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Sample records for femoral epiphysis widening

  1. Slipped capital femoral epiphysis

    MedlinePlus

    ... page: //medlineplus.gov/ency/article/000972.htm Slipped capital femoral epiphysis To use the sharing features on this page, please enable JavaScript. A slipped capital femoral epiphysis is a separation of the ball ...

  2. Slipped capital femoral epiphysis

    MedlinePlus

    A slipped capital femoral epiphysis is a separation of the ball of the hip joint from the thigh bone (femur) at ... A slipped capital femoral epiphysis may affect both hips. An epiphysis is an area at the end of a long bone . ...

  3. Bone scintigraphy in slipped capital femoral epiphysis

    SciTech Connect

    Gelfand, M.J.; Strife, J.L.; Graham, E.J.; Crawford, A.H.

    1983-12-01

    Tc-/sub 99m/ diphosphonate bone scans were performed on 11 children with slipped capital femoral epiphysis. On pinhole hip images, seven hips in seven patients had increased radionuclide uptake in the physis and adjacent proximal femoral metaphysis where the slip had occurred. Three hips in three patients had decreased radionuclide uptake in the femoral head on the side of the slipped epiphysis, indicating compromise of the femoral head blood supply. Three or more months following internal fixation, three children had scintigraphy that showed loss of the usual focal uptake in the physis and adjacent proximal femoral metaphysis. Bone scintigraphy in pediatric patients with slipped capital femoral epiphysis is valuable in defining the metabolic status of the femoral head. Absence of radiopharmaceutical uptake in the affected femoral head indicates that the femoral head is at risk for development of radiographic changes associated with aseptic necrosis.

  4. Slipped capital femoral epiphysis: what's new?

    PubMed

    Peck, Kathryn; Herrera-Soto, José

    2014-01-01

    Slipped capital femoral epiphysis (SCFE) is a common hip disorder among adolescents, whereby the epiphysis is displaced posteriorly and inferiorly to the metaphysis. Treatment modalities aim to stabilize the epiphysis, prevent further slippage, and avoid complications associated with long-term morbidity, such as osteonecrosis and chondrolysis. Controversy exists with SCFE regarding prophylactic fixation of the contralateral, painless, normal hip, the role of femoroacetabular impingement with SCFE, and whether in situ fixation is the best treatment method for SCFE. This article presents and discusses the latest diagnostic and treatment modalities for SCFE. PMID:24267209

  5. Seasonal variation of slipped capital femoral epiphysis.

    PubMed

    Maffulli, Nicola; Douglas, A Stuart

    2002-01-01

    During the 18-year period 1980-1997, 1103 patients were treated as in-patients for slipped capital femoral epiphysis (SCFE) in Scottish hospitals. This paper reports a significant seasonal variation, especially in male patients, with an excess admitted in the autumn. Examining the physiological seasonality of the monthly increment of growth in height and weight in childhood, we hypothesised that these physiological rhythms, while not pathogenetic, may be responsible for the timing of the seasonal features of SCFE. Previously published studies suggest that the average time between first symptoms and diagnosis is 3 to 5 months. The condition may start with the spring peak in growth and become more symptomatic with the autumn peak in weight. In conclusion, we report a new epidemiological finding, but, in accordance with other studies, we cannot provide a certain aetiological explanation. The timing, but not the pathogenesis, of admission to hospital for a SCFE might be related to the timing in the year of seasonal increments of height in spring and weight in autumn. It is tempting to draw attention to associations with environmental features. For example, in autumn there is the most rapid annual fall in temperature, and the hours of darkness are increasing from the autumn equinox to the winter solstice. However, there is no reason to conclude that these associations have anything to do with aetiology. PMID:11866078

  6. Current concepts in management of slipped capital femoral epiphysis.

    PubMed

    Bittersohl, Bernd; Hosalkar, Harish S; Zilkens, Christoph; Krauspe, Rüdiger

    2015-01-01

    Slipped capital femoral epiphysis (SCFE) is a common hip condition that can be disabling. In this review, we provide an orientation on current trends in the clinical management of SCFE including conventional procedures and specialised surgical developments. Different methods of fixation of the epiphysis, risks of complications, and the rationale of addressing deformity, primarily or secondarily, are presented. Although improved understanding of the anatomy, vascularity and implications of residual deformity have changed management strategies, the best modality of treatment that would restore complete vascularity to the femoral head and prevent any residual deformity, impingement and early osteoarthritis remains elusive. PMID:25362879

  7. Slipped capital femoral epiphysis caused by neurogenic heterotopic ossification.

    PubMed

    Chang, Sam Yeol; Yoo, Won Joon; Park, Moon Seok; Chung, Chin Youb; Choi, In Ho; Cho, Tae-Joon

    2013-11-01

    Slipped capital femoral epiphysis (SCFE) is rare in nonambulatory patients, as mechanical factors play important roles in the development of the disease. We report a case of SCFE, which occurred in a 12-year-old girl with a nonambulatory status after cerebral infarction. SCFE occurred after she received passive range of motion exercise and extracorporeal shock wave treatment for neurogenic heterotopic ossification around the hip joint. The patient was successfully managed by a stepwise approach, with radiological and clinical improvements. PMID:23969564

  8. Nonoperative treatment of slipped capital femoral epiphysis: a scientific study

    PubMed Central

    2011-01-01

    Background Treatment of the Slipped Capital Femoral Epiphysis remains a cause of concern due to the fact that the true knowledge of the etiopathogeny is unknown, as well as one of its major complications: chondrolysis. The conservative treatment remains controversial; it has been overlooked in the studies and subjected to intense criticism. The purpose of this study is to investigate the results of treatment on the hip of patients displaying slipped capital femoral epiphysis, using the plaster cast immobilization method and its link to chondrolysis. Methods The research was performed based on the study of the following variables: symptomatology, and the degree of slipping. A hip spica cast and bilateral short/long leg casts in abduction, internal rotation with anti-rotational bars were used for immobilizing the patient's hip for twelve weeks. Statistical analysis was accomplished by Wilcoxon's marked position test and by the Fisher accuracy test at a 5% level. Results A satisfactory result was obtained in the acute group, 70.5%; 94%; in the chronic group (chronic + acute on chronic). Regarding the degree of the slipping, a satisfactory result was obtained in 90.5% of hips tested with a mild slip; in 76% with moderate slip and 73% in the severe slip. The statistical result revealed that a significant improvement was found for flexion (p = 0.0001), abduction (p = 0.0001), internal rotation (p = 0.0001) and external rotation (p = 0.02). Chondrolysis was present in 11.3% of the hips tested. One case of pseudoarthrosis with aseptic capital necrosis was presented. There was no significant variation between age and chondrolysis (p = 1.00).Significant variation between gender/non-white patients versus chondrolysis (p = 0.031) and (p = 0.037), respectively was verified. No causal association between plaster cast and chondrolysis was observed (p = 0.60). In regard to the symptomatology group and the slip degree versus chondrolysis, the p value was not statistically

  9. Complete Traumatic Separation of Proximal Femoral Epiphysis in A 2 Year Old Child

    PubMed Central

    Pal, Chandra Prakash; Kumar, Deepak; Singh, Pulkesh; Gaurav, Vishal

    2014-01-01

    Introduction: Hip fractures are very common in adults, but are rare in children, comprising less than 1% of all pediatric fractures. Separation of the proximal femoral epiphysis can occur in a child with a traumatic hip dislocation and an open epiphysis. Regardless of the mechanism of proximal femoral epiphyseal separation, the prognosis is poor secondary to the development of osteonecrosis. Case Report: Here we are reporting a case of complete separation of the proximal epiphysis of the femur in a 2 year old female child. She was treated by open reduction and internal fixation by a single k-wire of proximal femoral epiphysis. Regular follow up showed fusion of proximal femoral epiphysis at about 3 months of post operative period. After 8 months of follow up she can stand and walk without support. Long term outcome is awaited. Conclusion: Traumatic separation of the proximal femoral epiphysis is a rare but devastating injury because osteonecrosis occurs in most cases. In our study we found fusion of the proximal femoral epiphysis to the neck after 3 months of postoperative period. But to comment upon the final outcome a long follow up is awaited.

  10. Pseudohypoparathyroidism as a rare cause of bilateral slipped capital femoral epiphysis

    PubMed Central

    Somasundaram, Karthikeyan R; Sankararaman, Senthilkumar; Siddiqui, Athar; Zadeh, Hamid

    2012-01-01

    Slipped capital femoral epiphysis (SCFE) is a disorder of adolescent age. Presentation of SCFE earlier than the expected age range should prompt the clinician to consider the presence of an underlying endocrinopathy. Early recognition and aggressive management of the predisposing endocrine disorder is crucial to prevent treatment failure and associated morbidity. We report the clinical presentation and treatment of an 8-year-old girl with bilateral slipped capital femoral epiphysis. The unusual age, persistent hypocalcemia, and associated distal femoral physeal deformities prompted further evaluations, which led to the diagnosis of pseudohypoparathyroidism type 1b. PHP type 1b is an extremely rare cause of SCFE and only a few cases have been reported. A delay in diagnosis in such case is not uncommon. PMID:23325976

  11. Tibia vara and slipped upper femoral epiphysis: is there an association?

    PubMed

    Jamil, Kamal; Abdul Rashid, A H; Ibrahim, Sharaf

    2015-01-01

    Tibia vara and slipped upper femoral epiphysis (SUFE) share a common risk factor, but their relationship is unclear. In both conditions, the patients are usually obese. To the best of our knowledge, there have been only two previous reports in the literature that have described the occurrence of tibia vara and SUFE in three patients. We report a child who was treated for bilateral tibia vara at the age of 3 years and subsequently developed a SUFE at the age of 13 years. PMID:25192368

  12. Significantly lower femoral neck growth in screw fixation of the asymptomatic contralateral hip in unilateral slipped capital femoral epiphysis.

    PubMed

    Wölfle-Roos, Julia V; Urlaub, Stefanie; Reichel, Heiko; Taurman, Rita

    2016-05-01

    There is an ongoing debate on which fixation technique should be preferred for the prophylactic fixation of the asymptomatic contralateral hip in slipped capital femoral epiphysis (SCFE). In the case of Kirschner-wire (K-wire) fixation, there is a possibility of secondary loss of fixation because of longitudinal growth of the physis, whereas in screw fixation, physeal growth of the femoral neck might be impaired. The aim of this matched-pair study was to compare the longitudinal growth of the femoral neck in screw fixation versus K-wire fixation of the asymptomatic contralateral hip in SCFE. All 18 patients (female : male=3 : 15), who had undergone screw fixation of the asymptomatic contralateral hip between 9/2001 and 9/2011, were matched according to age, bone age, sex, and time to follow-up to another 18 patients with K-wire fixation. The length of the femoral neck of the contralateral hip was measured in parallel to either screw or K-wire from the apex of the femoral head to the opposite cortical bone. The ratio of the femoral neck length measured directly after surgery and on follow-up was defined as femoral neck growth. There was no significant difference between groups with respect to age, modified Oxford Bone age score, and time to follow-up. We found a significant difference in femoral neck growth between patients with screw fixation (5.5±4.3%) compared with K-wire fixation (8.9±5.7%, P=0.048 matched Wilcoxon test). The difference in femoral neck growth of patients with K-wire or screw fixation of the contralateral asymptomatic hip in SCFE was small, but statistically significant. Thus, despite high rates of secondary loss of fixation, K-wire fixation should still be considered, especially in very young patients. PMID:26919622

  13. Statistical Shape Modeling of Proximal Femoral Shape Deformities in Legg-Calvé-Perthes Disease and Slipped Capital Femoral Epiphysis

    PubMed Central

    Chan, Elaine F.; Farnsworth, Christine L.; Koziol, James A.; Hosalkar, Harish S.; Sah, Robert L.

    2013-01-01

    Introduction The current understanding of morphological deformities of the hip such as femoroacetabular impingement (FAI), Legg-Calve-Perthes disease (LCPD), and slipped capital femoral epiphysis (SCFE) is based on 2-dimensional metrics, primarily involving the femoral head, that only partially describe the complex skeletal morphology. Objective This study aimed to improve the 3-dimensional understanding of shape variations during normal growth, and in LCPD and SCFE, through statistical shape modeling. Design Thirty-two patients with asymptomatic, LCPD, and SCFE hips, determined from physical and radiographic examination, were scanned using 3-D CT at a voxel size of (0.5–0.9mm)2 in-plane and 0.63mm slice thickness. Statistical shape modeling was performed on segmented proximal femoral surfaces to determine modes of variation and shape variables quantifying 3-D shape. In addition, conventional variables were determined for all femora. Results Proximal femur shape was described by 8 modes of variation and corresponding shape variables. Statistical shape variables were distinct with age and revealed coordinated, growth-associated differences in neck length-to-width ratio, femoral head medialization, and trochanter protrusion. After size and age-based shape adjustment, diseased proximal femora were characterized by shape variables distinct from those of asymptomatic hips. The shape variables defined morphology in health and disease, and were correlated with certain conventional variables of shape, including neck-shaft angle, head diameter, and neck diameter. Conclusion 3-D quantitative analyses of proximal femoral bone shape during growth and in disease are useful for furthering the understanding of normal and abnormal shape deviations which affect cartilage biomechanics and risk of developing osteoarthritis. PMID:23274103

  14. The modified Dunn procedure for slipped capital femoral epiphysis does not reduce the length of the femoral neck

    PubMed Central

    Cosma, Dan; Vasilescu, Dana Elena; Corbu, Andrei; Văleanu, Mădălina; Vasilescu, Dan

    2016-01-01

    Objective: The treatment of slipped capital femoral epiphysis (SCFE) is evolving, with the development of new surgical techniques. |We wanted to study if modified Dunn procedure restores the normal alignment of the proximal femur and the risk of avascular necrosis is increased. Methods: This is a single centre, retrospective study, comparing the outcomes of in situ pinning and modified Dunn procedure. Between 2001 and 2014, 7 children (7 hips) underwent the modified Dunn procedure and 10 children (10 hips) pinning in situ for stable and unstable SCFE. Mean age of the patients was 12.7 years with a median follow-up of 18 months. Results: The radiological parameters improved in the modified Dunn procedure group, while the length of the femoral neck didn’t change significantly (p=0.09). Postoperative clinical outcomes were slightly better in the modified Dunn procedure group (6 hips out of 7 had good and excellent results) compared to the pinning in situ group (8 good and excellent results out of 10 hips) (p=0.04). No avascular necrosis was found and there were no cases of chondrolysis. Conclusion: Radiographic parameters of the proximal femur assessed in our study improved in all hips that underwent modified Dunn procedure, without the creation of secondary deformities. PMID:27182244

  15. Levels of Evidence in the Treatment of Slipped Capital Femoral Epiphysis: A Systematic Review.

    PubMed

    Moriarity, Andrew; Kennedy, Jim; Baker, Joe; Kiely, Pat

    2016-06-27

    The primary aim of this study was to analyze the current level of evidence available on the surgical management of Slipped Capital Femoral Epiphysis (SCFE). Secondary aims were to correlate the level of evidence with the impact factor of the journal to evaluate the level of evidence over time, and to evaluate the geographic distribution of the studies. Therapeutic studies published in English between January 1991 and August 2014 that reported on SCFE were identified via electronic search was performed using the databases PubMed, EMBASE, and the Cochrane Library. The search terms used included: Slipped capital femoral epiphyses OR SCFE OR Slipped upper femoral epiphyses OR SUFE AND Management OR Treatment. Correlation between the level of evidence and the impact factor of the journal were analyzed together with linear regression models to reveal any significant trends over time. A total of 1516 studies were found, of which 321 were included in the final analysis. The most frequent study type was the case series (51.1%) followed by case reports (22.4%) and expert opinion (14.0%). Randomized control trial accounted for only 0.6%. The Journal of Pediatric Orthopedics (American) had the most studies (22.6%) and the highest number of level 2 (n=1) and level 3 (n=15) type evidence. There was no progression of level of evidence over time. There was no correlation between level of evidence and impact factor of journal. The majority of therapeutic studies on SCFE are of low level of evidence. High-level RCTs are difficult to perform in pediatric orthopedic surgery, however the management of SCFE would benefit from well-designed, multicenter, clinical RCTs to advance evidence-based practice. PMID:27433299

  16. Levels of Evidence in the Treatment of Slipped Capital Femoral Epiphysis: A Systematic Review

    PubMed Central

    Moriarity, Andrew; Kennedy, Jim; Baker, Joe; Kiely, Pat

    2016-01-01

    The primary aim of this study was to analyze the current level of evidence available on the surgical management of Slipped Capital Femoral Epiphysis (SCFE). Secondary aims were to correlate the level of evidence with the impact factor of the journal to evaluate the level of evidence over time, and to evaluate the geographic distribution of the studies. Therapeutic studies published in English between January 1991 and August 2014 that reported on SCFE were identified via electronic search was performed using the databases PubMed, EMBASE, and the Cochrane Library. The search terms used included: Slipped capital femoral epiphyses OR SCFE OR Slipped upper femoral epiphyses OR SUFE AND Management OR Treatment. Correlation between the level of evidence and the impact factor of the journal were analyzed together with linear regression models to reveal any significant trends over time. A total of 1516 studies were found, of which 321 were included in the final analysis. The most frequent study type was the case series (51.1%) followed by case reports (22.4%) and expert opinion (14.0%). Randomized control trial accounted for only 0.6%. The Journal of Pediatric Orthopedics (American) had the most studies (22.6%) and the highest number of level 2 (n=1) and level 3 (n=15) type evidence. There was no progression of level of evidence over time. There was no correlation between level of evidence and impact factor of journal. The majority of therapeutic studies on SCFE are of low level of evidence. High-level RCTs are difficult to perform in pediatric orthopedic surgery, however the management of SCFE would benefit from well-designed, multicenter, clinical RCTs to advance evidence-based practice. PMID:27433299

  17. The seasonality of slipped upper femoral epiphysis--meta-analysis: a possible association with vitamin D.

    PubMed

    Farrier, Adam J; Ihediwa, Ugwunna; Khan, Shoaib; Kumar, Ameet; Gulati, Vivek; Uzoigwe, Chika E; Choudhury, Muhammed Z

    2015-01-01

    We performed a meta-analysis of studies evaluating the seasonality of slipped upper femoral epiphysis (SUFE). In addition we compared the monthly incidences of SUFE at latitudes greater than 40° with the established serum 25-hydroxyvitamin levels for children resident at a comparative latitude. In total 11 relevant studies were identified, involving 7451 cases of SUFE. There was significant variation in the month of onset of SUFE. The degree of variability increased with increasing latitude. The modal month of symptomatic onset was dependent upon latitude. At latitudes greater than 40°, the most common month of onset was August. At latitudes between 20° and 40°, this was earlier in the calendar year, around April. The seasonal variability was statistically significant (p<0.0001 and p<0.005 for latitudes >40° and 20°-40° respectively). The pattern of monthly fluctuation in onset of SUFE very closely mirrored the monthly pattern of variation for serum 25-hydroxyvitamin D3. There was a very strong positive correlation (Spearman rank rho = + 0.8, p = 0.001). There is a monthly variation in incidence of SUFE. The degree of variability increases with increasing latitude. There may be an association with vitamin D. We hypothesise that elevated serum 25-hydroxyvitamin D3 accelerates growth thus rendering the growth plate vulnerable to slippage in analogous manner to the pubertal growth spurt. PMID:26044532

  18. Total hip arthroplasty in young adults, with focus on Perthes' disease and slipped capital femoral epiphysis

    PubMed Central

    2012-01-01

    Background and purpose Pediatric hip diseases account for 9% of all primary hip arthroplasties in the Norwegian Arthroplasty Register. We wanted to validate the diagnosis as reported to the register and to assess the quality of life of these patients after hip replacement. Patients and methods 540 patients accepted to participate in this follow-up study (634 hips). All were less than 40 years of age and had been reported to the Norwegian Arthroplasty Register as having undergone a primary total hip arthroplasty (THA) between 1987 and 2007. The underlying diagnosis, age at diagnosis, and type of treatment given prior to the hip replacement were recorded from the original hospital notes. Results The diagnoses reported to the Norwegian Arthroplasty Register were confirmed to be correct in 91% of all cases (538/592). For the 94 hips that had been treated due to Perthes' disease or slipped capital femoral epiphysis (SCFE), the diagnosis was verified in 95% of cases (89/94). The corresponding proportion for inflammatory hip disease was 98% (137/140) and it was only 61% for primary osteoarthritis (19/31). The self reported quality of life (EQ-5D) was poorer for these young patients with THA than for persons in age-matched cohorts from Great Britain and Sweden, except for those with an underlying SCFE. Interpretation The diagnoses reported to the Norwegian Arthroplasty Register as the underlying cause of THA were correct in 91% of cases. Individuals who undergo THA before the age of 40 have a reduced quality of life, except for those requiring a hip replacement because of SCFE. PMID:22112152

  19. The demographics of slipped capital femoral epiphysis. An international multicenter study.

    PubMed

    Loder, R T

    1996-01-01

    One thousand six hundred thirty children with 1993 slipped capital femoral epiphyses were reviewed; 41.2% were girls and 58.8% were boys. There were 47.5% white, 24.8% black, 16.9% Amerindian, 7.4% Indonesian-Malay, 2.1% Native Australian/Pacific Islands, and 1.3% Indo-Mediterranean children. The diseased hip was unilateral in 77.7% and bilateral in 22.3% of the children, and chronic in 85.5% and acute in 14.5% of the children. Of the unilateral slips, 40.3% involved the right hip and 59.7% the left hip. The child's weight was greater than or equal to the ninetieth percentile in 63.2% of the children. The average age for the girls and boys was 12 and 13.5 years. The age at diagnosis decreased with increasing obesity. The youngest children were the Native Australian/Pacific Island children (11.8 years) and the oldest were the white and Indo-Mediterranean children (13 years). The Indonesian-Malay and Indo-Mediterranean children were the lightest in weight, and the black children the heaviest. The Indo-Mediterranean children had the highest proportion of boys (90.5%), and the Native Australian/Pacific Island children the lowest (50%). The highest percentage of bilaterality was in the Native Australian/Pacific Island children (38.2%), and the lowest in the Amerindian children (16.5%). The relative racial frequency of slipped capital femoral epiphysis compared with the white population was 4.5 for the Polynesian, 2.2 for the black, 1.05 for the Amerindian, 0.5 for the Indonesian-Malay, and 0.1 for the Indo-Mediterranean children. In children with unilateral involvement, the age at presentation was younger for those children in whom bilateral disease later developed (12 versus 12.9 years old). In 82% of the children with sequential bilateral slips, the second slip was diagnosed within 18 months of the first slip. PMID:8542716

  20. Abnormal Development of the Femoral Head Epiphysis in an Infant with no Developmental Dysplasia of the Hip Apparent on Ultrasonography

    PubMed Central

    Atalar, Hakan; Gunay, Cuneyd; Aytekin, Mahmut Nedim

    2014-01-01

    Introduction: In the investigation of hip development in newborns and infants, ultrasonography and radiography are widely used, but their optimal roles in this setting remain controversial. Case Report: Here we describe an 8.5-month-old infant who had undergone hip radiography at a primary care facility and was referred to our hospital to be evaluated for developmental dysplasia of the hip. Ultrasonography showed no developmental dysplasia of the hip according to standard criteria, but developmental retardation of the femoral head was apparent on the radiograph. Conclusion: This patient's findings demonstrate that abnormalities in femoral head epiphysis development can go undetected during routine ultrasonographic evaluations for developmental dysplasia of the hip. PMID:27298982

  1. Expression of HCA2 Receptors in Femoral Epiphysis and Metaphysis of Rats with Dexamethasone-Induced Osteoporosis

    PubMed Central

    Shomali, Tahoora; Kamalpour, Mohammad; Fazeli, Mehdi; Rafati, Alireza

    2016-01-01

    The present study describes the changes in expression of hydroxy- carboxylic acid receptor 2 (HCA2 receptor) in femoral epiphysis and metaphysis of rats with glucocorticoid-induced osteoporosis (GIO). 16 growing male Sprauge dawley rats were randomly divided into two equal groups consisting of normal control and rats that were rendered osteoporotic by receiving 0.1 mg/kg/day dexamethasone subcutaneously. After 4 weeks, all rats were sacrificed and immediately right and left femoral bones were removed for RT-qPCR and histological examination, respectively. Immunohistochemical parameters using a primary rabbit polyclonal GPR109A antibody in hematoxylin and eosin- counter stained slides were determined. HCA2 receptor expression was evaluated using RT- qPCR. Qualitative and histomorphometric evaluation of slides revealed the establishment of glucocorticoid- induced osteoporosis (GIO) in rats treated with dexamethasone. In immunohistochemical study, dexamethasone administration appreciably reduced receptor density in all evaluated cell types and in total slides as compared to control. mRNA level of HCA2 receptor gene was reduced in dexamethasone- treated group. GIO may be associated with down regulation of HCA2 receptors in proximal femoral bone of rats at mRNA as well as protein level in no- cell type-specific manner, although reduction in protein expression needs to be further confirmed by western blotting. PMID:27478807

  2. Expression of HCA2 Receptors in Femoral Epiphysis and Metaphysis of Rats with Dexamethasone-Induced Osteoporosis.

    PubMed

    Shomali, Tahoora; Kamalpour, Mohammad; Fazeli, Mehdi; Rafati, Alireza

    2016-01-01

    The present study describes the changes in expression of hydroxy- carboxylic acid receptor 2 (HCA2 receptor) in femoral epiphysis and metaphysis of rats with glucocorticoid-induced osteoporosis (GIO). 16 growing male Sprauge dawley rats were randomly divided into two equal groups consisting of normal control and rats that were rendered osteoporotic by receiving 0.1 mg/kg/day dexamethasone subcutaneously. After 4 weeks, all rats were sacrificed and immediately right and left femoral bones were removed for RT-qPCR and histological examination, respectively. Immunohistochemical parameters using a primary rabbit polyclonal GPR109A antibody in hematoxylin and eosin- counter stained slides were determined. HCA2 receptor expression was evaluated using RT- qPCR. Qualitative and histomorphometric evaluation of slides revealed the establishment of glucocorticoid- induced osteoporosis (GIO) in rats treated with dexamethasone. In immunohistochemical study, dexamethasone administration appreciably reduced receptor density in all evaluated cell types and in total slides as compared to control. mRNA level of HCA2 receptor gene was reduced in dexamethasone- treated group. GIO may be associated with down regulation of HCA2 receptors in proximal femoral bone of rats at mRNA as well as protein level in no- cell type-specific manner, although reduction in protein expression needs to be further confirmed by western blotting. PMID:27478807

  3. Preliminary study on the mineral apposition rate in distal femoral epiphysis of New Zealand white rabbit at skeletal maturity.

    PubMed

    Cacchioli, A; Ravanetti, F; Soliani, L; Borghetti, P

    2012-06-01

    Studies investigating the effect of different factors on the skeletal system require characterization of an appropriate animal model. Rabbits are among the most commonly studied animals for medical research, being used in about 35% of musculoskeletal research studies. The present dynamic cross-sectional histomorphometric study quantitatively determined mineral apposition rates (MARs) in the distal femoral epiphysis in four regions of interest (ROIs) in New Zealand white rabbits. ROIs included the craniolateral (CrL), caudolateral (CaL), craniomedial (CrM) and caudomedial (CaM) areas, using a reference height at different stages of skeletal maturity corresponding to experimental ages of 6, 7 and 8 months old (M6, M7 and M8). We evaluated whether a correlation exists in MARs between the times and the regions examined. Such data could be used in studies on growth of the rabbit's femur, on biomaterials for bone integration or regeneration and on growth disturbances produced by various pathologic factors. We found no interaction at the experimental times; thus, M6, M7 and M8 are considered homogeneous in terms of MARs. The velocity profiles of the MARs were statistically significantly different among the considered ROIs. For all experimental times, the CrM region had a higher MAR than the other ROIs. Both the CrM and CaM ROIs had higher MARs than the corresponding lateral ROIs. Our results indicate that bone formation is not constant within the cross-section, but is statistically different between the ROIs considered. PMID:22150415

  4. Slipped Capital Femoral Epiphysis

    MedlinePlus

    ... is held in place with a single central screw. This screw keeps the thigh bone from slipping and will ... including in-situ fixation with more than one screw) are used less often. Ask your doctor to ...

  5. Widening Participation; Widening Capability

    ERIC Educational Resources Information Center

    Walker, Melanie

    2008-01-01

    This paper proposes that widening participation in higher education might distinctively be conceptualised beyond economically driven human capital outcomes, as a matter of widening capability. Specifically, the paper proposes forming the capability of students to become and to be "strong evaluators", able to make reflexive and informed choices…

  6. Widener University

    ERIC Educational Resources Information Center

    Valesey, Brigitte; Allen, Jo

    2009-01-01

    Founded in 1821, Widener University is a two-state (Pennsylvania and Delaware), four-campus, eight-college private institution serving approximately 6,700 students. Following arrival of the new senior vice president and provost in 2004 and subsequent reorganization of vice presidential responsibilities, Student Affairs is now led by a dean of…

  7. Spontaneous capital femoral physeal fracture in a cat

    PubMed Central

    Schwartz, Galya

    2013-01-01

    A young neutered male cat was presented with a 1-week history of left hind limb lameness. Pain and crepitus were identified on manipulation of the left coxofemoral joint. Radiographic evaluation led to the diagnosis of physeal dysplasia with slipped capital femoral epiphysis of the left femur, which did not respond to conservative management. PMID:24155467

  8. Forensic age estimation via 3-T magnetic resonance imaging of ossification of the proximal tibial and distal femoral epiphyses: Use of a T2-weighted fast spin-echo technique.

    PubMed

    Ekizoglu, Oguzhan; Hocaoglu, Elif; Inci, Ercan; Can, Ismail Ozgur; Aksoy, Sema; Kazimoglu, Cemal

    2016-03-01

    Radiation exposure during forensic age estimation is associated with ethical implications. It is important to prevent repetitive radiation exposure when conducting advanced ultrasonography (USG) and magnetic resonance imaging (MRI). The purpose of this study was to investigate the utility of 3.0-T MRI in determining the degree of ossification of the distal femoral and proximal tibial epiphyses in a group of Turkish population. We retrospectively evaluated coronal T2-weighted and turbo spin-echo sequences taken upon MRI of 503 patients (305 males, 198 females; age 10-30 years) using a five-stage method. Intra- and interobserver variations were very low. (Intraobserver reliability was κ=0.919 for the distal femoral epiphysis and κ=0.961 for the proximal tibial epiphysis, and interobserver reliability was κ=0.836 for the distal femoral epiphysis and κ=0.885 for the proximal tibial epiphysis.) Spearman's rank correlation analysis indicated a significant positive relationship between age and the extent of ossification of the distal femoral and proximal tibial epiphyses (p<0.001). Comparison of male and female data revealed significant between-gender differences in the ages at first attainment of stages 2, 3, and 4 ossifications of the distal femoral epiphysis and stage 1 and 4 ossifications of the proximal tibial epiphysis (p<0.05). The earliest ages at which ossification of stages 3, 4, and 5 was evident in the distal femoral epiphysis were 14, 17, and 22 years in males and 13, 16, and 21 years in females, respectively. Proximal tibial epiphysis of stages 3, 4, and 5 ossification was first noted at ages 14, 17, and 18 years in males and 13, 15, and 16 years in females, respectively. MRI of the distal femoral and proximal tibial epiphyses is an alternative, noninvasive, and reliable technique to estimate age. PMID:26797254

  9. The lateral clavicular epiphysis: fusion timing and age estimation.

    PubMed

    Langley, Natalie R

    2016-03-01

    This study utilizes a forensic autopsy sample of twentieth century American Whites (the McCormick Clavicle Collection) to describe the morphology, variation, and fusion timing of the lateral clavicle epiphysis. Clavicles from individuals between 11 and 25 years at the time of death were used to document fusion of the lateral epiphysis (n= 133, 38 females and 95 males). The lateral epiphysis was scored as unfused, fusing, or fused. A linear weighted kappa indicates that this scoring method is highly replicable with almost perfect inter-rater agreement (kappa = 0.849), according to a widely used standard for assessing kappa values. Transition analysis, or probit regression, was employed to quantify fusion timing of the lateral epiphysis. The transition from "unfused" to "fusing" is most likely to occur at 16.5 years in females and 17.5 years in males. The transition from "fusing" to "fused" occurs at age 21 in females and age 20 in males. The earliest age at which fusion began was 15 years (n = 1), but the majority began fusing between 17 and 20 years. Most individuals (98.5 % of the sample) aged >24 years had fused lateral epiphyses. The epiphysis assumes one of two forms: (1) a separate bony flake fusing to the diaphysis or (2) a mound of bone glazing/smoothing over the diaphyseal surface. As socioeconomic status has been cited as the most influential variable on skeletal maturation rates, the fusion ages offered here should not be applied to populations with a socioeconomic status different from the greater US population. PMID:26253853

  10. Widening ERTS applications

    NASA Technical Reports Server (NTRS)

    Mercanti, E. P.

    1974-01-01

    In less than two years of operation ERTS-1 is shown to have successfully completed its experimental mission and to be delivering an ever-increasing roster of benefits. The widening ERTS applications reviewed include air quality and weather modification, aid to oil exploration, ore-deposit exploration, short-lived event observation, flood area assessment and flood-plain mapping, land and water quality assessment, soil association mapping, crop production measurements, wildlife resources, drought and desertification studies, ground-water exploration, watershed surveys, snow and ice monitoring, surface water mapping, and iceberg surveys. Future projects and developments are also briefly reviewed.

  11. Pleural effusion presenting as mediastinal widening

    PubMed Central

    Mohapatra, Prasanta R.; Garg, Kranti; Prashanth, Chikkahonnaiah; Lahoria, Rupali

    2013-01-01

    We report a case of middle-aged female presenting with mediastinal widening on chest radiograph owing to pleural effusion. The pleural effusion presenting as mediastinal widening on chest radiograph is rarely reported. PMID:24339499

  12. Study on Running Safety with Gauge Widening

    NASA Astrophysics Data System (ADS)

    Adachi, Masakazu; Sato, Yasuhiro; Ohno, Hiroyuki; Matsumoto, Akira; Iwamoto, Atsushi; Kobayashi, Minoru

    Gauge widening has been set in order that rolling stock runs safely and smoothly on curved tracks. Recently gauge widening has been reduced due to the change of vehicle structures and track maintenance. The reduction of gauge widening may lead the decrease of steering ability of wheelsets and running safety of vehicles. The purpose of this study is to grasp curving performance and running safety when gauge widening was varied. Stand tests were carried out by a bogie test stand, and the authors concluded that the curving performance can be increased according to gauge widening, but the effect is limited in perfect rolling region, and not so effective for normal setting range.

  13. Femoral nerve damage (image)

    MedlinePlus

    The femoral nerve is located in the leg and supplies the muscles that assist help straighten the leg. It supplies sensation ... leg. One risk of damage to the femoral nerve is pelvic fracture. Symptoms of femoral nerve damage ...

  14. Femoral nerve dysfunction

    MedlinePlus

    Neuropathy - femoral nerve; Femoral neuropathy ... Craig EJ, Clinchot DM. Femoral neuropathy. In: Frontera WR, Silver JK, Rizzo TD Jr, eds. Essentials of Physical Medicine and Rehabilitation: Musculoskeletal Disorders, Pain, and Rehabilitation . 3rd ...

  15. Variation in mammalian proximal femoral development: comparative analysis of two distinct ossification patterns

    PubMed Central

    Serrat, Maria A; Reno, Philip L; McCollum, Melanie A; Meindl, Richard S; Lovejoy, C Owen

    2007-01-01

    The developmental anatomy of the proximal femur is complex. In some mammals, including humans, the femoral head and greater trochanter emerge as separate ossification centres within a common chondroepiphysis and remain separate throughout ontogeny. In other species, these secondary centres coalesce within the chondroepiphysis to form a single osseous epiphysis much like the proximal humerus. These differences in femoral ontogeny have not been previously addressed, yet are critical to an understanding of femoral mineralization and architecture across a wide range of mammals and may have key implications for understanding and treating hip abnormalities in humans. We evaluated femora from 70 mammalian species and categorized each according to the presence of a ‘separate’ or ‘coalesced’ proximal epiphysis based on visual assessment. We found that ossification type varies widely among mammals: taxa in the ‘coalesced’ group include marsupials, artiodactyls, perissodactyls, bats, carnivores and several primates, while the ‘separate’ group includes hominoids, many rodents, tree shrews and several marine species. There was no clear relationship to body size, phylogeny or locomotion, but qualitative and quantitative differences between the groups suggest that ossification type may be primarily an artefact of femoral shape and neck length. As some osseous abnormalities of the human hip appear to mimic the normal morphology of species with coalesced epiphyses, these results may provide insight into the aetiology and treatment of human hip disorders such as femoroacetabular impingement and early-onset osteoarthritis. PMID:17331175

  16. Cloud Technology May Widen Genomic Bottleneck - TCGA

    Cancer.gov

    Computational biologist Dr. Ilya Shmulevich suggests that renting cloud computing power might widen the bottleneck for analyzing genomic data. Learn more about his experience with the Cloud in this TCGA in Action Case Study.

  17. Vasculature deprivation – induced osteonecrosis of the rat femoral head as a model for therapeutic trials

    PubMed Central

    Bejar, Jacob; Peled, Eli; Boss, Jochanan H

    2005-01-01

    Experimental Osteonecrosis The authors' experience with experimentally produced femoral capital osteonecrosis in rats is reviewed: incising the periosteum at the base of the neck of the femur and cutting the ligamentum teres leads to coagulation necrosis of the epiphysis. The necrotic debris is substituted by fibrous tissue concomitantly with resorption of the dead soft and hard tissues by macrophages and osteoclasts, respectively. Progressively, the formerly necrotic epiphysis is repopulated by hematopoietic-fatty tissue, and replaced by architecturally abnormal and biomechanically weak bone. The femoral heads lose their smooth-surfaced hemispherical shape in the wake of the load transfer through the hip joint such that, together with regressive changes of the joint cartilage and inflammatory-hyperplastic changes of the articular membrane, an osteoarthritis-like disorder ensues. Therapeutic Choices Diverse therapeutic options are studied to satisfy the different opinions concerning the significance of diverse etiological and pathogenic mechanisms: 1. Exposure to hyperbaric oxygen. 2. Exposure to hyperbaric oxygen and non-weight bearing on the operated hip. 3. Medication with enoxaparin. 4. Reduction of intraosseous hypertension, putting to use a procedure aimed at core decompression, namely drilling a channel through the femoral head. 5. Medication with vascular endothelial growth factor with a view to accelerating revascularization. 6. Medication with zoledronic acid to decrease osteoclastic productivity such that the remodeling of the femoral head is slowed. Glucocorticoid-related osteonecrosis appears to be apoptosis-related, thus differing from the vessel-deprivation-induced tissue coagulation found in idiopathic osteonecrosis. The quantities of TNF-α, RANK-ligand and osteoprotegerin are raised in glucocorticoid-treated osteoblasts so that the differentiation of osteoclasts is blocked. Moreover, the osteoblasts and osteocytes of the femoral cortex mostly

  18. Shape Analysis of the Femoral Head: A Comparative Study Between Spherical, (Super)Ellipsoidal, and (Super)Ovoidal Shapes.

    PubMed

    Lopes, Daniel Simões; Neptune, Richard R; Gonçalves, Artur A; Ambrósio, Jorge A; Silva, Miguel T

    2015-11-01

    In this work, MacConaill's classification that the articular surface of the femoral head is better represented by ovoidal shapes rather than purely spherical shapes is computationally tested. To test MacConaill's classification, a surface fitting framework was developed to fit spheres, ellipsoids, superellipsoids, ovoids, and superovoids to computed tomography (CT) data of the femoral proximal epiphysis. The framework includes several image processing and computational geometry techniques, such as active contour segmentation and mesh smoothing, where implicit surface fitting is performed with genetic algorithms. By comparing the surface fitting error statistics, the results indicate that (super)ovoids fit femoral articular surfaces better than spherical or (super)ellipsoidal shapes. PMID:26399629

  19. Widening Participation: A Post-War Scorecard

    ERIC Educational Resources Information Center

    Tight, Malcolm

    2012-01-01

    Widening participation--though it has only recently been labelled as such--has been a continuing concern for policy makers and higher education institutions in the United Kingdom since 1945 (and before). This article reviews the evidence for four key target groups--women, lower socio-economic groups, mature adults and ethnic minorities--to produce…

  20. Working towards widening participation in nurse education.

    PubMed

    Young, Kate

    The widening participation agenda has particular significance for worldwide nursing since it is a profession which is under increasing scrutiny in its recruitment and retention practices. Debate about this agenda within nurse education is strengthened by careful scrutiny of the research within the wider context of higher education, some of which challenges commonly held assumptions. This paper examines four areas of relevance to the UK widening participation agenda: disability, ethnicity, socioeconomic status and family responsibilities. Taken together, they indicate that nurse education operates within a particularly complex context with some important implications for the future design of pre-registration programmes. These complexities should be debated in depth by educational commissioners and providers, in tandem with regulatory bodies. PMID:27119543

  1. Posterior sternoclavicular Salter-Harris fracture-dislocation in a patient with unossified medial clavicle epiphysis.

    PubMed

    Beckmann, Nicholas; Crawford, Lindsay

    2016-08-01

    Sternoclavicular injuries are relatively rare, composing less than 1 % of all musculoskeletal fractures or dislocations. When sternoclavicular injuries do occur, they typically present as an isolated dislocation of the sternoclavicular joint without associated fracture of the clavicle or manubrium. However, in patients with unfused medial clavicle physis, sternoclavicular joint injuries can present as a fracture-dislocation through the unfused physis. These physeal injuries are important to recognize as the displaced epiphysis can block reduction of the sternoclavicular joint. We present a case of a 15-year-old female basketball player presenting with suspected sternoclavicular joint injury after sustaining a direct blow to the left shoulder. An initial shoulder CT confirmed the presence of the clinically suspected posterior sternoclavicular dislocation without fracture identified. An MRI of the left sternoclavicular joint was then performed for suspected physeal fracture, which confirmed the presence of a fracture through the medial clavicle physis with anterior displacement of the unossified epiphysis, blocking reduction of the metaphysis. Given the findings on MRI, the pediatric orthropedic surgeon was able to counsel the family of the high likelihood of failed closed reduction of the sternoclavicular joint requiring conversion to open reduction and internal fixation. The patient underwent successful open reduction and internal fixation of the medial clavical physeal fracture after an initial gentle attempt at closed reduction was unsuccessful. PMID:27107998

  2. Widening economic & social disparities: implications for India.

    PubMed

    Kurian, N J

    2007-10-01

    India is often characterized as an emerging economic super power. The huge demographic dividend, the high quality engineering and management talent, the powerful Indian diaspora and the emerging Indian transnational--kneeling the optimism. In contrast, there is another profile of India which is rather gloomy. This is the country with the largest number of the poor, illiterates and unemployed in the world. High infant mortality, morbidity and widespread anaemia among women and children continue. India suffers from acute economic and social disparities. This article addresses four dimensions of such disparities, viz. regional, rural-urban, social, and gender. There is empirical evidence to indicate that during the last two decades all these disparities have been increasing. As a result of economic reforms, the southern and western States experienced accelerated economic and social development as compared to northern and eastern States. This has led to widening gap in income, poverty and other indicators of development between the two regions. Rural-urban divide also widened in the wake of reforms. While large and medium cities experience unprecedented economic prosperity, the rural areas experience economic stagnation. As a result, there is widespread agrarian distress which results in farmers' suicide and rural unrest. Socially backward sections, especially scheduled castes and tribes (SCs and STs) have gained little from the new prosperity which rewards disproportionately those with assets, skills and higher education. STs have often been victims of development as a result of displacement. The gender gap in social and economic status, traditionally more in India as compared to other societies; has further widened by the economic reforms and globalization. The approach paper to the Eleventh Plan stresses the importance of more inclusive economic growth. It emphasizes the need for bridging the divides discussed in this article. Unless these are achieved in a time

  3. Effect of growth plate geometry and growth direction on prediction of proximal femoral morphology.

    PubMed

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

    2016-06-14

    Mechanical stimuli play a significant role in the process of endochondral growth. Thus far, approaches to understand the endochondral mechanical growth rate have been limited to the use of approximated location and geometry of the growth plate. Furthermore, growth has been simulated based on the average deflection of the growth plate or of the femoral neck. It has also been reported in the literature that the growth plate lies parallel to one of the principal stresses acting on it, to reduce the shear between epiphysis and diaphysis. Hence the current study objectives were (1) to evaluate the significance of a subject-specific finite element model of the femur and growth plate compared to a simplified growth plate model and (2) to explore the different growth direction models to better understand proximal femoral growth mechanisms. A subject-specific finite element model of an able-bodied 7-year old child was developed. The muscle forces and hip contact force were computed for one gait cycle and applied to a finite element model to determine the specific growth rate. Proximal femoral growth was simulated for two different growth direction models: femoral neck deflection direction and principal stress direction. The principal stress direction model captured the expected tendency for decreasing the neck shaft angle and femoral anteversion for both growth plate models. The results of this study suggest that the subject-specific geometry and consideration of the principal stress direction as growth direction may be a more realistic approach for correct prediction of proximal femoral growth morphology. PMID:27063249

  4. A rare cause of neural foraminal widening.

    PubMed

    Rodrigues, Jonathan C L; Mortimer, Alex M; Love, Seth; Renowden, Shelley A

    2012-12-01

    The differential diagnosis for lesions causing neural foraminal widening is vast. The majority are solitary benign peripheral nerve sheath tumours, such as neurofibromas or schwannomas. We present a case of a rare cause of neural foraminal expansion secondary to a posterior thoracic extradural angiolipoma. We describe the presence of chemical shift artefact on post gadolinium T1-weighted imaging as indirect evidence of a fatty component. This potentially important diagnostic sign may raise the suspicion of angiolipoma, especially in an isointense or hypointense dumbbell lesion on T1-weighted imaging, and has not been described previously in this context. Accurate radiological diagnosis of an angiolipoma is important to reduce unexpected haemorrhagic complications from biopsy or resection of the lesion. PMID:23365697

  5. The widening gap—a swedish perspective

    NASA Astrophysics Data System (ADS)

    Brandell, Gerd; Hemmi, Kirsti; Thunberg, Hans

    2008-09-01

    Transition problems from secondary to tertiary level in mathematics have been a recurrent issue in Sweden. This paper summarises the development during the last decades. Results from two recent research studies that illuminate the transition problem are presented. The first one, based on empirical data from a major Swedish technical university, characterises the widening gap, in content and in approach, between secondary school and first year university courses. The second study deals with students' encounters with mathematical proof and is based on a large investigation at another main Swedish university. We discuss the influence on the current transition problems of school reforms and of the great expansion of higher education in Sweden during the last 10 - 15 years in view of the results from the research studies.

  6. [Trochanteric femoral fractures].

    PubMed

    Douša, P; Čech, O; Weissinger, M; Džupa, V

    2013-01-01

    At the present time proximal femoral fractures account for 30% of all fractures referred to hospitals for treatment. Our population is ageing, the proportion of patients with post-menopausal or senile osteoporosis is increasing and therefore the number of proximal femoral fractures requiring urgent treatment is growing too. In the age category of 50 years and older, the incidence of these fractures has increased exponentially. Our department serves as a trauma centre for half of Prague and part of the Central Bohemia Region with a population of 1 150 000. Prague in particular has a high number of elderly citizens. Our experience is based on extensive clinical data obtained from the Register of Proximal Femoral Fractures established in 1997. During 14 years, 4280 patients, 3112 women and 1168 men, were admitted to our department for treatment of proximal femoral fractures. All patients were followed up until healing or development of complications. In the group under study, 82% were patients older than 70 years; 72% of those requiring surgery were in their seventies and eighties. Men were significantly younger than women (p<0.001) and represented 30% of the group. The fractures were 2.3-times more frequent in women than in men. In the category under 60 years, men significantly outnumbered women (p<0.001). The patients with pertrochanteric fractures were, on the average, eight years older than the patients with intertrochanteric fractures, which is a significant difference (p<0.001). The mortality rate within a year of injury was about 30%. Trochanteric fractures accounted for 54.7% and femoral neck fractures for 45.3% of all fractures. The inter-annual increase was 5.9%, with more trochanteric than femoral neck fractures. There was a non-significant decrease in intertrochanteric (AO 31-A3) fractures. On the other hand, the number of pertrochanteric (AO 31-A1+2) fractures increased significantly (p<0.001). A total of 1 394 fractures were treated with a proximal

  7. Widening Access by Changing the Criteria for Selecting Medical Students

    ERIC Educational Resources Information Center

    Powis, David; Hamilton, John; McManus, I. C.

    2007-01-01

    Objective: To review the principles underlying medical student selection from the perspective of the imperatives of widening access policies. Setting: A recent government initiative has increased the number of medical school places in Great Britain. A priority is to widen access to sections of the community hitherto inadequately represented in…

  8. Failed vascularized fibular graft in treatment of osteonecrosis of the femoral head. A histopathological analysis

    PubMed Central

    MELONI, MARIA CHIARA; HOEDEMAEKER, W. RUSSALKA; FORNASIER, VICTOR

    2016-01-01

    Purpose vascularized fibular grafting has been used to treat osteonecrosis of the femoral head in younger patients. Although the results described in the literature are promising, the failure rate is still significant, especially in steroid users. This study was undertaken to learn more, on a histopathological level, about the mechanism of vascularized fibular graft failure. Methods fifteen femoral heads removed at conversion to total hip arthroplasty were analyzed. The case load comprised 10 men and 5 women. They ranged in age from 28 to 39 years and had a median age of 35 years. The interval between the vascularized fibular implant procedure and the conversion to total hip arthroplasty ranged from 22 months to 30 months; the median interval was 26 months. All the patients were steroid users. The heads were sectioned and axial and coronal sections were taken and stained using the WHO method (hematoxylin, phloxine, saffron and Alcian green). A quantitative and qualitative analysis of graft-host interaction at the head (zone 1), neck (zone 2) and epiphysis (zone 3) was performed. Results all the specimens showed recognizable collapse of the articular surface over the area of necrosis. Thirteen femoral heads showed the presence of an osteochondral flap attached only at the margins of the area of avascular necrosis, and 10 of these 13 femoral heads also showed loss of the articulating surface with an ulcer crater corresponding to the exposed area of avascular necrosis. Conclusions vascularized fibular graft failure seems to be related to a negative effect of creeping substitution: the revascularization becomes a negative force as it supports unbalanced bone resorption, which, as is well known, is enhanced by corticosteroids. Clinical relevance creeping substitution is an undermining force in the repair and revascularization of the necrotic area in the femoral head. PMID:27386444

  9. Axial vessel widening in arborescent monocots.

    PubMed

    Petit, Giai; DeClerck, Fabrice A J; Carrer, Marco; Anfodillo, Tommaso

    2014-02-01

    Dicotyledons have evolved a strategy to compensate for the increase in hydraulic resistance to water transport with height growth by widening xylem conduits downwards. In monocots, the accumulation of hydraulic resistance with height should be similar, but the absence of secondary growth represents a strong limitation for the maintenance of xylem hydraulic efficiency during ontogeny. The hydraulic architecture of monocots has been studied but it is unclear how monocots arrange their axial vascular structure during ontogeny to compensate for increases in height. We measured the vessel lumina and estimated the hydraulic diameter (Dh) at different heights along the stem of two arborescent monocots, Bactris gasipaes (Kunth) and Guadua angustifolia (Kunth). For the former, we also estimated the variation in Dh along the leaf rachis. Hydraulic diameter increased basally from the stem apex to the base with a scaling exponent (b) in the range of those reported for dicot trees (b = 0.22 in B. gasipaes; b = 0.31 and 0.23 in G. angustifolia). In B. gasipaes, vessels decrease in Dh from the stem's centre towards the periphery, an opposite pattern compared with dicot trees. Along the leaf rachis, a pattern of increasing Dh basally was also found (b = 0.13). The hydraulic design of the monocots studied revealed an axial pattern of xylem conduits similar to those evolved by dicots to compensate and minimize the negative effect of root-to-leaf length on hydrodynamic resistance to water flow. PMID:24488857

  10. Analysis of the Tibial Epiphysis in the Skeletally Immature Knee Using Magnetic Resonance Imaging

    PubMed Central

    Davis, Derik L.; Almardawi, Ranyah; Mitchell, Jason W.

    2016-01-01

    Background: Physeal-sparing anterior cruciate ligament (ACL) reconstruction is being performed increasingly in skeletally immature knees. Purpose: To determine normal values for the maximum oblique length and “safe” physeal-sparing length and their corresponding angular trajectories across the tibial epiphysis on reconstructed magnetic resonance images (MRIs) in children and adolescents. Study Design: Cross-sectional study; Level of evidence, 3. Methods: An electronic search for pediatric knee MR examinations from April 2003 to April 2013 was performed at our institution. A 3-dimensional system viewer was used to measure the maximum oblique length, physeal-sparing length, and their corresponding angular trajectories on reconstructed MRIs. Knees were stratified by age into 2 groups: group 1 consisted of boys <13 years and girls <12 years and group 2 consisted of older boys (13-14 years) and girls (12-14 years). Each cohort was further stratified by sex. Group 1 consisted of 36 knees (mean age, 10.9 years) and group 2 consisted of 59 knees (mean age, 13.6 years). Results: Significant differences existed for the maximum oblique length and its angular trajectory for the younger versus older cohort (22.2 ± 2.7 vs 23.8 ± 2.7 mm, P = .007; 42.0° ± 4.0° vs 39.4° ± 4.2°, P = .003) and for the physeal-sparing length and its angular trajectory (19.4 ± 2.8 vs 21.3 ± 2.9 mm, P = .001; 30.1° ± 4.1° vs 28.2° ± 4.5°, P = .042). In group 2, females had shorter maximal oblique length and physeal-sparing length than boys (22.7 ± 2.3 vs 25.0 ± 2.7 mm, P < .001; 20.3 ± 2.6 vs 22.4 ± 2.9 mm, P = .004). Conclusion: The maximum oblique length across the tibial epiphysis is shorter than previously believed, measuring approximately 22 mm and approximately 24 mm for high- and intermediate-risk knees, respectively. However, “safe” physeal-sparing lengths were only approximately 19 mm and 21 mm for the younger and older cohorts, respectively. The angles

  11. Normalization of mediastinal widening after successful treatment of mediastinal tuberculosis.

    PubMed

    Raskin, Jo; Van Bleyenbergh, Pascal

    2016-08-01

    Clinical image of an asymmetrical mediastinal widening due to tuberculosis of mediastinal lymph nodes, without evidence of pulmonary tuberculosis. Image at first presentation and after successful treatment, showing normalization of the mediastinum. PMID:27149681

  12. Risk Factors for Femoral Head Deformity in the Early Stage of Legg-Calvé-Perthes Disease: MR Contrast Enhancement and Diffusion Indexes.

    PubMed

    Yoo, Won Joon; Choi, In Ho; Cho, Tae-Joon; Jang, Wooyoung; Chung, Chin Youb; Park, Moon Seok; Choi, Eun-Seok; Cheon, Jung-Eun

    2016-05-01

    Purpose To determine whether changes in diffusion and/or contrast enhancement are of prognostic value in the early stage of Legg-Calvé-Perthes disease (LCPD). Materials and Methods This study was approved by the institutional review board, and written informed consent was obtained from patient parents. Diffusion and contrast agent-enhanced magnetic resonance (MR) imaging studies were performed in 46 children (37 boys and nine girls; mean age, 7.5 years [age range, 3.3-11.9 years]) with unilateral LCPD at the early stage before development of extensive femoral head deformity. The degree of contrast enhancement was measured on the contrast-enhanced MR images, and the apparent diffusion coefficient (ADC) value was measured on the ADC map at various regions of interest in the proximal femur. The association of the MR imaging parameters that compared the affected side with the contralateral normal side with the femoral head deformity index value above 0.3 at 2 years was investigated. Results Increased diffusion in the metaphysis (P = .003) and decreased contrast enhancement in the central epiphysis (P = .034) were the significant prognostic indicators of subsequent femoral head deformation. ADC in the metaphysis 45% higher and a contrast enhancement in the central epiphysis 37% lower than those of the contralateral normal side are associated with a nonfavorable prognosis. For diffusion MR imaging, sensitivity was 83% (15 of 18), specificity was 86% (24 of 28), positive predictive value was 79% (15 of 19), negative predictive value was 89% (24 of 27), and accuracy was 85% (39 of 46). For contrast-enhanced MR imaging, sensitivity was 78% (14 of 18), specificity was 64% (18 of 28), positive predictive value was 58% (14 of 24), negative predictive value was 82% (18 of 22), and accuracy was 70% (32 of 46). Conclusion Diffusion and contrast-enhanced MR imaging are potentially useful to assess risk of later development of femoral head deformity. (©) RSNA, 2015. PMID:26606039

  13. Femoral approach to lead extraction.

    PubMed

    Mulpuru, Siva K; Hayes, David L; Osborn, Michael J; Asirvatham, Samuel J

    2015-03-01

    Laser and radiofrequency energy-assisted lead extraction has greatly facilitated this complex procedure. Although success rates are high, in some instances alternate methods of extraction are required. In this review, we discuss techniques for femoral extraction of implanted leads and retained fragments. The major tools available, including commonly used snares and delivery tools, are discussed. We briefly describe combined internal jugular and femoral venous extraction approaches, as well as complimentary utilization of more than one technique via the femoral vein. Animated and procedural sequences are included to help the reader visualize the key components of these techniques. PMID:25311643

  14. [Pathogenesis of atypical femoral fracture].

    PubMed

    Iwata, Ken; Mashiba, Tasuku

    2016-01-01

    We demonstrated microdamage accumulation in the fracture sites in the patients of subtrochanteric atypical femoral fracture with long term bisphosphonate therapy and of incomplete shaft fracture of lateral femoral bowing without bisphosphonate therapy. Based on these findings, pathogenesis of atypical femoral fracture is revealed stress fracture caused by accumulation of microdamages between distal to the lesser trochanter and proximal to the supracondylar flare in the femur in association with severely suppressed bone turnover and/or abnormal lower limb alignment, that causes stress concentration on the lateral side cortex of the femur. PMID:26728533

  15. Experimental determination of the linear biphasic constitutive coefficients of human fetal proximal femoral chondroepiphysis.

    PubMed

    Brown, T D; Singerman, R J

    1986-01-01

    The mechanical properties of the cartilaginous regions of the proximal femoral epiphysis are an important factor in load transmission through the hip joint of young children. Cylindrical test specimens excised from the chondroepiphysis of human stillborn femoral heads were subjected to uniaxial loading in peripherally-unconfined compression, using a ramp/plateau input strain history. The corresponding load vs time curves were analyzed in terms of a recent analytical solution for a linear biphasic material (the well-known KLM model), allowing calculation of that model's three fundamental constitutive coefficients (permeability, equilibrium modulus and solid-phase Poisson ratio) for this material. The numerical algorithm developed to evaluate the biphasic solution yielded very precise replication of previously published KLM parametric plots. When fitted to experimental load histories, however, the model provided only a rather loose approximation of specimen behavior, due apparently to a substantial underestimation of the transient response component associated with interstitial fluid transport. Averaged over the series, the best-fit values for permeability (2.51 X 10(-15) m4 Ns-1) and equilibrium modulus (0.699 MPa) were in the range of values accepted for human adult articular cartilage. A consequence of the coarseness of the analytical curve fits was that a solid-phase Poisson ratio of 0.0 was inferred for all specimens. The permeability vs equilibrium modulus exhibited a nearly linear (r = 0.74) inverse relationship similar to that reported for adult articular cartilage. PMID:3771582

  16. CT evaluation of medial clavicular epiphysis as a method of bone age determination in adolescents and young adults

    PubMed Central

    Ufuk, Furkan; Agladioglu, Kadir; Karabulut, Nevzat

    2016-01-01

    PURPOSE We aimed to investigate the use of computed tomography (CT) staging of the medial clavicular epiphysis ossification in forensic bone age determination, and find a CT criterion to determine whether an individual is adult or not. METHODS Chest CT and pulmonary CT angiography exams of 354 patients between 10 and 30 years of age (mean, 21.4 years) were retrospectively evaluated for epiphyseal ossification phase of the bilateral medial clavicles (708 clavicles) and compared with the sex and chronologic age of the individuals. The ossification phase of the medial clavicular epiphyses was classified from stage I to stage V using a modified staging system. RESULTS Epiphyseal ossification center appeared from 11 to 21 years of age. Partial fusion occurred between 16 and 23 years of age. Complete fusion was first achieved at the ages of 18 and 19 years for male and female individuals, respectively. The probability of an individual being ≥18 years old was 70.8% in stage III A and 100% in stages III B, IV, and V in females and males. CONCLUSION CT evaluation of the medial clavicular epiphysis is helpful in forensic age determination and stage III B can be used as a criterion to make the prediction that an individual is older than 18 years. PMID:27015321

  17. Future aerosol reductions and widening of the northern tropical belt

    NASA Astrophysics Data System (ADS)

    Allen, Robert J.; Ajoku, Osinachi

    2016-06-01

    Observations show that the tropical belt has widened over the past few decades, a phenomenon associated with poleward migration of subtropical dry zones and large-scale atmospheric circulation. Although part of this signal is related to natural climate variability, studies have identified an externally forced contribution primarily associated with greenhouse gases (GHGs) and stratospheric ozone loss. Here we show that the increase in aerosols over the twentieth century has led to contraction of the northern tropical belt, thereby offsetting part of the widening associated with the increase in GHGs. Over the 21st century, however, when aerosol emissions are projected to decrease, the effects of aerosols and GHGs reinforce one another, both contributing to widening of the northern tropical belt. Models that have larger aerosol forcing, by including aerosol indirect effects on cloud albedo and lifetime, yield significantly larger Northern Hemisphere (NH) tropical widening than models with direct aerosol effects only. More targeted simulations show that future reductions in aerosols can drive NH tropical widening as large as greenhouse gases, and idealized simulations show the importance of NH midlatitude aerosol forcing. Mechanistically, the 21st century reduction in aerosols peaks near 40°N, which results in a corresponding maximum increase in surface solar radiation, NH midlatitude tropospheric warming amplification, and a poleward shift in the latitude of maximum baroclinicity, implying a corresponding shift in atmospheric circulation. If models with aerosol indirect effects better represent the real world, then future aerosol changes are likely to be an important -- if not dominant -- driver of NH tropical belt widening.

  18. Does dynamic immobilization reduce chondrocyte apoptosis and disturbance to the femoral head perfusion?

    PubMed Central

    Li, Lian-Yong; Zhang, Li-Jun; Jia, Jing-Yu; Zhao, Qun; Wang, En-bo; Li, Qi-Wei

    2013-01-01

    The purpose of this study is to investigate whether the dynamic hip immobilization is more favourable for lessening ischemic injury to the immature femoral head than a static immobilization. 152 Japanese white rabbits were divided into four groups randomly, and the hips were immobilized into “human” position (group A), “frog leg” position (group B) and “dynamic frog leg” position (group C). Group D was used as control. Ten rabbits in each group were killed, and the hip specimens were harvested at 1, 2, and 3 weeks after immobilization. Bcl-2/Bax expression balance and chondrocytes apoptosis were analyzed. The remaining eight rabbits in each group were used to measure the blood supply of capital femoral epiphysis by selective vascular perfusion with Indian ink. The Bcl-2/Bax expression ratio in group C was significantly increased than that in group A and B (p<0.001), while that was not significantly different from control group (p=0.0592). At three weeks after immobilization, the average apoptotic ratio was 36.7%, 45.8%, and 26.7% in group A, B and C, respectively (p<0.01). There was no significant difference between group C and normal control (p=0.0597). The perfusion ratio was 0.03±0.03, 0.03±0.02, and 0.08±0.03 in group A, B and C respectively, and 0.12±0.04 in control group (p<0.05). Thus, the dynamic immobilization model exhibited a relatively less chondrocytes apoptosis and disturbance to the femoral head perfusion than other immobilizations in vivo, which therefore may be useful for reducing avascular necrosis following the treatment of developmental dysplasia of the hip. PMID:23330006

  19. Some Flaws in the Common Theory of "Widening Participation."

    ERIC Educational Resources Information Center

    Minter, Chris

    2001-01-01

    A critique of the British model for widening participation in lifelong learning, using research from the United States, Palestine, and Singapore, identified flaws: (1) reliance on single-loop learning; (2) assumptions that blame nonparticipants instead of program inadequacies; (3) mislabeling of target groups; (4) neglect of learning trajectories;…

  20. The Widening Participation Agenda: The Marginal Place of Care

    ERIC Educational Resources Information Center

    Alsop, Rachel; Gonzalez-Arnal, Stella; Kilkey, Majella

    2008-01-01

    This paper is based upon two empirical studies, which identify care-giving responsibilities as a key mediator of mature students'--a target group within the widening participation strategy--experiences of higher education. Employing a feminist lens on care, we identify a disjuncture between how students experience the challenges of negotiating…

  1. Institutional Statements of Commitment and Widening Participation Policy in Australia

    ERIC Educational Resources Information Center

    Chapman, Amy; Mangion, Antoine; Buchanan, Rachel

    2015-01-01

    This article describes ways in which the equity agenda, as outlined in the Bradley Review of Higher Education (Bradley et al., 2008), is translated into action in one Australian university. Drawing on the conceptual work of Ahmed (2012) to elaborate institutional life, we investigate the effects of the widening participation policy. Ahmed (2012)…

  2. Evaluation of base widening methods on flexible pavements in Wyoming

    NASA Astrophysics Data System (ADS)

    Offei, Edward

    The surface transportation system forms the biggest infrastructure investment in the United States of which the roadway pavement is an integral part. Maintaining the roadways can involve rehabilitation in the form of widening, which requires a longitudinal joint between the existing and new pavement sections to accommodate wider travel lanes, additional travel lanes or modification to shoulder widths. Several methods are utilized for the joint construction between the existing and new pavement sections including vertical, tapered and stepped joints. The objective of this research is to develop a formal recommendation for the preferred joint construction method that provides the best base layer support for the state of Wyoming. Field collection of Dynamic Cone Penetrometer (DCP) data, Falling Weight Deflectometer (FWD) data, base samples for gradation and moisture content were conducted on 28 existing and 4 newly constructed pavement widening projects. A survey of constructability issues on widening projects as experienced by WYDOT engineers was undertaken. Costs of each joint type were compared as well. Results of the analyses indicate that the tapered joint type showed relatively better pavement strength compared to the vertical joint type and could be the preferred joint construction method. The tapered joint type also showed significant base material savings than the vertical joint type. The vertical joint has an 18% increase in cost compared to the tapered joint. This research is intended to provide information and/or recommendation to state policy makers as to which of the base widening joint techniques (vertical, tapered, stepped) for flexible pavement provides better pavement performance.

  3. Widening Access to the Teaching Profession: Perspectives from Scotland

    ERIC Educational Resources Information Center

    Menter, Ian; Hartshorn, Bryce; Hextall, Ian; Howell, Irene; Smyth, Geri

    2006-01-01

    This paper draws from a systematic literature review carried out for the General Teaching Council for Scotland on "Widening access into the teaching profession." The paper first sets out a rationale for seeking the creation of a teaching profession that is demographically representative of the wider population. It is suggested that eight…

  4. Unfinished Business in Widening Participation: The End of the Beginning

    ERIC Educational Resources Information Center

    Stanton, Geoff; David, Miriam; Hall, Geoff; Brown, Richard; Ebdon, Les; Kendall, Steve; Watters, Kate

    2008-01-01

    Over a decade has gone by since the report of the Widening Participation Committee--"Learning works"--was presented to the Further Education Funding Council. Ten years on, this report asks how far have we come in the decade since "Learning works"? What progress have we made? And what barriers have we yet to overcome? Bringing together the…

  5. New Perspectives: Using Participatory Photography to Evaluate Widening Participation Interventions

    ERIC Educational Resources Information Center

    Raven, Neil

    2015-01-01

    With much emphasis now placed upon determining the effectiveness of widening participation (WP) interventions, there is value in identifying evaluation methods best able to provide insights into the impact of this work. One method that has received little attention in the field of WP and yet has considerable potential in this respect is associated…

  6. On Widening Participation in Higher Education through Positive Discrimination

    ERIC Educational Resources Information Center

    Clayton, Matthew

    2012-01-01

    Notwithstanding an ongoing concern about the low representation of certain groups in higher education, there is reluctance on the part of politicians and policy makers to adopt positive discrimination as an appropriate means of widening participation. This article offers an account of the different objections to positive discrimination and,…

  7. Acute Primary Hematogenous Osteomyelitis in the Epiphysis of the Distal Tibia: A Case Report With Review of the Literature.

    PubMed

    Hwang, Hyun-Jung; Jeong, Woong-Kyo; Lee, Dae-Hee; Lee, Soon-Hyuck

    2016-01-01

    Osteomyelitis originating in the epiphysis of the long bones is quite rare and is usually found at either the distal femur or the proximal tibia. We report the case of a 12-year-old male with epiphyseal osteomyelitis that had developed in the distal tibia. To the best of our knowledge, this is the first published case report. The patient's history of a trauma that resembled an ankle sprain had delayed the diagnosis and subsequently led him to develop septic arthritis. The ankle is a common site of simple trauma; however, epiphyseal osteomyelitis is rare at this site. Therefore, if the symptoms continue or worsen after trauma, the clinician should check the affected site and take a more aggressive approach to make an early diagnosis. PMID:26878809

  8. Assessing the restoration success of river widenings: a landscape approach.

    PubMed

    Rohde, Sigrun; Kienast, Felix; Bürgi, Matthias

    2004-10-01

    During the last 200 years, many rivers in industrialized countries have been modified by canalization. In the last two decades, the philosophy of river management has changed considerably, and restoration of ecological integrity has become an important management goal. One appealing restoration approach is to create "river widenings" that permit braiding within a limited area. This study presents a new and efficient framework for rapidly assessing such widening projects and offers a novel method to comparing restored sites with near-natural stretches (stencil technique). The proposed framework evaluates spatial patterns of riparian habitat types using landscape metrics as indicators. Three case studies from river restoration (river widening) in Switzerland are presented for demonstration purposes. The method compares restored sites with prerestoration conditions and near-natural conditions, which are assumed to represent the worst and best case states of a river system. To take into account the limited spatial extent of the restored sites, the so-called "stencil technique" was developed, where the landscape metrics of the near-natural reference sites are calculated for both the entire study area and smaller sections (clips). The clips are created by using a stencil that has the exact shape and size of the restored area (random window-sampling technique). Subsequently, the calculated metrics for the restored sites are compared to the range of values calculated for the near-natural data subset. Our studies show that the proposed method is easy to apply and provides a valid way to assess the restoration success of river widenings. We found that river widenings offer real opportunities for establishing riparian habitats. However, they promote mainly pioneer successional stages and the habitat mosaic of the restored section is more complex than at the near-natural reference sites. PMID:15633030

  9. Arthroscopically confirmed femoral button deployment.

    PubMed

    Sonnery-Cottet, Bertrand; Rezende, Fernando C; Martins Neto, Ayrton; Fayard, Jean M; Thaunat, Mathieu; Kader, Deiary F

    2014-06-01

    The anterior cruciate ligament TightRope RT (Arthrex, Naples, FL) is a graft suspension device for cruciate ligament reconstruction. It is an adjustable-length graft loop cortical fixation device designed to eliminate the requirement for loop length calculation and to facilitate complete graft fill of short femoral sockets that are common with anatomic anterior cruciate ligament placement. The adjustable loop length means "one size fits all," thus removing the need for multiple implant sizes and allowing graft tensioning even after fixation. However, the device has been associated with the same complications that have been described with EndoButton (Smith & Nephew Endoscopy, Andover, MA) fixation. The button of the TightRope RT may remain in the femoral tunnel rather than flipping outside of the tunnel to rest on the lateral femoral cortex, or it may become jammed inside the femoral canal. Conversely, the button may be pulled too far off the femoral cortex into the overlying soft tissue and flip in the substance of the vastus lateralis. We describe a new and simple arthroscopic technique to directly visualize the deployment and seating of the TightRope button on the lateral cortex of the femur to avoid all the aforementioned complications. PMID:25126492

  10. Cultural evolution and prosociality: Widening the hypothesis space.

    PubMed

    Huebner, Bryce; Sarkissian, Hagop

    2016-01-01

    Norenzayan et al. suggest that Big Gods can be replaced by Big Governments. We examine forms of social and self-monitoring and ritual practice that emerged in Classical China, heterarchical societies like those that emerged in pre-Columbian Mesoamerica, and the contemporary Zapatista movement of Chiapas, and we recommend widening the hypothesis space to include these alternative forms of social organization. PMID:26948732

  11. Widening Disparity and its Suppression in a Stochastic Replicator Model

    NASA Astrophysics Data System (ADS)

    Sakaguchi, Hidetsugu

    2016-04-01

    Winner-take-all phenomena are observed in various competitive systems. We find similar phenomena in replicator models with randomly fluctuating growth rates. The disparity between winners and losers increases indefinitely, even if all elements are statistically equivalent. A lognormal distribution describes well the nonstationary time evolution. If a nonlinear load corresponding to progressive taxation is introduced, a stationary distribution is obtained and disparity widening is suppressed.

  12. Femoral head cartilage disarticulation disorder

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Femoral head cartilage disarticulation disorder and necrosis is a major skeletal problem in broiler breeders since they are maintained for a long time in the farm. The etiology of this disease is not well understood. A field study was conducted to understand the basis of this metabolic disease. Six ...

  13. Tibial hemimelia and femoral bifurcation.

    PubMed

    Ugras, Ali Akin; Sungur, Ibrahim; Akyildiz, Mustafa Fehmi; Ercin, Ersin

    2010-02-01

    Femoral bifurcation and tibial agenesis are rare anomalies and have been described in both the Gollop-Wolfgang complex and tibial agenesis-ectrodactyly syndrome. This article presents a case of Gollop-Wolfgang complex without hand ectrodactyly. Tibial agenesis-ectrodactyly syndrome and Gollop-Wolfgang complex are variants of tibial field defect, which includes distal femoral duplication, tibial aplasia, oligo-ectrodactylous toe defects, and preaxial polydactyly, occasionally associated with hand ectrodactyly.This article describes the case of a patient with bilateral tibial hemimelia and left femoral bifurcation. The proximal tibial anlage had not been identified in the patient's left leg. After failed fibular transfer procedure, the knee was disarticulated. The other leg was treated with tibiofibular synostosis and centralization of fibula to os calcis. At 7-year follow-up, the patient ambulates with an above-knee prosthesis and uses an orthopedic boot for ankle stability.In patients with a congenital absence of the tibia, accurate diagnosis is of the utmost importance in planning future treatment. In the absence of proximal tibial anlage, especially in patients with femoral bifurcation, the knee should be disarticulated. Tibiofibular synostosis is a good choice in the presence of a proximal tibial anlage and good quadriceps function. PMID:20192156

  14. Collaborating for Change? Managing Widening Participation in Further and Higher Education.

    ERIC Educational Resources Information Center

    Stuart, Mary

    This book, which is addressed to managers in further education and higher education across Great Britain, explains what managers must do to enable the changes required to widen participation in their sectors. The following are among the topics discussed: (1) the why and how of widening participation (the importance of widening participation in a…

  15. Thyroid hormone receptor-β1 signaling is critically involved in regulating secondary ossification via promoting transcription of the Ihh gene in the epiphysis.

    PubMed

    Xing, Weirong; Aghajanian, Patrick; Goodluck, Helen; Kesavan, Chandrasekhar; Cheng, Shaohong; Pourteymoor, Sheila; Watt, Heather; Alarcon, Catrina; Mohan, Subburaman

    2016-05-15

    Thyroid hormone (TH) action is mediated through two nuclear TH receptors, THRα and THRβ. Although the role of THRα is well established in bone, less is known about the relevance of THRβ-mediated signaling in bone development. On ther basis of our recent finding that TH signaling is essential for initiation and formation of secondary ossification center, we evaluated the role of THRs in mediating TH effects on epiphysial bone formation. Two-day treatment of TH-deficient Tshr(-/-) mice with TH increased THRβ1 mRNA level 3.4-fold at day 7 but had no effect on THRα1 mRNA level at the proximal tibia epiphysis. Treatment of serum-free cultures of tibias from 3-day-old mice with T3 increased THRβ1 expression 2.1- and 13-fold, respectively, at 24 and 72 h. Ten-day treatment of Tshr(-/-) newborns (days 5-14) with THRβ1 agonist GC1 at 0.2 or 2.0 μg/day increased BV/TV at day 21 by 225 and 263%, respectively, compared with vehicle treatment. Two-day treatment with GC1 (0.2 μg/day) increased expression levels of Indian hedgehog (Ihh) 100-fold, osterix 15-fold, and osteocalcin 59-fold compared with vehicle at day 7 in the proximal tibia epiphysis. Gel mobility shift assay demonstrated that a putative TH response element in the distal promoter of mouse Ihh gene interacted with THRβ1. GC1 treatment (1 nM) increased Ihh distal promoter activity 20-fold after 48 h in chondroctyes. Our data suggest a novel role for THRβ1 in secondary ossification at the epiphysis that involves transcriptional upregulation of Ihh gene. PMID:27026086

  16. Probabilistic age classification with Bayesian networks: A study on the ossification status of the medial clavicular epiphysis.

    PubMed

    Sironi, Emanuele; Pinchi, Vilma; Taroni, Franco

    2016-01-01

    In the past few decades, the rise of criminal, civil and asylum cases involving young people lacking valid identification documents has generated an increase in the demand of age estimation. The chronological age or the probability that an individual is older or younger than a given age threshold are generally estimated by means of some statistical methods based on observations performed on specific physical attributes. Among these statistical methods, those developed in the Bayesian framework allow users to provide coherent and transparent assignments which fulfill forensic and medico-legal purposes. The application of the Bayesian approach is facilitated by using probabilistic graphical tools, such as Bayesian networks. The aim of this work is to test the performances of the Bayesian network for age estimation recently presented in scientific literature in classifying individuals as older or younger than 18 years of age. For these exploratory analyses, a sample related to the ossification status of the medial clavicular epiphysis available in scientific literature was used. Results obtained in the classification are promising: in the criminal context, the Bayesian network achieved, on the average, a rate of correct classifications of approximatively 97%, whilst in the civil context, the rate is, on the average, close to the 88%. These results encourage the continuation of the development and the testing of the method in order to support its practical application in casework. PMID:26699731

  17. Using Genetic Technologies To Reduce, Rather Than Widen, Health Disparities.

    PubMed

    Smith, Caren E; Fullerton, Stephanie M; Dookeran, Keith A; Hampel, Heather; Tin, Adrienne; Maruthur, Nisa M; Schisler, Jonathan C; Henderson, Jeffrey A; Tucker, Katherine L; Ordovás, José M

    2016-08-01

    Evidence shows that both biological and nonbiological factors contribute to health disparities. Genetics, in particular, plays a part in how common diseases manifest themselves. Today, unprecedented advances in genetically based diagnoses and treatments provide opportunities for personalized medicine. However, disadvantaged groups may lack access to these advances, and treatments based on research on non-Hispanic whites might not be generalizable to members of minority groups. Unless genetic technologies become universally accessible, existing disparities could be widened. Addressing this issue will require integrated strategies, including expanding genetic research, improving genetic literacy, and enhancing access to genetic technologies among minority populations in a way that avoids harms such as stigmatization. PMID:27503959

  18. Arthroplasty in Femoral Head Osteonecrosis

    PubMed Central

    Nam, Dong Cheol; Jung, Kwangyoung

    2014-01-01

    Osteonecrosis of the femoral head is a destructive joint disease requiring early hip arthroplasty. The polyethylene-metal design using a 22-mm femoral head component, introduced by Charnley in 1950, has been widely used for over half a century. Since then, different materials with the capacity to minimize friction between bearing surfaces and various cement or cementless insert fixations have been developed. Although the outcome of second and third generation designs using better bearing materials and technologies has been favorable, less favorable results are seen with total hip arthroplasty in young patients with osteonecrosis. Selection of appropriate materials for hip arthroplasty is important for any potential revisions that might become inevitable due to the limited durability of a prosthetic hip joint. Alternative hip arthroplasties, which include hemiresurfacing arthroplasty and bipolar hemiarthroplasty, have not been found to have acceptable outcomes. Metal-on-metal resurfacing has recently been suggested as a feasible option for young patients with extra physical demands; however, concerns about complications such as hypersensitivity reaction or pseudotumor formation on metal bearings have emerged. To ensure successful long-term outcomes in hip arthroplasty, factors such as insert stabilization and surfaces with less friction are essential. Understanding these aspects in arthroplasty is important to selection of proper materials and to making appropriate decisions for patients with osteonecrosis of the femoral head. PMID:27536561

  19. Conservative femoral stem revision: avoiding therapeutic escalation.

    PubMed

    Pinaroli, Alban; Lavoie, Frédéric; Cartillier, Jean-Claude; Neyret, Philippe; Selmi, Tarik Ait Si

    2009-04-01

    A conservative approach to femoral revision is assessed. We report on 41 femoral revisions using an extensively coated hydroxyapatite primary femoral stem. Clinical, operative, and radiological data were gathered. Harris hip scores increased from 65/100 to 90/100 at the minimal follow-up of 1 year (P < .05). All stems showed signs of osseous integration. No significant migration was measured. No patient had to be reoperated because of problems related to the stem. Good results are reported for femoral revision with Paprosky type I and II bone defects with no significant difference between the 2 subgroups, hereby proving that conservative femoral revision is a reasonable treatment alternative. Reproducible results with such a technique may bring surgeons to be more aggressive when noticing early signs of femoral loosening. PMID:18534426

  20. How Children's Mentalistic Theory Widens their Conception of Pictorial Possibilities.

    PubMed

    Gilli, Gabriella M; Ruggi, Simona; Gatti, Monica; Freeman, Norman H

    2016-01-01

    An interpretative theory of mind enables young children to grasp that people fulfill varying intentions when making pictures. We tested the hypothesis that in middle childhood a unifunctional conception of artists' intention to produce a picture widens to include artists' intention to display their pictures to others. Children aged between 5 and 10 years viewed a brief video of an artist deliberately hiding her picture but her intention was thwarted when her picture was discovered and displayed. By 8 years of age children were almost unanimous that a picture-producer without an intention to show her work to others cannot be considered to be an artist. Further exploratory studies centered on aspects of picture-display involving normal public display as well as the contrary intentions of hiding an original picture and of deceitfully displaying a forgery. Interviews suggested that the concept of exhibition widened to take others' minds into account viewers' critical judgments and effects of forgeries on viewers' minds. The approach of interpolating probes of typical possibilities between atypical intentions generated evidence that in middle childhood the foundations are laid for a conception of communication between artists' minds and viewers' minds via pictorial display. The combination of hypothesis-testing and exploratory opening-up of the area generates a new testable hypothesis about how an increasingly mentalistic approach enables children to understand diverse possibilities in the pictorial domain. PMID:26955360

  1. The widening gap between socioeconomic status and mortality.

    PubMed

    Queen, S; Pappas, G; Hadden, W; Fisher, G

    1994-01-01

    Despite important declines in U.S. death rates since 1960, poor and less-educated people have not shared equally in this decline. Data from the 1986 National Mortality Followback Survey and the 1986 National Health Interview Survey were compared to data from the 1960 Matched Record Study. The data clearly show an inverse relationship between mortality and socioeconomic status. Results further indicate a widening of differences in mortality by education among both men and women aged 25 to 64. That is, the mortality differential has increased between those with higher levels of education and those with lower educational attainment. The disparity in mortality rates increased between 1960 and 1986 for both sexes. These findings focus attention on the disparity in death rates for subgroups of the population and point to the increasing need to address socioeconomic differentials to close the gap. PMID:8009425

  2. [Aneurysm of the femoral and popliteal vein].

    PubMed

    Hansen, L G; Boris, P

    1986-04-01

    Aneurysms of the popliteal and femoral veins are rare and may be seen as casual findings with no clinical manifestations whatsoever. On the other hand they may be potential source of recurrent pulmonary embolism. A case is reported, where an aneurysm of the femoral vein was found in a clinically symptomless woman aged 48. PMID:3715020

  3. Unusual presentation of a femoral stress fracture

    PubMed Central

    Ejnisman, Leandro; Wajnsztejn, Andre; Queiroz, Roberto Dantas; Ejnisman, Benno

    2013-01-01

    Stress fractures are common injuries in sports medicine. Among these fractures, femoral neck stress fractures frequently have a benign course, especially when it happens in the medial aspect of the neck. This case report describes a stress fracture of the medial aspect of the femoral neck that developed a complete fracture and underwent surgical fixation. PMID:23283621

  4. A Randomised Single Centre Study to Compare the Long-term Performance of 4 Designs of the DePuy Ultima LX Stem in Primary Total Hip Replacement

    ClinicalTrials.gov

    2016-05-09

    Osteoarthritis; Post-traumatic Arthritis; Collagen Disorder; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis

  5. A Randomised Single Centre Study to Compare the Long-Term Wear Characteristics of Marathon™ and Enduron™ Polyethylene Cup Liners in Primary Total Hip Replacement

    ClinicalTrials.gov

    2009-04-07

    Osteoarthritis; Post-Traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis

  6. A Multi-centre Study to Assess the Long-term Performance of the Summit™ Hip in Primary Total Hip Replacement

    ClinicalTrials.gov

    2016-08-03

    Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis

  7. A Two Centre Study to Assess the Long-term Performance of the Pinnacle™ Cup With a Metal-on-Metal Bearing in Primary Total Hip Replacement

    ClinicalTrials.gov

    2014-04-29

    Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis

  8. A Multi-centre Study to Assess the Long-term Performance of the Pinnacle™ Cup With a Polyethylene-on-metal Bearing in Primary Total Hip Replacement

    ClinicalTrials.gov

    2016-08-15

    Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis.

  9. A Two Centre Study to Assess the Stability and Long-term Performance of the C-Stem™ AMT in a Total Primary Hip Replacement

    ClinicalTrials.gov

    2016-07-01

    Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis.

  10. A Randomised Multi-centre Study to Compare the Long-term Performance of the Future Hip to 3 Other Implants in Primary Total Hip Replacement

    ClinicalTrials.gov

    2011-09-01

    Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis; Perthes Disease

  11. A Study to Assess the Long-term Performance of SmartSet® HV and SmartSet® GHV Bone Cements in Primary Total Hip Replacement

    ClinicalTrials.gov

    2016-08-12

    Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis

  12. A Single Centre Study to Assess the Long-term Performance of the Pinnacle™ Cup With a Ceramic-on-ceramic Bearing in Primary Total Hip Replacement

    ClinicalTrials.gov

    2014-08-13

    Rheumatoid Arthritis; Osteoarthritis; Post-traumatic Arthritis; Collagen Disorders; Avascular Necrosis; Traumatic Femoral Fractures; Nonunion of Femoral Fractures; Congenital Hip Dysplasia; Slipped Capital Femoral Epiphysis

  13. Treatment of neglected femoral neck fracture

    PubMed Central

    Jain, Anil K; Mukunth, R; Srivastava, Amit

    2015-01-01

    Intra-capsular femoral neck fractures are seen commonly in elderly people following a low energy trauma. Femoral neck fracture has a devastating effect on the blood supply of the femoral head, which is directly proportional to the severity of trauma and displacement of the fracture. Various authors have described a wide array of options for treatment of neglected/nonunion (NU) femoral neck fracture. There is lack of consensus in general, regarding the best option. This Instructional course article is an analysis of available treatment options used for neglected femoral neck fracture in the literature and attempt to suggest treatment guides for neglected femoral neck fracture. We conducted the “Pubmed” search with the keywords “NU femoral neck fracture and/or neglected femoral neck fracture, muscle-pedicle bone graft in femoral neck fracture, fibular graft in femoral neck fracture and valgus osteotomy in femoral neck fracture.” A total of 203 print articles were obtained as the search result. Thirty three articles were included in the analysis and were categorized into four subgroups based on treatment options. (a) treated by muscle-pedicle bone grafting (MPBG), (b) closed/open reduction internal fixation and fibular grafting (c) open reduction and internal fixation with valgus osteotomy, (d) miscellaneous procedures. The data was pooled from all groups for mean neglect, the type of study (prospective or retrospective), classification used, procedure performed, mean followup available, outcome, complications, and reoperation if any. The outcome of neglected femoral neck fracture depends on the duration of neglect, as the changes occurring in the fracture area and fracture fragments decides the need and type of biological stimulus required for fracture union. In stage I and stage II (Sandhu's staging) neglected femoral neck fracture osteosynthesis with open reduction and bone grafting with MPBG or Valgus Osteotomy achieves fracture union in almost 90% cases

  14. Lateral femoral cutaneous neuralgia: an anatomical insight.

    PubMed

    Dias Filho, L C; Valença, M M; Guimarães Filho, F A V; Medeiros, R C; Silva, R A M; Morais, M G V; Valente, F P; França, S M L

    2003-07-01

    A detailed anatomic study was carried out on the lateral femoral cutaneous nerve to better understand the etiology and treatment of lateral femoral cutaneous neuralgia. As it passed from the pelvis into the thigh, the lateral femoral cutaneous nerve ran through an "aponeuroticofascial tunnel," beginning at the iliopubic tract and ending at the inguinal ligament; as it passed through the tunnel, an enlargement in its side-to-side diameter was observed, suggesting that the fascial structures proximal to the inguinal ligament may be implicated in the genesis of lateral femoral cutaneous neuralgia. The finding of pseudoneuromas at this location, distant from the inguinal ligament, supports this hypothesis. The anterior superior iliac spine is located approximately 0.7 cm from the lateral femoral cutaneous nerve and serves as the bony landmark for nerve localization. Within the first 3 cm of leaving the pelvis, the lateral femoral cutaneous nerve was observed deep to the fascia lata; therefore, surgical dissection within the subcutaneous fascia may be conducted with relative impunity near the anterior superior iliac spine just inferior to the inguinal ligament. In 36% of cases there was no posterior branch of the nerve, which is correlated to lateral femoral cutaneous neuralgia symptoms often being limited to the anterior branch region. An accessory nerve was found in 30% of cases. PMID:12794914

  15. 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

  16. Introducing Widening Participation Policies in Higher Education: The Influence of Institutional Culture

    ERIC Educational Resources Information Center

    Greenbank, Paul

    2007-01-01

    This paper examines the role of culture in the development of higher education institution (HEI) policy on widening participation. The study involved documentary research and interviews with senior and middle managers. It suggests that a culture of widening participation is often not embedded throughout institutions. Therefore, widening…

  17. A View from the Other Side: Interpretations of Widening Participation by a Post-1992 University

    ERIC Educational Resources Information Center

    Lightfoot, Nic

    2009-01-01

    The role of the academic in interpreting the complex and confused concept of widening participation is central to the practice of widening participation within higher education. These interpretations are bound up within the context of what it means to be an academic, and external constraints on that role. Government policy has insufficiently…

  18. Why Did the Black-White Dropout Gap Widen in the 2000s?

    ERIC Educational Resources Information Center

    Suh, Suhyun; Malchow, Ashley; Suh, Jingyo

    2014-01-01

    This research investigates causes of the widening Black-White gap in dropout rates during the 2000s using two cohorts of National Longitudinal Surveys of Youth, NLSY79 and NLSY97. The authors found four factors which contributed to the widening of the Black-White gap: school suspension policies, peer impact, fatherless households, and the…

  19. Widening Participation to Doctoral Education and Research Degrees: A Research Agenda for an Emerging Policy Issue

    ERIC Educational Resources Information Center

    McCulloch, Alistair; Thomas, Liz

    2013-01-01

    Widening participation is on the political agenda but, to date, policy, practice and research has focused on undergraduate education. This article identifies an emerging widening participation focus on doctoral education. Using England as a case study, the article examines this development within the context of the long-standing concern with…

  20. Impact of race training on volumetric bone mineral density and its spatial distribution in the distal epiphysis of the third metatarsal bone of 2-year-old horses.

    PubMed

    Bogers, Sophie H; Rogers, Christopher W; Bolwell, Charlotte F; Roe, Wendi D; Gee, Erica K; McIlwraith, C Wayne

    2014-09-01

    The aim of the study was to use spatial and multiple correspondence analysis (MCA) to describe and compare the regional proportion and spatial pattern of volumetric bone mineral density (BMDv) values within loaded regions of the plantar metatarsal epiphysis of young horses in race training. A single 2 mm transverse peripheral quantitative computed tomography 'slice', 10 mm proximal from the distal limit of the sagittal ridge of the distal metatarsal epiphysis was obtained from 14 2-year-old Thoroughbred fillies (7 exercised and 7 controls). Six regions of interest were generated and examined for relative BMDv using MCA. The spatial distribution of BMDv was statistically examined at two sites loaded by the proximal sesamoid bones using geographical information software. The BMDv response was focal with distinct regional differences in relation to load. Deposition of new bone within existing high density bone contributed to a greater bone fraction and the distinct profile of clusters of uniformly distributed high density bone as well as a lower proportion of lower density bone in exercised horses. The MCA and spatial analysis provided statistical techniques to quantify and describe non-invasively the exercise induced changes in bone that had previously been described using microradiography of thin slices and by block-face imaging. These statistical techniques may prove useful in quantifying spatial patterns of response to load. PMID:25066031

  1. Unilateral Isolated Proximal Femoral Focal Deficiency

    PubMed Central

    Doğer, Emek; Köpük, Şule Y.; Çakıroğlu, Yiğit; Çakır, Özgür; Yücesoy, Gülseren

    2013-01-01

    Objective. To discuss a patient with a prenatal diagnosis of unilateral isolated femoral focal deficiency. Case. Antenatal diagnosis of unilateral isolated femoral focal deficiency was made at 20 weeks of gestation. The length of left femur was shorter than the right, and fetal femur length was below the fifth percentile. Proximal femoral focal deficiency was diagnosed. After delivery, the diagnosis was confirmed with skeletal radiographs and magnetic resonance imaging. In prenatal ultrasonographic examination, the early recognition and exclusion of skeletal dysplasias is important; moreover, treatment plans should be initiated, and valuable information should be provided to the family. PMID:23984135

  2. Meralgia Paresthetica and Femoral Acetabular Impingement: A Possible Association

    PubMed Central

    Ahmed, Aiesha

    2010-01-01

    Meralgia paresthetica consists of pain and dysesthesia in the anterolateral thigh. Etiology is divided into spontaneous and iatrogenic causes. To my knowledge this has never been attributed to femoral acetabular impingement. This case highlights the presence of lateral femoral cutaneous neuropathy in the setting of femoral acetabular impingement syndrome thus raising the possibility of an association. Keywords Femoral acetabular impingement; Lateral femoral cutaneous nerve; Dysesthesia; Nerve conduction studies PMID:22043261

  3. Flows In Model Human Femoral Arteries

    NASA Technical Reports Server (NTRS)

    Back, Lloyd H.; Kwack, Eug Y.; Crawford, Donald W.

    1990-01-01

    Flow is visualized with dye traces, and pressure measurements made. Report describes experimental study of flow in models of human femoral artery. Conducted to examine effect of slight curvature of artery on flow paths and distribution of pressure.

  4. Atypical periprosthetic femoral fracture: a case report.

    PubMed

    Woo, S B; Choi, S T; Chan, W L

    2016-08-01

    We report an 82-year-old woman who underwent fixation with a long-spanning cable-plate for a bisphosphonate-induced Vancouver B1 periprosthetic femoral fracture. Non-union and breakage of the plate occurred at 16 months and necessitated revision surgery using a long-stem femoral prosthesis augmented with a cable-plate construct. Bone union was achieved eventually after 10 months. PMID:27574277

  5. Emerging health issues: the widening challenge for population health promotion.

    PubMed

    McMichael, Anthony J; Butler, Colin D

    2006-12-01

    The spectrum of tasks for health promotion has widened since the Ottawa Charter was signed. In 1986, infectious diseases still seemed in retreat, the potential extent of HIV/AIDS was unrecognized, the Green Revolution was at its height and global poverty appeared less intractable. Global climate change had not yet emerged as a major threat to development and health. Most economists forecast continuous improvement, and chronic diseases were broadly anticipated as the next major health issue. Today, although many broadly averaged measures of population health have improved, many of the determinants of global health have faltered. Many infectious diseases have emerged; others have unexpectedly reappeared. Reasons include urban crowding, environmental changes, altered sexual relations, intensified food production and increased mobility and trade. Foremost, however, is the persistence of poverty and the exacerbation of regional and global inequality. Life expectancy has unexpectedly declined in several countries. Rather than being a faint echo from an earlier time of hardship, these declines could signify the future. Relatedly, the demographic and epidemiological transitions have faltered. In some regions, declining fertility has overshot that needed for optimal age structure, whereas elsewhere mortality increases have reduced population growth rates, despite continuing high fertility. Few, if any, Millennium Development Goals (MDG), including those for health and sustainability, seem achievable. Policy-makers generally misunderstand the link between environmental sustainability (MDG #7) and health. Many health workers also fail to realize that social cohesion and sustainability--maintenance of the Earth's ecological and geophysical systems--is a necessary basis for health. In sum, these issues present an enormous challenge to health. Health promotion must address population health influences that transcend national boundaries and generations and engage with the

  6. Hybrid phononic crystal plates for lowering and widening acoustic band gaps.

    PubMed

    Badreddine Assouar, M; Sun, Jia-Hong; Lin, Fan-Shun; Hsu, Jin-Chen

    2014-12-01

    We propose hybrid phononic-crystal plates which are composed of periodic stepped pillars and periodic holes to lower and widen acoustic band gaps. The acoustic waves scattered simultaneously by the pillars and holes in a relevant frequency range can generate low and wide acoustic forbidden bands. We introduce an alternative double-sided arrangement of the periodic stepped pillars for an enlarged pillars' head diameter in the hybrid structure and optimize the hole diameter to further lower and widen the acoustic band gaps. The lowering and widening effects are simultaneously achieved by reducing the frequencies of locally resonant pillar modes and prohibiting suitable frequency bands of propagating plate modes. PMID:24996255

  7. Femoral neck shortening after internal fixation of a femoral neck fracture.

    PubMed

    Zielinski, Stephanie M; Keijsers, Noël L; Praet, Stephan F E; Heetveld, Martin J; Bhandari, Mohit; Wilssens, Jean Pierre; Patka, Peter; Van Lieshout, Esther M M

    2013-07-01

    This study assesses femoral neck shortening and its effect on gait pattern and muscle strength in patients with femoral neck fractures treated with internal fixation. Seventy-six patients from a multicenter randomized controlled trial participated. Patient characteristics and Short Form 12 and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores were collected. Femoral neck shortening, gait parameters, and maximum isometric forces of the hip muscles were measured and differences between the fractured and contralateral leg were calculated. Variables of patients with little or no shortening, moderate shortening, and severe shortening were compared using univariate and multivariate analyses. Median femoral neck shortening was 1.1 cm. Subtle changes in gait pattern, reduced gait velocity, and reduced abductor muscle strength were observed. Age, weight, and Pauwels classification were risk factors for femoral neck shortening. Femoral neck shortening decreased gait velocity and seemed to impair gait symmetry and physical functioning. In conclusion, internal fixation of femoral neck fractures results in permanent physical limitations. The relatively young and healthy patients in our study seem capable of compensating. Attention should be paid to femoral neck shortening and proper correction with a heel lift, as inadequate correction may cause physical complaints and influence outcome. PMID:23823040

  8. Removal of a well-fixed cementless femoral component with an extended proximal femoral osteotomy.

    PubMed

    Younger, T I; Bradford, M S; Paprosky, W G

    1995-05-01

    Removal of a stable, well-fixed cementless femoral arthroplasty component occasionally is necessary because of infection, component malposition, persistent pain, or incompatibility with a femoral revision component. Restricted access to ingrowth surfaces may make implant removal exceedingly difficult and increases the risk of iatrogenic damage to the proximal femur. A new extended proximal femoral osteotomy technique is described for use in removing well-fixed cementless femoral components. Previous techniques have been modified to allow access to the bone-implant interface and to provide straight-shot access to the femoral canal for proper sizing and positioning of the revision implant. The osteotomy can be extended to accommodate the entire length of the porous coating on the revision component. If a shorter osteotomy is desired, access to the prosthesis for transection with a metal-cutting burr is possible. The osteotomy is easily repositioned with cerclage wires or cables and reliable healing has been demonstrated. PMID:10150358

  9. Femoral tunnel malposition in ACL revision reconstruction.

    PubMed

    Morgan, Joseph A; Dahm, Diane; Levy, Bruce; Stuart, Michael J

    2012-11-01

    The Multicenter Anterior Cruciate Ligament (ACL) Revision Study (MARS) group was formed to study a large cohort of revision ACL reconstruction patients. The purpose of this subset analysis study of the MARS database is to describe specific details of femoral tunnel malposition and subsequent management strategies that surgeons chose in the revision setting. The design of this study is a case series. The multicenter MARS database is compiled from a questionnaire regarding 460 ACL reconstruction revision cases returned by 87 surgeons. This subset analysis described technical aspects and operative findings in specifically those cases in which femoral tunnel malposition was cited as the cause of primary ACL reconstruction failure. Of the 460 revisions included for study, 276 (60%) cases cited a specific "technical cause of failure." Femoral tunnel malposition was cited in 219 (47.6%) of 460 cases. Femoral tunnel malposition was cited as the only cause of failure in 117 cases (25.4%). Surgeons judged the femoral tunnel too vertical in 42 cases (35.9%), too anterior in 35 cases (29.9%), and too vertical and anterior in 31 cases (26.5%). Revision reconstruction involved the drilling of an entirely new femoral tunnel in 91 cases (82.1%). For primary reconstruction, autograft tissue was used in 82 cases (70.1%). For revision reconstruction, autograft tissue was used in 61 cases (52.1%) and allograft tissue in 56 cases (47.9%). Femoral tunnel malposition in primary ACL reconstruction was the most commonly cited reason for graft failure in this cohort. Graft selection is widely variable among surgeons. PMID:23150344

  10. Femoral Tunnel Malposition in ACL Revision Reconstruction

    PubMed Central

    Morgan, Joseph A.; Dahm, Diane; Levy, Bruce; Stuart, Michael J.

    2013-01-01

    The Multicenter Anterior Cruciate Ligament (ACL) Revision Study (MARS) group was formed to study a large cohort of revision ACL reconstruction patients. The purpose of this subset analysis study of the MARS database is to describe specific details of femoral tunnel malposition and subsequent management strategies that surgeons chose in the revision setting. The design of this study is a case series. The multicenter MARS database is compiled from a questionnaire regarding 460 ACL reconstruction revision cases returned by 87 surgeons. This subset analysis described technical aspects and operative findings in specifically those cases in which femoral tunnel malposition was cited as the cause of primary ACL reconstruction failure. Of the 460 revisions included for study, 276 (60%) cases cited a specific “technical cause of failure.” Femoral tunnel malposition was cited in 219 (47.6%) of 460 cases. Femoral tunnel malposition was cited as the only cause of failure in 117 cases (25.4%). Surgeons judged the femoral tunnel too vertical in 42 cases (35.9%), too anterior in 35 cases (29.9%), and too vertical and anterior in 31 cases (26.5%). Revision reconstruction involved the drilling of an entirely new femoral tunnel in 91 cases (82.1%). For primary reconstruction, autograft tissue was used in 82 cases (70.1%). For revision reconstruction, autograft tissue was used in 61 cases (52.1%) and allograft tissue in 56 cases (47.9%). Femoral tunnel malposition in primary ACL reconstruction was the most commonly cited reason for graft failure in this cohort. Graft selection is widely variable among surgeons. PMID:23150344

  11. Ossification of the Medial Clavicular Epiphysis on Chest Radiographs: Utility and Diagnostic Accuracy in Identifying Korean Adolescents and Young Adults under the Age of Majority.

    PubMed

    Yoon, Soon Ho; Yoo, Hye Jin; Yoo, Roh Eul; Lim, Hyun Ju; Yoon, Jeong Hwa; Park, Chang Min; Lee, Sang Seob; Yoo, Seong Ho

    2016-10-01

    The aim of our study was to evaluate the utility and diagnostic accuracy of the ossification grade of medial clavicular epiphysis on chest radiographs for identifying Korean adolescents and young adults under the age of majority. Overall, 1,151 patients (age, 16-30) without any systemic disease and who underwent chest radiography were included for ossification grading. Two radiologists independently classified the ossification of the medial clavicular epiphysis from chest radiographs into five grades. The age distribution and inter-observer agreement on the ossification grade were assessed. The diagnostic accuracy of the averaged ossification grades for determining whether the patient is under the age of majority was analyzed by using receiver operating characteristic (ROC) curves. Two separate inexperienced radiologists assessed the ossification grade in a subgroup of the patients after reviewing the detailed descriptions and image atlases developed for ossification grading. The median value of the ossification grades increased with increasing age (from 16 to 30 years), and the trend was best fitted by a quadratic function (R-square, 0.978). The inter-observer agreements on the ossification grade were 0.420 (right) and 0.404 (left). The area under the ROC curve (AUC) was 0.922 (95% CI, 0.902-0.942). The averaged ossification scores of 2.62 and 4.37 provided 95% specificity for a person < 19 years of age and a person ≥ 19 years of age, respectively. A preliminary assessment by inexperienced radiologists resulted in an AUC of 0.860 (95% CI, 0.740-0.981). The age of majority in Korean adolescents and young adults can be estimated using chest radiographs. PMID:27550480

  12. Femoral lipectomy increases postprandial lipemia in women.

    PubMed

    Hernandez, Teri L; Bessesen, Daniel H; Cox-York, Kimberly A; Erickson, Christopher B; Law, Christopher K; Anderson, Molly K; Wang, Hong; Jackman, Matthew R; Van Pelt, Rachael E

    2015-07-01

    Femoral subcutaneous adipose tissue (SAT) appears to be cardioprotective compared with abdominal SAT, possibly through better triglyceride (TG) sequestration. We hypothesized that removal of femoral SAT would increase postprandial TG through a reduction in dietary fatty acid (FA) storage. Normal-weight (means ± SD; BMI 23.9 ± 2.6 kg/m(2)) women (n = 29; age 45 ± 6 yr) were randomized to femoral lipectomy (LIPO) or control (CON) and followed for 1 yr. Regional adiposity was measured by DEXA and CT. A liquid meal labeled with [(14)C]oleic acid was used to trace the appearance of dietary FA in plasma (6-h postprandial TG), breath (24-h oxidation), and SAT (24-h [(14)C]TG storage). Fasting LPL activity was measured in abdominal and femoral SAT. DEXA leg fat mass was reduced after LIPO vs. CON (Δ-1.4 ± 0.7 vs. 0.1 ± 0.5 kg, P < 0.001) and remained reduced at 1 yr (-1.1 ± 1.4 vs. -0.2 ± 0.5 kg, P < 0.05), as did CT thigh subcutaneous fat area (-39.6 ± 36.6 vs. 4.7 ± 14.6 cm(2), P < 0.05); DEXA trunk fat mass and CT visceral fat area were unchanged. Postprandial TG increased (5.9 ± 7.7 vs. -0.6 ± 5.3 × 10(3) mg/dl, P < 0.05) and femoral SAT LPL activity decreased (-21.9 ± 22.3 vs. 10.5 ± 26.5 nmol·min(-1)·g(-1), P < 0.05) 1 yr following LIPO vs. CON. There were no group differences in (14)C-labeled TG appearing in abdominal and femoral SAT or elsewhere. In conclusion, femoral fat remained reduced 1 yr following lipectomy and was accompanied by increased postprandial TG and reduced femoral SAT LPL activity. There were no changes in storage of meal-derived FA or visceral fat. Our data support a protective role for femoral adiposity on circulating TG independent of dietary FA storage and visceral adiposity. PMID:25968576

  13. Laparoscopic repair of an incarcerated femoral hernia

    PubMed Central

    Pillay, Yagan

    2015-01-01

    Introduction A femoral hernia is a rare, acquired condition, which has been reported in less than 5% of all abdominal wall hernias, with a female to male ratio of 4:1. Presentation of case We report a case in a female patient who had a previous open inguinal herniorrhaphy three years previously. She presented with right sided groin pain of one month duration. Ultrasound gave a differential diagnosis of a recurrent inguinal hernia or a femoral hernia. A transabdominal preperitoneal repair was performed and the patient made an uneventful recovery. Discussion Laparoscopic repair of a femoral hernia is still in its infancy and even though the outcomes are superior to an open repair, open surgery remains the standard of care. The decision to perform a laparoscopic trans abdominal preperitoneal (TAPP) repair was facilitated by the patient having previous open hernia surgery. The learning curve for laparoscopic femoral hernia repair is steep and requires great commitment from the surgeon. Once the learning curve has been breached this is a feasible method of surgical repair. This is demonstrated by the fact that this case report is from a rural hospital in Canada. Conclusion Laparoscopic femoral hernia repair involves more time and specialized laparoscopic skills. The advantages are a lower recurrence rate and lower incidence of inguinodynia. PMID:26581083

  14. Rising CO2 widens the transpiration-photosynthesis optimality space

    NASA Astrophysics Data System (ADS)

    de Boer, Hugo J.; Eppinga, Maarten B.; Dekker, Stefan C.

    2016-04-01

    ). Measurements of gs and V cmax were obtained with a portable photosynthesis system. Our empirical results support the prediction that the V cmax:gs-ratio increases with higher CO2 in both Solanum genotypes. The 'dry' genotype revealed a significantly higher Huber value and lower V cmax than the 'wet' genotype at each CO2 growth level. Moreover, we found that the down-regulation of V cmax under higher CO2 was stronger in the 'dry' genotype than in the 'wet' genotype, whereas no change in the Huber value was observed between CO2 levels. Consistent with the theoretical trade-off between the resulting costs of transpiration and photosynthesis, we found that the CO2-induced increase in the V cmax:gs-ratio was stronger in the 'wet' genotype than in the 'dry' genotype. Given the divergence of V cmax:gs relationships observed, we conclude that rising atmospheric CO2 may widen the V cmax ‑ gs optimality space available for plants to achieve an optimal trade-off between photosynthesis and transpiration. References Prentice, I. C., Dong, N., Gleason, S. M., Maire, V. and Wright, I. J.: Balancing the costs of carbon gain and water transport: testing a new theoretical framework for plant functional ecology, Ecol. Lett., 17(1), 82-91, 2014.

  15. Micromotion of cemented and uncemented femoral components.

    PubMed

    Burke, D W; O'Connor, D O; Zalenski, E B; Jasty, M; Harris, W H

    1991-01-01

    We evaluated the initial stability of cemented and uncemented femoral components within the femoral canals of cadaver femurs during simulated single limb stance and stair climbing. Both types were very stable in simulated single limb stance (maximum micromotion of 42 microns for cemented and 30 microns for uncemented components). However, in simulated stair climbing, the cemented components were much more stable than the uncemented components (76 microns as against 280 microns). There was also greater variation in the stability of uncemented components in simulated stair climbing, with two of the seven components moving 200 microns or more. Future implant designs should aim to improve the initial stability of cementless femoral components under torsional loads; this should improve the chances of bony ingrowth. PMID:1991771

  16. Guide wire migration during femoral vein catheterization.

    PubMed

    Khatami, Mohammad Reza; Abbasi, Rozita; Sadigh, Gelareh

    2010-10-01

    Central vein catheterization is a routine and relatively safe procedure in critically ill patients. Complications with this procedure depend to the site of catheterization and the skill of the operator. In addition to the common complications with femoral vein catheterization there are some rare usually preventable side effects related to guide wire and catheter. In our patient who underwent femoral catheterization for acute hemodialysis, we report migration of guide wire through the systemic circulation from the femoral vein to the jugular vein. This is a very rare complication that is a human error and is totally preventable by doing the procedure by a skilled doctor and considering the standards described for central vein catheter insertion. PMID:20852377

  17. Optimizing Stability in Femoral Neck Fracture Fixation.

    PubMed

    Ye, Ye; Hao, Jiandong; Mauffrey, Cyril; Hammerberg, E Mark; Stahel, Philip F; Hak, David J

    2015-10-01

    Optimizing stability of femoral neck fracture fixation is important in obtaining a successful outcome. The mechanical problems and strategies for achieving optimal stability differ depending on patients' age and degree of osteoporosis. Femoral neck fractures in younger adults usually result from high-energy trauma and have a vertical fracture pattern. Strategies for optimizing fixation stability in this group include placing additional screws at right angles to the fracture plane and medial buttress plate augmentation. In elderly patients, screw position relative to the intact cortical femoral neck bone is of critical importance. Additional strategies for optimizing fixation stability in this group include the concept of length stable fixation, use of adjunctive calcium phosphate cement, and use of novel fixed angle fixation implants. PMID:26488776

  18. Emergency intravenous access through the femoral vein.

    PubMed

    Swanson, R S; Uhlig, P N; Gross, P L; McCabe, C J

    1984-04-01

    A study was undertaken to assess the efficacy and safety of femoral venous catheterization for resuscitation of critically ill patients in the emergency department setting. From May 1982 to April 1983, 100 attempts were made at percutaneous insertion of a large-bore catheter into the femoral veins of patients presenting to our emergency department in cardiac arrest or requiring rapid fluid resuscitation. Eighty-nine attempts were successful. Insertion was generally considered easy, and flow rates were excellent. The only noted complications were four arterial punctures and one minor groin hematoma. This study suggests that short-term percutaneous catheterization of the femoral vein provides rapid, safe, and effective intravenous access. PMID:6703430

  19. Adventitial cystic disease of common femoral vein

    PubMed Central

    Suh, Bo-Yang

    2011-01-01

    Adventitial cystic disease (ACD) of venous system is an extremely rare condition. Very few reports of ACD in venous system have been described. In this report we discuss two cases of common femoral vein ACD that presented with a swollen leg by the obstruction of the vein. Ultrasound imaging showed the typical hypoechoic fluid filled cyst with a posterior acoustic window. Computed tomography scan and ascending venogram showed a stenosis to flow in the common femoral vein caused by an extrinsic mass. Trans-adventitial evacuation of cyst with removal of vein wall was performed for both cases. During operation we found the gelatinous material in the cysts arising in the wall of the common femoral vein and compressing the lumen. The patients were released after short hospitalization and have remained symptom free with no recurrence. PMID:22066091

  20. Reverse distal femoral locking compression plate a salvage option in nonunion of proximal femoral fractures

    PubMed Central

    Dumbre Patil, Sampat S; Karkamkar, Sachin S; Patil, Vaishali S Dumbre; Patil, Shailesh S; Ranaware, Abhijeet S

    2016-01-01

    Background: When primary fixation of proximal femoral fractures with implants fails, revision osteosynthesis may be challenging. Tracts of previous implants and remaining insufficient bone stock in the proximal femur pose unique problems for the treatment. Intramedullary implants like proximal femoral nail (PFN) or surface implants like Dynamic Condylar Screw (DCS) are few of the described implants for revision surgery. There is no evidence in the literature to choose one implant over the other. We used the reverse distal femur locking compression plate (LCP) of the contralateral side in such cases undergoing revision surgery. This implant has multiple options of fixation in proximal femur and its curvature along the length matches the anterior bow of the femur. We aimed to evaluate the efficacy of this implant in salvage situations. Materials and Methods: Twenty patients of failed primary proximal femoral fractures who underwent revision surgery with reverse distal femoral locking plate from February 2009 to November 2012 were included in this retrospective study. There were 18 subtrochanteric fractures and two ipsilateral femoral neck and shaft fractures, which exhibited delayed union or nonunion. The study included 14 males and six females. The mean patient age was 43.6 years (range 22–65 years) and mean followup period was 52.1 months (range 27–72 months). Delayed union was considered when clinical and radiological signs of union failed to progress at the end of four months from initial surgery. Results: All fractures exhibited union without any complications. Union was assessed clinically and radiologically. One case of ipsilateral femoral neck and shaft fracture required bone grafting at the second stage for delayed union of the femoral shaft fracture. Conclusions: Reverse distal femoral LCP of the contralateral side can be used as a salvage option for failed fixation of proximal femoral fractures exhibiting nonunion. PMID:27512218

  1. Management of femoral head osteonecrosis: Current concepts

    PubMed Central

    Tripathy, Sujit Kumar; Goyal, Tarun; Sen, Ramesh Kumar

    2015-01-01

    Osteonecrosis of femoral head (ONFH) is a disabling condition of young individuals with ill-defined etiology and pathogenesis. Remains untreated, about 70-80% of the patients progress to secondary hip arthritis. Both operative and nonoperative treatments have been described with variable success rate. Early diagnosis and treatment is the key for success in preserving the hip joint. Once femoral head collapses (>2 mm) or if there is secondary degeneration, hip conservation procedures become ineffective and arthroplasty remains the only better option. We reviewed 157 studies that evaluate different treatment modalities of ONFH and then a final consensus on treatment was made. PMID:25593355

  2. Intramedullary nailing of pediatric femoral shaft fracture.

    PubMed

    Hosalkar, Harish S; Pandya, Nirav K; Cho, Robert H; Glaser, Diana A; Moor, Molly A; Herman, Martin J

    2011-08-01

    Intramedullary nail fixation of pediatric long bone fracture, particularly femoral shaft fracture, has revolutionized the care and outcome of these complex injuries. Nailing is associated with a high rate of union and a low rate of complications. Improved understanding of proximal femoral vascularity has led to changes in nail insertion methodology. Multiple fixation devices are available; selection is based on fracture type, patient age, skeletal maturity, and body mass index. A thorough knowledge of anatomy and biomechanics is required to achieve optimal results without negatively affecting skeletal development. PMID:21807915

  3. History of femoral head fracture and coronal fracture of the femoral condyles.

    PubMed

    Bartoníček, Jan; Rammelt, Stefan

    2015-06-01

    The first known description of the coronal fracture of the lateral femoral condyle was published by Busch in 1869. Hoffa used Busch's drawing in the first edition of his book in 1888 and accompanied it only with one sentence. A full case history of this fracture pattern was described by Braun in 1891. However, Braun's article fell into oblivion and so the fracture was popularized only in the fourth edition of Hoffa's textbook, particularly thanks to the drawing, rather than the brief description. Therefore, a fracture of the posterior femoral condyle, or more specifically, of the lateral condyle, could properly be called "Busch-Hoffa fracture". Femoral head fracture was initially described by Birkett in 1869. Of essential importance in this respect were the publications by Christopher in 1924 and, particularly, Pipkin's study of 1957, including his classification that is still in use today. A historically correct eponym for a femoral head fracture would therefore be "Birkitt-Pipkin fracture". PMID:25787681

  4. EPIDEMIOLOGICAL STUDY OF CHILDREN DIAPHYSEAL FEMORAL FRACTURES

    PubMed Central

    Hoffmann, Cassiano Ricardo; Traldi, Eduardo Franceschini; Posser, Alexandre

    2015-01-01

    Objective: To evaluate the personal, fracture, treatment and complication characteristics among patients with pediatric femoral shaft fractures attended at the pediatric orthopedic service of the Joana de Gusmão Children's Hospital. Methods: This was a retrospective cross-sectional study on a population consisting of patients with femoral shaft fractures, aged between birth and 14 years and 11 months, who were divided into four age groups. Information was obtained from medical records and was transferred to a survey questionnaire to present personal, fracture, treatment and complication variables. Results: The study population consisted of 96 patients. Their mean age was 6.8 years. The cases were predominantly among males, comprising closed fractures on the right side, in the middle third with a single line. Regarding fracture etiology, traffic accidents predominated overall in the sample. Most of the patients (74 to 77.1%) presented femoral fractures as their only injury. Conservative treatment predominated in the group younger than six years of age, and surgical treatment in the group aged 6 to 14 years and 11 months. The complications observed until bone union were: discrepancy, infection and movement limitation. The mean time taken for consolidation was 9.6 ± 2.4 weeks, varying with age. Conclusion: The features of these fractures were similar to those described in the literature and the treatment used showed good results. The Joana de Gusmão Children's Hospital has used the treatment proposed in the literature for pediatric femoral shaft fractures. PMID:27042619

  5. Femoral neck version affects medial femorotibial loading.

    PubMed

    Papaioannou, T A; Digas, Georgios; Bikos, Ch; Karamoulas, V; Magnissalis, E A

    2013-01-01

    The aim of this study was to provide a preliminary evaluation of the possible effect that femoral version may have on the bearing equilibrium conditions developed on the medial tibiofemoral compartment. A digital 3D solid model of the left physiological adult femur was used to create morphological variations of different neck-shaft angles (varus 115, normal 125, and valgus 135 degrees) and version angles (-10, 0, and +10 degrees). By means of finite element modeling and analysis techniques (FEM-FEA), a virtual experiment was executed with the femoral models aligned in a neutral upright position, distally supported on a fully congruent tibial tray and proximally loaded with a vertical only hip joint load of 2800 N. Equivalent stresses and their distribution on the medial compartment were computed and comparatively evaluated. Within our context, the neck-shaft angle proved to be of rather indifferent influence. Reduction of femoral version, however, appeared as the most influencing parameter regarding the tendency of the medial compartment to establish its bearing equilibrium towards posteromedial directions, as a consequence of the corresponding anteroposterior changes of the hip centre over the horizontal tibiofemoral plane. We found a correlation between femoral anteversion and medial tibiofemoral compartment contact pressure. Our findings will be further elucidated by more sophisticated FEM-FEA and by clinical studies that are currently planned. PMID:24959355

  6. Femoral development in chronically centrifuged rats

    NASA Technical Reports Server (NTRS)

    Smith, S. D.

    1977-01-01

    Groups of 30-d-old male and female rats were centrifuged at 2.00 G (RE, Rotation Experimental), 1.05 G (RC, Rotation Control) or exposed to the noise and wind of the centrifuge at 1.00 G (EC, Earth Control) for periods of 1, 2, 4, 8, and 16 weeks. Measurements of their femurs indicated that exposure to centrifugation a) decreased femoral length in RE animals, b) increased femoral length in RC animals, c) reduced femoral diameter in RE and RC animals, d) increased L/D ratios in RC animals, e) decreased L/D ratios in RE animals, f) increased femur length/body weight in RE animals, g) decreased cortical thickness (CT) in RE animals, h) increased relative CT in RE animals, and decreased it in RC animals, i) accelerated ossification in RC femoral heads, j) thinned and distorted RE epiphyseal plates, and k) thickened condylar cartilage in RE females. The effects tended to be strongly sexually dimorphic, with females more severely affected by the stress than males.

  7. Femoral mononeuropathy caused by a malignant sarcoma: two case reports.

    PubMed

    Montoliu, Patrícia; Pumarola, Martí; Zamora, Angels; Espada, Ivonne; Lloret, Albert; Añor, Sònia

    2008-11-01

    A 9-year old miniature poodle and a 6-year old American Staffordshire terrier were evaluated for slowly progressive lameness and atrophy of the left pelvic limb. Neurological examinations of both animals were consistent with femoral nerve lesions. In both cases, neoplastic masses were identified within the left psoas muscle, invading the left femoral nerve or, in one case, its nerve roots. Ultrasound-guided fine needle aspirate and histopathological examination of the masses revealed that these were malignant sarcomas. Femoral mononeuropathies are very rare in dogs, and most descriptions of femoral nerve lesions are caused by traumatic injuries. Descriptions of neoplastic processes affecting the femoral nerve are limited to peripheral nerve sheath tumours (PNST). These cases provide the first descriptions of malignant neoplasms other than PNSTs that infiltrate the femoral nerve or its nerve roots and cause unilateral femoral mononeuropathy and lameness of obscure origin. PMID:17889576

  8. Postcatheterization Femoral Arteriovenous Fistulas: Endovascular Treatment with Stent-Grafts

    SciTech Connect

    Onal, Baran Kosar, Sule; Gumus, Terman; Ilgit, Erhan T.; Akpek, Sergin

    2004-09-15

    Purpose: To report our results of stent-graft implantation for the endovascular treatment of postcatheterization femoral arteriovenous fistulas (AVFs) occurring between the deep femoral artery and the femoral vein.Methods: Endovascular treatment of iatrogenic femoral AVFs as a result of arterial puncture for coronary angiography and/or angioplasty was attempted in 10 cases. Balloon-expandable stent-grafts, one for each lesion, were used to repair the fistulas, which were between the deep femoral artery and the femoral vein in all cases. Stent-graft implantation to the deep femoral artery was performed by a contralateral retrograde approach.Results: All stent-grafts were deployed successfully. Complete closure of the fistulas was accomplished immediately in nine of 10 cases. In one case, complete closure could not be obtained but the fact that the complaint subsided was taken to indicate clinical success. In three cases, side branch occlusion of the deep femoral artery occurred. No complications were observed after implantation. Follow-up for 8-31 months (mean 18.5 months) with color Doppler ultrasonography revealed patency of the stented arterial segments without recurrent arteriovenous shunting in those nine patients who had successful immediate closure of their AVFs.Conclusion: Our results with a mean follow-up 18.5 months suggest that stent-graft implantation for the closure of postcatheterization femoral AVFs originating from the deep femoral artery is an effective, minimally invasive alternative procedure.

  9. Spontaneous stress fractures of the femoral neck

    SciTech Connect

    Dorne, H.L.; Lander, P.H.

    1985-02-01

    The diagnosis of spontaneous stress fractures of the femoral neck, a form of insufficiency stress fracture, can be missed easily. Patients present with unremitting hip pain without a history of significant trauma or unusual increase in daily activity. The initial radiographic features include osteoporosis, minor alterations of trabecular alignment, minimal extracortical or endosteal reaction, and lucent fracture lines. Initial scintigraphic examinations performed in three of four patients showed focal increased radionuclide uptake in two and no focal abnormality in one. Emphasis is placed on the paucity of early findings. Evaluation of patients with persistent hip pain requires a high degree of clinical suspicion and close follow-up; the sequelae of undetected spontaneous fractures are subcapital fracture with displacement, angular deformity, and a vascular necrosis of the femoral head.

  10. Atypical femoral fracture following zoledronic acid treatment.

    PubMed

    Ataoğlu, Baybars; Kaptan, Ahmet Yiğit; Eren, Toygun Kağan; Yapar, Ali Ekber; Berkay, Ahmet Fırat

    2016-04-01

    A 68-year-old female patient admitted to our clinic with right anterior thigh pain ongoing for six months and which increased in last two months. The patient had no trauma history. The patient had been followed-up for 15 years because of osteoporosis and administrated alendronate and ibandronate treatment for 10 years. Patient had three shots of zoledronate once a year during the last three years. Her pain was increasing when she was walking. Physical examination revealed pain in her right thigh. Radiogram showed thickened lateral cortex of the subtrochanteric area. Magnetic resonance imaging also showed thickening and edema of the same area. These images were correlated with atypical fracture in right femoral subthrochanteric zone. Dual energy X-ray absorptiometry revealed that T score was -3.3 in lumbar region and -2.5 in femoral neck. Zoledronate treatment was ended. Prophylactic surgical fixation was performed with titanium elastic nails. PMID:26874637

  11. Diminished Cartilage Creep Properties and Increased Trabecular Bone Density Following a Single, Sub-Fracture Impact of the Rabbit Femoral Condyle

    PubMed Central

    Borrelli, Joseph; Zaegel, Melissa A.; Martinez, Mario D.; Silva, Matthew J.

    2013-01-01

    Traumatic injury to articular cartilage can lead to post-traumatic arthritis. We used a custom pendulum device to deliver a single, near-fracture impact to the medial femoral condyles of rabbits. Impact was localized to a region ~3 mm in diameter, and impact stress averaged ~100 MPa. Animals were euthanized at 0, 1 and 6 months after impact. Cartilage mechanical properties from impacted and sham knees were evaluated by creep-indentation testing and periarticular trabecular bone was evaluated by microCT and histomorphometry. Impact caused immediate and statistically significant loss of cartilage thickness (-40% vs. sham) and led to a greater than two-fold increase in creep strain. From 0 to 6 months after impact, the ability of cartilage to recover from creep deformation became significantly impaired (percent recovery different from control at 1 and 6 months). At 1 month, there was a 33% increase in the trabecular bone volume fraction of the epiphysis beneath the site of impact compared to control, and increased bone formation was observed histologically. Taken together, these findings demonstrate that a single, high-energy impact below the fracture threshold leads to acute deleterious changes in the viscoelastic properties of articular cartilage that worsen with time, while at the same time stimulating increased bone formation beneath the impact site. PMID:20225288

  12. Femoral midshaft fractures: expandable versus locked nailing.

    PubMed

    Zhou, Zhen-Tao; Song, Yu-Chen; Zhou, Xiao-Zhong; Zhou, Hai-Bin; Luo, Zong-Ping; Dong, Qi-Rong

    2015-04-01

    Femoral midshaft fracture is one of the most common clinical injuries and is often caused by high-energy traffic accidents. Intramedullary nailings, plates, and external fixators are all used as treatment alternatives for a variety of patients depending on fracture location, displacement, comminution, soft tissue condition, and local tradition. Locked intramedullary nailing is currently the preferred treatment method for most diaphyseal fractures and has good clinical results. The goal of this study was to compare expandable and locked intramedullary nailing for the treatment of AO type 32A and 32B1 femoral midshaft fractures. The authors performed a retrospective analysis of 46 patients (33 men and 13 women; mean age, 32.3 years; range, 22-52 years) with femoral midshaft fractures who were divided into 2 groups-one treated with an expandable intramedullary nailing method and the other with a conventional locked intramedullary nailing. The 2 groups were compared with respect to operation time, fluoroscopic time, amount of estimated blood loss, hospitalization time, healing time, and complications. Patients were followed for at least 1 year. The results of this study showed that all of the patients achieved bone union within 12 to 24 months. Expandable nailing performed better than locked nailing in operation time, fluoroscopic time, amount of estimated blood loss, and healing time (P<.001). There was no difference in hospitalization time and no visible shortening or severe complications were observed in either group. Based on the results of this study, the expandable intramedullary nailing is an easy and effective treatment for AO type 32A and 32B1 diaphyseal femoral fractures. PMID:25901625

  13. Subtrochanteric fractures after retrograde femoral nailing.

    PubMed

    Mounasamy, Varatharaj; Mallu, Sathya; Khanna, Vishesh; Sambandam, Senthil

    2015-10-18

    Secondary fractures around femoral nails placed for the management of hip fractures are well known. We report, two cases of a fracture of the femur at the interlocking screw site in the subtrochanteric area after retrograde femoral nailing of a femoral shaft fracture. Only a few reports in the existing literature have described these fractures. Two young men after sustaining a fall presented to us with pain, swelling and deformity in the upper thigh region. On enquiring, examining and radiographing them, peri-implant fractures of subtrochanteric nature through the distal interlocking screws were revealed in both patients who also had histories of previous falls for which retrograde intramedullary nailing was performed for their respective femora. Both patients were managed with similar surgical routines including removal of the existing hardware, open reduction and ace cephallomedullary antegrade nailing. The second case did show evidence of delayed healing and was additionally stabilized with cerclage wires. Both patients had uneventful postoperative outcomes and union was evident at the end of 6 mo postoperatively with a good range of motion at the hip and knee. Our report suggests that though seldom reported, peri-implant fractures around the subtrochanteric region can occur and pose a challenge to the treating orthopaedic surgeon. We suggest these be managed, after initial stabilization and resuscitation, by implant removal, open reduction and interlocking intramedullary antegrade nailing. Good results and progression to union can be expected in these patients by adhering to basic principles of osteosynthesis. PMID:26495251

  14. Marketing Imperative or Cultural Challenge? Embedding Widening Participation in the Further Education Sector.

    ERIC Educational Resources Information Center

    Foskett, Nick

    2002-01-01

    The British government's widening participation agenda is influencing policy and culture in further education colleges. Evidence from five colleges suggests that the principle is established as a strategic imperative, although the impetus is more financial than moral/humanistic. Responsiveness tends to be project based: where resources are most…

  15. Involuntary outpatient treatment as "desintitutionalized coercion": the net-widening concerns.

    PubMed

    Geller, Jeffrey L; Fisher, William H; Grudzinskas, Albert J; Clayfield, Jonathan C; Lawlor, Ted

    2006-01-01

    In American jurisprudence, two justifications have traditionally been put forth to support the government's social control of persons with mental illness: police power and parens patriae. As public mental hospitals became less available as loci in which to exercise these functions, governments sought alternative means to achieve the same ends. One prominent but quite controversial means is involuntary outpatient treatment (IOT). While the concerns about IOT have been myriad, one often alluded to but never documented is that of "net-widening." That is, once IOT became available, it would be applied to an ever greater number of individuals, progressively expanding the margins of the designated population to whom it is applied, despite the formal standard for its application remaining constant. We tested the net-widening belief in a naturalistic experiment in Massachusetts. We found that net-widening did not occur, despite an environment strongly conducive to that expansion. At this time, whatever the arguments against IOT might be, net-widening should not be one of them. PMID:17097143

  16. Building an Institution Worthy of Its History: The Evergreen Strategic Plan at Widener University

    ERIC Educational Resources Information Center

    Allen, Jo; Baker, Joseph J.

    2012-01-01

    From its founding as a Quaker school for boys to its evolution into a military school and, ultimately, into the thriving coeducational civilian institution it is today, Widener University has been no stranger to change and transition. It may come as a surprise, therefore, that although it had a mission statement and goals, prior to 2004 the…

  17. The Discourse of Widening Participation and Its Critics: An Institutional Case Study

    ERIC Educational Resources Information Center

    Stevenson, Jacqueline; Clegg, Sue; Lefever, Ruth

    2010-01-01

    This paper takes as its focus the contradictory discourse of widening participation (WP). We argue that given the conflicting accounts of WP it is highly unlikely that higher education staff will be able articulate a coherent definition of WP practice. We illustrate our thesis with an institutional case study which analysed policy documents and…

  18. Widening Participation in Higher Education: An Examination of the Factors Influencing Institutional Policy

    ERIC Educational Resources Information Center

    Greenbank, Paul

    2006-01-01

    This article examines the factors influencing the development of widening participation policy in 16 higher education institutions (HEIs). It utilises documentary research, followed by interviews with key policy makers in three of the institutions: an "old" university, a "new" university and a college of higher education. The paper demonstrates…

  19. "Working-Class" Education: Notions of Widening Participation in the Nineteenth and Twenty-First Centuries

    ERIC Educational Resources Information Center

    Robinson, Denise; Walker, Martyn

    2013-01-01

    This paper argues that working-class widening participation in education is not necessarily new. While it can be argued that it was established in the late twentieth century as a concept and government strategy, aspects of its origins can be traced back to movements such as the mechanics' institute movement, first established by the 1850s.…

  20. Widening Access to Tertiary Education for Women in Ghana through Distance Education

    ERIC Educational Resources Information Center

    Kwapong, Olivia Adwoa Tiwaah Frimpong

    2007-01-01

    Distance education (DE) is seen as a tool for widening access to education at all levels. It is an educational tool that breaks most of the divides in education--age, gender, race, income, space, time etc. For the past decades, irrespective of the extensive expansion of tertiary institutions in the country, provision of tertiary education in Ghana…

  1. 32 CFR 644.422 - Authorized widening of a public highway, street, or alley.

    Code of Federal Regulations, 2010 CFR

    2010-07-01

    ... 32 National Defense 4 2010-07-01 2010-07-01 true Authorized widening of a public highway, street, or alley. 644.422 Section 644.422 National Defense Department of Defense (Continued) DEPARTMENT OF THE ARMY (CONTINUED) REAL PROPERTY REAL ESTATE HANDBOOK Disposal Disposal of Fee-Owned Real Property and Easement Interests § 644.422...

  2. Rethinking Widening Participation in Higher Education: The Role of Social Networks

    ERIC Educational Resources Information Center

    Fuller, Alison, Ed.; Heath, Sue, Ed.; Johnston, Brenda, Ed.

    2011-01-01

    Extending the chance for people from diverse backgrounds to participate in Higher Education (HE) is a priority in the UK and many countries internationally. Previous work on widening participation in HE however has focussed on why people choose to go to university but this vital new research has focussed on looking at why people choose not to go.…

  3. E-Learning as a Challenge for Widening of Opportunities for Improvement of Students' Generic Competences

    ERIC Educational Resources Information Center

    Birzina, Rita; Fernate, Andra; Luka, Ineta; Maslo, Irina; Surikova, Svetlana

    2012-01-01

    The rapidly changing economic, financial and social conditions require new knowledge and competences in order to be able to understand them, adapt to the new requirements and remain competitive and successful in the globalised social environment. Widening the access to lifelong learning is one way in which this could be achieved. A special role in…

  4. What Are We Doing This for? Widening Participation, Employability and Doing Sociology

    ERIC Educational Resources Information Center

    Marr, Liz; Leach, Bernard

    2005-01-01

    This article explores some of the consequences of the widening participation agenda for the teaching of sociology, particularly in the new university sector. Recent research within the Department of Sociology at Manchester Metropolitan University (MMU) suggests that we are increasingly facing new demands from students who take a more instrumental…

  5. The Enduring Association between Education and Mortality: The Role of Widening and Narrowing Disparities

    PubMed Central

    Miech, Richard; Pampel, Fred; Kim, Jinyoung; Rogers, Richard G.

    2015-01-01

    This paper examines how educational disparities in mortality emerge, grow, decline, and disappear across causes of death in the United States and how these change contribute to the enduring association of education and mortality over time. Focusing on adults age 40–64, we first examine the extent to which disparities in all-cause mortality by education persisted from 1989–2007. We then test the “fundamental cause” prediction that mortality disparities persist, in part, by shifting to new health outcomes over time, most importantly for those causes of death that have increasing mortality rates. To test this hypothesis, we focus in depth on the period from 1999–2007, when all causes of death were coded to the same classification system. The results indicate (a) both substantial widening and narrowing of mortality disparities across causes of death, (b) almost all causes of death that had increasing mortality rates also had widening disparities by education, and (c) the total disparity by education in all-cause mortality would be about 25% smaller today were it not for newly widened or emergent disparities since 1999. These results point to the theoretical and policy importance of identifying the social forces that cause health disparities to widen over time. PMID:26937041

  6. Repositioning the Subject Discipline for an "Academic-Enhancement" Model of Widening Participation: A Philosophical Sketch

    ERIC Educational Resources Information Center

    O'Brien, Mark

    2013-01-01

    This article addresses a question for those seeking to deepen engagement with nontraditional students for strategies of widening participation in the higher education setting. The question is as follows: how can the academic subject be made more "open" to what the student (and therefore also the nontraditional student) can bring to it?…

  7. Transition to Postgraduate Study: Practice, Participation and the Widening Participation Agenda

    ERIC Educational Resources Information Center

    O'Donnell, Victoria L.; Tobbell, Jane; Lawthom, Rebecca; Zammit, Maria

    2009-01-01

    This article explores transition to postgraduate (PG) study in terms of the widening participation (WP) agenda. The research is located within a Communities of Practice framework, allowing for explanations of transition in terms of learning, identity and participation in practices. A qualitative ethnographic methodology is employed, and analysis…

  8. Widening Participation, the Instrumentalization of Knowledge and the Reproduction of Inequality

    ERIC Educational Resources Information Center

    Mavelli, Luca

    2014-01-01

    According to Michel Foucault, modernity is predicated on the emergence of an instrumental idea of knowledge, which does not affect the constitution of the individual as a subject. This article aims to explore this thesis in the context of British Higher Education through a problematization of widening participation policies, and how they have been…

  9. Widening Participation in Sport-Related Studies in Higher Education: An Exploratory Study of Symbolic Struggles

    ERIC Educational Resources Information Center

    Lundvall, Suzanne; Meckbach, Susanne

    2012-01-01

    This paper focuses on widening participation in higher education and the low recruitment of students from diverse backgrounds within sport-related programs. The purpose of the study has been to describe and increase the understanding of how the preconditions and premises for choosing to study "sport" appear to students from diverse backgrounds,…

  10. The Right to Higher Education: Beyond Widening Participation. Foundations and Futures of Education

    ERIC Educational Resources Information Center

    Burke, Penny

    2012-01-01

    The landscape of higher education has undergone change and transformation in recent years, partly as a result of diversification and massification. However, persistent patterns of under-representation continue to perplex policy-makers and practitioners, raising questions about current strategies, policies and approaches to widening participation.…

  11. The Contribution of the Open University to Widening Participation in Psychology Education

    ERIC Educational Resources Information Center

    Cooper, Troy

    2010-01-01

    The work of the Open University is situated historically in widening participation, both through its open access policy and the modular structure of the qualifications if offers. The process by which the Open University produces more British Psychological Society accredited graduates with GBC than any other HEI, and the contribution of…

  12. Assessing Students' Emotional Competence in Higher Education: Development and Validation of the Widener Emotional Learning Scale

    ERIC Educational Resources Information Center

    Wang, Ning; Young, Thomas; Wilhite, Stephen C.; Marczyk, Geoffrey

    2011-01-01

    This article reports the development and validation studies of the Widener Emotional Learning Scale (WELS), a self-report measure, for assessing students' social and emotional competence in higher education. Conceptual specifications, item development, psychometric properties, and factor structure of the instrument are reported in the article. The…

  13. Stretching the Academy: The Politics and Practice of Widening Participation in Higher Education.

    ERIC Educational Resources Information Center

    Thompson, Jane, Ed.

    These 12 papers support the view that the current, general interest in widening participation in higher education in the United Kingdom may provide opportunities to radicalize policies and intervene strategically in institutional practices in ways that help to influence them. "Introduction" (Jane Thompson) precedes "Joining, Invading,…

  14. Widening Access to Higher Education: An Evaluative Case Study of a Foundation Year Alternative to Access

    ERIC Educational Resources Information Center

    Reddy, Peter A.; Moores, Elisabeth

    2008-01-01

    Universities are encouraged to widen access to a broad range of applicants, including mature students taking Access qualifications. Admissions tutors can find it difficult to compare and choose between Access and A-level applications, and Access applicants for popular courses may be disadvantaged relative to students with good A-levels. In this…

  15. Widening Participation and English Language Proficiency: A Convergence with Implications for Assessment Practices in Higher Education

    ERIC Educational Resources Information Center

    Murray, Neil

    2013-01-01

    The widening participation agenda has important implications for those in English-medium higher education institutions responsible for the provision of English language support. Importantly, given the diverse nature of the "non-traditional" student cohort that is the focus of this agenda, that section of the student population…

  16. From the Margins to the Mainstream: Embedding Widening Participation in Higher Education

    ERIC Educational Resources Information Center

    Thomas, Liz; May, Helen; Harrop, Helen; Houston, Muir; Knox, Hazel; Lee, Mee Foong; Osborne, Michael; Pudner, Heather; Trotman, Colin

    2005-01-01

    This is the third in a series of reports published by Universities UK and the Standing Conference of Principals (SCOP) charting the development of widening participation activity across the UK higher education sector. The study analyses 34 in-depth case studies (including a re-examination of the 23 previous case studies from the 1998 and 2002…

  17. Widening Income Inequalities: Higher Education's Role in Serving Low Income Students

    ERIC Educational Resources Information Center

    Dalton, Jon C.; Crosby, Pamela C.

    2015-01-01

    Many scholars argue that America is becoming a dangerously divided nation because of increasing inequality, especially in income distribution. This article examines the problem of widening income inequality with particular focus on the role that colleges and universities and their student affairs organizations play in serving low income students…

  18. Widening Participation in Higher Education: The Role of Professional and Social Class Identities and Commitments

    ERIC Educational Resources Information Center

    Wilkins, Andrew; Burke, Penny Jane

    2015-01-01

    Since the neoliberal reforms to British education in the 1980s, education debates have been saturated with claims to the efficacy of the market as a mechanism for improving the content and delivery of state education. In recent decades with the expansion and "massification" of higher education, widening participation (WP) has acquired an…

  19. Widening and Expanding Participation in Australian Higher Education: In the Absence of Sociological Imagination

    ERIC Educational Resources Information Center

    Gale, Trevor

    2015-01-01

    Social inclusion in Australian higher education was high on the agenda of the recent Rudd/Gillard Australian Government. This paper offers an assessment of that agenda, particularly the extent to which it worked in favour of under-represented groups. It argues that the Government's widening and expansion policies and its equity and aspiration…

  20. Widening the Gap: The Potential Impact of Eliminating the Colorado Preschool Program

    ERIC Educational Resources Information Center

    Colorado Children's Campaign, 2009

    2009-01-01

    Colorado has seen a growing gap in the achievement of poor and low-income students compared to their more affluent peers. A widening achievement gap has short- and long-term implications for children, as well as the state. Research suggests that high-quality early childhood programs are an effective way to reduce or even eliminate achievement…

  1. "Bums on Seats" or "Listening to Voices: Evaluating Widening Participation Initiatives Using Participatory Action Research.

    ERIC Educational Resources Information Center

    Thomas, Liz

    2000-01-01

    Evaluation of initiatives for widening participation in higher education by nontraditional groups should avoid positivist, economic approaches in favor of participatory action research (PAR). An example from Britain shows how PAR finds local solutions for local problems; promotes empowerment, ownership, and sustainability; and bridges and…

  2. Widening Access to University Education in Anglophone Africa: Problems and Prospects

    ERIC Educational Resources Information Center

    Oduaran, Akpovire; Oduaran, Choja

    2007-01-01

    Widening access to university-level education in Anglophone Africa has been moving away gradually from rhetorical optimism into the realm of political actualisation of collective intentions of community modernisation and growth. This is because university education is being deconstructed to embrace the welfare, self-actualisation and…

  3. English Universities, Additional Fee Income and Access Agreements: Their Impact on Widening Participation and Fair Access

    ERIC Educational Resources Information Center

    McCaig, Colin; Adnett, Nick

    2009-01-01

    This paper argues that the introduction of access agreements following the establishment of the Office for Fair Access (OFFA) has consolidated how English higher education institutions (HEIs) position themselves in the marketplace in relation to widening participation. However, the absence of a national bursary scheme has led to obfuscation rather…

  4. Diversity, Gender and Widening Participation in Global Higher Education: A Feminist Perspective

    ERIC Educational Resources Information Center

    David, Miriam E.

    2009-01-01

    This article provides an overview of global higher education focusing particularly on issues of diversity and gender. The main evidence is drawn from seven unique projects on Widening Participation in Higher Education funded by the British Government's Higher Education Funding Council for England and administered through the Economic and Social…

  5. Widening Participation, Social Justice and Injustice: Part-Time Students in Higher Education in England

    ERIC Educational Resources Information Center

    Callender, Claire

    2011-01-01

    This article critically assesses the nature and scope of current financial support for part-time undergraduates in England, highlighting its importance for widening participation. It considers the limitations of these financial arrangements, why they are in need of reform, and some of the consequences of their inadequacies. The paper argues that…

  6. Incomplete transposition of the common femoral artery and vein.

    PubMed

    Leite, J O; Carvalho Ventura, I; Botelho, F E; Costa Galvao, W

    2010-02-01

    Anatomical variations of the great saphenous vein, femoral artery and femoral vein at the inguinal level are rare. Modifications in the anatomical relationships among theses vessel can cause technical difficulties. There are two reports in the literature of the complete transposition of the femoral artery and vein. Both patients had large varicose veins only in the limb that presented the variation, which suggested an extrinsic compression. In the present paper, we report a case study of a patient with an incomplete transposition of the femoral artery and vein. Specifically, the common femoral vein and the saphenofemoral junction were completely overlapped by the common femoral artery. Although this anatomical variation did not present any clinical signs, it required a more complex surgical procedure. PMID:20224538

  7. Incidence of Avascular Necrosis of the Femoral Head After Intramedullary Nailing of Femoral Shaft Fractures

    PubMed Central

    Kim, Ji Wan; Oh, Jong-Keon; Byun, Young-Soo; Shon, Oog-Jin; Park, Jai Hyung; Oh, Hyoung Keun; Shon, Hyun Chul; Park, Ki Chul; Kim, Jung Jae; Lim, Seung-Jae

    2016-01-01

    Abstract The goal of this study was to determine the incidence of avascular necrosis of the femoral head (AVNFH) after intramedullary nailing of femoral shaft fractures and to identify risk factors for developing AVNFH. We retrospectively reviewed all patients with femoral shaft fractures treated with antegrade intramedullary nailing at 10 institutions. Among the 703 patients enrolled, 161 patients were excluded leaving 542 patients in the study. Average age was 42.1 years with average follow-up of 26.3 months. Patient characteristics and fracture patterns as well as entry point of femoral nails were identified and the incidence of AVNFH was investigated. Patients were divided into 2 groups according to open versus closed physis, open versus closed fractures, and age (<20 versus ≥20 years). Overall incidence of AVNFH was 0.2% (1 of 542): the patient was 15-year-old boy. Of 25 patients with open physis, the incidence of AVNFH was 4%, whereas none of 517 patients with closed physis developed AVNFH (P < 0.001). The incidence of AVNFH in patients aged < 20 versus ≥20 years was 1.1% (1 of 93) and 0.0% (0 of 449), respectively (P = 0.172), which meant that the incidence of AVNFH was 0% in adult with femur shaft fracture. Of 61 patients with open fractures, the incidence of AVNFH was 0%. The number of cases with entry point at the trochanteric fossa or tip of the greater trochanter (GT) was 324 and 218, respectively, and the incidence of AVNFH was 0.3% and 0.0%, respectively (P = 0.412). In patients aged ≥20 years with isolated femoral shaft fracture, there was no case of AVNFH following antegrade intramedullary nailing regardless of the entry point. Therefore, our findings suggest that the risk of AVNFH following antegrade femoral nailing is extremely low in adult patients. PMID:26844518

  8. Femoral neck structure and function in early hominins.

    PubMed

    Ruff, Christopher B; Higgins, Ryan

    2013-04-01

    All early (Pliocene-Early Pleistocene) hominins exhibit some differences in proximal femoral morphology from modern humans, including a long femoral neck and a low neck-shaft angle. In addition, australopiths (Au. afarensis, Au. africanus, Au. boisei, Paranthropus boisei), but not early Homo, have an "anteroposteriorly compressed" femoral neck and a small femoral head relative to femoral shaft breadth. Superoinferior asymmetry of cortical bone in the femoral neck has been claimed to be human-like in australopiths. In this study, we measured superior and inferior cortical thicknesses at the middle and base of the femoral neck using computed tomography in six Au. africanus and two P. robustus specimens. Cortical asymmetry in the fossils is closer overall to that of modern humans than to apes, although many values are intermediate between humans and apes, or even more ape-like in the midneck. Comparisons of external femoral neck and head dimensions were carried out for a more comprehensive sample of South and East African australopiths (n = 17) and two early Homo specimens. These show that compared with modern humans, femoral neck superoinferior, but not anteroposterior breadth, is larger relative to femoral head breadth in australopiths, but not in early Homo. Both internal and external characteristics of the australopith femoral neck indicate adaptation to relatively increased superoinferior bending loads, compared with both modern humans and early Homo. These observations, and a relatively small femoral head, are consistent with a slightly altered gait pattern in australopiths, involving more lateral deviation of the body center of mass over the stance limb. PMID:23341246

  9. Operative Management of Crossover Femoral-femoral Graft Erosion into Bladder: A Case Report.

    PubMed

    Motiani, Karan; Mahdy, Ayman

    2016-09-01

    Erosion of vascular grafts is not uncommon as seen in the recent literature. There have been many case reports documenting the work up and management of erosion of these grafts into bowel. We report a case of a crossover femoral-femoral graft that eroded into the anterior bladder wall and was incidentally found as an adherent bladder stone during cystoscopy. We demonstrate the importance of having a high level of clinical suspicion for eroding vascular grafts when preoperative imaging shows close proximity of graft to bladder. PMID:27462547

  10. A Ghanaian Response to the Study on "Widening Participation in Higher Education in Ghana and Tanzania: Developing an Equity Scorecard"

    ERIC Educational Resources Information Center

    Effah, Paul

    2011-01-01

    The study on "Widening Participation in Higher Education in Ghana and Tanzania: developing an Equity Scorecard" is a contribution to making higher education more socially inclusive in sub-Saharan Africa. The findings reinforce some of the policy initiatives taken in Ghana and Tanzania, and underscore the importance of widening participation in…

  11. Good Students, Bad Pupils: Constructions of "Aspiration", "Disadvantage" and Social Class in Undergraduate-Led Widening Participation Work

    ERIC Educational Resources Information Center

    Taylor, Yvette

    2008-01-01

    This C-SAP funded research explores undergraduate student involvement in widening participation initiatives at a traditional university and the ways that students promote and market their university and higher education more generally. It seeks to explore the widening participation messages disseminated by students in their work with pupils and…

  12. P and n-type microcrystalline semiconductor alloy material including band gap widening elements, devices utilizing same

    DOEpatents

    Guha, Subhendu; Ovshinsky, Stanford R.

    1988-10-04

    An n-type microcrystalline semiconductor alloy material including a band gap widening element; a method of fabricating p-type microcrystalline semiconductor alloy material including a band gap widening element; and electronic and photovoltaic devices incorporating said n-type and p-type materials.

  13. [Isolated true aneurysm of the deep femoral artery].

    PubMed

    Salomon du Mont, L; Holzer, T; Kazandjian, C; Saucy, F; Corpataux, J M; Rinckenbach, S; Déglise, S

    2016-07-01

    Aneurysms of the deep femoral artery, accounting for 5% of all femoral aneurysms, are uncommon. There is a serious risk of rupture. We report the case of an 83-year-old patient with a painless pulsatile mass in the right groin due to an aneurysm of the deep femoral artery. History taking revealed no cardiovascular risk factors and no other aneurysms at other localizations. The etiology remained unclear because no recent history of local trauma or puncture was found. ACT angiography was performed, revealing a true isolated aneurysm of the deep femoral artery with a diameter of 90mm, beginning 1cm after its origin. There were no signs of rupture or distal emboli. Due to unsuitable anatomy for an endovascular approach, the patient underwent open surgery, with exclusion of the aneurysm and interposition of an 8-mm Dacron graft to preserve deep femoral artery flow. Due to their localization, the diagnosis and the management of aneurysms of the deep femoral artery can be difficult. Options are surgical exclusion or an endovascular approach in the absence of symptoms or as a bridging therapy. If possible, blood flow to the distal deep femoral artery should be maintained, the decision depending also on the patency of the superficial femoral artery. In case of large size, aneurysms of the deep femoral artery should be treated without any delay. PMID:27289256

  14. Clinical Results of Internal Fixation of Subcapital Femoral Neck Fractures

    PubMed Central

    Moon, Kyoung Ho; Shin, Joong Sup; Shin, Eun Ho; Ahn, Chi Hoon; Choi, Geon Hong

    2016-01-01

    Background Subcapital femoral neck is known to cause many complications, such as avascular necrosis (AVN) of the femoral head or nonunion, compared with other femoral neck fractures. The purpose of this study was to analyze the incidence of AVN and fixation failures in patients treated with internal fixation using cannulated screws for the subcapital femoral neck fractures. Methods This study targeted a total of 84 cases of subcapital femoral neck fractures that underwent internal fixation using cannulated screws. The average follow-up time after surgery was 36.8 months (range, 24 to 148 months). Results Nine hips (10.7%) showing AVN of the femoral head and 6 hips (7.1%) showing fixation failures were observed. The factors affecting the incidence of AVN of the femoral head after sustaining fractures correlated well with fracture types in the Garden classification (p = 0.030). The factors affecting fixation failure were the degree of reduction (p = 0.001) measured by the Garden alignment index and firm fixation (p = 0.009) assessed using the technique of 3-point fixation through the inferomedial cortical bone of the femoral neck. Conclusions The complication rates for subcapital femoral neck fractures were lower than those previously reported; hence, internal fixation could be a primary treatment option for these fractures. PMID:27247738

  15. Effectiveness of Fulkerson Osteotomy with Femoral Nerve Stimulation for Patients with Severe Femoral Trochlear Dysplasia

    PubMed Central

    Crebs, D.T.; Anthony, C.A.; McCunniff, P.T.; Nieto, M.J.; Beckert, M.W.; Albright, J.P.

    2015-01-01

    Background Patients with femoral trochlear dysplasia are at risk for chronic recurrent patellofemoral dislocations, with extreme cases often requiring a surgical procedure. Anteromedialization of the tibial tubercle with intraoperative femoral nerve stimulation and concurrent medial patella-femoral ligament (MPFL) reconstruction is a previously reported method of maximizing patello-femoral congruency. We hypothesize the Fulkerson osteotomy with intraoperative femoral nerve stimulation and concurrent MPFL reconstruction in patients with severe trochlear dysplasia provides equivalent postoperative clinical outcomes to the same procedure in patients with low level trochlear dysplasia. Methods 48 knees underwent Fulkerson osteotomy with intraoperative femoral nerve stimulation and concurrent MPFL reconstruction for recurrent lateral patellar dislocations. MRI, surgeon intraoperative assessment, and X-ray were used to assess degrees of trochlear dysplasia; inter-observer and intra-observer error were measured. The knees positive for severe dysplasia on MRI, intraoperative assessment, and X-ray were considered as a comparison cohort to the rest of the study population. We considered postoperative dislocation events and patellar tracking kinematics as outcome measures. Independent student t tests and Fisher exact tests were used to evaluate differences between groups. Significance was set at P<0.05. Results 11 knees were positive for severe dysplasia (SD) by combined MRI, surgeon intraoperative assessment, and X-ray with the remaining 37 knees categorized as low dysplasia (LD). No patients in either group exhibited apprehension or required re-operation. Mean sulcus angle in the SD group was 175.8 +−2.45 degrees (95% CI 171.0–180.6); the LD group mean sulcus angle was 154.3 +− 0.98 degrees (95% CI 152.4–156.2) (P<.001). Postoperatively there was no significant difference in dislocation events between the SD group (0/11) and the LD group (2/37) (P>0.999). Patellar

  16. Bilateral Femoral Neck Insufficiency Fractures after Use of a Long-term Anti-resorptive Drug Therapy for Osteoporosis: A Case Report

    PubMed Central

    Ahn, Dong-Ki; Lee, Jae-Il; Kim, Jin-Woo

    2015-01-01

    A 78-year-old woman developed an insufficiency fracture on her right femoral neck without trauma after four years of treatment with a bisphosphonate. Her fracture was fixed by two screws and her anti-osteoporotic drug was changed from an anti-resorptive to an anabolic agent. Seven months later, however, she sustained similar insufficiency fracture on the left femoral neck and was treated with the same method. She developed right inguinal pain again approximately eight months after her right side operation. The results of imaging tests revealed that her insufficiency fracture was converted to complete fracture, and that the fracture gap had widened as well. Her right hip was revised with hemiarthroplasty. A histological exam of the fracture site revealed evidence of decreased bone healing. Long-term administration of anti-resorptive drug prevents bone healing and remodeling and can result in atypical fractures of the femoral neck. Osteosynthesis was difficult to accomplish despite the application of proactive fixation. Therefore, more rigid fixation and careful postoperative treatment should be considered.

  17. Correlation Between Asymmetric Resection of Posterior Femoral Condyles and Femoral Component Rotation in Total Knee Arthroplasty

    PubMed Central

    Güngör, Harun Reşit; Ök, Nusret; Ağladıoğlu, Kadir; Akkaya, Semih; Kıter, Esat

    2014-01-01

    Objectives: Pertaining to peculiar designs of current knee prostheses, more bone is removed from posteromedial femoral condyle than posterolateral condyle to obtain desired femoral component rotation. The aim of our study was to evaluate whether there is a correlation between the asymmetry of the cuts and the femoral component rotation in total knee arthroplasty. Methods: We built a model to simulate anterior chamfer cut (ACC) performed during total knee arthroplasty for measuring posterior condylar offset (PCO). Right knee axial MRI slices of a total 290 consecutive patients (142 male, 138 female, and mean age 31.39 ± 6.6) were examined. A parallel line to surgical transepiphyseal axis was drawn, and placed at the deepest part of trochlear groove. Posteromedial and posterolateral condylar offsets were measured by drawing perpendicular lines to ACC beginning from the intersection points of both anteromedial and anterolateral cortices to posterior joint line (PJL), respectively. Differences between posteromedial and posterolateral PCO were calculated, and femoral rotation angles (FRA) relative to PJL were measured. Results: The mean surgical FRA was 4.76 ± 1.16 degrees and the mean PCO differencesss- was 4.35 ± 1.04 mm for the whole group and there was no statistically significant difference between genders. There was a strong correlation between surgical FRA and PCO difference (p<0.0001, r=0.803). Linear regression analyses revealed that 0.8 mm of difference between the anteroposterior dimensions of medial and lateral PCO corresponds to 1 degree of surgical FRA (p<0.0001, R2=0.645). Conclusion: Correlation between the asymmetry of posterior chamfer cuts and achieved femoral component rotation can verify the accuracy of desired rotation, intraoperatively. However, further clinical investigations should be planned to test the results of our morphometric study.

  18. Accuracy of femoral templating in reproducing anatomical femoral offset in total hip replacement.

    PubMed

    Davies, H; Foote, J; Spencer, R F

    2007-01-01

    Restoration of hip biomechanics is a crucial component of successful total hip replacement. Preoperative templating is recommended to ensure that the size and orientation of implants is optimised. We studied how closely natural femoral offset could be reproduced using the manufacturers' templates for 10 femoral stems in common use in the UK. A series of 23 consecutive preoperative radiographs from patients who had undergone unilateral total hip replacement for unilateral osteoarthritis of the hip was employed. The change in offset between the templated position of the best-fitting template and the anatomical centre of the hip was measured. The templates were then ranked according to their ability to reproduce the normal anatomical offset. The most accurate was the CPS-Plus (Root Mean Square Error 2.0 mm) followed in rank order by: C stem (2.16), CPT (2.40), Exeter (3.23), Stanmore (3.28), Charnley (3.65), Corail (3.72), ABG II (4.30), Furlong HAC (5.08) and Furlong modular (7.14). A similar pattern of results was achieved when the standard error of variability of offset was analysed. We observed a wide variation in the ability of the femoral prosthesis templates to reproduce normal femoral offset. This variation was independent of the seniority of the observer. The templates of modern polished tapered stems with high modularity were best able to reproduce femoral offset. The current move towards digitisation of X-rays may offer manufacturers an opportunity to improve template designs in certain instances, and to develop appropriate computer software. PMID:19197861

  19. Strains caused by daily loading might be responsible for delayed healing of an incomplete atypical femoral fracture.

    PubMed

    Gustafsson, Anna; Schilcher, Jörg; Grassi, Lorenzo; Aspenberg, Per; Isaksson, Hanna

    2016-07-01

    Atypical femoral fractures are insufficiency fractures in the lateral femoral diaphysis or subtrochanteric region that mainly affect older patients on bisphosphonate therapy. Delayed healing is often seen in patients with incomplete fractures (cracks), and histology of bone biopsies shows mainly necrotic material inside the crack. We hypothesized that the magnitude of the strains produced in the soft tissue inside the crack during normal walk exceeds the limit for new bone formation, and thereby inhibit healing. A patient specific finite element model was developed, based on clinical CT images and high resolution μCT images of a biopsy from the crack site. Strain distributions in the femur and inside the crack were calculated for load cases representing normal walk. The models predicted large strains inside the crack, with strain levels above 10% in more than three quarters of the crack volume. According to two different tissue differentiation theories, bone would only form in less than 1-5% of the crack volume. This can explain the impaired healing generally seen in incomplete atypical fractures. Furthermore, the microgeometry of the crack highly influenced the strain distributions. Hence, a realistic microgeometry needs to be considered when modeling the crack. Histology of the biopsy showed signs of remodeling in the bone tissue adjacent to the fracture line, while the crack itself contained mainly necrotic material and signs of healing only in portions that seemed to have been widened by resorption. In conclusion, the poor healing capacity of incomplete atypical femoral fractures can be explained by biomechanical factors, and daily low impact activities are enough to cause strain magnitudes that prohibit bone formation. PMID:27113528

  20. Band widening of piezoelectric vibration energy harvesters by utilizing mechanical stoppers and magnets

    NASA Astrophysics Data System (ADS)

    Maeguchi, T.; Masuda, A.; Katsumura, H.; Kagata, H.; Okumura, H.

    2015-12-01

    This paper presents a design of a piezoelectric hardening-type nonlinear vibration energy harvester which has widened resonance band while maintaining the same peak performance at the resonance frequency as that of the reference linear harvester. To this end, a pair of mechanical stoppers and a pair of repulsive magnets are introduced in this study. An experimental prototype device is designed by using a stainless steel-based piezoelectric cantilever, and numerical simulations and experiments are conducted to examine the validity of the presented design strategy. It is concluded that using the magnets to shift the resonance peak toward the lower frequency and using stoppers to expanding the resonance band toward the higher frequency can broaden the resonance band effectively maintaining the peak response. The damping due to the contact of the tip mass with the stopper is one of the key parameters which should be as small as possible to enhance the band widening effect.

  1. Does Quality-of-Life Policing Widen the Net? A Partial Analysis

    PubMed Central

    Golub, Andrew; Johnson, Bruce D.; Taylor, Angela; Eterno, John

    2013-01-01

    In the 1990s, the New York City Police Department instituted a policy of arresting individuals for less serious offenses that impinge on the city’s quality of life (QOL). Critics contend that QOL policing widened the net for arrest, especially among minorities. Alternatively, QOL policing could have created additional opportunities for arresting individuals from the same populations that tend to incur arrests for more serious offenses. This article reports on a comparison of New York City QOL and serious arrestees interviewed in 1999 that provides partial support for this alternative hypothesis; the two groups were similar regarding prior arrests, participation in QOL offenses, and demographic composition. Of note, blacks and Hispanics comprised close to 90% of both arrest populations. These findings suggest that QOL policing does not necessarily widen the net for arrest. PMID:25309134

  2. Widening health inequalities among U.S. military retirees since 1974.

    PubMed

    Edwards, Ryan

    2008-12-01

    I explore trends in mortality among U.S. military retirees using a new dataset of payroll records that include pay grade. Trends in mortality by pay grade reveal that health inequalities steadily widened between 1974 and 2004. Additive differentials in mortality rates remained stable, but since mortality declined exponentially, by a factor of about one third, proportional differentials in mortality and thus additive differentials in life expectancy have widened. The advantage in life expectancy enjoyed by retired officers grew roughly from 3 to 4 years. The sources of these trends remain unclear and are beyond the ability of the data to inform, but the results bear implications for trends in inequality and for policy. PMID:18708275

  3. Further Observational Evidence of Hadley Cell Widening in the Southern Hemisphere

    SciTech Connect

    Choi, Jung; Son, Seok-Woo; Lu, Jian; Min, Seung-Ki

    2014-04-16

    Various observational and modeling studies have shown that the Hadley cell (HC) has widened during the past few decades. Here, we present further observational evidence of the widening of the HC in the Southern Hemisphere by tracking the location of the subtropical ridge. A robust and significant poleward shift of the southern edge of the HC has been observed during the austral summer over the past three decades with a shift of 0.22 degrees per decade having occurred between 1980 and 2012, primarily from the South Atlantic Ocean to Australia. In other seasons, significant changes in the southern edge of the HC have not been observed, with a discernable regional trend having only occurred in a limited region. The comparison of these results with those derived from reanalysis data and possible causes for the summer HC expansion are briefly discussed.

  4. [The changes of bone architecture in atypical femoral fracture].

    PubMed

    Yamamoto, Noriaki; Shimakura, Taketoshi; Takahash, Hideaki

    2013-07-01

    The feature of atypical femoral fracture is stress induced cortical bone reaction. It was considered to be the accumulation of microdamage which come from increasing of mechanical stress by femoral lateral bowing, and the decreased of ability of microdamage repair system. PMID:23811584

  5. High-Resolution Field-Of Widening in Human Eye Retina Imaging - Oral Paper

    NASA Astrophysics Data System (ADS)

    Dubinin, Alexander V.; Cherezova, Tatyana Yu.; Kudryashov, Alexey V.

    2008-01-01

    In this paper we investigate methods of widening high resolution area in fundus cameras equipped with adaptive optics. We first considered average phase correction method. It was found out that this method leads to isoplanatic patch increasing but residual error of correction between the reference sources increases. We also investigated the performance of an adaptive system with five reference sources and two correctors. For optimal corrector and reference sources positions we obtained approximately two times enlargement of isoplanatic patch area.

  6. A bivariate approach to the widening of the frontal lobes in the genus Homo.

    PubMed

    Bruner, Emiliano; Holloway, Ralph L

    2010-02-01

    Within the genus Homo, the most encephalized taxa (Neandertals and modern humans) show relatively wider frontal lobes than either Homo erectus or australopithecines. The present analysis considers whether these changes are associated with a single size-based or allometric pattern (positive allometry of the width of the anterior endocranial fossa) or with a more specific and non-allometric pattern. The relationship between hemispheric length, maximum endocranial width, and frontal width at Broca's area was investigated in extant and extinct humans. Our results do not support positive allometry for the frontal lobe's width in relation to the main endocranial diameters within modern humans (Homo sapiens). Also, the correlation between frontal width and hemispheric length is lower than the correlation between frontal width and parieto-temporal width. When compared with the australopithecines, the genus Homo could have experienced a non-allometric widening of the brain at the temporo-parietal areas, which is most evident in Neandertals. Modern humans and Neandertals also display a non-allometric widening of the anterior endocranial fossa at the Broca's cap when compared with early hominids, again more prominent in the latter group. Taking into account the contrast between the intra-specific patterns and the between-species differences, the relative widening of the anterior fossa can be interpreted as a definite evolutionary character instead of a passive consequence of brain size increase. This expansion is most likely associated with correspondent increments of the underlying neural mass, or at least with a geometrical reallocation of the frontal cortical volumes. Although different structural changes of the cranial architecture can be related to such variations, the widening of the frontal areas is nonetheless particularly interesting when some neural functions (like language or working memory, decision processing, etc.) and related fronto-parietal cortico

  7. Tibial tunnel widening after bioresorbable poly-lactide calcium carbonate interference screw usage in ACL reconstruction.

    PubMed

    Foldager, Casper; Jakobsen, Bent W; Lund, Bent; Christiansen, Svend Erik; Kashi, Lotte; Mikkelsen, Lone R; Lind, Martin

    2010-01-01

    Developing bio-absorbable interference screws for anterior cruciate ligament (ACL) reconstruction has proven to be a challenging task. The aim of this study was to investigate the osteogenetic response of poly-lactide carbonate (PLC) interference screws in ACL reconstruction in humans. Ten patients (median age, 28 years) underwent arthroscopic ACL reconstruction with semitendinosus/gracilis tendon graft and a PLC interference screw. The patients were scanned with a multi-slice CT scanner 2 weeks and 1 year postoperatively. Fourteen days postoperatively a mean tunnel widening of 78% [52%; 110%] was observed. At 1-year follow-up, the mean tunnel widening was 128% [84%; 180%]. No sign of bone replacement or bone ingrowth was observed. Factors such as accelerated rehabilitation, micro-motions, and early screw degradation might be responsible for this large tunnel widening. Our results demonstrate the difficulty in translation of preclinical data. This study illustrates the need for extensive preclinical investigation of new materials for clinical purposes. PMID:19609505

  8. Continuous blood gas monitoring in femoral arteries

    NASA Astrophysics Data System (ADS)

    Schlain, Les A.; Spar, Steven M.; Dellinger, Bart

    1995-05-01

    Continuous intra-arterial blood gas monitoring is a potentially valuable tool in the surgical and intensive care arenas. Patient oxygenation and acid base status can change rapidly and without warning. The ability to monitor pHa, PaCO2 and PaO2 in arterial blood will be a major medical advance for the anesthesiologist and intensivist. Intra-arterial blood gas sensors are typically placed in radial arteries. In certain patient populations accurate monitoring is not possible in radial arteries due to arterial environmental factors such as hypotension, vasoconstriction and atherosclerotic disease. These same factors can make radial cannulation difficult resulting in traumatic catheter insertion, thereby further compromising flow conditions. In situations where radial artery flow is expected to be compromised, selecting a large vessel for sensor placement is desirable. We report an initial feasibility study of our blood gas monitoring system using the femoral artery as the sensing site. Clinical results are presented as well as potential advantages and disadvantages associated with monitoring in the femoral artery.

  9. Complete guidewire retention after femoral vein catheterization.

    PubMed

    Cat, Bahar Gulcay; Guler, Sertac; Soyuduru, Murat; Guven, Ibrahim; Ramadan, Hayri

    2015-01-01

    Central venous catheters (CVCs) are often used for various purposes in the emergency departments (ED). The main uses of CVCs in the EDs are emergent hemodialysis, in situations where peripheral vein catheterization cannot be achieved, and continuous invasive hemodynamic monitoring. The complications related to CVC insertion are usually mechanical and observed in the near term after the procedure. Retained CVC guidewire after catheterization is a rare complication in the published reports and usually related with intra- or postoperative settings and jugular or subclavian vein. The present study reported a young female patient who underwent left femoral vein catheterization 6 months earlier in an intensive care unit of another hospital and was diagnosed with complete guidewire retention in the ED. To the best of the authors' knowledge, this is the first case in published reports with a diagnosis of retained CVC guidewire with retrograde migration into the femoral vein. Surprisingly, the patient developed no thrombotic or embolic complication during this 6-month period. PMID:26657235

  10. Current concepts in total femoral replacement

    PubMed Central

    Ramanathan, Deepak; Siqueira, Marcelo BP; Klika, Alison K; Higuera, Carlos A; Barsoum, Wael K; Joyce, Michael J

    2015-01-01

    Total femoral replacement (TFR) is a salvage arthroplasty procedure used as an alternative to lower limb amputation. Since its initial description in the mid-20th century, this procedure has been used in a variety of oncologic and non-oncologic indications. The most compelling advantage of TFR is the achievement of immediate fixation which permits early mobilization. It is anticipated that TFR will be increasingly performed as the rate of revision arthroplasty rises worldwide. The existing literature is mainly composed of a rather heterogeneous mix of retrospective case series and a wide assortment of case reports. Numerous TFR prostheses are currently available and the surgeon must understand the unique implications of each implant design. Long-term functional outcomes are dependent on adherence to proper technique and an appropriate physical therapy program for postoperative rehabilitation. Revision TFR is mainly performed for periprosthetic infection and the severe femoral bone loss associated with aseptic revisions. Depending on the likelihood of attaining infection clearance, it may sometimes be advisable to proceed directly to hip disarticulation without attempting salvage of the TFR. Other reported complications of TFR include hip joint instability, limb length discrepancy, device failure, component loosening, patellar maltracking and delayed wound healing. Further research is needed to better characterize the long-term functional outcomes and complications associated with this complex procedure. PMID:26716087

  11. Occult fracture of the femoral neck associated with extensive osteonecrosis of the femoral head: A case report

    PubMed Central

    Fukui, Kiyokazu; Kaneuji, Ayumi; Matsumoto, Tadami

    2015-01-01

    Introduction Although the subchondral portion of the femoral head is a common site for collapse in osteonecrosis of the femoral head (ONFH), femoral-neck fracture rarely occurs during the course of ONFH. We report a case of occult insufficiency fracture of the femoral neck without conditions predisposing to insufficiency fractures, occurring in association with ONFH. Presentation of case We report a case of occult fracture of the femoral neck due to extensive ONFH in a 60-year-old man. No abnormal findings suggestive of ONFH were identified on radiographs, and the fracture occurred spontaneously without any trauma or unusual increase in activity. The patient’s medical history, age, and good bone quality suggested ONFH as a possible underlying cause. Contrast-enhanced magnetic resonance imaging was useful in determining whether the fracture was caused by ONFH or was instead a simple insufficiency fracture caused by steroid use. Discussion The patient was treated with bipolar hemiarthroplasty, but if we had not suspected ONFH as a predisposing condition, the undisplaced fracture might have been treated by osteosynthesis, and this would have led to nonunion or collapse of the femoral head. To avoid providing improper treatment, clinicians should consider ONFH as a predisposing factor in pathologic fractures of the femoral neck. Conclusion ONFH should be included in the differential diagnosis of insufficiency fracture of the femoral neck. PMID:26275737

  12. Morphological Study of the Newly Designed Cementless Femoral Stem

    PubMed Central

    Baharuddin, Mohd Yusof; Salleh, Sh-Hussain; Zulkifly, Ahmad Hafiz; Lee, Muhammad Hisyam; Mohd Noor, Alias

    2014-01-01

    A morphology study was essential to the development of the cementless femoral stem because accurate dimensions for both the periosteal and endosteal canal ensure primary fixation stability for the stem, bone interface, and prevent stress shielding at the calcar region. This paper focused on a three-dimensional femoral model for Asian patients that applied preoperative planning and femoral stem design. We measured various femoral parameters such as the femoral head offset, collodiaphyseal angle, bowing angle, anteversion, and medullary canal diameters from the osteotomy level to 150 mm below the osteotomy level to determine the position of the isthmus. Other indices and ratios for the endosteal canal, metaphyseal, and flares were computed and examined. The results showed that Asian femurs are smaller than Western femurs, except in the metaphyseal region. The canal flare index (CFI) was poorly correlated (r < 0.50) to the metaphyseal canal flare index (MCFI), but correlated well (r = 0.66) with the corticomedullary index (CMI). The diversity of the femoral size, particularly in the metaphyseal region, allows for proper femoral stem design for Asian patients, improves osseointegration, and prolongs the life of the implant. PMID:25025068

  13. Comparison of the Sliding and Femoral Head Rotation among Three Different Femoral Head Fixation Devices for Trochanteric Fractures

    PubMed Central

    Chinzei, Nobuaki; Niikura, Takahiro; Tsuji, Mitsuo; Kuroda, Ryosuke; Doita, Minoru; Kurosaka, Masahiro

    2015-01-01

    Background Recently, various femoral head fixation devices (HFDs) for trochanteric fractures have become available. However, there are some cases in which femoral head rotation with excessive sliding of the HFD is observed and it is often followed by cutout. The purpose of this study is to compare the ability of the three types of HFDs to prevent femoral head rotation. Methods Between July 2005 and December 2009, 206 patients aged over 60 years with trochanteric fractures who had undergone surgical treatment using a short femoral nail in our institution were enrolled into the study. We used the gamma 3 nail (GMN) as the screw-type HFD in 66 cases, the gliding nail (GLN) as a non-cylindrical blade in 76 cases, and the proximal femoral nail antirotation (PFNA) as a cylindrical blade in 64 cases. The sliding length of HFDs and the occurrence of femoral head rotation were evaluated by assessing radiographs as the main outcome, and the results were compared among these devices. Results A comparison of the degree of sliding in the GMN group showed that femoral head rotation was observed significantly more frequently in cases with rotation. Further, it appeared that femoral head rotation occurred more frequently in comminuted fractures. However, no significant differences between the sliding lengths of the different HFDs were observed among three groups. Femoral head rotation was observed in 15 cases of GMN (22.7%), 0 case of GLN, and 5 case of PFNA (7.8%). Significant differences with regard to the occurrence of femoral head rotation were observed among the three groups. Furthermore, significant differences were also observed between GLN and PFNA with respect to the occurrence of femoral head rotation. Conclusions The ability to stabilize femoral head appears to be greater with blade-type materials than with screw-type materials. Furthermore, we believe that a non-cylindrical blade is preferable to a cylindrical blade for the surgical treatment of comminuted, unstable

  14. A compound heterozygote SLC26A2 mutation resulting in robin sequence, mild limbs shortness, accelerated carpal ossification, and multiple epiphysial dysplasia in two Brazilian sisters. A new intermediate phenotype between diastrophic dysplasia and recessive multiple epiphyseal dysplasia.

    PubMed

    Zechi-Ceide, Roseli Maria; Moura, Priscila Padilha; Raskin, Salmo; Richieri-Costa, Antonio; Guion-Almeida, Maria Leine

    2013-08-01

    Mutations in solute carrier family 26 (sulfate transporter), member 2 (SLC26A2) gene result in a spectrum of autosomal recessive chondrodysplasias that range from the mildest recessive form of multiple epiphysial dysplasia (rMED) through the most common diastrophic dysplasia (DTD) to lethal atelosteogenesis type II and achondrogenesis IB. The clinical variability has been ascribed to quantitative effect of mutations of the sulfate transporter activity. Here we describe two Brazilian sisters, born to healthy and non consanguineous parents, with Robin sequence, mild shortening of upper and lower limbs, brachymetacarpalia/tarsalia, additional and accelerated carpal ossification, marked genu valgum, and multiple epiphysial dysplasia. This phenotype was intermediate between DTD and rMED, and both girls have a compound heterozygous mutations for the SLC26A2, a Finnish founder mutation (c.-26 + 2T>C), and R279W. This combination of mutations has been observed in individuals with different phenotypes, including DTD, DTD variant, and rMED. The distinct phenotype of our cases reinforces the hypothesis that other factors may be influencing the phenotype as previously suggested. PMID:23840040

  15. Painful Spastic Hip Dislocation: Proximal Femoral Resection

    PubMed Central

    Albiñana, Javier; Gonzalez-Moran, Gaspar

    2002-01-01

    The dislocated hip in a non-ambulatory child with spastic paresis tends to be a painful interference to sleep, sitting upright, and perineal care. Proximal femoral resection-interposition arthroplasty is one method of treatment for this condition. We reviewed eight hips, two bilateral cases, with a mean follow-up of 30 months. Clinical improvement was observed in all except one case, with respect to pain relief and sitting tolerance. Some proximal migration was observed in three cases, despite routine post-operative skeletal traction in all cases and careful soft tissue interposition. One case showed significant heterotopic ossification which restricted prolonged sitting. This patient needed some occasional medication for pain. PMID:12180614

  16. Femoral lengthening with a motorized intramedullary nail

    PubMed Central

    Horn, Joachim; Grimsrud, Øyvind; Dagsgard, Anita Hoddevik; Huhnstock, Stefan; Steen, Harald

    2015-01-01

    Purpose We assessed whether an intramedullary lengthening device would reduce the problems normally associated with the external fixation technique. We also wanted to determine whether it is a reliable construct for limb lengthening and deformity correction in the femur. Patients and methods We conducted a matched-pair comparison of 30 femoral lengthenings, 15 with a motorized intramedullary nail (the nail group) and 15 lengthenings with an external ring fixator (the fixator group). The patients were matched based on age, sex, amount of lengthening, and the etiology of leg length discrepancy. Mean lengthening was 35 (25–55) mm in the nail group and 38 (15–75) mm in the fixator group. Outcome measures were: lengthening and alignment achieved, consolidation index, knee range of motion (ROM), and complications. Results The pairs in this matched-pair study were similar in terms of age, sex, diagnosis, and amount of lengthening. The planned amount of lengthening was achieved in all patients in both groups and axis correction was considered sufficient. The mean radiographic consolidation index in the nail group, at 1.5 (0.9–3.0) months/cm, was better than the mean value for the fixator group (1.9 (0.9–3.4) months/cm) (p = 0.01). Knee ROM was better in the nail group during the lengthening, 6 weeks after lengthening was completed, and 6 months after lengthening was completed (p < 0.001). A larger number of complications were observed in the fixator group than in the nail group. Interpretation A lengthening nail may be superior to external fixation in femoral lengthening, when the anatomical conditions and the complexity of the deformity allow the use of an intramedullary nail. PMID:25191936

  17. Risk of Anterior Femoral Notching in Navigated Total Knee Arthroplasty

    PubMed Central

    Lee, Ju Hong

    2015-01-01

    Background We retrospectively investigated the prevalence of femoral anterior notching and risk factors after total knee arthroplasty (TKA) using an image-free navigation system. Methods We retrospectively reviewed 148 consecutive TKAs in 130 patients beginning in July 2005. Seventy knees (62 patients) underwent conventional TKA, and 78 knees (68 patients) received navigated TKA. We investigated the prevalence of femoral anterior notching and measured notching depth by conventional and navigated TKA. Additionally, the navigated TKA group was categorized into two subgroups according to whether anterior femoral notching had occurred. The degree of preoperative varus deformity, femoral bowing, and mediolateral suitability of the size of the femoral component were determined by reviewing preoperative and postoperative radiographs. The resection angle on the sagittal plane and the angle of external rotation that was set by the navigation system were checked when resecting the distal femur. Clinical outcomes were compared using range of motion (ROM) and the Hospital for Special Surgery (HSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAX) scores between the two groups. Results The prevalence of anterior femoral notching by conventional TKA was 5.7%, and that for navigated TKA was 16.7% (p = 0.037). Mean notching depth by conventional TKA was 2.92 ± 1.18 mm (range, 1.8 to 4.5 mm) and 3.32 ± 1.54 mm (range, 1.55 to 6.93 mm) by navigated TKA. Preoperative anterior femoral bowing was observed in 61.5% (p = 0.047) and both anterior and lateral femoral bowing in five cases in notching group during navigated TKA (p = 0.021). Oversized femoral components were inserted in 53.8% of cases (p = 0.035). No differences in clinical outcomes for ROM or the HSS and WOMAX scores were observed between the groups. A periprosthetic fracture, which was considered a notching-related side effect, occurred in one case each in the conventional and navigated TKA groups

  18. Air-Photograph Based Estimates of Channel Widening within the Minnesota River Basin

    NASA Astrophysics Data System (ADS)

    Echterling, C.; Conway, J.; Graves, J.; Lauer, J. W.

    2010-12-01

    The Minnesota River is a major tributary of the Mississippi River that has experienced a roughly two-fold increase in mean April-November discharge over the past century. Because the Minnesota River supplies the majority of sediment to the Mississippi at the confluence, sediment sources within the basin, and in particular within the Le Sueur River sub-basin, have recently been the subject of several detailed sediment budget studies. One of the potential sediment sources is associated with channel widening. In the present study, we focus on channel widening as a potential source of sediment in the Minnesota, Little Cobb, Maple, Blue Earth, Le Sueur, Redwood, Cottonwood, and Watonwan Rivers, Minnesota. Using aerial photographs, changes in channel bankfull width were measured over the period from 1937 to 2009. Historic photographs were georeferenced to recent high-resolution imagery using a minimum of ten ground control points and a second order polynomial transformation in ArcGIS 9.3. Water surface width and the width between vegetation lines (which we take to be equivalent to the bankfull width) were determined by hand for representative reaches of a minimum of ten meander bends along each river. We chose to digitize by hand to avoid computer misclassification associated with the highly variable color spectra in the historic photographs and because this allowed us to visually interpolate the bank line where scattered overhanging vegetation partially obscured the banks. In general, bankfull width has increased steadily by between 20 and 50 percent over the period of photographic record. However, because our basic method focuses only on the vegetation line, it is possible in principle that the observed changes in width are primarily related to ecological change (i.e. to a change in the elevation at which vegetation colonizes the banks) and not directly to an increase in channel volume (and hence to a net export of sediment from these reaches). To determine whether the

  19. [How to determine the rotation of the femoral component].

    PubMed

    Matziolis, G; Roehner, E

    2015-04-01

    The different landmarks for determination of the rotation of the femoral component are shown and specific pros and cons are discussed. The videos demonstrate how to identify them intraoperatively. PMID:25874402

  20. Editorial Commentary: Anatomic Femoral Tunnel Drilling: Does It Really Matter?

    PubMed

    Hohmann, Erik

    2016-01-01

    An anatomic anteromedial portal and outside-in technique for creating the anterior cruciate ligament femoral tunnel may improve rotational stability but shows no published differences in clinical outcomes. PMID:26743417

  1. Circumflex femoral vein thrombosis misinterpreted as acute hamstring strain.

    PubMed

    Papastergiou, Stergios G; Koukoulias, Nikolaos E; Tsitouridis, Ioannis; Natsis, Constantinos; Parisis, Constantinos A

    2007-07-01

    The case of a 24-year-old female professional, long-distance runner who presented with acute proximal posterior thigh pain is reported. History and clinical findings were consistent with acute hamstring strain but MRI demonstrated circumflex femoral vein thrombosis. This is the first case of proximal posterior thigh pain caused by circumflex femoral vein thrombosis reported in the literature. Doctors dealing with sports injuries should be aware of this clinical entity that mimics hamstring strain. PMID:17224439

  2. Circumflex femoral vein thrombosis misinterpreted as acute hamstring strain

    PubMed Central

    Papastergiou, Stergios G; Koukoulias, Nikolaos E; Tsitouridis, Ioannis; Natsis, Constantinos; Parisis, Constantinos A

    2007-01-01

    The case of a 24‐year‐old female professional, long‐distance runner who presented with acute proximal posterior thigh pain is reported. History and clinical findings were consistent with acute hamstring strain but MRI demonstrated circumflex femoral vein thrombosis. This is the first case of proximal posterior thigh pain caused by circumflex femoral vein thrombosis reported in the literature. Doctors dealing with sports injuries should be aware of this clinical entity that mimics hamstring strain. PMID:17224439

  3. CIRCUMFERENTIAL PROXIMAL FEMORAL ALLOGRAFTS IN TOTAL HIP ARTHROPLASTY REVISION SURGERY

    PubMed Central

    Roos, Bruno Dutra; Roos, Milton Valdomiro; Júnior, Antero Camisa; Lampert, Henrique Bonotto; da Silva, Matheus Luis

    2015-01-01

    Objective: To evaluate the clinical and radiographic results from patients who underwent femoral reconstruction secondary to loosening of total hip arthroplasty, using circumferential proximal femoral allografts and cemented implants. Methods: A retrospective study was conducted on 32 patients (33 hips) who underwent femoral reconstruction secondary to loosening of total hip arthroplasty, using circumferential proximal femoral allografts and cemented implants. Among these patients, 28 (29 hips) fulfilled all the requirements for this study. The mean follow-up was five years and two months. The clinical evaluation was done in accordance with the Harris Hip Score. Radiographically, the patients were assessed regarding reabsorption and consolidation of the allograft, migration of the greater trochanter, stability of the femoral component and heterotypic calcification. Results: The average preoperative Harris Hip Score was 32 points. At the last postoperative follow-up, the average score was 82 points. Allograft resorption of some degree was seen in nine hips (31%). Regarding consolidation, 24 cases (82.8%) showed full consolidation, three (10.3%) showed partial consolidation and two (6.9%) showed pseudarthrosis. All femoral components were stable. According to the criteria established, 27 cases (93.1%) were considered to be successful reconstructions after a mean follow-up of five years and two months. Conclusion: From the results obtained, it was concluded that use of circumferential proximal femoral allografts in selected cases of femoral reconstruction secondary to loosening of arthroplasty presented a high survival rate from the reconstruction over an average follow-up of five years and two months. PMID:27047896

  4. Proximal femoral reconstruction with a constrained acetabulum in oncologic patients.

    PubMed

    Jawad, Muhammad Umar; Brien, Earl W

    2014-02-01

    Metallic endoprostheses are used for oncological reconstruction around the proximal femur and hip joint. Common modes of failure with hemiarthroplasty or standard hip arthroplasty after proximal femoral replacement include dislocation, late hip pain, and infection. The authors reviewed hospital records to identify patients undergoing constrained tripolar hip arthroplasty for oncological reasons between 2002 and 2012. Inclusion criterion was at least 12-cm proximal femoral resection, including patients with total femur reconstruction. A total of 33 patients were reviewed. Information regarding demographics, length of follow-up, treatment characteristics, and patient outcomes was extracted. Average follow-up for all patients was 912.33 days (30.4 months). Average follow-up was 1396.1 days for living patients and 428.6 days for deceased patients. Average estimated blood loss was 462.12 cc: an average of 1080 cc for patients undergoing total femoral resection and replacement and 315.8 cc for patients undergoing proximal femoral resection and replacement. Average operative time was 137.7 minutes: an average of 205 minutes for patients undergoing total femoral resection and replacement and 119.1 minutes for patients undergoing proximal femoral resection and replacement. Average Musculoskeletal Tumor Society score was 21.7. There were no dislocations in the cohort. A constrained tripolar device can be safely used for oncological proximal femoral reconstructions while minimizing the risk of dislocation. Positioning of the acetabular implant in neutral anatomic version in conjunction with a neutral-placed femoral component provides the greatest range of motion, reduction of liner impingement, and improved hip stability. PMID:24679207

  5. Movement of the Distal Carpal Row during Narrowing and Widening of the Carpal Arch Width

    PubMed Central

    Gabra, Joseph N.; Domalain, Mathieu; Li, Zong-Ming

    2013-01-01

    Change in carpal arch width (CAW) is associated with wrist movement, carpal tunnel release, or therapeutic tunnel manipulation. This study investigated the angular rotations of the distal carpal joints as the CAW was adjusted. The CAW was narrowed and widened by 2 and 4 mm in seven cadaveric specimens while the bone positions were tracked by a marker-based motion capture system. The joints mainly pronated during CAW narrowing and supinated during widening. Ranges of motion about the pronation axis for the hamate-capitate (H-C), capitate-trapezoid (C-Td), and trapezoid-trapezium (Td-Tm) joints were 8.1 ± 2.3°, 5.3 ± 1.3°, and 5.5 ± 3.5°, respectively. Differences between the angular rotations of the joints were found at ΔCAW = -4 mm about the pronation and ulnar-deviation axes. For the pronation axis, angular rotations of the H-C joint were larger than that of the C-Td and Td-Tm joints. Statistical interactions among the factors of joint, rotation axis, and ΔCAW indicated complex joint motion patterns. The complex three-dimensional motion of the bones can be attributed to several anatomical constraints such as bone arrangement, ligament attachments, and articular congruence. The results of this study provide insight into the mechanisms of carpal tunnel adaptations in response to biomechanical alterations of the structural components. PMID:23083195

  6. Widening the lens: what the manual modality reveals about language, learning and cognition

    PubMed Central

    Goldin-Meadow, Susan

    2014-01-01

    The goal of this paper is to widen the lens on language to include the manual modality. We look first at hearing children who are acquiring language from a spoken language model and find that even before they use speech to communicate, they use gesture. Moreover, those gestures precede, and predict, the acquisition of structures in speech. We look next at deaf children whose hearing losses prevent them from using the oral modality, and whose hearing parents have not presented them with a language model in the manual modality. These children fall back on the manual modality to communicate and use gestures, which take on many of the forms and functions of natural language. These homemade gesture systems constitute the first step in the emergence of manual sign systems that are shared within deaf communities and are full-fledged languages. We end by widening the lens on sign language to include gesture and find that signers not only gesture, but they also use gesture in learning contexts just as speakers do. These findings suggest that what is key in gesture's ability to predict learning is its ability to add a second representational format to communication, rather than a second modality. Gesture can thus be language, assuming linguistic forms and functions, when other vehicles are not available; but when speech or sign is possible, gesture works along with language, providing an additional representational format that can promote learning. PMID:25092663

  7. Widening the lens: what the manual modality reveals about language, learning and cognition.

    PubMed

    Goldin-Meadow, Susan

    2014-09-19

    The goal of this paper is to widen the lens on language to include the manual modality. We look first at hearing children who are acquiring language from a spoken language model and find that even before they use speech to communicate, they use gesture. Moreover, those gestures precede, and predict, the acquisition of structures in speech. We look next at deaf children whose hearing losses prevent them from using the oral modality, and whose hearing parents have not presented them with a language model in the manual modality. These children fall back on the manual modality to communicate and use gestures, which take on many of the forms and functions of natural language. These homemade gesture systems constitute the first step in the emergence of manual sign systems that are shared within deaf communities and are full-fledged languages. We end by widening the lens on sign language to include gesture and find that signers not only gesture, but they also use gesture in learning contexts just as speakers do. These findings suggest that what is key in gesture's ability to predict learning is its ability to add a second representational format to communication, rather than a second modality. Gesture can thus be language, assuming linguistic forms and functions, when other vehicles are not available; but when speech or sign is possible, gesture works along with language, providing an additional representational format that can promote learning. PMID:25092663

  8. How Children’s Mentalistic Theory Widens their Conception of Pictorial Possibilities

    PubMed Central

    Gilli, Gabriella M.; Ruggi, Simona; Gatti, Monica; Freeman, Norman H.

    2016-01-01

    An interpretative theory of mind enables young children to grasp that people fulfill varying intentions when making pictures. We tested the hypothesis that in middle childhood a unifunctional conception of artists’ intention to produce a picture widens to include artists’ intention to display their pictures to others. Children aged between 5 and 10 years viewed a brief video of an artist deliberately hiding her picture but her intention was thwarted when her picture was discovered and displayed. By 8 years of age children were almost unanimous that a picture-producer without an intention to show her work to others cannot be considered to be an artist. Further exploratory studies centered on aspects of picture-display involving normal public display as well as the contrary intentions of hiding an original picture and of deceitfully displaying a forgery. Interviews suggested that the concept of exhibition widened to take others’ minds into account viewers’ critical judgments and effects of forgeries on viewers’ minds. The approach of interpolating probes of typical possibilities between atypical intentions generated evidence that in middle childhood the foundations are laid for a conception of communication between artists’ minds and viewers’ minds via pictorial display. The combination of hypothesis-testing and exploratory opening-up of the area generates a new testable hypothesis about how an increasingly mentalistic approach enables children to understand diverse possibilities in the pictorial domain. PMID:26955360

  9. Femoral Component Survival in Hybrid Total Knee Arthroplasty.

    PubMed

    Perry, Clayton R; Perry, Kevin I

    2016-05-01

    Although the majority of North American surgeons perform total knee arthroplasty by cementing both the femoral and the tibial components, hybrid fixation with a press-fit femur and cemented tibia is an alternative form of total knee arthroplasty performed by some. Currently, there is a paucity of literature evaluating long-term outcomes after hybrid total knee arthroplasty. As such, the purpose of the current study was to describe the long-term results of total knee arthroplasty performed using the hybrid technique. The authors retrospectively reviewed a total of 77 hybrid total knee arthroplasties with at least 12 years of follow-up. Clinical and radiographic evaluations were performed to determine patient function and the incidence of femoral component failure after hybrid total knee arthroplasty. At the time of last follow-up, 76 of 77 (99%) of the femoral components remained in place without evidence of loosening. One femoral component failed due to aseptic loosening and was ultimately revised to a cemented femoral component without further complication. In addition, 1 tibial component and 2 patellar components failed due to aseptic loosening. Four tibial polyethylene liners were revised for polyethylene wear. In conclusion, press-fit fixation of the femoral component is a reliable and durable alternative to cemented fixation. [Orthopedics. 2016; 39(3):181-186.]. PMID:27135453

  10. Prevascular femoral hernia and its relation with inferior epigastric vessels: a rare presentation of the femoral hernia sac.

    PubMed

    Boshnaq, Mohamed; Phan, Yih Chyn; Akhtar, Mansoor; Hamade, Ayman

    2016-01-01

    A 61-year-old man presented to the emergency department, with a 2-week history of a painful lump on his right groin. A diagnosis of an irreducible right femoral hernia was made. As such, an urgent operation was carried out on the same day, and the patient was found to have a rare prevascular femoral hernia in which the sac was lying over the femoral vessels and split by the inferior epigastric vessels into 2 components resembling 2 trouser limbs. The hernia sac presented in a different and challenging way that necessitated meticulous dissection and full orientation of the anatomy of the femoral triangle. Complete dissection and control of the inferior epigastric vessels, and complete reduction of the sac followed by repair with a prosthetic mesh plug were performed successfully. The patient was discharged home the next day. PMID:27090547

  11. Rupture of the Deep Femoral Artery during Proximal Femoral Nailing Following an Intertrochanteric Fracture: A Case Report

    PubMed Central

    Yoon, Han Kook; Park, Junyoung; Oyunbat, Choidog; Kim, Taehwan

    2016-01-01

    Recently, we experienced a case where the diagnosis and management of a deep femoral artery rupture was delayed. This vascular complication occurred during the insertion of a distal interlocking screw of a proximal femoral nail for the fixation of an intertrochanteric femur fracture. A 79-year-old male patient was diagnosed with a right intertrochanteric fracture after a fall. We fixed the fracture with a proximal femoral nail (Zimmer® Natural Nail™ System). One day after the procedure, the patient complained of pain and swelling on the anteromedial side of his middle thigh followed by hypotension, anemia and prolonged thigh swelling. Computed tomography angiography was performed 7 days after the procedure. We found a pseudoaneurysm of the perforating artery caused by injury to the deep femoral artery and an intramuscular hematoma in the anterior thigh muscle. We successfully treated the pseudoaneurysm using coil embolization. Throughout the management of intertrochanteric femoral fractures, it is important to be aware and monitor signs and symptoms related to the possibility of blood vessel damage. When a patient presents with swelling and pain on the middle thigh and/or unexplained anemia postoperatively, the possibility that these symptoms are caused by an injury to the femoral artery must be considered.

  12. Intraosseous Lipoma of the Femor: Image Findings

    PubMed Central

    Yazdi, Hadi Rokni; Rasouli, Bahman; Borhani, Ali; Noorollahi, Mohammad Mahdi

    2014-01-01

    Introduction: Intraosseous lipoma is a rare benign bone disease. Long and cancellous bones are the most locationsthat can be affected. Almost all lesions were discovered incidentally on imaging modalities that were done during an unrelated investigation. As it is rare, it may be mistaken for nonossifying fibroma, aneurismal bone cyst, simple bone cyst, bone infarct or chondroid tumors. Recently with the high quality imaging modalities such as CT scan and/or MR imaging, the diagnosis of intramedullary lipoma and some other bone lesions can be done without the need for bone biopsy and surgery. Case Report: We’re reporting a rare case of intraosseous lipoma of the distal femur. Plain film radiography showed barely visible medullary expansion and lucency in the distal left femoral diaphysis. The patient underwent further evaluation with computed tomographic (CT) and magnetic resonance Imaging (MRI). According to the MRI and CT scan findings, intraosseous lipoma was confirmed and the need for more diagnostic tests were eliminated. Conclusion: Although Intraosseous lipoma doesn’t have any manifestations clinically but it should be considered in the differential diagnosis of bone pains. MRI has an important role in characterization of soft tissue and bone marrow lesions therefore non-surgical approach for most of the patients with intraosseous lipoma would be beneficial. PMID:27298943

  13. 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

  14. Full circle: 3D femoral mapping demonstrates age-related changes that influence femoral implant positioning.

    PubMed

    Tucker, Damien; Surup, Timm; Petersik, Andreas; Kelly, Michael

    2016-02-01

    The geometry of the femur is important in the final position of an intramedullary implant; we hypothesised that the femoral geometry changes with age and this may predispose the elderly to anterior mal-positioning of these implants. We used CT DICOM data of 919 intact left femora and specialist software that allowed us to defined landmarks for measurement reference - such as the linea aspera - on a template bone that could be mapped automatically to the entire database. We found that older (>80 years) cortical bone is up to 1.5 mm thinner anteriorly and 2 mm thinner posteriorly than younger (<40 years) bone but the rate of change of posterior to anterior cortex thickness is greater in the older bone. We also found the isthmus in the elderly to be more distal and less substantial than in the younger bone. This study has demonstrated femoral geometry changes with age that may explain our perception that the elderly are at increased risk for anterior mal-positioning of intramedullary implants. PMID:26686594

  15. Radiological assessment of the femoral bowing in Japanese population

    PubMed Central

    Abdelaal, Ahmed Hamed Kassem; Yamamoto, Norio; Hayashi, Katsuhiro; Takeuchi, Akihiko; Morsy, Ahmad Fawaz; Miwa, Shinji; Kajino, Yoshitomo; Rubio, Donnel A.; Tsuchiya, Hiroyuki

    2016-01-01

    Introduction: Differences in the magnitude of bowing between races are well-known characteristics of the femur. Asian races have an increased magnitude of femoral bowing but most of the orthopedic implants designed for the femur do not match this exaggerated bowing. We calculated the sagittal and coronal femoral bowing in the Japanese population at different levels of the femur and addressed its surgical significance. Material and methods: We calculated the sagittal and coronal bowing of 132 Japanese femora using CT scan of the femur. A mathematical calculation of the radius of curvature at proximal, middle, and distal regions of the femur was used to determine the degree of femoral bowing. Results: Mean sagittal bowing of the femur was 581, 188, and 161 mm for the proximal, middle, and distal thirds of the femur and mean lateral bowing was 528, 5092, and 876 mm, respectively. Mean sagittal and coronal bowing for the whole femur was 175 and 2640 mm, respectively. No correlation was found between age, gender, length of femur, and the degree of bowing. Conclusion: Our study reveals that femoral bowing in the Japanese population is 175 mm in the sagittal plane and 2640 mm in the coronal plane; these values are greater than the femoral bowing in other ethnic groups studied in the literature. This may result in varying degrees of mismatch between the western-manufactured femoral intramedullary implants and the Japanese femur. We recommend that orthopedic surgeons to accurately perform preoperative evaluation of the femoral bowing to avoid potential malalignment, rotation, and abnormal stresses between the femur and implant. PMID:27163091

  16. Structural and functional studies of bioobjects prepared from femoral heads

    SciTech Connect

    Kirilova, I. A. Podorozhnaya, V. T.; Sharkeev, Yu. P.; Popova, K. S. Uvarkin, P. V.

    2015-11-17

    Results of examination of physicomechanical characteristics of samples of medial femoral head cuts are presented. The samples of medial femoral head cuts resected in 6 patients with coxarthrosis in primary endoprosthetic replacement of a coxofemoral joint have been tested for micro- and nanohardness. Young’s modulus and elemental composition of bone tissue have been investigated. To estimate the architectonics of cancellous tissue of the femoral head, adjacent cuts of the same patient have been analyzed. The porosity of bone tissue was estimated from macroscopic images obtained using macrophotography. The total porosity is calculated as the ratio of the total length of straight line segments overlapping pores to the total length of secants. A three-point bending test of the samples has shown that their strength changed from 0.187 to 1.650 MPa and their elasticity modulus changes from 1.69 to 8.15 MPa. The microhardness of the samples changes in the range 220–265 MPa and the average microhardness of medial femoral head cuts is 240 MPa. The elemental composition of medial femoral head cuts is represented by basic Ca, P, O, Na and Mg elements as well as by Sn, S, Fe, Cr, and C in microamounts. The atomic Ca to P ratio for bone tissue is 1.55. It is revealed that pores of the upper part of the femoral head have a more regular shape and in the lower part they are more elongated along the cut and occupy a larger volume. The lower part of the femoral head has a higher porosity (39 and 33%) than the upper part (34 and 30%). The total porosity of all samples does not exceed 37%.

  17. Structural and functional studies of bioobjects prepared from femoral heads

    NASA Astrophysics Data System (ADS)

    Kirilova, I. A.; Sharkeev, Yu. P.; Podorozhnaya, V. T.; Popova, K. S.; Uvarkin, P. V.

    2015-11-01

    Results of examination of physicomechanical characteristics of samples of medial femoral head cuts are presented. The samples of medial femoral head cuts resected in 6 patients with coxarthrosis in primary endoprosthetic replacement of a coxofemoral joint have been tested for micro- and nanohardness. Young's modulus and elemental composition of bone tissue have been investigated. To estimate the architectonics of cancellous tissue of the femoral head, adjacent cuts of the same patient have been analyzed. The porosity of bone tissue was estimated from macroscopic images obtained using macrophotography. The total porosity is calculated as the ratio of the total length of straight line segments overlapping pores to the total length of secants. A three-point bending test of the samples has shown that their strength changed from 0.187 to 1.650 MPa and their elasticity modulus changes from 1.69 to 8.15 MPa. The microhardness of the samples changes in the range 220-265 MPa and the average microhardness of medial femoral head cuts is 240 MPa. The elemental composition of medial femoral head cuts is represented by basic Ca, P, O, Na and Mg elements as well as by Sn, S, Fe, Cr, and C in microamounts. The atomic Ca to P ratio for bone tissue is 1.55. It is revealed that pores of the upper part of the femoral head have a more regular shape and in the lower part they are more elongated along the cut and occupy a larger volume. The lower part of the femoral head has a higher porosity (39 and 33%) than the upper part (34 and 30%). The total porosity of all samples does not exceed 37%.

  18. Tuning the photonic stop bands of nanoporous anodic alumina-based distributed bragg reflectors by pore widening.

    PubMed

    Rahman, Mohammad Mahbubur; Marsal, Lluis F; Pallarès, Josep; Ferré-Borrull, Josep

    2013-12-26

    A distributed Bragg reflector based on nanoporous anodic alumina was fabricated using an innovative cyclic anodization voltage approach, which resulted in an in-depth modulation of the pore geometry and the refractive index. The effect of a pore-widening wet-etching step on the structure's photonic stop-band properties was studied. From transmittance measurements, it was shown that by changing the pore-widening time it is possible to modulate the photonic stop band in the range of visible to near infrared. With the help of a theoretical model, we were able to obtain information about the evolution with the pore widening of the material effective refractive indexes. This opens the possibility of obtaining several optoelectronic devices based on nanoporous anodic alumina. PMID:24283602

  19. Widening the Axion Window via Kinetic and Stückelberg Mixings

    NASA Astrophysics Data System (ADS)

    Shiu, Gary; Staessens, Wieland; Ye, Fang

    2015-10-01

    We point out that kinetic and Stückelberg mixings that are generically present in the low energy effective action of axions can significantly widen the window of axion decay constants. We show that an effective super-Planckian decay constant can be obtained even when the axion kinetic matrix has only sub-Planckian entries. Our minimal model involves only two axions, a Stückelberg U (1 ) and a modest rank instanton generating non-Abelian group. Below the mass of the Stückelberg U (1 ), there is only a single axion with a nonperturbatively generated potential. In contrast to previous approaches, the enhancement of the axion decay constant is not tied to the number of degrees of freedom introduced. We also discuss how kinetic mixings can lower the decay constant to the desired axion dark matter window. String theory embeddings of this scenario and their phenomenological features are briefly discussed.

  20. Widening the Axion Window via Kinetic and Stückelberg Mixings.

    PubMed

    Shiu, Gary; Staessens, Wieland; Ye, Fang

    2015-10-30

    We point out that kinetic and Stückelberg mixings that are generically present in the low energy effective action of axions can significantly widen the window of axion decay constants. We show that an effective super-Planckian decay constant can be obtained even when the axion kinetic matrix has only sub-Planckian entries. Our minimal model involves only two axions, a Stückelberg U(1) and a modest rank instanton generating non-Abelian group. Below the mass of the Stückelberg U(1), there is only a single axion with a nonperturbatively generated potential. In contrast to previous approaches, the enhancement of the axion decay constant is not tied to the number of degrees of freedom introduced. We also discuss how kinetic mixings can lower the decay constant to the desired axion dark matter window. String theory embeddings of this scenario and their phenomenological features are briefly discussed. PMID:26565455

  1. Frequency locking of a field-widened Michelson interferometer based on optimal multi-harmonics heterodyning.

    PubMed

    Cheng, Zhongtao; Liu, Dong; Zhou, Yudi; Yang, Yongying; Luo, Jing; Zhang, Yupeng; Shen, Yibing; Liu, Chong; Bai, Jian; Wang, Kaiwei; Su, Lin; Yang, Liming

    2016-09-01

    A general resonant frequency locking scheme for a field-widened Michelson interferometer (FWMI), which is intended as a spectral discriminator in a high-spectral-resolution lidar, is proposed based on optimal multi-harmonics heterodyning. By transferring the energy of a reference laser to multi-harmonics of different orders generated by optimal electro-optic phase modulation, the heterodyne signal of these multi-harmonics through the FWMI can reveal the resonant frequency drift of the interferometer very sensitively within a large frequency range. This approach can overcome the locking difficulty induced by the low finesse of the FWMI, thus contributing to excellent locking accuracy and lock acquisition range without any constraint on the interferometer itself. The theoretical and experimental results are presented to verify the performance of this scheme. PMID:27607936

  2. A Literature Review of the Use of Sodium Bicarbonate for the Treatment of QRS Widening.

    PubMed

    Bruccoleri, Rebecca E; Burns, Michele M

    2016-03-01

    Sodium bicarbonate is a well-known antidote for tricyclic antidepressant (TCA) poisoning. It has been used for over half a century to treat toxin-induced sodium channel blockade as evidenced by QRS widening on the electrocardiogram (ECG). The purpose of this review is to describe the literature regarding electrophysiological mechanisms and clinical use of this antidote after poisoning by tricyclic antidepressants and other agents. This article will also address the literature supporting an increased serum sodium concentration, alkalemia, or the combination of both as the responsible mechanism(s) for sodium bicarbonate's antidotal properties. While sodium bicarbonate has been used as a treatment for cardiac sodium channel blockade for multiple other agents including citalopram, cocaine, flecainide, diphenhydramine, propoxyphene, and lamotrigine, it has uncertain efficacy with bupropion, propranolol, and taxine-containing plants. PMID:26159649

  3. Movement of the distal carpal row during narrowing and widening of the carpal arch width.

    PubMed

    Gabra, Joseph N; Domalain, Mathieu; Li, Zong-Ming

    2012-10-01

    Change in carpal arch width (CAW) is associated with wrist movement, carpal tunnel release, or therapeutic tunnel manipulation. This study investigated the angular rotations of the distal carpal joints as the CAW was adjusted. The CAW was narrowed and widened by 2 and 4 mm in seven cadaveric specimens while the bone positions were tracked by a marker-based motion capture system. The joints mainly pronated during CAW narrowing and supinated during widening. Ranges of motion about the pronation axis for the hamate-capitate (H-C), capitate-trapezoid (C-Td), and trapezoid-trapezium (Td-Tm) joints were 8.1 ± 2.3 deg, 5.3 ± 1.3 deg, and 5.5 ± 3.5 deg, respectively. Differences between the angular rotations of the joints were found at ΔCAW = -4 mm about the pronation and ulnar-deviation axes. For the pronation axis, angular rotations of the H-C joint were larger than that of the C-Td and Td-Tm joints. Statistical interactions among the factors of joint, rotation axis, and ΔCAW indicated complex joint motion patterns. The complex three-dimensional motion of the bones can be attributed to several anatomical constraints such as bone arrangement, ligament attachments, and articular congruence. The results of this study provide insight into the mechanisms of carpal tunnel adaptations in response to biomechanical alterations of the structural components. PMID:23083195

  4. Widening Geographical Disparities in Cardiovascular Disease Mortality in the United States, 1969-2011

    PubMed Central

    Singh, Gopal K.; Azuine, Romuladus E.; Siahpush, Mohammad; Williams, Shanita D.

    2015-01-01

    Objectives: This study examined trends in geographical disparities in cardiovascular-disease (CVD) mortality in the United States between 1969 and 2011. Methods: National vital statistics data and the National Longitudinal Mortality Study were used to estimate regional, state, and county-level disparities in CVD mortality over time. Log-linear, weighted least squares, and Cox regression were used to analyze mortality trends and differentials. Results: During 1969-2011, CVD mortality rates declined fastest in New England and Mid-Atlantic regions and slowest in the Southeast and Southwestern regions. In 1969, the mortality rate was 9% higher in the Southeast than in New England, but the differential increased to 48% in 2011. In 2011, Southeastern states, Mississippi and Alabama, had the highest CVD mortality rates, nearly twice the rates for Minnesota and Hawaii. Controlling for individual-level covariates reduced state differentials. State- and county-level differentials in CVD mortality rates widened over time as geographical disparity in CVD mortality increased by 50% between 1969 and 2011. Area deprivation, smoking, obesity, physical inactivity, diabetes prevalence, urbanization, lack of health insurance, and lower access to primary medical care were all significant predictors of county-level CVD mortality rates and accounted for 52.7% of the county variance. Conclusions and Global Health Implications: Although CVD mortality has declined for all geographical areas in the United States, geographical disparity has widened over time as certain regions and states, particularly those in the South, have lagged behind in mortality reduction. Geographical disparities in CVD mortality reflect inequalities in socioeconomic conditions and behavioral risk factors. With the global CVD burden on the rise, monitoring geographical disparities, particularly in low- and middle-income countries, could indicate the extent to which reductions in CVD mortality are achievable and may

  5. [Delayed hypoxia after the surgical correction of femoral neck fracture].

    PubMed

    Goh, R; Mori, K; Abe, T; Kohyama, A; Minato, A

    1996-11-01

    We investigated perioperative blood gas changes in 26 patients scheduled for surgical correction of femoral neck fracture under epidural anesthesia. Arterial blood gases during spontaneous air respiration were measured eight times during the femoral neck prosthetic replacements (n = 16), and four times during osteosynthesis (n = 10). In the patients who received femoral neck replacements using bone cement (n = 8), arterial oxygen tension decreased significantly four hours after insertion of prosthesis, and did not recover during two postoperative days. In contrast, in the patients who received cementless femoral neck replacements (n = 8), arterial oxygen tension tended to decrease but not significantly, and returned to normal on the second postoperative day. In the patients who received osteosynthesis, arterial oxygen tension did not change. We suspected that the causes of delayed hypoxia in the femoral neck replacements were vascular endothelial cell injury in the lung by free fatty acid originating from fat embolism, and/or microthrombosis resulting from activated coagulation system. Bone cement was thought to intensify fat embolism because of elevated intramedullary pressure in the femur. PMID:8953864

  6. Rapid resolution of femoral head osteonecrosis after rotational acetabular osteotomy.

    PubMed

    Nozawa, Masahiko; Matsuda, Keiji; Maezawa, Katsuhiko; Kim, Sungon; Maeda, Kouichi; Ikegami, Takashi; Kubota, Reiko; Hayashi, Kentaro; Nagayama, Masataka; Kaneko, Haruka

    2008-12-01

    The natural history of osteonecrosis of the femoral head is generally thought to be one of progressive deterioration if no intervention is undertaken. However, it is unknown whether surgical intervention is beneficial for patients with a small region of osteonecrosis. We observed rapid improvement of MRI findings after rotational acetabular osteotomy (RAO) was performed in a young patient with osteonecrosis of the femoral head. The band-like low signal area on T2-weighted images almost resolved by six months after surgery. He returned to work as an electrician by six months after surgery. Early surgical intervention such as RAO that alters the mechanical force acting on the necrotic region of the femoral head may accelerate the recovery of osteonecrosis and the improvement of symptoms. PMID:19384490

  7. Bilateral midshaft femoral fractures in an adolescent baseball player.

    PubMed

    Ju, D G; Mogayzel, P J; Sponseller, P D; Familiari, F; McFarland, E G

    2016-07-01

    Bone disease, specifically low bone mineral density, is a common and undertreated complication that begins during childhood in patients with cystic fibrosis (CF). This case describes a male baseball player, aged 14years, with undiagnosed CF who sustained a left midshaft femoral fracture while running toward base; 8months later, he sustained a right midshaft femoral fracture under similar conditions. After the second fracture, further evaluation revealed low bone mineral density and CF. There is no previously published report of pathologic fractures occurring in the femoral shaft in an athlete with undiagnosed CF. Patients with CF have a higher fracture rate. Low-energy fractures of major bones in athletically active individuals should be viewed with suspicion for an underlying process. PMID:26927602

  8. Emergency Stenting of a Ruptured Infected Anastomotic Femoral Pseudoaneurysm

    SciTech Connect

    Klonaris, Chris Katsargyris, Athanasios; Matthaiou, Alexandros; Giannopoulos, Athanasios; Tsigris, Chris; Papadopouli, Katerina; Tsiodras, Sotiris; Bastounis, Elias

    2007-11-15

    A 74-year-old man presented with a ruptured infected anastomotic femoral pseudoaneurysm. Due to severe medical comorbidities he was considered unsuitable for conventional surgical management and underwent an emergency endovascular repair with a balloon-expandable covered stent. The pseudoaneurysm was excluded successfully and the patient had an uneventful postoperative recovery with long-term suppressive antimicrobials. He remained well for 10 months after the procedure with no signs of recurrent local or systemic infection and finally died from an acute myocardial infarction. To our knowledge, emergency endovascular treatment of a free ruptured bleeding femoral artery pseudoaneurysm has not been documented before in the English literature. This case illustrates that endovascular therapy may be a safe and efficient alternative in the emergent management of ruptured infected anastomotic femoral artery pseudoaneurysms when traditional open surgery is contraindicated.

  9. A Case of Late Femoral Pseudoaneurysm Caused by Stent Disconnection

    SciTech Connect

    Rivolta, Nicola; Fontana, Federico; Piffaretti, Gabriele Tozzi, Matteo; Carrafiello, Gianpaolo

    2010-10-15

    We present the case of a late superficial femoral artery stent disconnection causing an asymptomatic pseudoaneurysm successfully treated with a stent-graft. A 67-year-old female was referred to our department for evaluation of claudication of the left lower limb and was diagnosed to have a total occlusion of the superficial femoral artery. Three nitinol stents were used to revascularize this artery. At 48 months, duplex-ultrasonography control revealed the presence of a 45-mm saccular femoral dilatation; X-rays and CT angiography showed fractures of the proximal stents and the presence of a pseudoaneurysm at the site of the distal stents disconnection. The pseudoaneurysm was excluded using two stent-grafts. We conclude that patients and surgeons should be aware of structural complications with all stents. Rigorous follow-up controls should be mandatory. Endovascular repair proved to be feasible and durable to manage a previous endovascular procedure.

  10. Venting during prophylactic nailing for femoral metastases: current orthopedic practice

    PubMed Central

    Dalgorf, Dustin; Borkhoff, Cornelia M.; Stephen, David J.G.; Finkelstein, Joel; Kreder, Hans J.

    2003-01-01

    Introduction Reamed intramedullary nailing, recommended for impending fracture of a femur weakened by bone metastases, causes a rise in intramedullary pressure and increases the risk of a fat embolism syndrome. The pressure can be equalized by the technique of venting — drilling a hole into the distal cortex of the femur. Our objective was to study the current practice of orthopedic surgeons in Ontario with respect to venting during prophylactic intramedullary nailing for an impending femoral fracture due to bone metastases. Methods We mailed a questionnaire to all orthopedic surgeons from the Province of Ontario listed in the 1999 Canadian Medical Directory or on the Canadian Orthopaedic Association membership list, asking if they vent when prophylactically nailing an impending pathologic femoral fracture. The responses were modelled as a function of surgeon volume and year of graduation. Results Of the 415 surveys mailed, 223 (54%) surgeons responded. Of these, 81% reported having prophylactically treated a femoral metastatic lesion during the previous year; 67% treated 1 to 3 metastatic lesions and 14% treated more than 3; 19% did not treat a metastatic femoral lesion prophylactically. Over two-thirds of surgeons had never considered venting, whereas one-third always or sometimes vented the femoral canal. More recent graduates were 3 times more likely to vent than earlier (before 1980) graduates (odds ratio [OR] = 3.2, 95% confidence interval [CI] 1.6–6.5) as were those who treat a greater number of impending fractures (OR = 1.4, 95% CI 1.1–1.7). Conclusions Although there is a theoretical rationale for routine venting, there is disagreement among Ontario orthopedic surgeons regarding the use of this technique during prophylactic nailing for femoral metastatic lesions. Prospective evidence will be required to warrant a change in the standard of care. PMID:14680349

  11. Biophysical stimulation in osteonecrosis of the femoral head

    PubMed Central

    Leo, Massari; Milena, Fini; Ruggero, Cadossi; Stefania, Setti; GianCarlo, Traina

    2009-01-01

    Osteonecrosis of the femoral head is the endpoint of a disease process that results from insufficient blood flow and bone-tissue necrosis, leading to joint instability, collapse of the femoral head, arthritis of the joint, and total hip replacement. Pain is the most frequent clinical symptom. Both bone tissue and cartilage suffer when osteonecrosis of the femoral head develops. Stimulation with pulsed electromagnetic fields (PEMFs) has been shown to be useful for enhancing bone repair and for exerting a chondroprotective effect on articular cartilage. Two Italian studies on the treatment of avascular necrosis of the femoral head with PEMFs were presented in this review. In the first study, 68 patients suffering from avascular necrosis of the femoral head were treated with PEMFs in combination with core decompression and autologous bone grafts. The second one is a retrospective analysis of the results of treatment with PEMFs of 76 hips in 66 patients with osteonecrosis of the femoral head. In both studies clinical information and diagnostic imaging were collected at the beginning of the treatment and at the time of follow up. Statistical analysis was performed using chi-square test. Both authors hypothesize that the short-term effect of PEMF stimulation may be to protect the articular cartilage from the catabolic effect of inflammation and subchondral bone-marrow edema. The long-term effect of PEMF stimulation may be to promote osteogenic activity at the necrotic area and prevent trabecular fracture and subchondral bone collapse. PEMF stimulation represents an important therapeutic opportunity to resolve the Ficat stage-I or II disease or at least to delay the time until joint replacement becomes necessary. PMID:19753174

  12. Spontaneous modular femoral head dissociation complicating total hip arthroplasty.

    PubMed

    Talmo, Carl T; Sharp, Kinzie G; Malinowska, Magdalena; Bono, James V; Ward, Daniel M; LaReau, Justin

    2014-06-01

    Modular femoral heads have been used successfully for many years in total hip arthroplasty. Few complications have been reported for the modular Morse taper connection between the femoral head and trunnion of the stem in metal-on-polyethylene bearings. Although there has always been some concern over the potential for fretting, corrosion, and generation of particulate debris at the modular junction, this was not considered a significant clinical problem. More recently, concern has increased because fretting and corrosive debris have resulted in rare cases of pain, adverse local tissue reaction, pseudotumor, and osteolysis. Larger femoral heads, which have gained popularity in total hip arthroplasty, are suspected to increase the potential for local and systemic complications of fretting, corrosion, and generation of metal ions because of greater torque at the modular junction. A less common complication is dissociation of the modular femoral heads. Morse taper dissociation has been reported in the literature, mainly in association with a traumatic event, such as closed reduction of a dislocation or fatigue fracture of the femoral neck of a prosthesis. This report describes 3 cases of spontaneous dissociation of the modular prosthetic femoral head from the trunnion of the same tapered titanium stem because of fretting and wear of the Morse taper in a metal-on-polyethylene bearing. Continued clinical and scientific research on Morse taper junctions is warranted to identify and prioritize implant and surgical factors that lead to this and other types of trunnion failure to minimize complications associated with Morse taper junctions as hip implants and surgical techniques continue to evolve. PMID:24972443

  13. Patellofemoral dysbalance due to femoral deformities - diagnostic, therapy and results

    PubMed Central

    Dickschas, Jörg; Strecker, Wolf; Harrer, Jörg; Ferner, Felix

    2016-01-01

    Aims and Objectives: Anterior knee pain or patellofemoral instability are typical symptoms of patellofemoral dysbalance. Beside other reasons, this pathology can be caused by a femoral deformity. The two dimensions leading to this problems are torsional- and valgus deformities. This constellation often stays unrecognized. When diagnosed and analyzed, a femoral torsional or varization-osteotomy is the adequate treatment. Aim of this study was to show the diagnostic approach, the gold standard of therapy and the follow up results. Can patellofemoral stability be archived? Is the pain relief significant and how do clinical scores develop at the follow up? Materials and Methods: 33 femoral torsional osteotomies and 18 femoral varization osteotomies were included in this study, 5 of these were combined femoral varization and torsional corrections so that 46 knees are included in 41 patients, as 5 patients were operated on both legs. Major symptoms were patellofemoral dislocations in 28 cases and anterior knee pain in 26 cases. Beside clinical and radiographic evaluation full weight bearing long leg views and a torsional computertomography was always performed. Follow up examination was after 41 (6-113) months. Visual analog scala score, Japanese Knee Society Score, Tegner activity score and Lysholm score were taken before surgery and at the follow up. Results: Mechanical femorotibial valgus was on average 6,4° (5°-10°), femoral internal torsion was in average 40,9° (29°-66°; normal: 24°). Surgical treatment was performed with an arthroscopy followed by an acute femoral varization 7,2°(5°-10°) and / or external torsion osteotomy of 13.8° (5°-26°). Tegner activity score, Japanese knee society score and Lysholm score all significantly improved. Pain relief could be demonstrated as shown by a significant decrease of the VAS score. No further dislocation was reported during the follow up period. Conclusion: Valgus or torsional deformities of the femur frequently

  14. Parallel manipulator robot assisted femoral fracture reduction on traction table.

    PubMed

    Lin, H; Wang, J Q; Han, W

    2013-01-01

    The principle of femoral shaft fracture reduction is to restore its pre-fractured limb length and mechanical axis. The current documented treatment method with traction table reduction does not conform to the quantitative alignment and reduction. There is also a great amount of X-Ray radiation exposure to both surgeon and patient during the procedure. For this reason, we introduced an innovated Parallel Manipulator Robot (PMR) application: A Femoral Shaft Fracture Reduction with Parallel Manipulator Robot on Traction Table. With this application, the quantitative control on fracture reduction and alignment can be achieved and the radiation exposure to both surgeons and patients can be greatly reduced. PMID:24110820

  15. Intramedullary locking femoral nails. Experience with the AO nail.

    PubMed Central

    Fogarty, A. B.; Yeates, H. A.

    1991-01-01

    The AO interlocking nail was introduced to the Ulster Hospital, Dundonald in 1988 and since then has been used in over 50 patients with femoral shaft fractures. We have reviewed 45 patients with 46 femoral shaft fractures treated between June 1988 and April 1990. These included four compound fractures and 13 comminuted fractures. The results compare favourably with other series. The union rate was 98% and there were no instances of deep infection. The alternative treatment methods available are discussed along with a review of the relevant literature. Images Fig 3 Fig 5 PMID:1785145

  16. Bone SPECT/CT of Femoral Head Subchondral Insufficiency Fracture.

    PubMed

    Motomura, Goro; Yamamoto, Takuaki; Karasuyama, Kazuyuki; Iwamoto, Yukihide

    2015-09-01

    Subchondral insufficiency fracture of the femoral head may be confused with osteonecrosis, mainly because of radiological overlap. SPECT/CT with Tc-99 m hydroxymethylene diphosphonate images in 7 patients with subchondral insufficiency fracture were retrospectively reviewed and compared with those from 11 patients with symptomatic early osteonecrosis. In all of the hips with subchondral insufficiency fracture, SPECT/CT showed increased uptake at the subchondral lesions of the femoral head. On the other hand, in all of the hips with osteonecrosis, absence of uptake was confirmed at the subchondral lesions. SPECT/CT may assist in differentiating subchondral insufficiency fracture from osteonecrosis. PMID:26164176

  17. Traumatic Hip Dislocation with Associated Femoral Head Fracture

    PubMed Central

    Dortaj, H.; Emamifar, A.

    2015-01-01

    Dislocation of the hip is a critical injury that results from high-energy trauma. This paper describes a case of posterior dislocation of the right hip in a 35-year-old woman with associated ipsilateral femoral head fracture. Initial treatment included reduction of the right hip through posterior approach and fixation of the femoral head fracture with three absorbable screws. After 15-month follow-up, a full range of motion has been achieved and there are no signs of avascular necrosis, hip instability, or limping. The authors describe their method of surgery. PMID:25874147

  18. A rare case of femoral herniation of female internal genitalia

    PubMed Central

    Ambedkar, Vivek; Singh, Abhilash; Bain, Jayanta; Singh, Lal Mani

    2015-01-01

    We report a rare case with herniation of the uterus, fallopian tube, and ovary in a femoral hernia. A female patient was admitted with complain of the painful lump in the left groin. Clinical examination indicated strangulated femoral hernia, which necessitated an emergency surgery. During surgical procedure, the uterine tube, left fallopian tube and left ovary, were observed as the contents of the hernia. The contents were reduced back into the pelvic cavity, and the hernia was repaired. The patient made good recovery postsurgery. PMID:26283851

  19. Higher Education in Further Education: The Challenges of Providing a Distinctive Contribution That Contributes to Widening Participation

    ERIC Educational Resources Information Center

    Bathmaker, Ann-Marie

    2016-01-01

    This paper examines changing policy orientations to widening participation through college-based higher education in England. After more than 30 years of increasing and diversifying participation in higher education (HE) in a wide range of countries, such policy goals are coming under increasing scrutiny in countries such as the United States and…

  20. Method of fabricating n-type and p-type microcrystalline semiconductor alloy material including band gap widening elements

    DOEpatents

    Guha, Subhendu; Ovshinsky, Stanford R.

    1990-02-02

    A method of fabricating doped microcrystalline semiconductor alloy material which includes a band gap widening element through a glow discharge deposition process by subjecting a precursor mixture which includes a diluent gas to an a.c. glow discharge in the absence of a magnetic field of sufficient strength to induce electron cyclotron resonance.

  1. TiO2 nanotube arrays grown in ionic liquids: high-efficiency in photocatalysis and pore-widening

    SciTech Connect

    Li, Huaqing; Qu, Jun; Cui, Qingzhou; Xu, Hanbing; Luo, Huimin; Chi, Miaofang; Meisner, Roberta Ann; Wang, Wei; Dai, Sheng

    2011-01-01

    Debris-free, long, well-separated TiO2 nanotube arrays were obtained using an ionic liquid (IL) as electrolyte. The high conductivity of IL resulted in fast pore widening and few contaminants from electrolyte decomposition leading to high photocatalytic efficiency in water splitting.

  2. Diversity, Equality and Higher Education: A Critical Reflection on the Ab/uses of Equity Discourse within Widening Participation

    ERIC Educational Resources Information Center

    Archer, Louise

    2007-01-01

    This paper discusses how the rhetoric of "diversity" is mobilised within New Labour HE policy discourse around widening participation (WP). The paper argues that these constructions of diversity derive an important element of their symbolic power from an association with notions of "equality"--and yet the radical/egalitarian potential of WP policy…

  3. Responding to the Widening Participation Agenda through Improved Access to and within 3D Virtual Learning Environments

    ERIC Educational Resources Information Center

    Wood, Denise; Willems, Julie

    2012-01-01

    The Australian Government's widening participation agenda--also referred to as the social inclusion agenda--considers equity through the triple focus of access, participation and outcomes. These foci are catalysts for re-examining teaching and learning approaches in formal education. This article considers this national refocus and the…

  4. Economic Recovery Fails To Reduce Poverty Rates to Pre-Recession Levels. Gaps Widen Further between Rich and Poor.

    ERIC Educational Resources Information Center

    Center on Budget and Policy Priorities, Washington, DC.

    The gains of economic recovery have been unevenly distributed to benefit the rich much more than the poor. According to Census Bureau data, poverty, especially among children, is significantly higher than five years ago. Poverty has worsened despite decreased unemployment because of widening gaps between rich and poor. Even modest changes in…

  5. Osteochondral Autograft from the Ipsilateral Femoral Head by Surgical Dislocation for Treatment of Femoral Head Fracture Dislocation: A Case Report.

    PubMed

    Won, Yougun; Lee, Gi Soo; Kim, Sang Bum; Kim, Sun Joong; Yang, Kyu Hyun

    2016-11-01

    As anatomical reduction of the articular surface of femoral head fractures and restoration of damaged cartilage are essential for good long-term results, many treatment options have been suggested, including fixation of the fracture using various surgical exposures and implants, as well as arthroscopic irrigation and debridement, bone marrow stimulating techniques, osteochondral allograft, autograft, and autogenous chondrocyte implantation. We report a case of osteochondral autograft harvested from its own femoral articular surface through surgical hip dislocation. The osteochondral graft was harvested from the inferior non-weight-bearing articular surface and grafted to the osteochondral defect. One year later, the clinical and radiological results were good, without the collapse of the femoral head or arthritic change. This procedure introduced in our case is considered convenient and able to lessen surgical time without morbidity of the donor site associated with the harvest. PMID:27593886

  6. 21 CFR 888.3570 - Knee joint femoral (hemi-knee) metallic uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Knee joint femoral (hemi-knee) metallic uncemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3570 Knee joint femoral (hemi-knee) metallic uncemented prosthesis. (a) Identification. A knee joint femoral...

  7. 21 CFR 888.3570 - Knee joint femoral (hemi-knee) metallic uncemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Knee joint femoral (hemi-knee) metallic uncemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3570 Knee joint femoral (hemi-knee) metallic uncemented prosthesis. (a) Identification. A knee joint femoral...

  8. 21 CFR 888.3570 - Knee joint femoral (hemi-knee) metallic uncemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Knee joint femoral (hemi-knee) metallic uncemented... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3570 Knee joint femoral (hemi-knee) metallic uncemented prosthesis. (a) Identification. A knee joint femoral...

  9. 21 CFR 888.3400 - Hip joint femoral (hemi-hip) metallic resurfacing prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hip joint femoral (hemi-hip) metallic resurfacing... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3400 Hip joint femoral (hemi-hip) metallic resurfacing prosthesis. (a) Identification. A hip joint femoral...

  10. 21 CFR 888.3400 - Hip joint femoral (hemi-hip) metallic resurfacing prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Hip joint femoral (hemi-hip) metallic resurfacing... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3400 Hip joint femoral (hemi-hip) metallic resurfacing prosthesis. (a) Identification. A hip joint femoral...

  11. 21 CFR 888.3400 - Hip joint femoral (hemi-hip) metallic resurfacing prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... 21 Food and Drugs 8 2011-04-01 2011-04-01 false Hip joint femoral (hemi-hip) metallic resurfacing... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3400 Hip joint femoral (hemi-hip) metallic resurfacing prosthesis. (a) Identification. A hip joint femoral...

  12. 21 CFR 888.3400 - Hip joint femoral (hemi-hip) metallic resurfacing prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hip joint femoral (hemi-hip) metallic resurfacing... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3400 Hip joint femoral (hemi-hip) metallic resurfacing prosthesis. (a) Identification. A hip joint femoral...

  13. 21 CFR 888.3360 - Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hip joint femoral (hemi-hip) metallic cemented or... Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis is a device intended to be...

  14. 21 CFR 888.3360 - Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis.

    Code of Federal Regulations, 2012 CFR

    2012-04-01

    ... 21 Food and Drugs 8 2012-04-01 2012-04-01 false Hip joint femoral (hemi-hip) metallic cemented or... Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis is a device intended to be...

  15. 21 CFR 888.3400 - Hip joint femoral (hemi-hip) metallic resurfacing prosthesis.

    Code of Federal Regulations, 2014 CFR

    2014-04-01

    ... 21 Food and Drugs 8 2014-04-01 2014-04-01 false Hip joint femoral (hemi-hip) metallic resurfacing... HUMAN SERVICES (CONTINUED) MEDICAL DEVICES ORTHOPEDIC DEVICES Prosthetic Devices § 888.3400 Hip joint femoral (hemi-hip) metallic resurfacing prosthesis. (a) Identification. A hip joint femoral...

  16. 21 CFR 888.3360 - Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis.

    Code of Federal Regulations, 2013 CFR

    2013-04-01

    ... 21 Food and Drugs 8 2013-04-01 2013-04-01 false Hip joint femoral (hemi-hip) metallic cemented or... Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis is a device intended to be...

  17. Femoral Condyles Tangential Views: An Effective Method to Detect the Screw Penetration of Femoral Condyles After Retrograde Nailing

    PubMed Central

    Zheng, Zhan-Le; Yu, Xian; Chen, Wei; Liu, Yue-Ju; Yu, Kun-Lun; Wu, Tao; Zhang, Ying-Ze

    2015-01-01

    Background: Postoperative knee soft tissue irritation is a common complication after retrograde nail fixation of femoral fractures. Distal locking screw prominence is one of the causes for soft tissue irritation. This study aimed to determine whether the use of the femoral condyles tangential views improve the diagnostic accuracy compared with anteroposterior (A-P) view in detecting distal locking screw penetrations during retrograde femoral nailing. Methods: The angle between the sagittal plane and lateral aspect of the condyle and the angle between the sagittal plane and medial aspect of condyle were measured on computed tomography (CT) images. After the angles were measured and recorded, cadaveric femurs were used in a simulated surgical procedure. The retrograde femoral nail was inserted into the femur and placed distal locking screws, which were left 2, 4, and 6 mm proud of the medial and lateral condyles for each femur. A-P view, lateral condyle tangential view and medial condyle tangential view were obtained. All fluoroscopic images were recorded and sent to three observers blinded to the experimental procedure to determine whether screws penetrated the condyle cortex or not. Results: According to the results of CT scan, the lateral condyle view was 20.88 ± 0.98° and the medial condyle view was 40.46 ± 3.14°. In the A-P view, we detected 0% at 2 mm penetration, 16.7% (lateral condyle screw) and 25.0% (medial condyle screw) at 4 mm, and 41.7% (lateral condyle screw) and 58.3% (medial condyle screw) at 6 mm. In the lateral tangential view, we detected 91.7% at 2 mm penetration of the lateral condyle and 100% at 4 mm and 6 mm. In the medial tangential view, we detected 66.7% at 2 mm penetration of the medial condyle and 100% at 4 mm and 6 mm. The femoral condyle tangential views provided significant improvement in detecting screw penetrations at all lengths (2, 4, and 6 mm) compared with the A-P view (P < 0.05). Conclusions: The femoral condyles tangential

  18. Field-widened Michelson interferometer for spectral discrimination in high-spectral-resolution lidar: theoretical framework.

    PubMed

    Cheng, Zhongtao; Liu, Dong; Luo, Jing; Yang, Yongying; Zhou, Yudi; Zhang, Yupeng; Duan, Lulin; Su, Lin; Yang, Liming; Shen, Yibing; Wang, Kaiwei; Bai, Jian

    2015-05-01

    A field-widened Michelson interferometer (FWMI) is developed to act as the spectral discriminator in high-spectral-resolution lidar (HSRL). This realization is motivated by the wide-angle Michelson interferometer (WAMI) which has been used broadly in the atmospheric wind and temperature detection. This paper describes an independent theoretical framework about the application of the FWMI in HSRL for the first time. In the framework, the operation principles and application requirements of the FWMI are discussed in comparison with that of the WAMI. Theoretical foundations for designing this type of interferometer are introduced based on these comparisons. Moreover, a general performance estimation model for the FWMI is established, which can provide common guidelines for the performance budget and evaluation of the FWMI in the both design and operation stages. Examples incorporating many practical imperfections or conditions that may degrade the performance of the FWMI are given to illustrate the implementation of the modeling. This theoretical framework presents a complete and powerful tool for solving most of theoretical or engineering problems encountered in the FWMI application, including the designing, parameter calibration, prior performance budget, posterior performance estimation, and so on. It will be a valuable contribution to the lidar community to develop a new generation of HSRLs based on the FWMI spectroscopic filter. PMID:25969300

  19. Modelling soil carbon in agricultural systems: a way to widen the experimental space

    NASA Astrophysics Data System (ADS)

    O'Leary, Garry; Li Liu, De; Nuttall, James; Rajin Anwar, Muhuddin; Robertson, Fiona

    2015-07-01

    Mechanistic and explanatory simulation models provide robust and objective methods to extrapolate likely responses of crops and soils to climate change over different landscapes and time periods. Central to such simulation models are the supply of mineralised nutrients, in particular nitrogen, to crops through linked crop and nutrient sub-models that is achieved through modelling soil carbon dynamics. Attention to soil processes is therefore an essential part of building robust and sustainable production systems and understanding the potential impacts of climate change. To the farmer, focus must be on the productive capacity of the land and its rejuvenation to sustain production. In the broader context of reducing atmospheric CO2 concentration through soil C sequestration, understanding soil processes and the immediate environment likewise require attention to productivity issues. This is because without maintaining productivity a better understanding of soil organic carbon (SOC) processes is unlikely to lead to increased SOC sequestration in Australia's farming land. Some gaps in knowledge of how to manage SOC are being addressed in a national research effort, including the scant measured data against which models can be tested. Nevertheless, continuing to apply models to push the boundaries well beyond what can be achieved in practice widens the experimental space, allowing new ideas to be tested where physical experiments are not possible. This raises optimism that new ways may be discovered to explain change in SOC and increase SOC where it is possible in a beneficial way.

  20. Ultrasonic velocity profiling rheometry based on a widened circular Couette flow

    NASA Astrophysics Data System (ADS)

    Shiratori, Takahisa; Tasaka, Yuji; Oishi, Yoshihiko; Murai, Yuichi

    2015-08-01

    We propose a new rheometry for characterizing the rheological properties of fluids. The technique produces flow curves, which represent the relationship between the fluid shear rate and shear stress. Flow curves are obtained by measuring the circumferential velocity distribution of tested fluids in a circular Couette system, using an ultrasonic velocity profiling technique. By adopting a widened gap of concentric cylinders, a designed range of the shear rate is obtained so that velocity profile measurement along a single line directly acquires flow curves. To reduce the effect of ultrasonic noise on resultant flow curves, several fitting functions and variable transforms are examined to best approximate the velocity profile without introducing a priori rheological models. Silicone oil, polyacrylamide solution, and yogurt were used to evaluate the applicability of this technique. These substances are purposely targeted as examples of Newtonian fluids, shear thinning fluids, and opaque fluids with unknown rheological properties, respectively. We find that fourth-order Chebyshev polynomials provide the most accurate representation of flow curves in the context of model-free rheometry enabled by ultrasonic velocity profiling.

  1. Widening Life Expectancy Advantage of Hispanics in the United States: 1990–2010

    PubMed Central

    Blue, Laura

    2015-01-01

    We examine trends in the Hispanic longevity advantage between 1990 and 2010, focusing on the contribution of cigarette smoking. We calculate life expectancy at age 50 for Hispanics and non-Hispanic whites between 1990 and 2010. We use an indirect method to calculate the contribution of smoking to changes over time in life expectancy. Among women, the Hispanic advantage in life expectancy grows from 2.14 years in 1990 (95 % CI 1.99–2.30 years) to 3.53 years in 2010 (3.42–3.64 years). More than 40 % of this increase reflects widening differences in smoking-attributable mortality. The advantage for Hispanic men increases from 2.27 years (2.14–2.41 years) to 2.91 years (2.81–3.01 years), although smoking makes only a small contribution. Despite persistent disadvantage, US Hispanics have increased their longevity advantage over non-Hispanic whites since 1990, much of which reflects the continuing importance of cigarette smoking to the Hispanic advantage. PMID:24851822

  2. Field-widened Michelson interferometer for spectral discrimination in high-spectral-resolution lidar: practical development.

    PubMed

    Cheng, Zhongtao; Liu, Dong; Zhang, Yupeng; Yang, Yongying; Zhou, Yudi; Luo, Jing; Bai, Jian; Shen, Yibing; Wang, Kaiwei; Liu, Chong; Su, Lin; Yang, Liming

    2016-04-01

    A field-widened Michelson interferometer (FWMI), which is intended as the spectroscopic discriminator in ground-based high-spectral-resolution lidar (HSRL) for atmospheric aerosol detection, is described in this paper. The structure, specifications and design of the developed prototype FWMI are introduced, and an experimental approach is proposed to optimize the FWMI assembly and evaluate its comprehensive characteristic simultaneously. Experimental results show that, after optimization process, the peak-to-valley (PV) value and root-mean-square (RMS) value of measured OPD variation for the FWMI are 0.04λ and 0.008λ respectively among the half divergent angle range of 1.5 degree. Through an active locking technique, the frequency of the FWMI can be locked to the laser transmitter with accuracy of 27 MHz for more than one hour. The practical spectral discrimination ratio (SDR) for the developed FWMI is evaluated to be larger than 86 if the divergent angle of incident beam is smaller than 0.5 degree. All these results demonstrate the great potential of the developed FWMI as the spectroscopic discriminator for HSRLs, as well as the feasibility of the proposed design and optimization process. This paper is expected to provide a good entrance for the lidar community in future HSRL developments using the FWMI technique. PMID:27137015

  3. Is sprawl associated with a widening urban-suburban mortality gap?

    PubMed

    Fan, Yingling; Song, Yan

    2009-09-01

    This paper examines whether sprawl, featured by low development density, segregated land uses, lack of significant centers, and poor street connectivity, contributes to a widening mortality gap between urban and suburban residents. We employ two mortality datasets, including a national cross-sectional dataset examining the impact of metropolitan-level sprawl on urban-suburban mortality gaps and a longitudinal dataset from Portland examining changes in urban-suburban mortality gaps over time. The national and Portland studies provide the only evidence to date that (1) across metropolitan areas, the size of urban-suburban mortality gaps varies by the extent of sprawl: in sprawling metropolitan areas, urban residents have significant excess mortality risks than suburban residents, while in compact metropolitan areas, urbanicity-related excess mortality becomes insignificant; (2) the Portland metropolitan area not only experienced net decreases in mortality rates but also a narrowing urban-suburban mortality gap since its adoption of smart growth regime in the past decade; and (3) the existence of excess mortality among urban residents in US sprawling metropolitan areas, as well as the net mortality decreases and narrowing urban-suburban mortality gap in the Portland metropolitan area, is not attributable to sociodemographic variations. These findings suggest that health threats imposed by sprawl affect urban residents disproportionately compared to suburban residents and that efforts curbing sprawl may mitigate urban-suburban health disparities. PMID:19533362

  4. Experimental indication for band gap widening of chalcopyrite solar cell absorbers after potassium fluoride treatment

    SciTech Connect

    Pistor, P.; Greiner, D.; Kaufmann, C. A.; Brunken, S.; Gorgoi, M.; Steigert, A.; Calvet, W.; Lauermann, I.; Klenk, R.; Unold, T.; Lux-Steiner, M.-C.

    2014-08-11

    The implementation of potassium fluoride treatments as a doping and surface modification procedure in chalcopyrite absorber preparation has recently gained much interest since it led to new record efficiencies for this kind of solar cells. In the present work, Cu(In,Ga)Se{sub 2} absorbers have been evaporated on alkali containing Mo/soda-lime glass substrates. We report on compositional and electronic changes of the Cu(In,Ga)Se{sub 2} absorber surface as a result of a post deposition treatment with KF (KF PDT). In particular, by comparing standard X-ray photoelectron spectroscopy and synchrotron-based hard X-ray photoelectron spectroscopy (HAXPES), we are able to confirm a strong Cu depletion in the absorbers after the KF PDT which is limited to the very near surface region. As a result of the Cu depletion, we find a change of the valence band structure and a shift of the valence band onset by approximately 0.4 eV to lower binding energies which is tentatively explained by a band gap widening as expected for Cu deficient compounds. The KF PDT increased the open circuit voltage by 60–70 mV compared to the untreated absorbers, while the fill factor deteriorated.

  5. Measurement of two-dimensional Doppler wind fields using a field widened Michelson interferometer.

    PubMed

    Langille, Jeffery A; Ward, William E; Scott, Alan; Arsenault, Dennis L

    2013-03-10

    An implementation of the field widened Michelson concept has been applied to obtain high resolution two-dimensional (2D) images of low velocity (<50 m/s) Doppler wind fields in the lab. Procedures and techniques have been developed that allow Doppler wind and irradiance measurements to be determined on a bin by bin basis with an accuracy of less than 2.5 m/s from CCD images over the observed field of view. The interferometer scanning mirror position is controlled to subangstrom precision with subnanometer repeatability using the multi-application low-voltage piezoelectric instrument control electronics developed by COM DEV Ltd.; it is the first implementation of this system as a phase stepping Michelson. In this paper the calibration and characterization of the Doppler imaging system is described and the planned implementation of this new technique for imaging 2D wind and irradiance fields using the earth's airglow is introduced. Observations of Doppler winds produced by a rotating wheel are reported and shown to be of sufficient precision for buoyancy wave observations in airglow in the mesopause region of the terrestrial atmosphere. PMID:23478764

  6. Band Gap Narrowing and Widening of ZnO Nanostructures and Doped Materials.

    PubMed

    Kamarulzaman, Norlida; Kasim, Muhd Firdaus; Rusdi, Roshidah

    2015-12-01

    Band gap change in doped ZnO is an observed phenomenon that is very interesting from the fundamental point of view. This work is focused on the preparation of pure and single phase nanostructured ZnO and Cu as well as Mn-doped ZnO for the purpose of understanding the mechanisms of band gap narrowing in the materials. ZnO, Zn0.99Cu0.01O and Zn0.99Mn0.01O materials were prepared using a wet chemistry method, and X-ray diffraction (XRD) results showed that all samples were pure and single phase. UV-visible spectroscopy showed that materials in the nanostructured state exhibit band gap widening with respect to their micron state while for the doped compounds exhibited band gap narrowing both in the nano and micron states with respect to the pure ZnO materials. The degree of band gap change was dependent on the doped elements and crystallite size. X-ray photoelectron spectroscopy (XPS) revealed that there were shifts in the valence bands. From both UV-visible and XPS spectroscopy, it was found that the mechanism for band gap narrowing was due to the shifting of the valance band maximum and conduction band minimum of the materials. The mechanisms were different for different samples depending on the type of dopant and dimensional length scales of the crystallites. PMID:26319225

  7. Widening social inequalities in mortality: the case of Barcelona, a southern European city.

    PubMed Central

    Borrell, C; Plasència, A; Pasarin, I; Ortún, V

    1997-01-01

    OBJECTIVE: To analyse trends in mortality inequalities in Barcelona between 1983 and 1994 by comparing rates in those electoral wards with a low socioeconomic level and rates in the remaining wards. DESIGN: Mortality trends study. SETTING: The city of Barcelona (Spain). SUBJECTS: The study included all deaths among residents of the two groups of city wards. Details were obtained from death certificates. MAIN OUTCOME MEASURES: Age standardised mortality rates, age standardised rates of years of potential life lost, and age specific mortality rates in relation to cause of death, sex, and year were computed as well as the comparative mortality figure and the ratio of standardised rates of years of potential life lost. RESULTS: Rates of premature mortality increased from 5691.2 years of potential life lost per 100,000 inhabitants aged 1 to 70 years in 1983 to 7606.2 in 1994 in the low socioeconomic level wards, and from 3731.2 to 4236.9 in the other wards, showing an increase in inequalities over the 12 years, mostly due to AIDS and drug overdose as causes of death. Conversely, cerebrovascular disease showed a reduction in inequality over the same period. Overall mortality in the 15-44 age group widened the gap between both groups of wards. CONCLUSION: AIDS and drug overdose are emerging as the causes of death that are contributing to a substantial increase in social inequality in terms of premature mortality, an unreported observation in European urban areas. PMID:9519129

  8. System analysis of a tilted field-widened Michelson interferometer for high spectral resolution lidar.

    PubMed

    Liu, Dong; Hostetler, Chris; Miller, Ian; Cook, Anthony; Hair, Johnathan

    2012-01-16

    High spectral resolution lidars (HSRLs) have shown great value in aircraft aerosol remote sensing application and are planned for future satellite missions. A compact, robust, quasi-monolithic tilted field-widened Michelson interferometer is being developed as the spectral discrimination filter for an second-generation HSRL(HSRL-2) at NASA Langley Research Center. The Michelson interferometer consists of a cubic beam splitter, a solid arm and an air arm. Piezo stacks connect the air arm mirror to the body of the interferometer and can tune the interferometer within a small range. The whole interferometer is tilted so that the standard Michelson output and the reflected complementary output can both be obtained. In this paper, the transmission ratio is proposed to evaluate the performance of the spectral filter for HSRL. The transmission ratios over different types of system imperfections, such as cumulative wavefront error, locking error, reflectance of the beam splitter and anti-reflection coatings, system tilt, and depolarization angle are analyzed. The requirements of each imperfection for good interferometer performance are obtained. PMID:22274485

  9. Derivation of an optimal directivity pattern for sweet spot widening in stereo sound reproduction

    NASA Astrophysics Data System (ADS)

    Ródenas, Josep A.; Aarts, Ronald M.; Janssen, A. J. E. M.

    2003-01-01

    In this paper the correction of the degradation of the stereophonic illusion during sound reproduction due to off-center listening is investigated. The main idea is that the directivity pattern of a loudspeaker array should have a well-defined shape such that a good stereo reproduction is achieved in a large listening area. Therefore, a mathematical description to derive an optimal directivity pattern opt that achieves sweet spot widening in a large listening area for stereophonic sound applications is described. This optimal directivity pattern is based on parametrized time/intensity trading data coming from psycho-acoustic experiments within a wide listening area. After the study, the required digital FIR filters are determined by means of a least-squares optimization method for a given stereo base setup (two pair of drivers for the loudspeaker arrays and 2.5-m distance between loudspeakers), which radiate sound in a broad range of listening positions in accordance with the derived opt. Informal listening tests have shown that the opt worked as predicted by the theoretical simulations. They also demonstrated the correct central sound localization for speech and music for a number of listening positions. This application is referred to as ``Position-Independent (PI) stereo.''

  10. Exactech Opteon Femoral Component Fracture 12 Years after Arthroplasty

    PubMed Central

    Patel, Shaun P.; Antoci, Valentin; Kadzielski, John J.; Vrahas, Mark S.

    2016-01-01

    Arthroplasty implant fracture is a rare but critical complication that requires difficult revision surgery, often with poor results, patient disability, and significant cost. Several reports show component fracture either at the stem or at the neck interface after a relatively short postoperative course. We report such failure after 12 years, suggesting no safe period after which femoral implant fracture does not occur. PMID:26955493

  11. Unusual Foreign Bone Fragment in Femoral Open Fracture

    PubMed Central

    Sadoni, Hanon; Arti, Hamidreza

    2016-01-01

    Introduction: Femoral shaft fracture is one of the typical bone fractures due to high energy trauma and may occur as an open fracture. Some foreign materials may enter the fracture site such as sand, cloth particles and so on. Case Presentation: A 28-year-old motorcycle riding military member and his collaborator were received in the hospital because of multiple traumas due to a fall in a hollow during a surveillance mission. His collaborator died because of head trauma and multiple severe open fractures. When fixing the patients femoral fracture, a large femoral butterfly fragment was removed from the patient’s thigh as a foreign segment. The patient’s femur was fixed with a plate and screws. No femoral defect was detected during surgery or post-operative X-rays and CT scan. The removed segment was not a part of the patient’s femur. Conclusions: Surgical and post-surgical findings showed that this segment was not related to the patient’s femur. The foreign segment may have belonged to the other victim of this trauma.

  12. Chronic common femoral vein occlusion secondary to endometriosis

    PubMed Central

    Ju, Mila H.; Keldahl, Mark L.; Rodriguez, Heron E.

    2016-01-01

    Venous occlusion is sometimes caused by external compression due to adjacent masses. Endometriosis, the presence of functioning endometrial tissue outside the uterine cavity, is a rare cause of venous occlusion. We report a case of chronic common femoral vein occlusion due to endomctrioma causing severe leg edema and groin pain that was treated with resection and venous bypass. PMID:26993188

  13. Rotational alignment of the femoral component in total knee arthroplasty

    PubMed Central

    Falvo, Daniele Antonio; Iapicca, Mario Luigi; Gotti, Valerio

    2016-01-01

    We describe here various surgical options to obtain a correct rotational alignment of femoral component in total knee arthroplasty (TKA). The correct rotational alignment is the key point to obtain a rectangular balanced flexion gap as well to have a good patellar tracking. For that reason, rotation alignment largely affects postoperative kinematic results particularly during flexion. PMID:26855940

  14. Quantifying lateral femoral condyle ellipticalness in chimpanzees, gorillas, and humans.

    PubMed

    Sylvester, Adam D; Pfisterer, Theresa

    2012-11-01

    Articular surfaces of limb bones provide information for understanding animal locomotion because their size and shape are a reflection of habitual postures and movements. Here we present a novel method for quantifying the ellipticalness (i.e., departure from perfectly circular) of the lateral femoral condyle (LFC), applying this technique to hominid femora. Three-dimensional surface models were created for 49 Homo sapiens, 34 Pan troglodytes and 25 Gorilla gorilla femora. Software was developed that fit separate cylinders to each of the femoral condyles. These cylinders were constrained to have a single axis, but could have different radii. The cylinder fit to the LFC was allowed to assume an elliptical cross-section, while the cylinder fit to the medial condyle was constrained to remain circular. The shape of the elliptical cylinder (ratio of the major and minor axes of the ellipse) was recorded, and the orientation of the elliptical cylinder quantified as angles between the major axis of the ellipse and the anatomical and mechanical axes of the femur. Species were compared using analysis of variance and post hoc multiple comparisons tests. Confirming qualitative descriptions, human LFCs are more elliptical than those of chimpanzees and gorillas. Human femora exhibit a narrow range for the angle between the major axis of the elliptical cylinder and femoral axes. Conversely, the chimpanzee sample is bimodal for these angles, exhibiting two ellipse orientations, while Gorilla shows no preferred angle. Our results suggest that like modern human femora, chimpanzee femoral condyles have preferentially used regions. PMID:23042636

  15. Scaling in Theropod Dinosaurs: Femoral Bone Strength and Locomotion II

    ERIC Educational Resources Information Center

    Lee, Scott

    2015-01-01

    In the second paper of this series, the effect of transverse femoral stresses due to locomotion in theropod dinosaurs of different sizes was examined for the case of an unchanging leg geometry. Students are invariably thrilled to learn about theropod dinosaurs, and this activity applies the concepts of torque and stress to the issue of theropod…

  16. Does vitamin D affect femoral cartilage thickness? An ultrasonographic study.

    PubMed

    Malas, Fevziye Unsal; Kara, Murat; Aktekin, Lale; Ersöz, Murat; Ozçakar, Levent

    2014-09-01

    This study aims to investigate the association between vitamin D levels and distal femoral cartilage thickness in healthy subjects. Eighty patients who were admitted to our outpatient clinic between May and July 2013 were classified into three subgroups according to their 25-OH vitamin D levels of <10, 10-20, and ≥20 ng/mL. Distal femoral cartilage thickness was measured from the midpoints of the right medial condyle (RMC), right lateral condyle (RLC), right intercondylar area (RIA), left medial condyle (LMC), left lateral condyle (LLC), and left intercondylar area (LIA) by using musculoskeletal ultrasound (US). The group with severe vitamin D deficiency (<10 ng/mL) had thinner femoral cartilage thickness at LMC (p = 0.005). Positive correlations were determined only between vitamin D levels and US measurements in the severe vitamin D deficiency group at RLC (r = 444, p = 0.020), LMC (r = 357, p = 0.067), and LLC (r = 568, p = 0.002). Low levels of vitamin D seem to affect the femoral cartilage thickness, adversely. Further studies are necessary to ascertain the clinical relevance of this change in cartilage thickness and whether vitamin D supplementation can reverse the cartilage thinning process or the allied clinical symptoms in the course of knee osteoarthritis. PMID:24221506

  17. Distal Femoral Oblique Fracture in a Young Male Soldier

    PubMed Central

    Cohen, David Naji; Al Khateeb, Hesham; Safwat, Mohammed

    2016-01-01

    Abstract Here, we report a case of a distal femoral fracture in a 23-year-old male army cadet who presented to the Accident and Emergency department following a twisting injury while participating in a routine military marching exercise. A pathological fracture was considered but this suspicion was put to rest following thorough investigations, leaving only a diagnosis of a nontraumatic spontaneous femoral fracture. To our knowledge, there have been no reported cases of distal femoral fractures associated with nontraumatic military exercises, with the majority of injuries instead related to stress fractures. A vigilant literature search yielded no cases of similar injury nature, which is the primary reason we believe that those interested in orthopaedics or military doctors would find themselves drawn to this case. The patient presented with severe pain in his left thigh and on examination there was a deformity of his left thigh. In terms of investigations, a bone profile, plain film radiographs, C-reactive protein, erythrocyte sedimentation rate, and tumor markers were all preformed and proved unremarkable. The definitive treatment was by open reduction and internal fixation. Femoral fractures often require significant amounts of force, particularly in young, healthy individuals. Generally, these injuries in this demographic follow high-energy traumas, with the lion's share occurring following a road traffic accident or other high-speed impact. More often than not, the treatment is surgical. Given the extraordinary manner of this such, one must be attentive and exhaustive in their investigation of such presentations. PMID:27258509

  18. Postmortem angiography using femoral cannulation and postmortem microbiology.

    PubMed

    Palmiere, Cristian; Egger, Coraline; Grabherr, Silke; Jaton-Ogay, Katia; Greub, Gilbert

    2015-07-01

    Despite the undeniable advantages of postmortem angiography, numerous questions have arisen concerning the influence that the injected contrast media may exercise on biological fluids and tissues collected for toxicological and biochemical investigations. Moreover, cardiac blood for microbiological investigations cannot be obtained post-angiography. In this study, we examined whether the peripheral blood collected prior to postmortem angiography, using percutaneous access to femoral vessels after skin surface disinfection, could be suitable for microbiological investigations when postmortem angiography with femoral vessel cannulation is also performed. A total of 66 cases were included in the study and were divided into two subgroups (angiography and bacteriology group, 33 cases and control group, 33 cases). Autopsies, histology, toxicology, bacteriology, and biochemical investigations (procalcitonin, C-reactive protein, interleukin-6, and soluble triggering receptors expressed on myeloid cells type 1) were performed in all cases. No statistically significant differences between the two groups were noted, and identified category distribution (death unrelated to infection, true infection, false positive, and undetermined) was rather similar in both studied populations. These preliminary results suggest that postmortem angiography using a femoral approach does not constitute an impediment to the collection of peripheral blood for microbiology and vice versa. Moreover, the use of femoral blood for microbiology does not lead to an increased risk of doubtful results. PMID:25381195

  19. Risk factors in selected patients undergoing femoral embolectomy.

    PubMed Central

    Scott, D. J.; Davies, A. H.; Horrocks, M.

    1989-01-01

    Mortality rates after femoral embolectomy (FE) in patients with an acutely ischaemic leg vary from 20-40%. In the last 3 years we have adopted a policy of proceeding directly to femoral embolectomy in those patients with a strong clinical suspicion of an embolus. Where doubt exists about the diagnosis, arteriography is performed in combination with local streptokinase, balloon dilatation and/or reconstruction. In a prospective study between September 1984 and March 1987, 43 patients underwent femoral embolectomy with a limb salvage rate of 87%. The early mortality (within 30 days) was 16%, the late mortality was 26%, with a mean follow-up of 22 months. Of the seven patients who died within 30 days, one had a successful embolectomy but died from a cerebrovascular accident. The remaining six failed to improve clinically, all had poor backbleeding and no return of the peripheral pulses. None of these patients had an amputation. We recommend that femoral embolectomy be performed in those patients with a short history of ischaemia (less than 72 h), a risk factor suggesting an embolic source and no past history of intermittent claudication. If all three criteria are not met, arteriography should be performed with a view to fibrinolytic therapy or vascular reconstruction. In those patients who have had a failed embolectomy or where the circulation cannot be restored promptly, despite fibrinolytic therapy and/or distal reconstruction, early major amputation may be life-saving. PMID:2774451

  20. Quadratus lumborum block for femoral–femoral bypass graft placement

    PubMed Central

    Watanabe, Kunitaro; Mitsuda, Shingo; Tokumine, Joho; Lefor, Alan Kawarai; Moriyama, Kumi; Yorozu, Tomoko

    2016-01-01

    Abstract Introduction: Atherosclerosis has a complex etiology that leads to arterial obstruction and often results in inadequate perfusion of the distal limbs. Patients with atherosclerosis can have severe complications of this condition, with widespread systemic manifestations, and the operations undertaken are often challenging for anesthesiologists. Case report: A 79-year-old woman with chronic heart failure and respiratory dysfunction presented with bilateral gangrene of the distal lower extremities with obstruction of the left common iliac artery due to atherosclerosis. Femoral–femoral bypass graft and bilateral foot amputations were planned. Spinal anesthesia failed due to severe scoliosis and deformed vertebrae. General anesthesia was induced after performing multiple nerve blocks including quadratus lumborum, sciatic nerve, femoral nerve, lateral femoral cutaneous nerve, and obturator nerve blocks. However, general anesthesia was abandoned because of deterioration in systemic perfusion. The surgery was completed; the patient remained comfortable and awake without the need for further analgesics. Conclusion: Quadratus lumborum block may be a useful anesthetic technique to perform femoral–femoral bypass. PMID:27583851

  1. Femoral mycotic aneurysm presenting as arthritis and purpura.

    PubMed

    Feldman, C; Mason, P; Jones, R R; Kelley, C

    1985-11-01

    A case is described with recurrent arthritis and skin rash confined to the right lower limb and exacerbated on each occasion by exercise. Investigation established this to be due to a mycotic aneurysm of the right common femoral artery. Treatment with excision and grafting and antibiotics resulted in full recovery. Mycotic aneurysm and the unusual presenting features in this case are discussed. PMID:3840709

  2. Hybrid Anterolateral Approach for Open Reduction and Internal Fixation of Femoral Neck Fractures.

    PubMed

    Vopat, Bryan G; Daniels, Alan H; Lareau, Craig R; Christino, Melissa A; Kane, Patrick M; Hayda, Roman A; Born, Christopher T

    2015-07-01

    Displaced femoral neck fractures in physiologically young patients are best treated with anatomic reduction and stable fixation. Several surgical approaches to the femoral neck have previously been described, although they are fraught with disadvantages such as poor visualization, the need for 2 incisions, and risk of injury to the lateral femoral cutaneous nerve and branches of the medial femoral circumflex artery. The authors' hybrid anterolateral approach to the hip allows for excellent visualization of femoral neck fractures and for placement of plate and/or screw constructs through a single incision. This surgical technique additionally minimizes risk to neurovascular structures. PMID:26186310

  3. Current concepts on osteonecrosis of the femoral head

    PubMed Central

    Moya-Angeler, Joaquin; Gianakos, Arianna L; Villa, Jordan C; Ni, Amelia; Lane, Joseph M

    2015-01-01

    It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. The lack of level 1 evidence in the literature makes it difficult to identify optimal treatment protocols to manage patients with pre-collapse avascular necrosis of the femoral head, and early intervention prior to collapse is critical to successful outcomes in joint preserving procedures. There have been a variety of traumatic and atraumatic factors that have been identified as risk factors for osteonecrosis, but the etiology and pathogenesis still remains unclear. Current osteonecrosis diagnosis is dependent upon plain anteroposterior and frog-leg lateral radiographs of the hip, followed by magnetic resonance imaging (MRI). Generally, the first radiographic changes seen by radiograph will be cystic and sclerotic changes in the femoral head. Although the diagnosis may be made by radiograph, plain radiographs are generally insufficient for early diagnosis, therefore MRI is considered the most accurate benchmark. Treatment options include pharmacologic agents such as bisphosphonates and statins, biophysical treatments, as well as joint-preserving and joint-replacing surgeries. the surgical treatment of osteonecrosis of the femoral head can be divided into two major branches: femoral head sparing procedures (FHSP) and femoral head replacement procedures (FHRP). In general, FHSP are indicated at pre-collapse stages with minimal symptoms whereas FHRP are preferred at post-collapse symptomatic stages. It is difficult to know whether any treatment modality changes the natural history of core decompression since the true natural history of core decompression has not been delineated. PMID:26396935

  4. Femoral head diameter considerations for primary total hip arthroplasty.

    PubMed

    Girard, J

    2015-02-01

    The configuration of total hip arthroplasty (THA) implants has constantly evolved since they were first introduced. One of the key components of THA design is the diameter of the prosthetic femoral head. It has been well established that the risk of dislocation is lower as the head diameter increases. But head diameter impacts other variables beyond joint stability: wear, cam-type impingement, range of motion, restoration of biomechanics, proprioception and groin pain. The introduction of highly cross-linked polyethylene and hard-on-hard bearings has allowed surgeons to implant large-diameter heads that almost completely eliminate the risk of dislocation. But as a result, cup liners have become thinner. With femoral head diameters up to 36 mm, the improvement in joint range of motion, delay in cam-type impingement and reduction in dislocation risk have been clearly demonstrated. Conversely, large-diameter heads do not provide any additional improvements. If an "ecologically sound" approach to hip replacement is embraced (e.g. keeping the native femoral head diameter), hip resurfacing with a metal-on-metal bearing must be carried out. The reliability of large-diameter femoral heads in the longer term is questionable. Large-diameter ceramic-on-ceramic bearings may be plagued by the same problems as metal-on-metal bearings: groin pain, squeaking, increased stiffness, irregular lubrication, acetabular loosening and notable friction at the Morse taper. These possibilities require us to be extra careful when using femoral heads with a diameter greater than 36 mm. PMID:25596984

  5. Current concepts on osteonecrosis of the femoral head.

    PubMed

    Moya-Angeler, Joaquin; Gianakos, Arianna L; Villa, Jordan C; Ni, Amelia; Lane, Joseph M

    2015-09-18

    It is estimated that 20000 to 30000 new patients are diagnosed with osteonecrosis annually accounting for approximately 10% of the 250000 total hip arthroplasties done annually in the United States. The lack of level 1 evidence in the literature makes it difficult to identify optimal treatment protocols to manage patients with pre-collapse avascular necrosis of the femoral head, and early intervention prior to collapse is critical to successful outcomes in joint preserving procedures. There have been a variety of traumatic and atraumatic factors that have been identified as risk factors for osteonecrosis, but the etiology and pathogenesis still remains unclear. Current osteonecrosis diagnosis is dependent upon plain anteroposterior and frog-leg lateral radiographs of the hip, followed by magnetic resonance imaging (MRI). Generally, the first radiographic changes seen by radiograph will be cystic and sclerotic changes in the femoral head. Although the diagnosis may be made by radiograph, plain radiographs are generally insufficient for early diagnosis, therefore MRI is considered the most accurate benchmark. Treatment options include pharmacologic agents such as bisphosphonates and statins, biophysical treatments, as well as joint-preserving and joint-replacing surgeries. the surgical treatment of osteonecrosis of the femoral head can be divided into two major branches: femoral head sparing procedures (FHSP) and femoral head replacement procedures (FHRP). In general, FHSP are indicated at pre-collapse stages with minimal symptoms whereas FHRP are preferred at post-collapse symptomatic stages. It is difficult to know whether any treatment modality changes the natural history of core decompression since the true natural history of core decompression has not been delineated. PMID:26396935

  6. Analysis of Femoral Components of Cemented Total Hip Arthroplasty

    NASA Astrophysics Data System (ADS)

    Singh, Shantanu; Harsha, A. P.

    2015-10-01

    There have been continuous on-going revisions in design of prosthesis in Total Hip Arthroplasty (THA) to improve the endurance of hip replacement. In the present work, Finite Element Analysis was performed on cemented THA with CoCrMo trapezoidal, CoCrMo circular, Ti6Al4V trapezoidal and Ti6Al4V circular stem. It was observed that cross section and material of femoral stem proved to be critical parameters for stress distribution in femoral components, distribution of interfacial stress and micro movements. In the first part of analysis, designs were investigated for micro movements and stress developed, for different stem materials. Later part of the analysis focused on investigations with respect to different stem cross sections. Femoral stem made of Titanium alloy (Ti6Al4V) resulted in larger debonding of stem at cement-stem interface and increased stress within the cement mantle in contrast to chromium alloy (CoCrMo) stem. Thus, CoCrMo proved to be a better choice for cemented THA. Comparison between CoCrMo femoral stem of trapezium and circular cross section showed that trapezoidal stem experiences lesser sliding and debonding at interfaces than circular cross section stem. Also, trapezium cross section generated lower peak stress in femoral stem and cortical femur. In present study, femur head with diameter of 36 mm was considered for the analysis in order to avoid dislocation of the stem. Also, metallic femur head was coupled with cross linked polyethylene liner as it experiences negligible wear compared to conventional polyethylene liner and unlike metallic liner it is non carcinogenic.

  7. Resected femoral anthropometry for design of the femoral component of the total knee prosthesis in a Korean population

    PubMed Central

    Kwak, Dai-Soon; Han, Suhyoun; Han, Chang Whan

    2010-01-01

    We measured the mediolateral (ML) and anteroposterior (AP) length, height and widths of the anterior, posterior and inferior section of the resected distal femurs using three dimensional computer tomographic measurements in 200 knees from 100 cadavers. We also calculated the aspect ratio (ML/AP) and compared the measured parameters with that of six conventionally used total knee femoral prostheses. We found that the average ML (70.2±5.5 mm) and AP (53.9±3.8 mm) dimensions from our study were lower than those reported from Western populations. The aspect ratio showed a progressive decline with an increasing antero-posterior dimension. All of the compared designs showed undersizing for the mediolateral dimension distally and for the widths of the resected medial and lateral posterior femoral condyles. But some of the compared designs showed oversizing for the height of the resected medial and lateral posterior femoral condyles. This study provides guidelines for designing a suitable femoral component for total knee prostheses that fit Asian populations. PMID:21212865

  8. THA Retrievals: The Need to Mark the Anatomic Orientation of the Femoral Head.

    PubMed

    Heiner, Anneliese D; Kruger, Karen M; Tikekar, Nishant M; Callaghan, John J; Lannutti, John J; Brown, Thomas D

    2015-06-01

    The hypothesis of this study was that the rotational orientation of femoral head damage would greatly affect the volumetric wear rate of the opposing polyethylene (PE) liner. Damage on twenty retrieved cobalt-chromium femoral heads was simulated in a validated damage-feature-based finite element model. For each individual retrieval, the anatomic orientation of the femoral head about the femoral neck axis was systematically varied, in 30° increments. The PE wear rate differential between the maximum- versus minimum-wear orientations was often sizable, as high as 7-fold. Knowing the correct femoral head anatomic orientation is therefore important when analyzing the effects of femoral head damage on PE liner wear. Surgeons retrieving modular femoral heads should routinely mark the anatomic orientation of those components. PMID:25682206

  9. Proximal Femoral Nail Antirotation Versus Reverse Less Invasive Stabilization System-distal Femur for Treating Proximal Femoral Fractures

    PubMed Central

    Jiang, Xuan; Wang, Ying; Ma, XinLong; Ma, JianXiong; Wang, Chen; Zhang, ChengBao; Han, Zhe; Sun, Lei; Lu, Bin

    2016-01-01

    Abstract The aim of this study was to compare the effectiveness and safety of 2 surgical techniques that are used to treat proximal femoral fractures. A systematic literature search (up to December 2014) was conducted in Medline, Embase, PubMed, and The Cochrane Central Register of Controlled Trials to screen for studies comparing proximal femoral nail antirotation (PFNA) with less invasive stabilization system–distal femur (LISS-DF) for proximal femoral fractures. Two authors independently assessed the methodological quality of the included studies and extracted data. Surgical information and postoperative outcomes were analyzed. A total of 7 studies with 361 patients who satisfied the eligibility criteria included 3 randomized controlled trials and 4 case-controlled trials associated with PFNA versus LISS in treating proximal femoral fractures. Our results demonstrated that there was a significant reduction in hospital stay and time to weight-bearing ambulation and bone healing for PFNA compared with LISS (odds ratio [OR] −1.48, 95% confidence interval [CI] −2.92 to −0.05; OR −7.08, 95% CI −8.32 to −5.84; OR −2.71, 95% CI −4.76 to 0.67). No statistically significant difference was observed between the 2 groups for operative time, blood loss volume, Harris hip score, and incidence of complications. Based on the results of this analysis, we inferred that PFNA is safer and more effective than reverse LISS-DF in patients undergoing osteosynthesis for proximal femoral fractures, and that PFNA is associated with reduced hospital stays and reduced time to weight-bearing ambulation and bone healing. Nonetheless, in certain cases in which PFNA is not suitable due to abnormal structure of the proximal femur or particularly unstable fractures, the LISS plate technique could be a useful alternative. PMID:27057840

  10. Autogenic Scour and Channel Widening in Sharp Bends of the River Mahakam

    NASA Astrophysics Data System (ADS)

    Hoitink, T.; Vermeulen, B.; van Berkum, S.; Hidayat, H.; Labeur, R. J.

    2014-12-01

    Field evidence of the River Mahakam reveals autogenic scour and channel widening in a series of sharp bends. An integral analysis of a 300 km reach of the river is presented, including a comprehensive survey of the river banks, delineation of the river corridor from radar observations, Large Eddy Simulations of observed flow patterns, and a geometric analysis of planform and depth information. Scour depths strongly exceed what can be expected based on existing understanding of sharp bends, and are highly correlated with curvature. Histograms of the occurrence of erosive, stable, advancing, and bar-type banks as a function of curvature quantify the switch from a mildly curved bend regime to a sharp bend regime. In mild bends, outer banks erode and inner banks advance. In sharp bends the erosion pattern inverts. Outer banks stabilize or advance, while inner banks erode. In sharply curved river bends, bars occur near the outer banks that become less erosive for higher curvatures. Inner banks become more erosive for higher curvatures, but nevertheless accommodate the larger portion of exposed bars. Soil processes may play a crucial role in the formation of sharp bends, which is inferred from iron and manganese concretions observed in the riverbanks, indicating ferric horizons and early stages of the formation of plinthic horizons. Historical topographic maps show the planform activity of the river is low, which may relate to the scours slowing down planimetric development. The occurrence of exceptionally deep scours is attributed to downflow near the scour exceeding 12 cm/s, increasing the bed shear stress. The downflow, in turn, is explained from the cross-sectional area increase, which is shown to be important in generating adverse surface gradients driving flow recirculation in the Large Eddy Simulations. Strong secondary flow distorts the vertical pressure distribution that is no longer hydrostatic. The downflow advects longitudinal momentum, moving the core of the

  11. There's a hole in my symphysis -- a review of disorders causing widening, erosion, and destruction of the symphysis pubis.

    PubMed

    Budak, M J; Oliver, T B

    2013-02-01

    The symphysis pubis is demonstrated on many conventional radiographic and cross-sectional examinations and abnormality of the symphysis pubis is a common imaging finding with numerous possible causes. Many significant disorders that affect the symphysis pubis cause it to appear widened, eroded, or destroyed on imaging studies. It is useful for radiologists to have a working differential diagnosis for these appearances, to use when reporting such studies. This review briefly describes the anatomy of the symphysis pubis and presents examples of the various developmental, inflammatory, infectious, neoplastic, traumatic, and metabolic disorders that may cause it to become widened, eroded, or destroyed. Some disorders have pathognomonic imaging features. Others give rise to similar findings that depend more on overall disease activity, rather than the specific diagnosis itself. In such cases, correlation with clinical and laboratory findings will help narrow the differential diagnosis. PMID:22748520

  12. Association of biometric factors with anterior chamber angle widening and intraocular pressure reduction after uneventful phacoemulsification for cataract

    PubMed Central

    Huang, Guofu; Gonzalez, Eduardo; Lee, Roland; Chen, Yi-Chun; He, Mingguang; Lin, Shan C.

    2011-01-01

    PURPOSE To evaluate anterior chamber biometric factors associated with the degree of angle widening and intraocular pressure (IOP) reduction after phacoemulsification. SETTING University of California, San Francisco, California, USA. DESIGN Case series. METHODS Anterior chamber parameters obtained by anterior segment coherence tomography were compared preoperatively and 3 months postoperatively. Measurements included the angle opening distance 500 μm anterior to the scleral spur (AOD500), trabecular–iris space area 500 μm from the scleral spur (TISA500), iris curvature (I-Curv), anterior chamber angle (ACA), trabecular–iris space area, anterior chamber volume, anterior chamber width, and lens vault (LV). RESULTS The study enrolled 73 eyes. The mean patient age was 77.45 years ± 7.84 (SD); 65.75% of patients were women. From preoperatively to 3 months postoperatively, the mean AOD500 increased significantly (0.254 ± 0.105 to 0.433 ± 0.108 mm) and the mean IOP decreased significantly (14.97 ± 3.35 to 12.62 ± 3.37 mm Hg) (P < .001). The reduction in IOP was correlated with the increase in AOD500 (r = 0.240, P = .041) and preoperative LV (r = 0.235, P = .045). After adjusting for related factors, AOD500 widening was positively correlated with LV (β = 0.458, P = .044) and I-Curv (β = 0.235, P = .043) and negatively correlated with preoperative TISA500 (β = −0.269, P = .025) and ACA (β = −0.919, P = .027). CONCLUSIONS Surgically induced AOD widening was significantly correlated with anterior chamber biometric factors. Preoperative LV appears to be a significant factor in angle widening and IOP reduction after phacoemulsification. PMID:22055073

  13. Successful Return to Sport Following Distal Femoral Varus Osteotomy

    PubMed Central

    Voleti, Pramod Babu; Degen, Ryan; Tetreault, Danielle; Krych, Aaron John; Williams, Riley J.

    2016-01-01

    Objectives: Distal femoral varus osteotomy is an effective treatment for unloading valgus knee malalignment; however, there is limited evidence on the ability for patients to return to athletics following this procedure. The purpose of this study is to report the functional outcomes and return to sport for athletic patients that underwent distal femoral varus osteotomy. Methods: A consecutive series of athletic patients that had undergone distal femoral varus osteotomy for symptomatic lateral compartment overload and valgus knee malalignment were prospectively reviewed. All patients had a minimum of 2-year follow-up. Radiographs were assessed to determine pre-operative and post-operative alignment. Details regarding sport of interest, ability to return to sport, and timing of return were obtained from the patients. Prospective institutional registries were utilized to collect pre-operative and post-operative Marx Activity Scale and International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC) scores; these values were compared using paired t-tests with p < 0.05 as the threshold for significance. Results: A total of 13 patients with a mean age of 24 years (range: 17-35) and a mean follow-up of 43 months (range: 24-74) were included in the study. Six patients underwent medial closing wedge osteotomy, and seven patients underwent lateral opening wedge osteotomy. The mean alignment correction was 8 degrees (range: 5-13). Nine patients underwent one or more concomitant procedures at the time of the osteotomy: 6 lateral femoral condyle osteochondral allografts, 2 partial lateral meniscectomies, 1 lateral meniscus allograft transplantation, and 1 revision anterior cruciate ligament reconstruction. All patients were able to successfully return to their sport of choice (4 soccer, 2 softball, 2 running, 1 football, 1 basketball, 1 ice hockey, 1 volleyball, 1 rowing) at a mean of 11 months (range: 9-13). Furthermore, all 13 patients demonstrated an

  14. Differences in Femoral Geometry and Structure Due to Immobilization

    NASA Technical Reports Server (NTRS)

    Kiratli, Beatrice Jenny; Yamada, M.; Smith, A.; Marcus, R. M.; Arnaud, S.; vanderMeulen, M. C. H.; Hargens, Alan R. (Technical Monitor)

    1996-01-01

    Reduction in bone mass of the lower extremity is well documented in individuals with paralysis resulting from spinal cord injury (SCI). The consequent osteopenia leads to elevated fracture risk with fractures occurring more commonly in the femoral shaft and supracondylar regions than the hip. A model has recently been described to estimate geometry and structure of the femoral midshaft from whole body scans by dual X-ray absorptiometry (DXA). Increases in femoral geometric and structural properties during growth were primarily related to mechanical loading as reflected by body mass. In this study, we investigate the relationship between body mass and femoral geometry and structure in adults with normal habitual mechanical loading patterns and those with severely reduced loading. The subjects were 78 ambulatory men (aged 20-72 yrs) and 113 men with complete paralysis from SCI of more than 4 years duration (aged 21 73 yrs). Subregional analysis was performed on DXA whole body scans to obtain bone mineral content (BMC, g), cortical thickness (cm), crosssectional moment of inertia (CSMI, cm4), and section modulus (cm3) of the femoral midshaft. All measured bone variables were significantly lower in SCI compared with ambulatory subjects: -29% (BMC), -33% (cortical thickness), -23% (CSMI), and -22% (section modulus) while body mass was not significantly different. However, the associations between body mass and bone properties were notably different; r2 values were higher for ambulatory than SCI subjects in regressions of body mass on BMC (0.48 vs 0.20), CSMI (0.59 vs 0.32), and section modulus (0.59 vs 0.31). No association was seen between body mass and cortical thickness for either group. The greatest difference between groups is in the femoral cortex, consistent with reduced bone mass via endosteal expansion. The relatively lesser difference in geometric and structural properties implies that there is less effect on mechanical integrity than would be expected from

  15. Nd: Yag laser iridotomy in Shaffer-Etienne grade 1 and 2: angle widening in our case studies

    PubMed Central

    Carlesimo, Sandra Cinzia; Di Santo, Luigi; Bruni, Pietro; Librando, Aloisa; Falace, Antonietta Pompea; Barbato, Andrea

    2015-01-01

    AIM To obtain widening of a potentially occludable angle, in according to Kanski's indications, through preventive Nd:Yag laser iridotomy. The observational study was performed by using gonioscopy for the selection and follow-up of 1165 treated eyes and exploiting Shaffer-Etienne gonioscopic classification as a quality/quantity test of the angle recession. METHODS Between September 2000 and July 2012, 586 patients were selected at the Outpatients' Ophthalmological Clinic of the Policlinico Umberto I of Rome in order to undergo Nd: Yag laser iridotomy. A Goldmann type contact lens, Q-switched mode, 2-3 defocus, and 7-9 mJ intensity with 2-3 impulse discharges were used for surgery. RESULTS From as early as the first week, a whole 360° angle widening were evident in the patients, thus showing the success of Nd:Yag laser iridotomy in solving relative pupil block. The angle remained narrow by 270° in 14 eyes only, despite repetitions of further treatment with laser iridotomy in a different part of the iris, twice in 10 eyes and three times in 4 eyes. CONCLUSION Nd:Yag laser iridotomy revealed itself as being a safe and effective treatment in widening those critical Shaffer-Etienne grade 1 and 2 potentially occludable angles. PMID:26309867

  16. Three-Dimensional Analysis of the Characteristics of the Femoral Canal Isthmus: An Anatomical Study

    PubMed Central

    Su, Xiu-yun; Zhao, Jing-xin; Zhao, Zhe; Zhang, Li-cheng; Li, Chen; Li, Jian-tao; Zhou, Jian-feng; Zhang, Li-hai; Tang, Pei-fu

    2015-01-01

    Purpose. To establish a new approach for measuring and locating the femoral intramedullary canal isthmus in 3-dimensional (3D) space. Methods. Based on the computed tomography data from 204 Chinese patients, 3D models of the whole femur and the corresponding femoral isthmus tube were reconstructed using Mimics software (Materialise, Haasrode, Belgium). The anatomical parameters of the femur and the isthmus, including the femur length and radius, and the isthmus diameter and height, were measured accordingly. Results. The mean ratio of the isthmus height versus the femoral height was 55 ± 4.8%. The mean diameter of the isthmus was 10.49 ± 1.52 mm. The femoral length, the isthmus diameter, and the isthmus tube length were significantly larger in the male group. Significant correlations were observed between the femoral length and the isthmus diameter (r = 0.24, p < 0.01) and between the femoral length and the isthmus height (r = 0.6, p < 0.01). Stepwise linear regression analyses demonstrated that the femoral length and radius were the most important factors influencing the location and dimension of the femoral canal isthmus. Conclusion. The current study developed a new approach for measuring the femoral canal and for optimization of customer-specific femoral implants. PMID:26137483

  17. Simulation of human atherosclerotic femoral plaque tissue: the influence of plaque material model on numerical results

    PubMed Central

    2015-01-01

    Background Due to the limited number of experimental studies that mechanically characterise human atherosclerotic plaque tissue from the femoral arteries, a recent trend has emerged in current literature whereby one set of material data based on aortic plaque tissue is employed to numerically represent diseased femoral artery tissue. This study aims to generate novel vessel-appropriate material models for femoral plaque tissue and assess the influence of using material models based on experimental data generated from aortic plaque testing to represent diseased femoral arterial tissue. Methods Novel material models based on experimental data generated from testing of atherosclerotic femoral artery tissue are developed and a computational analysis of the revascularisation of a quarter model idealised diseased femoral artery from a 90% diameter stenosis to a 10% diameter stenosis is performed using these novel material models. The simulation is also performed using material models based on experimental data obtained from aortic plaque testing in order to examine the effect of employing vessel appropriate material models versus those currently employed in literature to represent femoral plaque tissue. Results Simulations that employ material models based on atherosclerotic aortic tissue exhibit much higher maximum principal stresses within the plaque than simulations that employ material models based on atherosclerotic femoral tissue. Specifically, employing a material model based on calcified aortic tissue, instead of one based on heavily calcified femoral tissue, to represent diseased femoral arterial vessels results in a 487 fold increase in maximum principal stress within the plaque at a depth of 0.8 mm from the lumen. Conclusions Large differences are induced on numerical results as a consequence of employing material models based on aortic plaque, in place of material models based on femoral plaque, to represent a diseased femoral vessel. Due to these large

  18. Long-Duration Spaceflight During the Bion-M1 Spaceflight Experiment Resulted in Significant Bone Loss in the Femoral Head and Alterations in Stem Cell Differentiation Potential in Male Mice

    NASA Astrophysics Data System (ADS)

    Blaber, Elizabeth; Almeida, Eduardo; Grigoryan, Eleonora; Globus, Ruth

    Scientific understanding of the effects of microgravity on mammalian physiology has been limited to short duration spaceflight experiments (10-15 days). As long duration and inter-planetary missions are being initiated, there is a great need to understand the long-term effects of spaceflight on various physiological processes, including stem cell-based tissue regeneration. Bion-M1, for the first time, enabled the possibility of studying the effects of 30-days of microgravity exposure on a mouse model with sufficient sample size to enable statistical analysis. In this experiment, we hypothesized that microgravity negatively impacts stem cell based tissue regeneration, such as bone remodeling and regeneration from hematopoietic and mesenchymal precursors, thereby resulting in tissue degeneration in mice exposed to spaceflight. To test this hypothesis we collected the pelvis and proximal femur from space-flown mice and asynchronous ground controls and analyzed bone and bone marrow using techniques including Microcomputed Tomography (MicroCT), and in-vitro differentiation and differentiating cell motility assays. To determine the effects of 30-days spaceflight on bone tissue mass, we used MicroCT to analyze the trabecular bone of the femoral head and the cortical bone of the femoral neck and mid-shaft. We found that spaceflight caused a 45% decrease in bone volume ratio, a 17% decrease in trabecular thickness, a 25% decrease in trabecular number, and a 17% increase in trabecular spacing of trabecular bone. Furthermore, structural model index and trabecular pattern factor were increased by 32% and 82% respectively indicating that 30-days spaceflight resulted not only in a large loss of trabecular bone but also in a decrease of bone strength indicators. Analysis of the femoral neck cortical bone showed an increase in marrow area and cortical porosity indicating an overall widening of the femoral neck. Interestingly, no significant alterations were found in the cortical

  19. Isolated common femoral artery injury caused by blunt trauma.

    PubMed

    Avaro, J P; Biance, N; Savoie, P H; Peycru, T; Bonnet, P M; Balandraud, P

    2008-01-01

    The authors report an isolated common femoral artery injury caused by blunt trauma with dissection and secondary ischaemia. A 21-year-old man was admitted to hospital after being stabbed during acute alcoholic intoxication. He presented with a stab wound on the left leg and blunt trauma in the right groin. The surgical exploration of the left-sided wound did not disclose any vascular injury. After a 12-hour period of observation, the patient was discharged. Six hours later, he came back with severe ischaemia on the right leg caused by a femoral artery dissection. The patient underwent surgical revascularization, and fully recovered. Isolated artery blunt trauma is a rare event. In this observation, the absence of early symptoms resulted in delayed diagnosis. PMID:19241930

  20. Periprosthetic Femur Fracture Occuring after Contralateral Neglected Femoral Neck Fracture

    PubMed Central

    Cankaya, Deniz; Toprak, Ali; IKilic, Enver; Bingol, Olgun; Tabak, Yalcin

    2016-01-01

    Introduction: Periprosthetic fractures of the femur are uncommon, but at times may lead to complications especially in elderly patients. As treatment of these fractures is difficult, prevention by identifying the risk factors is the best way to overcome these complex problems. Case Report: A periprosthetic right femur fracture associated with a neglected left femoral neck fracture in the contralateral femur in a 78-year-old elder woman patient is reported in the present article. We discuss the prevention of periprosthetic fractures after hip arthroplasty and address the risk factors associated with this complication. Conclusion: The present case emphasizes the importance of investigating and treating the cause of sudden onset of restriction on full weight-bearing in the contralateral limb, to prevent periprosthetic femoral fracture after hip arthroplasty in elderly patients. PMID:27299115

  1. Bilateral Simultaneous Femoral Neck and Shafts Fractures - A Case Report

    PubMed Central

    Sadeghifar, Amirreza; Saied, Alireza

    2014-01-01

    Simultaneous fractures of the femoral neck and shaft are not common injuries, though they cannot be considered rare. Herein, we report our experience with a patient with bilateral occurance of this injury. Up to the best of our knowkedge this is the first case reported in literature in which correct diagnosis was made initially. Both femurs were fixed using broad 4.5 mm dynamic compression plate and both necks were fixed using 6.5 mm cannulated screws. Femur fixation on one side was converted to retrograde nailing because of plate failure. Both neck fractures healed uneventfully. In spite of rarity of concomitant fractures of femoral neck and shaft, this injury must be approached carefully demanding especial attention and careful device selection. PMID:25692158

  2. Hip Arthroscopy for Excision of Osteoid Osteoma of Femoral Neck

    PubMed Central

    Said, Hatem Galal; Abdulla Babaqi, AbdulRahman; AbdelSalam El-Assal, Maher

    2014-01-01

    Osteoid osteoma (OO) is the most commonly seen benign bone-forming lesion. It can occur anywhere, including the metaphyseal regions of small and large bones. We present 2 cases that underwent an arthroscopic technique for removal of OO of the femoral neck. The diagnosis was confirmed by computed tomography in addition to magnetic resonance imaging. The lesions were accessed arthroscopically and excised by unroofing and curettage. The clinical and radiographic findings are presented, along with the surgical management. The patients improved dramatically postoperatively. OO of the femoral neck should be included in the differential diagnosis of hip pain in young patients. Arthroscopic excision and curettage provide a good choice for management, with low morbidity and rapid recovery. PMID:24749036

  3. Confronting Hip Resurfacing and Big Femoral Head Replacement Gait Analysis

    PubMed Central

    Karampinas, Panagiotis K.; Evangelopoulos, Dimitrios S.; Vlamis, John; Nikolopoulos, Konstantinos; Korres, Dimitrios S.

    2014-01-01

    Improved hip kinematics and bone preservation have been reported after resurfacing total hip replacement (THRS). On the other hand, hip kinematics with standard total hip replacement (THR) is optimized with large diameter femoral heads (BFH-THR). The purpose of this study is to evaluate the functional outcomes of THRS and BFH-THR and correlate these results to bone preservation or the large femoral heads. Thirty-one patients were included in the study. Gait speed, postural balance, proprioception and overall performance. Our results demonstrated a non-statistically significant improvement in gait, postural balance and proprioception in the THRS confronting to BFH-THR group. THRS provide identical outcomes to traditional BFH-THR. The THRS choice as bone preserving procedure in younger patients is still to be evaluated. PMID:24744841

  4. Osteochondral Fractures of the Lateral Femoral Trochlea in Young Athletes

    PubMed Central

    Walsh, Stewart

    2016-01-01

    Method: Between May 2012 and September 2014 cluster of five patients with large osteochondral fractures of the lateral femoral trochlea were treated at our institution. These all occurred in high level male athletes, one at a decathlete and the other four soccer players. The MRI scan showed a characteristic appearance of a large subchondral fracture involving most of the lateral femoral trochlea. All patients were symptomatic. The patients were treated with open reduction and internal fixation using headless compression screws. The operative technique and short term results will be outlined. Results: Fixation appears successful in most cases. Conclusion: This appears to be a repetitive trauma related injury that occurs in young high-level athletes.

  5. Extracorporeal shockwave therapy for avascular necrosis of femoral head.

    PubMed

    Wang, Ching-Jen; Cheng, Jai-Hong; Huang, Chung-Cheng; Yip, Han-Kan; Russo, Sergio

    2015-12-01

    The etiology of osteonecrosis of the femoral head (ONFH) is multifactorial. Treatment of ONFH is disease stage dependent. For early stages, femoral head preservation procedures are preferred including core decompression, muscle pedicle grafting and de-rotational osteotomy. Core decompression with bone grafting is considered the gold standard. However, the results are inconsistence and unpredictable. An effective non-invasive method of treatment is imperative. Recently, extracorporeal shockwave therapy (ESWT) has shown beneficial effects in ONFH. ESWT improves pain and function of the hip and regression of the ONFH lesion. ESWT is more effective than core decompression with or without bone grafting, cocktail therapy that combined HBO, ESWT and oral alendronate is shown effective for patients with early osteonecrosis. The purpose of the article is to review, update and summarize the clinical treatment of ONFH using shockwave therapy. PMID:26188081

  6. PROXIMAL FEMORAL EPIPHYSIOLYSIS AND SUBCLINICAL HYPOTHYROIDISM: CASE REPORT

    PubMed Central

    de Mello, Grasiele Correa; Grossi, Gabriela; Coelho, Sílvio Pereira

    2015-01-01

    Proximal femoral epiphysiolysis is an orthopedic disease that is prevalent during adolescence, because this coincides with the time of greatest growth of osteomuscular structures. Curiously, some patients present this disease early, and this outcome converts to the possible etiological explanation that the slippage might occur through a growth spurt. For these patients, the genesis of the slippage has not yet been elucidated, but endocrine disorders have been noted as possible causes. In an attempt to strengthen the theory of endocrinological etiology and present the results from surgical treatment for this pathological condition, the case of a male patient aged 9 years and 3 months with proximal femoral epiphysiolysis and subclinical hypothyroidism who was diagnosed and treated at our university's teaching hospital is reported here. PMID:27047883

  7. A Case of Femoral Fracture in Klippel Trenaunay Syndrome

    PubMed Central

    Nahas, Sam; Wong, Fabian; Back, Diane

    2014-01-01

    We present a case of Klippel Trenaunay syndrome (KTS) who presented with severe bilateral knee osteoarthritis (OA). Preoperative planning was commenced for a total knee replacement (TKR). Whilst on the waiting list the patient suffered a fall and sustained a complete femoral diaphysis fracture. Conservative management in the form of skin traction was initially chosen as significant extra- and intramedullary vascular malformations posed an increased risk of perioperative bleeding. This failed to progress to union, and so open reduction and internal fixation was performed. This subsequently resulted in on-going delayed union, which was subsequently managed with low intensity pulsed ultrasound (LIPUS, otherwise known as Exogen (Bioventus. exogen. Secondary exogen, 2012)). There are only two previous documented cases of femoral fracture in KTS. This is the first report of a patient with this rare syndrome receiving this treatment. We discuss the management of fracture in this challenging group of patients. PMID:25478269

  8. Osteomyelitis of Bilateral Femoral Heads After Childbirth: A Case Report

    PubMed Central

    Lee, Kyung Soo; Kong, Sangwon; Kim, Junho; Kim, Taikon; Choi, Chan Beom; Kim, Yee-Suk

    2015-01-01

    Hip and pelvic pain during pregnancy or after delivery is a common problem in young females, and in most cases this problem has a self-limiting course. The patient described in this case suffered from severe hip pain after childbirth. MR imaging study was performed and it showed arthritis of bilateral hip joints and osteomyelitis of femoral heads with an abscess in the surrounding muscle. Infection, such as septic arthritis or osteomyelitis, is an extremely rare cause of peripartum joint pain. The patient's clinical symptoms and laboratory findings improved with antibiotic therapy. However, limitation of motion of the bilateral hip joints persisted although the patient continued rehabilitative therapy for 15 months, and the patient had to undergo bilateral total hip replacement. Hereby, we present a case of severe osteomyelitis and pyogenic arthritis of bilateral femoral heads and hip joints after delivery, which eventually required bilateral total hip replacement. PMID:26161359

  9. [Treatment of early stage avascular necrosis of the femoral head].

    PubMed

    Zhu, He-Yu; Zhu, Bing

    2012-07-01

    Avascular necrosis is a progressively devastating disease and primarily affects weight-bearing joints. The hip is the most commonly affected joint. In early stage, nonoperative (including pharmacologic intervention and biophysical treatments) and operative modalities for protecting hip joint have become the main therapeutic methods. However there is still no satisfied mothod with reasonable effect. According to the treatment of the avascular necrosis of the femoral head of the pre-collapse stage, core decompression with modification of technique is still one of the safest and most commonly employed procedures. Recently there have been attempts to enhance the effect of core decompression with use of various growth and differentiation factors. Which is the hot spot of current research. Early diagnosis is the key to the treatment of the avascular necrosis of the femoral head. Comprehensive treatment which is based on the core decompression is still the main treatment of today. PMID:23116002

  10. Computer assisted measurement of femoral cortex thickening on radiographs

    NASA Astrophysics Data System (ADS)

    Yao, Jianhua; Liu, Yixun; Chen, Foster; Summers, Ronald M.; Bhattacharyya, Timothy

    2013-03-01

    Radiographic features such as femoral cortex thickening have been frequently observed with atypical subtrochanteric fractures. These features may be a valuable finding to help prevent fractures before they happen. The current practice of manual measurement is often subjective and inconsistent. We developed a semi-automatic tool to consistently measure and monitor the progress of femoral cortex thickening on radiographs. By placing two seed points on each side of the femur, the program automatically extracts the periosteal and endosteal layers of the cortical shell by active contour models and B-spline fitting. Several measurements are taken along the femur shaft, including shaft diameter, cortical thickness, and integral area for medial and lateral cortex. The experiment was conducted on 52 patient datasets. The semi-automatic measurements were validated against manual measurements on 52 patients and demonstrated great improvement in consistency and accuracy (p<0.001).

  11. Hydrocele of Femoral Hernial Sac-an Extremely Rare Case.

    PubMed

    Madhivanan, S; Jain, Ravindra Kumar

    2016-06-01

    A previously healthy 40-year-old woman presented with a right groin swelling for the last 2 years. Diagnosed preoperatively as uncomplicated, irreducible epiplocele of right femoral hernia, later per-operatively was diagnosed as hydrocele of femoral hernial sac also known as "femorocele"; ultrasound abdomen and groin demonstrated as a cystic mass right groin with no precise origin. All other basic line investigations within normal limits, except anemia 7 gm %, corrected to 10 gm %, by preoperative transfusions of 2 units of complete fresh blood. After low approach incision, excision of hydrocele sac, and feormal hernia repair were done with approximation of iliopectineal ligament to inguinal ligament, patient was discharged on 5th postoperative day with satisfactory wound healing and uneventful hospitalization. PMID:27358521

  12. Development of phantom limb pain after femoral nerve block.

    PubMed

    Siddiqui, Sadiah; Sifonios, Anthony N; Le, Vanny; Martinez, Marc E; Eloy, Jean D; Kaufman, Andrew G

    2014-01-01

    Historically, phantom limb pain (PLP) develops in 50-80% of amputees and may arise within days following an amputation for reasons presently not well understood. Our case involves a 29-year-old male with previous surgical amputation who develops PLP after the performance of a femoral nerve block. Although there have been documented cases of reactivation of PLP in amputees after neuraxial technique, there have been no reported events associated with femoral nerve blockade. We base our discussion on the theory that symptoms of phantom limb pain are of neuropathic origin and attempt to elaborate the link between regional anesthesia and PLP. Further investigation and understanding of PLP itself will hopefully uncover a relationship between peripheral nerve blocks targeting an affected limb and the subsequent development of this phenomenon, allowing physicians to take appropriate steps in prevention and treatment. PMID:24872817

  13. Femoral neck erosions: sign of hip joint synovial disease

    SciTech Connect

    Goldberg, R.P.; Weissman, B.N.; Naimark, A.

    1983-07-01

    Pathologic synovial processes in the hip joint can cause characteristic extrinsic erosions of the femoral neck, which in extreme cases produce an ''apple core'' appearance. Nine such cases of synovial diseases, including synovial osteochondromatosis, pigmented villonodular synovitis, rheumatoid arthritis, and amyloidosis, that demonstrate this radiographic finding are presented. The anatomic relations of the hip joint that result in theis appearance, differential diagnosis, and radiographic techniques useful in diagnosis are discussed.

  14. Femoral neck non-union treatment by valgus intertrochanteric osteotomy

    PubMed Central

    Schwartsmann, Carlos Roberto; Spinelli, Leandro de Freitas; Yépez, Anthony Kerbes; Boschin, Leonardo Carbonera; Silva, Marcelo Faria

    2015-01-01

    ABSTRACT OBJECTIVE : The purpose of this study was to evaluate the performance of valgus intertrochanteric osteotomy in femoral neck non-union. METHODS : Forty-two patients with femoral neck fractures with non-union treated using Pauwels' intertrochanteric osteotomy were reviewed. Demographics, time elapsed between fracture and surgery, follow--up, osteosynthesis used, Garden's classification, limb shortening, and x-rays were evaluated. RESULTS : Twenty-two men and 20 women were reviewed. The youngest patient was 18 years old and the oldest 65 years old, with a mean age of 42.4 years (±11.2). The minimum follow-up was 2 years, with a mean of 10.2 years. The average time elapsed between initial fracture and osteotomy was 6.5 months. Twel-ve cases were neglected femoral neck fractures. Nineteen patients were classified as Garden III, and 23 patients as Garden IV. After valgus osteotomy, non-union healing was observed in 38 patients (38/42; 90.4%). Healing of thirty-seven cases of pseudoarthrosis were obtained after the first-attempt osteotomy, and one case required two operations for healing. The osteotomy failed in four cases. Conside-ring the healed osteotomies, good to excellent functional results were achieved in 80.9% (34/42) of the patients. Total hip replacement was subsequently performed in 14.2% (6/42) of the patients for unfavoura-ble outcomes (two for cutting out, two for osteonecrosis, and two for osteoarthritis). CONCLUSIONS : Valgus intertrochanteric osteotomy has a high success rate in archiving healing in femoral neck non-union with good functional results. It is a biological and effective method. Level of Evidence IV, Therapeutic Study. PMID:27057146

  15. Robotic assisted reduction of femoral shaft fractures using Stewart platform.

    PubMed

    Majidifakhr, Kamran; Kazemirad, Siavash; Farahmand, Farzam

    2009-01-01

    A robotic system with 6 DOF mobility was proposed for reduction of femoral shaft fractures based on Stewart platform. A plan for implementing the platform on bone fragments was introduced and a step by step strategy for performing the reduction procedure, based on the system's inverse kinematic solution, was proposed. The efficacy of the system was evaluated in some case studies and it was shown that it can be locked to act as an external fixator. PMID:19377143

  16. Pathogenesis, Management and Prevention of Atypical Femoral Fractures

    PubMed Central

    Jeong, Seung-Hyo

    2015-01-01

    Much attention has been paid to the relationship between atypical femoral fractures (AFF) and use of bisphosphonates (BPs). While a significant cause-effect relationship was not established in earlier studies, more recent data shows a growing relationship between AFF and BPs use. The definition of an 'AFF' has also undergone significant changes. This review briefly summarizes the definition, pathogenesis, and management of AFF. PMID:25774358

  17. Femoral prosthesis subsidence in asymptomatic patients. A stereophotogrammetric assessment.

    PubMed

    Chafetz, N; Baumrind, S; Murray, W R; Genant, H K

    1984-01-01

    A radiographic stereophotogrammetric technique (SPG) was used to evaluate quantitatively the presence of early femoral prosthesis subsidence after total hip arthroplasty (THA). This paper focuses on the measurement of subsidence in 12 patients who remained asymptomatic during the first two years after surgery. Only one of these had SPG estimated subsidence in excess of one millimeter at any timepoint. These findings are consistent with the conclusion that early postoperative subsidence is not a common finding among asymptomatic THA patients. PMID:6469528

  18. Endovascular Treatment of Complications of Femoral Arterial Access

    SciTech Connect

    Tsetis, Dimitrios

    2010-06-15

    Endovascular repair of femoral arterial access complications is nowadays the treatment of choice in a group of patients who cannot tolerate vascular reconstruction and bleeding due to advanced cardiovascular disease. Endovascular procedures can be performed under local anesthesia, are well tolerated by the patient, and are associated with a short hospitalization time. Ninitinol stent technology allows for safe stent and stent-graft extension at the common femoral artery (CFA) level, due to increased resistance to external compression and bending stress. Active pelvic bleeding can be insidious, and prompt placement of a stent-graft at the site of leakage is a lifesaving procedure. Percutaneous thrombin injection under US guidance is the treatment of choice for femoral pseudoaneurysms (PAs); this can theoretically be safer with simultaneous balloon occlusion across the entry site of a PA without a neck or with a short and wide neck. In a few cases with thrombin failure due to a large arterial defect or accompanying arteriovenous fistula (AVF), a stent-graft can be deployed. The vast majority of catheter-induced AVFs can be treated effectively with stent-graft implantation even if they are located very close to the femoral bifurcation. Obstructive dissection flaps localized in the CFA are usually treated with prolonged balloon inflation; however, in more extensive dissections involving iliac arteries, self-expanding stents should be deployed. Iliofemoral thrombosis can be treated effectively with catheter-directed thrombolysis (CDT) followed by prolonged balloon inflation or stent placement. Balloon angioplasty and CDT can occasionally be used to treat stenoses and occlusions complicating the use of percutaneous closure devices.

  19. Cortical bone distribution in the femoral neck of strepsirhine primates.

    PubMed

    Demes, B; Jungers, W L; Walker, C

    2000-10-01

    The thickness of the inferior and superior cortices of the femoral neck was measured on X-rays of 181 strepsirhine primate femora representing 24 species. Neck length, neck depth and neck-shaft angle were also measured. The strength of the femoral neck in frontal bending was estimated by modeling the neck as a hollow cylinder, with neck depth as the outer diameter and cortical thickness representing the superior and inferior shell dimensions. Results indicate that the inferior cortex is always thicker than the superior cortex. The ratio of superior to inferior cortical thickness is highly variable but distinguishes two of the three locomotor groups in the sample. Vertical clingers and leapers have higher ratios (i.e., a more even distribution of cortical bone) than quadrupeds. The slow climbers tend to have the lowest ratios, although they do not differ significantly from the leapers and quadrupeds. These results do not confirm prior theoretical expectations and reported data for anthropoid primates that link greater asymmetry of the cortical shell to more stereotypical hip excursions. The ratio of superior to inferior cortical thickness is unrelated to body mass, femoral neck length, and neck-shaft angle, calling into question whether the short neck of strepsirhine primates acts as a cantilever beam in bending. On the other hand, the estimated section moduli are highly correlated with body mass and neck length, a correlation that is driven primarily by body mass. In conclusion, we believe that an alternative interpretation to the cantilever beam model is needed to explain the asymmetry in bone distribution in the femoral neck, at least in strepsirhine primates (e.g., a thicker inferior cortex is required to reinforce the strongly curved inferior surface). As in prior studies of cross-sectional geometry of long bones, we found slightly positive allometry of cortical dimensions with body mass. PMID:11006046

  20. Left behind: widening disparities for males and females in US county life expectancy, 1985–2010

    PubMed Central

    2013-01-01

    . Conclusions The reduction in the number of counties where female life expectancy at birth is declining in the most recent period is welcome news. However, the widening disparities between counties and the slow rate of increase compared to other countries should be viewed as a call for action. An increased focus on factors affecting health outcomes, morbidity, and mortality such as socioeconomic factors, difficulty of access to and poor quality of health care, and behavioral, environmental, and metabolic risk factors is urgently required. PMID:23842281

  1. Widening Rural-Urban Disparities in Youth Suicides, United States, 1996-2010

    PubMed Central

    Fontanella, Cynthia A.; Hiance-Steelesmith, Danielle L.; Phillips, Gary S.; Bridge, Jeffrey A.; Lester, Natalie; Sweeney, Helen Anne; Campo, John V.

    2015-01-01

    IMPORTANCE Little is known about recent trends in rural-urban disparities in youth suicide, particularly sex- and method-specific changes. Documenting the extent of these disparities is critical for the development of policies and programs aimed at eliminating geographic disparities. OBJECTIVE To examine trends in US suicide mortality for adolescents and young adults across the rural-urban continuum. DESIGN, SETTING, AND PARTICIPANTS Longitudinal trends in suicide rates by rural and urban areas between January 1, 1996, and December 31, 2010, were analyzed using county-level national mortality data linked to a rural-urban continuum measure that classified all 3141 counties in the United States into distinct groups based on population size and adjacency to metropolitan areas. The population included all suicide decedents aged 10 to 24 years. MAIN OUTCOMES AND MEASURES Rates of suicide per 100 000 persons. RESULTS Across the study period, 66 595 youths died by suicide, and rural suicide rates were nearly double those of urban areas for both males (19.93 and 10.31 per 100 000, respectively) and females (4.40 and 2.39 per 100 000, respectively). Even after controlling for a wide array of county-level variables, rural-urban suicide differentials increased over time for males, suggesting widening rural-urban disparities (1996-1998: adjusted incidence rate ratio [IRR], 0.98; 2008-2010: adjusted IRR, 1.19; difference in IRR, P = .02). Firearm suicide rates declined, and the rates of hanging/suffocation for both males and females increased. However, the rates of suicide by firearm (males: 1996-1998, 2.05; and 2008-2010: 2.69 times higher) and hanging/suffocation (males: 1996-1998, 1.24; and 2008-2010: 1.63 times higher) were disproportionately higher in rural areas, and rural-urban differences increased over time (P = .002 for males; P = .06 for females). CONCLUSIONS AND RELEVANCE Suicide rates for adolescents and young adults are higher in rural than in urban communities

  2. Widening of normal fault zones due to the inhibition of vertical propagation

    NASA Astrophysics Data System (ADS)

    Roche, Vincent; Homberg, Catherine; van der Baan, Mirko; Rocher, Muriel

    2015-04-01

    Fault zones structures are the result of a progressive development and are largely controlled by fault geometry inherited from the early stage of faulting. In this paper, we document this early stage, based on detailed observations on mesocale faults in layered rocks in two outcrops. Study includes analyses of fault structures, along-planes displacement profiles, and far-field displacement profiles. This last profile take into account the total strain induced by fault zones including folding and segmentation. The vertical propagation of the studied faults is stopped by layer-parallel faults. This restriction involves a flat-topped displacement profile along the fault plane. Far from the restricted tip, fault structures correspond to simple planar slip surfaces exhibiting dip refraction due to layering. Near the restricted tips, their structures range from planar structures to complex fault zone characterized by abundant parallel fault segment. In one site, fault-related folding also occurs at the fault tips. Unlike the segmentation, fault-related folding is not restricted by the layer-parallel fault. Far-field displacement profiles have therefore flat topped shape along the restricted faults exhibiting segmentation, whereas profiles become more triangular when folding take place. Based on the observations, we developed a model of fault zone evolution in which the complexities and the width of fault zone are inherited during the fault restriction period. In this model fault propagation alternates between periods of vertical restriction and vertical propagation. In the course of restriction, faults form first as simple isolated planar structures, then, fault zone complexity, specifically the number of sub parallel segments, increases to accommodate increasing strain. Eventually the fault should finally propagate through the layer-parallel faults with a complex geometry. This model implies that fault widening is controlled by the fault capacity to propagate vertically

  3. An Advanced Quantitative Echosound Methodology for Femoral Neck Densitometry.

    PubMed

    Casciaro, Sergio; Peccarisi, Marco; Pisani, Paola; Franchini, Roberto; Greco, Antonio; De Marco, Tommaso; Grimaldi, Antonella; Quarta, Laura; Quarta, Eugenio; Muratore, Maruizio; Conversano, Francesco

    2016-06-01

    The aim of this paper was to investigate the clinical feasibility and the accuracy in femoral neck densitometry of the Osteoporosis Score (O.S.), an ultrasound (US) parameter for osteoporosis diagnosis that has been recently introduced for lumbar spine applications. A total of 377 female patients (aged 61-70 y) underwent both a femoral dual X-ray absorptiometry (DXA) and an echographic scan of the proximal femur. Recruited patients were sub-divided into a reference database used for ultrasound spectral model construction and a study population for repeatability assessments and accuracy evaluations. Echographic images and radiofrequency signals were analyzed through a fully automatic algorithm that performed a series of combined spectral and statistical analyses, providing as a final output the O.S. value of the femoral neck. Assuming DXA as a gold standard reference, the accuracy of O.S.-based diagnoses resulted 94.7%, with k = 0.898 (p < 0.0001). Significant correlations were also found between O.S.-estimated bone mineral density and corresponding DXA values, with r(2) up to 0.79 and root mean square error = 5.9-7.4%. The reported accuracy levels, combined with the proven ease of use and very good measurement repeatability, provide the adopted method with a potential for clinical routine application in osteoporosis diagnosis. PMID:27033331

  4. Hip replacement in femoral head osteonecrosis: current concepts

    PubMed Central

    Scaglione, Michelangelo; Fabbri, Luca; Celli, Fabio; Casella, Francesco; Guido, Giulio

    2015-01-01

    Summary Osteonecrosis of the femoral head is a destructive disease that usually affects young adults with high functional demands and can have devastating effects on hip joint. The treatment depends on extent and location of the necrosis lesion and on patient’s factors, that suggest disease progression, collapse probability and also implants survival. Non-idiopathic osteonecrosis patients had the worst outcome. There is not a gold standard treatment and frequently it is necessary a multidisciplinary approach. Preservation procedures of the femoral head are the first choice and can be attempted in younger patients without head collapse. Replacement procedure remains the main treatment after failure of preserving procedures and in the late-stage ONFH, involving collapse of the femoral head and degenerative changes to the acetabulum. Resurfacing procedure still has good results but the patient selection is a critical factor. Total hip arthroplasties had historically poor results in patients with osteonecrosis. More recently, reports have shown excellent results, but implant longevity and following revisions are still outstanding problems. PMID:27134633

  5. Natural frequency analysis of osseointegration for trans-femoral implant.

    PubMed

    Shao, F; Xu, W; Crocombe, A; Ewins, D

    2007-05-01

    Osseointegration trans-femoral implants are a new orthopaedic anchoring method to attach prosthetic limbs. The clinical success of this promising technique depends on the effectiveness of osseointegration achieved after implantation. The aim of this study is to use the resonant characteristics of the implant system to determine the changes in stability as a reflection of boundary condition of the implant. With a small mechanical excitation, Vibration responses of the trans-femoral implant to a small mechanical excitation were measured using an accelerometer and the vibration signal was analyzed using Fast Fourier Transform (FFT) software to obtain the fundamental natural frequency (NF) of the implant system. In-vitro study was conducted using different silicone rubbers to simulate the interface condition. The result showed that a high NF corresponded to a high elastic modulus of the interface material between the implant and bone. A preliminary in-vivo study with one osseointegration trans-femoral implant patient showed that there was a decrease of NF after initial weight bearing rehabilitation. After continued weight bearing, the NF gradually returned to the pre-loading level at around day 24 and the general trend of the NF reached a stable state 38 days after the first weight bearing exercise. PMID:17377843

  6. The suitability of the femoral vein for permanent vascular access.

    PubMed

    Pecorari, M

    2004-01-01

    In our dialysis unit, we commonly position permanent catheters (the Tesio twin catheter) in femoral veins with 'high' exit sites, in the abdominal area. We prefer this method because of its intrinsic safety in patients immediately requiring hemodialysis (HD), because there is no need for ultrasound guidance and a low incidence of complications during and after positioning. In addition, we consider that this method is suitable for older patients without good native vessels for an arteriovenous fistula (AVF). Sixty-nine femoral catheters were positioned in 61 patients (mean age 70.8 yrs): 307 observational months/patients (mean duration 4.45 months) demonstrated the following results: a) no incidents during catheter positioning; b) four iliac-femoral thromboses (in three cases complete recanalization with heparin treatment); c) two catheters were removed due to an infection of the tunnel; d) no generalized, life-threatening sepsis. Therefore, we recommend this solution as a 'bridge-access' between the immediate need for HD and the successive best strategy for the treatment of end-stage renal disease (ESRD). PMID:16596552

  7. Variations in treatment of femoral neck fractures in Alberta

    PubMed Central

    Cree, Marilyn; Yang, Qian; Scharfenberger, Angela; Johnson, David; Carrière, K.C.

    2002-01-01

    Objectives To examine, in the province of Alberta, temporal trends, regional variations in treatment options and in-hospital death rates after a femoral neck fracture. Design A retrospective cohort study. Patients Six years’ data were abstracted from the Alberta Morbidity File, the Alberta Health Stakeholder File and the Alberta Health Care Claims File. Patients were included if they were Alberta residents, aged 65 years or older, had sustained a femoral neck fracture and had undergone internal fixation, hemiarthroplasty or total hip arthroplasty. Main outcome measures Death rates, arthroplasty rates and hospital stay. Results In-hospital death rates were similar across hospitals, with risks being higher for men, patients aged 80 years or older and those with more comorbid conditions. Arthroplasty rates varied from 58% to 77% among hospitals, and hospital stays associated with arthroplasty were significantly longer than those associated with internal fixation. The chance of undergoing arthroplasty varied from hospital to hospital by gender and by the number of comorbid conditions. Conclusion Regional variations suggest lack of agreement among Alberta’s surgeons as to how best to treat femoral neck fractures. PMID:12174977

  8. Necrosis of the femoral head after kidney transplantation.

    PubMed

    Lausten, G S; Lemser, T; Jensen, P K; Egfjord, M

    1998-12-01

    We reviewed the medical records of 750 patients (445 men, 305 women), who had received a kidney transplant during the period 1968-1995, for any sign of necrosis of the femoral head. For post-operative immunosuppression, 374 patients had received high-dose corticosteroids (average 12.5 g during the first year post-operatively), while 376 patients had received low-dose corticosteroids (average 6.5 g during the first year post-operatively) and cyclosporin A. Survival curves according to Kaplan and Meier (J Am Stat Ass 1958: 53: 457-481) were constructed. In the high-dose steroid group, 42/374 patients (11.2%) developed femoral head necrosis, at an average of 26.2 months post-transplantation. In the low-dose steroid group, only 19/376 (5.1%) patients developed this complication, at an average of 20.5 months post-transplantation. This difference in numbers of femoral head necroses was highly significant (p < 0.005). We conclude that steroid doses should be minimized whenever feasible in post-transplant immunosuppression therapy. PMID:9850453

  9. Patient doses in abdominal aortogram and aorta femoral runoff examinations.

    PubMed

    Chu, R Y; Parry, C; Thompson, W; Loeffler, C

    1998-11-01

    Radiation doses to adult male patients from abdominal aortogram and aorta femoral runoff examinations in a medical center were determined with the help of a dose-area product meter. The abdominal aortogram and aorta femoral runoff examination consisted of scout radiographs, fluoroscopy (to position a catheter near the area of interest), and serial films (to record the flow of contrast media). Measurements were converted to effective doses with the help of published results from Monte Carlo simulation calculations. Data from 19 male adult patients weighing 53 to 86 kg were analyzed. The resulting total effective dose had a value of 14.0 +/- 4A mSv (mean and standard deviation). The percent contribution by fluoroscopy was 18.5 +/- 9.9%. The fluoroscopy effective dose had a stronger correlation with the dose-area product (correlation coefficient of 0.97) than with duration of exposure (correlation coefficient of 0.84). Most of the radiation exposure in the observed abdominal aortogram and aorta femoral runoff examination was attributed to radiography. PMID:9790557

  10. Large diameter femoral heads: is bigger always better?

    PubMed

    Cooper, H J; Della Valle, C J

    2014-11-01

    Dislocation remains among the most common complications of, and reasons for, revision of both primary and revision total hip replacements (THR). Hence, there is great interest in maximising stability to prevent this complication. Head size has been recognised to have a strong influence on the risk of dislocation post-operatively. As femoral head size increases, stability is augmented, secondary to an increase in impingement-free range of movement. Larger head sizes also greatly increase the 'jump distance' required for the head to dislocate in an appropriately positioned cup. Level-one studies support the use of larger diameter heads as they decrease the risk of dislocation following primary and revision THR. Highly cross-linked polyethylene has allowed us to increase femoral head size, without a marked increase in wear. However, the thin polyethylene liners necessary to accommodate larger heads may increase the risk of liner fracture and larger heads have also been implicated in causing soft-tissue impingement resulting in groin pain. Larger diameter heads also impart larger forces on the femoral trunnion, which may contribute to corrosion, metal release, and adverse local tissue reactions. Alternative large bearings including large ceramic heads and dual mobility bearings may mitigate some of these risks, and several of these devices have been used with clinical success. PMID:25381403

  11. Femoral head viability following hip fracture. Prognostic role of radionuclide bone imaging

    SciTech Connect

    Drane, W.E.; Rudd, T.G.

    1985-03-01

    A retrospective study was made of all radionuclide (RN) bone images performed at our institution over a two-year period to evaluate femoral head viability after nonpathologic fracture of the femoral neck. Twelve patients had avascular femoral heads during the perioperative period, of which nine had adequate follow-up. Seven of these nine patients had follow-up bone images. Revascularization occurred in four patients, while three had persistent absence of femoral head uptake. With clinical follow-up ranging from four to 29 months (median: 14 months), only two of these nine patients developed clinical or radiographic evidence of osteonecrosis. RN bone imaging performed in the perioperative period does not reliably predict the development of post-traumatic osteonecrosis of the femoral head and, at present, should not be used to determine prospectively method of treatment of femoral neck fracture.

  12. Comparison of vertebral and femoral bone mineral density in adult females

    PubMed Central

    Choe, Han Seong; Lee, Jae Hong; Min, Dong Ki; Shin, So Hong

    2016-01-01

    [Purpose] This study assessed vertebral and femoral bone mineral density in adult females. [Subjects and Methods] A total of 314 females in their 40s to 70s were divided into normal, osteopenia, and osteoporosis groups and their vertebral and femoral bone mineral densities were compared. [Results] Comparisons of T scores revealed significant differences among measurements of the third lumbar vertebra, femoral neck, Ward’s triangle, and femoral trochanter. Pearson correlation coefficients were used to assess differences between the vertebral and femoral measurements, and significant differences and positive correlations were observed among third lumbar vertebra, femoral neck, Ward’s triangle, and femur trochanter in the normal group. [Conclusion] Females in the normal, osteopenia, and osteoporosis groups showed significant differences in their third lumbar vertebrae. The lack of significant differences among measurements in the osteoporosis group in this study suggests that patients with osteoporosis require careful and accurate diagnosis. PMID:27390449

  13. Perthes’ disease and femoroacetabular impingement in a child with proximal femoral focal deficiency

    PubMed Central

    Pun, Terence; Stokes, Oliver M; Chow, Wang; To, Michael

    2012-01-01

    A girl with known proximal femoral focal deficiency presented with Perthes’ disease at 5 years of age. Her treatment involved a Salter osteotomy. This in conjunction with articular incongruence, due to deformity of the femoral head, resulted in mixed type femoroacetabular impingement when she was 10 years old. Surgical hip dislocation and femoral neck osteochondroplasty successfully relieved her symptoms of impingement. This is the first reported case of Perthes’ disease in a patient with proximal femoral focal deficiency. The case highlights the importance of thoroughly investigating pain in patients with proximal femoral focal deficiency, a condition which is normally painless. Timely diagnosis of Perthes’ disease and containment procedures can prevent collapse of the femoral head and the resultant sequelae. Acetabular over-coverage should be avoided in pelvic osteotomy to prevent the development of femoroacetabular impingement. PMID:23148394

  14. Comparison of vertebral and femoral bone mineral density in adult females.

    PubMed

    Choe, Han Seong; Lee, Jae Hong; Min, Dong Ki; Shin, So Hong

    2016-06-01

    [Purpose] This study assessed vertebral and femoral bone mineral density in adult females. [Subjects and Methods] A total of 314 females in their 40s to 70s were divided into normal, osteopenia, and osteoporosis groups and their vertebral and femoral bone mineral densities were compared. [Results] Comparisons of T scores revealed significant differences among measurements of the third lumbar vertebra, femoral neck, Ward's triangle, and femoral trochanter. Pearson correlation coefficients were used to assess differences between the vertebral and femoral measurements, and significant differences and positive correlations were observed among third lumbar vertebra, femoral neck, Ward's triangle, and femur trochanter in the normal group. [Conclusion] Females in the normal, osteopenia, and osteoporosis groups showed significant differences in their third lumbar vertebrae. The lack of significant differences among measurements in the osteoporosis group in this study suggests that patients with osteoporosis require careful and accurate diagnosis. PMID:27390449

  15. Atypical femoral fractures bilaterally in a patient receiving bisphosphonate: a case report

    PubMed Central

    Moghnie, Alessandro; Scamacca, Veronica; De Fabrizio, Giovanni; Valentini, Roberto

    2016-01-01

    Summary Atypical femoral fractures are often associated with prolonged bisphosphonate use. The American Society for Bone and Mineral Research (ASBMR) has set the diagnosis criteria for atypical subtrochanteric and diaphyseal femoral fractures by classifying them according to their major and minor criteria. Prolonged bisphosphonate use is correlated with AFF, but the pathogenetic mechanism that causes this kind of fracture has not been defined yet. We describe simultaneous bilaterally femoral fractures in a 76-year-old woman. PMID:27252749

  16. A low-energy femoral shaft fracture from performing a yoga posture.

    PubMed

    Moriarity, Andrew; Ellanti, Prasad; Hogan, Niall

    2015-01-01

    The femoral shaft is rarely the site of a low-energy fracture in a healthy individual. The vast majority of these fractures are due to major trauma such as motor vehicle accidents. Although low-energy femoral shaft fractures do occur, they are typically in patients with osteoporotic bone, or prosthesis related. In this case report, we present a man in his late 30s who was practising a specific yoga stance when he experienced a femoral shaft fracture. PMID:26452743

  17. Use of an anatomic long-stemmed component in femoral impaction grafting.

    PubMed

    Westerman, Richard W; Timperley, Andrew J

    2016-01-01

    We describe a challenging femoral revision for aseptic loosening in a relatively young and active man. The femur had gross osteolysis, an absent calcar and a cortical diaphyseal defect at the level of the isthmus (Paprosky 3b defect). The cortical defects were repaired and the whole femur then restored with Femoral Impaction Grafting (FIG) using custom-made impaction instruments and an anatomic shaped collarless, polished, tapered femoral component.In the active adult, bone restoring revision techniques such as impaction grafting should be considered to give a realistic prospect of host bone augmentation rather than simply aiming for a distally fixed stem in a patulous femoral canal. PMID:26692247

  18. Periprosthetic Atypical Femoral Fracture-like Fracture after Hip Arthroplasty: A Report of Three Cases.

    PubMed

    Lee, Kyung-Jae; Min, Byung-Woo; Jang, Hyung-Kyu; Ye, Hee-Uk; Lim, Kyung-Hwan

    2015-09-01

    Atypical femoral fractures are stress or insufficient fractures induced by low energy trauma or no trauma and have specific X-ray findings. Although the American Society for Bone and Mineral Research has excluded periprosthetic fractures from the definition of an atypical femoral fracture in 2013, this is still a matter of controversy because some authors report periprosthetic fractures showing specific features of atypical fractures around a well-fixed femoral stem. We report 3 cases of periprosthetic femur fractures that had specific radiographic features of atypical femoral fractures in patients with a history of prolonged bisphosphonate use; we also review relevant literature. PMID:27536624

  19. Investigation of creep mechanical characteristics of femoral prostheses by simulated hip replacement

    PubMed Central

    LIU, GUANG-YAO; JIN, YAN; LI, PENG

    2013-01-01

    In order to provide creep mechanical parameters for the clinical application of both traditional and reserved anatomy femoral artificial joint replacements, simulated hip replacement femoral stress relaxation and creep experiments were performed. Twenty-four corpse femoral specimens were obtained, with 8 specimens being randomly assigned to the control group and 8 specimens being randomly assigned to the traditional prosthesis group. Our results showed that the retaining femoral neck prosthesis and traditional prosthesis groups have different stress relaxation and creep mechanical properties. PMID:23596489

  20. Subtrochanteric femur fracture after removal of screws for femoral neck fracture in a child.

    PubMed

    Song, Kwang Soon; Lee, Si Wook

    2015-01-01

    Displaced femoral neck fractures are rare in children and are associated with a high rate of complications. Subtrochanteric fractures after cannulated screw fixation of femoral neck fractures in adults are well recognized, and there are several reports on the topic. However, there are no reports on complications related to hardware or subtrochanteric fractures after removal of the screws in the treatment of femoral neck fractures in children. Here we report the case of a 10-year-old boy who sustained a subtrochanteric fracture after the screw removal and healing that followed a femoral neck fracture. PMID:25566556

  1. Periprosthetic Atypical Femoral Fracture-like Fracture after Hip Arthroplasty: A Report of Three Cases

    PubMed Central

    Lee, Kyung-Jae; Jang, Hyung-Kyu; Ye, Hee-Uk; Lim, Kyung-Hwan

    2015-01-01

    Atypical femoral fractures are stress or insufficient fractures induced by low energy trauma or no trauma and have specific X-ray findings. Although the American Society for Bone and Mineral Research has excluded periprosthetic fractures from the definition of an atypical femoral fracture in 2013, this is still a matter of controversy because some authors report periprosthetic fractures showing specific features of atypical fractures around a well-fixed femoral stem. We report 3 cases of periprosthetic femur fractures that had specific radiographic features of atypical femoral fractures in patients with a history of prolonged bisphosphonate use; we also review relevant literature.

  2. Outcome of Kidney Allografts in Recipients With a Femoral Arteriovenous Fistula: Report of Two Cases.

    PubMed

    Özdemir-van Brunschot, Denise M D; de Sévaux, Ruud G L; van Hamersvelt, Henk W; Warlé, Michiel C

    2016-09-01

    Two patients, who were on hemodialysis over a femoral arteriovenous fistula, were transplanted in our center. Despite adequate blood pressure, perfusion of the renal allograft remained poor after completion of the vascular anastomoses. Ligation of the femoral arteriovenous fistula (1.6 L/min) led to adequate perfusion. Initial graft function was good. Although it remains unclear whether ischemia of a renal allograft is caused by venous hypertension or vascular steal due to a femoral arteriovenous fistula, it might be necessary to ligate a femoral arteriovenous fistula to obtain adequate graft perfusion. PMID:27313989

  3. Development of Femoral Head Interior Supporting Device and 3D Finite Element Analysis of its Application in the Treatment of Femoral Head Avascular Necrosis

    PubMed Central

    Xiao, Dongmin; Ye, Ming; Li, Xinfa; Yang, Lifeng

    2015-01-01

    Background The aim of this study was to develop and perform the 3D finite element analysis of a femoral head interior supporting device (FHISD). Material/Methods The 3D finite element model was developed to analyze the surface load of femoral head and analyze the stress and strain of the femoral neck, using the normal femoral neck, decompressed bone graft, and FHISD-implanted bone graft models. Results The stress in the normal model concentrated around the femoral calcar, with displacement of 0.3556±0.1294 mm. In the decompressed bone graft model, the stress concentrated on the femur calcar and top and lateral sides of femoral head, with the displacement larger than the normal (0.4163±0.1310 mm). In the FHISD-implanted bone graft model, the stress concentrated on the segment below the lesser trochanter superior to the femur, with smaller displacement than the normal (0.1856±0.0118 mm). Conclusions FHISD could effectively maintain the biomechanical properties of the femoral neck. PMID:26010078

  4. Use of embedded strain gages for the in-vitro study of proximal tibial cancellous bone deformation during knee flexion-extension movement: development, reproducibility and preliminary results of feasibility after frontal low femoral osteotomy

    PubMed Central

    2011-01-01

    Background This paper reports the development of an in-vitro technique allowing quantification of relative (not absolute) deformations measured at the level of the cancellous bone of the tibial proximal epiphysis (CBTPE) during knee flexion-extension. This method has been developed to allow a future study of the effects of low femoral osteotomies consequence on the CBTPE. Methods Six strain gages were encapsulated in an epoxy resin solution to form, after resin polymerisation, six measurement elements (ME). The latter were inserted into the CBTPE of six unembalmed specimens, just below the tibial plateau. Knee motion data were collected by three-dimensional (3D) electrogoniometry during several cycles of knee flexion-extension. Intra- and inter-observer reproducibility was estimated on one specimen for all MEs. Intra-specimen repeatability was calculated to determine specimen's variability and the error of measurement. A varum and valgum chirurgical procedure was realised on another specimen to observed CBTPE deformation after these kind of procedure. Results Average intra-observer variation of the deformation ranged from 8% to 9% (mean coefficient of variation, MCV) respectively for extension and flexion movement. The coefficient of multiple correlations (CMC) ranged from 0.93 to 0.96 for flexion and extension. No phase shift of maximum strain peaks was observed. Inter-observer MCV averaged 23% and 28% for flexion and extension. The CMC were 0.82 and 0.87 respectively for extension and flexion. For the intra-specimen repeatability, the average of mean RMS difference and the mean ICC were calculated only for flexion movement. The mean RMS variability ranged from 7 to 10% and the mean ICC was 0.98 (0.95 - 0.99). A Pearson's correlation coefficient was calculated showing that RMS was independent of signal intensity. For the chirurgical procedure, valgum and varum deviation seems be in agree with the frontal misalignment theory. Conclusions Results show that the

  5. Widening Access, Widening Participation, Widening Success: An Indian Case Study

    ERIC Educational Resources Information Center

    Thornton, Mary

    2006-01-01

    Multiple deprivations are widespread in rural India. Literacy levels remain stubbornly low, albeit gradually improving. Caste, class, religion, gender, age and disability all impact on access to education, participation and successful completion. The education of girls remains problematic given the higher value attached to sons, especially in…

  6. Degradation in urban air quality from construction activity and increased traffic arising from a road widening scheme.

    PubMed

    Font, Anna; Baker, Timothy; Mudway, Ian S; Purdie, Esme; Dunster, Christina; Fuller, Gary W

    2014-11-01

    Road widening schemes in urban areas are often proposed as a solution to traffic congestion and as a means of stimulating economic growth. There is however clear evidence that new or expanded roads rapidly fill with either displaced or induced traffic, offsetting any short-term gains in eased traffic flows. What has not been addressed in any great detail is the impact of such schemes on air quality, with modelled impact predictions seldom validated by measurements after the expansion of road capacity. In this study we made use of a road widening project in London to investigate the impact on ambient air quality (particulate matter, NOX, NO2) during and after the completion of the road works. PM10 increased during the construction period up to 15 μg m(-3) during working hours compared to concentrations before the road works. A box modelling approach was used to determine a median emission factor of 0.0022 kg PM10 m(-2) month(-1), three times larger than that used in the UK emission inventory (0.0007 kg PM10 m(-2) month(-1)). Peaks of activity released 0.0130 kg PM10 m(-2) month(-1), three and eight times smaller than the peak values used in the European and US inventories. After the completion of the widening there was an increase in all pollutants from the road during rush hour: 2-4 μg m(-3) for PM10; 1 μg m(-3) for PM2.5; 40 and 8 μg m(-3) for NOX and NO2, respectively. NO2 EU Limit Value was breached after the road development illustrating a notable deterioration in residential air quality. Additionally, PM10, but not PM2.5, glutathione dependent oxidative potential increased after the road was widened consistent with an increase in pro-oxidant components in the coarse particle mode, related to vehicle abrasion processes. These increased air pollution indices were associated with an increase in the number of cars, taxis and LGVs. PMID:25128882

  7. Dam Sites In Terrains of Soluble Rocks: A Model of Increasing Leakage By Dissolutional Widening of Fractures

    NASA Astrophysics Data System (ADS)

    Romanov, D.; Gabrovsek, F.; Dreybrodt, W.

    Water flowing through narrow fractures of soluble rock, e. g. limestone and gypsum widens these by chemical dissolution. This process called karstification sculptures subterranean rivers which drain most of their catchment. Close to dam sites unnatu- rally high hydraulic gradients exist to drive the impounded water downstream through fractures reaching below the dam. This poses the question whether under such condi- tions karstification beneath the dam is accelerated to such an extent that high leakage arises. Model simulations by coupling dissolutional widening and hydrodynamic flow are presented. The scenario is a dam 100 m wide with flanks of insoluble rock; but its bottom is limestone or gypsum. The modelling domain is a two-dimensional slice 1 m wide directed perpendicular to the dam. It extends 375 m vertically and 750 m horizontally. The dam is located in its center. This domain is divided by fractures with average aperture width of 0.02 cm into blocks of 7.5 m x 7.5 m x 1 m. We have per- formed model runs for a dam site with 150 m height of impounded water, a horizontal impermeabilization apron 131 m wide, and a grouting curtain reaching down 97 m. To calculate widening of the fractures experimental data on the dissolution of limestone and gypsum are used. All runs exhibit a characteristic behaviour. Shortly after fill- ing the reservoir there is small leakage of about 0.01 m3s-1, which increases steadily until a breakthrough event occurs after several 10 years with an abrupt increase of leakage to about 0.1 m3s-1 within a few years. Then flow in the fractures becomes turbulent and the leakage increases to 10 m3s-1 in about 10 years. Small channels propagate downstream and leakage rises slowly until the first channel has reached the surface causing breakthrough and establishing a dense net of flow pathways. We have performed a sensitivity analysis of the dependence of breakthrough times on the height of impounded water, the depth of grouting, the average

  8. Automated segmentation of necrotic femoral head from 3D MR data.

    PubMed

    Zoroofi, Reza A; Sato, Yoshinobu; Nishii, Takashi; Sugano, Nobuhiko; Yoshikawa, Hideki; Tamura, Shinichi

    2004-07-01

    Segmentation of diseased organs is an important topic in computer assisted medical image analysis. In particular, automatic segmentation of necrotic femoral head is of importance for various corresponding clinical tasks including visualization, quantitative assessment, early diagnosis and adequate management of patients suffering from avascular necrosis of the femoral head (ANFH). Early diagnosis and treatment of ANFH is crucial since the disease occurs in relatively young individuals with an average age of 20-50, and since treatment options for more advanced disease are frequently unsuccessful. The present paper describes several new techniques and software for automatic segmentation of necrotic femoral head based on clinically obtained multi-slice T1-weighted MR data. In vivo MR data sets of 50 actual patients are used in the study. An automatic method built up to manage the segmentation task according to image intensity of bone tissues, shape of the femoral head, and other characters. The processing scheme consisted of the following five steps. (1) Rough segmentation of non-necrotic lesions of the femur by applying a 3D gray morphological operation and a 3D region growing technique. (2) Fitting a 3D ellipse to the femoral head by a new approach utilizing the constraint of the shape of the femur, and employing a principle component analysis and a simulated annealing technique. (3) Estimating the femoral neck location, and also femoral head axis by integrating anatomical information of the femur and boundary of estimated 3D ellipse. (4) Removal of non-bony tissues around the femoral neck and femoral head ligament by utilizing the estimated femoral neck axis. (5) Classification of necrotic lesions inside the estimated femoral head by a k-means technique. The above method was implemented in a Microsoft Windows software package. The feasibility of this method was tested on the data sets of 50 clinical cases (3000 MR images). PMID:15249072

  9. An integrated CAD/CAM/robotic milling method for custom cementless femoral prostheses.

    PubMed

    Wen-ming, Xi; Ai-min, Wang; Qi, Wu; Chang-hua, Liu; Jian-fei, Zhu; Fang-fang, Xia

    2015-09-01

    Aseptic loosening is the primary cause of cementless femoral prosthesis failure and is related to the primary stability of the cementless femoral prosthesis in the femoral cavity. The primary stability affects both the osseointegration and the long-term stability of cementless femoral prostheses. A custom cementless femoral prosthesis can improve the fit and fill of the prosthesis in the femoral cavity and decrease the micromotion of the proximal prosthesis such that the primary stability of the custom prosthesis can be improved, and osseointegration of the proximal prosthesis is achieved. These results will help to achieve long-term stability in total hip arthroplasty (THA). In this paper, we introduce an integrated CAD/CAM/robotic method of milling custom cementless femoral prostheses. The 3D reconstruction model uses femoral CT images and 3D design software to design a CAD model of the custom prosthesis. After the transformation matrices between two units of the robotic system are calibrated, consistency between the CAM software and the robotic system can be achieved, and errors in the robotic milling can be limited. According to the CAD model of the custom prosthesis, the positions of the robotic tool points are produced by the CAM software of the CNC machine. The normal vector of the three adjacent robotic tool point positions determines the pose of the robotic tool point. In conclusion, the fit rate of custom pig femur stems in the femoral cavities was 90.84%. After custom femoral prostheses were inserted into the femoral cavities, the maximum gaps between the prostheses and the cavities measured less than 1 mm at the diaphysis and 1.3 mm at the metaphysis. PMID:26210779

  10. Proximal Femoral Geometry as Fracture Risk Factor in Female Patients with Osteoporotic Hip Fracture

    PubMed Central

    Han, Jun

    2016-01-01

    Background Proximal femoral geometry may be a risk factor of osteoporotic hip fractures. However, there existed great differences among studies depending on race, sex and age of subjects. The purpose of the present study is to analyze proximal femoral geometry and bone mineral density (BMD) in the osteoporotic hip fracture patients. Furthermore, we investigated proximal femoral geometric parameters affecting fractures, and whether the geometric parameters could be an independent risk factor of fractures regardless of BMD. Methods This study was conducted on 197 women aged 65 years or more who were hospitalized with osteoporotic hip fracture (femur neck fractures ; 84, intertrochanteric fractures; 113). Control group included 551 women who visited to check osteoporosis. Femur BMD and proximal femoral geometry for all subjects were measured using dual energy X-ray absorptiometry (DXA), and compared between the control and fracture groups. Besides, proximal femoral geometric parameters associated with fractures were statistically analyzed. Results There were statistically significant differences in the age and weight, cross-sectional area (CSA)/length/width of the femoral neck and BMD of the proximal femur between fracture group and control group. BMD of the proximal femur in the control group was higher than in the fracture group. For the femoral neck fractures group, the odds ratio (OR) for fractures decrease in the CSA and neck length (NL) of the femur increased by 1.97 times and 1.73 times respectively, regardless of BMD. The OR for fractures increase in the femoral neck width increased by 1.53 times. In the intertrochanteric fracture group, the OR for fractures increase in the femoral neck width increased by 1.45 times regardless of BMD. Conclusions We found that an increase of the femoral neck width could be a proximal femoral geometric parameter which plays important roles as a risk factor for fracture independently of BMD. PMID:27622182

  11. [Local vascular complications after iatrogenic femoral artery puncture].

    PubMed

    Fruhwirth, J; Pascher, O; Hauser, H; Amann, W

    1996-01-01

    Over a period of 5 years 81 vascular complications after 15,460 catheterizations of the femoral artery for diagnostic (n = 11,883) or therapeutic (n = 3577) procedures were registered. The following complications were observed in declining frequency: 1. False aneurysm (n = 65), 2. arterial occlusion (dissection, embolia, thrombosis) (n = 8), 3. vascular lesion causing profuse bleeding (n = 7), 4. AV-fistula (n = 1). The total complication rate was 0.52%. The complication rate was significantly higher in therapeutical procedures (1,03%) than in diagnostic investigations (0.37%). Pseudoaneurysms were complicated by thrombosis of the femoral vein (n = 3), lymphatic fistula (n = 3) and deep wound infection (n = 9); secondary complication rate 18.5%. Risk factors for local vascular complications are old age, female gender, high grade arteriosclerosis at the puncture site, overweight, manifest arterial hypertension and medication with cumarin, acetylsalicylic acid or heparin. Further complicating factors are connected with technical risks such as duration of the procedure. French size of the catheter, the catheter sheath and multiple punctures. Vascular repair was performed by simple angiography in most cases, but in 14.8% more extensive surgical procedures were required. In patients with signs of occlusive vascular disease the external iliac artery was replaced by a PTFE-vascular access graft in 4 cases and an arterioplasty of the deep femoral artery was performed in 2 patients. 36% of the operations were undertaken as emergencies. Reintervention was necessary for a postoperative bleeding complication in 1 case (surgical complication rate 1.2%). A female patient suffering from aortic valve stenosis died during emergency operation due to massive retroperitoneal hemorrhage after cardiac catheterization (mortality rate 1.2%). Over a median follow-up period of 37 months no late complications of the intervention were recorded, nor recurrences of peripheral arterial occlusive

  12. Multiple cannulated screw fixation of young femoral neck fractures

    PubMed Central

    Kim, Joo Yong; Kong, Gyu Min; Park, Dae Hyun; Kim, Dae Yoo

    2015-01-01

    Objective: We wanted to analyze the factors affecting the results of multiple cannulated screws fixation in patients less than 60 years old with femoral neck fracture (FNF). Methods: We reviewed 52 patients (30 males, 22 females) who were treated with multiple cannulated screws fixation for FNFs. They were followed up for more than one year during January 2002 to December 2012. They were classified by Garden’s classification. The anatomic reduction was evaluated by Garden’s alignment index on hip both anteroposterior and lateral images. Postoperative complications were analyzed during follow up periods. Results: By Garden’s classification, 6 cases were in stage I, 13 cases in stage II, 30 cases in stage III and 3 cases in stage IV. During follow up periods, avascular necrosis of the femoral head was observed in 12 cases (23%) and nonunion was observed in 5 cases (9%). The 16 patients who had complications underwent total hip arthroplasty (31%). In non-displaced fracture groups (Garde I, II) did not have AVN nor nonunion. The incidence of complications in displaced fracture group was 51.5%. The complicated cases showed tendency for increased apex anterior angulation of femoral neck on hip lateral images and the result was statistically significant. (p=0.0260). Conclusion: The patients less than 60 years old who were treated with multiple cannulated screws fixation for displaced FNFs showed the incidence of complications was more than 50%. It needs a cautious approach for anatomical reduction, especially related to anterior angulation on hip lateral image. PMID:26870127

  13. Risk of atypical femoral fracture during and after bisphosphonate use

    PubMed Central

    Schilcher, Jörg; Koeppen, Veronika; Aspenberg, Per; Michaëlsson, Karl

    2015-01-01

    Background and purpose Use of bisphosphonates in women is associated with higher risk of atypical femoral fractures. The risk in terms of timing of use and type of bisphosphonate, and in men, remains unclear. Patients and methods We reviewed radiographs of 5,342 Swedish women and men aged 55 years or more who had had a fracture of the femoral shaft in the 3-year period 2008–2010 (97% of those eligible), and found 172 patients with atypical fractures (93% of them women). We obtained data on medication and comorbidity. The risk of atypical fracture associated with bisphosphonate use was estimated in a nationwide cohort analysis. In addition, we performed a case-control analysis with comparison to 952 patients with ordinary shaft fractures. A short report of the findings has recently been presented (Schilcher et al. 2014a). Here we provide full details. Results The age-adjusted relative risk (RR) of atypical fracture associated with bisphosphonate use was 55 (95% CI: 39–79) in women and 54 (CI: 15–192) in men. In bisphosphonate users, women had a 3-fold higher risk than men (RR = 3.1, CI: 1.1–8.4). Alendronate users had higher risk than risedronate users (RR = 1.9, CI: 1.1–3.3). The RR after 4 years or more of use reached 126 (CI: 55–288), with a corresponding absolute risk of 11 (CI: 7–14) fractures per 10,000 person-years of use. The risk decreased by 70% per year since last use. Interpretation Women have a higher risk of atypical femoral fracture than men. The type of bisphosphonate used may affect risk estimates and the risk decreases rapidly after cessation. PMID:25582459

  14. Heterologous mesenchymal stem cells successfully treat femoral pseudarthrosis in rats

    PubMed Central

    2012-01-01

    Background This study evaluated the effectiveness of treating pseudarthrosis in rats by using bone marrow cell suspensions or cultures of bone marrow mesenchymal stromal cells Methods Thirty-eight specific pathogen-free (SPF) animals were randomly assigned to four groups: Group 1, Control, without surgical intervention; Group 2 (Placebo), experimental model of femoral pseudarthrosis treated only with saline solution; Group 3, experimental model of femoral pseudarthrosis treated with heterologous bone marrow cells suspension; Group 4, experimental model of femoral pseudarthrosis treated with cultures of heterologous mesenchymal stromal cells from bone marrow. When pseudarthrosis was confirmed by simple radiological studies, digital radiography and histopathology after a 120-day postoperative period, Groups 2, 3 and 4 were treated as above. At 30, 60 and 90 days after the treatment, all animals were evaluated by simple radiological studies, and at the end of the experiment, the animals were assessed by computed axial tomography and anatomopathological and histomorphometric examinations. Results Injected cells were detected in the areas affected by pseudarthrosis using scintigraphy within the first 24 hours after their administration. After 60 days, the animals of Group 3 showed callus formation while the animals of Group 4 presented periosteal reaction and had some consolidated areas. In contrast, Group 2 showed a predominance of fibro-osteoid tissue. After 90 days, bone consolidation and remodeling was observed in all animals from Group 3 whereas animals from Group 4 exhibited partial consolidation and those ones from Group 2 persisted with pseudarthrosis. Conclusion The treatment with heterologous bone marrow cells suspension proved to be effective in the treatment of pseudarthrosis whereas cultures of heterologous bone marrow mesenchymal stromal cells did not show the same potential to aid bone healing. PMID:22429995

  15. Complications With Long Cemented Stems in Proximal Femoral Replacement.

    PubMed

    Naik, Amish A; Lietman, Steven A

    2016-05-01

    This study attempted to determine whether patients undergoing cemented long-stem proximal femoral replacement had: (1) an increased short-term mortality rate; (2) greater intraoperative hemodynamic instability; (3) a greater need for resuscitation; and (4) a decreased risk of periprosthetic fracture. The current study reviewed intraoperative and short-term events related to clinical outcomes in 24 consecutive patients who were treated at a single institution over a 5-year period. These patients underwent primary long-stem (≥250 mm, n=13) vs short-stem (<250 mm, n=11) cemented proximal femoral replacement. Other than stem length, the 2 groups were not significantly different in terms of patient age, sex, height, weight, body mass index, diagnosis, or preoperative American Society of Anesthesiologists functional score. Primary outcomes were intraoperative death, blood loss, blood transfusions, fluid resuscitation, hypotension, oxygen desaturation, mortality up to 1 year, and need for revision surgery. At 1 year, a significantly increased mortality rate (77% vs 27%, P=.03) was noted in patients receiving long-stem vs short-stem arthroplasty. Patients who received longer stems also required more intraoperative blood transfusions and fluid resuscitation (P=.04) for greater hypotension (P=.04) and oxygen desaturation (P=.04). Two intraoperative deaths occurred in the long-stem group, and none occurred in the short-stem group. The findings suggest that there is an increased risk of intraoperative hemodynamic instability with long-stem vs short-stem proximal femoral replacement, with a need for greater resuscitative efforts and an increased risk of mortality at 1 year. [Orthopedics. 2016; 39(3):e423-e429.]. PMID:27064780

  16. Femoral neck anteversion measurement using linear slot scanning radiography.

    PubMed

    Chimhundu, Chipo; Sivarasu, Sudesh; Steiner, Stefan; Smit, Julian; Douglas, Tania S

    2016-02-01

    Measurements between anatomical landmarks on radiographs are useful for diagnosis and treatment planning in the orthopedic field. Direct measurement on single radiographic images, however, does not truly reflect spatial relationships, as depth information is lost. We used stereo images from a slot scanning X-ray machine to estimate coordinates of three-dimensional (3D) bony landmarks for femoral neck anteversion (FNA) measurement. A set of 7 landmarks consisting of the centre of the femoral head; the centre of the base of the femoral neck; the medial and lateral condyles; the medial and lateral posterior condyles; and finally the centre of the knee; were found to be identifiable and suitable for radiographic measurement. The reconstructed 3D coordinates were then used to define the 3D geometry of the anatomical axes required to estimate FNA. Stereophotogrammetric measurements on a sample of 30 dry right adult femurs were compared to reference values obtained using the Kingsley Olmstead method applied to photographic images. A strong positive correlation (0.998) was found and the mean ± standard deviation of the stereophotogrammetric approach (13.08 ± 6.87)° was comparable to that of the Kingsley Olmstead method (13.14 ± 6.88)°. Intra- and inter-observer reliability were high, with the lower bound of the 95% confidence interval above 0.98 for the intra-class correlation coefficient. The results merit further validation against three dimensional imaging technology such as computed tomography, to confirm stereophotogrammetry as a suitable alternative for FNA measurement. PMID:26776374

  17. Possible Platelet Thrombi Formation in Dog and Human Femoral Arteries

    PubMed Central

    Folts, John D.; Detmer, Donald E.; Nadler, Robert

    1982-01-01

    Atherosclerosis is a ubiquitous condition that commonly produces vessel stenosis and progresses ultimately to vascular occlusion. It is thought by many that platelets collect on sites of atherosclerosis and exacerbate its progression. We have previously shown that platelet thrombi can form within 10 minutes in the stenosed coronary arteries of a dog and can produce acute cyclical reduction in blood flow measured with an electromagnetic flowmeter (EMF). This is followed by sudden restoration of flow as the platelet thrombus breaks loose and is carried distally (Circulation 54:365-370, 1976). In five dogs, blood flow was measured simultaneously in a femoral artery stenosed 70%, exposed proximally with an EMF, and monitored distally over intact skin with a Doppler ultrasonic flowmeter (DUF). Cyclical reductions in blood flow were detected by both the EMF and the DUF, presumably due to platelet thrombi forming in the stenosed femoral artery and then breaking loose and moving distally. These flow reductions could be consistently abolished with aspirin (ASA). In ten patients with angiographically proven substantial stenoses of the femoral or popliteal arteries who were not taking ASA, the popliteal blood flow velocity was measured with a DUF. Six of the ten patients showed cyclical blood flow velocity reductions during 30 minutes of observation. These flow velocity reductions were similar to those observed in the stenosed dog femoral arteries. One hour after taking 600 mg ASA orally, five of the six patients no longer showed flow velocity reductions. Eight male control subjects who were not on ASA and had no known stenoses had no flow velocity reductions when studied with the DUF. Since many factors, such as cigarette smoking, diabetes, and elevated plasma lipids, are known to increase human platelet aggregation, we postulate that platelet thrombi may form in stenosed peripheral arteries, hasten the development of atherosclerosis, and reduce blood flow. This postulate

  18. Femoral metastases from ovarian serous/endometroid adenocarcinoma

    PubMed Central

    Beresford–Cleary, NJA; Mehdi, SA; Magowan, B

    2012-01-01

    Bony metastases from ovarian cancer are rare, tend to affect the axial skeleton and are associated with abdomino-pelvic disease. The median time interval between diagnosis of ovarian carcinoma and presentation of bony metastases is 44 months (1). We describe a rare case of high grade left ovarian serous / endometrioid adenocarcinoma presenting with a pathological right femoral fracture 4 weeks following diagnosis and optimal debulking of the ovarian tumour. Orthopaedic surgeons must be vigilant when planning treatment of fractures presenting in patients with a history of ovarian cancer. PMID:24960734

  19. Supportive parenting mediates widening neighborhood socioeconomic disparities in children’s antisocial behavior from ages 5 to 12

    PubMed Central

    Odgers, Candice L.; Caspi, Avshalom; Russell, Michael A.; Sampson, Robert J.; Arsenault, Louise; Moffitt, Terrie E.

    2012-01-01

    In this article we report a graded relationship between neighborhood socioeconomic status (SES) and children’s antisocial behavior that (1) can be observed at school entry, (2) widens across childhood, (3) remains after controlling for family-level SES and risk, and (4) is completely mediated by maternal warmth and parental monitoring (defined throughout as supportive parenting). Children were participants in the Environmental Risk (E-Risk) Longitudinal Twin Study (n=2232), which prospectively tracked the development of children and their neighborhoods across childhood. Direct and independent effects of neighborhood-level SES on children’s antisocial behavior were observed as early as age 5 and the gap between children living in deprived versus more affluent neighborhoods widened as children approached adolescence. By age 12, the effect of neighborhood socioeconomic status on children’s antisocial behavior was as large as the effect observed for our most robust predictor of antisocial behavior – sex! (Cohen’s d = .51 when comparing children growing up in deprived versus more affluent neighborhoods in comparison to Cohen’s d = .53 when comparing antisocial behavior among boys versus girls). However, differences in children’s levels and rate of change in antisocial behavior across deprived versus more affluent neighborhoods were completely mediated by supportive parenting practices. Implications of our findings for studying and reducing socioeconomic disparities in antisocial behavior among children are discussed. PMID:22781850

  20. Successful management of simple fractures of the femoral neck with femoral head and neck excision arthroplasty in two free-living avian species.

    PubMed

    Burgdorf-Moisuk, Anne; Whittington, Julia K; Bennett, R Avery; McFadden, Mike; Mitchell, Mark; O'Brien, Robert

    2011-09-01

    A red-tailed hawk (Buteo jamaicensis) and a Canada goose (Branta canadensis) were evaluated for unilateral pelvic limb lameness. Physical examination findings and results of diagnostic imaging revealed femoral neck fractures in both birds. Both birds were treated with a femoral head and neck excision arthroplasty. The affected legs were not immobilized, and the birds were encouraged to use the legs immediately after surgery to encourage formation of a pseudoarthrosis. Within 2 weeks, both birds were using the affected limb well enough to be either successfully released or transferred to a wildlife rehabilitation facility. Femoral head and neck excision arthroplasty without immobilization of the limb is recommended for managing avian femoral neck fractures, especially in free-ranging species in which a rapid and complete or near complete return to function is vital for survival in the wild. PMID:22216722

  1. Limited femoral navigation versus conventional intramedullary femoral jig based instrumentation for achieving optimal restoration of mechanical axis post total knee arthroplasty: a prospective comparative study of 200 knees.

    PubMed

    Shah, Nilen A; Patil, Hitendra G; Dhawale, Amol S; Khedkar, Bipin M

    2015-04-01

    A prospective comparative study was conducted to compare the mechanical axis post total knee arthroplasty (TKA) between two groups: In the first group of 100 knees (ASM group) Articular Surface Mounted navigation system was used to guide the distal femoral cut. In the second group of 100 knees (JIG group) conventional intramedullary femoral jig was used. The postoperative mechanical axis of the leg was within 3° of neutral alignment in 90% of the TKA in the ASM group (mean 178.12°) as compared to 74% in the JIG group (mean 177.02°). This difference was statistically significant (P<0.05). The data presented show that the use of limited femoral navigation leads to more accurate restoration of mechanical axis alignment when compared to conventional intramedullary femoral jigs. PMID:25466168

  2. Efficacies of surgical treatments based on Harris hip score in elderly patients with femoral neck fracture

    PubMed Central

    Liang, Chengwei; Yang, Fengjian; Lin, Weilong; Fan, Yongqian

    2015-01-01

    Aim: To compare the efficacies of four surgical treatments, i.e., total hip arthroplasty (THA), internal fixation (IF), hemiarthroplasty (HA), and artificial femoral head replacement (artificial FHR), by performing a network meta-analysis based on Harris hip score (HHS) in elderly patients with femoral neck fracture. Methods: In strict accordance with specific inclusion and exclusion criteria, randomized controlled trails (RCTs) were screened and selected from a larger group of studies that were retrieved through a comprehensive search of scientific literature databases, further complimented by manual search. The resultant high-quality data from final selected studies were analyzed using Stata 12.0 software. Results: A total of 3680 studies were initially retrieved from database search, and 15 RCTs were eventually incorporated into this meta-analysis, containing 1781 elderly patients who had undergone various surgical treatments for femoral neck fracture (THA group = 604; HA group = 604; IF group = 495; artificial FHR group = 78). Our major result revealed a statistically significant difference in HHS of femoral neck fracture when HA and IF groups were compared with THA. No differences were detected in the HHS of femoral neck fracture undergoing artificial FHR and THA. The surface under the cumulative ranking curves (SUCRA) value of HHS, in elderly patients with femoral neck fracture after surgery, revealed that IF has the highest value. Conclusions: The current network meta-analysis results suggest that IF is the superlative surgical procedure for femoral neck fracture patients, and IF significantly improves the HHS in femoral neck fracture patients. PMID:26221216

  3. Proteomic changes in plasma of broiler chickens with femoral head necrosis

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Femoral head necrosis (FHN) is a skeletal problem in broiler chickens where the proximal femoral head cartilage shows susceptibility to separation from its growth plate. The FHN selected birds showed higher bodyweights and reduced plasma cholesterol. The proteomic differences in the plasma of health...

  4. [Treatment strategy for posttraumatic complex deformity : After bilateral femoral shaft fractures].

    PubMed

    Ahrend, M; Ateschrang, A; Stöckle, U; Schröter, S

    2016-02-01

    A case of complex posttraumatic deformity after bilateral femoral shaft fractures is reported. Different possibilities for correction in cases of valgus malalignment combined with internal rotation deformity as well as shortening combined with external rotation deformity are presented. Oblique osteotomy and a motorized femoral extension nail were used. PMID:26187430

  5. Simultaneous Bilateral Fracture of Femoral Neck in Korea: A Case Report

    PubMed Central

    Jeong, Hwa-Jae; Shin, Hun-Kyu; Kim, Eugene; Ko, Taeg Su; Choi, Young-Min

    2015-01-01

    Unilateral femoral neck factures are common and their incidence is increasing. However, simultaneous bilateral femoral neck fractures are rare. Although cases of simultaneous bilateral femoral neck fractures have been reported, most were caused by strong muscle contractions during electroconvulsive therapy. Simultaneous bilateral femoral neck fractures caused by a simple fall are an extremely rare injury; therefore, limited literature is available, and no case has been reported in Korea. We report herein a case of simultaneous bilateral femoral neck fractures caused by a simple fall. An 83-year-old woman visited the emergency department with bilateral hip joint pain and gait disturbance, which developed 1 day after a fall. Tenderness and severe limitation in left hip joint range of motion and mild limitation in right hip joint range of motion were observed on a physical examination. A Garden type IV femoral neck fracture in the left hip joint and a Garden type I femoral neck fracture in the right hip joint were observed on plain radiography. She underwent right screw fixation and left bipolar hemiarthroplasty 2 days after admission. The patient could walk using a walker 4 weeks postoperatively. Bone union in the right femoral neck was observed at the 3 month follow-up. No specific findings were observed at the left hip hemiarthroplasty site.

  6. Fracture of the femoral component associated with polyethylene wear and osteolysis after total knee arthroplasty.

    PubMed

    Huang, C H; Yang, C Y; Cheng, C K

    1999-04-01

    Fracture of the femoral component associated with polyethylene wear and osteolysis after total knee arthroplasty (TKA) has not been well reported before. A 63-year-old man with osteoarthritis of the right knee underwent TKA with a New Jersey LCS Knee, with cementing on the tibia and patella but not on the femoral component. After 42 months, in addition to wearing of polyethylene of the tibia and patella, severe osteonecrosis of the medial femoral condyle was noted. Osteonecrosis caused loss of osseous support of the medial flange of the femoral component, and the bone ingrowth of the central and lateral flange to the distal femur was so good that it overcame the yield stress of the metal of the femoral component and caused fracture of the femoral component. The osteolytic area was filled with autogenous iliac bone, and a new femoral component was inserted and cemented. The patient's condition became satisfactory with relief of pain. Although uncommon, fracture of the femoral component does occur associated with polyethylene wear and osteolysis. PMID:10220194

  7. Effect of the high femoral osteotomy upon the vascularity and blood supply of the hip joint

    SciTech Connect

    Day, B.; Shim, S.S.; Leung, G.

    1984-05-01

    This investigation was done to study the effects of high femoral osteotomy upon the vascularity and blood supply of the hip and to further our knowledge of its physiologic basis. We have used established methods of study, including bone scans, microangiography, isotope clearance and perosseous venography, and based upon the results of these studies, we have reached certain conclusions. First, high femoral osteotomy increases the blood flow and vascularity in the hip joint, the femoral head and neck and the great trochanter. Second, bone scanning techniques using /sup 99m/Tc labeled diphosphonate have shown increased uptake in the femoral head and neck after high femoral osteotomy. The localization was done using a Digital Gamma III computer, and the activity on the osteotomy side at two weeks was 3.5 times as great as on the control side. By 16 weeks postoperatively, there was still two times as much activity on the osteotomy side. Third, microangiography showed increased vascularity both at the osteotomy site and in the femoral head and neck and the greater trochanter on that side. Such an increase in vascularity first became evident two weeks after osteotomy and persisted during the four month period studied. Fourth, the results of the /sup 99m/Tc diphosphonate clearance study showed a 25 per cent increase in femoral head blood flow on the operative side. Fifth, perosseous venography of the femoral head and neck showed a marked increase in venous drainage through the osteotomy site in the immediate postosteotomy stage.

  8. Serum chemistry and histopathology of broiler femoral head necrosis and tibial dyschondroplasia

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Femoral head necrosis (FHN) and tibial dyschondroplasia (TD) are two major leg problems in young meat type poultry which cause lameness, bone deformity and infections. Whereas FHN results from disarticulation of the femoral growth plate from the articular cartilage, TD lesions are characterized by i...

  9. The effect of postural control and balance on femoral anteversion in children with spastic cerebral palsy

    PubMed Central

    Karabicak, Gul Oznur; Balcı, Nilay Comuk; Gulsen, Mustafa; Ozturk, Basar; Cetin, Nuri

    2016-01-01

    [Purpose] The aim of the study was to investigate the relationships between femoral anteversion and functional balance and postural control in children with spastic cerebral palsy. [Subjects and Methods] Twenty children with spastic cerebral palsy (mean age=12.4 ± 4.5) with grosss motor functional classification system levels I, II, and III were recruited for this study. Functional balance was evaluated using the Pediatric Balance Scale, postural control was evaluated using the Trunk Control Measurement Scale, and femoral anteversion was assessed with a handheld goniometer using the great trochanter prominence method. [Results] The results indicated that there was significant correlation between femoral anteversion and Trunk Control Measurement Scale dynamic reaching score. There were no significant correlation between femoral anteversion and the Trunk Control Measurement Scale static sitting balance, Trunk Control Measurement Scale selective movement control, total Trunk Control Measurement Scale and Pediatric Balance Scale results. [Conclusion] Increased femoral anteversion has not correlation with functional balance, static sitting, and selective control of the trunk. Femoral anteversion is related to dynamic reaching activities of the trunk, and this may be the result of excessive internal pelvic rotation. It is important for the health professionals to understand that increased femoral anteversion needs to be corrected because in addition to leading to femoral internal rotation during walking, it also effects dynamic reaching activities of spastic children with cerebral palsy. PMID:27390397

  10. Ultrasonographic Measurement of the Femoral Cartilage Thickness in Hemiparetic Patients after Stroke

    ERIC Educational Resources Information Center

    Tunc, Hakan; Oken, Oznur; Kara, Murat; Tiftik, Tulay; Dogu, Beril; Unlu, Zeliha; Ozcakar, Levent

    2012-01-01

    The aim of the study was to evaluate the femoral cartilage thicknesses of hemiparetic patients after stroke using musculoskeletal ultrasonography and to determine whether there is any correlation between cartilage thicknesses and the clinical characteristics of the patients. Femoral cartilage thicknesses of both knees were measured in 87 (33…

  11. A simplified technique of distal femoral screw insertion for the Grosse-Kempf interlocking nail.

    PubMed

    MacMillan, M; Gross, R H

    1988-01-01

    Failure accurately to determine distal femoral screw hole position can sometimes prolong operating time for placing an interlocking Grosse-Kempf rod. The described technique allows the distal femoral screw holes to be localized accurately with minimal radiation exposure. This technique utilizes readily available instruments and is not technically demanding. PMID:3335100

  12. 21 CFR 888.3360 - Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis.

    Code of Federal Regulations, 2010 CFR

    2010-04-01

    ... uncemented prosthesis. 888.3360 Section 888.3360 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis is a device intended to be...

  13. 21 CFR 888.3360 - Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis.

    Code of Federal Regulations, 2011 CFR

    2011-04-01

    ... uncemented prosthesis. 888.3360 Section 888.3360 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF... Hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis. (a) Identification. A hip joint femoral (hemi-hip) metallic cemented or uncemented prosthesis is a device intended to be...

  14. Fracture of the femoral alignment stem of a hip resurfacing arthroplasty. A case report.

    PubMed

    Bhutta, Mohammed A; Shah, Vinod B

    2011-02-01

    Metal-on-metal hip resurfacing arthroplasty has become increasingly popular for the treatment of osteoarthritis in a younger patient population. While the initial complication of femoral neck fracture is being addressed, we describe a fracture of the femoral alignment stem in a component two years from the primary procedure. PMID:21473460

  15. Histopathology and serum clinical chemistry evaluation of broilers with femoral head separation disorder

    Technology Transfer Automated Retrieval System (TEKTRAN)

    Femoral head disarticulation (FHD) and necrosis is a sporadic leg problem of unknown etiology in broiler breeders. To determine the underlying physiology of FHD, the blood chemistry and the histopathology of the femoral heads of the affected chickens were compared with their age matched controls. Ch...

  16. Large Diameter Femoral Heads Impose Significant Alterations on the Strains Developed on Femoral Component and Bone: A Finite Element Analysis

    PubMed Central

    Theodorou, E.G; Provatidis, C.G; Babis, G.C; Georgiou, C.S; Megas, P.D

    2011-01-01

    Total Hip Arthroplasty aims at fully recreating a functional hip joint. Over the past years modular implant systems have become common practice and are widely used, due to the surgical options they provide. In addition Big Femoral Heads have also been implemented in the process, providing more flexibility for the surgeon. The current study aims at investigating the effects that femoral heads of bigger diameter may impose on the mechanical behavior of the bone-implant assembly. Using data acquired by Computed Tomographies and a Coordinate Measurement Machine, a cadaveric femur and a Profemur-E modular stem were fully digitized, leading to a three dimensional finite element model in ANSYS Workbench. Strains and stresses were then calculated, focusing on areas of clinical interest, based on Gruen zones: the calcar and the corresponding below the greater trochanter area in the proximal femur, the stem tip region and a profile line along linea aspera. The performed finite elements analysis revealed that the use of large diameter heads produces significant changes in strain development within the bone volume, especially in the lateral side. The application of Frost’s law in bone remodeling, validated the hypothesis that for all diameters normal bone growth occurs. However, in the calcar area lower strain values were recorded, when comparing with the reference model featuring a 28mm femoral head. Along line aspera and for the stem tip area, higher values were recorded. Finally, stresses calculated on the modular neck revealed increased values, but without reaching the yield strength of the titanium alloy used. PMID:21792381

  17. A biomechanical evaluation of proximal femoral nail antirotation with respect to helical blade position in femoral head: A cadaveric study

    PubMed Central

    Hwang, Jin-Ho; Garg, Anant Kumar; Oh, Jong-Keon; Oh, Chang-Wug; Lee, Sung-Jae; Myung-Rae, Cho; Kim, Min-Keun; Kim, Hyun

    2012-01-01

    Objective: Despite new developments in the management of osteoporotic fractures, complications like screw cutout are still found in the fixation of proximal femur fractures even with biomechanically proven better implants like proximal femoral nail antirotation (PFNA). The purpose of this cadaveric study was to investigate the biomechanical stability of this device in relation to two common positions (center-center and inferior-center) of the helical blade in the femoral head in unstable trochanteric fractures. Materials and Methods: Eight pairs of human cadaveric femurs were used; in one group [center-center (C-C) group], the helical blade of PFNA was fixed randomly in central position both in anteroposterior and lateral view, whereas in the other group it was fixed in inferior one-third position in anteroposterior and in central position in lateral view [inferior-center (I-C) group]. Unstable intertrochanteric fracture was created and each specimen was loaded cyclically till load to failure Results: Angular and rotational displacements were significantly higher within the C-C group compared to the I-C group in both unloaded and loaded condition. Loading to failure was higher in the I-C group compared to the C-C group. No statistical significance was found for this parameter. Correlations between tip apex distance, cyclic loading which lead to femoral head displacement, and ultimate load to failure showed a significant positive relationship. Conclusion: The I-C group was superior to the C-C group and provided better biomechanical stability for angular and rotational displacement. This study would be a stimulus for further experimental studies with larger number specimens and complex loading protocols at multicentres. PMID:23325963

  18. [Joint and sensory branch block of the obturator and femoral nerves in a case of femoral head osteonecrosis and arthritis].

    PubMed

    Cortiñas-Sáenz, M; Salmerón-Velez, G; Holgado-Macho, I A

    2014-01-01

    The sensory innervation of the hip joint is complex. The joint and sensory branch block of the obturator and femoral nerves is effective for treating the pain caused due to different hip diseases. This could be an option to be considered in certain circumstances such as, being a surgical-anaesthetic high risk, or if there is significant overweight, It could also be useful on other occasions if the traumatoligist considers that it is better to delay hip replacement for a limited period. PMID:24656423

  19. A simple new technique for the removal of fractured femoral stems: a case report

    PubMed Central

    2014-01-01

    Introduction The removal of broken femoral stems has become a major issue in revision surgery, and is a technically difficult and time-consuming procedure. Case presentation We present a case of a fracture of a cementless long femoral stem in a 65-year-old, white Caucasian man. The distal part was removed with a special longitudinal osteotomy through the anterior cortex extending distally for 10cm. It was then followed by a transversal osteotomy 2cm below the tip of the femoral stump to allow enough space for two locking pliers. Simultaneously using a lamina spreader on the distal part, the broken stem was extracted while hammering on two locking pliers. Conclusions We developed a simple and easy technique for the removal of a broken femoral stem that can be applied to all kinds of femoral stems and intramedullary nails regardless of their cross section. We used ordinary surgical instruments and spared the remaining bone stock. PMID:24886067

  20. Traumatic subchondral fracture of the femoral head in a healed trochanteric fracture

    PubMed Central

    Lee, Sang Yang; Niikura, Takahiro; Iwakura, Takashi; Kurosaka, Masahiro

    2014-01-01

    An 82-year-old woman sustained a trochanteric fracture of the left femur after a fall. Fracture fixation was performed using proximal femoral nail antirotation (PFNA) II, and she was able to walk with a T-cane after 3 months. Eleven months following the operation, the patient presented with left hip pain after a fall. Radiographs showed a subchondral collapse of the femoral head located above the blade tip. The authors removed the PFNA-II and subsequently performed cemented bipolar hemiarthroplasty. Histological evaluation of the femoral head showed osteoporosis with no evidence of osteonecrosis. Repair tissue, granulation tissue and callus formation were seen at the collapsed subchondral area. Based on these findings, a traumatic subchondral fracture of the femoral head in a healed trochanteric fracture was diagnosed. A traumatic subchondral fracture of the femoral head may need to be considered as a possible diagnosis after internal fixation of the trochanteric fracture. PMID:25015169

  1. Intraoperative measurement of rotational stability of femoral components of total hip arthroplasty.

    PubMed

    Harris, W H; Mulroy, R D; Maloney, W J; Burke, D W; Chandler, H P; Zalenski, E B

    1991-05-01

    High out-of-plane forces acting on the hip joint can produce important rotational micromotion of the femoral component. This micromotion at the prosthesis interface may be detrimental to the stability of the implant. In cementless femoral implants this could prevent bone ingrowth, and in the cemented component this could cause generation of particulate debris, lysis, and loosening. The introduction of the torque wrench micrometer for assessment of intraoperative femoral component stability can quantify the initial stability of primary cementless femoral components and critically evaluate the stability (at either the initial or revision arthroplasty) of both cemented and cementless femoral components. It allows the surgeon to produce a known torque in the direction and magnitude of the out-of-plane forces that load the hip in vivo. PMID:2019039

  2. Experimental study on cheng zai wan for treatment of necrosis of the femoral head.

    PubMed

    Chen, Yanping; Huang, Keqin; Lang, Fengping; Huang, Yongxun; Huang, Hui; Huang, Hong; Zhou, Chongguang; Zhang, Wanqiang

    2003-12-01

    Cheng Zai Wan ([symbol: see text]), a Chinese herbal preparation was administrated in the two-leg rat model of aseptic necrosis of the femoral head established by taking prednisone acetate for a long period and the osteoporosis model rat by castration in order to explore the effects of the prescription on necrosis of the femoral head. The results showed that after treatment, the pitting on the surface of the femoral head disappeared, the reticular structure with filling cells was restored; the fat droplets in bone cells or cartilage cells of the femoral head were significantly reduced; sparse capillaries were improved, density and width of the bone trabecula were increased somewhat; bone mineral density, bone weight, bone strength and rigidity were significantly increased; and the low level of estrin was improved. It is suggested that Cheng Zai Wan has definite therapeutic effects on aseptic necrosis of the femoral head. PMID:14719304

  3. Spontaneous and bilateral necrosis of the femoral head in a young experimental beagle dog

    PubMed Central

    Kobayashi, Ryosuke; Kurotaki, Tetsuro; Yamada, Naoaki; Kumabe, Shino; Doi, Takuya; Wako, Yumi; Tsuchitani, Minoru

    2015-01-01

    This report describes the pathological characterizations of a rare case of necrosis of the femoral head that was spontaneous, bilateral, avascular and nontraumatic. A 14-month-old beagle dog was presented with pain in the hind limbs. At necropsy, the articular surface in the bilateral femoral head was markedly irregular. There were no gross abnormalities other than in the hip joints. Microscopically, a wide range of trabecular bone necrosis localized in the subchondral area was observed in both femoral heads. In the right femoral head, fibrosis and proliferative vessels were noted in the subchondral area. The articular cartilage was thickened irregularly, but there was no evidence of cartilage necrosis. The bone marrow adjacent to the affected area showed severe depression. In the metaphysis, atrophic bone marrow, but not bone necrosis, was observed. This was a rare case of spontaneous necrosis of the femoral head in an experimental beagle dog. PMID:26028821

  4. The development of a validated checklist for femoral venous catheterization: preliminary results.

    PubMed

    Riesenberg, Lee Ann; Berg, Katherine; Berg, Dale; Davis, Joshua; Schaeffer, Arielle; Justice, Ellen M; Tinkoff, Glen

    2014-01-01

    Femoral venous catheterization is a common, invasive procedure, which may lead to serious complications. Validated checklists are central to teaching and assessing procedural skills and may result in improved health care quality. The results of the first step of the validation of a femoral venous catheterization checklist are described. A comprehensive literature review of articles published on femoral venous catheterization did not yield a checklist validated by the Delphi method. A modified Delphi technique, involving a panel of 8 interdisciplinary, interinstitutional experts, was used to develop a femoral venous catheterization checklist. The internal consistency coefficient using Cronbach α was .99. Developing a 29-item checklist for teaching and assessing femoral venous catheterization is the first step in the validation process. For this checklist to become further validated, it should be implemented and studied in the simulation and clinical environments. PMID:24045368

  5. Hip Arthroscopic Osteochondral Autologous Transplantation for Treating Osteochondritis Dissecans of the Femoral Head

    PubMed Central

    Kubo, Takanori; Utsunomiya, Hajime; Watanuki, Makoto; Hayashi, Hidetoshi; Sakai, Akinori; Uchida, Soshi

    2015-01-01

    Osteochondritis dissecans (OCD) of the femoral head is not a common source of hip pain. Hip arthroscopy is becoming a more frequent indication for intra-articular pathologies of the hip. Osteochondral autologous transplantation is a promising technique that theoretically can reconstruct osteochondral lesions of the femoral head. We describe our technique for arthroscopic antegrade osteochondral autologous transplantation for the treatment of OCD of the femoral head. The advantages of this technique include that it is a less invasive method with the ability to assess and treat intra-articular pathologies associated with OCD of the femoral head at same time. Case series and outcomes after this technique are not currently reported in the literature; however, it could be a less invasive method and provide favorable clinical outcomes for patients with OCD lesions of the femoral head. PMID:26870645

  6. Do larger femoral heads improve the functional outcome in total hip arthroplasty?

    PubMed

    Allen, Charlotte L; Hooper, Gary J; Frampton, Christopher M A

    2014-02-01

    Use of larger diameter femoral heads has been popularised in total hip arthroplasty (THA). Recent studies have implicated larger femoral heads in early failure. We evaluated what effect the size of the femoral head had on the early functional outcome in order to determine the optimal head size for the maximal functional outcome. There were 726 patients who underwent elective THA and were divided into 3 groups according to head size then compared with respect to functional outcome scores and dislocation rates. This study failed to show that increasing the size of the femoral head significantly improved the functional outcome at 1 year after total hip arthroplasty but that the use of a 36 mm or greater femoral head did reduce the dislocation rate. PMID:23891058

  7. 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

  8. FEMORAL INSERTION OF THE POSTERIOR CRUCIATE LIGAMENT: AN ANATOMICAL STUDY

    PubMed Central

    de Paula Leite Cury, Ricardo; Severino, Nilson Roberto; Camargo, Osmar Pedro Arbix; Aihara, Tatsuo; Neto, Leopoldo Viana Batista; Goarayeb, Dedley Nelson

    2015-01-01

    Objective: To identify objective parameters to guide correct location of the posterior cruciate ligament (PCL) in the femur. Methods: The PCLs of 20 human cadavers were resected. The following portions were measured: distance from the most distal portion of the PCL, close to the roof, to the most anterior edge of the cartilage (AB); distance from the most proximal portion of the PCL, close to the roof, to the most anterior cartilage (AC); distance between the two parts of the ligament close to the roof (BC); distance from the distal edge in its posterior portion, to the more posterior joint edge (DE); distance from the distal edge of the ligament in its posterior portion, to the intercondylar roof (DF); and finally, the format of the ligament insertion and area of coverage on the femoral condyle. Results: The PCL has the shape of a quarter ellipse, with an average area of 153.5mm2. The mean distances found were: AB of 2.1mm, AC of 10.7mm, BC of 8.6mm DE of 12.4mm and DF of 16.8mm. Conclusions: The edge close to the roof of the anterolateral bundle is closer to the joint cartilage (2.1mm) than the posteromedial bundle is, which is 12.4mm from the edge proximal to the cartilage. These references should assist in better and more accurate positioning of femoral tunnels in PCL reconstruction. PMID:27027059

  9. BLEEDING OF FEMORAL HEAD DURING TOTAL HIP ARTHROPLASTY FOR OSTEOARTHROSIS

    PubMed Central

    Schwartsmann, Carlos Roberto; Spinelli, Leandro de Freitas; Sotomayor, Marco Yánez; Yépez, Anthony Kerbes; Boschin, Leonardo Carbonera; Silva, Marcelo Faria

    2015-01-01

    ABSTRACT Objective: To evaluate the bleeding of the femoral head on hip osteoarthritis in patients who underwent total hip arthroplasty. Methods: One hundred and three hips affected by primary hip osteoarthritis were evaluated. After surgical dislocation, the femoral head was divided into four quadrants, and micro perforations were made in order to observe and assess the presence of bleeding, as early type (EB), late type (LB) or without bleeding (WB). Results: We observed early bleeding (EB) in the upper quadrant in 16 hips (15.5%), late bleeding in 14 hips (13.6%) and no bleeding (WB) in 73 hips (70.9%). The anterior quadrant showed EB in 24 hips (23.3%), LB in 7 hips (6.8%) and WB in 72 hips (69.9%). The lower quadrant presented EB in 40 hips (38.8%), LB 14 hips (13.6%) and WB in 49 hips (47.6%). The posterior quadrant showed EB in 39 hips (37.9%), LB 19 hips (18.4%) and WB in 45 hips (43.7%). Comparing BMI and gender, we found no association between these parameters (p> 0.05). Conclusions: The inferior and posterior quadrant had the highest bleeding levels, following the path of the medial circumflex artery. Level of Evidence III, Therapeutic Study. PMID:26981036

  10. Mechanical properties of femoral cortical bone following cemented hip replacement.

    PubMed

    Ni, G X; Lu, W W; Chiu, P K Y; Wang, Y; Li, Z Y; Zhang, Y G; Xu, B; Deng, L F; Luk, K D K

    2007-11-01

    Femoral bone remodeling following total hip replacement is a big concern and has never been examined mechanically. In this study, six goats underwent unilateral cemented hip hemiarthroplasty with polymethyl methacrylate (PMMA) bone cement. Nine months later animals were sacrificed, and the femoral cortical bone slices at different levels were analysed using microhardness testing and microcomputed tomography (micro-CT) scanning. Implanted femurs were compared to contralateral nonimplanted femurs. Extensive bone remodeling was demonstrated at both the proximal and middle levels, but not at the distal level. Compared with the nonimplanted side, significant decreases were found in the implanted femur in cortical bone area, bone mineral density, and cortical bone hardness at the proximal level, as well as in bone mineral density and bone hardness at the middle level. However, no significant difference was observed in either variable for the distal level. In addition, similar proximal-to-distal gradient changes were revealed both in cortical bone microhardness and bone mineral density. From the mechanical point of view, the results of the present study suggested that stress shielding is an important mechanical factor associated with bone adaptation following total hip replacement. PMID:17506504

  11. Normalization of chromium and cobalt values after femoral head replacement

    PubMed Central

    Iacobellis, Claudio; Berizzi, Antonio; Pozzuoli, Assunta; Biz, Carlo

    2015-01-01

    Introduction Adverse reaction to metal debris (ARMD) can be caused by metal-on-metal total hip arthoplasty. We treated a case of ARMD in a 61-year-old patient by limited prosthetic revision, replacing the metal head with a polyethylene one. Presentation of case Two years after metal-on-metal total arthoplasty of the left hip, radiographic control showed osteolysis of the patient’s greater trochanter. He underwent surgical curettage and the application of demineralized bone matrix. After a few months, blood Co and Cr increased, and at clinical evaluation, the patient had worsening paresthesias. He agreed to prosthetic revision after 14 months. Discussion During surgery, the acetabular cup and femoral stem appeared correctly osteointegrated; therefore, the cup was maintained, while the prosthetic femoral head was removed and replaced with a 50 mm polyethylene head. Conclusion Blood Cr and urinary Cr and Co decreased and normalized 3 months after surgery, and the patient no longer suffered paresthesias. Blood Co normalized 7 months after revision. Radiographic follow-up showed no change after 30 months post-operatively. We believe this case report could be a starting point for a future randomized clinical trial to test the efficacy of the procedure used compared with complete implant revision. PMID:25841157

  12. Management of Osteochondritis Dissecans of the Femoral Condyle.

    PubMed

    Shea, Kevin G; Carey, James L; Brown, Gregory A; Murray, Jayson N; Pezold, Ryan; Sevarino, Kaitlyn S

    2016-09-01

    The American Academy of Orthopaedic Surgeons has developed the Appropriate Use Criteria (AUC) document Management of Osteochondritis Dissecans of the Femoral Condyle. Evidence-based information, in conjunction with the clinical expertise of physicians, was used to develop the criteria to improve patient care and obtain the best outcomes while considering the subtleties and distinctions necessary in making clinical decisions. The AUC clinical patient scenarios were derived from patient indications that generally accompany osteochondritis dissecans of the femoral condyle, as well as from current evidence-based clinical practice guidelines and supporting literature. The 64 patient scenarios and 12 treatments were developed by the Writing Panel, a group of clinicians who are specialists in this AUC topic. Lastly, a separate, 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:27479835

  13. Wear and degradation on retrieved zirconia femoral heads.

    PubMed

    Nogiwa-Valdez, A A; Rainforth, W M; Stewart, T D

    2014-03-01

    Zirconia femoral heads retrieved from patients after different implantation periods (up to 13 years) were analysed using vertical scanning interferometry, atomic force microscopy and Raman microspectroscopy. A range of topographical and compositional changes on the surface of the retrievals are reported in this work. The study revealed that changes in roughness are the result of a combination of factors, i.e. scratching, surface upheaval due to transformation to the monoclinic phase and grain pull-out. Clusters of transformed monoclinic grains were observed on heads implanted for more than 3 years. The phase composition of these clusters was confirmed by Raman microspectroscopy. Increased abrasive wear and a higher monoclinic phase content concentrated on the pole of the femoral heads, confirming that the tetragonal to monoclinic phase transformation was not only induced by the tetragonal phase metastability and environmental conditions but mechanical and tribological factors, also affected the transformation kinetics. Additionally, the head implanted for 13 years showed evidence of a self-polishing mechanism leading to a considerable smoothening of the surface. These observations provide an insight into the interrelated mechanisms underlying the wear and transformation process on zirconia ceramics during implantation. PMID:24140384

  14. Proximal femoral diaphyseal cross-sectional geometry in Orrorin tugenensis.

    PubMed

    Bleuze, M

    2012-06-01

    Functional adaptations in femora attributed to Orrorin tugenensis provide a unique opportunity to examine locomotor behavior very early in the hominin lineage. This study examines relative cortical thickness, cortical area (CA) relative to the polar moment of area (J), and J relative to femoral head superoinferior diameter (FHD) in the proximal femur of O. tugenensis (BAR 1002'00 and BAR 1003'00), and compares patterns in this early hominin with those in a sample of modern humans (N=31), Plio-Pleistocene fossil hominins (N=8), Pan troglodytes troglodytes (N=13), and Pan paniscus (N=3). Relative cortical thickness and CA relative to J in the proximal femur of O. tugenensis are comparable to patterns generally found in other fossil hominins. Proximal femoral diaphyseal J relative to FHD in BAR 1002'00 is similar to patterns found in fossil hominins typically attributed to a non-Homo genus (i.e. SK 82, SK 97, and KNM-ER 738). Cross-sectional geometric patterns in the proximal femur of Orrorin are not unlike those generally found in australopithecines and fossil Homo. While the results of this study cannot confirm unequivocally that Orrorin was an obligate biped, a mode of locomotion comparable to that proposed for australopithecines cannot be ruled out. PMID:22609080

  15. Small diameter acetabulum and femoral head in total hip arthroplasty for developmental dysplasia of the hip, with no femoral osteotomy.

    PubMed

    Verettas, Dionysios-Alexandros; Chloropoulou, Pelagia; Xarchas, Konstantinos; Drosos, Georgios; Ververidis, Athanasios; Kazakos, Konstantinos

    2015-01-01

    We present the results of 66 total hip arthroplasties in 62 patients of mean age 46 years (24-74 years), with developmental dysplasia of the hip. In all cases the centre of rotation of the new hip was positioned at the site of the true acetabulum. In all patients cementless press fit acetabular components of small diameter (42-44 mm) were used, articulating exclusively with a 22.25 mm modular metal femoral head, without the use of bone grafts or shortening osteotomies of the femur. Despite the use of small diameter femoral heads the rate of dislocation was 3%. After an average follow-up period of 9 years (4-18 years), no revisions were required for infection, loosening or wear or implant migration. Osteolytic lesions were seen in the periacetabular region in 3 patients who were symptom free. A total of 2 revisions were required for instability and 2 patients had the wires of their trochanteric osteotomy removed because of bursitis. Leg length inequality was improved in 55% of the patients and one postoperative transient sciatic nerve lesion settled within 4 months. We believe that in patients with painful dysplastic hips, the use of small diameter implants with the centre of rotation at the true acetabulum, can give very satisfactory results, without any supplementary procedures. PMID:25907394

  16. Distal femoral derotational osteotomy with external fixation for correction of excessive femoral anteversion in patients with cerebral palsy.

    PubMed

    Skiak, Eyad; Karakasli, Ahmet; Basci, Onur; Satoglu, Ismail S; Ertem, Fatih; Havitcioglu, Hasan

    2015-09-01

    Patients with cerebral palsy (CP) disorder often develop rotational hip deformity. Increasing deformities impair already diminished walking abilities; femoral osteotomies are often performed to maintain and improve walking abilities. Fixation of osteotomies with condylar plates has been used successfully, but does not often enable immediate postoperative full weight-bearing. To avoid considerable postoperative rehabilitation deficit and additional bone loss because of inactivity, a postoperative treatment with full weight-bearing, is therefore, desirable. Self-tapping Schanz screws with a unilateral external fixator crossing the knee joint providing stronger anchoring in osteopenic bone might fulfill these demands. A retrospective study was carried out on 27 ambulatory CP patients, mean age 17.5 years (range 9-22 years); 11 patients with bilateral severe intoeing deformities underwent a supracondylar femoral osteotomy between September 2008 and April 2012. All patients were allowed to bear their full weight postoperatively. The aim of this study was to describe the technique, the results of this technique, to evaluate the time required for bone healing, and the type of complications associated with a distal derotational femoral osteotomy fixed with a uniaxial external fixator crossing the knee joint. A total of 27 patients were studied [mean weight 48.8 kg (range 29.8-75 kg)]. The mean preoperative rotation included internal rotation of 69° and external rotation of 17°. All patients were evaluated clinically and radiographically for a minimum of 1 year after surgery. There was a significant decrease in the mean medial rotation from 69° to 32° (P=0.00034). The lateral rotation increased significantly from preoperative 17° to postoperative 45° (P=0.0011). The femoral anteversion decreased significantly from a mean of 55° preoperatively to a mean 17° postoperatively (P=0.030). All patients, except one, achieved solid fusion uneventfully. One patient was a

  17. Symptomatic atypical femoral fractures are related to underlying hip geometry.

    PubMed

    Taormina, David P; Marcano, Alejandro I; Karia, Raj; Egol, Kenneth A; Tejwani, Nirmal C

    2014-06-01

    The benefits of bisphosphonates are well documented, but prolonged use has been associated with atypical femur fractures. Radiographic markers for fracture predisposition could potentially aid in safer medication use. In this case-control designed study, we compared hip radiographic parameters and the demographic characteristics of chronic bisphosphonate users who sustained an atypical femoral fracture with a group of chronic bisphosphonate users who did not sustain an atypical femur fracture and also a group who sustained an intertrochanteric hip fracture. Radiographic parameters included were neck-shaft angle (NSA), hip-axis length (HAL) and center-edge angle (CE). Multivariate regression was used to evaluate the relationship between radiographic measures and femur fracture. Receiver-operating characteristic analysis determined cut-off points for neck-shaft angle and risk of atypical femur fracture. Ultimately, pre-fracture radiographs of 53 bisphosphonate users who developed atypical fracture were compared with 43 asymptomatic chronic bisphosphonate users and 64 intertrochanteric fracture patients. Duration of bisphosphonate use did not statistically differ between users sustaining atypical fracture and those without fracture (7.9 [±3.5] vs. 7.7 [±3.3] years, p=0.7). Bisphosphonate users who fractured had acute/varus pre-fracture neck-shaft angles (p<0.001), shorter hip-axis length (p<0.01), and narrower center-edge angles (p<0.01). Regression analysis revealed associations between neck-shaft angle (OR=0.89 [95% CI=0.81-0.97; p=0.01), center edge angle (OR=0.89 [95% CI=0.80-0.99]; p=0.03), and BMI (OR=1.15 [95% CI=1.02-1.31; p=0.03) with fracture development. ROC curve analysis (AUC=0.67 [95% CI=0.56-0.79]) determined that a cut-off point for neck-shaft angle <128.3° yielded 69% sensitivity and 63% specificity for development of atypical femoral fracture. Ultimately, an acute/varus angle of the femoral neck, high BMI, and narrow center-edge angle were

  18. Management of osteonecrosis of the femoral head: A novel technique

    PubMed Central

    Samy, Ahmed M

    2016-01-01

    Background: Osteonecrosis of the femoral head (ONFH) is a debilitating disease in orthopedics, frequently progressing to femoral head collapse and osteoarthritis. It is thought to be a multifactorial disease. ONFH ultimately results in femoral head collapse in 75–85% of untreated patients. Total hip arthroplasty (THA) yields satisfactory results in the treatment of the end stage of the disease. However, disease typically affects males between the ages of 20 and 40 years and joint replacement is not the ideal option for younger patients. Recently, mesenchymal stem cells and platelet rich plasma (PRP) have been used as an adjunct to core decompression to improve clinical success in the treatment of precollapse hips. Materials and Methods: A prospective study of 40 hips in 30 patients was done. There were 19 males and 11 females with a mean age 36.7 ± 6.93 years. The indication for the operation was restricted primarily to modified Ficat stages IIb and III. 16 hips (40%) had stage IIb and 24 hips (60%) had stage III ONFH. The period of follow up ranged between 36–50 months with a mean 41.4 ± 3.53 months. All patients were assessed clinically during pre- and post-operative period according to the Harris Hip Score (HHS), Visual Analog Score (VAS) and radiologically by X-rays. Magnetic resonance imaging (MRI) was done preoperatively to confirm the diagnosis and every 6 months postoperatively for assessment of healing. The operative procedure include removal of necrotic area with drilling then the cavity was filled with a composite of bone graft mixed with PRP. Results: The mean HHS improved from 46.0 ± 7.8 preoperatively to 90.28 ± 19 at the end of followup (P < 0.0001). The mean values of VAS were 78 ± 21 and 35 ± 19 at preoperatively period and final followup, respectively, with an average reduction of 43 points. Conclusion: We found that the use of PRP with collagen sheet can increase the reparable capacity after drilling of necrotic segment in stage IIb and

  19. Computational Evaluation of Nucleotide Insertion Opposite Expanded and Widened DNA by the Translesion Synthesis Polymerase Dpo4.

    PubMed

    Albrecht, Laura; Wilson, Katie A; Wetmore, Stacey D

    2016-01-01

    Expanded (x) and widened (y) deoxyribose nucleic acids (DNA) have an extra benzene ring incorporated either horizontally (xDNA) or vertically (yDNA) between a natural pyrimidine base and the deoxyribose, or between the 5- and 6-membered rings of a natural purine. Far-reaching applications for (x,y)DNA include nucleic acid probes and extending the natural genetic code. Since modified nucleobases must encode information that can be passed to the next generation in order to be a useful extension of the genetic code, the ability of translesion (bypass) polymerases to replicate modified bases is an active area of research. The common model bypass polymerase DNA polymerase IV (Dpo4) has been previously shown to successfully replicate and extend past a single modified nucleobase on a template DNA strand. In the current study, molecular dynamics (MD) simulations are used to evaluate the accommodation of expanded/widened nucleobases in the Dpo4 active site, providing the first structural information on the replication of (x,y)DNA. Our results indicate that the Dpo4 catalytic (palm) domain is not significantly impacted by the (x,y)DNA bases. Instead, the template strand is displaced to accommodate the increased C1'-C1' base-pair distance. The structural insights unveiled in the present work not only increase our fundamental understanding of Dpo4 replication, but also reveal the process by which Dpo4 replicates (x,y)DNA, and thereby will contribute to the optimization of high fidelity and efficient polymerases for the replication of modified nucleobases. PMID:27347908

  20. Numerical modeling of the lateral widening of levee breach by overtopping in a flume with 180° bend

    NASA Astrophysics Data System (ADS)

    Dou, S.-T.; Wang, D.-W.; Yu, M.-H.; Liang, Y.-J.

    2014-01-01

    Floods caused by levee breaching pose disastrous risks to the lower reaches and the flood flow zones of rivers. Thus, a comprehensive assessment of flow and sediment transport during floods must be performed to mitigate flood disasters. Given that the flow state becomes relatively more complex and the range of the submerged area becomes more extensive after a levee breach, this paper established a flow and sediment model by using two-dimensional shallow water equations (SWEs) to explore the breach development process and the flow and sediment transport in a curved bed after a levee breach due to overtopping. A three-element weighted essentially non-oscillatory Roe scheme was adopted for the discretization of SWEs. In addition, a non-equilibrium total-load sediment transport model was established to simulate the scour depth development process of the breach. A stable equilibrium of the breach was established based on flow shear force and soil shear strength. The lateral widening of the breach was simulated by the scouring-collapse lateral widening mode. These simulations, together with the levee breach experiment conducted in the laboratory, demonstrate the validity of the flow and sediment transport process established in this paper. The effects of water head in and out of the watercourse, the flow rate, the levee sediment grading, and other variables during levee breaching were also analyzed. The mathematical model calculation provided a number of physical quantities, such as flow rate and flow state at the breach, that are difficult to measure by using the current laboratory facilities. The results of this research provide fundamental data for developing measures that can reduce casualties and asset loss due to floods caused by levee breaching.

  1. Attitudes of pregnant women and male partners towards non-invasive prenatal testing and widening the scope of prenatal screening

    PubMed Central

    van Schendel, Rachèl V; Kleinveld, Johanna H; Dondorp, Wybo J; Pajkrt, Eva; Timmermans, Danielle R M; Holtkamp, Kim C A; Karsten, Margreet; Vlietstra, Anne L; Lachmeijer, Augusta M A; Henneman, Lidewij

    2014-01-01

    Non-invasive prenatal testing (NIPT) and its potential to test for multiple disorders has received much attention. This study explores attitudes of women and men towards NIPT, and their views on widening the scope of prenatal testing in a country with a low uptake of prenatal screening (The Netherlands). Five focus groups with low-risk pregnant women (n=28), three focus groups with men (n=19) and 13 interviews with high- and low-risk pregnant women were conducted. Participants felt that current prenatal screening has great disadvantages such as uncertain results and risk of miscarriage from follow-up diagnostics. Characteristics of NIPT (accurate, safe and early testing) could therefore diminish these disadvantages of prenatal screening and help lower the barrier for participation. This suggests that NIPT might allow couples to decide about prenatal testing based mostly on their will to test or not, rather than largely based on fear of miscarriage risk or the uncertainty of results. The lower barrier for participation was also seen as a downside that could lead to uncritical use or pressure to test. Widening the scope of prenatal testing was seen as beneficial for severe disorders, although it was perceived difficult to determine where to draw the line. Participants argued that there should be a limit to the scope of NIPT, avoiding testing for minor abnormalities. The findings suggest that NIPT could enable more meaningful decision-making for prenatal screening. However, to ensure voluntary participation, especially when testing for multiple disorders, safeguards on the basis of informed decision-making will be of utmost importance. PMID:24642832

  2. Effect of triple pelvic osteotomy on the proximal femoral geometry in dysplastic dogs.

    PubMed

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

    2012-02-01

    Triple pelvic osteotomy (TPO) is one of the surgical procedures for use to try to reduce subsequent degenerative joint disease or modify the progress of hip dysplasia in young dogs. Joint force and pressure distribution were changed by this procedure. Therefore, the aim of this study was to find out whether the remodeling of proximal femur exists or not after TPO in dysplastic dogs. Ten femora from five young dysplastic mongrel dogs, treated unilaterally with TPO using 20° canine pelvic osteotomy plates, were used. One year after TPO, neck-proximal shaft angle, femoral head, neck, diaphyseal and mid-shaft diameters, total femoral, femoral neck axis, and intertrochanteric, femoral head offset lengths as well as the lengths from head center to lateral margin of greater trochanter and to proximal femoral axis were measured from the bone. The significant differences between treatment and control side were determined in Norberg angle, neck-proximal shaft angle, neck diameter, diaphyseal diameter, mid-shaft diameter, length from head center to proximal femoral axis and femoral head offset length. In conclusion, although small number of cases was used, it was determined that the aforementioned variables are affected by TPO. So, these variables may be supply additional information about the changes to the joint following TPO in dysplastic dogs. PMID:21176929

  3. Identification of femoral head center of bipolar hemiarthroplasy in radiostereometric analysis with elementary geometrical shape models.

    PubMed

    Tsukanaka, Masako; Röhrl, Stephan M; von Schewelov, Thord; Nordsletten, Lars

    2016-02-01

    Elementary geometrical shape (EGS) models are useful in radiostereometric analysis (RSA) on hip stems because tantalum markers attached to the stems can be omitted. In order to create an EGS model of a femoral stem, the center of the femoral head has to be identified. The contour of the femoral head is recommended to be used. However, the contour of the femoral head cannot be detected exclusively by computer if it is combined with a bipolar head or a metal cup. We therefore hypothesized that the contour of the outer head of bipolar hemiarthroplasty can be included in the EGS model as well as the femoral head contour. We calculated the time required for the detection of the contour, the precision of analysis and the stem micromotion at 2 years using the two different methods in the same picture set and compared the results. The detection of the bipolar head contour was 10 times faster than that of the femoral head contour. The precision for subsidence was 0.16 mm in EGS RSA with the femoral head contour, and 0.15 mm with the bipolar head contour (p=0.68). The precisions were comparable and clinically acceptable. There was no significant difference between the results of the 2-year micromotion with the two different methods. We conclude that this new method is applicable to measure stem micromotion of hemi-arthroplasty with EGS RSA and the method facilitates the Radiostereometric analysis. PMID:26705109

  4. [Progress in diagnosis and treatment of ipsilateral femoral neck and shaft fracture].

    PubMed

    Du, C G; Zhang, Y Z; Chen, W

    2016-07-01

    Ipsilateral femoral neck and shaft fractures are rare injuries, which are often caused by high-energy trauma and combined with multiple injuries, such as thoracic and abdominal injury, head injuries, and fractures of other sites.Delayed or missed diagnosis of the ipsilateral femoral neck fracture often occurs.When patients with femoral shaft fractures caused by high-energy trauma are admitted into hospital, physical examination should be conducted carefully.In addition to femoral shaft fractures, radiographs of the ipsilater hip and knee joints should been taken, simultaneously taking into consideration the potential effect of anteversion angle on the demonstration of femoral neck fracture.Computed tomograph and magnetic resonance imaging are advised to perform if necessary to facilitate early and accurate diagnosis of ipsilateral femoral neck fracture.Comprehensive evaluation should be done based on age, physical condition, associated injuries as well as fracture site, classification and injury severity.Accordingly, proper and reasonable surgical plan is made.During the operation, anatomical reduction of the fractures, especially femoral neck fractures, should be achieved, and then fixed with appropriate internal implants.Besides, attention should also be paid to the treatment of associated injuries as well as the prevention and management of complications. PMID:27373484

  5. Management of femoral neck fractures in the young patient: A critical analysis review

    PubMed Central

    Pauyo, Thierry; Drager, Justin; Albers, Anthony; Harvey, Edward J

    2014-01-01

    Femoral neck fractures account for nearly half of all hip fractures with the vast majority occurring in elderly patients after simple falls. Currently there may be sufficient evidence to support the routine use of hip replacement surgery for low demand elderly patients in all but non-displaced and valgus impacted femoral neck fractures. However, for the physiologically young patients, preservation of the natural hip anatomy and mechanics is a priority in management because of their high functional demands. The biomechanical challenges of femoral neck fixation and the vulnerability of the femoral head blood supply lead to a high incidence of non-union and osteonecrosis of the femoral head after internal fixation of displaced femoral neck fractures. Anatomic reduction and stable internal fixation are essentials in achieving the goals of treatment in this young patient population. Furthermore, other management variables such as surgical timing, the role of capsulotomy and the choice of implant for fixation remain controversial. This review will focus both on the demographics and injury profile of young patients with femoral neck fractures and the current evidence behind the surgical management of these injuries as well as their major secondary complications. PMID:25035822

  6. Femoral head diameter in subcapital fracture of the femur in Ibadan, Nigeria.

    PubMed

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

    2004-09-01

    Subcapital fracture of the femur is common in the elderly patients though the incidence is less in our environment than in the western world. Primary prosthetic replacement is the method of treatment in the majority of the patients. To facilitate this, a foreknowledge of the femoral head diameter is necessary. To determine the diameter of the femoral head and its magnification on radiograph among patients with hip fractures seen in South-West Nigeria, all patients with subcapital fracture of the neck of femur seen between March 1997 and February 2002 were included in the study. The femoral heads were measured on the radiographic film using a transparent ruler and after extraction of the femoral head during surgery using callipers. There were 25 patients in all, the mean age of patients was 73.2 years. Fall at home accounted for 70% of the cases. The femoral head diameter was between 42 mm and 50 mm in 92% of patients while magnification of femoral head diameter on radiograph was 10-14% in 92% of cases. The usaof 10-14% magnification of femoral head on radiograph would help the surgeon determine the size of prosthetic head before commencement of surgery. PMID:15819470

  7. Ultrasound-Guided Diagnosis of Femoral Osteomyelitis and Abscess.

    PubMed

    Hayden, Geoffrey E; Upshaw, Jana E; Bailey, Stephanie; Park, Daniel B

    2015-09-01

    Skin and soft tissue infections are common disease presentations to the pediatric emergency department, and rapid and accurate identification of potentially serious skin and soft tissue infections is critical. In cases of atraumatic musculoskeletal pain with systemic complaints, a bacterial etiology must be ruled out. Point-of-care ultrasonography is increasingly common in the pediatric emergency department and assists in rapid and accurate identification of a variety of disease processes. We present a case of a 14-year-old adolescent boy with atraumatic right knee pain to illustrate the benefits of point-of-care ultrasonography in the timely diagnosis of musculoskeletal and soft tissue pathology. Moreover, we describe the use of ultrasound in procedural guidance of deep-space fluid aspiration, with an eventual diagnosis of femoral osteomyelitis. Ultrasonographic techniques and the emergent work-up and management of osteomyelitis are reviewed. PMID:26335234

  8. 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

  9. The Vascularized Medial Femoral Corticoperiosteal Flap for Thumb Reconstruction

    PubMed Central

    Amin, Kavit; Darhouse, Nagham; Sivakumar, Bran; Floyd, David

    2015-01-01

    Summary: We present an interesting method of shaping a vascularized medial femoral condyle (MFC) flap into a “neophalanx” for phalangeal reconstruction. Our patient presented with limited strength and function secondary to fracture nonunion of the proximal phalanx of the dominant thumb. Following excision of the pseudarthrosis, an MFC corticoperiosteal flap was harvested, sculpted into a prism shape and inset. The superomedial genicular pedicle was anastomosed to the princeps pollicis artery and a cephalic tributary. On follow-up, new bone growth was seen on radiographs and the patient had substantially improved function, with full metacarpophalangeal extension, a Kapandji score of 9, and a markedly reduced Disabilities of the Arm, Shoulder and Hand score of 2.68. The MFC flap is useful for reconstruction of bony defects, with minimal donor morbidity. This versatile vascularized flap can be crafted to requisite shapes and is useful for small defects in the hand, including phalangeal reconstruction. PMID:26495205

  10. Staining and histomorphometry of microcracks in the human femoral head.

    PubMed

    Villanueva, A R; Longo, J A; Weiner, G

    1994-03-01

    We developed staining techniques that permit identification and histomorphometric analysis of microcracks in the human femoral head 1) from thick, ground bone sections (100 microns) by prestaining with the Villanueva mineralized bone stain (MIBS), and 2) from plastic embedded, undecalcified thin bone sections (5-15 microns) by staining in gallocyanin chrome alum-Villanueva blood stain methods. Both methods represent a significant improvement in the stainability of the microcracks, cellular and tissue elements, and the simultaneous assessment of osteoid seams and tetracycline markers by histomorphometry. Shrinkage and other artifacts were minimized, which helped to clarify some of the uncertainties arising from artifacts resulting from some bone staining methods. Histomorphometric analyses of microcracks were conducted on thick, ground sections of subchondral and trabecular bone. Microcracks were more prevalent in the subchondral bone and osteochondral junction than in the more distant trabeculae. We have consistently localized microcrack areas in bone tissues prepared in these ways. PMID:7515700

  11. Orrorin tugenensis femoral morphology and the evolution of hominin bipedalism.

    PubMed

    Richmond, Brian G; Jungers, William L

    2008-03-21

    Bipedalism is a key human adaptation and a defining feature of the hominin clade. Fossil femora discovered in Kenya and attributed to Orrorin tugenensis, at 6 million years ago, purportedly provide the earliest postcranial evidence of hominin bipedalism, but their functional and phylogenetic affinities are controversial. We show that the O. tugenensis femur differs from those of apes and Homo and most strongly resembles those of Australopithecus and Paranthropus, indicating that O. tugenensis was bipedal but is not more closely related to Homo than to Australopithecus. Femoral morphology indicates that O. tugenensis shared distinctive hip biomechanics with australopiths, suggesting that this complex evolved early in human evolution and persisted for almost 4 million years until modifications of the hip appeared in the late Pliocene in early Homo. PMID:18356526

  12. [The sulcus angle of the femoral trochlea: ultrasonographic evaluation].

    PubMed

    Martino, F; De Serio, A; Macarini, L; Colaianni, P; Solarino, M; Fracella, M R

    1995-03-01

    The sulcus angle of femoral trochlea is particularly important to evaluate the femoro-patellar joint. Our study was aimed at studying the normal trochlea, and especially the sulcus angle, with US. The right knees of 11 normal subjects were examined with US and Computed Tomography (CT) on the same section planes. The US measurements of the sulcus angle were correlated with CT results, which were considered the gold standard. The US and CT data were compared and a direct correlation was found (r = 0.832). The intraobserver difference in US measurements was r = 0.943. The mean sulcus angle value was 132 degrees, in agreement with literature data. We conclude that the US measurements of the sulcus angle are reproducible and as sensitive as CT. PMID:7754110

  13. Modeling polyethylene wear acceleration due to femoral head dislocation damage.

    PubMed

    Kruger, Karen M; Tikekar, Nishant M; Heiner, Anneliese D; Lannutti, John J; Callaghan, John J; Brown, Thomas D

    2014-08-01

    Scratching, scraping, and metal transfer to femoral heads commonly accompany acetabular shell contact during dislocation and closed reduction maneuvers. While head damage conceptually leads to accelerated wear, reports on this subject are mainly anecdotal, and differ widely on the potency of such effect. Towards better understanding this relationship, a physically validated finite element (FE) model was used to compute polyethylene wear acceleration propensity of specific head damage patterns on thirteen retrievals. These FE models estimated wear increases averaging half an order of magnitude when compared to simulations for undamaged heads. There was no correlation between the number of dislocations sustained and wear acceleration. These results underscore the importance of implant-gentle closed reduction, and heightened wear monitoring of successfully reduced dislocation patients. PMID:24851789

  14. Bilateral Femoral Nutrient Foraminal Cement Penetration during Total Hip Arthroplasty

    PubMed Central

    Coomber, Ross; Bhumbra, Rej S; Marston, Robert

    2012-01-01

    Introduction: Cement pressurisation is important for the insertion of both the acetabular and femoral components during Total Hip Arthroplasty (THA). Secondary to pressurization the rare phenomenon of unilateral cement incursion into the nutrient foramen has previously been reported. No bilateral case has been reported to date. This has implications both for misdiagnosis of periprosthetic fractures and for medico-legal consequences due to a presumed adverse intra-operative event. Case Report: We present a case report of a 59 year old, caucasian female who underwent staged bilateral cemented Stanmore THA. The post-operative radiographs demonstrate evidence of bilateral nutrient foramen penetration intra-operatively by standard viscosity cement. The patient suffered no adverse consequences. Conclusions: In summary, cement extravasation into the nutrient foramen is an important differential to be considered in presence of posterior-medial cement in the diaphysis of femur following THA. This requires no further intervention and has no effect on the outcome.

  15. Femoral neck fracture fixation: rigidity of five techniques compared.

    PubMed Central

    Mackechnie-Jarvis, A C

    1983-01-01

    Artificial cadaveric femoral neck fractures were internally fixed with five different devices and subjected to cyclical loading of 0-1.0 kilonewtons (approximately one body weight) whilst in an anatomical position. Displacement of the proximal fragment was detected by a transducer and charted. Bone strength was assessed by a preliminary control loading phase on the intact bone. Efficiency of each fracture fixator could then be directly compared by the relative movement in each case. Five specimens each were tested with Moore's Pins, Trifin Nail, Garden Screws and a sliding screw-plate (OEC Ltd). By the criteria of the experiment, which put a severe shearing load on the implant, none of these devices reliably bore the representative body weight. An extended barrel-plate, which supported the sliding screw almost up to the fracture line, was then made. This device, employing some of Charnley's concepts, tolerated body weight in four cases out of five. PMID:6887186

  16. Scaling in Theropod Dinosaurs: Femoral Bone Strength and Locomotion II

    NASA Astrophysics Data System (ADS)

    Lee, Scott

    2015-03-01

    In the second paper1 of this series, the effect of transverse femoral stresses due to locomotion in theropod dinosaurs of different sizes was examined for the case of an unchanging leg geometry. Students are invariably thrilled to learn about theropod dinosaurs, and this activity applies the concepts of torque and stress to the issue of theropod locomotion. In this paper, our model calculation of Ref. 1 is extended to incorporate the fact that larger animals run with straighter legs. As in Ref. 1, students use geometric data for the femora of theropod dinosaurs to analyze their locomotion abilities. This can either be an in-class activity or given as a homework problem. Larger theropods are found to be less athletic in their movements than smaller theropods since the stresses in the femora of large theropods are closer to breaking their legs than smaller theropods.

  17. Imaging evaluation of patients with osteonecrosis of the femoral head.

    PubMed

    Pierce, Todd P; Jauregui, Julio J; Cherian, Jeffrey J; Elmallah, Randa K; Mont, Michael A

    2015-09-01

    Imaging modalities for the diagnosis of osteonecrosis (ON) of the femoral head have been studied extensively, but there have been few reports strictly addressing radiographic evaluation. The purpose of this report is to examine the use and role of (1) plain radiographs, (2) magnetic resonance imaging (MRI), (3) computerized tomography (CT), (4) bone scanning, and (5) positron emission topography (PET) for the diagnostic evaluation of ON. Plain radiographs are a mainstay in diagnosis but have very low sensitivity for early ON. MRI is the gold standard for diagnostic evaluation but may not identify subchondral fractures on collapse as well as CT scan or tomogram. Bone scanning should not be used for diagnosis due to its low sensitivity. PET scanning does not have a definitive role in diagnosis yet. Future research should focus on the role of new imaging technologies in evaluation. PMID:26045084

  18. Subsidence of the femoral prosthesis. A stereophotogrammetric evaluation.

    PubMed

    Chafetz, N; Baumrind, S; Murray, W R; Genant, H K; Korn, E L

    1985-12-01

    A quantitative three-dimensional measurement method, radiographic stereophotogrammetry (SPG), was employed to assess the relation between early subsidence of the femoral prosthesis after total hip arthroplasty (THA) and subsequent clinical course. The SPG technique and the authors' error control mechanisms are described in 15 patients in the early postoperative period, and the findings are correlated with those of follow-up clinical examinations. Among the 12 patients who remained clinically asymptomatic with respect to pain, only one had an SPG estimate of subsidence in excess of 1 mm at any point in time. Each of the three patients who later became symptomatic had SPG estimates of subsidence in excess of 1.75 mm within six months of the operation. Thus far, the patient with the largest estimate of subsidence is the only one who required surgical revision. PMID:4064420

  19. A critical assessment of proximal macrotexturing on cemented femoral components.

    PubMed

    Duffy, G P; Muratoglu, O K; Biggs, S A; Larson, S L; Lozynsky, A J; Harris, W H

    2001-12-01

    We analyzed the cement-metal interface of 3 different types of femoral components that had proximal macrotexturing after in vitro insertion and after fatigue testing designed to produce debonding and micromotion. These components were compared with clinical retrieval specimens. The cement did not flow into the macrotexturing; rather, hollow, brittle volcanoes or calderas were formed. These fragile protrusions of cement become worn down or abraded by debonded components. This abrasion of cement may contribute to the early and aggressive osteolysis seen in some of these early failures with proximal macrotextured components. The formation of these volcanos and calderas can be aborted by placing bone-cement onto the macrotexturing before stem insertion. This simple technique allows the macrotexturing to be filled with cement. PMID:11742450

  20. HEMIARTHROPLASTY IN THE TREATMENT FRACTURES OF THE FEMORAL NECK

    PubMed Central

    Ono, Nelson Keiske; de Andrade Lima, Guilherme Didier; Honda, Emerson Kiyoshi; Polesello, Giancarlo Cavalli; Guimarães, Rodrigo Pereira; Júnior, Walter Ricioli; de Queiroz, Marcelo Cavalheiro

    2015-01-01

    Objective: To epidemiologically and clinically evaluate patients with displaced femoral neck fractures that were surgically treatment with cemented hip hemiarthroplasty. Methods: All patients with displaced femoral neck fractures (Garden III and IV) who underwent cemented hip hemiarthroplasty using a unipolar prosthesis (Thompson), by means of a posterolateral access between June 2005 and September 2008 were retrospectively evaluated. Results: Seventy patients were initially evaluated. Their mean age was 83.1 years. The patients were predominantly female (84.3%). Thirty-six patients were monitored as outpatients for periods ranging from 10 to 48 months (mean of 26.5 months). Fifteen patients were lost to follow-up. Nineteen patients died, and the mortality rate within the first year was 25.4%. Patients classified as ASA III had a mortality rate of 25.7% and ASA II patients, a rate of 12.1%. Two patients had symptomatic deep vein thrombosis; one patient had an operative wound infection; and none of the patients presented hip dislocation. Most of the patients did not experience pain. Twelve patients (33%) showed deterioration of their walking ability. Conclusion: There were no cases of hip dislocation. Patients classified as ASA III had a higher mortality rate than did patients with ASA I or II. There was a worsening of walking ability in 33% of the patients. No revision due to loosening or pain was needed for any patient. Thirty patients did not present any pain (83.3%), four presented moderate pain (11.1%) and two presented intense pain (5.5%). PMID:27022567

  1. Femoral Strength after Induced Lesions in Rats (Rattus norvegicus)

    PubMed Central

    Belill, Kathryn A; Settle, Timothy L; Angel, C Roselina; Kim, Seon-Woo; Rothwell, Stephen W

    2014-01-01

    Rats are a common model for the study of bone healing, with the cranium, femur, and tibia being the bones studied most frequently. This study examines noncritical-sized lesions that would allow rats to continue to bear weight without the need for fixation but that are sufficiently large to enable characterization of the healing process. We compared the femoral bone strength associated with 3 lesion sizes selected for use in future studies. Sprague–Dawley rats (age, 10 to 16 wk) were used to assess the ultimate breaking strength, stress, and break force of normal, unmanipulated femurs. We then created lesions of 3 different sizes in the mid- to distal diaphysis of the left and right femurs and characterized the associated decreases in bone strength. Femurs (n= 85) for this study were collected through tissue sharing from rats used in other acute surgical procedures and were tested by using a 3-point bending flexural materials-testing machine. Our hypothesis was that, as a model for bone healing, 3 induced lesions of different sizes would show incremental and proportional decreases in femoral strength, with the intermediate-sized (1.5-mm) lesion demonstrating a decrease of 20% to 40%. A lesion of 1.5 mm yielded a decrease in strength of 17% for both the left and right femurs. The strength of left femurs carrying intermediate lesions was significantly less than that of control, uninjured femur bones. In addition to providing validation for our own future bone-healing project, these data are a useful baseline for other investigators studying bone healing in a rat femur model. PMID:24956210

  2. Calcar Preservation Arthroplasty for Unstable Intertrochanteric Femoral Fractures in Elderly

    PubMed Central

    Togrul, Emre; Kose, Ozkan

    2015-01-01

    Background The treatment of unstable intertrochanteric fractures in elderly is still controversial. The purpose of this study is to present treatment strategies for unstable intertrochanteric fractures with hemiarthroplasty using standard uncemented collared femoral stems and at the same time preserving the fractured calcar fragment. Methods Fifty-four patients aged 75 years or older with unstable intertrochanteric fractures were included in this prospective cohort study. All patients were treated with calcar preserving hemiarthroplasty using cementless collored femoral stems. Fractured calcar fragment was stabilized either by compaction between the implant and femur or fixed with cable grip system. Follow-up evaluations were performed at least 24 months and later. Palmer and Parker mobility score and visual analogue scale (VAS) pain score were assessed. We also analyzed radiographs of the operated hip at each follow-up visit. Results The patients were 15 males and 39 females with a mean age of 81.3 years (range, 75 to 93 years). The average operative time was 86.6 minutes. The mean transfused blood units were 1.2 units. The average duration of hospital stay was 5.3 days. The preoperative mean mobility score was 6.20. This score was found to be 4.96 on postoperative third day and 5.90 at 24 months postoperatively. The results of the statistical analysis revealed significant increase in the mobility scores at each follow-up after three days. Radiological interpretation revealed no loosening in the cable-grip systems, and no significant subsidence (> 5 mm) of prosthesis was observed. Conclusions Calcar preservation arthroplasty is a good option for elderly patients with severe osteoporosis, frail constitution and the patients who are at higher risk for second operation due to unstable intertrochanteric fractures. PMID:26640625

  3. Effects of risedronate on femoral bone mineral density and bone strength in sciatic neurectomized young rats.

    PubMed

    Iwamoto, Jun; Seki, Azusa; Takeda, Tsuyoshi; Sato, Yoshihiro; Yamada, Harumoto

    2005-01-01

    Immobilization induces a rapid loss of bone density and bone strength in rats. The purpose of the present study was to examine the effects of risedronate (Ris) on the femoral bone density and bone strength of sciatic neurectomized young rats. Forty male Sprague-Dawley rats, 6 weeks of age, were randomized by the stratified weight method into the following four treatment groups of 10 rats each: sham-operation, bilateral sciatic neurectomy (NX), NX + low-dose Ris (0.25 mg/kg/day, orally), and NX + high-dose Ris (0.5 mg/kg/day, orally). After 8 weeks of feeding, the volumetric bone mineral density (vBMD) and stress strain index (SSI) of the femoral distal metaphysis and middiaphysis of the rats were measured by peripheral quantitative computed tomography. The mechanical properties of the femoral distal metaphysis and middiaphysis were measured by the compression and three-point bending tests, respectively. The femoral length was also measured. As compared with the findings in the sham-operated controls, NX resulted in a loss of femoral length, cancellous vBMD, SSI, maximum load, stiffness, and breaking energy of the femoral distal metaphysis; there was also loss of cortical thickness, SSI, maximum load, and stiffness of the femoral middiaphysis, with no significant effects on the cortical vBMD or breaking energy of the femoral middiaphysis. High-dose Ris increased the vBMD to values higher than those in the sham-operated controls, and prevented the loss of SSI, maximum load, and stiffness of the femoral distal metaphysis, while low-dose Ris prevented the loss of cancellous vBMD of the femoral distal metaphysis. Neither high- nor low-dose Ris affected any of the cortical bone parameters of the femoral middiaphysis, except for cortical thickness, or the femoral length. These findings suggest that Ris may prevent immobilization-induced loss of cancellous bone density and bone strength in a dose-dependent manner without interfering with bone growth, but has no apparent

  4. Femoral Artery Stenosis Following Percutaneous Closure Using a Starclose Closure Device

    SciTech Connect

    Bent, Clare Louise; Kyriakides, Constantinos; Matson, Matthew

    2008-07-15

    Starclose (Abbott Vascular Devices, Redwood City, CA) is a new arterial closure device that seals a femoral puncture site with an extravascular star-shaped nitinol clip. The clip projects small tines into the arterial wall which fold inward, causing the arterial wall to pucker, producing a purse-string-like seal closing the puncture site. The case history is that of a 76-year-old female patient who underwent day-case percutaneous diagnostic coronary angiography. A Starclose femoral artery closure device was used to achieve hemostasis with subsequent femoral artery stenosis.

  5. Subchondral Insufficiency Fracture of the Femoral Head Caused by Excessive Lateralization of the Acetabular Rim

    PubMed Central

    Kimura, Tetsuya; Goto, Tomohiro; Hamada, Daisuke; Tsutsui, Takahiko; Wada, Keizo; Fukuta, Shoji; Nagamachi, Akihiro; Sairyo, Koichi

    2016-01-01

    We present a case of a 53-year-old woman with subchondral insufficiency fracture (SIF) of the femoral head without history of severe osteoporosis or overexertion. Plain radiographs showed acetabular overcoverage with excessive lateralization of the acetabular rim. A diagnosis of SIF was made by typical MRI findings of SIF. The lesion occurred at the antipodes of the extended rim. Increased mechanical stress over the femoral head due to impingement against the excess bone was suspected as a cause of SIF. The distinct femoral head deformity is consistent with this hypothesis. This is the first report of SIF associated with acetabular overcoverage. PMID:27293935

  6. Postcatheterization Femoral Arteriovenous Fistula: Endovascular Treatment with N-Butyl-Cyanoacrylate Embolization

    SciTech Connect

    Onal, Baran Ilgit, Erhan T.; Akpek, Sergin; Coskun, Bilgen

    2006-04-15

    We report a case of an iatrogenic femoral arteriovenous fistula (AVF) in a 67-year-old man presenting with right femoral bruit on the day after sheath removal for cardiac catheterization. This was successfully treated with embolization using N-butyl-cynoacrylate (NBCA) through a coaxial microcatheter. Transcatheter embolization of iatrogenic femoral AVFs with NBCA in selected cases may be a safe and effective treatment in the presence of long fistula tracts. It is then easy to perform in experienced hands and relatively inexpensive.

  7. Annealing-induced optical-bandgap widening of Cu2ZnSnS4 thin films with observation of simultaneous increase in local-structure ordering

    NASA Astrophysics Data System (ADS)

    Toyama, Toshihiko; Konishi, Takafumi; Seo, Yuichi; Tsuji, Ryotaro; Terai, Kengo; Nakashima, Yuto; Maenishi, Ryuichiro; Arata, Akiko; Yudate, Shinji; Tsutsumi, Yasuo; Shirakata, Sho

    2015-01-01

    We achieved annealing-induced optical-bandgap widening in Cu2ZnSnS4 (CZTS), which is a promising material for use in high-efficiency thin-film solar cells, and we performed synchrotron-radiation X-ray absorption fine structure (XAFS) measurements to study the reasons underlying the widening. CZTS thin-film samples were fabricated at a low temperature of 230 °C via sputtering with a CZTS ceramic target followed by annealing at up to 550 °C. Optical absorption spectroscopy revealed optical bandgap widening when the annealing temperature was ≥350 °C. Compositional changes, phase separations, and lattice strains were excluded as possible reasons. XAFS measurements revealed that the radial distribution functions (RDFs) around the Zn K-absorption edge almost completely corresponded to those of a kesterite structure. In addition, the RDFs indicated that the disorder of atomic positions within 1 nm from zinc atoms tended to decrease with increasing annealing temperature, which we conclude is the primary reason for the optical-bandgap widening.

  8. Widening Access through Openness in Higher Education in the Developing World: A Bourdieusian Field Analysis of Experiences from the National Open University of Nigeria

    ERIC Educational Resources Information Center

    Olakulehin, Felix Kayode; Singh, Gurmit

    2013-01-01

    Bourdieu has argued that higher education is a field that reproduces social inequality, thus complicating how openness widens access to higher education in the developing world. Drawing on the experiences of the National Open University of Nigeria (NOUN), this paper critically analyses and evaluates the rationale, approach, difficulties,…

  9. Utility of Routine Exercise Testing to Detect Rate-Related QRS Widening in Patients Without Structural Heart Disease on Class Ic Antiarrhythmic Agents (Flecainide and Propafenone).

    PubMed

    Vallurupalli, Srikanth; Pothineni, Naga Venkata K; Deshmukh, Abhishek; Paydak, Hakan

    2015-09-01

    Class Ic antiarrhythmic agents are effective in the treatment of various atrial tachyarrhythmias. They are known to cause rate-related QRS widening in the presence of structural heart disease, which can lead to life-threatening arrhythmias. The role of routine exercise electrocardiography in patients without structural heart disease is unknown. All patients initiated on class Ic antiarrhythmic agents and who had exercise electrocardiography performed from June 2009 to June 2013 were included. Symptom-limited treadmill electrocardiography was performed to detect significant QRS widening at peak exercise (defined as an increase of >25% of baseline QRS). Fifty-six patients were included in the study. All patients were screened for structural heart disease before initiation of the medication. Significant QRS widening and atrial tachycardia occurred in a single patient, which terminated with cessation of exercise. This patient had a history of tachycardia-mediated cardiomyopathy with normalization of ejection fraction 3 years before being placed on flecainide. In conclusion, routine exercise testing to detect QRS widening is not warranted in patients with no structural heart disease. PMID:26100588

  10. Suture-mediated closure of antegrade femoral arteriotomy following infrainguinal intervention.

    PubMed

    Khosla, Sandeep; Kunjummen, Binu; Guerrero, Mayra; Manda, Ravi; Razminia, Mansoor; Ahmed, Aziz

    2002-12-01

    Antegrade femoral arterial access has been less commonly adopted for infrainguinal intervention due to increased risk of retroperitoneal hemorrhage secondary to noncompressibility of arteriotomy site. We evaluated the efficacy and safety of suture-mediated closure of antegrade femoral arteriotomy using the Closer device. Twelve consecutive patients undergoing infrainguinal intervention (females, 5; mean body weight, 69 +/- 16 kg; limb threatening ischemia, 50%) underwent repair of the antegrade femoral arteriotomy immediately postprocedure using the Closer. Indications for antegrade access were excessive iliac tortuosity (6/12), long femoral artery occlusion (5/12), and bilateral aortoiliac bifurcation stents (1/12). The acute procedural success (immediate hemostasis without need for manual compression) was 100%. The mean time to ambulation was 3.9 +/- 1.5 hr and the procedure-related length of stay was 18 +/- 5.5 hr. In conclusion, repair of antegrade arterial puncture is safe and effective following infrainguinal intervention. PMID:12455086

  11. Comparison of femoral inclination angle measurements in dysplastic and nondysplastic dogs of different breeds.

    PubMed

    Sarierler, M

    2004-01-01

    In this study, inclination angle of the femoral head and neck was measured on 484 limbs of 242 dogs belonging to 7 breeds, examined for hip dysplasia. These inclination angles were compared according to age, sex and joint laxity, evaluated with Subluxation Index (SI) and Norberg angle (NA) results. The findings indicate that (a) there was a minimal (nonsignificant) difference in femoral inclination angle between the dysplastic and nondysplastic dogs belonging to 7 breeds; (b) although there was no significant difference in femoral inclination angle between the nondysplastic dogs belonging to 4 breeds (Pointer, Irish Setter, Golden Retriever and German Shepherd), a significant difference was observed between Doberman and Labrador, and between Anatolian Karabash and the other six breeds (p < 0.001). Age and sex did not affect the femoral neck angle. PMID:15168756

  12. Cross-match protocols for femoral neck fractures--finding one that can work.

    PubMed Central

    Khan, A. M.; Mushtaq, N.; Giannakas, K.; Sochart, D. H.; Andrews, J. G.

    2004-01-01

    BACKGROUND: Cross-match practice for patients with femoral neck fractures continues to cause concern due to a failure of compliance to the existing protocols. To address this issue, a number of studies were conducted over a 3-year period. METHODS: First, the existing cross-match practice for patients admitted with femoral neck fractures was reviewed to demonstrate the deficiencies within the system. Second, the opinion of anaesthetic and orthopaedic trainees was assessed regarding blood requirements for different femoral neck fractures following surgery and the justification of their perceptions. RESULTS: A summation of the studies is reported which demonstrates the reasons for the poor compliance to previous protocols. CONCLUSIONS: A simple and effective protocol is provided that has helped reduce pre-operative cross-matching of femoral neck fractures from 71% to 16.7% when assessed 2 years after its introduction. PMID:15005938

  13. Iatrogenic Femoral Pseudoaneurysm and Secondary Ipsilateral Deep Vein Thrombosis: An Indication for Early Surgical Exploration.

    PubMed

    Papadakis, Marios; Zirngibl, Hubert; Floros, Nikolaos

    2016-07-01

    Pseudoaneurysm formation often complicates transfemoral interventional procedures. Nonsurgical treatment consists of femoral compression and thrombin injection under ultrasound guidance. We report a 74-year-old man who was diagnosed with a pseudoaneurysm, following coronary angiography. Duplex ultrasound revealed deep vein thrombosis of the ipsilateral common femoral vein. Ultrasound-guided thrombin injection was unsuccessfully performed, and the patient subsequently underwent surgical exploration for repair of the pseudoaneurysm and release of the venous compression. The increased local inflammation, because of the thrombosis, added in surgical difficulties. We conclude that early surgical intervention should be considered as a primary strategy in patients with femoral pseudoaneurysms and deep vein thrombosis secondary to femoral compression. PMID:27174354

  14. Norepinephrine responses in rat renal and femoral veins are reinforced by vasoconstrictor prostanoids.

    PubMed

    de Souza Rossignoli, Patrícia; Yamamoto, Fernanda Zocatelli; Pereira, Oduvaldo Câmara Marques; Chies, Agnaldo Bruno

    2015-09-01

    Norepinephrine (NE) responses are larger in renal and femoral veins compared to phenylephrine (PE). These differences may be due to the subtypes of adrenoceptor involved in these responses or to the involvement of local modulatory mechanisms. Therefore, the present study investigated in organ bath the adrenoceptor subtypes involved in the NE and PE responses in both renal and femoral veins as well as the influence of local mechanisms related to NO and to prostanoids upon these responses. The obtained data showed that the NE responses in these veins were not significantly modified by the selective inhibition of β1 or β2-adrenoceptors as well as AT1 or AT2 receptors. However, yohimbine reduced the NE Rmax in renal veins and, in parallel, right shifted the NE concentration-response curves in femoral veins. In both veins, prazosin reduced the NE Rmax and the clonidine induced a measurable contraction. The endothelium removal attenuated the NE responses in femoral veins, thereby abolishing the differences of NE and PE responses. Furthermore, the NE responses in renal and femoral veins were attenuated by indomethacin, which suppressed the statistical difference in relation to the PE response. In conclusion, a synergism between α1- and α2-adrenoceptors is essential to assure full NE contractile responses in both renal and femoral veins. Thus, by acting simultaneously in these adrenoceptors, NE induces more pronounced contractile responses, in comparison to PE, not only in renal but also in femoral veins. Moreover, this pronounced NE response in both renal and femoral veins appears to involve endothelium-derived vasoconstrictor prostanoids. PMID:26141930

  15. A three-dimensional axis for the study of femoral neck orientation

    PubMed Central

    Bonneau, Noémie; Libourel, Paul-Antoine; Simonis, Caroline; Puymerail, Laurent; Baylac, Michel; Tardieu, Christine; Gagey, Olivier

    2012-01-01

    A common problem in the quantification of the orientation of the femoral neck is the difficulty to determine its true axis; however, this axis is typically estimated visually only. Moreover, the orientation of the femoral neck is commonly analysed using angles that are dependent on anatomical planes of reference and only quantify the orientation in two dimensions. The purpose of this study is to establish a method to determine the three-dimensional orientation of the femoral neck using a three-dimensional model. An accurate determination of the femoral neck axis requires a reconsideration of the complex architecture of the proximal femur. The morphology of the femoral neck results from both the medial and arcuate trabecular systems, and the asymmetry of the cortical bone. Given these considerations, two alternative models, in addition to the cylindrical one frequently assumed, were tested. The surface geometry of the femoral neck was subsequently used to fit one cylinder, two cylinders and successive cross-sectional ellipses. The model based on successive ellipses provided a significantly smaller average deviation than the two other models (P < 0.001) and reduced the observer-induced measurement error. Comparisons with traditional measurements and analyses on a sample of 91 femora were also performed to assess the validity of the model based on successive ellipses. This study provides a semi-automatic and accurate method for the determination of the functional three-dimensional femoral neck orientation avoiding the use of a reference plane. This innovative method has important implications for future studies that aim to document and understand the change in the orientation of the femoral neck associated with the acquisition of a bipedal gait in humans. Moreover, the precise determination of the three-dimensional orientation has implications in current research involved in developing clinical applications in diagnosis, hip surgery and rehabilitation. PMID:22967192

  16. Adventitial cystic disease of the common femoral vein presenting as deep vein thrombosis.

    PubMed

    Kim, Young-Kyun; Chun, Ho Jong; Hwang, Jeong Kye; Kim, Ji Il; Kim, Sang Dong; Park, Sun-Cheol; Moon, In Sung

    2016-07-01

    Adventitial cystic disease of the common femoral vein is a rare condition. We herein report the case of a 50-year-old woman who presented with painless swelling in her left lower leg that resembled deep vein thrombosis. She underwent femoral exploration and excision of the cystic wall. The presentation, investigation, treatment, and pathology of this condition are discussed with a literature review. PMID:23978427

  17. Curvature analysis of femoral shaft in total knee arthroplasty patient and control group.

    PubMed

    Lim, Ki Seon; Oh, Wang Kyun; Shin, Ji Yun; Cho, Byung Ki; Lee, Tae Soo

    2013-01-01

    For some patients with joint illnesses such as rheumarthritis or varus deformity, the total knee arthroplasty (TKA) procedures are performed. However, when inserting metal cutting guide for the procedures, due to the femoral shaft bowing, complications such as the cortex of the femoral shaft damages or secondary fractures can be caused. If the central coordinate value of the femoral shaft is known, the metal cutting guide could be inserted into the anatomical center, so such complications can be prevented. In this study, CT images of femoral shafts of 10 individuals in the experiment group who are in need of receiving the total knee arthroplasty procedures and those of 10 individuals in the control group without illness in the femoral shaft have been utilized to locate the 3-dimensional coordinate values. Then, Matlab was utilized to identify the central coordinate value in order to obtain a graph reflecting the anatomical shapes as well as to acquire the 3-dimensional curvature values by section. As a result, the average curvature range of femoral shafts of the experiment group was determined to be 631.2 mm whereas the average curvature range of femoral shafts of the control group was determined to be 1430.4 mm. The statistical significant of the measured results was verified through ANOVA analysis. Based on these results, it was verified that the level of curvature of the femoral shaft of the experiment group was higher. If the anatomical central points are located and analyzed using this methodology, it would be helpful in performing orthopedic operations such as the total knee arthroplasty. PMID:24110202

  18. Extraluminal lipoma with common femoral vein obstruction: a cause of chronic venous insufficiency.

    PubMed

    Gasparis, Antonios P; Tsintzilonis, Stylianos; Labropoulos, Nicos

    2009-02-01

    A 49-year-old man, with a misdiagnosis of common femoral vein deep vein thrombosis presented with advanced chronic venous insufficiency. Further imaging revealed a patent common femoral vein with augmentation that was compressed by an extrinsic mass. Exploration identified a lipoma that was extravascular and was resulting in venous outflow obstruction. Excision of the lipoma resulted in clinical improvement and ulcer healing. PMID:19216966

  19. USE OF CORTICAL STRUCTURAL HOMOLOGOUS BONE GRAFT IN FEMORAL RECONSTRUCTIVE SURGERY

    PubMed Central

    Roos, Milton Valdomiro; Roos, Bruno Dutra; Giora, Taís Stedile Busin; Taglietti, Thiago Martins

    2015-01-01

    To perform a clinical and radiographic assessment of patients undergoing surgical treatment using a cortical structural homologous bone graft for femoral reconstruction following mechanical failure of total hip arthroplasty and periprosthetic fractures. Methods: A retrospective study was conducted on 27 patients who underwent surgical treatment for femoral reconstruction following mechanical failure of total hip arthroplasty (12 cases) and periprosthetic fractures (15 cases), using a cortical structural homologous bone graft and cemented implants, between June 1999 and February 2008. Of these, 21 fulfilled all the criteria required for this study. The patients underwent pre and postoperative clinical assessments using the Harris Hip Score. Preoperative, immediate postoperative and late postoperative radiographs were also evaluated, with comparisons of fracture consolidation, radiographic signs of graft consolidation, changes to the bone stock and femoral bone quality, and femoral alignment. Results: Nine patients (42.9%) underwent femoral reconstruction following mechanical failure of total hip arthroplasty and 12 cases (57.1%) underwent femoral reconstruction following periprosthetic fracture. Regarding the postoperative clinical classification, the results were considered satisfactory in 85.7% of the cases and unsatisfactory in 14.3%. Radiographic signs of graft consolidation were seen in all cases. There was an increase in bone stock in 90.5% of the hip reconstructions, as measured by the cortical index. Furthermore, the changes to femoral bone quality were considered good in 66.7% of the cases. Conclusion: The use of cortical structural homologous bone grafts for both femoral reconstructive surgery on total hip arthroplasty and periprosthetic fractures is a good treatment option for selected cases, enabling satisfactory clinical and radiographic results. PMID:27026955

  20. Co-evolution of in-channel sediment deposition and channel widening. The case of the gravel-bed Dunajec River upstream from the Czorsztyn Reservoir, Polish Carpathians.

    NASA Astrophysics Data System (ADS)

    Liro, Maciej

    2015-04-01

    In this study the changes of the gravel bar area and the channel width were analysed in the base-level raised section of the gravel-bed Dunajec River upstream from the Czorsztyn Reservoir (CR) (Polish Carpathians). The construction of the CR and the large flood which occurred in 1997, as well as the existence of aerial imagery taken before (1982, 1994) and after (2003) those events during very similar and low river discharges, provided unique opportunity to investigate temporal and spatial changes of channel width and bar area. In the post-dam period (1994-2003), a major flood in 1997 caused more than two times greater channel widening and ten-fold greater bar area increasing in the backwater section than in the section not affected by base-level rising. The extents of accelerated channel widening and bar area growing in the longitudinal channel profile reached 2400 m and 1800 m upstream from the CR respectively. The highest channel widening and the bar growth were spatially related to the highly developing meander bends located partly at the upstream limit of the backwater (1400-2400 m). In this section, very wide braided channel existed at end of the 19th century. This study shows that the reservoir-induced base-level rising may have promoted the sediment storage and major channel change, but the trajectories of these phenomenons are temporally related to floods, and spatially and casually interdependent on local site specific conditions (e.g. bend development site in wider valley bottom section). In this site the existence of negative feedback mechanisms between bar growth and channel widening resulted in a progressive channel widening and large bar development.

  1. A complication during femoral broaching in total hip arthroplasty: a case report.

    PubMed

    Waldstein, Wenzel; Boettner, Friedrich

    2013-01-01

    Press-fit component fixation is one of the primary goals in uncemented total hip arthroplasty. When aiming at proximal load transfer, the stem size has to be selected with regard to the shape of the proximal femoral canal. This can be challenging in patients with 'champagne flute' femurs with a relatively narrow diaphysis, especially when a long stem femoral component is used. The present case report describes a complication during femoral broaching for a primary uncemented femoral component. Because of the narrow diaphysis, the distal portion of the broach got caught in the narrow canal and it became impossible to remove the broach with conventional techniques. Via a second distal incision, the femur was split from the distal tip of the broach to approximately 5 cm distal of the femoral neck cut along the posterior aspects of the femur. This loosened the broach enough to allow for an uncomplicated removal. The longitudinal split was secured with cables before a similar size primary implant was press fitted into the femoral canal. PMID:23961301

  2. RigidFix femoral fixation: a test for detecting inaccurate cross pin positioning.

    PubMed

    Papastergiou, Stergios G; Koukoulias, Nikolaos E; Dimitriadis, Theofilos; Pappis, Georgios; Parisis, Constantinos A

    2007-11-01

    The RigidFix Cross Pin System (DePuy Mitek, Raynham, MA) is a popular technique for femoral fixation of graft in ACL reconstruction. In some cases, though, cross pins miss the femoral tunnel resulting in inadequate proximal graft fixation. We present a simple test to detect the incorrect placement of cross pins. The pinholes are drilled through the guide frame, leaving 2 sleeves for cross pins insertion. The manufacturer's recommendations, at this stage, are to reinsert the femoral tunnel guidewire, remove the guide frame, and insert the graft without verifying accurate pinhole positioning. We reinsert the femoral tunnel guidewire without removing the guide frame, and a second guidewire is introduced through each of the sleeves in turn. In case of appropriate pinhole placement, the 2 guidewires will meet in the cannulated rod of the guide frame and the surgeon will have the metal-to-metal feeling. If the pinhole misses the femoral tunnel, the 2 guidewires will not meet and the surgeon will not have the metal-to-metal feeling. In our practice, 9 cases of inaccurate pinhole placement were detected with this test and verified by direct vision of the femoral tunnel with the arthroscope. We find this test simple, reliable, and not time consuming. PMID:17986419

  3. What is the optimal alignment of the tibial and femoral components in knee arthroplasty?

    PubMed Central

    Gromov, Kirill; Korchi, Mounim; Thomsen, Morten G; Husted, Henrik; Troelsen, Anders

    2014-01-01

    Background Surgeon-dependent factors such as optimal implant alignment are thought to play a significant role in outcome following primary total knee arthroplasty (TKA). Exact definitions and references for optimal alignment are, however, still being debated. This overview of the literature describes different definitions of component alignment following primary TKA for (1) tibiofemoral alignment in the AP plane, (2) tibial and femoral component placement in the AP plane, (3) tibial and femoral component placement in the sagittal plane, and (4) rotational alignment of tibial and femoral components and their role in outcome and implant survival. Methods We performed a literature search for original and review articles on implant positioning following primary TKA. Definitions for coronal, sagittal, and rotational placement of femoral and tibial components were summarized and the influence of positioning on survival and functional outcome was considered. Results Many definitions exist when evaluating placement of femoral and tibial components. Implant alignment plays a role in both survival and functional outcome following primary TKA, as component malalignment can lead to increased failure rates, maltracking, and knee pain. Interpretation Based on currently available evidence, surgeons should aim for optimal alignment of tibial and femoral components when performing TKA. PMID:25036719

  4. Simulated knee wear with cobalt chromium and oxidized zirconium knee femoral components.

    PubMed

    White, S E; Whiteside, L A; McCarthy, D S; Anthony, M; Poggie, R A

    1994-12-01

    A knee simulator that mimics the plowing/rolling wear mechanisms of the knee was used to compare wear properties of cobalt chromium and oxidized zirconium femoral components. The simulator flexes and extends the knee so that the femoral components travels from 0 degrees to 30 degrees while applying axial loads from 130 to 1300 lb. Three oxidized zirconium and 3 cobalt chromium femoral components were tested with 10-mm tibial polyethylene components. The oxidized zirconium femoral components caused significantly less ultra high molecular weight polyethylene wear than cobalt chromium femoral components. Tibial inserts that were articulated against the cobalt chromium components had evidence of scratching, burnishing, and delamination, but none of the surfaces that were articulated against oxidized zirconium components had evidence of delamination. Cobalt chromium surface roughness significantly increased during the 2,000,000 cycle test, but oxidized zirconium surface roughness was not affected. Polyethylene wear was correlated to a significant degree with the surface roughness of the femoral components. The improved wear characteristics of the ceramic articular surfaces can be explained by the wettability of the ceramic surface, which minimized adhesive wear, and the resistance of the hard, ceramic surface to roughening. PMID:7994957

  5. Misdiagnosis of pathological femoral fracture in a patient with intramuscular hemangioma: A case report

    PubMed Central

    YU, XIAOLONG; NIE, TAO; ZHANG, BIN; DAI, MIN; LIU, HUCHENG; ZOU, FAN

    2016-01-01

    Hemangioma is a common disease; however, intramuscular hemangioma (IH) presenting with a pathological fracture is extremely rare. The present study reports a case of a 46-year-old male patient that suffered from IH of the right thigh, presenting with a pathological femoral fracture. The patient was initially diagnosed with a traumatic femoral fracture, and routine open reduction and internal fixation were performed at a local hospital. However, 20 days subsequent to surgery, gradual swelling and soreness around the incision were observed. The incision eventually ruptured during squatting for bowel movement, which led to extensive blood loss. Based on computed tomography (CT) and deep femoral artery arteriography, IH presenting with a pathological femoral fracture was diagnosed. The patient underwent artery embolization, from which he recovered well. At the 6-month follow-up, the femoral fracture was revealed to have healed, and a CT scan demonstrated no evidence of recurrence; however, continuous observation using CT is required in order to determine the long-term outcome. To the best of our knowledge, this is the first case of a misdiagnosed pathological femoral fracture in a patient with IH reported in the English literature. PMID:27347124

  6. Microstructure analysis and wear behavior of titanium cermet femoral head with hard TiC layer.

    PubMed

    Luo, Yong; Ge, Shirong; Liu, Hongtao; Jin, Zhongmin

    2009-12-11

    Titanium cermet was successfully synthesized and formed a thin gradient titanium carbide coating on the surface of Ti6Al4V alloy by using a novel sequential carburization under high temperature, while the titanium cermet femoral head was produced. The titanium cermet phase and surface topography were characterized with X-ray diffraction (XRD) and backscattered electron imaging (BSE). And then the wear behavior of titanium cermet femoral head was investigated by using CUMT II artificial joint hip simulator. The surface characterization indicates that carbon effectively diffused into the titanium alloys and formed a hard TiC layer on the Ti6Al4V alloys surface with a micro-porous structure. The artificial hip joint experimental results show that titanium cermet femoral head could not only improve the wear resistance of artificial femoral head, but also decrease the wear of UHMWPE joint cup. In addition, the carburized titanium alloy femoral head could effectively control the UHMWPE debris distribution, and increase the size of UHMWPE debris. All of the results suggest that titanium cermet is a prospective femoral head material in artificial joint. PMID:19836751

  7. Hip contact stress and femoral neck retroversion: a biomechanical study to evaluate implication of femoroacetabular impingement

    PubMed Central

    Satpathy, Jibanananda; Kannan, Arun; Owen, John R.; Wayne, Jennifer S.; Hull, Jason R.; Jiranek, William A.

    2015-01-01

    The current literature on femoroacetabular impingement (FAI) is focused on acetabular orientation and femoral head asphericity, with little emphasis on the effect of version of the femoral neck. A biomechanical model was developed to determine the causative effect, if any, of femoral retroversion on hip contact stress and, if present, delineate the type of FAI with femoral neck retroversion. Five pairs of cadaveric hips (n = 10) were tested by loading the hip in 90° of flexion and measured the peak joint pressure and the location of the peak joint pressure. The experiment was repeated after performing a subtrochanteric osteotomy and retroverting the proximal femur by 10°. Ten hips were successfully tested, with one hip excluded due to an outlier value for peak joint pressure. Retroversion of the proximal femur significantly increased the magnitude of mean peak joint pressure. With retroversion, the location of the peak joint pressure was shifted posteroinferiorly in all cases. In conclusion, femoral neck retroversion increases peak joint pressure in the flexed position and may act as a cause of femoroacetabular impingement. The location of peak joint pressure suggests a pincer-type impingement with retroversion. The version of femoral neck should be assessed as a possible causative factor in patients with FAI, especially those with pincer-type impingement. PMID:27011851

  8. Arthroscopic repair of "peel-off" lesion of the posterior cruciate ligament at the femoral condyle.

    PubMed

    Rosso, Federica; Bisicchia, Salvatore; Amendola, Annunziato

    2014-02-01

    Posterior cruciate ligament (PCL) injuries are uncommon, and most occur in association with other lesions. The treatment of PCL injuries remains controversial; in addition, PCL injuries have been documented to have a propensity to heal. In the literature several different patterns of PCL injury have been described including midsubstance tears/injuries, tibial bony avulsions, femoral bony avulsions, and femoral "peel-off" injuries. A peel-off injury is a complete or incomplete soft-tissue disruption of the PCL at its femoral attachment site without associated bony avulsion. In recent years arthroscopic repair of femoral avulsion and peel-off lesions of the PCL has been reported. In most of these articles, a transosseous repair with sutures passed through 2 bone tunnels into the medial femoral condyle has been described. We present a case of a femoral PCL avulsion in a 20-year-old collegiate football player with an associated medial collateral ligament injury, and we report about a novel technique for PCL repair using 2 No. 2 FiberWire sutures and two 2.9-mm PushLock anchors (Arthrex) to secure tensioning the ligament at its footprint. PMID:24749037

  9. Avascular necrosis of the femoral head at 2 years after pertrochanteric fracture surgery: Case report

    PubMed Central

    Deleanu, Bogdan; Prejbeanu, Radu; Vermesan, Dinu; Honcea, Lucian; Mioc, Mihail Lazar; Tsiridis, Eleftherios; Predescu, Vlad

    2015-01-01

    Introduction The avascular necrosis of the femoral head represents the death of bone tissue due to the lack of blood supply. The disease has a progressive evolution and left untreated leads to femoral head collapse and severe arthritis. Case presentation We present a case of a pertrochanteric fracture which has been successfully operated with a dynamic interlocking trochanteric gamma nail on the right hip. At 2 years after surgery the patient developed an incipient avascular necrosis of the femoral head. Despite the good positioning of the implant, we considered that the source of the pain was an intolerance of the implant, and thus we removed it. After implant removal, the patient was kept under observation and conservative treatment, to prevent further damage to the right hip and allow the healing to occur. At 6 months after the gamma nail was removed the X-rays revealed advanced avascular necrosis of the femoral head and secondary osteoarthritis on the right hip. The patient underwent surgery with an uncemented total hip arthroplasty. Discussion There are a few discussions regarding the avascular necrosis of the femoral head. These discussions may include the predisposing risk factors, the treatment of choice and the postoperative complications. Conclusion The avascular necrosis of the femoral head is a complication of pertrochanteric fractures that can not be foreseen or avoided. The optimal treatment in these cases is uncemented total hip arthroplasty. PMID:26900462

  10. Predictors of atypical femoral fractures during long term bisphosphonate therapy: A case series & review of literature

    PubMed Central

    Bhadada, Sanjay Kumar; Sridhar, Subbiah; Muthukrishnan, Jeyaram; Mithal, Ambrish; Sharma, Dinesh C.; Bhansali, Anil; Dhiman, Vandana

    2014-01-01

    Background & objectives: Bisphosphonates (BPs) are the most widely prescribed medicines for the treatment of osteoporosis because of their efficacy and favourable safety profile. There have been, several reports on an increased incidence of atypical femoral fractures after long term treatment with BPs. The objective of this study was to evaluate the clinical presentation including prodromal symptoms, skeletal radiograph findings, type and duration of BPs received and treatment outcome of patients who developed atypical femoral fractures during bisphosphonate therapy. Methods: In this retrospective study, eight patients with atypical femoral fractures were analysed based on clinical features, biochemical and radiological investigations. Results: Of the eight patients, who sustained atypical femoral fractures, six were on alendronate and two were on zoledronate therapy before the fractures. In addition to BPs, two patients were on long term corticosteroid therapy for rheumatoid arthritis and Addison's disease. Three patients had bilateral atypical femoral fractures. Except one, all of them had prodromal symptoms prior to fracture. Skeletal radiograph showed cortical thickening, pointed (beaking of) cortical margin and transverse fracture in meta-diaphyseal location. Serum calcium, phosphate, alkaline phosphatase (ALP) and intact parathyroid hormone (iPTH) concentrations were within the reference range in all patients. Interpretation & conclusions: Long term bisphosphonate therapy may increase the risk of atypical femoral fractures. Presence of prodromal pain, thickened cortex with cortical beaking may be an early clue for predicting the atypical fractures. High risk patients need periodical skeletal survey and a close follow up for early detection of cases. PMID:25222777

  11. Biomechanical optimization of subject-specific implant positioning for femoral head resurfacing to reduce fracture risk.

    PubMed

    Miles, Brad; Kolos, Elizabeth; Appleyard, Richard; Theodore, Willy; Zheng, Keke; Li, Qing; Ruys, Andrew J

    2016-07-01

    Peri-prosthetic femoral neck fracture after femoral head resurfacing can be either patient-related or surgical technique-related. The study aimed to develop a patient-specific finite element modelling technique that can reliably predict an optimal implant position and give minimal strain in the peri-prosthetic bone tissue, thereby reducing the risk of peri-prosthetic femoral neck fracture. The subject-specific finite element modelling was integrated with optimization techniques including design of experiments to best possibly position the implant for achieving minimal strain for femoral head resurfacing. Sample space was defined by varying the floating point to find the extremes at which the cylindrical reaming operation actually cuts into the femoral neck causing a notch during hip resurfacing surgery. The study showed that the location of the maximum strain, for all non-notching positions, was on the superior femoral neck, in the peri-prosthetic bone tissue. It demonstrated that varus positioning resulted in a higher strain, while valgus positioning reduced the strain, and further that neutral version had a lower strain. PMID:27098752

  12. Haemodynamic analysis of femoral artery bifurcation models under different physiological flow waveforms.

    PubMed

    Javadzadegan, Ashkan; Lotfi, Azadeh; Simmons, Anne; Barber, Tracie

    2016-08-01

    Thrombus in a femoral artery may form under stagnant flow conditions which vary depending on the local arterial waveform. Four different physiological flow waveforms - poor (blunt) monophasic, sharp monophasic, biphasic and triphasic - can exist in the femoral artery as a result of different levels of peripheral arterial disease progression. This study aims to examine the effect of different physiological waveforms on femoral artery haemodynamics. In this regard, a fluid-structure interaction analysis was carried out in idealised models of bifurcated common femoral artery. The results showed that recirculation zones occur in almost all flow waveforms; however, the sites at where these vortices are initiated, the size and structure of vortices are highly dependent on the type of flow waveform being used. It was shown that the reverse diastolic flow in biphasic and triphasic waveforms leads to the occurrence of a retrograde flow which aids in 'washout' of the disturbed flow regions. This may limit the likelihood of thrombus formation, indicating the antithrombotic role of retrograde flow in femoral arteries. Furthermore, our data revealed that the flow particles experience considerably higher residence time under blunt and sharp monophasic waveforms than under biphasic and triphasic waveforms. This confirms that the risk of atherothrombotic plaque initiation and development in femoral arteries is higher under blunt and sharp monophasic waveforms than under biphasic and triphasic flow waveforms. PMID:26582544

  13. Patency of Femoral Tunneled Hemodialysis Catheters and Factors Predictive of Patency Failure

    SciTech Connect

    Burton, Kirsteen R.; Guo, Lancia L. Q.; Tan, Kong T.; Simons, Martin E.; Sniderman, Kenneth W.; Kachura, John R.; Beecroft, John R.; Rajan, Dheeraj K.

    2012-12-15

    Purpose: To determine the patency rates of and factors associated with increased risk of patency failure in patients with femoral vein tunneled hemodialysis catheters. Methods: All femoral tunneled catheter insertions from 1996 to 2006 were reviewed, during which time 123 catheters were inserted. Of these, 66 were exchanges. Patients with femoral catheter failure versus those with femoral catheter patency were compared. Confounding factors, such as demographic and procedural factors, were incorporated and assessed using univariate and multivariable Cox proportional hazards regression analyses. Results: Mean catheter primary patency failure time was 96.3 days (SE 17.9 days). Primary patency at 30, 60, 90, and 180 days was 53.8%, 45.4%, 32.1%, and 27.1% respectively. Crude rates of risk of catheter failure did not suggest a benefit for patients receiving catheters introduced from one side versus the other, but more cephalad location of catheter tip was associated with improved patency. Multivariate analysis showed that patients whose catheters were on the left side (p = 0.009), were of increasing age at the time of insertion (p = 0.002) and that those who had diabetes (p = 0.001) were at significantly greater risk of catheter failure. The catheter infection rate was 1.4/1000 catheter days. Conclusion: Patients who were of a more advanced age and had diabetes were at greater risk of femoral catheter failure, whereas those who received femoral catheters from the right side were less at risk of catheter failure.

  14. Contact stress distributions on the femoral head of the emu (Dromaius novaehollandiae).

    PubMed

    Troy, Karen L; Brown, Thomas D; Conzemius, Michael G

    2009-11-13

    Osteonecrosis of the femoral head remains a challenging orthopaedic problem. The disease frequently progresses to femoral head collapse, leading to debilitating osteoarthritis in the affected hip(s). Since a major goal of pre-collapse interventions is to forestall the need for hip arthroplasty, it is important that any animal models used to develop or study such interventions also have a natural history of progression to femoral head collapse. The emu (Dromaius novaehollandiae), a large flightless bird native to Australia, consistently progresses to femoral head collapse when osteonecrosis is experimentally induced cryogenically. Full biomechanical characterization of the demands this animal places on its hip is an important consideration in future usage of this model. This study reports in vitro measurement of the contact stress distributions on the emu femoral head during stance phase of the gait cycle, using Fuji pressure-sensitive film. Applied hip loadings were based upon ground reaction forces and hip flexion angles recorded in vivo. The contact stress data showed reasonable homology with the human hip, both in terms of stress magnitude and sites of habitual loading on the femoral head. PMID:19665715

  15. A Review of the Role of National Policy and Institutional Mission in European Distance Teaching Universities with Respect to Widening Participation in Higher Education Study through Open Educational Resources

    ERIC Educational Resources Information Center

    Lane, Andy

    2012-01-01

    The open educational resources (OER) movement is relatively new with few higher education institutions (HEIs) publishing or using them, and even fewer using them to widen engagement or participation in HE study. Although distance teaching universities have been in the vanguard of widening opportunities for HE study, they vary in how far they are…

  16. Excessive distal migration of fiber-mesh coated femoral stems

    PubMed Central

    2011-01-01

    Background The surface texture, localization, and magnitude of the surface material applied to the femoral stem can facilitate bone ingrowth and influence the survival of total hip arthroplasties. Clinical and radiographic studies have shown superior bone ingrowth in proximally porous-coated stems with a diaphyseal grit-blasted surface in comparison to a smooth diaphyseal surface. Surface textures—especially porous surface material—have been suggested to have a sealing effect against migration of polyethylene debris along the implant-bone interface and to reduce the inflammatory response, leading to a prolonged implant survival. Patients and methods Between 2004 and 2006, we conducted a randomized, controlled trial (RCT) involving 50 patients with non-inflammatory arthritis. They received either a distally tapered, extended coated stem or a straight, proximally coated stem. During surgery, tantalum markers were inserted into the greater and lesser trochanter. Implant migration was evaluated at 3, 12, and 24 months postoperatively by radiostereometric analysis. The primary endpoint was stem migration 2 years after surgery. Results All femoral components in both groups showed pronounced distal translation, with the highest rate of translation occurring between 0 and 3 months. After 2 years, the mean distal translation was 2.67 (95% CI: –3.93 to –1.42) mm for the tapered, extended coated stem and 1.80 (–2.45 to –1.15) mm for the straight, proximally coated stem. Half of the tapered, extended coated stems and two-thirds of the straight, proximally coated stems had migrated more than 1 mm. No difference between the 2 stems could be seen with regard to translation or rotation at any time point. After 2 years, 2 hips have been reoperated due to mechanical loosening of the stem. Interpretation An excessive amount of migration of both stem types was seen 2 years postoperatively. It is of vital importance to follow this patient cohort since radiostereometric

  17. Proximal femoral growth plate mechanical behavior: Comparison between different developmental stages.

    PubMed

    Castro-Abril, Héctor Alfonso; Gutiérrez, María Lucía; Garzón-Alvarado, Diego Alexander

    2016-09-01

    In long bones the growth plate is a cartilaginous structure located between the epiphysis and the diaphysis. This structure regulates longitudinal growth and helps determine the structure of mature bone through the process of endochondral ossification. During human growth the femur's proximal growth plate experiences changes in its morphology that may be related to its mechanical environment. Thus, in order to test this hypothesis from a computational perspective, a finite element analysis on a proximal femur was performed on which we modeled different physeal geometries corresponding to the shapes acquired for this structure in a child between the ages of five to eleven. Results show augmented Von Mises stress values with increasing irregularities in physeal geometry, whereas displacement decreased with increased irregularities in the growth plate's morphology. Such observations suggest that growth plate's shape changes follows a possible mechanical adaptation on imposed loads to sustain a person's increasing body mass during growth. PMID:27479492

  18. P2X1 receptor inhibition and soluble CD39 administration as novel approaches to widen the cardiovascular therapeutic window

    PubMed Central

    Fung, C.Y. Eleanor; Marcus, Aaron J.; Broekman, M. Johan; Mahaut-Smith, Martyn P.

    2010-01-01

    Thrombus formation at sites of disrupted atherosclerotic plaques is a leading cause of death and disability worldwide. Although the platelet is now recognized to be a central regulator of thrombus formation, development of antiplatelet reagents that selectively target thrombosis over hemostasis represents a challenge. Existing prophylactic antiplatelet therapies are centered on the use of aspirin, an irreversible cyclo-oxygenase inhibitor, and a thienopyridine such as clopidogrel (Plavix), which inactivates the ADP-stimulated P2Y12 receptor. Whilst these compounds are widely used and have beneficial effects for patients, their antithrombotic benefit is complicated by an elevated bleeding risk and substantial or partial “resistance”. Moreover, combination therapy with these two drugs increases the hemorrhagic risk even further. This review explores the possibility of inhibiting the platelet-surface ionotropic P2X1 receptor and/or elevating CD39/NTPDase1 activity as new therapeutic approaches to reduce overall platelet reactivity and recruitment of surrounding platelets at pro-thrombotic locations. Since both proteins affect platelet activation at an early stage in the events leading to thrombosis, but are less crucial in hemostasis, they provide new strategies to widen the cardiovascular therapeutic window without compromising safety. PMID:19467446

  19. FE-simulation of the Presta joining process for assembled camshafts - local widening of shafts through rolling

    NASA Astrophysics Data System (ADS)

    Scherzer, R.; Silbermann, C. B.; Ihlemann, J.

    2016-03-01

    Considerable weight benefits and the option to combine various steel alloys of the single parts are the major advantages of assembled over conventional camshafts. The Presta joining process is the leading manufacturing method of assembled camshafts in the global market. The process is divided into two substeps. At first, the outer diameter of the shaft is widened with a profile oriented orthogonal to the shaft axis at the intended cam seat. At this position the shaft is subsequently joined with a cam with an internal profile oriented parallel to the shaft axis. As a result, these perpendicular profiles form a tight fit due to plastic deformations. Consequently the simulation of the manufacturing process has to start with the simulation of the rolling of the shaft. The resulting profile requested in this step is axisymmetric, but the arrangement of tools is not. Thus a three-dimensional model is required, which is presented in this work. Furthermore, the infeed of the rolling tool is unknown and controlled by the stiffness of the holders of the rolling tool. This work shows the modeling of this behavior. To predict realistic results for the underlying process, the use of precise material models is essential in order to take several hardening mechanisms into account. However, the use of complex material models implies additional effort, which is shown in this work.

  20. NOVEL MUTATIONS WIDEN THE PHENOTYPIC SPECTRUM OF SLOW SKELETAL/β-CARDIAC MYOSIN (MYH7) DISTAL MYOPATHY

    PubMed Central

    Lamont, Phillipa J.; Wallefeld, William; Hilton-Jones, David; Udd, Bjarne; Argov, Zohar; Barboi, Alexandru C.; Bonneman, Carsten; Boycott, Kym M.; Bushby, Kate; Connolly, Anne M.; Davies, Nicholas; Beggs, Alan H.; Cox, Gerald F.; Dastgir, Jahannaz; DeChene, Elizabeth T.; Gooding, Rebecca; Jungbluth, Heinz; Muelas, Nuria; Palmio, Johanna; Penttilä, Sini; Schmedding, Eric; Suominen, Tiina; Straub, Volker; Staples, Christopher; Van den Bergh, Peter Y.K.; Vilchez, Juan J.; Wagner, Kathryn R.; Wheeler, Patricia G.; Wraige, Elizabeth; Laing, Nigel G.

    2014-01-01

    Laing early onset distal myopathy and myosin storage myopathy are caused by mutations of slow skeletal/β-cardiac myosin heavy chain encoded by the gene MYH7, as is a common form of familial hypertrophic/dilated cardiomyopathy. The mechanisms by which different phenotypes are produced by mutations in MYH7, even in the same region of the gene, are not known. To explore the clinical spectrum and pathobiology we screened the MYH7 gene in 88 patients from 21 previously unpublished families presenting with distal or generalised skeletal muscle weakness, with or without cardiac involvement. Twelve novel mutations have been identified in thirteen families. In one of these families the grandfather of the proband was found to be a mosaic for the MYH7 mutation. In eight cases de novo mutation appeared to have occurred, which was proven in three. The presenting complaint was footdrop, sometimes leading to delayed walking or tripping, in members of 17 families (81%), with other presentations including cardiomyopathy in infancy, generalised floppiness and scoliosis. Cardiac involvement as well as skeletal muscle weakness was identified in 9 of 21 families. Spinal involvement such as scoliosis or rigidity was identified in 12 (57%). This report widens the clinical and pathological phenotypes, and the genetics of MYH7 mutations leading to skeletal muscle diseases. PMID:24664454

  1. Interactions between concentrations of chemical elements in human femoral heads.

    PubMed

    Brodziak-Dopierala, Barbara; Kwapulinski, Jerzy; Kusz, Damian; Gajda, Zbigniew; Sobczyk, Krzysztof

    2009-07-01

    Environmental and occupational exposure to various metals has been a major public health concern and the subject of many studies. With the development of industry and transportation, environmental pollution has markedly worsened. As a result, metals are now ubiquitous and are absorbed into the body with food, drinking water, and polluted air. Exposure to these elements leads to numerous health problems, affecting almost every system of the human body, including the skeletal system. Bone is a specific research material that is difficult to obtain, therefore chemical analyses of metal concentrations in this tissue are rarely found in the literature. Nevertheless, bone, due to its long regeneration period, can serve as a biomarker of a long-term metal accumulation resulting from environmental or occupational exposure. Our study was conducted on bone samples harvested from inhabitants of the Upper Silesia region during hip replacement surgery. Femoral heads removed during surgery were sectioned into slices and further subdivided into samples comprising articular cartilage, cortical bone, and trabecular bone. Concentrations of 12 trace elements were measured with an atomic absorption spectrophotometry method. We found significant correlation between concentrations of these metal elements in the samples of cortical bone. This is determined not only by the physiological functions of these metals in hydroxyapatite, but also by the specific mineral structure of the bone tissue. PMID:18776997

  2. Unique plasma metabolomic signature of osteonecrosis of the femoral head.

    PubMed

    Liu, Xiaolin; Li, Qing; Sheng, Jiagen; Hu, Bin; Zhu, Zhenzhong; Zhou, Shumin; Yin, Junhui; Gong, Qiang; Wang, Yang; Zhang, Changqing

    2016-07-01

    Metabolomic analysis was performed to determine the metabolomic signature of osteonecrosis of the femoral head (ONFH), and to investigate the underlying relationship between the metabolomic signature and the pathogenesis of ONFH. Plasma samples were collected from 30 ONFH patients and 30 normal subjects. The global metabolomic profile was obtained through a combination of high-throughput liquid- and gas-chromatography-based mass spectrometry analyses. All statistical analyses were conducted using the R software. The results showed clear differences in the metabolomic signature between the plasma of ONFH patients compared with normal subjects. Among the 354 identified metabolites, the expression of 123 metabolites were significantly changed in ONFH patients compared with normal subjects (p < 0.05, q < 0.10). Bioinformatics analysis revealed that these abnormal metabolites were mainly involved in lipid-, glutathione-, nucleotide-, and energy-associated pathways, which might be related to enhanced inflammation, oxidative stress, and energy deficiency due to ONFH. This study provides the first metabolomic analysis of ONFH, and identifies a previously unrecognized metabolic signature in ONFH plasma. The results offer new insights into the pathological mechanisms of ONFH through its influence on metabolic pathways, providing the requisite framework for identifying biomarkers or novel targets for therapeutic intervention. © 2015 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 34:1158-1167, 2016. PMID:26662932

  3. Femoral/humeral strength in early African Homo erectus.

    PubMed

    Ruff, Christopher

    2008-03-01

    Lower-to-upper limb-bone proportions give valuable clues to locomotor behavior in fossil taxa. However, to date only external linear dimensions have been included in such analyses of early hominins. In this study, cross-sectional measures of femoral and humeral diaphyseal strength are determined for the two most complete early Homo erectus (or ergaster) associated skeletons--the juvenile KNM-WT 15000 and the adult KNM-ER 1808. Modern comparative samples include an adult human skeletal sample representative of diverse body shapes, a human longitudinal growth series, and an adult chimpanzee sample. When compared to appropriately age-matched samples, both H. erectus specimens fall very close to modern human mean proportions and far from chimpanzee proportions (which do not overlap with those of humans). This implies very similar mechanical load-sharing between the lower and upper limbs, and by implication, similar locomotor behavior in early H. erectus and modern humans. Thus, by the earliest Pleistocene (1.7 Ma), completely modern patterns of bipedal behavior were fully established in at least one early hominin taxon. PMID:17977577

  4. Periprosthetic Femoral Fracture With Broken Implant Insitu: - A Treatment Prospect

    PubMed Central

    Pal, Chandra Prakash; Singh, Pulkesh; Kumar, Deepak; Singh, Arpit

    2014-01-01

    Introduction: Fractures involving bones containing a component of a prosthetic joint are becoming more common. The causation is multifactorial but most of these injuries are associated with trivial trauma. The options available for operative management of these fractures include internal fixation of the fracture alone, fixation of the fracture with revision of the prosthesis, and reconstruction of proximal femur with either modified impaction bone grafting or proximal femoral replacement. Case Report: We present here a case of periprosthetic fracture Vancouver type B1 with a broken cemented bipolar prosthesis insitu, in which the broken implant was firmly fixed in the proximal fragment and could not be removed following which the whole of the proximal fragment along with the broken implant was removed and replaced by a customized steel long stem cemented mega prosthesis. Conclusion: This case is being presented on account of its unusual presentation and fracture pattern. A broken prosthesis along with a periprosthetic fracture is not a common incident. Thus the treatment had to be individualized. Since the prosthesis was well fixed, its broken stem could not be removed from the proximal fragment and so the whole of the proximal fragment along with stem was removed and replaced with a long stem custom made bipolar prosthesis. PMID:27298972

  5. Knee range of motion in isolated femoral lengthening.

    PubMed

    Herzenberg, J E; Scheufele, L L; Paley, D; Bechtel, R; Tepper, S

    1994-04-01

    Twenty-five patients underwent isolated Ilizarov femoral lengthenings (mean lengthening, 6 cm). A retrospective review of the charts showed the specific changes in knee range of motion (ROM) during lengthening, after removal of the frame, and at the final follow-up examination. A decrease in ROM was seen during lengthening to an average minimum of 37 degrees +/- 15 degrees. Toward the end of the consolidation phase, improvement to 69 degrees +/- 28 degrees was noted. A progressive increase in ROM was seen after frame removal. Mean preoperative flexion was 127 degrees +/- 16 degrees, and at follow-up flexion was 122 degrees +/- 23 degrees (p = 0.191). Of the five patients who did not achieve 120 degrees flexion at the final follow-up examination, three had a diminished ROM (average, 107 degrees) at the outset. Two patients lost more than 15% of their preoperative flexion. There was no correlation noted between worst ROM (during lengthening) and final ROM at the last follow-up examination. PMID:8156696

  6. Deep wound infection after proximal femoral fracture: consequences and costs.

    PubMed

    Pollard, T C B; Newman, J E; Barlow, N J; Price, J D; Willett, K M

    2006-06-01

    The purpose of this study was to assess the impact of deep wound infection after surgery for proximal femoral fracture (PFF) on the patient in terms of mortality and social consequences, and on the National Health Service in terms of financial burden. Sixty-one cases of PFF over a six-year period were complicated with deep surgical wound infection. These cases were compared with a matched control group of 122 patients without infection. Infected cases had greatly increased hospital stay (P<0.001), were 4.5 times less likely to survive to discharge (P=0.002), and if they survived, were three times less likely to return to their original residence (P=0.05). The total cost of treatment per infected case was 24,410 pound sterling compared with 7210 pound sterling for controls (P<0.001). Meticillin-resistant Staphylococcus aureus (MRSA) infection increased admission length and cost compared with non-MRSA infection (P=0.02). Deep wound infection after PFF is a devastating and costly complication for both the patient and the healthcare services. The cost consequences should be considered when allocating resources to trauma services to ensure adequate provision to minimize infection risks and to accommodate treatment costs in this vulnerable group. PMID:16621145

  7. Decreased femoral arterial flow during simulated microgravity in the rat

    NASA Technical Reports Server (NTRS)

    Roer, Robert D.; Dillaman, Richard M.

    1994-01-01

    To determine whether the blood supply to the hindlimbs of rats is altered by the tail-suspension model of weightlessness, rats were chronically instrumented for the measurement of femoral artery flow. Ultrasonic transit-time flow probes were implanted into 8-wk-old Wistar-Furth rats under ketamine-xylazine anesthesia, and, after 24 h of recovery, flow was measured in the normal ambulatory posture. Next, rats were suspended and flow was measured immediately and then daily over the next 4-7 days. Rats were subsequently returned to normal posture, and flow was monitored daily for 1-3 days. Mean arterial flow decreased immediately on the rats being suspensed and continued to decrease until a new steady state of approximately 60% of control values was attained at 5 days. On the rats returning to normal posture, flow increased to levels observed before suspension. Quantile-quantile plots of blood flow data revealed a decrease in flow during both systole and diastole. The observed decrease in hindlimb blood flow during suspension suggests a possible role in the etiology of muscular atrophy and bone loss in microgravity.

  8. Operative management of Hoffa fracture of the femoral condyle.

    PubMed

    Sahu, Ramji Lal; Gupta, Pratiksha

    2014-01-01

    Hoffa fracture is a rare injury consisting of unicondylar tangential posterior fracture of the distal femur and only very few cases have been reported in the literature. These fractures are due to high energy trauma and conservative treatment generally yields poor results, but rigid internal fixation allows early functional rehabilitation and decreases the incidence of complications. The purpose of the study was to prospectively analyse the clinico-radiological and functional outcome following open surgical treatment. From July 2005 to July 2010, 22 patients (14 males and 8 females) were recruited from Emergency and outpatient department having closed and open Hoffa fracture of the femoral condyle. All patients were operated under general or spinal anesthesia. Post-operatively, all the patients were followed for 12 months. Fractures were united in a mean time of 10 weeks (range from 6 - 16 weeks) depending on the type of fracture pattern. Fractures were reduced anatomically in all except in one patient. During follow-up, there were no losses of reduction or fixation. Full weight bearing were started in the mean time of 8.8 weeks. Mean duration of hospital stay were 9.8 days. Complications were stiffness and pain in one patient, collateral laxity in one patient and progression of arthritis in one patient. The results were excellent in 90.90% and good in 9.09% patients. Finally, we conclude that the early anatomical reduction and rigid fixation with screws provide best results and minimal complications. PMID:25130151

  9. Best estimation of spectrum profiles for diagnosing femoral prostheses loosening.

    PubMed

    Díaz-Pérez, Francisco; García-Nieto, Evelyn; Ros, Antonio; Claramunt, Rafael

    2014-02-01

    For the past few years, some authors have proposed several vibration analysis techniques to detect the prosthetic femoral stem loosening, having found some differences in the frequency response between secure and loose stems. Classical methods like periodogram have been used in most studies for the spectral estimation, and their conclusions have been reached only by visual inspection. A new metric called Non-linear Logarithmic Weighted Distance (NLWD), based on log-spectral distance is presented. As its name suggests, the spectral power is weighted in order to highlight discriminatory patterns of the spectral profiles. A Generalized Discriminant Ratio (GDR) based on NLWD metric has been also defined. In this study, experiments on a cadaveric dried bone with two kinds of fixation, Loose Stem class (LS) and Secure Stem class (SS), have been analyzed. To select the most discriminating approach to spectral estimation, five well known algorithms (Welch's, Burg's Auto-Regressive (AR), Auto-Regressive Moving Average (ARMA), Multiple Signal Classification (MUSIC) and Thomson's Multi-taper (MTM)) have been compared by using GDR. Finally, the use of the MTM method is proposed for the analysis of bone-stem interface vibratory signals, since it yields the most discriminatory profiles. PMID:24332977

  10. Midterm Outcome of Femoral Artery Stenting and Factors Affecting Patency

    PubMed Central

    Yu, Jae Seoung; Park, Keun-Myoung; Jeon, Yong Sun; Cho, Soon Gu; Hong, Kee Chun; Shin, Woo Young; Choe, Yun-Mee; Shin, Seok-Hwan; Kim, Kyung Rae

    2015-01-01

    Purpose: The purpose of this study was to evaluate the early and midterm results of superficial femoral artery (SFA) stenting with self-expanding nitinol stents and to identify the factors affecting patency. Materials and Methods: SFA stenting was performed in 165 limbs of 117 patients from January 2009 to December 2013. Patients were followed-up for the first occurrence of occlusion or stenosis based on computed tomography and duplex scan results and a decrease in ankle brachial index of >15%. Results: During the follow-up period (mean, 15.3±3.2 months), no early thrombotic reocclusions occurred within 30 days, but in-stent restenosis developed in 78 limbs. The primary patency rates at 6, 12, 18, and 24 months were 78%, 66%, 42%, and 22%, respectively, and the secondary patency rates were 85%, 72%, 58%, and 58%, respectively. TASC II C or D lesions, stent length >8 cm, number of patent tibial arteries and diabetes were significantly associated with reintervention. Conclusion: The midterm results of stenting for SFA occlusive disease were disappointing because the primary and secondary patency rates at two years were 22% and 58%, respectively. Reintervention after SFA stenting remains a major problem, particularly in patients with diabetes mellitus or long TASC II C or D lesions. PMID:26719837

  11. Injectable biocomposites for bone healing in rabbit femoral condyle defects.

    PubMed

    Liu, Jianheng; Mao, Kezheng; Liu, Zhengsheng; Wang, Xiumei; Cui, Fuzhai; Guo, Wenguang; Mao, Keya; Yang, Shuying

    2013-01-01

    A novel biomimetic bone scaffold was successfully prepared in this study, which was composed of calcium sulfate hemihydrate (CSH), collagen and nano-hydroxyapatite (nHAC). CSH/nHAC was prepared and observed with scanning electron microscope and rhBMP-2 was introduced into CSH/nHAC. The released protein content from the scaffold was detected using high performance liquid chromatography at predetermined time interval. In vivo bone formation capacity was investigated by means of implanting the scaffolds with rhBMP-2 or without rhBMP-2 respectively into a critical size defect model in the femoral condyle of rabbit. The releasing character of rhBMP-2 was that an initial burst release (37.5%) was observed in the first day, followed by a sustained release and reached 100% at the end of day 20. The CSH/nHAC showed a gradual decrease in degradation with the content of nHAC increase. The results of X-rays, Micro CT and histological observation indicated that more new bone was formed in rhBMP-2 group. The results implied that this new injectable bone scaffold should be very promising for bone repair and has a great potential in bone tissue engineering. PMID:24146770

  12. Femoral Varus Osteotomy for Hip Instability after Traumatic Fracture Dislocations of the Hip Associated with Femoral Head Fractures: A Report of Two Cases

    PubMed Central

    Nakamura, Junichi; Takahashi, Kazuhisa

    2016-01-01

    Fracture of the femoral head and the acetabulum with traumatic dislocation of the hip is a severe injury representing various types and unfavorable outcome. We showed a 45-year-old man with Pipkin type-IV fracture and coxa valga. An immediate closed reduction was achieved followed by open reduction and internal fixation via a posterior approach 6 days later. However, dislocation occurred three times without traumatic events after three weeks. CT demonstrated no displacement of posterior fragments or implant failure. Femoral intertrochanteric varus osteotomy was performed to gain concentric stability and successfully resolved recurrent dislocation. Another 45-year-old woman with Pipkin type-IV fracture and coxa valga also underwent closed reduction initially and then continued conservative treatment. After eight weeks, when she started gait training, progressive pain became symptomatic. Persistent hip pain at weight bearing was not improved in spite of arthroscopic synovectomy and osteochondroplasty. Two years after injury, femoral intertrochanteric varus osteotomy was indicated and her refractory pain was resolved gradually. We suggest that femoral varus osteotomy should be considered for superolateral subluxation associated fracture dislocation of the hip in Pipkin type-IV and coxa valga. PMID:27293934

  13. Femoral Varus Osteotomy for Hip Instability after Traumatic Fracture Dislocations of the Hip Associated with Femoral Head Fractures: A Report of Two Cases.

    PubMed

    Miyamoto, Shuichi; Nakamura, Junichi; Iida, Satoshi; Suzuki, Chiho; Ohtori, Seiji; Orita, Sumihisa; Takahashi, Kazuhisa

    2016-01-01

    Fracture of the femoral head and the acetabulum with traumatic dislocation of the hip is a severe injury representing various types and unfavorable outcome. We showed a 45-year-old man with Pipkin type-IV fracture and coxa valga. An immediate closed reduction was achieved followed by open reduction and internal fixation via a posterior approach 6 days later. However, dislocation occurred three times without traumatic events after three weeks. CT demonstrated no displacement of posterior fragments or implant failure. Femoral intertrochanteric varus osteotomy was performed to gain concentric stability and successfully resolved recurrent dislocation. Another 45-year-old woman with Pipkin type-IV fracture and coxa valga also underwent closed reduction initially and then continued conservative treatment. After eight weeks, when she started gait training, progressive pain became symptomatic. Persistent hip pain at weight bearing was not improved in spite of arthroscopic synovectomy and osteochondroplasty. Two years after injury, femoral intertrochanteric varus osteotomy was indicated and her refractory pain was resolved gradually. We suggest that femoral varus osteotomy should be considered for superolateral subluxation associated fracture dislocation of the hip in Pipkin type-IV and coxa valga. PMID:27293934

  14. Custom stems for femoral deformity in patients less than 40 years of age

    PubMed Central

    Akbar, Michael; Aldinger, Guenther; Krahmer, Knut; Bruckner, Thomas

    2009-01-01

    Background and purpose Femoral deformity associated with osteoarthritis is a challenge for both the surgeon and the implant. Many of the patients with these deformities are young. Standard implants can be difficult to fit into these femurs. We prospectively evaluated the outcome of custom uncemented femoral stems in young patients. Methods 61 consecutive patients (72 hips) underwent surgery for osteoarthritis because of femoral deformity at a mean age of 35 (22–40) years. The patients received a CT3D-A custom-made femoral stem and an uncemented cup. The mean follow-up time was 14 (10–16) years. 2 patients died at 7 and 8 years after surgery, otherwise, none of the patients were lost to follow-up. Results At follow-up, the femoral prosthesis had not been revised in 59 patients (70 hips). 3 patients (3 hips) had required revision surgery due to loosening of the acetabular component; 2 hips were awaiting revision surgery for loosening of the acetabular cup. There were no cases of dislocation or infection. At review, all stems were considered stable according to the radiographic criteria. No migration or subsidence was observed on plain radiographs. Interpretation Our results are comparable to published results of custom stems regarding survival and outcome. Considering the young age and the deformities in this series of uncemented custom femoral stems, and the fact that there was follow-up of up to 16 years, the survival is remarkable. This technique appears to be a reasonable alternative in younger patients with femoral deformities. PMID:19513891

  15. Anterior Hip Fracture Dislocation with Intrapelvic Retention of the Femoral Head and Ureter Fistula

    PubMed Central

    Patrascanu, Calin; Cibu, Dan

    2014-01-01

    Introduction: The anterior dislocation of the hip represents only a small percentage of all hip dislocations: 85% are posterior. Most commonly associated with this dislocation is a fracture of the femoral head and, in rare cases, a femoral neck fracture. We have found in literature no report of an anterior dislocation of the hip associated with femoral neck fracture, pelvic retention of the head and ureteral fistula. We report such a case of a 68 year old male. Case Report: A 68 year old male was presented to our attention, following a severe injury of the hip when falling from a high bridge, with severe pain in the hip and a clinical aspect of femoral neck fracture. The X-ray confirmed the femoral neck fracture but following an anterior dislocation with the head retained into the pelvis. The patient also had hematuria. An Austin Moore prosthesis was implanted for the femoral neck fracture and the head was extracted by the urologist by a new abdominal incision. Urological evaluation revealed a fistula of the ureter, treated by an internal drainage for three months. One month later the Moore prosthesis was extracted and the patient had a Girldestone hip for 5 months. Revision with a Muller cemented prosthesis had a normal evolution. Conclusion: The anterior fracture dislocation of the hip with pelvic retention of the femoral head and ureteral fistula is a rare condition resulting from high energy trauma. A multidisciplinary team is necessary to diagnose and treat fracture and soft tissue lesions. Early diagnosis and treatment is necessary to avoid septic complications. PMID:27298980

  16. Bilateral avascular necrosis of the femoral head due to the use of heroin: A case report

    PubMed Central

    Ozkunt, Okan; Sarıyılmaz, Kerim; Sungur, Mustafa; Ilen, Ferhat; Dikici, Fatih

    2015-01-01

    Introduction Femoral head avascular necrosis is caused by disruption of the blood supply of the femoral head, which finally results in hip dysfunction. Non traumatic osteonecrosis may related with corticosteroid use, alcohol abuse, SLE, hemoglobinopathies or exposure to cytotoxic agents. But avascular necrosis of the femoral head (ANFH) due to heroin use is a rare condition. We report a patient with bilateral ANFH due to heroin use treated by simultaneous bilateral hip arthroplasty. Presentation of case 37 year-old male patient presented with bilateral hip pain that had been occurring for four years. The patient had no history of smoking, excessive drinking, using corticosteroid and the other drugs or trauma but used heroin for 10 years. In clinic and radiologic examination indicated advanced degenerative changes on both hip due to femoral head avascular necrosis. The patient was treated with simultaneous bilateral total hip arthroplasty. After 6 months postoperatively the active hip range of motion was painless. Discussion Avascular femoral head necrosis caused by the using of heroin is rare. Ultimately, osteonecrosis of the femoral head occurs through one final common pathway, which is decreased blood flow to the femoral head that leads bone ischemia and death. But it is still unknown that heroin’s systemic effects. Intravenous drug use more as a serious problem for today. There is a need for comprehensive studies to demonstrate effects of heroin on bone and vascularity metabolism. Conclusion Heroin use will be important problem for population. That’s why is crucial to understand the effect of heroin. PMID:26595896

  17. How much hamstring graft needs to be in the femoral tunnel? A MOON cohort study

    PubMed Central

    Mariscalco, Michael W.; Magnussen, Robert A.; Mitchell, Joshua; Pedroza, Angela D.; Jones, Morgan H.; Andrish, Jack T.; Parker, Richard D.; Kaeding, Christopher C.; Flanigan, David C.

    2014-01-01

    Background Recent evidence that smaller hamstring graft diameter is associated with increased failure risk following anterior cruciate ligament (ACL) reconstruction has increased the popularity of graft configurations that increase graft diameter at the expense of graft length. A key question is how much graft needs to be in contact with the femoral tunnel to ensure that healing occurs. We hypothesize that no difference in two-year patient-reported outcomes or failure risk exists based on the amount of graft in the femoral tunnel. Methods Through the use of prospectively collected cohort data augmented with retrospective chart review, 120 of 181 consecutive patients (66.3 %) undergoing primary ACL reconstruction with hamstring autograft were evaluated. Patient and surgical factors along with pre-operative and two-year postoperative knee injury and osteoarthritis outcome score (KOOS) and International Knee Documentation Committee (IKDC) scores and whether each patient underwent revision ACL reconstruction during the two-year follow-up period were recorded. Results No differences in two-year patient-reported outcome scores were noted between patients with graft length in the femoral tunnel less than 25 mm and those with graft length in the femoral tunnel of at least 25 mm. Controlling for age, sex, BMI, and femoral tunnel technique, no correlation was noted between KOOS or IKDC scores and either the length of graft in the femoral tunnel or the contact area between the graft and the tunnel. Conclusions Variation of the length of hamstring autograft in the femoral tunnel between 14 and 35 mm does not predict KOOS or IKDC scores at 2 years postoperative. PMID:25984246

  18. Computed tomography for femoral and tibial torsion in children with clubfoot.

    PubMed

    Cuevas de Alba, C; Guille, J T; Bowen, J R; Harcke, H T

    1998-08-01

    Forty-seven children with 70 clubfeet had computed tomography studies performed to determine the degree of femoral, tibial, and total limb torsion in both lower limbs. The total limb torsion angle (angle between the axis of the femoral neck and the axis of the ankle), which describes the relationship between femoral and tibial torsion, was used to evaluate the whole rotational deformity of the lower limb. The children were between the ages of 2 and 10 years (mean, 5 years) at the time of the computed tomography study. The mean femoral torsion was 25 degrees in the limbs with a clubfoot and 23 degrees in the contralateral limbs of patients with a unilateral clubfoot. The mean tibial torsion was 25 degrees in the limbs with a clubfoot and 24 degrees in the contralateral limb of patients with a unilateral clubfoot. The authors observed decreases of anterior femoral torsion corresponding to increases in age, consistent with the observations made by other authors of studies of children without clubfoot. External tibial torsion increased with age, with similar values in limbs with and without clubfoot. Ten limbs (nine with clubfoot, one without clubfoot) had femoral torsion greater than the means plus one standard deviation and 12 limbs (eight with clubfoot, four without clubfoot) had tibial torsion less than the means minus one standard deviation. The authors found four limbs (all with clubfoot) in three patients with lower than the mean minus one standard deviation of the total limb torsion angle (intoeing). Overall, there was no appreciable difference in the amount of femoral or tibial torsion in limbs with and without a clubfoot. PMID:9728175

  19. Reduction of Femoral Fractures in Long-Term Care Facilities: The Bavarian Fracture Prevention Study

    PubMed Central

    Becker, Clemens; Cameron, Ian D.; Klenk, Jochen; Lindemann, Ulrich; Heinrich, Sven; König, Hans-Helmut; Rapp, Kilian

    2011-01-01

    Background Hip fractures are a major public health burden. In industrialized countries about 20% of all femoral fractures occur in care dependent persons living in nursing care and assisted living facilities. Preventive strategies for these groups are needed as the access to medical services differs from independent home dwelling older persons at risk of osteoporotic fractures. It was the objective of the study to evaluate the effect of a fall and fracture prevention program on the incidence of femoral fracture in nursing homes in Bavaria, Germany. Methods In a translational intervention study a fall prevention program was introduced in 256 nursing homes with 13,653 residents. The control group consisted of 893 nursing homes with 31,668 residents. The intervention consisted of staff education on fall and fracture prevention strategies, progressive strength and balance training, and on institutional advice on environmental adaptations. Incident femoral fractures served as outcome measure. Results In the years before the intervention risk of a femoral fracture did not differ between the intervention group (IG) and control group (CG). During the one-year intervention period femoral fracture rates were 33.6 (IG) and 41.0/1000 person years (CG), respectively. The adjusted relative risk of a femoral fracture was 0.82 (95% CI 0.72-0.93) in residents exposed to the fall and fracture prevention program compared to residents from CG. Conclusions The state-wide dissemination of a multi-factorial fall and fracture prevention program was able to reduce femoral fractures in residents of nursing homes. PMID:21918688

  20. A method to quantify and visualize femoral head intraosseous arteries by micro-CT.

    PubMed

    Qiu, Xing; Shi, Xiaotian; Ouyang, Jun; Xu, Dachuan; Zhao, Dewei

    2016-08-01

    We describe a technique for perfusing a barium sulphate suspension into the intraosseous artery. Following the perfusion of abarium sulphate suspension into 14 fresh lower limbs of Chinese cadavers, micro-CT scanning was applied to digitize, quantify and visualize the intraosseous arteries in the human femoral heads. Then, the femoral heads were removed and subjected to micro-CT scanning. The data were imported into the amira and mimics programs to reconstruct and quantify the intraosseous arteries. The femoral head intraosseous artery lengths, areas, volumes, and femoral head bone volumes were quantified. The artery densities and artery ratios were calculated and analysed with independent-samples t-tests. The intraosseous vasculature volume renderings were displayed as screenshots and videos made with amira. Many intraosseous artery study technologies were compared. The barium sulphate suspension was milky white in colour. The perfusion of the barium sulphate suspension followed by micro-CT scanning provided a good representation of the intraosseous artery. The femoral head intraosseous artery lengths, areas and volumes, and the femoral head bone volumes were displayed as the X¯±S . No differences were observed between the left and right femoral head intraosseous arteries in terms of the artery densities or artery ratios. The volume renderings and 3-D orthogonal projections displayed the overall distributions of the intraosseous arteries. The videos clearly demonstrated the entry sites of the nutrition-carrying arteries, their courses and branches, and the intraosseous arterial anastomoses. Our technique is the simplest and least time-consuming method of producing accurate vascular three-dimensional reconstructions. The perfusion of a barium sulphate suspension into intraosseous arteries combined with micro-CT scanning can deliver high-resolution 3-D digitized data and images of intraosseous arteries. This technique does not require bone decalcification or bone

  1. Proximal Femoral Shortening after Operation with Compression Hip Screws for Intertrochanteric Fracture in Patients under the Age of 60 Years

    PubMed Central

    Choi, Won-Kee; Kim, Dong-Young

    2015-01-01

    Purpose We aimed to quantify proximal femoral shortening after operation with compression hip screws for intertrochanteric fracture in patients under the age of 60 years. Materials and Methods We followed 37 consecutive patients with intertrochanteric fractures treated with compression hip screws from March 2005 to February 2014. We designated the aspect of the fracture, a defect of the postero-medial wall, a defect of the lateral wall, and the degree of reduction as four potentially important factors we assumed would strongly affect proximal femoral shortening. We quantified proximal femoral shortening and compared the effects of above factors. We divided femoral shortening into two plane vectors; femoral offset in the horizontal plane and leg length discrepancy in the vertical plane. We measured shortening separately during two periods: during operation and after weight bearing (called dynamic compression). Results After bone union, the average femoral offset shortening was 5.45 mm. Patient groups with anatomic reduction and intact postero-medial wall showed lower femoral offset shortening than the respective opposite groups. As to functional score using modified Harris hip score, low femoral offset shortening group showed more 2.35 scores than high groups. None of the factors significantly affected leg length shortening. Conclusion We found that a stable medial buttress is involved in lower femoral offset shortening. Thus, surgeons need to attempt to recover the defect of the medial wall and to reduce anatomically when operating intertrochanteric fractures with compression hip screws.

  2. Widening the Circle

    ERIC Educational Resources Information Center

    Donahoe, Marta

    2006-01-01

    In their unique approach to education, Montessorians are challenged to create an academic forum that engages the mind and the hand, and most importantly, the heart. It is in essence the heart of the adolescent that gives birth to the adult, and the mind and the hand follow along. However, there can be barriers to accessing the engagement of the…

  3. Columbia Accident Probe Widens

    NASA Technical Reports Server (NTRS)

    Covault, Craig

    2003-01-01

    The Columbia Accident Investigation Board has identified about a dozen shuttle program safety concerns it will address in its final report, in addition to foam shedding from the Lockheed Martin external tank-believed by many board members to be the direct cause for the loss of Columbia and her crew. As new evidence narrows the location of Columbia's left-wing breach to a lower corner of reinforced carbon-carbon (RCC) Panel 8 and its adjoining T-seal, the board is broadening its penetration of other shuttle safety issues. As the board works in Houston, United Space Alliance technicians here at Kennedy last week sent the first six of 22 RCC panels from the orbiter Atlantis left wing to Vought Aircraft Industries Inc. in Dallas for extensive testing to assess their integrity. The move is a key step toward both returning the shuttle to flight with Atlantis and obtaining more data on RCC panels subjected to fewer flights, and less exposure to the weather, than the older panels used on Columbia.

  4. Widening Privacy Concerns.

    ERIC Educational Resources Information Center

    Amidon, Paige

    1992-01-01

    Discusses privacy concerns relating to electronic information media. European privacy initiatives from the European Community are described, including personal data protection, impact on the online industry, and telecommunications privacy; and activities in the United States are examined, including telephone caller privacy, electronic mail…

  5. Evaluation of proximal femoral locking plate in unstable extracapsular proximal femoral fractures: Surgical technique & mid term follow up results☆

    PubMed Central

    Kumar, Nishikant; Kataria, Himanshu; Yadav, Chandrashekhar; Gadagoli, Bharath S.; Raj, Rishi

    2014-01-01

    Background Stable trochanteric femur fractures can be treated successfully with conventional implants such as sliding hip screw, cephalomedullary nails, angular blade plates. However comminuted and unstable inter or subtrochanteric fractures with or without osteoporosis are challenging & prone to complications. The PF-LCP is a new implant that allows angular stability by creating fixed angle block for treatment of complex, comminuted proximal femoral fractures. Method We reviewed 30 patients with unstable inter or subtrochanteric fractures, which were stabilized with PF-LCP. Mean age of patient was 65 years, and average operative time was 80 min. Patients were followed up for a period of 3 years (June 2010–June 2013). Patients were examined regularly at 3 weekly interval for signs of union (radiological & clinical), varus collapse (neck-shaft angle), limb shortening, and hardware failure. Result All patients showed signs of union at an average of 9 weeks (8–10 weeks), with minimum varus collapse (<10°), & no limb shortening and hardware failure. Results were analysed using IOWA (Larson) hip scoring. Average IOWA hip score was 77.5. Conclusion PF-LCP represents a feasible alternative for treatment of unstable inter- or subtrochanteric fractures. PMID:25983487

  6. Proximal Femoral Nail Antirotation Versus Reverse Less Invasive Stabilization System-distal Femur for Treating Proximal Femoral Fractures: A Meta-analysis.

    PubMed

    Jiang, Xuan; Wang, Ying; Ma, XinLong; Ma, JianXiong; Wang, Chen; Zhang, ChengBao; Han, Zhe; Sun, Lei; Lu, Bin

    2016-04-01

    The aim of this study was to compare the effectiveness and safety of 2 surgical techniques that are used to treat proximal femoral fractures.A systematic literature search (up to December 2014) was conducted in Medline, Embase, PubMed, and The Cochrane Central Register of Controlled Trials to screen for studies comparing proximal femoral nail antirotation (PFNA) with less invasive stabilization system-distal femur (LISS-DF) for proximal femoral fractures. Two authors independently assessed the methodological quality of the included studies and extracted data. Surgical information and postoperative outcomes were analyzed.A total of 7 studies with 361 patients who satisfied the eligibility criteria included 3 randomized controlled trials and 4 case-controlled trials associated with PFNA versus LISS in treating proximal femoral fractures. Our results demonstrated that there was a significant reduction in hospital stay and time to weight-bearing ambulation and bone healing for PFNA compared with LISS (odds ratio [OR] -1.48, 95% confidence interval [CI] -2.92 to -0.05; OR -7.08, 95% CI -8.32 to -5.84; OR -2.71, 95% CI -4.76 to 0.67). No statistically significant difference was observed between the 2 groups for operative time, blood loss volume, Harris hip score, and incidence of complications.Based on the results of this analysis, we inferred that PFNA is safer and more effective than reverse LISS-DF in patients undergoing osteosynthesis for proximal femoral fractures, and that PFNA is associated with reduced hospital stays and reduced time to weight-bearing ambulation and bone healing. Nonetheless, in certain cases in which PFNA is not suitable due to abnormal structure of the proximal femur or particularly unstable fractures, the LISS plate technique could be a useful alternative. PMID:27057840

  7. Structural-Thermal-Optical-Performance (STOP) model development and analysis of a field-widened Michelson interferometer

    NASA Astrophysics Data System (ADS)

    Scola, Salvatore J.; Osmundsen, James F.; Murchison, Luke S.; Davis, Warren T.; Fody, Joshua M.; Boyer, Charles M.; Cook, Anthony L.; Hostetler, Chris A.; Seaman, Shane T.; Miller, Ian J.; Welch, Wayne C.; Kosmer, Adam R.

    2014-09-01

    An integrated Structural-Thermal-Optical-Performance (STOP) model was developed for a field-widened Michelson interferometer which is being built and tested for the High Spectral Resolution Lidar (HSRL) project at NASA Langley Research Center (LaRC). The performance of the interferometer is highly sensitive to thermal expansion, changes in refractive index with temperature, temperature gradients, and deformation due to mounting stresses. Hand calculations can only predict system performance for uniform temperature changes, under the assumption that coefficient of thermal expansion (CTE) mismatch effects are negligible. An integrated STOP model was developed to investigate the effects of design modifications on the performance of the interferometer in detail, including CTE mismatch, and other threedimensional effects. The model will be used to improve the design for a future spaceflight version of the interferometer. The STOP model was developed using the Comet SimApp™ Authoring Workspace which performs automated integration between Pro-Engineer®, Thermal Desktop®, MSC Nastran™, SigFit™, Code V™, and MATLAB®. This is the first flight project for which LaRC has utilized Comet, and it allows a larger trade space to be studied in a shorter time than would be possible in a traditional STOP analysis. This paper describes the development of the STOP model, presents a comparison of STOP results for simple cases with hand calculations, and presents results of the correlation effort to bench-top testing of the interferometer. A trade study conducted with the STOP model which demonstrates a few simple design changes that can improve the performance seen in the lab is also presented.

  8. Room temperature d (0) ferromagnetism in hole doped Y2O3: widening the choice of host to tailor DMS.

    PubMed

    Chakraborty, Brahmananda; Ramaniah, Lavanya M

    2016-08-24

    Transition metal-free-ferromagnetism in diluted magnetic semiconductors (DMS) is of much current interest in view of the search for more efficient DMS materials for spintronics applications. Our DFT results predict for the first time, that impurities from group1A (Li(+), Na(+), K(+)) doped on Y2O3 can induce a magnetic signature with a magnetic moment around 2.0 μ B per defect at hole concentrations around 1.63  ×  10(21) cm(-3), which is one order less than the critical hole density of ZnO with ferromagnetic coupling large enough to promote room temperature ferromagnetism. The induction of room temperature ferromagnetism by hole doping with an impurity atom from group 1A, which injects two holes per defect in the system, implies that the recommendation of three holes per defect given in the literature, which puts a restriction on the choice of host material and the impurity, is not a necessary criterion for hole induced room temperature ferromagnetism. DFT simulations with the generalized gradient approximation (GGA), confirmed by the more sophisticated hybrid functional, Heyd-Scuseria-Ernzerhof (HSE06), predict that the magnetic moment is mostly contributed by O atoms surrounding the impurity atom and the magnetic moment scale up with impurity concentration which is a positive indicator for practical applications. We quantitatively and extensively demonstrate through the analysis of the density of states and ferromagnetic coupling that the Stoner criterion is satisfied by pushing the Fermi level inside the valence band to activate room temperature ferromagnetism. The stability of the structure and the persistence of ferromagnetism at room temperature were demonstrated by ab initio MD simulations and computation of Curie temperature through the mean field approximation. This study widens the choice of host oxides to tailor DMS for spintronics applications. PMID:27351301

  9. Room temperature d 0 ferromagnetism in hole doped Y2O3: widening the choice of host to tailor DMS

    NASA Astrophysics Data System (ADS)

    Chakraborty, Brahmananda; Ramaniah, Lavanya M.

    2016-08-01

    Transition metal-free-ferromagnetism in diluted magnetic semiconductors (DMS) is of much current interest in view of the search for more efficient DMS materials for spintronics applications. Our DFT results predict for the first time, that impurities from group1A (Li+, Na+, K+) doped on Y2O3 can induce a magnetic signature with a magnetic moment around 2.0 μ B per defect at hole concentrations around 1.63  ×  1021 cm‑3, which is one order less than the critical hole density of ZnO with ferromagnetic coupling large enough to promote room temperature ferromagnetism. The induction of room temperature ferromagnetism by hole doping with an impurity atom from group 1A, which injects two holes per defect in the system, implies that the recommendation of three holes per defect given in the literature, which puts a restriction on the choice of host material and the impurity, is not a necessary criterion for hole induced room temperature ferromagnetism. DFT simulations with the generalized gradient approximation (GGA), confirmed by the more sophisticated hybrid functional, Heyd–Scuseria–Ernzerhof (HSE06), predict that the magnetic moment is mostly contributed by O atoms surrounding the impurity atom and the magnetic moment scale up with impurity concentration which is a positive indicator for practical applications. We quantitatively and extensively demonstrate through the analysis of the density of states and ferromagnetic coupling that the Stoner criterion is satisfied by pushing the Fermi level inside the valence band to activate room temperature ferromagnetism. The stability of the structure and the persistence of ferromagnetism at room temperature were demonstrated by ab initio MD simulations and computation of Curie temperature through the mean field approximation. This study widens the choice of host oxides to tailor DMS for spintronics applications.

  10. Structural-Thermal-Optical-Performance (STOP) Model Development and Analysis of a Field-widened Michelson Interferometer

    NASA Technical Reports Server (NTRS)

    Scola, Salvatore J.; Osmundsen, James F.; Murchison, Luke S.; Davis, Warren T.; Fody, Joshua M.; Boyer, Charles M.; Cook, Anthony L.; Hostetler, Chris A.; Seaman, Shane T.; Miller, Ian J.; Welch, Wayne C.; Kosmer, Adam R.

    2014-01-01

    An integrated Structural-Thermal-Optical-Performance (STOP) model was developed for a field-widened Michelson interferometer which is being built and tested for the High Spectral Resolution Lidar (HSRL) project at NASA Langley Research Center (LaRC). The performance of the interferometer is highly sensitive to thermal expansion, changes in refractive index with temperature, temperature gradients, and deformation due to mounting stresses. Hand calculations can only predict system performance for uniform temperature changes, under the assumption that coefficient of thermal expansion (CTE) mismatch effects are negligible. An integrated STOP model was developed to investigate the effects of design modifications on the performance of the interferometer in detail, including CTE mismatch, and other three- dimensional effects. The model will be used to improve the design for a future spaceflight version of the interferometer. The STOP model was developed using the Comet SimApp'TM' Authoring Workspace which performs automated integration between Pro-Engineer®, Thermal Desktop®, MSC Nastran'TM', SigFit'TM', Code V'TM', and MATLAB®. This is the first flight project for which LaRC has utilized Comet, and it allows a larger trade space to be studied in a shorter time than would be possible in a traditional STOP analysis. This paper describes the development of the STOP model, presents a comparison of STOP results for simple cases with hand calculations, and presents results of the correlation effort to bench-top testing of the interferometer. A trade study conducted with the STOP model which demonstrates a few simple design changes that can improve the performance seen in the lab is also presented.

  11. Peptide hormone release monitored from single vesicles in "membrane lawns" of differentiated male pituitary cells: SNAREs and fusion pore widening.

    PubMed

    Stenovec, Matjaž; Gonçalves, Paula P; Zorec, Robert

    2013-03-01

    In this study we used live-cell immunocytochemistry and confocal microscopy to study the release from a single vesicle in a simplified system called membrane lawns. The lawns were prepared by exposing differentiated pituitary prolactin (PRL)-secreting cells to a hypoosmotic shear stress. The density of the immunolabeled ternary soluble N-ethylmaleimide-sensitive factor-attachment protein receptor (SNARE) complexes that bind complexin was approximately 10 times lower than the PRL-positive, lawn-resident vesicles; this indicates that some but not all vesicles are associated with ternary SNARE complexes. However, lawn-resident PRL vesicles colocalized relatively well with particular SNARE proteins: synaptobrevin 2 (35%), syntaxin 1 (22%), and 25-kDa synaptosome associated protein (6%). To study vesicle discharge, we prepared lawn-resident vesicles, derived from atrial natriuretic peptide tagged with emerald fluorescent protein (ANP.emd)-transfected cells, which label vesicles. These maintained the structural passage to the exterior because approximately 40% of ANP.emd-loaded vesicles were labeled by extracellular PRL antibodies. Cargo release from the lawn-resident vesicles, monitored by the decline in the ANP.emd fluorescence intensity, was similar to that in intact cells. It is likely that SNARE proteins are required for calcium-dependent release from these vesicles. This is because the expression of the dominant-negative SNARE peptide, which interferes with SNARE complex formation, reduced the number of PRL-positive spots per cell (PRL antibodies placed extracellularly) significantly, from 58 ± 9 to 4 ± 2. In dominant-negative SNARE-treated cells, the PRL-positive area was reduced from 0.259 ± 0.013 to 0.123 ± 0.014 μm(2), which is consistent with a hindered vesicle luminal access for extracellular PRL antibodies. These results indicate that vesicle discharge is regulated by SNARE-mediated fusion pore widening. PMID:23372020

  12. A Widening Gap? Changes in Multiple Lifestyle Risk Behaviours by Socioeconomic Status in New South Wales, Australia, 2002–2012

    PubMed Central

    Ding, Ding; Do, Anna; Schmidt, Heather-Marie; Bauman, Adrian E.

    2015-01-01

    Background Socioeconomic inequalities in health outcomes have increased over the past few decades in some countries. However, the trends in inequalities related to multiple health risk behaviours have been infrequently reported. In this study, we examined the trends in individual health risk behaviours and a summary lifestyle risk index in New South Wales, Australia, and whether the absolute and relative inequalities in risk behaviours by socioeconomic positions have changed over time. Methods Using data from the annual New South Wales Adult Population Health Survey during the period of 2002–2012, we examined four individual risk behaviours (smoking, higher than recommended alcohol consumption, insufficient fruit and vegetable intake, and insufficient physical activity) and a combined lifestyle risk indicator. Socioeconomic inequalities were assessed based on educational attainment and postal area-level index of relative socio-economic disadvantage (IRSD), and were presented as prevalence difference for absolute inequalities and prevalence ratio for relative inequalities. Trend tests and survey logistic regression models examined whether the degree of absolute and relative inequalities between the most and least disadvantaged subgroups have changed over time. Results The prevalence of all individual risk behaviours and the summary lifestyle risk indicator declined from 2002 to 2012. Particularly, the prevalence of physical inactivity and smoking decreased from 52.6% and 22% in 2002 to 43.8% and 17.1% in 2012 (p for trend<0.001). However, a significant trend was observed for increasing absolute and relative inequalities in smoking, insufficient fruit and vegetable consumption, and the summary lifestyle risk indicator. Conclusions The overall improvement in health behaviours in New South Wales, Australia, co-occurred with a widening socioeconomic gap. Implications Governments should address health inequalities through risk factor surveillance and combined

  13. Population variation and individual maximum size in two leech populations: energy extraction from cannibalism or niche widening?

    PubMed

    Persson, Lennart; Elliott, J Malcolm

    2013-05-01

    The theory of cannibal dynamics predicts a link between population dynamics and individual life history. In particular, increased individual growth has, in both modeling and empirical studies, been shown to result from a destabilization of population dynamics. We used data from a long-term study of the dynamics of two leech (Erpobdella octoculata) populations to test the hypothesis that maximum size should be higher in a cycling population; one of the study populations exhibited a delayed feedback cycle while the other population showed no sign of cyclicity. A hump-shaped relationship between individual mass of 1-year-old leeches and offspring density the previous year was present in both populations. As predicted from the theory, the maximum mass of individuals was much larger in the fluctuating population. In contrast to predictions, the higher growth rate was not related to energy extraction from cannibalism. Instead, the higher individual mass is suggested to be due to increased availability of resources due to a niche widening with increased individual body mass. The larger individual mass in the fluctuating population was related to a stronger correlation between the densities of 1-year-old individuals and 2-year-old individuals the following year in this population. Although cannibalism was the major mechanism regulating population dynamics, its importance was negligible in terms of providing cannibalizing individuals with energy subsequently increasing their fecundity. Instead, the study identifies a need for theoretical and empirical studies on the largely unstudied interplay between ontogenetic niche shifts and cannibalistic population dynamics. PMID:23053229

  14. An occult acetabular fracture preceding a femoral neck fracture.

    PubMed

    Lasanianos, Nikolaos; Kanakaris, Nikolaos; Giannoudis, Peter V

    2009-08-01

    This article describes the case of a 69-year-old patient with an occult acetabular fracture complicated by an ipsilateral femoral neck fracture occurring within 2 months. The acetabular fracture remained undiagnosed at examination due to insufficient clinical and radiographic data interpretation. The patient was assured of early mobilization that led to a fall and subsequent hip fracture. We focus on the potential reasons for the nondiagnosis of the acetabular fracture. Acetabular fractures in the elderly may occur after low-energy injuries. The lack of history of violent injury may lead to an incorrect diagnosis. Plain anteroposterior (AP) pelvis radiographs alone may prove an insufficient tool, especially in the hands of inexperienced personnel. As is characteristic, a retrospective review of the AP pelvis radiograph obtained after the first fall in our case revealed the undisplaced fracture of the anterior column that was missed initially. Combined fractures of the hip and the acetabulum are rarely described in the literature and are usually addressed by total hip arthroplasty (THA) alone. Similar fracture patterns that develop in 2 stages (2 injuries), as the 1 presented herein, are even more rare. The uniqueness of this combined fracture required a unique surgical treatment. The senior surgeon (P.V.G.) addressed the acetabular fracture separately to graft the anterior column fracture and facilitate union, as it was already 8 weeks old and the second fall had generated a further gap between the fragments. Stable fixation was felt appropriate prior to the THA. Thus, a double surgical approach was used. Six weeks postoperatively, the patient was able to perform full weight-bearing mobilization without an antalgic gait pattern. At 6-month follow-up, radiographs showed the metalwork to be in place with no displacement, and the fracture had progressed to union. PMID:19708620

  15. Femoral lengths and stature in Plio-Pleistocene hominids.

    PubMed

    McHenry, H M

    1991-06-01

    This study reports the femoral lengths of 31 Plio-Pleistocene hominids dated between 3.1 and 0.7 million years ago, and uses those lengths to estimate stature by way of the femur-stature ratio reported by Feldesman et al. (Am. J. Phys. Anthropol. 78:219-220, 1989). By this method the average female Australopithecus afarensis is 105 cm and the average male is 151 cm. The respective values are 115 and 138 cm for A. africanus. As defined by Howell (In VJ Maglio and HBS Cooke (eds): The Evolution of African Mammals. Cambridge: Harvard University Press, 1978) and Johanson et al. (Kirtlandia 28:1-14, 1978), Homo habilis is a sexually dimorphic species, with females standing 118 cm and males 157 cm. Such apparently strong dimorphism may be due to the possibility that there are actually two species of nonrobust hominids between 2 and 1.7 m.y.a. The estimate for the female Australopithecus boisei is 124 cm and for the male, 137 cm, but these estimates are especially difficult to be certain of because there are no femora that can be positively identified as male A. boisei. Australopithecus robustus is estimated to be 110 cm (female) and 132 cm (male). African Homo erectus stood 160 cm (female) and 180 cm (male). From these estimates several generalizations are apparent. First, there is apparently strong sexual dimorphism in stature in A. afarensis and H. habilis, but less in the other species. Second, the "robust" australopithecines were relatively small statured. Third, it is apparently not true that humans have been getting progressively taller throughout their evolutionary history. Some individuals were as tall as modern humans 3 m.y.a., by 2 m.y.a. one individual stood about 173 cm, and by 1.7 m.y.a. a stature of 180+ cm was not uncommon. PMID:1882979

  16. Opening- and Closing-Wedge Distal Femoral Osteotomy

    PubMed Central

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

    2016-01-01

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

  17. Comparison of DXA and MRI methods for interpreting femoral neck bone mineral density.

    PubMed

    Arokoski, Merja H; Arokoski, Jari P A; Vainio, Pauli; Niemitukia, Lea H; Kröger, Heikki; Jurvelin, Jukka S

    2002-01-01

    The aim of the study was to improve the practical implementation of the dual X-ray absorptiometry (DXA) by converting the areal bone mineral density BMD (BMD(areal)) to volumetric BMD using magnetic resonance (MR) imaging (MRI) because a failure to control for the femoral neck size can lead to erroneous interpretation of BMD values. We also evaluated the feasibility of MR T2* relaxation time in assessing bone mineral status of the femoral neck. Twenty-eight randomly selected 47- to 64-yr-old healthy men were studied. The men had neither unilateral nor bilateral hip osteoarthritis according to radiographs. Bone width, mineral content (BMC), BMD(areal), and apparent volumetric BMD (BMD(vol)) of the right femoral neck were measured with DXA. The BMD(vol) was calculated by approximating the femoral neck to be cylindrical with a circular cross-section (Vol(dxa)). Volumetric measurements from MR (Vol(mri)) images of the femoral neck were also used to create a BMD measure that was corrected for the femoral neck volume (BMD(mri)). T2* measurements were performed with a 1.5-T scanner (Siemens Magnetom 63SP, Erlangen, Germany). A single 10-mm-thick coronal slice was generated on the femur with a repetition time of 60 ms, and nine echo times (4-20 ms) were used to derive T2* values. Vol(mri) correlated positively (r = 0.828, p < 0.001) with Vol(dxa). However, the Vol(mri) of the femoral neck was 18% lower than the Vol(dxa). Similarly, the BMD(mri) was related to the BMD(vol) (r = 0.737, p < 0.001). Because of the difference in the volumetric measures, the BMD(mri) of the femoral neck was 21% higher than the BMD(vol) (p < 0.001). T2* relaxation time showed a significant negative correlation with BMC, BMD(areal), BMD(vol), and BMD(mri) (r = -0.423 to -0.757, p < 0.05-0.001). In conclusion, these results are evidence that DXA-derived volume approximations by the cylinder with circular cross-section geometry may lead to lower DXA-derived BMD(vol) values, as compared to true MRI

  18. The Reamer/Irrigator/Aspirator Reduces Femoral Canal Pressure in Simulated TKA

    PubMed Central

    Van Gorp, Cornel C.; Falk, James V.; Kmiec, Stanley J.

    2008-01-01

    Inserting the femoral intramedullary alignment rod during total knee arthroplasty (TKA) can generate high intramedullary pressure, which increases the risk of intraoperative complications caused by fat embolism. Despite modifications to the surgical procedure, the best method to prevent this increase in pressure remains unknown. The reamer/irrigator/aspirator is a surgical instrument designed for use during femoral canal entry to increase the canal size and remove intramedullary fat and may prevent this pressure increase. We posed two hypotheses: (1) using the reamer/irrigator/aspirator system will result in lower maximum femoral intramedullary pressure than using only conventional instrumentation during the initial steps of a TKA; and (2) using the reamer/irrigator/aspirator system in the initial steps of TKA will result in a mean maximum intramedullary pressure less than 200 mm Hg. We simulated a TKA on 14 cadaveric femurs to compare the femoral intramedullary pressure using both methods. Considerable decreases in femoral intramedullary pressure of 86% proximally and 87% distally were obtained by using the reamer/irrigator/aspirator system. The mean maximum pressure using the reamer/irrigator/aspirator system was less than 200 mm Hg. Additional clinical studies are needed to confirm any reduction in complications using the reamer/irrigator/aspirator system. PMID:18425558

  19. Does Metal Transfer Differ on Retrieved Ceramic and CoCr Femoral Heads?

    PubMed

    Fredette, Eliza K; MacDonald, Daniel W; Underwood, Richard J; Chen, Antonia F; Mont, Michael A; Lee, Gwo-Chin; Klein, Gregg R; Rimnac, Clare M; Kurtz, Steven M

    2015-01-01

    Metal transfer has been observed on retrieved THA femoral heads for both CoCr and ceramic bearing materials. In vitro wear testing has shown increased wear to polyethylene acetabular liners with the presence of metal transfer. This study sought to investigate the extent of metal transfer on the bearing surface of CoCr and ceramic femoral heads and identify prevalent morphologies. Three bearing couple cohorts: M-PE (n = 50), C-PE (n = 35), and C-C (n = 15), were derived from two previously matched collections (n = 50/group) of CoCr and ceramic femoral heads. From the three cohorts, 75% of the femoral heads showed visual evidence of metal transfer. These femoral heads were analyzed using direct measurement, digital photogrammetry, and white light interferometry. Surface area coverage and curved median surface area were similar among the three cohorts. The most prevalent metal transfer patterns observed were random stripes (n = 21/75), longitudinal stripes (n = 17/75), and random patches (n = 13/75). Metal transfer arc length was shorter in the M-PE cohort. Understanding the morphology of metal transfer may be useful for more realistic recreation of metal transfer in in vitro pin-on-disk and joint simulators studies. PMID:26583097

  20. Mid-term Results of Revision Total Hip Arthroplasty Using Modular Cementless Femoral Stems

    PubMed Central

    Jang, Hyung-Gyu; Min, Byung-Woo; Ye, Hee-Uk; Lim, Kyung-Hwan

    2015-01-01

    Purpose The purpose of this study was to evaluate the clinical and radiological results of revision total hip arthroplasty using modular distal fixation stems for proximal femoral deficiency. Materials and Methods Forty-five patients (47 hips) were analyzed more than 24 months after revision total hip arthroplasty that used modular distal fixation stems and was performed between 2006 and 2012. There were proximal femoral defects in all cases. Preoperative femoral defect classification revealed Paprosky type II in 31 cases, type IIIA in 7, and type IIIB in 9. The mean duration of follow-up was 53.4 (25-100) months. We evaluated the Harris hip score (HHS), walking ability according to Koval as clinical parameters, stem stability, and stem position change as radiographic parameters. Kaplan-Meier survival analysis was performed. Results The average HHS improved form 39.5 points to 91.3 points and walking ability also improved in most cases; all patients had stable fixation of the femoral stem. Postoperative complications included 5 cases of infection and 2 cases of dislocation. The survival rate with the end point of re-revision surgery due to infection or dislocation was 86% after 8-year follow-up. Conclusion Cementless revision total hip arthroplasty using modular femoral stems is useful because the stems can be stably fixed on the diaphyseal portion of the femur, which has relatively good bone quality at mid-term follow-up. PMID:27536616