loosening, low-grade infection, and need for ball replacement. The Aptis total DRUJ replacement prosthesis is an alternative to salvage procedures that enables a full range of motion as well as the ability to grip and lift weights encountered in daily living activities. PMID:24436788

  18. TEST: A Z, A&Z, Adistal radius fractures

    PubMed Central

    2013-01-01

    Background Soft tissue injuries associated with distal radius fractures have been reported by some authors. Arthroscopy can be used to evaluate the condition of the articular surface and intracarpal soft tissues and as an aid to treatment. There are three intracarpal soft tissues of particular importance: the triangular fibrocartilage complex (TFCC), the scapholunate interosseous ligament (SLIL), and the lunotriquetral interosseous ligament (LTIL). The purpose of this study was to evaluate intracarpal soft tissue injuries and their relationships with fracture types during arthroscopic surgical treatment of distal radius fractures. Methods Eighty-nine patients in our hospital underwent surgical treatment by arthroscopy for a fracture of the distal end of the radius. They ranged in age from 17 to 92 years (mean, 62.2 years), and comprised 20 men (mean age, 45.6 years) and 69 women (mean age, 66.5 years). The AO classification data on plain radiographs indicated A2 fracture in four patients, A3 fracture in 10 patients, C1 fracture in two patients, C2 fracture in 24 patients, and C3 fracture in 49 patients. Wrist arthroscopy was performed with vertical traction, and intracarpal soft tissues were examined. For assessment of the TFCC in the radiocarpal space, the Palmar classification was used. For assessment of the SLIL and LTIL in the midcarpal space, the Geissler classification was used. Results TFCC injury was present in 59% of cases, SLIL injury in 54.5% of cases, and LTIL injury in 34.5% of cases. Only 17.1% of patients (14/82 patients) were negative for all three types of injury. In 81% of cases (72/89 patients), some intracarpal soft tissue injury was present in association with the fracture. Conclusions The fracture was complicated by TFCC injury in 59% of patients, SLIL injury in 54.5% of patients, and LTIL injury in 34.5% of patients, irrespective of the fracture type. PMID:24004506

  19. Open reduction and internal fixation versus casting for highly comminuted and intra-articular fractures of the distal radius (ORCHID): protocol for a randomized clinical multi-center trial

    PubMed Central

    2011-01-01

    Background Fractures of the distal radius represent the most common fracture in elderly patients, and often indicate the onset of symptomatic osteoporosis. A variety of treatment options is available, including closed reduction and plaster casting, K-wire-stabilization, external fixation and open reduction and internal fixation (ORIF) with volar locked plating. The latter is widely promoted by clinicians and hardware manufacturers. Closed reduction and cast stabilization for six weeks is a simple, convenient, and ubiquitously available intervention. In contrast, ORIF requires hospitalization, but allows for functional rehabilitation. Given the lack of randomized controlled trials, it remains unclear whether ORIF leads to better functional outcomes one year after injury than closed reduction and casting. Methods/Design ORCHID (Open reduction and internal fixation versus casting for highly comminuted intra-articular fractures of the distal radius) is a pragmatic, randomized, multi-center, clinical trial with two parallel treatment arms. It is planned to include 504 patients in 15 participating centers throughout Germany over a three-year period. Patients are allocated by a central web-based randomization tool. The primary objective is to determine differences in the Short Form 36 (SF-36) Physical Component Score (PCS) between volar locked plating and closed reduction and casting of intraarticular, comminuted distal radius fractures in patients > 65 years of age one year after the fracture. Secondary outcomes include differences in other SF-36 dimensions, the EuroQol-5D questionnaire, the Disability of the Arm, Shoulder, and Hand (DASH) instrument. Also, the range of motion in the affected wrist, activities of daily living, complications (including secondary ORIF and revision surgery), as well as serious adverse events will be assessed. Data obtained during the trial will be used for later health-economic evaluations. The trial architecture involves a central

  20. High-resolution peripheral quantitative computed tomography (HR-pQCT) can assess microstructural and biomechanical properties of both human distal radius and tibia: Ex vivo computational and experimental validations.

    PubMed

    Zhou, Bin; Wang, Ji; Yu, Y Eric; Zhang, Zhendong; Nawathe, Shashank; Nishiyama, Kyle K; Rosete, Fernando Rey; Keaveny, Tony M; Shane, Elizabeth; Guo, X Edward

    2016-05-01

    High-resolution peripheral quantitative computed tomography (HR-pQCT) provides in vivo three-dimensional (3D) imaging at the distal radius and tibia and has been increasingly used to characterize cortical and trabecular bone morphology in clinical studies. In this study, we comprehensively examined the accuracy of HR-pQCT and HR-pQCT based micro finite element (μFE) analysis predicted bone elastic stiffness and strength through comparisons with gold-standard micro computed tomography (μCT) based morphological/μFE measures and direct mechanical testing results. Twenty-six sets of human cadaveric distal radius and tibia segments were imaged by HR-pQCT and μCT. Microstructural analyses were performed for the registered HR-pQCT and μCT images. Bone stiffness and yield strength were determined by both HR-pQCT and μCT based linear and nonlinear μFE predictions and mechanical testing. Our results suggested that strong and significant correlations existed between the HR-pQCT standard, model-independent and corresponding μCT measurements. HR-pQCT based nonlinear μFE overestimated stiffness and yield strength while the linear μFE underestimated yield strength, but both were strongly correlated with those predicted by μCT μFE and measured by mechanical testing at both radius and tibia (R(2)>0.9). The microstructural differences between HR-pQCT and μCT were also examined by the Bland-Altman plots. Our results showed HR-pQCT morphological measurements of BV/TV(d), Tb.Th, and Tb.Sp, can be adjusted by correction values to approach true values measured by gold-standard μCT. In addition, we observed moderate correlations of HR-pQCT biomechanical and microstructural parameters between the distal radius and tibia. We concluded that morphological and mechanical properties of human radius and tibia bone can be assessed by HR-pQCT based measures. PMID:26924718

  1. Cost effectiveness of treatment with percutaneous Kirschner wires versus volar locking plate for adult patients with a dorsally displaced fracture of the distal radius: analysis from the DRAFFT trial.

    PubMed

    Tubeuf, S; Yu, G; Achten, J; Parsons, N R; Rangan, A; Lamb, S E; Costa, M L

    2015-08-01

    We present an economic evaluation using data from the Distal Radius Acute Fracture Fixation Trial (DRAFFT) to compare the relative cost effectiveness of percutaneous Kirschner wire (K-wire) fixation and volar locking-plate fixation for patients with dorsally-displaced fractures of the distal radius. The cost effectiveness analysis (cost per quality-adjusted life year; QALY) was derived from a multi-centre, two-arm, parallel group, assessor-blind, randomised controlled trial which took place in 18 trauma centres in the United Kingdom. Data from 460 patients were available for analysis, which includes both a National Health Service cost perspective including costs of surgery, implants and healthcare resource use over a 12-month period after surgery, and a societal perspective, which includes the cost of time off work and the need for additional private care. There was only a small difference in QALYs gained for patients treated with locking-plate fixation over those treated with K-wires. At a mean additional cost of £714 (95% confidence interval 588 to 865) per patient, locking-plate fixation presented an incremental cost effectiveness ratio (ICER) of £89,322 per QALY within the first 12 months of treatment. Sensitivity analyses were undertaken to assess the ICER of locking-plate fixation compared with K-wires. These were greater than £30,000. Compared with locking-plate fixation, K-wire fixation is a 'cost saving' intervention, with similar health benefits. PMID:26224825

  2. UK DRAFFT: a randomised controlled trial of percutaneous fixation with Kirschner wires versus volar locking-plate fixation in the treatment of adult patients with a dorsally displaced fracture of the distal radius.

    PubMed Central

    Costa, Matthew L; Achten, Juul; Plant, Caroline; Parsons, Nick R; Rangan, Amar; Tubeuf, Sandy; Yu, Ge; Lamb, Sarah E

    2015-01-01

    BACKGROUND In high-income countries, 6% of all women will have sustained a fracture of the wrist (distal radius) by the age of 80 years and 9% by the age of 90 years. Advances in orthopaedic surgery have improved the outcome for patients: many such fractures can be treated in a plaster cast alone, but others require surgical fixation to hold the bone in place while they heal. The existing evidence suggests that modern locking-plate fixation provides improved functional outcomes, but costs more than traditional wire fixation. METHODS In this multicentre trial, we randomly assigned 461 adult patients having surgery for an acute dorsally displaced fracture of the distal radius to either percutaneous Kirschner-wire fixation or locking-plate fixation. The primary outcome measure was the Patient-Rated Wrist Evaluation© (PRWE) questionnaire at 12 months after the fracture. In this surgical trial, neither the patients nor the surgeons could be blind to the intervention. We also collected information on complications and combined costs and quality-adjusted life-years (QALYs) to assess cost-effectiveness. RESULTS The baseline characteristics of the two groups were well balanced and over 90% of patients completed follow-up. Both groups of patients recovered wrist function by 12 months. There was no clinically relevant difference in the PRWE questionnaire score at 3 months, 6 months or 12 months [difference at 12 months: -1.3; 95% confidence interval (CI) -4.5 to 1.8; p=0.398]. There was no difference in the number of complications in each group and small differences in QALY gains (0.008; 95% CI -0.001 to 0.018); Kirschner-wire fixation represents a cost-saving intervention (-£727; 95% CI -£588 to -£865), particularly in younger patients. CONCLUSIONS Contrary to the existing literature, and against the increasing use of locking-plate fixation, this trial shows that there is no difference between Kirschner wires and volar locking plates for patients with dorsally displaced

  3. Improved fracture risk assessment based on nonlinear micro-finite element simulations from HRpQCT images at the distal radius

    PubMed Central

    Christen, David; Melton, L. Joseph; Zwahlen, Alexander; Amin, Shreyasee; Khosla, Sundeep; Müller, Ralph

    2013-01-01

    More accurate techniques to estimate fracture risk could help reduce the burden of fractures in postmenopausal women. Although micro-finite element (µFE) simulations allow a direct assessment of bone mechanical performance, in this first clinical study, we investigated whether the additional information obtained using geometrically and materially nonlinear µFE simulations allows a better discrimination between fracture cases and controls. We used patient data and high-resolution peripheral quantitative computed tomography (HRpQCT) measurements from our previous clinical study on fracture risk which compared 100 postmenopausal women with a distal forearm fracture to 105 controls. Analyzing these data with the nonlinear µFE simulations, the odds ratio (OR) for the factor-of-risk (yield load divided by the expected fall load) was marginally higher (1.99; 95% CI, 1.41–2.77) than for the factor-of-risk computed from linear µFE (1.89; 95% CI, 1.37–2.69). The yield load and the energy absorbed up to the yield point as computed from nonlinear µFE were highly correlated with the initial stiffness (R2, 0.97 and 0.94, respectively) and could therefore be derived from linear simulations with little loss in precision. However, yield deformation was not related to any other measurement performed and was itself a good predictor of fracture risk (OR, 1.89; 95% CI, 1.39–2.63). Moreover, a combined risk score integrating information on relative bone strength (yield load-based factor-of-risk), bone ductility (yield deformation) and the structural integrity of the bone under critical loads (cortical plastic volume) improved the separation of cases and controls by one third (OR, 2.66; 95% CI, 1.84–4.02). We therefore conclude that nonlinear µFE simulations provide important additional information on the risk of distal forearm fractures not accessible from linear µFE nor from other techniques assessing bone microstructure, density or mass. PMID:23703921

  4. A Two Phase Treatment of an Infected Hip Endoprosthesis.

    PubMed

    Ciriviri, Jasmin; Talevski, Darko; Nestorovski, Zoran; Vraniskoski, Tode; Mishevska-Perchinkova, Snežana

    2015-01-01

    The revision of the two phase treatment represents a golden standard in the treatment of infected endoprosthesis. Throughout this study, the results of 21 patients with an infected hip endoprosthesis treated in two phases have been processed, with the use of an antibiotic spacer, within the period of 2009 and 2012. Thereby, a unique protocol for diagnosis and treatment of infections has been applied to all the patients, which entails a preoperational x-ray image, laboratory findings (Se, CRP), as well as a puncture aspiration with a microbiological and biochemical examination of the aspirated fragments. The operational treatment consists of: taking a sample for microbiological and histopathological diagnosis, removal of the implanted endoprosthesis, excision of the avascular and necrotic tissue and installing an antibiotic spacer. Postoperatively, the patients are treated with a parenteral application of an antibiotics based on an antibiogram, throughout a period of two weeks, and later on an oral treatment, a combination of two antibiotics, depending on the antibiogram, within the following four to six weeks. After the appeasement of the local findings and the laboratory results, a revision with a removal of the antibiotic spacer and reimplantation of an endoprosthesis - revisional or primary has been conducted on the patients, depending on the bone deficit. The functionality of the joint is graded based on the Haris Hip Score. The patients are being observed postoperatively for a period of 12 to 36 months. A definite reimplantation has been applied to 20 patients, while one patient has been treated with a resection method. The Haris Hip Score was 45 preoperatively, and 80 postoperatively. The applied protocol of the treatment of infected endoprosthesis is effective in the eradication of the infection and the final reimplantation. PMID:27442385

  5. Use of MR-based trabecular bone microstructure analysis at the distal radius for osteoporosis diagnostics: a study in post-menopausal women with breast cancer and treated with aromatase inhibitor

    PubMed Central

    Baum, Thomas; Karampinos, Dimitrios C.; Seifert-Klauss, Vanadin; Pencheva, Tsvetelina D.; Jungmann, Pia M.; Rummeny, Ernst J.; Müller, Dirk; Bauer, Jan S.

    2016-01-01

    Summary Purpose Treatment with aromatase inhibitor (AI) is recommended for post-menopausal women with hormone-receptor positive breast cancer. However, AI therapy is known to induce bone loss leading to osteoporosis with an increased risk for fragility fractures. The purpose of this study was to investigate whether changes of magnetic resonance (MR)-based trabecular bone microstructure parameters as advanced imaging biomarker can already be detected in subjects with AI intake but still without evidence for osteoporosis according to dual energy X-ray absorptiometry (DXA)-based bone mineral density (BMD) measurements as current clinical gold standard. Methods Twenty-one postmenopausal women (62±6 years of age) with hormone-receptor positive breast cancer, ongoing treatment with aromatase inhibitor for 23±15 months, and no evidence for osteoporosis (current DXA T-score greater than −2.5) were recruited for this study. Eight young, healthy women (24±2 years of age) were included as controls. All subjects underwent 3 Tesla magnetic resonance imaging (MRI) of the distal radius to assess the trabecular bone microstructure. Results Trabecular bone microstructure parameters were not significantly (p>0.05) different between subjects with AI intake and controls, including apparent bone fraction (0.42±0.03 vs. 0.42±0.05), trabecular number (1.95±0.10 mm−1 vs 1.89±0.15 mm−1), trabecular separation (0.30±0.03 mm vs 0.31±0.06 mm), trabecular thickness (0.21±0.01 mm vs 0.22±0.02 mm), and fractal dimension (1.70±0.02 vs. 1.70±0.03). Conclusion These findings suggest that the initial deterioration of trabecular bone microstructure as measured by MRI and BMD loss as measured by DXA occur not sequentially but rather simultaneously. Thus, the use of MR-based trabecular bone microstructure assessment is limited as early diagnostic biomarker in this clinical setting. PMID:27252740

  6. DISTAL MYOPATHIES

    PubMed Central

    Dimachkie, Mazen M.; Barohn, Richard J.

    2014-01-01

    Over a century ago, Gowers described two young patients in whom distal muscles weakness involved the hand, foot, sternocleidomastoid, and facial muscles in the other case the shoulder and distal leg musculature. Soon after, , similar distal myopathy cases were reported whereby the absence of sensory symptoms and of pathologic changes in the peripheral nerves and spinal cord at postmortem examination allowed differentiation from Charcot-Marie-Tooth disease. In 1951, Welander described autosomal dominant (AD) distal arm myopathy in a large Scandanavian cohort. Since then the number of well-characterized distal myopathies has continued to grow such that the distal myopathies have formed a clinically and genetically heterogeneous group of disorders. Affected kindred commonly manifest weakness that is limited to foot and toe muscles even in advanced stages of the disease, with variable mild proximal leg, distal arm, neck and laryngeal muscle involvement in selected individuals. An interesting consequence of the molecular characterization of the distal myopathies has been the recognition that mutation in a single gene can lead to more than one clinical disorder. For example, Myoshi myopathy (MM) and limb girdle muscular dystrophy (LGMD) type 2B are allelic disorders due to defects in the gene that encodes dysferlin. The six well described distal myopathy syndromes are shown in Table 1. Table 2 lists advances in our understanding of the myofibrillar myopathy group and Table 3 includes more recently delineated and less common distal myopathies. In the same manner, the first section of this review pertains to the more traditional six distal myopathies followed by discussion of the myofibrillar myopathies. In the third section, we review other clinically and genetically distinctive distal myopathy syndromes usually based upon single or smaller family cohorts. The fourth section considers other neuromuscular disorders that are important to recognize as they display prominent

  7. [Total endoprosthesis of knee joint for the severe deformity of the femoral and tibial condyles].

    PubMed

    Ternovoĭ, N K; Zazirnyĭ, I M; Kosiakov, A N; Dubok, V A; Ul'ianich, N V; Kikhniakevich, T G; Evseenko, V G

    2000-06-01

    The method of knee joint endoprosthesis for its pronounced deformity was proposed. As a transplant there was applied the ceramic hydroxiapatite, manufactured according to special technology. The implant was fixed on the transplant adjusted. PMID:11288279

  8. High-resolution peripheral quantitative computed tomography and finite element analysis of bone strength at the distal radius in ovariectomized adult rhesus monkey demonstrate efficacy of odanacatib and differentiation from alendronate.

    PubMed

    Cabal, Antonio; Jayakar, Richa Y; Sardesai, Swanand; Phillips, Eual A; Szumiloski, John; Posavec, Diane J; Mathers, Parker D; Savitz, Alan T; Scott, Boyd B; Winkelmann, Christopher T; Motzel, Sherri; Cook, Lynn; Hargreaves, Richard; Evelhoch, Jeffrey L; Dardzinski, Bernard J; Hangartner, Thomas N; McCracken, Paul J; Duong, Le T; Williams, Donald S

    2013-10-01

    Translational evaluation of disease progression and treatment response is critical to the development of therapies for osteoporosis. In this study, longitudinal in-vivo monitoring of odanacatib (ODN) treatment efficacy was compared to alendronate (ALN) in ovariectomized (OVX) non-human primates (NHPs) using high-resolution peripheral computed tomography (HR-pQCT). Treatment effects were evaluated using several determinants of bone strength, density and quality, including volumetric bone mineral density (vBMD), three-dimensional structure, finite element analysis (FEA) estimated peak force and biomechanical properties at the ultradistal (UD) radius at baseline, 3, 6, 9, 12, and 18 months of dosing in three treatment groups: vehicle (VEH), low ODN (2 mg/kg/day, L-ODN), and ALN (30 μg/kg/week). Biomechanical axial compression tests were performed at the end of the study. Bone strength estimates using FEA were validated by ex-vivo mechanical compression testing experiments. After 18months of dosing, L-ODN demonstrated significant increases from baseline in integral vBMD (13.5%), cortical thickness (24.4%), total bone volume fraction BV/TV (13.5%), FEA-estimated peak force (26.6%) and peak stress (17.1%), respectively. Increases from baseline for L-ODN at 18 months were significantly higher than that for ALN in DXA-based aBMD (7.6%), cortical thickness (22.9%), integral vBMD (12.2%), total BV/TV (10.1%), FEA peak force (17.7%) and FEA peak stress (11.5%), respectively. These results demonstrate a superior efficacy of ODN treatment compared to ALN at the UD radii in ovariectomized NHPs. PMID:23791777

  9. Distal radioulnar joint injuries.

    PubMed

    Thomas, Binu P; Sreekanth, Raveendran

    2012-09-01

    Distal radioulnar joint is a trochoid joint relatively new in evolution. Along with proximal radioulnar joint, forearm bones and interosseous membrane, it allows pronosupination and load transmission across the wrist. Injuries around distal radioulnar joint are not uncommon, and are usually associated with distal radius fractures,fractures of the ulnar styloid and with the eponymous Galeazzi or Essex_Lopresti fractures. The injury can be purely involving the soft tissue especially the triangular fibrocartilage or the radioulnar ligaments. The patients usually present with ulnar sided wrist pain, features of instability, or restriction of rotation. Difficulty in carrying loads in the hand is a major constraint for these patients. Thorough clinical examination to localize point of tenderness and appropriate provocative tests help in diagnosis. Radiology and MRI are extremely useful, while arthroscopy is the gold standard for evaluation. The treatment protocols are continuously evolving and range from conservative, arthroscopic to open surgical methods. Isolated dislocation are uncommon. Basal fractures of the ulnar styloid tend to make the joint unstable and may require operative intervention. Chronic instability requires reconstruction of the stabilizing ligaments to avoid onset of arthritis. Prosthetic replacement in arthritis is gaining acceptance in the management of arthritis. PMID:23162140

  10. Fixation of distal radius fractures in adults: a review.

    PubMed

    Obert, L; Rey, P-B; Uhring, J; Gasse, N; Rochet, S; Lepage, D; Serre, A; Garbuio, P

    2013-04-01

    In patients for whom function is a priority, anatomic reduction and stable fixation are prerequisites for good outcomes. Several therapeutic options exist, including orthopedic treatment and internal fixation with pins (intra- and extrafocal), external fixation which may or may not bridge the wrist, and different internal fixation techniques with dorsal or palmar plates using or not, locking screws. Arthroscopy may be necessary in case of articular fracture. In the presence of significant metaphyseal bone defects, filling of the comminution with phosphocalcic cements provides better graft stability. The level of evidence is too low to allow recommending one type of fixation for one type of fracture; and different fixation options to achieve stable reduction exist, each with its own specific complications. With the new generations of palmar plate, secondary displacement is becoming a thing of the past. PMID:23518070

  11. Surgical exposures of the radius and ulna.

    PubMed

    Catalano, Louis W; Zlotolow, Dan A; Hitchcock, Phillip B; Shah, Suparna N; Barron, O Alton

    2011-07-01

    The forearm contains many muscles, nerves, and vascular structures that change position on forearm rotation. Exposure of the radial shaft is best achieved with the Henry (volar) or Thompson (dorsal) approach. The volar flexor carpi radialis approaches are used increasingly for exposure of the distal radius. Although the dorsal approach is a safe utilitarian option with many applications, its use for managing fracture of the distal radius has waned. Potential complications associated with radial exposure include injury to the superficial branch of the radial nerve, the lateral antebrachial cutaneous nerve, and the cephalic vein. Dorsal and ulnar proximal radial exposures are associated with increased risk of injury to the posterior interosseous nerve. With surgical exposure of the ulna, care is required to avoid injuring the dorsal cutaneous branch of the ulnar nerve. PMID:21724922

  12. Analysis of rehabilitation procedure following arthroplasty of the knee with the use of complete endoprosthesis

    PubMed Central

    Wilk-Frańczuk, Magdalena; Tomaszewski, Wiesław; Zemła, Jerzy; Noga, Henryk; Czamara, Andrzej

    2011-01-01

    Summary Background The use of endoprosthesis in arthroplasty requires adaptation of rehabilitation procedures in order to reinstate the correct model of gait, which enables the patient to recover independence and full functionality in everyday life, which in turn results in an improvement in the quality of life. Material/Methods We studied 33 patients following an initial total arthroplasty of the knee involving endoprosthesis. The patients were divided into two groups according to age. The range of movement within the knee joints was measured for all patients, along with muscle strength and the subjective sensation of pain on a VAS, and the time required to complete the ‘up and go’ test was measured. The gait model and movement ability were evaluated. The testing was conducted at baseline and after completion of the rehabilitation exercise cycle. Results No significant differences were noted between the groups in the tests of the range of movement in the operated joint or muscle strength acting on the knee joint. Muscle strength was similar in both groups. In the “up and go” task the time needed to complete the test was 2.9 seconds shorter after rehabilitation in Group 1 (average age 60.4), and 4.5 seconds shorter in Group 2 (average age 73.1)). Conclusions The physiotherapy procedures we applied, following arthroplasty of the knee with cemented endoprosthesis, brought about good results in both research groups of older patients. PMID:21358604

  13. Large mode radius resonators

    NASA Technical Reports Server (NTRS)

    Harris, Michael R.

    1987-01-01

    Resonator configurations permitting operation with large mode radius while maintaining good transverse mode discrimination are considered. Stable resonators incorporating an intracavity telescope and unstable resonator geometries utilizing an output coupler with a Gaussian reflectivity profile are shown to enable large radius single mode laser operation. Results of heterodyne studies of pulsed CO2 lasers with large (11mm e sup-2 radius) fundamental mode sizes are presented demonstrating minimal frequency sweeping in accordance with the theory of laser-induced medium perturbations.

  14. Early experience using the Wallgraft in the management of distal microembolism from common iliac artery patholology.

    PubMed

    Kumins, Norman H; Owens, Erik L; Oglevie, Steven B; Ronaghi, Amir H; Bergan, John J; Tripathy, Uttam; Sparks, Steven R

    2002-03-01

    Blue toe syndrome commonly occurs as a result of aneurysmal or atherosclerotic disease in the iliac arteries. Surgery, angioplasty, or intraarterial stent placement are the most common treatment options but the optimal management has not been defined. Here we report managing distal microembolization from iliac artery atherosclerosis associated with aneurysmal dilation with the Wallgraft Endoprosthesis, a self-expanding metallic stent covered with Dacron. Three common iliac arteries in two patients were treated using this device. A 79-year-old male presented with unilateral symptoms and an 83-year-old female with bilateral disease. Arteriography demonstrated complex plaque at the aortic bifurcation associated with aneurysmal dilation of the distal common iliac artery in both patients. This complex disease was successfully covered using the Wallgraft Endoprosthesis. Postoperatively the patients received aspirin, their toe lesions healed, and neither has had a recurrence after 16 months. Covered stents offer the theoretic advantage of completely excluding the diseased segment, preventing the escape of thrombus or plaque debris, and covering aneurysmal dilation in the artery. PMID:11972249

  15. Hominid radius from the middle Pliocene of Lake Turkana, Kenya.

    PubMed

    Heinrich, R E; Rose, M D; Leakey, R E; Walker, A C

    1993-10-01

    A nearly complete left radius, KNM-ER 20419, was recovered from middle Pliocene sediments east of Lake Turkana, Kenya in 1988. Ape-like characteristics of the fossil include an eccentrically positioned articular fovea, relatively long radial neck, wide distal metaphysis, and large brachioradialis crest. The robustness of the radial neck in proportion to the radial head, and the semilunar shape of the distal diaphysis, however, clearly distinguish KNM-ER 20419 as hominid. The distal articular surface possesses a larger area for radius-lunate articulation than for radius and scaphoid, a radiocarpal arrangement that is associated with increased wrist adduction among quadrumanous climbers. Since this morphology is also found in hylobatids, Pongo, and other early australopithecines, it is argued to be plesiomorphic for hominoids. This further supports the argument that vertical climbing was an important locomotor behavior among both early hominoids and our more immediate prebipedal ancestors. PMID:8273826

  16. The Proton Radius Puzzle

    NASA Astrophysics Data System (ADS)

    Downie, E. J.

    2016-03-01

    The proton radius puzzle is the difference between the proton radius as measured with electron scattering and in the excitation spectrum of atomic hydrogen, and that measured with muonic hydrogen spectroscopy. Since the inception of the proton radius puzzle in 2010 by the measurement of Pohl et al.[1], many possible resolutions to the puzzle have been postulated, but, to date, none has been generally accepted. New data are therefore necessary to resolve the issue. We briefly review the puzzle, the proposed solutions, and the new electron scattering and spectroscopy experiments planned and underway. We then introduce the MUSE experiment, which seeks to resolve the puzzle by simultaneously measuring elastic electron and muon scattering on the proton, in both charge states, thereby providing new information to the puzzle. MUSE addresses issues of two-photon effects, lepton universality and, possibly, new physics, while providing simultaneous form factor, and therefore radius, measurements with both muons and electrons.

  17. Two-wave propagation in in vitro swine distal ulna

    NASA Astrophysics Data System (ADS)

    Mano, Isao; Horii, Kaoru; Matsukawa, Mami; Otani, Takahiko

    2015-07-01

    Ultrasonic transmitted waves were obtained in an in vitro swine distal ulna specimen, which mimics a human distal radius, that consists of interconnected cortical bone and cancellous bone. The transmitted waveforms appeared similar to the fast waves, slow waves, and overlapping fast and slow waves measured in the specimen after removing the surface cortical bone (only cancellous bone). In addition, the circumferential waves in the cortical bone and water did not affect the fast and slow waves. This suggests that the fast-and-slow-wave phenomenon can be observed in an in vivo human distal radius.

  18. Distal splenorenal shunt

    MedlinePlus

    ... shunt procedure; Renal - splenic venous shunt; Warren shunt; Cirrhosis - distal splenorenal; Liver failure - distal splenorenal ... hepatitis Blood clots Certain congenital disorders Primary biliary cirrhosis When blood cannot flow normally through the portal ...

  19. Distal Convoluted Tubule

    PubMed Central

    Ellison, David H.

    2014-01-01

    The distal convoluted tubule is the nephron segment that lies immediately downstream of the macula densa. Although short in length, the distal convoluted tubule plays a critical role in sodium, potassium, and divalent cation homeostasis. Recent genetic and physiologic studies have greatly expanded our understanding of how the distal convoluted tubule regulates these processes at the molecular level. This article provides an update on the distal convoluted tubule, highlighting concepts and pathophysiology relevant to clinical practice. PMID:24855283

  20. [APPLICATION OF PREPARATION OF COCARNIT FOR PATIENTS AFTER ENDOPROSTHESIS OF HIP AND KNEE JOINTS].

    PubMed

    Korzh, N A; Filippenko, V A; Leont'eva, F S; Tulyakov, V A; Bondarenko, S E

    2015-01-01

    In the article the results of clinical researches of efficiency of preparation of Cocarnit are resulted for patients after endoprosthesis of large joints. It is routine that for patients, receiving preparation of Cocarnit after the operation period there was a decline in the amount of complaints of patients on the total somatical state. Preparation of Ccocarnit was positively estimated outside patients, meaningful by-reactions, serving reason of abolition of preparation, was not marked. At the reception preparation of Cocarnit greater part of investigational laboratory indexes (table of contents of glucose, β-lipoproteines, total chondroitisulfates, TBC-productes (malonic dyaldehyde), activity of aspartataminotransferase, alkaline phosphatase and β-glutamyltranspeptidase), the indexes of clinical blood test and leucocytar indexes during a supervision did not have reliable differences from such as the persons of the control group, that confirms good bearab leness of the indicated preparation. Application preparation of Cocarnit for patients in composition the chart of treatment of patients after endoprosthesis of large joints brought maintenance over of cholesterol to the decline, glycoproteins, TBC-products (malonic dyaldehyde), activity of alaninaminotransferase, that specifies on normalizing influence of the indicated preparation in relation to the basic types of exchange of matters. PMID:27089730

  1. The Possibilities to Decrease the Coefficient of Friciton Between Head and Socket of the Endoprosthesis of Hip Joint

    NASA Astrophysics Data System (ADS)

    Haringová, Andrea; Stračár, Karol; Prikkel, Karol

    2014-12-01

    The article deals with the question of physical parameters that could positively influence the overall lifetime of hip joint endoprosthesis. As the important physical parameter it was selected the coefficient of friction. The contribution offers possibilities how to decrease the coefficient of friction and experimentally test these assumptions

  2. Distal Myopathies: Case Studies.

    PubMed

    Shaibani, Aziz

    2016-08-01

    About 15% of myopathies present with distal weakness. Lack of sensory deficit, and preservation of sensory responses and deep tendon reflexes, favors a myopathic cause for distal weakness. Electromyogram confirms this diagnosis. Profuse spontaneous discharges are common in inflammatory, metabolic, and myofibrillar myopathy (MFM). If the clinical picture indicates a specific disease such as facioscapulohumeral muscular dystrophy (FSHD), genetic testing provides the quickest diagnosis. Otherwise, muscle biopsy can distinguish specific features. The common causes of myopathic distal weakness are FSHD, myotonic dystrophy, and inclusion body myositis. Other causes include MFM, distal muscular dystrophies, metabolic myopathies, and congenital myopathies. PMID:27445241

  3. Aortic Endoprosthesis for the Treatment of Native Aortic Coarctation and Concomitant Aneurysm in an Octogenarian Patient.

    PubMed

    Rabellino, Martín; Kotowicz, Vadim; Kenny, Alberto; Kohan, Andres Alejandro; García-Mónaco, Ricardo

    2015-11-01

    We report a case of an 82-year-old female patient with native coarctation of the aorta and poststenotic aneurysm of the descending thoracic aorta. On consultation, she was receiving 4 antihypertensive drugs, and physical examination revealed nonpalpable lower-limb pulses with intermittent claudication at 50 min. Because of her age, high surgical risk and combination of lesions, endovascular treatment was suggested. Placement of a Valiant thoracic aorta endoprosthesis followed by coarctation angioplasty was performed. At 48 hr, the patient was discharged on 1 antihypertensive drug, palpable pulses on both limbs and a normal ankle-brachial index. At 1 month follow-up, the patient remained as discharged and multislice computed tomography angiography depicted complete coarctation expansion without residual stenosis, exclusion of the aortic aneurysm, and no signs of endoleaks. PMID:26318556

  4. A 5-10 year follow-up of the Sheehan total knee endoprosthesis in Tayside.

    PubMed

    Rickhuss, P K; Gray, A J; Rowley, D I

    1994-10-01

    The Sheehan total knee endoprosthesis has been widely used since 1971. It takes the form of a semi-constrained hinge with intramedullary stems cemented into the femur and tibia for fixation. In Tayside the prosthesis has been in use since 1980. The clinical impression was that the prosthesis was not performing well and formal assessment of surviving prostheses was therefore carried out using the Hospital for Special Surgery (HSS) scoring system. Thirty-seven patients were available for follow-up, 15.6% of whom had good results while 40% had poor results according to this assessment. At review, 31% of patients had undergone revision surgery or were awaiting such surgery. This compares poorly with reported results of surface joint replacements. In the light of these results the authors feel that the Sheehan knee replacement is now obsolete. PMID:7861349

  5. CEMENTLESS ENDOPROSTHESIS IN THE TREATMENT OF GIANT CELL TUMOR OF THE TIBIA: EIGHTEEN YEARS OF EVOLUTION

    PubMed Central

    Mello, Glauco Pauka; Sonehara, Helio Ayabe; Neto, Mario Armani

    2015-01-01

    This is a case report on a giant cell tumor of the juxta-articular proximal tibia with a pathological fracture. A female patient presented pain and increased local volume after falling from her own height. She underwent clinical examination, radiographic examination and puncture biopsy. A diagnosis of giant cell tumor was made. The patient was then treated with tumor resection and use of an unconventional partial endoprosthesis of the tibia with preservation of the joint surface of the tibial plateau. The patient evolved with improvement of symptoms and maintenance of joint function of the operated limb, absence of recurrence and complications, without any need for reoperation over 18 years of follow-up. PMID:27026973

  6. Prospective controlled trial of transhepatic biliary endoprosthesis versus bypass surgery for incurable carcinoma of head of pancreas.

    PubMed

    Bornman, P C; Harries-Jones, E P; Tobias, R; Van Stiegmann, G; Terblanche, J

    1986-01-11

    53 patients with obstructive jaundice due to incurable carcinoma of the head of the pancreas were randomly allocated to percutaneous transhepatic placement of a permanent biliary endoprosthesis (PTE) or bypass surgery. After exclusions 25 patients in each group were treated. Technical success was achieved in 21 patients (84%) in the PTE group and 19 (76%) in the surgery group. The incidence of postprocedural complications (PTE 7, surgery 8) and 30-day mortality (PTE 2, surgery 5) were similar. Recurrent jaundice occurred more often in the PTE (8/21) than the surgery group (3/19). Duodenal obstruction developed in 3 patients in the PTE group. Although the initial median postprocedural hospital stay was significantly shorter in the PTE than the surgery group, the difference was no longer significant when readmissions for blocked endoprosthesis and gastric outlet obstruction were taken into account. There was no difference in the median survival time in the two groups (PTE 19 weeks, surgery 15 weeks). PMID:2417075

  7. Subtle radiographic findings of acute, isolated distal radioulnar joint dislocation.

    PubMed

    Duryea, Dennis M; Payatakes, Alexander H; Mosher, Timothy J

    2016-09-01

    Distal radioulnar dislocations typically occur in association with fractures of the distal radius and/or ulna. Rare isolated dislocations or subluxations are more difficult to diagnose and are initially missed in up to 50 % of cases. We present two cases of missed isolated volar rotatory dislocation of the distal radioulnar joint. Subtle, overlooked radiographic findings of abnormal radioulnar alignment and ulnar styloid projection are highlighted. The supplemental role of cross-sectional imaging is reviewed. Adequate clinical information, appropriate radiographic technique, and high index of suspicion are necessary for the accurate and timely diagnosis of this rare injury pattern. PMID:27229875

  8. Resection interposition arthroplasty for failed distal ulna resections.

    PubMed

    Papatheodorou, Loukia K; Rubright, James H; Kokkalis, Zinon T; Sotereanos, Dean G

    2013-02-01

    The major complications of distal ulna resection, the Darrach procedure, are radioulnar impingement and instability. High failure rates have been reported despite published modifications of the Darrach procedure. Several surgical techniques have been developed to treat this difficult problem and to mitigate the symptoms associated with painful convergence and impingement. No technique has demonstrated clinical superiority. Recently, implant arthroplasty of the distal ulna has been endorsed as an option for the management of the symptomatic patient with a failed distal ulna resection. However, there are concerns for implant longevity, especially in young, active adults. Resection interposition arthroplasty relies on interposition of an Achilles tendon allograft between the distal radius and the resected distal ulna. Although this technique does not restore normal mechanics of the distal radioulnar joint, it can prevent painful convergence of the radius on the ulna. Achilles allograft interposition arthroplasty is a safe and highly effective alternative for failed distal ulna resections, especially for young, active patients, in whom an implant or alternative procedure may not be appropriate. PMID:24436784

  9. Transphyseal Distal Humerus Fracture.

    PubMed

    Abzug, Joshua; Ho, Christine Ann; Ritzman, Todd F; Brighton, Brian

    2016-01-01

    Transphyseal distal humerus fractures typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small height. Prompt and accurate diagnosis of a transphyseal distal humerus fracture is crucial for a successful outcome. Recognizing that the forearm is not aligned with the humerus on plain radiographs may aid in the diagnosis of a transphyseal distal humerus fracture. Surgical management is most commonly performed with the aid of an arthrogram. Closed reduction and percutaneous pinning techniques similar to those used for supracondylar humerus fractures are employed. Cubitus varus caused by a malunion, osteonecrosis of the medial condyle, or growth arrest is the most common complication encountered in the treatment of transphyseal distal humerus fractures. A corrective lateral closing wedge osteotomy can be performed to restore a nearly normal carrying angle. PMID:27049206

  10. Giant distal humeral geode.

    PubMed

    Maher, M M; Kennedy, J; Hynes, D; Murray, J G; O'Connell, D

    2000-03-01

    We describe the imaging features of a giant geode of the distal humerus in a patient with rheumatoid arthritis, which presented initially as a pathological fracture. The value of magnetic resonance imaging in establishing this diagnosis is emphasized. PMID:10794554

  11. Corrective osteotomies of the radius: Grafting or not?

    PubMed Central

    Mugnai, Raffaele; Tarallo, Luigi; Lancellotti, Enrico; Zambianchi, Francesco; Di Giovine, Ettore; Catani, Fabio; Adani, Roberto

    2016-01-01

    AIM: To review the current literature regarding corrective osteotomies to provide the best evidence of the rule of bone grafting. METHODS: Our MEDLINE literature search included 280 studies using the following key words “Malunited distal radius fracture” and 150 studies using key words “Corrective osteotomy of the distal radius”. Inclusion criteria were: Malunited distal radial, extra articular fracture, volar locking plate, use of iliac bone graft (cancellous or corticocancellous), non-use of bone graft. Twelve studies met the inclusion criteria. RESULTS: Seven of the 12 studies considered, described the use of a graft; the remaining five studies didn’t use any graft. Type of malunion was dorsal in most of the studies. The healing time was comparable using the graft or not (mean 12.5 wk), ranging from 7.5 to 16 wk. The mean disabilities of the arm, shoulder and hand score improvement was 23 points both in the studies that used the graft and in those not using the graft. CONCLUSION: This review demonstrated that corrective osteotomy of extra-articular malunited fractures of the distal radius treated by volar locking plate does not necessarily require bone graft. PMID:26925385

  12. Complications of Percutaneous Nephrostomy, Percutaneous Insertion of Ureteral Endoprosthesis, and Replacement Procedures

    SciTech Connect

    Kaskarelis, Ioannis S.; Papadaki, Marina G.; Malliaraki, Niki E.; Robotis, Epaminondas D.; Malagari, Katerina S.; Piperopoulos, Ploutarchos N.

    2001-07-15

    Purpose: The aim of the present study was to record and identify the frequency of complications following percutaneous nephrostomy, replacement of nephrostomy drains and percutaneous insertion of ureteral endoprostheses.Methods: During a 10-year period 341 patients were referred to our department with indications for percutaneous nephrostomy and/or percutaneous insertion of a ureteral endoprosthesis, and a total of 1036 interventional procedures were performed (nephrostomy, catheter change, stenting).Results: There were three major complications (0.29%): two patients died during the first 30 days after the procedure, due to aggravation of their condition caused by the procedure, and one patient had retroperitoneal bleeding requiring surgery. There were 76 complications of intermediate severity (7.33%): catheter or stent displacement (n = 37, 3.57%) catheter occlusion (n = 18, 1.73%), hematuria (n = 12, 1.16%), and urinary tract infection (n = 9, 0.87%). The 55 minor complications (5.3%) comprised inflammation of the skin at the site of insertion of the percutaneous catheter.Conclusion: The small number of complications observed during acts of interventional uroradiology prove transcutaneous manipulations to be safe medical procedures.

  13. Distal median nerve dysfunction

    MedlinePlus

    ... Names Neuropathy - distal median nerve Images Central nervous system and peripheral nervous system References Jarvik JG, Comstock BA, Kliot M, et al. Surgery versus non-surgical therapy for carpal tunnel syndrome: a randomized ... D. Disorders of peripheral nerves. In: Daroff RB, Fenichel GM, Jankovic J, ...

  14. Vertebral Augmentation with Nitinol Endoprosthesis: Clinical Experience in 40 Patients with 1-Year Follow-up

    SciTech Connect

    Anselmetti, Giovanni Carlo; Manca, Antonio; Marcia, Stefano; Chiara, Gabriele; Marini, Stefano; Baroud, Gamal; Regge, Daniele; Montemurro, Filippo

    2013-05-08

    PurposeThis study was designed to assess the clinical outcomes of patients treated by vertebral augmentation with nitinol endoprosthesis (VNE) to treat painful vertebral compression fractures.MethodsForty patients with one or more painful osteoporotic VCF, confirmed by MRI and accompanied by back-pain unresponsive to a minimum 2 months of conservative medical treatment, underwent VNE at 42 levels. Preoperative and postoperative pain measured with Visual Analog Scale (VAS), disability measured by Oswestry Disability Index (ODI), and vertebral height restoration (measured with 2-dimensional reconstruction CT) were compared at last follow-up (average follow-up 15 months). Cement extravasation, subsequent fractures, and implant migration were recorded.ResultsLong-term follow-up was obtained in 38 of 40 patients. Both VAS and ODI significantly improved from a median of 8.0 (range 5–10) and 66 % (range 44–88 %) to 0.5 (range 0–8) and 6 % (range 6–66 %), respectively, at 1 year (p < 0.0001). Vertebral height measurements comparing time points increased in a statistically significant manner (ANOVA, p < 0.001). Overall cement extravasation rate was 9.5 %. Discal and venous leakage rates were 7.1 and 0 % respectively. No symptomatic extravasations occurred. Five of 38 (13.1 %) patients experienced new spontaneous, osteoporotic fractures. No device change or migration was observed.ConclusionsVNE is a safe and effective procedure that is able to provide long-lasting pain relief and durable vertebral height gain with a low rate of new fractures and cement leakages.

  15. Anatomic dorsal and volar radioulnar ligament reconstruction with Mersilene augmentation for distal radioulnar joint instability.

    PubMed

    Stein, Andrew J; Adabi, Kian; Schofield, Jennifer L; Marsh, Mike; Paulo, Jerry

    2015-03-01

    Instability of the distal ulna is a fairly common problem after acute distal radius fracture (DRF), distal radius malunion, triangular fibrocartilage complex injury, and a host of other types of trauma. We present a new anatomic technique to stabilize the distal ulna with a tendon graft augmented with Mersilene tape, which has been used primarily to treat unidirectional (dorsal or volar) instability, but could be used for global instability as well. Of the 12 patients who underwent this procedure, 9 had stability fully restored and the remaining 3 had only mild instability after surgery. The procedure is an effective treatment for distal radioulnar joint instability and we believe that this surgical technique will be a valuable adjunct to the existing described procedures for hand surgeons. We present a retrospective single-surgeon case series with outcome measures. PMID:25575187

  16. Effect of replacement of mandibular defects with a modular endoprosthesis on bone mineral density in a monkey model.

    PubMed

    Wong, R C W; Lee, S; Tideman, H; Merkx, M A W; Jansen, J; Liao, K

    2011-06-01

    The effect of mandibular modular endoprostheses on bone mineral density (BMD) in the stem regions was studied. Modular endoprostheses were inserted into standardized mandibular condyle or body defects in 16 Macaca fascicularis. Each group of eight monkeys was divided into two groups, one killed at 3 months, the other at 6 months post-surgery. The mandibles were harvested, sectioned and scanned with a micro-computed tomography scanner. The reconstructed slices, made at a right angles to the long axis of the prosthesis, were analysed using software to calculate BMD in regions of interest buccal, lingual and inferior to the stems of the endoprosthesis. Measurements of the contralateral sides of three monkeys that underwent a similar procedure were used as control/baseline BMD. BMD for the condyle replacement group did not differ significantly from the control group. At 6 months, BMD decreased slightly; significant only at the inferior region. BMD for the body replacement group was significantly lower in all regions compared with control and condyle replacement groups probably because of connection screw loosening and infection. Loss of BMD in the peri-implant region of a modular endoprosthesis for mandibular replacement is minimal up to 6 months postoperatively, provided the device remains stable and well-fixed. PMID:21216566

  17. Distal Ulna Reconstruction using the Second Metatarsal: Anatomical Study.

    PubMed

    Cavadas, Pedro C; Thione, Alessandro; Martinez, Isabel Elía

    2016-05-01

    Background The ulnar head is a key stabilizer of the wrist and forearm. The authors investigated the possibility of using the second metatarsal bone to replace the distal ulna in an anatomical study. Methods The morphology of the distal ulna and the head of the second metatarsal (MT2) were studied using three-dimensional computerized tomographic (CT) scans of the wrist and foot in 52 patients without pathology related to these two areas, and 11 cadaveric specimens. The radius and height of the best-fit cylinder for both epiphyses were measured in the CT scans and compared. In the cadaveric specimens an osteotomy of the metatarsal neck was performed to rotate 90 degrees the head of the MT2 to match the shape of the distal ulna. Results The osseous morphology of the distal ulna and the head of the MT2 are roughly cylindrical, but differently oriented relative to the diaphyseal axes. In the osteotomized cadaveric MT2specimens, the overall morphology was relatively similar that of the distal ulna. The mean length of the MT2 after the osteotomy was 65 mm. Conclusion The head of the MT2 was found to have a similar cylindrical morphology to that of the ulnar head, with a different orientation. The radius of the cylinder was similar, although the height was bigger for the MT2. After a rotation osteotomy of the neck of the MT2 the overall shape and orientation of the epiphysis was more similar to the distal ulna. A vascularized transfer of an osteotomized MT2 would be an option for autologous reconstruction of the distal ulna in selected patients, but further study is needed in terms of the vascular supply, ligamentous reconstruction, and reconstruction of the sigmoid notch. Level of Evidence Therapeutic, level IV. PMID:27104084

  18. Laser differential confocal radius measurement.

    PubMed

    Zhao, Weiqian; Sun, Ruoduan; Qiu, Lirong; Sha, Dingguo

    2010-02-01

    A new laser differential confocal radius measurement (DCRM) is proposed for high precision measurement of radius. Based on the property of an axial intensity curve that the absolute zero precisely corresponds to the focus of the objective in a differential confocal system (DCS), DCRM uses the zero point of the DCS axial intensity curve to precisely identify the cat's-eye and confocal positions of the test lens, and measures the accurate distance between the two positions to achieve the high-precision measurement of radius of curvature (ROC). In comparison with the existing measurement methods, DCRM proposed has a high measurement precision, a strong environmental anti-interference capability and a low cost. The theoretical analyses and preliminary experimental results indicate that DCRM has a relative measurement error of better than 5 ppm. PMID:20174065

  19. Squeaking friction phenomena in ceramic hip endoprosthesis: Modeling and experimental validation

    NASA Astrophysics Data System (ADS)

    Ouenzerfi, G.; Massi, F.; Renault, E.; Berthier, Y.

    2015-06-01

    minimizing friction rising factors (such edge loading and situations promoting metal transfer or stripe wear) or by developing endoprosthesis design to avoid the unstable vibrations, regressing the squeaking emission to a negligible phenomenon.

  20. Mortality after distal radial fractures in the Medicare population

    PubMed Central

    Shauver, Melissa J.; Zhong, Lin; Chung, Kevin C.

    2016-01-01

    The occurrence of a low energy fracture of the distal radius increases the risk for another, more serious fracture such as a proximal femoral fracture. Early mortality after proximal femoral fracture has been widely studied, but the association between distal radial fracture and mortality is unknown. The date of death for all Medicare beneficiaries who sustained an isolated distal radial fracture in 2007 was determined using Medicare Vital Statistics files. The adjusted mortality rate for each age-sex group was calculated and compared with published US mortality tables. Distal radial fractures were not associated with an increased mortality rate. In fact, beneficiaries had a significantly lower mortality rate after distal radial fractures than the general population. This may be related to the injured beneficiaries’ involvement in the healthcare system. Mortality rate did not vary significantly based on time from injury. Our results indicate that any mortality is unlikely to be attributable to the distal radial fracture or its treatment. Level of Evidence: III PMID:26085186

  1. Metatarsalgia: distal metatarsal osteotomies.

    PubMed

    Schuh, Reinhard; Trnka, Hans Joerg

    2011-12-01

    Metatarsalgia is a common pathologic entity. It refers to pain at the MTP joints. Pain in the foot unrelated to the MTP joints (such as Morton’s neuroma) must be distinguished from those disorders, which lead to abnormal pressure distribution, reactive calluses, and pain. Initial treatment options for metatarsalgia include modifications of shoe wear, metatarsal pads, and custom-made orthoses. If conservative treatment fails, operative reconstructive procedures in terms of metatarsal osteotomies should be considered. Lesser metatarsal osteotomy is an effective and well-accepted method for the management of metatarsalgia. The main purpose of these osteotomies is to decrease prominence of the symptomatic metatarsal head. The distal metatarsal oblique osteotomy (Weil osteotomy) with its modification represents the best evaluated distal metatarsal osteotomy in terms of outcome studies and biomechanical analysis. The role of the Weil osteotomy in metatarsalgia owing to a subluxed or dislocated MTP joint is to bring the metatarsal head proximal to the callus and to provide axial decompression of the toe to correct the deformity contributing to metatarsalgia. PMID:22118231

  2. Simultaneous dislocation of radiocapitellar and distal radioulnar joint.

    PubMed

    Nishi, Tomio; Suzuki, Noriyuki; Tani, Takayuki; Aonuma, Hiroshi

    2013-01-01

    A 45-year-old male presented to the emergency room of our institution complaining of severe pain around the left elbow. While playing volleyball, he slipped down with his left arm hit between the floor and his body. He complaind of strong pain from left elbow to hand, and active motion of elbow and wrist joint was impossible. His forearm was held in supinated position. On X-ray examination, radius head was deviated to anterior lateral side, and distal end of radius was dislocated to dorsal side. Tenderness was prominent at the site of radial head and distal radioulnar joint. Surgical treatment was performed using triceps tendon strip. Good functional recovery was gained. PMID:24194995

  3. Genetics Home Reference: distal arthrogryposis type 1

    MedlinePlus

    ... Conditions distal arthrogryposis type 1 distal arthrogryposis type 1 Enable Javascript to view the expand/collapse boxes. ... Open All Close All Description Distal arthrogryposis type 1 is a disorder characterized by joint deformities (contractures) ...

  4. Imaging of the Distal Airways

    PubMed Central

    Tashkin, Donald P.; de Lange, Eduard E.

    2009-01-01

    Imaging techniques of the lung continues to advance with improving ability to image the more distal airways. Two imaging techniques are reviewed, computerized tomography and magnetic resonance with hyperpolarized helium-3. PMID:19962040

  5. Incidence and characteristics of distal radial fractures in an urban population in The Netherlands.

    PubMed

    Bentohami, A; Bosma, J; Akkersdijk, G J M; van Dijkman, B; Goslings, J C; Schep, N W L

    2014-06-01

    The increasing incidence of distal radius fracture is thought to be due to the aging population. Surprisingly, some authors have reported a decrease in the incidence of distal radius fracture. Moreover, the type-specific incidence of distal radial fracture classified according to fracture severity is not well documented. The aim of this population-based study was to estimate the overall and type-specific incidences of distal radius fracture in a urban population in The Netherlands. During 2009, all persons aged ≥18 years old with an acute distal radius fracture in two hospitals in The Netherlands were prospectively registered. In 2009, the mid-year study population consisted of 245,559 inhabitants ≥18 years old. Fractures were categorized according to the AO classification. 494 patients with acute distal radius fractures were registered in the two participating hospitals during the 1-year study period. The overall incidence of distal radius fracture was 20 per 10,000 person-years. Among women, the incidence rate increased from the age of 50 and reached a peak of 124 per 10,000 person-years in women 80 years and older. Among men, the incidence rate was low until the age of 80 years and older, and reached a peak of 24 per 10,000 person-years. The incidence rate among women between 50 and 79 years was 54/10,000 person-years. Extra-articular AO type A fractures were most common among all age groups, comprising 50 % of all fractures (40 % in men and 53 % in women). The overall incidence rate of distal radius fracture was 20 per 10,000 person-years. This incidence increases with age for both women and men. A lower incidence rate among women 50-79 years of age was found than previously reported, which may indicate a declining incidence in this age group. Extra-articular AO type A fractures were the most common fracture types. PMID:26816072

  6. Radius of curvature controlled mirror

    DOEpatents

    Neil, George R.; Rathke, John Wickham; Schultheiss, Thomas John; Shinn, Michelle D.; Dillon-Townes, Lawrence A.

    2006-01-17

    A controlled radius of curvature mirror assembly comprising: a distortable mirror having a reflective surface and a rear surface; and in descending order from the rear surface; a counter-distortion plate; a flow diverter having a flow diverter aperture at the center thereof; a flow return plate having a flow return aperture at the center thereof; a thermal isolation plate having a thermal isolation plate aperture at the center thereof and a flexible heater having a rear surface and a flexible heater aperture at the center thereof; a double walled tube defining a coolant feed chamber and a coolant return chamber; said coolant feed chamber extending to and through the flow diverter aperture and terminating at the counter-distortion plate and the coolant return chamber extending to and through the thermal isolation backplate and terminating at the flow diverter; and a coolant feed and a coolant return exit at the rear of said flexible heater.

  7. Dislocation of the distal radioulnar joint associated with a transstyloid radiocarpal fracture dislocation. A case report and review of the literature.

    PubMed

    Stoffelen, D; Fortems, Y; De Smet, L; Broos, P

    1996-03-01

    Dislocations of the distal radio-ulnar joint (DRUJ) can be isolated or combined with fractures. Cases of DRUJ dislocations have been described with Galleazi fractures, open radius and ulna fractures and intraarticular fractures of the distal radius. We report a case of a volar DRUJ dislocation combined with a transstyloid radio-carpal dislocation. Because of severe instability of the wrist, open reduction of the radial styloid combined with an open reduction of the dislocated DRUJ is advised. PMID:8669257

  8. Entrapment of the Flexor Digitorum Profundus in the Callus after a Closed Distal Radial Fracture

    PubMed Central

    Cavadas, Pedro C.; Rubi, Carlo G.

    2016-01-01

    Summary: A 17-year-old boy sustained a closed distal radius fracture; a closed reduction and external fixation was performed. After failed rehabilitation for digital flexion restriction, a surgical exploration was decided, revealing entrapment of flexor digitorum profundus in the bony callus; tendons were freed, obtaining a full range of motion. PMID:27200249

  9. [Arthroscopic distal ulna resection after post traumatic ulno carpal abutment].

    PubMed

    Mathoulin, C; Pagnotta, A

    2006-11-01

    Ulno carpal abutments secondary to the sequels of a fracture of the radius are often due to the inversion of the distal radio ulnar index by shortening relative to the radius. This positive ulnar variance eventually leads to an abutment between the head of the ulnar and the proximal articular face of the lunate with alteration of the cartilaginous carpal surfaces. The wrist arthroscopy makes diagnosis and treatment possible in a less invasive way. The patients are operated on as outpatients under local regional anaesthetic using a pneumatic tourniquet. The arthroscope is positioned using the 3-4 radio carpal opening permitting exploration of the joint. The surgical treatment is performed by arthroscopy using a burr and going in through the 6R radio carpal opening. In this way we use the technique of partial resection of the distal ulna. We have a series of 62 patients who have benefited from the technique of partial resection of the ulnar head by arthroscopy. There were 30 men and 32 women. The average age was 66 years old (between 45 and 82). Our average follow-up is 32 months (between 12 and 60 months). Recovery of mobility was immediate in all cases with persistent pain in the radio ulnar joint in 8 cases. Arthroscopic treatment of ulno carpal abutment has proved itself effective and innocuous. It should nevertheless be reserved for operations on small sized inversions of the distal radio ulnar index (less than 5 mm). In the event of larger ulnar variances we prefer ulnar shortening osteotomy. The other techniques will be restricted to cases where the distal radio ulnar joint has been impaired. PMID:17361890

  10. [Arthroscopic distal ulna resection after post traumatic ulno carpal abutment.

    PubMed

    Mathoulin, C; Pagnotta, A

    2006-11-01

    Ulno carpal abutments secondary to the sequels of a fracture of the radius are often due to the inversion of the distal radio ulnar index by shortening relative to the radius. This positive ulnar variance eventually leads to an abutment between the head of the ulnar and the proximal articular face of the lunate with alteration of the cartilaginous carpal surfaces. The wrist arthroscopy makes diagnosis and treatment possible in a less invasive way. The patients are operated on as outpatients under local regional anaesthetic using a pneumatic tourniquet. The arthroscope is positioned using the 3-4 radio carpal opening permitting exploration of the joint. The surgical treatment is performed by arthroscopy using a burr and going in through the 6R radio carpal opening. In this way we use the technique of partial resection of the distal ulna. We have a series of 62 patients who have benefited from the technique of partial resection of the ulnar head by arthroscopy. There were 30 men and 32 women. The average age was 66 years old (between 45 and 82). Our average follow-up is 32 months (between 12 and 60 months). Recovery of mobility was immediate in all cases with persistent pain in the radio ulnar joint in 8 cases. Arthroscopic treatment of ulno carpal abutment has proved itself effective and innocuous. It should nevertheless be reserved for operations on small sized inversions of the distal radio ulnar index (less than 5 mm). In the event of larger ulnar variances we prefer ulnar shortening osteotomy. The other techniques will be restricted to cases where the distal radio ulnar joint has been impaired. PMID:17349395

  11. [Fracture of the diaphyseal radius during Cyr wheel practice - an uncommon injury of wheel gymnastics].

    PubMed

    Kauther, M D; Rummel, S; Hussmann, B; Lendemans, S; Nast-Kolb, D; Wedemeyer, C

    2011-12-01

    The cyr wheel is a modified gymnastic wheel with only one ring that can lead to extreme forces on the gymnast. We report on a distal radius shaft fracture (AO 22 A 2.1) and a fracture of the styloid process of the ulna that occurred after holding on to a slipping Cyr wheel and exposition to high pressure on the lower arm. The fracture was fixed by screws and a plate. PMID:22161268

  12. Mirror with thermally controlled radius of curvature

    DOEpatents

    Neil, George R.; Shinn, Michelle D.

    2010-06-22

    A radius of curvature controlled mirror for controlling precisely the focal point of a laser beam or other light beam. The radius of curvature controlled mirror provides nearly spherical distortion of the mirror in response to differential expansion between the front and rear surfaces of the mirror. The radius of curvature controlled mirror compensates for changes in other optical components due to heating or other physical changes. The radius of curvature controlled mirror includes an arrangement for adjusting the temperature of the front surface and separately adjusting the temperature of the rear surface to control the radius of curvature. The temperature adjustment arrangements can include cooling channels within the mirror body or convection of a gas upon the surface of the mirror. A control system controls the differential expansion between the front and rear surfaces to achieve the desired radius of curvature.

  13. The medium-term results of the Stanmore non-invasive extendible endoprosthesis in the treatment of paediatric bone tumours.

    PubMed

    Picardo, N E; Blunn, G W; Shekkeris, A S; Meswania, J; Aston, W J; Pollock, R C; Skinner, J A; Cannon, S R; Briggs, T W

    2012-03-01

    In skeletally immature patients, resection of bone tumours and reconstruction of the lower limb often results in leg-length discrepancy. The Stanmore non-invasive extendible endoprosthesis, which uses electromagnetic induction, allows post-operative lengthening without anaesthesia. Between 2002 and 2009, 55 children with a mean age of 11.4 years (5 to 16) underwent reconstruction with this prosthesis; ten patients (18.2%) died of disseminated disease and one child underwent amputation due to infection. We reviewed 44 patients after a mean follow-up of 41.2 months (22 to 104). The mean Musculoskeletal Tumor Society score was 24.7 (8 to 30) and the Toronto Extremity Salvage score was 92.3% (55.2% to 99.0%). There was no local recurrence of tumour. Complications developed in 16 patients (29.1%) and ten (18.2%) underwent revision. The mean length gained per patient was 38.6 mm (3.5 to 161.5), requiring a mean of 11.3 extensions (1 to 40), and ten component exchanges were performed in nine patients (16.4%) after attaining the maximum lengthening capacity of the implant. There were 11 patients (20%) who were skeletally mature at follow-up, ten of whom had equal leg lengths and nine had a full range of movement of the hip and knee. This is the largest reported series using non-invasive extendible endoprostheses after excision of primary bone tumours in skeletally immature patients. The technique produces a good functional outcome, with prevention of limb-length discrepancy at skeletal maturity. PMID:22371554

  14. [Radius fractures in children--causes and mechanisms of injury].

    PubMed

    Antabak, Anko; Stanić, Lana; Matković, Nikša; Papeš, Dino; Romić, Ivan; Fuchs, Nino; Luetić, Tomislav

    2015-01-01

    Radius fractures are the most common fractures in childhood. The main mechanism of injury is fall onto an outstretched hand. This retrospective study analyzed the data on 201 children admitted for radius fractures at KBC-Zagreb in the period 2011-2013. The study included 85 girls (42.3%) and 116 boys (57.7%) . The average age of the children was 9.6 years. Radius was injured in the distal segment in 79.1% of children. The sites of injuries were: park, campi and beach (24.9% of all children), playground, skate park and swimming pool (23.9%), kindergarten or school (20.9%), at home and around the house (17.9%), in the street (11.4%) and in the store or at a hotel (0.9%). The boys were mostly injured at playgrounds, during skating and at swimming pools (37.1% of all boys), while girls were mostly injured in parks, camps and at beach (42.4% girls). Fall was the major cause of the injury (49.3%), and children usually fell during ice skating and skating (32.3% of all falls). In 20.4% the injury was caused by pushing and hitting. The smallest percentage (9.5%) of children were injured in traffic accidents while riding a bike (only one child was hit by a car). Sport related activities caused injuries in 53.7% of the cases. Sport activities are the most important cause of the radial fractures in the pediatric population and falls during sports are the main mechanism of injury. The peak incidence is at 12 years for boys and at 10 years for girls, so intervention and/or prevention should be aimed at the age groups. Preventive actions should be focused on injuries that tend to occur in parks, schools and during sport activities. PMID:26065283

  15. Genetics Home Reference: Laing distal myopathy

    MedlinePlus

    ... for This Page GeneReview: Laing Distal Myopathy Laing NG, Laing BA, Meredith C, Wilton SD, Robbins P, ... T, Bridges LR, Fabian V, Rozemuller A, Laing NG. Laing early onset distal myopathy: slow myosin defect ...

  16. Management of distal humerus fractures.

    PubMed

    McCarty, L Pearce; Ring, David; Jupiter, Jesse B

    2005-09-01

    Fractures of the distal humerus are complex injuries that can be effectively treated with open reduction and internal fixation (ORiF). Exposure of a complex intra-articular fracture may best be achieved through a posterior approach with osteotomy of the olecranon process. The ulnar nerve must be identified and protected, the articular surface must be reduced anatomically, and rigid fixation must be applied to both the medial and lateral columns of the distal humerus. Range of motion should be initiated as soon as possible postoperatively. Complications such as ulnar neuropathy, elbow stiffness, heterotopic ossification, and nonunion should be treated aggressively. Total elbow arthroplasty represents an effective option for fractures that cannot be treated with ORIF. PMID:16250484

  17. Distal clavicle fractures in children☆

    PubMed Central

    Labronici, Pedro José; da Silva, Ricardo Rodrigues; Franco, Marcos Vinícius Viana; Labronici, Gustavo José; Pires, Robinson Esteves Santos; Franco, José Sergio

    2015-01-01

    Objective To analyze fractures of the distal clavicle region in pediatric patients. Methods Ten patients between the ages of five to eleven years (mean of 7.3 years) were observed. Nine patients were treated conservatively and one surgically. All the fractures were classified using the Nenopoulos classification system. Results All the fractures consolidated without complications. Conservative treatment was used for nine patients, of whom three were in group IIIB, three IIb, two IIa and one IV. The only patient who was treated surgically was a female patient of eleven years of age with a group IV fracture. Conclusion The treatment indication for distal fractures of the clavicle in children should be based on the patient's age and the displacement of the fragments. PMID:26962489

  18. Endoscopic Distal Tibiofibular Syndesmosis Arthrodesis.

    PubMed

    Lui, Tun Hing

    2016-04-01

    Chronic distal tibiofibular syndesmosis disruption can be managed by endoscopic arthrodesis of the syndesmosis. This is performed through the proximal anterolateral and posterolateral portals. The scar tissue and bone block are resected to facilitate the subsequent reduction of the syndesmosis. The reduction of the syndesmosis can be guided either arthroscopically or endoscopically. The tibial and fibular surfaces of the tibiofibular overlap can be microfractured to facilitate subsequent fusion. PMID:27462544

  19. [Headgear-free molar distalization].

    PubMed

    Manhartsberger, C

    1994-12-01

    The difficulty in treating dentoalveolar class II disharmonies is briefly outlined. An innovative treatment method is presented which makes possible a distalization without the use of headgear. In the treatment method bands are cemented on the first molars, next impressions are made of the upper and lower dental arch, and then the impressions are poured with plaster. Following this the models are mounted in centric relationship in an articulator and the bite is opened 2 mm to 3 mm, so that the molars can be moved without making occlusal contact. The apparatus, an acrylic splint, is constructed in such a fashion as to cover the palatal surfaces from 2nd premolar to 2nd premolar. In addition, the premolars are also covered occlusally and buccally and the canine tips and the incisal edges are covered labially. A headgear tube is attached at the buccal surface in the premolar region of the acrylic splint. This acrylic splint, which is itself retentive, is cemented using glass ionomer cement. Combining this apparatus with a modified Nance Button makes it possible to establish an anchoring segment which is able to retain its position in the face of molar distalization. Molar distalization is then performed using a 0.032 inch stainless steel wire, which is placed between the headgear tube of the acrylic splint and the headgear tube of the band of the first molar. Highly elastic nickel-titanium open coil springs are used as the force elements. PMID:7851830

  20. Distal Femoral Complications Following Antegrade Intramedullary Nail Placement

    PubMed Central

    Fantry, Amanda J.; Elia, Gregory; Vopat, Bryan G.; Daniels, Alan H.

    2015-01-01

    While antegrade nailing for proximal and diaphyseal femur fractures is a commonly utilized fixation method with benefits including early mobilization and high rates of fracture union, both intraoperative and postoperative complications may occur. Intraoperative errors include leg length discrepancy, anterior cortical perforation, malreduction of the fracture, and neurovascular injury, and postoperative complications include nonunion, malunion, infection, and hardware failure. This case series reviews complications affecting the distal femur after intramedullary nailing including fracture surrounding a distal femoral interlocking screw (Case #1), nonunion after dynamization with nail penetration into the knee joint (Case #2), and anterior cortical perforation (Case #3). Prevention of intraoperative and postoperative complications surrounding intramedullary nailing requires careful study of the femoral anatomy and nail design specifications (radius of curvature), consideration of the necessity of distal interlocking screws, the need for close radiographic follow-up after nail placement with X-rays of the entire length of the nail, and awareness of possible nail penetration into the knee joint after dynamization. PMID:25874066

  1. Chondromyxoid Fibroma of Radius: A Case Report

    PubMed Central

    Bagewadi, Rajakumar M.; Hippargi, Surekha B.

    2016-01-01

    Chondromyxoid fibroma (CMF) is a rare benign cartilaginous tumour accounting to less than 1% of bone tumours. It is most commonly seen in lower extremity involving tibia. CMF of radius is rare. We report a rare case of CMF of proximal radius in a 37-year-old female who presented with swelling and pain over right elbow. Wide local excision of proximal radius along with radial head was done and above elbow POP slab was applied for one month. Elbow range of movement exercises started after one month. PMID:27437232

  2. Chondromyxoid Fibroma of Radius: A Case Report.

    PubMed

    Bagewadi, Rajakumar M; Nerune, Savitri Mallikarjun; Hippargi, Surekha B

    2016-05-01

    Chondromyxoid fibroma (CMF) is a rare benign cartilaginous tumour accounting to less than 1% of bone tumours. It is most commonly seen in lower extremity involving tibia. CMF of radius is rare. We report a rare case of CMF of proximal radius in a 37-year-old female who presented with swelling and pain over right elbow. Wide local excision of proximal radius along with radial head was done and above elbow POP slab was applied for one month. Elbow range of movement exercises started after one month. PMID:27437232

  3. Diminished bone strength is observed in adult women and men who sustained a mild trauma distal forearm fracture during childhood.

    PubMed

    Farr, Joshua N; Khosla, Sundeep; Achenbach, Sara J; Atkinson, Elizabeth J; Kirmani, Salman; McCready, Louise K; Melton, L Joseph; Amin, Shreyasee

    2014-10-01

    Children and adolescents who sustain a distal forearm fracture (DFF) owing to mild, but not moderate, trauma have reduced bone strength and cortical thinning at the distal radius and tibia. Whether these skeletal deficits track into adulthood is unknown. Therefore, we studied 75 women and 75 men (age range, 20 to 40 years) with a childhood (age < 18 years) DFF and 150 sex-matched controls with no history of fracture using high-resolution peripheral quantitative computed tomography (HRpQCT) to examine bone strength (ie, failure load) by micro-finite element (µFE) analysis, as well as cortical and trabecular bone parameters at the distal radius and tibia. Level of trauma (mild versus moderate) was assigned using a validated classification scheme, blind to imaging results. When compared to sex-matched, nonfracture controls, women and men with a mild trauma childhood DFF (eg, fall from standing height) had significant reductions in failure load (p < 0.05) of the distal radius, whereas women and men with a moderate trauma childhood DFF (eg, fall while riding a bicycle) had values similar to controls. Consistent findings were observed at the distal tibia. Furthermore, women and men with a mild trauma childhood DFF had significant deficits in distal radius cortical area (p < 0.05), and significantly lower dual-energy X-ray absorptiometry (DXA)-derived bone density at the radius, hip, and total body regions compared to controls (all p < 0.05). By contrast, women and men with a moderate trauma childhood DFF had bone density, structure, and strength that did not differ significantly from controls. These findings in young adults are consistent with our observations in children/adolescents with DFF, and they suggest that a mild trauma childhood DFF may presage suboptimal peak bone density, structure, and strength in young adulthood. Children and adolescents who suffer mild trauma DFFs may need to be targeted for lifestyle interventions to help achieve improved skeletal health

  4. Diminished Bone Strength Is Observed in Adult Women and Men Who Sustained a Mild Trauma Distal Forearm Fracture During Childhood

    PubMed Central

    Farr, Joshua N; Khosla, Sundeep; Achenbach, Sara J; Atkinson, Elizabeth J; Kirmani, Salman; McCready, Louise K; Melton, L Joseph; Amin, Shreyasee

    2015-01-01

    Children and adolescents who sustain a distal forearm fracture (DFF) owing to mild, but not moderate, trauma have reduced bone strength and cortical thinning at the distal radius and tibia. Whether these skeletal deficits track into adulthood is unknown. Therefore, we studied 75 women and 75 men (age range, 20 to 40 years) with a childhood (age <18 years) DFF and 150 sex-matched controls with no history of fracture using high-resolution peripheral quantitative computed tomography (HRpQCT) to examine bone strength (ie, failure load) by micro–finite element (µFE) analysis, as well as cortical and trabecular bone parameters at the distal radius and tibia. Level of trauma (mild versus moderate) was assigned using a validated classification scheme, blind to imaging results. When compared to sex-matched, nonfracture controls, women and men with a mild trauma childhood DFF (eg, fall from standing height) had significant reductions in failure load (p < 0.05) of the distal radius, whereas women and men with a moderate trauma childhood DFF (eg, fall while riding a bicycle) had values similar to controls. Consistent findings were observed at the distal tibia. Furthermore, women and men with a mild trauma childhood DFF had significant deficits in distal radius cortical area (p < 0.05), and significantly lower dual-energy X-ray absorptiometry (DXA)-derived bone density at the radius, hip, and total body regions compared to controls (all p < 0.05). By contrast, women and men with a moderate trauma childhood DFF had bone density, structure, and strength that did not differ significantly from controls. These findings in young adults are consistent with our observations in children/adolescents with DFF, and they suggest that a mild trauma childhood DFF may presage suboptimal peak bone density, structure, and strength in young adulthood. Children and adolescents who suffer mild trauma DFFs may need to be targeted for lifestyle interventions to help achieve improved skeletal

  5. Large-Larmor-radius interchange instability

    SciTech Connect

    Ripin, B.H.; McLean, E.A.; Manka, C.K.; Pawley, C.; Stamper, J.A.; Peyser, T.A.; Mostovych, A.N.; Grun, J.; Hassam, A.B.; Huba, J.

    1987-11-16

    We observe linear and nonlinear features of a strong plasma/magnetic field interchange Rayleigh-Taylor instability in the limit of large ion Larmor radius. The instability undergoes rapid linear growth culminating in free-streaming flute tips.

  6. Direct Arthroscopic Distal Clavicle Resection

    PubMed Central

    Lervick, Gregory N

    2005-01-01

    Degenerative change involving the acromioclavicular (AC) is frequently seen as part of a normal aging process. Occasionally, this results in a painful clinical condition. Although AC joint symptoms commonly occur in conjunction with other shoulder pathology, they may occur in isolation. Treatment of isolated AC joint osteoarthritis is initially non-surgical. When such treatment fails to provide lasting relief, surgical treatment is warranted. Direct (superior) arthroscopic resection of the distal (lateral) end of the clavicle is a successful method of treating the condition, as well as other isolated conditions of the AC joint. The following article reviews appropriate patient evaluation, surgical indications and technique. PMID:16089089

  7. Mass and radius of cosmic balloons

    NASA Technical Reports Server (NTRS)

    Wang, Yun

    1994-01-01

    Cosmic balloons are spherical domain walls with relativistic particles trapped inside. We derive the exact mass and radius relations for a static cosmic balloon using Gauss-Codazzi equations. The cosmic balloon mass as a function of its radius, M(R), is found to have a functional form similar to that of fermion soliton stars, with a fixed point at 2GM(R)/R approximately or equal to 0.486 which corresponds to the limit of infinite central density. We derive a simple analytical approximation for the mass density of a spherically symmetric relativistic gas star. When applied to the computation of the mass and radius of a cosmic balloon, the analytical approximation yields fairly good agreement with the exact numerical solutions.

  8. A Maximum Radius for Habitable Planets.

    PubMed

    Alibert, Yann

    2015-09-01

    We compute the maximum radius a planet can have in order to fulfill two constraints that are likely necessary conditions for habitability: 1- surface temperature and pressure compatible with the existence of liquid water, and 2- no ice layer at the bottom of a putative global ocean, that would prevent the operation of the geologic carbon cycle to operate. We demonstrate that, above a given radius, these two constraints cannot be met: in the Super-Earth mass range (1-12 Mearth), the overall maximum that a planet can have varies between 1.8 and 2.3 Rearth. This radius is reduced when considering planets with higher Fe/Si ratios, and taking into account irradiation effects on the structure of the gas envelope. PMID:26159097

  9. Inside the Bondi radius of M87

    NASA Astrophysics Data System (ADS)

    Russell, H. R.; Fabian, A. C.; McNamara, B. R.; Broderick, A. E.

    2015-07-01

    Chandra X-ray observations of the nearby brightest cluster galaxy M87 resolve the hot gas structure across the Bondi accretion radius of the central supermassive black hole (SMBH), a measurement possible in only a handful of systems but complicated by the bright nucleus and jet emission. By stacking only short frame-time observations to limit pileup, and after subtracting the nuclear point spread function, we analysed the X-ray gas properties within the Bondi radius at 0.12-0.22 kpc (1.5-2.8 arcsec), depending on the black hole mass. Within 2 kpc radius, we detect two significant temperature components, which are consistent with constant values of 2 and 0.9 keV down to 0.15 kpc radius. No evidence was found for the expected temperature increase within ˜ 0.25 kpc due to the influence of the SMBH. Within the Bondi radius, the density profile is consistent with ρ ∝ r-1. The lack of a temperature increase inside the Bondi radius suggests that the hot gas structure is not dictated by the SMBH's potential and, together with the shallow density profile, shows that the classical Bondi rate may not reflect the accretion rate on to the SMBH. If this density profile extends in towards the SMBH, the mass accretion rate on to the SMBH could be at least two orders of magnitude less than the Bondi rate, which agrees with Faraday rotation measurements for M87. We discuss the evidence for outflow from the hot gas and the cold gas disc and for cold feedback, where gas cooling rapidly from the hot atmosphere could feed the cirumnuclear disc and fuel the SMBH. At 0.2 kpc radius, the cooler X-ray temperature component represents ˜20 per cent of the total X-ray gas mass and, by losing angular momentum to the hot gas component, could provide a fuel source of cold clouds within the Bondi radius.

  10. Distal femoral fractures: current concepts.

    PubMed

    Gwathmey, F Winston; Jones-Quaidoo, Sean M; Kahler, David; Hurwitz, Shepard; Cui, Quanjun

    2010-10-01

    The diversity of surgical options for the management of distal femoral fractures reflects the challenges inherent in these injuries. These fractures are frequently comminuted and intra-articular, and they often involve osteoporotic bone, which makes it difficult to reduce and hold them while maintaining joint function and overall limb alignment. Surgery has become the standard of care for displaced fractures and for patients who must obtain rapid return of knee function. The goal of surgical management is to promote early knee motion while restoring the articular surface, maintaining limb length and alignment, and preserving the soft-tissue envelope with a durable fixation that allows functional recovery during bone healing. A variety of surgical exposures, techniques, and implants has been developed to meet these objectives, including intramedullary nailing, screw fixation, and periarticular locked plating, possibly augmented with bone fillers. Recognition of the indications and applications of the principles of modern implants and techniques is fundamental in achieving optimal outcomes. PMID:20889949

  11. The Tidal Radius of the Arches Cluster

    NASA Astrophysics Data System (ADS)

    Hosek, Matthew; Lu, Jessica R.; Anderson, Jay; Ghez, Andrea; Morris, Mark; Clarkson, William

    2015-08-01

    At a projected distance of just ˜26 pc from the center of the Milky Way, the Arches cluster allows us to examine the structure of a young massive cluster in the strong tidal environment of the Galactic center (GC). We use the HST WFC3IR camera to conduct an astrometric and photometric study of the outer region of the Arches cluster (R > 6.25”) in order to measure its radial profile. Using proper motions we separate cluster members from field stars down to F153M = 20 mag (˜2.5 M_sun) over a 120” x 120” field of view, covering an area 144 times larger than previous proper motion studies. This is a significant improvement over photometrically-determined cluster membership, which is complicated by the high degree of differential reddening across the field. Using cluster membership probabilities, a derived extinction map, and extensive completeness simulations, we construct the radial profile of the Arches cluster to a radius of ˜80” (˜3.1 pc assuming a distance of 8 kpc). Evidence of mass segregation out to this radius is observed, and no significant tidal tail structure is apparent. We find that the projected radial extent of the Arches cluster is significantly larger than its expected tidal radius. This result suggests either that the cluster is not as close to the GC as previously thought or that it is inflated beyond its nominal tidal radius.

  12. Proton radius from electron scattering data

    NASA Astrophysics Data System (ADS)

    Higinbotham, Douglas W.; Kabir, Al Amin; Lin, Vincent; Meekins, David; Norum, Blaine; Sawatzky, Brad

    2016-05-01

    Background: The proton charge radius extracted from recent muonic hydrogen Lamb shift measurements is significantly smaller than that extracted from atomic hydrogen and electron scattering measurements. The discrepancy has become known as the proton radius puzzle. Purpose: In an attempt to understand the discrepancy, we review high-precision electron scattering results from Mainz, Jefferson Lab, Saskatoon, and Stanford. Methods: We make use of stepwise regression techniques using the F test as well as the Akaike information criterion to systematically determine the predictive variables to use for a given set and range of electron scattering data as well as to provide multivariate error estimates. Results: Starting with the precision, low four-momentum transfer (Q2) data from Mainz (1980) and Saskatoon (1974), we find that a stepwise regression of the Maclaurin series using the F test as well as the Akaike information criterion justify using a linear extrapolation which yields a value for the proton radius that is consistent with the result obtained from muonic hydrogen measurements. Applying the same Maclaurin series and statistical criteria to the 2014 Rosenbluth results on GE from Mainz, we again find that the stepwise regression tends to favor a radius consistent with the muonic hydrogen radius but produces results that are extremely sensitive to the range of data included in the fit. Making use of the high-Q2 data on GE to select functions which extrapolate to high Q2, we find that a Padé (N =M =1 ) statistical model works remarkably well, as does a dipole function with a 0.84 fm radius, GE(Q2) =(1+Q2/0.66 GeV2) -2 . Conclusions: Rigorous applications of stepwise regression techniques and multivariate error estimates result in the extraction of a proton charge radius that is consistent with the muonic hydrogen result of 0.84 fm; either from linear extrapolation of the extremely-low-Q2 data or by use of the Padé approximant for extrapolation using a larger

  13. Dorsoradial avulsion of the triangular fibrocartilage complex with an avulsion fracture of the sigmoid notch of the radius.

    PubMed

    Morisawa, Y; Nakamura, T; Tazaki, K

    2007-12-01

    We report two extremely rare cases of dorsal radial avulsion injury of the triangular fibrocartilage complex accompanied by an avulsion fracture of the sigmoid notch of the radius. Anatomical reduction of the bone fragment in conjunction with reattachment of the dorsal portion of the radioulnar ligament to the radial sigmoid notch were necessary to restore stability of the distal radioulnar joint and tension of the triangular fibrocartilage proper. PMID:17993436

  14. [Treatment of long tubular bone pseudoarthrosis with revascularized cortical layer of radius].

    PubMed

    Milanov, N O; Trofimov, E I; Umerenkov, A G

    1997-01-01

    The method of osteogenesis without resection of the false joint was employed in the treatment of long tubular bone pseudarthrosis. The authors used a free revascularized radial flap, including the corticoperiosteal layer of the radius as a source of osteogenesis. A thin corticoperiosteal graft was taken from the distal third of the radius with or without a skin flap, if necessary. The graft was placed into the slotted bed of the false joint and fixed by two screws. Final fixation was made by using an Ilizarov apparatus or a metal plate. The authors used this procedure in the treatment of 12 patients with long tubular bone pseudarthrosis who had undergone at two operations on the false joint or fracture. Eight patients suffered from chronic osteomyelitis. Eleven patients completely recovered at postoperative month 12. Radiographic and scintigraphic investigations showed signs of bed-graft adhesion at month 3 after surgery and those of false joint ossification at month 6 postoperatively. PMID:9376741

  15. Modified transfixation pinning of compound radius and ulna fracture in a heifer.

    PubMed

    Baxter, G M; Wallace, C E

    1991-02-15

    A 405-kg heifer sustained a compound fracture of the distal portion of the radius and ulna after being hit by a car. The fracture was thoroughly debrided, lavaged, and reduced with the heifer under general anesthesia. The fracture was immobilized with a modified walking cast, using 2 fully threaded 6.4-mm (outside diameter) Steinmann pins placed through the proximal portion of the radius. The pins were incorporated into a full-limb fiberglass cast, and a 0.5-cm X 2.25-cm aluminum walking bar was positioned medially and laterally on the limb. The modified walking cast was removed after 7 weeks, and the fracture healed without complication. The transfixation pins and aluminum walking bar helped reduce the strong compressive and rotational forces at the fracture site. The modified walking cast can potentially be used for fixation of a variety of fractures in large animals. PMID:2019540

  16. On solar radius measurements with PICARD

    NASA Astrophysics Data System (ADS)

    Meftah, M.; Irbah, A.; Hauchecorne, A.; Corbard, T.; Hochedez, J. F.

    2014-12-01

    Solar diameter measurements performed from the ground for several decades seem to indicate a relation between the solar diameter and the solar activity. If this relationship is confirmed, it would be possible to use measurements of solar diameter as a proxy of solar activity in the past since the 1715 solar eclipses, and to use this input for the reconstruction of solar irradiance in climate models. However the interpretation of ground observations is controversial, ground-based measurements being affected by refraction, by atmospheric turbulence, and perhaps by atmospheric aerosols scattering. The only way to be free from atmospheric effects is to measure from space. This is the reason why, since the beginning, the PICARD program included a space and a ground component set up at the Calern site of the Observatoire de la Côte dAzur. During the last 4 years, the PICARD space mission has been used for observing the apparent solar diameter. First results of the astrometry program include a study of the June 2012 Venus transit for solar diameter determination. From this, the value of the solar radius from one astronomical unit was found to be equal to 959.86 arc-seconds at 607.1 nm. However, concerning observed variations in time of the solar radius, instrumental effects affect the results. Space is known to represent a harsh environment for optical instruments. Nevertheless, we can use the PICARD data to monitor the solar radius variation. PICARD aims to perpetuate historical series of the solar radius measurements, in particular during the solar cycle 24. This paper presents solar radius measurements obtained with PICARD.

  17. Robotic distal pancreatectomy: a valid option?

    PubMed

    Jung, M K; Buchs, N C; Azagury, D E; Hagen, M E; Morel, P

    2013-10-01

    Although reported in the literature, conventional laparoscopic approach for distal pancreatectomy is still lacking widespread acceptance. This might be due to two-dimensional vision and decreased range of motion to reach and safely dissect this highly vascularized retroperitoneal organ by laparoscopy. However, interest in minimally invasive access is growing ever since and the robotic system could certainly help overcome limitations of the laparoscopic approach in the challenging domain of pancreatic resection, notably in distal pancreatectomy. Robotic distal pancreatectomy with and without spleen preservation has been reported with encouraging outcomes for benign and borderline malignant disease. As a result of upgraded endowristed manipulation and three-dimensional visualization, improved outcome might be expected with the launch of the robotic system in the procedure of distal pancreatectomy. Our aim was thus to extensively review the current literature of robot-assisted surgery for distal pancreatectomy and to evaluate advantages and possible limitations of the robotic approach. PMID:24101006

  18. MASS-RADIUS RELATIONSHIPS FOR EXOPLANETS

    SciTech Connect

    Swift, D. C.; Eggert, J. H.; Hicks, D. G.; Hamel, S.; Caspersen, K.; Schwegler, E.; Collins, G. W.; Nettelmann, N.; Ackland, G. J.

    2012-01-01

    For planets other than Earth, particularly exoplanets, interpretation of the composition and structure depends largely on comparing the mass and radius with the composition expected given their distance from the parent star. The composition implies a mass-radius relation which relies heavily on equations of state calculated from electronic structure theory and measured experimentally on Earth. We lay out a method for deriving and testing equations of state, and deduce mass-radius and mass-pressure relations for key, relevant materials whose equation of state (EOS) is reasonably well established, and for differentiated Fe/rock. We find that variations in the EOS, such as may arise when extrapolating from low-pressure data, can have significant effects on predicted mass-radius relations and on planetary pressure profiles. The relations are compared with the observed masses and radii of planets and exoplanets, broadly supporting recent inferences about exoplanet structures. Kepler-10b is apparently 'Earth-like', likely with a proportionately larger core than Earth's, nominally 2/3 of the mass of the planet. CoRoT-7b is consistent with a rocky mantle over an Fe-based core which is likely to be proportionately smaller than Earth's. GJ 1214b lies between the mass-radius curves for H{sub 2}O and CH{sub 4}, suggesting an 'icy' composition with a relatively large core or a relatively large proportion of H{sub 2}O. CoRoT-2b is less dense than the hydrogen relation, which could be explained by an anomalously high degree of heating or by higher than assumed atmospheric opacity. HAT-P-2b is slightly denser than the mass-radius relation for hydrogen, suggesting the presence of a significant amount of matter of higher atomic number. CoRoT-3b lies close to the hydrogen relation. The pressure at the center of Kepler-10b is 1.5{sup +1.2}{sub -1.0} TPa. The central pressure in CoRoT-7b is probably close to 0.8 TPa, though may be up to 2 TPa. These pressures are accessible by planar

  19. Running with the radius in RS1

    NASA Astrophysics Data System (ADS)

    Lewandowski, Adam; May, Michael J.; Sundrum, Raman

    2003-01-01

    We derive a renormalization group formalism for the Randall-Sundrum scenario, where the renormalization scale is set by a floating compactification radius. While inspired by the AdS-CFT conjecture, our results are derived concretely within higher-dimensional effective field theory. Matching theories with different radii leads to running hidden brane couplings. The hidden brane Lagrangian consists of four-dimensional local operators constructed from the induced value of the bulk fields on the brane. We find hidden Lagrangians which are nontrivial fixed points of the RG flow. Calculations in RS1 can be greatly simplified by “running down” the effective theory to a small radius. We demonstrate these simplifications by studying the Goldberger-Wise stabilization mechanism. In this paper, we focus on the classical and tree-level quantum field theory of bulk scalar fields, which demonstrates the essential features of the RG in the simplest context.

  20. Solar Radius Measurements at Mount Wilson

    NASA Astrophysics Data System (ADS)

    Lefebvre, S.; Bertello, L.; Ulrich, R. K.; Boyden, J. E.; Rozelot, J.

    2004-12-01

    Variations of the solar radius are not only important for solar physics but they also play a fundamental role in the research of terrestrial climate. In fact, changes in the apparent size of the Sun could account for a significant fraction of the total irradiance variations, and solar irradiance is known to be a primary force in driving atmospheric circulation. While the MDI instrument aboard SOHO is likely to provide the most accurate constraint on possible solar radius variations, the radius measurements obtained from ground base observations represent a unique resource due to their long temporal coverage. Since 1970, the Mount Wilson synoptic programme of solar magnetic observations carried out at the 150-foot tower scans the solar disk using the radiation in the neutral iron line at 525.0 nm. For these images, the radius has been determined and results are presented on this paper. We show first the temporal behavior of these measurements. Secondly, if data are gathered by heliolatitude, the shape of the Sun differs from a perfect ellipsoid and shows solar distortions. We compare these results with others obtained with the heliometer at the Pic du Midi observatory in France. The comparison show a similitude in the shape with a bulge near the equator extending on 20-30 degrees followed by a depression at higher latitude near 60-70 degrees. These solar distortions needs to be confirmed by future space measurements (PICARD microsatellite) but it already raises the problem of a better understanding of the physics in the sub-surface layers.

  1. Measurement of the Radius of Neutron Stars

    NASA Astrophysics Data System (ADS)

    Guillot, Sebastien

    2012-07-01

    A physical understanding of the behavior of cold ultra-dense matter -- at and above nuclear density -- can only be achieved by the study of neutron stars. The recent 1.97+/-0.04 Msun measurement for PSR 1614-2230 suggests that strange quark matter and hyperons/kaons condensate equations of state (EoSs) are disfavored, in favor of hadronic EoSs. Over much of the neutron star mass-radius parameter space, the latter EoSs produce lines of nearly constant radii (within about 10%). We present a simultaneous spectral analysis of several globular cluster quiescent low-mass x-ray binaries where we require the radius to be the same among all neutron stars analyzed. Our (preliminary) results suggest a neutron star radius much smaller than previously reported, in the range 7.5-10 km (90% confidence). The Markov-Chain Monte-Carlo method and the Bayesian approach developed in this analysis permits including uncertainties in the distance, in the hydrogen column density, and possible contributions to the spectra due to unmodelled spectrally hard components.

  2. Measurement of the Radius of Neutron Stars

    NASA Astrophysics Data System (ADS)

    Guillot, Sebastien; Rutledge, R. E.; Servillat, M.; Webb, N.

    2013-01-01

    A physical understanding of the behavior of cold ultra dense matter - at and above nuclear density - can only be achieved by the study of neutron stars. The recent 1.97 ± 0.04 M⊙ measurement for PSR 1614-2230 suggests that strange quark matter and hyperons/kaons condensate equations of state (EoSs) are disfavored, in favor of hadronic EoSs. Over much of the neutron star mass-radius parameter space, the latter EoSs produce lines of nearly constant radii (within about 10%). We present a simultaneous spectral analysis of several globular cluster quiescent low-mass X-ray binaries where we require the radius to be the same among all neutron stars analyzed. Our (preliminary) results suggest a neutron star radius much smaller than previously reported, in the range 7.5-10 km (90% confidence). The Markov-Chain Monte-Carlo method and the Bayesian approach developed in this analysis permits including uncertainties in the distance, in the hydrogen column density, and possible contributions to the spectra due to unmodeled spectrally hard components.

  3. Solar radius change between 1925 and 1979

    NASA Technical Reports Server (NTRS)

    Sofia, S.; Dunham, D. W.; Dunham, J. B.; Fiala, A. D.

    1983-01-01

    From an analysis of numerous reports from different locations on the duration of totality of the solar eclipses on January 24, 1925, and February 26, 1979, it is found that the solar radius at the earlier date was 0.5 arcsec (or 375 km) larger than at the later date. The correction to the standard solar radius found for each eclipse is different when different subsets of the observations are used (for example, edge of path of totality timings compared with central timings). This is seen as suggesting the existence of systematic inaccuracies in our knowledge of the lunar figure. The differences between the corrections for both eclipses, however, are very similar for all subsets considered, indicating that changes of the solar size may be reliably inferred despite the existence of the lunar figure errors so long as there is proper consideration of the distribution of the observations. These results are regarded as strong evidence in support of the occurrence of solar radius changes on shorter than evolutionary time scales.

  4. Electrode radius predicts lesion radius during radiofrequency energy heating. Validation of a proposed thermodynamic model

    SciTech Connect

    Haines, D.E.; Watson, D.D.; Verow, A.F. )

    1990-07-01

    Myocardial heating by transcatheter delivery of radiofrequency (RF) energy has been proposed as an effective means of arrhythmia ablation. A thermodynamic model describing the radial temperature gradient at steady state during RF-induced heating is proposed. If one assumes that RF power output is adjusted to maintain a constant electrode-tissue interface temperature at all times, then this thermodynamic model predicts that the radius of the RF-induced lesion will be directly proportional to the electrode radius. A total of 76 RF-induced lesions were created in a model of isolated canine right ventricular free wall perfused and superfused with oxygenated Krebs-Henseleit buffer. Electrode radius was varied between 0.75 and 2.25 mm. RF energy (500 kHz) was delivered for 90 seconds, and the power output was adjusted to maintain a constant electrode-tissue interface temperature of 60 degrees C. A strong linear correlation was observed between electrode radius and lesion radius in two dimensions: transverse (p = 0.0001, r = 0.85) and transmural (p = 0.0001, r = 0.89). With these data, the temperature correlation with irreversible myocardial injury in this model was calculated at 46.6-48.8 degrees C. Therefore, the proposed thermodynamic model closely predicts the observed relation between electrode radius and lesion size during RF myocardial heating.

  5. Unilateral Molar Distalization: A Nonextraction Therapy

    PubMed Central

    Prasad, M. Bhanu; Sreevalli, S.

    2012-01-01

    In the recent years, nonextraction treatment approaches and noncompliance therapies have become more popular in the correction of space discrepancies. One of the conventional approaches for space gaining in the arches without patient compliance is done by using certain extra oral appliances or intraoral appliance. The greatest advantage of certain appliances like fixed functional and molar distalization appliances is that they minimize the dependence on patient cooperation. Molar distalization appliances like pendulum appliance which distalizes the molar rapidly without the need of head gear can be used in patients as a unilateral space gaining procedure due to buccal segment crowding. PMID:23320203

  6. Effects of odanacatib on the radius and tibia of postmenopausal women: improvements in bone geometry, microarchitecture, and estimated bone strength.

    PubMed

    Cheung, Angela M; Majumdar, Sharmila; Brixen, Kim; Chapurlat, Roland; Fuerst, Thomas; Engelke, Klaus; Dardzinski, Bernard; Cabal, Antonio; Verbruggen, Nadia; Ather, Shabana; Rosenberg, Elizabeth; de Papp, Anne E

    2014-08-01

    The cathepsin K inhibitor odanacatib (ODN), currently in phase 3 development for postmenopausal osteoporosis, has a novel mechanism of action that reduces bone resorption while maintaining bone formation. In phase 2 studies, odanacatib increased areal bone mineral density (aBMD) at the lumbar spine and total hip progressively over 5 years. To determine the effects of ODN on cortical and trabecular bone and estimate changes in bone strength, we conducted a randomized, double-blind, placebo-controlled trial, using both quantitative computed tomography (QCT) and high-resolution peripheral (HR-p)QCT. In previously published results, odanacatib was superior to placebo with respect to increases in trabecular volumetric BMD (vBMD) and estimated compressive strength at the spine, and integral and trabecular vBMD and estimated strength at the hip. Here, we report the results of HR-pQCT assessment. A total of 214 postmenopausal women (mean age 64.0 ± 6.8 years and baseline lumbar spine T-score -1.81 ± 0.83) were randomized to oral ODN 50 mg or placebo, weekly for 2 years. With ODN, significant increases from baseline in total vBMD occurred at the distal radius and tibia. Treatment differences from placebo were also significant (3.84% and 2.63% for radius and tibia, respectively). At both sites, significant differences from placebo were also found in trabecular vBMD, cortical vBMD, cortical thickness, cortical area, and strength (failure load) estimated using finite element analysis of HR-pQCT scans (treatment differences at radius and tibia = 2.64% and 2.66%). At the distal radius, odanacatib significantly improved trabecular thickness and bone volume/total volume (BV/TV) versus placebo. At a more proximal radial site, odanacatib attenuated the increase in cortical porosity found with placebo (treatment difference = -7.7%, p = 0.066). At the distal tibia, odanacatib significantly improved trabecular number, separation, and BV/TV versus placebo. Safety

  7. Stanmore non-invasive growing arthrodesis endoprosthesis in the reconstruction of complicated total knee arthroplasty: A case report.

    PubMed

    Gupta, A; Meswania, J; Blunn, G; Cannon, S R; Briggs, T W R

    2006-06-01

    As the number of primary and revision arthroplasties performed each year increases, the complexity of the reconstructive efforts also increases. A case of a patient with a total knee arthroplasty complicated with infection, deficient extensor mechanism, bone loss and limb shortening of 5.5 cm is reported. We describe an alternative surgical technique of reconstruction of the knee and lengthening of the limb using the Stanmore Non-Invasive Growing-Distal Femoral Prosthesis. The prosthesis had a magnetic disc attached to a gearbox. The generation of an external electromagnetic field caused the magnetic disc to rotate and lengthen the prosthesis. This reconstructive technique has not been described in the literature. PMID:16631369

  8. The comparative risk of developing postoperative complications in patients with distal radius fractures following different treatment modalities

    PubMed Central

    Qiu, Wen-Jun; Li, Yi-Fan; Ji, Yun-Han; Xu, Wei; Zhu, Xiao-Dong; Tang, Xian-Zhong; Zhao, Huan-Li; Wang, Gui-Bin; Jia, Yue-Qing; Zhu, Shi-Cai; Zhang, Feng-Fang; Liu, Hong-Mei

    2015-01-01

    In this study, we performed a network meta-analysis to compare the outcomes of seven most common surgical procedures to fix DRF, including bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. Published studies were retrieved through PubMed, Embase and Cochrane Library databases. The database search terms used were the following keywords and MeSH terms: DRF, bridging external fixation, non-bridging external fixation, K-wire fixation, plaster fixation, dorsal plating, volar plating, and dorsal and volar plating. The network meta-analysis was performed to rank the probabilities of postoperative complication risks for the seven surgical modalities in DRF patients. This network meta-analysis included data obtained from a total of 19 RCTs. Our results revealed that compared to DRF patients treated with bridging external fixation, marked differences in pin-track infection (PTI) rate were found in patients treated with plaster fixation, volar plating, and dorsal and volar plating. Cluster analysis showed that plaster fixation is associated with the lowest probability of postoperative complication in DRF patients. Plaster fixation is associated with the lowest risk for postoperative complications in DRF patients, when compared to six other common DRF surgical methods examined. PMID:26549312

  9. Radiostereometric Evaluation of Tendon Elongation after Distal Biceps Repair

    PubMed Central

    Marshall, Nathan; Keller, Robert A.; Guest, John-Michael; Moutzouros, Vasilios

    2016-01-01

    Objectives: Operative repair of distal biceps tendon ruptures have shown successful outcomes. However, little is known about the amount of tendon or repair site lengthening or creep. Treatment algorithms in regards to repair fixation, immobilization, initiation of activity and physical therapy are largely made on previous tendon healing principles and anecdotal findings. The purpose of our study was to evaluate distal biceps tendon repair via intratendinous radiostereometric analysis to evaluate tendon lengthening/creep at different time intervals of healing. Methods: Ten patients were recruited who sustained a distal biceps rupture requiring operative repair. Distal biceps repairs were performed using an endobutton only, single incision technique. Intraoperatively, two 2-mm tantalum beads with laser-etched holes were sutured to the distal biceps tendon. One bead was placed at the radius tendon interface and the other placed 1cm proximal to the first bead. Beads were evaluated via both CT scans immediately post-operatively and at 16 weeks and x-rays obtained at time 0 and then at 4, 8, and 16 weeks. Measurements were made using the endobutton to bead and bead-to-bead distances in order to assess repair site elongation as well as tendon elongation over time. Following final follow-up, patients underwent a DASH questionnaire and ultrasound to confirm the integrity of the tendon. Results: Ten patients were included in the study. Nine patients had complete ruptures with one having a partial rupture that underwent completion and subsequent repair. All patients showed statistically significant lengthening after surgery. The mean amount of lengthening after surgery was 21.8 mm (range 10.1-29.7 mm, p < 0.05). The repair site lengthened a mean of 12.5 mm (range 8.8-17.0 mm, p <0.05) and the tendon lengthened a mean of 9.4 mm (range: 4.0-18.8 mm, p<0.05) from surgery to final follow-up. The greatest change in lengthening was noted between time 0 and week 4 (mean: 11.8 mm

  10. Mathematical Model analysis of Wallstent and Aneurx: dynamic responses of bare-metal endoprosthesis compared with those of stent-graft.

    PubMed

    Canic, Suncica; Ravi-Chandar, K; Krajcer, Zvonimir; Mirkovic, Dragan; Lapin, Serguei

    2005-01-01

    We performed this study in order to analyze the mechanical properties of bare-metal Wallstent endoprostheses and of AneuRx stent-grafts and to compare their responses to hemodynamic forces. Mathematical modeling, numerical simulations, and experimental measurements were used to study the 2 structurally different types of endoprostheses. Our findings revealed that a single bare-metal Wallstent endoprosthesis is 10 times more flexible (elastic) than is the wall of the aneurysmal abdominal aorta. Graphs showing the changes in the diameter and length of the stent when exposed to a range of internal and external pressures were obtained. If the aorta is axially stiff and resists length change, a force as large as 1 kg can act in the axial direction on the aortic wall. If the stent is not firmly anchored, it will migrate. In contrast, a fabric-covered, fully supported, stent-graft such as the AneuRx is significantly less compliant than the aorta or the bare-metal stent. During each cardiac cycle, the stent frame tends to move due to its higher elasticity, while the fabric resists movement, which might break the sutures that join the fabric to the frame. Elevated local transmural pressure, detected along the prosthesis graft, can contribute to material fatigue. PMID:16429893

  11. Management of distal humeral coronal shear fractures

    PubMed Central

    Yari, Shahram S; Bowers, Nathan L; Craig, Miguel A; Reichel, Lee M

    2015-01-01

    Coronal shear fractures of the distal humerus are rare, complex fractures that can be technically challenging to manage. They usually result from a low-energy fall and direct compression of the distal humerus by the radial head in a hyper-extended or semi-flexed elbow or from spontaneous reduction of a posterolateral subluxation or dislocation. Due to the small number of soft tissue attachments at this site, almost all of these fractures are displaced. The incidence of distal humeral coronal shear fractures is higher among women because of the higher rate of osteoporosis in women and the difference in carrying angle between men and women. Distal humeral coronal shear fractures may occur in isolation, may be part of a complex elbow injury, or may be associated with injuries proximal or distal to the elbow. An associated lateral collateral ligament injury is seen in up to 40% and an associated radial head fracture is seen in up to 30% of these fractures. Given the complex nature of distal humeral coronal shear fractures, there is preference for operative management. Operative fixation leads to stable anatomic reduction, restores articular congruity, and allows initiation of early range-of-motion movements in the majority of cases. Several surgical exposure and fixation techniques are available to reconstruct the articular surface following distal humeral coronal shear fractures. The lateral extensile approach and fixation with countersunk headless compression screws placed in an anterior-to-posterior fashion are commonly used. We have found a two-incision approach (direct anterior and lateral) that results in less soft tissue dissection and better outcomes than the lateral extensile approach in our experience. Stiffness, pain, articular incongruity, arthritis, and ulnohumeral instability may result if reduction is non-anatomic or if fixation fails. PMID:25984515

  12. [Kapandji corrective operation of post-traumatic disorder of the distal radio-ulnar joint].

    PubMed

    Zilch, H; Kauschke, T

    1996-11-01

    The Sauvé-Kapandji procedure comprises distal radioulnar arthrodesis with screwing of the caput ulnae at the basis of the radius after the correction of the radioulnar length discrepancy. Therefore the best indications are posttraumatic changes of the distal radioulnar joint. At the same time a distal ulnar segment resection about 12 mm in length is necessary to restore forearm rotation, producing an iatrogenic pseudarthrosis. The proximal ulnar segment functionally assimilates to a rotating joint, as could be shown by X-rays. Between 1988 and 1993 this procedure was performed in 12 patients. Follow-up after an average of 38.2 months showed improvements in forearm rotation of 84% for pronation and 60% for supination. All patients had significant pain relief. Grip strength also improved, by 55%. No patient got worse postoperatively as measured by the score of Gartland and Werley. Neither non-union of the distal radioulnar joint fusion nor bony regeneration across the resected ulnar segment was seen. The good results are the consequence of adherence to a rigorous indication: no preexisting arthrosis at the radiocarpal joint. PMID:9036550

  13. Failure of distal biceps repair by gapping

    PubMed Central

    Copas, David; Watts, Adam C

    2016-01-01

    Background We describe the clinical, radiological and surgical findings of failed distal biceps repair by gapping and report the functional outcomes following revision repair. Methods A retrospective review of five consecutive patients was conducted. Patients presented with radial-sided forearm pain after their distal biceps fixation. All patients had less than 5 cm of retraction of the biceps muscle belly, a palpable tendon although the manoeuvre was painful with weakness on resisted supination. Flexed abducted supinated magnetic resonance imaging (FABS MRI) showed a gap between the distal end of the tendon and the footprint on the radial tuberosity. Results Mean FEA score at presentation was 44/100 (35 to 49). Mean time to re-operation was 18 months (range 4 months to 36 months). At revision, the distal end of the tendon was retracted and not making contact with the bone. All cases were revised to an in-bone endobutton repair. Mean postoperative Functional Elbow Assessment (FEA) scores undertaken at a mean of 14 months (range 5 months to 22 months) after revision improved to 95/100 (90 to 100). Conclusions Patients presenting with persistent radial sided forearm pain and weakness on provocative testing after distal biceps repair with a seemingly intact repair should be investigated with FABS MRI to look for evidence of failure of repair by gapping. Revision repair with an anatomic in-bone technique can lead to good results. PMID:27583018

  14. Understanding the mass-radius relation for sub-Neptunes: radius as a proxy for composition

    SciTech Connect

    Lopez, Eric D.; Fortney, Jonathan J.

    2014-09-01

    Transiting planet surveys like Kepler have provided a wealth of information on the distribution of planetary radii, particularly for the new populations of super-Earth- and sub-Neptune-sized planets. In order to aid in the physical interpretation of these radii, we compute model radii for low-mass rocky planets with hydrogen-helium envelopes. We provide model radii for planets 1-20 M {sub ⊕}, with envelope fractions 0.01%-20%, levels of irradiation 0.1-1000 times Earth's, and ages from 100 Myr to 10 Gyr. In addition we provide simple analytic fits that summarize how radius depends on each of these parameters. Most importantly, we show that at fixed H/He envelope fraction, radii show little dependence on mass for planets with more than ∼1% of their mass in their envelope. Consequently, planetary radius is to a first order a proxy for planetary composition, i.e., H/He envelope fraction, for Neptune- and sub-Neptune-sized planets. We recast the observed mass-radius relationship as a mass-composition relationship and discuss it in light of traditional core accretion theory. We discuss the transition from rocky super-Earths to sub-Neptune planets with large volatile envelopes. We suggest ∼1.75 R {sub ⊕} as a physically motivated dividing line between these two populations of planets. Finally, we discuss these results in light of the observed radius occurrence distribution found by Kepler.

  15. Corrective osteotomy of distal radial deformities: a new method of guided locking fixed screw positioning.

    PubMed

    Farshad, M; Hess, F; Nagy, L; Schweizer, A

    2013-01-01

    Corrective osteotomy for distal radial malunion is a valuable but at times technically challenging operation. We have developed a new device to aid in the performance of the operation. We compared clinical use of the new technique with the standard technique. In 11 patients treated with the new technique the volar locking plate needed repositioning only once. With the standard technique in 17 patients the plate was repositioned in nine cases and needed bending in six cases. The new method corrected radial inclination (SD of 3° vs. 9°) and ulnar variance (SD of 0.9 mm vs. 1.4 mm) more predictably than the standard technique but there was no advantage in correction of volar tilt (SD of 6° vs. 4°). In our experience the new device makes corrective osteotomy of the distal radius easier and more reliable. PMID:22184783

  16. 21 CFR 886.1450 - Corneal radius measuring device.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Corneal radius measuring device. 886.1450 Section... (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1450 Corneal radius measuring device. (a) Identification. A corneal radius measuring device is an AC-powered device intended to...

  17. 21 CFR 886.1450 - Corneal radius measuring device.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Corneal radius measuring device. 886.1450 Section... (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1450 Corneal radius measuring device. (a) Identification. A corneal radius measuring device is an AC-powered device intended to...

  18. 21 CFR 886.1450 - Corneal radius measuring device.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Corneal radius measuring device. 886.1450 Section... (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1450 Corneal radius measuring device. (a) Identification. A corneal radius measuring device is an AC-powered device intended to...

  19. 21 CFR 886.1450 - Corneal radius measuring device.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Corneal radius measuring device. 886.1450 Section... (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1450 Corneal radius measuring device. (a) Identification. A corneal radius measuring device is an AC-powered device intended to...

  20. Acquired distal renal tubular acidosis in man.

    PubMed

    Better, O S

    1982-10-01

    Distal renal tubular acidosis (dRTA) may complicate renal transplantation, liver cirrhosis, and obstructive uropathy. Indeed, its occurrence may be an early clue to an episode of rejection of the graft or to obstructive uropathy. The mechanism in most patients with dRTA is impaired distal secretion of protons. In some patients, however, back leak of protons from tubular lumen to blood may abolish distal tubular ability to maintain urine to blood proton gradients. In patients with obstructive uropathy the spectrum of tubular acidosis is widened by the occurrence of additional defects in tubular secretion of potassium and impairment of hydrogen ion secretion secondary to hypoaldosteronism. Hyperkalemia is also seen in "voltage dependent" states such as following the administration of lithium and amiloride. Hyperkalemia per se is conducive to acidosis by a combination of extrarenal and several intrarenal mechanisms. PMID:6755051

  1. Treatment Options for Distal Femur Fractures.

    PubMed

    von Keudell, Arvind; Shoji, Kristin; Nasr, Michael; Lucas, Robert; Dolan, Robert; Weaver, Michael J

    2016-08-01

    Despite advances in implant design, the management of distal femur fractures remains challenging. Fracture comminution and intra-articular extension can make it difficult to obtain an adequate reduction while preserving the soft tissue attachments to bone fragments to allow for bone healing. Many implant manufacturers have developed optimal anatomically contoured, distal femoral locking plates with percutaneous guides. This environment allows for the application of lateral locked plates in a biologically friendly manner. Although initial reports had high success rates, more recently a high rate of nonunion has been found, particularly in elderly patients. Limited literature is available for the treatment of patients with osteoporotic bone and associated ipsilateral total knee replacement and hip replacement. We present a patient with a distal femur fracture with significant comminution in the setting of an ipsilateral total hip replacement. PMID:27441931

  2. Management of complications of distal radioulnar joint.

    PubMed

    Ozer, Kagan

    2015-05-01

    The distal radioulnar joint (DRUJ) is a complex structure that participates in forearm rotation and weight-bearing. Myriad disorders affect the DRUJ and present diagnostic and management challenges. Degenerative and posttraumatic arthritis and pain at the DRUJ have been traditionally treated with resection of 1 of the 2 arthritic surfaces. Although the procedure often relieves pain associated with incongruence, it creates a different problem by changing the overall dynamics of the forearm rotation and weight-bearing, resulting in radioulnar convergence and ulnar translation of the carpus. This article focuses on the management of painful radioulnar convergence after distal ulnar resections. PMID:25934199

  3. Disorders of the distal radioulnar joint.

    PubMed

    Houdek, Matthew T; Wagner, Eric R; Moran, Steven L; Berger, Richard A

    2015-01-01

    The distal radioulnar joint is responsible for stable forearm rotation. Injury to this joint can occur following a variety of mechanisms, including wrist fractures, ligamentous damage, or degenerative wear. Accurate diagnosis requires a clear understanding of the anatomy and mechanics of the ulnar aspect of the wrist. Injuries can be divided into three major categories for diagnostic purposes, and these include pain without joint instability, pain with joint instability, and joint arthritis. New advancements in imaging and surgical technique can allow for earlier detection of injuries, potentially preserving joint function. In this article, the authors review the pertinent anatomy, biomechanics, and major abnormality involving the distal radioulnar joint. PMID:25285686

  4. Distal Humerus Fractures: Open Reduction Internal Fixation.

    PubMed

    Mighell, Mark A; Stephens, Brent; Stone, Geoffrey P; Cottrell, Benjamin J

    2015-11-01

    Distal humerus fractures are challenging injuries for the upper extremity surgeon. However, recent techniques in open reduction internal fixation have been powerful tools in getting positive outcomes. To get such results, the surgeon must be aware of how to properly use these techniques in their respective practices. The method of fixation depends on the fracture, taking the degree of comminution and the restoration of the columns and articular surface into account. This article helps surgeons understand the concepts behind open reduction internal fixation of the distal humerus and makes them aware of pitfalls that may lead to negative results. PMID:26498548

  5. Radial shortening following a fracture of the proximal radius

    PubMed Central

    2011-01-01

    Background and purpose The Essex-Lopresti lesion is thought to be rare, with a varying degree of disruption to forearm stability probable. We describe the range of radial shortening that occurs following a fracture of the proximal radius, as well as the short-term outcome in these patients. Patients and methods Over an 18-month period, we prospectively assessed all patients with a radiographically confirmed proximal radial fracture. Patients noted to have ipsilateral wrist pain at initial presentation underwent bilateral radiography to determine whether there was disruption of the distal radio-ulnar joint suggestive of an Essex-Lopresti lesion. Outcome was assessed after a mean of 6 (1.5–12) months using clinical and radiographic results, including the Mayo elbow score (MES) and the short musculoskeletal function assessment (SMFA) questionnaire. One patient with a Mason type-I fracture was lost to follow-up after initial presentation. Results 60 patients had ipsilateral wrist pain at the initial assessment of 237 proximal radial fractures. Radial shortening of ≥ 2mm (range: 2–4mm) was seen in 22 patients (mean age 48 (19–79) years, 16 females). The most frequent mechanism of injury was a fall from standing height (10/22). 21 fractures were classified as being Mason type-I or type-II, all of which were managed nonoperatively. One Mason type-III fracture underwent acute radial head replacement. Functional outcome was assessed in 21 patients. We found an excellent or good MES in 18 of the 20 patients with a Mason type-I or type-II injury. Interpretation The incidence of the Essex-Lopresti lesion type is possibly under-reported as there is a spectrum of injuries, and subtle disruptions often go unidentified. A full assessment of all patients with a proximal radial fracture is required in order to identify these injuries, and the index of suspicion is raised as the complexity of the fracture increases. PMID:21504305

  6. Comparative evaluation of molar distalization therapy using pendulum and distal screw appliances

    PubMed Central

    Cafagna, Alessandra; Fontana, Mattia; Cozzani, Mauro

    2015-01-01

    Objective To compare dentoalveolar and skeletal changes produced by the pendulum appliance (PA) and the distal screw appliance (DS) in Class II patients. Methods Forty-three patients (19 men, 24 women) with Class II malocclusion were retrospectively selected for the study. Twenty-four patients (mean age, 12.2 ± 1.5 years) were treated with the PA, and 19 patients (mean age, 11.3 ± 1.9 years) were treated with the DS. The mean distalization time was 7 months for the PA group and 9 months for the DS group. Lateral cephalograms were obtained at T1, before treatment, and at T2, the end of distalization. A Mann-Whitney U test was used for statistical comparisons of the two groups between T1 and T2. Results PA and DS were equally effective in distalizing maxillary molars (4.7 mm and 4.2 mm, respectively) between T1 and T2; however, the maxillary first molars showed less distal tipping in the DS group than in the PA group (3.2° vs. 9.0°, respectively). Moreover, significant premolar anchorage loss (2.7 mm) and incisor proclination (5.0°) were noted in the PA group, whereas premolar distal movement (1.9 mm) and no significant changes at the incisor (0.1°) were observed in the DS group. No significant sagittal or vertical skeletal changes were detected between the two groups during the distalization phase. Conclusions PA and DS seem to be equally effective in distalizing maxillary molars; however, greater distal molar tipping and premolar anchorage loss can be expected using PA. PMID:26258063

  7. Photospheric Radius Expansion During Magnetar Bursts

    NASA Astrophysics Data System (ADS)

    Watts, Anna L.; Kouveliotou, Chryssa; van der Horst, Alexander J.; Göǧüş, Ersin; Kaneko, Yuki; van der Klis, Michiel; Wijers, Ralph A. M. J.; Harding, Alice K.; Baring, Matthew G.

    2010-08-01

    On 2008 August 24 the new magnetar SGR 0501+4516 (discovered by Swift) emitted a bright burst with a pronounced double-peaked structure in hard X-rays, reminiscent of the double-peaked temporal structure seen in some bright thermonuclear bursts on accreting neutron stars. In the latter case this is due to Photospheric Radius Expansion (PRE): when the flux reaches the Eddington limit, the photosphere expands and cools so that emission becomes softer and drops temporarily out of the X-ray band, re-appearing as the photosphere settles back down. We consider the factors necessary to generate double-peaked PRE events, and show that such a mechanism could plausibly operate in magnetar bursts despite the vastly different emission process. Identification of the magnetic Eddington limit in a magnetar would constrain magnetic field and distance and could, in principle, enable a measurement of gravitational redshift. It would also locate the emitting region at the neutron star surface, constraining the burst trigger mechanism. Conclusive confirmation of PRE events will require more detailed radiative models for bursts. However, for SGR 0501+4516 the predicted critical flux (using the magnetic field strength inferred from timing and the distance suggested by its probable location in the Perseus arm of our Galaxy) is consistent with that observed in the August 24 burst.

  8. Experimental study of finite Larmor radius effects

    SciTech Connect

    Struve, K.W.

    1980-08-01

    Linear Z-pinches in Ar, Kr, Xe, N/sub 2/, and He are experimentally studied in regimes where strong finite Larmor radius effects could provide a significant stabilizing effect. Scaling arguments show that for deuterium such a pinch has an electron line density of order 2 x 10/sup 15//cm. For higher Z plasmas a higher line density is allowed, the exact value of which depends on the average ion charge. The pinch is formed by puffing gas axially through the cathode towards the anode of an evacuated pinch chamber. When the gas reaches the anode, the pinch bank is fired. The pinch current rises in 2 to 3 ..mu..sec to a maximum of 100 to 200 kA. The pinch bank capacitance is 900 ..mu..F, and the external inductance is 100 nH. Additionally, the bank is fused to increase dI/dt. The primary diagnostics are a framing camera, a spatially resolved Mach-Zehnder interferometer, and X-ray absorption.

  9. Distal axonopathy in streptozotocin diabetes in rats.

    PubMed

    Chokroverty, S; Seiden, D; Navidad, P; Cody, R

    1988-05-15

    We noted the earliest morphological changes in the motor endplates 8 weeks after the induction of streptozotocin diabetes in rats. Morphometric measurements showed reduced axonal areas of the lateral plantar and the sciatic nerves in the diabetic rats 28 but not 2 and 8 weeks after the experiment. These findings suggested distal axonopathy. PMID:3371449

  10. Locked volar distal radioulnar joint dislocation

    PubMed Central

    Bouri, Fadi; Fuad, Mazhar; Elsayed Abdolenour, Ayman

    2016-01-01

    Introduction Volar dislocation of the distal radioulnar joint is a rare injury which is commonly missed in the emergency departments. A thorough review of literature showed very few reported cases and the cause for irreducibility varied in different cases, Lack of suspicion and improper X-ray can delay the diagnosis. Case presentation Our article discusses a case 40 year old construction worker, who presented to the Emergency with work-related injury, complaining of left wrist pain, deformity and inability to rotate his forearm. X-rays revealed a volar dislocation of distal ulna which was reducible after manipulation under General Anesthesia (GA). The joint was stable after the reduction. Discussion Isolated dislocation of the distal radioulnar joint can be either volar or dorsal, although dorsal dislocation is more common. The distal radioulnar articulation plays an important role in the rotational movement of the forearm. It allows pronation and supination which are essential for the function of the upper limb. Pronator Quadratus muscle spasm is an important blockade to reduction and was preventing reduction in this case. Methods The work has been reported in line with the CARE criteria [9]. Conclusion Volar locked dislocation of Distal Radio ulnar joint is a rare injury. High degree of clinical suspicion and proper X-ray is required for prompt detection. The importance of this case is to raise the awareness among physicians in treating these kind of injuries by careful assessment of the patient and radiographs, and to consider pronator quadratus as an important cause for the blockade to reduction. PMID:27016647

  11. Tidal radius estimates for three open clusters

    NASA Astrophysics Data System (ADS)

    Danilov, V. M.; Loktin, A. V.

    2015-10-01

    A new method is developed for estimating tidal radii and masses of open star clusters (OCL) based on the sky-plane coordinates and proper motions and/or radial velocities of cluster member stars. To this end, we perform the correlation and spectral analysis of oscillations of absolute values of stellar velocity components relative to the cluster mass center along three coordinate planes and along each coordinate axis in five OCL models. Mutual correlation functions for fluctuations of absolute values of velocity field components are computed. The spatial Fourier transform of the mutual correlation functions in the case of zero time offset is used to compute wavenumber spectra of oscillations of absolute values of stellar velocity components. The oscillation spectra of these quantities contain series of local maxima at equidistant wavenumber k values. The ratio of the tidal radius of the cluster to the wavenumber difference Δ k of adjacent local maxima in the oscillation spectra of absolute values of velocity field components is found to be the same for all five OCL models. This ratio is used to estimate the tidal radii and masses of the Pleiades, Praesepe, and M67 based on the proper motions and sky-plane coordinates of the member stars of these clusters. The radial dependences of the absolute values of the tangential and radial projections of cluster star velocities computed using the proper motions relative to the cluster center are determined, along with the corresponding autocorrelation functions and wavenumber spectra of oscillations of absolute values of velocity field components. The Pleiades virial mass is estimated assuming that the cluster is either isolated or non-isolated. Also derived are the estimates of the Pleiades dynamical mass assuming that it is non-stationary and non-isolated. The inferred Pleiades tidal radii corresponding to these masses are reported.

  12. Indications for ulnar head replacement.

    PubMed

    Berger, Richard A

    2008-08-01

    Implanting an endoprosthesis is a clinically proven means of reestablishing mechanical contact between the distal radius and ulna, thus providing the foundation for stability of the entire forearm. The indications for, contraindications to, and outcomes of ulnar head replacement are discussed, together with the underlying mechanics, pathomechanics of ulnar head excision, the theoretical basis for implant arthroplasty, and the designs that have been employed. PMID:18836608

  13. Contribution to the cloud droplet effective radius parameterization

    SciTech Connect

    Pontikis, C.; Hicks, E. )

    1992-11-01

    An analytic cloud droplet effective radius expression is derived and validated by using field experiment microphysical data. This expression shows that the effective radius depends simultaneously upon the cloud liquid water content, droplet concentration and droplet spectral dispersion. It further suggests that the variability in these parameters present at all scales, due to turbulent mixing and secondary droplet activation, could limit the accuracy of the effective radius parameterizations used in climate models. 12 refs.

  14. INDICATIONS FOR DISTAL RADIOULNAR ARTHROPLASTY: REPORT ON THREE CLINICAL CASES

    PubMed Central

    Santos, Cláudia; Pereira, Alexandre; Sousa, Marco; Trigeuiros, Miguel; Silva, César

    2015-01-01

    Distal radioulnar arthroplasty is an attractive solution for treating various pathological conditions of the distal radioulnar joint because it allows restoration of stability, load transmission and function. The main indications are: radioulnar impingement after partial or complete resection of the distal ulna; and degenerative, inflammatory or post-traumatic arthritis of the distal radioulnar joint. The authors present three clinical cases of distal radioulnar pathological conditions: two patients with post-traumatic sequelae and one case of distal radioulnar impingement after a Sauvé-Kapandji operation. The three cases were treated surgically with a metallic prosthesis to replace the distal ulna (First Choice - Ascension®). The first two were treated with a resurfacing prosthesis and the last one with a modular prosthesis. All of the patients had achieved pain relief and increased movement of the distal radioulnar joint after one year of postoperative follow-up. PMID:27047827

  15. Genetics Home Reference: distal hereditary motor neuropathy, type II

    MedlinePlus

    ... hereditary motor neuropathy, type II distal hereditary motor neuropathy, type II Enable Javascript to view the expand/ ... Open All Close All Description Distal hereditary motor neuropathy, type II is a progressive disorder that affects ...

  16. Genetics Home Reference: distal hereditary motor neuropathy, type V

    MedlinePlus

    ... hereditary motor neuropathy, type V distal hereditary motor neuropathy, type V Enable Javascript to view the expand/ ... Open All Close All Description Distal hereditary motor neuropathy, type V is a progressive disorder that affects ...

  17. Discharge coefficients of cooling holes with radiused and chamfered inlets

    NASA Astrophysics Data System (ADS)

    Hay, N.; Spencer, A.

    1991-06-01

    The flow of cooling air within the internal passages of gas turbines is controlled and metered using holes in disks and casings. The effects of inlet radiusing and chamfering of these holes on the discharge coefficient are discussed. Experimental results for a range of radiusing and chamfering ratios for holes of different length to diameter ratios are presented, covering the range of pressure ratios of practical interest. The results indicate that radiusing and chamfering are both beneficial in increasing the discharge coefficient. Increases of 10-30 percent are possible. Chamfered holes give the more desirable performance characteristics in addition to being easier to produce than radiused holes.

  18. Improving optical bench radius measurements using stage error motion data

    SciTech Connect

    Schmitz, Tony L.; Gardner, Neil; Vaughn, Matthew; Medicus, Kate; Davies, Angela

    2008-12-20

    We describe the application of a vector-based radius approach to optical bench radius measurements in the presence of imperfect stage motions. In this approach, the radius is defined using a vector equation and homogeneous transformation matrix formulism. This is in contrast to the typical technique, where the displacement between the confocal and cat's eye null positions alone is used to determine the test optic radius. An important aspect of the vector-based radius definition is the intrinsic correction for measurement biases, such as straightness errors in the stage motion and cosine misalignment between the stage and displacement gauge axis, which lead to an artificially small radius value if the traditional approach is employed. Measurement techniques and results are provided for the stage error motions, which are then combined with the setup geometry through the analysis to determine the radius of curvature for a spherical artifact. Comparisons are shown between the new vector-based radius calculation, traditional radius computation, and a low uncertainty mechanical measurement. Additionally, the measurement uncertainty for the vector-based approach is determined using Monte Carlo simulation and compared to experimental results.

  19. Aerotactile Integration from Distal Skin Stimuli

    PubMed Central

    Derrick, Donald; Gick, Bryan

    2015-01-01

    Tactile sensations at extreme distal body locations can integrate with auditory information to alter speech perception among uninformed and untrained listeners. Inaudible air puffs were applied to participants' ankles, simultaneously with audible syllables having aspirated and unaspirated stop onsets. Syllables heard simultaneously with air puffs were more likely to be heard as aspirated. These results demonstrate that event-appropriate information from distal parts of the body integrates in speech perception, even without frequent or robust location-specific experience. In addition, overall performance was significantly better for those with hair on their ankles, which suggests that the presence of hair may help establish signal relevance, and so aid in multi-modal speech perception. PMID:24649526

  20. Lateral supporting ligament of the distal phalanx.

    PubMed

    Winter, W G; Iwersen, L J; Johnson, E D

    1989-06-01

    A 49-year-old woman complained of 3 months of constant aching pain deep to the ingrown medial nail margin of her right hallux that was unaffected by shoe wear. Physical examination disclosed no purulence, discoloration, or obvious acute inflammation; an incurved medial nail plate was seen. There was mild chronic thickening of the medial nail fold. Tenderness was maximal 2 to 3 mm plantar to the medial edge of the nail. By roentgenogram, bony projections were seen arcing from the distal phalangeal tuft and the proximal metaphyseal flare toward each other. This was considered to be a "normal" radiological variant. A partial medial onychectomy and matricectomy (Winograd procedure) was performed. Further dissection 1 to 2 mm deeper along the medial phalangeal border revealed a 1-mm wide longitudinal ligament extending from the phalangeal distal tuft to the proximal metaphyseal flare. Bony projections and ligament were excised. The wound healed satisfactorily, and symptoms ceased. PMID:2744674

  1. Measurement of humerus and radius bone mineral content in the term and preterm infant

    SciTech Connect

    Vyhmeister, N.R.; Linkhart, T.A.

    1988-07-01

    We compared two anatomic sites for single-photon absorptiometric measurement of bone mineral content (BMC) in term and preterm infants. The distal one third of the radius and the midportion of the humerus were evaluated for measurements of BMC with an unmodified, commercially available bone densitometer. We assessed reproducibility of BMC and bone width (BW) measurements and defined normal at-birth ranges of BMC, BW, and BMC/BW ratio for infants with gestational ages of 24 to 42 weeks. Humerus BMC correlated with gestational age, birth weight, and BW of patients and did not differ from humerus BMC values determined over the same range of gestational ages at another center. Representative serial measurements of two very low birth weight (VLBW) infants are presented to demonstrate the feasibility of using humerus BMC in longitudinal studies to assess changes in bone mineralization. We conclude that bone densitometer measurements of mid-humerus BMC can be successfully performed and are preferable to similar measurements of the radius for VLBW infants. Normal humerus BMC values were defined for use in diagnosis and evaluation of the efficacy of treatment in VLBW infants who are at high risk of developing osteopenia of prematurity.

  2. Fracture of distal end clavicle: A review

    PubMed Central

    Sambandam, Balaji; Gupta, Rajat; Kumar, Santosh; Maini, Lalit

    2014-01-01

    Management of fracture distal end clavicle has always puzzled the orthopaedic surgeons. Now-a-days with a relatively active lifestyle, patients want better results both cosmetically and functionally. Despite so much literature available for the management of this common fracture, there is no consensus regarding the gold standard treatment for this fracture. In this article, we reviewed the literature on various techniques of management for this fracture, both conservative as well as surgical, and their merits and demerits. PMID:25983473

  3. Distal Embolic Protection for Renal Arterial Interventions

    SciTech Connect

    Dubel, Gregory J. Murphy, Timothy P.

    2008-01-15

    Distal or embolic protection has intuitive appeal for its potential to prevent embolization of materials generated during interventional procedures. Distal protection devices (DPDs) have been most widely used in the coronary and carotid vascular beds, where they have demonstrated the ability to trap embolic materials and, in some cases, to reduce complications. Given the frequency of chronic kidney disease in patients with renal artery stenosis undergoing stent placement, it is reasonable to propose that these devices may play an important role in limiting distal embolization in the renal vasculature. Careful review of the literature reveals that atheroembolization does occur during renal arterial interventions, although it often goes undetected. Early experience with DPDs in the renal arteries in patients with suitable anatomy suggests retrieval of embolic materials in approximately 71% of cases and renal functional improvement/stabilization in 98% of cases. The combination of platelet inhibition and a DPD may provide even greater benefit. Given the critical importance of renal functional preservation, it follows that everything that can be done to prevent atheroembolism should be undertaken including the use of DPDs when anatomically feasible. The data available at this time support a beneficial role for these devices.

  4. The Origin of the Ionic-Radius Ratio Rules

    ERIC Educational Resources Information Center

    Jensen, William B.

    2010-01-01

    In response to a reader query, this article traces the origins of the ionic-radius ratio rules and their incorrect attribution to Linus Pauling in the chemical literature and to Victor Goldschmidt in the geochemical literature. In actual fact, the ionic-radius ratio rules were first proposed within the context of the coordination chemistry…

  5. Determination of Radius of Curvature for Teeth With Cycloid Profile

    NASA Astrophysics Data System (ADS)

    Shatalov, E. V.; Efremenkov, E. A.; Shibinskiy, K. G.

    2016-04-01

    In the article the geometric determination of curvature radius is considered for teeth with cycloid profile. The equations are obtained for the determination of a radius of curvature with point coordinates of a cycloid profile. The conditions of convexo-concavity of a teeth profile are defined for transmission with intermediate rollers.

  6. Distal residue-CO interaction in carbonmonoxy myoglobins: a molecular dynamics study of three distal mutants.

    PubMed Central

    Jewsbury, P; Kitagawa, T

    1995-01-01

    Six 90-ps molecular dynamics trajectories, two for each of three distal mutants of sperm whale carbonmonoxy myoglobin, are reported; solvent waters within 16 A of the active site have been included. In both His64GIn trajectories, the distal side chain remains part of the heme pocket, forming a "closed" conformation similar to that of the wild type 64N delta H tautomer. Despite a connectivity more closely resembling the N epsilon H histidine tautomer, close interactions with the carbonyl ligand similar to those observed for the wild type 64N epsilon H tautomer are prevented in this mutant by repulsive interactions between the carbonyl O and the 64O epsilon. The aliphatic distal side chain of the His64Leu mutant shows little interaction with the carbonyl ligand in either His64Leu trajectory. Solvent water molecules move into and out of the active site in the His64Gly mutant trajectories; during all the other carbonmonoxy myoglobin trajectories, including the wild type distal tautomers considered in an earlier work, solvent molecules rarely encroach closer than 6 A of the active site. These results are consistent with a recent structural interpretation of the wild type infrared spectrum, and the current reinterpretation that the distal-ligand interaction in carbonmonoxy myoglobin is largely electrostatic, not steric, in nature. Images FIGURE 5 FIGURE 7 PMID:7787018

  7. Decreasing the spectral radius of a graph by link removals.

    PubMed

    Van Mieghem, Piet; Stevanović, Dragan; Kuipers, Fernando; Li, Cong; van de Bovenkamp, Ruud; Liu, Daijie; Wang, Huijuan

    2011-07-01

    The decrease of the spectral radius, an important characterizer of network dynamics, by removing links is investigated. The minimization of the spectral radius by removing m links is shown to be an NP-complete problem, which suggests considering heuristic strategies. Several greedy strategies are compared, and several bounds on the decrease of the spectral radius are derived. The strategy that removes that link l=i~j with largest product (x(1))(i)(x(1))(j) of the components of the eigenvector x(1) belonging to the largest adjacency eigenvalue is shown to be superior to other strategies in most cases. Furthermore, a scaling law where the decrease in spectral radius is inversely proportional to the number of nodes N in the graph is deduced. Another sublinear scaling law of the decrease in spectral radius versus the number m of removed links is conjectured. PMID:21867251

  8. Ejecta emplacement: from distal to proximal

    NASA Astrophysics Data System (ADS)

    Artemieva, N.

    2008-09-01

    Introduction Most part of impact ejecta is deposited ballistically at some distance from a crater, defined by ejection velocity V and ejection angle α: d=v2sinα/g. In case of giant impacts, planetary curvature should be taken into account [1]. Combined with ejecta scaling [2], these relations allow to define ejecta thickness as a function of distance. Ejecta from large craters are deposited at velocity high enough to mobilize substrate material and to thicken ejecta deposits [3]. Ballistic approximation is valid for airless bodies (if impact vaporization is not vast) or for proximal ejecta of large impact craters, where ejecta mass per unit area is substantially greater than the mass of involved vapor/atmosphere (M-ratio). Deposition of distal ejecta, in which ejecta mass is negligible compared to the atmosphere, may be also treated in a simplified manner, i.e. as 1) passive motion of ejected particles within an impact plume and 2) later, as sedimentation of particles in undisturbed atmosphere (equilibrium between gravity and drag). In all intermediate M-ratio values, impact ejecta move like a surge, i.e. dilute suspension current in which particles are carried in turbulent flows under the influence of gravity. Surges are well-known for near-surface explosive tests, described in detail for volcanic explosions (Plinian column collapse, phreato-magmatic eruption, lateral blast), and found in ejecta from the Chicxulub [4] and the Ries [5]. Important aspects of surge transport include its ability to deposit ejecta over a larger area than that typical of continuous ballistic ejecta and to create multiple ejecta layers. Numerical model Two-phase hydrodynamics. Surges should be modeled in the frame of two-phase hydrodynamics, i.e. interaction between solid/molten particles and atmospheric gas/impact vapor should be taken into account. There are two techniques of solving equations for dust particle motion in a gas flow. The first one describes solid/molten particles as a

  9. Patella dislocation following distal femoral replacement after bone tumour resection

    PubMed Central

    Akiyama, Toru; Kanda, Shotaro; Maeda, Akinori; Endo, Minoru; Saita, Kazuo

    2014-01-01

    We report the case of a 16-year-old girl with patella dislocation following distal femur replacement for a malignant tumour. We performed a medial plication and lateral release procedure to treat her persistent patellar dislocation after distal femur replacement following malignant tumour resection. This treatment improved the patient's gait ability dramatically. A distal femur reconstruction with a total knee arthroplasty (TKA) system for tumour resection is a frequently performed procedure. The reported incidence of patella dislocation following distal femur reconstruction with a TKA is 2.3%. However, treatment procedures for patella dislocation following a distal femur replacement after malignant tumour resection have not been studied extensively. To the best of our knowledge, this is the first English case report about patella dislocation following distal femoral replacement focusing on surgical treatment. Our experience suggests that treatment for patella dislocation following distal femur reconstruction with a TKA should be considered positively. PMID:25073529

  10. Hemodynamics of distal revascularization-interval ligation.

    PubMed

    Illig, Karl A; Surowiec, Scott; Shortell, Cynthia K; Davies, Mark G; Rhodes, Jeffrey M; Green, Richard M

    2005-03-01

    Distal revascularization-interval ligation (DRIL) empirically corrects steal after arteriovenous fistula (AVF) creation in most cases, but because there is no topologic alteration in anatomy, it is unclear as to why it is effective. To explore this issue, nine symptomatic patients underwent intravascular pressure and flow measurements before and after DRIL following upper arm autologous AVFs. Mean pre-DRIL systolic pressure (mmHg; mean +/- SD) in the proximal brachial artery (PROX) was 102 +/- 17, while that at the AV anastomosis (AV ANAST) was 47 +/- 38 (p < 0.0006). Flow (mL/min) distal to AV ANAST was retrograde with the fistula open (-21 +/- 64) but became antegrade (58 +/- 29; p < 0.03) with occlusion of the fistula. Following DRIL, pressures at both PROX and AV ANAST sites did not change (104 +/- 24 and 51 +/- 43, respectively). However, pressure at the point at which the blood flow split to supply the hand or the fistula, now PROX, increased from 47 +/- 38 (pre-DRIL AV ANAST) to 104 +/- 24 (p < 0.0001). Pressure in the brachial artery distal to the ligature increased to 104 +/- 27 (p < 0.0001), flow at this point (to the hand) became antegrade (51 +/- 39; p < 0.03), and occlusion of the fistula did not significantly change pressure at this site. We hypothesize that improvement in hand perfusion following DRIL is due to a higher pressure at the point at which the blood flow splits to supply both hand and fistula (pre-DRIL: AV ANAST; post-DRIL: PROX), allowing antegrade flow down the new bypass to the lower pressure forearm. This increased pressure must be due to the increased resistance of the fistula created by interposing the arterial segment between the original AV ANAST and new PROX ANAST. As such, DRIL is schematically equivalent to banding, but resistance is increased in a fashion that is physiologically and empirically acceptable. PMID:15770367

  11. Thermoconvective vortices in a cylindrical annulus with varying inner radius

    NASA Astrophysics Data System (ADS)

    Castaño, D.; Navarro, M. C.; Herrero, H.

    2014-12-01

    This paper shows the influence of the inner radius on the stability and intensity of vertical vortices, qualitatively similar to dust devils and cyclones, generated in a cylindrical annulus non-homogeneously heated from below. Little relation is found between the intensity of the vortex and the magnitude of the inner radius. Strong stable vortices can be found for both small and large values of the inner radius. The Rankine combined vortex structure, that characterizes the tangential velocity in dust devils, is clearly observed when small values of the inner radius and large values of the ratio between the horizontal and vertical temperature differences are considered. A contraction on the radius of maximum azimuthal velocity is observed when the vortex is intensified by thermal mechanisms. This radius becomes then nearly stationary when frictional force balances the radial inflow generated by the pressure drop in the center, despite the vortex keeps intensifying. These results connect with the behavior of the radius of the maximum tangential wind associated with a hurricane.

  12. Thermoconvective vortices in a cylindrical annulus with varying inner radius.

    PubMed

    Castaño, D; Navarro, M C; Herrero, H

    2014-12-01

    This paper shows the influence of the inner radius on the stability and intensity of vertical vortices, qualitatively similar to dust devils and cyclones, generated in a cylindrical annulus non-homogeneously heated from below. Little relation is found between the intensity of the vortex and the magnitude of the inner radius. Strong stable vortices can be found for both small and large values of the inner radius. The Rankine combined vortex structure, that characterizes the tangential velocity in dust devils, is clearly observed when small values of the inner radius and large values of the ratio between the horizontal and vertical temperature differences are considered. A contraction on the radius of maximum azimuthal velocity is observed when the vortex is intensified by thermal mechanisms. This radius becomes then nearly stationary when frictional force balances the radial inflow generated by the pressure drop in the center, despite the vortex keeps intensifying. These results connect with the behavior of the radius of the maximum tangential wind associated with a hurricane. PMID:25554036

  13. On the Variation of Solar Radius in Rotation Cycles

    NASA Astrophysics Data System (ADS)

    Qu, Z. N.; Kong, D. F.; Xiang, N. B.; Feng, W.

    2015-01-01

    The Date Compensated Discrete Fourier Transform and CLEANest algorithm are used to study the temporal variations of the solar radius observed at Rio de Janeiro Observatory from 1998 March 2 to 2009 November 6. The CLEANest spectra show several significant periodicities around 400, 312, 93.5, 86.2, 79.4, 70.9, 53.2, and 26.3 days. Then, combining the data on the daily solar radius measured at Calern Observatory and Rio de Janeiro Observatory and the corresponding daily sunspot areas, we study the short-term periodicity of the solar radius and the role of magnetic field in the variation of the solar radius. The rotation period of the daily solar radius is determined to be statistically significant. Moreover, its temporal evolution is anti-phase with that of sunspot activity, and it is found anti-phase with solar activity. Generally, the stronger solar activity is, the more obvious is the anti-phase relation of radius with solar activity. This indicates that strong magnetic fields have a greater inhibitive effect than weak magnetic fields on the variation of the radius.

  14. ON THE VARIATION OF SOLAR RADIUS IN ROTATION CYCLES

    SciTech Connect

    Qu, Z. N.; Kong, D. F.; Xiang, N. B.; Feng, W.

    2015-01-10

    The Date Compensated Discrete Fourier Transform and CLEANest algorithm are used to study the temporal variations of the solar radius observed at Rio de Janeiro Observatory from 1998 March 2 to 2009 November 6. The CLEANest spectra show several significant periodicities around 400, 312, 93.5, 86.2, 79.4, 70.9, 53.2, and 26.3 days. Then, combining the data on the daily solar radius measured at Calern Observatory and Rio de Janeiro Observatory and the corresponding daily sunspot areas, we study the short-term periodicity of the solar radius and the role of magnetic field in the variation of the solar radius. The rotation period of the daily solar radius is determined to be statistically significant. Moreover, its temporal evolution is anti-phase with that of sunspot activity, and it is found anti-phase with solar activity. Generally, the stronger solar activity is, the more obvious is the anti-phase relation of radius with solar activity. This indicates that strong magnetic fields have a greater inhibitive effect than weak magnetic fields on the variation of the radius.

  15. Distal Renal Tubular Acidosis and Calcium Nephrolithiasis

    NASA Astrophysics Data System (ADS)

    Moe, Orson W.; Fuster, Daniel G.; Xie, Xiao-Song

    2008-09-01

    Calcium stones are commonly encountered in patients with congenital distal renal tubular acidosis, a disease of renal acidification caused by mutations in either the vacuolar H+-ATPase (B1 or a4 subunit), anion exchanger-1, or carbonic anhydrase II. Based on the existing database, we present two hypotheses. First, heterozygotes with mutations in B1 subunit of H+-ATPase are not normal but may harbor biochemical abnormalities such as renal acidification defects, hypercalciuria, and hypocitraturia which can predispose them to kidney stone formation. Second, we propose at least two mechanisms by which mutant B1 subunit can impair H+-ATPase: defective pump assembly and defective pump activity.

  16. Reconstruction of foreskin in distal hypospadias repair.

    PubMed

    Frey, P; Cohen, S J

    1989-01-01

    In the period between 1980 and 1985 101 one-stage repairs for distal hypospadias were carried out. Fifty-five patients were operated on using the Magpi technique as originally described by Duckett (1981). The hypospadias of the remaining 46 patients were corrected using a modification of this technique incorporating reconstruction of the foreskin. The technique of the modified, prepuce-preserving operation is described. Despite complications such as moderate meatal stenosis, fistulae and glandular-meatal as well as foreskin dehiscence, the overall functional and cosmetic results were very good. PMID:2498999

  17. Total Elbow Arthroplasty for Distal Humerus Fractures.

    PubMed

    Harmer, Luke S; Sanchez-Sotelo, Joaquin

    2015-11-01

    Total elbow arthroplasty is a good treatment alternative for selected patients with distal humerus fractures. Its attractiveness is related to several factors, including the possibility of performing the procedure; leaving the extensor mechanism intact; faster, easier rehabilitation compared with internal fixation; and overall good outcomes reported in terms of both pain relief and function. Implant failure leading to revision surgery does happen, and patients must comply with certain limitations to extend the longevity of their implant. Development of high-performance implants may allow expanding the indications of elbow arthroplasty for fractures. PMID:26498549

  18. New Precision Measurement for Proton Zemach Radius with Laser Spectroscopy

    NASA Astrophysics Data System (ADS)

    Ma, Y.; Ishida, K.; Iwasaki, M.; Matsuzaki, Y.; Oishi, Y.; Okada, S.; Sato, M.; Midorikawa, K.; Saito, N.; Wada, S.; Aikawa, S.; Kanda, S.; Matsuda, Y.; Tanaka, K.; Takamine, A.

    2016-02-01

    In this proceeding, a new proposal aiming to improve the precision of the proton Zemach radius will be presented. A circularly polarized laser will be shed on a sample of muonic hydrogen in its ground state. By observing the maximum muon decay asymmetry during scanning laser wave length, the ground-state hyperfine splitting energy can be identified, which is directly related to Zemach radius.citedupays The precision of Zemach radius by this measurement is estimated to be three times better compared to PSI experiment. This result will contribute to the solution of proton size puzzle.

  19. Study of a non-intrusive electron beam radius diagnostic

    SciTech Connect

    Kwan, T.J.T.; DeVolder, B.G.; Goldstein, J.C.; Snell, C.M.

    1997-12-01

    The authors have evaluated the usefulness and limitation of a non-intrusive beam radius diagnostic which is based on the measurement of the magnetic moment of a high-current electron beam in an axisymmetric focusing magnetic field, and relates the beam root-mean-square (RMS) radius to the change in magnetic flux through a diamagnetic loop encircling the beam. An analytic formula that gives the RMS radius of the electron beam at a given axial position and a given time is derived and compared with results from a 2-D particle-in-cell code. The study has established criteria for its validity and optimal applications.

  20. Maxillary molar distalization with first class appliance

    PubMed Central

    Ramesh, Namitha; Palukunnu, Biswas; Ravindran, Nidhi; Nair, Preeti P

    2014-01-01

    Non-extraction treatment has gained popularity for corrections of mild-to-moderate class II malocclusion over the past few decades. The distalization of maxillary molars is of significant value for treatment of cases with minimal arch discrepancy and mild class II molar relation associated with a normal mandibular arch and acceptable profile. This paper describes our experience with a 16-year-old female patient who reported with irregularly placed upper front teeth and unpleasant smile. The patient was diagnosed to have angles class II malocclusion with moderate maxillary anterior crowding, deep bite of 4 mm on a skeletal class II base with an orthognathic maxilla and retrognathic mandible and normal growth pattern. She presented an ideal profile and so molar distalization was planned with the first-class appliance. Molars were distalised by 8 mm on the right and left quadrants and class I molar relation achieved within 4 months. The space gained was utilised effectively to align the arch and establish a class I molar and canine relation. PMID:24577171

  1. Minimally Invasive Plate Osteosynthesis of Distal Tibia and Fibular Fractures Through a Single Distal Anterolateral Incision.

    PubMed

    Unlu, Serhan; Catma, Mehmet F; Bilgetekin, Yenel G; Altay, Murat; Ates, Yalim; Bozkurt, Murat; Kapicioglu, Mehmet I Safa

    2015-01-01

    Treating distal tibia fractures is often challenging given the extent of soft tissue damage around the fracture and the risk of infection and other complications with internal fixation and the accompanying incisions. Minimally invasive plate osteosynthesis minimizes these complications and can be performed through a single incision. From April 2009 to January 2011, we treated 20 patients who had both tibial and fibular distal fractures through a distal anterolateral approach with this technique. The mean follow-up period was 15.5 (range 12 to 26) months. The mean interval to bony union was 21 (range 18 to 25) weeks. A 5° varus deformity was found in 1 patient. Another patient, who had a history of alcohol consumption and smoking, developed wound necrosis that was treated successfully with debridement and without skin grafting. The mean American Orthopaedic Foot and Ankle Society score for all patients was 91.8 (range 84 to 97). The anterolateral, minimally invasive plate osteosynthesis technique is a useful method for treating distal tibial and fibular fractures at the same level, with a low complication rate. PMID:26190782

  2. Giant Cell Tumour of Distal Fibula Managed by En Block Resection and Reconstruction with Ipsilateral Proximal Fibula.

    PubMed Central

    Nadkarni, Sambprasad; Punit, Abhinanadan S; Nair, Rohit V

    2015-01-01

    Introduction: Giant cell tumour is the commonest benign bone tumour arising at the epiphyseometaphyseal regions of long bones. Around the knee is commonest site followed by distal radius. A giant cell tumour of the distal fibula is extremely rare. We report here a case of giant cell tumour of distal fibula. There are very few similar cases reported worldwide and it is the purpose of this report to describe the management of such a case. Case Report: A 17 year old girl presented with swelling of ankle and pain while walking for six months. Radiographs were suggestive of a giant cell tumour, computerised tomography revealed cortical break, en block resection was done with ipsilateral proximal fibula used in reconstruction of ankle mortise. Conclusion: Giant cell tumour of long bones are common but those involving the distal fibula are exceedingly rare. The management of such tumours with high recurrence rates can be easily accomplished by en block resection and reconstruction of the ankle mortise with proximal fibula ensuring good range of motion of the joint post operatively.

  3. Impact of Radius Malunion on Wrist Contact Mechanics.

    PubMed

    Lalone, Emily A; Grewal, Ruby; MacDermid, Joy C

    2016-05-01

    The patient was a 15-year-old adolescent girl with a chief complaint of intermittent pain and clicking at her right distal radioulnar joint, after having fractured her forearm 5 months previously. Radiographs of the patient's forearm indicated a midshaft radial deformity. Given the patient's pain and limited range of motion, computed tomography imaging was requested to assess whether the midshaft malunion resulted in distal radioulnar joint instability and to plan the corrective osteotomy. J Orthop Sports Phys Ther 2016;46(5):399. doi:10.2519/jospt.2016.0406. PMID:27133942

  4. Laser confocal radius measurement method for unpolished spheres.

    PubMed

    Wang, Xu; Zhao, Weiqian; Qiu, Lirong; Yang, Shuai; Wang, Zhongyu

    2016-06-10

    A laser confocal radius measurement method for unpolished spheres (CRMUS) is proposed for measuring the radius of an unpolished sphere during optical sphere processing. CRMUS uses the laser confocal focusing technique to accurately identify the cat's eye and confocal positions of the unpolished sphere, and then uses the distance between the cat's eye and confocal positions measured by a distance measurement interferometer to derive the radius. The partially coherent optical theoretical model of the CRMUS derived indicates that the CRMUS is able to measure the radius of the unpolished sphere with a roughness of less than 0.15 μm. Using an unpolished sphere made of Schott BK7 as the test sphere, experimental results indicate that the CRMUS has a relative expanded uncertainty of less than 20 ppm. The CRMUS could greatly increase processing efficiency. PMID:27409012

  5. 21 CFR 886.1450 - Corneal radius measuring device.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... (CONTINUED) MEDICAL DEVICES OPHTHALMIC DEVICES Diagnostic Devices § 886.1450 Corneal radius measuring device... small, hand held, single tube penscope or eye gauge magnifier. (b) Classification. Class I...

  6. Catastrophic osteomyelitis following percutaneous wire fixation of a distal radial fracture: a cautionary tale of poor patient selection followed by surgical mishap

    PubMed Central

    Shields, David W; Elson, David W; Marsh, Martin; Gray, Andrew C

    2013-01-01

    We present a case of distal radius fracture. Several sequential unfortunate events resulted in a poor outcome. The patient was poorly selected because the degree of early dementia was not fully appreciated, due to intermittent periods of lucidity. Having elected to treat this distal radius fracture with Kirschner wires, a wire snapped during the procedure and was deemed safe to leave within the medullary cavity. Subsequently, the patient was left in a cast for 4 weeks without regular pin site inspection. When the cast was removed a gross osteomyelitis had developed. This series of events, led to unnecessary morbidity and extended the immobilisation time with reduced wrist function. This case highlights the importance of careful patient selection, surgical tactics and continuity of care. PMID:23355597

  7. Isolated Diaphyseal Fractures of the Radius in Skeletally Immature Patients

    PubMed Central

    Guitton, Thierry G.; Van Dijk, Niek C.; Raaymakers, Ernst L.

    2009-01-01

    Diaphyseal radius fractures without associated ulna fracture or radioulnar dislocation (isolated fracture of the radius) are recognized in adults but are rarely described in skeletally immature patients. A search of our database (1974–2002) identified 17 pediatric patients that had an isolated fracture of the radius. Among the 13 patients with at least 1 year follow-up, ten were treated with manipulative reduction and immobilization in an above elbow cast and three had initial operative treatment with plate and screw fixation. These 13 patients were evaluated for an average of 18 months (range, 12 to 45 months) after injury using the system of Price and colleagues. The incidence of isolated diaphyseal radius fractures in skeletally immature patients was 0.56 per year in our database and represented 27% of the 63 patients with a diaphyseal forearm fracture. All 13 patients, with at least 1 year follow-up, regained full elbow flexion and extension and full forearm rotation. According to the classification system of Price, all 13 patients (100%) had an excellent result. As in adults, isolated radius fractures seem to occur in children more frequently than previously appreciated. Treatment of isolated radius fractures in skeletally immature patients has a low complication rate, and excellent functional outcomes are the rule. PMID:19859772

  8. LONG-TERM PERIODICITY VARIATIONS OF THE SOLAR RADIUS

    SciTech Connect

    Qu, Z. N.; Xie, J. L.

    2013-01-01

    In order to study the long-term periodicity variations of the solar radius, daily solar radius data from 1978 February to 2000 September at the Calern Observatory are used. Continuous observations of the solar radius are difficult due to the weather, seasonal effects, and instrument characteristics. Thus, to analyze these data, we first use the Dixon criterion to reject suspect values, then we measure the cross-correlation between the solar radius and sunspot numbers. The result indicates that the solar radius is in complete antiphase with the sunspot numbers and shows lead times of 74 months relative to the sunspot numbers. The Lomb-Scargle and date compensated discrete Fourier transform methods are also used to investigate the periodicity of the solar radius. Both methods yield similar significance periodicities around {approx}1 yr, {approx}2.6 yr, {approx}3.6 yr, and {approx}11 yr. Possible mechanisms for these periods are discussed. The possible physical cause of the {approx}11 yr period is the cyclic variation of the magnetic pressure of the concentrated flux tubes at the bottom of the solar convection zone.

  9. Distal Communication by Chimpanzees (Pan troglodytes): Evidence for Common Ground?

    PubMed Central

    Leavens, David A.; Reamer, Lisa A.; Mareno, Mary Catherine; Russell, Jamie L.; Wilson, Daniel; Schapiro, Steven J.; Hopkins, William D.

    2015-01-01

    van der Goot et al. (2014) proposed that distal, deictic communication indexed the appreciation of the psychological state of a common ground between a signaler and a receiver. In their study, great apes did not signal distally, which they construed as evidence for the human uniqueness of a sense of common ground. This study exposed 166 chimpanzees to food and an experimenter, at an angular displacement, to ask, “Do chimpanzees display distal communication?” Apes were categorized as (a) proximal or (b) distal signalers on each of four trials. The number of chimpanzees who communicated proximally did not statistically differ from the number who signaled distally. Therefore, contrary to the claim by van der Goot et al., apes do communicate distally. PMID:26292996

  10. Relay NBS Graft with the Plus Delivery System to Improve Deployment in Aortic Arch with Small Radius Curve

    SciTech Connect

    Ferro, Carlo; Rossi, Umberto G. Seitun, Sara; Guastavino, Andrea; Scarano, Flavio; Passerone, Gian Carlo

    2011-04-15

    The purpose of this report is to describe deployment of the Relay NBS Thoracic Stent Graft with the Plus Delivery System (Bolton Medical, Sunrise, FL) in a flexible resin arch model with a 15-mm radius curve as well as our preliminary clinical results. The Relay NBS graft with the Plus Delivery System was evaluated by way of bench testing, which was performed with stent grafts with diameters ranging from 24 to 46 mm and lengths ranging from 100 to 250 mm in flexible resin arch models with a 15-mm arch radius of curvature. The deployment sequence was analyzed. The Relay NBS graft with the Plus Delivery System was deployed in two patients, respectively, having a 6.5-cm penetrating aortic ulcer of the proximal third of the descending thoracic aorta and a DeBakey type-I aortic dissection with chronic false lumen dilatation after surgery due to an entry site at the distal thoracic aorta. Bench tests showed proper conformation and apposition of the Relay NBS graft with the Plus Delivery System in the flexible resin model. This stent graft was deployed successfully into the two patients with a correct orientation of the first stent and without early or late complications. The Relay NBS graft with the Plus Delivery System ensures an optimal conformation and apposition of the first stent in the aortic arch with a small radius of curvature.

  11. Distal Xq duplication and functional Xq disomy

    PubMed Central

    Sanlaville, Damien; Schluth-Bolard, Caroline; Turleau, Catherine

    2009-01-01

    Distal Xq duplications refer to chromosomal disorders resulting from involvement of the long arm of the X chromosome (Xq). Clinical manifestations widely vary depending on the gender of the patient and on the gene content of the duplicated segment. Prevalence of Xq duplications remains unknown. About 40 cases of Xq28 functional disomy due to cytogenetically visible rearrangements, and about 50 cases of cryptic duplications encompassing the MECP2 gene have been reported. The most frequently reported distal duplications involve the Xq28 segment and yield a recognisable phenotype including distinctive facial features (premature closure of the fontanels or ridged metopic suture, broad face with full cheeks, epicanthal folds, large ears, small and open mouth, ear anomalies, pointed nose, abnormal palate and facial hypotonia), major axial hypotonia, severe developmental delay, severe feeding difficulties, abnormal genitalia and proneness to infections. Xq duplications may be caused either by an intrachromosomal duplication or an unbalanced X/Y or X/autosome translocation. In XY males, structural X disomy always results in functional disomy. In females, failure of X chromosome dosage compensation could result from a variety of mechanisms, including an unfavourable pattern of inactivation, a breakpoint separating an X segment from the X-inactivation centre in cis, or a small ring chromosome. The MECP2 gene in Xq28 is the most important dosage-sensitive gene responsible for the abnormal phenotype in duplications of distal Xq. Diagnosis is based on clinical features and is confirmed by CGH array techniques. Differential diagnoses include Prader-Willi syndrome and Alpha thalassaemia-mental retardation, X linked (ATR-X). The recurrence risk is significant if a structural rearrangement is present in one of the parent, the most frequent situation being that of an intrachromosomal duplication inherited from the mother. Prenatal diagnosis is performed by cytogenetic testing

  12. Improved radiographic visualization of calculus in distal ureter.

    PubMed

    Amar, A D

    1979-10-01

    Roentgenographic visualization of a calculus in the distal ureter is often made difficult by gas or bowel contents in the region of the pelvis. Filling the bladder with sterile water raises the bladder dome and displaces the bowel upward. Any calculus in the lower 4 to 5 cm. of the distal ureter is then clearly demonstrated on roentgenograms taken against the water-filled bladder instead of against the bowel filled with gas and feces. This maneuver also aids in differentiation of a calculus in the distal ureter from a phlebolith in the bladder wall, and has improved visualization of distal ureteral calculus in 50 patients during the last six years. PMID:494477

  13. The Size of the Radial Tuberosity is Not Related to the Occurrence of Distal Biceps Tendon Ruptures: A Case-Control Study

    PubMed Central

    Kodde, Izaäk F.; van den Bekerom, Michel P.J.; Mulder, Paul G.H.; Eygendaal, Denise

    2016-01-01

    Introduction: Hypertrophic changes at the radial tuberosity have traditionally been related to distal biceps tendon degeneration and rupture. From supination to pronation of the forearm, the space available for the distal biceps tendon between de lateral ulna and radial bicipital tuberosity (RBT) decreases by almost 50%. A hypertrophic change at the radial tuberosity further reduces this space with impingement of the distal biceps tendon as a result. The purpose of this study was to evaluate whether the size of the RBT plays a role in the pathophysiology of distal biceps tendon ruptures. Materials and Methods: Twenty-two consecutive patients with a surgically proven distal biceps tendon rupture were matched to controls, in a 1:1 ratio. The size of the RBT was expressed as a ratio of the maximum diameter of the radius at the RBT to the diameter of the diaphysis just distal to the RBT (RD ratio), measured on standard radiographs of the elbow. The RD ratio of patients and matched controls were compared. Results: The mean RD ratio in control group was 1.25 and not significantly different from the mean 1.30 in the group of patients with a distal biceps tendon rupture. Each 0.1 point increase in RD ratio results in an estimated 60% increase of the rupture odds, which was not significant either. Conclusion: Based on the RD ratio on conventional radiographs of the elbow, there was no significant difference in RBT size between patients with a distal biceps tendon rupture and matched controls without biceps tendon pathology. PMID:27006729

  14. Transphyseal Fracture of the Distal Humerus.

    PubMed

    Abzug, Joshua M; Ho, Christine A; Ritzman, Todd F; Brighton, Brian K

    2016-02-01

    Transphyseal fractures of the distal humerus typically occur in children younger than 3 years secondary to birth trauma, nonaccidental trauma, or a fall from a small height. Prompt and accurate diagnosis of the injury is crucial for a successful outcome. Recognizing that the forearm is not aligned with the humerus on plain radiography can aid in the diagnosis of the injury. Surgical management is most commonly performed with the aid of an arthrogram. Closed reduction and percutaneous pinning techniques similar to those used for supracondylar humerus fractures are employed. The most common complication is cubitus varus caused by a malunion, osteonecrosis of the medial condyle, or growth arrest. A corrective lateral closing wedge osteotomy can be performed to restore a nearly normal carrying angle. PMID:26808044

  15. Management of distal biceps and triceps ruptures.

    PubMed

    Blackmore, Susan M; Jander, Ryan M; Culp, Randall W

    2006-01-01

    The management of distal biceps and triceps ruptures is reviewed. Epidemiology, clinical presentation, evaluation, surgical management, nonoperative management, and rehabilitation rationale and techniques are presented. Although various surgical repair techniques are used, none has been shown to produce superior clinical outcomes. The literature is lacking information to provide evidence-based decisions regarding rehabilitation strategies. Prospective studies comparing types and timing of repairs and timing and techniques for a postoperative program are needed. As that information is not yet available, the rehabilitation plan outlined in this article is based on timetables for healing tissue, strength of repair, prevention of complications, consideration of patient's medical history and injury history, and review of the literature. Familiarity with the different treatment options assists the surgeon and therapist tailor a therapy program that is optimal for each individual patient. PMID:16713863

  16. Arthroscopic visualisation of the distal radioulnar joint.

    PubMed

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

    2008-01-01

    The diagnosis of chronic wrist pain is challenging and wrist arthroscopy has been recognised as the "gold standard". The present study investigated the efficacy of adding distal radioulnar joint (DRUJ) arthroscopy to routine wrist arthroscopy. The records of 67 patients who underwent DRUJ arthroscopy were reviewed, and the success rates for visualisation of intra-articular structures were determined. Pathological findings were correlated with ulnar-side wrist pain. In seven patients, pre-operative diagnoses were altered after DRUJ arthroscopy. The ulnar head and proximal surface of the triangular fibrocartilage complex (TFCC) were visualised in 100% and 99% of patients, respectively, while the foveal insertion of TFCC and sigmoid notch were visualised in 57% and 69%, respectively. Pathological findings of the proximal surface of TFCC tended to relate to ulnar wrist pain (p = 0.06). DRUJ arthroscopy should be included in routine wrist arthroscopy to enhance the accuracy of diagnosis. PMID:19378356

  17. Lung Adenocarcinoma Distally Rewires Hepatic Circadian Homeostasis.

    PubMed

    Masri, Selma; Papagiannakopoulos, Thales; Kinouchi, Kenichiro; Liu, Yu; Cervantes, Marlene; Baldi, Pierre; Jacks, Tyler; Sassone-Corsi, Paolo

    2016-05-01

    The circadian clock controls metabolic and physiological processes through finely tuned molecular mechanisms. The clock is remarkably plastic and adapts to exogenous "zeitgebers," such as light and nutrition. How a pathological condition in a given tissue influences systemic circadian homeostasis in other tissues remains an unanswered question of conceptual and biomedical importance. Here, we show that lung adenocarcinoma operates as an endogenous reorganizer of circadian metabolism. High-throughput transcriptomics and metabolomics revealed unique signatures of transcripts and metabolites cycling exclusively in livers of tumor-bearing mice. Remarkably, lung cancer has no effect on the core clock but rather reprograms hepatic metabolism through altered pro-inflammatory response via the STAT3-Socs3 pathway. This results in disruption of AKT, AMPK, and SREBP signaling, leading to altered insulin, glucose, and lipid metabolism. Thus, lung adenocarcinoma functions as a potent endogenous circadian organizer (ECO), which rewires the pathophysiological dimension of a distal tissue such as the liver. PAPERCLIP. PMID:27153497

  18. Clinical profile of distal renal tubular acidosis.

    PubMed

    Jha, Ratan; Muthukrishnan, J; Shiradhonkar, Shekhar; Patro, Kiran; Harikumar, Kvs; Modi, K D

    2011-03-01

    To determine the clinical profile and progression of renal dysfunction in distal renal tubular acidosis (dRTA), we retrospectively studied 96 consecutive cases of dRTA diagnosed at our center. Patients with unexplained metabolic bone disease, short stature, hypokalemia, re-current renal stones, chronic obstructive uropathy or any primary autoimmune condition known to cause dRTA were screened. Distal RTA was diagnosed on the basis of systemic metabolic acidosis with urine pH >5.5 and positive urine anion gap. In those patients who had fasting urine pH >5.5 with normal baseline systemic pH and bicarbonate levels (incomplete RTA), acid load test with ammonium chloride was done. A cause of dRTA could be established in 53 (54%) patients. Urological defect in children (22/44) and autoimmune disease in adults (11/52) were the commonest causes. Hypokalemic paralysis, proximal muscle weakness and voiding difficulty were the common modes of presentation. Doubling of serum creatinine during the study period was noted in 13 out of 27 patients who had GFR <60 mL/min at presentation whereas in only one of the 70 with initial GFR >60 mL/min (P <0.005). In conclusion, urological disorders were the commonest cause of dRTA in children while autoimmune disorders were the commonest asso-ciation in adults. Worse baseline renal function, longer duration of disease and greater frequency of nephrolithiasis/nephrocalcinosis and urological disorders were noted in those who had wor-sening of renal dysfunction during the study period. PMID:21422623

  19. The radius distribution of planets around cool stars

    SciTech Connect

    Morton, Timothy D.; Swift, Jonathan

    2014-08-10

    We calculate an empirical, non-parametric estimate of the shape of the period-marginalized radius distribution of planets with periods less than 150 days using the small yet well-characterized sample of cool (T{sub eff} < 4000 K) dwarf stars in the Kepler catalog. In particular, we present and validate a new procedure, based on weighted kernel density estimation, to reconstruct the shape of the planet radius function down to radii smaller than the completeness limit of the survey at the longest periods. Under the assumption that the period distribution of planets does not change dramatically with planet radius, we show that the occurrence of planets around these stars continues to increase to below 1 R{sub ⊕}, and that there is no strong evidence for a turnover in the planet radius function. In fact, we demonstrate using many iterations of simulated data that a spurious turnover may be inferred from data even when the true distribution continues to rise toward smaller radii. Finally, the sharp rise in the radius distribution below ∼3 R{sub ⊕} implies that a large number of planets await discovery around cool dwarfs as the sensitivities of ground-based transit surveys increase.

  20. Evidence for a large radius of the 11Be projectile

    NASA Astrophysics Data System (ADS)

    So, W. Y.; Choi, K. S.; Cheoun, Myung-Ki; Kim, K. S.

    2016-05-01

    We investigate ratios of the elastic scattering cross section to Rutherford cross section, PE, and angular distributions of breakup cross section by using an optical model which exploits various long-range dynamic polarization potentials as well as short-range nuclear bare potentials for the 11Be projectile. From these simultaneous analyses, we extract a large radius of a halo projectile from the experimental data for PE and the angular distribution of the breakup cross section of the 11Be + 64Zn and 11 + 120Sn systems. It results from the fact that a large radius for the long-range nuclear potential is more reasonable for properly explaining these data simultaneously. The extracted reduced interaction radius turns out to be r0=3.18 ˜3.61 fm for 11Be nucleus, which is larger than the conventional value of r0=1.1 ˜1.5 fm used in the standard radius form R =r0A1 /3 . Furthermore, the larger radius as well as the normalization constant N is shown to be important for understanding Coulomb dipole strength distribution.

  1. Solar radius measurements with the space instrument HMI (SDO)

    NASA Astrophysics Data System (ADS)

    Irbah, Abdanour; Hauchecorne, Alain; Meftah, Mustapha; Damé, Luc; Keckhut, Philippe

    2016-04-01

    The solar radius variations and its effects on the Earth climate are still a long scientific debate. The observed variations from ground experiments were not totally admitted and several space missions have had these measures as a goal. The high angular resolution of radius measurements and its long-term trend is however a challenge in space. The first attempts with MDI (Soho) then SODISM (PICARD) and HMI (SDO) revealed the difficulties of such measures due to the hostile environment which introduces thermal variations on the instruments all along the satellite orbit. These variations have non-negligible impacts on the optical properties of the onboard telescopes and therefore on the images and the parameters which are extracted such as the solar radius. We need then to make a posteriori corrections using the thermal housekeeping's recorded together with the data science. We present here how we make such correction on the solar radius obtained from the HMI images. We will then compare and discuss the results with the solar radius recorded at 607 nm with the ground-based instrument of PICARD.

  2. The Mass - Radius Relation of Giant Gas Planets

    NASA Astrophysics Data System (ADS)

    Çelik Orhan, Zeynep; Kayhan, Cenk; Yildiz, Mutlu

    2016-07-01

    Thanks to CoRoT and Kepler space telescope, the thousand of exoplanets have been discovered. The only observational construct on planetary interior is planetary radius. Mass-radius relation is widely studied in the literature. Many mechanisms have been suggested in the literature to explain the inflated radii of these planets. In this study, our aim is to consider planet and host star interaction and assess the basic mechanisms responsible for excess in radius of transiting giant gas planets. We show that there is much more definite relation between radius and energy per gram per second (log (l- )). There is a good linear relation between planetary radius and log (l- ) for log (l- /l0 ) < 3.75. The relation changes if log (l- /l0 ) > 3.5. There is a relatively clump for the range log (l- /l0 ) > 3.75. The reason for the change in the relation may be related with the structure of the heated part of the planets. We focus on these inflated planet.

  3. ON THE CONSTANCY OF THE SOLAR RADIUS. III

    SciTech Connect

    Bush, R. I.; Emilio, M.; Kuhn, J. R. E-mail: memilio@uepg.b

    2010-06-20

    The Michelson Doppler Imager on board the Solar and Heliospheric Observatory satellite has operated for over a sunspot cycle. This instrument is now relatively well understood and provides a nearly continuous record of the solar radius in combination with previously developed algorithms. Because these data are obtained from above Earth's atmosphere, they are uniquely sensitive to possible long-term changes of the Sun's size. We report here on the first homogeneous, highly precise, and complete solar-cycle measurement of the Sun's radius variability. Our results show that any intrinsic changes in the solar radius that are synchronous with the sunspot cycle must be smaller than 23 mas peak to peak. In addition, we find that the average solar radius must not be changing (on average) by more than 1.2 mas yr{sup -1}. If ground- and space-based measurements are both correct, the pervasive difference between the constancy of the solar radius seen from space and the apparent ground-based solar astrometric variability can only be accounted for by long-term changes in the terrestrial atmosphere.

  4. Intraoperative sentinel lymph node mapping guides laparoscopic-assisted distal gastrectomy for distal gastric cancer

    PubMed Central

    Liu, Naiqing; Niu, Zhengchuan; Niu, Wei; Peng, Cheng; Zou, Xueqing; Sun, Shuxiang; Shinichi, Obo; Shahbaz, Muhammad; Sun, Qinli; Jun, Niu

    2015-01-01

    Aims: The aim of this retrospective study is to explore the effects of sentinel lymph node (SLN) mapping guided laparoscopic-assisted distal gastrectomy (LADG) for distal gastric cancer. Methods: Two hundred patients were enrolled in this study. One hundred and one patients undergoing SLN guided LADG were designated as the SLN group. Ninety-nine patients having conventional LADG with D1 or D2 lymph node dissection were designated as the control group. Intraoperative and postoperative indicators such as the number of lymph nodes dissected, intraoperative and postoperative conditions, flow cytometry analysis of T lymphocyte subsets and natural killer (NK) cells, survival rates, recurrence rates and postoperative complications were investigated between these two groups. Results: The number of lymph nodes dissected in the SLN group was significantly lesser than that in the control group. Furthermore, in the SLN group, the patients achieved better immunization status, improved intraoperative and postoperative conditions and decreased postoperative complications. There were no significant differences were found in the positive lymph nodes detected, the distance between proximal and distal cutting edge, postoperative survival or recurrence rates. Conclusions: SLN guided LADG for gastric cancer is a safe and effective method and could achieve an equal clinical effect as traditional laparoscopic D1 or D2 radical operation with less operation trauma and better recovery. PMID:26131162

  5. Incidence of distal femoral and distal tibial deformities in infantile and adolescent blount disease.

    PubMed

    Myers, Thomas G; Fishman, Michael K; McCarthy, James J; Davidson, Richard S; Gaughan, John

    2005-01-01

    The purpose of this study was to assess distal femoral and tibial deformity in patients with infantile and adolescent Blount disease. This was a retrospective review of patients at the authors' institution diagnosed with Blount disease. Thirty-eight patients (21 in the infantile group and 17 in the adolescent group) met the study criteria. Measurements of the anatomic lateral distal femoral angle (aLDFA), anatomic lateral distal tibial angle (aLDTA), and tibiofemoral angle (TFA) were made from long-leg radiographs. The results of the infantile and adolescent measurements were compared with each other and to a normal database. Intraobserver and interobserver error was determined. The adolescent aLDFA measurements were significantly greater (more varus) than for the infantile group and normal database. The aLDTA (ankle) measurements were not statistically different between the two groups, or from the normal database. Analysis of both intraobserver and interobserver error for the aLDFA and aLDTA showed good reliability. PMID:15718905

  6. FY15 Progress Report for PL14-Lg Radius SIMS-PD1Ea: Large Radius SIMS Support / Large Radius SIMS for Nuclear Materials Analysis and Characterization

    SciTech Connect

    Zimmer, Mindy M.; Naes, Benjamin E.; Willingham, David G.; Cloutier, Janet M.

    2015-09-15

    PNNL has been procured a Cameca 1280 Large Radius Secondary Ions Mass Spectrometer (LRSIMS) from the Amtek corporation out of France. This state-of-the-art instrument is aligning PNNL to deliver to NNSA the ability to address issues from proliferation detection to nuclear archeology of reactor operation and cascade enrichment history verification pushing beyond the limits of currently available methods and instrumentation at PNNL.

  7. Young Children's Sibling Relationship Quality: Distal and Proximal Correlates

    ERIC Educational Resources Information Center

    Kretschmer, Tina; Pike, Alison

    2009-01-01

    Background: Relationships within families are interdependent and related to distal environmental factors. Low socioeconomic status (SES) and high household chaos (distal factors) have been linked to less positive marital and parent-child relationships, but have not yet been examined with regard to young children's sibling relationships. The…

  8. Distal hereditary motor neuronopathy of the Jerash type.

    PubMed

    Middleton, L T; Christodoulou, K; Mubaidin, A; Zamba, E; Tsingis, M; Kyriacou, K; Abu-Sheikh, S; Kyriakides, T; Neocleous, V; Georgiou, D M; el-Khateeb, M; al-Qudah, A; Horany, K

    1999-09-14

    A novel form of autosomal recessive distal hereditary motor neuronopathy (distal HMN) is reported. The presence of pyramidal signs within the early stages of the disease with persistence of knee hyperreflexia form distinctive clinical features. We have mapped the HMN-J gene to chromosome 9p21.1-p12, within an estimated interval of 1.2-Mb. PMID:10586232

  9. Attractor radius, a new determination criterion of predictability limit

    NASA Astrophysics Data System (ADS)

    Liu, Deqiang; Ding, Ruiqiang; Li, Jianping; Feng, Jie

    2014-05-01

    Firstly, the definition of the attractor radius was given and then the property of that the attractor radius (AR) in a given n-dimensional attractor A is a constant was proved in theory. Secondly, the SV of the square of the RMS difference was separated into two components - the systematic error and the attractor radius, and it was proved that the observed global climatological RMS (OCR) difference is not equal to 71% of the SV of the RMS difference when the systematic error is existed, however, it is always equal to 71% of the AR. Then the physical understanding of the AR and also the predictability limit determinated by it were discussed. Finally, the spatial distributions of the predictability limit calculated from CFSv2 data by different criterions were compared.

  10. [Lesions of the distal radio-ulnar joint associated with isolated fractures of the radial shaft].

    PubMed

    Hattoma, N; Rafai, M; Zahar, A; Largab, A; Trafeh, M

    2002-12-01

    The authors have performed a retrospective study of 49 Galeazzi fractures treated between 1990 and 1998. This lesion is considered rare because it is often misdiagnosed as an isolated fracture of the radius. The mean age of the patients was 31 years. There was a male predominance with a sex ratio of 4/1. Road traffic accidents were the main etiology (45%). Galeazzi fracture type III in Mansat's classification represented 53%, followed by type II (33%), type I (8%) and equivalents of Galeazzi fracture (6%). The treatment was surgical in all cases. The radial fracture was internally fixed with a plate. Reduction of the distal radio-ulnar instability, achieved by manipulation, was maintained with radio-ulnar pin fixation in 53% and with plaster cast immobilization 45%. The results, evaluated according to Mikic's criteria were excellent in 87%. The prognosis of Galeazzi's fracture depends mainly on the initial treatment of the lesions of the distal radio-ulnar joint, which require for their diagnosis a meticulous clinical evaluation and a good radiological analysis. PMID:12584977

  11. Stability of a Wheel with Various Radius Rim

    NASA Astrophysics Data System (ADS)

    Kinugasa, Tetsuya; Yoshida, Koji

    This paper describes the dynamics and impact model of a wheel with various radius rim. The dynamics is expressed by a rst order linear ordinary dierential equation with respect to the absolute orientation of the wheel, and an analytic solution is derived. Poincaré map is also derived analytically. Stability and basin of attraction (BoA) of the Poincaré map are discussed. Finally, the analysis is validated through some numerical simulations. As a result, the rim radius aects the stability and broadens its BoA. The analysis helps understanding of not only a geometric tracking control but also many underactuated control methods for bipeds.

  12. Consistency of electron scattering data with a small proton radius

    NASA Astrophysics Data System (ADS)

    Griffioen, Keith; Carlson, Carl; Maddox, Sarah

    2016-06-01

    We determine the charge radius of the proton by analyzing the published low momentum transfer electron-proton scattering data from Mainz. We note that polynomial expansions of the form factor converge for momentum transfers squared below 4 mπ2 , where mπ is the pion mass. Expansions with enough terms to fit the data, but few enough not to overfit, yield proton radii smaller than the CODATA or Mainz values and in accord with the muonic atom results. We also comment on analyses using a wider range of data, and overall obtain a proton radius RE=0.840 (16 ) fm.

  13. Proton Charge Radius (PRad) Experiment at Jefferson Lab

    NASA Astrophysics Data System (ADS)

    Peng, C.; Gao, H.

    2016-03-01

    The puzzle of proton charge radius was recently raised by the measurement of muonic hydrogen Lamb shift at Paul Scherrer Institute (PSI), whose results were seven standard deviations smaller than the CODATA recommended value. To investigate this discrepancy, the PRad experiment was proposed and approved at Thomas Jefferson National Accelerator Facility (JLab). The experiment will extract the proton charge radius with a sub-percent accuracy by measuring the cross-sections of unpolarized electronproton elastic scattering in an unprecedented low Q2 region (2×10-4 GeV2/c2).

  14. The PRad experiment and the proton radius puzzle

    SciTech Connect

    Gasparian, Ashot H.

    2014-06-01

    New results from the recent muonic hydrogen experiments seriously questioned our knowledge of the proton charge radius, r_p. The new value, with its unprecedented less than sub-percent precision, is currently up to eight standard deviation smaller than the average value from all previous experiments, triggering the well-known "proton charge radius puzzle" in nuclear and atomic physics. The PRad collaboration is currently preparing a novel, magnetic-spectrometer-free ep scattering experiment in Hall B at JLab for a new independent r_p measurement to address this growing "puzzle" in physics.

  15. A 3-Dimensional Anatomic Study of the Distal Biceps Tendon

    PubMed Central

    Walton, Christine; Li, Zhi; Pennings, Amanda; Agur, Anne; Elmaraghy, Amr

    2015-01-01

    Background Complete rupture of the distal biceps tendon from its osseous attachment is most often treated with operative intervention. Knowledge of the overall tendon morphology as well as the orientation of the collagenous fibers throughout the musculotendinous junction are key to intraoperative decision making and surgical technique in both the acute and chronic setting. Unfortunately, there is little information available in the literature. Purpose To comprehensively describe the morphology of the distal biceps tendon. Study Design Descriptive laboratory study. Methods The distal biceps terminal musculature, musculotendinous junction, and tendon were digitized in 10 cadaveric specimens and data reconstructed using 3-dimensional modeling. Results The average length, width, and thickness of the external distal biceps tendon were found to be 63.0, 6.0, and 3.0 mm, respectively. A unique expansion of the tendon fibers within the distal muscle was characterized, creating a thick collagenous network along the central component between the long and short heads. Conclusion This study documents the morphologic parameters of the native distal biceps tendon. Reconstruction may be necessary, especially in chronic distal biceps tendon ruptures, if the remaining tendon morphology is significantly compromised compared with the native distal biceps tendon. Knowledge of normal anatomical distal biceps tendon parameters may also guide the selection of a substitute graft with similar morphological characteristics. Clinical Relevance A thorough description of distal biceps tendon morphology is important to guide intraoperative decision making between primary repair and reconstruction and to better select the most appropriate graft. The detailed description of the tendinous expansion into the muscle may provide insight into better graft-weaving and suture-grasping techniques to maximize proximal graft incorporation. PMID:26665092

  16. The use of distal rhynchokinesis by birds feeding in water.

    PubMed

    Estrella, Sora M; Masero, José A

    2007-11-01

    The use of distal rhynchokinesis, which consists of the movement of the distal part of the upper jaw with respect to the cranium, is well documented in long-billed shorebirds (Scolopacidae), commonly being associated with the deep probing feeding method. However, the functional and evolutionary significance of distal rhynchokinesis and other cranial kinesis is unclear. We report for the first time the use and occurrence of distal rhynchokinesis in wild long-billed shorebirds feeding on small prey items suspended in water. We tested whether prey size in captive dunlins Calidris alpina influences the occurrence of distal rhynchokinesis during feeding and also whether its use affects foraging efficiency. We found that wild dunlin, curlew sandpiper Calidris ferruginea, sanderling Calidris alba and little stint Calidris minuta commonly use distal rhynchokinesis to strike, capture and transport small prey items. Prey size influenced the occurrence of distal rhynchokinesis during the transport phase, with this type of cranial kinesis being more frequently used with larger prey. The rhynchokinesis protraction angle (a measure of bill tip elevation) during prey strike and transport was affected by prey size, and bill gape was modulated through the use of distal rhynchokinesis in relation to prey size. Finally, the use of distal rhynchokinesis throughout intra-oral prey transport was related to shorter transport times, which improved foraging efficiency. We conclude that distal rhynchokinesis is a mechanism that could contribute to the flexible feeding behaviour of long-distance migratory shorebirds, enhancing small prey profitability and so improving foraging efficiency, and may have played a role in the evolutionary radiation of Scolopacidae (Charadrii). PMID:17951416

  17. Clinical Features and Treatment of Distal Intracranial Aneurysms.

    PubMed

    Mou, Kejie; Zhou, Zheng; Yin, Jinbo; Yang, Hui; Liu, Jun

    2016-05-01

    To analyze the clinical characteristics, therapies, and outcomes of distal intracranial aneurysms, the authors retrospectively studied the clinical and imaging data of 18 patients with distal intracranial aneurysms. There were 10 males and 8 females, aged from 11 months to 59 years (mean, 40.4 ± 11.4 years). All patients were diagnosed by digital subtract angiography. Aneurysm locations were as follows: distal anterior cerebral artery (n = 5), distal middle cerebral artery (n = 2), distal posterior cerebral artery (n = 6), distal posterior inferior cerebellar artery (n = 3), distal anterior inferior cerebellar artery (n = 1), and distal superior cerebellar artery (n = 1). Endovascular embolization was performed on 16 patients, including coil embolization on 10 patients and embolization using Glubran 2 surgical glue on 6 patients, and 7 of the 16 patients also underwent parent artery occlusion. Aneurysms were all completely embolized at the first phase for these 16 patients. The other 2 patients underwent craniotomy with hematoma evacuation and complete aneurysm clipping. Postoperatively, 14 patients showed a good recovery, 2 patients had neurological deficits, 1 patient had seizures and was managed with drugs, 1 patient developed hydrocephalus, and a ventriculo-peritoneal shunt was performed. Follow-up angiographies showed no aneurysm recurrence. Clinical manifestations of distal intracranial aneurysms are varied. Their treatment should follow the principle of individual choice. Endovascular embolization is an effective way to treat distal intracranial aneurysms; and for those with intracranial hematoma, craniotomy with hematoma evacuation and aneurysm clipping may be a feasible treatment. PMID:26982109

  18. Distal Stressors and Depression among Homeless Men.

    PubMed

    Coohey, Carol; Easton, Scott D

    2016-05-01

    Depression is a common problem among homeless men that may interfere with functional tasks, such as securing stable housing, obtaining employment, and accessing health services. Previous research on depression among homeless men has largely focused on current psychosocial resources, substance abuse, and past victimization. Guided by Ensel and Lin's life course stress process model, the authors examined whether distal stressors, including victimization and exposure to parent problems in childhood, contributed to men's depression above and beyond current (or proximal) stressors, such as substance abuse and health problems, and social resources. The sample consisted of 309 homeless men who had entered a federally funded emergency shelter. Using the Burns Depression Checklist, the authors found that one out of three men met the threshold for moderate to severe depression during the past week. The logistic regression showed that past exposure to parent problems was related to depression after accounting for current stressors and social resources (number of close adult relationships and whether their emotional support needs were met). Past victimization was not related to depression. To address men's depression, workers should concurrently provide services that meet men's basic needs (for example, housing) and address their relationship needs, including their need for emotional support. PMID:27263201

  19. Mitotoxicity in distal symmetrical sensory peripheral neuropathies

    PubMed Central

    Bennett, Gary J.; Doyle, Timothy; Salvemini, Daniela

    2016-01-01

    Chronic distal symmetrical sensory peripheral neuropathy is a common neurological complication of cancer chemotherapy, HIV treatment and diabetes. Although aetiology-specific differences in presentation are evident, the clinical signs and symptoms of these neuropathies are clearly similar. Data from animal models of neuropathic pain suggest that the similarities have a common cause: mitochondrial dysfunction in primary afferent sensory neurons. Mitochondrial dysfunction is caused by mitotoxic effects of cancer chemotherapeutic drugs of several chemical classes, HIV-associated viral proteins, and nucleoside reverse transcriptase inhibitor treatment, as well as the (possibly both direct and indirect) effects of excess glucose. The mitochondrial injury results in a chronic neuronal energy deficit, which gives rise to spontaneous nerve impulses and a compartmental neuronal degeneration that is first apparent in the terminal receptor arbor—that is, intraepidermal nerve fibres—of cutaneous afferent neurons. Preliminary data suggest that drugs that prevent mitochondrial injury or improve mitochondrial function could be useful in the treatment of these conditions. PMID:24840972

  20. Bacterial biota in the human distal esophagus

    PubMed Central

    Pei, Zhiheng; Bini, Edmund J.; Yang, Liying; Zhou, Meisheng; Francois, Fritz; Blaser, Martin J.

    2004-01-01

    The esophagus, like other luminal organs of the digestive system, provides a potential environment for bacterial colonization, but little is known about the presence of a bacterial biota or its nature. By using broad-range 16S rDNA PCR, biopsies were examined from the normal esophagus of four human adults. The 900 PCR products cloned represented 833 unique sequences belonging to 41 genera, or 95 species-level operational taxonomic units (SLOTU); 59 SLOTU were homologous with culture-defined bacterial species, 34 with 16S rDNA clones, and two were not homologous with any known bacterial 16S rDNA. Members of six phyla, Firmicutes, Bacteroides, Actinobacteria, Proteobacteria, Fusobacteria, and TM7, were represented. A large majority of clones belong to 13 of the 41 genera (783/900, 87%), or 14 SLOTU (574/900, 64%) that were shared by all four persons. Streptococcus (39%), Prevotella (17%), and Veilonella (14%) were most prevalent. The present study identified ≈56–79% of SLOTU in this bacterial ecosystem. Most SLOTU of esophageal biota are similar or identical to residents of the upstream oral biota, but the major distinction is that a large majority (82%) of the esophageal bacteria are known and cultivable. These findings provide evidence for a complex but conserved bacterial population in the normal distal esophagus. PMID:15016918

  1. Finite Larmor radius flute mode theory with end loss

    SciTech Connect

    Kotelnikov, I.A.; Berk, H.L.

    1993-08-01

    The theory of flute mode stability is developed for a two-energy- component plasma partially terminated by a conducting limiter. The formalism is developed as a preliminary study of the effect of end-loss in open-ended mirror machines where large Larmor radius effects are important.

  2. Observational Constraints on the White Dwarf Mass--Radius Relation

    NASA Astrophysics Data System (ADS)

    Oswalt, Terry D.; Dhital, Saurav; Mizusawa, Trisha; Holberg, Jay B.; Zhao, Jingkun

    2014-02-01

    We propose to measure gravitational redshifts for white dwarf stars that have distant, non-interacting main-sequence companions. With independent radius constraints obtained from parallaxes and surface gravity determinations obtained by fitting the Balmer series from our spectra, we will make improved estimates of white dwarf masses and radii that can be critically compared with theoretical mass-radius relations specific to each star. These observations will allow us to examine serious discrepancies between the theoretical and empirical measurements of the white dwarf mass-radius relation and extend the range of masses over which it has been tested, spanning 0.5-1.2 Msun. Currently, the measured radius for only a single WD matches its predicted value. Using the same spectra, we will also estimate the metallicity of the main-sequence companion and examine how the initial-final-mass ratio for WDs depends on metallicity. Thus, this project will put robust constraints on two fundamental relations that govern our understanding of white dwarfs: the mass-ratio and the initial-final-mass relations.

  3. Observational Constraints on the White Dwarf Mass-Radius Relation

    NASA Astrophysics Data System (ADS)

    Dhital, Saurav; Oswalt, Terry D.; Holberg, J. B.; Zhao, Jingkun

    2014-08-01

    We propose to measure gravitational redshifts for white dwarf stars that have distant, non-interacting main-sequence companions. With independent radius constraints obtained from parallaxes and surface gravity determinations obtained by fitting the Balmer series from our spectra, we will make improved estimates of white dwarf masses and radii that can be critically compared with theoretical mass-radius relations specific to each star. These observations will allow us to examine serious discrepancies between the theoretical and empirical measurements of the white dwarf mass-radius relation and extend the range of masses over which it has been tested, spanning 0.5-1.2 Msun. Currently, the measured radius for only a single WD matches its predicted value within 5%. With the expected precision of ≲5% for over half the sample, we will also distinguish whether the white dwarfs have ``thick'' or ``thin'' H envelopes. Using the same spectra, we will also estimate the metallicity of the main-sequence companion and examine how the initial-final-mass ratio for WDs depends on metallicity. Thus, this project will put robust constraints on two fundamental relations that govern our understanding of white dwarfs: the mass-ratio and the initial-final-mass relations.

  4. Nonlinear buckling analyses of a small-radius carbon nanotube

    NASA Astrophysics Data System (ADS)

    Liu, Ning; Wang, Yong-Gang; Li, Min; Jia, Jiao

    2014-04-01

    Carbon nanotube (CNT) was first discovered by Sumio Iijima. It has aroused extensive attentions of scholars from all over the world. Over the past two decades, we have acquired a lot of methods to synthesize carbon nanotubes and learn their many incredible mechanical properties such as experimental methods, theoretical analyses, and computer simulations. However, the studies of experiments need lots of financial, material, and labor resources. The calculations will become difficult and time-consuming, and the calculations may be even beyond the realm of possibility when the scale of simulations is large, as for computer simulations. Therefore, it is necessary for us to explore a reasonable continuum model, which can be applied into nano-scale. This paper attempts to develop a mathematical model of a small-radius carbon nanotube based on continuum theory. An Isotropic circular cross-section, Timoshenko beam model is used as a simplified mechanical model for the small-radius carbon nanotube. Theoretical part is mainly based on modified couple stress theory to obtain the numerical solutions of buckling deformation. Meanwhile, the buckling behavior of the small radius carbon nanotube is simulated by Molecular Dynamics method. By comparing with the numerical results based on modified couple stress theory, the dependence of the small-radius carbon nanotube mechanical behaviors on its elasticity constants, small-size effect, geometric nonlinearity, and shear effect is further studied, and an estimation of the small-scale parameter of a CNT (5, 5) is obtained.

  5. Effect of limiter end loss in finite Larmor radius theory

    SciTech Connect

    Berk, H.L.; Kotelnikov, I.A.

    1993-08-01

    We have examined the effect of incomplete line tying on the MHD flute mode with FLR (finite Larmor radius) effects. We show that the combination of line tying and FLR effects can slow down MHD instability, but cannot produce complete stabilization.

  6. A 4-Sphere With Noncentral Radius and its Instanton Sheaf

    NASA Astrophysics Data System (ADS)

    Cirio, Lucio Simone; Pagani, Chiara

    2015-02-01

    We build an SU(2)-Hopf bundle over a quantum toric four-sphere whose radius is noncentral. The construction is carried out using local methods in terms of sheaves of Hopf-Galois extensions. The associated instanton bundle is presented and endowed with a connection with anti-self-dual curvature.

  7. Nonlinear buckling analyses of a small-radius carbon nanotube

    SciTech Connect

    Liu, Ning Li, Min; Jia, Jiao; Wang, Yong-Gang

    2014-04-21

    Carbon nanotube (CNT) was first discovered by Sumio Iijima. It has aroused extensive attentions of scholars from all over the world. Over the past two decades, we have acquired a lot of methods to synthesize carbon nanotubes and learn their many incredible mechanical properties such as experimental methods, theoretical analyses, and computer simulations. However, the studies of experiments need lots of financial, material, and labor resources. The calculations will become difficult and time-consuming, and the calculations may be even beyond the realm of possibility when the scale of simulations is large, as for computer simulations. Therefore, it is necessary for us to explore a reasonable continuum model, which can be applied into nano-scale. This paper attempts to develop a mathematical model of a small-radius carbon nanotube based on continuum theory. An Isotropic circular cross-section, Timoshenko beam model is used as a simplified mechanical model for the small-radius carbon nanotube. Theoretical part is mainly based on modified couple stress theory to obtain the numerical solutions of buckling deformation. Meanwhile, the buckling behavior of the small radius carbon nanotube is simulated by Molecular Dynamics method. By comparing with the numerical results based on modified couple stress theory, the dependence of the small-radius carbon nanotube mechanical behaviors on its elasticity constants, small-size effect, geometric nonlinearity, and shear effect is further studied, and an estimation of the small-scale parameter of a CNT (5, 5) is obtained.

  8. Computational Analysis of Dual Radius Circulation Control Airfoils

    NASA Technical Reports Server (NTRS)

    Lee-Rausch, E. M.; Vatsa, V. N.; Rumsey, C. L.

    2006-01-01

    The goal of the work is to use multiple codes and multiple configurations to provide an assessment of the capability of RANS solvers to predict circulation control dual radius airfoil performance and also to identify key issues associated with the computational predictions of these configurations that can result in discrepancies in the predicted solutions. Solutions were obtained for the Georgia Tech Research Institute (GTRI) dual radius circulation control airfoil and the General Aviation Circulation Control (GACC) dual radius airfoil. For the GTRI-DR airfoil, two-dimensional structured and unstructured grid computations predicted the experimental trend in sectional lift variation with blowing coefficient very well. Good code to code comparisons between the chordwise surface pressure coefficients and the solution streamtraces also indicated that the detailed flow characteristics were matched between the computations. For the GACC-DR airfoil, two-dimensional structured and unstructured grid computations predicted the sectional lift and chordwise pressure distributions accurately at the no blowing condition. However at a moderate blowing coefficient, although the code to code variation was small, the differences between the computations and experiment were significant. Computations were made to investigate the sensitivity of the sectional lift and pressure distributions to some of the experimental and computational parameters, but none of these could entirely account for the differences in the experimental and computational results. Thus, CFD may indeed be adequate as a prediction tool for dual radius CC flows, but limited and difficult to obtain two-dimensional experimental data prevents a confident assessment at this time.

  9. Theory on the mechanism of distal action of transcription factors: looping of DNA versus tracking along DNA

    NASA Astrophysics Data System (ADS)

    Murugan, R.

    2010-10-01

    In this paper, we develop a theory on the mechanism of distal action of the transcription factors, which are bound at their respective cis-regulatory enhancer modules on the promoter-RNA polymerase II (PR) complexes to initiate the transcription event in eukaryotes. We consider both the looping and tracking modes of their distal communication and calculate the mean first passage time that is required for the distal interactions of the complex of enhancer and transcription factor with the PR via both these modes. We further investigate how this mean first passage time is dependent on the length of the DNA segment (L, base-pairs) that connects the cis-regulatory binding site and the respective promoter. When the radius of curvature of this connecting segment of DNA is R that was induced upon binding of the transcription factor at the cis-acting element and RNAPII at the promoter in cis-positions, our calculations indicate that the looping mode of distal action will dominate when L is such that L > 2πR and the tracking mode of distal action will be favored when L < 2πR. The time required for the distal action will be minimum when L = 2πR where the typical value of R for the binding of histones will be R ~ 16 bps and L ~ 102 bps. It seems that the free energy associated with the binding of the transcription factor with its cis-acting element and the distance of this cis-acting element from the corresponding promoter of the gene of interest is negatively correlated. Our results suggest that the looping and tracking modes of distal action are concurrently operating on the transcription activation and the physics that determines the timescales associated with the looping/tracking in the mechanism of action of these transcription factors on the initiation of the transcription event must put a selection pressure on the distribution of the distances of cis-regulatory modules from their respective promoters of the genes. The computational analysis of the upstream sequences

  10. Optimal Taylor-Couette flow: radius ratio dependence

    NASA Astrophysics Data System (ADS)

    Ostilla-Mónico, Rodolfo; Huisman, Sander G.; Jannink, Tim J. G.; Van Gils, Dennis P. M.; Verzicco, Roberto; Grossmann, Siegfried; Sun, Chao; Lohse, Detlef

    2014-05-01

    Taylor-Couette flow with independently rotating inner (i) and outer (o) cylinders is explored numerically and experimentally to determine the effects of the radius ratio {\\eta} on the system response. Numerical simulations reach Reynolds numbers of up to Re_i=9.5 x 10^3 and Re_o=5x10^3, corresponding to Taylor numbers of up to Ta=10^8 for four different radius ratios {\\eta}=r_i/r_o between 0.5 and 0.909. The experiments, performed in the Twente Turbulent Taylor-Couette (T^3C) setup, reach Reynolds numbers of up to Re_i=2x10^6$ and Re_o=1.5x10^6, corresponding to Ta=5x10^{12} for {\\eta}=0.714-0.909. Effective scaling laws for the torque J^{\\omega}(Ta) are found, which for sufficiently large driving Ta are independent of the radius ratio {\\eta}. As previously reported for {\\eta}=0.714, optimum transport at a non-zero Rossby number Ro=r_i|{\\omega}_i-{\\omega}_o|/[2(r_o-r_i){\\omega}_o] is found in both experiments and numerics. Ro_opt is found to depend on the radius ratio and the driving of the system. At a driving in the range between {Ta\\sim3\\cdot10^8} and {Ta\\sim10^{10}}, Ro_opt saturates to an asymptotic {\\eta}-dependent value. Theoretical predictions for the asymptotic value of Ro_{opt} are compared to the experimental results, and found to differ notably. Furthermore, the local angular velocity profiles from experiments and numerics are compared, and a link between a flat bulk profile and optimum transport for all radius ratios is reported.

  11. OBSERVATIONAL CONSTRAINTS ON THE DEGENERATE MASS-RADIUS RELATION

    SciTech Connect

    Holberg, J. B.; Oswalt, T. D.; Barstow, M. A. E-mail: toswalt@fit.edu

    2012-03-15

    The white dwarf mass-radius relationship is fundamental to modern astrophysics. It is central to routine estimation of DA white dwarf masses derived from spectroscopic temperatures and gravities. It is also the basis for observational determinations of the white dwarf initial-final-mass relation. Nevertheless, definitive and detailed observational confirmations of the mass-radius relation (MRR) remain elusive owing to a lack of sufficiently accurate white dwarf masses and radii. Current best estimates of masses and radii allow only broad conclusions about the expected inverse relation between masses and radii in degenerate stars. In this paper, we examine a restricted set of 12 DA white dwarf binary systems for which accurate (1) trigonometric parallaxes, (2) spectroscopic effective temperatures and gravities, and (3) gravitational redshifts are available. We consider these three independent constraints on mass and radius in comparison with an appropriate evolved MRR for each star. For the best-determined systems it is found that the DA white dwarfs conform to evolve theoretical MRRs at the 1{sigma} to 2{sigma} level. For the white dwarf 40 Eri B (WD 0413-077) we find strong evidence for the existence of a 'thin' hydrogen envelope. For other stars improved parallaxes will be necessary before meaningful comparisons are possible. For several systems current parallaxes approach the precision required for the state-of-the-art mass and radius determinations that will be obtained routinely from the Gaia mission. It is demonstrated here how these anticipated results can be used to firmly constrain details of theoretical mass-radius determinations.

  12. Treatment of the distal fracture in radioulna based on the volar wrist dual channel approach and postoperative X-ray diagnosis.

    PubMed

    Li, Zheng; Zhang, Zhenwei; Yu, Shaoxiao; Bai, Yinwei; Lin, Huixin; Zeng, Jinhao; Ye, Xuelang; Xu, Dachuan

    2015-12-01

    The fracture of the distal ulna and radius is a kind of fracture that results in high morbidity and occurrence rate and contributes to about one-sixth of the entire body's fracture. In this study, we implemented the improved palmar wrist surgery by a volar wrist dual channel approach. Between 2011 and 2014, we have treated 67 distal radius fracture patients. We divided them into two parts randomly, and treat them by the Carpometacarpal direct approach solution and dual wrist palmar surgical approach solution respectively. After the surgery, the differences in the incidence of median nerve irritation are significant (P < 0.01). With reference to the exposure time of fracture, the operation time and the pronator quadratus muscle repair rate, we find that the exposure time of fracture and the operation time in the dual wrist palmar surgical approach solution are much less than that as compared to the Carpometacarpal direct approach solution (P < 0.01). The improved dual wrist palmar surgical approach can lead to a successful treatment of the distal radius fractures volar distal radial ulnar by reducing the blind exposure problem. As such, the surgeon can complete treatment of fractures of the region under direct vision during operation. Furthermore, reducing the median nerve in the carpal tunnel and the structure of the stretch can decrease the incidence of postoperative complications. Postoperative X-ray diagnosis is then performed to examine the patients' recovery and assist in clinical follow-up. Our study proves that the volar wrist dual channel approach can be successfully achieved by a surface incision surgical implementation of the dual channel, and gives rise to a minimally invasive operation. PMID:26206398

  13. Distal Insertions of the Biceps Femoris

    PubMed Central

    Branch, Eric A.; Anz, Adam W.

    2015-01-01

    Background: Avulsion of the biceps femoris from the fibula and proximal tibia is encountered in clinical practice. While the anatomy of the primary posterolateral corner structures has been qualitatively and quantitatively described, a quantitative analysis regarding the insertions of the biceps femoris on the fibula and proximal tibia is lacking. Purpose: To quantitatively assess the insertions of the biceps femoris, fibular collateral ligament (FCL), and anterolateral ligament (ALL) on the fibula and proximal tibia as well as establish relationships among these structures and to pertinent surgical anatomy. Study Design: Descriptive laboratory study. Methods: Dissections were performed on 12 nonpaired, fresh-frozen cadaveric specimens identifying the biceps femoris, FCL, and ALL, and their insertions on the proximal tibia and fibula. The footprint areas, orientations, and distances from relevant osseous landmarks were measured using a 3-dimensional coordinate measurement device. Results: Dissection produced 6 easily identifiable and reproducible anatomic footprints. Tibial footprints included the insertion of the ALL and an insertion of the biceps femoris (TBF). Fibular footprints included the insertion of the FCL, a distal insertion of the biceps femoris (DBF), a medial footprint of the biceps femoris (MBF), and a proximal footprint of the biceps femoris (PBF). The mean area of these footprints (95% CI) was as follows: ALL, 53.0 mm2 (38.4-67.6); TBF, 93.9 mm2 (72.0-115.8); FCL, 86.8 mm2 (72.3-101.2); DBF, 119 mm2 (91.1-146.9); MBF, 46.8 mm2 (29.0-64.5); and PBF, 215 mm2 (192.4-237.5). The mean distance (95% CI) from the Gerdy tubercle to the center of the ALL footprint was 24.3 mm (21.6-27.0) and to the center of the TBF was 22.5 mm (21.0-24.0). The center of the DBF was 8.68 mm (7.0-10.3) from the anterior border of the fibula, the center of the FCL was 14.6 mm (12.5-16.7) from the anterior border of the fibula and 20.7 mm (19.0-22.4) from the tip of the fibular

  14. Distal humerus fractures: a review of current therapy concepts.

    PubMed

    Amir, Steinitz; Jannis, Sailer; Daniel, Rikli

    2016-06-01

    Fractures of the distal humerus in the adult comprise approximately one third of all humeral fractures. Successful management of distal humerus fractures depends on correct reduction of the fracture, reconstruction of the articular surface if needed, stability and rigidity of the fixation, and appropriate rehabilitation. In this review, we evaluated the available literature and highlighted current therapy concepts. We assessed the evolution of internal fixation and elbow arthroplasty focusing on the established surgical approaches against the background of a growing incidence of distal humeral fractures in an aging patient population. Therefore evaluating the aspect and influence of age-dependent comorbidities like osteoporosis on successful treatment. PMID:27039395

  15. Variable radius cartography - History and perspectives of a new discipline

    NASA Astrophysics Data System (ADS)

    Scalera, Giancarlo

    2014-05-01

    The map that Toscanelli sent to Columbus was an unconscious application of cartography at a smaller radius than the real. The first really conscious attempts to represent the geography of Earth on globes of radius less than the current one occurred after the formulation of the concept of expanding Earth through geological time. The American chemist and geologist Richard Owen (1810-1890) in his book Key to the geology of the globe (1857) described the principles of what he himself called Anatomical Geology, with the Earth growing as a biological organism. The book contained a global paleogeographic map of the Earth that would have had a radius of about 4000 kilometers. In 1928 J.A.H. Kerkhoff (under the pseudonym Aero-dilettant) published a series of paleogeographic globes on which the modern oceans disappeared. With the same artisan methods of transfer continental outlines from a sphere to a smaller one, in 1933 O.C. Hilgenberg represented three different geological epochs, and, later, for the first time mapped paleopoles with their site-pole segments of meridian. Even today the traditional method of Hilgenberg is followed by senior researchers (Klaus Vogel, 2003) and younger geologists (James Maxlow). In England Hugh Owen applied the methods of traditional cartography to the variable radius one. His Atlas of Continental Displacement was in the 70s and 80s, for this discipline, a real milestone. While in the field of constant radius paleogeography the adherents to plate tectonics created many computer codes of automatic mapping (Bullard et al., 1965; Smith & Hallam, 1970; Scotese et al., 1979; and many others), in the variable radius field few tried to reach the same task. In 1972 in United States a first very simple attempt (but was not further developed) came from a private, R.B. Perry, followed by the still not-computerized Atlas of Owen, and both them constituted inspiration for the construction of a FORTRAN variable radius mapping code at INGV, with which it

  16. The Pronator Quadratus and Distal Anterior Interosseous Nerve: A Cadaveric Study

    PubMed Central

    Hinds, Richard M.; Gottschalk, Michael B.; Capo, John T.

    2015-01-01

    Background The pronator quadratus (PQ) muscle is an important and commonly encountered structure in surgery of the wrist. A thorough understanding of the anatomy of the PQ and the anterior interosseous nerve (AIN), which innervates the PQ, is important, particularly during distal radius fracture osteosynthesis and distal AIN transfer to deep branch of the ulnar nerve. Furthermore, there is a paucity of literature regarding sex differences in the morphology of these structures. We describe the morphology of the PQ and AIN and compare PQ and AIN findings in male and female specimens. Methods Twenty-five cadaveric upper extremities underwent loupe-aided dissection of the volar forearm with identification of the AIN and PQ. A digital photograph taken perpendicular to the volar surface of the forearm was used to measure the PQ and assess AIN morphology using ImageJ (National Institutes of Health; Bethesda, MD). Comparisons between male and female specimens were performed. Results Of the 25 specimens, 84% appeared as a single trapezoidal muscle bundle, with the remaining 16% demonstrating a double-bundle morphology. The PQ was a mean 3.8 ± 0.5 cm in radial-ulnar width and 4.6 ± 0.7 cm in proximal-distal length with a mean thickness, area, and volume of 0.6 ± 0.2 cm, 18.2 ± 4.8 cm2, and 10.5 ± 3.7 cm3, respectively. The PQ branch of the AIN was a mean 3.8 ± 1.1 cm long and had a mean diameter of 1.4 ± 0.2 mm. Male specimens demonstrated significantly greater radial-ulnar width (p = 0.005), area (p = 0.006), and volume (p = 0.033) of the PQ, as well as a greater distance from the radial styloid to the distal arborization of the AIN (p = 0.005) compared with female specimens. Conclusions The current study informs hand surgeons of the morphologic variability and sexual dimorphism of the PQ and AIN and may help guide operative planning. PMID:26261744

  17. Randomized clinical trial on percutaneous minimally invasive osteosynthesis of fractures of the distal extremity of the radius☆☆☆

    PubMed Central

    Aita, Marcio Aurélio; Vieira Ferreira, Carlos Henrique; Schneider Ibanez, Daniel; Saraiva Marquez, Rafael; Hideki Ikeuti, Douglas; Toledo Mota, Rodrigo; Credidio, Marcos Vinicius; Noboru Fujiki, Edison

    2014-01-01

    Objectives the purpose of this study was to compare the postoperative radiological and clinical outcomes with minimally invasive percutaneous osteosynthesis using three implants: volar locking plate, intramedullary nail system and nonbridging external fixator for distal radius fractures. Methods forty-eight patients (A group, 16; B group 16; C group 16) underwent minimally invasive percutaneous osteosynthesis of reductible and unstable displaced (Type IIB by Rayhack Classification) distal radius fractures. In B group intramedullary nail system was used, in A group the patients were treated with volar locking plate and in C group the patients were treated by nonbridging external fixator from January 2011 to December 2012. The mean follow-up period was 12 months. Radiologic parameters, range of motion, grip strength, and disability of the arm, shoulder, and hand score were evaluated at each examination (3rd and 6th week, and 12th months). The visual analog scale of wrist pain and complications were assessed at the final follow-up. Results the groups did not differ significantly in radiological outcomes after 12 months, but the clinical results, VAS scale and dash score in group A (volar locking plate) and B (nail intramedullary) were statistically significantly better than that of C group (nonbridging external fixator). One patient underwent an osteosynthesis with nail intramedullary and another with external fixator (C group) developed persistent pain near the site of the superficial radial nerve because of the distal's screw and pins, respectively. Conclusion in clinical parameters, significant differences in outcomes were found between groups A and B after six weeks versus C group. PMID:26229804

  18. Motion perception during variable-radius swing motion in darkness.

    PubMed

    Rader, A A; Oman, C M; Merfeld, D M

    2009-10-01

    Using a variable-radius roll swing motion paradigm, we examined the influence of interaural (y-axis) and dorsoventral (z-axis) force modulation on perceived tilt and translation by measuring perception of horizontal translation, roll tilt, and distance from center of rotation (radius) at 0.45 and 0.8 Hz using standard magnitude estimation techniques (primarily verbal reports) in darkness. Results show that motion perception was significantly influenced by both y- and z-axis forces. During constant radius trials, subjects' perceptions of tilt and translation were generally almost veridical. By selectively pairing radius (1.22 and 0.38 m) and frequency (0.45 and 0.8 Hz, respectively), the y-axis acceleration could be tailored in opposition to gravity so that the combined y-axis gravitoinertial force (GIF) variation at the subject's ears was reduced to approximately 0.035 m/s(2) - in effect, the y-axis GIF was "nulled" below putative perceptual threshold levels. With y-axis force nulling, subjects overestimated their tilt angle and underestimated their horizontal translation and radius. For some y-axis nulling trials, a radial linear acceleration at twice the tilt frequency (0.25 m/s(2) at 0.9 Hz, 0.13 m/s(2) at 1.6 Hz) was simultaneously applied to reduce the z-axis force variations caused by centripetal acceleration and by changes in the z-axis component of gravity during tilt. For other trials, the phase of this radial linear acceleration was altered to double the magnitude of the z-axis force variations. z-axis force nulling further increased the perceived tilt angle and further decreased perceived horizontal translation and radius relative to the y-axis nulling trials, while z-axis force doubling had the opposite effect. Subject reports were remarkably geometrically consistent; an observer model-based analysis suggests that perception was influenced by knowledge of swing geometry. PMID:19625542

  19. Distal ulna giant cell tumor resection with reconstruction using distal ulna prosthesis and brachioradialis wrap soft tissue stabilization.

    PubMed

    Burke, Charity S; Gupta, Amit; Buecker, Peter

    2009-12-01

    This is a surgical technique report concerning the treatment of a 32-year-old male who had a giant cell tumor of distal ulna with suspected metastatic disease to the lungs. Three curettage procedures and a Darrach procedure were performed at an outlying facility. Upon the fourth reoccurrence, the patient was referred to our facility. It was established that the patient needed a distal ulna en bloc resection. To accommodate his activity requirements, reconstruction of the sigmoid notch and distal ulna was undertaken using a prosthesis. Soft tissue stabilization of the prosthesis was a challenge due to his previous procedures. This was accomplished using a brachioradialis tendon wrap. PMID:19370378

  20. Combined open proximal and stent-graft distal repair for distal arch aneurysms: an alternative to total debranching.

    PubMed

    Zierer, Andreas; Sanchez, Luis A; Moon, Marc R

    2009-07-01

    We present herein a novel, combined, simultaneous open proximal and stent-graft distal repair for complex distal aortic arch aneurysms involving the descending aorta. In the first surgical step, the transverse arch is opened during selective antegrade cerebral perfusion, and a Dacron graft (DuPont, Wilmington, DE) is positioned down the descending aorta in an elephant trunk-like fashion with its proximal free margin sutured circumferentially to the aorta just distal to the left subclavian or left common carotid artery. With the graft serving as the new proximal landing zone, subsequent endovascular repair is performed antegrade during rewarming through the ascending aorta. PMID:19559261

  1. Distally based sural artery flap without sural nerve.

    PubMed

    Motamed, Sadrollah; Yavari, Masood; Mofrad, Hamid Reza Hallaj; Rafiee, Reza; Shahraki, Feaz Niazi

    2010-01-01

    The distal third of the tibia, ankle and heel area is difficult to reconstruct. For small to medium size defects, local flaps are often an easier alternative than free flap. In lower limb surgery, the sural flap is based on this principle and this flap is becoming increasingly popular. The distally based superficial sural artery flap, first described as a distally based neuro skin flap by masquelet et al., is a skin island flap supplied by the vascular axis of the sural nerve. The main disadvantage of distally based sural artery flap is sacrifice of the sural nerve because it is described the concept of neurocutaneus island flap. We describe one case of reverse sural flap without sural nerve .The aim of this paper is to establish the reliability of this flap even without sural nerve. PMID:21133008

  2. Distal urethroplasty for fossa navicularis and meatal strictures

    PubMed Central

    Dielubanza, Elodi J.; Han, Justin S.

    2014-01-01

    Distal urethral strictures involving the fossa navicularis and meatus represent a unique subset of urethral strictures that are particularly challenging to reconstructive urologists. Management of distal urethral strictures must take into account not only maintenance of urethral patency but also glans cosmesis. A variety of therapeutic approaches exist for the management of distal urethral strictures, including dilation, meatotomy, extended meatotomy, flap urethroplasty, and substitution grafting. Common etiologies for distal urethral strictures include lichen sclerosus, instrumentation, and prior hypospadias repair. Proper patient selection is paramount to the ultimate success and durability of the treatment, which should be individualized and include an assessment of the stricture etiology, location, and burden, and patient-centered goals of care. PMID:26816765

  3. Distal Humeral Fixation of an Intramedullary Nail Periprosthetic Fracture

    PubMed Central

    Divecha, Hiren M.; Marynissen, Hans A. J.

    2013-01-01

    Distal humeral periprosthetic fractures below intramedullary nail devices are complex and challenging to treat, in particular due to the osteopenic/porotic nature of bone found in these patients. Fixation is often difficult to satisfactorily achieve around the intramedullary device, whilst minimising soft tissue disruption. Descriptions of such cases in the current literature are very rare. We present the case of a midshaft humeral fracture treated with a locking compression plate that developed a nonunion, in a 60-year old female. This went on to successful union after exchange for an intramedullary humeral nail. Unfortunately, the patient developed a distal 1/5th humeral periprosthetic fracture, which was then successfully addressed with a single-contoured, extra-articular, distal humeral locking compression plate (Synthes) with unicortical locking screws and cerclage cables proximally around the distal nail tip region. An excellent postoperative range of motion was achieved. PMID:23662231

  4. Distal Renal Tubular Acidosis in Infancy: A Bicarbonate Wasting State

    ERIC Educational Resources Information Center

    Rodriguez-Soriano, J.; And Others

    1975-01-01

    Studied were three unrelated infants with distal renal tubular acidosis (a condition characterized by an inability to acidify the urine to minimal pH levels resulting in the loss of bicarbonates). (DB)

  5. Measurements of small radius ratio turbulent Taylor-Couette flow

    NASA Astrophysics Data System (ADS)

    van der Veen, Roeland; Huisman, Sander; Merbold, Sebastian; Sun, Chao; Harlander, Uwe; Egbers, Christoph; Lohse, Detlef

    2014-11-01

    In Taylor-Couette flows, the radius ratio (η =ri /ro) is one of the key parameters of the system. For small η, the asymmetry of the inner and outer boundary layer becomes more important, affecting the general flow structure and boundary layer characteristics. Using high-resolution particle image velocimetry we measure flow profiles, local transport, and statistical properties of the flow for a radius ratio of 0.5 and a Reynolds number of up to 4 .104 . By measuring flow profiles at varying heights, roll structures are characterized for two different rotation ratios of the inner and outer cylinder. In addition, we systematically vary the rotation ratio and the Reynolds number. These results exemplify how curvature affects flow in strongly turbulent Taylor-Couette Flow.

  6. Maximal radius of the aftershock zone in earthquake networks

    NASA Astrophysics Data System (ADS)

    Mezentsev, A. Yu.; Hayakawa, M.

    2009-09-01

    In this paper, several seismoactive regions were investigated (Japan, Southern California and two tectonically distinct Japanese subregions) and structural seismic constants were estimated for each region. Using the method for seismic clustering detection proposed by Baiesi and Paczuski [M. Baiesi, M. Paczuski, Phys. Rev. E 69 (2004) 066106; M. Baiesi, M. Paczuski, Nonlin. Proc. Geophys. (2005) 1607-7946], we obtained the equation of the aftershock zone (AZ). It was shown that the consideration of a finite velocity of seismic signal leads to the natural appearance of maximal possible radius of the AZ. We obtained the equation of maximal radius of the AZ as a function of the magnitude of the main event and estimated its values for each region.

  7. Artificial gravity: head movements during short-radius centrifugation

    NASA Astrophysics Data System (ADS)

    Young, Laurence R.; Hecht, Heiko; Lyne, Lisette E.; Sienko, Kathleen H.; Cheung, Carol C.; Kavelaars, Jessica

    2001-08-01

    Short-radius centrifugation is a potential countermeasure to long-term weightlessness. Unfortunately, head movements in a rotating environment induce serious discomfort, non-compensatory vestibulo-ocular reflexes, and subjective illusions of body tilt. In two experiments we investigated the effects of pitch and yaw head movements in participants placed supine on a rotating bed with their head at the center of rotation, feel at the rim. The vast majority of participants experienced motion sickness, inappropriate vertical nystagmus and illusory tilt and roll as predicted by a semicircular canal model. However, a small but significant number of the 28 participants experienced tilt in the predicted plane but in the opposite direction. Heart rate was elevated following one-second duration head turns. Significant adaptation occurred following a series of head turns in the light. Vertical nystagmus, motion sickness and illusory tilt all decreased with adaptation. Consequences for artificial gravity produced by short-radius centrifuges as a countermeasure are discussed.

  8. Flute waves at the ion Larmor radius scales

    SciTech Connect

    Onishchenko, O. G.

    2010-12-14

    The theory of the magnetic Rayleigh-Taylor instability (RTI) is discussed. Modified linear kinetic theory allows us to investigate RTI and flute waves with arbitrary perpendicular spatial scales compared to the ion Larmor radius. It is shown that in the linear limit a Fourier transform of these equations yields the dispersion relation which in the so-called Pade approximation corresponds to results of the kinetic theory. This analysis represents an extension of the previous study of the magnetic RTI obtained in the large wave scale approximation. It is shown that incorporation of the effects associated with wave scales of the order of the ion Larmor radius leads to a broader wave number range of the magnetic RTI.

  9. Proton Radius, Darwin-Foldy Term and Radiative Corrections

    NASA Astrophysics Data System (ADS)

    Jentschura, Ulrich

    2013-04-01

    It is not an easy task to define the proton charge radius. Namely, by definition, the proton radius is the slope of the GESachs form factor of the proton at zero momentum transfer, provided one has subtracted from the scattering cross sections, all effects due to QED. That means that radiative corrections must be subtracted; these otherwise ``mask'' the proton structure from the surroundings. On the other hand, the self-energy of the proton (not of the electron or of the muon) also influence the spectrum of atomic hydrogen, or muonic hydrogen, respectively. In the talk, we shall review the difficulties faced by a consistent definition, offer a way to resolve them, and review the current status of Lamb shift predictions in muonic hydrogen, with a special reference to the current experimental-theoretical discrepancy, as reported by the CREMA collaboration.

  10. Core Deuterium Fusion and Radius Inflation in Hot Jupiters

    NASA Astrophysics Data System (ADS)

    Jaikumar, Prashanth; Rachid Ouyed

    2016-06-01

    Several laboratory-based studies have shown that the Deuterium fusion cross-section is enhanced in a solid deuterated target as compared to a gas target, attributable to enhanced mobility of deuterons in a metal lattice. As an application, we propose that, for core temperatures and compositions characterizing hot Jupiters, screened Deuterium fusion can occur deep in the interior, and show that the amount of radius inflation from this effect can be important if there is sufficient rock-ice in the core. The mechanism of screened Deuterium fusion, operating in the above temperature range, is generally consistent with the trend in radius anomaly with planetary equilibrium temperature. We also explore the trend with planetary mass using a simple analytic model.

  11. Comparison of Chevron and Distal Oblique Osteotomy for Bunion Correction.

    PubMed

    Scharer, Brandon M; DeVries, J George

    2016-01-01

    The chevron osteotomy is a standard procedure by which bunions are corrected. One of us routinely performs a distal oblique osteotomy, which, to the best of our knowledge, has not been described for the correction of bunion deformities. The purpose of the present study was to compare the short- and medium-term results of the distal oblique and chevron osteotomies for bunion correction. We performed a retrospective clinical and radiographic comparison of patients who had undergone a distal oblique or chevron osteotomy for the correction of bunion deformity. In addition, a prospective patient satisfaction survey was undertaken. A total of 55 patients were included in the present study and were treated from January 2012 to November 2014. Of the 55 patients, 27 (49.2%) were in the chevron group and 28 (50.8%) in the distal oblique group. Radiographically, no statistically significant difference was found between the 2 groups with respect to postoperative first intermetatarsal angle (p < .0001) and hallux valgus angle (p < .0001), but a greater change was found in the intermetatarsal angle in the distal oblique group (p = .467). Prospective patient satisfaction scores were available for 33 patients (60%), 16 (29%) in the chevron group and 17 (31%) in the distal oblique group. When converting the satisfaction score to a numerical score, the chevron group scored 3.3 ± 1.1 and the distal oblique group scored 3.2 ± 0.8 (p = .812). We found that the distal oblique osteotomy used in the present study is simple and reliable and showed radiographic correction and patient satisfaction equivalent to those in the chevron osteotomy. PMID:26972755

  12. Management of distal left main coronary artery aneurysm.

    PubMed

    Ko, Po-Yen; Chang, Chih-Ping; Lin, Jen-Jyh; Liu, Juhn-Cherng

    2013-12-01

    Aneurysms of the left main coronary artery are extremely rare. The cause of such aneurysms is uncertain. Although the treatment of distal left main aneurysms is very complicated, definitive treatment is necessary because the aneurysm may grow further and cause embolism or rupture. Herein, we report a case of acute myocardial infarction caused by aneurysm of the distal left main coronary artery, which was successfully treated by performing coronary artery bypass surgery, followed by implantation of a polytetrafluoroethylene-covered stent. PMID:22535673

  13. Post-traumatic osteolysis of the distal clavicle.

    PubMed

    Reber, P; Patel, A G; Hess, R; Noesberger, B

    1996-01-01

    We report a case of post-traumatic osteolysis of the distal clavicle of a 25-year-old man. The diagnosis was missed for several months, and the patient continued to have pain in his right shoulder. The pain continued in spite of intensive physiotherapy. When he was seen for the first time in our clinic 6 months after the accident, the radiographs showed an osteolysis of the distal clavicle. PMID:9063852

  14. A minimally invasive surgical technique to treat distal clavicle fractures.

    PubMed

    Swanson, Kyle E; Swanson, Britta L

    2009-07-01

    Treatment of distal clavicle fractures ranges from nonoperative to operative approaches. Various surgical procedures have been described in the literature, each with potential complications. For fractures treated operatively, the goal is to maximize stability and functionality while minimizing pain and deformity. This article describes a double-button suture system using a mini-open technique to repair a distal clavicle fracture providing stable fixation with minimal disruption of the surrounding anatomy. PMID:19634845

  15. Thrombocytopenia with absent radius in a boy and his uncle.

    PubMed

    Schnur, R E; Eunpu, D L; Zackai, E H

    1987-09-01

    We report a boy and his maternal uncle who have Thrombocytopenia-Absent Radius (TAR) syndrome. The mother of the propositus is normal. A maternal aunt has mild radial hypoplasia, possibly representing partial expression of the syndrome. A review of the literature shows several pedigrees in which relatives other than sibs were affected with TAR. Thus, autosomal recessive inheritance may not account for all cases and alternate modes of transmission should be considered. PMID:3314504

  16. Experimental bound on the charge radius of the electron neutrino

    SciTech Connect

    Allen, R.C.; Chen, H.H.; Doe, P.J.; Hausamann, R.; Lee, W.P.; Lu, X.; Mahler, H.J.; Potter, M.E.; Wang, K.C. ); Bowles, T.J.; Burman, R.L.; Carlini, R.D.; Cochran, D.R.F.; Frank, J.S.; Piasetzky, E.; Sandberg, V.D. ); Krakauer, D.A.; Talaga, R.L. )

    1991-01-01

    A limit on the electron-neutrino charge radius {vert bar}{ital r}{vert bar} is derived from a measurement of the weak-neutral-current vector coupling constant {ital g}{sub {ital V}} obtained in electron-neutrino electron elastic scattering. The 90%-confidence interval for {ital g}{sub {ital V}} is {minus}0.177{lt}{ital g}{sub {ital V}}{lt}0.187, which for sin{sup 2}{theta}{sub {ital W}}=0.227 implies that the {nu}{sub {ital e}} mean-square charge radius is in the range {minus}2.74{times}10{sup {minus}32}{lt}{l angle}{ital r}{sup 2}{r angle}{lt}4.88{times}10{sup {minus}32} cm{sup 2}, or simply {vert bar}{ital r}{vert bar}{lt}2.2{times}10{sup {minus}16} cm. This is the first experimental bound on the {nu}{sub {ital e}} charge radius, and is the same order of magnitude as bounds for {nu}{sub {mu}} structure.

  17. Ring polymer simulations with global radius of curvature.

    PubMed

    Neuhaus, T; Zimmermann, O; Hansmann, Ulrich H E

    2007-05-01

    We simulate three-dimensional flexible off-lattice ring polymers of length L up to L=4000 for various values of the global radius of curvature Rgrc=0.25 , 0.48, and 1.0 and Rgrc=2.0 . We utilize two different ensembles: one with a delta -function constraint on the radius, and the other with a theta -function. For both cases the global radius of curvature provides a valid regularization of polymers with thickness D=2Rgrc . The Flory-type critical exponent nu SAW of self-avoiding rings at D=2 is found to be nu SAW=0.5869(5) from the radii of gyration chain length scaling, while other D values produce consistent results. For our current implementation, the numerical effort of chain thickness calculations is bounded by a number O(LlnL) per single update. We also study low-temperature configurations of spatially dense Lennard-Jones homopolymers on a ring and identify some conformational building blocks. PMID:17677089

  18. Chondrosarcoma of the radius with distant metastasis in a dog.

    PubMed

    Boudrieau, R J; Schelling, S H; Pisanelli, E R

    1994-08-15

    A 9-year-old castrated male Doberman Pinscher was admitted for evaluation of lameness of the left forelimb. Radiography and examination of biopsy specimens revealed a moderately differentiated chondrosarcoma of the proximal portion of the radius. The dog was treated by local excision of the neoplasm, which involved resection of the radial head and proximal portion of the radius. Despite the large size of the dog and the weight-bearing forces exerted on the cubital joint, major problems with ambulation did not develop after surgery. Functional use of the limb returned slowly; however, substantial limb use was observed despite the development of mild degenerative changes of the joint and migration of the humeroulnar articulation. Six months after surgery, metastasis of a widely disseminated, poorly differentiated chondrosarcoma to the subcutaneous tissues and thoracic and abdominal cavities was diagnosed. Local redevelopment of the chondrosarcoma in the area of the cubital joint was not detected. Resection of the radial head and proximal portion of the radius may be considered a viable, alternative, limb-sparing technique. The biologically aggressive nature of this chondrosarcoma of the appendicular skeleton indicated that additional information was needed before a reliable prognosis could be established for this dog with this tumor type. Reports of low rates of metastasis have been based on insufficient numbers of dogs to adequately or accurately determine the long-term prognosis of dogs with chondrosarcoma of the appendicular skeleton. PMID:7961094

  19. Is the proton radius puzzle evidence of extra dimensions?

    NASA Astrophysics Data System (ADS)

    Dahia, F.; Lemos, A. S.

    2016-08-01

    The proton charge radius inferred from muonic hydrogen spectroscopy is not compatible with the previous value given by CODATA-2010, which, on its turn, essentially relies on measurements of the electron-proton interaction. The proton's new size was extracted from the 2S-2P Lamb shift in the muonic hydrogen, which showed an energy excess of 0.3 meV in comparison to the theoretical prediction, evaluated with the CODATA radius. Higher-dimensional gravity is a candidate to explain this discrepancy, since the muon-proton gravitational interaction is stronger than the electron-proton interaction and, in the context of braneworld models, the gravitational potential can be hugely amplified in short distances when compared to the Newtonian potential. Motivated by these ideas, we study a muonic hydrogen confined in a thick brane. We show that the muon-proton gravitational interaction modified by extra dimensions can provide the additional separation of 0.3 meV between the 2S and 2P states. In this scenario, the gravitational energy depends on the higher-dimensional Planck mass and indirectly on the brane thickness. Studying the behavior of the gravitational energy with respect to the brane thickness in a realistic range, we find constraints for the fundamental Planck mass that solve the proton radius puzzle and are consistent with previous experimental bounds.

  20. Neutron charge radius and the neutron electric form factor

    SciTech Connect

    Gentile, T. R.; Crawford, C. B.

    2011-05-15

    For nearly forty years, the Galster parametrization has been employed to fit existing data for the neutron electric form factor, G{sub E}{sup n}, vs the square of the four-momentum transfer, Q{sup 2}. Typically this parametrization is constrained to be consistent with experimental data for the neutron charge radius. However, we find that the Galster form does not have sufficient freedom to accommodate reasonable values of the radius without constraining or compromising the fit. In addition, the G{sub E}{sup n} data are now at sufficient precision to motivate a two-parameter fit (or three parameters if we include thermal neutron data). Here we present a modified form of a two-dipole parametrization that allows this freedom and fits both G{sub E}{sup n} (including recent data at both low and high four-momentum transfer) and the charge radius well with simple, well-defined parameters. Analysis reveals that the Galster form is essentially a two-parameter approximation to the two-dipole form but becomes degenerate if we try to extend it naturally to three parameters.

  1. Infected Nonunion of Radius and Ulna – Strategy of Approach

    PubMed Central

    Parihar, Mangal; Ahuja, Divya

    2012-01-01

    Introduction: Infected nonunion of radius and ulna are rare but difficult problems to deal. We report a case of successfully managed infected non-unonion of forearm bones and the reasoning behind strategy of approach to the case. Case Report: 42 year old female presented with history of closed forearm fracture three months back for which she was operated with open reduction and internal fixation using dynamic compression plate. There was pain and fever post-surgery and discharge and wound gape. This was treated with resuturing of the wound and oral antibiotics. She continued to have pain fever and discharge and consulted another surgeon who removed first the radius plate and then the ulna plate sequentially with stabilisation by external fixation. She presented to us at three months post injury with infected nonunion of radius and ulna with loosening of fixators, sequestrum on radiograph and wristdrop. A staged treatment was planned for her. As first stage debridement, antibiotic Calcium Sulphate cement bead insertion and intramedullary flexible nail fixation. She was given iv antibiotics as per culture report. At 3 months post surgery the infection had settled and pellets were resorbed. Double barrel vascularized fibula graft was used to fill the gap and fixation using long locked plates was done. At one year follow up radiographs showed good healing and clinically patient had a good elbow movements and was able to carry out her daily activities. Conclusions: Proper planning and staged management of such cases helps to achieve goals with good functional outcome.

  2. Conversion of radius of curvature to power (and vice versa)

    NASA Astrophysics Data System (ADS)

    Wickenhagen, Sven; Endo, Kazumasa; Fuchs, Ulrike; Youngworth, Richard N.; Kiontke, Sven R.

    2015-09-01

    Manufacturing optical components relies on good measurements and specifications. One of the most precise measurements routinely required is the form accuracy. In practice, form deviation from the ideal surface is effectively low frequency errors, where the form error most often accounts for no more than a few undulations across a surface. These types of errors are measured in a variety of ways including interferometry and tactile methods like profilometry, with the latter often being employed for aspheres and general surface shapes such as freeforms. This paper provides a basis for a correct description of power and radius of curvature tolerances, including best practices and calculating the power value with respect to the radius deviation (and vice versa) of the surface form. A consistent definition of the sagitta is presented, along with different cases in manufacturing that are of interest to fabricators and designers. The results make clear how the definitions and results should be documented, for all measurement setups. Relationships between power and radius of curvature are shown that allow specifying the preferred metric based on final accuracy and measurement method. Results shown include all necessary equations for conversion to give optical designers and manufacturers a consistent and robust basis for decision-making. The paper also gives guidance on preferred methods for different scenarios for surface types, accuracy required, and metrology methods employed.

  3. Stokes radius determination of radioiodinated polypeptide hormones by gel filtration

    SciTech Connect

    Ribela, M.T.; Bartolini, P.

    1988-11-01

    A simple technique for determination of the molecular (Stokes) radius of radioiodinated proteins was developed using the same column and chromatographic conditions employed in routine radioimmunoassay tracer purification. The calibration curve for five radioiodinated standard proteins presented a highly significant correlation (r = -0.996; P less than 0.001) and allowed precise molecular radius determination for labeled human growth hormone (hGH), luteotropin (hLH), follicle-stimulating hormone (hFSH), thyrotropin (hTSH), prolactin (hPRL), and corticotropin (hACTH), enabling detection of differences of the order of +/- 3%. The validity of the method was verified by determining the molecular radius of hGH in both ''cold'' (unlabeled standards and unknowns) and ''hot'' (radioiodinated standards and unknowns) systems. The technique can be applied in a very simple manner, requiring just one simple additional calibration run before Sephadex G-100 tracer purification. Furthermore, it can be applied to any protein, even when only extremely limited amounts are available. Since the standards and unknowns are labeled and chromatographed under identical conditions, potential common alterations of the molecule due to oxidation, iodine incorporation, tracer-carrier interactions, etc., are automatically corrected for.

  4. Distal Locking Screws for Intramedullary Nailing of Tibial Fractures.

    PubMed

    Agathangelidis, Filon; Petsatodis, Georgios; Kirkos, John; Papadopoulos, Pericles; Karataglis, Dimitrios; Christodoulou, Anastasios

    2016-01-01

    Recently introduced tibial intramedullary nails allow a number of distal screws to be used to reduce the incidence of malalignment and loss of fixation of distal metaphyseal fractures. However, the number of screws and the type of screw configuration to be used remains obscure. This biomechanical study was performed to address this question. Thirty-six Expert tibial nails (Synthes, Oberdorf, Switzerland) were introduced in composite bone models. The models were divided into 4 groups with different distal locking configurations ranging from 2 to 4 screws. A 7-mm gap osteotomy was performed 72 mm from the tibial plafond to simulate a 42-C3 unstable distal tibial fracture. Each group was divided in 3 subgroups and underwent nondestructive biomechanical testing in axial compression, coronal bending, and axial torsion. The passive construct stiffness was measured and statistically analyzed with one-way analysis of variance. Although some differences were noted between the stiffness of each group, these were not statistically significant in compression (P=.105), bending (P=.801), external rotation (P=.246), and internal rotation (P=.370). This in vitro study showed that, when using the Expert tibial nail for unstable distal tibial fractures, the classic configuration of 2 parallel distal screws could provide the necessary stability under partial weight-bearing conditions. PMID:26840700

  5. The distal residue-CO interaction in carbonmonoxy myoglobins: a molecular dynamics study of two distal histidine tautomers.

    PubMed Central

    Jewsbury, P; Kitagawa, T

    1994-01-01

    Four independent 90 ps molecular dynamics simulations of sperm-whale wild-type carbonmonoxy myoglobin (MbCO) have been calculated using a new AMBER force field for the haem prosthetic group. Two trajectories have the distal 64N delta nitrogen protonated, and two have the 64N epsilon nitrogen protonated; all water molecules within 16 A of the carbonyl O are included. In three trajectories, the distal residue remains part of the haem pocket, with the protonated distal nitrogen pointing into the active site. This is in contrast with the neutron diffraction crystal structure, but is consistent with the solution phase CO stretching frequencies (upsilon CO) of MbCO and various of its mutants. There are significant differences in the "closed" pocket structures found for each tautomer: the 64N epsilon H trajectories both show stable distal-CO interactions, whereas the 64N delta H tautomer) has a weaker interaction resulting in a more mobile distal side chain. One trajectory (a 64N delta H tautomer) has the distal histidine moving out into the "solvent", leaving the pocket in an "open" structure, with a large unhindered entrance to the active site. These trajectories suggest that the three upsilon CO frequencies observed for wild-type MbCO in solution, rather than representing significantly different Fe-C-O geometries as such, arise from three different haem pocket structures, each with different electric fields at the ligand. Each pocket structure corresponds to a different distal histidine conformer: the A3 band to the 64N epsilon H tautomer, the A1,2 band to the 64N delta H tautomer, and the A0 band to the absence of any significant interaction with the distal side chain. PMID:7696465

  6. Maximum wind radius estimated by the 50 kt radius: improvement of storm surge forecasting over the Western North Pacific

    NASA Astrophysics Data System (ADS)

    Takagi, H.; Wu, W.

    2015-10-01

    Even though the maximum wind radius (Rmax) is an important parameter in determining the intensity and size of tropical cyclones, it has been overlooked in previous storm surge studies. This research reviewed the existing estimation methods of Rmax based on the central pressure or maximum wind speed. These over or underestimated Rmax because of the substantial variety of the data, though an average radius could be moderately estimated. Alternatively, we proposed an Rmax estimation method based on the radius of the 50 knot wind (R50). The data obtained during the passage of strong typhoons by a meteorological station network in the Japanese archipelago enabled us to derive the following formula, Rmax = 0.23R50. Although this new method substantially improved the estimation of Rmax compared to the existing models, an estimation error was unavoidable because of fundamental uncertainties regarding the typhoon's structure or insufficient number of available typhoon data. In fact, a numerical simulation from 2013 Typhoon Haiyan demonstrated a substantial difference in the storm surge height for different Rmax. Therefore, the variability of Rmax should be taken into account in storm surge simulations, independently of the model used, to minimize the risk of over or underestimation of storm surges. The proposed method is expected to increase the reliability of storm surge prediction and contribute to disaster risk management, particularly in the Western North Pacific, including countries such as Japan, China, Taiwan, Philippines, and Vietnam.

  7. Arthroplasty of the distal ulna distal in managing patients with post-traumatic disorders of the distal radioulnar joint: measurement of quality of life☆

    PubMed Central

    Aita, Marcio Aurélio; Ibanez, Daniel Schneider; Saheb, Gabriel Cunha Barbosa; Alves, Rafael Saleme

    2015-01-01

    Objective To measure the quality of life and clinical–functional results from patients diagnosed with osteoarthrosis of the distal radioulnar joint who underwent surgical treatment using the technique of total arthroplasty of the ulna, with a total or partial Ascension® prosthesis of the distal ulna. Methods Ten patients were evaluated after 12 months of follow-up subsequent to total or partial arthroplasty of the distal ulna. All of them presented post-traumatic osteoarthrosis and/or chronic symptomatic instability of the distal radioulnar joint. The study was prospective. Seven patients had previously undergone wrist procedures (two cases with Darrach, three with Sauvé–Kapandji and two with ligament reconstruction of the fibrocartilage complex) and three presented fractures of the distal ulna that evolved with pain, instability and osteoarthrosis of the distal radioulnar joint. The following were assessed: quality of life (DASH scale); percentage degree of palm grip strength (kgf) and pronosupination range of motion in relation to the unaffected side; pain (VAS); return to work; subjective evaluation of radiography; and complications. Results The patients presented a mean range of motion of 174.5° (normal side: 180°). Quality of life was analyzed by applying the DASH questionnaire and the mean value found was 5.9. The mean pain score using the VAS was 2.3. The mean degree of palm grip strength (kgf) was 50.7, which represented 90.7% of the strength on the unaffected side. The complication rate was 10%: this patient presented slight dorsal instability of the ulna and persistent pain, and did not return to work. This patient is still being followed up in the outpatient clinic and occupational therapy sector, with little improvement. He does not wish to undergo a new procedure. The mean length of follow-up was 16.8 months, with a minimum of 10 and maximum of 36 months. Conclusion This concept is subject to the test of time. Implantation of a prosthesis is a

  8. Distal gap junctions and active dendrites can tune network dynamics.

    PubMed

    Saraga, Fernanda; Ng, Leo; Skinner, Frances K

    2006-03-01

    Gap junctions allow direct electrical communication between CNS neurons. From theoretical and modeling studies, it is well known that although gap junctions can act to synchronize network output, they can also give rise to many other dynamic patterns including antiphase and other phase-locked states. The particular network pattern that arises depends on cellular, intrinsic properties that affect firing frequencies as well as the strength and location of the gap junctions. Interneurons or GABAergic neurons in hippocampus are diverse in their cellular characteristics and have been shown to have active dendrites. Furthermore, parvalbumin-positive GABAergic neurons, also known as basket cells, can contact one another via gap junctions on their distal dendrites. Using two-cell network models, we explore how distal electrical connections affect network output. We build multi-compartment models of hippocampal basket cells using NEURON and endow them with varying amounts of active dendrites. Two-cell networks of these model cells as well as reduced versions are explored. The relationship between intrinsic frequency and the level of active dendrites allows us to define three regions based on what sort of network dynamics occur with distal gap junction coupling. Weak coupling theory is used to predict the delineation of these regions as well as examination of phase response curves and distal dendritic polarization levels. We find that a nonmonotonic dependence of network dynamic characteristics (phase lags) on gap junction conductance occurs. This suggests that distal electrical coupling and active dendrite levels can control how sensitive network dynamics are to gap junction modulation. With the extended geometry, gap junctions located at more distal locations must have larger conductances for pure synchrony to occur. Furthermore, based on simulations with heterogeneous networks, it may be that one requires active dendrites if phase-locking is to occur in networks formed

  9. Semi-rigid ureteroscopy: Proximal versus distal ureteral stones

    PubMed Central

    Alameddine, Mahmoud; Azab, Mohamad M.; Nassir, Anmar A.

    2016-01-01

    Objective: To evaluate the safety and efficacy of semi-rigid ureteroscopy in proximal and distal ureteral stones, and to compare the operative and perioperative characteristics between the two stone groups. Materials and Methods: We retrospectively reviewed the medical records of patients who underwent semi-rigid ureteroscopy for management of ureteral stones at the International Medical Center between June 2007 and September 2012. All stones were fragmented using Holmium: yttrium-aluminum-garnet (YAG) laser lithotripter. Stones located above the pelvic brim are considered proximal and below it are distal. Results: One hundred and ninety-one patients were included. One hundred and three patients (54%) underwent ureteroscopy for proximal stones and 88 (46%) for distal stones. The stone size in the proximal group was 10 mm (±5.5) versus 8.6 mm (±5) in the distal group. The initial stone-free rate for proximal and distal calculi were 89–98.2%, respectively. The perioperative complication rate was higher in the proximal group 10% compared to the distal group which is 1.5% (P = 0.06). Both groups have the same average of hospital stay 1.2 days. Conclusion: Although there is a clinical difference between proximal and distal calculi groups in terms of complication and stone-free rates, this difference remained statistically insignificant (P = 0.06). Using a smaller caliber semi-rigid ureteroscopy combined with Holmium-YAG laser can be carried out as a day care procedure and showed a slightly higher risk in patients with proximal ureteral calculi which should be explained to the patient PMID:26834409

  10. Measurement of Capillary Radius and Contact Angle within Porous Media.

    PubMed

    Ravi, Saitej; Dharmarajan, Ramanathan; Moghaddam, Saeed

    2015-12-01

    The pore radius (i.e., capillary radius) and contact angle determine the capillary pressure generated in a porous medium. The most common method to determine these two parameters is through measurement of the capillary pressure generated by a reference liquid (i.e., a liquid with near-zero contact angle) and a test liquid. The rate of rise technique, commonly used to determine the capillary pressure, results in significant uncertainties. In this study, we utilize a recently developed technique for independently measuring the capillary pressure and permeability to determine the equivalent minimum capillary radii and contact angle of water within micropillar wick structures. In this method, the experimentally measured dryout threshold of a wick structure at different wicking lengths is fit to Darcy's law to extract the maximum capillary pressure generated by the test liquid. The equivalent minimum capillary radii of different wick geometries are determined by measuring the maximum capillary pressures generated using n-hexane as the working fluid. It is found that the equivalent minimum capillary radius is dependent on the diameter of pillars and the spacing between pillars. The equivalent capillary radii of micropillar wicks determined using the new method are found to be up to 7 times greater than the current geometry-based first-order estimates. The contact angle subtended by water at the walls of the micropillars is determined by measuring the capillary pressure generated by water within the arrays and the measured capillary radii for the different geometries. This mean contact angle of water is determined to be 54.7°. PMID:26538412

  11. Ground solar radius survey in view of microsatellite missions

    NASA Astrophysics Data System (ADS)

    Delmas, C.; Morand, F.; Laclare, F.; Irbah, A.; Thuillier, G.; Bourget, P.

    For the last 25 years, ground time series of the solar radius have shown (different) apparent variations according to different instruments. The origin of these variations may search in the observer, the instrument, the atmosphere and up to the sun. Ground instruments are automated to reduce the “personnal equation” and place that origin in the atmosphere and/or in the sun. Astrometric satellites scheduled at the end of this decade will perform non ambiguous diameter measurements. A survey of the Solar radius has been initiated in 1975 by Francis Laclare, at the Calern site of the Observatoire de la Côte d’Azur, which have been chosen for hosting the ground segment of the Centre National d’Etudes Spatiales (CNES) Microsatellite PICARD mission, to be launched in 2008. This reference series was obtained by Visual observations of the Sun, with a Solar Astrolabe whose metrological character has to be stressed. Considering the Visual series results, we have compared the solar diameter variations with the solar activity cycle, and we found an opposite phase, for the whole series and at the different times of the cycles. Parallel to that series, CCD measurements were made with the same instrument and gave results which are perfectly blended together, within our quoted uncertainties. Located next to the Solar Astrolabe, DORAYSOL (Définition et Observation du Rayon Solaire) is a second generation instrument, which keeps the major features of the design of its predecessor and, which is designed to increase the number of CCD measurements and to be eventually automated. Since 1999, both series overlap correctly within our quoted uncertainties. Some information is added to explain the pattern of the PICARD mission ground segment, next to those instruments at Calern Observatory, as well as the international network intended to carry out the Sun’s Radius ground survey (R2S3: Réseau de Suivi au Sol du Rayon Solaire).

  12. HABITABILITY OF EXOMOONS AT THE HILL OR TIDAL LOCKING RADIUS

    SciTech Connect

    Hinkel, Natalie R.; Kane, Stephen R.

    2013-09-01

    Moons orbiting extrasolar planets are the next class of object to be observed and characterized for possible habitability. Like the host-planets to their host-star, exomoons have a limiting radius at which they may be gravitationally bound, or the Hill radius. In addition, they also have a distance at which they will become tidally locked and therefore in synchronous rotation with the planet. We have examined the flux phase profile of a simulated, hypothetical moon orbiting at a distant radius around the confirmed exoplanets {mu} Ara b, HD 28185 b, BD +14 4559 b, and HD 73534 b. The irradiated flux on a moon at its furthest, stable distance from the planet achieves its largest flux gradient, which places a limit on the flux ranges expected for subsequent (observed) moons closer in orbit to the planet. We have also analyzed the effect of planetary eccentricity on the flux on the moon, examining planets that traverse the habitable zone either fully or partially during their orbit. Looking solely at the stellar contributions, we find that moons around planets that are totally within the habitable zone experience thermal equilibrium temperatures above the runaway greenhouse limit, requiring a small heat redistribution efficiency. In contrast, exomoons orbiting planets that only spend a fraction of their time within the habitable zone require a heat redistribution efficiency near 100% in order to achieve temperatures suitable for habitability. This means that a planet does not need to spend its entire orbit within the habitable zone in order for the exomoon to be habitable. Because the applied systems comprise giant planets around bright stars, we believe that the transit detection method is most likely to yield an exomoon discovery.

  13. Concentration at a radius for Hardy class functions

    NASA Astrophysics Data System (ADS)

    Kelly, Brian P.

    2007-03-01

    In this paper we establish the fundamental properties of concentration at a radius for functions in the classical Hardy space on the unit disk. For f(z) which is not identically zero and given r, 0

  14. Trajectory Calculator for Finite-Radius Cutter on a Lathe

    NASA Technical Reports Server (NTRS)

    Savchenkov, Anatoliy; Strekalov, Dmitry; Yu, Nan

    2009-01-01

    A computer program calculates the two-dimensional trajectory (radial vs. axial position) of a finite-radius-of-curvature cutting tool on a lathe so as to cut a workpiece to a piecewise-continuous, analytically defined surface of revolution. (In the original intended application, the tool is a diamond cutter, and the workpiece is made of a crystalline material and is to be formed into an optical resonator disk.) The program also calculates an optimum cutting speed as F/L, where F is a material-dependent empirical factor and L is the effective instantaneous length of the cutting edge.

  15. Progress towards a measurement of the proton radius in hydrogen

    NASA Astrophysics Data System (ADS)

    Vutha, A. C.; Bezginov, N.; Ferchichi, I.; George, M. C.; Weel, M.; Storry, C. H.; Hessels, E. A.

    2014-05-01

    The proton's charge radius continues to have a 7 standard-deviation discrepancy between its CODATA value and determinations from muonic hydrogen measurements. Improved measurements in atomic hydrogen will shed light on this discrepancy. We present a novel experimental scheme, using frequency-offset separated oscillatory fields in standing-wave waveguides, to measure the n=2 Lamb shift in a fast metastable hydrogen beam. We report on our progress, including our first observations of microwave transitions in a fast metastable beam and high signal-to-noise ratio detection in a large-solid-angle photoionization detector. We acknowledge funding from NSERC, CFI, CRC, ORF, and NIST.

  16. Method and apparatus for logging short radius horizontal drainholes

    SciTech Connect

    Taylor, D.E.

    1991-04-30

    This patent describes an apparatus for use in logging a short radius horizontal drainhole. It comprises: a tubing string having a low portion; the lower portion of the tubing string including sensor support means therein; the lower portion of the tubing string containing openings communicating with the interior thereof in the vicinity of the sensor support means to thereby exposed the interior to the pressure and temperature conditions of the horizontal drainhole; and the lower portion of the tubing string including an end portion extending transversely of the tubing sting.

  17. Radius of gyration and intrinsic viscosity of polyelectrolyte solutions

    SciTech Connect

    Milas, M.; Borsali, R.; Rinaudo, M.

    1993-12-31

    Relatively low molecular weights polyelectrolytes (10{sup 4}-10{sup 6}) behave as worm-like chain when electrostatic repulsions are assumed to govern the excluded volume parameter. Under such conditions, predictions of chain expansion and effect of polyelectrolyte concentrations are made assuming that unperturbed dimensions could be obtained at infinite salt content. Experimental studies of an ionic polysaccharide, namely the Na-hyaluronate, were done and the values obtained for the radius of gyration as well as the intrinsic viscosity at different charge densities are in good agreement with the predictions.

  18. A New Orthodontic Appliance with a Mini Screw for Upper Molar Distalization

    PubMed Central

    2016-01-01

    The aim of this study is to present a new upper molar distalization appliance called Cise distalizer designed as intraoral device supported with orthodontic mini screw for upper permanent molar distalization. The new appliance consists of eight main components. In order to understand the optimum force level, the appliance under static loading is tested by using strain gage measurement techniques. Results show that one of the open coils produces approximately 300 gr distalization force. Cise distalizer can provide totally 600 gr distalization force. This range of force level is enough for distalization of upper first and second molar teeth. PMID:27528796

  19. Open reduction and internal fixation compared to closed reduction and external fixation in distal radial fractures

    PubMed Central

    Kopylov, Philippe; Geijer, Mats; Tägil, Magnus

    2009-01-01

    Background and purpose In unstable distal radial fractures that are impossible to reduce or to maintain in reduced position, the treatment of choice is operation. The type of operation and the choice of implant, however, is a matter of discussion. Our aim was to investigate whether open reduction and internal fixation would produce a better result than traditional external fixation. Methods 50 patients with an unstable or comminute distal radius fracture were randomized to either closed reduction and bridging external fixation, or open reduction and internal fixation using the TriMed system. The primary outcome parameter was grip strength, but the patients were followed for 1 year with objective clinical assessment, subjective outcome using DASH, and radiographic examination. Results At 1 year postoperatively, grip strength was 90% (SD 16) of the uninjured side in the internal fixation group and 78% (17) in the external fixation group. Pronation/supination was 150° (15) in the internal fixation group and 136° (20) in the external fixation group at 1 year. There were no differences in DASH scores or in radiographic parameters. 5 patients in the external fixation group were reoperated due to malunion, as compared to 1 in the internal fixation group. 7 other cases were classified as radiographic malunion: 5 in the external fixation group and 2 in the internal fixation group. Interpretation Internal fixation gave better grip strength and a better range of motion at 1 year, and tended to have less malunions than external fixation. No difference could be found regarding subjective outcome. PMID:19857180

  20. Geometric morphometric analysis reveals sexual dimorphism in the distal femur.

    PubMed

    Cavaignac, Etienne; Savall, Frederic; Faruch, Marie; Reina, Nicolas; Chiron, Philippe; Telmon, Norbert

    2016-02-01

    An individual's sex can be determined by the shape of their distal femur. The goal of this study was to show that differences in distal femur shape related to sexual dimorphism could be identified, visualized, and quantified using 3D geometric morphometric analysis. Geometric morphometric analysis was carried out on CT scans of the distal femur of 256 subjects living in the south of France. Ten landmarks were defined on 3D reconstructions of the distal femur. Both traditional metric and geometric morphometric analyses were carried out on these bone reconstructions; these analyses identified trends in bone shape in sex-based subgroups. Sex-related differences in shape were statistically significant. The subject's sex was correctly assigned in 77.3% of cases using geometric morphometric analysis. This study has shown that geometric morphometric analysis of the distal femur is feasible and has revealed sexual dimorphism differences in this bone segment. This reliable, accurate method could be used for virtual autopsy and be used to perform diachronic and interethnic comparisons. Moreover, this study provides updated morphometric data for a modern population in the south of France. PMID:26743712

  1. A New Radiographic Classification for Distal Shaft Fifth Metatarsal Fractures.

    PubMed

    Soave, Ronald L; Bleazey, Scott; Rudowsky, Asher; Clarke, Roxann V; Avino, Attilio; Kuchar, David J

    2016-01-01

    In the present report, a new radiographic classification for distal shaft fractures of the fifth metatarsal is presented. The classification system is based on a review of 79 spiral oblique fractures of the distal shaft of the fifth metatarsal. The sample was grouped into "grades" of deformity according to the configuration of the fracture and the amount of displacement observed for each injury. Four distinct fracture configurations emerged as a result of our radiographic analysis, and these were categorized as grades I, IIA, IIB, and III. Grade II fractures were most prevalent and accounted for 49% of the cases reviewed. Grade I and III fractures accounted for 29% and 22% of the distal fifth metatarsal fractures, respectively. To our knowledge, a classification system for fractures of the distal shaft of the fifth metatarsal has not been previously reported. The radiographic classification that we have proposed is intended to aid surgeons treating and discussing fractures localized to the distal portion of the fifth metatarsal. PMID:27079304

  2. An intrinsic timer specifies distal structures of the vertebrate limb

    PubMed Central

    Saiz-Lopez, Patricia; Chinnaiya, Kavitha; Campa, Victor M.; Delgado, Irene; Ros, Maria A.; Towers, Matthew

    2015-01-01

    How the positional values along the proximo-distal axis (stylopod-zeugopod-autopod) of the limb are specified is intensely debated. Early work suggested that cells intrinsically change their proximo-distal positional values by measuring time. Recently, however, it is suggested that instructive extrinsic signals from the trunk and apical ectodermal ridge specify the stylopod and zeugopod/autopod, respectively. Here, we show that the zeugopod and autopod are specified by an intrinsic timing mechanism. By grafting green fluorescent protein-expressing cells from early to late chick wing buds, we demonstrate that distal mesenchyme cells intrinsically time Hoxa13 expression, cell cycle parameters and the duration of the overlying apical ectodermal ridge. In addition, we reveal that cell affinities intrinsically change in the distal mesenchyme, which we suggest results in a gradient of positional values along the proximo-distal axis. We propose a complete model in which a switch from extrinsic signalling to intrinsic timing patterns the vertebrate limb. PMID:26381580

  3. The Role of Fibular Fixation in Distal Tibial Fractures

    PubMed Central

    Antin, S.M.; Akkimaradi, R.C.; Policepatil, Prasad; Naikawadi, Girish.

    2016-01-01

    Introduction Lower tibial extra-articular fractures of lower tibial extra-articular bone, treated with Minimally Invasive Percutaneous plate osteosynthesis (MIPPO) may have certain advantages, though the modiality is technically demanding. Aim To assess the results of distal tibial fractures treated with minimally invasive plate osteosynthesis utilizing precontoured dital medial tibial locking plates without fibular fracture fixation. Material and Methods The study was conducted during the period from june 2009 to june 2011. A series of 30 patients (22 men and 8 women) with concurrent distal tibia and fibula fractures who underwent minimally plate osteosynthesis utilizing precontoured distal tibial medial locking plates without fibular fracture fixation have been reviewed after surgery. 14 fractures were type A1, 6 type A2, and 4 type A3. Open Grade II fracture were 4 and Open Grade IIIA fracture is2. Results The mean follow-up duration was 2 years. The mean time to bone union was 20 weeks. No patient had shortening, hardware breakdown, or deep-seated infection. Out of 30 patients, 24 had excellent results, 6 had good results. Four patients had palpable screws, two patient had blisters which subsidized with conservative treatment. This minimally invasive technique for treatment of distal tibial fractures proved to be a feasible and worthwhile method of stabilization. Conclusion It appears from our study that fibula fixation is not required in non-syndesmotic distal metaphyseal extra articular fractures when fixed by locking plate using minimal invasive techniques. PMID:27190908

  4. Ejecta emplacement: from distal to proximal

    NASA Astrophysics Data System (ADS)

    Artemieva, N.

    2008-09-01

    Introduction Most part of impact ejecta is deposited ballistically at some distance from a crater, defined by ejection velocity V and ejection angle α: d=v2sinα/g. In case of giant impacts, planetary curvature should be taken into account [1]. Combined with ejecta scaling [2], these relations allow to define ejecta thickness as a function of distance. Ejecta from large craters are deposited at velocity high enough to mobilize substrate material and to thicken ejecta deposits [3]. Ballistic approximation is valid for airless bodies (if impact vaporization is not vast) or for proximal ejecta of large impact craters, where ejecta mass per unit area is substantially greater than the mass of involved vapor/atmosphere (M-ratio). Deposition of distal ejecta, in which ejecta mass is negligible compared to the atmosphere, may be also treated in a simplified manner, i.e. as 1) passive motion of ejected particles within an impact plume and 2) later, as sedimentation of particles in undisturbed atmosphere (equilibrium between gravity and drag). In all intermediate M-ratio values, impact ejecta move like a surge, i.e. dilute suspension current in which particles are carried in turbulent flows under the influence of gravity. Surges are well-known for near-surface explosive tests, described in detail for volcanic explosions (Plinian column collapse, phreato-magmatic eruption, lateral blast), and found in ejecta from the Chicxulub [4] and the Ries [5]. Important aspects of surge transport include its ability to deposit ejecta over a larger area than that typical of continuous ballistic ejecta and to create multiple ejecta layers. Numerical model Two-phase hydrodynamics. Surges should be modeled in the frame of two-phase hydrodynamics, i.e. interaction between solid/molten particles and atmospheric gas/impact vapor should be taken into account. There are two techniques of solving equations for dust particle motion in a gas flow. The first one describes solid/molten particles as a

  5. A variable-radius measure of local hospital market structure.

    PubMed Central

    Phibbs, C S; Robinson, J C

    1993-01-01

    OBJECTIVE. To provide a radius measure of the structure of local hospital markets that varies with hospital characteristics and is available for all hospitals in the United States. DATA SOURCES. 1982 American Hospital Association (AHA) Survey of Hospitals, 1982 Area Resource File (ARF), and 1983 California Office of Statewide Health Planning and Development (OSHPD) discharge abstracts. STUDY DESIGN. The OSHPD data were used to measure the radii necessary to capture 75 percent and 90 percent of each hospital's admissions. These radii were used as the dependent variables in regression models in which the independent variables were from the AHA and ARF. To estimate predicted market radii, the estimated parameters from the California models were applied to all nonfederal, short-term, general hospitals in the continental United States. These radii were used to define each hospital's service area, and all other hospitals within the calculated radii were considered potential competitors. Using this definition, we calculated two measures of local market structure: the number of other hospitals within the radius and a Herfindahl-Hirschman Index based on the distribution of hospital bed shares in the market. DATA EXTRACTION METHODS. These measures were calculated for all nonfederal, short-term, acute care hospitals in the continental United States for whom complete data were available (N = 4,884). CONCLUSIONS. These measures are available from the authors on computer-readable diskette, matched to hospital identifiers. PMID:8344822

  6. The energy-weighted sum rule and the nuclear radius

    NASA Astrophysics Data System (ADS)

    Schröder, Hans Peter

    2015-09-01

    The energy-weighted integrated cross-section for photon absorption --known as sum rule -- is under certain conditions proportional to the mean square nuclear radius (Levinger, Bethe (Phys. Rev. 78, 115 (1950))). Due to the energy weight factor the low-energy absorption components are emphasized and the dipole transitions in the region of giant resonances contribute enhanced at . Thus, the cross-section of the full interaction can be replaced in good approximation by the dipole cross-section. Under these aspects, we have calculated and the radii of various gg-nuclei. For our purpose, we have chosen a simple shell model where the integrals can be solved analytically, and the contributions of uncorrelated functions and correlation corrections can be shown explicitly. The mean square radius as a function of differs by a factor of 1.5/0.87 from the previous result of Levinger and Kent (Phys. Rev. 95, 418 (1954)) without correlation corrections. Plotting the function of the correlation corrections and the uncorrelated function as a ratio it shows that tends towards a limit. Finally, our results for the radii of gg-nuclei are in good agreement with recent experiments (I. Angeli, K.P. Marinova, At. Data Nucl. Data Tables 99, 69 (2013)).

  7. Artificial gravity: head movements during short-radius centrifugation

    NASA Technical Reports Server (NTRS)

    Young, L. R.; Hecht, H.; Lyne, L. E.; Sienko, K. H.; Cheung, C. C.; Kavelaars, J.

    2001-01-01

    Short-radius centrifugation is a potential countermeasure to long-term weightlessness. Unfortunately, head movements in a rotating environment induce serious discomfort, non-compensatory vestibulo-ocular reflexes, and subjective illusions of body tilt. In two experiments we investigated the effects of pitch and yaw head movements in participants placed supine on a rotating bed with their head at the center of rotation, feet at the rim. The vast majority of participants experienced motion sickness, inappropriate vertical nystagmus and illusory tilt and roll as predicted by a semicircular canal model. However, a small but significant number of the 28 participants experienced tilt in the predicted plane but in the opposite direction. Heart rate was elevated following one-second duration head turns. Significant adaptation occurred following a series of head turns in the light. Vertical nystagmus, motion sickness and illusory tilt all decreased with adaptation. Consequences for artificial gravity produced by short-radius centrifuges as a countermeasure are discussed. Grant numbers: NCC 9-58. c 2001. Elsevier Science Ltd. All rights reserved.

  8. Pion loop contribution to the electromagnetic pion charge radius

    SciTech Connect

    Roberts, C.D.; Bender, A.; Alkofer, R.

    1995-08-01

    There is a widely held misconception, based on a misrepresentation of the application of chiral perturbation theory, that the electromagnetic structure of the pion is dominated by the pion`s own pion-cloud. To clarify this the Global Color-symmetry Model (GCM), was used to calculate the electromagnetic charge radius of the pion. In this calculation the contributions from the quark core and pion loop were identified and compared. It was shown explicitly that the divergence of the charge radius in the chiral limit is due solely to the pion loop and that, at the physical value of the pion mass, this loop contributes less than 15% {l_angle}r{sub {pi}}{sup 2}{r_angle}; i.e. the quark core is the dominant determining characteristic for the pion. This suggests that quark-based models that fail to reproduce the m{sub {pi}} divergence of {l_angle}{sub {pi}}{sup 2}{r_angle} nevertheless incorporate the dominant characteristic of the pion: its quark core. The result`s studylend further support to the contention that, away from resonances, the dominant determining characteristic of kinematic and dynamical properties of hadrons is their quark core. A paper describing this work was submitted for publication.

  9. Automated bone age assessment of older children using the radius

    NASA Astrophysics Data System (ADS)

    Tsao, Sinchai; Gertych, Arkadiusz; Zhang, Aifeng; Liu, Brent J.; Huang, Han K.

    2008-03-01

    The Digital Hand Atlas in Assessment of Skeletal Development is a large-scale Computer Aided Diagnosis (CAD) project for automating the process of grading Skeletal Development of children from 0-18 years of age. It includes a complete collection of 1,400 normal hand X-rays of children between the ages of 0-18 years of age. Bone Age Assessment is used as an index of skeletal development for detection of growth pathologies that can be related to endocrine, malnutrition and other disease types. Previous work at the Image Processing and Informatics Lab (IPILab) allowed the bone age CAD algorithm to accurately assess bone age of children from 1 to 16 (male) or 14 (female) years of age using the Phalanges as well as the Carpal Bones. At the older ages (16(male) or 14(female) -19 years of age) the Phalanges as well as the Carpal Bones are fully developed and do not provide well-defined features for accurate bone age assessment. Therefore integration of the Radius Bone as a region of interest (ROI) is greatly needed and will significantly improve the ability to accurately assess the bone age of older children. Preliminary studies show that an integrated Bone Age CAD that utilizes the Phalanges, Carpal Bones and Radius forms a robust method for automatic bone age assessment throughout the entire age range (1-19 years of age).

  10. Comparison of distal and proximal centralising devices in hip arthroplasty

    PubMed Central

    Bezer, M.; Akgulle, A. H.; Saygi, B.; Kocaoğlu, B.; Guven, O.

    2008-01-01

    Centralising devices were introduced to ensure that the prosthesis is implanted in a neutral position and that a cement mantle of optimal thickness is achieved proximally and distally. A distal centralising device (DCD) is compared with a proximal midshaft centralising device (PCD) to test which one provides a more neutral prosthetic alignment. Thirty consecutive patients undergoing hemiarthroplasties for femoral neck fractures were studied prospectively. Patients were blindly randomised to receive either a femoral component with proximal midshaft centraliser or distal centraliser. Both components were implanted following the manufacturer’s protocol. Postoperative true anteroposterior and lateral radiographs were made to assess the stem position. There was no statistically significant difference between the two groups in zones 1, 2, 3, 4, 5, 6 and 7 in both anteroposterior and lateral radiographic measurements. DCP and PCD both have similar centralisation and cement mantle. Future studies should be done to evaluate their long-term effect. PMID:18712387

  11. Dual-incision laparoscopic spleen-preserving distal pancreatectomy

    PubMed Central

    Kim, Eun Young; You, Young Kyoung; Kim, Dong Goo; Lee, Soo Ho; Han, Jae Hyun; Park, Sung Kyun; Na, Gun Hyung

    2015-01-01

    Laparoscopic spleen-preserving distal pancreatectomy has been widely performed for benign and borderline malignancy in the body or tail of the pancreas when there are not oncologic indications for splenectomy. As the need for minimally invasive procedures to reduce postoperative morbidity and improve the quality of life is increasing, many surgeons have attempted to reduce the number of trocars and incision size to minimize access trauma and scarring. Single-port laparoscopic spleen-preserving distal pancreatectomy is the result of these efforts; however it has many limitations such as technical difficulty and prolonged operation time. In this article, we report the first case of dual-incision laparoscopic spleen-preserving distal pancreatectomy, proving that it can be a safe and feasible minimally invasive procedure for benign or borderline malignant tumors in the body or tail of the pancreas. PMID:25741499

  12. Management of radionecrosis of the vulva and distal vagina

    SciTech Connect

    Roberts, W.S.; Hoffman, M.S.; LaPolla, J.P.; Ruas, E.; Fiorica, J.V.; Cavanagh, D. )

    1991-05-01

    Twelve patients were seen between January 1983 and June 1989 with the clinical diagnosis of radionecrosis of the vulva or distal vagina. Seven patients received radiation for vulvar cancer, three for distal vaginal cancer, and two for recurrent endometrial cancer. No patient healed spontaneously and the mean delay in surgical therapy was 8.5 months. The radionecrotic site was treated with local therapy, radical local excision (with or without colostomy), or exenteration. The operative defect was closed primarily in three patients and covered with local flaps or myocutaneous flaps in seven patients. The two patients with local care still have radionecrotic ulcers. One of three patients who were closed primarily continues to have an ulcer. All other patients have healed satisfactorily except one who died after two attempts to correct the problem. Radionecrosis of the vulva and distal vagina should generally be treated surgically.

  13. Isolation and Characterization of Distal Lung Progenitor Cells

    PubMed Central

    Driscoll, Barbara; Kikuchi, Alex; Lau, Allison N.; Lee, Jooeun; Reddy, Raghava; Jesudason, Edwin; Kim, Carla F.; Warburton, David

    2013-01-01

    The majority of epithelial cells in the distal lung of rodents and humans are quiescent in vivo, yet certain cell populations retain an intrinsic capacity to proliferate and differentiate in response to lung injury or in appropriate culture settings, thus giving them properties of stem/progenitor cells. Here, we describe the isolation of two such populations from adult mouse lung: alveolar epithelial type 2 cells (AEC2), which can generate alveolar epithelial type 1 cells, and bronchioalveolar stem cells (BASCs), which in culture can reproduce themselves, as well as generate a small number of other distal lung epithelial cell types. These primary epithelial cells are typically isolated using enzyme digestion, mechanical disruption, and serial filtration. AEC2 and BASCs are distinguished from other distal lung cells by expression of specific markers as detected by fluorescence-activated cell sorting, immunohistochemistry, or a combination of both of these techniques. PMID:22610556

  14. Reverse telescoping in distal skarns at Campiglia Marittima (Italy)

    NASA Astrophysics Data System (ADS)

    Vezzoni, Simone; Dini, Andrea; Rocchi, Sergio

    2014-05-01

    Skarn deposits commonly results from the metasomatic alteration of a rock, usually carbonate-rich, by infiltration of hydrothermal fluids. Most carbonate-hosted skarn deposits show a direct spatial relationship with magmatic intrusions and an intimate relationship with porphyry copper deposits. Their primary mineralogical and geochemical features indicate metasomatism by high-temperature magmatic fluids. Conversely, many distal Pb-Zn-Ag skarns pose an important challenge because there is no apparent association with magmatic intrusions and external, meteoric and/or basinal fluids should become increasingly dominant with increasing distance from the igneous source. Nevertheless recent investigation of distal skarn deposits indicates that ore-forming fluids match the composition of proximal magmatic fluids in granitoid-related mineral deposits. Besides that metal producer (Pb, Zn, Ag, Cu, Fe, W, Sn), skarn deposits can be key to understanding fluid dynamics at the periphery of magmatic-hydrothermal systems, unraveling pathways to hidden ore deposits (e.g porphyry copper). In this scenario, research on distal skarns opens new perspectives for deep mineral exploration and/or modeling of intrusion centered geothermal systems, because they should represent the outer limit of the hydrothermal system dominated by magmatic aqueous fluids. Here we present exceptional evidences from a distal Pb-Zn-Ag skarn deposit in Campiglia Marittima, Italy, where the magma, after having released the metasomatic fluids, fled up chasing its own fluid stream and invading large pockets of the newly formed skarn bodies at shallower level. Detailed underground mapping and petrologic data indicate that, after the formation of a typical distal Pb-Zn-Ag skarn, the intrusion of the parent magma produced prograde reactions in the skarn silicates, mobilization of the Pb-Zn-Ag sulfides and precipitation of a new Cu-Fe sulfide assemblage. This is a very unusual case of reverse telescoping during which

  15. Laparoscopic distal pancreatectomy for adenocarcinoma: safe and reasonable?

    PubMed Central

    Postlewait, Lauren M.

    2015-01-01

    As a result of technological advances during the past two decades, surgeons now use minimally invasive surgery (MIS) approaches to pancreatic resection more frequently, yet the role of these approaches for pancreatic ductal adenocarcinoma resections remains uncertain, given the aggressive nature of this malignancy. Although there are no controlled trials comparing MIS technique to open surgical technique, laparoscopic distal pancreatectomy for pancreatic adenocarcinoma is performed with increasing frequency. Data from retrospective studies suggest that perioperative complication profiles between open and laparoscopic distal pancreatectomy are similar, with perhaps lower blood loss and fewer wound infections in the MIS group. Concerning oncologic outcomes, there appear to be no differences in the rate of achieving negative margins or in the number of lymph nodes (LNs) resected when compared to open surgery. There are limited recurrence and survival data on laparoscopic compared to open distal pancreatectomy for pancreatic adenocarcinoma, but in the few studies that assess long term outcomes, recurrence rates and survival outcomes appear similar. Recent studies show that though laparoscopic distal pancreatectomy entails a greater operative cost, the associated shorter length of hospital stay leads to decreased overall cost compared to open procedures. Multiple new technologies are emerging to improve resection of pancreatic cancer. Robotic pancreatectomy is feasible, but there are limited data on robotic resection of pancreatic adenocarcinoma, and outcomes appear similar to laparoscopic approaches. Additionally fluorescence-guided surgery represents a new technology on the horizon that could improve oncologic outcomes after resection of pancreatic adenocarcinoma, though published data thus far are limited to animal models. Overall, MIS distal pancreatectomy appears to be a safe and reasonable approach to treating selected patients with pancreatic ductal

  16. Volar Stabilization of the Distal Radioulnar Joint for Chronic Instability Using the Pronator Quadratus.

    PubMed

    Lee, Sang Ki; Lee, Jae Won; Choy, Won Sik

    2016-04-01

    In cases of chronic distal radioulnar joint (DRUJ) instability without DRUJ arthritis, reconstruction of the mechanical integrity of the radioulnar ligaments of the triangular fibrocartilage complex has been considered an ideal surgical treatment. However, reconstructive methods have several disadvantages.We evaluated volar stabilization of the DRUJ for chronic instability using the pronator quadratus (PQ) to determine whether it provided (1) proper stability, (2) restored wrist function, (3) was relatively convenient, and (4) was associated with a low complication rate. Altogether, 21 patients with chronic DRUJ instability (12 men, 9 women) with a mean age of 34 years (range, 17-65 years) were enrolled in the study. The diagnostic criteria were as follows: 3 months after the injury, greater than 8 mm of palmar-dorsal translation of the ulna relative to the radius, there was a lack of clear end point resistance compared with the contralateral side, and nonstressed computed tomographic scans provided supporting evidence. Follow-up was at least 12 months (range, 12-38 months). Palmar-dorsal translation of the ulna relative to the radius was decreased significantly from 10 to 4 mm (P = 0.028) and epicenter was increased significantly at the last follow-up [P = 0.015/0.026 (70 degrees of supination/neutral, respectively)]. Wrist range of motion was not significantly different, but grip strength had increased from 72% to 91%. Disabilities of the arm, shoulder, and hand and patient-rated wrist evaluation were also decreased compared with preoperative measurements [34.4 to 12.5/42.7 to 14.7 (disabilities of the arm, shoulder, and hand/patient-rated wrist evaluation, respectively)]. Pronator quadratus advancement volar stabilization provided proper stability, restored wrist function, was relatively convenient, and was associated with few complications. Our experience indicates that it is an acceptable, effective treatment option to reverse DRUJ instability in patients

  17. Management of distal femoral periprosthetic fractures by distal femoral locking plate: A retrospective study.

    PubMed Central

    Thukral, Rajiv; Marya, SKS; Singh, Chandeep

    2015-01-01

    Background: Management of periprosthetic supracondylar femoral fractures is difficult. Osteoporosis, comminution and bone loss, compromise stability with delayed mobility and poor functional outcomes. Open reduction and internal fixation (ORIF) with anatomic distal femoral (DF) locking plate permits early mobilization. However, this usually necessitates bone grafting (BG). Biological fixation using minimally invasive techniques minimizes periosteal stripping and morbidity. Materials and Methods: 31 patients with comminuted periprosthetic DF fractures were reviewed retrospectively from October 2006 to September 2012. All patients underwent fixation using a DF locking compression plate (Synthes). 17 patients underwent ORIF with primary BG, whereas 14 were treated by closed reduction (CR) and internal fixation using biological minimally invasive techniques. Clinical and radiological followup were recorded for an average 36 months. Results: Mean time to union for the entire group was 5.6 months (range 3-9 months). Patients of ORIF group took longer (Mean 6.4 months, range 4.5-9 months) than the CR group (mean 4.6 months, range 3-7 months). Three patients of ORIF and one in CR group had poor results. Mean knee society scores were higher for CR group at 6 months, but nearly identical at 12 months, with similar eventual range of motion. Discussion: Locked plating of comminuted periprosthetic DF fractures permits stable rigid fixation and early mobilization. Fixation using minimally invasive biological techniques minimizes morbidity and may obviate the need for primary BG. PMID:26015610

  18. Distal renal tubular acidosis and amelogenesis imperfecta: A rare association.

    PubMed

    Ravi, P; Ekambaranath, T S; Arasi, S Ellil; Fernando, E

    2013-11-01

    Renal tubular acidosis (RTA) is characterized by a normal anion gap with hyperchloremic metabolic acidosis. Primary distal RTA (type I) is the most common RTA in children. Childhood presentation of distal RTA includes vomiting, failure to thrive, metabolic acidosis, and hypokalemia. Amelogenesis imperfecta (AI) represents a condition where the dental enamel and oral tissues are affected in an equal manner resulting in the hypoplastic or hypopigmented teeth. We report a 10-year-old girl, previously asymptomatic presented with the hypokalemic paralysis and on work-up found out to have type I RTA. The discoloration of teeth and enamel was diagnosed as AI. PMID:24339526

  19. Extreme distal bypass to improve wound healing in Buerger's disease.

    PubMed

    De Caridi, Giovanni; Massara, Mafalda; Villari, Simona; Martelli, Eugenio; Spinelli, Francesco; Grande, Raffaele; Butrico, Lucia; de Franciscis, Stefano; Serra, Raffaele

    2016-02-01

    Thromboangiitis obliterans or Buerger's disease is a rare non-atherosclerotic segmental inflammatory vasculitis that most commonly involves small and medium-sized arteries, veins and nerves of the extremities, and generally affects young tobacco smokers. A 53-year-old man was found to have critical ischaemia of his left lower limb with foot gangrene. He underwent extremely distal surgical revascularisation using a great saphenous vein bypass graft. The choice of a very distal artery as run-off vessel promoted a faster wound healing and pain relief, with improvement in quality of life. PMID:24612761

  20. Hydrodynamic radius fluctuations in model DNA-grafted nanoparticles

    NASA Astrophysics Data System (ADS)

    Vargas-Lara, Fernando; Starr, Francis W.; Douglas, Jack F.

    2016-05-01

    We utilize molecular dynamics simulations (MD) and the path-integration program ZENO to quantify hydrodynamic radius (Rh) fluctuations of spherical symmetric gold nanoparticles (NPs) decorated with single-stranded DNA chains (ssDNA). These results are relevant to understanding fluctuation-induced interactions among these NPs and macromolecules such as proteins. In particular, we explore the effect of varying the ssDNA-grafted NPs structural parameters, such as the chain length (L), chain persistence length (lp), NP core size (R), and the number of chains (N) attached to the nanoparticle core. We determine Rh fluctuations by calculating its standard deviation (σRh) of an ensemble of ssDNA-grafted NPs configurations generated by MD. For the parameter space explored in this manuscript, σR h shows a peak value as a function of N, the amplitude of which depends on L, lp and R, while the broadness depends on R.

  1. Inductive voltage adder (IVA) for submillimeter radius electron beam

    SciTech Connect

    Mazarakis, M.G.; Poukey, J.W.; Maenchen, J.E.

    1996-12-31

    The authors have already demonstrated the utility of inductive voltage adder accelerators for production of small-size electron beams. In this approach, the inductive voltage adder drives a magnetically immersed foilless diode to produce high-energy (10--20 MeV), high-brightness pencil electron beams. This concept was first demonstrated with the successful experiments which converted the linear induction accelerator RADLAC II into an IVA fitted with a small 1-cm radius cathode magnetically immersed foilless diode (RADLAC II/SMILE). They present here first validations of extending this idea to mm-scale electron beams using the SABRE and HERMES-III inductive voltage adders as test beds. The SABRE experiments are already completed and have produced 30-kA, 9-MeV electron beams with envelope diameter of 1.5-mm FWHM. The HERMES-III experiments are currently underway.

  2. Radius of the ρ meson determined from its decay constant

    NASA Astrophysics Data System (ADS)

    Krutov, A. F.; Polezhaev, R. G.; Troitsky, V. E.

    2016-02-01

    We present a unified model describing electroweak properties of the π and ρ mesons. Using a general method of the relativistic parametrization of matrix elements of local operators, adjusted for the nondiagonal in the total angular momentum case, we calculate the ρ -meson lepton-decay constant fρ using the same parameters of free constituent quarks that have ensured exclusively good results for the π meson previously. The only free parameter, characterizing quark interactions, which include an additional spin-spin contribution and hence differ from the π -meson case, is fixed by matching the decay constant to its experimental value. The mean square charge radius is calculated, ⟨rρ2⟩=(0.56 ±0.04 ) fm2 . This result confirms, for the ρ -meson case, the conjecture of equality between electromagnetic and strong radii of hadrons. This conjecture was tested previously for proton, π and K mesons.

  3. Muonic bound systems, virtual particles, and proton radius

    NASA Astrophysics Data System (ADS)

    Jentschura, U. D.

    2015-07-01

    The proton radius puzzle questions the self-consistency of theory and experiment in light muonic and electronic bound systems. Here we summarize the current status of virtual particle models as well as Lorentz-violating models that have been proposed in order to explain the discrepancy. Highly charged one-electron ions and muonic bound systems have been used as probes of the strongest electromagnetic fields achievable in the laboratory. The average electric field seen by a muon orbiting a proton is comparable to hydrogenlike uranium and, notably, larger than the electric field in the most advanced strong-laser facilities. Effective interactions due to virtual annihilation inside the proton (lepton pairs) and process-dependent corrections (nonresonant effects) are discussed as possible explanations of the proton size puzzle. The need for more experimental data on related transitions is emphasized.

  4. Inclusive jet spectrum for small-radius jets

    NASA Astrophysics Data System (ADS)

    Dasgupta, Mrinal; Dreyer, Frédéric A.; Salam, Gavin P.; Soyez, Gregory

    2016-06-01

    Following on our earlier work on leading-logarithmic (LL R ) resummations for the properties of jets with a small radius, R, we here examine the phenomenological considerations for the inclusive jet spectrum. We discuss how to match the NLO predictions with small- R resummation. As part of the study we propose a new, physically-inspired prescription for fixed-order predictions and their uncertainties. We investigate the R-dependent part of the next-to-next-to-leading order (NNLO) corrections, which is found to be substantial, and comment on the implications for scale choices in inclusive jet calculations. We also examine hadronisation corrections, identifying potential limitations of earlier analytical work with regards to their p t -dependence. Finally we assemble these different elements in order to compare matched (N)NLO+LLR predictions to data from ALICE and ATLAS, finding improved consistency for the R-dependence of the results relative to NLO predictions.

  5. Severely comminuted radius fracture presenting as a signature patterned injury

    PubMed Central

    Jain, Saurabh; Rajan, Sunil; Srivastava, Abhishek

    2016-01-01

    Dilemma still prevails, regarding the exact management of mangled extremity injuries between limb salvage versus amputation, each having there own set of complications. We here present a case of severely comminuted fractures of radius (bag of bones) along with the multiple criss-cross shaped lacerated wounds on the forearm and wrist presenting as a “signature pattern injury” caused by entrapment of the limb in the concrete mixer. MESS score of patient was 8, a score valid for amputation, but contrary, we successfully salvaged the patient's limb with use of radio-carpal distracter. Management of mangled injuries should be individualized, with due consideration to the mechanism and force of injury, associated injuries, and the patient profile. PMID:27053813

  6. Finite Larmor radius effect on ion pickup at Venus

    NASA Technical Reports Server (NTRS)

    Phillips, J. L.; Luhmann, J. G.; Russell, C. T.; Moore, K. R.

    1987-01-01

    The interaction of the solar wind with Venus is influenced by the pickup of newly born exospheric oxygen ions by the convecting magnetosheath plasma. The flow and field configuration of the magnetosheath plasma, together with the large gyroradius of the pickup ions, cause mass loading to occur preferentially on one side of the magnetosheath. The observed hemispherical asymmetry in the magnetic field in the near-planet magnetosheath, attributed to this pickup process, is confirmed by direct observation of the picked-up planetary particles. Test particle calculations show that a current system created by ion pickup has the appropriate location and magnitude to account for the magnetic field asymmetry. The results indicate that a fluid treatment of the Venus mass-loading problem is not entirely appropriate; a hybrid or kinetic model is necessary to incorporate the finite Larmor radius of the pickup particles which produces the observed asymmetry.

  7. Radius of Curvature Measurements: An Independent Look at Accuracy Using Novel Optical Metrology

    NASA Technical Reports Server (NTRS)

    Taylor, Bryon; Kahan, Mark; Russell, Kevin (Technical Monitor)

    2002-01-01

    The AMSD (Advanced Mirror System Demonstrator) program mirror specifications include the ability to manufacture the mirror to a radius of curvature of 10 m +/- 1 mm and to control its radius at 30K to the same specification. Therefore, it is necessary for the Government Team to be able to measure mirror radius of curvature to an accuracy of better than 0.5 mm. This presentation discusses a novel optical metrology system for measuring radius of curvature.

  8. Proximal versus Distal Validity Coefficients for Teacher Observational Instruments

    ERIC Educational Resources Information Center

    Marzano, Robert J.

    2014-01-01

    This study examined the use of measures of student learning computed using end-of-year assessments (distal measures) versus measures of student learning associated with a single lesson (proximal measures) as criterion scores for the validity of observations of teachers' pedagogical skills. The validity coefficients computed using distal…

  9. Distal biceps reconstruction 13 years post-injury

    PubMed Central

    Burrus, M. Tyrrell

    2015-01-01

    Distal biceps tendon ruptures are relatively rare injuries most commonly caused by an eccentric contraction of the biceps brachii. The majority of complete ruptures receive early surgical intervention, however, some patients do present in a delayed fashion. There are many surgical options at this time for acute and chronic injuries, and this case report describes an Achilles allograft reconstruction in a male who sustained a complete tear 13 years prior to presentation. At 12-month follow up, he had regained full function of his dominant extremity as evidence by returning to work with no limitations and by a Disabilities of the Arm, Shoulder, and Hand (DASH) score of zero. We are unaware of a successfully surgically reconstructed distal biceps tendon of this chronicity. As the literature on this subject is sparse, this case report gives credence to the idea that certain patients with a chronic distal biceps rupture should be considered for operative reconstruction and not relegated to continued failed conservative treatment. Discussed are the surgical treatment options and controversies for chronic distal biceps ruptures, and we review various outcome studies using different surgical techniques. PMID:25829956

  10. [Clinical relevance of distal airway involvement in asthma].

    PubMed

    Torrego Fernández, Alfons; Muñoz Cano, Rosa M

    2011-04-01

    Asthma continues to be a global health problem, despite advances in diagnostic techniques and treatment. The inflammatory nature of asthma is currently indisputable, as is the involvement of the entire respiratory tree, both the proximal and most distal airways, which has been demonstrated in multiple studies. The development of the therapeutic arsenal, with more potent drugs and improved inhalation devices, has allowed a certain control to be maintained over the inflammatory process, although the inability to reach the most distal points of the airways has posed a stumbling block that seems difficult to overcome. However, the available information on the real role of distal airway involvement in asthma remains very scarce. Physiopathological evidence shows that, in addition to the large airways, the small or distal airways (those with a diameter of less than 2 mm) substantially contribute to the severity of asthma. Several studies have shown that the inflammatory process seems to be more intense in this area. This finding has been related to nocturnal asthma and an increase in glucocorticoid receptor-beta-expressing cells, associated with corticosteroid-resistant asthma and fatal asthma. Equally, small airway involvement seems to be a highly important factor in asthma in the pediatric age group. PMID:21640280

  11. Sural Versus Perforator Flaps for Distal Medial Leg Wounds.

    PubMed

    Schannen, Andrew P; Truchan, Lisa; Goshima, Kaoru; Bentley, Roger; DeSilva, Gregory L

    2015-12-01

    Soft tissue coverage of distal medial ankle wounds is a challenging problem in orthopedic surgery because of the limited local tissues and prominent instrumentation. Traditionally, these wounds required free tissue transfer to achieve suitable coverage and subsequent bony union. To better respect the reconstructive ladder and to avoid the inherent difficulty of free flap coverage, rotational flaps have been used to cover these wounds. Both sural fasciocutaneous flaps and rotational fasciocutaneous perforator (propeller) flaps have been described for distal medial soft tissue coverage. The authors performed a retrospective chart review of patients who underwent distal medial leg coverage with the use of either sural flaps or rotational fasciocutaneous perforator flaps. The authors identified 14 patients by Current Procedural Terminology code who met the study criteria. The average age and degree of medical comorbidities were comparable in the 2 groups. The authors reviewed their medical records to evaluate fracture healing, flap size, complications, and return to normal shoe wear. All 7 sural flaps healed without incident, with underlying fracture healing. Of the 7 perforator flaps, 6 healed without incident, with underlying fracture healing. One perforator-based flap was complicated by superficial tip necrosis and went on to heal with local wound care. All patients returned to normal shoe wear. Both sural artery rotational flaps and posterior tibial artery-based rotational flaps are viable options for coverage of the distal medial leg. Coverage can be achieved reliably without microsurgery, anticoagulation, or monitoring in the intensive care unit. PMID:26652325

  12. Prediction of distal residue participation in enzyme catalysis.

    PubMed

    Brodkin, Heather R; DeLateur, Nicholas A; Somarowthu, Srinivas; Mills, Caitlyn L; Novak, Walter R; Beuning, Penny J; Ringe, Dagmar; Ondrechen, Mary Jo

    2015-05-01

    A scoring method for the prediction of catalytically important residues in enzyme structures is presented and used to examine the participation of distal residues in enzyme catalysis. Scores are based on the Partial Order Optimum Likelihood (POOL) machine learning method, using computed electrostatic properties, surface geometric features, and information obtained from the phylogenetic tree as input features. Predictions of distal residue participation in catalysis are compared with experimental kinetics data from the literature on variants of the featured enzymes; some additional kinetics measurements are reported for variants of Pseudomonas putida nitrile hydratase (ppNH) and for Escherichia coli alkaline phosphatase (AP). The multilayer active sites of P. putida nitrile hydratase and of human phosphoglucose isomerase are predicted by the POOL log ZP scores, as is the single-layer active site of P. putida ketosteroid isomerase. The log ZP score cutoff utilized here results in over-prediction of distal residue involvement in E. coli alkaline phosphatase. While fewer experimental data points are available for P. putida mandelate racemase and for human carbonic anhydrase II, the POOL log ZP scores properly predict the previously reported participation of distal residues. PMID:25627867

  13. Distal Prosodic Context Affects Word Segmentation and Lexical Processing

    ERIC Educational Resources Information Center

    Dilley, Laura C.; McAuley, J. Devin

    2008-01-01

    Three experiments investigated the role of distal (i.e., nonlocal) prosody in word segmentation and lexical processing. In Experiment 1, prosodic characteristics of the initial five syllables of eight-syllable sequences were manipulated; the final portions of these sequences were lexically ambiguous (e.g., "note bookworm", "notebook worm"). Distal…

  14. Haptic Distal Spatial Perception Mediated by Strings: Haptic "Looming"

    ERIC Educational Resources Information Center

    Cabe, Patrick A.

    2011-01-01

    Five experiments tested a haptic analog of optical looming, demonstrating string-mediated haptic distal spatial perception. Horizontally collinear hooks supported a weighted string held taut by a blindfolded participant's finger midway between the hooks. At the finger, the angle between string segments increased as the finger approached…

  15. Genetics Home Reference: CAV3-related distal myopathy

    MedlinePlus

    ... gene causes a peculiar form of distal myopathy. Neurology. 2002 Jan 22;58(2):323-5. Erratum in: Neurology 2002 Mar 12;58(5):839. Itoyoma Y [ ... 3 cause four distinct autosomal dominant muscle diseases. Neurology. 2004 Feb 24;62(4):538-43. Review. ...

  16. A unique physeal injury of the distal phalanx

    PubMed Central

    Berber, Onur; Singh, Bijayendra

    2015-01-01

    Abstract An unusual Salter–Harris Type 1 fracture variant of the distal phalanx of the index finger is described. The epiphysis was dislocated, sitting dorsally over the middle phalanx head with the articular surface facing dorsal. Reduction could only be achieved through an open procedure. The reduction was stable without supplemental fixation.

  17. The effectiveness of distal soft tissue procedures in hallux valgus

    PubMed Central

    Ozturk, Hasan; Agus, Haluk; Altay, Taskin; Hancerli, Ozgur

    2008-01-01

    Background Hallux valgus is a common disorder affecting mostly women population. Distal soft tissue procedure in the treatment of hallux valgus is one of the main operative techniques described. The aim of this study is to evaluate the outcomes of McBride’s distal soft tissue procedure in hallux valgus cases. Materials and methods This study includes 30 patients (27 women) having 31 hallux valgus, who were treated between 1999 and 2004. Modified McBride’s distal soft tissue procedure was carried out in all cases. Pain status of the cases was recorded by using VAS, clinical assessment described by Bonney and Macnab, and American Orthopaedic Foot and Ankle Society’s (AOFAS) score at the last follow up. Results The mean hallux valgus and intermetatarsal angles decreased from 31.4° and 13.8° to 13.5° and 10.5°, respectively, with an average follow-up period of 54.4 months. AOFAS’s score displayed significant improvement from 57 to 87. The mean VAS showed a significant decrease from 8.75 preoperatively to 2.1 at the last follow-up. According to Bonney and Macnab criteria, only one case was accepted as poor result due to 5° hallux varus. Conclusions McBride’s distal soft tissue procedure yields high rate of satisfaction for mild to moderate hallux valgus with no bony complications related to osteotomy. PMID:19384606

  18. Prediction of distal residue participation in enzyme catalysis

    PubMed Central

    Brodkin, Heather R; DeLateur, Nicholas A; Somarowthu, Srinivas; Mills, Caitlyn L; Novak, Walter R; Beuning, Penny J; Ringe, Dagmar; Ondrechen, Mary Jo

    2015-01-01

    A scoring method for the prediction of catalytically important residues in enzyme structures is presented and used to examine the participation of distal residues in enzyme catalysis. Scores are based on the Partial Order Optimum Likelihood (POOL) machine learning method, using computed electrostatic properties, surface geometric features, and information obtained from the phylogenetic tree as input features. Predictions of distal residue participation in catalysis are compared with experimental kinetics data from the literature on variants of the featured enzymes; some additional kinetics measurements are reported for variants of Pseudomonas putida nitrile hydratase (ppNH) and for Escherichia coli alkaline phosphatase (AP). The multilayer active sites of P. putida nitrile hydratase and of human phosphoglucose isomerase are predicted by the POOL log ZP scores, as is the single-layer active site of P. putida ketosteroid isomerase. The log ZP score cutoff utilized here results in over-prediction of distal residue involvement in E. coli alkaline phosphatase. While fewer experimental data points are available for P. putida mandelate racemase and for human carbonic anhydrase II, the POOL log ZP scores properly predict the previously reported participation of distal residues. PMID:25627867

  19. [Distalization of the upper second molar: clinical case].

    PubMed

    Castaldo, A; Blasi, S; Vettese, P

    1991-01-01

    The Authors showed a clinical case in which has been put on a distalizing system together with a palatal bar between the first upper molars, a sectional placed between the first and the second molar and a 100 g precalibrated Sentalloy coil. PMID:1784297

  20. Non-compliance Appliances for Upper Molar Distalization: An Overview.

    PubMed

    Noorollahian, Saeed; Alavi, Shiva; Shirban, Farinaz

    2015-01-01

    Tooth Size Arch-length Discrepancy (TSALD) is a common problem in orthodontics. Its clinical signs are tooth crowding, impaction and incisor proclination. The treatment options are dental arch expansion or tooth mass reduction (stripping or extraction). The "extraction versus non-extraction" controversy has been widely debated in the orthodontic literature. Distalization is a kind of arch expansion in anetro-posterior dimension. Several studies have evaluated both the therapeutic effectiveness and the side effects of the appliances for this method of space gaining. In some cases molar distalization is preferred, e.g., a patient with acceptable profile and skeletal pattern and half cusp Class II molar malocclusion or even less. In some cases molar distalization is the only way, e.g., the patient with previous upper premolar extraction and excessive overijet, or a skeletal Class III patient with previous upper premolar extraction needed upper anterior teeth retraction to create reverse overjet aspre surgical orthodontic decompensation. In this review article, we described non-compliance upper molar distalizing appliances. PMID:26720949

  1. Post-traumatic osteolysis of the distal clavicle.

    PubMed

    Murphy, O B; Bellamy, R; Wheeler, W; Brower, T D

    1975-01-01

    Five cases of painful bone resorption from the distal clavicle following shoulder trauma are reported to demonstrate that the lesion is generally benign. Surgical excision is curative. The multiplicity of circumstances leading to clavicular osteolysis suggest that the balance between bone accretion and resorption is precarious in this region of the skeleton. PMID:1132191

  2. Non-reducible palmar dislocation of the distal radioulnar joint

    PubMed Central

    Zannou, Rupestre S.; Rezzouk, Joel; Ruijs, Aleid C.J.

    2015-01-01

    Abstract A rare case of an isolated traumatic palmar dislocation of the distal radioulnar joint is presented. Clinically, there is a loss of pronation and supination. The dislocation was treated using an open reduction, reinsertion of the capsule-ligamentous complex and temporary stabilization using K-wires. PMID:26158121

  3. Avascular necrosis of the distal pole of the scaphoid

    PubMed Central

    Tokyay, Abbas; Gunal, Izge

    2015-01-01

    Abstract Avascular necrosis (AVN) of the scaphoid predominantly occurs in the proximal pole. Review of the literature revealed only six cases and all are suspect due to the lack of either MRI investigation or investigation of bleeding preoperatively. We report four new cases and one of them appears to be a real distal pole AVN of the scaphoid in the literature.

  4. A novel technique for detecting instability of the distal radioulnar joint in complete triangular fibrocartilage complex lesions.

    PubMed

    Hess, Florian; Farshad, Mazda; Sutter, Reto; Nagy, Ladislav; Schweizer, Andreas

    2012-11-01

    We performed this study to investigate whether discrepancy of bilateral dorsovolar shift of the distal radioulnar joint (DRUJ) is decisive for the diagnosis of DRUJ instability. Although several cadaver studies have quantified the amount of physiological dorsovolar shift, so far, there is no reliable method of quantification of DRUJ mobility in daily practice. The aim was to describe a novel sonographic method of quantifying DRUJ instability and evaluate its reliability and validity. In this study, 40 healthy volunteers and 17 patients with complete rupture of the triangular fibrocartilage complex (TFCC) underwent sonographic quantification of the grade of instability of their DRUJ bilaterally. Dorsovolar ulnar head translation relative to the distal radius was quantified by means of ultrasonography performed in a transversal plane through the ulnar head and Lister tubercle. Measurements were done while actively pressing the volar surface of the hand onto a brick 30 degrees pronated, and after lifting the hand. A quotient Q of the radioulnar distance (distance between the dorsal radius surface and the ulnar head) between the unloaded and loaded wrist was calculated for differentiation of a normal and unstable DRUJ. The Q ratio of the 17 patients with unilateral TFCC lesion was significantly different between the pathologic side and the contralateral wrist (1.19 vs. 0.54, p < 0.001). There was no significant difference in the Q ratio in the 40 healthy volunteers between the right and left side or dominant and nondominant wrist. A Q ratio > 0.8 was found to be a reasonable cut-off for pathologic laxity of the DRUJ with a sensitivity of 88% and a specificity of 81%. A quotient Q > 0.8 determines instability of the DRUJ reliably. This was a level II diagnostic study. PMID:24179720

  5. Maximum wind radius estimated by the 50 kt radius: improvement of storm surge forecasting over the western North Pacific

    NASA Astrophysics Data System (ADS)

    Takagi, Hiroshi; Wu, Wenjie

    2016-03-01

    Even though the maximum wind radius (Rmax) is an important parameter in determining the intensity and size of tropical cyclones, it has been overlooked in previous storm surge studies. This study reviews the existing estimation methods for Rmax based on central pressure or maximum wind speed. These over- or underestimate Rmax because of substantial variations in the data, although an average radius can be estimated with moderate accuracy. As an alternative, we propose an Rmax estimation method based on the radius of the 50 kt wind (R50). Data obtained by a meteorological station network in the Japanese archipelago during the passage of strong typhoons, together with the JMA typhoon best track data for 1990-2013, enabled us to derive the following simple equation, Rmax = 0.23 R50. Application to a recent strong typhoon, the 2015 Typhoon Goni, confirms that the equation provides a good estimation of Rmax, particularly when the central pressure became considerably low. Although this new method substantially improves the estimation of Rmax compared to the existing models, estimation errors are unavoidable because of fundamental uncertainties regarding the typhoon's structure or insufficient number of available typhoon data. In fact, a numerical simulation for the 2013 Typhoon Haiyan as well as 2015 Typhoon Goni demonstrates a substantial difference in the storm surge height for different Rmax. Therefore, the variability of Rmax should be taken into account in storm surge simulations (e.g., Rmax = 0.15 R50-0.35 R50), independently of the model used, to minimize the risk of over- or underestimating storm surges. The proposed method is expected to increase the predictability of major storm surges and to contribute to disaster risk management, particularly in the western North Pacific, including countries such as Japan, China, Taiwan, the Philippines, and Vietnam.

  6. Hemiarthroplasty for the treatment of distal humerus fractures: short-term clinical results.

    PubMed

    Argintar, Evan; Berry, Micah; Narvy, Steven J; Kramer, Jonathan; Omid, Reza; Itamura, John M

    2012-12-01

    Total elbow arthroplasty is the current gold standard of treatment for unreconstructable distal humerus fractures; however, longevity of the implant remains a concern in younger, more active patients. Distal humerus hemiarthroplasty offers an alternative and may allow for more durable results. The authors retrospectively evaluated the short-term clinical outcomes of 10 patients who underwent elbow hemiarthroplasty for distal humerus fractures. This short-term review suggests that distal humerus hemiarthroplasty may be an effective treatment for certain distal humerus fractures. Additional studies must be conducted to further define the role of elbow hemiarthroplasty for the treatment of complex fractures of the distal humerus. PMID:23218618

  7. Indolent infection in nonunion of the distal femur.

    PubMed

    Kim, Ji Wan; Byun, Seong-Eun; Oh, Hyoung Keun; Kim, Jung Jae

    2015-04-01

    In the treatment of nonunions of the distal femur, infection should be excluded. However, it is difficult to determine whether the nonunion is infected or not with negative history and signs of infection. The purpose of this study was to investigate indolent infection as a cause of presumptive aseptic distal femur nonunion. All presumptive aseptic distal femur nonunions treated from 1998 to 2008 were retrospectively reviewed. Any patient with suspected of having an infection clinically was excluded. Multiple tissue cultures were performed at the nonunion site. The main outcomes were to analyze the rate of positive cultures in presumptive aseptic distal femur nonunion and to compare the rate of secondary surgery in positive and negative culture groups. Of the 22 patients, 3 (13.6%) had positive culture results. The organisms cultured were Staphylococcus aureus, Staphylococcus epidermidis, and Enterobacter cloacae. The overall rate of infection was 9.1% (2/22), and one patient underwent a secondary procedure. In the open fracture group, 2 of 10 patients (20%) had positive cultures; all developed infection. In the closed fracture group, 1 of 12 patients (8.3%) had positive culture results, but Infection did not occur in the patient with a 3-week intravenous antibiotic treatment. The postoperative infection rate was 67% (2/3) in patients with positive intraoperative cultures, while 0% (0/18) in the group with negative intraoperative cultures (p<0.001). The presence of indolent infection can be verified in patients with presumptive aseptic nonunion of distal femoral fractures by obtaining intraoperative biopsy tissue cultures. Positive intraoperative culture results were related with postoperative infection. PMID:25189289

  8. Surgical repair of chronic rupture of the distal end of the biceps brachii. A modified anterior surgical repair technique.

    PubMed

    Sharma, Dinesh K; Goswami, Ved; Wood, Jane

    2004-06-01

    The authors have used a modified surgical technique for repair of the distal end of the biceps brachii in three patients who presented with chronic rupture, all more than 6 weeks old. All patients were males; two lesions were on the dominant right side and one was on the non-dominant left side. An anterior incision was made over the cubital fossa, a hole was drilled over the radial tuberosity and a simple pull-through technique with an Ethibond suture was used to attach the tendon to an endobutton over the posterior surface of the radius. All patients returned to their employment and preinjury activity levels by six months. There were no postoperative complications and clinically all repairs remained intact. The patients regained their normal range of movements in 3 months; all but one regained the endurance and strength of their bicep in 6 months as assessed by Cybex testing. Surgical repair of the distal end of the biceps using the technique reported has given excellent results in these three patients. PMID:15287407

  9. The Relation Between Radius, Mass, and Incident Flux of Exoplanets

    NASA Astrophysics Data System (ADS)

    Weiss, Lauren M.; Marcy, G. W.; Rowe, J.; Isaacson, H. T.; Howard, A.; Fortney, J. J.; Miller, N.; Demory, B.; Fischer, D.; Adams, E. A.; Dupree, A. K.; Howell, S. B.; Horch, E.; Everett, M. E.; Seager, S.; Fabrycky, D. C.

    2013-01-01

    We measure the mass of a modestly irradiated giant or "warm Jupiter," KOI-94d, in order to calculate its density. We wish to determine whether this planet, which is in a 22 day orbit and receives 107 times as much incident flux as the Earth, is bloated like "hot Jupiters" or as dense as our own Jupiter. In addition to its warm Jupiter, KOI-94 hosts at least 3 smaller planets, all of which were detected through transits by the Kepler Mission. This presents the opportunity to characterize a multi-planet system and to test dynamic stability and formation theory through observations of the masses and orbital elements of these planets. With 26 radial velocity measurements of KOI-94 from the W. M. Keck Observatory/HIRES, we measure the mass of the giant planet and upper limits to the masses of the three smaller planets. Transit timing variations will allow us to hone the mass measurements of the three smaller planets. Using the KOI-94 system and all other planets with published values for both mass and radius, we establish two fundamental planes for exoplanets that relate their mass, incident flux, and radius from a few Earth masses up to ten Jupiter masses: log(Rp/RE) = 0.007 + 0.53 log(M/ME) - 0.001 log(F/[erg/s/cm^2]) for Mp < 150ME; log(Rp/RE) = 0.67 - 0.036 log(M/ME) + 0.06 log(F/[erg/s/cm^2]) for Mp > 150ME. We also solve these planes in density-mass-flux space: log(ρp/[g/cm^3]) = 0.69 - 0.57 log(M/ME) + 0.02 log(F/[erg/s/cm^2]) for Mp < 150ME; log(ρp/[g/cm^3]) = -1.23 + 1.10 log(M/ME) - 0.18 log(F/[erg/s/cm^2]) for Mp > 150ME.

  10. What Is the Largest Einstein Radius in the Universe?

    SciTech Connect

    Oguri, Masamune; Blandford, Roger D.

    2008-08-05

    The Einstein radius plays a central role in lens studies as it characterizes the strength of gravitational lensing. In particular, the distribution of Einstein radii near the upper cutoff should probe the probability distribution of the largest mass concentrations in the universe. Adopting a triaxial halo model, we compute expected distributions of large Einstein radii. To assess the cosmic variance, we generate a number of Monte-Carlo realizations of all-sky catalogues of massive clusters. We find that the expected largest Einstein radius in the universe is sensitive to parameters characterizing the cosmological model, especially {sigma}{sub s}: for a source redshift of unity, they are 42{sub -7}{sup +9}, 35{sub -6}{sup +8}, and 54{sub -7}{sup +12} arcseconds (errors denote 1{sigma} cosmic variance), assuming best-fit cosmological parameters of the Wilkinson Microwave Anisotropy Probe five-year (WMAP5), three-year (WMAP3) and one-year (WMAP1) data, respectively. These values are broadly consistent with current observations given their incompleteness. The mass of the largest lens cluster can be as small as {approx} 10{sup 15} M{sub {circle_dot}}. For the same source redshift, we expect in all-sky {approx} 35 (WMAP5), {approx} 15 (WMAP3), and {approx} 150 (WMAP1) clusters that have Einstein radii larger than 2000. For a larger source redshift of 7, the largest Einstein radii grow approximately twice as large. While the values of the largest Einstein radii are almost unaffected by the level of the primordial non-Gaussianity currently of interest, the measurement of the abundance of moderately large lens clusters should probe non-Gaussianity competitively with cosmic microwave background experiments, but only if other cosmological parameters are well-measured. These semi-analytic predictions are based on a rather simple representation of clusters, and hence calibrating them with N-body simulations will help to improve the accuracy. We also find that these 'superlens

  11. System Estimates Radius of Curvature of a Segmented Mirror

    NASA Technical Reports Server (NTRS)

    Rakoczy, John

    2008-01-01

    A system that estimates the global radius of curvature (GRoC) of a segmented telescope mirror has been developed for use as one of the subsystems of a larger system that exerts precise control over the displacements of the mirror segments. This GRoC-estimating system, when integrated into the overall control system along with a mirror-segment- actuation subsystem and edge sensors (sensors that measure displacements at selected points on the edges of the segments), makes it possible to control the GROC mirror-deformation mode, to which mode contemporary edge sensors are insufficiently sensitive. This system thus makes it possible to control the GRoC of the mirror with sufficient precision to obtain the best possible image quality and/or to impose a required wavefront correction on incoming or outgoing light. In its mathematical aspect, the system utilizes all the information available from the edge-sensor subsystem in a unique manner that yields estimates of all the states of the segmented mirror. The system does this by exploiting a special set of mirror boundary conditions and mirror influence functions in such a way as to sense displacements in degrees of freedom that would otherwise be unobservable by means of an edge-sensor subsystem, all without need to augment the edge-sensor system with additional metrological hardware. Moreover, the accuracy of the estimates increases with the number of mirror segments.

  12. Kinetic theory of plasma adiabatic major radius compression in tokamaks

    NASA Astrophysics Data System (ADS)

    Gorelenkova, M. V.; Gorelenkov, N. N.; Azizov, E. A.; Romannikov, A. N.; Herrmann, H. W.

    1998-05-01

    In order to understand the individual charged particle behavior as well as plasma macroparameters (temperature, density, etc.) during the adiabatic major radius compression (R-compression) in a tokamak, a kinetic approach is used. The perpendicular electric field from the Ohm's law at zero resistivity is made use of in order to describe particle motion during the R-compression. Expressions for both passing and trapped particle energy and pitch angle change are derived for a plasma with high aspect ratio and circular magnetic surfaces. The particle behavior near the passing trapped boundary during the compression is studied to simulate the compression-induced collisional losses of alpha particles. Qualitative agreement is obtained with the alphas loss measurements in deuterium-tritium (D-T) experiments in the Tokamak Fusion Test Reactor (TFTR) [World Survey of Activities in Controlled Fusion Research [Nucl. Fusion special supplement (1991)] (International Atomic Energy Agency, Vienna, 1991)]. The plasma macroparameters evolution at the R-compression is calculated by solving the gyroaveraged drift kinetic equation.

  13. Placing molecules with Bohr radius resolution using DNA origami.

    PubMed

    Funke, Jonas J; Dietz, Hendrik

    2016-01-01

    Molecular self-assembly with nucleic acids can be used to fabricate discrete objects with defined sizes and arbitrary shapes. It relies on building blocks that are commensurate to those of biological macromolecular machines and should therefore be capable of delivering the atomic-scale placement accuracy known today only from natural and designed proteins. However, research in the field has predominantly focused on producing increasingly large and complex, but more coarsely defined, objects and placing them in an orderly manner on solid substrates. So far, few objects afford a design accuracy better than 5 nm, and the subnanometre scale has been reached only within the unit cells of designed DNA crystals. Here, we report a molecular positioning device made from a hinged DNA origami object in which the angle between the two structural units can be controlled with adjuster helices. To test the positioning capabilities of the device, we used photophysical and crosslinking assays that report the coordinate of interest directly with atomic resolution. Using this combination of placement and analysis, we rationally adjusted the average distance between fluorescent molecules and reactive groups from 1.5 to 9 nm in 123 discrete displacement steps. The smallest displacement step possible was 0.04 nm, which is slightly less than the Bohr radius. The fluctuation amplitudes in the distance coordinate were also small (±0.5 nm), and within a factor of two to three of the amplitudes found in protein structures. PMID:26479026

  14. Mass-radius relation of strongly magnetized white dwarfs

    NASA Astrophysics Data System (ADS)

    Bera, Prasanta; Bhattacharya, Dipankar

    2016-07-01

    We study the strongly magnetized white dwarf configurations in a self-consistent manner as a progenitor of the over-luminous type-Ia supernovae. We compute static equilibria of white dwarf stars containing a strong magnetic field and present the modification of white dwarf mass-radius relation caused by the magnetic field. From a static equilibrium study, we find that a maximum white dwarf mass of about 1.9 M_{⊙} may be supported if the interior poloidal field is as strong as approximately 10^{10} T. On the other hand, if the field is purely toroidal the maximum mass can be more than 5 M_⊙. All these modifications are mainly from the presence of Lorenz force. The effects of i) modification of equation of state due to Landau quantization ii) electrostatic interaction due to ions, ii) general relativistic calculation on the stellar structure and, iii) field geometry are also considered. These strongly magnetised configurations are sensitive to magnetic instabilities where the perturbations grow at the corresponding Alfven time scales.

  15. Placing molecules with Bohr radius resolution using DNA origami

    NASA Astrophysics Data System (ADS)

    Funke, Jonas J.; Dietz, Hendrik

    2016-01-01

    Molecular self-assembly with nucleic acids can be used to fabricate discrete objects with defined sizes and arbitrary shapes. It relies on building blocks that are commensurate to those of biological macromolecular machines and should therefore be capable of delivering the atomic-scale placement accuracy known today only from natural and designed proteins. However, research in the field has predominantly focused on producing increasingly large and complex, but more coarsely defined, objects and placing them in an orderly manner on solid substrates. So far, few objects afford a design accuracy better than 5 nm, and the subnanometre scale has been reached only within the unit cells of designed DNA crystals. Here, we report a molecular positioning device made from a hinged DNA origami object in which the angle between the two structural units can be controlled with adjuster helices. To test the positioning capabilities of the device, we used photophysical and crosslinking assays that report the coordinate of interest directly with atomic resolution. Using this combination of placement and analysis, we rationally adjusted the average distance between fluorescent molecules and reactive groups from 1.5 to 9 nm in 123 discrete displacement steps. The smallest displacement step possible was 0.04 nm, which is slightly less than the Bohr radius. The fluctuation amplitudes in the distance coordinate were also small (±0.5 nm), and within a factor of two to three of the amplitudes found in protein structures.

  16. Detection of periodic motion trajectories: Effects of frequency and radius.

    PubMed

    Wilkinson, Frances; Haque, Yousra; Or, Charles C-F; Gottlieb, Audrey S; Wilson, Hugh R

    2016-05-01

    Periodic trajectories are an important component of biological motion. Or, Thabet, Wilkinson, and Wilson (2011) studied radial frequency (RF) motion trajectory detection and concluded that, for RF2-5 trajectories, the threshold function paralleled that of static RF patterns. We have extended Or et al.'s (2011) findings to a broader range of RFs (three to 24 cycles) and across a 4-fold range of radii (1°-4°). We report that (a) thresholds for RF trajectories decrease as a power function of RF for low RF trajectories (three to six cycles) before approaching an asymptote at high RFs (12-24 cycles); (b) detection thresholds for RF trajectories scale proportionally with radius; and (c) there is no lower versus upper field advantage in the parafoveal field for stimuli displaced from fixation on the vertical midline. The results are compared to earlier findings for static RF thresholds, and we argue that our findings support the existence of parallel spatial and temporal processing channels that may contribute to both action perception and production. PMID:27183192

  17. Mass-Radius Relation for Rocky Planets Based on PREM

    NASA Astrophysics Data System (ADS)

    Zeng, Li; Sasselov, Dimitar D.; Jacobsen, Stein B.

    2016-03-01

    Several small dense exoplanets are now known, inviting comparisons to Earth and Venus. Such comparisons require translating their masses and sizes to composition models of evolved multi-layer interior planets. Such theoretical models rely on our understanding of the Earth’s interior, as well as independently derived equations of state, but so far have not involved direct extrapolations from Earth’s seismic model: the Preliminary Reference Earth Model (PREM). To facilitate more detailed compositional comparisons between small exoplanets and the Earth, we derive here a semi-empirical mass-radius relation for two-layer rocky planets based on PREM, \\frac{R}{{R}\\oplus }=(1.07-0.21\\cdot {CMF})\\cdot {≤ft(\\frac{M}{{M}\\oplus }\\right)}1/3.7, where CMF stands for core mass fraction. It is applicable to 1 ˜ 8 M⊕ and a CMF of 0.0 ˜ 0.4. Applying this formula to Earth and Venus and several known small exoplanets with radii and masses measured to better than ˜30% precision gives a CMF fit of 0.26 ± 0.07.

  18. The mass-radius relationship of massive compact stars

    SciTech Connect

    Chowdhury, Partha Roy

    2015-02-24

    The properties of pure hadronic and hybrid compact stars are reviewed using nuclear equation of state (EoS) for β-equilibrated neutron star (NS) matter obtained using a density-dependent M3Y (DDM3Y) effective nucleon-nucleon interaction. Depending on the model, the energy density of quark matter can be lower than that of this nuclear EoS at higher densities, implying the possibility of transition to quark matter inside the core and the transition density depends on the particular quark matter model used. The recent observations of the binary millisecond pulsar J1614–2230 by P.B. Demorest et al. [1] and PSR J0348+0432 by J. Antoniadis et al. [2] suggest that the masses lie within 1.97 ± 0.04 M{sub ⊙} and 2.01 ± 0.04 M{sub ⊙}, respectively, where M{sub ⊙} is the solar mass. In conformity with recent observations, a pure nucleonic EoS determines that the maximum mass of NS rotating with frequency ν∼ 667 Hz below r-mode instability is ∼ 1.95 M{sub ⊙} with radius ∼ 10 km. Compact stars with quark cores rotating with same frequency have the maximum mass of ∼ 1.72 M{sub ⊙} turns out to be lower than the observed masses.

  19. Massive radius-dependent flow slippage in carbon nanotubes.

    PubMed

    Secchi, Eleonora; Marbach, Sophie; Niguès, Antoine; Stein, Derek; Siria, Alessandro; Bocquet, Lydéric

    2016-01-01

    Measurements and simulations have found that water moves through carbon nanotubes at exceptionally high rates owing to nearly frictionless interfaces. These observations have stimulated interest in nanotube-based membranes for applications including desalination, nano-filtration and energy harvesting, yet the exact mechanisms of water transport inside the nanotubes and at the water-carbon interface continue to be debated because existing theories do not provide a satisfactory explanation for the limited number of experimental results available so far. This lack of experimental results arises because, even though controlled and systematic studies have explored transport through individual nanotubes, none has met the considerable technical challenge of unambiguously measuring the permeability of a single nanotube. Here we show that the pressure-driven flow rate through individual nanotubes can be determined with unprecedented sensitivity and without dyes from the hydrodynamics of water jets as they emerge from single nanotubes into a surrounding fluid. Our measurements reveal unexpectedly large and radius-dependent surface slippage in carbon nanotubes, and no slippage in boron nitride nanotubes that are crystallographically similar to carbon nanotubes, but electronically different. This pronounced contrast between the two systems must originate from subtle differences in the atomic-scale details of their solid-liquid interfaces, illustrating that nanofluidics is the frontier at which the continuum picture of fluid mechanics meets the atomic nature of matter. PMID:27604947

  20. MASS-RADIUS RELATIONSHIPS FOR VERY LOW MASS GASEOUS PLANETS

    SciTech Connect

    Batygin, Konstantin; Stevenson, David J.

    2013-05-20

    Recently, the Kepler spacecraft has detected a sizable aggregate of objects, characterized by giant-planet-like radii and modest levels of stellar irradiation. With the exception of a handful of objects, the physical nature, and specifically the average densities, of these bodies remain unknown. Here, we propose that the detected giant planet radii may partially belong to planets somewhat less massive than Uranus and Neptune. Accordingly, in this work, we seek to identify a physically sound upper limit to planetary radii at low masses and moderate equilibrium temperatures. As a guiding example, we analyze the interior structure of the Neptune-mass planet Kepler-30d and show that it is acutely deficient in heavy elements, especially compared with its solar system counterparts. Subsequently, we perform numerical simulations of planetary thermal evolution and in agreement with previous studies, show that generally, 10-20 M{sub Circled-Plus }, multi-billion year old planets, composed of high density cores and extended H/He envelopes can have radii that firmly reside in the giant planet range. We subject our results to stability criteria based on extreme ultraviolet radiation, as well as Roche-lobe overflow driven mass-loss and construct mass-radius relationships for the considered objects. We conclude by discussing observational avenues that may be used to confirm or repudiate the existence of putative low mass, gas-dominated planets.